Intravenous immunoglobulin in the treatment of severe methotrexate-induced acral erythema

Chemotherapy-induced acral erythema is an uncommon and dramatic reaction to high-dose chemotherapy. It is characterized by painful erythema of both palms and soles with symmetrically well-defined borders, which may progress to bullae formation and desquamation. The bullous variant of this reaction has been reported with methotrexate and more frequently cytosine arabinoside. Rapid differential diagnosis and discrimination from more serious conditions such as graft versus host disease or toxic epidermal necrolysis is essential. In this case report, we present a 13-year-old boy who developed severe and prolonged chemotherapy-induced acral erythema after high-dose methotrexate treatment and successfully responded to intravenous immunoglobulin.     

An unexpected finding in a child with neurological problems: mosaic ring chromosome 18

Major neurological disorders may accompany rare chromosomal abnormalities. As an example of this rare condition, we present a case with microcephaly, mental retardation, developmental delay, hyperactivity, stereotypic movements, seizures and dysmorphic facial appearance in whom a mosaic ring chromosome 18 was found [45,XX,-18/46,XX,r(18)/46,XX,dicr(18)]. Although ring chromosome 18 phenotype has been known for a long time, this is the third reported patient with a dicentric ring chromosome 18 mosaicism. The presented case will contribute to the identification of the genotype-phenotype correlation in chromosome 18 anomalies.     

Linezolid-induced reversible bicytopenia in a 4-year-old boy with methicillin-resistant Staphylococcus aureus bacteremia

The authors report on a 4-year-old child with the diagnosis of tetralogy of Fallot (TOF) and infective endocarditis. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture of the patient. While receiving imipenem, amikacin, and linezolid therapies, the boy's general condition improved, acute phase reactants decreased, and his blood culture became negative for MRSA. On his follow-up echocardiography, the vegetation had also disappeared. However, he developed progressive bicytopenia following linezolid therapy for 5 weeks. During linezolid therapy, his hemoglobin level decreased from 12.1 to 5.3 g/dL and his platelet count from 242 × 10⁹ to 14 × 10⁹/L. His white blood cell count (WBC) did not decrease during linezolid therapy. Six days following termination of linezolid therapy, his hemoglobin had increased to 8.2 g/dL and platelet count to 192 × 10⁹/L. Thus, it should be kept in mind that linezolid may induce cytopenias in children. If these side effects of linezolid are known, unnecessary laboratory investigations may be prevented and cessation of the drug may be sufficient for reversal of the cytopenias.     

Periorbital necrobiosis lipoidica diabeticorum: case report

Necrobiosis lipoidica diabeticorum (NLD) is a relatively common manifestation of diabetes mellitus that is thought to be related to immune-complex vasculitis. The legs are the most common site for NLD, but other locations, such as the forearms or hands, have been reported. We describe a case of periorbital NLD that was diagnosed on the basis of histopathology.     

Mutations in influenza A virus (H5N1) and possible limited spread, Turkey, 2006

We report mutations in influenza A virus (H5N1) strains associated with 2 outbreaks in Turkey. Four novel amino acid changes (Q447L, N556K, and R46K in RNA polymerase and S133A in hemagglutinin) were detected in virus isolates from 2 siblings who died.     

Osteotomy assisted maxillary posterior impaction with miniplate anchorage

This case report presents orthodontic treatment with miniplate anchorage accelerated by osteotomy-assisted maxillary posterior impaction in a severe open bite case. A 14-year-old girl with a severe anterior open bite was treated by intrusion of the maxillary posterior teeth. A segmental osteotomy was applied, and the miniplates were fixed to the zygomatic buttress area. The intrusive force was applied with nickel-titanium closed coil springs using a force of 250 g between the miniplates and the upper first and second molar buccal tubes. The intrusion was completed 2.5 months after osteotomy. The treatment was continued with the fixed orthodontic appliances and completed after 12 months. At the end of treatment, optimal occlusion and the correction of the anterior open bite were achieved. The maxillary molars were impacted 4.0 mm, and the mandibular plane showed a counterclockwise autorotation of 3.0 degrees . The results showed that osteotomy-facilitated orthodontic treatment clearly reduced the treatment time and had no adverse effects. In conclusion, this one-stage osteotomy technique can be an effective option to help molar intrusion in severe open bite cases.     

Colorimetric analysis of opaque porcelain fired to different base metal alloys used in metal ceramic restorations

STATEMENT OF PROBLEM: The popularity of base metal alloys has considerably increased in recent years because of their superior mechanical properties as well as the high cost of noble alloys. However, there is disagreement about their effect on the opaque porcelain color and the color differences among base metal alloys. PURPOSE: The purpose of this in vitro study was to determine and compare the influence of various commercially available base metal alloys (excluding titanium-based systems) on the resulting color of opaque porcelain with the use of a colorimetric device. MATERIAL AND METHODS: Fourteen different types of Ni-Cr and 3 different types of Co-Cr porcelain bonding alloys were selected with a Au-Pd alloy (V-Delta SF) as the control group for colorimetric measurements and determination of color shift after opaque application. Shade B1 of an opaque porcelain (IPS d.SIGN Opaquer) was applied (0.1 mm) to all specimens (16 mm x 1 mm). The color coordinates of each specimen were measured with a chromameter. The data were displayed in L*, a*, and b* values according to the CIELAB system, and the color differences (DeltaE) between base metal alloys and the control group were calculated. Data were statistically analyzed with 1-way ANOVA (alpha=.05). The ANOVA was followed by Dunnett's multiple comparison test for comparisons with the control group to determine specifically which groups were significantly different from the control group. RESULTS: The L* value of only 1 base metal alloy was significantly different from the control group (P<.001). All base metal alloy groups except 3 had a* values which were significantly different from the control group a* value (P=.001 for Rexillium III, P=.008 for Heracles N, and P<.001 for the remaining 12 alloys), whereas only 3 base metal alloys were not statistically significantly different from the control group in the means of b* values (P<.001). All base metal alloys to which opaque porcelain was applied had significantly different DeltaE values in comparison with the control group (P<.001). CONCLUSIONS: The data of the study indicated that a 0.1-mm-thick layer of opaque porcelain applied on the Ni-Cr and Co-Cr alloys did not reliably reproduce the color of opaque porcelain. However, within the limitations of this study, the color differences of base metal alloys measured according to the control group are within clinically acceptable limits (DeltaE<3.5).     

Increased frequency of pulmonary hypertension in psoriasis patients

Several reports have demonstrated an association between psoriasis and cardiovascular diseases such as hypertension, valvular disease and arrhythmia. However, the data is scarce. Forty-seven psoriasis patients and 20 healthy people underwent transthoracic echocardiographic examination including pulse- and tissue Doppler analysis and 24-h ambulatory electrocardiographic monitoring including heart rate variability (HRV) analysis. Patients having systemic hypertension, diabetes mellitus, history of structural or ischemic heart disease, chronic obstructive pulmonary disease and any associated systemic disease were excluded. Psoriasis Area and Severity Index (PASI) was calculated and severe psoriasis was defined in the case of history of hospitalizations for psoriasis and/or getting systemic therapy. Mean age of the patients was 35.7 ± 12.9 years and disease duration was 123.2 ± 84.3 (3–360) months. PASI ranged from 0.4 to 34.0 (mean ± SD: 7.1 ± 6.6) and 20 (42.6%) patients had severe psoriasis. There were no significant differences between psoriasis patients and control group with respect to mean values of blood pressure, body mass index, lipid profile and cardiac dimensions. However, frequency of being overweight was significantly higher in psoriasis patients (42.6 vs. 10.0%, P = 0.011). No patient had valvular disease. Mild pulmonary hypertension (PH) (30–40 mmHg) was significantly more frequent in psoriasis patients (31.9 vs. 0%, P = 0.003). Pulse wave mitral Doppler deceleration and isovolumetric relaxation times were significantly longer in psoriasis patients (195.9 ± 29.7 vs. 191.6 ± 14.7 ms, P = 0.002 and 91.6 ± 14.7 vs. 79.6 ± 10.5 ms, P = 0.001, respectively). However, frequency of diastolic dysfunction was not significantly different than the control group (8.5 vs. 0%, P = 0.309). HRV parameters and frequency of supraventricular and ventricular premature beats were not significantly different between the groups. No patient had ventricular tachycardia. Echocardiographic follow-up of psoriasis patients may be important due to possible association of PH. However, incidences of structural heart disease and arrythmia are not increased in psoriasis according to our results.