Situs inversus totalis and secondary biliary cirrhosis: a case report

Situs inversus totalis is is a congenital anomaly associated with various visceral abnormalities, but there is no data about the relationship between secondary biliary cirrhosis and that condition. We here present a case of a 58 year-old female with situs inversus totalis who was admitted to our clinic with extrahepatic cholestasis. After excluding all potential causes of biliary cirrhosis, secondary biliary cirrhosis was diagnosed based on the patient's history, imaging techniques, clinical and laboratory findings, besides histolopathological findings. After treatment with tauroursodeoxycholic acid, all biochemical parameters, including total/direct bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and gama glutamyl transferase, returned to normal ranges at the second month of the treatment. We think that this is the first case in literature that may indicate the development of secondary biliary cirrhosis in a patient with situs inversus totalis. In conclusion, situs inversus should be considered as a rare cause of biliary cirrhosis in patients with situs inversus totalis which is presented with extrahepatic cholestasis

Prognostic significance of survivin, β-catenin and p53 expression in urothelial carcinoma

Survivin, β-catenin, and p53 are well-known cell-cycle and apoptosis regulators of tumorigenesis. Urothelial carcinomas (UCs) are the most common of the human cancers. Compared to superficial tumors (Ta, CIS, or T1), invasive UCs are important with regard to recurrence, progression, and mortality. Therefore, we examined whether survivin, β-catenin, and p53 could be used as the biomarkers for the early prediction of the invasiveness of UCs and the overall survival of the patients. We investigated the prognostic expressions of those biomarkers in UC (n=147) and in non-muscle invasive UC (NMI-UC) (n=113), using tissue microarray and immunohistochemistry. Spearman's correlation analysis and multivariate Cox regression analyses were used for statistical interpretation. High expressions of β-catenin, survivin, and p53 were associated with a high T stage, recurrence, progression, mortality, low recurrence-free survival, low progression-free survival and low overall survival (p < 0.01). Similar findings were achieved for recurrence and progression in the NMI-UC group, except for mortality. Moreover, a positive correlation was shown between p53 and β-catenin and between p53 and survivin (r=0.221, p < 0.01; r=0.236, p < 0.01, respectively). Survivin, p53, and β-catenin overexpression, as prognostic markers, might suggest that the UCs are biologically aggressive with the poor prognosis. Thus, dysregulation of those these cell-cycle and apoptosis regulators in bladder carcinoma could be used as a molecular marker to determine the best treatment strategy and could contribute to the development of targeted therapies

Concentrations of Connective Tissue Growth Factor in Patients with Nonalcoholic Fatty Liver Disease: Association with Liver Fibrosis

Aim: In this study, we aimed to investigate the relationship between the histological fibrosis stage of nonalcoholic fatty liver disease (NAFLD) and serum connective tissue growth factor (CTGF) to determine the usefulness of this relationship in clinical practice. Methods: Serum samples were collected from 51 patients with biopsy-proven NAFLD and 28 healthy controls, and serum levels of CTGF were assayed by ELISA. Results: Levels of CTGF were significantly higher in patients with NAFLD compared with controls (P = 0.001). The serum CTGF levels were significantly increased, that correlated with histological fibrosis stage, in patients with NAFLD [in patients with no fibrosis (stage 0) 308.2 ± 142.9, with mild fibrosis (stage 1–2) 519.9±375.2 and with advanced fibrosis (stage 3–4) 1353.2 ± 610 ng/l, P < 0.001]. Also serum level of CTGF was found as an independent predictor of histological fibrosis stage in patients with NAFLD (β = 0.662, t = 5.6, P < 0.001). The area under the ROC curve was estimated 0.931 to separate patients with severe fibrosis from patients with other fibrotic stages. Conclusion: Serum levels of CTGF may be a clinical utility for distinguishing NAFLD patients with and without advanced fibrosis

Tick-related facial cellulitis caused by francisella tularensis

Tick-borne illnesses have diverse biological and clinical features that make recognition and appropriate treatment challenging. Arthropod-transmitted (ticks, fleas and deer flies) tularaemia remains a concern worldwide. Generally, two kinds of tularaemia manifestations, namely ulceroglandular and glandular infections, can arise from the bite of an infected arthropod vector. If the ulceroglandular or glandular form is not treated, suppuration can arise from the gland. In addition, cellulitis is rarely observed around the ulcers. In our case, with the knowledge of tick exposure to the scalp, tularaemia was not initially considered for facial cellulitis without regional lymphadenopathy and also due to apparent failure to respond to doxycycline and gentamicin therapy. Serological confirmation in the late stages of the disease suggests the importance of clinical suspicion in such rare conditions

Real-world evaluation of "Eczema in psoriatico": Bridging the gap between dermatology and dermatopathology

The diagnosis of psoriasis is mainly made by clinical examination but on some occasions according to the localization or duration of the lesions when spongiosis is more prominent, it can be challenging and may be considered as overlapping eczema. To evaluate the patients for "eczema in psoriatico" and to present the differences between psoriasis. Biopsy outcomes of thirty-one patients who were histologically diagnosed with psoriasis and psoriasiform dermatitis because of the erythematous and scaly plaque lesions located on hands and feet, between 2013 and 2015, were evaluated retrospectively. Histopathologic findings compatible with psoriasis and accompanied by spongiosis and spongiotic vesicles were evaluated as eczema in psoriatico and compared with psoriasis. In this study thirty-one patients, including 18 patients with eczema in psoriatico and 13 patients with psoriasis of hands and/or feet were included. Of the 31 patients, 15 (48.4%) were women and 16 (51.6%) were men, in 61.3% of cases, biopsies were taken from hands (61.1% of "eczema in psoriatico", 61.5% of psoriasis) and 38.7% from feet (38.9% of "eczema in psoriatico", 38.5% of psoriasis). There was a statistically significant difference between two groups in terms of parakeratosis severity and distribution, the presence of neutrophil and plasma in stratum corneum, the presence of granular layer loss and suprapapillar plate thinning, the shape of retes, the presence of lymphocytic exocytosis, spongiosis and spongiotic vesicles, the intensity of infiltrates in the papillar dermis and the presence of dermal edema (P < .05). Histology supports a continuum between psoriasis and eczema that share histological similarities and at the same time should be considered a separate entity, eczema in psoriatico