The value of pathologic evaluation in diagnosis of Munchausen syndrome

Munchausen sendromunda kişi ya kendini yada bir başkasını kendi çabaları ile semptom ve bulgu verecek bir tabloya sokmaktadır. Bu şekilde kendisi veya örneğin çocuğunu hastaymış gibi göstermeyi başaran kişiler, bundan ikincil kazançlar elde etmektedirler. Semptom ve bulguların ortaya çıkması inanılmaz hikayeler içerebil-mektedir. Bizim hastamız, koluna yabancı cisim batırarak sadece kolunda yumuşak doku enfeksiyonlarına yol açmak sureti ile, sorunlu aile hayatından uzakta kalmak adına hastanelerde kalmayı tercih etmekteydi. Sunduğu-muz olgu ile Munchausen sendromu tanısı koyarken kaybedilen para ve zaman kaybına vurgu yapmak ve yapılması gerekenleri tartışmayı amaçladık. Hastamız 27 yaşında olup son iki buçuk yılını değişik hastanelerde ve çok pahalı tedaviler ile tetkiklere maruz kalarak ama kesin tanısız geçirmişti. Hastada bugüne kadar yapılmayan tek tanısal değerlendirme aracı histopatolojik muayene idi. Patolojik değerlendirme sonucunda tanı yapmacık pannikülit olarak kondu. Her ne kadar biz hastayı daha sonra pisikiyatri kıliniğine konsulte edip bazı tedaviler önerdiysek de hastanın tekrar aynı yakınmalar ile hastanelere başvurması halinde, öncelikle bizim kıliniğimizce kabulunun doğru olacağını düşünüyoruz. Böylece zaman ve para israfının önüne geçilebileceğini ümit ediyoruz.Any patient with Munchaussen syndrome causes a clinical case associated with some findings and symptoms on either himself or herself or his or her kid. Their aim by doing so is for profit. It may be associated with unbelievable stories. The patient presented here chose to live in hospitals by separating herself from her family by inserting some foreign bodies into her arm caused soft tissue infections in the right arm merely for a long time. By aiming to emphasis on wasting time and money during the diagnosis of the Münchhausen syndrome and to discuss the things should be done, we presented a 27 year old women treated in several hospitals with different diagnoses for 2 and half years. The only examination method that had not been done on the patient was the histopathologic one. We did it and the pathologic diagnosis confirmed the problem as factitious panniculitis. Although we consulted the patient to the physiciatry department and gave her some treatment, we decided that if the patient comes again with the same symptoms and signs it would be better to admit her to our department to avoid unnecessary searching and treatments by her admission to another department or hospital

Derin lob yerleşimli parotis lipomu: Olgu sunumu

Derin lob yerleşimli parotis lipomu son derece na-dirdir. Kırk iki yaşındaki bir erkek hastada sol preauriküler bölgede ağrısız, yumuşak, yavaş büyüme gösteren bir kitle saptandı. Ultrasonografi ve bilgisayarlı tomografi, lipom özellikleriyle uyumlu bulgular ortaya koydu. Hasta yüzeyel parotidektomi ve tümörün total eksizyonuyla tedavi edildi; fasyal sinir korundu. Histolojik bulgular tanıyı doğruladı. Ameliyattan sonra 1.5 yıllık izlemde herhangi bir nükse rastlanmadı.Lipoma of the deep lobe of the parotid gland is extremely rare. A forty-two-year-old man presented with a painless, soft, and slow-growing mass in the left preauricular area. Ultrasonography and computed tomography findings were consistent with lipoma. The patient was treated with superficial parotidecto-my and total excision of the mass with preservation of the facial nerve. Histologic findings~confirmed the diagnosis. No recurrences were detected during 1.5 years in the postoperative period

Spinal granulocytic sarcoma (chloroma) presenting as acute cord compression in a nonleukemic patient

The case of a previously healthy 24-year-old man diagnosed with extradural thoracic granulocytic sarcoma with no evidence of bone marrow or other hematological involvement is described. The tumor was removed totally by microsurgery. The histopathological examination was consistent with granulocytic sarcoma. Granulocytic sarcomas are most commonly found in the context of an acute myelogenous leukemia or in chronic myelogenous leukemia. They rarely have been reported in otherwise healthy patients without any evidence of systemic disease. A review of the literature revealed only 14 more nonleukaemic cases with granulocytic sarcoma causing thoracic spinal cord compression

The efficiency of rifampicin and clindamycin treatment in a case of tufted folliculitis

Tufted folikülit (TF), saçlı derinin nadir görülen ve sebebi bilinmeyen, kronik, ilerleyici, süpüratif bir hastalığıdır. Hastalık 8-15 adet terminal kılın tek bir follikül ağzından çıkışı ile karakterizedir. TF'in fizyopatolojisi tam olarak açıklanamamıştır. Skar oluşumuna neden olan çeşitli saç hastalıklarında görülen folliküler hasarın ilerlemiş evresinde oluşabileceği düşünülmektedir. Otuz bir yaşında beyaz erkek olgu polikliniğimize oksipital bölgede 4 yıldır devam eden hassasiyet, pürülan akıntı ve saç dökülmesi şikayetleri ile başvurdu. Tufted follikülit tanısı konulan olguya 8 hafta süreyle 600 mg/gün rifampisin ve 600 mg/gün klindamisin kombinasyonu verilerek tedavi edildi. Yapılan kontrol muayenelerinde lezyonların tekrarlamadığı ve foliküllerdeki terminal kıl dağılımının normal düzene girmeye başladığı gözlendi. TF'in nadir gözlenmesi ve özellikle tedavisini zorluğu nedeni ile olgunun sunulması uygun görüldü.Tufted folliculitis (TF) is a rare, recurrent, chronic and progressive suppurative disease of the scalp of unknown etiology. The disease is characterized by presence of 8-15 hairs emerging from a single follicular opening. The physiopathology of TF remains unknown. It probably represents an advanced stage of follicular damage common to several different forms of scarring alopecia. A 31-year-old white man presented to our clinic with a four-year history of tender, suppurating lesions on the scalp and patchy hair loss. The diagnosis was made as TF and the patient was treated with 600mg/day rifampicin and 600mg/day clindamycin for 8 weeks. In the follow up of the patient, it was observed that lesions did not recur and terminal hair distribution in the follicles began to return to normal arrangement. We report this case as TF is a rarely encountered disease and it is difficult to be treated

Homocysteine, folate and vitamin B12 levels in patients with psoriasis vulgaris treated with low-dose methotrexate

Metotreksat (MTX) şiddetli psoriasis ve psoriatik artrit tedavisinde kullanılan bir folik asit (folat) analoğudur. Düşük doz MTX tedavisinin homosistein (Hey) ve folat düzeylerini etkilediği bildirilmiştir. Çalışmamızda psoriasis vulgaris hastalarında düşük doz MTX tedavisinin erken dönemde serum folat, vitamin B12 ve plazma Hey seviyeleri üzerine etkisini araştırdık. Çalışmaya orta ve şiddetli psoriasis vulgaris tanısı konulan 16 (10 erkek, 6 kadın) hasta ile yaş ve cinsleri uyumlu 20 (12 erkek, 8 kadın) sağlıklı kontrol dahil edildi. Kontrol grubundan ve hastalardan MTX tedavisi öncesi serum folat, vitamin B12 ve plazma Hey için venöz kan alındı. Hastalardan, 4 hafta süresince her hafta, 20 mg intramusküler MTX uygulandıktan 48 saat sonra folat, vitamin B12 ve plazma Hey düzeyleri için tekrar kan örnekleri alındı. Hastaların ve kontrol grubunun tedavi öncesi folat ve plazma Hey düzeyleri arasında anlamlı fark bulunmazken (p>0.05), vitamin B12 değerleri hastalarda kontrol grubundan anlamlı düzeyde düşük idi (p0.05). Metotreksat tedavisi sonrası folat ve Hey seviyeleri arasında ise korelasyon yoktu (p0.05). Düşük doz MTX tedavisinin serum folat seviyesinde kısa süreli azalmaya ve plazma Hey seviyesinde artmaya neden olduğu ve MTX tedavisi süresince Hey seviyesinin artmadığı kanaatine vardık.Background and Design: Methotrexate (MTX), a folic acid (folate) analog, is used for treatment of severe psoriasis or psoriatic arthritis. It has been reported that the&quot; homocysteine (Hey) and folate levels were affected by low dose MTX treatment. In this study we investigated the effect of low dose MTX treatment on folate, vitamin B12 and plasma Hey levels of patients with psoriasis vulgaris at early phase. Material and Method: Sixteen patients (10 males, 6 females) diagnosed as moderate and severe psoriasis vulgaris and age-sex matched twenty healthy subjects (12 males, 8 females) were included in the study. Blood samples were drawn from the both groups before initiation of MTX treatment for folate, vitamin B12 and plasma Hey measurements. Again, after 48 hours following 20 mg intramuscular MTX injection, blood samples of patients were drawn for folate, vitamin B12 and plasma Hey level measurements Results: While there were no significant differences in the folate and plasma Hey levels between patients and healthy subjects (p>0.05), vitamin B12 levels were significantly lower in the patients than the controls (p0.05). There was no correlation been folate and Hey levels after MTX treatment (p>0.05). Negative correlation was found between vitamin B12 and Hey levels before and after treatment (p<0.05). Conclusion: We concluded that low dose MTX treatment cause transient decrease of serum folate levels and transient increase of plasma Hey levels that did not increase throughout the MTX treatment

Gaucher disease: two case

Gaucher hastalığı beta glukoserobrozidaz genindeki mutasyon sonucunda gelişen, otozomal resesif kalıtımla geçen, lipit depo hastalığıdır. Mutasyon sonucunda enzim aktivitesindeki azalma sonucunda retikuloendotelial sistemde makrofajlarda glukoserobrozid birikimi olur. Nörolojik komponenti olup (tip 2 ve 3) olmamasına (tip 1) göre klinik üç subtipi vardır. Hastalar sıklıkla hepatosplenomegali, anemi, trombositopeni ve kemik ağrıları vardır. Biz birinde siroz gelişmiş iki tip 1 Gaucher hastasını sunduk.Gaucher's disease is an autosomal recessive glycolipid storage disorder caused by mutations in the beta glucocerebrosidase gene. This defect leads to reduced enzyme activity with accumulation of glucocerebroside in the macrophages of the reticuloendothelial system. Three clinical subtypes of Gaucher's disease have been described on the basis of the absence (type I) or presence (types II and III) of a neurological component. Type I is the more common subtype. Common presenting features include hepatosplenomegaly, anemia, thrombocytopenia, and often bone pains. We present two cases with Gaucher disease type 1, one of whom also had cirrhosis

Comparison of spermiograms of infertile men before and during the COVID-19 pandemic

This was a clinical study investigating the possible relationship between covid 19 infection and spermiogram in male populationObjective: Since the start of the COVID-19 pandemic, there has been interest in the impact of both SARS-CoV-2 infection and pandemic-induced social restrictions on male reproductive health. This study aimed to evaluate the spermiogram values of men who presented for infertility during the pandemic compared with the previous 2 years. Methods: Patients who presented to a urology outpatient clinic for the first time due to infertility were included. The patients' age, semen volume, and spermiogram results were recorded. Based on the presentation date, the patients were divided into prepandemic group 1 (March 2018-February 2019), prepandemic group 2 (March 2019-February 2020), and pandemic group (March 2020-February 2021) for comparison. Results: A total of 594 patients were included. There was no significant difference between the three groups in terms of the number of patients who presented for infertility (207, 190, and 197 patients, respectively; p=0.691). The mean age was 36.6±7.2 in the prepandemic group 1, 35.5±7.1 in the prepandemic group 2, and 33.1±6.3 in the pandemic group. Patients who presented during the pandemic were significantly younger (p<0.001). There were no differences between the groups in terms of semen volume (p=0.910) or rates of normospermia and pathological spermiogram findings (p=0.222). Conclusions: In the first year of the COVID-19 pandemic, there was no significant difference in the number of patients who presented for infertility or in their spermiogram results compared with 2018 and 2019. However, it is noteworthy that the patients were significantly younger during the pandemic than in the previous 2 years.No sponso