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    Langerhans cell histiocytosis in adults [Langerhans hücreli histiyositoz]
    (2004) Mazlum A.; Ceylan B.; Güngör K.; Ceylan Ş.
    Langerhans cell histiocytosis (LCH) is a rare disorder in which lesions contain cells with features similar to the Langerhans cells (LC) of the epidermidis. It was first described by Alfred Hand in 1893. The median age in adults at diagnosis is approximately 60 years and has a female preponderance (female/male: 1,1-2,1). Adult LCH most commonly affects skin, lung, and bone, although diabetes insipidus is a relatively common comorbidity. Involvement of liver, spleen, lymph nodes, and bone marrow is much less frequent. More than three quarters of patients presented with skin involvement, and a quarter has pulmonary lesions. Patients are either asymptomatic or manifest bone pain, skin lesion, dry unproductive cough with dyspnea, thirst, polyuria and central nervous system related symptoms. Clinical examination may reveal hepatosplenomegaly, lymphadenopathy, pneumothorax, exophthalmos, skin lesions resempling seborrheic dermatitis or nodular infiltration, neurologic dysfunction (cerebellar syndrome, space-occupying central nervous system lesions, hypothalamic-pituitary lesions). The basic lesion of LCH is formed by collection of pathologic LC (PLC). The demonstration of LC granules by electron microscopy or the expression of the CD1a antigen on the cell surface are necessary for a definitive diagnosis of LCH. S-100 positivity further supports the diagnosis. Diagnostic radiology has an important role in the management of LCH. On plain radiography, bone lesions are typically lytic. High resolution CT (HRCT) can show evidence of interstitial lung disease (reticular, reticulonodular, nodular opacities and diffuse cysts). NMR imaging has improved the diagnosis of CNS abnormalities in patients with LCH. Patients with limited involvement of LCH have excellent prognosis without need for systemic therapy. Symptomatic single lesions that potentially threaten organ function require radiation therapy. Patients with multifocal and systemic LCH can be treated with vinblastin, prednisone, vincristine, etoposide, 6-mercaptopurine and methotrexate. Patients who have otherwise refractory disease can benefit from 2 chlorodeoxyadenosine. The prognosis of the patients who didn't show any significant response to therapy during the first 6 weeks are poor with a mortality of less than 40 % at 5 years.
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    Oral-dental health problems and related risk factors among low socio-economic status students [Düşük sosyoekonomik durumdaki Öğrenciler arasında ağız-diş sağlığı sorunları ve risk faktörleri]
    (Gulhane Military Medical Academy, 2014) Kocoglu D.; Ceylan B.; Sarı E.
    AIM: Oral health is still the most important health problem for school age-children. It is important to determine the modifiable risk factors for the control and management of dental problems. Although comparison of risk between groups of high and low socioeconomic status, it need to assessed risk factor within the low socioeconomic group. METHOD: This cross-sectional study was held on a sample of 151 students who are disadvantaged socio-economic status, between the ages of 7-15. The data were collected with a questionnaire, including oral health screening and possible risk factors. The data were summarized as the number and percentage, analysis of odds ratios and confidence interval were used. RESULTS: According to the results of oral health screening 74.8% of students had dental caries and 44.4% had poor oral hygiene. We found that average of missing teeth 1.12±1.4; stained teeth 1.69±2.1, dental caries 3.07±2.8. Age, gender, mother's education were not risk factors for dental caries. Father’s education level of secondary and below (OR:4.272 Cl:1.893-9,644); not having toothbrush (OR:3.938, Cl:1.526-10.167);and not to consume milk per day (OR:3,043, Cl:1.395-6,635) were important risk factors effected oral health negatively. Risk factors for poor oral hygiene were under the age of 10 (OR:2.0202 Cl:1.410-4,253); mother's education level of primary school and below (OR:3,051 Cl:1,471-6,329); father’s education level of secondary and below (OR:9,212 Cl:3,056-27,773); not having toothbrush (OR: 4.258, CI :2,096-8, 650) and not to consume milk per day (OR: 2.240, CI :1,661-4 .3622). CONCLUSIONS: Poor socio-economic situation is considered a major risk for dental health however parents with low education, not having toothbrush and not to consume milk per day were risk factors for dental health negatively affect. Providing toothbrush for students with low socioeconomic status and distribution of milk in school can decrease the problems of in terms of dental health for this group. © 2014 Gulhane Military Medical Academy. All rights reserved.