A rare case of low-grade endometrial stromal sarcoma with myxoid differentiation and atypical bizarre cells

Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor with characteristic histological appearances, consisting of diffuse infiltrate of small uniform endometrial stromal cells with a multinodular arrangement and distinct vascular pattern. Less common variants of ESS include "mixed endometrial stromal and smooth muscle tumors", "endometrial stromal tumors resembling ovarian sex cord tumors" and "endometrial stromal neoplasms with endometrial glands", and "aggressive endometriosis". Rarely do endometrial stromal tumors have a prominent fibrous or myxoid appearance which causes confusion and possible misdiagnosis as myxoid leiomyosarcoma. In this report we present a very unusual subtype of ESS in a 32-year-old woman. The tumor revealed atypical pleomorphic bizarre cells which were stained positive only with vimentin and CD10 in an abundant myxoid matrix. A low-proliferative rate was established with MIB-1 staining. To our knowledge such appearance has not been previously reported.

Gold weight implantation for rehabilitation of the paralysed eyelid

Patients with complete facial nerve palsy are at risk of severe eye complications due to corneal exposure. Gold weight implantation improves function, cosmetic appearance and morbidity. Three patients with nerve palsy underwent insertion of precisely prepared gold weights between May 2000 and December 2001. Individual gold weights were implanted into a small pocket between the orbicularis oculi and the tarsal plate of the upper eyelid, fitting the curvature of the eye. According to follow-up examinations (after at least 5 years), none of the gold weights had extruded; all patients experienced marked improvement of their dry-eye symptoms and expressed a high degree of satisfaction. Implantation of gold weights is effective and should be considered in all patients for the management of paralytic lagophthalmos.

Posterior tibial nerve stimulation for faecal incontinence after partial spinal injury: preliminary report

BACKGROUND

This study evaluated the possible effects of posterior tibial nerve stimulation in two patients with faecal incontinence due to partial spinal cord injury.

METHODS

Posterior tibial nerve stimulation was performed for 30 min, every other day for 4 weeks, and was then repeated every 2 months for three months. Clinical examination, anorectal physiological work-up, faecal incontinence severity index, and quality of life assessments were performed before and after the treatment.

RESULTS

After posterior tibial nerve stimulation, patients showed improvement in rectal sensory threshold, pudendal nerve terminal motor latency, Wexner faecal incontinence score, faecal incontinence severity index, faecal incontinence quality of life scales, resting pressure, and maximum squeeze pressure measurements.

CONCLUSIONS

Posterior tibial nerve stimulation can be an effective method for the treatment of faecal incontinence caused by partial spinal cord injury.

Seizures during treatment of Vitamin B12 deficiency

Epileptic seizures during infancy have a wide variety of clinical presentations and the outcome differs according to the etiology. Among the benign and rare causes of infantile seizures, Vitamin B12 deficiency has been encountered. Common symptoms of Vitamin B12 deficiency in infants include megaloblastic anemia, feeding difficulties, developmental delay, microcephaly, failure to thrive, hypotonia, lethargy, irritability, involuntary movements, seizures and cerebral atrophy. Involuntary movements and seizures may rarely be the initial symptoms of Vitamin B12 deficiency. Involuntary movements have also been reported to appear after initiation of Vitamin B12 supplementation in isolated cases, whereas, no such information exits for seizures. In this paper, three infants with Vitamin B12 deficiency associated with motor and mental retardation are reported because of long-lasting focal/multifocal epileptic seizures following the initiation of intramuscular Vitamin B12 treatment. Antiepileptics were introduced in addition to Vitamin B12. Seizures disappeared within a few days or weeks; electroencephalographic findings were normalized in a few months. No relapses occurred during the follow-up period.

Urinary profile of 6 beta-hydroxycortisol in workers exposed to aluminum

The aim of the present study was to evaluate whether aluminum exposure may cause alterations of cytochrome P4503A4 by measuring the urinary excretion of 6 beta-hydroxycortisol as biomarker. There is a positive correlation between urinary 6 beta-hydroxycortisol and aluminum excretion (p < 0.05). The correlations between occupational duration, smoking habits, and age were also evaluated. The increased excretion of the biomarker suggests that this element may induce formation of cytochrome P 450 in exposed individuals.

Heavy metal contamination and distribution in the urban environment of Guangzhou, SE China

Ever-increasing heavy metal accumulation in the urban environment of Guangzhou, the largest light industrial production base and one of the most rapidly developing cities in China, poses a serious threat to environment as well as to human health in the region. As a sink or source, urban deposits are good indicators of the level and extent of heavy metal accumulation in the surface environment. The aim of this preliminary study was to examine the distribution of heavy metal contamination in the urban environment of Guangzhou. It was based on a systematic sampling of road dusts and corresponding gully sediments along major roads running mainly through commercial and residential to industrial districts of the city. In addition to road dusts and gully sediments, ceiling dusts from the Pearl River Tunnel were also collected to characterize anthropogenic emissions dominated by traffic-related activities. In general, the level of Cd, Cu, Pb and Zn contaminations were more severe on the industrialized side of Guangzhou than on the western side where heavy traffic and industrial activities were limited. The primary determinants of the level of heavy metal contamination and the distribution of this contamination in the urban environment of Guangzhou were the site-specific conditions of its urban setting, particularly the types of industries, the nature of the traffic flow, sample residence times and variations in grain size of the particulate contaminants. This study highlights the complexity of the urban system and indicates that in just such a system individual urban components should be interlinked to assess the long-term environmental and health effects of heavy metal contamination. Among the heavy metals tested--Cd, Cu, Pb and Zn--the level of Zn contamination was the most severe and widespread, and thus requires immediate attention.

Combined administration of ethodolac, ascorbic acid and radiotherapy as adjuvant therapies in an extrathoracic desmoid tumor with gross postoperative residual disease; case report and review of the literature

A 37-year-old man was admitted with an extrathoracic desmoid tumor invading the brachial plexus. Magnetic resonance imaging (MRI) of the thorax demonstrated a 20 x 9 x 14 cm mass in the supraclavicular fossa, axillary fossa and the right side of the chest. It invaded the brachial plexus and circumscribed the subclavian and axillary arteries concentrically. Biopsy revealed desmoid tumor which was resected subtotally with the brachial plexus. The gross residual mass was treated postoperatively with radiotherapy (60 Gy) which resulted in major regression of the mass. Following radiotherapy, ethodolac with ascorbic acid were administered. The tumor was clinically indiscernible 35 months post-radiotherapy. This case shows the high effectiveness of radiotherapy along with less toxic medical treatment modalities in instances where local control is hard to achieve with surgery and highlights the importance of using multidisciplinary treatments to maintain good functional results.

Evaluation of asymptomatic central neuropathy in type I diabetes mellitus

OBJECTIVES

Diabetic neuropathy is recognized as the most common clinical picture of nervous system disorders caused by diabetes mellitus (DM). Although peripheral and autonomic nervous system involvements are frequently encountered, there exists a few data about the incidence of central diabetic neuropathies. Central nervous system degeneration is a well known pathology in diabetic patients in the long term. It is possible to reveal central nervous system involvement at the early stages by using evoked potentials (EP). The aim of this study is to evaluate the auditory, visual and sensorial abnormalities in type I diabetic patients, who also have normal nerve conduction studies, with somatosensory, brainstem auditory and visual EP studies (SEP, VEP BAEP); to determine the frequency of these abnormalities and to investigate the relationship between other variables such as age, gender, duration of the diabetes and degree of the metabolic control.

PATIENTS AND METHODS

A total of 36 asymptomatic type I DM children, ages ranging between 6-17 (mean age 11 +/- 3.24) taking insulin treatments were included in this study. Control group was made up of healthy children. EPs were evaluated and comparisons were made between the two groups.

RESULTS

In a large group of diabetic children (47.2%), independent from parameters such as age, gender, glycemic control degree, auditory and visual deficits, retinopathy, joint movement limitation; but dependent on the peripheral SEP pathologies and disease duration there were central electrophysiological disturbances. In 13 (36.1%) of the patients SEP pathologies; in 9 (25%) of the patients VEP pathologies and in 14 (38.9%) of the patients BAEP pathologies were detected.

CONCLUSION

Besides independent from peripheral pathologies, central nervous system involvement could also be observed in diabetic children. EP changes can be detected in asymptomatic patients that would be a predictor of future symptoms.

Effects of Perfusion Solutions on Kidney Ischemia-Reperfusion Injury in Pigs

During ischemia-reperfusion, free oxygen radicals which directly affect renal cells may cause delayed graft function. We investigated whether there was a difference regarding antioxidant enzyme content between use of Ringer's lactate (RL) versus University of Wisconsin (UW) perfusion solutions in kidney transplantation. Ischemia was achieved by clamping the renal pedicle for 20 minutes followed by perfusion with either solution for 20 minutes and reperfusion for another 20 minutes. A parenchymal biopsy was taken before and after the ischemia, perfusion, and reperfusion (IPR) process. The levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), and malondialdehyde (MDA) were investigated in the biopsy specimens. We used paired t tests within groups and t tests for comparisons between groups. The results were expressed as mean values +/- SEM with P < .05 accepted as statistically significant. After IPR, SOD, GPx, and MDA were decreased in all groups: only GPx (P = .001) and MDA (P = .04) for the RL group and SOD (P = .001) and MDA (P = .05) for the UW group were statistically significant. In the control group, we did not observe any difference (P > .05). Comparisons between groups did not reveal differences (P > .05). In our study, no difference was observed between RL and UW regarding their effects on antioxidant enzymes following renal I/R injury in pigs. More investigations are needed to evaluate graft function in this setting.

Prokinetic agents in childen with poor appetite

BACKGROUND

Of the feeding disorders in children, poor appetite is probably one of the most common complaints notified by parents. Since gastric motility disorders may be the cause of this symptom, the aim of our study was to investigate the effect of prokinetics on children with poor appetite and delayed gastric emptying.

METHODS

Poor appetite was graded by VAS at start and end of treatment. Delayed gastric emptying was assessed by 99mTechnetium tincolloid scintigraphy. Malnutrition was defined according to Waterlow criteria. After initial assessment behavioural feeding recommendations were provided and trimebutine given for 6 months. Scintigraphy was repeated during treatment. Anthropometrical measurements and daily energy intake calculations were performed monthly

RESULTS

21 children (M/F: 12/9) with a mean age of 7 +/- 3 years were studied. At the end of treatment, weight and height standard deviation scores improved significantly (-1.0 +/- 0.6 vs. -0.8 +/- 0.7, p = 0.008 and -1.1 +/- 1.0 vs. -0.8 +/- 0.9, p=0.003, respectively) and malnutrition rate decreased from 81% to 66.7%. Improvement of gastric emptying was shown in 11 out of 16 children but was not statiscally significant (P = 0.059). The visual analogue scale scores of appetite showed significant improvement with therapy (7.5 +/- 1.3 vs. 5.3 +/- 2.0, p = 0.012).

CONCLUSION

Children with poor appetite who have delayed gastric emptying might benefit from prokinetic agent therapy combined with behavioural feeding recommendations.

Evaluation of a new intraoral controlled fluoride release device

The aim of the study was to determine the pharmacokinetics of a new hydroxyapatite-Eudragit RS100 diffusion-controlled fluoride-releasing system designed for intraoral use with a 0.15 mg F(-)/day release for a 1-month period. Matrix tablets, each containing 18 mg of sodium fluoride, were bonded to the buccal surface of the first maxillary molar teeth of 20 subjects (age 20-23 years). Morning and evening salivary and urinary samples were collected 5 days before the study and every day for the 1st week, then once a week for 1 month. Fluoride ion measurements were done using the microdiffusion method. The salivary and urinary fluoride concentrations were significantly raised during the treatment period (p < 0.05). Morning salivary fluoride levels were higher than evening salivary fluoride levels (p < 0.05) whereas evening urinary fluoride levels were higher than morning urinary fluoride levels (p < 0.05). The statistically significant increase in salivary fluoride levels indicates a caries-preventive role for this device.

Effect of aluminum exposure on pteridine metabolism

Occupational and environmental aluminum (Al) exposure cause serious health problems by interaction with biological systems. Al is one of the most documented metals because its cellular targets are unclear biochemical processes and membranes of organisms. The major aim of the present study was to investigate the alteration of serum and urine aluminum in occupational exposure and to observe whether the metal exposure could cause any changes in pteridine-pathway-related critical compounds such as urinary neopterin and biopterin and blood dihydropteridine reductase (DHPR). In this study, determination of the metal concentrations was carried out in Al-exposed workers (n=23) and healthy volunteers (n=18) by using atomic absorption spectrometer. DHPR enzyme activity and levels of neopterin and biopterin were detected by spectrophotometric and high-performance liquid chromatographic methods, respectively. It was found that occupational exposure to the metal led to a statistically significant increase in serum Al levels compared to the controls (p<0.05). At the same time, urinary neopterin and biopterin concentrations of the exposed group were higher than nonexposed subjects (both p<0.05). The correlations among Al levels and DHPR activity, magnesium concentration in serum and urine, working years, smoking status, and age were evaluated.

Delayed gastric emptying in children with poor appetite

BACKGROUND

In this study we aimed to evaluate gastric emptying time in children with poor appetite.

METHODS

Anthropometrical measurements, daily energy intakes and gastric emptying times were determined in 36 children with poor appetite. The children were grouped as those with normal and delayed gastric emptying. These groups were then compared with respect to age and nutritional status.

RESULTS

Malnutrition was found in 63.9% and gastric emptying was delayed in 58.3% of all cases. Children with delayed gastric emptying were significantly older and malnutrition was significantly higher in this group (7.2 +/- 3.1 vs 3.9 +/- 1.5 years, P: 0.001 and 81.0% vs 40.0%, P: 0.017, respectively). Daily mean energy intake was significantly lower than daily mean energy requirement in children with delayed and normal gastric emptying (P = 0.002 and 0.026 respectively).

CONCLUSION

In children with poor appetite, probability of gastric motility disorders should be taken into consideration. Especially in children with failure to thrive at preschool and early school years gastric motility studies should be undertaken.

Relation between actinomycosis and histopathological and clinical features of the palatine tonsils: a comparative study between adult and pediatric patients

OBJECTIVE

To find out the incidence of actinomyces in the palatine tonsil of the adult and pediatric patients, and evaluate our results relevant to the clinical diagnoses and histopathological features of tonsillectomy specimens.

METHODS

The medical records of 1820 tonsillectomies, which were performed in the Department of Otolaryngology between 1987 and 2002 were retrospectively reviewed. The paraffin embedded specimens of the patients were also obtained for histopathologic assessment, and Hematoxylin-Eosin stained sections re-evaluated mainly for cryptitis and actinomycosis.

RESULTS

There was actinomyces in 122 (6.7%) of 1820 patients, of whom 62 were adult and 60 were pediatric patients. That is, actinomyces was present in 62 (10.9%) of 568 adult patients, and 60 (4.8%) of 1252 pediatric patients. The rate of actinomyces was significantly higher in adults than children (p < 0.01). There was no correlation between the clinical diagnoses and the histopathologic parameters assessed (p > 0.05). On histopathology, the cryptitis was encountered in 53 (85%) of 62 adult patients and 47 (78%) of 60 pediatric patients with actinomyces (p > 0.05). The rate of cryptitis was significantly higher in the presence of actinomyces both in adult and pediatric patients (p < 0.05).

CONCLUSION

There was no correlation between the clinical diagnosis of tonsillar disease and the presence of actinomycosis both in adult and pediatric patients. Histopathologic findings of adult and pediatric tonsillectomy material was similar except for the higher rate of actinomycosis in the adults than in children. However, cryptitis was a substantial finding in the presence of actinomycosis. Based on the significant association of cryptitis with actinomycosis, cyptitis can be considered a histopathologic indicator for tonsillar actinomycosis.

The role of gamma probe activity counts in minimally invasive parathyroidectomy. Preliminary results

AIM

The benefit of preoperative gamma probe in the diagnosis of adenoma in patients with histopathologically proven parathyroid (PT) adenomas was examined.

PATIENTS, MATERIAL, METHODS

20 patients with positive (99m)Tc MIBI uptake in PT scintigraphy with primary hyperparathyroidism were enrolled in this study. 740 MBq (99m)Tc MIBI were injected 3 h before operation. Counts of four PT regions were obtained with gamma probe before surgery in the operation room. All suspected PT adenomas were resected and histopathologically diagnosed as adenomas. We also obtained counts of the resection region and the resected adenoma with gamma probe after the parathyroidectomy. Preoperative counts of adenoma bearing regions (ABR), non-adenoma bearing regions (NABR), postoperative resection region (PRR), resected adenoma counts (RA) were registered. Statistical analysis was performed by Wilcoxon rank test.

RESULTS

The mean counts of ABR, NABR, the PRR and RA were 462 +/- 106, 230 +/- 66, 164 +/- 42, 374 +/- 87, respectively. The mean counts from ABR were twofold higher than those of NABR. The PRR mean counts decreased by 64% when compared to the mean counts of ABR and by 55% when compared to the mean counts of RA. The differences in mean counts of ABR and NABR, PRR and ABR, PRR and RA (p <0.01) turned out as statistically significant.

DISCUSSION

According to our preliminary results, the region with the highest counts is at least 2 +/- 0,4 times higher than the mean of the other three PT regions. Thus, it seems to be significant for PT adenoma. Resection of adenoma may be accepted as successful, if the count of ABR decreased more than 64% with decreased postoperative parathormone levels.

CONCLUSION

This technique should not yet be applied instead of parathormone measurement or frozen technique. But it may replace the frozen technique used for confirmation of the diagnosis during the operation in the future.

Brachioradialis re-routing for the restoration of active supination and correction of forearm pronation deformity in cerebral palsy

A brachioradialis muscle rerouting procedure was used to restore active supination in five children with cerebral palsy and a pronation deformity. Following release and lengthening of the pronator quadratus and pronator teres muscles, respectively, the brachioradialis tendon was divided as a Z plasty and the distal part of the tendon was passed through the interosseous space in a dorsal to palmar direction, and then sutured to its proximal end. The procedure resulted in a gain of 81 degrees of active supination.

Blue nevus with an unusual presentation: two patients with endocervical location

OBJECTIVE

To report two cases of endocervically located blue nevus.

SUBJECT

Case report.

SETTING

University of Abant Izzet Baysal, Duzce, Turkey.

SUBJECT AND METHOD

Blue nevus is a benign lesion, which is usually found on the skin, rarely on mucous membranes. In two patients the endocervical location of blue nevus was described.

CONCLUSION

Blue nevus when located on the cervix may be confused with other benign or malignant lesions.

Tumoral calcinosis infiltrating the biceps brachii tendon - excision and reconstruction with allograft: a case report

Two patients with limited elbow motion due to tumoral calcinosis underwent resection of calcified masses around the elbow joints. This necessilated removal of the distal two thirds and three fourths of the biceps muscles. The resulting defects were reconstructed with homologous Achilles tendon grafts. Both patients regained M4 muscle power and no recurrences were observed.