Is there an influence of hepatic steatosis on fibrosis and necroinflammation in young patients with chronic viral hepatitis B?

OBJECTIVES

Our aim was to investigate the association of liver fibrosis and necroinflammation with HS in untreated young patients with chronic hepatitis B (CHB).

MATERIALS AND METHODS

A retrospective study was conducted in a military hospital in Turkey. A total of 254 subjects with CHB were included in this study. These subjects were divided into two groups: group 1 consisted of patients with hepatic steatosis (HS) according to ultrasonography (USG) and group 2 consisted of non-HS subjects. Sociodemographic, biochemical, histopathological, virological and USG results were recorded for both groups retrospectively. Statistical analysis was performed using SPSS 22.0.

RESULTS

The prevalence of HS was found to be 11.4%. A significant statistical difference was found between group 1 and group 2 regarding the fibrosis degree (p = 0.045). No statistically significant difference was noted between two groups for age, levels of ALT, AST, HBeAg, HBV-DNA levels, HAI scores, diagnosis age and duration of CHB. No difference was noted between the grade of HS and variables. A positive correlation was found between fibrosis groups and the grade of HS (p = 0.012, r = 0.158) and between HAI groups and the grade of HS (p = 0.029, r = 0.137).

CONCLUSION

The prevalence of steatosis was not higher in patients with CHB. HS is associated with advanced hepatic fibrosis, but not viral liver disease.

Eyelid tumors: clinical data from an eye center in Ankara, Turkey

INTRODUCTION

The aim of the study was to explore the distribution of eyelid tumors in Ankara, the capital city of Turkey, from a histopathological point of view.

MATERIALS AND METHODS

Medical records of 1,502 patients who had eyelid surgery because of tumoral lesions were retrospectively reviewed after obtaining institutional review board approval. A total of 1,541 lesions with histopathologic diagnosis were included. Inflammatory tumoral lesions were excluded. The lesions were categorized into three groups according to the origin: epidermal, adnexal tumors and 'others', including melanocytic, neural and vascular lesions.

RESULTS

Of the total of 1,541, 908 lesions were epidermal in origin. Only 22 (1.5%) were malignant, and 6.0% was premalignant lesions such as actinic keratosis and Bowen's disease. Twenty-one of 22 malignant lesions were basal cell carcinoma. There was only one patient with squamous cell carcinoma and no sebaceous cell carcinoma. Among the benign tumors (92.5%), squamous papilloma was the most frequent (21.8% of all lesions). The other frequent lesions were nevus (17.6%), seborrheic keratosis (17.3%), hydrocystomas (10.6%), xanthelasma (7.6%) and epidermal cysts (7.2%).

CONCLUSIONS

The results of this study are in accordance with published literature. The absence of sebaceous cell carcinomas needs to be stressed.

Giant isolated mesenteric hydatid cyst case report without organ involvement

A 21-year-old man presented with a 1-year history of intermittent attacks of abdominal distention and abdominal pain. Abdominal ultrasonography (USG) and abdominal computed tomography (CT) showed a large multicystic mass. After the operation, histopathological findings revealed a lamellated ectocyst and germinal layer with a thick outer, non-cellular membrane in the wall of the cyst, making a diagnosis of primary hydatid cyst for sure. He was discharged on the 10th postoperative day with albendazole 800 mg/day treatment. Herein, we report an unusual case of an isolated primary hydatid cyst of the mesenterium. As a conclusion, in endemic areas, hydatid cysts should be considered for the diagnosis of a patient with cystic mass lesions.

Hyperbaric oxygen therapy reduces the severity of necrotizing enterocolitis in a neonatal rat model

INTRODUCTION

Hyperbaric oxygen (HBO) therapy is known to increase oxygen concentration in tissues leading to induction of an adaptive increase in antioxidants, stimulation of angiogenesis, improvement of white blood cell action, and regulation of inflammatory process. Therefore, we tested the potential beneficial effect of HBO in neonatal rat model of necrotizing enterocolitis (NEC).

MATERIALS AND METHODS

Thirty newborn Sprague-Dawley rats, provided by the Experimental Research Council, Gulhane Military Medical Academy, Ankara,Turkey, were randomly divided into 3 groups as follows: NEC, NEC + HBO, and control. Necrotizing enterocolitis was induced by enteral formula feeding and exposure to hypoxia after cold stress at 4 degrees C and oxygen. The NEC + HBO group received HBO at 2.8 atmosphere absolute (ATA) for 90 minutes daily for 3 days. The pups were killed on the fourth day, and their intestinal tissues were harvested for biochemical and histopathologic analysis. Blood samples were also obtained from the pups.

RESULTS

The mortality rate was highest in the NEC group (3 pups in the NEC group vs 1 pup in the NEC + HBO group). Malondialdehyde and protein carbonyl content were significantly increased, whereas superoxide dismutase and glutathione peroxidase were significantly decreased in the NEC group. All these changes were similar to control levels in the NEC group by HBO treatment. Nitrate plus nitrite (NO(x)) levels and serum tumor necrosis factor alpha were increased in the NEC group and histopathologic injury score and apoptosis index in the NEC group were significantly higher than in the NEC + HBO group.

CONCLUSION

Hyperbaric oxygen significantly reduced the severity of NEC in our study.

Nuclear planimetry on the samples from cytologically overlapping proliferative breast lesions

Differentiation of low-grade breast carcinomas from fibroadenomas with atypia on fine-needle aspiration cytology material may sometimes be problematic. In some cytological samples of these lesions, both the nuclei of cells and patterns of cell clusters display substantial overlapping morphological characteristics. Nuclear morphometry on cytological material is suggested as an ancillary method for the differential diagnosis in many lesions, including breast tumors. Twenty-five cytological samples obtained from patients with breast lesions, which were histopathologically confirmed as grade I ductal carcinomas (n=10), tubular carcinomas (n=5), and fibroadenomas with atypia (n=10), were utilized in this study. Eight geometric features of about 2002 nuclei from these tumors were measured. Discriminant analysis was performed on this data set in order to test the correct classification based on the eight measured variables. Statistical analyses were carried out with two fundamentally different approaches: in the first one, the entire data from all measured nuclei were used for classification. In the second one, a subset of data representing the 10% most deviated values of variables was extracted from the entire dataset to simulate the "selective examination" performed during classical morphologic evaluation. When the entire data was used in discriminant analysis, the overall performance in the correct classification rate was found to be approximately 50%, which was considered an unacceptable value in routine diagnostic practice. In the subset of data constructed with our systematic and reproducible "selection bias", the overall performance of correct classification rate of the same discriminant model improved substantially to 97%. Morphologic examination is actually based on selection. The use of data obtained from all of the cells in morphometry, as previously used in nearly all of the statistical methods, may cause a masking effect in diagnostically important features. Morphometric studies may seem to be useless when this effect is not taken into account. However, with a systematic and reproducible selection of the values with a proper "bias", morphometry may provide some discriminatory information in overlapping lesions.

Effects of different doses of hyperbaric oxygen on cisplatin-induced nephrotoxicity

Cisplatin, an effective antineoplastic agent, frequently induces acute renal failure in animals and humans. Hyperbaric oxygen (HBO) has been shown to prevent cisplatin-induced nephrotoxicity in rats. This study investigated the effect of two different HBO regimes on renal functions, oxidative stress, and histopathological changes in rat kidneys after cisplatin treatment. Wistar rats were divided into five groups: control, HBO, cisplatin, cisplatin plus once daily HBO, and cisplatin plus twice daily HBO. Cisplatin was given as a single intraperitoneal dose of 6 mg/kg, and HBO was applied for 60 min at 2.5 atm for six days. HBO alone did not alter any biochemical parameters or histopathological findings compared with the control group. Cisplatin increased serum urea and creatinine levels and caused severe histopathological injury. In addition, cisplatin increased lipid peroxidation and impaired superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in kidney tissue. Once daily HBO after cisplatin treatment slightly reduced serum urea and creatinine levels and attenuated histopathological injury. HBO also reduced lipid peroxidation and increased SOD and GSH-Px activities significantly. Although twice daily HBO was determined to be more effective than once daily HBO on oxidative stress parameters, it increased serum creatinine levels and histopathological injury compared with the cisplatin group. It was concluded that HBO alone does not induce nephrotoxicity and oxidative stress in rat kidneys; once daily HBO may prevent cisplatin-induced nephrotoxicity, an effect that is partially mediated by the modification of oxidant/antioxidant systems in the kidneys; and twice daily HBO potentiates cisplatin nephrotoxicity by a ROS-independent mechanism.

The effect of inhaled budesonide and formoterol on bronchial remodeling and HRCT features in young asthmatics

Asthma is a chronic disease that may cause remodeling of the airways. We aimed to observe the effects of the combined use of inhaled budesonide and formoterol on both the reversibility of remodeling and structural changes in the airways. Thirty-six male patients (age range, 20-31) with mild-to-moderate persistent asthma were given inhaled formoterol and budesonide treatment for three months. Bronchial diameter (BD) and bronchial wall thickness (BWT), as measured by high-resolution computerized tomography, and reticular basement membrane thickness (RBMT), assessed in bronchoscopic biopsy specimens, were compared with pretreatment findings. Twenty-two age-matched male controls were also enrolled. BDs of the patients were significantly smaller than in the controls, whereas BWT and RBMT were greater. After three months BWT and RBMT of the subsegmental airways significantly decreased and BD increased. There was a prominent eosinophilic and lymphocytic infiltration in the bronchial mucosa of the asthmatics, and the eosinophilic infiltration significantly improved with treatment. Both serum total IgE and eosinophil counts were related to eosinophilic infiltration in the biopsy samples (r = 0.494 and r = 0.463, respectively). FEV(1) was positively correlated with the diameters of the segmental and subsegmental airways (r = 0.491 and r = 0.265, respectively) and negatively correlated with BWT of the subsegmental airways (r = -0.293) and with the RBMT of both the segmental and subsegmental airways (r = -0.597 and r = -0.590, respectively). We suggest that treatment with inhaled formoterol and budesonide may reverse increased RBMT and BWT as part of remodeling in patients with asthma.

Hyperbaric Oxygen Therapy Attenuates Renal Ischemia/Reperfusion Injury in Rats

OBJECTIVE

Renal ischemia/reperfusion (I/R) injury occurs in both native and transplanted kidneys. Hyperbaric oxygen (HBO) has been shown to prevent I/R injury in different tissues. The aim of this study was to evaluate the effect of HBO on renal I/R injury in rats.

MATERIALS AND METHODS

Sprague-Dawley rats were randomly assigned to one of three groups. The Control group (n = 6) received right nephrectomy. The I/R (n = 6) and I/R+HBO groups (n = 6) received 30 min left renal ischemia followed by 24 h of reperfusion after right nephrectomy. The I/R+HBO group (n = 6) received additional HBO therapy for 60 min at 2.5 absolute atmospheres starting at the initial 15th minute of reperfusion.

RESULTS

In the I/R group, blood urea nitrogen (BUN) and creatinine levels increased significantly compared with the Control and I/R+HBO groups (p < 0.05). BUN and creatinine levels were similar in the Control and I/R+HBO groups. Kidney samples from I/R group rats revealed severe tubular damage and neutrophil infiltration at histopathological examination. The animals treated with HBO showed markedly improved lesions and less neutrophil infiltration compared with the I/R group (p < 0.05).

CONCLUSIONS

HBO exhibited marked protection against I/R injury in this study as measured using BUN and creatinine levels and renal histopathology. However, further studies are needed to clarify the renoprotective effect of HBO on I/R injury.

Identification of a morphometrical parameter that predicts the response to splenectomy in patients with idiopathic thrombocytopenic purpura

Idiopathic thrombocytopenic purpura (ITP) is an isolated thrombocyte disease that has no correlation with other causes of clinical thrombocytopenia in adults. About 70% of patients with ITP were successfully treated by medical care and splenectomy, but nearly 30% of ITP patients do not respond to these treatments. The aim of this study is to evaluate the predictive factors that affect the success of treatment in 26 patients with ITP. Thirteen patients with ITP responded to splenectomy (responsive group), whereas 13 other patients were resistant to medical treatment and splenectomy (resistant group). The control group consisted of 13 patients who had undergone posttraumatic splenectomy. Age, sex, spleen weight, the number of follicles per mm(2), and the length of time between diagnosis and splenectomy were retrospectively analyzed. No significant difference was found between the groups with respect to these variables. Mean maximum follicle diameter (MMaFD), mean minimum follicle diameter (MMiFD), and the number and distribution of CD56 (+) cells were evaluated for each spleen specimen. There was no statistical difference in the distribution of CD56 (+) cells between the ITP patients and the control group, but the number of CD56 (+) cells was significantly higher in the control group than in patients with ITP. While MMiFD showed no statistical difference between the groups of ITP patients, a MMaFD of 350 microm and above was significantly more likely in the resistant group than in the other groups. In conclusion, this study has shown that the MMaFD is a significant predictor of the response to splenectomy.

Effect of combined therapy with hyperbaric oxygen and antioxidant on infarct volume after permanent focal cerebral ischemia

The aim of the present study was to evaluate the efficiency of combination of hyperbaric oxygen (HBO) and an antioxidant on permanent focal cerebral ischemia. Male Wistar rats underwent permanent middle cerebral artery occlusion (MCAO). Then, animals were randomly assigned to one of four groups: the control group (n=9) received no treatment, HBO group (n=9) was treated for 90 min at 2.5 absolute atmosphere for 3 days, the U-74389G group (n=8) received single U-74389G injection (3 mg/kg), the HBO + U-74389G group (n=8) received both HBO and U-74389G treatments. Treatments were initiated within the first 10 min after MCAO. After 3 days, the infarct volumes in rat brains were measured. The infarct ratios were 25.6+/-6.5 % for the control group, 21.9+/-6.4 % for the HBO group, 15.7+/-5.7 % for U-74389G group and 12.5+/-3.8 % for HBO + U74389G group. The infarct volumes were significantly reduced in rats treated with U-74389G (p<0.05) and combination therapy (p<0.05). HBO failed to reduce infarct volume significantly. We concluded that 1) U-74389G is more beneficial than HBO on permanent MCAO in rats, and 2) a combined therapy failed to significantly improve infarct volume more than either single treatment.

Investigation of the Effect of Hyperbaric Oxygen on Experimental Cyclosporine Nephrotoxicity

Hyperbaric oxygen interacts with drugs which patients use concurrently with hyperbaric oxygen treatment, which may cause in potentiation or inhibition of both therapeutic and toxic effects. We examined the effect of hyperbaric oxygen therapy on experimental cyclosporine A nephrotoxicity. The study comprised four groups of rats: a control group, a cyclosporine A group (25 mg/kg/day intraperitoneally for four days), a hyperbaric oxygen group (60 min. every day for four days at 2.5 atmospheric pressure), and a cyclosporine A+hyperbaric oxygen group (CsA 25 mg/kg/day intraperitoneally for four days+hyperbaric oxygen for 60 min. every day for four days at 2.5 atmospheric pressure). Hyperbaric oxygen did not alter biochemical parameters. Cyclosporine A increased serum urea and serum creatinine levels and decreased creatinine clearance. In the cyclosporine A+hyperbaric oxygen group serum urea level increased more than in the cyclosporine A group. Cyclosporine A increased tubular epithelial cell apoptosis and necrosis score values. The numbers of apoptotic cells in proximal tubule epithelial cells in the cyclosporine A+hyperbaric oxygen group were significantly higher than those of the cyclosporine A group. We recommend that renal functions of the patients receiving cyclosporine A should be monitored during hyperbaric oxygen therapy.

MRI appearance of retrocalcaneal bursitis and rheumatoid nodule in a patient with rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disorder of unknown etiology characterized by symmetric, erosive synovitis and sometimes multisystem involvement. Rheumatoid nodules have been reported in as many as 20-30% of patients with rheumatoid arthritis; however, they are not commonly seen in the feet. We present magnetic resonance (MR) findings of a rarely seen case of rheumatoid bursitis in the retrocalcaneal bursa associated with a subcutaneous rheumatoid nodule inferior to the calcaneus which histologically confirmed the rheumatoid arthritis. To the best of our knowledge, this is the first case that rheumatoid bursitis in the retrocalcaneal bursa associated with the rheumatoid nodule in the foot was revealed by MR imaging.

The Role of Recipient Sites in Fat-Graft Survival

The survival of fat grafts depends on many factors, 1 of the major being early revascularization. Early studies showed that adipose tissue has a low tolerance to ischemia. Some methods have been described to increase the tolerance of adipose tissue to ischemia. This study was designed to compare volume maintenance of the transplanted fat graft in different recipient sites of the rabbit face. Three groups of 5 New Zealand white rabbits were studied. Fat grafts harvested from the right inguinal fat pad were transplanted to the buccomandibular area of the rabbit's face. Three different recipient sites (subcutaneous, supramuscular, and submuscular) were dissected on each side of the face, and groups were formulated based on this difference of recipient sites. Morphometric, as well as histopathologic, analyses were done, and the results revealed a statistically significant increase of fat graft survival in supramuscular layer (81.95% +/- 4.40%) than in subcutaneous (41.62% +/- 3.29%) and submuscular layer (37.31% +/- 5.77%) (P<0.05). This study demonstrates that selection of an "appropriate recipient site" should enhance ultimate fat-graft survival.

Investigation of the role of hyperbaric oxygen therapy in cisplatin-induced nephrotoxicity in rats

Cisplatin (CP) is an effective chemotherapeutic agent used in the treatment of a variety of solid tumours. The most frequently observed side-effect of the use of CP is nephrotoxicity. Recently, evidence has been demonstrated that reactive oxygen species forming in the tubular epithelium play an important role in CP-linked nephrotoxicity. The aim of the study was to observe the effect of hyperbaric oxygen (HBO) therapy on CP nephrotoxicity, a subject which has not been studied previously. Wistar rats were treated with CP (a single intraperitoneal (IP) dose of 0.6 mg/100 g) alone and in combination with HBO (60 min every day for seven days at 2.5 x atmospheric pressure). Effects of the treatment on renal function and histology were determined. In analyses at the end of the study it was observed that serum urea, creatinine, and daily urinary protein excretion levels of the CP group were higher than at the start of the study, and that the creatinine clearance level had fallen (P < 0.05). There was no significant difference between the CP+HBO group and HBO group serum urea, creatinine, creatinine clearance, and daily urinary protein excretion levels at the beginning and end of the study (P > 0.05). Histopathological examination showed that the necrosis score in the proximal tubule epithelial cells and average apoptitic cell numbers in the CP group were higher than those in the CP+HBO and HBO groups (P < 0.05). There was no statistical difference between the CP+HBO group and the HBO group in terms of necrosis score in the proximal tubule epithelial cells and the percentage of distal tubules containing hyaline casts in the lumen. In conclusion, in this study it was observed that in experimental study of CP nephrotoxicity the synchronous application of HBO therapy with CP prevents kidney damage.

Bombesin in short bowel syndrome

Short bowel syndrome comprises the sequel of nutrient, fluid, and weight loss that occurs subsequent to greatly reduced functional surface area of the small intestine. The aim of this study is to investigate the trophic and functional effects of bombesin on remaining gut in rats with experimentally induced short bowel syndrome. Thirty-two rats were allocated randomly and experimental short bowel syndrome was induced by 80% bowel resection in all rats. A regular enteral diet and isocaloric elemental enteral nutrition for 12 days were given in the control group and the elemental nutrition group, respectively. In the bombesin group 10 microg/kg subcutaneous bombesin (t.i.d.) for 10 days with regular enteral diet for 12 days was given. In the elemental nutrition and bombesin group the diet consisted of 10 microg/kg subcutaneous bombesin (t.i.d.) for 10 days with isocaloric elemental enteral nutrition for 12 days was given. All rats underwent physical, histological, and biochemical evaluation. Reduction in weight loss, bowel diameter, fecal fat content, and glycemia, increase in cellularity, and d-xylose absorption were observed in all treatment groups. These changes were more evident in the bombesin treatment groups. Increases in serum protein and albumin levels were seen with bombesin treatment with or without elemental diet, whereas reductions in villous height and crypt depth were observed only with bombesin treatment without elemental diet. Serum calcium, iron, and vitamin B(12) levels were not affected with any treatment. It is concluded that bombesin may be a useful trophic agent contributing to increased absorptive capacity and improved biochemical values even in the absence of elemental nutrition.

Investigation of Helicobacter pylori in bronchoscopic lung specimens of young male patients with bronchiectasis but without gastrointestinal symptoms

Anti-Helicobacter pylori IgG serum levels were measured in 31 young male bronchiectasis patients without gastrointestinal symptoms, and 56 healthy males. The possible presence of H. pylori was also investigated by rapid urease tests, culture and histopathological examination of protected catheter brush and biopsy specimens from the bronchiectatic site. No serological, microbiological or histological evidence of H. pylori infection was found in the bronchiectasis patient group. H. pylori did not appear to be an agent of infection or chronic colonisation in bronchiectasis, and may not have a significant role in the progression of this disease.

Prevalence and prognostic value of c-erbB2 expression in non-small cell lung cancer (NSCLC)

The c-erbB2 oncoprotein is highly expressed in approximately one third of non-small cell lung cancer (NSCLC) patients. We determined the status of c-erbB2 expression in our patients with NSCLC and investigated its correlation with disease stage, histological type and response to treatment. Eighty-four patients were examined for the expression of c-erbB2 by immunohistochemistry using a polyclonal antibody. The scoring criteria of Clinical Trial Assay (CTA) were used to evaluate staining (0 to +3). c-erbB2 overexpression was determined in 35% of the cases. Tumors from higher stage disease (stage IIIb-IV) were more often c-erbB2 positive in adenocarcinoma (ADC) (p=0.04). In addition, there was an association between c-erbB2 score and disease stage in ADC patients (p=0.03). Our study did not demonstrate an association of c-erbB2 overexpression with response to chemotherapy. We conclude that c-erbB2 overexpression may be a prognostic marker for evaluating tumor progression in NSCLC patients but further studies must be performed with larger patient populations.

Effect of long-term application of epinephrine on rat skin vasculature: experimental study

As a potent vasoconstrictor, epinephrine is used ubiquitously in plastic surgery. It is typically delivered subcutaneously in very low concentrations over a brief time interval. We are aware of no reports describing the long-term release of epinephrine as an independent agent to the soft tissues for the purpose of causing prolonged local vasoconstriction. This study was designed to address two goals: first, to investigate the effect of long-term local release of epinephrine from a drug delivery system on rat abdominal skin vasculature; secondly, to evaluate the pharmacological properties of this drug delivery system (DDS). Thirty male Sprague-Dawley rats, weighing 300-400 g, were included in the study. Animals were subdivided into two groups of 15 each. Group A (control group) and Group B (experimental group) were treated with saline and epinephrine-loaded microspheres (msps), respectively. The manufacturing process and formulation studies of the DDS are described. In vivo assays revealed a 7-day sustained release of epinephrine. After 7 days, neither residual nor supraphysiologic release of epinephrine was shown with high-performance liquid chromatography (HPLC). Histological studies with hematoxylin-eosin and periodic acid Schiff revealed a statistically significant increase in number of vessels as well as their diameter and wall thickness (P <0.05). Epinephrine release via this msp/DDS predictably induces local vasoconstriction over a time sequence known to be optimally associated with hypoxia and promotion of vascular augmentation. This model can be valuable in sustaining hemostasis during long-lasting (more than a few hours) surgical procedures by its long-acting vasoconstructive effect. The system's ability to intentionally cause vascular augmentation also bodes great potential in flap and graft surgery.

Significance of p53 and bcl-2 immunoexpression in the prognosis of laryngeal squamous cell carcinoma

This study was undertaken to determine whether p53 or bcl-2 immunoexpression has any significance in the prognosis of laryngeal squamous cell carcinoma. Eighty-four cases of laryngeal squamous cell carcinoma at different pathological stages and locations were studied. All patients were treated surgically first, and followed up for 6-96 months (mean, 35 months). p53 and bcl-2 immunoexpression in tumour cells, evaluated by image analysis and histoscore, were found in 71.4% and 46.4% of tumours, respectively. Glottic location was correlated with significantly longer survival than tumours at other locations. Pathological stage and histological grade of tumour were also significant predictors of survival. Neither p53 nor bcl-2 immunoexpression was found to be predictive of post-operative survival. Only transglottic tumours expressed significantly high levels of bcl-2. Both methods used to evaluate p53 and bcl-2 immunoexpression correlated well with each other. This study suggests that immunoexpression of p53 and bcl-2 is not a significant prognostic predictor in laryngeal squamous cell carcinoma.

Muscle metastasis as initial manifestation of epidermoid carcinoma of the lung

Typical sites of squamous cell carcinoma of lung metastases include liver, brain, bones, pulmonary and adrenal glands. In advanced dissemination it can rarely involve the skeletal muscle. The patient in this case report was a 46-year-old man, with no significant medical history. He was admitted to hospital because of a large swelling on his left thigh. Investigations resulted in a diagnosis of primary squamous cell carcinoma of the lung. Biopsy of the left great adductor muscle produced similar pathology to that of the lung primary. This case report describes a skeletal muscle metastasis as the first sign of metastatic disease.

Comparison of the therapeutic efficacy of 4-methylpyrazole and N-acetylcysteine on acetaminophen (paracetamol) hepatotoxicity in rats

Obtaining effective analgesia with a minimal erosive effect on gastric mucosal tissue has increased the consumption of acetaminophen (paracetamol), especially among the elderly. However, the hepatotoxic effects of acetaminophen have also increased. We aimed to compare the effects of 4-methylpyrazole (4-MP), N-acetylcysteine (NAC) and their combined use on the hepatotoxicity of acetaminophen in a rat model. Male Wistar Albino rats were divided into six groups. Groups 1-5 received 2,000 mg/kg acetaminophen by gavage while the control group was group 6. Group 2 animals were given NAC (loading dose 140 mg/kg followed by seven doses at 4 h intervals); group 3 received 50 mg/kg 4-MP; group 4 received 200mg/kg 4-MP; and group 5 received NAC as in group 2 plus 200 mg/kg 4-MP. Blood samples were taken for measurements of serum AST and ALT levels. The livers of the rats were removed for microscopic examination and grading of hepatic necrosis. AST and ALT levels in groups 2-5 were lower than that of group 1 (p < 0.001), although no significant difference was noted between groups 2-5 (p > 0.05). Higher levels of ALT were found in group 5 than in group 2 (p < 0.05), and higher levels of AST were found in group 5 than in group 3 (p < 0.01). Median necrosis scores were 3.36 for rats receiving acetaminophen alone (p < 0.001, compared with groups 2-6), 1.45-1.81 for groups 2-5 (p > 0.05, compared with each other), and 0.18 for control rats (p < 0.001, compared with groups 1-5). In conclusion, the administration of 4-MP and/or NAC after 4 h of administering toxic dose of acetaminophen, inhibits hepatotoxicity in rats. There was no difference between the 4-MP and NAC-treated groups as reflected by comparable levels of serum transaminases and the degree of hepatic necrosis. Combining of 4-MP and NAC offers no benefit.