Evaluation of Optic Nerve Sheath Diameter for Prediction of the Development of Brain Death in Patients Admitted to the Intensive Care Unit with Intracranial Hemorrhage

OBJECTIVES

Intracranial hemorrhage results in an increase in intracranial pressure, which is considered to be the leading cause of brain death. Follow-up of these patients and early recognition of possible brain death are important for organ donation. It has been shown that increased intracranial pressure is proportional to the changes in optic nerve sheath diameter. The aim of this study was to investigate the usability of changes in optic nerve sheath diameter secondary to increased intracranial pressure as a precursor for identification of patients who will develop brain death.

MATERIALS AND METHODS

Patients admitted to the intensive care unit with intracranial hemorrhage and a Glasgow Coma Scale score of 7 or less were divided into 3 groups: brain death group (patients with brain death), hemorrhage group (patients who died due to hemorrhage), and survivor group (patients who were discharged from the intensive care unit). Optic nerve sheath diameter was measured by computed tomography taken at admission.

RESULTS

The highest value for optic nerve sheath diameter was measured in the brain death group (P < .001). The cutoff point for optic nerve sheath diameter to predict the presence of brain death was determined as >6.62 mm. The area underthe curve for optic nerve diameter was 0.85 (sensitivity 66.20%, specificity 90%; P < .001). The results showed a 25.529- fold increased risk of brain death in measurements above this value.

CONCLUSIONS

An optic nerve sheath diameter value of >6.62 mm measured on initial cranial computed tomography of patients admitted to the intensive care unit with a diagnosis of intracranial hemorrhage is indicative of an increased risk of brain death.

Duration of operation and diagnosis of hepatitis B (HBV) is an independent risk factor for surgical site infections after liver transplantation

Objectives

Surgical site infections (SSI) are the most common complications after liver transplantation (LT). Although there are some risk factors known in the literature after LT, the available data is insufficient for routine use. In the present study, it was aimed to define the parameters that may be used to clearly determine the risk of SSI after LT in our clinic.

Material and Methods

In the present study, we evaluated 329 patients who underwent liver transplantation with regard to risk factors for surgical site infections. The relation between demographic data and SSI was evaluated using SPSS, Graphpad, and Medcalc statistical programs.

Results

In a total of 329 patients, SSIs were determined in 37 (11.24%). Among the 37 patients, 24 were classified as organ space (64.9%) and 13 as deep SSI (35.1%). None of these patients developed superficial incisional infection. SSI showed statistically significant relation with operation time (p= 0.008), diabetes (p= 0.004), and cirrhosis due to hepatitis B (p <0.001).

Conclusion

As a result, deep and organ space infections are much more observed in patients undergoing liver transplantation with hepatitis B, diabetes mellitus and prolonged surgery. This is thought to have developed because of chronic irritation and increased inflammation. Since data on hepatitis B and duration of surgery are limited in the literature, this study is considered to be a contribution to the literature.

Do morphologic characteristics play a role in nodal metastatic progression of well-differentiated pancreatic neuroendocrine tumors?

BACKGROUND

Pancreatic neuroendocrine neoplasms (NENs) are tumors with histopathologic and prognostic heterogeneity that pose difficulties in establishing standards for diagnosis, classification, and treatment. Among NENs, well-differentiated neuroendocrine tumors (NETs) have been classified as grade 1, 2, and 3 in the most recently released World Health Organization classification. Although well-differentiated NETs are associated with relatively better prognosis, they have a potential for malignant behavior such as extrapancreatic spread, metastasis, or recurrence. The present study aimed to evaluate clinical and histomorphologic findings of patients with well-differentiated pancreatic NETs and to identify histopathologic findings effective in predicting nodal metastatic progression.

METHODS

The study group consisted of 54 patients diagnosed with well-differentiated NET. All preparations and blocks of the patients were examined for the following histopathologic parameters: tumor diameter, microscopic tumor growth pattern (solid, trabecular, acinar, and mixed), cellular features (clear, eosinophilic, oncocytic, peliotic, and pseudopapillary), stromal changes (calcification, lymphocytic infiltration, and stromal hyalinization), presence of necrosis, perineural invasion, lymphovascular invasion, mitotic activity, and Ki67 proliferative index.

RESULTS

Lymph node metastasis was present in 7 patients. Lymph node metastasis was significantly associated with tumor diameter of >2 cm (p = 0.012), Ki67 proliferative index of >20% (p = 0.022), grade 3 tumors (p = 0.002), presence of dense stromal hyalinization (p = 0.034), and mild lymphocytic infiltration (p = 0.041).

CONCLUSION

The present study revealed that the new findings such as presence of dense stromal hyalinization and absence of remarkable lymphocytic infiltration could be predictive morphologic findings for the development of lymph node metastasis.

Effect of High Fructose Corn Sirup on Pancreatic Ductal Adenocarcinoma Induced by Dimethyl Benzantracene (DMBA) in Rats

Increased risk of pancreatic cancer may be associated with consumption of sugar containing foods. The aim of this study was to evaluate the effect of peach nectar containing high fructose corn sirup (HFCS) consumption in a pancreatic carcinogenesis rat model induced by 7,12-Dimethyl benzanthracene (DMBA). Fifty-day-old male Sprague Dawley rats were fed with peach nectar containing HFCS + chow, peach nectar containing sucrose + chow and only chow. After 8 mo, feeding period, each group was divided into two subgroups, in which the rats were implanted with DMBA and no DMBA (sham). Histologic specimens were evaluated according to the routine tissue processing protocol. The animals with ad libitum access to pn-HFCS, pn-sucrose and chow (only) showed significant differences in chow consumption and glucose level. Necropsy and histopathologic findings showed tumor formation in the entire group treated with DMBA. Excluding one rat in chow group, which was classified as poorly differentiated type, the others were classified as moderately differentiated pancreatic ductal adenocarcinoma (PDAC). This study demonstrated that daily intake of HFCS did not increase body weight and there was no effect of peach nectar consumption on the development of PDAC induced by DMBA in rats.

Immunohistochemical expression of CDX2, CK7, HER2 and HER4 in periampullary adenocarcinoma : implications for clinicopathology and patient outcomes

Background

Periampullary carcinomas originate from the pancreatic head, the ampulla, the distal bile duct, or the duodenum. The expression of CK7 and CDX2 has been used in the classification of periampullary carcinomas. There is prognostic value of human epidermal growth factor receptor (HER) 2 and HER 4, which have been linked to poor prognosis in several types of tumors, such as breast and gastric carcinomas. We aimed to evaluate the expression and prognostic value of CDX2, CK7, HER 2, and HER4 in periampullary adenocarcinoma.

Patients and Methods

We retrospectively selected 98 patients who had undergone pancreatoduodenectomy for periampullary adenocarcinoma at our pathology department. The tumor location, pathological subtype, involvement of vessels and lymph nodes, perineural invasion, clinical follow-up, and tumorstage were noted. Immunohistochemistry was performed for CK7, CDX2, HER2, and HER4.

Results

CDX2 staining was predictive of perineural invasion. Additionally, there was a significant association between the overexpression of HER2 and HER4 and the presence of perineural invasion. HER4 was significantly positive in patients with the pancreatobiliary subtype compared with patients with the intestinal subtype. Patients with the pancreatobiliary subtype, lymph node involvement, and advanced pT and UICC stages had significantly lower median survival.

Conclusion

Our findings suggest that only pancreatobiliary subtype, lymph node involvement and advanced pT and UICC stages were independent predictors of short survival, but the ampulla tumor location predicted a significantly better survival time. The immunohistochemical expression of CDX2, CK7, HER4, and HER2, vessel involvement, and perineural invasion were not associated with the survival of patients with periampullary adenocarcinoma.

Retrospective analysis of clinicopathological features of solid pseudopapillary neoplasm of the pancreas

Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare neoplasm that accounts for 2-3% of all primary pancreatic neoplasms. This study aimed to characterize clinicopathological features associated with SPNs and to retrospectively evaluate the relationship of these features with predictive parameters associated with aggressive behavior. We reviewed 16 cases of SPN of the pancreas that had been diagnosed between 2005 and 2014 at our pathology department. A total of 16 cases, 15 female and one male, were evaluated in this study. The patient age ranged from 13 years to 63 years with a median of 35.70 years. The mean tumor diameter ranged from 2 cm to 18 cm with a mean diameter of 5.90 cm. We identified a significant association between the presence of clear cells and perineural invasion (p=0.019), which was considered to be a predictive factor for aggressive behavior. Other features (i.e., localization, nuclear grooves, central hyalinization, myxoid stroma, eosinophilic bodies, foamy histiocyte aggregates, multinucleated cells, and calcification) were not significantly associated with predictive factors for aggressive behavior. One patient died as a result of a pancreatic fistula that developed as a postoperative complication. The remaining 15 patients are alive and have not demonstrated any signs of recurrence or metastasis. The current study suggested that the presence of clear cells might serve as a possible prognostic indicator of perineural invasion, which is a predictive parameter associated with aggressive behavior in SPN.

Gestational Gigantomastia

Gestational gigantomastia is a rare condition characterized by fast, disproportionate and excessive breast growth, decreased quality of life in pregnancy, and presence of psychologic as well as physical complications. The etiology is not fully understood, although hormonal changes in pregnancy are considered responsible. Prolactin is the most important hormone. To date, 125 cases of gigantomastia have been reported in the literature. In this case presentation, we report a pregnant woman aged 26 years with a 22-week gestational age with gestational gigantomastia and review the diagnosis and treatment of this rare disease in relation with the literature.

The correlation between Doppler US measurement of hepatic arterial flow and the MELD score in patients with chronic liver disease

OBJECTIVE

The aim of the study was to determine the relationship between the Model for End-Stage Liver Disease (MELD) score and hepatic arterial hemodynamic parameters measured via Doppler US.

PATIENTS AND METHODS

Etiologic causes and hepatic artery hemodynamic parameters of 121 patients with chronic liver parenchymal disease were compared with MELD scores.  Doppler ultrasonography (US) was used to assess flow velocity, pulsatility index (PI) and resistance index (RI) in the hepatic artery (HA). Each patient's MELD scores were calculated at the time of Doppler ultrasound performed.

RESULTS

There was statistically significant difference between MELD score and hepatic artery RI value (p < 0.001, r = 0.616). This difference was statistically more significant in the group which consisted of multiple etiologic causes (p < 0.001, r = 0.837).

CONCLUSIONS

We found significant relation between MELD score and hepatic artery RI measurements in patients with chronic liver parenchymal disease.

Primary thyroid lymphoma

Primary thyroid lymphoma is an uncommon thyroid malignancy. The treatment modalities significantly differ from other thyroid malignancies. Frequently it is accompanied by Hashimoto's thyroiditis, and it may be difficult to differentiate the two entities histologically. Patients typically present with suddenly growing mass in the thyroid gland. Discrimination between primary and secondary lymphoma is important due to variations in diagnostic tools, treatment modalities and prognosis. Surgery, chemotherapy, radiotherapy or combinations of these modalities may be applied in treatment. In this report, three cases with primary thyroid lymphoma in which three different treatment modalities have been applied are presented.

Non-recurrent laryngeal nerve

Injury to the recurrent laryngeal nerve is a serious complication in thyroid and parathyroid surgery. The anatomy of the recurrent laryngeal nerve is variable. Non-recurrent nerve is a very rare variation of the inferior laryngeal nerve. Because of the anatomical variations of the nerve, preservation of the nerve is the optimal strategy during surgery. In this case report, we present a non-recurrent laryngeal nerve abnormality in a patient who underwent parathyroidectomy, thyroidectomy and functional neck dissection for malignant parathyroid disease. A non-recurrent laryngeal nerve was identified during nerve exploration.

Antioxidant and antigenotoxic effects of lycopene in obstructive jaundice

BACKGROUND

Obstructive jaundice, a frequently observed condition caused by obstruction of the common bile duct or its flow and seen in many clinical situations, may end up with serious complications like sepsis, immune depression, coagulopathy, wound breakdown, gastrointestinal hemorrhage, and hepatic and renal failures. Intrahepatic accumulation of reactive oxygen species is thought to be an important cause for the possible mechanisms of the pathogenesis of cholestatic tissue injury from jaundice. Carotenoids have been well described that are able to scavenge reactive oxygen species. Lycopene, a carotenoid present in tomatoes, tomato products, and several fruits and vegetables, have been suggested to have antioxidant activity, so may play a role in certain diseases related to the oxidative stress. The aim of the present study was to determine the effects of lycopene on oxidative stress and DNA damage induced by experimental biliary obstruction in Wistar albino rats.

MATERIALS AND METHODS

Daily doses of 100 mg/kg lycopene were given to the bile duct-ligation (BDL) rats orally for 14 days. DNA damage was evaluated by an alkaline comet assay. The levels of aspartate transferase, amino alanine transferase, gamma glutamyl transferase, alkaline phosphatase, and direct bilirubin were analyzed in plasma for the determination of liver functions. The levels of malondialdehyde, reduced glutathione, nitric oxide, catalase, superoxide dismutase, and glutathione S transferase were determined in the liver and kidney tissues. Pro-inflammatory cytokine tumor necrosis factor-alpha level was determined in the liver tissues. Histologic examinations of the liver and kidney tissues were also performed.

RESULTS

According to this study, lycopene significantly recovered the parameters of liver functions in plasma, reduced malondialdehyde and nitric oxide levels, enhanced reduced glutathione levels, as well as enhancing all antioxidant enzyme activity in all tissues obtained from the BDL group. Moreover, the parameters of DNA damage in the liver and kidney tissue cells, whole blood cells, and lymphocytes were significantly lower in the lycopene-treated BDL group, compared with the BDL group.

CONCLUSIONS

Lycopene significantly reduced the DNA damage, and markedly recovered the liver and kidney tissue injuries seen in rats with obstructive jaundice.