Microsatellite Instability Status and the Expression of p16 and Cyclin D1 Proteins in Uterine Adenosarcoma and Their Clinicopathological Significance

OBJECTIVE

Uterine adenosarcoma has low malignant potential, except in cases with sarcomatous overgrowth (SOG) and a high-grade morphology. We here point out the prognostic clinicopathological and immunohistochemical features as well as the microsatellite instability (MSI) status of high- and low-grade adenosarcomas.

MATERIAL AND METHOD

In this study, DNA mismatch repair proteins, p16, cyclin D1, ER, PR, and CD10 were examined in uterine adenosarcoma cases using immunohistochemistry. The association between these proteins and clinicopathological parameters was also evaluated.

RESULTS

ER, PR and CD10 expressions were lower and weaker in high-grade adenosarcomas with SOG compared to low-grade adenosarcomas without SOG (p < 0.05). p16 positivity was more frequent in high-grade adenosarcomas than low-grade adenosarcomas (p < 0.05). There was no statistically significant difference between cyclin D1 positivity, MSI, and other clinicopathological parameters (p ≥ 0.05). Cyclin D1 positivity and loss of CD10 expression were associated with shorter disease-free survival (DFS). Loss of ER and CD10 expression was associated with shorter overall survival (OS) (p < 0.05). MSI was not associated with DFS or OS (p ≥ 0.05).

CONCLUSION

These results suggested that p16 positivity, and loss of ER, PR, and CD10 expression were predictors of high-grade morphology. Additionally, the current study showed that cyclin D1-positive tumors had high recurrence rates; however, no significant relationships were found between MSI and DFS or OS in patients with uterine adenosarcoma. Further investigations are required to determine the importance of p16, cyclin D1, and MSI in uterine adenosarcomas.

Association of frontal and maxillary bone fractures and concomitant craniocerebral injuries in patients presenting with head trauma

Background

Maxillofacial fractures and craniocerebral injuries are common in patients with head trauma. These are injuries with high mortality and morbidity. Therefore, patients with head trauma should be evaluated early with a multidisciplinary approach.

Aim

The association between frontal and maxillary bone fractures and concurrent craniocerebral injuries were investigated in patients presenting with head trauma in this study. The data of the patients were analyzed retrospectively.

Methods and Material

Age and gender distributions were evaluated in frontal and maxillary fractures. Concomitant craniocerebral injuries were investigated. Craniocerebral injuries were grouped as pneumocephalus, extra-axial, intra-axial injuries and brain edema. Craniocerebral injuries in frontal and maxillary fractures were compared statistically.

Results

Frontal bone and maxillary bone fractures were detected in 24% and 95% of the patients. Coexistence of pneumocephalus and intra-axial injuries in frontal bone fracture was statistically significant. The association of frontal posterior wall fractures with pneumocephalus and parenchymal contusion was found to be statistically significant. In addition, the association of craniocerebral injuries were evaluated and statistically significant ones were determined.

Conclusion

The presence of maxillofacial fractures in patients presenting with head trauma increases mortality and morbidity. Craniocerebral injuries can be life-threatening and delay the treatment of facial fractures. Upper facial bone fractures are significantly more common in craniocerebral injuries.

Atypical glandular cells in Papanicolaou test: Which is more important in the detection of malignancy, architectural or nuclear features?

OBJECTIVE

Atypical glandular cells (AGCs) in Pap (Papanicolaou) smears are uncommon but may represent various benign and malignant lesions. The aim of this study was to evaluate the AGC incidence in Pap smears, analyse the relationship between AGC and malignancy, and reveal the importance of architectural and nuclear features observed cytologically in malignancies.

METHODS

Patients diagnosed with AGC on the basis of cervicovaginal cytology between May 2011 and July 2018 were included in this study. All slides were retrospectively reviewed and subclassified according to the Bethesda 2001 classification system. The cytomorphological features observed in the smears were recorded. Cytohistological correlations were evaluated, and the significant clinicopathological findings for malignancy were determined.

RESULTS

Of 87 536 Pap smears, 195 (0.22%) had AGC results and 156 had tissue follow-up. Among the 156 smears with AGC, 80 (51.3%) were diagnosed as AGC-NOS (atypical glandular cells, not otherwise specified) and 76 (48.7%) as AGC-FN (atypical glandular cells, favour neoplastic). Follow-up biopsies revealed benign pathologies in 49 cases (31.4%) and malignant pathologies in 107 (68.6%). The rate of malignancy observed in AGC-FN cases (89.5%) was higher than the rate of malignancy in AGC-NOS cases (48.8%). Among the cytomorphological features, nuclear irregularity, presence of macronucleoli, feathering, loss of polarity, papillary pattern, and three-dimensional formation were found to be significant indicators of malignancy.

CONCLUSION

As AGC in Pap smear was associated with a clinically significant diagnosis in 68.6% of the cases in our study, we suggest that all patients with AGC should undergo further clinical assessment.

Microsatellite Instability in Glioblastoma: Is It Really Relevant in Tumor Prognosis?

AIM

To evaluate the frequency and prognostic significance of microsatellite instability (MSI) in patients with glioblastoma (GBM), an immunohistochemical analysis of mismatch repair (MMR) proteins was performed.

MATERIAL AND METHODS

A total of 71 patients with GBM who underwent surgery between 2011 and 2019, were included in the study. MMR protein expression was examined using immunohistochemistical analysis of tumor tissue samples; the association between the MMR status and clinicopathological findings was evaluated.

RESULTS

Immunohistochemical analysis revealed expressions of MLH1, MSH2, MSH6, and PMS2 proteins in 67 (94.4%), 65 (91.5%), 67 (94.4%), and 64 (90.1%) patients, respectively. Among the 71 patients, 64 (90.1%) expressing all MMR proteins were considered microsatellite stable (MSS), and 7 (9.9%) patients showing loss of at least one of the MMR proteins were considered to show MSI. Tumor recurrence was noted in 25 (39.1%) patients in the MSS GBM group, and 4 (57.1%) patients in the MSI GBM group (p=0.433). The overall median survival was 30.65 ± 5.1 and 10.71 ± 5.2 months in the MSS GBM and MSI GBM groups, respectively (p=0.059).

CONCLUSION

The results of this study showed no significant relationships between MMR protein expression and recurrence rates or overall survival in patients with GBM.

Effect of Topical Platelet-Rich Plasma on Burn Healing After Partial-Thickness Burn Injury

BACKGROUND To investigate the effects of platelet-rich plasma on tissue maturation and burn healing in an experimental partial-thickness burn injury model. MATERIAL AND METHODS Thirty Wistar albino rats were divided into 3 groups of 10 rats each. Group 1 (platelet-rich plasma group) was exposed to burn injury and topical platelet-rich plasma was applied. Group 2 (control group) was exposed to burn injury only. Group 3 (blood donor group) was used as blood donors for platelet-rich plasma. The rats were killed on the seventh day after burn injury. Tissue hydroxyproline levels were measured and histopathologic changes were examined. RESULTS Hydroxyproline levels were significantly higher in the platelet-rich plasma group than in the control group (P=.03). Histopathologically, there was significantly less inflammatory cell infiltration (P=.005) and there were no statistically significant differences between groups in fibroblast development, collagen production, vessel proliferations, or epithelization. CONCLUSIONS Platelet-rich plasma seems to partially improve burn healing in this experimental burn injury model. As an initial conclusion, it appears that platelet-rich plasma can be used in humans, although further studies should be performed with this type of treatment.

Good outcomes of patients with stage IB endometrial cancer with surgery alone

BACKGROUND

Most patients with endometrial cancer have stage I disease. Adjuvant therapy in stage IB (formerly IC) endometrial cancer is controversial, treatment options including observation or brachytherapy/ radiotherapy in grade 1-3 patients with or without chemotherapy. The purpose of this study was to assess the outcomes of our patients with stage IB endometrioid endometrial cancer.

MATERIALS AND METHODS

Sixty two patients with stage IB endometrial cancer and endometrioid histology were retrospectively evaluated. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Adjuvant radiotherapy was discussed with patients and utilized by those who accepted. Adjuvant chemotherapy was not given to any of the patients.

RESULTS

Median age was 62 (range, 42-95). Ninety percent of the patients had grade 1-2 disease. Thirteen patients (21%) received intra vaginal brachytherapy (IVBT) and one received whole pelvic radiotherapy (WPRT). Median follow-up time was 46 months (range, 9-77 months). Three patients experienced recurrence (4.8%), two of them died on follow-up and one was still alive at last visit. Two patients with recurrence had FIGO grade 2 tumors and one had a grade 3 tumor. Two patients (3.2%) died without evidence of recurrent disease. Relapse free survival at 5 years was 94.4% and overall survival was 93.1%.

CONCLUSIONS

Patients with stage IB disease in our study demonstrated relatively low recurrence rates although the majority of them received no adjuvant treatment. Surgery alone may be sufficient for most patients with this stage of endometrial cancer.

Presence of matrix metalloproteinase-2 and tissue inhibitor matrix metalloproteinase-2 gene polymorphisms and immunohistochemical expressions in intracranial meningiomas

OBJECT

Meningiomas are benign extraaxial tumors with a slow progression. Some of them, in spite of being benign in nature, may show an aggressive progression pattern. To investigate the behavioral characteristics of meningiomas, researchers have studied matrix metalloproteinases (MMPs), their tissue inhibitors (TIMPs), interstitial collagens, proteins, vascular endothelial growth factors (VEGF), and tumor necrosis factors.

METHODS

In this study, the authors investigated MMP2 and TIMP2 gene polymorphisms in formalin-fixed paraffin-embedded tissue samples obtained from meningioma patients who had previously undergone surgery at the authors' institution. In addition, brain invasion, Ki-67 index, and MMP-2 and TIMP-2 expressions were investigated using immunohistochemical methods. MMP2 (735C>T, 1575G>A, 1306C>T) and TIMP2 (418G>C, 303C>T) gene polymorphisms were investigated from paraffin-embedded tissue sections using the polymerase chain reaction-restriction fragment length polymorphism method.

RESULTS

There were statistically significant differences between genotype (p = 0.001) and allele frequencies (p = 0.001 and OR 7.4 [95% CI 1.5-36.2]) in patient and control groups for MMP2 1306C>T polymorphism. The authors did not find a statistically significant difference for other polymorphisms. GA genotype was found to be more frequent when brain invasion was suspected for MMP2 1575G>A polymorphism (p = 0.006). There was not a statistically significant difference for other MMP2 or TIMP2 gene polymorphisms.

CONCLUSIONS

The authors' results support the importance of MMPs and their tissue inhibitors in meningioma pathogenesis. In future studies, these gene polymorphisms, especially MMP2 1306C>T and 1575G>A, should be investigated for meningioma or brain invasion susceptibility in larger study groups.

Does Aquaporin-1 expression have clinical significance in serous epithelial ovarian cancer?

OBJECTIVE

To assess the relationship between Aquaporin-1 (AQP1) expression and clinicopathological variables in serous epithelial ovarian cancer (EOC).

MATERIAL AND METHODS

Serous EOC cases treated in our institution between January 2007 and December 2009 were included in the study. A semi-quantitative immunohistochemical method was used to determine AQP1 expression levels, intratumoral microvessel density (IMD) and AQP1/IMD ratios. The relationship between these parameters and clinicopathological variables were assessed. P values less than 0.05 was considered statistically significant.

RESULTS

A total of 55 cases of serous EOC were included in the study. AQP1 was strongly expressed in the membranes of microvessels and small vessels within all tumor tissues. In a few cases, AQP1 expression was also observed in the membrane of interstitial cells and in individual tumor cells. A positive correlation was detected between preoperative CA125 levels and the expression of AQP1 (R: 0.277, p<0.05). AQP1 expression was similar between FIGO stage I-II and FIGO stage III-IV cases (p > 0.05). A significant relationship did not exist between AQP1 expression and FIGO stage, lymph node metastasis or ascites volume (p>0.05).

CONCLUSION

In this study, AQP1 expression did not have a significant association with important clinicopathological variables in serous EOC. Future studies are needed to determine AQP1 expression in other histological types of EOC.

Effect of melatonin on cerebral vasospasm following experimental subarachnoid hemorrhage

OBJECT

The current study was undertaken to determine whether melatonin therapy reverses vasospasm and prevents apoptosis by inhibiting lipid peroxidation in an experimental subarachnoid hemorrhage (SAH) model.

MATERIALS AND METHODS

The rabbits were divided into four groups as follows: Group 1, SAH + melatonin (5 mg/kg/i.p. BID) simultaneously with SAH (n = 6); Group 2, SAH + melatonin (5 mg/kg/i.p. BID) treated 2 hours after SAH (n = 6); Group 3, control group (n = 4); Group 4, SAH only (n = 6). Light microscopic examinations of the basilar arteries were performed to demonstrate the pathophysiological changes of the arterial wall with hematoxylin- eosin. Apoptosis: Immunohistology using the ApopTag Peroxidase In Situ Apoptosis Detection Kit was used to demonstrate apoptosis in a cross section of basilary arteries. Apoptotic index was calculated as the number of the immunoreactive nuclei per total number of endothelial cells, and expressed as a percentage.

RESULTS

The results of measurements of diameters of the vessels between groups were significantly different (p = 0.028). While basilar arteries of the SAH only group showed 57% constriction, Groups 1 and 2 were calculated as 33 and 26% constriction, respectively, compared with the control group (p < 0.05). And also Groups 1 and 2 showed significant protection of apoptosis compared with Group 4. The difference between the four groups was tested by Kruskal-Wallis test and the significance between the two groups was tested by Mann- Whitney U-test.

CONCLUSION

Melatonin with its strong antioxidant effect can prevent SAH-induced vasospasm and apoptosis of endothelial cells of vessels.

Tenosynovial giant cell tumor in the cervico-thoracic junction

Tenosynovial giant cell tumor (TGT) rarely arises from the posterior coloumn of the cervical spine. Most lesions of TGT involve the tendon sheath and joint lining of the small joints of the fingers and hands, and consecutively the knee, ankles and feet, and hips. Rate of extra-articular presentation is about 5-15% in all cases. In this report, a case with paraparesis caused by TGT in the cervico-thoracic junction is presented. The clinical manifestations, diagnosis, and treatment of this unusual condition are discussed. In the treatment of TGT of the vertebral column, the main aim should be total surgical excision of the tumor.

Impact of treatment strategies on local control and survival in uterine carcinosarcomas

e16526

Background: Carcinosarcoma is a biphasic neoplasm composed of a mixture of malignant epithelial and mesenchymal components. Uterine carcinosarcomas comprise only 3% of all uterine malignancies, however they account for a disproportionally higher rate of mortality from uterine cancer because of their agressive nature. No standardized treatment has yet been established. The purpose of this study was to determine the clinical characteristics, patterns of recurrence and survival outcomes in patients with uterine carcinosarcoma treated in our institution. Methods: Records of the patients with uterine carcinosarcoma were retrospectively evaluated and 29 pts with carcinosarcoma diagnosed between 2007 and 2012 were identified. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy , bilateral pelvic and paraaortic lymph node dissection and omentectomy. Demographic features, tumor characteristics, treatment regimens and patient outcomes in terms of relapse-free survival (RFS) and overall survival (OS) were analyzed. Results: Median age was 63 (range 43-78). 13 patients (45%) had stage I disease, 5 patients (17%) had stage III and 11 patients (38%) had stage IV disease at diagnosis. Median tumor size was 6 cm (range 1.7-20 cm) and lymphovascular invasion was present in 17 patients 59%). Twenty patients (69%) received chemotherapy (90% with paclitaxel and carboplatin) for 6 cycles. One patient received radiotherapy. Median follow up was 13 mos. Seventeen patients (59%) relapsed and 20 patients (69%) died on follow up. Two patients had vaginal cuff recurrence, 4 had pelvic, 4 had abdominal and 7 had distant recurrences. All recurrences were fatal. 3 year RFS was 31%. 3 year OS was 15%. Conclusions: Our data show that uterine carcinosarcomas tend to be more at more advanced stage at diagnosis and despite the use of chemotherapy and radiotherapy, overall prognosis is poor. Surgery remains the mainstay of treatment. More effective adjuvant strategies are needed to reduce relapse and death rates because recurrences are generally fatal.

Outcomes of patients with endometrial cancer and aggressive histology

e16536

Background: To present patterns of practice and outcomes of patients with early stage poor histology endometrial cancer. Methods: Records of the patients with FIGO stage I-II serous papillary, clear cell, mixed or undifferentiated endometrial cancer were retrospectively evaluated. All patients were initially treated surgically by the same surgeon with comprehensive staging lymphadenectomy, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Adjuvant chemotherapy was offered to all patients and given unless the patient refused. Results: 38 patients with early stage poor histology were identified Median age was 61 and 86.8 % of the patients were post menopausal. Median BMI was 31.2 kg/m2. 28 patients (73.7%) received chemotherapy (90% with paclitaxel and carboplatin for 6 cycles). 5 patients (13.2 %) received external radiotherapy 3 patients (7.9%) received brachytherapy. Median follow up was 19 mos. Totally 3 patients (7.9%) had relapse on follow up; Among those who received adjuvant chemotherapy, only one patient had recurrence on vaginal cuff and was treated with radiotherapy and currently disease free for 4 years. Among those who did not receive adjuvant chemotherapy, 2 patients had widespread abdominal and distal recurrence and died on follow up. 2 patients died without recurrence. Conclusions: Complete surgical staging and adjuvant chemotherapy results in excellent prognosis in our patient series. [Table: see text]

Impact of comorbidities on recurrence rates and survival in patients with endometrial cancer

e16528

Background: The aim was to determine the clinical characteristics, comorbidities, tumor features, and survival outcomes in patients with uterine carcinoma treated in our institution. Methods: Charecteristics of 410 patients underwent initial abdominal surgery for primary endometrial cancer in our institution between 2006 and 2012 were reviewed. Demographic features, histologic types, stage, type of surgery, comorbidities, treatment modalities and patient outcomes in terms of relapse-free survival (RFS) and overall survival (OS) were assessed. Results: Patient characteristics are shown in the Table. Nearly all patients (97%) were initially treated surgically with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Median follow up was 26 mos. 3 year RFS was 90%. 3 year RFS was 97% at stage 1, 80% at stage 2, 62% at stage 3 and 4. 3 year OS was 91%. 3 year OS was 96% at stage 1, 85% at stage 2, 64% at stage 3-4. The only significant independent predictor of RFS was disease stage (HR 5.7, 95% CI 2.1-15.3, p<0.0001) while histologic grade also bordered significance (HR 2.3, 95% CI ,8-6.4, p=0.085). Independent predictors of OS was age (HR 4.5, 95% CI 1.5-13.7, p<0.007), presence of diabetes mellitus (HR 4.5, 95% CI %1.1-6.7, p=0.019) and stage (HR 5.2, 95% CI 2.2-12.6, p<0.0001). Conclusions: Our data shows that older age (>60 years) and advanced stage patients with endometrial cancer have significantly decreased overall survival. Presence of diabetes mellitus is not associated with recurrence rates but is associated with worse overall survival. Stage and grade are considered independent risk factors for recurrence [Table: see text]

Peritoneal washing cytology in an adult granulosa cell tumor: A case report and review of literature

Adult-type granulosa cell tumors (AGCT) account for 1-2% of all ovarian tumors and 95% of granulosa cell tumors. In AGCT, at the time of peritoneal washing, tumor cells are rarely seen to exfoliate and FIGO stage is raised from IA/IB or IIA/IIB to stage IC or IIC despite the absence of a gross intraepithelial tumor. Patients with positive peritoneal washing cytology must be followed up for pelvic recurrence and metastasis. A more sensitive cytologic evaluation, histopathologic correlation and immunohistochemical staining can advance our practice. Here, we describe a case of AGCT with the emphasis on cytologic features observed in specimens obtained from peritoneal washing fluid.

Ovarian serous borderline tumor detected by conventional papanicolaou smear: a case report

BACKGROUND

Although the Papanicolaou (Pap) smear was originally designed to detect premalignant cervical lesions and cancer, it has become apparent that malignant cells from extrauterine primaries may also appear in the smears. Here, we report a case of a serous borderline tumor (SBT) of the ovary that was detected by a conventional Pap smear.

CASE REPORT

In a 34-year-old woman, who was operated on for a left borderline ovarian tumor 2 years ago, glandular dysplasia was discovered in a Pap smear screening. The Pap smear showed a large number of atypical glandular cells forming 3-dimensional papillary clusters. The cell clusters were enlarged and had variably sized round or oval nuclei. The background was clean, and this finding pointed to the noncervical origin of the malignant cells. A right ovarian cystic mass was discovered and a laparotomy performed. A histologic examination of the ovarian mass revealed a SBT of the ovary.

CONCLUSION

This case illustrates the value of the Pap smear in discovering unsuspected extrauterine malignancies, including SBTs of the ovary.

Retrospective analysis of stage IC uterine cancer patients: A single center experience

e15573

Background: Stage IC patients are at an increased risk of recurrence and overall worse prognosis compared with stage IA and IB patients. Adjuvant chemoherapy is utilized based on specific pathologic factors. The objective of this study is to evaluate treatment outcomes at a single institution in patients with 1988 FIGO stage IC endometrial adenocarcinoma. Methods: Records of the patients with FIGO stage IB (formerly IC) endometrial cancer were retrospectively evaluated. All patients were initially treated surgically with comprehensive staging lymphadenectomy. Results: A total of 85 patients were included. Patient and tumor characteristics are shown in the table. Median age of the patients was 60 (range 27-95). Fifty-nine patients had at least one co-morbid disease. Complete surgical staging including pelvic and paraaortic lymph node dissection was performed in all the patients. Sixteen patients (19%) received adjuvant chemotherapy, including 6 patients with serous cancer and one patient with small cell cancer. Paclitaxel/carboplatin was the preferred regimen in Median follow up was 30 months (range 10-61 months). Seven patients (8%) relapsed and 4 patients (5%) died on follow up. 5 year disease free survival was 89% and overall survival was 95%. One of the 16 patients (6.2%) who received chemotherapy and 6 of the 69 patients (8.7%) who did not receive relapsed/died on follow up. Survival analysis was not performed because of the low number of events in both groups. Conclusions: We found similar rates of recurrence and death with previous studies in stage IC endometrial cancer. Complete surgical staging is the mainstay of treatment. Marginally lower recurrence rate in chemotherapy treated patients delineate the need for prospective randomized data addressing the role of adjuvant systemic therapy in early-stage patients with endometrial adenocarcinoma. [Table: see text]

Retrospective analysis of stage IIIc uterine carcinoma patients: A single center experience

e15572

Background: Stage IIIC comprises 8% of all endometrial cancers. Both local and systemic relapse risks are high. Current standard of care is adjuvant chemotherapy; however the addition of radiotherapy seems to improve outcomes in retrospective series but prospective data is lacking. We herein report outcomes of our patients with stage IIIC endometrial cancer operated and treated with adjuvant chemotherapy±radiotherapy. Methods: 29 patients with stage IIIC endometrial cancer diagnosed between 2006-2011 were included. Demographic features, tumor characteristics, treatment regimens and patient outcomes in terms of DFS and OS were analyzed. Results: Median age was 64 (41-82). Surgical procedure was TAH+BSO+BPPLND and omentectomy in 26 patients. 4 patients who were operated (TAH+BSO) in another center were restaged and BPPLND and omentectomy were performed. 13 patients (45%) had endometrioid histology, 11 (38%) had papillary serous carcinoma, 2 (7%) had clear cell carcinoma, 2 (7%) had mixed carcinoma and 1 (3%) had undifferentiated carcinoma. 6 patients had ovarian, 9 had uterine serosal involvement, 1 had positive cytology of abdominal washing, 18 (62%) had lymph node-only disease. 14 patients (48%) had positive nodes both in pelvic and paraaortic region, 9 (31%) only in pelvic region and 6 (21%) only in paraaortic region. 24 patients (83%) received chemotherapy with paclitaxel and carboplatin, 13 (45%) received external RT, 4 (14%) received brachytherapy and 3 (10%) patients received chemoradiation with weekly cisplatin or carboplatin. Median follow-up was 19 months. 10 patients recurred during follow-up and 6 patients died. All of the recurrences except one were intraabdominal. 3-year PFS was 64% and OS was 71.6%. Conclusions: With the use contemporary chemotherapy regimens and radiotherapy, we achieved ~70% 3-year survival rate in stage IIIC endometrial carcinoma patients with 45% of the patients having high risk histologies (serous and clear cell). We propose that combined adjuvant chemotherapy and radiation might improve survival in patients with advanced stage disease compared to either modality alone. Results of GOG258 and PORTEC 3 trials should be awaited for definitive conclusions.

A moderate response to plasmapheresis in nephrogenic systemic fibrosis

Nephrogenic systemic fibrosis (NSF) is a recently identified idiopathic cutaneous fibrosing disorder that occurs in the setting of renal failure. The disease initially called nephrogenic fibrosing dermopathy is closely linked to exposure to gadolinium-based contrast media used during magnetic resonance imaging in patients with renal insufficiency. Although little is known about the pathogenesis of this disease, the increased expression of transforming growth factor-beta has been demonstrated recently. Herein, we present a case of NSF was partially treated due to a moderate and temporary response to plasmapheresis with no recurrence for 6 months, but returned at the end of 6^th month.

Antithrombin III and enoxaparin treatment inhibit contusion-triggered cell death, inflammation, hemorrhage and apoptosis after severe traumatic brain injury in rats

AIM

In this study, we aimed to show the neuroprotective effects of AT III and Enoxaparin after severe traumatic brain injury.

MATERIAL AND METHODS

The animals were divided into four groups as Group 1; control group, Group 2; trauma group, Group 3; AT III group and Group 4; Enoxaparin group. Severe trauma was performed by the weight dropping technique. These animals were killed 48 hours after injury. Histopathological and immunohistochemical analysis were performed. Specimens were graded for cell death, inflammation, hemorrhage and apoptosis.

RESULTS

The control group showed normal ultrastructure of brain tissue. Trauma produced obvious damage. 8 rats (80%) in the trauma group demonstrated minimal inflammation and grade 5 cell death. Trauma increased hemorrhage and apoptosis scores to statistically significant levels (p < 0.001). Enoxaparin was found to reduce neuronal cell death but not as effectively as AT III. A statistically significant difference was observed between the AT III and Enoxaparin group according to inflammation grades. Significant antiapoptotic properties of AT III were observed while hemorrhage was more common in the Enoxaparin group.

CONCLUSION

Anticoagulants such as AT III and enoxaparin are promising drugs in the treatment of traumatic brain injuries.

Extraabdominal desmoid tumor appearing following resection of thoracolumbar schwannoma

The authors report the case of an adult female patient who developed a thoracic paraspinous desmoid tumor (aggressive fibromatosis) located just cranially to the incision scar of the previous surgery for resection of a spinal schwannoma. To the best of the authors' knowledge, this is the first report of an extraabdominal desmoid tumor occurring after resection of a spinal schwannoma. Desmoid tumors develop from muscle connective tissue, fasciae and aponeuroses. They are known to occur in association with surgical scars or implants. Incidence of this tumor is low. The etiology is still uncertain. Although rare, this distinctive tumor should be kept in mind in the differential diagnosis of palpable masses and especially those occurring around the previous skin incisions.

The effect of repetitious concussions on cognitive functions in rats

AIM

In this study, we aimed to investigate the effect of repetitious concussions on the spatial learning and memory function in rats.

MATERIAL AND METHODS

46 adult, male Sprague-Dawley rats were assigned to three homogenous groups by stratified random sampling according to their basal performance during the first four days of the Morris water maze (MWM), as Control (n=10), Sham (n=10) and Concussion (n=26) groups. On the 12th day, the MWM experiment was repeated to evaluate the memory function. Rats in the concussion group were then subjected to the first head trauma. Some of the trauma-applied rats were sacrificed for histopathological examination 4 hours (n=4) and 24 hours (n=3) after the trauma. The spatial memory function of the rest of the rats was re-evaluated by MWM on the 20th day. Some of the rats were then subjected to the second head trauma (n=13), four of which were then sacrificed at the 4th hour, and three of which were sacrificed at the 24th hour. On the 27th day, six rats that had received single concussion and the remaining six that had received two concussions were re-evaluated for retention development by the third MWM experiment.

RESULTS

Escape latency curves showed a decrease in Sham and Control groups on the 20th and 27th days, and an increase in concussion group on the 20th day but no statistical significance was found between the groups.

CONCLUSION

Repetitious concussions did not significantly affect spatial learning-memory functions in rats, and may lead to a counter-adaptive mechanism against concussive injury.

Clinical significance of TRAIL and TRAIL receptors in patients with head and neck cancer

BACKGROUND

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) is a death ligand currently under clinical trials for cancer. The molecular profile of TRAIL and TRAIL receptors has not yet been mapped for patients with laryngeal squamous cell carcinoma (SCC) or patients with oral cavity squamous cell carcinoma (OCSCC).

METHODS

Paraffin-embedded tissues from 60 patients with laryngeal SCC and 14 patients with OCSCC were retrospectively analyzed using immunohistochemistry.

RESULTS

An increase in decoy-R1 (DcR1) but a decrease in decoy-R2 (DcR2) expression were observed in patients with laryngeal SCC and in patients with OCSCC compared with control individuals with benign lesions. Clinical and pathologic grading revealed distinctive TRAIL and TRAIL receptor profiles in patients with squamous cell carcinoma of the head and neck (SCCHN).

CONCLUSIONS

TRAIL and a TRAIL receptor expression profile might be useful to follow-up disease progression by virtue of its connection with clinical staging and pathologic grading in patients with laryngeal SCC.

Fetal allogeneic umbilical cord cell transplantation improves motor function in spinal cord-injured rats

AIM

The objective of this study was to investigate whether the transplantation of fetal umbilical cord tissue cells as a source of stem cells into the acutely injured spinal cord would produce some regenerations and/or functional recovery in a rat model of spinal cord injury.

MATERIAL AND METHODS

Five pregnant albino Wistar rats of 12 days gestation were used for obtaining an umbilical cord cell graft. At the second stage of the experiment only Th8-Th9 laminectomy was performed in Group A animals while Group B animals underwent spinal cord hemitransection. The cultured fetal umbilical cord cells coated with Alginate Gel were placed into the lesion cavity immediately after surgery in Group C animals. Group D animals received only Alginate gel sponges into the injured area. All experiment groups were analyzed histologically and immunohistochemically (GFAP, Ki-67, and Pan cadherin) and for motor function after surgery.

RESULTS

The umbilical cord cell transplanted animals showed a significant motor recovery compared to non-transplanted animals at 8 and 21 days after spinal cord injury (p=0.008). Significant GFAP and Ki-67 expressions were noted in transplanted animals (p=0.048) suggesting astroglial proliferation.

CONCLUSION

Our findings support the possibility of some functional recovery after umbilical cord cell transplantation following spinal cord injury.

Immunohistochemical FHIT expression still exists in early lesions of basal cell carcinoma

In this study, we evaluated the expression of Fragile Histidine Triad (FHIT) in basal cell carcinoma (BCC). The FHIT locus was found to be altered in numerous types of cancer [6,7,18,20,22,25,26]. However, we found only one study dealing with FHIT expression in BCC [11]. In our study, we used immunohistochemical methods for the evaluation of FHIT expression in tissue samples of 42 BCC cases. The control group was formed by intradermal melanocytic nevi (IMN). Ki-67 labeling index was used to compare cellular proliferation of BCC with internal and external controls. The study group was further separated into two subgroups, according to the intensity of FHIT staining. The Ki-67 indexes of these subgroups were also compared with each other. As a primary result, there was no significant decrease in FHIT expression in early lesions of BCC. As a second finding, there was no correlation between the intensity of FHIT staining and Ki-67 labeling index. As a third finding, there was no difference in Ki-67 labeling index between early lesions of BCC and non-neoplastic epidermis. The results were unexpected, since FHIT expression has been reported to be lost in an above mentioned study [11]. We concluded that FHIT expression remains to be positive, at least in early lesions of BCC.

The diet of Clinitrachus argentatus (Blennioidei: Clinidae) in the northern Aegean and Marmara Seas

Differences in the diet composition of small (28-42 mm total length, L(T)) and large (43-75 mm L(T)) individuals of the cline Clinitrachus argentatus (Clinidae) were evident. Smaller individuals preyed mainly on copepods, whereas larger individuals ate mainly amphipods, isopods, brachyurans and polychaetes.

Evaluation of auditory brainstem potentials in children with acute Herpes simplex encephalitis

OBJECTIVE

In this study, auditory brainstem potentials (ABPs) were studied in children with Herpes simplex encephalitis (HSE) to determine the ABP abnormalities in HSE during childhood. We also wished to determine whether or not to use ABP in early diagnosis of HSE.

METHOD

The study includes 28 children; eight children with acute HSE, nine with nonspecific encephalitis, and 11 healthy age-matched control subjects. The diagnosis of HSE was confirmed by the demonstration of Herpes simplex virus type 1 in CSF by polymerase chain reaction. Recordings of ABPs were performed by using Nihon Kohden Neuropack 2 device.

RESULTS

The study includes eight children (four females and four males) with acute HSE, nine children (five males and four females) with nonspecific encephalitis, and 11 healthy age-matched control subjects (six males and five females). Age ranges of the patients and controls were between six months and 12 years. There was not statistically significant difference between the groups for age and gender (p > .05). There were significant differences in the mean latencies of the wave IV on the right ear and in the mean interpeak latencies (IPLs) of the waves III-V on the right and left ears between the nonspecific encephalitis group and the control group (p < .05). However, there were no statistically significant differences between the HSV and control groups (p > .05). In addition, there was no significant difference between HSV and nonspecific groups (p > .05).

CONCLUSIONS

Our findings revealed that there were mild ABP abnormalities in children with nonspecific encephalitis, but no ABP abnormality in patients with HSV encephalitis. However, we think that more extensive and detailed studies should be performed to determine whether or not there were ABP abnormalities in childhood HSV encephalitis.

Glioblastoma multiforme mimicking arteriovenous malformation

Glioblastoma multiforme is the most common intracranial neoplasm of all primary central nervous system tumors. Glial tumors can present in different forms. Intracranial hemorrhage may occur in all central nervous system tumors to a varying degree and extent and may even be massive. A 58-year-old man presented with intraparenchymal hemorrhage manifesting as severe headache and vomiting. Cranial computed tomographic scans revealed a right posterior temporoparietal intraparenchymal hemorrhage. Cerebral angiography revealed a 3 x 2 cm right inferior parietal arteriovenous malformation. The patient underwent surgical treatment with a diagnosis of arteriovenous malformation. Postoperatively, the histological diagnosis was glioblastoma. Glioblastoma may mimic an arteriovenous malformation. Close follow-up of such patients is essential.

INHIBIN B LEVELS IN PERIPHERAL VEIN DO NOT CORRELATE WITH INHIBIN B LEVELS IN THE SPERMATIC VEIN IN ADOLESCENTS WITH VARICOCELE

This study was conducted to evaluate the inhibin B with FSH and LH levels on spermatogenesis in varicocele patients. The study group consisted of 10 adolescent with left idiopathic varicocele of grade II and III. Blood specimens were obtained from dilated spermatic vein and peripheral vein simultaneously. Peripheral samples were also collected from 7 healthy children as controls. Inhibin B was measured with ELISA inhibin B kits. FSH and LH were analyzed by radioimmunoassay techniques. The results were analyzed using Mann-Whitney U and Spearman's rank tests. A value of p < 0.05 was considered significant. Peripheral FSH, LH and inhibin B levels were the same in the study and control group (p > 0.05). Mean inbibin B levels of spermatic vein were significantly higher than the control and peripheral blood of the study groups (p < 0.05). FSH, LH, and inhibin B levels correlated poorly each other (p > 0.05). Preoperative serum inhibin B concentration could not reliably predict a response to varicocelectomy, but the increase in inhibin B levels after treatment might suggest an improvement in testicular function.

Her-2/neu gene amplification in paraffin-embedded tissue sections of meningioma patients

AIM

Meningiomas arise from the meningoendothelial cells and are one of the most common tumors of the central nervous system. The HER-2/neu gene is located on the 17q11.2-q12 chromosome region and encodes an epidermal growth factor receptor. HER- 2/neu gene amplification and/or over expression have been studied most widely in breast carcinomas. Previous studies have shown the importance of HER-2/neu gene amplification on the prognosis of meningioma cases. In this study, we aimed to detect HER-2/neu gene copy number in archive materials of 55 meningioma patients by fluorescent in situ hybridization (FISH).

MATERIAL AND METHODS

The patients included in the study had undergone surgery in the neurosurgery department of our hospital between 1999 and 2002. Tissue samples were classified histologically according to WHO 2007 guidelines. Interphase FISH was performed on 3 to 4microm thick paraffin embedded tissue sections for the detection of HER- 2/neu gene amplification status.

RESULTS

We found HER-2/neu gene amplification in 7 (12.73%) patients. Another 2 patients had only one signal for the HER-2/neu region. We confirmed this finding by a second hybridization with the chromosome 17p13.1 (p53) probe.

CONCLUSION

According to our results, HER-2/neu amplification could be regarded as an additional genetic factor playing role in meningioma pathogenesis together with known chromosomal abnormalities.

Extraventricular neurocytoma--report of a case

Neurocytomas are typically located within the supratentorial ventricular system. Extraventricular neurocytoma is a rare brain tumour that poses diagnostic difficulty. We report a case of cerebral extraventricular neurocytoma. A 44-year-old man presented with a 6-month history of tonic-clonic seizures. Magnetic resonance imaging demonstrated a left frontoparietal mass lesion. The patient underwent surgical therapy, and a radical excision was performed. The histological appearance and immuno-histochemical findings of the tumour are consistent with an extraventricular neurocytoma with anaplastic features. An excellent prognosis can be expected if a gross total resection is achieved. Postoperatively, radiotherapy and chemotherapy may be used as adjuvant therapies.

Pap smear findings in chronic renal failure patients compared with the normal population according to Bethesda 2001

Dialysis remains the most common treatment for end-stage renal disease (ESRD). Although the increased risk of cancer after renal transplant is well documented, there is less certainty about the risk of cancer in patients treated only with dialysis. From 1997 to 2002, 262 ESRD patients received a Pap test at Başkent University. The smears of 149 patients who had ESRD for more than 9 months were compared with the smears of 150 otherwise healthy patients. All of the Pap smears were re-examined according to Bethesda 2001 criteria. The mean age of the patients was 42.88 years. Regarding micro-organisms, no statistically significant difference between the groups were observed. In 36 Pap smears, a shift in flora suggestive of bacterial vaginosis was detected. There were statistically significant differences between the groups. When age was considered as a marker of atrophy, atrophy in patients younger than 50 years was statistically different between the groups. Also, we determined that the shift in flora suggestive of bacterial vaginosis and atrophy in patients aged younger than 50 years did not depend on the length of hemodialysis. Of 13 patients (4.3%) who had epithelial cell abnormalities there were not statistically significant differences between the groups. In conclusion, according to our study, CRF seems not to be a predictive factor for cervical cancer. Shift in flora suggestive of bacterial vaginosis and atrophy in patients aged younger than 50 years might be the natural effects of uremia, and they appear not to be dependent on the length of the hemodialysis period.

Nogo-A inhibitory peptide (NEP1-40) increases pan-cadherin expression following mild cortical contusion injury in rats

BACKGROUND

Nogo-A is a myelin-associated neurite outgrowth inhibitory protein that limits elongation of central nerve fibers, neuronal regeneration and plasticity. We investigated the effect of delivering an inhibitory peptide that neutralizes Nogo-A on neuronal recovery following mild cortical contusion injury.

METHODS

41 rats were allocated into the control and NEP1-40 treatment groups. PBS was applied following trauma over the parietal cortex after opening the dura in the control group. NEP1-40 solution was immediately applied following trauma after opening the dura in the treatment group. Each group was further divided into 3 subgroups and sacrificed on the third, eighth, and 21st days after injury. The brains were removed for analysis.

RESULTS

Immunohistochemical staining of the injured cortex for pan-cadherin revealed a significant increase in staining in the NEP 1-40 treatment group at the 8th and 21st days after injury. Electron microscopic evaluation revealed better cytoarchitectural preservation in the axons of the animals treated with NEP 1-40.

CONCLUSION

We observed improved preservation of injured neurons after topical application of NEP 1-40 following mild cortical injury. Pan-cadherin expression may correlate with the recovery of neurons and axonal bodies. Electron microscopical findings confirmed better preservation of neuronal structures after NEP1-40 treatment. Pan-cadherin is a good marker for neuronal recovery after cortical injury.

Diagnostic pitfalls in the evaluation of fine needle aspiration cytology of the thyroid: correlation with histopathology in 260 cases

OBJECTIVES

Fine needle aspiration cytology (FNAC) of the thyroid is a non-invasive, cost-effective screening procedure that is valuable for distinguishing neoplastic lesions from non-neoplastic nodules. The aim of this study was to determine the diagnostic accuracy of FNACs performed at our institution by correlating FNAC results with histopathological diagnoses.

METHODS

Two hundred and seventy-one aspiration cytology specimens followed by thyroidectomy were included in the study, and the results of 260 adequate FNACs were compared with their histological diagnoses.

RESULTS

The sensitivity and specificity of thyroid FNAC for detecting neoplasia were 92.6% and 91.6%, respectively. There were 15 (5.7%) false positives and six (2.3%) false negatives.

CONCLUSIONS

The results showed that follicular cells that exhibit some of the features of papillary carcinoma could be observed in a cytology slide of Hashimoto's thyroiditis, leading to a diagnostic pitfall. In addition, cellularity and overlapping cytological criteria in hyperplasia might lead to a false diagnosis.

Tentorium schwannoma mimicking meningioma: an unusual location

A 60-year-old female was admitted to our clinic complaining of a long-lasting headache. Cranial magnetic resonance imagining examination of the patient revealed a 22x24 mm extra-axial, well-demarcated, mass lesion based on the left tentorium. The patient underwent a craniotomy and the tumor was totally excised with the adjacent tentorium. The histopathological examination of the tumor complied with the diagnosis of schwannoma. The rest of the clinical course was uneventful and the patient was released from the hospital without any neurological deficit. Intracranial schwannomas can rarely originate from atypical dural locations and radiological techniques are not always helpful in distinguishing tentorial schwannoma from tentorial meningioma. We presented a patient with a tentorium schwannoma mimicking meningioma and discussed the current literature.

Intraventricular dysembryoplastic neuroepithelial tumor: case report

OBJECTIVE

The most common localization of dysembryoplastic neuroepithelial tumors (DNTs) is the supratentorial cortex, often in the temporal lobe. However, intraventricular localization of a DNT is extremely rare.

CLINICAL PRESENTATION

A 30-year-old woman presented with a 1-year history of epileptic seizures. The seizures had not been controlled despite standard doses of antiepileptics.

INTERVENTION

Neuroimaging results demonstrated a lesion located in the occipital horn of the right lateral ventricle. The lesion was totally removed. Based on histopathological and immunohistochemical evaluation, a DNT was diagnosed. Over the course of the next 8 months, the patient's epileptic seizures were under control. The most recent neuroimaging examinations revealed neither residual nor recurrent tumor.

CONCLUSION

Because DNTs are surgically curable and neither radiotherapy nor chemotherapy is required after surgery, recognition of an intraventricular DNT in this location is extremely important.

The accuracy and diagnostic yield of computerized tomography guided stereotactic biopsy in brain lesions

OBJECTIVES

Radiological imaging techniques provide early detection of neurological diseases but they do not always provide an adequate and reliable diagnosis. With the help of stereotactic biopsy techniques, it is possible to access brain lesions safely and with high precision. We described the surgical method used in our clinic and discussed our results with the help of the current literature.

METHODS

Ninety-four patients underwent computerized tomography-guided stereotactic brain biopsy in our clinic. Anatomical locations, diagnostic yield and accuracy of the procedure, morbidity and mortality rates were analyzed.

RESULTS

A total of 100 stereotactic surgery procedures were performed on 94 patients. The localizations of the lesions were 13.83% frontal, 21.27% temporal, 27.66% parietal, 4.25% occipital, 4.25% multiple, 27.66% deep seated and 1.06% suprasellar. The histopathological diagnoses were 61.71% neuro-epithelial tumors, 8.51% metastases and 10.64% infectious lesions. Diagnostic yield was 86.16% and the accuracy was 90% in our series.

CONCLUSION

Computerized tomography-guided stereotactic brain biopsy is a reliable and safe method. Main diagnostic problems in SBB are tissue heterogeneity, insufficient material and sampling error. These problems can be minimized by careful correlation of clinical, radiological and histopathological findings by an experienced team and by using modern technologies.

Antibodies neutralizing Nogo-A increase pan-cadherin expression and motor recovery following spinal cord injury in rats

STUDY DESIGN

A rat model of spinal cord injury was used to test the hypothesis that Nogo-A monoclonal antibody (NEP1-40) promotes morphologic and functional recoveries of injured spinal cord.

OBJECTIVE

Nogo-A is a myelin-associated neurite outgrowth inhibitory protein, which blocks elongation nerve fibers and limits neuronal regeneration after central nervous system injury.

METHODS

Forty-four rats were utilized and allocated into control (vehicle) and NEP1-40-treated groups. In all animals, the spinal cord was hemi-transected at Th-10 and phosphate-buffered saline solution was immediately applied on the injured area in the control group. NEP1-40 solution was immediately applied on the hemi-transected area in the treatment group. Each group was subdivided into three subgroups according to the postsurgical day of killing (3, 8 and 21 days). The spinal cords were removed for analysis.

RESULTS

Motor scores in the NEP1-40-treated groups were significantly higher than those in the vehicle groups both at 8 and 21 days post injury. Immunohistochemical staining for pan-cadherin, a marker of neuronal cell adhesion and axonal sprouting, revealed a significant increase in staining in the NEP1-40 treatment group at 8 and 21 days post injury. Transmission electron microscopical evaluation revealed degeneration of the myelin and loss of cytoarchitectural organization in the axons of controls. Better preservation and normal histologic features were observed in the NEP1-40-treated groups.

CONCLUSION

We have demonstrated improved preservation of injured axons and significant pan-cadherin expression after NEP1-40 treatment after the spinal cord injury. Inhibition of Nogo-A may improve the capacity for neuronal regeneration after spinal cord injury.

Expression of p53 in lesions and unaffected skin of patients with plaque-type and guttate psoriasis: A quantitative comparative study

Psoriasis is a common inflammatory and hyperproliferative skin disease characterized by hyperproliferation of keratinocytes. The pathogenesis of psoriasis has yet to be determined. The control of cell growth is a delicately balanced process, regulated by external signals or the internal genetic program of an individual cell. In psoriasis, these processes are disturbed and some candidate genes like p53 are suspected of being involved in the pathogenesis of the disease. The p53 protein is essential for the regulation of cell proliferation. The study was performed on 32 patients with psoriasis (24 plaque type, eight guttate type). Biopsy specimens for immunohistochemical determination of p53 protein expression were collected from both the lesional and the nonlesional skin sites that were not exposed to sun in all of the patients (n = 32). Taking the ultraviolet (UV) exposure of the skin into consideration, a third skin sample was taken from each patient (n = 7) who had lesions on the sun-exposed areas. Immunohistochemical assessment of p53 expression in skin was determined as p53 protein expression per 1000 cells (keratinocytes). The statistical analysis revealed that the expressions of p53 per 1000 cells were higher in non-sun-exposed lesional skin than the non-sun-exposed nonlesional skin, also in plaque-type psoriasis than guttate-type psoriasis (P = 0.000, P = 0.046, P = 0.037, respectively). There was a positive correlation between the p53 expression in non-sun-exposed lesional skin versus expression in sun-exposed lesional skin (cubic centimeters = 0.811, P = 0.027). Our results show a stronger association of elevated p53 expression with chronic rather than acute inflammatory psoriasis. This may indicate a mechanistic difference between plaque-type and guttate psoriasis. Alternatively, this could reflect a chronological course as the disease transitions from an acute to a chronic phase.

Spinal drop metastasis of choroid plexus papilloma

A rare case of choroid plexus papilloma (CPP) with spinal drop metastasis is presented. A 51-year-old woman was operated on for a tumor of the fourth ventricle with histopathological diagnosis of CPP. Seven years later, she was re-admitted with low back pain. MRI showed multilobulated tumor at the lumbosacral subarachnoidal space with histopathological diagnosis of CPP. Thus, CPP can spread via the cerebrospinal fluid pathways and cause drop metastasis.

Impact of aromatase inhibitors on adhesion formation in a rat model

OBJECTIVE

To investigate the antiadhesion potential of tamoxifen and anastrozole in a rat uterine horn model.

DESIGN

Experimental animal study.

SETTING

University animal laboratory.

ANIMAL(S)

Forty-five female Wistar albino rats.

INTERVENTION(S)

We examined the effects of tamoxifen and anastrozole to reduce the extent and severity of postoperative adhesions in a rat uterine horn model: the control group received no therapy while the second and third groups received 500 mug/day tamoxifen and 0.2 mg/kg/day anastrazole, respectively, through an enteric tube, starting 5 days before surgery. These protocols were continued for 14 days after the surgery until the rats were killed.

MAIN OUTCOME MEASURE(S)

Adhesions were scored according to their extent and severity, and specimens were also evaluated and scored histologically according to the following features: inflammation, fibroblastic activities, foreign body reaction, collagen formation, and vascular proliferation.

RESULT(S)

Anastrozole had the lowest mean adhesion scores, and these scores were significantly different from those of the controls. However, there were no statistically significant differences between control and tamoxifen groups and between tamoxifen and anastrozole groups. Histologic scores were lowest in the anastrozole group, which were statistically different from those of the tamoxifen and anastrozole groups, whereas scores of the control group were not statistically different from those of the tamoxifen group.

CONCLUSION(S)

Anastrazole decreased postsurgical adhesion scores by both visual scores and histologic analyses in a rat model. Further experimental and clinical trials are required to confirm these results.

Treatment of Morgagni hernias by transabdominal approach

BACKGROUND

Recently, the thoracic approach has been suggested in the surgical treatment of Morgagni hernias with some reported advantages over abdominal surgery. This manuscript reports the authors' experience with childhood Morgagni hernias repaired via laparotomy.

SUBJECTS AND METHODS

Records of five cases of Morgagni hernias were evaluated with respect to age, presentation, operative data, complications, and outcome.

RESULTS

The average age of four male and one female patients was 34 months (range 6 months to 8 years). Predominant presenting symptoms were related to the respiratory system. The diagnoses were made by posterior-anterior and lateral chest X-rays and confirmed by barium enema contrast radiographs. Associated anomalies were detected in three cases. All cases were managed by abdominal approach through upper midline incisions reducing the herniated viscera (transverse colon in all and including omentum in one patient) and excising the hernia sac which was present in all patients. The postoperative period was uneventful in this series and no recurrence was detected in an average of four years of follow-up.

CONCLUSION

The transabdominal approach is appropriate in the surgical correction of paediatric Morgagni hernias.

The effect of mexiletine on the level of lipid peroxidation and apoptosis of endothelium following experimental subarachnoid hemorrhage

OBJECTIVE

The role of apoptosis in etiopathogenesis of vasospasm is not clearly understood yet. It is widely accepted that protection of the endothelial cells from the process of apoptosis could have beneficial effects on cerebral vasospasm after subarachnoid hemorrhage (SAH). Mexiletine blocks sodium and calcium channels and activates ATP-sensitive K(+) channels. Moreover, mexiletine is known to have potent antioxidant effects through inhibiting free-radical production.

METHODS

Twenty-one rabbits were allocated into three groups randomly. Group I was sham operated group (n=7). SAH occurred but no medication was given to the Group II rabbits (SAH only group) (n=7). Mexiletine (50 mg/kg, b.i.d., i.p.) was administered just before SAH and continued until 48 hours following SAH to the Group III rabbits (Mexiletine treated group) (n=7). The ApopTag peroxidase in situ apoptosis detection kit (Serologicals Corporation, former Intergen) was used to demonstrate apoptosis in a cross section of basillary arteries. Thiobarbituric acid reactive material was used to determine the lipid peroxidation levels.

RESULTS

There was a statistically significant difference between lipid peroxidation product levels of the control and SAH only groups (p<0.05). The level of lipid peroxidation production in Mexiletine treated group was significantly lower compared with SAH only group (p<0.05) but not significantly higher than the control group (p>0.05).

DISCUSSION

In the present study we investigated the antioxidant action of mexiletine on apoptosis of endothelium following a rabbit SAH model. This experimental study directly suggested that lipid peroxidation is an important step in development of apoptosis in endothelial cells and prevention of structural integrity of endothelial cell should play a beneficial role in attenuation of cerebral vasospasm. Mexiletine treatment prevented the increase in lipid peroxidation and cerebral vasospasm. Examination of endothelial cells by staining specific for apoptosis demonstrated significant protection of cell integrity in the treated group.