Automated Urine Cell Image Classification Model Using Chaotic Mixer Deep Feature Extraction

Microscopic examination of urinary sediments is a common laboratory procedure. Automated image-based classification of urinary sediments can reduce analysis time and costs. Inspired by cryptographic mixing protocols and computer vision, we developed an image classification model that combines a novel Arnold Cat Map (ACM)- and fixed-size patch-based mixer algorithm with transfer learning for deep feature extraction. Our study dataset comprised 6,687 urinary sediment images belonging to seven classes: Cast, Crystal, Epithelia, Epithelial nuclei, Erythrocyte, Leukocyte, and Mycete. The developed model consists of four layers: (1) an ACM-based mixer to generate mixed images from resized 224 × 224 input images using fixed-size 16 × 16 patches; (2) DenseNet201 pre-trained on ImageNet1K to extract 1,920 features from each raw input image, and its six corresponding mixed images were concatenated to form a final feature vector of length 13,440; (3) iterative neighborhood component analysis to select the most discriminative feature vector of optimal length 342, determined using a k-nearest neighbor (kNN)-based loss function calculator; and (4) shallow kNN-based classification with ten-fold cross-validation. Our model achieved 98.52% overall accuracy for seven-class classification, outperforming published models for urinary cell and sediment analysis. We demonstrated the feasibility and accuracy of deep feature engineering using an ACM-based mixer algorithm for image preprocessing combined with pre-trained DenseNet201 for feature extraction. The classification model was both demonstrably accurate and computationally lightweight, making it ready for implementation in real-world image-based urine sediment analysis applications.

PatchResNet: Multiple Patch Division-Based Deep Feature Fusion Framework for Brain Tumor Classification Using MRI Images

Modern computer vision algorithms are based on convolutional neural networks (CNNs), and both end-to-end learning and transfer learning modes have been used with CNN for image classification. Thus, automated brain tumor classification models have been proposed by deploying CNNs to help medical professionals. Our primary objective is to increase the classification performance using CNN. Therefore, a patch-based deep feature engineering model has been proposed in this work. Nowadays, patch division techniques have been used to attain high classification performance, and variable-sized patches have achieved good results. In this work, we have used three types of patches of different sizes (32 × 32, 56 × 56, 112 × 112). Six feature vectors have been obtained using these patches and two layers of the pretrained ResNet50 (global average pooling and fully connected layers). In the feature selection phase, three selectors-neighborhood component analysis (NCA), Chi2, and ReliefF-have been used, and 18 final feature vectors have been obtained. By deploying k nearest neighbors (kNN), 18 results have been calculated. Iterative hard majority voting (IHMV) has been applied to compute the general classification accuracy of this framework. This model uses different patches, feature extractors (two layers of the ResNet50 have been utilized as feature extractors), and selectors, making this a framework that we have named PatchResNet. A public brain image dataset containing four classes (glioblastoma multiforme (GBM), meningioma, pituitary tumor, healthy) has been used to develop the proposed PatchResNet model. Our proposed PatchResNet attained 98.10% classification accuracy using the public brain tumor image dataset. The developed PatchResNet model obtained high classification accuracy and has the advantage of being a self-organized framework. Therefore, the proposed method can choose the best result validation prediction vectors and achieve high image classification performance.

CCPNet136: automated detection of schizophrenia using carbon chain pattern and iterative TQWT technique with EEG signals

Objective.Schizophrenia (SZ) is a severe, chronic psychiatric-cognitive disorder. The primary objective of this work is to present a handcrafted model using state-of-the-art technique to detect SZ accurately with EEG signals.Approach.In our proposed work, the features are generated using a histogram-based generator and an iterative decomposition model. The graph-based molecular structure of the carbon chain is employed to generate low-level features. Hence, the developed feature generation model is called the carbon chain pattern (CCP). An iterative tunable q-factor wavelet transform (ITQWT) technique is implemented in the feature extraction phase to generate various sub-bands of the EEG signal. The CCP was applied to the generated sub-bands to obtain several feature vectors. The clinically significant features were selected using iterative neighborhood component analysis (INCA). The selected features were then classified using the k nearest neighbor (kNN) with a 10-fold cross-validation strategy. Finally, the iterative weighted majority method was used to obtain the results in multiple channels.Main results.The presented CCP-ITQWT and INCA-based automated model achieved an accuracy of 95.84% and 99.20% using a single channel and majority voting method, respectively with kNN classifier.Significance.Our results highlight the success of the proposed CCP-ITQWT and INCA-based model in the automated detection of SZ using EEG signals.

Swin-textural: A novel textural features-based image classification model for COVID-19 detection on chest computed tomography

Background

Chest computed tomography (CT) has a high sensitivity for detecting COVID-19 lung involvement and is widely used for diagnosis and disease monitoring. We proposed a new image classification model, swin-textural, that combined swin-based patch division with textual feature extraction for automated diagnosis of COVID-19 on chest CT images. The main objective of this work is to evaluate the performance of the swin architecture in feature engineering.

Material and method

We used a public dataset comprising 2167, 1247, and 757 (total 4171) transverse chest CT images belonging to 80, 80, and 50 (total 210) subjects with COVID-19, other non-COVID lung conditions, and normal lung findings. In our model, resized 420 × 420 input images were divided using uniform square patches of incremental dimensions, which yielded ten feature extraction layers. At each layer, local binary pattern and local phase quantization operations extracted textural features from individual patches as well as the undivided input image. Iterative neighborhood component analysis was used to select the most informative set of features to form ten selected feature vectors and also used to select the 11th vector from among the top selected feature vectors with accuracy >97.5%. The downstream kNN classifier calculated 11 prediction vectors. From these, iterative hard majority voting generated another nine voted prediction vectors. Finally, the best result among the twenty was determined using a greedy algorithm.

Results

Swin-textural attained 98.71% three-class classification accuracy, outperforming published deep learning models trained on the same dataset. The model has linear time complexity.

Conclusions

Our handcrafted computationally lightweight swin-textural model can detect COVID-19 accurately on chest CT images with low misclassification rates. The model can be implemented in hospitals for efficient automated screening of COVID-19 on chest CT images. Moreover, findings demonstrate that our presented swin-textural is a self-organized, highly accurate, and lightweight image classification model and is better than the compared deep learning models for this dataset.

Hamlet-Pattern-Based Automated COVID-19 and Influenza Detection Model Using Protein Sequences

SARS-CoV-2 and Influenza-A can present similar symptoms. Computer-aided diagnosis can help facilitate screening for the two conditions, and may be especially relevant and useful in the current COVID-19 pandemic because seasonal Influenza-A infection can still occur. We have developed a novel text-based classification model for discriminating between the two conditions using protein sequences of varying lengths. We downloaded viral protein sequences of SARS-CoV-2 and Influenza-A with varying lengths (all 100 or greater) from the NCBI database and randomly selected 16,901 SARS-CoV-2 and 19,523 Influenza-A sequences to form a two-class study dataset. We used a new feature extraction function based on a unique pattern, HamletPat, generated from the text of Shakespeare's Hamlet, and a signum function to extract local binary pattern-like bits from overlapping fixed-length (27) blocks of the protein sequences. The bits were converted to decimal map signals from which histograms were extracted and concatenated to form a final feature vector of length 1280. The iterative Chi-square function selected the 340 most discriminative features to feed to an SVM with a Gaussian kernel for classification. The model attained 99.92% and 99.87% classification accuracy rates using hold-out (75:25 split ratio) and five-fold cross-validations, respectively. The excellent performance of the lightweight, handcrafted HamletPat-based classification model suggests that it can be a valuable tool for screening protein sequences to discriminate between SARS-CoV-2 and Influenza-A infections.

The effects of quercetin on liver regeneration after liver resection in rats

The aim of the present study was to assess the influence of quercetine (QE) on liver regeneration after partial hepatectomy (PH) in rats. A total of 24 male Wistar albino rats were divided into three groups: sham-operated (SH), PH and PH+QE; each group contain 8 animals. The rats in QE-treated groups were given QE (15 mg/kg body weight) once a day i.p., for 7 days starting 3 days prior to hepatectomy operation. At 7 days after resection, liver samples were collected. The malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione (GSH) levels were estimated in liver homogenates. Moreover, histopathological examination, mitotic index (MI), proliferating cell nuclear antigen labelling, proliferation index (PI), transferase-mediated dUTP nick end-labelling assay, apoptotic index (AI) were evaluated at 7 days after hepatectomy. As a result, QE significantly increased MI, PI, and significantly decreased AI in PH rats. Additionally, QE remarkably inhibited the elevation of MDA, restored impaired antioxidant SOD activity and GSH level, and also attenuated hepatic vacuolar degeneration and sinusoidal congestion. These results suggested that QE treatment had a beneficial effect on liver regenerative capacity of the remnant liver tissue after hepatectomy, probably due to its antioxidative, antiapoptotic and proliferative property.

Association of choroidal thickness with eye growth: a cross-sectional study of individuals between 4 and 23 years

BACKGROUND AND AIMS

We aimed to evaluate the association of subfoveal choroidal thickness (SFCT) with age and to determine its relationship with axial length (AL) and ocular biometric parameters, in children and young adults during growth period.

METHODS

One hundred and sixty patients (80 male, 80 female) aged between 4 and 23 years were included. Patients were classified into five groups according to their ages as group 1 (4-7 years of age), group 2 (8-11 years), group 3 (12-15 years), group 4 (16-19 years), and group 5 (20-23 years). SFCT was assessed using spectral-domain optical coherence tomography (3D OCT-2000). The measurements were taken at the same daytime (1000-1200 hours) to avoid diurnal fluctuation. Ocular AL and anterior segment parameters were measured using optical biometry (Lenstar LS900)).

RESULTS

The average SFCT was 308.1±47.6 μm, ranging from 206 to 410 μm. The mean SFCT values in group 1 to 5 were measured as 306.8±42.0, 297.8±48.1, 283.2±38.9, 326.9±57.4, and 325.8±35.9 μm, respectively. The mean CT of group 3 was significantly thinner than group 4 and 5 (P<0.05 for two groups), however, there was no statistical significance compared with group 1 (P=0.227) and group 2 (P=0.693). On stepwise regression analysis, age exhibited a positive association with SFCT (B=2.8, P<0.001) and AL exhibited a negative association with choroidal thickness (B=-16.7, P<0.001).

CONCLUSIONS

We found that SFCT shows no age-related difference until age of 15, whereas 16-23-year old participants had thicker SFCT compared with the younger ones. In that aspect, a thicker choroid associated with age in certain age groups suggests an age period of SFCT increase to a plateau in young adulthood. Larger studies are warranted to elucidate the age-related changes in SFCT in childhood, as improved evaluation of normal choroidal thicknesses during eye growth should assist in the diagnosis of choroidal abnormalities associated with eye disease.

Circulating resistin is elevated in patients with non-alcoholic fatty liver disease and is associated with steatosis, portal inflammation, insulin resistance and nonalcoholic steatohepatitis scores

AIM

We aimed to investigate the association between serum levels of resistin and the biochemical and histological features of patients with nonalcoholic fatty liver disease (NAFLD) to determine the usefulness of this relationship in the clinical practice.

METHODS

A total of 97 patients with NAFLD and 66 age- and sex-matched healthy controls were recruited. Detailed epidemiological, anthropometric and laboratory data were recorded. Serum levels of resistin were measured with ELISA.

RESULTS

Serum levels of resistin were significantly higher in patients with NAFLD (32.10±10.0 ng/mL and 26.57±13.60 ng/mL, respectively) compared with healthy controls (P=0.003). Serum resistin levels were associated with AST, ALT, HOMA-IR, histological steatosis, portal inflammation and nonalcoholic steatohepatitis (NASH) scores. The serum levels of resistin were significantly higher in patients with definite NASH compared to patients with simple steatosis (29±13 and 20±10 ng/mL, respectively, P=0.03). There was no association between the serum resistin levels and the liver fibrosis stages.

CONCLUSION

Our data suggest that resistin levels are elevated in patients with NAFLD and could discriminate simple steatosis from definite NASH.

Histological effects of zinc and melatonin on rat testes

BACKGROUND

The objective of this study is to examine the histological effects of zinc and melatonin, alone or in combination, on rat testes.

METHODS

For this purpose four study groups of ten Sprague-Dawley male rats were formed and treated for one month as follows: (1) Controls; (2) Rats injected with 3 mg/kg/day zinc, as zinc sulfate; (3) Rats injected with 3 mg/kg/day melatonin and (4) Rats injected with 3 mg/kg/day each zinc and melatonin.

RESULTS

After four weeks the rats treated with melatonin showed inhibited spermatogenesis, testicular tubular degeneration and necrosis, obstruction of tubular lumen and lymphocytic infiltration. The two zinc-treated groups showed no histological differences to controls but the melatonin-only group showed inhibited spermatogenetic activity, tubular degeneration and necrosis, as well as obstruction of tubule lumens and lymphocytic infiltration.

CONCLUSION

The obtained results suggest that 4-week treatment with melatonin leads to histological and physiological impairments of testis and that zinc supplementation might offset these damaging effects (Tab. 2, Fig. 4, Ref. 12).

Providers' knowledge of, attitude to and practice of emergency contraception

OBJECTIVES

Barriers to widespread use of hormonal emergency contraceptives (EC), such as lack of knowledge and prejudices held by health-care providers, still exist today. This study was initiated to evaluate the knowledge, attitudes and prejudices of family-planning (FP) providers.

METHODS

This survey was conducted in FP units of primary-health-care centers in Istanbul. A total of 180 providers were interviewed in 80 units to whom a questionnaire was administered by face-to-face technique.

RESULTS

One-hundred and fifty-two of the providers stated that they had heard of EC. The correct timing and dose interval of EC were known by 50% of them. The participants held the belief that EC caused abortion (39.4%), and that it was harmful for the fetus (31.1%). Other prejudices were the possibility of increased unprotected sexual intercourse (78.9%) and a tendency for men to give up condom use (75%); female providers were more prejudiced concerning these statements. The providers' tendency towards the provision of counseling was significantly related to their prejudices (p = 0.011, p = 0.033) and to the application rate (p = 0.000). Conclusion Providers need more detailed information about EC. During FP training courses, the providers should be encouraged towards counseling EC which would increase the application rate of the users and decrease their own prejudices.

Fallopian tube carcinoma metastatic to the pericardium and breast

INTRODUCTION

Fallopian tube carcinoma is a rare gynecological tumor and simultaneous pericardial and breast metastasis of this cancer is an extremely exceptional event.

CASE

A 46-year-old woman with FIGO Stage IIIc, grade 3 adenocarcinoma of the fallopian tube received cyclophosphamide and carboplatin subsequent to surgery. The disease had been completely silent for 41 months and then it relapsed with pericardial and breast metastasis consecutively. She expired one year after the relapse.

CONCLUSION

Although clinical and biological behavior and response to the treatment of fallopian tube carcinoma is quite similar to epithelial ovarian carcinoma, breast and pericardium are unusual sites of metastasis for each malignancy. As survival is prolonged with new chemotherapeutics these atypical cancer metastases will be observed more frequently.

Clinical and histopathological findings of 'psoriatic neurodermatitis' and of typical lichen simplex chronicus

BACKGROUND

We have seen several patients with itchy lichenified plaques located bilaterally on the elbows and/or knees and have named this condition 'psoriatic neurodermatitis' (PN).

OBJECTIVE

The purpose of this study was to compare clinical and histopathological characteristics of these patients to those of patients with typical lichen simplex chronicus (LSC).

METHODS

Nineteen patients with PN and 34 patients with typical LSC were included. Besides clinical dermatological evaluation, the prick test was carried out on 49 patients; the Phadiatop test on 40 patients; the patch test with European standard series on 47 patients; histopathological evaluation on 39 patients; and clinical psychiatric examination on 38 patients.

RESULTS

Almost exclusively, PN was seen in females and was located on the extremities. It caused more plaques than typical LSC did. In PN, the plaques were smaller, sharper, more keratotic and less excoriated, and had fewer lichenoid papules around them. Itching was usually more severe in the evening, while resting and in a hot environment in typical LSC, but not in PN. In plaques of PN, microabscesses in the horny layer, hypogranulosis, regular acanthosis and thinning of the suprapapillary plates were more frequent, and hyperpigmentation in the basal layer was less. In patients with PN, depressive disorder was found more frequently; and generalized anxiety disorder or psychosomatic characteristics, less. There were no significant differences in the results of prick, Phadiatop and patch tests between patients with PN and those with typical LSC.

CONCLUSION

In our opinion, it is most likely that the so-called PN is itchy psoriasis superimposed by LSC.

Oesophageal involvement during attacks in pemphigus vulgaris patients

BACKGROUND

Pemphigus vulgaris (PV) is a rare autoimmune bullous skin disorder characterized by frequent involvement of the mucous membranes, usually beginning at the mouth.

AIMS

To investigate the oesophageal involvement in patients with PV and to explore the primary relationship of the disease with symptoms such as dysphagia, odynophagia and retrosternal burning.

METHODS

Oesophageal involvement was investigated by upper gastrointestinal endoscopy and biopsy during the early phase of the attacks in 26 patients with PV (12 men, 14 women, age range 24-63 years).

RESULTS

Histopathological examination and direct immunofluorescence of the oesophageal biopsy specimens revealed pemphigus involvement in 12 of 26 patients (46.15%).

CONCLUSION

The oesophagus is an important predilection zone for PV, thus care must be taken to detect these lesions at an early stage.

Malignant struma ovarii: A case report

Malignant struma ovarii is a rare form of the ovarian germ cell tumors. Hence, diagnosis and management of malignant struma ovarii have not been clearly defined. We present the case of a 34-year-old woman with papillary carcinoma arising in struma ovarii. The malignant component of this tumor was detected after laparoscopic removal, and a re-staging operation was performed afterwards. There was no evidence of clinical malignancy or metastases. In this paper, clinical features, treatment guidelines, diagnostic features, and immunohistochemical characteristics of this tumor are reviewed.

Antimicrobial resistance patterns and serotype distribution among Salmonella enterica strains in Turkey, 2000?2002

Since Turkey currently lacks a national reference center for Salmonella infections, the present study was conducted to document the distribution of serotypes and antimicrobial resistance patterns among Salmonella enterica isolates recovered from clinical samples in ten Turkish provinces over a 2-year period. Among the 620 Salmonella enterica isolates recovered between 1 July 2000 and 30 June 2002, strains belonging to the serotypes Enteritidis (47.7%), Typhimurium (34.7%), Paratyphi B (6.0%), Typhi (2.9%), Paratyphi A (0.2%) and serogroup C (8.5%) were found. Resistance to multiple antimicrobial agents was particularly high among Salmonella Typhimurium isolates (76.7%), and resistance or decreased susceptibility to ciprofloxacin (MIC> or =0.125 mg/l) was demonstrated in Salmonella Paratyphi B, Salmonella Typhimurium and Salmonella Enteritidis strains. All of the Salmonella Typhi isolates were susceptible to ciprofloxacin. The results indicate that decreased susceptibility to ciprofloxacin is an emerging problem in Salmonella enterica in Turkey, particularly in multiresistant strains.

Ovarian actinomycosis mimicking malignancy

OBJECTIVE

To emphasize the importance of frozen section diagnosis in the treatment of ovarian carcinoma and to remind physicians that it may mimic ovarian carcinoma and occur in women without intrauterine contraceptive devices (IUDs).

METHODS

Three cases operated on in Adana University Hospital between the year 2001-2003 with the diagnosis of ovarian actinomycosis were reported.

CASE REPORT

Three female patients who had never used IUDs, aged 37, 45 and 47, who presented with pelvic pain and tumoral masses in the pelvis were operated on with the initial diagnosis of ovarian carcinoma between the years 2001 and 2003. Intraoperative frozen-section diagnoses of the pelvic masses were actinomycosis. In the postoperative period the patients received long-term antibiotic therapy initially intravenously (15 days), and later orally with 4 g/day for three months. They were healthy without evidence of actinomycosis infection for two years after the treatment.

DISCUSSION

Pelvic actinomycosis is uncommon and may present a diagnostic dilemma because of an atypical clinical presentation. The behavior of the disease, which mimics malignancy and urogenital manifestation, poses difficulties in diagnosis and management. Preoperative examinations could not establish the nature of the tumour. An initial diagnosis of ovarian carcinoma is usually considered in all cases. Surgeons should be aware of this infection to potentially spare women morbidity from excessive surgical procedures.

Urethral cultures in patients with spinal cord injury

STUDY DESIGN

Prospective analysis.

OBJECTIVES

To investigate the colonization of the distal urethra and bladder during the initial stages of rehabilitation in acute spinal-cord injury (SCI) and to examine the association between bacteriuria and colonization of the distal urethra.

SETTING

Selcuk University Meram Faculty of Medicine, Konya, Turkey.

METHODS

A total of 27 patients with SCI (13 females and 14 males) and 40 controls without evidence of disease of the urinary tract were studied. Cultures were taken from the patients who applied clean intermittent catheterization and compared with normal subjects.

RESULTS

Escherichia coli was predominantly isolated from the urine and urethral cultures of both female and male SCI patients. Colonization of other bacteria in the urine and urethral cultures was similar in both female and male patients, except for Pseudomonas, which was colonized in male patients. In all, 72% of patients who had E. coli positive urethral cultures also had E. coli colonization in their simultaneous urine cultures. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.82). When urethral cultures collected 1 week before were evaluated in patients with E. coli positive urine cultures (n=24 cultures), 15 of these urethral cultures also had E. coli colonization. There was concordance between urethra and urine cultures concerning the growth of E. coli (P=0.66).

CONCLUSIONS

Our study suggested that urethral flora was a significant source for the development of urinary infection in spinal cord-injured patients.

The role of Urtica dioica and Nigella sativa in the prevention of carbon tetrachloride-induced hepatotoxicity in rats

The role of Nigella sativa L. (Ranunculaceae) (NS) and Urtica dioica L. was investigated (UD) in the prevention of carbon tetrachloride (CCl4) induced liver fibrosis and cirrhosis. Fifty Sprague-Dawley rats were allocated into fi ve groups (I, IIA and B, IIIA and B) and CCl4 was injected biweekly to all groups. Group I (control, CCl4 only), group IIA and B (NS fixed oil and volatile oil), group IIIA and B (UD fixed oil and UD decoction extract) rats were killed at the end of week 12 and histopathological and immunohistochemical examinations of liver tissues were performed. In the control group, coagulation necrosis and hydropic degeneration were marked in the periacinar regions (zone 3) associated with fibrosis in the periacinar regions and in the portal tracts. In groups IIA-B and IIIA-B (NS and UD), none of the serious histopathological findings were detected except for sparse coagulation necrosis in the periacinar regions. ASMA-positive perisinusoidal cells with myo fibroblastic transformation and lysosomal enzyme activity suggesting fibrogenesis were also significantly more common in the control group than in the NS and UD groups. UD and NS seem to be significantly effective in the prevention of carbon tetrachloride induced hepatotoxicity in rats.

Hepatoprotective effect of Foeniculum vulgare essential oil

Hepatoprotective activity of Foeniculum vulgare (fennel) essential oil (FEO) was studied using carbon tetrachloride (CCl(4)) induced liver injury model in rats. The hepatotoxicity produced by acute CCl(4) administration was found to be inhibited by FEO with evidence of decreased levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and bilirubin. The results of this study indicate that FEO has a potent hepatoprotective action against CCl(4)-induced hepatic damage in rats.

Coexistence of cystic intra-abdominal lymphangiomas and diffuse venous haemangiomas in adult life

Diffuse haemangioma and intra-abdominal lymphangioma are rare in adults. In this case report, we present a 33-year-old female with coexisting multiple cutaneous and visceral cavernous haemangiomas and two huge intra-abdominal lymphangiomas of 25 and 35 cm in diameter. The organs involved were the liver, pericardium, renal hilus and bladder. She died due to disseminated intravascular coagulation and multiorgan failure, which resembled Kasabach-Merritt syndrome. The coexistence of generalised haemangiomas and intra-abdominal lymphangiomas and the lack of complaints until the age of 33 years makes her an unusual case in the literature. We also emphasise the other clinical conditions that should be considered in the differential diagnosis.

Comparison of differential PCR and immunohistochemistry for the evaluation of c-erbB-2 in breast carcinoma and relationship to other prognostic factors

The c-erbB-2 gene codes for a membrane receptor protein that is homologous to the epidermal growth factor receptor. Differential polymerase chain reaction (PCR) is an alternative semi-quantitative method for evaluating gene amplification and can be performed in formalin-fixed paraffin-embedded specimens. We aimed to compare differential PCR and IHC (immunohistochemistry) in the determination of c-erbB-2 status of breast cancers. Correlation between the prognostic impact of c-erbB-2 gene amplification and protein overexpression with conventional prognostic factors were also evaluated. Differential PCR and IHC for c-erbB-2 were performed on formalin-fixed paraffin sections of 60 invasive breast cancers. Results and the relation with the other prognostic parameters were compared. A highly significant degree of concordance between differential PCR and IHC in the evaluation of c-erbB-2 status of breast carcinoma was detected. Amplification and overexpression were significantly related to the number of metastatic lymph nodes, histologic grade, and lymphatic invasion but not age, histologic type, tumor size and estrogen status. We demonstrated and confirmed the importance of c-erbB-2 overexpression and amplification as a single and combined prognostic parameter together with conventional factors and confirmed that it can be detected by both immunohistochemistry and differential PCR techniques in breast carcinoma. This semi-quantitative technique provides reliable results and can be used routinely.

Bacillary angiomatosis of the scalp in a human immunodeficiency virus-negative patient

Bacillary angiomatosis (BA) is a recently recognized bacterial infectious disease that is mainly seen in patients with the acquired immunodeficiency syndrome. BA has rarely been reported in immunocompetent individuals. A case of BA of the scalp in an immunocompetent patient, who was human immunodeficiency virus seronegative, is reported. The importance of differential diagnosis of this lesion is emphasized.

Surveillance of antimicrobial resistance in gram-negative isolates from intensive care units in Turkey: analysis of data from the last 5 years

A multicenter antimicrobial surveillance program was established in Turkey in 1995 to monitor the predominant Gram-negative pathogens from intensive care units (ICUs) and antimicrobial resistance patterns of these isolates. Sixteen hospitals participated in the study and a total of 1479 isolates from 1,100 patients were collected. The isolates were tested for their susceptibility against 13 antibiotics by E-test method. Minimum inhibitory concentrations (MICs) for each isolate were determined for imipenem, ceftazidime, ceftazidime-clavulanate, cefoperazone-sulbactam, ceftriaxone, cefepime, cefuroxime, piperacillin-tazobactam, ticarcillin-clavulanate, gentamicin, amikacin and ciprofloxacin. The most common isolates were Pseudomonas spp. (28.2%), Escherichia coli (19.2%) and Klebsiella spp. (19.1%). We found very high resistance rates to all major antibiotics that are used to treat serious infections. Although imipenem is the most active agent, it had an overall susceptibility rate of 68%. Half of the tested Klebsiella spp. strains were found to produce ESBL. This is a very high rate when compared with the literature. Cross-resistance among species was also investigated. 52% of ciprofloxacin-resistant strains were also resistant to imipenem, 80% to ceftazidime, 97% to ceftriaxone, 86% to amikacin and 19% of imipenem-resistant strains were susceptible to ceftazidime and 18% to amikacin. When susceptibilities of the years 1995 and 1999 were compared, the most interesting finding was the decrease in resistance to 3rd generation cephalosporins. In conclusion, this national clinical isolate database shows that resistance rates are high, the change over years is not predictable and continuous surveillance is necessary to monitor antimicrobial resistance and to guide antibacterial therapy.

Anterior abdominal wall malignant peripheral nerve sheath tumor in an infant

Malignant peripheral nerve sheath tumors (MPNST), also known as malignant schwannomas, are highly malignant lesions that tend to arise in the head and neck region or on the extremities, and only rarely in the retroperitoneum. These tumors are not common in children. Almost 50% of cases are associated with neurofibromatosis. When these neoplasms arise in the retroperitoneum, they usually are difficult to diagnose and to treat. Although various radiologic imaging methods are helpful for identifying some features of the mass, definitive diagnosis requires histologic examination and immunohistochemical staining. After treatment, the tumor recurs in 25% of patients. Five-year survival rates as high as 80% have been reported. Total excision, lack of invasion of surrounding tissues and vessels, and absence of neurofibromatosis, are features associated with better outcome. The authors present the case of a 1-month-old boy who had malignant schwannoma diagnosed in a unique location over the peritoneum of the anterior abdomen. The location and rapid growth of the tumor permitted early identification and total excision. J Pediatr Surg 36:1866-1868.

Persistently normal alanine transaminase levels in chronic C hepatitis: what does it tell us?

BACKGROUND/AIMS

We evaluated the demographic, clinical, histological and serological characteristics of chronic hepatitis C infection with persistently normal serum alanine transaminase levels and compared the results with those obtained in a group of chronic hepatitis C infection with serum alanine transaminase levels above normal.

METHODOLOGY

Twenty-one patients who had chronic hepatitis C infection with normal alanine transaminase during the follow-up period and 34 patients who had chronic C infection with serum alanine transaminase levels above normal were included in this study. Demographic, clinical, histological and serological parameters of these two groups were evaluated.

RESULTS

There were no significant differences in age, gender, known route of infection, viral load and genotype distribution between the two groups (P > 0.05). The gamma-glutamyltransferase and gamma-globulin levels were significantly higher in the serum alanine transaminase levels above normal group (P < 0.01 and P < 0.05). Among the patients with normal alanine transaminase, liver biopsy findings were normal in eight patients (38%). None of the patients with serum alanine transaminase levels above normal had normal liver biopsy findings. Histologic activity index was significantly higher in serum alanine transaminase levels above normal group (9.7 +/- 2.2 vs. 6.4 +/- 1.9; P < 0.001). Histologic activity index and alanine transaminase levels correlate with the stage of the disease (P < 0.05).

CONCLUSIONS

For a definite diagnosis in patients with HCV-RNA+ and normal alanine transaminase liver biopsy is necessary and significant liver disease may be present in such patients irrespective of viral load, genotype and alanine transaminase levels.

Environmental malignant mesothelioma in southern Anatolia: a study of fifty cases

Malignant mesothelioma is a highly aggressive tumor of the serous membranes, which in humans results from exposure to asbestos and asbestiform fibers. Although occupational malignant mesothelioma is still the most common form of this lesion, naturally contaminated soil can play an important role in the development of environmental malignant mesothelioma in some parts of the world. Fifty cases of malignant mesothelioma (MM) from southern Turkey with no occupational history of asbestos exposure were reviewed regarding pathologic and clinical features. A case of hyaline fibrous plaque of the pleura was also included in this series. Histologically the cases were classified as epithelial (36 cases); sarcomatous (7 cases); and biphasic (7 cases). One of the sarcomatous cases was desmoplastic. Ultrastructural examination of the tumor tissue in three cases revealed long-surface microvilli in epithelial cells. Interstitial cells of the lung in one case showed electron-dense asbestos fibers in the cytoplasm. Mineralogical analyses of the lung tissue in three cases of MM and the case of pleural plaque showed high amounts of asbestos fibers most consistent with tremolite and actinolite. The clinical and pathologic features of our cases support that the environmental inhalation of asbestos is still a major health problem in some parts of Turkey.

Surveillance of antimicrobial resistance among gram-negative isolates from intensive care units in eight hospitals in Turkey

With the participation of eight major reference hospitals in Turkey, 749 aerobic Gram-negative isolates obtained from 473 intensive care patients in 1997 were tested for their susceptibility to 13 commonly employed antibacterial agents. The frequency with which species were isolated and resistance rates were compared with data from the previous 2 years. Imipenem was the most active agent against the majority of isolates (75%), followed by ciprofloxacin, cefepime and amikacin. The per cent susceptibility to all antibiotics declined from 1995 to 1996. With the exception of imipenem, for which there was no change in resistance, the per cent susceptibility somewhat increased in 1997. However, it was still lower than in 1995.

Lymphomatous skin infiltration at the site of previous varicella zoster virus infection in a patient with T cell lymphoma

Cutaneous infiltrations in hemopoietic neoplasias are not uncommon. They are generally localized on the legs, arms, back, anterior chest, scalp and face. In rare cases specific infiltration of neoplastic cells is localized in the site of herpes zoster and herpes simplex scars. In this report a case with T cell lymphoma in leukemic phase with skin infiltration in the previous Varicella Zoster Virus (VZV) site of infection is reported and literature is reviewed.

Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma

OBJECTIVE

To evaluate the adequacy of intraoperative assessment of depth of myometrial invasion in patients with endometrial adenocarcinoma.

METHODS

Of the 58 evaluable cases, depth of myometrial invasion was estimated by gross examination of fresh tissue by an experienced surgeon and a pathologist and on the frozen section by the same pathologist. This was compared with the depth of invasion on the final microscopic examination performed by another pathologist.

RESULTS

The depth of invasion was accurately predicted by the surgeon in 89.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon and the pathologist had a significant error rate in predicting accurate depth of invasion (7.6%-33%).

CONCLUSION

If frozen section shows that myometrial invasion in patients with grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be omitted. In all other cases radical surgery and surgical staging is mandatory to avoid undertreatment.

Callotasis in a fasciosteal flap model in rabbits: part II. a new contribution to the concept of distraction osteogenesis

The basis of lengthening bones at their anatomic locations has been defined in detail by many authors. The possibility of distraction osteogenesis in vascularized bone grafts and the role of periosteum was investigated in 35 growing New Zealand White rabbits in four experimental groups: group 1, the scintigraphic assessment group (N = 4); group 2, the distraction group with intact periosteum (N = 15); group 3, the control group without periosteum in the distraction area (N = 6); and group 4, the control group in which the flaps were wrapped in silicone leaves (N = 10). Scintigraphy was used to evaluate the survival of the bone graft. Metatarsal fasciosteal flaps were fixed by external fixators and then subjected to osteotomy. Distraction was started after 10 days of osteotomy and continued at 0.5 mm/24 hr for 10 days, with a total elongation of 4 to 6 mm. Radiological examination at day 10 of starting the distraction, and both radiological and histological examinations at days 15, 20, and 30 were performed. In group 1, positive scintigraphic images of the flaps were obtained. In group 2, progressive calcification was detected radiologically and mixed-type ossification was observed histologically. However, in group 3, distraction failed. Group 4 was excluded from the study due to silicone exposition. The authors demonstrated that vascularized bone segments can be lengthened, and provided information about the importance of periosteum in distraction osteogenesis.

Wegener's granulomatosis : a case with multiple symmetric cranial neuropathy

We report a 47 year-old woman with Wegener's granulomatosis presenting with an atypical onset of multiple symmetric cranial neuropathies. The diagnosis was established by clinical and laboratory data. To our knowledge, this is the first case of Wegener's granulomatosis presenting with bilateral multiple symmetric cranial neuropathy.

Callotasis in nonvascularized periosteal bone grafts and the role of periosteum: a new contribution to the concept of distraction osteogenesis

Bone lengthening by slow, progressive distraction has gained widespread acceptance. In this study we investigated the possibility of distraction osteogenesis in nonvascularized periosteal bone grafts, and assessed callus formation and callotasis by means of radiological and histological examination with the aim of determining the role of the periosteum. The process of distraction osteogenesis in nonvascularized bone grafts was studied histologically and radiologically in 22 growing rabbits. The metatarsal bone grafts taken from the rabbits were divided into two groups. Group 1 contained 15 bone grafts covered with periosteum and group 2 (the control group) contained 7 bone grafts without periosteum. These grafts were subjected to osteotomy and then placed in the lumbar pocket. After 10 days, distraction was started and continued at 0.5 mm per day for 10 days. Thus an elongation of 4 to 6 mm was achieved in both groups. Radiological examination was performed postoperatively and after 10, 15, 20, and 30 days of starting the distraction. Histological examination was performed after 15, 20, and 30 days. Radiologically, progressive calcification and, histologically, both intramembranous and endochondral ossification were detected in group 1. However, in the control group (group 2), bone lengthening failed. Our study demonstrated the possibility of distraction osteogenesis in periosteal bone grafts, and provides information regarding the importance of periosteum as well as its osteogenic capacity.

Relationship of Helicobacter pylori infection to several malignant and non-malignant gastrointestinal diseases

The importance of the Helicobacter pylori infection was investigated as a risk factor for several gastrointestinal diseases. In this study 203 patients with gastric cancer, 61 with peptic ulcus, 60 with gastritis and 100 asymptomatic control subjects were investigated. Serum samples were examined for IgC antibodies to H. pylori by enzyme linked immunoassay - tissue samples were stained for H. pylori by Wartin-Stary technique and by Giemsa for routine histopathology. H. pylori seropositivity was 58.1% in gastric cancer, 54% in peptic ulcus, 63.3% in gastritis and 27% in asymptomatic control group. There was a 10.1% discordance between the serum and tumor determinants in the seropositive group and 11.3% of discordance in the seronegative group. The frequency of H. pylori seropositivity was lowest in cardia tumors (22.7%) and highest in antral tumors (65.5%, p=0.00002). H. pylori seropositivity was 29% in diffuse type of histology, 35% in mixed type and 79% in the intestinal type (p=0.00000). In the gastric cancer patients the frequent use of salty food (p=0.00001, OR=6.4), excessive salt, pickled food (p=0.0000, OR=24.92) and proteins (p=0.003, OR=0.45) were more significant than asymptomatic volunteers. In gastric cancer patients the frequent use of salty and pickled food were relevantly associated with H. pylori infection (p=0.001). It was concluded that H. pylori infection could play a role in the pathogenesis of non-malignant gastrointestinal diseases which may be the precursor of carcinoma. However, other contributing factors to carcinogenesis must be investigated.

Two cases of nephrotic syndrome and tertian malaria in south-eastern Anatolia

Tertian malaria is endemic in south-eastern Anatolia. As in Europe and America, in south-eastern Anatolia, an etiological agent is seldom identified in nephrotic syndrome. Two patients with Plasmodium vivax and nephrotic syndrome are described here. The possible relationship between Plasmodium vivax and nephrotic syndrome should be explored in children in endemic malarial regions.

Endoscopic retrograde cholangiopancreatography in the diagnosis and management of choledochal cysts

Choledochal cysts are an uncommon anomaly of the biliary system manifested by cystic dilatation of the extra or intrahepatic biliary tree or both. It is most frequently found in Orientals and in females. Endoscopic retrograde cholangiopancreatography is a valuable imaging technique in the diagnosis of choledochal cysts in adults. Additionally, in selected cases, a choledochocele may be effectively managed by endoscopic sphincterotomy. We present clinical and endoscopic findings of six adult patients with choledochal cysts. Clinical symptoms were characterized by abdominal pain, jaundice and cholangitis. Associated hepatobiliary pathologic findings included cholelithiasis, recurrent acute pancreatitis, gallbladder carcinoma, Cystolithiasis, choledocholithiasis, biliary stricture and hepatic abscess.

p53 protein expression in gastrointestinal lymphomas

We investigated the p53 protein expression in gastrointestinal lymphomas (GIL). Paraffin-embedded samples of 52 patients were examined for this purpose. The avidin-biotin Complex method was used for immunostaining. Nine of the 52 samples (17.3%) showed p53 staining. There was no relationship between the p53 protein expression and clinical characteristics, such as stage, disease localization and tumor burden. Complete remission was higher in patients not expressing this protein, and the p53 protein was more frequently expressed in intermediate and high grade histopathology than low grade lymphomas, but there was no statistically significant difference between the two groups (p = 0.008). Interestingly, patients expressing the p53 protein were younger than the ones not expressing it (30.7 +/- 14.1 vs. 43.6 +/- 15.7 years). We conclude that the p53 protein expression in GILs may be a poor prognostic indicator due to a lower response rate to chemotherapy.

Wegener's granulomatosis : a case with multiple symmetric cranial neuropathies

A 47 year-old woman with Wegener's granulomatosis presented with an atypical onset of multiple symmetric cranial nerve involvement. The diagnosis was established by clinical examination and laboratory data. To our knowledge, this is the first case of Wegener's granulomatosis presenting with bilateral multiple symmetric cranial neuropathies.

Variant high-origin radial artery: a bilateral case

During a dissection of both upper extremities, an abnormally high origin of the radial a. was found on each side. However, the arterial patterns were not the same. On the right side, the radial a. arose 2 cm above the junction of the two roots of the median n. On the left side, the radial a. arose from the brachial a. 3 cm distal to the origin of the profunda brachii a. The course of these arteries in the forearm were normal. However, in the hand, on the right side, the contributions of the radial and ulnar aa. to the superficial and deep palmar arches were, unusually, equal. On the left side, the superficial palmar arch was formed as usual mainly by the ulnar a. and the deep palmar arch was formed mainly by the radial a. The high origin of the radial aa. in this case is explained on the basis of the embryologic development and is distinguished from the other common arterial variations in the upper limb.