Pediatric langerhans cell histiocytosis: single center experience over a 17-year period

This study aimed to analyze children with the diagnosis of Langerhans cell histiocytosis (LCH) who were diagnosed and treated between 1998-2015. Medical records were evaluated retrospectively for clinical and laboratory features, treatment details, and outcome. There were 20 patients, the median age of diagnosis was 37 months, M/F ratio: 1.5. Nine had single system (SS), 11 had multisystem (MS) LCH. Spontaneous regression occurred in three infants with skin limited LCH. Eight patients had risk organ involvement in MS-LCH group. The curettage alone was performed in only one case. Patients received LCH-II/ LCH-III based chemotherapy schema. Radiotherapy was performed to vertebral disease and residual craniofacial bone disease in four cases. The regression and relapse rates were 100% and 33% for SS-LCH. The regression and relapse rates were 73%, and 18% for MS-LCH. Two infants with MS-LCH died despite chemotherapy. Pulmonary and liver involvements affected outcome adversely in MS-LCH. Multidisciplinary treatment approaches are needed.

Inflammatory myofibroblastic tumor of the gallblader

BACKGROUND

Inflammatory myofibroblastic tumors are rare benign tumors that can mimic malignancy. Their precise aetiology is unknown. They are seen more frequently in childhood and the most common involvement is seen in the lungs. Primary inflammatory myofibroblastic tumors of the gallbladder are rather infrequent. The present knowledge is based on case reports.

CASE REPORT

A 66 year-old male patient presented to the hospital with complaints of abdominal pain, nausea and vomiting. Upon physical examination, a clinical picture of abdominal tenderness on the right upper quadrant of the abdomen was identified. Laboratory examinations revealed leukocytosis and hypochromic microcytic anaemia with an increased erythrocyte sedimentation rates and C-reactive protein levels. A mass almost completely filling the gallbladder was detected by imaging studies. The patient was operated on with a malignant preoperative diagnosis and underwent a liver resection of segments 4 and 5, which included a cholecystectomy. The histopathological examination of the surgical specimen revealed an inflammatory myofibroblastic tumor including many histiocytes stained positively with CD 68.

CONCLUSION

Inflammatory myofibroblastic tumors can be localised in the gallbladder mimicking gallbladder cancer.

A regional panorama of dysferlinopathies

OBJECTIVE

We describe the characteristic features of 11 patients (6 men and 5 women) with dysferlinopathies confirmed by muscle biopsies. In addition, we aimed to provide a realistic comprehensive picture of the severe muscle diseases in the Aegean Region of Turkey.

MATERIAL AND METHOD

We retrospectively reviewed 90 patients who underwent muscle biopsy examinations between 2008 and 2011 in the pathology laboratory of Izmir Dr.Behcet Uz Children's Hospital. Biopsy specimens of all patients clinically diagnosed as muscular dystrophy referred from 4 different centers of neurological disorders were collected.

RESULTS

Dystrophinopathy was the most (n=45) and gammasarcoglycanopathy was the second common (n=13) muscular dystrophy in this series. The mean age of all 90 patients was 8.8 years (3 months- 64 years). Only 14 cases (15.5%) were older than 14, and 23 cases were younger than two years. Dysferlinopathy was the most common dystrophy in the older age group. There were statistical significant differences between the types of dystrophy and inflammation (0.021), creatine kinase levels (p= 0.001), age (p=0.001), and gender (p < 0.001) of the patients.

CONCLUSION

The present study revealed that dysferlinopathies is not an uncommon form of muscular dystrophies in western Turkey. We have concluded that if avoidance from unnecessary therapeutic interventions is desired, we must be aware of the relative frequencies of dysferlinopathies.

[Angiomyxoma: always myxoid, sometimes aggressive]

Angiomyxoma is a distinct soft tissue tumor characterized by the presence of prominent myxoid matrix and numerous thin-walled blood vessels. This tumor has a predilection for the trunk, head and neck, extremities, and genitalia. It is a benign tumor and total excision is curative. Recurrence is rare except for aggressive angiomyxomas. A 12-year-old girl with a 10-year history of a subcutaneous mass on the left gluteus measuring 4.5x4x3 cm had been referred. The tumor was encapsulated and was located in the reticular dermis and subcutaneous tissue, composed of stellate cells with mucinous stroma. Thin-walled blood vessels were prominent. Immunohistochemically, tumor cells were immunoreactive for vimentin. No immunoreactivity was present for estrogen receptor, CD34, smooth muscle actin, S-100 protein and desmin. The purpose of this report is to present a classical example of an isolated superficial angiomyxoma and discuss the differential diagnosis, because of its relatively infrequent occurence.

Case report of intrafamilial variability in autosomal recessive centronuclear myopathy associated to a novel BIN1 stop mutation

Centronuclear myopathies (CNM) describe a group of rare muscle diseases typically presenting an abnormal positioning of nuclei in muscle fibers. To date, three genes are known to be associated to a classical CNM phenotype. The X-linked neonatal form (XLCNM) is due to mutations in MTM1 and involves a severe and generalized muscle weakness at birth. The autosomal dominant form results from DNM2 mutations and has been described with early childhood and adult onset (ADCNM). Autosomal recessive centronuclear myopathy (ARCNM) is less characterized and has recently been associated to mutations in BIN1, encoding amphiphysin 2. Here we present the first clinical description of intrafamilal variability in two first-degree cousins with a novel BIN1 stop mutation. In addition to skeletal muscle defects, both patients have mild mental retardation and the more severely affected male also displays abnormal ventilation and cardiac arrhythmia, thus expanding the phenotypic spectrum of BIN1-related CNM to non skeletal muscle defects. We provide an up-to-date review of all previous cases with ARCNM and BIN1 mutations.

Protective effects of trimetazidine in transient spinal cord ischemia

The neuroprotective effect of trimetazidine (TMZ) was tested prospectively in a rabbit spinal cord ischemia model. Ischemia was induced by clamping the aorta just distal to the left renal artery and proximal aortic bifurcation for 20 min. Twenty-five male New Zealand white rabbits were randomized as follows: TMZ group (n=100) receiving 3 mg/kg trimetazidine intravenously before the occlusion of the aorta; control group undergoing occlusion but receiving no pharmacologic intervention (n=10); sham-operation group (n=5) subjected to operative dissections without aortic occlusion. Physiological parameters and somatosensory evoked potentials (SEP) were monitored in animals before the ischemia, during the ischemia and in the 1st, 15th and 60th min of reperfusion. Neurologic status was assessed 24 and 48 h after the operation. The spinal cord, abdominal aorta, and its branches were processed for histopathologic examinations 48 h after the operation. At the end of the ischemic period, the average N1-P1 amplitude was reduced to 22% of the baseline in all ischemic animals. This was followed by a gradual return to 90+/-2% of the initial amplitude in the TMZ group and 81+/-2% in the control group (P<0.05) after 60 min of reperfusion. The average motor function score was significantly higher in the TMZ group than the control group (3.7+/-0.5 vs 3.1+/-0.6 at 24 and 3.5+/-0.7 vs 2.9+/-0.6 at 48 h; P<0.05). Histologic observations were clearly correlated with the neurologic findings. The results suggest that trimetazidine reduces spinal cord injury during thoracoabdominal aortic operations and may have therapeutic utility during high risk operations.

Teratoid Wilms' tumor: a case report

Teratoid Wilms' tumor is rarely seen and is a description used only recently. The term describes classical nephroma with a diversity of cell types and tissues. In this reported case, the epithelial component consisting of squamous areas made up 70 percent of the tumor; no criteria of dysplasia nor any nephroblastomatosis areas or endodermal elements were presented. Although it is reported that teratoid Wilms' tumor is not usually aggressive or metastatic, a case of unilateral teratoid Wilms' tumor in a 2.5-year-old-boy who died because of metastatic disease is presented and the literature reviewed.

Pentoxifylline reduces injury of the brain in transient ischaemia

OBJECTIVE

The beneficial effect of pentoxifylline (PTX) on ischaemic-reperfusion injury was assessed in a rat model of transient global cerebral ischaemia.

DESIGN

Randomized, controlled, prospective study.

SETTING

University research laboratory.

SUBJECTS

Thirty-six male Wistar albino rats.

INTERVENTIONS

Ischaemia was induced with a four-vessel occlusion technique in 24 animals with the duration of 15 minutes. Group 1 animals (n = 12) received PTX treatment started 20 minutes before the occlusion of carotid arteries (60 mg/kg bolus followed by infusion at 0.1 mg/kg/min). A similar volume of saline solution was used in animals of the control group (group 2, n = 12). The animals in group 3 (sham group, n = 12) were anaesthetized and subjected to operative dissections without vascular occlusion.

MEASUREMENTS

Physiological parameters and somatosensory evoked potentials (SEP) were monitored in animals before ischaemia, during ischaemia and in the first 30 minutes of reperfusion. Their neurological outcome had been clinically evaluated and scored up to 4 days post ischaemia. The intergroup differences were compared. Then the animals were sacrificed and their brains were processed for histopathological examination.

MAIN RESULTS

In group 3, SEP amplitudes did not change during the procedures, and all animals recovered without neurologic deficits. At the end of the ischaemic period, the average amplitude was reduced to 4 +/- 3% of the baseline in all ischaemic animals. This was followed by a gradual return to 92 +/- 9% and 82 +/- 8% of the initial amplitude after 30 minutes of reperfusion in group 1 and group 2, respectively (p < 0.05). The average neurological score was significantly higher in group 1 than in group 2 in the post-ischaemia period (p < 0.05). Histological observations were clearly correlated with the neurological findings.

CONCLUSION

The results suggest that PTX reduces cerebral injury and preserves neurologic function in transient global ischaemia in rats.

Neuroprotective effects of preischemia subcutaneous magnesium sulfate in transient cerebral ischemia

OBJECTIVE

Neurological injury due to transient cerebral ischemia is a potential complication of cardiovascular surgery. The neuroprotective effect of magnesium, when given subcutaneously before the ischemia, was assessed in a rat model of transient global cerebral ischemia.

METHODS

Thirty-six male Wistar albino rats were included to this randomized, controlled, prospective study. In 24 animals, ischemia was induced with four-vessel occlusion technique with the duration of 15 min. MgSO4 was given 600 mg/kg subcutaneously 48 h before the procedure in group 1 (n = 12). Similar volume of saline solution was used in animals of control group (group 2, n = 12). The animals in group 3 (sham group, n = 12) were anesthetized and subjected to operative dissections without vascular occlusion. Physiological parameters and somatosensory evoked-potentials (SEP) were monitored in animals before ischemia, during ischemia and in the first 30 min of reperfusion. Their neurological outcome had been clinically evaluated and scored up to 4 days postischemia. The intergroup differences were compared. Then the animals were sacrificed and their brains were processed for histopathological examination.

RESULTS

In group 3, SEP amplitudes did not change during the procedures, and all animals recovered without neurologic deficits. At the end of ischemic period, the average amplitude was reduced to 5 +/- 3% of the baseline in all ischemic animals. This was followed by a gradual return to 87 +/- 10% and 83 +/- 8% of the initial amplitude after 30 min of reperfusion in group 1 and group 2, respectively (P > 0.05). The average neurological score was significantly higher in group 1 than in group 2 at 48, 72 and 96 h after the ischemic insult (P < 0.05). Histological observations were clearly correlated with the neurological findings.

CONCLUSION

The results suggest that subcutaneous MgSO4 reduces cerebral injury and preserves neurologic function when given two days before the transient global ischemia in rats.

Aprotinin reduces injury of the spinal cord in transient ischemia

OBJECTIVE

The protective effect of aprotinin, which is a protease inhibitor, was assessed in a rabbit spinal cord ischemia model.

DESIGN

Randomized, controlled, prospective study.

SETTING

University research laboratory.

SUBJECTS

New Zealand white rabbits (36) of both sexes.

METHODS

In 24 animals, ischemia was induced with midline laparotomy and clamping the aorta just distal to left renal artery and proximal to aortic bifurcation for 20 min. Aprotinin was given 30000 KIU as a short intravenous injection after anesthesia, and was followed by 10000 KIU/h by continuous infusion in group 1 (n = 12). Similar volume of saline solution was used in control group of animals (group 2, n = 12). Group 3 of animals (sham group, n = 12) were anesthetized and subjected to laparotomy without aortic occlusion. Physiological parameters and somatosensory evoked-potentials (SEP) were monitored in animals before ischemia, during ischemia and in the first 60 min of reperfusion. Their neurological outcome was clinically evaluated up to 48 h postischemia. Their motor function was scored, and the intergroup differences were compared. The animals were sacrificed after two days of postischemia. Their spinal cord, abdominal aorta, and its branches were processed for histopathological examination.

RESULTS

In group 3, SEP amplitudes did not change during the procedures, and all animals recovered without neurologic deficits. At the end of ischemic period, the average amplitude was reduced to 53+/-7% of the baseline in all ischemic animals. This was followed by a gradual return to 89+/-8 and 81+/-13% of the initial amplitude after 60 min of reperfusion in group 1 and group 2 correspondingly (P > 0.05). The average motor function score was significantly higher in group 1 than group 2 at 24 and 48 h after the ischemic insult (P < 0.05). Histological observations were clearly correlated with the neurological findings.

CONCLUSION

The results suggest that aprotinin reduces spinal cord injury and preserves neurologic function in transient spinal cord ischemia in rabbits.

Ureteral fibroepithelial polyps in children

Fibroepithelial polyps of the ureter presenting as pelviureteric junction (PUJ) obstruction in two boys are reported. These neoplasms are uncommon, especially in children. Surgical excision of the PUJ with the polyp and dismembered pyeloplasty was performed in each case. Postoperative recoveries were uneventful.

The omentum-pedicled intestinal segment: an experimental model for bowel lengthening

Various experiments designed to increase the absorptive surface of the intestine to minimize dependence on total parenteral nutrition in short-bowel syndromes have been challenged by the limitations of the vascular supply to the gut. We have investigated the feasibility of small-bowel lengthening in a rabbit model by creating a neo-mesentery for a segment of jejunum. In this method the serosa of the antimesenteric aspect of the jejunum is removed and a flap of omentum is attached to this surface. Intestinal segments were separated from their original mesentery after 5, 6, and 7 weeks of omental revascularization and specimens examined histologically 24 h after vascular division. Our data support the hypothesis that intestinal segments with both omental and mesenteric pedicles are viable and that the small bowel can be divided longitudinally and remodelled for elongation with the vascular support of the two distinct sources.