The correlation between tumor markers and Ga-68 DOTA-TATE PET/CT findings in patients with advanced medullary thyroid cancer

BACKGROUND

Medullary thyroid cancer is a rare type of neuroendocrine tumor. Calcitonin (Ctn) and carcinoembryonic antigen (CEA) are used as markers for medullary thyroid cancer. The aim of the study was to evaluate the importance of serum Ctn and CEA levels in predicting total tumor volume.

MATERIAL AND METHODS

Ga-68 DOTA-TATE PET/CT findings such as whole-body somatostatin receptor-expressing metabolic tumor volume (SSR-E MTV) and total lesion volume (SSR-E TLV) were calculated and correlation analysis was done for tumor markers and whole-body SSR-E MTV and TLV.

RESULTS

A total of 28 patients with advanced medullary thyroid cancer were included in this retrospective study. In the correlation analysis, there was a statistically significant positive correlation between Ctn and whole-body SSR-E MTV (rho=0.503 and P=.008). Similarly, significant positive correlation was observed between Ctn and whole-body SSR-E TLV (rho=0.436 and P=.023). There was a significant positive correlation between CEA and whole-body SSR-E MTV (rho=0.584 and P=.007). Also, a positive correlation was observed between CEA and whole-body SSR-E TLV (rho=0.436 and P=.023). These correlations were most marked in patients with Ctn≥152pg/mL and/or both nodal and bone involvement.

CONCLUSION

These results could stimulate clinicians to perform Ga-68 PET for treatment decisions, especially in patients with high CEA and Ctn levels at the time of diagnosis.

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts

OBJECTIVE

There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories.

MATERIAL AND METHOD

In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire.

RESULTS

The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers.

CONCLUSION

There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

Comparison of arch width changes following orthodontic treatment with and without extraction using three-dimensional models

OBJECTIVE

To compare the arch width changes in patients treated fixed orthodontic mechanics without extraction (Group 1), with upper and lower first premolar extractions (Group 2), and with upper first premolar extraction only (Group 3).

MATERIALS AND METHODS

The study was conducted with pre- and post-treatment digital models from 240 patients. Anterior, middle, and posterior distances were measured on pre- and post-treatment models. At T1 measurements, the distance among the canine cusp tips, the second premolar buccal cusp tips, and the first molar mesiobuccal cusp tips were measured. In addition, the distance (D) between the intercanine and intermolar lines and the distance (D') between the interpremolar and intermolar lines were defined on the anatomic y-axis, and this distance was maintained in calculating posttreatment measurements (T2). Mandibular and maxillary arch width changes were evaluated within and between groups.

RESULTS

Anterior, middle, and posterior arch widths increased significantly in Groups 1 and 3. Maxillary anterior and middle arch widths also increased in Group 2, but the increases were not statistically significant. Changes in maxillary anterior and middle arch widths were higher in Groups 1 and 3 when compared to Group 2. However, there was no statistically significant difference in mandibular arch changes between the groups.

CONCLUSION

Extraction treatment mechanics did not cause narrow dental arches, but nonextraction treatment increased arch width in all 3 measurements. Treatments with only upper arch extraction showed similar results with nonextraction treatment.

The diagnostic ability of core needle biopsy in nodular thyroid disease

INTRODUCTION Non-diagnostic results of fine needle aspiration biopsy (FNAB) remain an important limitation of this technqiue. The aim of our study was to evaluate the results of core needle biopsy (CNB) of thyroid nodules and its effectiveness in non-diagnostic FNAB cases. METHODS CNBs were performed in 1,000 patients (154 male, 846 female; mean age: 50.2 years, range: 18-86 years) with a spring loaded 20G needle. Of these, 143 had initially had FNABs that were insufficient for evaluation. The CNB reports were reviewed. Patients with suspicious or malignant CNB results underwent total thyroidectomy. RESULTS When considering all 1,000 CNBs, the non-diagnostic rate was 1.5% (15/1,000). However, when the first 100 cases were eliminated as a learning curve, this reduced to 0.9% (8/900). Of the 143 cases with initial FNABs that were non-diagnostic, 0.7% (1/143) were also non-diagnostic on CNB. Twelve patients underwent surgery because of malignant CNB reports and all of these cases were confirmed as malignant by the postoperative pathology specimen results (100% accuracy). There were no major complications although three self-limiting minor complications were observed. CONCLUSIONS CNB is a safe and accurate method. It is more diagnostic than FNAB for nodular thyroid disease.

Immunocytoexpression profile of ProExC in smears interpreted as ASC-US, ASC-H, and cervical intraepithelial lesion

Aims:

We aimed to investigate the immunocytoexpression profiles of a novel assay ProEx C for topoisomerase II alpha (TOP2A) and minichromosome maintenance protein 2 (MCM2) in abnormal interpreted smears.

Settings and Design:

Screening programs with Papanicolaou smear and high risk group human papilloma virus testing have yielded a dramatic reduction of cervical cancer incidence. However, both of these tests have limited specificity for the detection of clinically significant cervical high grade lesions. ProEx C for topoisomerase II alpha (TOP2A) and minichromosome maintenance protein 2 (MCM2) has been considered to have tight association with high grade intraepithelial lesions.

Materials and Methods:

A total number of 54 SurePath cervical cytology specimens of patients previously interpreted as atypical squamous cells–undetermined significance (ASC-US), atypical squamous cells–cannot exclude high grade squamous intraepithelial lesion (ASC-H), low grade squamous intraepithelial lesion (LSIL), and high grade squamous intraepithelial lesion (HSIL) were included in our study.

Results and Conclusions:

ProEx C was positive in 14 of HSILs (100%), 3 of 19 LSILs (16%), 2 of 4 ASC-Hs, and none of ASC-USs (0%). The ProEx C test showed very intense nuclear staining in all cytologically abnormal cells. Further studies are indicated to evaluate the diagnostic role of ProEx C.

Primary pancreatic lymphoma: A rare cause of pancreatic mass

Primary pancreatic lymphoma (PPL) is a rare entity, most likely to be clinically misdiagnosed as pancreatic cancer. The cure rate of PPL is higher compared with that of pancreatic adenocarcinoma. This is the case report of a 57-year-old male patient who was hospitalized with complaints of abdominal pain, weight loss and jaundice. The radiological evaluation revealed a pancreatic head mass and, following endoscopic ultrasound-guided fine-needle aspiration biopsy, the tumor was diagnosed as diffuse large B-cell lymphoma. The final diagnosis was PPL, and the patient went into remission after receiving three cycles of treatment with rituximab, doxorubicin, cyclophosphamide, vincristine and prednisolone (R-CHOP regimen). Therefore, PPL should be considered in the differential diagnosis of pancreatic masses and its management differs from that of other types of pancreatic tumor.

New thyroid fine needle aspiration biopsy needle. Prospective, randomized, clinical study

Nodular disease of thyroid in the adult population is common [1]. Estimated prevalence of thyroid nodules on the basis of palpation ranges from 3% to 7% [2]. During the past two decades, according to widespread use of ultrasonography (US) for evaluation of thyroid and nonthyroid neck diseases prevalence of clinically inapparent thyroid nodules is increased, estimated at 20% to 76% in the general population [3,4]. This article is protected by copyright. All rights reserved.

Effects of the Chemokine Receptor 5 (CCR5)-Delta32 Mutation on Hepatitis C Virus-Specific Immune Responses and Liver Tissue Pathology in HCV Infected Patients

BACKGROUND

The specific antiviral T cells provide CC chemokine receptor 5 (CCR5) for the immune response during the hepatitis C virus (HCV) infection. Heterogenous and/or homozygous 32 base pair deletion in CCR5 gene (CCR5Δ32 bpdel) leads to reduced protein expression.

OBJECTIVES

In the current case control study, we aimed to compare the histopathological findings of liver to the CCR5Δ32 bpdel mutation profiles, expression and some other clinical findings in patients with chronic HCV infection.

MATERIALS AND METHODS

Multiple Strip Assay reverse hybridisation and Real Time PCR techniques were used to determine the germline CCR5 mutations and immunohistochemical technique was used to evaluate the gene expression in targer tissue biopsies.

RESULTS

Target CCR5 WT/WT, WT/Δ32, and Δ32/Δ32 genotypes were observed in 91.4%, 8.6% and 0.0% for HCV positive patients and 98.3%, 1.7% and 0.0% for control group respectively. The histologic activity index (HAI) was significantly lower (4.0 ± 1.0) in the mutated group than the non-mutated group (5.7 ± 1.0). Decreased fibrosis levels were detected in HCV positive mutated group.

CONCLUSIONS

Results showed that CCR5 polymorphism was more frequent in HCV positive patients than in healthy population in Turkish population. Current results also showed that mutated CCR5 signalling pathway due to CCR5-Delta32 may potentially result in subtle reduction of HCV specifity to the drug responses due to the positive impact on liver inflammation, fibrosis levels and liver destruction in HCV infection.

Prevalence of sleep disturbance in chronic pain

OBJECTIVE

Sleep is a vital function for human beings, which can be affected by several factors. Chronic pain is one of these factors where it is the most frequent cause for seeking medical care in combination with insomnia. The aim of this study is to examine the prevalence and relationship between sleep disturbance and chronic pain.

PATIENTS AND METHODS

After approval, a total of 85 Family Medicine Units from over 170 in Tokat were randomly selected using a 50% sampling. A sample of 2635 subjects, over the age of 19 years, who were registered with the selected Family Medicine Units, were assessed due to gender, age group, and the urban/rural population size of Tokat using the stratified sampling method. The sample size distribution was calculated as 1515 urban subjects, 1120 rural subjects; 1345 female subjects, 1290 male subjects; 1123 subjects between 20-39 years of age, 1103 subjects between the ages of 40-64, and 409 subjects over 64 years of age. After sampling, subjects were invited to participate in the study via an invitation letter, and agreeing individuals were taken to the Family Medicine Unit for face-to-face meetings. Written, informed consent was obtained, along with demographic data. The presence of chronic pain was recorded. According to the presence of chronic pain, all subjects were separated into two groups as Group Chronic Pain and Group Non-Chronic Pain. The visual analog scale for pain intensity, and Pittsburgh Sleep Quality Index for sleep quality, were performed with all subjects. A multiple linear regression model was used to assess the predictors of sleep quality. Analyses were conducted using the Statistical Package for Social Sciences program (SPSS Inc., Chicago, IL, USA), version 20.0. The statistical significance for all analyses was set at p < 0.05.

RESULTS

The mean global Pittsburgh Sleep Quality Index score of Group Chronic Pain (5.30 ± 4.29) was significantly higher than in Group Non-Chronic Pain (3.22 ± 3.30; p < 0.01). The mean Pittsburgh Sleep Quality Index scores of females (5.69 ± 4.40) were significantly higher than males (4.54 ± 3.96) in Group Chronic Pain (p = 0.000045). A total of 40.7% of patients in Group Chronic Pain, and 21.9% in Group Non-Chronic Pain demonstrated poorer sleep quality according to the Pittsburgh Sleep Quality Index scores, with a cut-off level > 5. A moderate positive correlation was found between the global Pittsburgh Sleep Quality Index and Visual Analog Scale scores (r = 0.310, p < 0.01). A multiple linear regression analysis showed that age, gender, income, Visual Analog Scale, and presence of depression were the significant predictors for Pittsburgh Sleep Quality Index score.

CONCLUSIONS

The current study revealed that chronic pain and pain intensity are important predictors of sleep quality.

Effects of isoflurane in an intoxication model: experimental study

BACKGROUND

Isoflurane is a volatile anaesthetic that has been commonly used since 1980. The major metabolites of isoflurane are fluoride ion and trifluoroacetate, both excreted in the urine.

AIM

This study manage to show the histopathological findings of ingested isoflurane on liver, kidney and lugs in an animal model. Twenty-one rabbits were selected and divided into three groups: Group Isoflurane-5 (I-5); Group Isoflurane-10 (I-10); and Group Control (C). Each group consisted of seven rabbits. I-5 and I-10 received 5 ml/kg and 10 ml/kg of liquid isoflurane, respectively, via nasogastric tube, while C received 5 ml/kg saline (0.9% NaCI). All animals in I-5 and I-10 were sacrificed without anesthetic drug administration. Tissue samples from livers, kidneys and lungs were collected, preserving tissue unity and avoiding infliction of any trauma. Samples were fixed in 10% formalin solution, embedded in paraffin blocks and sliced into 5 μm sections. To investigate the effects of isoflurane, sections were examined under light microscope and histopathological changes were scored.

RESULTS

Mean injury scores and the appearance of portal lymphocyte infiltration in liver samples showed significant increases in I-5 and I-10 compared to C (p = 0.005, p = 0.001 and p = 0.001, respectively). Mean lung injury scores revealed significant increases after isoflurane treatment in I-5 and I-10 compared to C (p = 0.026 and p = 0.017, respectively).

CONCLUSIONS

Ingested isoflurane led to mild liver and lung injuries in rabbits.

Prospective, randomized, double-blinded comparison of the effects of caudally administered levobupivacaine 0.25% and bupivacaine 0.25% on pain and motor block in children undergoing circumcision surgery

BACKGROUND

Caudal anesthesia is widely used as intraoperative and postoperative analgesia in children's subumbilical surgeries such as on the urogenital system, lower extremities and lower abdomen to reduce the stress response to surgery and to facilitate the general anesthesia.

AIM

The purpose of this study was to compare the effects of caudally administered bupivacaine and levobupivacaine of equal volume and concentration on motor block and postoperative pain in children undergoing circumcision surgery.

PATIENTS AND METHODS

The prospective, randomized, double-blind study included 60 patients with ages ranging from 1-10 years and ASA (American Society of Anesthesiologists) physical status of I-II who underwent elective circumcision surgery. The patients were divided into two groups: group B received 0.5 ml/kg of bupivacaine 0.25% caudally and group L received 0.5 ml/kg of levobupivacaine 0.25% caudally. Postoperative pain was assessed by children's and infant's postoperative pain scale and motor block was assessed by the Bromage scale.

RESULTS

The mean children's and infant's postoperative pain scale of group B was significantly lower than that of group L (p < 0.001). Three patients in group B and seven patients in group L needed additional analgesia after the incision. There was no significant difference between groups in terms of Bromage scores and in both groups the residual motor block was found to be zero at the 150th minutes.

CONCLUSION

According to these findings, bupivacaine has an adequate quality of analgesia than levobupivacaine. We suggest that bupivacaine for caudal block at the concentration of 0.25% (0.5 ml/kg) provides an adequate level of analgesia for outpatient circumcision surgery.

Immunohistochemistry with apoptotic-antiapoptotic proteins (p53, p21, bax, bcl-2), c-kit, telomerase, and metallothionein as a diagnostic aid in benign, borderline, and malignant serous and mucinous ovarian tumors

Background

In many tumors including ovarian cancer, cell proliferation and apoptosis are important in pathogenesis and there are many alterations in most of the genes related to the cell cycle. This study was designed to evaluate immunohistochemistry with apoptotic-antiapoptotic proteins (p53, p21, bax, and bcl-2), c-kit, telomerase, and metallothionein as a diagnostic aid in typing of benign, borderline, and malignant serous and mucinous ovarian tumors.

Methods

Total of 68 ovarian tumors, 25 benign [13 (19.1%) serous and12 (17.6%) mucinous], 16 borderline [9 (13.2%) serous and 7(10.3%) mucinous], and 27 malignant ovarian tumors [24 (35.3%) serous and 3 (4.4%) mucinous tumors] were included in the study. Immunohistochemical expression of p53, p21, bax, bcl–2, telomerase, c-kit, and metallothionein were evaluated.

Results

When all 68 cases were evaluated as benign, borderline, and malignant ovarian tumors without considering histopathological subtypes, the p53, p21, bax and metallothionein showed significantly higher staining scores in the borderline and malignant ones (p < 0.05). After evaluation of all 68 cases, the serous tumors showed significantly higher staining scores of p53, p21, c-kit, and metallothionein compared to the mucinous ones (p < 0.05). For differentiation of benign and borderline and malignant tumors combined, p53 was not used because all benign tumors has no staining, and p21, bax, and metallothionein was determined the significant predictors for borderline and malignant tumors combined (p < 0.05). For differentiation of borderline and malignant tumors, only p53 was determined the significant predictor for malignant tumors (p < 0.05).

Conclusions

In conclusion, p53, p21, bax, c-kit, and metallothionein may be helpful for the typing of ovarian tumors as benign, borderline and malignant or serous and mucinous. p53, p21, bax, c-kit, and metallothionein may have different roles in the pathogenesis of ovarian tumor types. p53 and metallothionein may be helpful in the typing of borderline and malignant ovarian tumors. The immunohistochemical staining with bcl-2 and telomerase may not provide meaningful contribution for the typing of ovarian tumors.

Virtual slide

The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2013030833768498

Expression of p16 protein and cyclin D1 in periampullary carcinomas

OBJECTIVE

The majority of the tumors in periampullary region are pancreatic and ampulla of Vater carcinomas. The aim of this study was to compare histopathological features of ampulla of Vater carcinomas with pancreatic ductal adenocarcinomas and to determine diagnostic and predictive values of p16 protein and cyclin D1 expression.

MATERIAL AND METHOD

Tissue samples from pancreatic ductal adenocarcinomas and ampulla of Vater carcinomas were obtained from 31 patients who underwent pancreticoduodenectomy for periampullary carcinoma. The study group was composed of 12 women and 19 men. Their median age was found to be 62.32 years (range 26-85 years). The parameters analyzed in the study included lymph node metastases, perineural invasion, differentiation, duodenal invasion, grade of intraepithelial neoplasia and p16 and cyclin D1 expression in tumoral and peritumoral pancreatic tissues.

RESULTS

In both tumor groups, the loss of p16 protein expression was significantly correlated with perineural invasion (p = 0.0001). Perineural invasion was more frequent in the pancreatic ductal adenocarcinoma group than the ampulla of Vater carcinoma group (p = 0.01). When desmoplasia and lymphoplasmacytic stromal infiltration were examined, desmoplastic reaction was significantly higher in pancreatic ductal adenocarcinomas than ampulla of Vater carcinomas (p = 0.01). No significant difference was observed between tumor groups for Cyclin D1 (p > 0.05).

CONCLUSION

The results suggest that loss of p16 protein expression may be a sign for poor prognosis in periampullary cancers that is correlated mainly with perineural invasion. Desmoplastic stromal reaction may be a distinctive feature for pancreatic ductal adenocarcinoma compared with ampulla of Vater carcinoma.

Small bowel tumors in emergency surgery

BACKGROUND

The aim of the present study was to describe the clinical presentation, diagnostic work-up, surgical therapy, and prognosis of 13 patients with small bowel tumor admitted for surgical procedures in an emergency setting.

METHODS

From 1996 to 2008, 13 consecutive surgical cases of small bowel tumors were treated at the Cumhuriyet University Faculty of Medicine, Department of General Surgery, and Kütahya State Hospital, Department of General Surgery. Clinical and radiological charts of these patients were reviewed retrospectively from the department database.

RESULTS

Intestinal obstruction (7 cases) and perforation (5 cases) were the most common clinical presentations, followed by intussusception (1 case). Adenocarcinoma was the most frequent histologic type (4 cases), while small bowel sarcoma was seen in three cases and non-Hodgkin lymphoma in two cases. The remaining cases had carcinoid tumor, small bowel angioleiomyoma, Brunner's gland adenoma, and inflammatory pseudotumor of the small intestine.

CONCLUSION

Small bowel tumors are rare, the symptoms often non-specific, and the accuracy of different diagnostic tests remains to be improved. Timing and type of the intervention to the process and biological behavior of the pathological cells predict the prognosis.

Epigenetic inactivation of tumor suppressor SFRP2 and point mutation in KRAS proto-oncogene in fistula-associated mucinous type anal adenocarcinoma: report of two cases

The secreted frizzled-related proteins (SFRPs) genes are unmethylated in normal colorectal mucosa tissue but aberrant methylation profiles can be detected in colorectal cancer (CRC), adenomas, and in aberrant crypt foci. The aim of the current study was to clarify whether SFRP2 methylation and K-ras structural mutation in fecal DNA can be found in stool and tumoral tissues of individuals with fistula-associated mucinous type anal adenocarcinomas (MTAA).Two man patients (68 and 56 years old) were treated for anorectal fistula in the surgical department. Patients were evaluated for clinical findings, tumoural tissue samples were examined histopathologically and DNA from fecal and tumoral tissue samples were isolated. K-ras mutation and promoter hypermethylation of SFRP2 gene in tumoral tissues were assessed by methylation-specific PCR based stripAssay hybridisation technique (Me-PCR) and compared to the healthy controls. Fecal and tumoural tissue samples from both patients were found to be fully hypermethylated profiles for SFRP2 gene and combined point mutations were detected in codon 12 and 13 of K-ras proto-oncogene. The current results showed that the combined effects of somatic mutations in K-ras and epigenetic alterations in SFRP2 genes may play an active role in the development of mucinous type anal adenocarcinoma.

Effects of contrast media on the hepato-pancreato-biliary system

AIM: To determine the effects of high osmolarity contrast media (HOCM) and iso-osmolar contrast media (CM) application, with or without pressure, on hepato-pancreato-biliary (HPB) system.

METHODS: Sixty rats were divided into six equal groups as follows: Group 1: (0.9% NaCl, control), Group 2: (diatrizoate meglumine Na, ionic HOCM, Urographin^®), Group 3: (iodixanol, iso-osmolar non-ionic CM, Visipaque^®); each of which was applied without pressure, whereas the animals of the remaining three groups (1p, 2p, 3p) were subjected to the same CM with pressure. We performed a duodenal puncture and introduced a catheter into the ampulla. After the catheterization, 0.2 mL CM or 0.9% NaCl was injected with or without pressure. Blood samples were taken for biochemical evaluations. The histopathological examinations of liver, common bile duct, and pancreas were performed.

RESULTS: There were no significant differences between the six groups for blood amylase, alanine aminotransferases, aspartate aminotransferases, bilirubin levels (P > 0.05). Alkaline phosphatase and γ glutamyl transaminase levels were higher (P < 0.05) in the Urographin^® groups (2, 2p) than the Visipaque^® groups (3, 3p), or control groups (1, 1p). Hepatocyte necrosis, portal area inflammation, and Kupffer’s cell hyperplasia were higher (P < 0.05) in the study groups than the control group. However, there were no significant differences (P > 0.05) between HOCM (2, 2p) and iso-osmolar CM (3, 3p) groups. Bile duct proliferation and regeneration in the Urographin^® groups (2, 2p) were significantly higher (P < 0.05) than the Visipaque^® groups (3, 3p) or the control groups (1, 1p). Although CM caused minor damage to the pancreas, there were no statistically significant differences (P > 0.05) between the groups. Application of the CM with pressure did not cause additional damage to the HPB system.

CONCLUSION: Iso-osmolar, non-ionic CM could be more reliable than the ionic HOCM, whereas the application of pressure during the CM application had no effect on the HPB system.

Expression of claudin-4 and beta-catenin in gastric premalignant lesions

BACKGROUND AND STUDY AIMS

Abnormal expression of claudin-4 and beta-catenin play a role in carcinogenesis. The purpose of the present study was to examine claudin-4 and beta-catenin expression in normal and precancerous gastric mucosa.

PATIENTS AND METHODS

Endoscopic biopsy specimens [normal gastric mucosa (n = 22), intestinal metaplasia (n = 24), dysplasia (n = 18), Helicobacter pylori (H. pylori)-associated chronic gastritis (n = 32) and remnant gastric mucosa (n = 18)] obtained from different 114 patients were examined by immunohistochemistry.

RESULTS

Claudin-4 expression was present in 94.4% of dysplasia, 87.5% of intestinal metaplasia, 62.5% H. pylori-associated chronic gastritis, and 88.9% remnant gastric mucosa but only 18.2% of normal gastric mucosa biopsies. Decreased expression of beta-catenin was present in 27.8% of dysplasia, 8.3% of intestinal metaplasia, 15.6% of H. pylori-associated chronic gastritis, and 22.2% of remnant gastric mucosa biopsies, but was not present in normal gastric mucosa. When compared with normal gastric mucosa, there was a significant difference in claudin-4 expression in all groups (P < 0.05), but a significant difference was detected in dysplasia and remnant gastric mucosa for beta-catenin (P < 0.05).

CONCLUSIONS

Our results suggest that claudin-4 expression is upregulated in premalignant gastric alterations.

Effects of NO/L-arginine pathway on gallbladder contractility in bile duct ligated guinea pigs

BACKGROUND

Common bile duct ligation (CBDL) produces gallbladder distension and acute inflammation similar to that seen in human acute acalculous cholecystitis. CBDL in the guinea pig affects smooth muscle contractility. The aim of this study was to determine whether the nitric oxide-L-arginine pathway plays a role in the inflammatory process and abnormal gallbladder contractility that occur after CBDL.

MATERIALS AND METHODS

Contractility of gallbladder muscle from CBDL and sham-operated guinea pigs was studied in vitro. Animals were treated with saline, aminoguanidine (AG), or an aminoguanidine + L-arginine combination (AG + L-Arg) in vivo. Potassium chloride, carbachol, and electric field stimulation (EFS) were used for contracting the gallbladder muscle strips or activating intrinsic nerves. Hematoxylin and eosin-stained slides of muscle strips were scored for inflammation.

RESULTS

Contraction responses to carbachol and EFS were decreased significantly in CBDL guinea pigs compared with those in the sham-operated group. AG partly reversed the smooth muscle contractile response to carbachol and EFS, but did not reduce the inflammation score. Treatment with AG + L-arg did not reverse either the contraction response or the inflammation score.

CONCLUSIONS

These findings suggest that AG and AG + L-Arg treatments have no beneficial effect on inflammation in guinea pigs after CBDL, although AG significantly reversed the effect on muscle contractility (P < 0.05). This improvement was independent of inflammation and may be due to a decreased level of NO and its diminished relaxant effect.

Effect of angiotensin-converting enzyme inhibition on experimental hepatic fibrogenesis

The renin-angiotensin system is suggested to be important in liver fibrogenesis. It induces hepatic stellate cell proliferation and up-regulates transforming growth factor beta-1 (TGF-beta1) expression. Matrix metalloproteinase-2 (MMP-2) is involved in extracellular matrix remodelling. Fibrosis, a consequence of most chronic liver diseases, may be the result of a disturbed balance between fibrogenesis and fibrolysis. The aim of this study was to investigate the effect of enalapril on liver fibrogenesis induced in rats by bile-duct ligation. Forty-seven rats were divided into two groups: bile-duct ligated (BDL) (n = 24) and BDL + enalapril (n = 23). Fibrosis was evaluated by the Knodell scoring system, and TGF-beta1 and MMP-2 were assessed with immunohistochemistry at the second, fourth and sixth weeks after bile-duct ligation. In the BDL group, TGF-beta1 increased by the second week and this increase continued through weeks 4 and 6. In the BDL + enalapril group, TGF-beta1 was significantly lower than the other group (P < 0.05). MMP-2 progressively decreased after week 2 in the BDL group. In the BDL + enalapril group, MMP-2 was significantly higher than the BDL group at the fourth and sixth weeks. These results suggest that enalapril reduces the liver tissue TGF-beta1 and has an ameliorating effect on the fibrosis markers TGF-beta1 and MMP-2.

Supernumerary ovary on sigmoid colon resembling an endometriotic lesion

A 30-year-old woman with a history of endometriosis and chronic pelvic pain had right-sided pain and sonographic evaluation demonstrated a right ovarian cyst 5 cm in diameter. Laparotomy revealed a right ovarian cystic mass and the cystic mass was found on the sigmoid colon. After excision, histopathologic study revealed endometrioma for the ovarian cyst and a supernumerary ovary for the cystic mass on the sigmoid colon.

Investigation of the effects of heparin and low molecular weight heparin on E-cadherin and laminin expression in rat pregnancy by immunohistochemistry

BACKGROUND

Heparin and low molecular weight heparin (LMWH) are used widely to improve the pregnancy outcome in women with thrombophilia, miscarriage, recurrent miscarriage and fetal death. This study was designed to investigate the effects of heparin and LMWHs, enoxaparin and tinzaparin, on E-cadherin and laminin expression in placental and decidual tissues in rat pregnancy.

METHODS

Wistar albino female rats (n = 48) were randomly assigned to four study groups (normal saline, heparin, enoxaparin and tinzaparin) in the preconceptional period. Tissue sections of placenta and decidua were immunohistochemically examined for the expression of E-cadherin and laminin.

RESULTS

E-cadherin placental staining score of heparin group was significantly lower and E-cadherin decidual staining score of heparin and enoxaparin groups were significantly lower than control group. There were no significant differences in placental and decidual laminin staining scores among the study groups.

CONCLUSIONS

Heparin and enoxaparin can reduce E-cadherin expression but not laminin expression in rat pregnancy. They might modulate trophoblast invasion. We suggest that this is the possible underlying mechanism involving in improvement of trophoblast invasion by the use of heparin and LMWH in patients with the history of miscarriage.

In vitro comparison of biomechanical characteristics of sagittal split osteotomy fixation techniques

The aim of the present study was to compare the biomechanical stability of 10 different fixation methods used in sagittal split osteotomy. Twenty-five fresh sheep mandibles were stripped of all soft tissues and sectioned at the midline. A sagittal split osteotomy with 5mm advancement was performed on each hemimandible. The hemimandibles were randomly divided into 10 groups of 5, and then fixed with 5 different bicortical screws, 4 different miniplates with or without bicortical screws, and 1 resorbable screw configuration. All specimens were mounted on a specially designed 3-point biomechanical test model and compression loads were applied using the Lloyd LRX testing machine until 3mm displacement was reached. Load/displacement data were gathered and compared using the Mann-Whitney U-test with Bonferroni correction (P<0.01). The 3 bicortical screws in an inverted backward-L pattern provided the most biomechanical stability of the screw patterns tested. The miniplate fixed obliquely with 2 bicortical screws in the proximal segment provided the most biomechanical stability of the miniplate groups.

The intratumoral microvessel density and expression of bFGF and nm23-H1 in colorectal cancer

It has previously been reported that intratumoral microvessel density (IMD), and the expression of bFGF and nm23-H1 are useful prognostic markers in colorectal cancer (CRC). In this study, a total of 100 CRCs were evaluated histopathologically, and IMD, bFGF and nm23-H1 expression were assessed by immunohistochemistry. IMD of patients increased with grade and stage, and this increase was statistically significant (p<0.05). A significantly higher incidence of high bFGF expression scores was also associated with increasing grade and stage (p<0.05). However, there was no significant difference between the grades in nm23-H1 expression (p=0.234). nm23-H1 expression occurred with lower incidence in stages C1, C2 and D than in stages B1 and B2 (p<0.05). Thus, a negative correlation was found between nm23-H1 expression and stage or lymph node metastasis (LNM) (p<0.05). IMD and bFGF expression were positively correlated with grade, stage, LNM, and lymphovascular invasion. Although positive correlation was found between IMD and bFGF, nm23-H1 expression negatively correlated with both of them. As a result, in clinical practice, increased IMD and bFGF expression and decreased nm23-H1 expression may provide valuable information in characterizing the malignant phenotype.

Effects of sandblasting metal bracket base on the bond strength of a resin-modified glass ionomer cement: an in vitro study

The introduction of air abrasion (sandblasting) technology to orthodontics may allow reaching optimum bond strength between the metal bracket and resin-modified glass ionomer cement. This study examined the effects of sandblasting metal bracket bases on the in vitro tensile bond strength of a resin-modified glass ionomer cement. Two-hundred foil-mesh based brackets were divided into ten groups and combinations of three sizes of aluminum oxide powder (25, 50 and 110 microm) and three sandblasting times (3, 6 and 9 seconds) were tested. One group was not sandblasted and used as control. Analysis of variance showed that bond strength was significantly affected by the sandblasting time (p < 0.001) and size of the aluminum oxide powder (p < 0.001). Only the group (SO(25)) sandblasted with 25 microm aluminum oxide powder for 3 seconds yielded higher mean bond strength than that of the control group. The bond strength values were also analyzed using a Weibull analysis, which showed the most favorable size (25 microm) and time combination (3 seconds), and the 5% and 90% probabilities of failures. This study suggests that sandblasting time and particle size have and important effect on the bond between the metal bracket and resin-modified glass ionomer cement.

An easy way of intruding an upper central incisor

Discrepancies of the incisal edges of the anterior teeth, particularly in the upper jaw, could adversely affect dental aesthetics. This paper presents an easy and straight forward treatment of such a case, which was accomplished taking the patient's demands and profession into consideration. In dentistry, the social status of the patient could affect the treatment plan.

Atypical presentation of an unusual lung tumor

We describe a case of a rare bronchial epithelial- myoepithelial carcinoma of the lung in a 36-year-old man. Tumor enucleation was carried out and the patient was put on long-term follow up. Tumor categorisation was difficult. The patient is disease-free on the 30th postoper- ative month. The clinicopathological uniqueness of this neoplasm is reviewed.

A prospective randomised cross-over study of the effect of local haemostasis after third molar surgery on facial swelling: an exploratory trial

OBJECTIVE

This study was undertaken in order to evaluate the effects of local haemostasis on the facial swelling induced in patients undergoing surgical removal of impacted mandibular third molar teeth.

DESIGN

A prospective randomised cross-over study.

SETTING

Department of Oral and Maxillofacial Surgery, Samsun, Turkey, 2002.

MATERIALS AND METHODS

Twenty-five healthy patients who were having bilaterally symmetric, impacted third molar extraction were studied. The teeth were removed in two separate operations by two surgeons who had equal academic degrees. The patients were assigned to test and control groups by random selection. One side served as control and on the other local haemostasis was achieved by a haemostatic agent (oxidised regenerated cellulose). This was placed into the socket following gauze packing for 3 minutes (test). The operating time therefore significantly increased in the test group. Data was collected regarding the operating time, mouth opening and facial swelling.

RESULTS

There were no statistically significant differences between the test and control groups for the mean values of the facial swelling and mouth opening at day 1 and 3 post-operatively (P > 0.05). Operating time was statistically longer for the test group than the control (P < 0.001).

CONCLUSION

This study has shown that establishment of local haemostasis after removal of impacted mandibular third molars is not so effective in preventing facial swelling.

Sigmoid colon perforation as an unusual complication of Behçet's syndrome: report of a case

A 47-year-old man with long-standing Behçet's syndrome presented with an acute abdomen, and was found to have perforation of the sigmoid colon. Laparotomy revealed gangrenous changes in the sigmoid colon and perforation in the center of the affected segment. This is a very rare complication of Behçet's disease, and we report this case to stress the importance of performing careful abdominal examination while evaluating patients with Behçet's disease.

Pancreatic pseudotumor due to peripancreatic tuberculous lymphadenitis

Peripancreatic tuberculous lymphadenitis is a very rare and difficult diagnosis. We report herein a patient with a clinically solitary abdominal tuberculoma. A 68-year-old woman was admitted to our hospital with moderate-level obstructive jaundice due to a mass located between pylorus and head of the pancreas. There were no clinical signs or symptoms of tuberculosis in lungs or abdomen. After the diagnosis of a neoplasm of the pancreas was made, exploratory laparotomy was performed which revealed a conglomerated mass penetrating into the pancreas. Since an exact diagnosis could not be reached on the basis of frozen sections prepared during the operation, a standard Whipple procedure was performed. After the histopathological examination of the resected specimen revealed tuberculous lympadenitis, the patient was given antituberculous medication. The patient recovered well. An abdominal tuberculoma is often mistaken for a malignant neoplasm, and nonsurgical diagnosis and treatment of this entity continues to be a challenge.

Oral findings in a typical case of achondroplasia

We report a 16-year-old boy who had all the typical manifestations of achondroplasia but also had a skeletal and dental class III malocclusion, a narrow maxilla, macroglossia and an open bite between the posterior teeth. The narrow maxilla and bilateral cross-bite were treated with rapid palatal expansion. The open bite and irregular teeth were corrected with fixed orthodontic treatment, taking account of the macroglossia. This case is of clinical interest since dental class III malocclusion, posterior open bite, macroglossia and benign migratory glossitis have not previously been reported in achondroplasia.

Histopathological changes in ovary and endometrium after tubal ligation: a rat model

BACKGROUND

To evaluate the histopathological effects of tubal ligation on ovary and endometrium in a rat model.

METHODS

Twenty-four female Wistar albino rats weighing 220-260 g were used. The rats were assigned randomly into tubal ligation and control groups. While tubal ligation was applied to the first group of rats, only a laparotomy was performed in the second group. Six weeks later, a second laparotomy was performed and uterine horns and ovaries of the rats in the two groups were excised for histopathological assessment. A pathologist blinded to the groups made histopathological examination including quantification of endometrial phases, presence of endometrial inflammation and counting the number of tertiary follicles and corpora lutea in each ovary.

RESULTS

We found no significant difference between tubal ligation and control groups related to the number of tertiary follicles and corpora lutea (p > 0.05). However, in the tubal ligation group, endometrial inflammatory infiltration was significantly higher than in the control group (p < 0.05).

CONCLUSION

Tubal ligation does not affect ovarian histology as an indicator of ovarian function. However, endometrial inflammation may occur after tubal ligation and lead to menstrual irregularities as an early complication.

First-trimester diagnosis of Robinow syndrome

We present 2 cases with Robinow syndrome in a nonconsanguineous Turkish couple. The first case, second living child of the family, has all of the cardinal features of this syndrome including short stature, mesomelic shortening of forearms, frontal bossing, hypertelorism, anteverted nares, triangular mouth, hypoplastic genitalia and vertebral and costal anomalies. The second case was diagnosed with first-trimester ultrasonographic findings such as shortening of extremities and increased nuchal translucency thickness at 12 + 4 weeks of gestation, and the family wished to terminate this pregnancy. After abortion, we obtained findings such as typical face features, shortening of forearms, ambiguous genitalia suggesting Robinow syndrome with autopsy examination.

Prevalence of Helicobacter pylori in patients with primary hyperparathyroidism

Dyspeptic symptoms are common in patients with primary hyperparathyroidism (PHPT) and have been attributed to hypercalcemia; however, they may also become permanent after parathyroid surgery. We aimed to evaluate the prevalence of Helicobacter pylori in patients with PHPT and to see whether there is a relationship between dyspeptic complaints and H. pylori infection. Of 21 patients with PHPT, 18 patients had dyspeptic complaints. These 18 female patients with PHPT and dyspeptic symptoms were the study population, and 20 female volunteers with dyspeptic symptoms were the controls. An endoscopic examination was performed in all controls and in patients before parathyroid surgery. H. pylori was assessed by serological and histological evaluation. H. pylori was identified upon histological evaluation in 17 patients (94.4%) and serologically in 17 patients (94.4%). Active macroscopic and microscopic gastritis were found in 15 (83.3%) and in 17 (94.4%) of the patients, respectively. In the control group, H. pylori was identified histologically in 13 subjects (65%) and serologically in 17 subjects (85%). The prevalence of H. pylori assessed by histological examination was significantly (P < 0.05) different between patients and controls. There was a significant association between H. pylori infection identified by histology and/or serology and the presence of microscopic (r = 1; P < 0.001), as well as macroscopic (r = 0.54; P < 0.05), gastritis. In conclusion, this study showed that H. pylori infection was found frequently (85.7%) in patients with PHPT. In the management of PHPT with or without surgery, patients, especially those with dyspeptic symptoms, should be evaluated for H. pylori infection, which can be effectively eradicated by appropriate therapy.

The force levels required to mechanically debond ceramic brackets: an in vitro comparative study

The in vitro force levels generated by four differing methods of mechanical debonding techniques for ceramic brackets, using debonding pliers, were measured. The forces generated using wide (method W) and narrow blades (method N) were compared with those generated using a diagonally opposite corner application of the wide blades (method C) and incisal-gingival application of a pair of pointed blades (method P). Chemically retained ceramic brackets (Transcend) were bonded to bovine teeth using a filled, two-paste, chemically cured composite (Concise). After 24 hours storage at 37 degrees C in water, each specimen was subjected to one of the four mechanical debonding methods in a custom-built jig, simulating the clinical application of conventional debonding pliers. A one-way ANOVA with a Tukey's honestly significant difference test revealed statistically significant differences in debonding strengths between the four methods at the 0.05 level of significance. The mean debonding strength generated by method C was 40 and 25 per cent lower than that for methods W and N, respectively. Scoring of the adhesive remnant index (ARI) revealed that the predominant bond failure site was at the bracket/adhesive interface for all groups. Macroscopically, no enamel damage or bracket fractures were observed.

Detection and genotyping of Epstein-Barr virus by polymerase chain reaction in tissues obtained from cases with Hodgkin's disease in Turkey

In order to determine the positivity rate and genotype of Epstein-Barr virus (EBV) in cases with Hodgkin's disease (HD) in Turkey, 40 tissue specimens from HD patients were analysed. Ten non-lymphoid tissue samples from individuals without any evidence for lymphoma were used as controls. The cases with HD included 33 males and 7 females with a mean age of 28 years. Nodular sclerosis was the most prevalent histological subtype (16/40) followed by mixed cellularity (10/40), lymphocyte predominance (9/40), and lymphocyte depletion (5/40). After histopathological evaluation, deparafinisation and lysis of the specimens, one-stage polymerase chain reaction (PCR) and two-stage (nested) PCR assays were performed with the primers common for both EBV genotypes and the primers specific for EBV types 1 and 2, respectively. EBV DNA was detected in 22 of 40 (55%) cases with HD and in 1 of 10 (10%) control specimens. The distribution of EBV DNA positivity according to the histological subtypes was as follows: 10 of 16 (62.5%) for nodular sclerosis, 3 of 5 (60%) for lymphocyte depletion, 5 of 9 (55.6%) for lymphocyte predominance, and 4 of 10 (40%) for mixed cellularity. Although most of the HD patients were males of 15-34 years of age, there were no significant differences between EBV positivities obtained from different sex and age groups. The rates of EBV genotypes were 82% for type 1, 9% for type 2, and 9% for both types, respectively.

Porous ceramic lamellae for orthodontic ceramic brackets: part II: in vitro performance testing

This study was undertaken to test a new and original orthodontic bracket base, consisting of a porous lamella, which was designed to facilitate removal of ceramic brackets from the enamel surface after treatment. In the phase of the study presented here, two types of lamella and the adhesive resin used to bond them to brackets and teeth, were evaluated in vitro. Two types of test were carried out on bracketed teeth. The tensile bond strength was measured for specimens that had been either kept in water for 24 h at 37 degrees C or subjected to 18000 cycles in water between 6 degrees C and 55 degrees C. The stress required to remove brackets with debracketing pliers was measured and the mode of failure recorded for specimens that had been kept in water for 24 h at 37 degrees C. The results indicate that bracket/lamella assemblies can be bonded to enamel sufficiently strongly for clinical application and can be safely removed without damage to enamel.

Porous ceramic lamellae for orthodontic ceramic brackets: part I: fabrication and characterization

This study was undertaken to test a new and original orthodontic bracket base, consisting of a porous lamella, which was designed to facilitate removal of ceramic brackets from the enamel surface after treatment. In the phase of the study presented here, porous pellets were made by bonding coarse alumina particles (calcined or fused) with mullite, formed by their reaction with fine quartz particles during firing of the mixture at 1700 degrees C. After machining the pellets to the desired shape, nine types of lamellae with different porosities were attached to the brackets using two different adhesive resins, and also bonded to bovine enamel using the same adhesives. The tensile bond strengths for the assemblies were determined so that the lamellae and the bonding adhesive that might be suitable for clinical application could be selected for testing in vitro in the second phase of the study.

Alternatives to ceramic brackets: the tensile bond strengths of two aesthetic brackets compared ex vivo with stainless steel foil-mesh bracket bases

The mean tensile/peel bond strengths were evaluated for three types of aesthetic brackets (a ceramic-reinforced bracket and two generations of a ceramic/polycarbonate combination bracket). These were found to be significantly lower than the mean tensile/peel bond strength of a convention foil-mesh stainless steel bracket base. Failure of the ceramic-reinforced polycarbonate brackets occurred predominantly by fracture of the tie wings during testing. With the ceramic/polycarbonate combination brackets, the majority of the specimens failed due to separation of the ceramic and polycarbonate parts of the bracket.