The Use of Platelet-Rich Fibrin and Polypropylene Mesh in Repair of Nasal Septal Perforation

OBJECTIVE

In this study, we aimed to investigate the effectiveness of the use of polypropylene mesh and platelet-rich fibrin (PRF) in nasal septal perforation (NSP) repair.

STUDY DESIGN

Prospective experimental study.

SETTING

Laboratory.

METHODS

Twenty-four adult male New Zealand rabbits were used in our study. In all subjects, a 10 × 10 mm perforation was created in the septum. The subjects were divided into 3 equal groups according to the different methods used in perforation closure. The bilateral mucosal flap was used in the control group, polypropylene mesh + bilateral mucosal flap in the mesh group, and polypropylene mesh + bilateral mucosal flap + PRF in the mesh + PRF group.

RESULTS

NSP treatment success rate was found to be significantly higher in the mesh (4/6, 66.7%) and mesh + PRF (6/6, 100%) groups compared to the control group (0/6, 0%). Re-epithelialization score was higher in the mesh + PRF group and the control group compared to the mesh group. While the necrosis, neutrophil, and abscess scores were highest in the mesh group, they were similar to the control group in the mesh + PRF group.

CONCLUSIONS

While polypropylene mesh significantly increases the success rate in NSP repair, it causes severe inflammatory responses. However, when polypropylene mesh is combined with PRF, it both increases the rate of perforation closure and significantly reduces the complications associated with the use of mesh.

Nicotinamide N-methyltransferase overexpression may be associated with poor prognosis in ovarian cancer

Ovarian cancer is the fifth leading cause of cancer-related mortality in women. Nicotinamide N-methyltransferase (NNMT) is a metabolic enzyme and there is growing evidence to suggest that it plays an important role in cancer progression. This is the first study to examine the expression of NNMT in serous ovarian cystadenomas, serous borderline tumours, low grade serous carcinomas (LGSC) and high grade serous carcinomas (HGSC) and investigate the potential independent association of NNMT expression with survival. Tissue samples were analysed immunohistochemically for NNMT expression. The stromal NNMT score was significantly higher in HGSC compared to serous cystadenomas and serous borderline tumours (p < .001, p < .043, respectively). The mean stromal NNMT score of patients with HGSC was significantly higher than patients with LGSC (p = .043). Patients with low expression of NNMT had a significantly higher mean recurrence-free survival than patients with high expression (p = .036). NNMT may support tumour progression in ovarian cancer by promoting desmoplastic stromal tumour reaction. NNMT overexpression may be associated with poor prognosis and can be a therapeutic target in ovarian cancer.IMPACT STATEMENTWhat is already known on this subject? Nicotinamide N-methyltransferase (NNMT) is a cytosolic enzyme that is overexpressed in many malignancies. Its overexpression was shown to lead to histone hypomethylation, which in turn can decrease and increase the expression of tumour suppressor proteins and onco-proteins, respectively. NNMT was also shown to play a role in epithelial-to-mesenchymal transition, which is critical in tumour progression and the stromal tumour reaction. The stromal tumour reaction was recently targeted with promising therapeutic results in ovarian cancer.What do the results of this study add? The expression of NNMT in various ovarian neoplasms including serous cystadenomas, borderline tumours and serous carcinomas has not been studied and independently associated with poor survival, previously. This study suggests that NNMT is progressively overexpressed in the stroma of ovarian neoplasms from benign cysts to HGSCs. NNMT overexpression appears to be independently associated with poor survival in ovarian cancer.What are the implications of these findings for clinical practice and/or further research? The implications of these findings are that NNMT may play an important role in the stromal tumour reaction, and therefore its overexpression may contribute to poor survival. NNMT overexpression may be an important target of ovarian cancer therapy.

Nicotinamide N-methyltransferase expression and its association with phospho-Akt, p53 expression, and survival in high-grade endometrial cancer

Background/aim

Nicotinamide N-methyltransferase (NNMT) is an enzyme that is overexpressed in malignancies. NNMT expression has not been previously studied in endometrial cancer (EC). Increased phospho-Akt (pAkt) levels in response to NNMT overexpression have been reported in in vitro studies of different cancer types. We assayed NNMT expression in primary and metastatic high-grade EC and investigated the relationship of NNMT with p53, pAkt, and survival.

Materials and methods

NNMT, pAkt, and p53 expressions were assayed in 100 tissue samples of benign endometria, primary EC, and metastatic EC by immunohistochemistry.

Results

The NNMT immunoreactivity score was significantly higher in primary high-grade EC than benign endometrial tissue (P = 0.001). NNMT expression in metastatic tissue was significantly higher than in primary cancer (P < 0.001). Metastatic stromal NNMT expression was significantly higher than that of the adjacent tumor and stroma adjacent to the primary tumor. p53 expression in the primary tumor showed a significant positive correlation with omental NNMT and pAkt expression. NNMT expression was also correlated with pAkt expression in metastatic tissue. NNMT overexpression in metastatic tissue was associated with decreased survival (P = 0.039).

Conclusion

This study suggests that NNMT may promote cancer progression and that NNMT overexpression is associated with aberrant p53 expression, pAkt, and poor survival. NNMT’s role in cancer progression could make it a target of EC therapy.

Synovial sarcoma in a premature newborn

Synovial sarcoma is rarely detected in infants, with an annual incidence of 0.5 per million. Synovial sarcoma occurs more frequently in adolescents and young adults, with the majority of patients presenting between 15 and 40 years of age. It is extremely rare, however, in pediatric patients under 2 years of age. In the present study we examined a 3-day-old male infant born at 32 weeks who had a mass on his left arm. Synovial sarcoma was identified on histopathological and immunohistochemical analysis of biopsy material acquired from the mass. On whole body magnetic resonance imaging, diffuse metastases were detected in the bilateral lungs in the retroperitoneal zone, in bilateral suprarenal glands, the right liver lobe, the right kidney, and the brain. To our knowledge this is the youngest patient to be diagnosed with synovial sarcoma in the literature.

Neurothekeoma in childhood: a benign tumor mimicking malignant disease

Neurothekeoma (NT) sometimes extends to subcutaneous adipose tissue, skeletal muscle or epidermis, and thus may imitate some malignant situations. A 17-year-old female patient was admitted to another medical center with a swelling at her waistline. Plexiform fibrous histiocytoma was diagnosed, and she was referred to our clinic. Total re-excision was performed. The new pathology report indicated features of atypical NT. A case of atypical NT, which can be misdiagnosed as a malignant mesenchymal tumor, is discussed in this paper.

Comparison of 21 and 27 gauge needles for determining sample adequacy in the aspiration biopsy of thyroid nodules

PURPOSE

To compare 21 and 27 gauge (G) needles used for fine-needle aspiration (FNA) of thyroid nodules to obtain better specimens for adequacy and cytological diagnosis.

MATERIALS AND METHODS

One hundred patients with thyroid nodules (100 nodules) were included in this study. Each nodule was aspirated with both 27 G and 21 G needles. The obtained aspirates were classified as adequate and inadequate by two separate cytopathologists. The results were analyzed by appropriate statistical methods.

RESULTS

There was no statistically significant difference between 21 G and 27 G needles in terms of adequacy, according to each pathologist (P > 0.05). After pathological evaluation with consensus, the adequacy prevalence was the same (84%) for both needle types in all study populations (P > 0.05). According to the ultrasound characteristics of nodules, the prevalence of inadequate samples in patients with hypoechoic or heterogeneous nodules was significantly higher compared with the prevalence of inadequate samples in patients with isoechoic or hyperechoic nodules for both types of needles (P < 0.05). However, according to the size of the needles, there was no significant difference between hypoechoic and heterogeneous nodules or between isoechoic and hyperechoic nodules with regard to the ability to yield adequate samples (P > 0.05).

CONCLUSION

The results of our study showed that FNA with 27 G needles can aspirate adequate material for cytopathological diagnosis. The probability of inadequate sample aspiration of hypoechoic and heterogeneous nodules is higher than that for other nodule types.

An unusual cause of recurrent joint effusions: nonhemophilic hemosiderotic synovitis of the knee

A 20-year-old female presented with a painful swelling in the right knee and snapping sensation on joint motion that appeared without trauma and recurred several times. She had no history of a bleeding disease or trauma. Physical examination showed no signs of rash or temperature change or systemic or local findings of an infection. The knee was tender and knee motion was painful, with 90 degrees of flexion and full extension. The ballottement test was positive. All laboratory tests including rheumatologic and bleeding parameters were normal. Joint effusion analysis was normal except for its rusty-brown color. Magnetic resonance imaging showed synovial hypertrophy and grade 2 degeneration in the medial meniscus. During diagnostic and surgical arthroscopy, rust-colored synovial hypertrophy was noted in the suprapatellar pouch accompanied by patchy villi and nodules and cystic changes. The gross appearance of the synovium mimicked that of pigmented villonodular synovitis. Biopsy specimens were obtained from different parts of the synovium and a subtotal synovectomy was performed. The histopathologic diagnosis was reported as hemosiderotic synovitis. During a three-year follow-up, she had no pain, snapping sensation, or limitation of motion. There were no recurrent effusions.

[Treatment of olfactory neuroblastoma via subfrontal and midfacial degloving approaches: a case report]

A 12-year-old girl presented with complaints of nasal obstruction and a right infraorbital swelling. A biopsy obtained from the right nasal passage revealed olfactory neuroblastoma. The tumor was completely excised via subfrontal craniofacial and midfacial degloving approaches. No recurrence was observed during a three-year follow-up.

Possible role of Helicobacter pylori in the etiopathogenesis of chronic otitis media

OBJECTIVE

To investigate a possible contribution from Helicobacter pylori to the etiopathogenesis of chronic otitis media.

STUDY DESIGN

Prospective clinical trial.

METHODS

Tympanomastoidectomy, radical mastoidectomy, and modified radical mastoidectomy procedures were performed according to the pathology of ear disease. Biopsy specimens were taken from middle ear, mastoid antrum, and tympanic orifice of eustachian tube. Helicobacter pylori DNA was extracted from these biopsy specimens by using nested polymerase chain reaction.

RESULTS

Helicobacter pylori DNA was detected in 3 (7.9%) of 38 chronic otitis media patients.

CONCLUSION

Even though it is possible to detect Helicobacter pylori in middle ear cleft in chronic otitis media, its role in the etiopathogenesis of the issue is controversial.

Analgesic and hepatotoxic effects ofOnonis spinosa L

The present study investigated the analgesic and hepatoprotective activities of a water extract of Ononis spinosa L. (OS) in mice. Analgesic activity was based on the pain thresholds measured with the tail-flick test before administration at 30, 90 and 150 min. The results were analysed with one-way variance analysis. The extract of Ononis spinosa showed analgesic activity equivalent to aspirin at 30 and 90 min and even higher than aspirin with the 50 mg/kg dose. At a dose of 100 mg/kg OS showed an analgesic effect equivalent to aspirin at all time points.The hepatoprotective influence of OS on carbon tetrachloride (CCl(4))-induced acute liver toxicity was also studied. The extract had no significant effect on the increased levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin in CCl(4) treated animals (p > 0.05). Thus, the results reveal that the extract of OS had no hepatoprotective effect on CCl(4)-induced acute liver toxicity.

Deep intracranial extension of squamous cell carcinoma of the scalp

We report a case of recurrent squamous cell carcinoma (SCC) of the scalp with deep cerebral invasion in a 15-year-old girl. Plain films and CT showed extensive, full thickness, and skull destruction at the vertex. Gadolinium-enhanced MRI revealed neoplastic invasion of the meninges and both cerebral hemispheres down to the lateral ventricle. This case represents an example of (SCC) imitating a primary brain tumor by exhibiting intracranial extension.

Hepatoprotective and anti-inflammatory activities of Ballota glandulosissima

Water extract of Ballota glandulosissima Hub.-Mor & Patzak (Lamiaceae) (BG) was investigated for anti-inflammatory activity using the carrageenan-induced rat paw oedema test and for hepatoprotective effect on carbon tetrachloride (CCl(4))-induced hepatotoxicity in rats. Biochemical parameters of hepatic damage such as serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and bilirubin concentrations were determined. CCl(4) (0.8 mL/kg i.p. for 7 days) treatment increased the serum AST, ALT, ALP and bilirubin levels significantly as compared to controls. Treatment of animals with BG (100 mg/kg, i.p.) +CCl(4) (0.8 mL/kg i.p.) for 7 days significantly ameliorated the levels of AST, ALT and ALP elevated by the CCl(4) treatment alone. The results of biochemical tests were also confirmed by histopathological examination. BG together with CCl(4) treatment decreased the balloning degeneration but did not produced apoptosis of hepatocytes, centrilobular and bridging necrosis observed in the CCl(4) treatment alone. BG, at 100 mg/kg per os, showed a significant reduction (34.22%) in rat paw oedema induced by carrageenan. The reference anti-inflammatory drugs etodolac (50 mg/kg, p.o.) and indomethacin (3 mg/kg, i.p.) significantly reduced the oedeme by 43.42 and 95.70%, respectively. The present study reveals that the water extract of Ballota glandulosissima possesses promising protective activity against CCl(4) induced hepatic damage and anti-inflammatory activity in rats.

Desmoplastic Medulloblastoma in a 48-Year-Old Male

Medulloblastoma is a malignant invasive embryonal tumor of the cerebellum with preferential manifestation in children. The peak of occurrence is seven years of age. Seventy percent of medulloblastomas occur in individuals younger than 16. In adulthood, 80% of medulloblastomas arise in the 21-40 years age group. A 48-year-old male patient was admitted to the hospital with complains of headache, ataxia, morning vomiting and difficulty in speech was operated with the diagnosis of presence of mass of 4 x 7 cm size retaining a diffuse homogenous contrast in the posterior fossa. The diagnosis of desmoplastic medulloblastoma was given after histopathological examination. Immunohistochemical examination revealed that neoplastic cells showed staining with neuron-specific enolase and synaptophysin but not with glial fibrillary acidic protein. This lesion showed nodular, reticulin free-zones (pale islands) surrounded by densely packed, highly proliferative cells. The pale regions within the tumor did not contain reticulin fibers. Desmoplastic medulloblastoma is encountered especially in adulthood. This type of tumor rarely occurs beyond the fifth decade of life. We present a case of desmoplastic medulloblastoma in a 48-year-old male.

Adenocarcinoma of the larynx: a case report with histochemical and immunohistochemical studies

Adenocarcinomas constitute a histologically diverse group of rare laryngeal neoplasms accounting in aggregate for less than 1% of all laryngeal carcinomas. Adenocarcinoma of the larynx "not otherwise specified" (NOS) is a very uncommon neoplasia, but it shows a high degree of malignancy. We report a case of adenocarcinoma "NOS" arising in the larynx of a 60-year-old man. Histologically, the tumor tissue was composed of only adenocarcinoma component. Histochemically, the adenocarcinoma cells demonstrated Alcian blue pH: 2.5 and PAS reactivity, but did not include argentaffin and argyrophil granules. Immunohistochemical studies revealed negative reactivity for desmin, HMB45 and NSE. S-100 and chromogranin was focally positive, cytokeratin was diffusely positive.

Tissue transglutaminase expression in duodenal mucosa of patients with celiac disease and of normal subjects

BACKGROUND/AIMS

Our aim in the present study was to investigate tissue transglutaminase expression by immunohistochemistry in duodenal mucosa of patients with celiac disease.

METHODS

A total of twelve patients with celiac disease were examined. The patients had different clinical and histopathologic degrees of severity and responded to gluten withdrawal with clinical improvement. Ten subjects with various unrelated diseases served as controls. Serum endomysium antibodies were measured by an indirect immunofluorescence method using a commercial kit. Duodenal biopsy specimens were stained with hematoxylin and eosin. Immunohistochemical staining for anti-tissue transglutaminase antibodies was performed using commercial kit.

RESULTS

Serum endomysium antibodies and evaluation of small bowel biopsy specimens were normal in all control subjects. However, serum endomysium antibodies were positive in all of the celiac patients. Immunohistochemical staining pattern of duodenal biopsy specimen performed using anti-tissue transglutaminase antibodies was similar in celiac patients and control subjects.

CONCLUSION

Tissue transglutaminase expression by immunohistochemical methods in untreated celiac mucosa is not suitable for diagnosis of celiac disease.

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.

[Differences in clinical and histopathologic features between chronic adenotonsillitis and chronic adenotonsillar hypertrophy]

OBJECTIVES

This study sought to determine the clinical and histopathological differences between chronic adenotonsillitis and chronic adenotonsillar hypertrophy.

PATIENTS AND METHODS

This prospective study included 286 patients (147 males, 139 females; mean age 16.6 years; range 3 to 45 years) with chronic adenotonsillitis and 197 patients (98 males, 99 females; mean age 9.5 years; range 2 to 18 years) with adenotonsillar hypertrophy. Clinical and histopathological findings were compared.

RESULTS

The mean age was significantly higher (p<0.001) and acute attacks of fever, dysphagia, and sore throat were more frequent in chronic adenotonsillitis. Patients with adenotonsillar hypertrophy more commonly manifested snoring, mouth breathing, and dispnea. Physical examination showed hyperemia of the anterior plica in 93% and 15% in chronic adenotonsillitis and adenotonsillar hypertrophy, respectively. Histopathologically, the former was more commonly associated with severe lymphocyte infiltration to surface epithelium, surface epithelial defects, plasma cells, atrophy, and fibrosis. The sole outweighing difference in favor of chronic adenotonsillar hypertrophy was increased germinal centers.

CONCLUSION

Clinical and histopathologic findings suggest that chronic adenotonsillitis and chronic adenotonsillar hypertrophy may be diverse diseases requiring different approaches in treatment.

Fibromatosis of the mandible in a child

Fibromatosis represents a group of fibrous tumors showing clinic and biologic features between benign fibrous lesions and fibrosarcoma. These locally aggressive tumors have high recurrence rates (20% to 70%). A four-year-old boy presented with mandibular fibromatosis occupying the mandible completely and extending to the submandibular gland and soft tissues. Complete hemimandibulectomy and submandibular gland excision were performed followed by reconstruction with a curved Kirschner wire. No signs of recurrence was observed during a follow-up period of 18 months. In addition, no limitations in the functions of the jaw, mastication, and swallowing were noted.

BCG vaccination to prevent implantation of endometriosis: an experimental study in rats

To investigate whether BCG vaccination can prevent endometrial implantation in a rat model. Forty sexually mature virgin Wistar-Albino rats weighing 185-215g were randomly assigned (double-blind) to two groups. The first group (n=20) were injected with BCG 3 weeks before endometrial implantation to the eye. The second group (n=20) with BCG not injected before endometrial implantation was the control. Photobiomicroscopy observation was done weekly and 6 weeks post endometrial implantation all eyes were investigated histologically.Five implants grew in the anterior surface of the iris of the first (vaccinated) group and 17 in the second (control) group. The difference was statistically significant. Systemic prophylaxis with BCG can exert an inhibitory effect on endometrial transplantation.

Transverse uterine incision non-closure versus closure: an experimental study in sheep

SUBJECT

This study was designed to investigate whether the non-closure of the layers of the uterus during low transverse cesarean section would result in healing and have advantage on closure.

MATERIAL AND METHOD

Thirty pregnant ewes randomly divided into two groups. Each group included 15 ewes. Each ewe was anesthetized at para-vertebral region with the injection of 20 ml Prilocine 2%. Following left transverse abdominal incision, a transverse incision was made on the uterus and lambs were delivered. In the first group, uterine incision line was left open. In the second group, uterine incision line was sutured with no. 1 Chromic catgut by Schimiden technique. In both groups, all layers of abdominal wall except skin were sutured as en-bloc with Vicryl no. 2, by continuous suture technique. Skin was sutured with no. 00 silk interrupted sutures. The ewes were slaughtered four months after cesarean section. A coworker was asked to open the abdominal cavities, and score the intra-abdominal adhesions. Tissues taken from incision line of each uterus were fixed in 10% neutral buffered-formalin and were embedded in paraffin-block. Sections were cut and stained with hematoxylin-eosin. A pathologist, who knew nothing about the study, evaluated all sections, and reported the findings. Student's t test was used for comparison of mean ewe age, gestational age, and mean operation time of the two groups. Z test was used for comparing the ratio of the two groups by means of histopathological findings.

RESULTS

No cervical dilatation and delivery of the placenta were seen during the four week follow up period. The average operating time was significantly less for the non-closure group (48.07 +/- 3.83 minutes) than for the closure group (62.53 +/- 6.57 minutes; p = 0.001). The ranges of myometrial necrosis (100% versus 13.3%; p = 0.001) and endometriosis (53.3% versus 00.0%; p = 0.001) were significantly higher for closure group than for non-closure group.

CONCLUSION

It was found that non-closure layers of the uterus along low transverse cesarean incision proves to have no adverse effect on immediate and late postoperative period in ewes. Our data showed that non-closure of all layers of the uterus results in significantly less muscular necrosis and endometriosis than closure group. We suggest that lower uterine incision can be left unclosed or, at least, simple closure can be preferable instead of vigorous locking technique.

Juvenile hyaline fibromatosis in one Turkish child

We describe a case of juvenile hyaline fibromatosis (JHF) in a Turkish child. Only about 40 cases of juvenile hyaline fibromatosis had been reported in English literature as of March 1998, and it had not been reported in English literature from Turkey as of November 1998. Juvenile hyaline fibromatosis characterized by multiple cutaneous masses is a rare hereditary disorder. This disease is usually found in children, and a malfunction of collagen synthesis is considered as the pathogenetic cause. In the presented case, light microscopy demonstrated an abundance of a homogeneous, amorphous, eosinophilic extracellular matrix in which fibroblasts were embedded. Well-formed collagen fibers could not be demonstrated with Gieson's method or with reticulin preparation. The hayalin material periodic acid-Schiff-positive and diastase-resistant, whereas the Congo red method was negative. Immunohistochemically, the spindle-shaped cells were actin (smooth muscle) negative.

Primary composite tumour with bipartite differentiation of the esophagus

Primary small cell carcinoma of the esophagus is a rare tumour. A primary composite tumour of the esophagus is even rarer and only four cases had been reported in the literature up to August 1998. The definitive histogenesis of this tumour remains controversial in spite of the additional information provided by electron microscopy and immunohistochemistry. In the presented case, histologically, the tumour tissue was composed of two malignant components: approximately 50% of a moderately differentiated squamous cell carcinoma, and approximately 50% of a small cell carcinoma. A lot of morphological transition zones were observed between the squamous cell carcinoma components and the small cell carcinoma components in some areas in the squamous cell carcinoma component. Histochemically and immunohistochemically, the small cell carcinoma cells demonstrated argyrophil granules, and Cytokeratin and Chromogranin A reactivity, but the squamous cell carcinoma cells demonstrated only Cytokeratin reactivity. Negative reactivity for argentaffin granules, neuron-specific enolase and S-100 were observed in both the small cell carcinoma and the squamous cell carcinoma components. Histological, histochemical and immunohistochemical findings suggest that a primary composite tumour of the esophagus may be derived from a totipotent primitive cell in the basal region of the squamous mucosa of the esophagus. The patient received chemotherapy preoperatively but died one month after the initial diagnosis.

Transverse uterine incision non-closure versus closure: an experimental study in dogs

This study was conducted to test the hypothesis that non-closure of all layers of the uterus during low transverse cesarean section is not associated with increased intra-operative or immediate and late postoperative complication. Eleven pregnant dogs underwent cesarean section for the evaluation of non-closure and closure of all layers of the uterus on immediate or early and late postoperative complication and the effect of suture in tissue. Statistical analysis was performed using Student's t-test for continuous variables and analysis for qualitative variables. Significance was defined as P < 0.05. The ranges of wound infection, other morbidity, and mortality were similar between the groups. The average operating time was significantly less for the non-closure group (71.00+/-7.11 min) than for the closure group (92.00+/-6.12 min; P < 0.005). Adhesion was significantly less (P < 0.001) for the non-closure group than for the closure group. The ranges of myometrial necrosis (5/5: 100% versus 0/5: 00%; P < 0.001) and fibrosis (2/5: 40% versus 0/5: 00%; P < 0.01) were significantly higher for the closure group than for the open group. It was found that non-closure of all layers of the uterus at low transverse cesarean incision had no adverse effect on immediate and late postoperative complication in dogs. Our data show that non-closure of all layers of the uterus at low transverse cesarean incision results in significantly less muscular necrosis and fibrosis than in the closure group. We suggest that non-closure and/or at least non-vigorous locking but very simple closure of all layers of the uterus at low transverse cesarean incision may be preferential in appropriate cases.

The effect of lymphatic blockage on the amount of endotoxin in portal circulation, nitric oxide synthesis, and the liver in dogs with peritonitis

This study was performed to investigate the effect of lymphatic blockage on the amount of endotoxin in portal venous blood, nitric oxide synthesis, the release of aspartate aminotransferase (AST) from the liver, hepatic damage, and survival in an experimental model of dogs with peritonitis. The dogs were divided into a control group (group 1), an unligated thoracic duct peritonitis group (group 2), and a ligated thoracic duct peritonitis group (group 3). Peritoneal fluid and blood from the portal vein and femoral artery were taken for peritoneal culture, endotoxin, and AST assay, respectively, and liver biopsies were performed to assess for hepatic damage and for nitric oxide assay. There was a higher bacteria count in the peritoneal fluid from group 3 than in that from group 2 (P < 0.0001). Bacteria grew in all of the blood cultures from the group 2 animals, but growth was seen only in blood cultures from four of the group 3 animals. The levels of endotoxin, nitrite, and AST levels in group 3 were significantly increased in comparison with those in group 2 (P < 0.0001). Extensive hepatocellular necrosis with hemorrhage was observed in the livers of the group 3 animals, and all of them died within 48 h. The results of this study suggest that the blockage of lymph flow has a negative effect on liver and survival in dogs with peritonitis, and that hepatic damage is directly related to the amount of endotoxin to which the liver is exposed.

A morphological study in broiler chick hearts

The normally developing cardiovascular system of the chicken resembles that of the human. The purpose of the present study is to investigate some macroscopic and microscopic similarities between the chick and the human heart. For this study 20 adult and 10 newborn Broiler chickens were used. The heart and great vessels were routinely fixed in 10% formaldehyde in a phosphate buffer. Five adult and five newborn chicks hearts were embedded in paraffin. All section were examined by light microscopy. The atrioventricular valve of 15 adult chick hearts were examined macroscopically. While some structures previously reported were determined, two different properties of the mural leaf which are chordae tendineae in its posterolateral region anchoring at the right ventricle and its widening from the anterior to posterior commissure was also observed.

Surgical treatment of hydatid cyst of the lung: review of 30 cases

Hydatid cyst disease is still a problem in Turkey, especially in the east Anatolian region, as well as in many other places in the world. A retrospective review was made of the surgical treatment of 30 patients with pulmonary hydatid cysts during the last 3 yrs. Nineteen patients were male and 11 female with an average age of 23.5 yrs (range 4-44 yrs). Cystotomy and capitonnage were performed in 28 of the 30 cases (93.4%). The transdiaphragmatic route or simultaneous laparotomy was preferred when the liver was involved. Albendazole was used in four patients with multiple hydatid cyst due to probable recurrence in the postoperative period. Cough and chest pain were the prominent symptoms in the majority of cases. A single lobe was affected in 22 patients. Unilateral multiple foci were present in four patients and bilateral multiple foci in four. Six patients had concomitant liver cysts. Morbidity was low and no mortality was seen. No recurrences were seen on control chest radiographs during the last 2-yr follow-up. In the treatment of hydatid cyst of the lung, conservative surgical methods such as cystotomy and capitonnage still remain the treatment of choice. Medical treatment could be used for prophylactic purposes and in some instances, but the percutaneous aspiration method should not be performed.

Endodermal sinus (yolk sac) tumor of oral cavity originating from gingiva

Endodermal sinus tumor is a malignant germ cell tumor which usually arises in gonads. Extragonadal endodermal sinus tumors in the head and neck are very rare. Here a gingival endodermal sinus tumor is reported. The lesion demonstrated typical microscopic features of the endodermal sinus tumors of gonads. The tumor cells showed alpha-fetoprotein immunoreactivity in immunohistochemical evaluation. The serum alpha-fetoprotein level was high. This is the first gingival case in the related literature.

Progressive pseudorheumatoid chondrodysplasia: a hereditary disorder simulating rheumatoid arthritis

Progressive pseudorheumatoid chondrodysplasia is a rare hereditary disorder. This autosomal recessive condition is characterised by progressive arthropathy and platyspondyly. The symptoms are similar to those of rheumatoid arthritis but synovitis is absent. In this study a patient with inherited progressive pseudorheumatoid chondrodysplasia is presented.

Use of an autologous vein graft and stent in the repair of common bile defects: an experimental study

We investigated the effectiveness of using an autologous vein graft and stent in the repair of large defects of the common bile duct (CBD) in a canine model. A 3-cm segment of the vena cephalica antibrachii and a 2-cm segment of the CBD were removed from eight healthy mongrel dogs with normal blood biochemistry levels. A stent was passed through the vein segment, and one end was introduced into the proximal end of the CBD while the other end was introduced into the distal end. The venous graft was then sutured to the CBD. A liver biopsy was taken for histopathological examination during laparotomy and relaparotomy. Blood samples were obtained on postoperative days 7, 14, and 20 for biochemical examination. The defect was effectively repaired by the autologous vein graft and stent in 7 dogs, after the exclusion of 1 dog that died of hemorrhage 3 days after the operation. No change in blood biochemistry was observed postoperatively, and no histopathological change in the liver was found in the preoperative or postoperative periods. These findings indicate that the use of an autologous vein graft and stent to repair CBD injuries may be a feasible and alternative method of treatment.

Rothmund Thomson syndrome associated with esophageal stenosis: report of a case

Rothmund Thomson syndrome (RTS) is a rare autosomal recessive disorder which is primarily diagnosed by clinical manifestations that include poikiloderma, short stature, sparse hair distribution, juvenile cataracts, small hands and feet, bone defects, photosensitivity, hypogonadism, defective dentition, onychodystrophy, and hyperkeratosis. Although a few reports have been published on patients with RTS associated with gastrointestinal abnormalities, to our knowledge the case described herein is the first documentation of a patient with RTS having upper esophageal stenosis.

The effect of the suture-induced delay phenomenon on skin flap survival and lipid peroxidation in rats

Skin flap ischemia has been associated with the presence of free radicals. In this study we designed a suture-induced delay model in 30 rats using two different suture techniques. A total of 13 rats that underwent McFarlane's acute random-flap model served as controls. We found a statistically significant difference between the flaps of the experimental and control groups regarding the viability of flaps. Malondialdehyde levels in tissue samples taken from the proximal and distal ends of each flap were estimated at 6 and 24 hours postoperatively. Malondialdehyde levels in the experimental groups were found to be quite lower than those of the controls. In conclusion, the suture-induced delay model seems to be effective in improving flap viability. Also, we found lower malondialdehyde levels in experimental groups compared with controls.

Experimental testicular torsion and its effects on the contralateral testicle

OBJECTIVE

Following experimental unilateral torsion of the testis the histologic effects of unilateral testicular torsion on the contralateral testis were investigated.

MATERIALS AND METHODS

Utilizing detorsion or orchiectomy at 4 hours and 8 hours after torsion, the effects of early and late treatment modalities on the contralateral testicle were observed.

RESULTS

Morphometry of the contralateral testis revealed some alterations including focal sclerosis, decrease in mean seminiferous tubular diameter and a marked increase of the Leydig cells in some subgroups.

CONCLUSION

In spite of some changes, definite evidence for contralateral damage due to ipsilateral torsion contributing to male infertility was hardly observed.

Blood and tissue findings in the diagnosis of mesenteric ischaemia: an experimental study

In this experimental study, after inducing mesenteric ischaemia in dogs, we investigated routine blood biochemistry, serum malondialdehyde (MDA) levels, histopathological changes and tissue MDA levels in the liver and intestines. The study group included 10 dogs. Six dogs which underwent sham operation served as controls. In the study group, the MDA level in liver tissue increased after superior mesenteric artery (SMA) ligation. Various degrees of necrosis were seen in the ileal biopsies 10 hours after the ligation. Hyperaemia and focal necrosis in the liver accompanied the intestinal necrosis if it was limited within the mucosa. However, massive or centrilobular necrosis was observed in the liver of those dogs which had intestinal necrosis that extended into muscular layers. MDA levels in intestinal tissue measured after SMA ligation were significantly higher than the preligation levels. On the other hand, the difference between serum and tissue MDA levels was not significant. The alterations in MDA were not significant in the sham group. Thus it is concluded that the serum MDA levels are valuable markers of diagnosis in intestinal ischaemia.

Testicular needle biopsy: is it a safe and adequate method?

We aimed to investigate if testicular needle biopsy is adequate and safe for the examination of testis. Needle biopsies were performed on 21 testes of 5 patients with advanced prostate cancer and 11 patients with cryptorchidism before orchiectomy. Biopsies were done with the prostatic tru-cut needle. After needle biopsy, the tract and puncture sites were explored and an incisional biopsy was performed on each testis. Both needle specimens and open biopsy specimens were fixed in Bouin's solution and sent for histologic examination. There were small haematomas in two testes and moderate haemorrhage between tunica vaginalis layers in another. The tissues obtained by needle biopsy were sufficient except for two specimens and diagnostic accuracy was perfect. Nevertheless, measurement of the seminiferous tubules of the lamina propria could not be achieved in many cases.

Primary leiomyosarcoma of the breast

Sarcomas of the breast are rare, accounting for about 1% of all malignant breast tumors. Leiomyosarcoma of the breast was an almost unknown tumor until some 20 years ago, and the few previously published cases lacked detailed information. Only 11 well-documented cases of leiomyosarcoma of the breast had been reported in the literature up to February 1992. The clinical features, diagnosis, therapy, and prognosis are discussed here in the light of the previously published literature.

Immunohistochemical study on histogenesis of congenital epulis and review of the literature

Congenital epulis is a very rare lesion found only in newborn infants. This tumor is multiple in about 10% of reported cases, rarely with the simultaneous involvement of the maxilla and mandibula, as in this article. In the presented case, light microscopy demonstrated large eosinophilic granular cells arranged in solid nests that are separated by thin fibrovascular areas. The tumors in the maxilla and mandibula were investigated with a panel of polyclonal and monoclonal antibodies, and using immunoperoxidase methods on formalin-fixed, paraffin-embedded sections. Immunohistochemical studies revealed strong and diffuse cytoplasmic staining for neuron specific enolase and vimentin. However, all other reactions were negative. These results suggest that the congenital epulis may be derived from uncommitted nerve-related mesenchymal cells.

Squamous cell carcinoma of the scrotum

A patient complained of scrotal mass which was found to be a squamous cell carcinoma. There was no occupational exposure and nodal spread was not obtained. We present this rare case.