The effect of melatonin and vitamin C treatment on the experimentally induced tympanosclerosis: study in rats.

INTRODUCTION: The ethiopathogenesis of tympanosclerosis has not been completely under- stood yet. Recent studies have shown that free oxygen radicals are important in the formation of tympanosclerosis. Melatonin and Vitamin C are known to be a powerful antioxidant, interacts directly with Reactive Oxygen Species and controls free radical-mediated tissue damage. OBJECTIVE: To demonstrate the possible preventative effects of melatonin and Vitamin C on tympanosclerosis in rats by using histopathology and determination of total antioxidant status total antioxidant status. METHODS: Standard myringotomy and standard injury were performed in the middle ear of 24 rats. The animals were divided into three groups: Group 1 received melatonin, Group 2 received vitamin C, and Group 3 received saline solution. RESULTS: The mean values of total antioxidant status were similar in the all study groups before the treatment period. The mean values of total antioxidant status were significantly higher in the melatonin and vitamin C groups compared to control group but vitamin C with melatonin groups were similar after the treatment period (p<0.001). Minimum and maximum wall thicknesses were lower in the melatonin and vitamin C groups compared to the control group but the differences were insignificant. CONCLUSION: Melatonin increases total antioxidant status level and might have some effect on tympanosclerosis that develops after myringotomy.

Can Helicobacter pylori cause inflammation in the middle ear?

OBJECTIVES: To investigate whether Helicobacter pylori causes inflammation in the normal middle ear and in the middle ear with effusion. METHODS: Sixteen adult New Zealand white rabbits were divided into two gropus equally. Group I was representing histamine-induced middle ear inflammation and Group II was representing normal middle ear. While H. pylori was inoculated in the right ears, physiologic saline was inoculated in the left ears of the rabbits in both groups. Results were evaluated clinically, histopathologically and microbiologically. Fisher's exact test was used for statistical analysis. RESULTS: In Group I, clinical scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Histopathological scores of the inflammation in the right ears were higher than the left ears scores at the 7th day. Also, H. pylori was isolated in 6 of the 8 right ears of the rabbits. In Group II, while clinical scores of the inflammation in the right ears scores were higher than the left ears scores at the 7th day, histopathological scores were not significantly different between both ears. Also, no H. pylori was isolated in right ears of the rabbits. CONCLUSIONS: Effusion in the middle ear induced by histamine is an appropriate medium for H. pylori reproduction and it also aggravates the inflammation process. In contrary, H. pylori did not cause inflammation in the normal middle ear. We suggest that H. pylori does not play a role in the etiology of otitis media with effusion alone, but it contributes to the inflammation process in the presence of an effusion.

Effect of pentoxifylline and 5-fluorouracil/triamcinolone on laryngotracheal stenosis developing as a complication of tracheostomy: study in rats.

We aimed to investigate the prophylactic effect of pentoxifylline (PTX) and 5-fluorouracil (5-FU) on laryngotracheal stenosis in tracheotomised rats by evaluating blood glutathione peroxidase (GPx) and superoxide dismutase activities and by histopathological evaluation of laryngotracheal segment. Randomized prospective single-blind study. Standard vertical tracheotomy was performed on 24 rats. Then, the animals were randomly divided into three groups. Intraperitoneal PTX administered to group A (study group) for 10 days. 5-FU was injected in paratracheal tissues in group B (study group) for 10 days. In group C (control group), intraperitoneal saline was administered for 10 days. After 10 days, tracheal cannules were removed. For biochemical analysis, two blood samples were obtained. Three weeks later, all animals were euthanized and trachea specimens were harvested. Stenosis index and mean wall thickness in PTX group were lower as compared to other groups but the difference was statistically insignificant. Minimum inflammation and fibrosis plus maximum epithelial regeneration were seen in PTX group. In addition, GPx activity was at highest level in PTX group and a statistically significant difference was found between control and PTX groups (P = 0.024) though the difference between remaining groups was statistically insignificant (P = 0.121). Superoxide dismutase activity was highest in PTX group but no statistically significant difference was found between the three groups (P = 0.305). The administration of PTX increases GPx activity and it may have some effect on tracheal scar formation which develops following tracheostomy.

Impression cytology and ocular surface characteristics in patients with seborrhoeic dermatitis.

PURPOSE: To evaluate the clinical findings, tear film functions and ocular surface changes in patients with seborrhoeic dermatitis. METHODS: This prospective study involved 63 patients with seborrhoeic dermatitis (Group 1) and 65 control subjects (Group 2). Best-corrected visual acuity measurement, slit-lamp examination, Schirmer I test, tear film break-up time (BUT), Rose Bengal staining and conjunctival impression cytology were performed in all patients. Subjective ocular complaints were scored using an Ocular Surface Disease Index (OSDI) questionnaire. Results between the two groups were compared. RESULTS: In group 1, meibomitis, blepharitis and conjunctival hyperemia were seen significantly more frequently than in group 2 (p < 0.001). Impression cytology revealed grade 0 changes in 25 (39.6%) eyes, grade 1 changes in 22 (34.9%) eyes, grade 2 changes in 13 (20.6%) eyes and grade 3 changes in 3 (4.7%) eyes in group 1, whereas grade 0 changes in 48 (73.8%) eyes, grade 1 changes in 11 (16.9%) eyes and grade 2 changes in 6 (9.2%) eyes were seen in group 2 (p = 0.032). Mean goblet cell density was 795 ± 55 cells/mm(2) in group 1 and 1820 ± 100 cells/mm(2) in group 2 (p < 0.001). Mean Schirmer I and mean BUT results were statistically lower in group 1 than in group 2 (p = 0.043 and p < 0.001, respectively). Mean Rose Bengal scores and mean OSDI scores were statistically higher in group 1 than in group 2 (p = 0.002 and p < 0.001, respectively). CONCLUSIONS: Our data show that patient with seborrhoeic dermatitis has decreased tear production, tear film instability and significant degeneration of the ocular surface epithelium, compared with normal subjects.

Expression of a disintegrin and metalloproteinase 33 protein in nasal polyposis: an immunohistochemical study.

BACKGROUND: A disintegrin and metalloproteinase (ADAM)-33 is a member of matrix metalloproteinases. This protein takes a role in angiogenesis and airway remodeling in asthma. Because histopathological findings of airway remodeling in asthma and nasal polyposis (NP) are similar, the aim of this study was to evaluate the ADAM-33 expression in NP. METHODS: Immunohistochemical staining of specimens of 47 patients with NP and 8 patients with concha bullosa was performed to detect the expression of ADAM-33. Paraffin blocks were used to identify the expression of ADAM-33 polyclonal antibodies. Immunostaining of epithelial cells, stroma, mesenchymal cells of vessels, and inflammatory cells were analyzed by using light microscopy. RESULTS: Immunopositivity scores in epithelial cells in NP (median, 2; range, 1-3) were significantly higher than those of controls (median, 1.5; range, 1-2; p < 0.001). ADAM-33 staining was increased in the mesenchymal cells of vessels of nasal polyps (median, 2; range, 1-3) compared with control tissues (median, 1.5; range, 1-2; p = 0.006). Although the staining scores of fibroblasts in nasal polyp specimens were also high (median, 3; range 1-3), there was no statistical significance when compared with controls (median 2; range, 1-3; p = 0.228). ADAM-33 immunostaining was not related with the presence of allergies, asthma, and aspirin intolerance (p > 0.05). Moreover, no relationship was found between increased expression of ADAM-33 and the stages of polyp or computerized tomography scores (p > 0.05). CONCLUSION: This study suggests that the increased expression of ADAM-33 protein may have a role in the pathogenesis of NP.

Topical use of colchicine to prevent spinal epidural fibrosis in rats.

OBJECTIVES: Epidural fibrosis after spinal surgery may be the cause in most cases of recurrent pain. Numerous pharmacological agents and anti-adhesive barriers have been used to prevent epidural fibrosis, but the success rates are variable. Colchicine is an historical drug extracted from the flowers of Colchium autumnale widely used in arthritic conditions in the past. Currently, it is used in acute gout attacks, familial mediterranean fever for its anti-inflammatory and antifibrotic effects. Also, colchicine is used locally in the cutaneous diseases (e.g. actinic keratoses, psoriasis) for its similar effects. In present study, we investigated the effect of topical colchicine on spinal epidural fibrosis in the rats. METHODS: The rats were randomly divided to three groups of six animals each. Total L4-5 laminectomy was performed, and ligamentum flavum and epidural fat were removed gently. Meticulous hemostasis was achieved by using cotton pad when necessary, and no bone wax and cauterization were used. Dura was left clean with no hemorrhages. In treatment group cotton pads (5 × 5 mm) soaked with 0.005 mg/ml colchicine and applied on laminectomy sites for 10 minutes and removed, in sham group only saline irrigation was done. In control group no medication or irrigation was applied. The wound was closed in layers using the same material in each group. Four weeks later, the rats were killed, and the spinal column, including surrounding muscle tissue, was removed en bloc, decalcified, and fixed in formaldehyde. Epidural fibrosis was evaluated histologically. RESULTS: In colchicine-treated group, epidural fibrosis was significantly reduced compared with control and sham groups. CONCLUSIONS: Epidural fibrosis is a well-known complication following lumbar disc surgery. Topical application of colchicine is very effective in preventing epidural fibrosis.

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

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

An unusual cause of acute abdominal pain in a child: an inverted Meckel diverticulum: report of a case.

Inverted Meckel diverticulum has been reported as a lead point for intussusception in children. However all cases of isolated inversion of a Meckel diverticulum have involved adults in whom the diagnosis was clinically unexpected. We describe the sonographic appearance of isolated inversion of Meckel diverticulum in a 3-year-old boy with acute abdominal symptoms.

Chest wall lipoblastomatosis in a 2-year-old girl: a case report and literature review.

Lipoblastoma is an uncommon tumor of adipose tissue that usually occurs in infancy and early childhood. They predominantly locate in the extremities, but are less frequently found in the head and neck region, trunk and various other locations. The most common sign is a rapidly growing mass. In spite of their potential for local invasion and rapid growth, they are benign tumors and have no distant metastasis. Although more than 180 cases of lipoblastoma distributed over various parts of the body have been reported, only nine cases were located in the thoracic wall. We present the case of a two-year-old girl with lipoblastomatosis of the chest wall that was identified by histologic examination. In this article, the English literature on this disorder is briefly reviewed.

The effects of caspofungin and voriconazole in an experimental fungal infection of the ear due to Aspergillus.

The purpose of the study was to evaluate the effectiveness of caspofungin and voriconazole in the treatment of experimental Aspergillus otitis media in an experimental rabbit model. A total of 30 New Zealand white rabbits were divided into four treatment groups and one control group. The rabbits were immunosuppressed by cyclophosphamide and triamcinolone acetonide. The right ear of each rabbit was infected by an injection of the inoculum of 0.1 ml (8.6 x 103 CFU/0.1 ml) of Aspergillus fumigatus into the middle ear cavity. At 72 h after the inoculation, amphotericin B 1 mg/kg per day (n = 6), itraconazole 10 mg/kg per day (n = 6), voriconazole 10 mg/kg per day (n = 6) and caspofungin 5 mg/kg per day (n = 6) were injected to each treatment group. No antifungal drug was administered to the control group (n = 6). Clinical and histopathological examination scores and microbiological analysis of middle ear mucosa were compared.There was statistically significant difference in the clinical scores, histopathological scores, and mean CFU/g between the treatment and control groups (P < 0.05). There was no statistically significant difference among the treatment groups in the clinical and histopathological scores, whereas there was statistically significant difference in the mean CFU/g (P < 0.05). The mean CFU/g of amphotericin B and caspofungin groups were similar and both were lower than the itraconazole and voriconazole groups. Also, the mean CFU/g of voriconazole group was lower than the itraconazole group (P < 0.05). Caspofungin and voriconazole were demonstrated at least as effective as amphotericin B and itraconazole. We suggest that caspofungin and voriconazole may be considered for the treatment of fungal infection of the ear.

Giant small intestine gastrointestinal stromal tumor with gastrointestinal bleeding.

Small intestine stromal tumors are relatively rare and cause subtle clinical signs and symptoms. Their diagnosis is often delayed until complications develop. Even if complications occur, an exact preoperative diagnosis may be very difficult. Surgery remains the mainstay of treatment, and other treatment modalities are limited. We present herein a patient with a giant gastrointestinal tumor who presented with gastrointestinal bleeding. Complete resection was performed despite the large tumor size (23 x 20 x 8 cm) and the patient was free of signs and symptoms during the 4-month follow-up.

Efficacy of olopatadine HCI 0.1%, ketotifen fumarate 0.025%, epinastine HCI 0.05%, emedastine 0.05% and fluorometholone acetate 0.1% ophthalmic solutions for seasonal allergic conjunctivitis: a placebo-controlled environmental trial.

PURPOSE: We aimed to compare the clinical efficacy and ocular surface variables of olopatadine, ketotifen fumarate, epinastine, emedastine and fluorometholone acetate ophthalmic solutions in preventing the signs and symptoms of seasonal allergic conjunctivitis (SAC). METHODS: This was a prospective, randomized, double-blinded and placebo-controlled study. A total of 100 patients with SAC were randomly assigned to one of five groups, in which they were administered olopatadine, ketotifen fumarate, epinastine, emedastine or fluorometholone acetate, instilled twice daily for 2 weeks. One eye of each patient was treated with the study drug and the other was treated with a placebo. Signs and symptoms of allergic conjunctivitis (itching, redness, tearing, chemosis and eyelid swelling) were scored on a 4-point scale. Each symptom was assessed at baseline and then again after 1 and 2 weeks of treatment. Ocular surface variables were assessed by conjunctival impression cytology. RESULTS: At weeks 1 and 2, all antiallergic agents were significantly more effective than placebo in alleviating itching, redness, tearing, chemosis and eyelid swelling. Fluorometholone acetate was significantly less effective than the other agents in reducing itching and redness at all control visits. Ocular surface findings by impression cytology improved significantly after all treatments compared with placebo. CONCLUSIONS: In patients with SAC, olopatadine, ketotifen, epinastine and emedastine are more efficacious than fluorometholone acetate in preventing itching and redness. All the antiallergic agents gave similar results in terms of reducing tearing, chemosis and eyelid swelling. Our data showed that impression cytology parameters improved after treatment with antiallergic agents in patients with SAC.

Are CD57+ natural killer cells really important in early pregnancy failure?

OBJECTIVE: The aim of this study was to compare the CD57+ Natural Killer (NK) cell counts in normal pregnancies and in cases grouped according to different types of early pregnancy failure. MATERIALS AND METHODS: A prospective case control study which was set in Baskent University Faculty of Medicine, Obstetrics and Gynecology Department. A total of 119 women whose pregnancies ended in the first trimester were divided into elective pregnancy termination, incomplete miscarriage, intrauterine demise, ectopic pregnancy and recurrent pregnancy loss groups. CD57+ NK cells were stained and counted in the histologic preparations of the decidua in all of these groups. RESULTS: CD57+ NK cell counts were 2.14+/-1.42 in control, 2.24+/-1.92 in incomplete miscarriage, 1.82+/-1.34 in intrauterine demise, 2.54+/-1.80 in ectopic pregnancy and 3.42+/-2.15 in recurrent pregnancy failure group. There were no statistically significant differences between the control group and the other four groups with respect to the CD57+ NK cell counts. CONCLUSION: This study suggests that CD57+ NK cell count is not associated with early pregnancy failure.

Conjunctival impression cytology and tear-film changes in patients with familial Mediterranean fever.

PURPOSE: To evaluate the ocular surface changes and tear-film functions in patients with familial Mediterranean fever (FMF). METHODS: This prospective case-control clinical study examined 35 patients with FMF (group 1) and 35 controls (group 2). All patients underwent a full ophthalmological examination. Ocular surface changes were evaluated by determining cell content of surface conjunctival epithelium using conjunctival impression cytology and tear-film functions using Schirmer-I, break-up time (BUT), corneal fluorescein and Rose Bengal tests. Subjective ocular complaints were scored with a four-point scale. Between-group results were compared. RESULTS: In group 1, impression cytology revealed grade 0 changes in 15 eyes, grade 1 changes in 11 eyes and grade 2 changes in nine eyes in group 1; in group 2, it revealed grade 0 changes in 27 eyes, grade 1 changes in five eyes and grade 2 changes in three eyes (p = 0.013). Mean goblet cell density was 765 +/- 45 cells/mm(2) in group 1 and 1730 +/- 100 cells/mm(2) in group 2 (P < 0.001). Mean results on the Schirmer-I test results were 17.36 +/- 3.18 mm in group 1 and 19.60 +/- 4.17 mm in group 2 (p = 0.364). Mean BUT was 8.20 +/- 1.60 seconds in group 1 and 9.93 +/- 2.33 seconds in group 2 (p = 0.001). Mean corneal fluorescein and Rose Bengal staining scores were 3.26 +/- 1.67 and 0.96 +/- 0.71 in group 1 and 1.37 +/- 0.34 and 0.40 +/- 0.49 in group 2 (p = 0.037, p = 0.005). The presence of subjective ocular complaints was more frequent in group 1 than in group 2. CONCLUSION: Despite normal tear production, the ocular surface and tear-film functions of FMF patients differ from those of healthy individuals. These changes may be related to the chronic inflammatory nature of FMF.

Conjunctival impression cytology, ocular surface, and tear-film changes in patients treated with systemic isotretinoin.

PURPOSE: To evaluate the ocular surface changes and tear-film functions in patients treated with systemic isotretinoin. METHODS: Fifty subjects treated with 0.8 mg/kg oral isotretinoin were enrolled in this prospective clinical trial. All patients underwent a full ophthalmoscopic examination before, during, and after treatment with isotretinoin. Ocular surface changes of the cell content of the surface conjunctival epithelium were evaluated by conjunctival impression cytology and tear-film functions using the Schirmer test, anesthetized Schirmer test, tear breakup time, and rose bengal staining. Subjective ocular complaints were scored with an Ocular Surface Disease Index questionnaire. RESULTS: There were no significant differences observed in average Schirmer test scores for patients before, during, or after isotretinoin treatment. Mean anesthetized Schirmer test scores and tear breakup time decreased significantly during treatment (P < 0.001). Mean impression cytology scores, Ocular Surface Disease Index scores, and rose bengal staining scores increased significantly during treatment (P < 0.05, P < 0.001 and P < 0.001, respectively). Blepharitis was seen in 36% of patients. All abnormal findings disappeared 1 month after the cessation of treatment. CONCLUSIONS: Conjunctival epithelial cells, tear basal secretion, and tear quality are markedly affected in patients during systemic treatment with isotretinoin (0.8 mg/kg). Ocular adverse effects of isotretinoin are generally not serious and are reversible after discontinuation.

Expression of metalloproteinases MMP-2 and MMP-9 in antrochoanal polyps.

BACKGROUND: Matrix metalloproteinase (MMP) 2 and MMP-9 are known to cleave specifically type 4 collagen, which is a major structural component of basement membrane. This is an early step of inflammation. Because of this property they have been studied in chronic sinonasal disorders. The aim of this study was to determine the MMP-2 and MMP-9 expressions in an antrochoanal polyp (ACP). METHODS: We examined tissue samples from 10 ACPs, 10 diffuse nasal polyps, and 10 control nasal mucosa (CM) by immunohistochemistry for MMP-2 and MMP-9 expression. RESULTS: Most of epithelial and endothelial cells showed positive immunostaining for MMP-2 and MMP-9 in all tissue samples. MMP-2 staining of inflammatory cells showed no difference among the groups (p > 0.05). On the other hand, MMP-9+ inflammatory cells were found to be significantly increased in ACP and diffuse nasal polyps when compared with CM (p < 0.05). CONCLUSION: MMP-9-expressing inflammatory cells could play a role in the pathophysiology of ACP as well as nasal polyps.

Congenital mesoblastic nephroma rich from mitosis after in vitro fertilization: a case report.

Recently, various childhood tumors such as leukemia, neuroblastoma, hepatoblastoma, retinoblastoma, and central nervous system tumors in patients born after assisted conception have been reported. Although involvement of in vitro fertilization in the tumor pathogenesis was not established, the likely effect of assisted reproductive technology has been increasingly considered in these tumors in the last decade. Congenital mesoblastic nephroma is the most common renal tumor of infancy younger than 6 months associated with an overall good prognosis. The cellular variant of congenital mesoblastic nephroma, which occurs primarily in infants older than 3 months, confers a less favorable prognosis. We present a case of an atypical congenital mesoblastic nephroma with cellular elements in a 2-month-old infant who was born after in vitro fertilization. To our knowledge, this is the second congenital mesoblastic nephroma case and the first one with cellular variant reported to date in the English literature after a pregnancy induced by an assisted reproductive technology.

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

OBJECTIVES: Radiological imaging techniques provide early detection of neurological diseases but they do not always provide an adequate and reliable diagnosis. With the help of stereotactic biopsy techniques, it is possible to access brain lesions safely and with high precision. We described the surgical method used in our clinic and discussed our results with the help of the current literature. METHODS: Ninety-four patients underwent computerized tomography-guided stereotactic brain biopsy in our clinic. Anatomical locations, diagnostic yield and accuracy of the procedure, morbidity and mortality rates were analyzed. RESULTS: A total of 100 stereotactic surgery procedures were performed on 94 patients. The localizations of the lesions were 13.83% frontal, 21.27% temporal, 27.66% parietal, 4.25% occipital, 4.25% multiple, 27.66% deep seated and 1.06% suprasellar. The histopathological diagnoses were 61.71% neuro-epithelial tumors, 8.51% metastases and 10.64% infectious lesions. Diagnostic yield was 86.16% and the accuracy was 90% in our series. CONCLUSION: Computerized tomography-guided stereotactic brain biopsy is a reliable and safe method. Main diagnostic problems in SBB are tissue heterogeneity, insufficient material and sampling error. These problems can be minimized by careful correlation of clinical, radiological and histopathological findings by an experienced team and by using modern technologies.

Role of fragile histidine triad protein expression in pathogenesis of malignant pleural mesothelioma.

AIM: To investigate the relationship of fragile histidine triad (FHIT) and Ki-67 expression with clinicopathological variables of patients with malignant pleural mesothelioma (MPM). METHODS: Formalin-fixed, paraffin-embedded tissue sections of 30 asbestos induced MPM (epithelial and biphasic) patients were examined for FHIT and Ki-67 expression using immunohistochemical techniques and results were compared with clinicopathological variables. RESULTS: Immunohistochemical study results were as follows: 12 (40%) cases showed low FHIT expression and 18 (60%) showed high expression. There was no significant relationship between FHIT and age, gender or histological subtypes (p > 0.05). Ki-67 expression was 'low' in 13 (43.3%) cases and 'high' in 17 (56.7%) cases. No correlation could be demonstrated between Ki-67 expression and age, gender or histological subtypes (p > 0.05). No significant association was observed between FHIT and Ki-67 expression in MPM. CONCLUSION: The results support the role of FHIT as a tumour suppressor gene in asbestos induced MPM. There is no significant correlation between FHIT and cell proliferation marker expressions in malignant pleural mesothelioma. Therefore, it can be concluded that loss of FHIT does not interfere with tumour proliferation. This can be accepted as evidence for an early role of FHIT loss in carcinogenesis; however, it needs to be strengthened by further studies.