The Effect of Udenafil on Stasis Zone in an Experimental Burn Model.

BACKGROUND: Management of the burn injuries is still a problematic issue because the stasis zone may become necrotic. We hypothesized that udenafil, a potent phospodiesterase inhibitor, can be beneficial in burn treatment by enhancing the viability of the stasis zone. METHODS: Fifteen Wistar rats were randomly divided into 3 groups. Comb burn injury model was conducted bilaterally on the back of rats in each subject. Group 1 received 1 mL/d of saline orally for 7 days. Group 2 received 10 mg/kg per day of udenafil for 7 days. Group 3 received 20 mg/kg per day of udenafil for 7 days. At the end of seventh day, gross morphological and histopathological samples of stasis zone survival were evaluated. RESULTS: Histopathological examination of groups 2 and 3 revealed that the stasis zone was mostly viable. The mean necrotic area and severity of inflammation was significantly higher in the control group compared with the treatment groups. Significant differences were determined in treatment groups compared with control group in terms of vital stasis zone area and histopathological parameters. CONCLUSIONS: Udenafil treatment improved tissue survival on zone of stasis in. Future experimental studies should be conducted to develop zone of stasis treatment protocols combining udenafil with potent anti-inflammatory and antioxidant drugs.

The role of osteopontin in the pathogenesis of placenta percreta.

OBJECTIVE: This study aims to determine how the expression of osteopontin is altered in the placenta percreta by compar-ing osteopontin expression in normal placentas and placenta percreta tissues. MATERIAL AND METHODS: Placental tissues from hysterectomy materials which were histopathologically diagnosed with placenta percreta (study group, n = 20) and placental tissues obtained from normal term pregnancies (control group, n = 20) were immunohistochemically stained with osteopontin antibody. The groups were compared with respect to the intensity of cytoplasmic staining for osteopontin. RESULTS: The study and control groups were similar with respect to age, gravidity, parity, gestational age at birth, number of previous cesarean deliveries and curettages and (p > 0.05 for all). Immediate postoperative hemoglobin was significantly lower and the need for blood transfusion was significantly higher in the study group (p = 0.001 for both). Placental osteo-pontin expression was significantly altered in the study group (p = 0.020). Negative staining for placental osteopontin was significantly more frequent in the placenta percreta group than the control group (9/20 vs 0/20, 45.0% vs 0%, p = 0.037). CONCLUSION: As reduced placental osteopontin expression was determined in the placenta percreta cases compared to the normal term placenta tissues, osteopontin can be considered to have a role in morbidly adherent placentation. This study is of value as the first study to investigate the changes in osteopontin expression in placenta percreta cases.

What is the role of matrix metalloproteinase-2 in placenta percreta?

AIM: This study compared the placental expression of the matrix metalloproteinase-2 (MMP-2) enzyme, which is thought to play a key role in the penetration of trophoblastic cells, in third-trimester placenta percreta (PP) patients with that of women with normal pregnancies. METHODS: Twenty-five pregnant subjects who underwent cesarean section due to PP and 25 term pregnant subjects who underwent cesarean section for obstetric reasons were included in the study. Demographic data, pathology reports, and histopathological samples were examined. Blocks containing samples of placenta underwent immunohistochemical analysis using the MMP-2 antibody. Immunohistochemical expression of placental samples obtained from both groups was examined and compared. RESULTS: There were no statistically significant differences in the demographic data (P > 0.05). With regard to immunohistochemistry, cytoplasmic staining of trophoblastic cells was considered immunohistochemically positive. In the PP tissue samples, positive MMP-2 staining was detected as follows: 0 immunoreactivity, one patient (4%); 1(+), six patients (24%); 2(+), seven patients (28%); and 3(+), 11 patients (44%). In the term pregnant placental tissue samples, positive MMP-2 staining was detected in five patients (20%) at 0 immunoreactivity, 12 (48%) at 1(+) immunoreactivity, five (20%) at 2(+) immunoreactivity, and three patients (12%) at 3(+) immunoreactivity. Immunohistochemical expression was significantly different between the PP and normal term pregnancy placental tissues (P = 0.02). CONCLUSION: The stronger expression of the MMP-2 enzyme in the PP as compared to the normal placental tissue suggests that this enzyme may be an effective mediator in the pathogenesis of PP.

Does moxifloxacin alter oxidant status in the cornea? An experimental study.

OBJECTIVE: In this experimental study, we investigated the possible effects of intracameral moxifloxacin on oxidative stress parameters and endothelial cell morphology in corneal tissue. METHODS: In total, 30 rats were randomly assigned to three groups of 10 rats: the sham group (Group 1, n = 10); the control group (Group 2), where balanced salt solution (BSS) was administered at a dose of 0.01 cc (n = 10); and the treatment group (Group 3), where moxifloxacin was administered at a dose of 0.05 mg/0.01 cc (n = 10). Total antioxidant status (TAS) and total oxidant status (TOS) in corneal tissue and blood samples were measured and the oxidative stress index (OSI) was calculated. Also, corneal tissue histopathology was evaluated with caspase-3 and caspase-8 staining. Apoptotic activity was also evaluated. RESULTS: In blood samples, TAS, TOS, and OSI levels were not statistically significantly different (all p > 0.05). Compared with the sham and control groups, TOS and OSI levels in cornea tissue were significantly different in the moxifloxacin group (all p < 0.05). However, compared with the control group, no statistically significant difference was found in the sham group (all p > 0.05). Compared with the sham and control groups, apoptotic activity was higher in the moxifloxacin group, in both immunohistochemical staining for caspase-3 and caspase-8. CONCLUSIONS: Intracameral moxifloxacin injection seems to be safe systemically, but it may have toxic effects on corneal tissues, as suggested by oxidative stress parameters and a histopathological evaluation.

Juvenile dermatomyositis with joint contractures and calcinosis cutis.

A 12-year-old boy presented to our department with firm papules on the fingers of both hands, erythematous scaly plaques on the dorsum of the hands and elbow, and deformities and limitation of motion in the joints of the hands and feet. His parents reported that the eruption started 6 years prior to presentation. He was previously diagnosed with psoriasis by physicians and acitretin treatment was given. However, he did not benefit from the treatment.

Urothelial Carcinoma Concomitant With Malakoplakia In Non-Functioning Nephrolithic Kidneys.

Nephrolithic non-functioning kidney and malakoplakia are major health problems. Kidney function cannot be fulfilled and also this leads to a high risk of development of urothelial neoplasm. We report herein a case of urothelial carcinoma concomitant with malakoplakia in non-functioning nephrolithic kidneys.

The relationship of mast cells and angiogenesis with prognosis in renal cell carcinoma.

OBJECTIVE: To evaluate the effects of mast cell count and angiogenesis on the prognosis of renal cell carcinoma. METHODS: The retrospective study was conducted at the Harran University, Sanliurfa, Turkey, and included 64 cases with diagnosis of renal cell carcinoma between 2002 and 2012. Immunohistochemical analysis was performed on paraffin sections using the standard streptavidin-biotin immunoperoxidase method. CD31 antibodies were used to identify microvessels in tumoural tissues. The microvessel density was calculated using a serological method. The mean vascular density was equivalent to the vascular surface area (in mm2) per unit tissue volume (in mm3) (MVD = mm3). Mast cells tryptase antibody was used to evaluate the mast cell count in tumoural and non-tumoural tissues. The relationship between mast cell count and microvessel density was evaluated and compared with stage, grade, tumour diameter, and age. RESULTS: The mast cell count in the tumoral tissue of renal cell carcinoma was significantly higher compared with non-neoplastic renal tissue (p < 0.001). A significant relationship was found between the mast cell count in tumoral tissue and stage, grade, and tumour diameter (p < 0.001). However, no relation was found with age (p > 0.05). The intratumoural mast cell count in clear cell renal carcinoma was significantly higher compared with non-clear variety (p = 0.001). No significant relationship was found between microvessel density, age, stage, diameter, or grade of the tumour and tumoral mast cell count (p > 0.05). CONCLUSION: No significant association was found between the number of mast cells in tumoral tissue and microvessel density. Further studies are needed to demonstrate the effect of mast cells on angiogenesis in renal cell carcinoma.

Pseudo-Meigs syndrome secondary to endodermal sinus tumor.

Ovarian tumors are the most common gynecological tumors seen in girls. Approximately 60-70% of them are germ cell tumors. Pseudo-Meigs syndrome is characterized by the presence of pelvic tumoral mass (benign or malign), pleural effusion, and massive acid. If the tumor is removed, acid and hydrothorax disappear. Endodermal sinus (yolk sac) tumor is a very rare cause in the diagnosis of Pseudo-Meigs syndrome, and only a few cases have been reported. This case is one of the rare cases presenting with Pseudo-Meigs syndrome and pathologically diagnosed as yolk sac tumor.

Investigation of sensory nerve endings in pulvinar, ligamentum teres, and hip joint capsule: A prospective immunohistochemical study of 36 cases with developmental hip dysplasia.

OBJECTIVE: The aim of this study was to immunohistochemically identify and characterize the presence of sensory nerve endings (SNEs) in pulvinar, ligamentum teres (LT), and hip joint capsule (HJC) of children with developmental dysplasia of the hip (DDH). METHODS: Pulvinar, LT, and HJC specimens were obtained from 38 hips of 36 children (31 girls, five boys; mean age=49 months; age range=18-132 months) during open reduction surgery for DDH. All specimens underwent subsequent routine tissue processing (formalin fixation and paraffin embedding). To determine tissue morphology, haematoxylin and eosin staining was used. SNEs were analyzed immunohistochemically using a mouse monoclonal antibody against S-100 Beta Protein based on the classification of Freeman and Wyke including four types of SNEs including mechanoreceptors: type I Ruffini corpuscles, type II Pacini corpuscles, type III Golgi organs, and type IVa unmyelinated free nerve endings (FNEs). Additionally, children were sorted into three groups based on their age at the time of surgery: Group 1 (age <3 years; 19 hips of 18), Group 2 (age: 3-5 years; 10 hips of 10 children), and Group 3 (age >5 years; 9 hips of 8 children). RESULTS: Although no Type I, II, or III SNEs were identified in any specimen, type IVa mechanoreceptor (FNEs) was immunohistochemically characterized in 13 (34%) pulvinar, 19 (50%) LT, and 16 (42%) HJC specimens. The total density of FNEs was 3.31±5.70)/50 mm2 (range 0-21) in pulvinar specimens, 3.18 ± 5.92)/50 mm2 (range 0-24) in HJC specimens, and 4.51±6.61/50 mm2 (range 0-22) in LT specimens. Furthermore, the operated side, gender, and the number of FNEs in specimens did not differ significantly among the age groups (p>0.05 for all), and the number of FNEs was not significantly correlated with age, gender, or the operated side (p>0.05 for all). CONCLUSION: Evidence from this study revealed that pulvinar, LT, and HJC include only FNEs, which play a role in pain sensation, among mechanoreceptors. Surgical excision of these tissues may not cause a significant loss of sensory function in the hip joint of children with DDH. LEVEL OF EVIDENCE: Level II, Therapeutic Study.

A New Method Involving Percutaneous Application in the Treatment of Deep Venous Insufficiency: An Experimental Study With Internal Compression Therapy in a Porcine Model.

INTRODUCTION: To study the efficiency of internal compression therapy (ICT), a new and promising method of treatment for deep venous insufficiency, how that efficiency is achieved, and its potential side-effects, in a porcine model. MATERIAL AND METHODS: The femoral vein diameters of 4 pigs were first measured. ICT was then applied such as to reduce the diameter of these veins by 50%. The femoral vein diameters of 2 pigs were re-measured after 1 month. The femoral vein and its surrounding tissue were excised for immunohistopathological and genetic examination. The same procedures were applied to the remaining 2 pigs 3 months subsequently. Collagen I and IV immunohistochemical staining and Masson's trichrome and Alcian blue histochemical staining were applied during immunohistopathological examination. Collagen I, III, and IV and connective tissue growth factor (CTGF) mRNA expressions were examined for genetic examination. RESULTS: The femoral vein diameters decreased by approximately 50% after ICT application. This decrease persisted after the first and third months. Histopathological examination revealed loose connective tissue around the venous tissue after the operation, particularly in the third month, together with perivascular fibrosis and increased collagen in connective tissue. No difference was observed between regions with and without ICT application in terms of mucinous degeneration, an indicator of tissue injury, during Alcian blue staining. Genetic examination revealed an increase in collagen I and IV and CTGF mRNA expression in perivascular tissue resulting from ICT application. CONCLUSION: ICT is effective both in terms of creating a durable tissue around the vein and of increasing collagen tissue and stimulating fibrosis, and has no deleterious side-effects on tissue.

Comparison of the effects of thymoquinone and silymarin on the brain of rats having ischemia-reperfusion in the lower extremities.

AIM: We aimed to show whether ischemia reperfusion (I/R) injury causes damage on brain or not, and whether thymoquinone and silymarin, as antioxidant and anti-inflammatory herbs, have beneficial effects on this damage or not. METHODS: Forty Wistar albino rats were carried out and were randomized to 4 groups with equal numbers (n=10): sham group, implemented of only anesthesia; control group, implemented of anesthesia and I/R injury; silymarin group, implemented of anesthesia and I/R injury and treated with a dose of 200 milligram/kg silymarin ip and thymoquinone group, implemented of anesthesia and I/R injury and treated with a dose of 20 mg/kg thymoquinone. Serum lipid hydroperoxide (LOOH) and total free sulfhydryl (Sh) levels were determined. Light microscopy was used to evaluate histological changes in brain tissue. RESULTS: Serum LOOH levels (0.21 ± 0.04 for control group, 0.29 ± 0.01 for sham group, 0.23 ± 0.09 for silymarin group, 0.29 ± 0.09 for thymoquinone group) were significantly higher and Sh levels (10.74 ± 1.71 for control group, 6.82 ± 0.24 for sham group, 9.12 ± 1.04 for silymarin group, 8.41 ± 1.12 for thymoquinone group) were significantly lower in control, silymarin and thymoquinone groups compared to control group (p<0.05 for all). According to the histopathologic damage score assessment, it was seen that the damage decreased significantly in the silymarin and the thymoquinone groups. CONCLUSION: We showed that tissue damage also occurs in brain following the ischemia reperfusion. It was shown that thymoquinone and silymarin is quite effective in preventing this damage. KEY WORDS: Brain, Hydroperoxide levels, Ischemia reperfusion injury, Sulfhydryl levels, Silymarin, Thymoquinone.

Giant renal metastasis from prostate cancer mimicking renal cell carcinoma.

The most common sites for prostate cancer metastasis include bone, distant lymph nodes, liver and lungs. Renal metastasis of prostate cancer is a rarely seen pattern of invasion. In the current study, we described an 83-year-old male with a history of prostate cancer. He was admitted because of edema, hyperemia, warm and pain at left leg and inguinal region. In the further evaluation, a mass lesion at prostate region and conglomerate lymphadenopathy at left iliac vascular trajectory and a mass lesion at left kidney with heterogeneous contrast-enhancement were observed on contrast-enhanced magnetic resonance imaging and computerized tomography scan. Fine-needle aspiration biopsy was performed in the lesion with radiologically suspect renal cell carcinoma. By evaluating histopathological features and immunohistochemical staining of the tumor, we decided that the lesion was metastasis from prostate cancer.

A Giant Mature Cystic Teratoma Mimicking a Pleural Effusion.

The vast majority of teratomas originating from more than a single germ layer are benign. Often, such teratomas are initially asymptomatic. Later symptoms are caused by the weight per se of the teratoma and include chest pain, cough, dyspnea, and/or recurrent attacks of pneumonia. A mediastinal teratoma is treated by total surgical resection of the mass. Here, we report a case of giant mature cystic teratoma mimicking a pleural effusion in the thorax at the 7-month-old female patient with a symptom of persistent pulmonary infection and tachypnea.

Trophoblastic E-cadherin and TGF-beta expression in placenta percreta and normal pregnancies.

OBJECTIVE: This study aimed to evaluate whether trophoblastic transforming growth factor beta (TGF-ß) and E-cadherin expression levels have a role in placenta percreta (PP) aetiopathogenesis. METHODS: This study was carried out in the Obstetrics & Gynecology and Pathology Departments of Harran University Medicine School. Forty-four women who underwent caesarean section for PP and other obstetric reasons were included in this study. PP was defined as the detection of placental invasion during the histopathological examination of the hysterectomy specimen, which passes the uterine wall as a whole layer and involves the uterine serosa. Placental tissue samples were collected from all pregnant patients to evaluate TGF-ß and E-cadherin expression levels. RESULTS: No significant difference was found in demographic features, including age, gestational week, number of pregnancies and body mass index, among the groups. Immunohistochemical staining against E-cadherin, a cell adhesion molecule, showed significantly reduced staining in PP patients (p = 0.048). TGF-ß staining was also low in PP patients, but this difference was not significant (p = 0.107). CONCLUSIONS: The findings of this study suggest that a decrease in trophoblastic E-cadherin expression may have an important role in PP aetiopathogenesis.

Anti-inflammatory effect of lycopene on endotoxin-induced uveitis in rats.

PURPOSE:: We evaluated the efficacy of lycopene, a dietary carotenoid and potent antioxidant, against ocular inflammation and oxidative stress in an experimental uveitis model. METHODS:: Endotoxin-induced uveitis (EIU) was induced in Sprague-Dawley rats by a single subcutaneous injection of 200 µg lipopolysaccharide (LPS). Induction of EIU was preceded by daily intraperitoneal injection of 10 mg/kg lycopene for three consecutive days (Lycopene + LPS group) or equivolume vehicle (Vehicle + LPS group). A positive control group received 1 mg/kg dexamethasone pretreatment (DEX + LPS), and a negative control group received daily vehicle injection but no LPS (Vehicle Control). Twenty-four hours after LPS or final vehicle administration, eyes were enucleated, and aqueous humor was collected for measurement of the number of infiltrating cells, total protein concentration, and levels of nitric oxide (NO), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and oxidative stress markers. Inflammatory response severity was compared among groups clinically and histopathologically. RESULTS:: Infiltrating cell number, total protein concentration, and NO, TNF-α, and IL-6 levels were significantly elevated in the aqueous humor of Vehicle + LPS group rats compared to Vehicle Controls. Compared to the Vehicle + LPS group, lycopene pretreatment significantly reduced aqueous humor concentrations of oxidative stress markers, NO (0.29 ± 0.1 µM vs. 0.19 ± 0.1 µM, p=0.003), TNF-α (71.0 ± 22.3 ng/ml vs. 50.1 ± 2.1 ng/ml, p=0.043), and IL-6 (121.6 ± 3.0 pg/ml vs. 111.1 ± 5.6 pg/ml, p=0.008). Inflammatory score was also reduced (2.0 ± 0.0 vs. 0.4 ± 0.5, p=0.001). Lycopene reduced the infiltrating cell count and protein concentration, but differences did not reach significance. Most lycopene effects were equivalent to dexamethasone. CONCLUSIONS:: Lycopene may aid in the clinical management of uveitis by suppressing inflammation and oxidative stress.

Intraperitoneal Administration of Silymarin Protects End Organs from Multivisceral Ischemia/Reperfusion Injury in a Rat Model.

Objective: To determine whether intraperitoneal silymarin administration has favorable effects on the heart, lungs, kidney, and liver and on oxidative stress in a rat model of supraceliac aorta ischemia/reperfusion injury. Methods: Thirty male Wistar albino rats were divided equally into three groups: sham, control, and silymarin. The control and silymarin groups underwent supraceliac aortic occlusion for 45 min, followed by a 60 min period of reperfusion under terminal anesthesia. In the silymarin group, silymarin was administered intraperitoneally during ischemia at a dose of 200 mg/kg. Rats were euthanized using terminal anesthesia, and blood was collected from the inferior vena cava for total antioxidant capacity, total oxidative status, and oxidative stress index measurement. Lungs, heart, liver and kidney tissues were histologically examined. Results: Ischemia/reperfusion injury significantly increased histopathological damage as well as the total oxidative status and oxidative stress index levels in the blood samples. The silymarin group incurred significantly lesser damage to the lungs, liver and kidneys than the control group, while no differences were observed in the myocardium. Furthermore, the silymarin group had significantly lower total oxidative status and oxidative stress index levels than the control group. Conclusion: Intraperitoneal administration of silymarin reduces oxidative stress and protects the liver, kidney, and lungs from acute supraceliac abdominal aorta ischemia/reperfusion injury in the rat model.

Relationship Between Echocardiographically Evaluated Aortic Stiffness and Prolidase Activity in Aortic Tissue of Patients with Critical Coronary Artery Disease.

BACKGROUND AND AIMS: The aim of this study was to determine the relationship between echocardiographically evaluated aortic stiffness and prolidase activity in aortic tissue of patients with critical coronary occlusion. METHODS: Thirty six patients with coronary artery disease (CAD) scheduled for CABG and 30 control patients with no CAD proven angiographically were enrolled in this study. Plasma prolidase activities were quantified spectrophotometrically. During performance of the proximal anastomoses in the study group, a piece of aortic tissue was taken by punch and tissue prolidase activity was quantified spectrophotometrically and also evaluated pathologically by prolidase immunostaining. Eventually, the correlation of plasma prolidase activity, aortic tissue prolidase activity and aortic prolidase immunohistochemical staining with aortic stiffness was studied. RESULTS: The correlation of aortic stiffness with aortic tissue prolidase activity (rs = 0.364; p = 0.029) and aortic prolidase immunohistochemical staining (rs = 0.354; p = 0.034) was significant in the study group. However, the correlation of plasma prolidase activity with aortic stiffness was not statistically significant (rs = 0.083; p = 0.292). Linear regression analysis showed that the aortic stiffness ß index was significantly associated with aortic tissue prolidase activity (ß = 0.354; p = 0.034) and statin usage (ß = -0.334; 0.047) in the study group. Regression analysis revealed that ATPA and statin use were predictors of aortic stiffness, and API+ was found to be the predictor for ATPA (ß = 0.449; p = 0.006). CONCLUSION: Aortic tissue prolidase activity was more significant than plasma prolidase activity and aortic tissue prolidase immunohistochemical staining in the relationship with aortic stiffness in the critical CAD group.

The effects of lycopene on intestinal injury due to methotrexate in rats.

OBJECTIVE: The aim of this study was to investigate the effects of lycopene (Lyc) on methotrexate (Mtx)-induced intestinal damage in rats. METHOD: Twenty-eight male Sprague Dawley rats were divided into four equal groups: control, Mtx, Lyc, and Mtx-L. CONTROL GROUP: Rats were given only the vehicle. Lyc group: Rats were given Lyc (10 mg/kg) with corn oil by oral gavage for 10 days. Mtx group: Rats were injected intraperitoneally with a single dose of 20 mg/kg of Mtx and given corn oil by oral gavage. Mtx-L group: Rats were treated with Lyc (10 mg/kg) for 10 days after a single dose of Mtx (20 mg/kg). All of the rats were euthanized using terminal anesthesia, and the intestinal tissues were removed for histological examination and for pro-inflammatory cytokine measurement (tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1ß)), total oxidative status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI). RESULTS: Mtx administration increased histopathological damage and increased TNF-α, IL-1ß, TOS, TAC, and OSI levels in the small intestine tissues. Lyc therapy applied to the Mtx-L group provided significant improvement in all parameters of histopathological damage to the small intestine and significantly reduced the levels of IL-1ß, TOS, and OSI in the intestinal tissues. CONCLUSIONS: The results of this study indicate that Lyc might be useful for protecting intestinal damage induced by Mtx in rats by reducing the increased oxidative stress and pro-inflammatory cytokine (IL-1ß) levels.

Ki-67 proliferation index in patients with placenta previa percreta in the third trimester.

AIM: The purpose of this study was to investigate proliferative capacity of placenta previa percreta in the third trimester via evaluating Ki-67 proliferating index. METHODS: The paraffin blocks of placental tissues, which were obtained from the patients who underwent hysterectomy for placenta previa percreta (n = 12, gestational age > 28 weeks), from legal abortions (n = 12, gestational age < 10 weeks), and of cesarean deliveries with the indication of previous cesarean section, without any complication (n = 12, gestational age > 38 weeks), between January 2011 and April 2013, were included into the study. The paraffin blocks of the patients were stained with Ki-67 (proliferating cell marker) immunohistochemically, and Ki-67 proliferation index levels were calculated. RESULTS: Ki-67 proliferation index levels were higher in patients with legal abortions than patients with placenta percreta or noncomplicated cesarean delivery group. However, any statistically significant difference was not detected between the percreta and noncomplicated groups (p > 0.05). CONCLUSION: The tissue samples of the patients with placenta previa percreta exhibited low proliferative capacity similar to the samples of normal placentation group.