ADRENAL ARTERIOVENOUS MALFORMATION MASQUERADING AS AN ADRENAL ADENOMA.

Arteriovenous malformations of adrenal gland are extremely rare. We report a case of an adrenal arteriovenous malformation, mimicking an adrenal tumor in preoperative imaging. A 48-year-old woman presented to our clinic with abdominal pain. A 9x7 cm right adrenal tumor was detected. Based on the imaging findings, adrenal adenoma was suspected. However, clinical symptoms and endocrine abnormalities were absent, the lesion was thought to be non-functional. Laparoscopic right adrenalectomy was performed. Pathologically, this was diagnosed as an adrenal arteriovenous malformation. To the best of our knowledge, this is the first reported case of an adrenal arteriovenous malformation in the current literature.

Influence of sumac (Rhus Coriaria L.) and ginger (Zingiber officinale) on egg yolk fatty acid, cholesterol and blood parameters in laying hens.

The aim of the study was to evaluate the potential effect of different levels of sumac (Rhus coriaria L.) seed powder and ginger (Zingiber officinale) root powder on egg yolk fatty acid composition, blood/yolk cholesterol in laying hen. A total of 63 (ATAK-S: Domestic Turkish Laying Hens) laying hens (average weight: 1470 g each hen, 25-weeks of age) were assigned to seven treatment diets including sumac seed (S) and ginger root powder (G) at 0 g/kg (control), 10 g/kg (S1), 20 g/kg (S2), and 30 g/kg (S3); 10 g/kg (G1), 20 g/kg (G2), or 30 g/kg in rations respectively, for 8 weeks. After a two-week adaptation period to cages, the hens were allocated to 7 groups with 9 replicates of 1 hen in per cage each. The replications were allotted equally into the upper and lower cages to minimize the effects of cage level. In this study, egg yolk cholesterol had a decrease (p <0.05) in supplemented diet( sumac seed and ginger root powder). Fatty acid content in yolk; saturated fatty acid, monounsaturated fatty acids, polyunsaturated fatty acids and rate of n6/n3 were not significant (p <0.05). However, dietary supplementation with sumac and ginger powder reduced and yolk/blood cholesterol concentrations in laying hens. Supplementation of sumac and ginger affected on HDL, there was found a significant effect (p < 0.05) in treatment groups. Moreover, LDL positively decreased in all treatment groups compared with the control group. The findings of this study suggested that feeding sumac and ginger tend to be decreasing cholesterol levels in both yolk and blood on laying hens. It can be concluded that ginger root and sumac seed powder can be used as an effective feed additive to improve fatty acid composition and yolk and blood cholesterol in ATAK-S laying hens.

Correlation between c-erbB2 expression, lymphovascular invasion and other biological and clinical prognostic factors and preoperative tumor markers in patients with early-stage and locally advanced breast cancer.

PURPOSE: To evaluate the correlation between c-erbB2 expression, lymphovascular invasion and other biological and clinical prognostic variables and preoperative CA 15-3 and CEA levels in patients with early-stage and locally advanced breast cancer. METHODS: Preoperative serum concentrations of CA 15- 3 and CEA were measured in 123 patients undergoing surgical treatment for stage I-III breast cancer and the association between these markers and clinical and biological variables were evaluated. RESULTS: With cut-off values of 45 U/ml (CA 15-3) and 2.5 ng/ml (CEA), the sensitivity for CA 15-3 and CEA was 10% and 24% and their mean values were 23 U/ml and 2.32 ng/ml, respectively. A significant correlation between preoperative levels of CA 15-3 and CEA was noticed (p=0.023). Preoperative CA 15-3 levels were significantly higher in patients with tumors > 5 cm (p<0.0001), with positive axillary lymph nodes (p=0.04), with increasing nodal burden (p= 0.025) and in patients with stage III disease (p=0.003). Tumor size >5 cm (p=0.002), increasing axillary nodal burden (p=0.02) and stage III disease (p<0.0001) were also significantly correlated with CEA values above the cut-off level. There were no correlations between CA 15-3 and CEA levels and other variables including c-erbB2 expression, age, grade, hormone receptor status, and lymphovascular invasion. CONCLUSION: Preoperative CA 15-3 and CEA levels are significantly correlated with tumor size, axillary nodal status and stage in patients with non-metastatic breast carcinoma. No correlation between preoperative values of CA15-3/CEA and c-erbB2 status, lymphovascular invasion and other prognostic factors was detected.

Screw prominences related to palmar locking plating of distal radius.

Fixation of unstable distal radius fractures with palmar locking plates provides a stable reduction and early return of function, but complications arising from unrecognized dorsally prominent screws penetrating the extensor compartments are increasingly reported. Standard radiographs and fluoroscopy may not adequately visualize screw lengths, owing to the complex shape of the dorsum of the distal radius. We examined 46 distal radius fractures treated with palmar locking plates by ultrasound. Of the total 230 locking screws, 59 protruded from the dorsal cortical surface by 0.5 mm or more (range 0.5-6.1 mm). The first extensor compartment was violated by one screw, the second compartment by 22 screws, the third compartment by 15 screws, and the fourth compartment by 21 screws. Asymptomatic tenosynovitis was detected in four and symptomatic tenosynovitis in 14 of the 59 prominent screws. Ultrasound imaging may be useful in cases where intra-articular and/or comminuted fractures require distal plate placement and engagement of screws in the dorsal cortex.

Primary peritoneal spindle cell sarcoma presented with massive ascites: a case report.

Soft tissue sarcomas (STSs) are a heterogeneous group of rare neoplasms originating from the embryonic mesoderm and mesenchymal cells. Primary peritoneal sarcomas have been reported as leiomyosarcoma, liposarcoma and carcinosarcoma. However, primary peritoneal spindle cell sarcoma has never been reported in the literature. Herein, we report on a 38-year-old woman with massive ascites diagnosed as primary peritoneal spindle cell sarcoma. Following doxorubicin and ifosfamide chemotherapy, her symptoms improved and ascites regressed. Other primary peritoneal sarcomas rarely cause massive ascites. We suggest that in patients presenting with massive exudative ascites associated with malignancy, primary peritoneal sarcomas should be also considered in the differential diagnosis.

An high performance liquid chromatographic method for the quantification of cotinine in the urine of preschool children.

Tobacco smoke exposure is an important and preventable cause of morbidity among children. Enviromental tobacco smoke (ETS) increases respiratory symptoms and disease and also decreases lung function in children who live in a household with at least one smoker. We have developed a simple and reliable HPLC method with diode array dedection to determine the urine concentrations of cotinine in children aged 3 to 6 years, exposed to ETS. The assay involved a liquid-liquid extraction with chloroform. The HPLC method utilized a Chromasil C18 column (150 mm x 4.6 mm i.d.) and an isocratic mobile phase of phosphate buffer: acetonitrile (83:17 v/v, 0.02 M containing 0.1% triethylamine, adjusted to pH 6.72 with orthophosphoric acid), at a flow rate of 0.7 ml min(-1). The detection was performed at 260 nm and the total analysis time of analysis was less than 15 min. Linearity ranged from 0 to 80 microg L(-1); correlation coefficients (r2) for calibration curves were greater than 0.99. With 2 mL of urine for extraction, the limit of detection was 0.1 microg L(-1). The mean extraction ratio of cotinine was 88.78%. This analytical method is suitable for the determination of cotinine levels in a large number of urine samples.

Immunophenotypical profiles of salivary gland tumours: a new evidence for their histogenetic origin.

The histogenetic origin of salivary gland tumours is not clear. In normal tissues smooth muscle actin (SMA) is expressed in myoepithelial cells, CK14 immunoreactivity is seen in myoepithelial and basal cells and CK10 in keratinized squamous epithelium. In this study, we examine the immunophenotypic properties of salivary gland tumours in order to obtain further insight into their histogenesis. 30 cases of salivary gland tumours (18 pleomorphic adenomas, 8 Warthin's tumours, 2 basal cell adenomas, 2 acinic cell carcinomas) were included in our study. Cytokeratin (CK) 10, CKI4, CKI7, CK18, CK 19, and smooth muscle actin (SMA) immunostains were applied to the sections. Immunoreactivities were detected and the statistical significance was evaluated by chi square test. SMA was not detected in Warthin's tumour (p < 0.0001). CK14 was found in all tumours except acinic cell carcinomas (p < 0.0001). CK10 immunoreactivity was observed in 5 Warthin's tumour. In conclusion, pleomorphic adenomas and basal cells adenomas originate from stem cells. Immunophenotypic profile of Warthin's tumour is suggestive of an embryological remnant origin.

Evaluation of alloderm and autologous skin in quadriceps muscles of rats for injection laryngoplasty.

There are three surgical methods utilized in treating glottic insufficiency: laryngeal framework surgery, reinnervation procedures and injection medialization. The trend towards the use of less invasive procedures led us to focus on injection medialization in this study. The advantages of vocal fold injection are that the procedure requires no external incisions, is easily applicable and can be applied in an office setting. Furthermore, injection medialization is applicable in cases of atrophic vocal fold and vocal fold scarring. In developing injection medialization, laryngologists are in search of an "ideal material" that should be biocompatible and resistant to resorption. In the initial applications of this method, synthetic materials were used. In the past 2 decades, however, researchers have become more and more interested in the advantages of biological materials. In our animal study, we investigated the behavior of AlloDerm and autologous skin injected in the quadriceps muscles of rats. The materials were easily injected. Histopathological and volumetric analyses were done; the rats were sacrificed the 1st day post-injection and subsequently in the 1st, 3rd and 6th months. AlloDerm's absorption levels were generally high, and its inflammation and fibrosis levels were low and medium. In the 6th month, histiocytic foreign body reaction was observed. The mean graft yield was 4.5%. Autologous skin results for inflammation and fibrosis levels were similar to those of AlloDerm. However, no foreign body reaction was observed in AS injected muscle. The graft yield was 74.6%. The growth of keratin cysts had an effect on the results of the graft yield.

Cytokeratin expression in lichen amyloidosus and macular amyloidosis.

AIM: To understand the role of epidermal cells in the pathogenesis of lichen amyloidosus (LA) and macular amyloidosis (MA). METHODS: We carried out immunohistochemical investigations on cytokeratins (CKs) in amyloid deposits in formalin-fixed and paraffin-embedded tissue specimens from eight persons with LA and 12 with MA. The primary antibodies of CK1-8 (AE3), CK10 (DEK-10), CK14 (LL002), CK17 (E3), CK18 (DC10), CK19 (KS19.1), CK5/6/18 (LP34) and CK8/18 (5D3) were used in the study. RESULTS: In amyloid deposits, immunoreactivity with only two monoclonal antibodies (CK1-8 and CK5/6/18) was observed in 14 cases (eight LA and six MA), confirming the hypothesis that epidermal cells participate in amyloid formation of LA and MA. COMMENTS: All of the CKs detected in amyloid deposits were basic type (type II). It seems plausible either that acidic CKs might be degraded faster than basic types in amyloidogenesis or that paraffin-embedded tissue specimens are less sensitive than frozen tissue sections. The results of our study suggest that when paraffin-embedded specimens are investigated by immunohistochemical methods, CK5 antibody is useful in the diagnosis of LA and MA.

Clear cell carcinoma of the breast with solid papillary pattern: a case report with immunohistochemical profile.

Glycogen rich clear cell carcinoma of the breast is a rare neoplasm with different morphological characteristics to ordinary breast carcinomas. However, it has some common features with clear cell carcinomas of other organs. This report describes a case of clear cell carcinoma of the breast with a solid papillary pattern centrally localised in the left breast of a 45 year old woman. Antibodies directed against cytokeratin 7 (CK7), CK10, CK14, CK17, CK18, CK19, CK20, CK5/6/18, CK8/18, high molecular weight cytokeratin AE3, high molecular weight cytokeratin 34betaE12, the oestrogen receptor, the progesterone receptor, chromogranin, S-100 protein, smooth muscle actin, vimentin, and carcinoembryogenic antigen were applied to analyse the immunophenotypical profile of this rare neoplasm.

Reasons for non-vaccination during national immunization days: a case study in Istanbul, Turkey.

OBJECTIVE: The member states of the 41st World Health Assembly agreed to aim for the global eradication of polio by the year 2000. Turkey adopted this goal and made substantial progress. In this report, we present the results of a coverage and risk factor survey conducted to evaluate vaccine delivery during the 1999 national immunization days (NIDs) in a large district of Istanbul, Turkey. This study provides important information regarding risk factors and reasons for non-vaccination during the NIDs, defines rumours about the NIDs, and provides estimates of vaccination coverage. SETTING AND PARTICIPANTS: A survey was conducted 3-10 days after the second round of 1999 NIDs using the standard expanded programme on immunization cluster survey method, for each of 10 health centre areas in Umraniye. In total, 2102 children were included in the analysis. RESULTS: The vaccination coverage rate was 82.2%. Logistic regression analysis showed increased risk of non-vaccination in people who did not know the purpose of the NIDs, who had not had contact with a mobile vaccination team, who were unvaccinated in the first round of 1999 NIDs and who lived in the area of the Central Health Centre. Use of primary-level state healthcare facilities for routine childhood immunizations, and living in the area of the Adem Yavuz Health Centre had significant positive effects on vaccination. CONCLUSIONS: To achieve better results, better publicity of national campaigns using mass media, and improved use of mobile teams, are necessary.

Age dependent changes in some immune system parameters and GFAP immunoreactivity in genetically absence epileptic rats.

The present study evaluated the contribution of some peripheral immunological parameters and GFAP immunoreactivity at different ontogenic stages of non convulsive absence epilepsy in WAG/Rij rats. For this, 2- and 6-month-old WAG/Rij rats, and the aged-matched control Wistar-albino rats were used. After collecting blood samples from all rats, the CD3 + (T cells), CD4 + (T helper), CD8 + (T cytotoxic), CD19 + (B cells) and CD25 + (IL-2 receptor, active T cell) cell ratios were determined by indirect immunofluorescence method and, serum IgG, IgA, IgM levels were evaluated by using rat radial immunodiffusion plates. After decapitation, brains were dissected and, GFAP staining was evaluated in the areas of caudate nucleus, thalamus, hippocampus, amygdala and cerebellum by immunohistochemistry. CD3 + cells and IgM levels increased with age in WAG/Rij rats. However, GFAP + astrocytes were decreased with age in caudate nucleus, thalamus, amygdala, and cerebellum of WAG/Rij rats. In the genetically absence epileptic rats, the humoral immunity was found to be affected more and activated by age. Additionally, astrocytes in thalamus and caudate nucleus that are the most important areas in the pathogenesis of absence epilepsy, were found to be decreased with age in WAG/Rij rats. From the results, it can be concluded that peripheral immunological parameters together with astrocytic activity may participate in the etiopathogenesis of absence epilepsy.

Synchronous occurrence of bladder carcinosarcoma and testicular seminoma.

We report a case of urinary bladder carcinosarcoma with simultaneous testicular seminoma. A 60-year-old male presented with painless gross hematuria and a left testicular mass. The bladder tumor was deeply infiltrating muscular tissue and had histologic features of both carcinoma and sarcoma. Testicular tumor was diagnosed as classical seminoma. Radical cystectomy, pelvic and left-modified retroperitoneal lymphadenectomy were performed. The lymph nodes did not show metastasis. At the 26 months follow-up, the patient is free of disease.

Helicobacter pylori status and cell proliferation activity in chronic antral gastritis.

BACKGROUND: Helicobacter pylori is known to cause antral gastritis and multifocal atrophic gastritis. In addition to its inflammatory effect, H. pylori has a direct effect on gastric mucosa. Increased epithelial proliferation, which may be an early biologic change in the development of gastric carcinoma, can be measured using silver stain for nuclear organizer regions (AgNOR). AIM: To detect the relation between H. pylori colonization and AgNOR index. METHODS: One hundred and twenty consecutive antral endoscopic biopsy specimens from patients with dyspepsia were examined for H. pylori colonization, polymorphonuclear infiltrate, mononuclear infiltrate, germinal center formation, mucus depletion and AgNOR index. RESULTS: AgNOR indices were not significantly related to grades of H. pylori colonization and chronic and active inflammation. The index increased significantly (p=0.03; ANOVA) with increasing mucin depletion. CONCLUSION: H. pylori colonization and presence of gastric antral inflammation are not related to cell proliferation activity; the latter is associated with mucin depletion.

Stromal microcalcification in prostate.

Prostatic calcification is most commonly encountered as calculus or intraluminal calcifications within atypical small glandular proliferations. This study was undertaken to detect stromal microcalcifications in prostate tissue. All slides from 194 needle biopsies were retrospectively reviewed. Six cases (3.1%) had stromal microcalcifications constantly associated with mononuclear inflammatory infiltrate around the each focus. Association with prostatic glands was not seen in any of the microcalcification foci. Three cases had simultaneous adenocarcinoma and one had high-grade prostatic intraepithelial neoplasia, all of which were apart from the microcalcification foci. In conclusion, stromal microcalcification is a dystrophic, inflammation-mediated, benign process.