Extending Myringotomy Patency with Topical Everolimus in Rats.

BACKGROUND: Everolimus is an immunosuppressant agent that has antiproliferative properties and negative effects on wound healing. The effect of everolimus use to delay the closure time of myringotomy is not known. OBJECTIVES: The aim of the study was to evaluate the impact of topical everolimus on myringotomy patency and to investigate its histopathologic effects on the tympanic membrane. MATERIAL AND METHODS: Twenty Sprague-Dawley rats were bilaterally myringotomized with a myringotomy knife. Gelfoam soaked in 0.05% everolimus in a microemulsion formulation was applied to the right myringotomy site of the rats for 10 min (the everolimus group). The myringotomy sites of the left ears were treated with sterile saline topically (the control group). The tympanic membranes were routinely examined otomicroscopically every other day for 31 days. The membranes were then harvested and evaluated histologically after 31 days. RESULTS: All tympanic membranes were closed by the 15(th) day in the control group, while in the everolimus group the myringotomy remained open in five rats (25%) on day 31. The mean durations of myringotomy patency in the everolimus group and control group were 20.90 ± 7.85 and 10.10 ± 3.14 days, respectively. The difference was found to be statistically significant (p < 0.01). In the histopathological examination of the tympanic membranes, there was less fibrosis and less inflammation in the everolimus group than in the control group (p < 0.01). CONCLUSIONS: Topical everolimus application is effective in extending myringotomy patency in rat tympanic membranes. Inflammatory reactions and fibrosis in the lamina propria were observed to be significantly less when topical everolimus was used.

The role of PET-CT in the differential diagnosis of thymic mass after treatment of patients with lymphoma.

Thymic hyperplasia is a common phenomenon in both children and young adults after chemotherapy and may explain the finding of a mediastinal mass in patients with malignant lymphoma after complete remission. In the present study, we report 5 cases with malignant lymphoma presenting with a mediastinal mass on CT scan after completion of chemotherapy diagnosed as thymic hyperplasia by PET-CT imaging. We retrospectively analyzed 5 patients who presented with anterior mediastinal masses a median of 4 months (range 3-6) after achieving complete remission following successful treatment for malignant lymphoma. Three patients were diagnosed with Hodgkin's lymphoma (HL) and the others with non-Hodgkin's lymphoma (NHL). The median age of the patients was 23 (range of 18-47). PET-CT was performed on these patients to determine the characteristics of a mass which had been detected on CT. PET-CT was performed for all patients, and the thymic masses demonstrated only mild FDG uptake considered to be consistent with thymic hyperplasia. During a median of 24 months of follow-up, all patients were recurrence-free with a median survival of 15 months (range 10-26 months). It is important to be aware of the possibility of thymic hyperplasia after chemotherapy to avoid misdiagnosis or over-staging of disease, as well as unnecessary biopsies, especially when the presenting anterior mediastinal mass was originally located near the thymus on CT scan. Mild FDG PET uptake was sufficient for the diagnosis of benign disease in the cases in this study.

[Evaluation of Ki-67 expression in recurrent cases of cholesteatoma]. / Tekrarlayan kolesteatomlu olgularda Ki-67 ekspresyonunun degerlendirilmesi.

OBJECTIVES: Recurrences are still a challenge despite appropriate techniques in cholesteatoma surgery. This study was designed to evaluate the level of Ki-67 expression in recurrent cases of cholesteatoma. PATIENTS AND METHODS: The study included 32 patients (18 males, 14 females; mean age 34 years; range 12 to 63 years) who underwent surgery for otitis media. Of these, 19 patients had cholesteatoma, and eight patients had recurrent cholesteatoma. Five patients who underwent tympanoplasty for chronic otitis media comprised the control group. All the patients with cholesteatoma underwent radical mastoidectomy. At surgery, tissue samples of cholesteatoma were taken and prepared for immunohistochemical staining. In controls, retroauricular skin samples were used. The two patient groups with cholesteatoma were compared with respect to Ki-67 expression. RESULTS: Increased cellular proliferation was detected in both groups of cholesteatoma. No significant difference was found between two cholesteatoma groups with respect to Ki-67 staining (p>0.05). Compared to the controls, patients with cholesteatoma and those with recurrent cholesteatoma had significantly higher levels of Ki-67 staining (p<0.05 and p<0.01, respectively). CONCLUSION: Our results suggest that, despite a higher degree of proliferation in recurrent cholesteatoma cases, treatment failures may be mainly associated with the surgical technique, accompanying infections, and the type of cholesteatoma.

Sarcoidosis presenting as cold thyroid nodules: report of two cases.

Sarcoidosis is a systemic disease characterized by noncaseating granulomas. Thyroid involvement is rare in sarcoidosis. In this paper, two sarcoidosis patients who demonstrated cold thyroid nodules are presented. A 42-year-old woman presented with multinodular goiter and was diagnosed as having sarcoidosis when noncaseating granulomas were observed during the pathological examination of the thyroidectomy specimen. Enlarged mediastinal lymph nodes were observed in the routine preoperative chest X-ray in another 53-year-old woman, while she was being prepared to undergo a thyroidectomy. The pathological examination of the thyroid specimens showed noncaseating granulomas in both patients, and the diagnosis was confirmed by either hepatic biopsy or chest X-ray findings. In conclusion, thyroid involvement should be suspected in sarcoidosis patients who present with cold nodules in the thyroid. Furthermore, if noncaseating granulomas are observed in thyroid specimens after a thyroidectomy in an otherwise healthy person, the patient should be evaluated further for sarcoidosis.

A patient with metachronous gastric, colonic, and thyroid cancers: a case report.

In this paper, we discuss a 62-year-old woman who, in the course of 7 years (1994-2001), developed three cancers: adenocarcinoma of the stomach, adenocarcinoma of the cecum, and insular thyroid carcinoma, which metastasized to the retroperitoneal lymph nodes and liver. The patient died from complications related to the metastases. The results of basic genetic tests were normal. To the best of our knowledge, no other patient with the combination of these three cancers has been reported in the literature. Although patients with multiple cancers are not common, it is nonetheless important for clinicians to consider the possibility of second and third cancers in patients who were treated for a primary malignant tumor.