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.

Investigation of histopathological effects after intra-arterial sugammadex injection in an experimental animal model.

PURPOSE: Intra-arterial injection of medications are related to mortality and morbidity. It was aimed to investigate the histopathological effects caused by two different intra-arterial doses of sugammadex, a new selective relaxant binding agent used to reverse the effects of steroidal systemic muscle relaxants used in surgeries carried out under general anesthesia. METHODS: A total of 15 rabbits were randomly divided into 3 groups. The control group was given 1 mL saline bolus into the central artery of the ear. The other two groups (Group Sgdx2 and group Sgdx16) were given 2 and 16 mg/kg sugammadex, respectively, intra-arterially. RESULTS: In control group, histopathological evaluation was in normal limits. The cross-sections belonging to Group Sgdx2 did not have any significant pathological change compared with control group (p > 0.05). Edema and single-cell necrosis were significantly higher in Group Sgdx16 when compared to control group (p < 0.05). In comparison to Group Sgdx2, single-cell necrosis was significantly higher in Group Sgdx16 (p < 0.05). CONCLUSION: Being broadly used in anesthesia, sugammadex should be administered with care because when given by intra-arterial route it may cause tissue damage and tissue loss and the patients' arteries should be carefully checked.

Investigation of the effects of oleuropein rich diet on rat enteric bacterial flora.

OBJECTIVES AND BACKGROUND: Oleuropein is a phenolic compound of olive leaves. Enteric bacterial flora is very important for human health and diet is a directly affecting factor of enteric bacterial flora composition. In this study, it was hypothesized that oleuropein could reduce total aerobic bacterial count in rat caecal flora. METHODS: Twenty adult, male, Wistar albino rats were randomly divided into two groups. Group C (n=10) was fed with standard rat chow and water for 30 days. Group O (n=10) received olive leaf extract 20 mg/kg/day by intragastric gavage in addition to standard rat chow and water for 30 days. One gram of caecal content was collected from each rat and then consecutive 10-fold serial dilutions were prepared with a final concentration of 10-8. Then 0.1 ml of each dilution were spread onto the surfaces of Plate Count Agar and Violet Red Bile Glucose Agar to enumerate the aerobic enteric bacteria. RESULTS: Total aerobic bacterial counts of Group O were significantly lower than of Group C in all agar plates inoculated with ceacal samples for every dilution (p<0.05). CONCLUSION: Adding oleuropein to enteral feeding solutions of critically ill patients may be adventageous in the presence of clinical conditions predisposing to bacterial translocation by reducing enteric bacterial counts (Tab. 1, Ref. 32).

Malignant mixed Müllerian tumor with small cell neuroendocrine differentiation: a case report and review of the literature.

INTRODUCTION: Small cell neuroendocrine differentiation (NE) in malignant mixed Müllerian tumors (MMMTs) is a rare and unusual occurrence with very few previously reported cases. There is no consensus regarding its diagnosis, classification, and optimal treatment options. CASE: The authors report a patient with endometrial MMMT and NE differentiation who initially received comprehensive surgery followed by adjuvant chemotherapy containing cisplatin and etoposide. She further underwent metastasectomy and received carboplatin and paclitaxel for the relapse. She is still alive 12 months after the diagnosis. The authors performed a review of literature in order to characterize the clinical phenotype. These patients have a very aggressive disease. Median life expectancy seems to be less than a year. CONCLUSIONS: It is reasonable to perform comprehensive staging surgery followed by adjuvant chemotherapy irrespective to stage of the disease.

EFFECTS OF STANDARD AND/OR GLUTAMINE DIPEPTIDE AND/OR OMEGA-3 FATTY ASCID-SUPPLEMENTED PARENTERAL NUTRITION ON NEUTROPHIL FUNCTIONS, INTERLEUKIN-8 LEVEL AND LENGTH OF STAY--A DOUBLE BLIND,CONTROLLED, RANDOMISED STUDY.

BACKGROUND AND AIMS: Protein calorie malnutrition for cancer patients is related with altered cellular and humoral immunity. Standard TPN and glutamine and lipid emulsion with omega 3 fatty acids were given to colorectal cancer patients and the effects of these to neutrophil functions and IL-8 levels are compared. METHODS: Consecutive 36 patients with colorectal cancer diagnosed with endoscopic biopsy and with malnutrition determined by subjective global assessment were enrolled to study. The patients are randomly divided into four groups. Standard TPN to control group, TPN with glutamine solution to S-D group, TPN with omega 3 fatty acid solution to S-O group and TPN with omega 3 fatty acids solution and glutamine to S-D-O group were given for seven days after the operation. At the preoperative, postoperative first day and 7th day, neutrophil phagocytosis index, neutrophil adhesivity index and IL-8 levels were determined. RESULTS: In all groups compared to control group neutrophil phagocytosis index were increased significantly (p<0.05). The most increasing was in group 3. There wasn't significant difference between groups about postoperative first day neutrophil adhesiveness index (p>0.05). At the 7th day the neutrophil adhesivity index for study groups were increased compared with control group, but there was no significant differences between groups. There was no significant difference between groups for IL-8 levels. CONCLUSIONS: As a result of the study, altered cellular immunity in colorectal cancer patients with malnutrition can be corrected with omega 3 fatty acid emulsions and glutamine added to TPN so the ratio of morbidity and mortality can be decreased.

Mean platelet volume in nasal polyps.

BACKGROUND: Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in haemostasis, tissue repairing and inflammation. However, to our knowledge, there are no reports in the literature that study the association between platelet parameters and nasal polyps. SUBJECTS AND METHODS: Forty-three patients with nasal polyps and forty-nine healthy controls were enrolled in the study, retrospectively. Laboratory data of patients with nasal polyp were obtained at the time of diagnosis. RESULTS: There were no statistically significant differences between the two groups in terms of white blood count, haemoglobin, haematocrit and platelet count. The mean platelet volume (MPV) value of the nasal polyp group was significantly lower than the control group (p = 0.025). Mean eosinophil count was significantly elevated in the nasal polyp group compared to the control group (p < 0.001). CONCLUSIONS: Reduction in MPV may be an indicator for nasal polyp formation. Further studies with a larger study population are needed to detect the possible correlation between eosinophil count and MPV values in patients with nasal polyps.

Laparoscopic surgery compared to traditional abdominal surgery in the management of early stage cervical cancer.

UNLABELLED: The purpose of the study was to compare laparoscopic total radical hysterectomy with classic radical hysterectomy regarding parametrial, and vaginal resection, and lymphadenectomy. METHODS: Laparoscopic or laparotomic total radical hysterectomy with advantages and disadvantages was offered to the patients diagnosed as having operable cervical cancer between 2007 and 2010. Lymph node status, resection of the parametria and vagina, and margin positivity were recorded for both groups. Data were collected prospectively. Statistical analysis was performed with the SPSS statistical software program. RESULTS: Totally, 53 cases had classical abdominal radical hysterectomy and 35 laparoscopic radical hysterectomy, respectively. Parametrial involvement was detected in four (11.4%) cases in laparoscopic radical surgery versus nine (16.9%) in laparatomic surgery. All the cases with parametrial involvement had free surgical margins of tumor. Also there were no significant statistical differences in lymph node number and metastasis between the two groups. CONCLUSION: There is no difference in anatomical considerations between laparoscopic and laparatomic radical surgery in the surgical management of cervical cancer.

Glaucoma and increased central corneal thickness in aphakic and pseudophakic patients after congenital cataract surgery.

AIM: To compare the mean central corneal thickness (CCT) among aphakic and pseudophakic patients following congenital cataract surgery with age matched controls. METHODS: This study included 43 eyes of 43 aphakic and pseudophakic patients following congenital cataract surgery. 44 healthy, age and sex matched volunteers were recruited for comparison with the patients. After a complete eye examination, corneal thickness and intraocular pressure were measured. RESULTS: In the study group, 33 eyes were aphakic, and the remaining 10 eyes were pseudophakic. The median CCT was 556.0 microm (range 490-640 microm) in the control group and 626 microm (range 523-870 microm) in the study group (p<0.05). There was a significant difference in CCT between aphakic and pseudophakic eyes in which an intraocular lens (IOL) had been implanted at the time of congenital cataract surgery (p = 0.011). The same difference was not observed between aphakic and pseudophakic eyes in which an IOL had been implanted secondarily (p = 0.835). The median age of the patients at the time of lensectomy was 24 months (range 1 week to 120 months). There was a negative correlation between the age at lensectomy and CCT (r = -0.485, p = 0.001). CONCLUSION: Aphakic and pseudophakic patients have significantly thicker corneas than age matched controls. This difference can have an important effect on interpreting intraocular pressures in these patients. It is also important to assess the effects of early surgery for congenital cataracts, as well as those of primary and secondary IOL implantation, on CCT.

Effects of fine-needle aspiration biopsy (FNAB) nodule depth on pain score.

PURPOSE: Fine-needle aspiration biopsy (FNAB) of the thyroid is generally a well-tolerated procedure associated with weak levels of pain. However, pain may be very intense in some patients. The cause for the pain in these patients has not been identified. The hypothesis of this study is that there is a likely relationship between pain level and nodule depth during FNAB. MATERIALS AND METHODS: Included in the study were 98 patients with euthyroid nodular goiter who underwent FNAB. When ultrasound guided thyroid fine-needle aspiration biopsy was performed findings such as the distance of the nodule to the skin, the size of the nodule, visual analogue scale (VAS) score values were recorded. FINDINGS: The distance of nodule to skin and nodule size was measured, respectively, as 10.7 ± 2.8 mm and 21.7 ± 8.6 mm. Mean VAS score was 36 ± 16. FNAB-related pain was correlated with the nodule depth (r = 0.43, p < 0.001). In the logistic regression analysis, we also found that high VAS score class was effected by only nodule depth (B = -1.619; OR 1.287; CI 1.057-1.565, p < 0.05). CONCLUSION: Our results show that pain increased significantly during FNAB in patients who had more deeply situated nodules. Local anesthetic methods may be recommended for these patients.

Impact of different hormone replacement therapy regimens on the size of myoma uteri in postmenopausal period: tibolone versus transdermal hormonal replacement system.

OBJECTIVES: To assess the effect of different hormone replacement therapy regimens on myoma uteri in postmenopausal period. METHODS: Totally 46 patients with 60 myomas attending to Department of Obstetrics and Gynecology, Akdeniz University School of Medicine between May 2000 and March 2001 because of postmenopausal symptoms and having myoma uteri were included in this study. These patients were randomized for tibolone and transdermal hormonal replacement therapy system. The patients who were taking hormonal replacement therapy, discontinued the treatments and lost for follow-up were excluded from the study. Impact of the treatments on the size of myoma uteri was evaluated 6 months after starting the therapy. Size of myomas were evaluated by transvaginal sonography before and 6 months after onset of the treatment. RESULTS: Mean age was 57.3 (50-70) and mean gravida 3.6 (1-6) for all the patients. Although, increase in the size of myoma uteri was frequent in transdermal HRT, it was not statistically significant. CONCLUSION: There are no statistical significant differences between tibolone and transdermal hormonal replacement therapy regimens in respect to increase in the size of myoma uteri.

Case report: bilateral vocal cord paralysis caused by cervical spinal osteophytes.

Thyroid and cervical surgery, tracheal intubation, trauma and neurodegenerative and neuromuscular diseases may cause bilateral vocal cord paralysis. There are only a few reported cases of bilateral cord paralysis associated with cervical hyperostosis in the English literature. We report the MR and CT findings of a case of bilateral vocal cord paralysis caused by cervical spinal osteophytes compressing the recurrent laryngeal nerves.

Comparative efficacy of beta-irradiation and mitomycin-C in primary and recurrent pterygium.

PURPOSE: To determine the efficacy and safety of mitomycin-C as adjunctive treatment and to compare this drug with beta irradiation with strontium-90 after surgical excision of primary and recurrent pterygia. MATERIALS AND METHODS: The study group consisted of 193 patients with primary and recurrent pterygia who underwent surgical excision with the bare sclera technique. They were divided into two groups according to the type of adjunctive treatment. In group I, 130 patients (141 eyes, 67.8%) were treated with beta irradiation with Sr-90 doses of 1000-7000 cGy. In group II 63 patients (67 eyes, 32.2%) received topical mitomycin-C at a concentration of 0.02% four times daily for one week postoperatively. Recurrence rates, complications and efficacy of these treatments were compared with the chi-square of Fisher's exact test. RESULTS: The recurrence rates were 6.4% in group I after a mean postoperative follow-up of 89 months and 17.9% in group II after a mean follow-up of 14.9 months. Recurrence, rates and complications were higher in group II and the difference was significant (p<0.05, p<0.001). Life-table analysis showed a success rate of 93.6% for Sr-90 and 81.9% for the mitomycin-C, the difference being significant (p<0.005). CONCLUSIONS: Beta irradiation with Sr-90 after surgical excision was more effective than topical mitomycin-C in patients with primary and recurrent pterygium in terms of recurrence rates, and safer in terms of complications.

Toxicity of chemotherapeutical protocols in the treatment of uterine sarcomas (Vincristine, actinomycin D, Cyclophosphamide VAC versus ifosfamide).

OBJECTIVE: Uterine sarcomas are rare tumors which account for 1% of all genital tract malignancies. They have a poor prognosis with an overall survival of under 50% at 2 years. The benefit of chemotherapy is unclear and different chemotherapy protocols are used for the treatment of uterine sarcomas. But there is little experience about their toxicity because of the limited case series. So we compared VAC protocol and ifosfamiide for toxic effects. MATERIAL AND METHOD: We reviewed 13 cases which were diagnosed as uterine sarcomas and treated with surgery plus chemotherapy at The Department of Obstetrics and Gynecology, Akdeniz University School of Medicine from 1990 to 1995. Data were obtained from patient files. RESULTS: Mean age was 55.7 (range 38-70), 7 (53.8%) patients had malignant mixed mullerian tumors and 6 (46.1) had leiomyosarcomas. A total of 32 courses of chemotherapy were given -20 ifosfamide and 12 VAC therapy. Leucopenia, hepatic dysfunction and peripheral neuropathy were more frequent in the VAC group as 75%, 16.6%, versus 30%, 0%, 0%, in the iFosfamide group respectively. However, urothelial toxicity (35%) was more common in the ifosfamide group. CONCLUSION: VAC protocol is more toxic for the liver, hematopoietic and peripheral neurologic system. On the other hand the major toxicity of ifosfamide was on the urinary tract. Ifosfamide may be a good choice with less toxicity than VAC therapy in the treatment of uterine sarcomas.

Primary pure choriocarcinoma of the ovary in reproductive ages: a case report.

Choriocarcinoma is an aggressive tumor with cyto- and syncytiotrophoblastic cells. It arises gestationally or nongestationally. Nongestational choriocarcinoma of the ovary can be pure or mixed with other germ cell tumors. Pure type is less frequent than mixed type and the diagnosis of nongestational choriocarcinoma of the ovary is very difficult in the reproductive period. A case of a 20-year-old woman with pure choriocarcinoma of the ovary is presented with a review of the literature and discussion of its origin.

The utilization of immunohistochemical prognostic factor in endometrial adenocarcinoma: is it cost effective?

This study investigated the relation between immunohistochemical prognostic factors and clinical stage and histopathological grade in endometrial adenocarcinoma. Twenty-seven patients with a mean age of 61 (38-74), who underwent radical surgery due to endometrial adenocarcinoma in our hospital between 1983-1998, were re-evaluated. For clinical staging FIGO criteria were used. Histopathological differentiation of the tumor was graded as good (grade 1), moderate (grade 2), and poor (grade 3). Estrogen and progesterone receptors, c-erb B2, UEA 1, Ki-67, PCNA and p53 were studied as immunohistochemical prognostic factors. There were no patients in stages IA and IIIB. Among the prognostic factors, PCNA was the most significantly stained marker, followed by c-erb B2, estrogen and progesterone receptors, regardless of the clinical stage and histopathological grade of the tumor. The least positivity was achieved with Ki-67. There was no significant difference when each prognostic factor was analysed with respect to clinical stage and histopathological grade. In our study no significant relation was found between the prognostic factors and the clinical stage and histopathological differentiation of the tumor. Therefore the cost effectiveness of the utilization of these factors should be reconsidered.

Drug resistance in epithelial ovarian cancer: P-glycoprotein and glutation S-transferase. Can they play an important role in detecting response to platinum-based chemotherapy as a first-line therapy.

OBJECTIVE: Drug resistance is important for the treatment of ovarian cancer. P-glycoprotein and glutation S-transferase as resistance markers play an important role in the effectivity of chemotherapeutical agents. The role of P-glycoprotein and glutation S-transferase in the treatment of epithelial ovarian cancer is not well understood. We investigated the relation between P-glycoprotein and glutation S-transferase level for response to platinum-based chemotherapy in epithelial ovarian cancer. MATERIAL AND METHODS: We reviewed 30 cases diagnosed as epithelial ovarian cancer and treated with platinum-based chemotherapy in the Department of Obstetrics and Gynecology, Akdeniz University School of Medicine. The material was attained from initial parafin-embeded blocks stained for P-glycoprotein and glutation S-transferase. The cases that were diagnosed and treated before attending our clinic were not enrolled in the study. RESULTS: Mean age was 58.2 (25-70) and mean gravida 4.1 (0-10). Twenty-four patients (80%) were glutation S-transferase positive. Three cases (10%) out of 30 had positive reaction for P-glycoprotein. No difference was revealed regarding chemotherapy response rate among the cases showing glutation S-transferase positivity and P-glycoprotein negativity. CONCLUSION: Detection of glutation S-transferase and P-glycoprotein levels in epithelial ovarian cancer tissue is not important for response to platinum-based chemotherapy as a first line.

Effect of hypothyroidism in the thyroidectomized rats on immunophenotypic characteristics and differentiation capacity of adipose tissue derived stem cells.

INTRODUCTION: Thyroid hormones influence multiple physiological functions, like growth, differentiation, protein synthesis and metabolic rate. The hypothyroid state is a complex hormonal dysfunction rather than a single hormonal defect. The relation between hypothyroidism after thyroidectomy and stem cells is not clear. AIM: This study was designed to investigate the effect of thyroidectomy on the proliferation, telomerase enzyme activities, immunophenotypic properties and differentiation potentials of adipose tissue-derived (AT-) stem cells (SCs). MATERIALS AND METHODS: AT-SCs after 60 and 120 days of thyroidectomized (Tx) rats were compared to normal rats by flow cytometry and immunocytochemistry analyses, and their telomerase activities were estimated. RESULTS: The telomerase activity was found to be positive for AT-SCs of Tx rats of both 60 and 120 days used in this study, but a decrease was noticed in the cells with the long-term exposure to hypothyroidism. This might indicate the decrease in the regenerative ability of the AT-SCs after 120 days of Tx compared to cells after 60 days of Tx. Both cell lines were induced to differentiate into adipogenic, osteogenic and neurogenic cell lineages, but osteogenic marker expression was not detected in the undifferentiated AT-SCs of the Tx rats. Osteogenic differentiation was also failed in stem cells derived from Tx rats, shown by Alizarin red S staining and alkaline phosphates enzyme assays. DISCUSSION: These results suggest that hypothyroidism affected SCs, altered stem cell characteristics, like telomerase activity and loss of in vitro bone formation, but not adipogenic or neurogenic differentiation ability. CONCLUSIONS: Hypothyroidism after Tx affects the osteogenic differentiation capacity of stem cells, which might be one of the factors of bone loss due to postnatal hypothyroidism.