Efficacy of Optic Nerve Sheath Fenestration in Patients with Increased Intracranial Pressure.

Objectives: To evaluate the effectiveness of optic nerve sheath fenestration (ONSF) on visual functions in patients with increased intracranial pressure (IIP). Materials and Methods: The medical records of 24 eyes of 17 patients who had IIP due to idiopathic intracranial hypertension, cerebral venous sinus thrombosis, or intracranial cyst and underwent ONSF surgery to prevent visual loss were evaluated. Pre- and postoperative visual acuity, optic disc images, and visual field findings were reviewed. Results: The mean age of the patients was 30.4±8.5 years, and 88.2% were female. The patients' mean body mass index was 28.67±6.1 kg/m2. The mean follow-up time was 24±12.1 months (range: 3-44). At postoperative 3 months, the mean best-corrected distance visual acuity had improved in 20 eyes (83.3%) and stabilized in 4 eyes (16.7%) compared to preoperative values. In visual field mean deviation, an improvement was observed in 10 eyes (90.9%), while 1 eye (9.1%) eye remained stable. Optic disc edema decreased in all patients. Conclusion: This study indicates that ONSF has beneficial effects on visual function in patients with rapidly progressive visual loss caused by increased intracranial pressure.

Effects of a new-generation hybrid contact lens on visual performance and vision-related quality of life in patients with keratoconus / Os efeitos de uma lente de contato híbrida de nova geração no desempenho visual e na qualidade de vida relacionada à visão em pacientes com ceratocone

ABSTRACT Purpose: The aim of this study was to evaluate the efficacy of a new-generation hybrid contact lens for improving visual outcomes and vision-related quality-of-life performance in patients with keratoconus who had intolerance or treatment failure of conventional correction methods such as the use of soft silicone-hydrogel or rigid gas-permeable contact lenses. Methods: Twenty-eight patients with keratoconus (42 eyes) were enrolled in this prospective cross-sectional study. Airflex (Swisslens) lenses were fitted in the patients' eyes in accordance with the manufacturer's instruction. Ophthalmologic examinations, including manifest refraction, best-corrected distance visual acuity, slit-lamp biomicroscopy, and National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) assessment, were performed at baseline and the 6-month visit. Results: An adequate fit was achieved in 39 eyes (92.9%) of 26 patients. Six eyes of 3 patients were excluded from the study owing to discontinuation of lens wearing. The mean age of the successful wearers was 20.3 ± 4.9 years. The mean best-corrected distance visual acuity was statistically significantly improved from 0.62 ± 0.30 to 0.11 ± 0.06 logMAR with the Airflex hybrid contact lenses (p<0.001). The mean overall composite NEI-VFQ-25 score statistically significantly increased with the Airflex hybrid contact lenses at the 6-month visit as compared with that at baseline (from 77.1 ± 16.3 to 90.9 ± 7.3, p=0.036). Statistically significantly better scores were obtained with the Airflex hybrid contact lenses in all the NEI-VFQ-25 subscale items (all p<0.05). No significant adverse effects were observed. Conclusions: New-generation hybrid contact lenses can be used as an effective alternative for correction of irregular astigmatism in patients with keratoconus who have intolerance or treatment failure of conventional methods. Significant improvement in vision-related quality-of-life in patients with keratoconus can be achieved with these lenses.

RESUMO Objetivo: Este estudo tem como objetivo avaliar a eficácia de lentes de contato híbridas de nova geração nos resultados visuais e na qualidade de vida relacionada à visão em pacientes com ceratocone com intolerância ou insucesso dos métodos de correção habituais, tais como lentes flexíveis de silicone-hidrogel ou rígidas permeáveis a gases. Métodos: Foram incluídos neste estudo transversal prospectivo 42 olhos de 28 pacientes com ceratocone. Uma lente Airflex (Swisslens) foi aplicada nos olhos de acordo com as instruções do fabricante. Um exame oftalmológico, incluindo refração manifesta, melhor acuidade visual corrigida para longe, biomicroscopia com lâmpada de fenda e a aplicação do National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), foi realizado no início do estudo e na visita de 6 meses. Resultados: Foi possível obter um ajuste adequado em 39 olhos (92,9%) de 26 pacientes. Foram excluídos do estudo 6 olhos de 3 pacientes devido à cessação do uso de lentes. A idade média dos usuários bem-sucedidos era de 20,3 ± 4,9 anos. A média da melhor acuidade visual corrigida para longe foi melhorada estatisticamente de 0,62 ± 0,30 para 0,11 ± 0,06 logMAR com as lentes de contato híbridas Airflex (p<0,001). A pontuação média geral composta no questionário NEI-VFQ-25 aumentou de forma estatisticamente significativa com a lente de contato híbrida Airflex na visita de 6 meses, em comparação com a pontuação inicial (de 77,1 ± 16,3 para 90,9 ± 7,3, p=0,036). As lentes de contato híbridas Airflex apresentaram pontuações melhores com significância estatística em todos os itens das sub-escalas do NEI-VFQ-25 (todos com p<0,05). Nenhum efeito adverso significativo foi observado. Conclusões: Lentes de contato híbridas de nova ge ração podem ser usadas como uma alternativa eficaz para a correção do astigmatismo irregular em pacientes com ceratocone com intolerância ou insucesso dos métodos habituais. Com essas lentes, pode-se alcançar uma melhora significativa na qualidade de vida relacionada à visão em pacientes com ceratocone.

The role of thymic stromal lymphopoietin in the development of chronic otitis media with effusion.

PURPOSE: To investigate the effect of thymic stromal lymphopoietin on the development of chronic otitis media with effusion MATERIALS AND METHODS: This study was conducted on 40 patients who had adenoidectomy operation. The objects were divided into two groups. Group 1; adenoidectomy with chronic serous otitis media, group 2; adenoidectomy without chronic serous otitis media. Serum and tissue thymic stromal lymphopoietin levels were measured by ELISA. Serum and tissue TLSP levels, mast cell count, adenoid size were compared between the groups. RESULTS: Twenty-four (60%) of patients were female and 16 (40%) were male. Twenty patients (55%) had adenoid hypertrophy with chronic serous otitis media, and 18 (45%) had adenoid hypertrophy without chronic serous otitis media. The mean age of the patients was 6.21 ± 2.31 years. The mean mast cell count was significantly higher in group 1 compared with group 2 (p = 0.017). The mean tissue thymic stromal lymphopoietin measurement was also significantly higher in group 1 than group 2 (p = 0.023). However, there was no significant difference in regards to serum levels between the groups (p = 0.480). CONCLUSION: The number of mast cells as well as thymic stromal lymphopoietin levels in the adenoids of children was significantly high in the chronic serous otitis media patients. The release of thymic stromal lymphopoietin from the adenoid tissue plays a role in initiating and maintaining a local inflammatory reaction in the eustachian tube that may lead eventually to middle ear effusion in non-atopic patients.

The diagnostic value of systemic immune-inflammation index in diabetic macular oedema.

CLINICAL RELEVANCE: Diabetic macular oedema (DME) is a significant cause of visual impairment and inflammation plays an important role in its pathophysiology. BACKGROUND: This study evaluates the diagnostic value of systemic immune-inflammation index (SII) in the occurrence of DME in patients with non-proliferative diabetic retinopathy. METHODS: In this prospective study, the SII was applied to 150 consecutive patients with non-proliferative diabetic retinopathy. The relationship between the SII and the occurrence of DME was examined. Patients with DME were also divided into two subgroups according to the presence of accompanying sub-retinal fluid. The SII value was calculated as follows: platelet count × (neutrophil/lymphocyte). The risk factors for DME were evaluated using multivariate logistic regression analysis. A receiver operating characteristic (ROC) curve analysis of SII for predicting DME was performed. RESULTS: Patients with DME had significantly higher levels of SII than those without DME (599.7 ± 279.2 and 464. 9 ± 172.2, respectively, p < 0.001). However, The SII values were similar between sub-retinal fluid subgroups. Multivariate regression analysis indicated that SII, together with duration of diabetes, was an independent factor for DME occurrence [Odds ratio (OR) = 1.005, 95% confidence interval = 1.001-1.009, p = 0.04, and OR = 1.146, 95% CI = 1.049-1.252, p = 0.003, respectively]. ROC curve analysis revealed that the best cut-off value of SII was 399 (area under the curve: 0.633; sensitivity: 70%; specificity: 60%). CONCLUSION: An elevated SII value is strongly associated with the development of DME. The SII may be a diagnostic biomarker for identifying DME to improve the risk stratification and management of non-proliferative patients with diabetic retinopathy.

Efficacy of two silicone-hydrogel bandage contact lenses after corneal crosslinking.

Silicone-hydrogel (SiH) contact lenses are frequently used as a bandage after anterior segment surgical procedures. Several types of lenses may exhibit clinical performances with different characteristics. This study aims to evaluate the efficacy of two SiH contact lenses following corneal crosslinking (CXL). Forty-nine keratoconus patients scheduled for consecutive CXL surgery in both eyes were included in this comparative, double-blind, prospective study. A Balafilcon A (Pure Vision 2 HD, Bausch+Lomb, Rochester, NY, USA) or Lotrafilcon B (Air Optix Aqua, Ciba Vision, Duluth, GA, USA) lens was fitted in a randomised fashion in the eyes at the end of the CXL. Remaining epithelial defect area measured by slitlamp biomicroscopy, subjective level of pain and discomfort with visual analogue scale (VAS) and total number of oral analgesics taken were evaluated and compared at post-operative days 0, 1, 2 and 3. The average epithelial defect size was significantly smaller in the eyes with Lotrafilcon B than the eyes with Balafilcon A at post-operative Day 1 (31.2 ± 4.3 mm2 and 33.8 ± 5.2 mm2, respectively, p < 0.001) and Day 2 (8.2 ± 3.6 mm2 and 10.5 ± 5.4 mm2, respectively, p = 0.039). There was no statistically significant in the average epithelial defect size between the groups at Day 3 (p = 0.859). Re-epithelialisation time was similar in both groups (p = 0.317) There was no statistically significant difference in VAS scores regarding the lens type in any post-operative follow-up. The mean oral analgesic numbers were similar in both groups (p = 0.217). SiH contact lenses can be used as an effective bandage for corneal re-epithelialisation after CXL. The material and features of bandage contact lens used after CXL may affect the corneal re-epithelialisation process. Lotrafilcon B lens showed faster re-epithelialisation at post-operative days 1 and 2 after CXL.

Matrix metalloprotease-9 expresssion in meningioma: Correlation with growth fraction and role of gender. A pilot immunohistochemical study.

OBJECTIVE: Matrix metalloproteases (MMPs), particularly MMP2 and MMP9 increase tumor invasion and edema in meningiomas. Although lesser recognized, MMPs may also enhance cell growth via liberating growth factors or via cleaving inactive growth factors into active isoforms. However, there exist very few studies, which investigated correlation of MMPs with growth fraction in meningiomas. Meningiomas are seen more frequently in women and their growth accelarate during pregnancy. However, no study examined whether MMP-expressions in meningioma differ with gender. PATIENTS AND METHODS: In a pilot immunohistochemical study, we analyzed the correlation of MMP9 expression with Ki67 index and whether gender influences MMP9 expression. We retrospectively selected 24 meningioma cases including 10 cases with WHO Grade-1 tumors and 7 cases each with WHO Grade-2 and 3 tumors, respectively. RESULTS: We separately determined the intensity and area of MMP9 staining and also calculated an expression index by multiplying these two parameters. Spearman correlation analyses revealed that MMP9 staining intensity, staining area and expression index significantly correlated with Ki67 proliferation index. MMP9 staining indices were significantly higher in women specimens. CONCLUSION: If these findings will be confirmed in larger series, MMP-inhibitors and female hormone receptor-antagonists may be combined to augment chemotherapy efficacy and to attenuate invasion in high-grade meningiomas.

Efficacy of different accelerated corneal crosslinking protocols for progressive keratoconus.

PURPOSE: To evaluate the efficacy of different accelerated corneal crosslinking (CXL) treatment protocols in patients with progressive keratoconus. SETTING: Marmara University School of Medicine, Istanbul, Turkey. DESIGN: Retrospective case series. METHODS: Patients with progressive keratoconus had 9 mW accelerated CXL (10 minutes; 9 mW/cm2), 30 mW continuous-light accelerated CXL (4 minutes; 30 mW/cm2), or 30 mW pulsed-light accelerated CXL (8 minutes [1 second on/1 second off]; 30 mW/cm2). RESULTS: Of 134 eyes, 34 eyes had conventional CXL, 45 had 9 mW accelerated CXL, 28 had 30 mW continuous-light accelerated CXL (4 minutes, 30 mW/cm2), and 27 eyes had 30 mW pulsed-light accelerated CXL. The uncorrected (UDVA) (P < .001 both) and corrected (CDVA) distance visual acuities increased in with conventional CXL and 9 mW accelerated CXL (P = .001 and P = .002, respectively). With 30 mW continuous accelerated CXL, only CDVA improved (P = .019). With 30 mW pulsed accelerated CXL, UDVA and CDVA did not change significantly (P > .05). With conventional CXL and 9 mW accelerated CXL, all keratometric (K) readings (K1, K2, mean K, maximum K) improved significantly (conventional CXL: P = .014, P = .002, P = .008, and P < .001, respectively; 9 mW accelerated CXL: all P < .001). With 30 mW, no K values changed significantly compared with baseline (all groups P > .05). CONCLUSION: Although 30 mW accelerated CXL treatment modalities appeared to be effective in stabilizing keratoconus progression, they seemed less effective in achieving topographic improvement.

CD56, HBME-1 and cytokeratin 19 expressions in papillary thyroid carcinoma and nodular thyroid lesions.

BACKGROUND: Carcinomas of the thyroid follicular epithelium are the most common cancers of the endocrine system. In the diagnosis of thyroid nodules and tumors, the gold standard is histological evaluation. In cases which have morphological overlap, immunohistochemistry is needed for differential diagnosis. The purpose of this study is to investigate the expressions of CD56, HBME-1, cytokeratin 19 (CK19) antibodies in papillary thyroid carcinoma (PTC) and thyroid nodular lesions and their contributions to differential diagnosis. MATERIALS AND METHODS: In this study, 47 PTCs (26 follicular variant, 21 classic type) and 26 benign thyroid lesions (15 nodular hyperplasia, 10 follicular adenomas, 1 Hurtle cell adenoma) were analyzed retrospectively. HBME-1, CK19, and CD56 antibodies were performed with immunohistochemical methods. The results were evaluated statistically. RESULTS: +3 staining with HBME-1 and CK19 was observed in 72.3% and 83% of patients with PTC. In 95.7% of PTC cases, loss of CD56 expressions in various degrees was identified. A statistically significant difference was detected in HBME-1, CK19, and CD56 expressions between PTCs and benign lesions (P < 0.001). CONCLUSION: In our study, positive staining of HBME-1, CK19, and loosing expression of CD56 that supports malignancy was found and concluded that CD56 is a helpful antibody for the differential diagnosis of benign and malignant lesions and may increase the diagnostic accuracy when used with HBME-1 and CK19.

Transepithelial versus epithelium-off crosslinking in adults with progressive keratoconus.

PURPOSE: To compare the efficacy of epithelium-off corneal collagen crosslinking (CXL) with transepithelial CXL in patients with progressive keratoconus. SETTING: Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey. DESIGN: Retrospective cohort study. METHODS: Eyes that had transepithelial CXL were compared with eyes treated with epithelium-off CXL. All patients with a follow-up of 18 months were evaluated for uncorrected (UDVA) and corrected (CDVA) distance visual acuities, corneal topography, aberrometry, and pachymetry (Pentacam). RESULTS: The mean patient age was 22.8 years ± 4.7 (SD) (range 18 to 31 years) in the transepithelial group (30 eyes) and 23.7 ± 3.9 years (range 18 to 30 years) in the epithelium-off group (30 eyes). The mean UDVA and CDVA significantly improved in both groups (P < .001). There was no significant difference in the CDVA gain between the 2 groups. In the epithelium-off group, significant improvements occurred in spherical error (P = .002), spherical equivalent (P = .004), maximum keratometry (K), flat K (P = .036), and steep K (P < .001). The reductions in flat K, steep K, and maximum K were greater in the epithelium-off group (P = .004 for flat K; P < .001 for steep K and maximum K). In the transepithelial group, significant improvements occurred in the cylindrical error (P = .009) and in the index of surface variance and index of surface asymmetry (both P < .001). CONCLUSION: Although transepithelial CXL seemed to have reduced effectiveness in inducing improvement in topographic indices, its effect on visual acuity is likely to be similar to that of epithelium-off CXL. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of an ablative and non-ablative laser procedure in the treatment of striae distensae.

BACKGROUND: Striae distensae or stretch marks are atrophic linear dermal scars with epidermal atrophy. There are many therapeutic options for management, but no consistently effective modality is available yet. OBJECTIVE: We compared the efficacy of 1064 nm long pulse (LP) Nd: YAG laser and 2940 nm variable square pulse (VSP) erbium: YAG laser in the treatment of striae distensae. METHODS: Twenty female volunteers (Fitzpatrick skin types II-V) aged between 20 and 40 years with striae (3 patients with the rubra type and 17 with the alba type) were enrolled in the study. The duration of striae ranged from 4 months to 12 years. Lesions were located on the abdomen in all patients except one patient who had striae on the arms and two patients with striae in the lumbar region. Treatments were randomly allocated to both sides of the body in each patient, one side being treated with VSP erbium: YAG laser and the opposite side with LP Nd: YAG laser. All subjects were treated monthly for a total of three treatments. Two 3-mm punch biopsies were obtained from six subjects, both of the same striae, one before the first treatment and one 4 weeks after the last session. RESULTS: Response was evaluated clinically by photographic comparison and was found to be poor in 17 subjects, both on the LP Nd: YAG laser treated side and VSP erbium YAG laser treated side. All these patients had mature lesions (striae distensae alba). Three subjects had a moderate response on both sides; these patients' striae were immature (striae distensae rubra). Histologically, elastic fibers were slightly increased in post-treatment samples compared with pretreatment skin biopsies. CONCLUSION: We observed no satisfactory clinical improvement in striae distensae alba lesions although histopathological changes were seen. We suggest that variable square pulse Er: YAG and long pulse Nd: YAG lasers are not useful in the treatment of striae distensae alba.

Is progesteron receptor status really a prognostic factor for intracranial meningiomas?

OBJECTIVE: Presence of steroid hormone receptors in meningiomas is well-known, but their correlation with tumour behaviour is unclear. The purpose of this study was to assess the relation between steroid hormone receptor expression and tumour behaviour. METHODS: We retrospectively reviewed 48 patients undergoing surgery for intracranial meningioma between January 2002 and December 2004. We included World Health Organization (WHO) Grade I meningiomas in Group 1 and WHO Grades II and III in Group 2. Tumour grade, progesterone receptor (PR), oestrogen receptor (ER) expressions, MIB-1 Index and Mitotic Index were assessed. We sought the correlation between tumour grade and MIB-1, Mitotic Indices, and also PR expression. Furthermore, the correlation between PR expression and MIB-1 and Mitotic Indices was assessed in Group 1 and Group 2, separately. RESULTS: 26 patients were in Group 1 and 22 patients in Group 2. PR expression was determined in 56% of the tumours while there was no ER expression. PR expression was found to be higher in Group 1 compared to Group 2. The Mean MIB-1 Index and the Mean Mitotic Index were significantly higher in Group 2 compared to Group 1. However, when Groups 1 and 2 were assessed separately, PR expression does not appear to be correlated with MIB-1 and Mitotic Indices in benign and also in non-benign meningioma groups. CONCLUSION: Our findings suggest that tumour grade, but not PR expression, is correlated with meningioma behaviour.

Metastatic renal cell carcinoma in the nasopharynx.

Metastatic renal cell carcinoma of the nasopharynx, nasal cavity, and paranasal sinuses can be misdiagnosed as primary malignant or benign diseases. A 33-year-old male attended our outpatient clinic complaining of difficulty breathing through the nose, bloody nasal discharge, postnasal drop, snoring, and discharge of phlegm. Endoscopic nasopharyngeal examination showed a vascularized nasopharyngeal mass. Under general anesthesia, multiple punch biopsies were taken from the nasopharynx. Pathologically, the tumor cells had clear cytoplasm and were arranged in a trabecular pattern lined by a layer of endothelial cells. After the initial pathological examination, the pathologist requested more information about the patient's clinical status. A careful history revealed that the patient had undergone left a nephrectomy for a kidney mass diagnosed as renal cell carcinoma 3 years earlier. Subsequently, nasopharyngeal metastatic renal cell carcinoma was diagnosed by immunohistochemical staining with CD10 and vimentin. Radiotherapy was recommended for treatment.

[Low grade sinonasal adenocarcinoma]. / Düsük Histolojik Dereceli Sinonazal Adenokarsinom.

Sinonasal adenocarcinoma is a rare neoplasm which is classified as 'intestinal' or 'nonintestinal' type, depending on its resemblance to gastrointestinal mucosa. These tumors are associated with occupational and environmental carcinogens. In this study, a fifty-year-old oil-painter male patient with a low-grade nonintestinal type sinonasal adenocarcinoma originating from the left middle concha and ethmoid sinus is presented. Microscopical examination revealed many infiltrative glandular structures, most of which were cystically dilated and some of which were smaller in diameter, arranged back to back in loose fibrous stroma as well as intraglandular papillary and micropapillary structures forming complex branches or a cribriform pattern. The glands were lined by epithelial cells that were faintly eosinophilic and relatively abundant cubical/ cylinderical cytoplasms and mildly pleomorphic round/oval nuclei, with rare mitotic figures. Intraluminal and focally intracytoplasmic mucin was demonstrated with Alcian Blue, mucicarmin and PAS stains. Immunohistochemically, tumor cells were strongly and diffusely positive with CK7; focally and weakly positive with CK20 and negative with CDX2 in accordance with the nonintestinal type. S-100, Actin and p63, applied for investigating the myoepithelial and salivary glandular origins, were all negative. Prognostic markers, TTF-1 and p53 were negative; while the Ki-67 index was 2%. The fact that intestinal type sinonasal adenocarcinomas are generally high grade, while nonintestinal tumors are histologically low grade makes this morphological and immunohistochemical-based classification valuable in predicting the prognosis of the disease. In addition to the morphological and immunohistochemical findings, clinical information stands out in the differentiation of the tumor from benign or malignant primary lesions or metastatic adenocarcinoma.

Effects of intra-abdominal pressure increase on intestinal ischemia and bacterial translocation in experimental sepsis model.

OBJECTIVE: To investigate the safety of laparoscopic intervention for diagnosis and treatment at 8 mm Hg pressure in one-hour period on acute peritonitis related intra-abdominal sepsis model. METHODS: In this study, we included 32 female Wistar-Albino rats, weighing 250 +/- 20 g, and divided them into 4 groups. This study was conducted in Istanbul University Experimental Medical Research Institution (DETAE) laboratory from April to May 2009. Intra-abdominal sepsis was created with intraperitoneal (i.p.) one mL (109 CFU/mL) Escherichia coli (E. coli) injection, and pneumoperitoneum was formed with CO2 insufflation at 8 mm Hg pressure for one hour i.p. The rats were administered with: Group 1 - one mL i.p. isotonic saline; Group 2 - one mL i.p. isotonic saline + pneumoperitoneum; Group 3 - i.p E. coli; and Group 4 - i.p. E.coli + pneumoperitoneum. Data were analyzed using the Statistical Package for Social Sciences version 15 for Windows (SPSS Inc, Chicago, IL, USA). RESULTS: Fever and leukocyte values were considered high in Groups 3 and 4 compared with Groups 1 and 2 (p=0.001). The administered reproduction ratio of the E. coli strain was determined as 0% in Groups 1 and 2, and 100% in Groups 3 and 4. CONCLUSION: In this study, as pneumoperitoneum was formed for one hour at 8 mm Hg pressure, in case of intra-abdominal derived sepsis where emergency intervention is needed, we consider that laparoscopic approaches with low pressure may be used safely for diagnosis and treatment.

Micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen in a case of small lymphocytic lymphoma: a Richter's transformation.

Abstract A case of micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen who had a prior diagnosis of small lymphocytic lymphoma is presented. Micronodular T-cell/histiocyte-rich B-cell lymphoma of the spleen was first described in 2003, and very few cases have been reported since then. This is the first reported case supervening in a patient with pre-existing chronic lymphocytic lymphoma. We review its clinical, pathologic, and immunohistochemical features and the difficulties we encountered during diagnosis.

Cyclooxygenase-2 expression and connection with tumor recurrence and histopathologic parameters in gastrointestinal stromal tumors.

Tissue cyclooxygenase-2 (COX-2) is a rate-limiting enzyme in prostaglandin synthesis and has been shown to have roles in carcinogenesis and tumor progression. Evaluation of COX-2 overexpression in malignancies has been performed mostly on tumors of epithelial origin, and little is known about its presence in mesenchymal tumors, especially gastrointestinal stromal tumors (GIST). COX-2 has been reported to be widely expressed in GIST and has been suggested as a potential diagnostic marker. We evaluated the overexpression and roles of COX-2 in tumorigenesis in GIST with regard to its relation to prognostic parameters and tumor recurrence. We studied the presence of COX-2 expression immunohistochemically and its relation to clinicopathologic prognostic variables in 41 cases of GIST. COX-2 was overexpressed in 21 (51%) of 41 tumors. The extent of overexpression was greater in tumors that recurred after surgical resection. COX-2 overexpression was also higher in tumors with coagulative necrosis, high mitotic index and an infiltrative pattern of growth. The observation of greater COX-2 expression levels in GIST with unfavorable histopathologic variables is contrary to previous reports and consistent with the reported roles of COX-2 in carcinogenesis of epithelial malignancies.

Diagnostic problems with parasitic and non-parasitic splenic cysts.

BACKGROUND: The splenic cysts constitute a very rare clinical entity. They may occur secondary to trauma or even being more seldom due to parasitic infestations, mainly caused by ecchinocccus granulosus. Literature lacks a defined concencus including the treatment plans and follow up strategies, nor long term results of the patients. In the current study, we aimed to evaluate the diagnosis, management of patients with parasitic and non-parasitic splenic cysts together with their long term follow up progresses. METHODS: Twenty-four patients with splenic cysts have undergone surgery in our department over the last 9 years. Data from eighteen of the twenty-four patients were collected prospectively, while data from six were retrospectively collected. All patients were assessed in terms of age, gender, hospital stay, preoperative diagnosis, additional disease, serology, ultrasonography, computed tomography (CT), cyst recurrences and treatment. RESULTS: In this study, the majority of patients presented with abdominal discomfort and palpable swelling in the left hypochondrium. All patients were operated on electively. The patients included 14 female and 10 male patients, with a mean age of 44.77 years (range 20-62). Splenic hydatid cysts were present in 16 patients, one of whom also had liver hydatid cysts (6.25%). Four other patients were operated on for a simple cyst (16%) two patients for an epithelial cyst, and the last two for splenic lymphangioma. Of the 16 patients diagnosed as having splenic hydatit cysts, 11 (68.7%) were correctly diagnosed. Only two of these patients were administered benzimidazole therapy pre-operatively because of the risk of multicystic disease The mean follow-up period was 64 months (6-108). There were no recurrences of splenic cysts. CONCLUSION: Surgeons should keep in mind the possibility of a parasitic cyst when no definitive alternative diagnosis can be made. In the treatment of splenic hydatidosis, benzimidazole therapy is not necessary, although it is crucial to perform splenectomy without rupturing and spilling the cysts.

Gaucher's disease diagnosed by splenectomy.

CONTEXT: Splenectomy continues to find common therapeutic indications for hematologic disorders. In addition, recently it is also performed in surgical clinics to assist diagnose of some illnesses. Gaucher's disease, especially Type I, is the most frequently encountered lysosomal storage disorder in man. Manifestations of it are highly variable. The most frequently found symptoms include splenomegaly with anaemia and thrombocytopenia, mostly due to hypersplenism, hepatomegaly and bone disease. CASES: Four patients were reported in the present study. Three of them were easily diagnosed with Gaucher's disease via bone marrow cytology, and one with Gaucher's disease was detected by pathological examination following the splenectomy. CONCLUSIONS: For the pouse of diagnosis of the Gaucher's disease, performing surgery is generally not necessary. However, for the cases of difficult to diagnose by classical methods, the corect diagnosis of Gaucher's disease can only be made by a special operation.