Cystic degeneration of the fibrous dysplasia presenting with loss of vision.

Cystic degeneration of the fibrous dysplasia is a very rare clinical condition and may present with loss of vision when it involved the skull base. A 12-year-old female child presented with an enlargement of the skull. She was diagnosed as large skull base and skull vault tumor. She underwent partial removal of the tumor, and custom-made titanium implant was inserted. The diagnosis was fibrous dysplasia. Two years after the initial diagnosis, she presented with total loss of vision at her right eye. Radiological imaging confirmed the cystic degeneration within the tumor. She re-operated and the cyst fluid was evacuated in association with the removal of cyst wall. The diagnosis was the cystic degeneration of the fibrous dysplasia. Her vision was improved a few days after the surgery. Fibrous dysplasia of the skull base should be closely followed-up in order to prevent severe visual complications.

Evaluation of activated charcoal and lipid emulsion treatment in model of acute rivaroxaban toxicity.

AIM: Reducing or reversing the toxicity effects of new oral anticoagulants is an important question.The purpose of the present study is to evaluate the effect of lipid emulsion (LE) and Activated Charcoal (AC) therapy on the intoxication of rivaroxaban, on mice. METHODS: Adult male Balb/c mice weighing approximately 30g were used in the study. Seven groups were assigned, with six mice in each group. Groups were defined; given only rivaroxaban, given only LE, given only AC, after the administration of rivaroxaban LE applied group in the 1st hour, after the administration of rivaroxaban LE applied group in the 3rd hour, after the administration of rivaroxaban AC applied group in the1st hour, after the administration of rivaroxaban AC applied group in the 1st hour and LE applied group in the 3rd hour. PT and Anti-Factor Xa activity were measured in all blood samples from subjects. RESULTS: A statistically significant difference was found when all groups were compared in terms of mean PT values and Anti-FactorXa values. However, no statistically significant difference was found in the mean PT and Anti-FactorXa values when only rivaroxaban administrated group and after the administration of rivaroxaban LE and/or AC applied groups were compared one to one. No deaths occurred in groups during the observation. CONCLUSION: Although the administration of either AC or LE alone or in combination resulted in a decrease in the mean values of PT and anti-Factor Xa, in case of rivaroxaban toxicity, but one-to-one comparison of the groups was not statistically significant.

Pro-Gastrin Releasing Peptide: A New Serum Marker for Endometrioid Adenocarcinoma.

BACKGROUND: Gastrin-releasing peptide (GRP) is thought to play a role in the metastatic process of various malignancies. The more stable precursor of GRP, pro-GRP (ProGRP), has been shown to be secreted by neuroendocrine tumors. This study was designed to assess the validity of ProGRP as a diagnostic marker in endometrioid adenocarcinomas (EAs) of the endometrium. METHODS: Thirty-seven patients with a diagnosis of EA, 23 patients with endometrial hyperplasia, and 32 age-matched controls with normal endometrial histology were recruited for this study. Serum ProGRP and cancer antigen 125 (CA125) values were compared between groups. RESULTS: Median serum ProGRP levels were significantly higher in the cancer group compared to corresponding levels in both the hyperplasia and control groups (p = 0.008 and p < 0.001 respectively; endometrial cancer: 27.5 pg/mL; hyperplasia: 16.1 pg/mL; controls: 12.9 pg/mL). Age and endometrial thickness were positively correlated with ProGRP levels (r = 0.322, p = 0.006 and r = 0.269, p = 0.023, respectively). Receiver Operating Characteristic curve analyses for EA revealed a threshold of 20.81 pg/mL, with a sensitivity of 60.7% and specificity of 81.4%, positive predictive value of 68% and negative predictive value of 76.1%. CONCLUSION: Significantly higher ProGRP levels were observed in patients with EA than in controls. Serum ProGRP has good diagnostic sensitivity and specificity for EA.

Extraordinary Presentation of Elastofibroma Dorsi After a Thoracotomy Procedure.

Elastofibroma dorsi is a reactive pseudotumor of connective tissue, typically located in the infrascapular region. Awareness of this benign entity is crucial for radiologists, as well as clinicians, to avoid misdiagnosis and potential patient harm. In this report, we present clinical and imaging findings of an elastofibroma dorsi after a thoracotomy procedure.

Nicolau syndrome following subcutaneous glatiramer acetate injection: A case report and review of the literature.

Nicolau syndrome is a rare serious drug reaction associated with the administering various injectable medications. It is often characterized by an acute and severe pain accompanying erythema that tends to rapidly evolve into the livedoid reticular or hemorrhagic patches and less commonly to ulcers and skin necrosis. Herein, we report a 34-year-old woman who presented with painful, tender discoloration over her abdominal skin following subcutaneous glatiramer acetate injection. Since the patient was diagnosed with multiple sclerosis 18 months ago, she had been on treatment with subcutaneous glatiramer acetate injections thrice weekly. The patient was diagnosed with Nicolau syndrome clinically and histopathologically. After 15-day treatment with topical betamethasone valerate and mucopolysaccharide polysulfate cream twice daily, the lesion completely regressed with only minimal hypopigmented irregular scarring. Nicolau syndrome should be considered in patients with severe pain, tenderness, and redness localized at the injection site following glatiramer subacetate.

A case of exogenous ochronosis associated with hydroxychloroquine.

Exogenous ochronosis is characterized by hyperpigmented skin lesions that arise in association with local suppression of homogentisic acid oxidase enzyme. Although it generally develops in association with topical application of chemical agents, it can occasionally develop in association with antimalarial drugs. Here we present the case of a patient with rheumatoid arthritis who developed hyperpigmentation on the face and neck regions during hydroxychloroquine treatment. Hydroxychloroquine is being widely used in rheumatology practice, and cutaneous hyperpigmentation may develop as an adverse effect. In the present case, we emphasize the potential underlying mechanisms through which it may cause cutaneous hyperpigmentation and determine the clinical and histopathological findings of exogenous ochronosis.

Histopathologic Evaluation of Hyaluronic Acid and Plasma-Rich Platelet Injection into Rabbit Vocal Cords: An Experimental Study.

OBJECTIVE: Various materials are used by otolaryngologists for vocal cord injections in the management of vocal cord paralysis. An ideal injection material should be long-term effective, readily available, cheap, easy to prepare, have no donor morbidity, easy to use, biocompatible, resistant to resorption or migration, and easy to extract during revision. In this study, we aimed to see the histopathological effects of hyaluronic acid (HYA) and platelet-rich plasma (PRP) injections into the vocal cords of New Zealand rabbits. METHODS: PRP was injected into the right vocal cords of twelve rabbits, which was prepared from their serum (PRP group). HYA was injected into the left vocal cords of first six rabbits (numbered 1-6) (HYA group), and the left vocal cords of the other six rabbits (numbered 7-12) were followed with no intervention (control group). Two months later, histomorphological findings in the vocal cords were assessed by two experienced pathologists in seven parameters: chronic inflammation, mucosal atrophy, necrosis, neovascularization, fibrosis, foreign body reaction, and muscular atrophy. They were scored double-blinded as negative (0), mild (+1), moderate (+2), and severe (+3). Fisher's chi-square test was used to evaluate any statistical significance among the three groups. RESULTS: Chronic inflammation, mucosal atrophy, necrosis, foreign body reaction, and muscular atrophy parameters were scored as "0" for each preparate by both pathologists. For neovascularization and fibrosis, a stasistically significant difference was seen among the three groups (p<0.05). Neovascularization was increased in the PRP and HYA groups compared with the control group. No significant difference was observed in fibrosis when the groups were compared separately. After two months, two of the six vocal cords injected with HYA revealed HYA; however, none of the PRP-injected vocal cords showed PRP. CONCLUSION: HYA and PRP can be safely injected into vocal cords. Our findings show that HYA is a biocompatible and safe injection material for clinical use. Only two of the six vocal cords showed HYA at the end of two months, suggesting that HYA is a short-term effective material. Similarly, PRP was also shown to be a short-term effective material and can be used in patients for testing purpose before using a long-term effective material. The advantages of PRP are that it is inexpensive, readily available, and completely inert as it is prepared from the subject itself.

Platelet-Rich Plasma Application for Acute Tympanic Membrane Perforations.

OBJECTIVE: To assess the efficacy of the application of platelet-rich plasma (PRP) in the healing process of acute tympanic membrane perforations (TMPs). MATERIALS AND METHODS: Acute TMPs were made in both the ears of 12 New Zealand rabbits. Plasma gel was applied at the right tympanic membrane (TM) of the same animal until the perforations were closed. The left TM was left untreated. On days 1, 4, 7, 10, 13, 16, 21, 28, and 35, the TMs were monitored to check the closure of perforations. The days of perforation closure for the 2 groups were compared using the paired t-test. The animals were sacrificed 2 months after making the perforations. Seven histopathological parameters were reviewed by 2 blinded pathologists: acute inflammation, chronic inflammation, edema in the lamina propria, congestion in the lamina propria, sclerosis, fibroblastic reaction, and an increase in the thickness of the squamous epithelial layer. The presence or absence of each histological parameter in both groups was compared using the Pearson Chi-square test. RESULTS: The average number of days for closure in the plasma gel group was 12 (range 8-18 days) and that in the control group was 17.7 (range 8-31 days). The difference was statistically significant (p=0.0145). There was no sclerosis or fibroblastic reaction in any of the specimens. No statistically significant difference was seen between the 2 groups with respect to acute inflammation, chronic inflammation, edema in the lamina propria, congestion in the lamina propria, and an increase in thickness of the squamous epithelial layer (p>0.05). CONCLUSION: Platelet-rich plasma fastens TMP closure; in long term, the eventual outcome is both microscopically and macroscopically same for the control as well as study groups in a rabbit traumatic TMP model. We believe that this study will encourage the clinical use of PRP for acute TMPs and trigger clinical studies in this field.

Ileocaecal Intussusception with a Lead Point: Unusual MDCT Findings of Active Crohn's Disease Involving the Appendix.

Adult intussusception is a rare entity accounting for 1% of all bowel obstructions. Unlike intussusceptions in children, which are idiopathic in 90% of cases, adult intussusceptions have an identifiable cause (lead point) in the majority of cases. Crohn's disease (CD) may affect any part of the gastrointestinal tract, including the appendix. It was shown to be a predisposing factor for intussusception. Here, we report a rare case of adult intussusception with a lead point, emphasizing diagnostic input of multidetector computed tomography (MDCT) in a patient with active CD that involves the appendix.

The association between ischemia modified albumin and placental histopathology in uncomplicated term deliveries.

Ischemia modified albumin (IMA) is a marker of ischemia elevated in different clinical conditions and its use for hypoxia in perinatology is of current interest. We aimed to investigate the association between maternal and cord blood IMA levels and placental histopathological findings in uncomplicated term deliveries. In this study, placental histopathological evaluation in uncomplicated deliveries that ended with healthy newborns revealed 80.6% vasculopathy. The results support the hypothesis that hypoxia exceeding the placental reserve ends with fetal compromise. Moreover, the presence of maternal vasculopathy in placenta is not correlated with maternal and fetal IMA levels.

Unusual coexistence of pulmonary sclerosing hemangioma and pericardial cyst.

Pulmonary sclerosing hemangioma is an uncommon tumor, thought to be a benign neoplasm. Pericardial cysts are also uncommon benign abnormalities, most often found incidentally on chest radiography. We describe the case of a 51-year-old woman in whom both lesions were incidentially detected on a routine chest radiograph. Enucleation of the pulmonary sclerosing hemangioma and simultaneous resection of the pericardial cyst were undertaken.

How reliable is 12-core prostate biopsy procedure in the detection of prostate cancer?

INTRODUCTION: Prostate biopsies incur the risk of being false-negative and this risk has not yet been evaluated for 12-core prostate biopsy. We calculated the false-negative rate of 12-core prostate biopsy and determined the patient characteristics which might affect detection rate. METHODS: We included 90 prostate cancer patients (mean age of 64, range: 49-77) diagnosed with transrectal ultrasound guided 12-core prostate biopsy between December 2005 and April 2008. All patients underwent radical retropubic prostatectomy and the 12-core prostate biopsy procedure was repeated on surgical specimen ex-vivo. Results of preoperative and postoperative prostate biopsies were compared. We analyzed the influence of patient age, prostate weight, serum prostate-specific antigen (PSA) level, free/total PSA ratio, PSA density and Gleason score on detection rate. RESULTS: In 67.8% of patients, prostate cancer was detected with repeated ex-vivo biopsies using the same mapping postoperatively. We found an increase in PSA level, PSA density and biopsy Gleason score; patient age, decreases in prostate weight and free/total PSA ratio yielded higher detection rates. All cores, except the left-lateral cores, showed mild-moderate or moderate internal consistency. Preoperative in-vivo biopsy Gleason scores remained the same, decreased and increased in 43.3%, 8.9% and 47.8% of patients, respectively, on final specimen pathology. CONCLUSIONS: The detection rate of prostate cancer with 12-core biopsy in patients (all of whom had prostate cancer) was considerably low. Effectively, repeat biopsies can still be negative despite the patient's reality of having prostate cancer. The detection rate is higher if 12-core biopsies are repeated in younger patients, patients with high PSA levels, PSA density and Gleason scores, in addition in patients with smaller prostates, lower free/total PSA ratios.