A retrospective multicenter evaluation of cutaneous melanomas in Turkey.

BACKGROUND: We defined melanoma distribution in a large series of Turkish patients and evaluated the prognostic parameters of melanomas. MATERIALS AND METHODS: A total of 1574 patients' data was retrospectively collected at 18 centers in Turkey. Demographic characteristics were questioned and noted. Prognostic parametres were evaluated based on sentinel lymph node involvement. RESULTS: Mean age was 56.7 (4-99) years. While 844 (53.6%) cases were male, 730 (46.4%) cases were female. One thousand four hundred forty-seven (92%) cases were invasive melanoma and 127 (8%) cases were in-situ melanoma. The most common histopathological form was the superficial spreading melanoma (SSM) which was found in 549 patients (37.9%). It was followed by nodular melanoma in 379 (26.2%), acral lentiginous melanoma (ALM) in 191 (13.2%) and lentigo maligna melanoma in 132 (9.1%), respectively. On univariate analysis, lymphovascular invasion (p<0.001), tumor thickness (p<0.001), histopathological subtype (p<0.001), Clark level (p=0.001), ulceration (p<0.001), ≥6/mm2 mitosis (p=0.005), satellite formation (p=0.001) and gender (p=0.03) were found to be associated with sentinel lymph node positivity. Regression was associated with sentinel lymph node negativity (p=0.017). According to multivariate analysis, lymphovascular invasion and tumor thickness were significant independent predictive factors of SLN positivity. Patient age, tumor localization, precursor lesions, lymphocytic infiltration and neurotropism were not related with sentinel lymph node involvement. CONCLUSIONS: In this retrospective analysis, it was found that the prevalence of SSM is at a lower rate while the prevalence of ALM is at a higher rate when compared to western countries. According to Breslow index; most of the melanoma lesions' thickness were greater than 2 mm, corresponding Clark IV. Vascular invasion and tumor thickness are the most important factors for sentinel lymph node involvement.

An unusual association of Goldenhar syndrome.

Goldenhar syndrome is well known for its classical triad of epibulbar dermoids or lipodermoids, auricular appendages and pretragal fistulas. Here we report a case of Goldenhar syndrome with an unusual association of a fibroepithelial polyp attached to a limbal dermoid. A case of Goldenhar syndrome in a 5-month-old male infant presented with the features of a fibroepithelial polyp attached to a limbal dermoid, right-sided polydactylia with hypoplastic thumb, and accessory preauricular appendages on the left side. The association of a fibroepithelial polyp attached to a limbal dermoid with Goldenhar syndrome is a rare report in the literature. In these cases, regular follow-up with an ophthalmologist is important to monitor the visual development of the patient. Ideally, a multidisciplinary approach is required to manage the other associated anomalies.

Perfusion CT evaluation in experimentally induced testicular torsion.

INTRODUCTION: In this study, we define the characteristics of perfusion computed tomography (CT) in an experimental model of testicular torsion. METHODS: Twenty male Sprague-Dawley rats were included for the study. Torsion was applied to 10 rats and perfusion CT was performed in the first hour to evaluate the following perfusion parameters: blood flow (BF), blood volume (BV) and time to peak (TTP) values. Detorsion was done for the same rats, and perfusion CT was repeated 2 hours later to evaluate reperfusion. Ten rats were left as part of the control group. RESULTS: There is significant statistical correlation between the BF and BV values in the torsion and control groups (p=0.001 and p=0.001, respectively). There is no statistical correlation of the TTP parameters between the groups. No correlation was found between torsion and detorsion perfusion parameters. CONCLUSION: Perfusion CT can demonstrate the testicular perfusion insult in an experimental model of torsion. Perfusion CT may be an alternative method for diagnosis of torsion in indeterminate cases. Following detorsion an interval of 2 hours is not sufficient for demonstrating luxury perfusion of the testis.

Perfusion CT evaluation in experimentally induced testicular torsion.

INTRODUCTION: In this study, we define the characteristics of perfusion computed tomography (CT) in an experimental model of testicular torsion. METHODS: Twenty male Sprague-Dawley rats were included for the study. Torsion was applied to 10 rats and perfusion CT was performed in the first hour to evaluate the following perfusion parameters: blood flow (BF), blood volume (BV) and time to peak (TTP) values. Detorsion was done for the same rats, and perfusion CT was repeated 2 hours later to evaluate reperfusion. Ten rats were left as part of the control group. RESULTS: There is significant statistical correlation between the BF and BV values in the torsion and control groups (p = 0.001 and p = 0.001, respectively). There is no statistical correlation of the TTP parameters between the groups. No correlation was found between torsion and detorsion perfusion parameters. CONCLUSION: Perfusion CT can demonstrate the testicular perfusion insult in an experimental model of torsion. Perfusion CT may be an alternative method for diagnosis of torsion in indeterminate cases. Following detorsion an interval of 2 hours is not sufficient for demonstrating luxury perfusion of the testis.

Assessment of the efficacy of absorbable adhesion barriers on dissection in esophagus operations.

OBJECTIVE: During childhood, recent repeated operations for esophagus are normally conducted if long gap esophageal atresia exists. During multistaged extrathoracic esophageal elongation procedure, the dissection of the esophagus poses severe problems due to adhesion. However, Gore-Tex membrane may simplify esophagus dissection. The most popular adhesion barriers used today are sodium hyaluronate (Seprafilm; Genzyme Corp., Cambridge, MA) and oxidized regenerated cellulose (Interceed; Johnson&Johnson Medical Inc., New Brunswick, NJ). The purpose of this study is to investigate the efficacy of adhesion barriers on esophagus dissection. METHODS: In the study, 21 Wistar albino adult male rats were worked on. The rats were randomly divided into three groups, each including seven rats. About 1cm-segment of the esophagus, located just behind the trachea, was dissected from the surrounding tissues through blunt dissection. Rats in group 1 were wrapped with Seprafilm, and in group 2 with Interceed. But the rats in group 3 underwent only esophagus dissection. Three weeks later, during esophagus dissection, adhesion scoring was performed and esophagus was divided into two parts: one for the assessment of hydroxyproline level, and the other for histological examination. RESULTS: When the adhesion scores of the three groups were compared, there was not a significant difference between the groups (p=0.75). In terms of tissue hydroxyproline levels, mean scores of hydroxyproline revealed no significant difference between the three groups (p=0.19). When the histopathological results were examined, esophagus looked normal and no connective tissues were seen around esophagus. CONCLUSION: Seprafilm and Interceed had no effect on esophagus dissection. Although Seprafilm had the best mean score, this was statistically insignificant. Gore-Tex might play a better role than Interceed in preventing adhesion formation; however, it is still not certain whether adhesion barrier should be used in such organs as esophagus having no serosa.

Examination of bcl-2 and p53 expressions and apoptotic index by TUNEL method in psoriasis.

BACKGROUND: Psoriasis is characterised by hyperproliferation and by aberrant differentiation. Blockage of the normal apoptotic process is one of the factors implicated in the pathogenesis. OBJECTIVE: To determine the apoptotic features by using TUNEL method and also bcl-2 and p53 expressions in psoriatic epidermis. MATERIALS AND METHODS: Biopsies of 35 patients with psoriasis vulgaris and 14 normal skin were evaluated. Apoptotic cells were detected using the dUTP nick-end labelling assay; bc1-2 and p53 expressions were assessed by using immunohistochemical techniques. A semi-quantitative grading system (HSCORE) was used for comparison. RESULTS: Bcl-2 was strongly expressed in basal keratinocytes of normal skin, while no expression was observed in 13 (37.2%) of the psoriatic samples and it was weakly expressed in the spinous cell layer of 22 (62.8%) samples. Moderate p53 expression was observed in the psoriasis group, while it was weak in the control. The percentage of TUNEL positive cells were significantly increased in the psoriasis group (65+/-2.30) when compared with the control (32.84+/-7.16). CONCLUSION: Apoptotic index besides bc1-2 and p53 expressions in psoriasis differ from normal epidermis. Down-regulation of bc1-2 is consistent with the dynamics of psoriasis but increased TUNEL positive cells and p53 expression has not been fully elucidated yet. Gündüz K, Demireli P, Vatansever S, Inanir I. Examination of bcl-2 and p53 expressions and apoptotic index by TUNEL method in psoriasis.

Expression of matrix metalloproteinases (MMP-2, MMP-3, and MMP-9) and fibronectin in lichen planus.

BACKGROUND: Keratinocyte damage and lichenoid-interface reaction are the two major pathologic findings in lichen planus (LP). Matrix metalloproteinases (MMPs) are proteinases that participate in extracellular matrix (ECM) degradation and may play an important role in basal membrane (BM) damage in LP. Fibronectin (FN) mediates a variety of cellular interactions with ECM and plays important roles in cell adhesion, migration, growth and differentiation. OBJECTIVE: To determine MMP-2, MMP-3, MMP-9 and FN expressions in LP and discuss the possible associations. MATERIALS AND METHODS: Skin biopsy samples of 55 patients with LP and 11 normal skin were investigated. Five discoid lupus erythematosus (DLE) and 5 chronic dermatitis (CD) samples were also examined for comparison. Immunochemical stainings were performed for MMP-2, MMP-3, MMP-9 and fibronectin. RESULTS: Weak or absent expressions of MMP-2 and MMP-3 in epidermis; and dense MMP-9 expression in dermal inflammatory infiltrate cells were detected in LP. FN expression was lost in epidermal basal layer and papillary dermis. CONCLUSION: Loss of MMP-2, MMP-3 and FN in LP can be explained with the destruction of the epidermal basal layer. Similar expressions of MMP-2 and MMP-3 both in LP and DLE implied that these MMPs may be involved in the pathogenesis of interface dermatitis.

A case of mycetoma successfully treated with itraconazole and co-trimoxazole.

A 29-year-old woman with swelling, multiple nodules and discharging sinuses of her right foot is presented. A single nodule on the sole was excised 15 years ago and since then she has had recurrent attacks of swelling and discharging sinuses that improved partially with antibiotics. Magnetic resonance images (MRI) revealed an ill-defined mass predominantly with low signal intensity on T2W images. Within the granulomata, multiple unenhancing foci, with low T1W and T2W signal most likely representing the fungal balls or grains were detected. Histopathological examination revealed large clusters of microorganisms resembling fungal hyphae and bacteria, which were surrounded by mixed inflammatory infiltrate cells and stained positively by PAS and Gomori's methenamine silver stain. As minimal regression was seen on MRI with 4 months' itraconazole (200 mg day(-1)) treatment, co-trimoxazole (160 TMP/800 SMX b.i.d.) was added to treatment. Complete remission was established by MRI examination after 10 months with this combination therapy.

Long-term effect of pentoxifylline and NG-nitro-L-arginine methyl ester on testicular function in spermatic artery ligation.

OBJECTIVE: To investigate long-term testicular function in pentoxifylline- and NG-nitro-L-arginine methyl ester (L-NAME)-treated rats prior to spermatic artery ligation by assessing serum inhibin B concentration, a reliable endocrine marker of spermatogenesis. MATERIAL AND METHODS: Forty prepubertal rats were randomly divided into four equal groups. Right orchiectomy was performed in all rats. Intraperitoneal pentoxifylline and L-NAME were administered to Groups 1 and 2, respectively. Rats in Group 3 did not receive any medication. The spermatic arteries of the left testes were ligated in all groups with the exception of the sham controls (Group 4). One month postoperatively, a histopathologic evaluation was performed and serum inhibin B concentrations were assessed in all groups. RESULTS: There were no statistically significant differences in testis size or serum inhibin B concentration between Groups 1, 2 and 3. However, the testes were significantly smaller (p(1)=0.01, p(2)=0.01, p(3)=0.01) and serum inhibin B levels were significantly decreased (p(1)=0.01, p(2)=0.01, p(3)=0.01) when Groups 1-3 were compared with Group 4. Histopathological evaluations revealed necrosis and calcification in all specimens with the exception of the sham-operated group. CONCLUSIONS: The long-term outcomes of spermatic artery ligation were poor and testicular atrophy developed in rat testes in all study groups. Testicular atrophy could not be reversed by preoperative administration of pentoxifylline and L-NAME.

The significance of venous dominance in color Doppler ultrasound for the diagnosis of primary nodular skin lesions: a new perspective in classification.

The aim of this study was to investigate the significance of color Doppler ultrasound (CDUS) findings in the differential diagnosis of suspicious nodular skin lesions and to compare the results according to the Giovagnorio 1999 classification and the modified classification. Forty nodular skin lesions were evaluated with CDUS and US. The number of arteries and veins was recorded in hypervascular lesions. Findings were compared with histopathological results. The specificity and predictivity of the modified classification were higher than those of the Giovagnorio 1999 classification.

[Endobronchial metastasis from urinary bladder cancer]. / Mesane kanserinin endobronsiyal metastazi

A rare case, a case of endobronchial metastasis from urinary bladder carcinoma is reported. A 70 years-old man was admitted with hematuria. He has a mass in urinary bladder and a mass in lung. He has no pulmonologic symptom. He is a smoker with 75 pack-years. Thorax computerized tomography revealed a mass in left lung upper lobe. Bronchoscopy demonstrated an endobronchial tumor in left upper lobe, apikoposterior segment. Histopathologically diagnosis was endobronchial metastasis from urinary bladder carcinoma. He received five courses of chemotherapy (cisplatin + gemcitabine). The mass was regressed after three months. Our patient lived for one year from diagnosis.