Comparison of the Effect of Platelet-rich Plasma (PRP) and Fat Graft on Autologous Bone Grafting in a Randomized-controlled Experimental Skull Model.

Gold standard method for the treatment of critical-sized bone defects is the autogenous bone grafting procedure. A number of new and potentially useful adjuncts currently are being investigated to enhance the success of bone grafting. We propose to evaluate the effect of the most known and easily obtained 2 biological materials, fat graft and platelet-rich plasma (PRP), on bone graft healing. Twenty-seven New Zealand male rabbits were included in this randomized, controlled study. Two-sided 15-mm diameter bone defects were created in the parietal bones and the bones taken were replaced right-to-left and vice versa with 1 control group, 1 fat graft applied group, and the last one PRP applied group. Histologic evaluation and 3-dimensional maxillofacial computerized tomography were performed and bone density was calculated. In radiologic analysis, bone density was significantly different in the PRP group compared with the control and fat graft group in the 12th week ( P <0.05). In histologic scoring analysis, the PRP group had a better score than the control and fat graft group, while the fat graft group was worse than the control group in the 6th week ( P <0.05). The addition of PRP had a positive effect whereas fat graft had a negative effect on bone graft healing compared with the control group.

Is it tuberculosis mastitis or granulomatous mastitis? A thirteen-year experience at a university hospital.

BACKGROUND: Granulomatous mastitis (GM) is a rare inflammatory disease of the breast. Tuberculosis mastitis (TM), one of the causes of GM, is a rare form of extrapulmonary tuberculosis. The clinical, radiological, and histopathological findings of TM and GM are similar, and sometimes it is difficult to make a distinction between these disease states. In this study, we aimed to evaluate the clinical and radiological features, diagnostic techniques, treatment modalities and treatment outcomes of the patients with GM and TM. METHODS: The data of the patients with confirmed GM by histopathologic examination of biopsy specimens between 2007 and 2020 were retrospectively analyzed. Demographic features, main complaints, physical findings, radiological and laboratory data, treatment modalities, and treatment outcomes were recorded. RESULTS: Sixty-eight GM patients with a mean age of 35.8 (18-63) years were evaluated. The patients had a mass lesion, pain, ulceration,and abscess in their breasts. All of the cases were female. Ultrasonographic examinations were performed on 62 cases. Abscess and/or sinus tract formation was detected in 34, heterogeneous hypoechoic mass in 15, heterogeneous parenchyma or parenchymal edema in 15, axillary lymphadenopathy in 18 and cysts in 13 patients. A total of 10 patients were lost to follow-up. Twenty-six patients underwent surgery for their breast lesions or had antibiotherapy (n = 13) or corticosteroid therapy (n = 7). Eleven (16.1%) patients were diagnosed with TM. These patients were evaluated by clinical examination, chest radiography, and tuberculin skin test. Acid-fast bacilli (AFB) staining and culture were negative in all cases. The diagnosis of TM was based on histopathological evaluation results. Eight of the 11 patients achieved complete remission with antituberculosis treatment. DISCUSSION: The etiological diagnosis of GM must be based on a multidisciplinary approach. Tuberculosis mastitis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis.

Effect of radiofrequency microtenotomy on degeneration of tendons: an experimental study on rabbits.

INTRODUCTION: Radiofrequency microtenotomy is used to enhance healing by increasing vascularity in the degenerated tendon. In the present study, the effect of radiofrequency microtenotomy (Rf-mt) treatment on tendon degeneration was investigated. MATERIALS AND METHODS: A total of 32 New Zealand rabbits were enrolled in the current study. Experimental degeneration was performed by injecting prostaglandin E1 (PGE1) into the bilateral Achilles tendons of rabbits. After excluding 4 rabbits with an infection on the injection site, 4 other rabbits were sacrificed to define the histopathologic changes in the tendons. The remaining 24 rabbits were divided into 2 groups: the control group and the Rf-mt group. In the control group, the Rf-mt device was only applied to the Achilles tendon without running the device. In the Rf-mt group, the Rf-mt device was applied bilaterally at the fourth energy level for 500ms to an area within 2cm proximal to the insertion site at 0.5cm intervals in order to form a grid. Six rabbits from each group were sacrificed at 6 and 12 weeks. The Achilles tendons were evaluated histopathologically by a modified Movin scale and by immunohistopathologic staining for vascular endothelial growth factor and type 4 collagen. RESULTS: After the PGE1 injection, findings similar to chronic degenerative tendinopathy were observed. The Rf-mt group showed significant improvement in vascularity in the histopathological and immunohistochemical examination (P<0.05). However, there was no significant difference in healing between the control and Rf-mt groups (P>0.05). CONCLUSIONS: Rf-mt treatment increases vascularity in degenerated tendons but does not create difference to facilitate the healing process comparing control group.

A lacrimal sac mass with bloody discharge.

We report a 38-year-old man who presented with a 7-year history of a mass in the right medial canthal region. He had several episodes of dacryocystitis, epiphora and bloody discharge. A cystic lesion was defined on MRI. Lacrimal sac excision was performed and a dark red mass was extirpated. External dacryocystorhinostomy and bicanalicular silicone tube intubation was performed. The polypoid lesion was diagnosed as an inflammatory polyp. Benign and malignant tumors of the lacrimal sac may have similar clinical findings on presentation. Preoperative ancillary testing may help us to have an idea of the nature of the lesion but histopathological examination is still the gold standard. Ophthalmologists should remember this similarity and be careful especially while performing endoscopic or laser-assisted dacryocystorhinostomy.

Osteoid osteoma of the trapezium: case report.

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.

[Overlooked primary hyperparathyroidism presented with fractures: case report]. / Kiriklarla gelen atlanmis primer hiperparatiroidi olgusu: Olgu Sunumu.

In the present paper, we report a female patient with multiple cystic lesions of bone arising from the primary hyperparathyroidism and pathological femur and contralateral tibia fractures at the level of these cystic lesions (osteitis fibrosa cystica). The patient's history revealed that she was admitted to a medical center with vague symptoms such as sudden onset of dyspepsia, loss of appetite, myalgia, arthralgia, fatigue, and weight loss six years ago but no disease was diagnosed. Loss of appetite and loss of weight continued. She had been walking only by assisted ambulation for the last year. However, primary hyperparathyroidism was overlooked until our examination. The fractures were managed by interlocking nailing and grafting after confirming with biopsy that the fractures were due to osteitis fibrosa cystica. The fractures healed uneventfully. In conclusion, it is essential to evaluate patients with these vague symptoms with full biochemical screening and radiological examination for the early detection of the disease.

HER-2/Neu and Hormone Receptor Analysis in Breast Carcinomas and Their Association with Clinicopathologic Parameters.

OBJECTIVE: Invasive breast carcinomas of no special type (IC-NST) are the heterogeneous tumours showing distinct prognostic features even in patients with similar clinicopathological characteristics. To date, many clinicopathological data have been analyzed to make a guess about prognosis and to determine treatment modality. In this study, HER-2/neu status was analyzed by using both immunohistochemical (IHC) and fluorescence in situ hybridization (FISH) methods, and its correlations with hormone receptor status and clinicopathological parameters were investigated. MATERIALS AND METHODS: The study was included 112 female patients with diagnosis of IC-NST. FISH for HER-2/neu was applied in only primary tumour tissues, while IHC analyses for HER-2/neu, estrogen (ER) and progesterone receptors (PR) were applied on both primary and metastatic lymph node foci. The results were compared with appropriate statistical methods. RESULTS: Our rates of HER-2/neu overexpression and gene amplification in the overall study group were 22.3 and 25%, respectively. In the metastatic group, these rates were higher than those of the overall study group (34% and 40%, respectively). Gene amplification rate of the axilla positive group was 40%, while this rate in non-metastatic group was 6.7% (p=0.015). Overexpression and amplification results were compliant (χ2=77,591, p<0.001). The concordance rates in HER-2/neu negative and overexpression groups were 95.3% and 88%, respectively. Our false negativity rate was 4.7%. While 36% of score 3+ cases were ER positive, 67.1% of HER-2/neu negative cases showed ER positivity (p=0.01). The increase of gene amplification rate in ER negative cases over 50 years age was more than two times and statistically significant (p=0.014). CONCLUSION: The concordance rates between the results of IHC and FISH in the HER-2 negative and the overexpression categories were compatible with the literature and lower than the literature, respectively. In the case of ER negativity, the patient's age over 50 years was associated with a higher rate of gene amplification.

[Surgical approach to encapsulated follicular variant of papillary thyroid carcinoma: a report of three cases]. / Tiroid papiller karsinomunun kapsüllü folliküler varyantinda cerrahi yaklasim: Uç olgu sunumu.

The diagnosis of follicular variant of thyroid papillary carcinoma is often difficult with fine-needle aspiration biopsy since this variant contains both benign and malignant follicular structures. The encapsulated follicular variant poses even more difficulty for diagnosis. It is usually agreed that this variant has similar clinical behavior to that of classic thyroid papillary carcinoma. However, some recent cases have been shown to have an aggressive course, leading to controversy as to the type of surgery. We presented three female patients whose results of fine-needle aspiration biopsy were not malignant, but postoperative histopathologic diagnosis was made as encapsulated follicular variant. One patient underwent thyroid lobectomy for a single thyroid nodule, and two patients underwent subtotal thyroidectomy. Upon histologic diagnosis of encapsulated follicular variant, total thyroidectomy was performed in two patients. Encapsulated follicular variant should be borne in mind in patients with a benign fine-needle aspiration biopsy result.

Large Cell Carcinoma with Adenocarcinoma in Lung.

Large cell neuroendocrine carcinoma (LCNC) is a rare and aggressive cancer accounting for 3% of all lung cancers. A small percentage of LCNC called combined LCNC, can be seen in combinations with other lung tumor types. Multimodal therapy is proposed for this type of tumor but there is no any significant therapy since it is very rare tumor. This patient was a 66-year male and a heavy smoker with no symptoms of lung disease. Computed tomography core biopsy showed suspected adenocarcinoma. Right lower lobectomy was performed with mediastinal lymph node dissection via mini thoracotomy. The tumor was diagnosed as combined LCNC with adenocarcinoma. The patient was discharged on the seventh postoperative day and sent to the oncology clinic for chemotherapy. There has been no recurrence for eight months after surgery.

Immunohistochemical Analysis of the Extrinsic Apoptosis Process in the Non-Neoplastic and Neoplastic Prostate.

OBJECTIVE: Deviations in the apoptotic process have been demonstrated in prostate carcinogenesis. We aimed to evaluate especially the process of extrinsic apoptosis in the spectrum of neoplastic lesions of the prostate epithelium so as to reveal the variations in the apoptotic process. MATERIAL AND METHOD: The study included 20 benign prostatic hyperplasia, 8 high-grade prostatic intraepithelial neoplasia and 82 prostatic carcinoma patients. Immunohistochemistry was performed on sections obtained from materials of suprapubic prostatectomy, tru-cut biopsy, transurethral resection and radical prostatectomy. While Fas and FasL were evaluated in glandular and stromal areas, DcR1 and FLIP were evaluated in only glandular areas. Intensity and extent of immunostaining for Fas and FasL antibodies were separately scored and both scores were summarized. The total score of ≥ 4 both for Fas and FasL, expressions of FLIP and DcR1determined in more than 5% of glandular areas were accepted as positive. RESULTS: Glandular FasL positivity was observed in 63.8 and 20% of the cases with prostatic carcinoma and benign prostatic hyperplasia, respectively (p=0.001). The loss of stromal Fas expression in PCa was obvious (p < 0.001). FLIP positivity was more frequently seen in high-grade prostatic intraepithelial neoplasia and PCa. CONCLUSION: In prostatic carcinoma, decreased stromal Fas expression, contrary to higher glandular FasL positivity, supports the assertion that sensitivity of epithelial and stromal cells to apoptosis and their protective pathways against apoptosis undergo alterations. Increased FLIP expressions in high-grade prostatic intraepithelial neoplasia and prostatic carcinoma can also be interpreted accordingly.

Alveolar adenoma of the lung. Immunohistochemical and flow cytometric characteristics of two new cases and a review of the literature.

Alveolar adenoma is a rare and benign tumour of the lung that usually presents in asymptomatic patients as a coin lesion on chest radiography. Only 25 cases have been reported in the English medical literature. Alveolar adenoma has a characteristic multicystic histology and often resembles the normal lung parenchyma. Ultrastructural studies indicate that the epithelial cells lining the cysts are type-II pneumocytes. Immunohistochemical analysis may aid in the characterization of alveolar adenoma and discriminate this condition from other types of benign lesions of the lung. An indolent clinical progression and absence of recurrence and metastasis after complete resection are the most important characteristics indicative of the benign nature of alveolar adenoma. Few studies have been conducted at the molecular level, such as by flow cytometry, with the objective of characterizing the biological nature of alveolar adenoma. Differential diagnoses include sclerosing hemangioma, papillary adenoma, lymphangioma, atypical adenomatous hyperplasia and bronchioloalveolar carcinoma. In this article we describe the immunohistochemical and flow cytometric features of this neoplasm in two male patients. Both the tumours showed a diploid DNA pattern with a low proliferation index. p53 test was found to be negative, and post-operative follow-up examinations at 22 and 32 months proved uneventful.

Orbital metastasis of prostate cancer: a case report.

We report a case with metastatic orbital cancer secondary to prostatic adenocarcinoma. After initiation of total androgen blockade, the visual complaints, pain and periorbital swelling regressed dramatically within 2 months of treatment. However, the disease subsequently progressed and the patient died 12 months after diagnosis.

Effect of chronic prostatitis on angiogenic activity and serum prostate specific antigen level in benign prostatic hyperplasia.

The aim of this study was to evaluate the effect of chronic inflammatory pathology on the angiogenic activity in benign prostatic hyperplasia (BPH). Besides the presence of a relationship between serum prostate specific antigen (PSA) values and microvessel density (mvd), the intensity and extent (widespread or focal) of tissue PSA expression was also examined. The distribution of 30 cases according to the diagnosis groups was as follows: group 1, nine cases with prostatic adenocarcinoma; group 2, 10 cases with BPH and chronic prostatitis; group 3, 11 cases with BPH. The biopsy materials obtained by tru-cut biopsy (five cases) and transurethral resection (25 cases) were evaluated retrospectively. The evaluation of angiogenesis was made by CD34 immune marker, while the analysis of immunohistochemical tissue PSA expression was verified by PSA immune marker. Serum PSA levels and other clinical parameters were obtained from the clinical files of the patients. The mean age of the patients was 68 +/- 3 years (range, 48-83 years). The difference between the mean mvd values of the groups was statistically significant (chi2 = 10.492, p = 0.005). Group 1 showed higher mean mvd value than the other two groups. Although group 2 showed higher mean mvd value than group 3, the difference was not statistically significant (p = 0.863). There was no correlation between the mean mvd and serum PSA levels in any group. The intensity of PSA expression in prostate specimens was different in all groups. Maximum cases in group 3 showed high tissue PSA expression (chi2 = 12.442, p = 0.014). In group 1, there was a significant relationship between the intensity of PSA expression and the mean mvd (U = 1, p = 0.032). In group 2, a statistically significant correlation was noted between the mean serum PSA levels and the widespread occurrence of PSA expression (U = 0, p = 0.017). In the present study, we determined that chronic prostatitis had no effect on mvd in BPH cases. The correlation between tissue PSA expression and mvd was contradictory to the reports in the literature. Analyses in larger series are needed to prove the presence of a probable effect of chronic prostatitis on angiogenesis.

Adenocarcinoma originating from a mature teratoma of the testis.

Malignant transformation in testicular teratomas has been reported very rarely in the literature. Although testicular teratomas in childhood are regarded as benign neoplasms, these tumors, if left untreated until advanced ages, may present the risk of malignant transformation. We report a case of differentiated adenocarcinoma originating from colonic glands in primary testicular teratoma.

A rare large mutation involving two exons of the SP-B gene in an infant with severe respiratory distress.

Takci S, Anuk-Ince D, Louha M, Couderc R, Çakar N, Köseoglu RD, Ates Ö. A rare large mutation involving two exons of the SP-B gene in an infant with severe respiratory distress. Turk J Pediatr 2017; 59: 483-486. Hereditary surfactant protein-B (SP-B) deficiency is a rare autosomal recessive disease of newborn infants causing severe respiratory failure and death within the first year of life. The most common cause of SP-B deficiency is a frameshift mutation in exon 4 (121ins2) in the gene encoding SP-B. We report a term infant with unremitting respiratory distress who was unresponsive to all treatment modalities. The parents were consanguineous and a term sibling of the infant had died due to respiratory failure without a certain diagnosis. In the first step of the diagnostic work-up, common genetic mutations for SP-B, surfactant protein C and ATP-binding cassette s3 were absent, however sequencing of SP-B gene revealed a large homozygous genomic deletion covering exon 8 and 9. In this case report, we aimed to emphasize further genetic evaluation in all cases suggestive of surfactant dysfunction, even if common mutations are absent.

Comparison of adhesive properties of five different prosthetic materials used in hernioplasty.

This experimental study was designed to assess and to compare intra-abdominal adhesions following the use of five commercially available prosthetic mesh grafts in the repair if abdominal wall defects. Sixty Wistar albino rats were randomly divided into six groups (n = 10). A 2 x 1 cm defect at abdominal wall was created and defects were closed either primarily or with one of the following prosthetic mesh grafts: monofilament polypropylene, polytetrafluoroethylene, sodium hyaluronate/carboxymethylcellulose-coated polypropylene, polypropylene/polyglactin 910 composite, or resorbable hydrophilic collagen-coated multifiber polyester. The severity of adhesions was graded, tensile strengths of adhesions were measured, and histopathological grades of inflammation and fibrosis were evaluated. Polypropylene mesh resulted in more adhesion formation in comparison to primary repair and other grafts used in this study, except polypropylene/polyglactin 910 composite mesh. In addition, the highest tensile strength of omental adhesions was detected in the polypropylene group (chi2 = 26.249; p = .0001). Polyester composite mesh caused the least adhesion formation among the groups. Sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polyester composite meshes revealed the highest fibrosis scores (chi2 = 50.776; p = .0001). The highest inflammatory activity was detected in the polytetrafluoroethylene mesh group (chi2 = 16.564; p = .005). Thus, sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polytetrafluoroethylene meshes following polyester composite mesh were the minimal adhesion-forming grafts in this study. Disadvantages of the polytetrafluoroethylene mesh were lower fibrotic activity and higher inflammatory reaction to the graft.

[The chondroprotective effect of intra-articular hyaluronic acid at early stages of osteoarthritis: an experimental study in rabbits]. / Eklem içine uygulanan hiyalüronik asidin erken evreli osteoartritte kikirdak koruyucu etkisi: Tavsanda deneysel çalisma.

OBJECTIVES: Hyaluronic acid (HA) is used in osteoarthritis, especially for the control of pain. In this study, we investigated the effect of intra-articular HA on experimental osteoarthritis of early stage. METHODS: Osteoarthritis was induced in both knees of 10 rabbits by transecting the anterior cruciate ligament under intramuscular anesthesia with ketamine and xylazine. Intra-articular HA at a dose of 0.6 ml (15 mg/ml) and physiologic saline solution (0.6 ml) were injected into the right and left knees, respectively, three times with a week interval. Three rabbits died during the study period and were excluded. The remaining rabbits were sacrificed in the 12th week via high dose anesthesia to remove the distal femora for histological evaluation using the Mankin scale and for measurements of the cartilage area. RESULTS: The mean cartilage areas calculated in HA- and saline-injected knees differed significantly (1.097 mm2 and 0.477 mm2, respectively; p<0.05). The overall mean Mankin score was significantly lower in HA-injected knees (3.57 versus 11.14; p<0.05). Although, there were no significant differences between the two groups with respect to cellular abnormality, matrix staining, and tidemark continuity (p>0.05), the mean scores for the structure of the cartilage were significantly different (0.86 versus 4.43; p<0.05). The integrity of the tidemark was preserved in all the HA-administered knees, though a notable disruption was observed in four control knees. CONCLUSION: Our results suggest that HA delays the development of osteoarthritis at early stages through exerting a chondroprotective effect.

The effects of melatonin and caffeic acid phenethyl ester (CAPE) on fracture healing under ischemic conditions.

OBJECTIVE: The aim of this study was to investigate the effects of antioxidant molecules melatonin and caffeic acid phenethyl ester (CAPE) on fracture healing under ischemic conditions. METHODS: A right tibia fracture was created and fixed with an intramedullary pin in forty four male Wistar-albino rats. The rats were then randomly allocated to fracture, fracture-ischemia, fracture- ischemia-melatonin, and fracture-ischemia-CAPE groups. Ischemia was created by clamping femoral arteries four and a half hours. Animals were killed and radiographic, histological and biomechanical evaluation was performed sixth week after surgery. RESULTS: The radiological and histological scores of the fracture-ischemia-CAPE group were significantly better than the fracture- ischemia group at 6th week follow-up. Complete radiographical and histological healing of all fractures was detected in all groups. There was a significant difference between the maximum fracture force between the groups (fracture-ischemia

A rare cause of pericardial effusion: giant cell arteritis.

Giant cell arteritis is a granulomatous vasculitis characterized by medium or large sized vessel involvement. Although extracranial branches of the carotid artery are typically involved, involvement of aorta and its major branches can also be seen. Cardiac involvement has been encountered less frequently and pericardial effusion is rarely encountered. In this paper, a case has been presented in which pericardial effusion was determined during the examination and diagnosis was giant cell arteritis.