First Reported Case of Echinococcal Disease on a Renal Graft Successfully Treated With Albendazole.

Echinococcal disease is an endemic disease for eastern Mediterranean countries. Various types of kidney involvement have been reported. Here, we report the first case of echinococcal disease on a transplanted kidney in a patient who was successfully treated with albendazole alone. The patient (a 38-year-old female) was evaluated for elevated creatinine levels 7 months after receiving a living-donor allograft. Standard immunosuppression therapy protocols were applied. Tacrolimus level was normal, and the patient was compliant with treatment. Creatinine level was 1.91 mg/dL (baseline: 1.2 mg/dL); proteinuria level was 1300 mg/day. The graft was found to be normal, as evaluated with standard sonographic methods. A kidney biopsy was performed, which showed that part of the cortical parenchyme was infiltrated by echinococcal protoscolices with hooklets. Because there were no cysts present on the graft, we concluded that disease was at an early stage. The patient was given albendazole for 3 months. After therapy, all echinococcal structures disappeared. Her creatinine level dropped to baseline, and proteinuria resolved. Echinococcal disease can affect transplanted kidneys. Albendazole is a valuable treatment option for patients who are not candidates for surgical resection.

Renal Allograft With Calcium Oxalate Deposition: Association with Urinary Tract Infection and Development of Interstitial Fibrosis.

OBJECTIVES: The interaction between calcium oxalate deposition and urinary tract infection is not well established. We aimed to identify the association between these and to determine the role of calcium oxalate deposition on interstitial fibrosis development. MATERIALS AND METHODS: Renal allograft biopsies of 967 patients were reviewed to identify those with calcium oxalate deposition in the renal allograft, with 27 (2.8%) identified. Follow-up biopsies were conducted to reevaluate for calcium oxalate presence and interstitial fibrosis development. At time of biopsy, presence of urinary tract infection and oxaluria was also examined from medical records. RESULTS: Mean time for development of calcium oxalate deposition in renal allografts was 1.7 ± 0.4 and 32.7 ± 21.6 months in patients with primary and secondary oxalosis, respectively (P < .001). Of 27 patients with calcium oxalate deposition, 7 (25.9%) showed tubulointerstitial nephritis, with 2 also having urinary tract infection. Four patients (14.8%) had only urinary tract infection. Causes of tubulointerstitial nephritis were secondary to bacterial infection in 2 and secondary to viral infection in 5 patients (2 polyomaviruses, 2 cytomegaloviruses, 1 adenovirus). Time until development of interstitial fibrosis after calcium oxalate deposition was 3.5 ± 2.1 and 10.3 ± 4.1 months in patients with primary and secondary oxalosis, respectively (P = .01). Time until graft loss after calcium oxalate deposition was 9.3 ± 7.8 and 21.8 ± 12 months in those with primary and secondary oxalosis (P < .001), with 1-, 3-, and 5-year kidney graft survival of 43%, 28%, and 0% and 100%, 100%, and 67% in those with primary and secondary oxalosis, respectively. CONCLUSIONS: Calcium oxalate deposits increased the risk of urinary tract infection and tubulointerstitial nephritis, with bacteria inducing increased presence of calcium oxalate deposition in a renal allograft. Calcium oxalate deposition had a significant influence on interstitial fibrosis development, therefore negatively affecting graft survival.

Expression of Cox-2 and Bcl-2 in Paget's disease of the breast.

BACKGROUND: Paget's disease (PD) is a rare form of intraepithelial adenocarcinoma that involves breast and extramammarian tissues. It is often associated with ductal carcinoma in situ and/or invasive ductal cancer. Molecular pathways that play a role in development of Paget's disease are stil unclear. Expression patterns of Cox-2 and bcl-2 were therefore assessed. MATERIALS AND METHODS: Patients with a histopathological diagnosis of Paget's disease were included in this study. Patient files were analysed retrospectively. RESULTS: Invasive cancer was diagnosed in 35 (76.1%) of the patients, 7 (15.2%) had ductal carcinoma in situ and 4 (8.7%) patients had no associated neoplasm. Twenty four (52.2%) patients showed COX-2 expression in Paget cells whereas no expression was seen in 22 (47.8%) patients. No relation was found between COX-2 expression and the lesion underlying Paget's disease (p=0.518). Bcl-2 expression in Paget cells was found positive in 12 (26.1%) and negative in 27 (58,7%) cases. There was no relation between Bcl-2 expression and the lesion accompanying Paget's disease (p=0.412). No relation was observed between COX-2 expression and Bcl-2 expression (p=0.389). CONCLUSIONS: In breast cancer, COX-2 expression is associated with poor prognostic factors. As COX-2 expression increases the tendency to metastasize also increases. In our study we found a significantly high COX-2 expression in Paget's disease of the breast. We suggest that COX-2 expression and inflammatory processes may play a role in pathogenesis of the Paget's disease of the breast.

Tangier disease in a Turkish family.

In this report we describe the upper gastrointestinal tractus involvement in a rare genetic disease of lipid metabolism. A 12-year-old boy presented with sore throat and fever. On physical examination, orange-yellow tonsils and adenoid tissue were noted. Mild hepatosplenomegaly was present. Lipid profile was compatible with Tangier disease (TD). Endoscopy of the upper gastrointestinal tract showed white-yellowish fatty deposits on the gastric mucosa. Microscopically, biopsy specimens contained numerous histiocytes with a foamy cytoplasm packed in the lamina propria of the gastric mucosa and at the crypt basement of the duodenum. His sister, 8 years old, was also diagnosed with TD based on abnormal lipid profile and orange-yellow tonsils. TD is a rare familial disorder of lipid metabolism, characterized by deposition of cholesteryl esters, probably involving the entirety of the gastrointestinal tract from the mouth to the anus.

Nonmelanoma skin cancer after kidney transplant.

OBJECTIVES: Solid-organ transplant recipients have a high risk of developing nonmelanoma skin cancers. This study sought to determine the incidence of skin cancer and identify possible risk factors for skin cancer in kidney transplant recipients. MATERIALS AND METHODS: Nonmelanoma skin cancer was diagnosed and confirmed with histology in 33 of 1275 kidney transplant recipients (2.6%). Demographic and clinical findings were reviewed retrospectively. RESULTS: Nonmelanoma skin cancers included squamous cell carcinoma in 10 patients (30%), basal cell carcinoma in 9 patients (27%), Kaposi sarcoma in 9 patients (27%), squamous cell carcinoma in situ in 3 patients (9%), and cutaneous lymphoma in 2 patients (6%). The ratio of squamous cell carcinoma to basal cell carcinoma was 1.1:1. The mean time from transplant to skin cancer diagnosis was 65 ± 55 months (range, 0-180 mo). Immunosuppressive therapy was based on cyclosporine in 22 patients (67%), tacrolimus in 8 patients (24%), and combination therapy (cyclosporine and azathioprine) in 3 patients (9%). CONCLUSIONS: Nonmelanoma skin cancer is an important clinical problem in kidney transplant recipients. Interventions that may benefit kidney transplant recipients may include intensive patient education, protection against sun exposure, and dermatologic screening programs.

Association of respiratory distress syndrome and perinatal hypoxia with histologic chorioamnionitis in preterm infants.

The aim of this study was to evaluate the relationship between neonatal mortality-morbidity and pregnancies with preterm premature rupture of membranes (PPROM), particularly those complicated by histologic chorioamnionitis (HCA), in preterm infants. A retrospective study was conducted on 58 preterm neonates born to 46 pregnant women with PPROM. Maternal characteristics, placental examination, and neonatal morbidity and mortality were analyzed. Of 1,392 deliveries, 46 (3.3%) pregnancies and 58 newborn infants were complicated with PPROM. HCA was present in 21 (1.5%) cases, and 15 of them were <28 weeks of gestational age. In the HCA (+) group, 8/21(38%) neonates had 5-minute Apgar scores of <5, 12/21 (57.1%) infants had patent ductus arteriosus (PDA), and 16/21 (76.1%) infants had respiratory distress syndrome (RDS). The latency period was significantly longer and the rate of chorioamnionitis and percentage of major neonatal morbidity and mortality were significantly higher in preterm infants with gestational age <28 weeks. Respiratory distress syndrome, perinatal hypoxia and PDA were significantly associated with HCA in preterm infants.

The effect of platelet rich fibrin on growth factor levels in urethral repair.

AIM: Platelet rich fibrin (PRF) is an autologous source of growth factors and promotes wound healing. An experimental study was performed to evaluate the effect of PRF on growth factor levels in urethral repair. MATERIALS AND METHODS: Eighteen Wistar albino rats were included in the study. Rats were allocated in three groups (n:6): control (CG), sham (SG), and PRF (PRFG). In SG, a 5 mm vertical incision was performed in the penile urethra and repaired with 10/0 Vicryl® under a microscope. In PRFG, during the urethral repair as described in SG, 1 cc of blood was sampled from each rat and centrifuged for 10 minutes at 2400 rpm. PRF obtained from the centrifugation was placed on the repair site during closure. Penile urethras were sampled 24 hours after PRF application in PRFG and after urethral repair in SG. Transforming growth factor beta receptor (TGF-ß-R-CD105), vascular endothelial growth factor (VEGF) and its receptor (VEGF-R), as well as endothelial growth factor receptor (EGFR), were evaluated in subepithelia of the penile skin and urethra. Groups were compared for growth factor levels and growth factor receptor expression with the Kruskal Wallis test. RESULTS: TGF-ß-R levels were significantly decreased in SG when compared to CG (p<0.05). In PRFG, TGF-ß-R was increased in both subepithelia of penile skin and urethra with respect to SG (p<0.05). When VEGF levels and its receptor expression were compared between SG and PRFG, VEGF levels were found to be increased in penile skin subepithelium, whereas VEGF-R expressions were decreased in urethral subepithelia in PRFG (p<0.05). There was no difference between groups for EGFR levels (p>0.05). CONCLUSION: Use of PRF after urethral repair increases TGF-ß-R and VEGF expressions in urethral tissue. PRF can be considered as an alternative measure to improve the success of urethral repair.

Effect of P/E-selectin blockage on antisperm antibody development and histopathological alterations in experimental orchitis.

AIM: This study aimed to evaluate the effect of P/E-selectin blockage on antisperm antibody (ASA) development and histopathological alterations in experimental orchitis. MATERIALS AND METHODS: Thirty-six Wistar albino-type male rats weighing 100-150 g were included in the study. Rats were allocated into six groups (n = 6) including control (CG), sham (SG), orchitis (OG), antimicrobial treatment (AG), P/E-selectin blockage (PESG), and both antimicrobial and P/E-selectin treatment (TG) groups. In CG, serum samples were taken from the tail vein prior to the procedure and followed by extraction of both testes. In SG, 1 ml of saline solution was injected in testicular parenchyma. OG was obtained by injecting 0.1 ml 106 cfu/ml Escherichia coli (0:6 strain) and 1 ml saline solution into the right testes. AG received ciprofloxacin (50 mg/kg/day) twice a day through gastrogavage 24 hours after generating orchitis. In PESG, P/E-selectin antibody (100 µg) was administered intravenously via the tail vein 24 hours after the induction of orchitis. Finally, both ciprofloxacin and P/E-selectin antibody were administered in TG 24 hours after the induction of orchitis for 14 days. At the end of treatment, 1 ml of serum sample was obtained to evaluate the ASA, P-selectin and E-selectin levels. In order to evaluate spermatogenesis (Johnsen score) and testicular injury (Cosentino score), both testes were extracted at the end of the 14th day. RESULTS: In orchitis-induced groups (OG, ATG, PSEG, TG), ASA levels were significantly increased at the 14th day when compared to SG (p < 0.05). In TG, ASA levels were decreased when compared to AG. However, similar alteration in ASA levels was not detected in PSEG (p > 0.05). In OG and AG, P-selectin levels were decreased at the 14th day when compared to levels observed on 0 day (p < 0.05). E-selectin levels on 0 day showed that each group had higher levels of E-selectin when compared to CG (p > 0.05). There was no significant difference regarding E-selectin when compared to CG (p > 0.05). No significant differences regarding E-selectin levels were detected on the 0th and 14th days between AG and CG (p > 0.05). When the Cosentino and Johnsen scores were compared among groups, TG and PSEG has decreased scores of Cosentino than OG on the right testicle (p < 0.05). In contrast, an increased Johnsen score was detected in TG and PSEG when compared to OG (p < 0/05). No significant difference was detected for both Cosentino and Johnsen scores on the left testicle (p > 0.05). There was no difference with regard to the right and left testicular injury in TG. In P/E-blocked groups, decreased histopathological alterations were observed in the contralateral testis. CONCLUSION: P/E-selectin blockage may reduce ASA production after orchitis when combined with antimicrobial treatment. P/E-selectin blockage not only has a protective effect on blood-testis barrier but also decreases the histopathological alterations in both the affected and contralateral testis. Histopathological parameters of spermatogenesis may also be prevented by P/E-selectin blockage in experimental orchitis.

Epithelial expression of extracellular matrix metalloproteinase inducer/CD147 and matrix metalloproteinase-2 in neoplasms and precursor lesions derived from cutaneous squamous cells: An immunohistochemical study.

Extracellular matrix metalloproteinase inducer (CD147) is a transmembrane glycoprotein involved in the regulation of matrix metalloproteinases (MMPs). The study investigated CD147 and MMP-2 expression in epidermis of cutaneous squamous lesions. CD147 and MMP-2 expressions were evaluated immunohistochemically in 44 specimens: 18 actinic keratoses (AK), 6 squamous cell carcinomas in situ (SCCIS), 13 squamous cell carcinomas (SCC; peritumoral and invasive portions assessed), and 7 normal skins. Patterns of expression were assessed, with MMP-2 in nuclei (MMP-2n) and cytoplasm (MMP-2c) evaluated separately. The expression of each marker was quantified using a calculated immunohistochemical/histologic score (H-score). Correlations were analyzed for the marker H-scores in each study group. Associations between H-scores and histopathologic parameters were also evaluated. CD147 H-score was the highest in SCC (invasive islands), followed by AK, SCCIS, and control specimens, respectively. MMP-2n and MMP-2c H-scores were the highest in AK, followed by SCCIS, SCC, and control specimens, respectively. MMP-2c and MMP-2n H-scores were significantly higher in peritumoral epidermis than in invasive islands of SCC. MMP-2c and CD147 H-scores were positively correlated in the peritumoral SCCs. CD147 H-score was positively correlated with tumor differentiation in SCC. The findings suggest that overexpression of CD147 plays a role in the development of SCC.

Effects of low-dose methotrexate in spinal cord injury in rats.

BACKGROUND: This study was designed to evaluate the possible protective effects of low-dose methotrexate in the spinal cord injury (SCI) in rats. METHODS: Thirty-seven Wistar albino rats were used in the present study. Except for the animals of the Sham group, all animals were divided into two main groups, which were used in acute and subacute stage investigations. Then, thoracal laminectomy was performed, and except for the Sham group, SCI was induced using a temporary aneurysm clip. After clip compression, the experimental material (methotrexate or methylprednisolone) was administered intraperitoneally, except in the Sham and Control groups. Then, the spinal cords were removed to evaluate the SCI histopathologically and biochemically at the scheduled date. RESULTS: Neither experimental material was shown to reduce the histopathological grade in either stage of SCI. Low-dose methotrexate was shown to decrease lipid peroxidation levels only in the subacute stage of SCI. However, methylprednisolone and low-dose methotrexate could not decrease or block myeloperoxidase enzyme activation in either stage of SCI. CONCLUSION: Low-dose methotrexate was effective in reducing the lipid peroxidation levels in the subacute stage of SCI, although histopathological evaluation results and myeloperoxidase levels of all groups did not support this finding at either stage.

Evaluation of omental inflammatory response with P-/E-selectin levels and histopathologic findings in experimental model.

AIM: The omentum plays a crucial role in abdominal defense mechanism by adhering to sites of inflammation and absorbing bacteria and debris from the peritoneal cavity. An experimental study was conducted to evaluate the inflammatory response of omentum in different abdominal events with omental P-/E-selectin levels and histopathologic findings. MATERIALS AND METHODS: Thirty Wistar rats were placed into 5 groups (n = 6), including a control group (CG), sham group (SG), bladder perforation (BP) group, splenic laceration (SL) group, and cecal ligation and puncture (CLP) group. Omental samples were obtained in CG after median laparotomy. In accordance with described models, BP, SL, and CLP were performed in experimental groups. Twenty-four hours after the first laparotomy, localization of the omental pad was noted, and omental samples were obtained for biochemical analysis of levels and histopathologic findings (no. of vessels in sections, polymorphic nuclear leukocytes [PMLs], lymphocytes). The mean P-/E-selectin levels and histopathologic findings of inflammation were compared between groups. RESULTS: Although omentum was adhered to the cecum in all subjects after CLP, similar findings were not detected in other groups. P-selectin and E-selectin levels and number of PML were significantly increased in the CLP group when compared with other groups (P < .05). The number of vessels in sections was significantly increased in CLP group when compared with SG and BP groups (P < .05), and the BP group had a decreased number of vessels than CG (P < .05). The number of PML was significantly increased in SG and SL and BP groups with respect to CG (P < .05). CONCLUSION: Among different experimental intraabdominal catastrophes, only CLP caused an inflammatory response and increased levels of adhesion molecules in the omentum. These findings suggest that the nature of the inflammation is the main determining factor for the omental function in intraabdominal events.

Protective effect of intraperitoneal ozone application in experimental ovarian ischemia/reperfusion injury.

AIM: The current accepted management of ovarian torsion is ovary-sparing surgery. Ozone therapy is used to reduce ischemia/reperfusion (I/R) injury in several situations. An experimental study was designed to evaluate effect of ozone application in ovarian I/R injury. MATERIALS AND METHODS: Three groups (n = 6) and 18 rats were included in the study. After anesthesia, right ovaries were fixed and removed at the end of 2 hours in sham group (SG). In torsion group (TG), right ovaries underwent 720° torsion in a counterclockwise direction. Ovaries were removed after 2 hours torsion and 2 hours reperfusion. In ozone group (OG), torsion was created by the same technique, and 95% oxygen plus 5% ozone gas mixture was given intraperitoneally (25 µg/mL, 0.5 mg/kg) 10 minutes before reperfusion. After 2 hours reperfusion, ovaries were removed. Histopathologic examination of ovarian and periovarian sections was performed for the presence of congestion (C), hemorrhage, interstitial edema (IE), and polymorphonuclear neutrophilic infiltrations. Tissue samples were analyzed for malondialdehyde, nitric oxide (NO), and total sulphidryl (t-SH) values. Results were compared between 3 groups. RESULTS: At histopathologic examination, the TG have elevation in terms of ovarian C, polymorphonuclear neutrophilic infiltration, and periovarian IE when compared with SG (P < ,05). In OG, ovarian C and periovarian IE were reduced according to TG, whereas the increase was observed only in ovarian C compared with SG (P < .05). At biochemical evaluation of oxidative stress markers in SG and TG, there was no difference between them (P < .05). Malondialdehyde levels were significantly lower in OG than TG, whereas NO and t-SH values were higher (P < .05). Malondialdehyde levels were decreased in OG compared with SG (P < .05). However, no difference was observed in NO and t-SH levels (P > .05). CONCLUSION: Intraperitoneal application of ozone creates a positive impact on histologic and biochemical markers on I/R injury owing to ovarian torsion. The ozone application can be developed to support efforts to protect ovary in ovarian torsion.

Neuroprotective effects of racemic ketamine and (S)-ketamine on spinal cord injury in rat.

BACKGROUND: The aim of this study was to investigate and to compare the potential neuroprotective effects of racemic ketamine, (S)-ketamine and methylprednisolone after an experimental spinal cord injury model in rats. METHODS: Fifty-nine Wistar albino rats were divided into three main groups as acute stage (A), subacute stage (SA) and sham groups and then acute and subacute stage groups were divided into four groups regarding the used drug as control (CONT), racemic ketamine (RK), (S)-ketamine (SK) and methylprednisolone (MP) groups. A dorsal laminectomy was performed; and spinal cord injury was induced by using a temporary aneurysm clip. Four hours later from the clip compression, except those of the sham and control groups, the drugs (60 mg/kg racemic ketamine, 60 mg/kg (S)-ketamine or 30 mg/kg methylprednisolone) were administered intraperitoneally. At 72th h and 7th days of the study, the spinal cords of rats were removed from T8 level to the conus medullaris level. The specimens were and evaluated histopathologically, tissue lipid peroxidation (LPO) and myeloperoxidation (MPO) levels were measured and biochemically. RESULTS: The histopathological results were similar both in the acute and in the subacute stage groups. There was a statistically significant difference among all groups regarding the tissue LPO levels (p<0.001). There was a statistically significant difference between the CONT-A group and the MP-A, RK-A and SK-A groups (p=0.004, p<0.001 and p=0.007, respectively) in acute stage and between the CONT-SA group and SK-SA group (p=0.002) in subacute stage. There was a statistically significant difference among all groups regarding the tissue MPO levels (p=0.001). The median MPO levels were similar among acute stage groups (p=0.057), but there was a statistical difference among subacute stage groups (p=0.046). CONCLUSION: (S)-ketamine is more effective than methylprednisolone and racemic ketamine to reduce the LPO levels in subacute stage of spinal cord injury in rats. And, it is as effective as methylprednisolone in preventing secondary spinal cord injury histopathologically.

Myofibroblastoma of breast in a male infant.

Breast masses are very rare in infants and premature telarche due to excessive endogen or exogenous estrogens is the most common presentation during infancy. Myofibroblastoma is a stromal tumor of the breast, occurring especially in elder males. This breast mass has a close relationship between androgen receptors and has not been reported in infants previously. A 10-month old male baby with a left breast mass, which is diagnosed as myofibroblastoma, is discussed to evaluate the clinical features and treatment modalities of breast myofibroblastomas in children.

Intrascrotal extratesticular neurofibroma as a possible cause of failed descent in ipsilateral testis.

Intrascrotal extratesticular neurofibromas (IEN) often originate from genitofemoral nerve (GFN) and present as a paratesticular mass. Synchronous presence of IEN and undescended testis has not been reported previously. A 12-year-old boy with neurocutaneous syndrome and congenital giant melanocytic nevi along with IEN and ipsilateral undescended testis is presented, to discuss the underlying pathophysiology of failed testicular descent in the presence of IEN.

Adenohibernoma: a rare breast tumor.

Adenohibernoma of the breast is a very rare tumor composed of brown fat tissue and intermingled glandular tissue. There are only 2 case reports in literature. This study reports the third case of adenohibernoma of the breast, which is not accompanied by breast cancer differing from the previous cases. And, to the best of the authors' knowledge, this is also the first case of adenohibernoma of the breast that has demonstrated adipophilin expression immunohistochemically.

Effect of phototherapy on growth factor levels in neonatal rat skin.

AIM: Neonates undergoing surgery may receive phototherapy (PT) for the treatment of hyperbilirubinemia. Although the effects of PT on neonatal structures are well documented, the effect of PT on wound healing has not been previously evaluated. An experimental study was performed to evaluate the effect of PT on growth factor levels responsible for wound healing in neonatal rat skin. MATERIALS AND METHODS: Eighteen Wistar newborn rats (7 ± 2 g) were included in the study. Rats were randomized into 3 groups: control (CG), PT, and sham (SG) (n = 6). Both groups had 1-cm median dorsal skin incision. In CG, 1 × 1 cm of dorsal skin was sampled including the incised skin. The PT group received 5 banks of blue light (wave density, 30-40 µw/cm(2) per nanometer; exposure distance, 45 cm). Phototherapy was started 24 hours after birth and exposed during light period (mean duration, 21 hours to 15 minutes ± 2 hour to 1.5 minutes). Sham group consisted of animals that received a bank of white light with same exposure distance and a total duration of 26 hours to 18 minutes ± 3 hours to 9.1 minutes. After exposure, 1 × 1 cm dorsal skin samples were obtained from both PT and SG groups, including the median incision. The effect of PT was evaluated with the expressions of vascular endothelial growth factor (VEGF), its receptor (VEGF receptor), and transforming growth factor ß (TGF-ß) in endothelial vessels and fibroblasts of neonatal skin samples. RESULTS: There was no significant difference between groups in VEGF receptor and transforming growth factor ß expressions. The VEGF levels in endothelial vessels were significantly decreased in PT and SG when compared with CG (P < .05). CONCLUSION: Vascular endothelial growth factor is a mediator of angiogenesis and may decrease in neonatal rat skin after light exposure. It can be suggested that decreased levels of VEGF after PT application may alter angiogenesis and also may adversely affect the healing features of neonatal skin.

Tolerance of prefabricated skin flaps to ischaemia and reperfusion: experimental study.

Custom prefabrication of tissues allows the surgeon to build what is required for the reconstruction and has enabled the surgeon to reinforce new blood supply into selected blocks of tissue without vessel anastomosis. However, prefabricated flaps have several drawbacks and characteristics that differentiate them from conventional flaps. The objective of this study was to test the tolerance of prefabricated flaps to ischaemia/reperfusion injury in rats. In the first stage, the unilateral-inferior-epigastric pedicle was ligated and divided, and then a skin flap was fabricated by implantation of distally ligated femoral arteriovenous pedicle beneath the abdominal skin. The femoral vessels were implanted either in skeletonised or in muscle-cuffed fashion beneath the abdominal skin, a portion of which was raised as an island flap, based on these vessels. Prefabricated flaps (3×6 cm) were raised 6 weeks after, and were subjected to 10 h ischaemia and followed by 12 h reperfusion. Flap survival and histological changes at the pedicle-skin junction were evaluated at 7 days. Flap necrosis in the sham group was 0%, whereas the control group (conventional) had 47.27±13.50% necrosis. Flaps prefabricated with skeletonised femoral pedicle demonstrated an insignificant pattern with 63.74±10.62% necrosis when compared with prefabricated flaps with muscle-cuffed pedicle with the percentage of necrosis of 64.51±11.24. The area of necrosis was significantly increased when both the prefabricated flaps were compared with the control group or with the sham-prefabricated group (p<0.05). Skin flaps prefabricated with either pedicle-alone or pedicles with muscle cuff are more susceptible to ischaemia and following reperfusion in comparison with the normal flaps.

Rathke cleft cyst in seven-year-old girl presenting with central diabetes insipidus and review of literature.

Rathke cleft cysts (RCC) are benign cysts derived from remnants of Rathke cleft, and are rarely symptomatic in children. Symptoms due to RCC are associated with mass effect and pituitary hormone deficiencies. Slow growth rate of the cyst makes its incidence increase with aging. Here we report on a seven-year-old girl who presented with central diabetes insipidus (CDI). Her sella MRI revealed a lesion in the sellar region which grew rapidly in follow-up. She underwent microneurosurgical operation and the lesion was totally excised. Pathologic examination revealed RCC with degenerative changes. In her follow-up, growth hormone deficiency developed in addition to arginine vasopressin deficiency. Rapid growth of the cyst is not the usual course of RCC's. Mechanisms regarding the cyst growth are unclear as they are in this case. This is the youngest child to date presenting with central diabetes insipidus due to RCC. Rapid growth of RCC can cause CDI in young children.

Evaluation of protective effects of the alpha lipoic acid after spinal cord injury: an animal study.

PURPOSE: Many of the hypotheses have been suggested to explain the mechanism of the secondary effects of traumatic spinal cord injury (TSCI) as follows: ischaemia/reperfusion disability theory, free radicals theory, exitotoxicity theory, immunological destruction theory, apoptosis theory. Recently, free radicals,lipid peroxidation reactions and apoptosis theories have been much more accepted than others. In this study, possible protective effects of the alpha lipoic acid were evaluated in the traumatic spinal cord of rats. METHODS: Using a well characterised weight drop technique, spinal cord contusions were formed to 48 Wistar albino rats at thoracal 8­10 level. After alpha lipoic acid and methylprednisolone were administered intraperitoneally, the spinal cord tissues were harvested for histopathological and biochemical studies. RESULTS: Histopathological examination results showed that neither methylprednisolone nor alpha lipoic acid can play an act to decrease or block the neural tissue destruction and necrosis in hyperacute and subacute stage of the TSCI in rats. Biochemical study results showed that alpha lipoic acid was much more decreased the lipid peroxidation levels than methylprednisolone in subacute stage. However, none of the agents was changed the myeloperoxidation level in subacute stage. INTERPRETATION: Alpha lipoic acid and methylprednisolone administrations did not alter the onset or degree of necrosis at the zone of the TSCI in rats. On the other hand, alpha lipoic acid is more effective than methylprednisolone treatment for the prevention of lipid peroxidation after spinal cord injury.