The role of macrophages in the pathogenesis of mycosis fungoides.

BACKGROUND: Macrophages are classified into classically activated (M1) and alternatively activated (M2) macrophages. Decrease in macrophage number in tumour tissue with treatment has been reported. AIM: The aim of this study was to determine whether treatment has an effect on the number of dermal M1 and M2 macrophages in patients with mycosis fungoides (MF). METHODS: In total, 21 patients (8 women, 13 men; age range 42-73 years) were included in this study. We determined markers for dermal M1 (inducible nitric oxide synthase and CD68) and M2 (markers: CD163 and CD206) macrophages using double immunohistochemistry to reduce the error rate, and then counted the cells. RESULTS: The number of dermal M1 cells was significantly lower pretreatment compared with post-treatment (P < 0.01). The numbers of dermal M2 cells were also numerically decreased by treatment. These results did not change significantly after exclusion of the patients who had recurrence (n = 2). There were no statistically significant differences between groups classified by stage, lesion type or treatment outcome. CONCLUSION: Macrophage numbers are decreased in MF after treatment of tumour tissue.

Polylactic acid and polyethylene glycol prevent surgical adhesions.

OBJECTIVES: Re-mediastinoscopy could be risky because of adhesions from the previous mediastinoscopy. The aim of this study was to evaluate the efficacy of a bio-resorbable barrier on adhesion formation in a re-mediastinoscopy rat model. METHODS: Mediastinal dissection similar to mediastinoscopy was done in twenty-eight rats and a polymeric film comprising of polylactic acid and polyethylene glycol (Repel-cv®, SyntheMed Inc., NJ, USA) was placed on trachea in the study groups. Group 1 (sham, sacrificed at day 30), Group 2 (single barrier, sacrificed at day 30), Group 3 (single barrier, sacrificed at day 60), Group 4(double layer barrier, sacrificed at day 60). Mediastinal adhesions, degree of inflammation, vascular proliferation, foreign body reaction and fibroblast proliferation was compared. RESULTS: Macroscopic dissection showed significantly dense adhesions in Sham Group and Group 3 (p < 0.05). Histopathologic examination showed that there was a significant difference between groups when the foreign body reaction and fibroblast proliferation was evaluated (p0.05). CONCLUSIONS: This unique experimental study showed that adhesion barrier was effective as single layer application at day 30 and double layer application at day 60. At clinical conversion, by the application of barrier, the formation of adhesions might be decreased to provide a safe re-mediastinoscopy (Tab. 2, Fig. 4, Ref. 23).

Giant condyloma acuminata of Buschke-Löwenstein: successful treatment with a combination of surgical excision, oral acitretin and topical imiquimod.

Human papillomavirus (HPV) is the most common sexually transmitted disorder in young, sexually active populations in the USA and Europe. Giant condyloma acuminatum (GCA) is a unique variant of condyloma acuminata, characterized by local aggressive behaviour despite benign histology. It carries a substantial risk of squamous cell carcinoma. Various treatments have been used, but response is often poor and recurrence rates high. We present a case of GCA successfully treated with a combination of surgical excision, oral acitretin and topical imiquimod. The diagnosis was based on histological examination, immunohistochemical analysis and in situ hybridization for HPV 6 and 11. We recommend a trial of oral retinoid and topical imiquimod in selected cases of GCA.

Vagus nerve stimulation suppresses generalized seizure activity and seizure-triggered postictal cardiac rhythm changes in rats.

In the present study, we investigated the effects of vagus nerve stimulation (VNS), a proposed treatment for patients with intractable epilepsy, on cardiac rhythm following seizures induced by pentylenetetrazole (PTZ) in Wistar rats. After a baseline recording of electroencephalogram (EEG), electrocardiogram (ECG) and blood pressure (BP), rats in the first group received a single convulsive dose of PTZ (70 mg/kg) (Group 1). In the other two groups, the Wistar rats were implanted with a cuff electrode on the left cervical vagus nerve. One day after surgery, rats in the second group were treated with VNS (Group 2), whereas rats in the third group were connected to the stimulator but did not receive VNS (Group 3). Ten minutes after VNS onset, 70 mg/kg dose of PTZ was injected. EEG, ECG and BP were continuously recorded during post-injection period. Seizure severity was scored behaviorally. Then, baseline, ictal and postictal periods were analyzed for cardiac rhythms, seizure severity and blood pressure variability. PTZ treatment induced tonic-clonic seizure activity in all animals of Group 1 and Group 3. In these groups a marked increase of mean arterial blood pressure (MABP) but a significant decrease in heart rate and PP interval fluctuations was observed at postictal period. However, in the VNS-treated group the seizure scores and cardiac parameter returned to the baseline level. Present results emphasize that VNS effectively reduces seizure severity and suppress the seizure-induced cardiac rhythm changes.

Extremely delayed renal cell carcinoma metastasis mimicking convexity meningioma.

Cerebral extra-axial metastasis mimicking meningioma which satisfy several criteria for a diagnosis of meningioma, but which have proved instead to be metastatic carcinoma and extremely delayed cerebral metastasis from renal cell carcinoma, form the focus of the presentation. 68-year-old-woman who had been operated for renal cell carcinoma 20 years previously is presented with new symptoms of intracranial mass. A large extra-axial mass of the convexity which destroyed calvarium and dura was excised with Simpson Grade I removal, revealed metastatic carcinoma. Imaging characteristics can not always discern between meningioma and metastatic tumours. A meticulous clinical evaluation and histopathological diagnosis is essential in patients with intracranial mass even when they resemble both primary and metastatic tumours.

Rare gallbladder parasitosis mimicking cholelithiasis: Dicrocoelium dendriticum.

Cholelithiasis is increasingly diagnosed in childhood and infancy. Biliary parasites are the rarest cause of cholelithiasis in all age groups. We present a twelve-year-old girl with non-hemolytic gallbladder stone and discuss the clinical features and differential diagnosis of Dicrocoelium dendriticum (DD) invasion that causes and/or mimics cholelithiasis in children.

Pigmented terminal hair cysts within an intradermal melanocytic naevus.

The combination of melanocytic naevi and cysts of adnexal or epithelial origin has been described previously. Herein we describe a case of intradermal melanocytic naevus containing pigmented terminal hair cysts, a rare variant of epithelial cysts. Our observation suggests that pigmented follicular cysts and combined cystic-melanocytic lesions may be attributed to follicular occlusion.

Tourniquet application and epinephrine injection to penile skin: is it safe?

Although a tourniquet is frequently used in penile surgery there is still no consensus on safe application time. The aim of the present study is to investigate the effect of malondialdehyde (MDA) levels and histological changes in skin flaps after penile tourniquet application and epinephrine injection. A total of 36 male white New Zealand rabbits were randomly divided into six groups each containing six animals. A Mathieu-like flap was raised in all of the groups and a tourniquet was applied and the penis was subjected to ischemia for 10, 20 and 40 min in groups 1, 2 and 3, respectively. The flaps were then allowed to reperfuse for 5 min. Biopsies for MDA measurement were harvested in these groups. Subcutaneous 1/200,000 epinephrine was injected into penile skin in group 4 and 5 rabbits and biopsies for MDA measurement were harvested 10 and 40 min after injection. The control group was anesthetized without tourniquet usage or epinephrine injection. Specimens taken from the harvested flaps of all groups were submitted for histological evaluation. The mean MDA levels in all experimental groups were higher than in the control group and the difference was statistically significant. Edema, congestion and extravasation were observed in groups 1, 2 and 3. Minimal congestion and edema were observed in group 4 and severe edema and extravasation in group 5. Tourniquet usage for a duration of less than 10 min is clearly safer than prolonged usage. Epinephrine injection to penile skin may show a deleterious effect on wound healing.

Hepatitis C virus infection prevalence in lichen planus: examination of lesional and normal skin of hepatitis C virus-infected patients with lichen planus for the presence of hepatitis C virus RNA.

Hepatitis C virus (HCV) is the main cause of parenterally transmitted non-A, non-B viral hepatitis. In recent years, a significant association between lichen planus and chronic HCV infection has been reported. Anti-HCV antibody status was evaluated by ELISA in 54 patients with lichen planus and 54 patients with minor dermatological disorders. PCR was used to examine HCV RNA from serum and lesional and nonlesional cutaneous biopsy samples of HCV-infected patients. Seven patients with lichen planus (12.9%) and two patients in the control group (3.7%) were anti-HCV antibody positive. Five out of seven patients with anti-HCV antibodies had demonstrable HCV RNA in lesional skin biopsies. The viral RNA was absent in three out of four patients with lichen planus whose serum samples were positive for HCV RNA and agreed to biopsy of nonlesional skin. The prevalence of HCV infection is not increased in Turkish patients with lichen planus. However our findings suggest that the virus may play a potential pathogenic role by replicating in cutaneous tissue and triggering lichen planus in genetically susceptible HCV-infected patients.

Short-term histopathologic effects of different intracavernosal agents on corpus cavernosum and antifibrotic activity of intracavernosal verapamil: an experimental study.

OBJECTIVES: To evaluate the short-term effects of different intracavernosal agents and to investigate the antifibrotic effect of verapamil combined with these intracavernosal agents. METHODS: Forty-five Sprague-Dawley rats weighing 400 to 500 g each (mean weight 435.27 +/- 13.65 g) were equally divided into nine groups (n = 5). Papaverine (group 1), alprostadil (group 2), sodium nitroprusside (group 3), and verapamil (group 4) were injected alone intracavernously in 0.2-mL doses. Verapamil combined with papaverine, alprostadil, and sodium nitroprusside in 0.2-mL doses (0.1 mL verapamil and 0.1 mL vasoactive agent) were injected in groups 5 through 7. Group 8 was kept as a control group without injection, and isotonic saline alone was injected in group 9 during the same period. The intracavernous injection was done twice weekly with a 4-day interval. At the end of the study, total penectomy and multiple liver biopsies were performed to evaluate the histopathologic effects of the vasoactive agents and to test the liver function. RESULTS: In all groups, the structure of the corpora cavernosa was well preserved generally and appeared similar to the control tissue. However, localized edema, fibrosis, macrophage infiltration, and polymorphonuclear leukocytes were found only at the injection site. Although these findings were not different from the findings in the saline and alprostadil groups, they were slightly more extensive in the papaverine and sodium nitroprusside alone groups and also in the vasoactive agent plus verapamil groups. Although mononuclear lymphocyte infiltration was found in the portal areas, advancing into the liver parenchyma, the liver function tests were within normal limits. CONCLUSIONS: We observed that intracavernous injection, except with nitroprusside, caused focal intracavernosal fibrosis and edema. We believe these effects might not be caused by just the drug, but also by needle trauma, since general fibrosis was not observed in the short term. However, nitroprusside has a severe fibrotic effect on cavernosal tissue in the short term. Moreover, intracavernous verapamil injection could not prevent the fibrosis in the short term.

Study on tear function abnormality in pterygium.

The purpose of this study was to determine whether there is any abnormality in the tear function in patients with pterygium. Eighty-four patients with pterygia (56 with unilateral and 28 with bilateral involvement) and 45 healthy controls were entered in the study. Schirmer's test, breakup time test and mucus fern test were applied to both eyes of the subjects. This was a prospective, comparative and interventional study. Tear function test results between the eyes with pterygium and controls were compared. They were similar in the eyes with or without pterygium. There were no tear function abnormalities in pterygium.

The effect of extracorporeal shock wave treatment (ESWT) on bone defects. An experimental study.

The aim of this study was to investigate the effects of extracorporeal shock wave therapy (ESWT) on the formation of callus in bone defects created in rabbit radii. this study searches for an answer to whether ESWT may have a therapeutic effect on bone defects. A bone defect with a radius of 1 cm was created in both forelimbs of 20 rabbits. At the 7th, 14th, and 21st days ESWT treatment was applied to the forming callus in the right radius under fluoroscopic control. At the 6th and 12th weeks, the animals were sacrificed and callus analysis was performed by computerized scan, dual energy x-ray absorptiometer. Histological analyses were also performed. The results revealed that the average callus area in the right (ESWT applied) radial defect was greater in both groups and statistically significant at the 12th week (p < 0.05). There was no difference in bone density between defects. Histologically the callus area was greater on the right side (ESWT applied side) in both groups. However in the first group trabeculae were occupying less space on the right side. Granulation tissue areas and chondroid areas were greater on the right side. We conclude that ESWT has a disorganizing and dispersing rather than a direct osteoinductive effect on forming callus. This effect may play a therapeutic role in bone defects and in situations like callus lengthening where a greater amount of callus is necessary.

Comparison of the efficacy of glibenclamide and glimepiride in reperfusion-induced arrhythmias in rats.

The effect of glibenclamide and glimepiride, two orally active antidiabetic sulphonylurea derivatives, was investigated on the development of reperfusion-induced arrhythmias and it was compared to their blood glucose lowering action. Arrhythmias were produced by reperfusion following 6 min coronary artery ligation in anaesthetised rats. Glimepiride pretreatment (0.001-0.01-0.1-5.0 mg/kg i.p., 30 min before coronary occlusion) significantly decreased the incidence of irreversible ventricular fibrillation and increased the survival rate during reperfusion (64%, 61%, 60%, and 67% vs. 27% in controls). Glibenclamide produced similar effect (81% survival) only in a dose of 5 mg/kg, while smaller doses were ineffective. The minimal hypoglycaemic dose and the dose required to inhibit significantly the oral glucose loading-induced hyperglycaemia were similar (1 and 0.1 mg/kg, respectively) after glibenclamide and glimepiride. It is concluded that although the blood glucose lowering potency of glibenclamide and glimepiride is rather similar, glimepiride appears to be more potent than glibenclamide in preventing reperfusion-induced cardiac arrhythmias.

Effect of glimepiride and glibenclamide, inhibitors of ATP-dependent K(+)-channel, on ischaemia-reperfusion induced arrhythmias in rats.

Glibenclamide or glimepiride pretreatment (5 mg/kg i.p. 30 min prior to coronary ligation) significantly improved the survival rate during reperfusion after 6 min myocardial ischaemia in rats (82% or 67% vs. 17% in controls). Smaller dose of glibenclamide (0.01 mg/kg) did not influence the survival rate (31%), while glimepiride still offered a significant protection (61%). These results suggest that different KATP inhibitors may increase the chance to survive life-threatening arrhythmias during myocardial ischaemia-reperfusion.

[Mesoblastic nephroma in adults: a clinical case]. / Néphrome mésoblastique de l'adulte: un cas clinique.

Mesoblastic nephroma is the most common renal tumor in infancy but is infrequent in the adult. It has a typical histological pattern but its histogenesis is unknown. We report a case of mesoblastic nephroma in an eighteen year old man who was treated by conservative surgery.