The effect of external beam irradiation timing on skin graft survival.

BACKGROUND: The purpose of this study was to evaluate skin graft integrity after external beam irradiation in a rat model. METHODS: Forty-eight male Wistar rats were randomly assigned to 8 groups (A, B, C, D, A(c), B(c), C(c) and D(c)). A rectangular full-thickness skin graft was raised and reapplied to its original bed on the dorsum of each rat. Groups A(c), B(c), C(c) and D(c) were the control groups and were not given postoperative irradiation. After grafting, 25 Gy unfractioned cobalt(60) irradiation was administered to groups A, B, C and D on postoperative days 10, 20, 30 and 40, respectively. Histological samples were obtained 8 weeks after grafting. Dermal and epidermal thickness were measured by the KS-400 image analysis program. RESULTS: The difference in the epidermal and/or dermal thickness between the irradiated groups was not found to be significant. Furthermore, when histological features and the image analysis of the irradiated groups were compared with each other, there were no significant differences between the groups. CONCLUSIONS: Although we are aware that experimental results may not directly translate to the clinical setting, the present study indicates that external radiotherapy can be performed to skin-grafted areas as early as 10 days postoperatively.

Evaluation of posttransplantation malignancies compared with de novo tumors.

It is uncertain whether tumors arising in transplant patients resemble ones that develop de novo in pathogenesis, morphology, and behavior. This study sought to investigate some clinical, morphological, and immunohistochemical features of several posttransplantation malignancies compared with similar de novo tumors. The study group consisted of 40 malignant tumors encountered in 1350 transplant patients (1229 kidneys, 113 livers, 8 hearts) between 1986 and 2006. Tumors with 3 or more examples were compared with randomly selected controls. These included Kaposi's sarcoma (n=14); extranodal lymphoma (n=9); squamous cell carcinoma (n=6); and nodal lymphoma (n=3). The variables that were analyzed were the localization, predisposing lesions, degree of differentiation, and host response. For lymphomas, we also determined histological subtype, origin, and Ki-67 proliferation index. Most tumors (36/40, 90%) occurred in patients with renal transplants. However, the relative frequency was higher among liver transplant cases (3.53% vs 2.92% for kidney transplants). No malignancy was seen in heart transplant cases. Squamous cell carcinomas were better differentiated (P<.05) compared with controls and they were more frequently associated with precursor lesions (P<.05). Kaposi's sarcomas involved internal organs more frequently in posttransplant patients, and the Ki-67 proliferation index was higher in posttransplantation nodal lymphomas. However, these factors were not significantly different (P>.05). Our findings suggested that certain posttransplantation malignancies display unique characteristics compared with their de novo counterparts.

Ki-67 proliferation index in Kaposi's sarcoma after renal transplantation: findings in skin-only cases versus cases with internal-organ involvement.

Kaposi's sarcoma (KS) is an angioproliferative condition that accounts for 6% of all malignancies in organ transplant patients. When we review the literature, the results of the studies comparing the different stages and the proliferative activity of the tumor are challenging. However, we found no previous study on Ki-67 protein expression in KS that correlates skin and organ lesions. In the current study, we investigated whether there is a correlation on the proliferative activity between skin and internal organ lesions in KS. Proliferative activity of 13 biopsy specimens of KS was assessed immunohistochemically using the monoclonal antibody MIB-1 (Ki-67). Mann-Whitney U test is used for statistical analysis and a P value < .05 was considered significant. Seven of 13 cases were skin and six were internal organ KS. For skin lesions, the mean MIB-1 proliferation index was 14.5%, and it was 13% for organ lesions. There was no significant association between skin and internal organ KS in regard to MIB-1 PI (P > .05). The findings suggested that the proliferative activity in KS does not differ in skin and organ lesions. On the other hand, it should be considered that the number of cases in our study was limited and further studies with a larger series are needed.

DNA ploidy and nuclear morphometry in adult intracranial ependymomas.

The identification of prognostic parameters in ependymomas remains an important but controversial issue in particular to the significance of histopathological features. Intracranial location is a rare presentation for adult ependymomas. DNA ploidy status and nuclear morphometric features of ependymomas are not well-established. We retrospectively studied the clinicopathologic features of 12 adult intracranial ependymomas and performed image cytometric DNA analysis with nuclear morphometry. The overall survival rate was 75%. Two cases were anaplastic ependymomas. Statistically, histology failed to demonstrate a correlation with clinical outcome or overall survival. DNA ploidy (p = 0.033), DNA index (p = 0.016) and 5c exceeding rate (p = 0.017) were statistically correlated with clinical outcome, but not correlated with overall survival. Nuclear morphometric features measured using 3 different data selection methods were not correlated with clinical outcome or overall survival. It is difficult to identify prognostic factors in a series of cases with limited number. The problem is complicated by the fact that the common criteria used for recognizing malignancy in gliomas are not completely reliable in ependymomas. Nuclear morphometric findings support the general impression that ependymomas are morphologically highly variable tumors. In spite of the small sample size of our series and other factors influencing survival such as the extent of resection and malignant histology, aneuploidy can be suggested as a promising factor, which may reflect potential aggressiveness of the tumor in adult intracranial ependymomas.

Changes in urethral connective tissue after estrogen replacement therapy in ovariectomized rats.

OBJECTIVE: Genuine stress urinary incontinence is a common problem after the middle age. Various treatment modalities have been tried as a treatment for this entity and estrogens are one of the most common alternatives. Their effects on the urethral mucosa have been described in many studies, while the impact on the urethral connective tissue has been evaluated only in a few reports. In this study, we aimed to investigate the effect of estrogen on urethral connective tissue in ovariectomized rats. MATERIAL AND METHODS: Thirty-six Wistar rats (4 months old, 250-300 g weight) were included in the study. They were organized as group 1 (ovariectomized, n = 10), group 2 (ovariectomized + late estrogen treatment, n = 10), group 3 (ovariectomized + early estrogen treatment, n = 10) and group 4 (sham operated, n = 6). Rats in group 1 were killed 6 weeks after the ovariectomy. Group 2 was ovariectomized 6 weeks before treatment and then received estradiol for 6 weeks. Group 3 was treated with estradiol for 6 weeks immediately after the ovariectomy. After killing the rats, urethral tissues were removed. Quantitative analysis of collagen fiber content was done by computerized image analyzer system in specimens stained with Masson's trichrome technique. RESULTS: Percentages of collagen fiber content (mean +/- standard error of mean) were 58.4 +/- 5.9% in group 1; 53.3 +/- 4.8% in group 2; 46.3 +/- 3.4% in group 3 and 40.2 +/- 3.2% in group 4. There was not any significant difference among the groups (p > 0.05). CONCLUSIONS: Our results suggest that early and late estrogen replacements do not seem to have a discriminating effect on the urethral connective tissue. Further studies are needed to assess the preventive effect of estrogen on urethra.

Presence of endocervical cells and number of slides in cervicovaginal smears: differences in performance between gynecologists.

OBJECTIVE: To study the association of precancerous cervical lesions with the presence of endocervical cells on Pap smears; and to evaluate gynecologists' approaches to the information on smear reports regarding endocervical cell status. STUDY DESIGN: Pap smear reports on 1,637 samples sent by 12 gynecologists were analyzed. The presence of endocervical cells, number of glass slides used per patient, and frequency and distribution of "atypia" and of pathogenetic microorganisms were recorded. Gynecologists' performances were compared, and their reactions to the reported lack of endocervical cells in their smears were evaluated. RESULTS: Atypia was detected significantly more frequently in samples with endocervical cells (1 in 664 versus 31 in 973, P < .01). Likelihood of detecting a pathogenetic microorganism, however, was not affected by the presence or absence of endocervical cells. In samples from certain gynecologists, endocervical cells were present most of the time, and in others they were generally lacking. This pattern did not change over time; specifically, the performance of the latter group of gynecologists did not improve in spite of their receiving information on the absence of endocervical cells in their samples. CONCLUSION: The performance of the "smear taker" is an important component of Pap smear screening practice. Efforts to increase the quality of service should cover not only laboratories but also gynecologists and others who take smears. Screening can only be successful as a system in the presence of good samples.

The effect of estrogen-replacement therapy on clitoral-cavernosal tissue in oophorectomized rats: a histo-quantitative study by image analyzer.

Sexual dysfunction is an important problem for aging females. However, little attention has been paid to female sexual dysfunction. The clitoris is an important organ for physiological sexual function in females. There is a close relationship between the presence of sexual complaints and levels of estrogen. Using the rat as an experimental model, we evaluated the effect of estrogen-replacement therapy and its timing on clitoral-cavernosal collogen fiber content after oophorectomy. Four-month-old female Wistar rats (n = 36) weighing 230-250 g were used. They were categorized into four groups: oophorectomized (Group 1: n = 10); oophorectomized delayed estrogen replacement (group 2: n = 10); oophorectomized + immediate estrogen replacement (group 3: n = 10); and sham operated (group 4: n = 6). The estrogen replacement used was 17-beta-estradiol. All rats were euthanized at the same age. The specimens were stained with Masson's trichome technique, and computerized image analysis was used to quantify the collagen-fiber content of clitoral-cavernous tissue. The clitoral collagen-fiber percentages in the different groups were as follows: group 1: 64.17 +/- 5.01%; group 2: 62.57 +/- 5.37%; group 3: 56.33 +/- 3.85%; group 4: 51.48 +/- 6.37%, respectively. Although there was a tendency in the untreated group for a higher collagen-fiber content, no statistically significant difference was found among groups (P > 0.05). Although the results of this study were not statistically significant, estrogen did appear to decrease clitoral-cavernosal collagen-fiber content. These findings may be important in the pathophysiology of postmenopausal female sexual dysfunction.

Intra-hospital use of a telepathology system.

Utilization of telepathology systems to cover distant geographical areas has increased recently. However, the potential usefulness of similar systems for closer distances does not seem to be widely appreciated. In this study, we present data on the use of a simple telepathology system connecting the pathology department and the intra-operative consultation room within the operating theaters of the hospital. Ninety-eight frozen section cases from a past period have been re-evaluated using a real-time setup. Forty-eight of the cases have been re-evaluated in the customary fashion; allowing both ends to communicate and cooperate freely. Fifty of the cases, however, were evaluated by the consultant while the operating room end behaved like a robot; moving the stage of the microscope, changing and focusing the objectives. The deferral rate was lower than the original frozen section evaluations. Overall, the sensitivity was 100%, specificity 98%, negative predictive value 96, 5% and positive predictive value 100%. No significant difference was found for the diagnostic performances between the cooperative and robotic simulation methods.Our results strengthen the belief that telepathology is a valuable tool in offering pathology services to remote areas. The far side of a hospital building can also be a remote area and a low cost system can be helpful for intraoperative consultations. Educational value of such a system is also commendable.

Primary non-Hodgkin's lymphoma of the liver (case report).

Primary non-Hodgkin's lymphoma of the liver is very uncommon, and fewer than 100 cases have been reported in the literature. Most reports describe either solitary or multiple mass lesions in the liver. A diffuse lesion without nodule formation is a relatively rare form of the disease. The histologic feature of the disease is a predominantly large cell lymphoma of B-cell lineage. We report a case of primary B-cell non-Hodgkin's lymphoma which had diffusely infiltrated the liver without nodule formation.

Radiology of an atypical fibro-osseous lesion confined to the nasal cavity.

Fibro-osseous lesions of the sinonasal region are relatively frequent, but those strictly confined to the nasal cavity are rare. We report an atypical fibro-osseous lesion in the nasal cavity and describe its radiological features. The differential diagnosis is discussed.

Estrogen and progesterone receptors in the peripheral giant cell granulomas of the oral cavity.

Peripheral giant cell granulomas are common proliferative lesions of the oral cavity with a predilection for females. In this study, the presence of estrogen and progesterone receptors in 26 peripheral giant cell granuloma cases were studied utilizing the immunoperoxidase technique. In fourteen cases, estrogen receptor positivity was found in stromal cells. In ten of these, osteoclast-type giant cells also exhibited estrogen receptor immunostaining. Progesterone receptor expression was not detected. It was concluded that the cells forming peripheral giant cell granuloma are potential targets for estrogens and that these lesions might be conditioned by sex hormones.

Intrasellar gangliocytoma resembling pituitary adenoma.

Cushing's disease resulting from intrasellar gangliocytomas is very rare and only three cases have been reported to date. All of the cases were female. We present a fourth case of Cushing's disease resulting from intrasellar gangliocytoma. Computed tomography and magnetic resonance imaging scans showed a pituitary macrotumor with suprasellar extension. A greenish-gray colored homogenous tumor was subtotally removed by a transcranial approach. Histological diagnosis was gangliocytoma. To the best of our knowledge, this is the first reported instance of a tumor causing Cushing's disease in a man in the absence of a pituitary adenoma component.

Isolate abdominal bronchogenic cyst: a case report.

Isolated abdominal bronchogenic cysts are rare abnormalities. They are usually asymptomatic unless secondarily infected or large enough to cause compression of other vital structures. The authors report on a 20-month-old girl who had an abdominal bronchogenic cyst and presented with a history of recurrent urinary tract infections. The evaluation and treatment of this patient is presented as well as a review of the ten previously reported cases. A literature review showed only four cases in the pediatric age group. Excision is recommended to establish diagnosis and alleviate any symptoms. Abdominal bronchogenic cysts should be considered in the differential diagnosis of retroperitoneal masses.

Examination of periodontal tissues by a cutting-grinding technique.

The decalcification process removes the mineralized part of the dental hard tissues, making the histologic examination of enamel-associated tissues less than optimal. The cutting-grinding technique allows preparation of histologic slides with well preserved dental hard tissues together with their surrounding soft tissue components. In this paper, the histologic appearances of undecalcified teeth and their associated periodontal tissues prepared using the cutting-grinding technique are described.

Gingival Langerhans' cells in type I diabetes mellitus.

Langerhans' cells (LCs) are intraepithelial immunocompetent cells. Changes in the number of LCs occur in inflammatory and autoimmune diseases. In this study, the number of gingival LCs in patients with type I diabetes mellitus was compared with those of normal individuals using immunohistochemical methods. Gingival biopsies were obtained from 20 type I diabetics and 10 healthy individuals. Anti-CD1 positive LCs formed an intraepithelial network and showed a marked increase in type I diabetics. This increase was not related to diabetic age. The number of LCs was proportional to the density of subepithelial inflammatory cells. Our findings suggest that LCs may play a role in the development of diabetic gingivitis.

Epidermolysis bullosa associated with pyloric, esophageal, and anal atresia: a case report.

The association of epidermolysis bullosa (EB) and pyloric atresia (PA) in newborns is rare but has been well described. It has been reported that in patients with EB, the esophageal, gastric, intestinal, and colonic mucosae are affected. The authors report a case of EB and PA associated with esophageal and anal atresia in a newborn. To our knowledge, these associations had not been reported in the English-language literature.

Secondary oxalosis of bone in a dialysis patient.

Secondary oxalosis of bone is a complication of chronic renal failure. Its frequency and the mechanism of the deposition is unknown. We report the case of chronic renal failure patient on hemodialysis with deposition of oxalate in bone. Possible mechanisms and the significance of the depositions is also discussed.

Prenatal diagnosis of autosomal recessive osteopetrosis, infantile type, by X-ray evaluation.

Prenatal diagnosis for infantile osteopetrosis was attempted during the third pregnancy of a first-cousin marriage whose family history revealed an affected previous child. At the 25th week of pregnancy, fetal X-ray evaluation revealed marked sclerosis of osteopetrotic bone and metaphyseal splaying and clubbing of both femurs. The pregnancy was terminated and repeated X-rays and histopathological examination of fetal bone (femur) confirmed the diagnosis.