The effects of intrauterine device on cervico-vaginal smears with liquid-based cytology technique: A North-Eastern Anatolia region study in Turkey.

Intrauterine device (IUD), is one of the most efficient methods of contraception. The aim of study to investigate the effects of intrauterine device in cervicovaginal smears with liquid based cytology technique in our patient population. Cervicovaginal smears of 5492 patients who sought the services of the pathology department in a sixmonth period were reviewed retrospectively. Samples were prepared with liquid based cytology technique. The patients using IUD as contraceptive method (n= 562 cases) were included in the study. The samples taken with the conventional method were excluded from the study. The results were categorized according to the Bethesda system. The age range of the patients was 18-61 years (mean age: 34.6). The most common diagnosis was "negative for intraepithelial lesion or malignancy" (97.2%). In 307 patients (54.6%) there were infection and only in 93 out of them (30.2%) a specific agent was detected. Actinomyces (11%) were recorded as the most common infectious agent, followed by Gardnerella vaginalis (2.8%) and Candida species (2.4%). There were reactive changes in 134 cases (23.8%). In 13 cases (2.3%) epithelial cell abnormalities were detected. The most common cytopathologic diagnosis was ASC-US (atypical squamous cells of undetermined significance) in patients who had epithelial cell abnormalities (2.1%). In conclusion, IUDs increase the frequency of genital infection by disrupting the genital flora. In our study the most frequent agent was Actinomyces, and this rate was higher than some studies. This high rate for Actinomyces may be associated with IUDs that are frequently used for contraception in Erzurum province with long term uses.

Anti-TNF agent etanercept augments UV-induced skin cancer development in SKH-1 mice.

BACKGROUND: Despite being employed in the treatment of inflammatory disorders for more than 20 years all over the world, data regarding photocarcinogenic risks of anti-TNF agents is scarce. OBJECTIVE: To assess photocarcinogenic potential of anti-TNF agents. METHODS: This was a placebo controlled, split-body (UVB-treated versus -untreated) study on mice. Treatment groups were infliximab (n = 11), etanercept (n = 11), cyclosporine (n = 11) and vehicle control (n = 11). Agents were introduced on the 10th week of phototherapy and continued through 24th week. The macroscopic, histological and immunohistochemical analysis of test sites were carried out. RESULTS: Overall 132 tumors were detected on test sites. All of these tumors developed on UV-exposed sides. Histologic examination of these tumors was compatible with keratinocytic neoplasia in 128, mastocytosis in 3, epidermal cyst in 1. Median tumor burden in the UVB exposed areas for ETN, IFX, CYC, and control groups were 14.91, 10.20, 6.28, and 3.14 cm2, respectively. ETN group demonstrated both higher tumor burden and keratinocytic neoplasia numbers than controls (p = .03, p = .025). Although there were 1.8 and 1.7 times more keratinocytic neoplasms in IFX and CYC groups compared to controls, these differences didn't reach statistically significant levels (p = .14; p = .19). CONCLUSION: This study points out to a significant photocarcinogenic potential of anti-TNF agent etanercept.

Neurogenic Stress Cardiomyopathy Following Subarachnoid Hemorrhage Is Associated with Vagal Complex Degeneration: First Experimental Study.

BACKGROUND: Neurogenic stunned myocardium (NSM) is a devastating complication of subarachnoid hemorrhage (SAH). The most widely accepted mechanism in the pathogenesis of NSM and takotsubo cardiomyopathy is catecholamine-mediated direct myocardial injury. The aim of this study is to examine if there is any effect of sympathetic overactivity of the stellate ganglions on myocardial tissues, secondary to vagal complex degeneration in SAH-induced NSM. MATERIALS AND METHODS: This study was conducted on 25 New Zealand female rabbits. After the examination, all animals were assigned into 3 groups randomly: a control group (n = 5), a sham group (n = 5), and a study group (n = 15) that was subjected to experimental SAH with double injection of blood into the cisterna magna. After 7 animals exhibited NSM, all animals were killed. Their brains, vagal complexes, stellate ganglions, and hearts were extracted and examined by histopathologic methods. Degenerated nodose ganglion neurons and stellate ganglion neuron densities were compared with degenerated myocardial tissue/normal myocardial tissue ratios, and the results were analyzed with the Mann-Whitney U test. RESULTS: Three rabbits in the study group died immediately after the second injection of blood. NSM developed in 7 animals after 1 to 5 days, which was diagnosed with transthoracic echocardiography. Interestingly, the animals that developed NSM had more stellate ganglia neurons and more degenerated neuron densities of nodose ganglia (P < 0.001). CONCLUSIONS: NSM and takotsubo cardiomyopathy may be induced by vagal complex degeneration and sympathetic overactivity, which originated from more neurons, including stellate ganglia and more degenerated neuron densities of nodose ganglia.

A case of atypically located leiomyoma mimicking axillary lymphadenomegaly.

Cevizci MN, Fettah A, Kabalar ME. A case of atypically located leiomyoma mimicking axillary lymphadenomegaly. Turk J Pediatr 2018; 60: 319-321. Leiomyomas are benign smooth muscle tumors rarely seen in children and may occur anywhere in the body containing smooth muscle. Here, we report a case of a 4-year-old girl presenting with swelling in the left axillary region and with pain during arm movements. The solid mass in the axillary region was totally excised. The patient was discharged without complications on the same day.

How Reliable Is Pupillary Evaluation Following Subarachnoid Hemorrhage? Effect of Oculomotor Nerve Degeneration Secondary to Posterior Communicating Artery Vasospasm: First Experimental Study.

BACKGROUND AND STUDY AIM: Basic neurophysiologic principles of the light reflex are well known. However, the effects of degenerated axon densities of oculomotor nerves (OMNs) secondary to posterior communicating artery (PComA) vasospasm following subarachnoid hemorrhage (SAH) have not been investigated. Our aim was to study this subject. METHODS: This study was conducted on 19 rabbits. There was a control group of five animals, a sham group of five animals in which saline was injected into the cisterna magna and a study group of nine animals in which homologous blood was injected into the cisterna magna. Pupillary diameters were measured for 1 week, then the animals were decapitated. The normal and degenerated axon densities of the OMNs were examined by stereological methods. Vasospasm indexes (VSIs) of posterior communicating arteries (PComAs) supplying OMNs were estimated and analyzed statistically. RESULTS: The pupillary diameter was 5.439 ± 368 µm, and the mean axon density of the OMNs was 0.924 ± 324/mm3 in the control group. The pupillary diameter and degenerated axon density of the OMNs in animals of the sham group were 6.980 ± 0.370 µm and 36 ± 8/mm3, respectively. The pupillary diameter was 9.942 ± 653 µm, and degenerated axon density of the OMNs was 265 ± 57/mm3 in animals with SAH. The mean VSI values of PComAs were 0.927 ± 0.224 in the control group, 1.542 ± 0.257 in the sham group, and 2.321 ± 0.324 in the SAH group. CONCLUSION: We found a linear relationship between the axon density of the OMNs and pupillary diameters. High degenerated neuron density in the OMNs may be responsible for an unresponsive pupillary that has not been mentioned in the literature.

Might Trauma Be a Triggering Factor for Craniofacial Fibrous Dysplasia?

Fibrous dysplasia (FD) is a rare, benign disease of unclear etiology where normal bone is replaced with abnormal fibrous and weak osseous tissue. Any bone of the skeleton might be involved but skull is one of the most commonly affected sites. Fibrous dysplasia is known to be caused by a genetic mutation leading to inappropriate proliferation and differentiation of osteoblastic cells. However; it is not known whether any triggering factor exists which might contribute to this genetic mutation. The authors postulated that trauma might be a triggering factor for this disease. Trauma, as a triggering factor, has not been reported to be clearly linked to FD in the literature so far. Through this perspective; the authors report a patient of fronto-orbital fibrous dysplasia developing 6 years after a fronto-orbital skull fracture, at the same localization of the fracture line.

The impact of L5 dorsal root ganglion degeneration and Adamkiewicz artery vasospasm on descending colon dilatation following spinal subarachnoid hemorrhage: An experimental study; first report.

CONTEXT: Somato-sensitive innervation of bowels are maintained by lower segments of spinal cord and the blood supply of the lower spinal cord is heavily dependent on Adamkiewicz artery. Although bowel problems are sometimes seen in subarachnoid hemorrhage neither Adamkiewicz artery spasm nor spinal cord ischemia has not been elucidated as a cause of bowel dilatation so far. AIMS: The goal of this study was to study the effects Adamkiewicz artery (AKA) vasospasm in lumbar subarachnoid hemorrhage (SAH) on bowel dilatation severity. SETTINGS AND DESIGN: An experimental rabbit study. MATERIALS AND METHODS: The study was conducted on 25 rabbits, which were randomly divided into three groups: Spinal SAH (N = 13), serum saline (SS) (SS; N = 7) and control (N = 5) groups. Experimental spinal SAH was performed. After 21 days, volume values of descending parts of large bowels and degenerated neuron density of L5DRG were analyzed. STATISTICAL ANALYSIS USED: Statistical analysis was performed using the PASW Statistics 18.0 for Windows (SPSS Inc., Chicago, Illinois). Two-tailed t-test and Mann-Whitney U-tests were used. The statistical significance was set at P < 0.05. RESULTS: The mean volume of imaginary descending colons was estimated as 93 ± 12 cm(3) in the control group and 121 ± 26 cm(3) in the SS group and 176 ± 49 cm(3) in SAH group. Volume augmentations of the descending colons and degenerated neuron density L5DRG were significantly different between the SAH and other two groups (P < 0.05). CONCLUSION: An inverse relationship between the living neuronal density of the L5DRG and the volume of imaginary descending colon values was occurred. Our findings will aid in the planning of future experimental studies and determining the clinical relevance on such studies.

Evaluation of 37,438 consecutive cervical smear results in the Turkish population.

INTRODUCTION: Retrospective evaluation of cervical smear results of women who attended our gynecology policlinics with various symptoms and discussion of the results in the light of the literature. MATERIAL AND METHODS: We performed a retrospective investigation on 37,438 Pap smear results of women who attended our hospital between January 2011 and December 2012 with a variety of symptoms. RESULTS: Average patient age was 43 (18-83) years. Of the Pap smear results analyzed, in 21,503 (57.4%) findings were within normal limits, while 153 (0.41%) showed epithelial cell abnormalities and 15,358 (41%) showed inflammation. Four hundred and twenty-four (1.1%) cases were reported to have inadequate Pap smear samples for evaluation. Of the epithelial cell abnormalities, 136 (88.8%) were squamous cell abnormalities and 17 (11.1%) were glandular cell abnormalities. Atypical squamous cells of unknown significance (ASCUS) were reported for 117 (0.3%) Pap smears, while other epithelial abnormalities included atypical glandular cells of unknown significance (AGUS) in 17 (0.05%) cases, low-grade squamous intraepithelial lesion (LSIL) in 8 (0.02%) cases, atypical squamous cells with possible high grade lesion (ASC-H) in 8 (0.02%) cases and high-grade squamous intraepithelial lesion (HSIL) in 3 (0.008%) cases. CONCLUSIONS: Public awareness should be raised on the importance of Pap smear testing repeated at appropriate intervals in the prevention and early diagnosis of cervical cancer. Health education should become more widespread, and the importance of screening programs and regular check-ups should be emphasized more often on this issue in the media.

Surgical treatment of a case with rapidly growing mass lesion after trauma: on the left forearm arteriovenous malformation.

In this case, we report a vascular malformation with high flow pattern complicated with trauma. A postoperative histopathology examination confirmed an arterio-venous malformation in specimens of surgical excision material. In our opinion, posttraumatic progression of a vascular malformation is an emergency and requires an urgent evaluation with surgery at any localization of the body.

Genetic alterations in benign, preneoplastic and malignant breast lesions.

CONTEXT: The c-erbB-2 proto-oncogene is a member of the epidermal growth factor receptor family and has been associated with a more aggressive breast tumor biology and resistance to some types of treatments. AIMS: The aim is to investigate the correlation among bcl-2 and c-erbB-2 and the micronucleus (MN) formation in patients with early breast cancer (BC). MATERIALS AND METHODS: This study was conducted between May 2010 and December 2011. We analyzed the MN frequencies in 15 patients with invasive breast carcinoma (IBC), 13 patients with intraductal proliferative lesion (IDPL) and 12 benign breast lesion (BBL). The sample consisted of 40 formalin-fixed, paraffin-embedded blocks of benign and malignant breast tissue. The specimens were evaluated for bcl-2 or c-erbB-2 immunoreactivity was semi-quantitatively evaluated in at least 1000 cells examined under the microscope at 40Χ magnification and recorded as the percentage of c-erbB-2 and bcl-2 positive tumor cells over the total number of cells examined in the same area. The percentage scores were subsequently categorized using the 5% cut-off point for positive staining. RESULTS: The MN was significantly increased in IBC and in IDPL patients compared to BBL patients (3.82 ± 0.17 and 2.37 ± 0.52, respectively, vs. 1.61 ± 0.40, P < 0.001). On other hand, the MN frequencies in IBC patients were higher than those in IDPL patients (3.82 ± 0.17 vs. 2.37 ± 0.52, P < 0.01). c-erbB-2, had the highest record in IBC (60%), and the score was not observed in both IDPL and BBL: bcl-2 immunostaining was also assessed, the lowest recorded score was in IBC (46.66%) and the highest in both BBL and IDPL (100%). Furthermore, there was a significantly difference in the mean MN frequency between c-erbB-2 positive IBC patients (4.06 ± 0.48) and c-erbB-2 negative IBC patients (3.44 ± 0.39) (P < 0.05). CONCLUSIONS: Our results suggest that increased chromosome / DNA instabilities may be associated with the pathogenesis of early BC.

Genomic instability in patients with Barrett's esophagus.

Our study aimed to determine, by counting sister chromatid exchange (SCE) and micronucleus (MN) frequencies, whether genetic impairment and DNA damage have an effect on the pathogenesis of Barrett's esophagus (BE). This study was conducted between June 2007 and November 2008 in the Erzurum Training and Research Hospital. We analyzed SCE and MN frequencies in 30 patients with BE, and in 30 control cases. SCE was significantly increased in BE patients compared with controls (6.89 +/- 1.04 vs. 5.01+/- 0.88, P < 0.001). Similarly, MN was significantly increased in BE patients compared with controls (3.48 +/- 1.08 vs. 1.83 +/- 0.64, P < 0.001). Our data indicate that the increased SCE and MN rates in lymphocytes of patients with BE may reflect genomic instability or deficiency of DNA repair capacity.

Micronucleus analysis in patients with colorectal adenocarcinoma and colorectal polyps.

AIM: To determine, by counting micronucleus (MN) frequencies, whether chromosomal or DNA damage have an effect on the pathogenesis of early colorectal adenocarcinoma (CRC). METHODS: We analyzed MN frequencies in 21 patients with CRC, 24 patients with colon polyps [10 neoplastic polyps (NP) and 14 non-neoplastic polyps (NNP)] and 20 normal controls. RESULTS: MN frequency was significantly increased in CRC patients and in NP patients compared with controls (3.72 +/- 1.34, 3.58 +/- 1.21 vs 1.97 +/- 0.81, P < 0.001). However, there was no difference in the MN frequency between CRC patients and NP patients (P > 0.05). Similarly, there was no difference in the MN frequency between NNP patients (2.06 +/- 0.85) and controls (P > 0.05). CONCLUSION: Our results suggest increased chromosome/DNA instabilities may be associated with the pathogenesis of early CRC.

Intraperitoneal dedifferentiated liposarcoma: a case report.

Dedifferentiated liposarcoma is a variant of liposarcoma with a more aggressive course. Mutations of the p53 gene have been found in different types of soft tissue sarcoma. It is generally accepted that p53 mutations in human malignant tumors are often related to a poor prognosis. In our case, analysis of p53 gene mutation in tumor samples was performed. p53 gene mutation was observed in dedifferentiated tumor tissue samples but not in well-differentiated tumor tissue samples. It has been reported that p53 gene mutation occurs most commonly in the retroperitoneum and rarely in other anatomic locations. Herein we report a case of dedifferentiated liposarcoma located at intraperitoneum.

Alteration of sister chromatid exchange frequencies in gastric cancer and chronic atrophic gastritis patients with and without H. pylori infection.

AIM: To determine, by counting sister chromatid exchange (SCE) frequencies, whether genetic impairment and DNA damage have an effect on the pathogenesis of gastric cancer (GC). METHODS: Analysis of SCE is a cytogenetic technique used to show DNA damage as a result of an exchange of DNA fragments between sister chromatids. We analyzed SCE frequency in 24 patients with GC, 26 patients with chronic atrophic gastritis (CAG), and 15 normal controls. The presence of H. pylori was confirmed by urease test, toluidine-blue stain and hematoxylin-eosin stain. RESULTS: SCE was significantly increased in H. pylori-negative GC patients, and in H. pylori-negative CAG patients compared with controls (7.41 +/- 1.36 and 6.92 +/- 1.20, respectively, vs 5.54 +/- 0.8, P < 0.001). There was no difference in the SCE frequency between H. pylori-negative GC patients and H. pylori-negative CAG patients (P > 0.05). On other hand, the SCE frequencies in H. pylori-positive GC patients were higher than those in H. pylori-positive CAG patients (9.20 +/- 0.94 vs 7.93 +/- 0.81, P < 0.01). Furthermore, H. pylori-positive GC patients had a higher SCE frequency than H. pylori-negative GC patients (9.20 +/- 0.94 vs 7.41 +/- 1.36, P < 0.001). Similarly, a significant difference was detected between H. pylori-positive CAG patients and H. pylori-negative CAG patients (7.93 +/- 0.81 vs 6.92 +/- 1.20, P < 0.05). CONCLUSION: We suggest the increased SCE in patients reflects a genomic instability that may be operative in gastric carcinogenesis.