Preventative effect of diclofenac sodium and/or diltiazem in rats with epidural fibrosis.

OBJECTIVE: Spinal epidural fibrosis is commonly seen after laminectomy. There is not yet proven any agent preventing fibrosis in clinical usage. We used diclofenac sodium and diltiazem, which are fibrosis inhibitors. METHODS AND MATERIALS: 40 rats were divided into four groups of equal numbers: control, diclofenac sodium, diltiazem, and diclofenac sodium + diltiazem. Laminectomies were performed at L5 and L6. After a 4 week period, the rats were decapitated and the vertebral column blocks were removed for histopathologic examination. Fibrosis percentage, spread of fibrous regions, and fibroblast numbers were evaluated in each group and compared between the groups. RESULTS: The distribution of epidural fibrosis density, percentage of fibrosis, and distribution of fibroblasts in the diclofenac sodium + diltiazem group were significantly lower than in the other groups. The fibroblast numbers of the diltiazem, and diclofenac sodium + diltiazem groups were significantly lower than in the other groups. CONCLUSION: Diclofenac sodium + diltiazem used together provided better outcomes because each of them prevented fibrosis via different ways, probably through synergistic action (Tab. 5, Fig. 3, Ref. 43).

Rosette-forming glioneuronal tumour of the fourth ventricle: case report and review of the literature.

Rosette-forming glioneuronal tumour (RGNT) of the fourth ventricle is one of the newly described primary tumours of the central nervous system. These tumours have two components of both neurocytic and glial areas but usually the glial component of the tumour predominates. They have biphasic cytoarchitecture with two elements; neurocytic rosettes resembling Homer-Wright rosettes, and astrocytic component resembling a pilocytic astrocytoma. They are low-grade tumours with lack of histopathological signs of malignancy. Here, clinical, magnetic resonance, computed tomography (CT) and pathological features of rosette-forming glioneuronal tumour of posterior fossa are presented. A 29-year-man was admitted with an acute neurological deterioration. A three ventricular hydrocephalus and a hypo-density around vermis in the posterior fossa were seen in his CT scans. He did well after an emergency external ventricular drainage. He had an elective operation and a mass that was reported to be a rosette-forming glioneuronal tumour of the fourth ventricle was excised.

Obturator mononeuropathy due to adenocarcinoma of unknown primary origin.

A 35-year-old woman presented with a three-month history of left groin and thigh pain. Neurological examination and electromyography showed pathological features consistent with obturator nerve involvement. Imaging studies revealed a left retroperitoneal mass, which by pathological examination was shown to be metastatic adenocarcinoma of possible Mullerian origin. Primary tumor could not be detected in a follow-up period of three years. Obturator mononeuropathy can be the first manifestation of cancer. Cancer of unknown primary origin may occasionally be local, well-restricted and carry a good prognosis.

Evaluation of colorectal adenocarcinomas at single-institution with respect to microsatellite instability.

BACKGROUND AND AIM: Hereditary non-poliposis colorectal cancers exhibit a high rate of microsatellite instability. Comparative studies involving stage and other prognostic parameters demonstrate a better prognosis in the presence of microsatellite instability versus colon cancers without microsatellite instability. METHODS: Our study included 608 cases diagnosed with colorectal adenocarcinoma by our laboratory between 2004-2010. The cases were re-evaluated with respect to criteria defined for MSI, taking into consideration age, anatomic localization, and histopathological criteria. Immunohistochemical study was performed in appropriate blocks for using MLH-1, MSH-2, MSH-6, and PMS-2. RESULTS: The specimens were re-evaluated according to the histological criteria defined for microsatellite instability. Anti-MLH-1, anti-MSH-2, anti-MSH-6, and anti-PMS-2 antibodies were applied to the paraffin blocks of 27 cases which presented morphological criteria suggestive of DNA repair mutation and had a high Mspath score. Immunohistochemical study with MLH-1, MSH-2, MSH-6, and PMS-2 for the analysis of mismatch repair was refined using the cases with higher Mspath scores. CONCLUSIONS: In this study, we reviewed the clinical and histopathological features of 608 cases with colorectal adenocarcinoma diagnosed in our laboratory between 2004-2010 and assessed pathological features in terms of microsatellite instability. The results were discussed in view of the literature.

Lymphovascular invasion, as a prognostic marker in patients with invasive breast cancer.

PURPOSE: The markers of prognosis are used to predict the clinical course of disease and the outcome for patients with invasive breast cancer. Our aim is to investigate the relationship of peritumoural lymphovascular invasion (LVI) with well-known prognostic markers. PATIENTS AND METHODS: Eighty-one surgically treated patients with invasive breast cancer were evaluated in this study during a mean follow-up period of 46 months (12-72). The patient's age (menopausal status), tumour size, nuclear grade, axillary lymph node involvement, and hormone receptor status were determined as markers of the prognosis. The relationship of LVI with these markers was established. RESULTS: Except for menopausal status (p = 0.25) a close relationship was found between the presence of LVI and studied prognostic factors. LVI was positive in 29% of T1, 54% of T2 (p = 0.028) and 100% of T3 tumours (p = 0.002). The rate of LVI (+) has increased gradually as 0%, 38% and 77% (p = 0.001) with grades 1, 2 and 3 respectively. Positive LVI has been determined in 85% (p < 0.0001) and 73% (p = 0.0004) of oestrogen and progesterone receptor negative tumours respectively. LVI was present in 14% and 73% (p < 0.0001) of patients with negative and positive axilla respectively. Metastatic cancer caused mortality in seven patients of whom 86% had more than four involved axillary nodes, and 100% LVI (+). CONCLUSION: The high rate of positive LVI shows a close relationship with known markers of poor prognosis. The presence of LVI can predict a worse outcome for patients with invasive breast cancer. LVI may be used as an indicator of aggressive behaviour, metastatic ability (nodal and systemic) of the primary malignancy.

Spinal epidural extraskeletal Ewing sarcoma.

A rare case of extraskeletal Ewing sarcoma, arising primarily in the spinal epidural space is reported. An 18-year-old male presented with a 2-month history of right shoulder pain progressing to complete paraplegia and urinary retention over the course of 2 days. Magnetic resonance imaging demonstrated an extradural mass extending from the C6 to T1 level. Histopathologic examination confirmed the diagnosis. The literature is reviewed and radiological differential diagnosis of this rare neoplasm is briefly discussed.

Multiple brain metastases from malignant thymoma.

A rare case of thymic carcinoma with multiple brain metastasis is reported. In our extensive review of the literature only six of 30 reports of intracranial thymoma metastasis describe multiple metastases. A 38-year-old man presented with signs of raised intracranial pressure that had began 15 days previously. Cranial MRI revealed over 70 cystic lesions in the supra and infratentorial regions. Stereotactic biopsy was planned. On the second day of his admission he deteriorated and died the following day. The autopsy revealed a mass in the mediastinum. In the brain parenchyma were multiple cystic lesions between 0.5 and 3 cm in diameter. Histopathologically they were diagnosed as metastases from the thymic carcinoma. The mean survival with a single brain metastasis is approximately 256 days, whereas with multiple brain metastases it is only 64 days, thus treatment of this tumor demands prompt surgery whenever possible and optimal adjuvant therapy.

Hyaline-vascular type Castleman's disease of the pararenal retroperitoneum: multidetector CT findings.

We describe the case of a 40-year-old woman who presented with a pararenal hyaline-vascular type Castleman's disease that had an arterial supply from the renal artery and a draining vein as showed by multidetector CT. Identification of the renal artery relationship to the feeding vessel of the mass is critical to prevent potential surgical complications.

Estrogen and progesterone expression of vessel walls with intravascular leiomyomatosis; discussion of histogenesis.

We report seven cases of intravenous leiomyomatosis. Growth beyond the uterus occurred in two of the seven cases in the broad ligament. One 21-year-old patient is one of the youngest reported cases in the literature. Five patients had total abdominal hysterectomy with removal of the adnexa and two patients underwent myomectomy. One of the myomectomy cases had abdominal hysterectomy and bilateral salpingo-oophorectomy one year later due to recurrence. The other one was disease free six months after the operation. Vessel walls harboring intravascular tumor were investigated immunohistochemically for Factor VIII, CD 34, estrogen and progesterone receptors with the hope of making the histogenesis of intravenous leiomyomatosis clear. Immunohistochemical analyses of estrogen receptors, progesterone receptors, vimentin, desmin, smooth muscle actin, CD 10 and h-caldesmon were performed on intravascular tumor cells. Endothelial and subendothelial cells expressed none to scant, very weak progesterone and estrogen receptor positivity. Intravascular tumor cells showed weak (10%) to strong (70%) progesterone receptor positivity and weak (10%) to strong (60%) estrogen receptor positivity. These results do not support the hypothesis of a vessel wall origin for intravenous leiomyomatosis.

Microscopic endometrioid carcinoma arising in endosalpingeal endometriosis.

We present a case of microscopic adenocarcinoma arising in the right fallopian tube, which was incidentally found in 74-year-old woman undergoing total abdominal hysterectomy with salpingo-oophorectomy for uterine myoma, hematometra and bilateral hydrosalpinx. A small focus of endometrioid adenocarcinoma confined within the endosalpingeal mucosa of the right fallopian tube associated with endometriosis was fortuitously found during histological examination. Our case seems to be unique since it shows an evident filiation between the lesions of tubal endometriosis and an adjoining focus of microscopic carcinoma. This is the second case report of a microscopic endometrioid carcinoma associated with endosalpingeal endometriosis.

Intra-suprasellar meningioma mimicking pituitary apoplexy.

The clinical and radiological features of an intra-suprasellar meningioma diagnosed as a pituitary macro-adenoma are presented. It is emphasized that this unusual tumour can mimic pituitary apoplexy. Differential diagnosis and surgical treatment of intrasellar meningioma versus pituitary adenoma are discussed with a review of the literature.

Unusual metastasis of renal cell carcinoma to the nasal cavity.

Metastasis of renal cell carcinoma (RCC) to the nose and paranasal sinuses is very rare. We present two cases of RCC metastatic to the nose who were treated with palliative radiotherapy. Although the prognosis was poor for both of the patients, the main symptoms (epistaxis and unilateral airway obstruction) were successfully palliated with irradiation.

HSP 60 expression in mucocutaneous lesions of Behçet's disease.

BACKGROUND: Heat shock protein (60 kd HSP) has been implicated in the etiology of Behçet's disease, but its expression at sites of inflammation is unknown. OBJECTIVE: Our aim was to investigate local HSP 60 expression and to quantify T-cell receptor (TCR) gamma delta-positive cells, which are known to respond to HSP peptides. METHODS: Patients with active Behçet's disease (n = 21) and controls (n = 18) were included. Flow cytometric analysis was performed on peripheral blood to investigate TCR gamma delta-positive cell counts. Biopsies were performed on active skin lesions, and immunohistochemical analysis was performed by a streptavidin-biotin method using the monoclonal ML-30 antibody; HSP staining intensity and distribution were evaluated in a blinded fashion. Immunohistochemical studies were performed to quantify TCR gamma delta-positive cells at lesional sites. RESULTS: Mucocutaneous lesions of patients with Behçet's disease had statistically significantly increased expression of HSP 60/65. Peripheral blood TCR gamma delta-positive cell counts were similar in both groups. However, lesional skin of patients with Behçet's disease had significantly increased gamma delta-positive T-cell counts. CONCLUSION: Up-regulation of HSP expression was found at lesional skin sites in Behçet's disease. The increased number of TCR gamma delta-positive cells, which are known to respond to HSP peptides, may support the function of HSPs in the etiology of Behçet's disease. However, these findings may also be an epiphenomenon that needs to be further investigated.

Blocking the buccal nerve using two methods of inferior alveolar block injection.

The anatomic relations of the buccal nerve branch of the mandibular division of the trigeminal nerve were studied to explain the rationale for the discrepancy in blocking the buccal nerve using two methods of blocking the inferior alveolar nerve, the conventional method and the Gow-Gates method. The conventional method rarely blocks the buccal nerve, while the Gow-Gates method is reported to consistently block the buccal nerve. Eight head and mandibular specimens were dissected to observe the path of buccal nerve and its relationship to the path of needles in the conventional and Gow-Gates techniques. The buccal nerve descends on the medial and then anterior aspect of the deep head of the temporalis muscle (Tdh). At the latter position the buccal nerve enters the retromolar fossa and is encased in a fascial sleeve created by a dense fascial band that spans between the temporalis muscle tendons and the buccinator muscle. At the level of the conventional block injection the buccal nerve was shielded from the path of the needle by the Tdh and the fascial band. In the Gow-Gates block injection, the buccal nerve was exposed on the medial surface of the Tdh, immediately lateral to the path of the needle and proximal to the fascial sleeve. Consequently, the anatomical relations of the buccal nerve in the conventional block method essentially shield the nerve from being bathed by anesthetic solution while in the Gow-Gates method the relations are such that the buccal nerve can be exposed to anesthetic solution and thus blocked, explaining the findings in clinical dentistry.

Chordoid meningioma: a clinicopathologic study of 42 cases.

The term chordoid meningiomas was first used by Kepes et al. in 1987 to describe a meningeal tumor in young patients associated with microcytic anemia and/of dysgammaglobulinemia. Such tumors were composed of spindle or epithelioid cells disposed in chordoma-like clusters and cords in a myxoid matrix and often featured a prominent lymphoplasmacellular infiltrate. Our study includes 42 chordoid meningiomas that represented 0.5% of all meningiomas operated at Mayo Clinic during the interval 1975 to 1997. The male to female ratio was 1:1 and the age range was 12 to 77 years (mean, 47.4 yrs). Only two (5.2%) occurred in children. The majority (88%) were large and supratentorial. No manifestation of systemic disease was noted. Chordoid elements comprised 10% to 100% of the tumors: 34 (81%) were more than 50% chordoid. Thirty-seven tumors (88%) were classified as typical and five as atypical. Lymphoplasmacytic infiltrates varied, being moderate in 10 cases (23.8%), mild in 15 (35.7%), and absent in 17 (40.5%). In 14 (42%) of the 33 cases with available follow up, one or more recurrences were noted. All but one recurrent tumor had been subtotally resected. In 86% of recurrent tumors, the primary lesion was more than 50% chordoid in pattern and contained little or no inflammatory infiltrate. In our experience, chordoid meningiomas are primarily tumors of adults, lack sex predilection, are unassociated with systemic manifestations, and uniformly recur when subtotally excised.

The viscoelastic properties of the human temporomandibular joint disc.

PURPOSE: This study evaluated the viscoelasticity of the human temporomandibular joint (TMJ) disc by comparing the moduli of elasticity generated by compressing disc specimens under two different loading rates. MATERIALS AND METHODS: Twelve TMJ disc specimens 4.25 mm +/- 0.15 mm in diameter were obtained from fresh cadavers between 65 and 75 years of age. One group of specimens was subjected to a loading rate of 0.00127 mm/sec, and the other was subjected to a loading rate of 0.000635 mm/sec. Modulus of elasticity was calculated from the stress and strain values obtained from each specimen. RESULTS: When the specimens were subjected to an average 0.00127 mm/sec loading rate, a mean modulus of elasticity of 0.541 N/mm2 was derived. When an average 0.000635 mm/sec loading rate was used, a mean modulus of elasticity value of 0.211 N/mm2 was derived. These two mean values were significantly different, as indicated by the results of a one-tailed t-test. CONCLUSIONS: Analysis of the data showed that the human TMJ disc specimens became stiffer as the loading rate increased.

Hepatitis B surface antigen in tears and aqueous humor. A comparative study of serum hepatitis B surface antigen levels.

Tear samples of 20 patients who were determined to have positive hepatitis B surface antigen (HBsAg) after an acute hepatitis B infection and aqueous humor samples of 10 patients who were HBsAg carriers were tested for HBsAg, and the results obtained for serum and these fluids were compared. In 85% of the 20 patients who were HBsAg positive, HBsAg was found to be positive in tear samples. In 50% of the other 10 patients in aqueous humor was also found to be HBsAg positive. Our findings show that tears and aqueous humor are important in the spreading of hepatitis B infections.

Hepatitis C virus antibodies among risk groups in Turkey.

In order to determine the prevalence of hepatitis C virus (HCV) infection in the Black Sea region in Turkey, 287 serum samples taken from risk groups were investigated for anti-HCV antibodies using HCV EIA system. Anti-HCV antibodies were found to be positive in 51.2% of chronic haemodialysis patients, 20.6% of probable acute non-A, non-B hepatitis patients, 4% of patients who had multiple blood transfusions, 1.5% of the health personnel, while in new haemodialysis patients anti-HCV antibodies were not found.