What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts.

OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

Ultrastructural analyses of the novel chimeric hemostatic agent generated via nanotechnology, ABS nanohemostat, at the renal tissue level.

Ankaferd Blood Stopper (ABS), a hemostatic agent of plant origin, has been registered for the prevention of clinical hemorrhages. Currently there is no data regarding the ultrastructural analysis of ABS at the tissue level. The aim of this study is to assess renal tissue effects via scanning electron microscopy (SEM) analyses for the ABS and ABS nanohemostat (formed by the combination of self-assembling peptide amphiphile molecules and ABS). SEM experiments were performed with FEI Nova NanoSEM 230, using the ETD detector at low vacuum mode with 30 keV beam energy. SEM analyses revealed that significant erythroid aggregation are present inside the capillary bed of the renal tissue. However, neither the signs of necrosis nor any other sign of tissue damage are evident in the surrounding renal tissue supplied by the microcapillary vasculature. Our study is important for several reasons. Firstly, in our study we used ABS nanohemostat which was recently developed. This study adds valuable information to the literature regarding ABS nanohemostat. Secondly, this study is the first ultrastructural analysis of ABS that was performed at the tissue level. Thirdly, we disclosed that ABS nanohemostat could induce vital erythroid aggregation at the renal tissue level as detected by SEM. Lastly, we detected that ABS nanohemostat causes no harm to the tissues including necrosis and any other detrimental effects.

Histopathologic Study of Pathergy Test in Behçet's Disease.

BACKGROUND: The pathergy test (PT) is important in the diagnosis of Behçet's disease (BD). However, misinterpretation of the test might cause false-positive or false-negative results. Therefore, immunopathologic and histopathologic tests are recommended with PT. AIMS AND OBJECTIVES: The aim of this study is to determine histopathologic findings of positive pathergy reaction at BD. MATERIALS AND METHODS: This study was performed on 23 patients with BD. All patients were in active period of the disease. After 48 h from the injection, biopsy was performed on positive pathergy lesions. RESULTS: Of the specimen from positive PT lesions of patients with BD, nine revealed mixed type inflammatory cell infiltration (39.1%), two revealed lobular panniculitis without vasculitis (8.7%), two revealed neutrophil rich infiltration (8.7%), and five revealed lymphocyte rich infiltration (21.7%) at the subcutaneous tissue. Mixed type inflammatory cell infiltration (43.4%), endothelial swelling and thickening (17.3%), erythrocyte extravasation (26.0%), perivascular cell infiltration (13.0%), lymphocytic vascular reaction (8.6%), lymphocytic vasculitis (13.0%), and leukocytoclastic vasculitis (21.7%) were detected in dermis by histopathologic examinations. There was no statistically significant difference between histopathologic findings and sex, family history, and systemic involvement except uveitis. CONCLUSION: This is an exceptional study since it is the first study that determines subcutaneous tissue findings of positive pathergy reaction in Behçet patients. In our study, uveitis was found to be statistically significant in the patients who had vasculitis in dermis. It can be a clue for prediction of disease severity and course. Further, studies that include wide number of patients will better illuminate the correlation between subcutaneous tissue findings and disease severity and clinical course.

Generation of Chimeric "ABS Nanohemostat" Complex and Comparing Its Histomorphological In Vivo Effects to the Traditional Ankaferd Hemostat in Controlled Experimental Partial Nephrectomy Model.

Purpose. Using the classical Ankaferd Blood Stopper (ABS) solution to create active hemostasis during partial nephrectomy (PN) may not be so effective due to insufficient contact surface between the ABS hemostatic liquid agent and the bleeding area. In order to broaden the contact surface, we generated a chimeric hemostatic agent, ABS nanohemostat, via combining a self-assembling peptide amphiphile molecule with the traditional Ankaferd hemostat. Materials and Methods. In order to generate ABS nanohemostat, a positively charged Peptide Amphiphile (PA) molecule was synthesized by using solid phase peptide synthesis. For animal experiments, 24 Wistar rats were divided into the following 4 groups: Group 1: control; Group 2: conventional PN with only 0.5 ml Ankaferd hemostat; Group 3: conventional PN with ABS + peptide gel; Group 4: conventional PN with only 0.5 ml peptide solution. Results. Mean warm ischemia times (WITs) were 232.8 ± 56.3, 65.6 ± 11.4, 75.5 ± 17.2, and 58.1 ± 17.6 seconds in Group 1 to Group 4, respectively. Fibrosis was not different among the groups, while inflammation was detected to be significantly different in G3 and G4. Conclusions. ABS nanohemostat has comparable hemostatic efficacy to the traditional Ankaferd hemostat in the partial nephrectomy experimental model. Elucidation of the cellular and tissue effects of this chimeric compound may establish a catalytic spark and open new avenues for novel experimental and clinical studies in the battlefield of hemostasis.

Cutaneous metastases of rectal mucinous adenocarcinoma mimicking granuloma inguinale.

A 46-year-old man complained of ulcerovegetative lesions in the anogenital region, which he had noted one month prior to presentation. The patient had a history of travel to African countries. Therefore, the ulcerovegetative lesions of the patient were suspected to be granuloma inguinale (GI). Calymmatobacterium granulomatis was not observed in the direct examination of scrapings collected from the base of the ulcerovegetative lesion. Instead, a histological examination revealed cutaneous metastasis of mucinous adenocarcinoma of the rectum. Therefore, a diagnosis of GI was eliminated. As the patient did not report his history of rectal cancer and had travelled to African countries, we had primarily focused on the diagnosis of GI.

Comparison of autogenous cartilage, acellular dermis, and solvent-dehydrated pericardium for the prevention and correction of dorsal nasal irregularities: an experimental study.

BACKGROUND: Numerous materials have been used for the correction and prevention of dorsal nasal irregularities. Experimental and clinical studies have been useful but have provided insufficient results for several reasons, including the impossibility of obtaining pathologic specimens from aesthetic patients and imprecise experimental models. In this study, an experimental model for rhinoplasty is used for the comparative evaluation of solvent-dehydrated pericardium, acellular dermal matrix, and autogenous ear cartilage as onlay grafts for the prevention and correction of nasal dorsal irregularities. We used an experimental rabbit rhinoplasty model that has a human nose-like osteocartilaginous junction. Thus, our goal is to get a more realistic idea about the features of these three materials. METHODS: Thirty New Zealand rabbits weighing 2,100-2,550 g were used. The noses of the rabbits were evaluated with computerized tomographic measurements, "pinch" tests were performed for skin properties, and all were photographed before the surgical procedures. They were divided into three groups: Autogenous cartilage grafts were applied after the rhinoplasty operation in group 1, acellular dermal matrixes were used after the rhinoplasty in group 2, and pericardium allografts were used after the rhinoplasty in group 3. The rabbits were followed up for 4 months before they were evaluated by photography, computerized tomography, and "pinch" tests for the skin properties of the nose. Then they were killed for histopathologic evaluation. Adhesion and resorption rates of the onlay grafts were observed and subdermal thickness measurements were made to determine the fate of the grafts as well as their effects on the overlying skin. RESULTS: The major advantages of the allografts used in groups 2 and 3 are the ease of obtaining them without any donor site morbidity, shorter operative procedures, and lower distortion rates due to lack of cartilage memory. The results of this study conform to those of previous reports and demonstrate that the used allografts had no adverse effects such as ulceration or extrusion. The evaluation of the internal nasal valve angles before and after the surgical interventions showed that cartilage grafts created a spreader effect as expected, but acellular dermis and solvent-dehydrated pericardium did not. Despite a moderate graft reaction, pericardium or acellular dermis remained intact. None of the materials caused adhesion to the overlying skin. CONCLUSION: The results of this experimental study showed that acellular dermis (AlloDerm®) or solvent-dehydrated pericardium (Tutogen) may be used successfully as an "onlay" graft for dorsal nasal problems compared to autogenous cartilage, which is commonly used for this purpose. There has been more cartilage resorption than thought. This should be considered when overcorrection is performed. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.

The effect of formoterol on peritoneal VEGF levels in rats with endometriosis.

AIM: The aim of this study is to investigate the effect of formoterol (ß2 adrenergic receptor agonist) on peritoneal VEGF levels in rats with endometriosis. MATERIALS AND METHODS: Experimental endometriosis was constituted with implantation of endometrial tissue. The implants were examined by second laparatomy and rats were divided randomly into four groups. One cc saline was applied ip to the control (C) group (n=8) daily, 22.5µg/kg/day ip formoterol was applied to the second (F) group (n=10) daily, 22.5µg/kg/day ip formoterol and 10mg/kg/day ip propranolol were applied to the third (FP) group (n=10) daily, 45µg/kg/day ip formoterol was applied to the fourth (FF) group (n=9). Before treatment and after 30 days treatment period, peritoneal VEGF levels, the volumes and histopathological properties of the implants were evaluated. RESULTS: There were significant differences in between the peritoneal VEGF levels before and after treatment in group 2(F) and group 4(FF) (p(a): 0.01, 0.01 respectively). But there were no significant changes in between the volumes of implants before and after treatment among the groups (p>0.05). There were no significant differences among the groups in histopathological parameters (p>0.05). CONCLUSION: Formoterol treatment was seen to have no effect on the volumes and histopathological structure of endometriotic implants in our study. On the other hand, based on the group 2(F) and 4's (FF) VEGF levels after the treatment, low dose or high dose formoterol may be effective with long term therapy. Formoterol may reduce the development of endometriosis.

Tissue effects of intracorporeal lithotripsy techniques during percutaneous nephrolithotomy: comparison of pneumatic and ultrasonic lithotripters on rat bladder.

The objectives of this study were to determine the tissue effects of ultrasonic and pneumatic lithotripsy on the rat urothelium. The rats were divided into three groups. Groups I and II consisted of ten rats each that underwent intracorporeal lithotripsy (pneumatic and ultrasonic lithotripsy, respectively). Group III contained ten control rats and no lithotripsy method was used, they served as references for absence of injury. The light microscopy findings were evaluated as follows: squamous metaplasia, papillary projection, inflammation, increased stratification, and stone formation. In five (71.4%) animals of group II, bladders were edematous and hemorrhagic, macroscopically. Histologically, the bladder wall was normal in four rats of group I and in one of group II. There was a significant increase in inflammation (31.5%), squamous metaplasia (85.7%), papillary projection (71.4%), increased stratification (71.4%), and microscopic or macroscopic stone formation (85.7%) in the bladder wall of group II rats in comparison with group I and control group. In the rat model, we noted that ultrasonic devices have a potential risk for tissue injury. In turn, this was associated with a markedly increased deposition of CaOx stones in the kidney. When confronted with harder stones, pneumatic lithotripsy can be more effective while also minimizing tissue injury.

Ectomesenchymal chondromyxoid tumor of the anterior tongue: a rare case.

Ectomesenchymal chondromyxoid tumor is a rare tumor seen in the anterior dorsal aspect of the tongue. Diagnosis of this lesion without a prediagnosis clinically is made only with histopathological findings including the immunohistochemical examinations. However, diverse results are being reported in the literature with keratin staining. While glial fibrillary acid protein positiveness maintain being a fixed repeating feature, we emphasized for our case of a 28-year-old Caucasian woman having the findings of qualities supporting the ectomesenchymal origin of the mentioned tumor.

NaOH-induced Crohn's colitis in rats: a novel experimental model.

AIM: Several models of experimental ulcerative colitis have been previously reported. To date, only one model of Crohn's colitis that was induced by trinitrobenzene sulfonic acid has been described. MATERIALS AND METHODS: Twenty-one male albino rats were divided into three groups: group I: sham control group (n = 7), group II: acetic acid group (n = 7), group III: NaOH group (n = 7). On the day of induction, all rats were lightly anesthetized with intramuscular ketamine (8 mg/kg). A 6F plastic catheter was inserted rectally until the tip was 5 cm proximal to the anus. Then, 2 ml of 0.9% saline, 2 ml of 4% acetic acid, and 2 ml of 6.25% NaOH was administered to groups I, II, and III, respectively. All rats were sacrificed 5 days after colitis induction. The distal colon segment was assessed macroscopically and microscopically. In addition, malondialdehyde (MDA) and nitric oxide (NO) levels of the colonic tissue and changes in body weight were measured. RESULTS: Macroscopic and microscopic examinations of colonic tissue samples showed morphological similarities to human Crohn's disease (CD). The MDA and NO levels of the colonic tissues were significantly higher in the NaOH group compared to the acetic acid and sham control groups (P = 0.001). CONCLUSION: NaOH may be used to induce Crohn's colitis as an experimental model.

Biphasic effects of ankaferd blood stopper on renal tubular apoptosis in the rat partial nephrectomy model representing distinct levels of hemorrhage.

OBJECTIVE: To investigate the effect of Ankaferd Blood Stopper (ABS), on renal tubular apoptosis and on expressions of endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS), and apoptosis protease-activating factor-1 (Apaf-1) in the ipsilateral kidney after an experimentally formed partial nephrectomy in a rat model. METHODS: The study was performed in 2009 at the Ankara Training and Research Hospital, Animal Laboratory Center, Ankara, Turkey. We divided 24 Wistar rats into the following 4 groups. Group I (GI) - partial nephrectomy (PN) with hilar control as the conventional technique, Group II (GII)-the conventional technique with ABS, Group III (GIII) - received ABS application to the renal parenchyma and collecting duct with hilar control (non-sutured group). Group IV (GIV) - PN and ABS were performed without hilar control. The ABS solution (1 cc) was applied during the surgery to stop bleeding from resected renal tissue. At first month, all rats were sacrificed. Renal tubular apoptosis was investigated. RESULTS: The mean percentage of apoptotic cell counts in GI were 20% iNOS, 20% eNOS, and 10% Apaf-1. In GII they were 10% iNOS, 20% eNOS, 5% Apaf-1, in GIII they were 40% iNOS, 50% eNOS, 30% Apaf-1, and in GIV they were 5% iNOS, 5% eNOS, and 3% Apaf-1. There was no significant decrease in apoptotic cells in GII, GIII, and GIV, to which we applied ABS. The highest percentage of apoptosis was shown in GIII accompanied by significant inflammation. The lowest percentage was determined in GIV, the non-warm ischemia group. The ABS has a dual biphasic de novo effects on apoptosis. CONCLUSION: The challenge of severe hemorrhage in the renal tubular cellular micro-environment causes ABS-induced down-regulations in the expressions of apoptotic molecules, indicating that ABS may act as a topical biological response modifier.

Preventive effects of propofol and ketamine on renal injury in unilateral ureteral obstruction.

PURPOSE: The aim of the present study was to investigate the preventive effects of propofol and ketamine as anesthetics on renal injury in unilateral ureteral obstruction (UO). METHODS: Twenty-four male New Zealand white rabbits were randomly assigned to four groups of six rabbits each. Anesthesia was induced and maintained with propofol in groups 1 and 2 and with ketamine in groups 3 and 4. Groups 2 and 4 received complete left ureteral ligation. Groups 1 and 3 (control groups) underwent an identical surgical procedure without ureteral ligation. At 14 days of obstruction, animals were sacrificed and ipsilateral kidneys were removed for determination of tissue nitric oxide (NO) levels and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and apoptosis protease-activating factor 1 (APAF-1). RESULTS: Between groups 1 and 3, there were no differences in tissue NO levels and eNOS, iNOS, and APAF-1 expressions. iNOS and APAF-1 expressions were at the mild to moderate levels in group 2, but these parameters were markedly increased in group 4 at 14 days of obstruction. Also, elevated expression of iNOS was accompanied by a high NO production in group 4 compared with group 2. Although eNOS expressions were increased in both groups 2 and 4, there were no significant differences between these groups. CONCLUSIONS: Propofol as an anesthetic agent may attenuate NO-induced renal tubular cell apoptosis by downregulating the expression of iNOS in an animal model of unilateral UO.

Differential diagnosis of basal cell carcinoma and benign tumors of cutaneous appendages originating from hair follicles by using CD34.

BACKGROUND AND AIMS: Differential diagnosis of the group of benign trichoblastomas, trichofolliculomas, trichoadenomas and trichoepitheliomas, and basal cell carcinomas (BCCs) is troublesome for the clinician as well as the pathologist, especially when only small biopsy specimens are available. Here we investigated whether CD34 expression might be of assistance. METHODS: Thirty benign tumors of cutaneous appendages originating from hair follicles (BTCOHF) and 30 BCCs were retrieved from our archives and immunohistochemically stained. CD 34 expression was graded from [0] to [2+] and compared among the groups and subgroups. RESULTS: There was no significant difference between the degree of expression between [0] and [1+] and [0] and [2+] for each group. However, [1+] and [2+] immunopositivity of BTCOHFs was significantly stronger than in BCCs (p= 0.014). CONCLUSIONS: CD34 may contribute to differential diagnosis of skin lesions.

CD10 for the distinct differential diagnosis of basal cell carcinoma and benign tumours of cutaneous appendages originating from hair follicle.

AIMS: Differential diagnosis between the group of trichoadenoma, trichofolliculoma, trichoepithelioma, trichoblastoma and basal cell carcinoma has been creating some difficulties for the pathologist and the clinicians, particularly in the presence of small specimens. MATERIAL AND METHODS: A total of 30 cases of benign tumours of cutaneous appendages originating from the hair follicle and 30 cases of basal cell carcinoma were retrieved from the archives deposited from 2004 to 2008. RESULTS: The expression of CD10 in both tumours was graded from [0] to [2+] for each case. The immunoreactivity of CD10 was comparatively examined among the groups and each subgroup. The stromal CD10 immunopositivity of benign tumours of cutaneous appendages originating from the hair follicle was stronger than the other (p = 0.003) regarding both the numerical and the degree of expression. However, peripheral CD10 of basal cell carcinoma was stronger than the other for [1+] immunopositivity (p = 0.03). It was exact opposite for [2+] (p = 0.013). Besides, central CD10 immunopositivity and CD10 reactivity for the subgroups was not significant. CONCLUSIONS: CD10 may be very useful for the differential diagnosis between them particularly in the small and superficial biopsies and it may be even a life-saving method in some selected cases.

An in vitro study comparing the coagulation and cautery effects of bipolar and unipolar cutting modalities on prostatic tissue.

INTRODUCTION: We aimed to compare plasmakinetic prostate resection (PKRP), plasmakinetic prostate vaporization (PKVP) and transurethral prostate resection (TURP) procedures according to cautery artifacts in tissue specimens and to compare the coagulation depths of these procedures. MATERIALS AND METHODS: The prostate specimens of 10 patients that underwent open transvesical prostatectomy were used. TURP, PKVP and PKRP procedures were performed immediately. Artifactual pathological patterns that were identified in the specimens included: abnormal cellular orientation and spindling, artifactual cellular detachment from the underlying basement membrane, atypical cytological changes and stromal coagulative artifacts. The severity of cautery artifact was graded as absent, mild, moderate or severe according to the sum of points in each specimen. RESULTS: When the groups were compared according to moderate and severe artifacts, it was observed that PKRP caused more moderate artifacts and TURP caused more severe artifacts than the other two groups (p < 0.05). The depth of the tissue affected by coagulation was 1.52 +/- 1.29 mm with the TURP procedure. There were significant differences between TURP and the other two methods (p < 0.05). CONCLUSIONS: Three transurethral procedures cause cautery artifacts of varying grades. The application of TURP seems to cause more severe artifacts and PKRP and PKVP procedures seem to result in a deeper coagulation zone in the residual prostatic tissue.

Do scattered white spots in the duodenum mark a specific gastrointestinal pathology?

OBJECTIVE: To discover whether scattered white spots (SWS) in the duodenum are related to a specific kind of disease. We also scrutinized other upper endoscopic findings which might be associated with SWS. METHODS: Among the patients who were admitted for upper gastrointestinal system endoscopy, those having the endoscopic appearance of SWS in duodenum were enrolled in this study. In total 107 patients [70 women, 37 men, mean age: 51.6 +/- 16.88 years (range: 17-82 years)] were included. At least three duodenal biopsies were taken from each patient and histopathological examinations were done by experienced pathologists. RESULTS: The histopathological examination revealed that 39 (36.4%) patients had intestinal lymphangiectasia (IL), 15 (14%) patients had giardiasis (G) and 30 (28.1%) patients had chronic non-specific duodenitis (CD). Two patients with IL were also found to have G. Twenty patients had both IL and CD. One had both G and CD. G was the least common etiology for SWS in the duodenum. The most common reasons for SWS in the duodenum in this study group were IL and CD, in order of decreasing frequency. There was no significant relationship with the other upper endoscopic findings in all these patients. CONCLUSION: Histopathological examinations should be provided for each patient with SWS in the duodenum to assess the etiology.