Radiotherapy result of a case of Kaposi's sarcoma located on the vocal cord.

Kaposi's sarcoma (KS) is an angiogenic tumor. KS lesions frequently develop in the skin and oral cavity mucosa in the head and neck regions, and pure laryngeal localization is extremely rare. We reported a 64-year-old male patient without HIV, HBV, and HCV positivity presented with a hemangiomatous lesion detected incidentally in the right vocal cord. Biopsy was taken for histopathological and immunohistochemical evaluation. Examination revealed that spindle cells were of vascular origin and expressed HHV-8, a specific marker associated with Kaposi's sarcoma-associated herpesvirus. Positron emission tomography-computed tomography (PET/CT) demonstrated an increased fluorodeoxyglucose (FDG) uptake in the vocal cord. The patient was treated with a 30 Gy volumetric arc plan. Disease-free follow-up continues in the first year after low-dose definitive RT. This is the first case report of KS in the vocal cord in which the most detailed data about RT were shared.

Histopathological and ultra-structural investigation of the damaging effects of hypoinsulinemia, hyper glycaemia and oxidative stress caused by parenteral nutrition combined with fasting on the small intestine of rabbits.

BACKGROUND AND STUDY AIMS: Parenteral nutrition (PN) is a life-saving practice when the use of the gastrointestinal tract is not appropriate. Despite its great benefits, however, PN may cause several complications. In this study, we conducted histopathological and ultra-structural examinations of the effect of PN combined with starvation on the small intestines of rabbits. MATERIALS AND METHODS: Rabbits were divided into four groups. A fasting + PN group was left completely unfed and received all its daily required energy by PN through an intravenous central catheter. An oral feeding + PN group received half the necessary daily calories by oral feeding and the other half through PN. A semi-starvation group received only half the necessary daily calories by oral feeding and no PN. The fourth group, serving as a control, was supplied with its entire daily energy requirements through oral feeding. After 10 days, the rabbits were euthanized. Blood and small intestine tissue samples were collected from all groups. Blood samples were biochemically analysed, and tissue samples were examined by light and transmission electron microscopy. RESULTS: The fasting + PN group exhibited lower insulin levels, higher glucose levels, and increased systemic oxidative stress than the other groups. Ultra-structural and histopathological examinations revealed a significant increase in apoptotic activity in this group's small intestines and a significant decrease in villus length and crypt depth. Severe damage to the intracellular organelles and nuclei of enterocytes was also observed. CONCLUSION: PN combined with starvation appears to cause apoptosis in the small intestine due to oxidative stress and hyperglycaemia with hypoinsulinemia, with destructive effects on small intestine tissue. Adding enteral nutrition to PN may reduce these destructive effects.

A Rare Sinonasal Malignancy: Biphenotypic Sinonasal Sarcoma.

Biphenotypic sinonasal sarcoma (BSNS), which has been described in the recent years, is a low-grade spindle cell sinonasal sarcoma characterized by rare neural and myogenic features. It has a slow growth pattern; does not metastasize, but local recurrences are common after surgery. Non-specificity of examination findings and symptoms and similarities of its histopathological features with other spindle cell sarcomas, neural tumors, and skeletal muscle-derived tumors involving the nasal cavity make the diagnosis difficult. Therefore, histopathological features should be evaluated together with immunophenotyping and molecular studies for differential diagnosis. There are very few BSNS cases or case series in the literature. In this report, we reported our clinical approach to a case with BSNS in the right nasal cavity and the histopathological features of the disease in the light of the current literature.

Glial Cell Line-Derived Neurotrophic Factor, S-100 Protein and Synaptophysin Expression in Biliary Atresia Gallbladder Tissue.

PURPOSE: Biliary atresia (BA) is a disease that manifests as jaundice after birth and leads to progressive destruction of the ductal system in the liver. The aim of this study was to investigate histopathological changes and immunohistochemically examine the expression of glial cell line-derived neurotrophic factor (GDNF), synaptophysin, and S-100 protein in the gallbladder of BA patients. METHODS: The study included a BA group of 29 patients and a control group of 41 children with cholecystectomy. Gallbladder tissue removed during surgery was obtained and examined immunohistochemically and histopathologically. Tissue samples of both groups were immunohistochemically assessed in terms of GDNF, S-100 protein, and synaptophysin expression. Expression was classified as present or absent. Inflammatory activity assessment with hematoxylin and eosin staining and fibrosis assessment with Masson's trichrome staining were performed for tissue sample sections of both groups. RESULTS: Ganglion cells were not present in gallbladder tissue samples of the BA group. Immunohistochemically, GDNF, synaptophysin, and S-100 expression was not detected in the BA group. Histopathological examination revealed more frequent fibrosis and slightly higher inflammatory activity in the BA than in the control group. CONCLUSION: We speculate that GDNF expression will no longer continue in this region, when the damage caused by inflammation of the extrahepatic bile ducts reaches a critical threshold. The study's findings may represent a missing link in the chain of events forming the etiology of BA and may be helpful in its diagnosis.

Cause of an acute abdomen never seen: Intraabdominal perforation of an umbilical pilonidal sinus abscess.

Pilonidal sinus is a well-known disease of the sacrococcygeal region, which is caused by hair shafts penetrating the epidermis. The granulomatous reaction is the characteristic of this chronic inflammatory disease. Umbilical pilonidal sinus is an acquired disease that may appear in many guises and mimic several umbilical conditions. Several risk factors for developing the disease have been described. Treatment is based on clinical experience rather than on evidence-based medicine. The umbilical pilonidal sinus, which is not treated medically or surgically, may cause regional or generalized infections. We suggest that our case which has never had symptoms before and has caused acute abdomen, will be considered in the diagnosis of acute abdomen.

Impaction of the polylactic membrane or hydrofiber with silver dressings on the interleukin-6, tumor necrosis factor-α, transforming growth factor-b3 levels in the blood and tissues of pediatric patients with burns.

BACKGROUND: We aimed to evaluate the effects of two different burn dressings, hydrofiber with a silver (HFAg) and polylactic membrane (PLM), on altering the levels of important biomarkers Interleukin-6 (IL-6), Tumor necrosis factor-α (TNF-α), Transforming growth factor-ß3 (TGF-ß3) in blood and burnt tissue in children with second-degree burns. METHODS: Children between the ages of one to 16 years, with 25-50% second-degree partial-thickness burns of the total body surface area were included in this study. Patients in the PLM group were dressed with PLM in a typical way according to the manual. The HFAg group was dressed with HFAg and a sterile cover. During and at the end of the 21-day treatment, blood and skin tissue samples were taken from the two burn and control groups. IL-6, TNF-α, and TGF-ß ß3 levels were evaluated in blood and tissue samples from all groups, and the results were analyzed statistically. RESULTS: In the PLM group, IL-6 and TNF-α levels decreased early days in both serum and tissue samples to reach normal ranges compared with the HFAg group. In the PLM group, TGF-ß3 levels were elevated than in other groups for two weeks. CONCLUSION: In this study, we found that PLM controls inflammation earlier in both systemic and burn tissue. We also found that PLM increased the level of TGF-ß3, which may be associated with the prevention of the development of hypertrophic scar in the burn wound, in the blood and burn tissue during this study.

Investigation of the cardiotoxic effects of parenteral nutrition in rabbits.

INTRODUCTION: Parenteral nutrition (PN) is used for the intravenous delivery of nutrients to patients who cannot take food orally. However, it is not clear whether PN also negatively impacts cardiac tissue. The present empirical study investigated the cardiac effects of PN in rabbits. METHODS: The effects of PN were examined in three groups of rabbits: animals in the PN + fasting group (n = 14) had been fully fasted before receiving a full PN dose via an intravenous central catheter; the PN + oral feeding group (n = 14) received half of the daily calorie requirement as a half dose of PN via an intravenous central catheter; the third group consisted of controls (n = 14) with full enteral feeding and full enteral fluid intake with no PN and no central venous catheter. At the end of the 10-day study period, the rabbits were subjected to echocardiographic examination and euthanized. Blood and tissue samples were obtained from all groups. DNA was isolated from nucleated blood cells. Tissue samples were examined by both light and electron microscopy, relative telomere length was determined from DNA, and blood samples were analyzed biochemically. RESULTS: At the end of the study, there were no statistically significant differences in weight change between the three groups. Echocardiography revealed minimally impaired diastolic function in the PN + fasting group compared to the other groups. Biochemical and histopathological analyses, relative telomere length determination, and electron micrographs showed significant cardiac damage in the PN + fasting group but not in the PN + oral feeding group or the control group. The blood biochemical analyses showed hyperglycemia and a low insulin level in the PN + fasting group but not in the other two groups. CONCLUSIONS: A combination of PN and fasting may damage the cardiac muscle cells of rabbits via a mechanism involving hyperglycemia and oxidative stress. Additional enteral feeding may protect against the destructive effects of PN on cardiac tissue.

The Effects of Different Burn Dressings on Length of Telomere and Expression of Telomerase in Children With Thermal Burns.

BACKGROUND: Burns are a common traumatic injury triggered by local tissue damage and a systemic response. In this study, we evaluated the effects of different burn dressings on telomere kinetics in children with thermal burn injury. METHODS: Sixty children with thermal burn were included in this prospective study. The burn area of the patients included 20 to 50% total body surface area. Three different dressings (hydrofiber with silver [HFAg], poylactic membrane [PLM], and silver sulfadiazine [SSD]) and control groups were created. Telomere length in nucleated blood cells and telomerase expression in the skin tissue were evaluated in control and burn groups. RESULTS: In the whole burn groups, telomere length in blood cells increased. The length of telomeres increased the most in the SSD group. The PLM group is the treatment that increases the number of squamous cell counts in the basal layer and telomerase expression in the skin. In HFAg and SSD groups, the expression of telomerase in the skin is decreased. In the HFAg group, the basal layer in the skin was also reduced in squamous cells. CONCLUSION: In all burn groups, the telomere length of nucleated cells in the blood was higher than in the control group. SSD dressing along with autografting is the treatment method that maximizes telomere length in blood cells. The PLM has the most increased telomerase expression in the skin of burned patients. The PLM application increases the number of cells on both burned and normal skin.

Immunohistochemical and morphologic findings in columnar cell lesions of the breast.

BACKGROUND: Columnar cell lesions (CCLs) with or without atypia frequently coexist with invasive or in situ breast carcinomas. In this study, 39 mastectomy specimens containing CCLs coexisting with invasive carcinomas were retrospectively analyzed for cellular characteristics and structural pattern of CCL neighboring the tumor. MATERIALS AND METHODS: The expression of estrogen receptor (ER), progesterone receptor (PR), and p53 antibodies in CCL and coexisting invasive tumors, type of invasive tumor, histopathologic grade, and presence of atypia in CCL have been studied. RESULTS: Sixteen (41%) of all CCLs were with atypia, whereas 23 (59%) of them were without atypia. No correlations were found between the presence of CCLs with atypia and either the morphologic type of carcinoma or histopathologic grade of the tumors. Presence of atypia in the CCL was not correlated with the expression of p53 in the invasive tumors. CCLs without atypia dominated in Grade III tumors. The percentages of CCLs without atypia were also higher in both ER (-) and PR (-) tumors. CONCLUSIONS: CCL with atypia is generally considered to be a precursor of invasive carcinoma; however, in our study, CCLs without atypia more frequently coexisted with breast carcinoma.

Induction of apoptosis of rabbit corneal endothelial cells by preservative-free lidocaine hydrochloride 2%, ropivacaine 1%, or levobupivacaine 0.75%.

PURPOSE: To determine and compare the amount of apoptosis and changes in rabbit corneal endothelial cell morphology after intracameral administration of different anesthetic agents. SETTING: Department of Ophthalmology, Baskent University Medical Faculty, Ankara, Turkey. METHODS: Right eyes of 64 Vienna white rabbits were injected intracamerally with preservative-free lidocaine hydrochloride 2%, ropivacaine 1%, levobupivacaine 0.75%, or fortified balanced salt solution (BSS Plus) (control). Animals were humanely killed 1 day or 7 days later. Terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling was used to detect apoptosis. Corneal endothelial cells and apoptotic cells were counted by light microscopy. The morphologic appearance was determined by transmission electron microscopy (TEM). RESULTS: Apoptotic cell density was high in the anesthetic groups on day 1 (P<.01); there was no significant difference between groups at 7 days. Apoptotic cell density declined significantly between 1 day and 7 days in the anesthetic groups (P<.05) but not in the control group. There was no difference in endothelial cell density between the 4 groups at 1 or 7 days. All anesthetic groups showed degenerative changes on TEM, with the least change in the preservative-free lidocaine hydrochloride 2% group. CONCLUSIONS: Intracameral injections of preservative-free lidocaine, ropivacaine, and levobupivacaine induced significantly more apoptotic endothelial cell loss than BSS Plus and led to morphologic changes in the corneal endothelial cells in the early period. This effect was temporary, with recovery by 7 days. Considering the limited proliferative capacity in human eyes, the induced apoptosis might result in the permanent cell loss and enlargement in human corneal endothelium.

Male breast cancer: thirteen years experience of a single center.

BACKGROUND: This retrospective study analysed the epidemiological, clinical, and therapeutic profiles of breast cancer in males. METHODS: We report our experience at the Hospital of the University of Baskent, where 20 cases of male breast cancer were observed and treated between 1995-2008. RESULTS: Median age at presentation was 66,7 +/- 10,9 years. Average follow-up was 63 +/- 18,5 months. The main presenting symptom was a mass in 65% of cases (13 patients). Ynvasive ductal carcinoma was the most frequent pathologic type (70% of cases). CONCLUSION: Male breast cancer patients have an incidence of prostate cancer higher than would be predicted in the general population. Cause of men have a higher rate of ER positivity the responses with hormonal agents are good.

Appendiceal endometriosis presenting as perforated appendicitis: report of a case and review of the literature.

While endometriosis is a common disorder in women of reproductive age, appendiceal endometriosis accounts for less than 1% of all pelvic endometriotic lesions. Involvement at this site may present as acute appendicitis and be diagnosed only upon postoperative histopathologic examination. We report such an occurrence of appendiceal endometriosis in a 40-year-old woman who presented with acute perforated appendicitis.

Meningoencephalocele formation after nasal septoplasty and management of this complication.

OBJECTIVE: Patients undergoing nasal septoplasty can face many complications. Some of these complications are rare but their results are life threatening. Being aware of this complication could prevent further problems such as enlargement of the bone and dural defect, herniation of the meninges and brain tissue through the defect by pulsation of the brain and ascending infection. With early diagnosis, a less aggressive method could be used to treat this complication. CASE DESCRIPTION: A 50-year-old woman was admitted our hospital with the complaint of loss of consciousness. Her Glasgow coma score was 7 on admission. She had no lateralizing signs, but had nuchal rigidity. Blood pressure was 200/110mm Hg, the respiratory pattern was apneic, complete blood count revealed 12000 leucocytes/mm3 and arterial blood gases showed respiratory acidosis and other biochemical parameters were within normal limits. Computerized cranial tomography (CCT) showed diffuse brain edema without evidence of other signs. Lumbar puncture was performed revealing purulent and highly viscous cerebrospinal fluid (CSF). CONCLUSION: Late diagnosis and late repair of arachnoidodural tearing could lead to life-threatening complications, and cases with meningitis and larger defects may require more extensive surgery instead of transnasal endoscopic repair.

Extraaxial chloroma of the cerebellopontine angle: case report.

A chloroma or granulocytic sarcoma is an extramedullary leukemia. It can be encountered at any anatomical location, but until now only three cases have been reported in the cerebellopontine angle. We present an 8-year old patient with an extraaxial chloroma of the cerebellopontine angle to highlight this very rare and malignant pathology in the differential diagnosis of cerebellopontine angle tumors. The presented case, being the fourth chloroma in the cerebellopontine angle, occurred in the absence of relapse which is very unusual for these lesions. Chloroma should be remembered as a very rare and a malignant pathology in the differential diagnosis of pediatric cerebellopontine angle tumors.