The comparison of macroscopic and histologic healing of side-to-side (SS) tenorrhaphy technique and primer tendon repair in a rabbit model.

INTRODUCTION: The side-to-side (SS) tenorrhaphy technique has been used in tendon transfer surgery. The mechanical properties of SS tendon suture have been studied previously. However, the histo-pathological healing of the SS tenorrhaphy of the tendons is unknown. The aim of this study was to assess the gross and histological effects of SS tenorrhaphy in a rabbit model. MATERIALS AND METHODS: Twenty New Zealand rabbits were used. The extensor hallucis longus and tibialis anterior tendon were sewed SS at the level distal to the ankle joint. The patellar tendon (PT) at the same side was used as control group. A unilateral midline incision was made and repaired with a single suture. The animals were killed at the 12th week postoperatively. The histological sections were obtained from the side of surgery from each group. Each sample was stained with hematoxylene and eosin (H&E). Gross and microscopic healing was compared between the two groups. RESULTS: Gross examination of the control group showed complete healing with a thin peri-tendinous sheath formation around the suture site, whereas in the study group, a thick peri-tendinous sheath was formed around the area of the tendon-tendon anastomosis. In the control group, at the 12th week after surgery, the healing was almost completed in all samples. In the study group, a thick fibro vascular sheath has formed around the side of anastomosis. In all specimens few inter-digitations were observed between the tendons;however, the trough was still present. CONCLUSION: The result of the current study showed that histological healing and union of SS tenorrhaphy differ from that in primary tendon injury and healing. Further studies are required to clarify the healing stages at the tenorrhaphy site.

The expressions of AMACR and iNOS in prostate adenocarcinomas.

BACKGROUND AND OBJECTIVE: Prostate cancer is the second leading cause of death in men. The localized disease often responds to conventional therapies like androgen ablation via castration and/or administration of chemical inhibitors but advanced disease resistant to any curative therapies is still challenge for investigators. There are increasing efforts to enhance the possibility of finding positive and sensitive immune markers for diagnosing and treating prostate cancer. The aim of this study was to investigate the expression patterns of AMACR and iNOS in prostate adenocarcinomas with different histopathologic grade. METHODOLOGY: We applied immunohistochemical markers; AMACR and iNOS. Formalin-fixed parafin embedded tissues of 64 prostate needle biopsy specimens diagnosed as prostate adenocarcinoma between 2005-2010 years were included in the study. RESULTS: AMACR expression were found in 58 (90.6%) and iNOS expression in 54 (84.4%) of 64 prostate adenocarcinomas. No significant relationship of AMACR and iNOS was obtained (p>0.05). There was no significant correlation of histopathologic grade of the tumors with AMACR and iNOS expression (p>0.05). CONCLUSIONS: The expression of AMACR and iNOS might be important diagnostic immune markers for prostate adenocarcinomas especially in needle biopsies where the quantity and quality of tissue are limited.

Tenosynovial giant cell tumor in an unusual localization.

Tenosynovial giant cell tumors are benign tumors that are often localized on the palmar sites of the hand. The involvement of large joints such as the knee and ankle are rare. We present an 18-year-old male patient referred to the orthopedics clinic with a mass on his right ankle. No differential diagnosis could be made radiologically. The marginally excised lesion was histopathologically diagnosed as a tenosynovial giant cell tumor. There was no local recurrence during a follow-up of 12 months.

Periosteal chondroma of the ischium; an unusual location.

Periosteal chondroma is a rare benign tumor of hyaline cartilage. Periosteal chondroma arising in the ischium is an extremely rare event. By presenting this case report, we aim to remind that differential diagnosis of these lesions should be carefully performed especially for unusual locations. A 51-year-old man visited the orthopedics clinic with the complaints of left pelvic mass and pain lasting about one year. Computed tomography showed a solid mass with abundant specks of calcification that was 4x5 cm in diameter and associated with the ischium of the left pelvic bone. There was no evidence of penetration into the medullary cavity and cortical sclerosis. No radiological aggressive appearance was observed. The lesion was removed with the covering periosteum. Microscopically, there were lobules of hyaline cartilage composed of chondrocytes with foci of endochondral ossification and calcification. The case was reported as 'periosteal chondroma'. In conclusion, this case report presents a case of periosteal chondroma, a rare tumor, which occurred in an unusual location and age range. The differential diagnosis of periosteal chondroma from malignant lesions is necessary for avoiding aggressive and inappropriate treatment.

Inflammatory linear verrucous epidermal nevus with genital involvement.

An 18-year-old woman was admitted to our clinic complaining of pruritic lesions on her inguinal and genital areas that had been present since birth. She had previously used topical steroids and a combination of topical steroids and calcipotriol for approximately 6 months; however, the treatment was unsuccessful. Her medical history was unremarkable. On dermatologic examination, mild erythematous, lichenified, and verrucous papules occurring in a linear pattern on the right inguinal area and on the region extending from the right labium majus to the perianal area were noted (Figure). Additionally, an erythematous area with central erosion surrounded by maceration was noted on the intergluteal area. Two separate punch biopsy samples were obtained from the erythematous, lichenified, verrucous, papular lesion on the inguinal area and from the erythematous, eroded, macerated lesion on the intergluteal area. Histopathological examination of both biopsy specimens revealed a thin orthokeratotic layer and scattered parakeratotic layers, as well as papillomatosis and acanthosis of the epidermis with a slight hyperpigmentation of the basal layer. A mild, perivascular, chronic inflammatory cell infiltration was noted in the dermis. Based on the clinical and histopathological findings, the patient was considered to have inflammatory linear verrucous epidermal nevus, and cryotherapy was initiated. At the 2-week follow-up after the first application, it was observed that the itching complaint decreased substantially and the eroded lesions in the intergluteal area were re-epithelialized. On clinical follow-up, no improvement was observed in the papular component of the lesion after 4 sessions of cryotherapy. The patient voluntarily discontinued the follow-up after 4 sessions of cryotherapy.

Scleredema diabeticorum partially treated with low-dose methotrexate: a report of five cases.

Scleredema is a rare connective tissue disorder that belongs to a group of scleroderma-like disorders. Although no known curative therapy exists, various specific treatments have been proposed in the literature. In this report, we describe five cases of scleredema partially treated with low-dose methotrexate therapy. All patients have diabetes mellitus type II. All patients were started on methotrexate 15 mg subcutaneously once weekly for 3 months. Biopsy specimens were taken from all patients and were examinated histologically before the treatment and after 3 months of treatment. All cases partially responded to low-dose methotrexate therapy. We believe that methotrexate therapy may be an alternative therapeutic options in scleredema in view of its efficacy.

Villous adenoma of the urinary bladder: rare location.

Villous adenomas are common lesions of the gastrointestinal tract but they are rarely located in the urinary tract including the urinary bladder. There are a few case reports and series in the literature. Here we report a 43-year-old male patient who had a polypoid lesion located on the left lateral wall of the urinary bladder. Transurethral resection was performed. The diagnosis was 'villous adenoma of urinary bladder' with clinical and histopathological findings. Villous adenomas are mostly seen in elderly males. The coexistence of villous adenoma with adenocarcinoma, squamous cell carcinoma, and urothelial carcinoma was observed but there is not clear evidence about progression to carcinoma, in spite of its colonic counterpart. Generally complete surgical resection is accepted as curative but there are no exact data about follow-up and recurrence. By presenting this case, we aim to emphasize that it is a rare but important lesion because of coexistence with malignancies and uncertain malignant potential.

Mature cystic teratomas in our series with review of the literature and retrospective analysis.

PURPOSE: Mature cystic teratomas are the most common benign ovarian neoplasms. Our aim is to analyse these cases by pathologic and clinical findings in our centre with the view of updated knowledge. MATERIALS AND METHODS: In our study, 50 case reports diagnosed as mature cystic teratoma (or dermoid cyst) in Mustafa Kemal University Pathology Laboratory between 2005 and 2010 have been reviewed. RESULTS: Of 50 cases, the findings on mature cystic teratomas were as follows: the number of tumours located at the right ovary was 22, the left ovary, 23, with 5 cases bilaterally. Age range was 14-58 with mean rate 35.4. In two cases, tumour markers were high, one case presented with torsion; one case was obtained incidentally during delivery. CONCLUSION: Mature cystic teratomas are benign neoplasms with low malign transformation rate. Our series are low in number but our findings show the dynamic nature of these tumours.

An atypical bladder diverticulum presented with recurrent peritonitis: case report.

Bladder diverticula develop from congenital detrusor muscle defect and frequently present with urinary tract infection, which occurs as a result of urinary stasis in the diverticula. Different clinical presentations, such as bladder outlet obstruction, cyanosis of the lower extremities, intestinal obstruction, ureteral obstruction (which may occur due to direct diverticular compression), and peritonitis due to spontaneous rupture of the diverticula, were reported previously. Here, we report a case with the diagnosis of bladder diverticulum that caused recurrent generalized peritonitis without perforation and mimicked perforated appendicitis.

Periorbital edema and erythema: an unusual localization of DLE in a patient with psoriasis.

Discoid lupus erythematosus (DLE) is characterized by erythematous, raised, indurated papules or plaques. DLE may rarely present as periorbital erythema and edema. We report the case of a 33-year-old woman with psoriasis localized on the trunk and extremities who developed prominent periorbital edema and erythema diagnosed as DLE.

The co-existence of vulvar lichen sclerosus, ulcerated calcinosis cutis, and dermatomyositis: coincidence or immunological mechanism?

Calcinosis cutis is a condition characterized by the deposition of calcium salts in the skin and subcutaneous tissues, and patients suffering from it encounter various connective tissue disorders, such as dermatomyositis (DM), scleroderma, and systemic lupus erythematosus. Although calcinosis cutis is frequently accompanied by juvenile dermatomyositis, rare cases have been reported in adult patients with DM. On the other hand, lichen sclerosus (LS) is a chronic inflammatory disease of the skin and mucosal surfaces. In the present report, we present a rare case of a 71-year-old patient with DM accompanied by ulcerated calcinosis cutis and vulvar LS.

Expression of cyclooxygenase-2 and its relation to histological grade, inducible nitric oxide synthase, matrix metalloproteinase-2, CD-34, Caspase-3, and CD8 in invasive ductal carcinoma of the breast.

OBJECTIVE: To assess by immunohistochemistry the cyclooxygenase-2 (COX-2) expression in invasive ductal carcinoma and its possible correlation with the histological grade, inducible nitric oxide synthase (iNOS), matrix metalloproteinase-2 (MMP2), and other common immunohistochemical parameters (CD-34, Caspase-3, and CD8). METHODS: This was a retrospective pathology archive study including 50 female patients and was performed in Mustafa Kemal University, Hatay, and Sutcu Imam University, Kahraman Maras, Turkey. The routine hematoxylin-eosin staining and COX-2, iNOS, MMP-2, CD-34, CASP-3, and CD8 immunoperoxidase techniques were performed on paraffin-embedded tissues. RESULTS: The mean value of COX-2 was 274.02+/-54.49 and MMP-2 was 263.42+/-54.30, whereas the mean iNOS values were 258.10+/-56.05. CD-34 staining also yielded positive results as 26.18+/-8.00. The mean value of CASP-3 was 284.06+/-41.2 and CD8 was 164.17+/-69.5. This reveals an inverse correlation between CASP-3 reactivity and CD8 (Spearman correlation [r]= -0.33, p=0.01). There was also an inverse correlation between iNOS reactivity and patients age (r = -0.29, p=0.03). There was a positive correlation with COX-2 and MMP-2 (p=0.00), but there was no relation with COX-2 and other parameters. CONCLUSION: COX-2 expression is an important parameter for invasive ductal carcinoma of the breast. We found a positive correlation between COX-2 and MMP-2, whereas, we could not show direct correlation between COX-2 and iNOS, CD-34, CASP-3, and CD8.

Effects of a single application of extractum cepae on the peritendinous adhesion: an experimental study in rabbits.

Peritendinous adhesion is an important cause of poor functional outcome after flexor tendon repair. The objective of this study was to investigate the effect of a single intraoperative application of extractum cepae, an extract of dietary onion, on the peritendinous adhesion, using a rabbit model of flexor tendon injury. The first, second, and third digits of the right hind paw of 18 rabbits were used for tendon operations. A standard partial division of the synovial sheath and flexor tendon was done at zone II to stimulate the adhesion formation. In the treatment group (n = 9 rabbits, 27 tendons), the flexor tendon sheath was treated with 50 mg/mL of extractum cepae which was applied locally and allowed to infiltrate for 5 minutes, the skin was sutured without suturing the sheath and the tendons. The same operation was done for the control group (n = 9 rabbits, 27 tendons) and 1 mL of normal saline solution was applied locally. Biomechanical and histologic evaluations of the specimens were done after 3 weeks. Tendons from the first toes were used for biomechanical studies. The second and third toe tendons were used for histopathologic evaluation. We have compared the peritendinous adhesions and the ultimate forces in the control and treated tendons. There were no statistically significant differences between the 2 groups with respect to the ultimate loads. Adhesion formation was absent in 1 tendon (5.5%), slight in 8 (44.4%), moderate in 6 (33.3), and severe in 3 tendons (16.7%) in the extractum cepae treated group (n = 18); while in the control group (n = 18), it was absent in 1 tendon (5.5%), slight in 1 tendon (5.5%), moderate in 3 (16.6%), and severe in 13 (72.4%) tendons. There was a significant reduction (P = 0.01) in the peritendinous adhesion in the treated group comparing to the control group. The problem of adhesion formation may be minimized using a single intraoperative application of extractum cepae.

Coexistence of acral syringomas and multiple trichoepitheliomas on the face.

BACKGROUND: An extremely rare variant of syringoma is an acral form, which affects the upper extremities as an isolated finding. The acral syringomas may also be associated with syringomas on the feet or usual distribution around the eyelids. Of the eight previously documented cases of acral syringomas, all were located on the dorsal aspect of the upper extremities (fingers, hand, wrist, or forearm) dominantly. OBJECTIVE: We report a 41-year-old woman who presented with multiple flesh-colored to reddish brown papules on the inner aspect of the forearms and many pearly, small papules on the periorbital regions. RESULTS: The clinical picture and histopathology indicated the coexistence of acral syringomas and multiple trichoepitheliomas on the face. CONCLUSION: To the best of our knowledge, this is the first case of acral syringomas coexisting with multiple trichoepitheliomas.

Lipoma arborescens of the peroneus longus and peroneus brevis tendon sheath: case report.

Lipoma arborescens is an uncommon pseudotumoral synovial lesion usually located in the suprapatellar pouch of the knee. Lipoma arborescens involving the synovial sheaths of the tendons is exceedingly rare. This diagnosis should be considered, particularly in patients with chronic joint effusion. We report a case with lipoma arborescens affecting the synovial sheaths of the peroneal tendons without involvement of the adjacent ankle joint. To our knowledge, this is the second reported case of lipoma arborescens involving tenosynovial sheaths of tendons around the ankle joint without ankle joint involvment.

Inducible nitric oxide synthase and histopathological correlation in chronic viral hepatitis.

BACKGROUND: Chronic liver disorders represent a serious health problem. Nitric oxide (NO) synthesized by inducible nitric oxide synthase (iNOS) can function as an antimicrobial agent able to kill or reduce replication of microorganisms, and plays an important role in immune regulation. This study was undertaken to evaluate the expression of iNOS in chronic viral hepatitis and its relation to histopathology. METHODS: This study included 56 patients with chronic viral hepatitis (38 hepatitis B, 18 hepatitis C). There were 35 men and 21 women with a mean age of 38.6+/-21.731 years. A modified form of the histology activity index (HAI) designed by Ishak and colleagues was used to assess grading and staging of chronic viral hepatitis. The needle biopsy specimens were fixed in 10% formalin and routinely processed. Routine hematoxylin-eosin, periodic acid-Schiff, and reticulin staining, and iNOS immunoperoxidase technique were performed on paraffin-embedded tissues. RESULTS: We demonstrated that all liver samples had a marked iNOS expression, with a diffuse distribution pattern. iNOS consistently labeled mononuclear cells infiltrating portal tracts in all samples. Statistical evaluation of data showed that the iNOS expression correlated with the HAI and fibrosis. Furthermore a correlation between iNOS and severity of disease was detected (r=0.772, p=0.000). CONCLUSIONS: Further investigations are required to determine whether iNOS-related treatment protocols could be useful in reducing disease severity.

The effects of increased cAMP content on inflammation, oxidative stress and PDE4 transcripts during Brucella melitensis infection.

Cyclic AMP (cAMP) is a key intracellular second messenger which at increased levels has been shown to have anti-inflammatory and tissue-protective effects. Its concentration is determined by the activities of both adenylate cyclase (AC) and the phosphodiesterase (PDE) enzymes. The aim of this study was to compare the effects of increased cAMP and glucocorticoid dexamethasone administration on B. melitensis-induced lipid peroxidation, Brucella suppressed antioxidant enzyme activities and PDE4 transcripts in rats. Intracellular cyclic AMP level was elevated by two different approaches; activation of AC and inhibition of PDE activities. Rats were inoculated with B. melitensis for seven days then a single dose of nonselective PDE inhibitor 3-isobutyl-1-methylxanthine (IBMX), the adenylate cyclase activator forskolin and dexamethasone were administrated to each infected group, and animals were challenged for 48 h. Brucella-induced lipid peroxidation was significantly reduced by the cAMP elevating agents as well as dexamethasone administration in plasma, liver and spleen. The antioxidant enzymes glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were significantly decreased by the pathogen. Whilst suppressed GSH-Px activity was reversed by cAMP elevating agents, SOD activity was not restored. Superoxide generating enzyme xanthine oxidase activity was not altered at the end of the infection period. Brucella infection increased plasma IL-12 level and this effect was also suppressed by the cAMP elevating agents, whereas TNF-alpha, IFN-gamma and IL-10 levels were unchanged. Intracellular cAMP levels are entirely hydrolyzed by cAMP-specific PDE 4 isozymes (PDE4s) in inflammatory and immunocompetent cells. Brucella reduced mRNA transcript levels for PDE4A by 40%, though PDE4B and 4D transcriptions were being unaffected in spleen. It was concluded that B. melitensis infection decreased activity of the antioxidant defence system, induced lipid peroxidation and suppressed PDE4A transcription. Administration of cAMP elevating agents exhibited similar affect with dexamethasone on lipid peroxidation, IL-12 production and antioxidant enzyme activities in Brucella infection.

Effectiveness of mesalamine and propolis in experimental colitis.

This study was conducted to investigate the effects of propolis and mesalamine on experimental colitis in rats. Distal colitis was induced in rats by intracolonic instillation of 2 mL of 4% acetic acid. The animals were randomly assigned to 5 groups: group 1, control, (n=8); group 2, colitis, received no treatment (n=8); group 3, colitis+mesalamine, 2 mL once a day via an enema (n=8); group 4, colitis+propolis, 600 mg/kg once a day via intragastric lavage (n=8); and group 5, colitis+mesalamine+propolis for 1 wk (n=8). Levels of nitric oxide were statistically significantly different in comparisons between groups 1 and 2, groups 2 and 3, and groups 4 and 5. Malondialdehyde levels were significantly different when group 2 was compared with groups 3, 4, and 5. A significant difference was observed when group 3 was compared with group 4 for myeloperoxidase. Most propolis-treated rats had normal histology; mesalamine-treated and propolis+mesalamine-treated rats had inflammatory cell infiltration at rates of 50% and 33%, respectively. The investigators concluded that propolis and mesalamine are efficient independently and in combination, but that their combined effect was not observed to be additive in experimental colitis.

Antibacterial activity of propolis against MRSA and synergism with topical mupirocin.

OBJECTIVES: The aim of the present study was to investigate the activity of the propolis and its combinations with mupirocin against methicillin-resistant Staphylococcus aureus (MRSA) in nasal carriage. METHODS: This study was carried out between June and August 2005. To infect nares of the rabbits, MRSA (ATCC 33591) strain was used. Minimum inhibitory concentration was determined according to National Committee for Clinical Laboratory Standards. Each inoculum was prepared in the same medium at a density adjusted to a 0.5 McFarland turbidity standard (10(5) colony-forming units [cfu]/mL) and diluted 1:100 for the broth microdilution procedure. Ten microliters (10 microL) (10(5) cfu/mL) of the bacterial suspension containing approximately 1000 cfu of MRSA was administered with sterile microsyringe through both nostrils of each rabbit. Ninety-six (96) hours after inoculation, the presence of infection was confirmed by using bacterial cultures. Twenty-six young New Zealand rabbits were randomly divided into 4 groups. Each treatment group (1, 2, and 3) included 7 rabbits and control group (group 4) included 5 rabbits. Group 1 was treated with topical mupirocin + ethanolic extract of propolis drops, group 2 received topical mupirocin, group 3 was administered ethanolic extract of propolis drops, and the control group (group 4) was only treated with phosphate-buffered solution drops for 7 days. At the end of study, nasal cultures and smears were obtained for bacterial count and cytologic examination. RESULTS: The colony numbers of bacteria in group 1 were determined to be significantly lower than in group 2 (p = 0.0001), group 3 (p = 0.0001), and group 4 (p = 0.0001). The mean bacterial cell counts of groups 1-4 were 360.2 +/- 52.4 cfu/mL, 4120.6 +/- 860.4 cfu/mL, 5980.8 +/- 1240.6 cfu/mL, and 11500.0 +/- 2568.4 cfu/mL, respectively. Mupirocin + propolis administration (group 1) resulted in a significant reduction in the polymorphonuclear leukocyte (PMNL) count in the mucous membranes of rabbits compared with the other treatment groups (p < 0.05). CONCLUSIONS: Propolis addition to mupirocin regimen was found to result in more profound reduction in bacterial cell count and inflammatory response compared with the rest of the treatment modalities.