Is there a link between alopecia areata and gut?

BACKGROUND: There may be an association between increased intestinal permeability and the progression of alopecia areata (AA). OBJECTIVE: The present study aimed to investigate the role of intestinal permeability in the etiopathogenesis of AA and its association with the severity of the disease. METHODS: Serum zonulin levels of 70 patients with AA who were not receiving any systemic treatment and of 70 healthy control subjects were measured. RESULTS: The median serum zonulin level in the patient group (46.38 ng/mL) did not differ significantly from that in the control group (50.34 ng/mL) (p = 0.828). Moreover, there was no significant relationship between serum zonulin levels and the severity of the disease (p = 0.549). LIMITATIONS: The present study had a cross-sectional design, and it did not include patients with alopecia totalis (AT) or alopecia universalis (AU). CONCLUSION: We did not observe an increase in intestinal permeability secondary to zonulin expression in patients with AA. However, in order to generalize this result to all patients with AA, serum zonulin levels need to be evaluated in studies including more patients with severe disease, AT, and AU.

Surgical treatment outcomes of pulmonary inflammatory myofibroblastic tumors.

BACKGROUND: Pulmonary inflammatory myofibroblastic tumor (PIMT) is an extremely rare disease. The aim of this study was to share the surgical outcomes of these tumors. METHODS: Patients who were operated for pulmonary myofibroblastic tumors between January 2005 and January 2021 were determined by retrospectively scanning patient files. Patients' demographic characteristics, tumor location, surgical techniques, and other parameters were obtained from the patient files. The KaplanMeier method was used for survival calculations, whereas the log-rank test was used for comparison of survival calculations. RESULTS: PIMTs were noted in 14 patients (0.12%) in a total of 11,108 thoracic procedures performed in our institution between January 2005 and January 2021. The mean age of the patients was 28.2 (range: 2-67) years. Of the patients, six were male and eight were female, with 50% (n = 7) aged under 18 years. A total of 17 surgical procedures were performed on 14 patients. One patient underwent pneumonectomy, two patients lobectomy, ten0 patients wedge resection, and one patient underwent debulking surgery. A total of 11 patients had complete surgery, whereas three patients had incomplete surgery. The 10-year overall survival was 84.6% and the 10-year disease-free survival (DFS) was 75.0%. Complete resection was found to be the only and significant factor that had an effect on survival (P = 0.004) and DFS (P = 0.012). CONCLUSION: PIMTs are extremely rare. Complete surgery should be considered an effective factor in survival and DFS.

Postoperative Thoracic Pain Treatment: Serratus Anterior or Erector Spinae Plane Block?

BACKGROUND: Thoracic surgery is one of the most painful surgeries. Effective analgesia is important in postoperative pain management. In this study, we aimed to compare the two new fascial block techniques. METHODS: A total of 107 patients who underwent thoracic surgery between October 2018 and November 2019 were retrospectively evaluated. The study included 59 patients in the serratus anterior plane block (SAPB) group and 48 patients in the erector spinae plane block (ESPB) group. Both groups were administered 30 mL of 0.25% bupivacaine and their morphine consumption was evaluated by a patient-controlled analgesia (PCA) method during the 2nd, 6th, 12th, 24th, and 48th postoperative hours. Pain was measured with the visual analog scale (VAS). Intraoperative mean arterial pressure (MAP) and heart rate (HR) were recorded. RESULTS: During the first 24 hours, VAS values were significantly lower in the ESPB group (p < 0.05). Moreover, morphine consumption was significantly lower in the ESPB group in the 24th and 48th hours (p < 0.05). Intraoperative remifentanil consumption was also significantly lower in the ESPB group (p < 0.05). Intraoperative MAP in the ESPB group was found to be significantly lower after the 4th hour. HR was similar in both groups. CONCLUSION: ESPB was more effective compared with SAPB in postoperative thoracic pain management.

Pleuropulmonary blastoma: A report of two cases.

Pleuropulmonary blastoma is a rare and aggressive childhood tumor of mesenchymal origin. It has a poor prognosis and mainly classified as cystic (type 1), mixed type (type 2), and solid (type 3). Herein, we present two cases of pleuropulmonary blastoma type 3 presenting with pneumothorax, a rare clinical presentation of pleuropulmonary blastoma, which was successfully treated with surgery.

Is mediastinoscopy an effective diagnostic method in mediastinal area evaluation in pediatric patients?

BACKGROUND: The purpose of the study was to discuss the effectiveness of mediastinoscopy for pediatric patients as the use of EBUS-EUS (Endobronchial Ultrasound-Endoscopic Ultrasound) has replaced mediastinoscopy for adult patients in evaluation of the mediastinal area. METHODS: The records of patients subject to cervical and anterior mediastinoscopy at our clinic from January 1, 2000 to June 1, 2019 were examined and patients aged 18 years or less were included in the study. Data were acquired on the demographic characteristics of the patients, type of surgery, complications, operation times, and histopathologic diagnoses. RESULTS: Of the 1505 patients subject to intervention by mediastinoscopy at our clinic from January 1, 2000 to June 1, 2019, only 22 (1.46%) were pediatric patients aged 18 years or less. Cervical and anterior mediastinoscopies were performed on 16 and six patients, respectively. Histopathological tissue diagnoses via mediastinoscopy were obtained for 19 (86.3%) of 22 patients. The most frequently observed diagnoses were sarcoidosis (n = 10), lymphoma (n = 4), thymoma (n = 1), tuberculosis (n = 1), undifferentiated round cell sarcoma (n = 1), and reactive lymph node (n = 2); three patients could not be diagnosed. Mortality was not detected. There were no major complications requiring thoracotomy or sternotomy and none of the patients were subject to tube thoracostomy as a result of surgery. CONCLUSION: Pediatric age mediastinoscopy may be the first method of diagnosis due to low complication rates and high diagnosis rates in mediastinal area.

Congenital lobar emphysema: diagnosis and treatment options.

Although congenital lobar emphysema is a rare lung disease, it can cause severe respiratory distress in the newborn. Lobectomy can be difficult because of the hyperinflated lobe and limited space to carry out surgery. During the past two decades, conservative treatment options have increased for patients with mild and moderate disease.

Is Bilateral Staged Muscle-Sparing Thoracotomy Performed within 1 Week for Lung Hydatid Cysts Safe for Pediatric Patients?

OBJECTIVES: Median sternotomy or staged thoracotomies are generally the preferred surgical treatment options for bilateral lung hydatid cysts. According to literature, it is usually recommended to wait from 3 weeks to 3 months between bilateral staged thoracotomies. The aim of this study is to compare postoperative complications, hospitalization days and morbidity and mortality ratios between unilateral thoracotomy and bilateral staged thoracotomy groups and to evaluate the safety of performing bilateral staged thoracotomy within 1 week for lung hydatid cysts in pediatric patients. MATERIAL AND METHODS: In total, 112 patients under the age of 16 years who underwent surgery between 2000 and 2016 because of pulmonary hydatid cysts were included in this study. The patients were classified into two groups as Group 1 (unilateral muscle-sparing thoracotomy) and Group 2 (bilateral staged muscle-sparing thoracotomy applied within 1 week). RESULTS: There were 91 patients in Group 1 and 21 patients in Group 2. No statistically significant differences were detected when both groups were compared by age, gender, perforation rates, follow-up period and postoperative complications. CONCLUSION: To prevent hydatid cysts complications, the elapsed time between two thoracotomies should be not only long enough to evaluate the postoperative complications but also relatively short to prevent possible complications that may develop in the other lung. In our opinion, a patient follow-up of 3-7 days between thoracotomies is sufficient for the assessment of patients' clinical status and possible complications.

The relation between the location and the perforation rate of lung hydatid cysts in children.

BACKGROUND/OBJECTIVE: The pressure, size, and central or peripheral location of lung hydatid cysts are the most studied topics among the factors affecting perforation. The aim of this study is to investigate the relation between the location and the perforation rate of lung hydatid cysts in children. METHODS: 197 patients under the age of 16 years, who were operated between January 2000 and December 2016 due to pulmonary hydatid cysts, were evaluated retrospectively. Patients who had giant hydatid cysts (n = 27), bilateral hydatid cysts (n = 24), and more than one cyst in one lung (n = 12) were excluded to create a more homogeneous group to enable investigation of the relation between the location and the perforation rates of hydatid cysts. Finally, 134 patients who had only one hydatid cyst were classified into two groups: Group 1 with perforated cysts and Group 2 with intact hydatid cysts. RESULTS: 70.9% of the patients were male. In total, 134 cysts were detected and 41% were perforated. The highest perforation rates were detected in the right middle lobe (70%) and the lingula (66.7%). There was a statistically significant difference between the location of the cysts and the perforation rates (p = 0.018). Also hydatid cysts located in the right middle lobe and the lingula had higher postoperative complication rates than hydatid cysts located in the upper and lower lobes (p = 0.018). CONCLUSION: We recommend surgical treatment as soon as possible in children with hydatid cysts located in the right middle lobe and lingula to prevent the risk of perforation.

Is Anatomic Lung Resection Necessary in Surgical Treatment of Giant Lung Hydatid Cysts in Childhood?

PURPOSE: The aim of this study is to evaluate the results of parenchymal saving methods for giant lung hydatid cysts and to discuss the necessity of anatomic lung resection in childhood. METHODS: The patients under the age of 16 years who were operated between January 2000 and January 2017 due to pulmonary hydatid cyst were evaluated retrospectively (n = 200). In all, 32 patients who had giant hydatid cyst were included in this study. Parenchymal saving methods (cystotomy-capitonnage) were preferred and decortication was also performed for pleural thickening if needed. No lung resections were applied. RESULTS: Male patients were 53.1%. The mean age was 11.3 ± 3.2 years. The total number of giant cysts was 32. The average size of the cysts was 11 cm. Thirty seven point five percent of the cysts were perforated. Postoperative complication rate was 31.3%. No recurrence and mortality were seen during follow-up period. CONCLUSION: Considering the high recovery capacity of lung tissue, a chance should be given to recover the existing infection, atelectasis, and parenchymal damage. Especially in areas where hydatid disease is endemic, children may be infected with the parasite again. For these reasons, we do not recommend resection with any indications.

Anton syndrome during oxygen-ozone therapy.

Ozone (O3) gas is a molecule that consists of 3 oxygen atoms, found out in the mid-19th century [1]. Ozone gas preserves humans from detrimental influences of ultraviolet radiation [1]. In spite of harmful effects of O3 gas, investigators think that it has excessive curative effects [1]. Nowadays, O3 therapy is used for many fields of medicine in precise therapeutic doses [1] and [2]. It is known that O3 therapy is helpful in dental procedures, cerebrovascular diseases, tinnitus, acquired immunodeficiency syndrome, hypercholesterolemia, sensorial hypoacusis, senile dementia, multiple sclerosis, irradiation sensitive tumors, herpes simplex and herpes zoster virus infections, muscular hypertonia, and chronic otitis media, etc.[2]. The complications and disadvantages of O3 therapy could be observed in the future. Herein, we presented a case of ischemic stroke after an oxygen-O3 therapy, which is called also Anton syndrome.

The effects of oral antibiotics on infection prophylaxis in traumatic wounds.

BACKGROUND: The objective of this study is to examine the effectiveness of oral antibiotics in the prevention of infection development in traumatic wounds. METHODS: Forty Wistar albino rats were divided into five groups of eight animals. After the crushed wound model was made on the back of the rats, wounds were closed with a simple suture and Staphylococcus aureus ATCC 29213 strain was used to create infection. All rats apart from the controls were given oral gavage with antibiotics, including cephalexin, amoxicillin-clavulanate, clarithromycin (CAM), or levofloxacin for 5 days. Wounds were evaluated qualitatively and quantitatively on 5th day approximately 18 h after the last treatment. RESULTS: In the quantitative evaluation, no infection was observed in the treatment groups with amoxicillin-clavulanate, CAM, cephalexin, or levofloxacin. There was no significant difference on the numbers of bacteria found in the wounds among the groups. In terms of quantitative inflammation findings, no hyperemia or pus was detected in the groups that were given medication. Furthermore, no statistically significant difference was found among the groups in terms of induration. CONCLUSION: Oral prophylactic antibiotics have been found to be effective in the prevention of wound infection in the traumatic crushed wound model infected with S. aureus in rats.

Accuracy of frozen-section examination for myometrial invasion and grade in endometrial cancer.

OBJECTIVE: To evaluate the accuracy of frozen section (FS) analysis in endometrial cancer. STUDY DESIGN: The medical records of 816 patients with stage IA-IVB endometrial carcinoma were evaluated. Concordance of the frozen section examination and postoperative evaluation in terms of the depth of myometrial invasion (MI) and grade was assessed. RESULTS: The mean age of the patients was 58.1 years. Postoperative pathology revealed endometrioid type tumor in 756 patients. Concordance of intraoperative and postoperative pathology results in terms of grade was 89%. This rate was 96.8% for grade 1, 86% for grade 2 and 91.3% for grade 3 tumors. Sensitivity and specificity of intraoperative evaluation for grade 1, grade 2 and grade 3 were 89.3%, 91.2%, 77.8% and 93.1%, 96.1%, 99.5%, respectively. Intraoperative and postoperative determination of MI was consistent in 85.4% of patients. MI was assessed accurately in 78.5% of patients with no involvement of myometrium and in 90.5% and 95.3% of patients with myometrial invasion <1/2 and ≥1/2, respectively. Sensitivity and specificity of FS in prediction of the absence of MI, MI<1/2 and ≥1/2 were 60%, 91.5%, 88.8% and 96.6%, 88.3%, 98.3%, respectively. The accuracy of myometrial invasion was affected by the postoperative grade. Concordance was higher in grade 2 and 3 than grade 1 tumors. CONCLUSION: The accuracy of intraoperative pathologic evaluation in endometrial cancer is reasonably high. For that reason, results of the intraoperative pathologic examination should be taken into consideration primarily in the management for lymphadenectomy.

An unusual growth of ovarian cystic teratoma with multiple floating balls during pregnancy: a case report.

We report a case of ovarian cystic teratoma with an important growth during pregnancy and the sonographic appearance of intracystic multiple, mobile, polygonal structures called intracystic "fat balls." Due to the rapid growth of the lesion, which exceeded 15 cm in diameter, a right oophorectomy was performed. Histopathologic diagnosis confirmed the mature cystic teratoma. The presence of floating balls composed of keratin and fat is rarely seen but is pathognomonic of mature cystic teratomas. Growth of a teratoma during pregnancy is a rare condition.

Complete mole coexistent with a twin fetus.

INTRODUCTION: Complete hydatiforme mole with coexisting live fetus (CMCF) is a rare entity. Management for this rare twin pregnancy still remains undetermined. We report the delivery of a healthy baby coexisting with complete mole as twins. There was no other complication during or after the pregnancy. CASE REPORT: A 30-year-old multiparous woman was first time assessed in the antenatal outpatient department of our hospital at 17 weeks gestation for normal pregnancy control. Ultrasound examination showed a 17 week and 5 days viable fetus with normal anatomy and placenta. There was a second multicystic placenta located at the posterior wall of the uterus next to the normal placenta. Hydatiforme mole was suspected. The couple was informed about the possible complications but they were not willing to consider pregnancy termination or to have any invasive procedure for diagnosis. A cesarean section was performed at 33 weeks gestation due to premature rupture of membranes and initiation of labor with the fetus presenting as breech. After the delivery of a live healthy female 1,950 g baby, as well as the normal placenta, a second vesicular placenta was delivered. Histopathologic examination confirmed the diagnosis of complete mole. CONCLUSION: Today most of the twin pregnancies with complete mole are identified in the first or second trimester. In this case, the parents who choose continuation of pregnancy, are counseled about the increased risk of complications like preeclampsia, fetal loss, persistent gestational trophoblastic disease. Close surveillance of the woman with CMCF is mandatory during and after the pregnancy.

A rare form of abruptio placenta and clinical presentation in a preterm labor case: Breus' mole.

A normotensive pregnant woman who had no historical risk factors for abruption placenta and found to have Breus' mole that indicates the pattern of single or multiple hematoma protrude above the chorionic plate was encountered. The case resembled a large fetal abdominal wall defect coexisting with a singleton live-born fetus at 27 weeks of gestational age is presented. The obstetric ultrasound showed that multiple coiled masses in the amniotic cavity, both the fetus and the placenta were normal. After two courses of tocolysis therapy, a healthy and, 1,400 g live-born infant was delivered through cesarean section due to fetal distress. Apgar scores at 1 and 5 min were 5 and 8, respectively. The infant died on postnatal day 6 due to severe respiratory distress and prematurity. This rare condition probably occurs frequently in missed abortion and the etiology is unknown, but is probably related to circulatory disturbance on maternal site. We report a rare clinical presentation and review the literature of Breus' mole.