Microsurgical anatomy of the cavernous sinus and limitations of surgical approaches: a cadaveric study.

BACKGROUND: The endoscopic endonasal approach is common in the treatment of pathologies in and around the cavernous sinus. This cadaveric study aims to examine the anatomy of the cavernous sinus to guide endoscopic studies and determine points to consider during surgical approaches. MATERIALS AND METHODS: For this study, a total of 7 cadavers, 4 male and 3 female, were injected with coloured silicone and dissections were performed under the microscope. The characteristics of the surgical corridors encountered during the transsphenoidal, transsellar and transcavernous approaches were examined and their images were recorded. RESULTS: The stages and limitations of surgical approaches to the cavernous sinus in cadavers are presented. The anatomical features of the triangles defined in the cavernous sinus and the structures they contain are explained. It was determined that the surgical field formed by clinoidal and anteromedial triangles could be used effectively to reach cavernous sinus pathologies during endoscopic endonasal interventions. It was also observed that supratrochlear and infratrochlear triangles are dangerous for such surgical interventions. CONCLUSIONS: The detailed anatomical features related to the cavernous sinus, revealed in our cadaveric study, are valuable in terms of preventing complications that may occur during surgical interventions.

Ameliorative potential of Lavandula stoechas in metabolic syndrome via multitarget interactions.

ETHNOPHARMACOLOGICAL IMPORTANCE: Decoction and infusion prepared from aerial parts of Lavandula stoechas L. (L. stoechas) have been traditionally used as remedy against several components of metabolic syndrome (MetS) and associated disorders including type II diabetes and cardiovascular diseases by Anatolian people. AIM OF THE STUDY: The aim is to elucidate the potential ameliorative effects of L. stoechas aqueous extracts on insulin resistance and inflammation models through multitarget in vitro approaches and also to elucidate mechanism of action by analyzing transcriptional and metabolic responses. MATERIALS AND METHODS: An aqueous extract was prepared and fractionated to give rise to ethyl acetate (EE) and butanol (BE) extracts. The anti-insulin resistance effects of BE and EE were evaluated on palmitate induced insulin resistance model of H4IIE, C2C12 and 3T3L1 cells by using several metabolic parameters. Specifically, whole genome transcriptome analysis was performed by using microarray over 55.000 genes in control, insulin resistant and EE (25 µg/mL) treated insulin resistant H4IIE cells. Anti-inflammatory effects of both extracts were analyzed in LPS-stimulated RAW264.7 macrophages. RESULTS: Both EE and BE at low doses (25-50 µg/mL) significantly decreased hepatic gluconeogenesis in H4IIE cell line by suppressing the expression of PEPCK and G6Pase. In C2C12 myotubes, both extracts increased the insulin stimulated glucose uptake more effectively than metformin. Both extracts decreased the isoproterenol induced lipolysis in 3T3L1 cell line. Moreover, they also effectively increased the expression of lipoprotein lipase protein level in insulin resistant myotubes at low doses. EE increased the protein level of PPARγ and stimulated the activation AKT in insulin resistant H4IIE and C2C12 cell lines. The results obtained from biochemical assays, mRNA/protein studies and whole genome transcriptome analyses were found to be complementary and provided support for the hypothesis that EE might be biologically active against insulin resistance and act through the inhibition of liver gluconeogenesis and AKT activation. Besides, LPS induced inflammation in RAW264.7 macrophages was mainly inhibited by EE through suppression of iNOS/NO signaling, IL1ß and COX-2 genes. HPLC-TOF/MS analysis of EE of L. stoechas mainly resulted in caffeic acid, apigenin, luteolin, rosmarinic acid and its methyl ester, 4-hydroxybenzoic acid, vanillic acid, ferrulic acid and salicylic acid. CONCLUSION: Data suggest that EE of L. stoechas contains phytochemicals that can be effective in the treatment/prevention of insulin resistance and inflammation. These results validate the traditional use of L. stoechas in Anatolia against several metabolic disorders including metabolic syndrome.

Characterization of Anatolian traditional quince cultivars, based on microsatellite markers.

We conducted simple sequence repeat (SSR) analyses of 15 traditional quince (Cydonia oblonga) cultivars from Anatolian gene sources for molecular characterization and investigation of genetic relationships. Three pear and two apple cultivars were used as references for SSR locus data analysis and to determine allele profiles between species. Eight SSR loci that were developed from apple and pear were used, and a total of 44 alleles were found among quince cultivars. The CH01F02 locus was found to have the highest identification probability, while the CH04E03 locus had the lowest identification probability. Analysis of similarity ratios between quince cultivars showed that the lowest similarity ratio was 18% (Esme-Bardacik ± k), while the highest similarity ratio was 87% (Bursa-Osmancik ± k and Osmancik ± k-Viranyadevi). In the phylogenetic dendrogram, Esme quince showed separate branching from other quince cultivars, and no synonymous accessions were found. These results suggest that SSR markers from pear and apple could be used to determine genetic variation among quince cultivars. These findings can be used to guide future quince breeding and management studies.

Prophylactic appendectomy: is it worth to be done?

There are still many controversial issues in prophylactic appendectomy. In this retrospective study, we have appraised the reasons and results of prophylactic appendectomies performed between January 1997 and August 1999. Sixty four prophylactic appendectomy cases were included in this study and all resected specimens were submitted to histopathological analysis. In 23 patients with incisional hernias, a prophylactic appendectomy was performed as, in the future, dense adhesions may lead to difficult appendectomy. Additional appendectomy had no negative effect on perioperative complications, compared with the patients without appendectomies. In conclusion, in the presence of optimal conditions, prophylactic appendectomy can be performed safely.

Bilateral galactocele in a male infant: a rare cause of gynecomastia in childhood.

A galactocele is a rare benign breast lesion usually occurring in females during or following lactation. These lesions are a rare cause of breast enlargement in infants and children. In this article we present a 10 month-old boy who was admitted with a two-month history of bilateral progressive breast enlargement, and diagnosed as having galactocele. Our purpose was to emphasize the importance of galactocele as a benign condition in the differential diagnosis of gynecomastia in childhood.

Inflammatory Pseudotumor of the Lung Associated with Anemia: A Case Report and Review of the Literature.

Inflammatory pseudotumor of the lung is a benign tumor which is rarely seen. A mass in the left lung was observed in the chest roentgenogram of an 8 year-old boy while investigating for anemia. Preoperative investigations could not render the exact diagnosis. Pneumonectomy was required in exploratris thoracotomy. Histopathologic diagnosis was fibrohistiocytic type of inflammatory pseudotumor. Four months after the operation, anemia was cured without any further treatment.

The influence of sphincterotomy and hepatic plexus vagotomy on ascending infections of the biliary tract: an experimental study in dogs.

BACKGROUND/AIMS: Hypertonic dyskinesia of the sphincter of Oddi is an important factor in the pathogenesis of postcholecystectomy syndrome, and this condition is usually treated by endoscopic sphincterotomy. However, it has been demonstrated that the biliary tract may also be contaminated after sphincterotomy. In various experimental studies, it has been established that the choledochal pressure decreases by a mean of 32% to 28% after hepatic plexus vagotomy. This experimental study was performed to investigate whether hepatic plexus vagotomy and/or sphincterotomy result in contamination of the biliary tract. METHODOLOGY: Thirty street dogs were divided into three equal groups. The three groups underwent simple laparotomy, transduodenal papillotomy, hepatic plexus vagotomy, respectively, and gallbladder bile samples were taken from all of them. Relaparotomy was performed after four weeks, and again, bile samples were taken from the gallbladder. All bile samples were examined microbiologically. RESULTS: Bacteria were not found in the first bile samples taken from the three groups. Bacteria were not found in the bile samples taken during the second surgery in the simple laparotomy and hepatic plexus vagotomy groups. However, both aerobic and anaerobic bacteria were found in the papillotomy group in seven of the ten dogs. CONCLUSION: These results demonstrate that hepatic plexus vagotomy decreased choledochal pressure and did not cause contamination of the biliary tract. It may be a treatment of choice to prevent postcholecystectomy syndrome resulting from sphincter of Oddi dysfunction.

Prevention of adriamycin-induced skin necrosis with various free radical scavengers.

Infiltration of antitumor agents into subcutaneous tissues may either result in a local area of self-resolving inflammation or progress to full-thickness loss of skin and underlying vital structures. Inadvertent extravasation of adriamycin can result in severe tissue necrosis. The mechanism of this tissue damage is believed to be release of oxygen free radicals into the tissue. After adriamycin extravasation, the treatment groups were made up according to drugs used, EGb 761, pentoxifylline, alpha-tocopherol acetate, and alpha-tocopherol succinate in rats. To prevent the necrosis and to decrease the tissue malondialdehyde levels, the most effective agent was found to be EGb 761, and pentoxifylline was also effective (P < 0.001). No difference was found between topical lanoline and saline (P > 0.05). The maximum ulcer diameter was obtained in 2 weeks. The maximum tissue malondialdehyde levels were obtained in 24 h, and in comparison to the control group the treatment groups showed lower levels. Our aim is to show the role of free radicals in the formation of skin necrosis as a cause of adriamycin extravasation and to prevent or decrease the skin necrosis using various free radical scavengers.

Immunohistochemical study on histogenesis of congenital epulis and review of the literature.

Congenital epulis is a very rare lesion found only in newborn infants. This tumor is multiple in about 10% of reported cases, rarely with the simultaneous involvement of the maxilla and mandibula, as in this article. In the presented case, light microscopy demonstrated large eosinophilic granular cells arranged in solid nests that are separated by thin fibrovascular areas. The tumors in the maxilla and mandibula were investigated with a panel of polyclonal and monoclonal antibodies, and using immunoperoxidase methods on formalin-fixed, paraffin-embedded sections. Immunohistochemical studies revealed strong and diffuse cytoplasmic staining for neuron specific enolase and vimentin. However, all other reactions were negative. These results suggest that the congenital epulis may be derived from uncommitted nerve-related mesenchymal cells.

Hydatid disease in a thyroglossal cyst.

The location of hydatid disease in organs other than the liver and lung is unusual and occasionally producing difficulties in diagnosis. Thyroglossal cyst itself is not so common, so that more careful search of thyroglossal cyst for the presence of scolex and/or laminated membrane may result in increase in frequency of such a condition in the area where hydatid disease is prevailed. Since we were unable to find a case of hydatid disease involving thyroglossal cyst, as in our present case, we feel justified in reporting this case, considering it would be the first publication in world literature.