Evaluation of circulating cell-free nucleic acids in health workers occupationally exposed to ionizing radiation.

Radiology workers might constantly be exposed to low-dose ionizing radiation due to their profession. Low doses of radiation in a short exposure time have the potential to alter the genome, which might potentially lead to diseases. The main objective of this study was to determine whether the amount of cell-free nucleic acids in plasma samples of radiation-exposed workers was different from the general public, in other words, non-exposed individuals. In this context, we investigated the association between radiation exposure and cell-free nucleic acids concentration by using radiation exposure parameters. The study consisted of 40 radiology workers and 40 individuals who were not exposed to ionizing radiation. The plasma concentrations of cell-free DNA, RNA, and miRNA were measured fluorometrically. We found that the ccfRNA concentration of the radiation-exposed group was significantly different from that of the non-exposed group (p = 0.0001). However, there are no differences between both groups in terms of ccfDNA and ccfmiRNA concentration. The concentration of ccfDNA is significantly correlated with working time in the fluoroscopy field (p < 0.05). We found that the concentration of ccfmiRNA was significantly correlated with working time in plain radiography (p < 0.01) and computed tomography (p < 0.05) and with total working time (p < 0.01). Similarly, the concentrations of ccfRNA were significantly correlated with working time in computed tomography (p < 0.01) and with the total working time (p < 0.05) of the workers. We found that imaging number in computed tomography significantly altered the level of ccfRNA (p = 0.006) and that working time in the computed tomography field significantly affected the ccfRNA concentration (p = 0.03, R2 = 0.36 for model). Finally, we determined that total working time was significantly associated with total ccfRNA concentration (p < 0.05, R2 = 0.25 for model). In conclusion, total RNA measured in radiation-exposed workers has the potential to predict the radiation exposure risk. Furthermore, total working time and working time in the tomography field significantly alter the level of free nucleic acids.

Patterns of motor branching of the musculocutaneous nerve in human fetuses and clinical significance.

The purpose of this morphologic study is to investigate the course and the branching pattern of motor branches of musculocutaneous nerve (MCN) in human fetuses. Twenty upper limbs (10 right, 10 left) of spontaneously aborted formalin-fixed fetuses were dissected under a stereomicroscope to determine motor branches for the biceps brachii and brachialis and the communicating branches between the MCN and median nerve (MN). The MCN entered the proximal and middle part of coracobrachialis in 13/20 and 5/20 of arms, respectively, and the remaining 2/20 did not pierce coracobrachialis. The communication between MCN and MN was observed in 5/20 of the arms and detected only in the distal part of the coracobrachialis. The most frequently observed innervation is the type wherein a single branch to biceps brachii, which bifurcated for supplying the short and long heads (12/20). For the innervation of brachialis, the most frequent type was a single branch from the main trunk of the MCN (15/20). During the dissections, the distance between the acromion and the emerging point of the motor branches was measured. The mean distance between the acromion and the emerging point of the all motor branches for biceps brachii in all types of specimens was 33.8 ± 6.1% of acromion-lateral epicondyle length and for brachialis was 50.6 ± 11.5% of acromion-lateral epicondyle length. The data of the MCN variations in the human fetus may be useful for the clinicians and pediatric surgery.

[Analysis of genetic penetrance in the pedigree of cases with Van der Woude syndrome: report of five cases]. / Van der Woude sendromlu olgularimizin soyagacinda genetik penetransin analizi: bes olgu sunumu.

Van der Woude syndrome is a congenital abnormality characterized by labial cysts, accessory salivary glands, pits, fistulas and paramedian sinuses of the lower lips, and is frequently associated with cleft lip and palate. This disease is the most common syndromic cleft abnormality. The disease is characterized by a single gene abnormality where craniofacial morphogenesis is affected. It has an autosomal dominant inheritance with involvement of 1q32-41 chromosomal locus. However, the gene expression profile is variable and the disease may present in some individuals with sinuses of the lower lips only. We present results of analysis of genetic penetrance in the pedigree of five cases with Van der Woude syndrome together with a review of the literature.

Quercetin associated with dimethylsulfoxide has a curative effect on experimental colon anastomosis injury.

Purpose To examine the effects of quercetin on healing of experimental colon anastomosis injury in early and late period. Methods Eighty male Wistar-Albino rats were divided into 8 groups. For all groups, left colons of the rats were resected and for the rest end-to-end anastomosis was performed. Two of the groups for which the experiment protocol was ended on the 3rd and 7th day following the anastomosis were not administered with either quercetin or dimethylsulfoxide DMSO, whereas two other groups were administered with DMSO only, and four other groups were administered with quercetin dissolved in DMSO in doses of 20 and 100 mg/kg during the protocol. At the end of the study, anastomosis line was resected, histopathological evaluation was performed and bursting pressure, malondialdehyde, superoxide dismutase, catalase, and hydroxyproline levels were measured. Results Quercetin significantly increased hydroxyproline, superoxide dismutase, catalase levels, histopathological healing score, bursting pressure values and decreased malondialdehyde level in early period. It also significantly increased superoxide dismutase, catalase, and hydroxyproline levels and decreased malondialdehyde level in late period. Conclusion It was seen that quercetin speeds up the injury healing process and reveals an antioxidant effect, specifically in early period.

Distraction osteogenesis is inhibited by cancer radiotherapy with Co 60.

AIM: To investigate the effects of radiotherapy on distraction osteogenesis performed on the same bone in an area that has not received radiation. Radiotherapy (Co60) was carried out in a region where tumors may develop, and then, on the assumption that the tumoral region had been removed, distraction osteogenesis was carried out, and the effects were investigated. METHOD: Thirty New Zealand rabbits were randomized into two groups, a study group (15 rabbits) and a control group (15 rabbits). In the study group, Co60 was administered by teletherapy to the distal half of the left tibia. Rabbits in the control group were kept in the same environment for the same period, but were not subjected to radiotherapy. Four weeks after radiotherapy, osteotomy was performed on the proximal part of the left tibia of all subjects, and distraction was carried out until 10mm. After distraction was completed, the outcomes were evaluated radiologically, scintigraphically, and histopathologically, and the results were compared. RESULTS: New bone formation achieved through distraction osteogenesis in the study group animals was inadequate, while new bone tissue achieved in the control group was superior (P < 0.001). CONCLUSION: Radiotherapy has a negative effect on distraction osteogenesis, even if performed on a different part of the bone.

Whole-body exposure of radiation emitted from 900 MHz mobile phones does not seem to affect the levels of anti-apoptotic bcl-2 protein.

The purpose of the present study was to investigate the anti-apoptotic bcl-2 protein in rat brain and testes after whole-body exposure to radiation emitted from 900 MHz cellular phones. Two groups (sham and experimental) of Sprague-Dawley rats of eight rats each were used in the study. Exposure began approximately 10 min after transferring into the exposure cages, a period of time when rats settled down to a prone position and selected a fixed location inside the cage spontaneously. For the experimental group, the phones were in the speech condition for 20 min per day for 1 month. The same procedure was applied to the sham group rats, but the phones were turned off. Immunohistochemical staining of bcl-2 was performed according to the standardized avidin-biotin complex method. The results of this study showed that 20 min of the radiation emitted from 900 MHz cellular phones did not alter anti-apoptotic bcl-2 protein in the brain and testes of rats. We speculate that bcl-2 may not be involved in the effects of radiation on the brain and testes of rats.

A case of solitary angiokeratoma circumscriptum of the tongue.

Angiokeratoma circumscriptum is an uncommon vascular entity. The lesion is present at birth and usually involves the lower extremities. A 9-year-old girl presented with multiple pink-colored, small-raised lesions in the dorsal part of her tongue, which had been present since birth. There was no history of trauma, cold injury, or similar lesions elsewhere in her body. She complained of pain and rare bleeding from the lesions after eating hard foods. Physical examination showed multiple, grouped, erythematous, shiny papules mostly in the dorsal aspect of the tongue. There were no other lesions in other parts of the oral mucosa. After an incisional biopsy of the lesion, the diagnosis was made as solitary angiokeratoma circumscriptum.

Auricular mucormycosis: a case report.

Mucormycosis is a rare, saprophytic, invasive, and fulminant fungal disease. It occurs in immunocompromised patients such as those with diabetes mellitus or blood dyscrasia, or in patients under immunosuppressive therapy. A 17-year-old female patient with diabetic ketoacidosis presented with a black-colored lesion in the auricle and external ear canal. Physical examination showed necrosis of the auricle, external ear canal, and neighboring skin. She also had facial paralysis. Debridement of the necrotic tissues was performed and the samples were submitted for microbiologic and histopathologic examination, which showed nonseptate hyphae. Postoperatively, systemic amphotericin B was empirically administered. The patient died on the seventh day.

A proposal for a new and more practical grading scheme for pancreatic ductal adenocarcinoma.

There is no uniformly applied grading system for pancreatic ductal adenocarcinoma (DA). The scheme advocated by the WHO is essentially that of Kloppel et al, and is based on the "highest grade" focus. Although it is precise with good prognostic value, it is unfortunately not widely applied, largely because of the lack of recognition and partly because of its complex nature (interpretation of multiple parameters). Furthermore, it is fundamentally different from the one used in Japan, which evaluates the overall pattern. To establish a more widely applicable, practical, and clinically relevant grading system, a scheme similar to Gleason's scoring system was developed and tested on 112 cases of resected pancreatic DA and was compared with the WHO system. In the grading system devised, patterns (P) of infiltration were classified as follows: P1, well-defined glands with easily discernible contours; P2, fused or poorly formed glands with ill-defined contours; P3, nonglandular patterns. A score was then obtained by the summation of the predominant and the secondary patterns. Scores < or =3 (at least some well-formed glands and no nonglandular pattern) was graded as G1, 4 as G2, and > or =5 (at least some nonglandular patterns and no well-formed glandular pattern) as G3. Seventy-three percent of the cases displayed mixed patterns, with disparate patterns (P1 with P3) in 13%, confirming the high degree of heterogeneity of DA. There was a significant correlation between grade and survival, better than the correlation between survival and either the major or minor patterns evaluated separately. The median survival for G1, G2, and G3 were 22, 14, and 8 months; 1-year survival 68%, 44%, and 33%; 2-year was 67%, 11%, and 0%; and 3-year was 23%, 4%, and 0%, respectively (P = 0.0019). In a multivariate analysis, correlating survival with grade, tumor size, and lymph node status, the grade was the strongest independent predictor of survival. Odds ratio of dying of disease were 3.56 (P < 0.0001) in G3 versus G1, 1.79 (P = 0.058) in G2 versus G1, and 1.98 (P = 0.03) in G3 versus G2. Compared with this, the same odds ratio were 1.17 (P = 0.01) in tumors >2 cm versus < or =2 cm and 1.78 (P = 0.01) in cases with positive versus negative lymph nodes. The WHO grading scheme was not found to have as good a correlation with survival in this study, with WHO grade 2 showing a better survival than 1. The reproducibility of both the proposed grading system and that of WHO were found to be moderately good (with kappa values of 0.43 and 0.44, respectively), when 32 slides of DA were graded by four independent observers. The grading scheme for pancreatobiliary adenocarcinoma proposed here is highly applicable because it is practical and readily adoptable. It reflects biologic characteristics of ductal carcinoma (prominent tubule formation and tumor heterogeneity). Most importantly, it is clinically relevant with good prognostic value. Lastly, it is also applicable for use in research, by utilizing "patterns," even in small specimens like microarrays or biopsies.

Coagulation parameters in the patients with Fournier's Gangrene.

AIM: In this prospective study, we aimed to determine the coagulation parameters in the patients with Fournier's gangrene. METHODS: The study group is consisted of 12 consecutive Fournier's gangrene patients (11 men and 1 woman) and control group is consisted of patients with periurethral abscess (n = 2), scrotal abscess (n = 4) and epididimorchitis (n = 4). Fibrinogen, protein C, protein S, antithrombin III, lupus anticoagulant, cardiolipin IgG and IgM, prothrombin time-international normalized ratio, activated partial thromboplastin time, platelet count, proaccelerin, antihemophilic globulin (FVIII), albumin, and calcium were evaluated in all subjects. Tissue specimens were taken from Fournier's gangrene patients. These specimens were tested for arterial and venous thrombosis using light microscopy. RESULTS: All of the patients with Fournier's gangrene had both arterial and venous thrombosis in tissue specimens. The levels of fibrinogen and FVIII were high, the level of protein C was low in 12 patients. Lupus Anticoagulant was positive 11 of 12 patients. CONCLUSIONS: According to our findings, we think that some coagulation parameters (FVIII, Lupus anticoagulant, protein C, fibrinogen) may be diagnostic for Fournier's gangrene.

Atypical Localization of Enchondroma in the Calcaneus.

A 53-year-old man presented to the orthopedic outpatient clinic with pain and swelling in the right heel without any trauma. On physical examination and radiologic assessment, a lesion with calcification and peripheral sclerosis was detected in the medullary cavity of the calcaneus, and computed tomographic images revealed cortical thinning adjacent to the lesion. Magnetic resonance images showed a 23 × 19-mm lesion. Tru-Cut biopsy, performed to clarify the diagnosis, revealed an enchondroma. As a definitive treatment, curettage of the lesion and grafting of the cavity was performed. Although enchondromas are common pathologic abnormalities of the skeleton and are usually asymptomatic, atypical localization, such as the calcaneus, and atypical clinical manifestations, such as heel pain, should also be kept in mind.

Atypical Localization of Enchondroma in the Calcaneus.

A 53-year-old man presented to the orthopedic outpatient clinic with pain and swelling in the right heel without any trauma. On physical examination and radiologic assessment, a lesion with calcification and peripheral sclerosis was detected in the medullary cavity of the calcaneus, and computed tomographic images revealed cortical thinning adjacent to the lesion. Magnetic resonance images showed a 23 × 19-mm lesion. Tru-Cut biopsy, performed to clarify the diagnosis, revealed an enchondroma. As a definitive treatment, curettage of the lesion and grafting of the cavity was performed. Although enchondromas are common pathologic abnormalities of the skeleton and are usually asymptomatic, atypical localization, such as the calcaneus, and atypical clinical manifestations, such as heel pain, should also be kept in mind.

The Effect of Systemic Carnitine Administration on Colon Anastomosis Healing in an Experimental Sepsis Model.

AIM: This study aimed to investigate the effects of L-carnitine, with its known antioxidant properties and positive effects on wound healing, on the healing of colon anastomosis in a cecal ligation and puncture sepsis model in rats. MATERIALS AND METHODS: A total of 40 Sprague-Dawley rats were used. The rats were randomly divided into four groups of 10 (n = 10). Groups 1 and 2 had laparotomy and colon anastomosis performed. Groups 3 and 4 had cecal ligation and puncture (CLP) and colon anastomosis performed. Rats in Groups 1 and 3 were given 15 mL/kg intraperitoneal 0.9% isotonic NaCl, while the rats in Groups 2 and 4 were given 100 mg/kg intraperitoneal L-carnitine. On the postoperative fifth day, the rats were sacrificed and the burst pressure of anastomosis, histopathological effects, and tissue hydroxyproline levels were investigated. RESULTS: In Groups 2 and 4, the anastomosis burst pressure and histopathological results in both noninfected abdomen and presence of peritonitis were statistically high compared to the control group (p < 0.05). Though the hydroxyproline levels were also high, there was no statistically significant difference for this parameter (p > 0.05). CONCLUSIONS: The findings obtained from the experimental sepsis model showed that healing of anastomosis in both the presence of peritonitis and noninfected abdomen was positively affected by the systemic administration of L-carnitine and this may contribute to the safety of anastomosis.

Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature.

The vast majority of pancreatic carcinomas are primary, and, among these, more than 90% are of ductal origin. However, a variety of extrapancreatic tumors may involve the pancreas secondarily and may manifest different clinicopathological characteristics and outcomes. In this study, pathology material from 973 surgical specimens and 4955 adult autopsy cases was reviewed to identify the tumors metastatic to or secondarily involving the pancreas. Biliary and periampullary neoplasms and tumors confined to peripancreatic soft tissue were excluded. In the autopsy series, the pancreas was involved by tumor in 190 cases, and 81 of these were secondary tumors. These were predominantly of epithelial origin, most commonly from lung (34), followed by GI tract (20), kidney (4), breast (3), liver (2), ovary (1), and urinary bladder (1). In addition, there were six tumors of hematopoietic origin, two melanomas, two sarcomas, and two mesotheliomas. Among the 973 surgical specimens, 38 cases contained metastatic tumors to the pancreas. Of these, 11 were lymphomas, and the others were carcinomas of stomach (7), kidney (6), lung (2), liver, prostate, ovary, uterus (1 case of each), and a Merkel cell carcinoma. In addition, there were three malignant gastrointestinal stromal tumors and one retroperitoneal leiomyosarcoma. In conclusion, lung cancer is the most common source of metastasis to pancreas, followed by gastrointestinal carcinomas and lymphomas. These tumors are usually seen in patients with disseminated disease and are detected mainly in autopsies. Secondary tumors constitute about 4% of pancreatic specimens in the authors' surgical database. Approximately one-third of them are clinically mistaken as primary tumors of the pancreas. These are predominantly hematopoietic malignancies or carcinomas of renal or gastric origin. Secondary tumors should be entertained in both the clinical and pathological differential diagnosis of pancreatic neoplasia.

A severe hepatitis flare in an HBV-HCV coinfected patient during combination therapy with alpha-interferon and ribavirin.

We report a reactivation of hepatitis B virus infection and a severe hepatitis flare in a patient with chronic hepatitis due to dual infection with hepatitis B and C viruses during combination therapy with alpha-interferon and ribavirin. Pretreatment, HCV was the dominant virus, with detectable serum HCV-RNA but undetectable HBV-DNA. The patient responded to therapy, with the disappearance of HCV-RNA and normalization of serum alanine aminotransferase (ALT) at months 1 and 6. In the seventh month of therapy, an ALT flare was observed, and serum HBV-DNA became detectable. The patient had a severe hepatitis flare leading to impending hepatic failure. Treatment was discontinued and the patient had marked clinical and biochemical improvement and recovered with normalization of liver function test results within 1 month. Two months later, serum HBV-DNA was again undetectable, both by hybridization and polymerase chain reaction (PCR) assays. The patient had a rapid progression to cirrhosis in a year. At month 24, 17 months after the end of therapy, serum HCV-RNA reappeared, with a level of 2.4 x 10(5) copies/ml. In conclusion, severe HBV reactivation may occur during interferon plus ribavirin therapy in patients with chronic hepatitis C who are also hepatitis B surface antigen (HBsAg)-positive, and thus more careful monitoring than usual should be considered. Longterm follow-up is recommended, because very late HCV relapses may occur in coinfected patients. These data exemplify the complexity of viral dominance in patients infected with multiple hepatitis viruses, and this has significant importance for treatment decisions. Lamivudine may be administered early in HCV-RNA/HBsAg-positive patients who are at high risk of liver failure once reactivation of HBV occurs during interferon therapy.

Evaluation of optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori, gastric atrophy and intestinal metaplasia.

BACKGROUND/AIMS: The study is designed to identify the optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori, gastric atrophy and intestinal metaplasia. METHODOLOGY: Ninety-two patients were included in the study, gastric biopsies were obtained from 5 different sites: lesser curvature of the mid-antrum (A1), greater curvature of the mid-antrum (A2), incisura angularis (IA), lesser curvature of the mid-corpus (B1), greater curvature of the mid-corpus (B2). Helicobacter pylori was evaluated in sections stained with toluidine blue, and histopathological examination was performed in sections stained with hematoxylin-eosin. RESULTS: Seventy-three patients were positive for Helicobacter pylori at least in one biopsy site. Helicobacter pylori was positive in 47 patients (64.3%) in A1, in 54 patients (73.9%) in A2, in 60 patients (82.1%) in IA, 44 patients (60.2%) in B1, and in 42 patients (57.5%) in B2. The highest positivity determined was in the combination of A2 and IA sites (95.8%). Gastric atrophy was determined in 35 of 73 patients (27.1% in A1, 20% in A2, 25.7% in IA, 20% in B1, and 7% in B2). Intestinal metaplasia was determined in 31 of the Helicobacter pylori-positive patients (18% in A1, 16% in A2, 30.9% in IA, 21.8% in B1, 12.7% in B2). CONCLUSIONS: It is considered that taking biopsies from both A1 and IA sites has the highest sensitivity in detecting Helicobacter pylori. However, it is difficult to define a specific site for detecting gastric atrophy and intestinal metaplasia.

Clear cell carcinoma of the liver: a case report.

Hepatocellular carcinoma represents the 8th most frequent malignancy worldwide. The World Health Organization recognizes five histologic patterns and four cytologic variants of hepatocellular carcinoma. Clear cell carcinoma of the liver is a well-defined variant of hepatocellular carcinoma in which a large number of cells show clear cytoplasm that does not stain with hematoxylin and eosin. It can be confused with other clear-cell malignancies. A 52-year-old man presented with mild dyspeptic symptoms, right-sided upper abdominal pain, weakness, weight loss, abdominal mass and jaundice symptoms for nearly six weeks. After diagnostic procedures, an ultrasonography-guided liver biopsy was performed. In microscopic examination, malignant cells with vacuolated foamy to clear cytoplasm and central and eccentric nuclei, tumor composed of solid mass and cords, and clear cells were observed, and hepatocellular carcinoma, clear cell variant, is diagnosed. We report this rare case of primary clear cell carcinoma in the cirrhotic liver. The case was discussed in detail regarding histological presentation, with particular attention to histopathologic differential diagnosis.

Cyclopia.

True cyclopia is a rare anomaly in which the organogenetic development of the 2 separate eyes is suppressed. We report a fetus with an association of cyclopia with other anomalies. The possible mechanism of the histogenesis is discussed, together with a review of the relevant literature.

Examination of the distribution of mast cells in the nasal mucosa of patients with seasonal allergic rhinitis.

OBJECTIVE: It is known that mast cells play an important role in pathogenesis of allergic rhinitis. In this study, we investigated the distribution of mast cells in the nasal mucosa of patients with seasonal allergic rhinitis during the pollen-season. METHODS: This study was carried out at the Faculty of Medicine, Dicle University, Turkey, during the grass-pollen season between, March and July in 2002. Twenty patients with seasonal allergic rhinitis (12 females and 8 males) and 20 healthy (10 females and 10 males) non-allergic controls were examined for the distribution and abundance of mast cells in nasal biopsies. Biopsies were performed in all patients and controls, once during natural provocation in the spring and were taken from the lower edge of the inferior turbinate using a forceps. The samples of nasal mucosa were fixed in 10% neutral buffered formaline, stained with 0.5% aqueous toluidine blue and hematoxylin and eosin were examined under a light microscope. RESULTS: Mast cells were observed in the nasal mucosa obtained from 12 patients (60%) and 5 patients (25%) controls cases (p=0.025). It was found out that intrapitelial mast cells are present in nasal mucosa samples of patients with SAR (seasonal allergic rhinitis) but not in the epithelium of non-allergic controls. CONCLUSION: The number of submucosal mast cells has considerably increased in the nasal mucosa samples of patients with SAR. Besides this, these cells are determined in great amounts in non-allergic individuals.

Strong association of HMB-45 expression with renal angiomyolipoma.

OBJECTIVE: Angiomyolipoma (AML) is a benign neoplasm consisting of varying mixtures of smooth muscle, blood vessels and fat. Although, most of these tumors are easy to recognize, some may pose a diagnostic dilemma due to unusual histologic features. Recently, it was suggested that melanosome-associated protein (HMB-45) immunoreactivity may be used for diagnostic confirmation of several neoplasm. The aim of this study is to analyze the diagnostic efficacy of HMB-45 in patients with AML. METHODS: This study was carried out at the Faculty of Medicine, Department of Pathology, Dicle University, Diyarbakir, Turkey, during the period January 2000 to September 2003. HMB-45 immunoreactivity was analyzed in 6 patients with AML and in 34 patients with other renal and retroperitoneal pathologies, including 10 nephrectomized patients for non-neoplastic reasons by means of immunohistochemistry. RESULTS: Patients with AML were positive for HMB-45. Whereas, HMB-45 immunoreactivity was negative in all of the histologic specimens from the patients with renal cell carcinoma, retroperitoneal sarcomas, Wilms' tumor, lipoma, leiomyoma, and nephrectomized kidneys of non-neoplastic reason. The association of AML with HMB-45 immunoreactivity was highly significant (p<0.001). CONCLUSION: Our findings suggest that HMB-45 may not be a melanocyte-restricted marker, and can be useful in differential diagnosis between AML and other tumors seen in kidney and retroperitoneal region.