Prevention of pleural adhesions using a membrane containing polyethylene glycol in rats.

BACKGROUND: Recurrent thoracotomies regardless of the cause are not a rare occurrence. However, each thoracotomy results in adhesion to some extent. This adhesions increase morbidity and mortality presents a significant inconvenience for surgeons and prolongs the length of operations. OBJECTIVE: We investigated the efficacy of Prevadh®, an anti-adhesion agent to prevent intrapleural adesions following thoracotomy in a rat model. METHODS: Twenty male adult Wistar Albino rats were divided into a sham group (Group A, n = 4), a control group (Group B, n = 8), and a study group (Group C, n = 8). Only left thoracotomy was performed in Group A. Group B underwent left thoracotomy, induction of adhesion, and 1 ml saline solution was administered to the thoracic cavity. However, in Group C underwent left thoracotomy, induction of adhesion, and Prevadh® was placed between the pleura and the lung. The rats were sacrificed on day 21, and adhesions were analyzed using both macroscopic and histopathological methods. The results were statistically analyzed. A value of P<0.05 was considered statistically significant. RESULTS: Mean lengths of adhesion differed statistically significantly among all three groups, while mean intensity of adhesion differed between Group A and Group B, and between Group B and Group C (P>0.05). There was also a statistically significant difference between Group A and Group C in mesothelium proliferation score (P>0.05). No statistically significant differences were found among the groups in terms of pleural thickness, macrophage and mononuclear cell infiltration (P>0.05). CONCLUSIONS: Prevadh® was shown in a rat model to effectively prevent post-thoracotomy adhesions.

Pedunculated cutaneous spindle cell/pleomorphic lipoma.

Spindle cell/pleomorphic lipoma is an infrequently seen benign adipose tissue tumor. This tumor, mostly arising from the subcutaneous tissue, usually affects male patients and occurs in back, shoulders, head and neck area. It is rarely localized to dermis. Cutaneous spindle cell/pleomorphic lipoma differs from its subcutaneous counterpart by wider anatomical distribution, female predilection and infiltrative margins. We here present a pedunculated type, cutaneous pleomorphic lipoma case localized to the nasolabial region of 59-year-old man.

Primary pulmonary extranodal marginal zone lymphoma/low grade B-cell lymphoma of MALT type combined with well-differentiated adenocarcinoma.

We describe a rare case of extranodal marginal zone/low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) combined with areas of well-differentiated adenocarcinoma. In addition, the MALT lymphoma was synchronously systemic, with involvement of the lung, stomach and duodenum.

Atypical infectious mononucleosis in a patient receiving tumor necrosis factor alpha inhibitory treatment.

The objective is to report a case of atypical acute infectious mononucleosis in a juvenile ankylosing spondylitis patient who was treated with infliximab. A 20-year-old man was hospitalized for the evaluation of lymphadenopathy and systemic symptoms. His symptoms developed at the eighth week of the infliximab treatment and he required hospitalization. Lymph node biopsy was performed and he was diagnosed as atypical infectious mononucleosis (absence of fever, pharyngitis, lymphocytosis and negative atypical lymphocytosis on blood smear). Infections have become major concerns in patients treated with TNF-blocking agents. In theoretical base, it is not surprising as TNF-alpha has a crucial role in the body's defense against both bacterial and viral invasion. Blocking the action of TNF may also change the course of the disease and could lead to a delay in the diagnosis. TNF-alpha-blocking treatment may mask the typical symptoms of infectious mononucleosis and atypical cases should be included in the differential diagnosis of lymphadenopathy in patients receiving anti-TNF-alpha agents.

Thymic enlargement in a patient with juvenile idiopathic arthritis during etanercept therapy.

Tumor necrosis factor (TNF) alpha inhibitors are effective in the treatment of inflammatory rheumatic diseases. Despite their effectiveness, anti-TNF drugs have some drawbacks such as severe adverse effects including infections and possibly lymphoproliferative disorders. In this report we described a case of juvenile idiopathic arthritis patient who developed thymic enlargement (true thymic hyperplasia), mediastinal lymphadenopathy and pleurisy associated with systemic symptoms under Etanercept treatment. The clinical presentation was highly suggestive of malignancy and the patient underwent diagnostic mediastinoscopy with biopsy.

Nodular lymphoid hyperplasia of the lung: the role of positron emission tomography in diagnosis.

Pulmonary nodular lymphoid hyperplasia (NLH) is defined as reactive lymphoid proliferation forming solitary or multiple nodules or localized infiltrates localized in the lungs. Radiological presentations are generally solitary or multiple nodules, but air bronchograms and ground glass attenuation may be present. Patients mostly asymptomatic and the lesions were detected coincidentally on routine chest X-rays. We present a case of NLH with cavitary lesion arising in the lung of a 61 year-old man who admitted with cough and massive hemoptysis. The lesion had positive fluorodeoxyglucose (FDG) uptake. To our knowledge, this is the only patient reported in the literature presenting with massive hemoptysis and a cavitary lesion with positive FDG uptake.

Diabetes insipidus caused by pituitary gland metastasis accompanied by iris metastasis of small cell lung cancer: case presentation and review of the literature.

Metastasis to the pituitary gland and iris is rarely seen in cancer patients. Breast cancer and lung cancer are the most common tumors that metastasize to these sites. Most lung cancer patients have non-small cell lung cancer and metastasis of small cell lung cancer to the pituitary gland and iris have been very rarely reported in the literature. Here we present a case of iris metastasis and pituitary gland metastasis which caused diabetes insipidus in a patient with small cell lung cancer.

[Dental technician's pneumoconiosis; a case report]. / Dis teknisyeni pnömokonyozu olgusu.

Since 1939, it has been known that, silicosis and extrinsic allergic alveolitis can be seen among dental technicians. The interstitial disease caused by the exposure to complex substances used by dental technicians is classified as a special group called dental technician's pneumoconiosis. A 36-year-old man, who has no smoking history, presented with severe dyspnea. He had worked in different dental laboratories for 22 years, but he did not have respiratory symptoms until five years ago. After that date, he had hospitalized and had been examined for respiratory pathologies for many times. He had came to our clinic, because of the progression of his dyspnea. Diffuse pulmonary parenchymal infiltrates which can be related with pneumoconiosis and chronic type 1 respiratory deficiency had been diagnosed as the result of the examinations. While he has no history of smoking or any other risk factors or diseases in his medical history, the case was accepted as dental technician's pneumoconiosis. The factors related with the pathogenesis of dental technician's pneumoconiosis are; the complex compound of the substances (metal dusts, silica, plaster, wax and resins, chemical liquids, methyl methacrylate) used in this sector and their effects on the lung parenchyma. Extrinsic allergic alveolitis related with methyl methacrylate has been reported. The most important factor to acquire an occupational lung disease is a complex occupational exposure. The insufficient workplace airing and the lack of preventive measures added on this exposure, the risks become much more greater.

The diagnostic value of TTF-1, CK 5/6, and p63 immunostaining in classification of lung carcinomas.

This study was aimed to evaluate the utility of a panel of antibodies, consisting of thyroid transcription factor-1 (TTF-1), p63, and cytokeratins (CK) 5/6 for distinguishing between small cell lung carcinoma (SCLC) and nonsmall cell lung carcinoma, as well as for identifying glandular or squamous differentiation in small tissues obtained by bronchoscopy. Bronchoscopic biopsies of 77 lung carcinoma cases with easily recognizable morphologic features were included in this study. All the cases were immunohistochemically stained for p63, CK5/6 [indicators of squamous cell carcinoma (SCC)] and TTF-1 [indicator of SCLC and adenocarcinoma (AC)]. Although, 28 SCLC displayed TTF-1 positive, p63 negative immunoprofile, most of the SCC (32/39) had the opposite immunoprofile. All of the 10 ACs were negative for p63 and most of them (8/10) were negative for CK5/6. p63 and CK 5/6 seem to be useful for differentiating AC and SCLC from SCC with 100% specificity and 82% sensitivity, 89% specificity and 79% sensitivity, respectively. It seems that to achieve histologic typing of lung cancer as accurate as possible, TTF-1 in combination with p63 and CK 5/6 might be useful components of immunohistochemical analysis of poorly differentiated lung carcinomas in biopsy tissues.

Fibrosis in Hodgkin and non-Hodgkin lymphomas.

There is little quantitative information about the amount of fibrosis in lymphomas. The aim of the present study was to investigate the amount of fibrosis in lymphomas and to highlight the relationship between fibrosis and mast cells, the key players of fibrosis. Tissue sections of 60 patients with diagnosis of lymphoma were reevaluated for classification. The mean fibrotic-stained area percentage (F-SAP) was determined in van Gieson-stained digital images using image analysis (Mediscope, Dokuz Eylul University, Clinical Engineering, Turkey). Mast cells were visualized using streptavidin peroxidase immunohistochemistry with anti-tryptase staining. Twenty-seven (44%) cases were Hodgkin's lymphoma (HL). F-SAP was 11.09+/-8.96 and 1.72+/-1.76 for HL and non-HL cases (Mann-Whitney U, p<0.000), and the mean mast cell count (MMCC) was 24.63+/-13.58 and 8.03+/-8.07, respectively (Mann-Whitney U test, p<0.000). There was a significant difference between F-SAP and MMCC concerning different types of lymphomas (Kruskal-Wallis test, p>0.000). F-SAP was highest in nodular sclerosis HL, and MMCC was highest in mixed cellular HL. There was a strong positive correlation between MMCC and F-SAP (Pearson Correlation test, p<0.000, r=0.51). These results suggest that the amount of fibrosis demonstrates differences in subtypes of lymphomas, and mast cells are increased in fibrosing lymphomas. However, it seems likely that more than one cell type is involved.

Prognostic significance of cell proliferation and apoptosis-regulating proteins in Epstein-Barr virus positive and negative pediatric Hodgkin lymphoma.

Apoptosis-related genes and proteins and proliferation activity and their relationship with Epstein-Barr virus (EBV) is a contemporary issue. In this study, prognostic or pathogenetic roles of EBV latent infection, proliferating activity, and apoptosis-regulating proteins in pediatric Hodgkin lymphomas were explored. EBV-EBER, lmp-1, ki-67, bcl-2, survivin, Bax, fas, c-myc, and p53, and apoptotic index were analyzed in 63 pediatric Hodgkin lymphoma cases. The results were evaluated by chi-square, Mann Whitney U test, Pearson correlation analysis, and Kaplan Meier survival analysis. Thirty-two cases were stage I or II, whereas 31 cases were stage III or IV. The mean age was 8.4 +/- 63.54 years. EBV was positive in 52 (82.5%) cases. Overall survival was 94% and event-free survival 83.6%. Bax expression was observed 74.6%, bcl-2 47.6%, survivin 43%, p53 33.3%, fas 54%, and c-myc 25.4%. The mean apoptotic index was 18.22%. The mean proliferation index was 57.83%. The proliferation index was positively related with EBV but not with prognosis. None of the parameters were related with prognosis. EBV was negatively related with the apoptotic index. There were no relationships between bax, bcl-2, survivin, p53, fas, and c-myc with EBV. These results suggest that EBV might play a role in Hodgkin lymphoma pathogenesis by inducing proliferative activity and inhibiting apoptosis. Apoptosis-related proteins were not correlated with EBV. None of the parameters was found to predict prognosis.

Follicular bronchiolitis associated with lung abscess in an eight-year-old girl.

Hemoptysis as a result of pulmonary or bronchial pathologies is a rare but potentially serious problem in childhood. The presented case is an eight-year-old previously healthy girl who was admitted to the emergency department because of recurrent hemoptysis. Because high resolution computerized tomography (HRCT) showed an abscess cavity, antibiotic therapy was continued about six weeks. Lobectomy was done when massive hemoptysis recurred. Histopathological examination revealed follicular bronchiolitis, which is a very rare entity, particularly in childhood. Although HRCT imaging is of great value in the diagnosis of this disease, in our case it failed to show any evidence of follicular bronchiolitis. In conclusion, the definitive diagnosis of follicular bronchiolitis always requires histopathologic examination of open lung biopsy.

Indocyanine green angiographic features of systemic non-Hodgkin's lymphoma and bilateral choroidal involvement.

A 35-year-old man with systemic non-Hodgkin's lymphoma and bilateral choroidal involvement is described. Indocyanine green angiography depicts choroidal involvement much better than fluorescein angiography and seems to be superior in diagnosing and monitoring patients with systemic non-Hodgkin's lymphoma and choroidal involvement.

[A case of resistant pulmonary and cerebral aspergillosis successfully treated with voriconazole]. / Vorikonazol ile tedavi edilen dirençli pulmoner ve serebral aspergilloz olgusu.

Invasive pulmonary aspergillosis (IPA) is the most common fungal pulmonary infection in immunocompromised patients. In this disease, it is hard to diagnose, it's therapy process is variable and mortality is high. Prognosis is even worse in the cases which have cerebral aspergillosis. The patient was following up as a diagnosis of usual interstitial pneumonia and treating with corticosteroids and azothiopurine. Patient attended our clinic with headache and lose of vision. IPA and cerebral aspergillosis was the diagnosis as his examinations. Amphotericin B lipid complex treatment were given because of pulmonary and cerebral aspergillosis. Voriconazole was the second therapy because of the no response. Voriconazole is more effective in cerebral aspergillosis and treated this patient successfully.

Acute trichinellosis in children compared with adults.

OBJECTIVES: Trichinellosis is a cosmopolitan parasite infection caused by Trichinella nematodes that is acquired from consumption of raw meat from several animal species. Knowledge of the clinical pattern and laboratory features of the disease in childhood is limited. The purpose is to study the clinical pattern of trichinellosis caused by Trichinella britovi in children and to compare it in household adults. METHODS: We evaluated all children up to 17 years of age and their adult householders exposed to the consumption of infected meat during an outbreak of trichinellosis. A questionnaire was developed to record clinical data. The blood sample was collected for blood count, muscle enzymes, serum electrolytes, albumin and serology. All exposed children were treated with mebendazole, and severe symptomatic patients received prednisolone. Clinical and laboratory presentations and outcome were recorded. To evaluate the clinical picture of trichinellosis in childhood, clinical and laboratory findings were compared between children and household adults with a confirmed diagnosis who consumed the same amount of infected meat. RESULTS: In 47 (62%) of 76 children with suspected trichinellosis, the diagnosis was serologically confirmed. The main clinical and laboratory findings in children were fever, abdominal pain, myalgia, facial and/or eyelid edema, rash, eosinophilia and increased muscular enzymes. The incubation period was similar in children and adults, but myalgia (66% versus 96%, P < 0.01), facial and/or eyelid edema (57% versus 86%, P < 0.05), eosinophilia (52% versus 96%, P < 0.01) and increased serum creatine kinase (38% versus 79%, P < 0.01) were less common in children than in adults. Seroconversion occurred in fewer children than adults, but the difference was not statistically significant. CONCLUSIONS: T. britovi infection shows a benign course and a milder clinical picture in children than in adults who consumed the same amount of infected meat.

[Dedifferentiated Liposarcoma with Peculiar Meningothelial-Like Whorling and Metaplastic Bone Formation, Case Report]. / Meningotelyal Benzeri Girdapsi Yapilar ve Metaplastik Kemik Yapimi ile Karakterli Dediferansiye Liposarkom Olgusu.

Dedifferentiated liposarcoma represents a both morphologically and biologically fascinating lesion in which transition from low-grade to high-grade nonlipogenic morphology within a well-differentiated liposarcoma is observed. A peculiar form of dedifferentiated liposarcoma characterized by a nonlipogenic component with a meningothelial- like whorling pattern of growth and metaplastic bone formation has been described. A 59-year-old man presented with a pelvic retroperitoneal mass measuring 13x10x8 cm. Histopathologically the mass consisted almost entirely of a dedifferentiated nonlipogenic component with meningothelial-like whorling pattern, metaplastic cartilage and bone. Dedifferentiated liposarcoma with meningothelial- like whorling pattern has rarely been encountered. Here, we report this case because of the problems in differential diagnosis especially for cases that have an extensive dedifferentiated component and the uncertainty of the biological behavior of these tumors.

Association of macrophages, mast cells and eosinophil leukocytes with angiogenesis and tumor stage in non-small cell lung carcinomas (NSCLC).

The association between inflammatory cells, including tumor associated macrophage (TAM), mast cell (MC) and eosinophil leucocyte (EL) densities and angiogenesis, as well as the relation of TAM, MC and EL densities and angiogenesis to tumor stage were investigated in specimens of 63 non-small cell lung carcinoma (NSCLC). Fifteen cases were in stage I, 12 were in stage II, 33 were in stage III and 3 were in stage IV. ELs and MCs were identified by hematoxilen-eosin and toluidine-blue histochemical stains, respectively. TAMs were shown by immunohistochemistry for CD68. Microvessels demonstrated by immunohistochemistry for CD31 were quantified by a stereological method and vascular surface density (VSD) and microvessel number (NVES) were calculated. There was not any statistically significant correlation between tumor's stage and VSD, TAM and EL counts. MC count and NVES were found to be higher in early stages. VSD and NVES were not associated with EL, MC and TAM counts. The lack of consistent correlation of angiogenesis to the stage of disease in this study supports the view that tumor angiogenesis is not a significant prognostic factor in NSCLCs. The absence of correlation between MCs, ELs and TAM counts and angiogenesis and absence of any relation between ELs and TAMs and tumor stage are discordant with the results of some of the previous studies in NSCLCs and in other tumors. The differing results may be due to wide variations in methodologies which were used for demonstration of inflammatory cells and vessels and variations in the degree of activation and complexity of functions of these cells.

Gingival involvement in a patient with CD56+ chronic myelomonocytic leukemia.

Leukemic infiltration of the gingiva is most commonly reported to be associated with monocytic subtypes of acute myeloblastic leukemia (AML) but rarely with myelodysplastic syndromes (MDS). Here we report a case of CD56+ chronic myelomonocytic leukemia (CMML) who developed gingival involvement simultaneously when the leukocyte count elevated. At that time no increase in peripheral or bone marrow blasts were observed. Gingival hypertrophy regressed with the treatment of hydroxyurea. Three months later, bone marrow blast count elevated and the patient was treated with two courses of AML-like regimen and then one course of consolidation therapy. The patient is in complete hematological remission for one and a half years. Similar to other extramedullary involvements, gingival hypertrophy in CMML can be a harbinger of the disease entering a more aggressive phase requiring systemic chemotherapy.

EBV-associated nasal-type T/natural killer cell lymphoma presenting with polyserositis and rhabdomyolysis.

Nasal-type T/natural killer (NK)-cell lymphoma, a distinct clinicopathological entity is highly associated with Epstein-Barr virus which shows an aggressive course. We present a CD56+ nasal-type T/(NK)-cell lymphoma case with systemic manifestations of rhabdomyolysis and polyserositis who died of multiorgan failure shortly after his admission to hospital in spite of adequate chemotherapy and supportive care.

Tenascin C and cathepsin d expression in adipocytic tumors: an immunohistochemical investigation of 43 cases.

Cathepsin D (CatD) and tenascin C (Tn-C) have been implicated in invasion and metastasis of carcinomas. However, little is known about CatD and Tn-C distribution in mesenchymal tumors. Therefore, we aimed to investigate the expression of Tn-C and CatD in adipocytic tumors. Tn-C and CatD expressions in 27 lipomas, 5 atypical lipomatous tumor/well-differentiated liposarcomas (ALT/WDLS) and 11 liposarcomas (LS) were evaluated by immunohistochemistry and scored semiquantitatively. CatD expression was higher in ALT/WDLS than in lipomas (p<0.001), and higher in LS than in ALT/WDLS (p=0.009). Stromal Tn-C expression was higher in ALT/WDLS than in lipomas (p=0.02), but no difference was observed between ALT/WDLS and LS (p>0.05). These results indicate that Tn-C and CatD may be markers of locally aggressive or malignant behavior in adipocytic tumors.