IS THERE A RELATIONSHIP BETWEEN TUBEROUS SCLEROSIS COMPLEX AND INSULINOMA?

Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disease characterized by multiple hamartomas in multiple organs. However, there is limited evidence about neuroendocrine tumors (NETs) in patients with TSC, and routine screening of NETs is not recommended in the guidelines. Insulinomas are also an extremely rare disease. According to our knowledge, we presented the 10th TSC patient diagnosed with insulinoma in the literature. Thirty-two years old male patient diagnosed with TSC at the age of 27 due to typical skin findings, renal angiomyolipoma, history of infantile seizures, and cranial involvement was referred to our clinic. The main symptoms of the patient were palpitations, diaphoresis, confusion, and symptoms were improved after consuming sugary foods. Seventy-two hours fasting test was performed, and a low glucose level at 41 mg/dl, a high insülin level at 21.65 µIU/mL, and a high C-peptide level at 7.04 ng/mL were found at the 8th hour. In addition, a 12x7 mm lesion in the pancreatic tail was detected in abdominal imaging. Ga-68 PET-CT (gallium-68 positron emission tomography-computed tomography) detected an increased uptake of Ga-68 in the pancreatic tail. The patient underwent distal pancreatectomy, and pathological evaluation was consistent with an insulinoma. The patient's symptoms improved postoperatively. Since in nearly all TSC cases, as in our case, neuropsychiatric abnormalities, such as epilepsy, are one of the main disease manifestations, and these symptoms may be confused with the clinical manifestations of hypoglycemia in insulinoma. Therefore, patients with newly developed neurological symptoms and behavioral defects should be evaluated in terms of insulinoma.

Monoclonal/polyclonal PAX-8, PTH and GATA3 immunohistochemistry in parathyroid lesions.

BACKGROUND: Parathyroid gland (PG) is an endocrine organ which may display different immunohistochemical stainings with chief cells and oxyphilic cells in normal as well as hyperplasic/tumoral lesions. PURPOSE: In this study, we aimed to identify the demographic properties and diagnostic value of the GATA3 antibody, which is a transcription factor in addition to PTH, and of PAX-8 (monoclonal and polyclonal) antibody. METHODS: We have analyzed in detail the cellular components and staining intensities of 46 adenomas all of which contained parathyroid rims, 12 hyperplasia and 5 adjacent non-neoplastic thyroidectomy materials (63 patients, 114 tissues). RESULTS: While no staining was identified in the thyroid tissue, cytoplasmic PTH immunoreactivity was observed in all (100%) normal parathyroid tissues, rim of PGs and hyperplasia, and in 43/46 cases (93.4%) of adenomas. Adenoma and hyperplasia were less stained than normal PG (p < 0.05). We detected GATA3 staining in all cases except for the thyroid (100%). Weak positivity (1+) was most apparent in adenoma cases (p < 0.05). Monoclonal PAX-8 immunoreactivity was not identified in any normal parathyroid tissue and rim of PG but positive immunoreactivity was detected in 83.3% of hyperplasia cases (10/12), 84.8% of adenoma (39/46) and 100% of thyroid tissues (5/5) (p < 0.05). However, polyclonal PAX-8 immunoreactivity was detected in one normal parathyroid tissue (1/5) and seven (7/46) rim of PGs. In cases of hyperplasia and adenoma, positive immunoreactivity was 75% (9/12) and 74% (34/46), respectively. CONCLUSION: In conclusion, we have observed that PTH and GATA3 constitute a much more reliable and sensitive marker for parathyroid and are stained less in adenomas. While monoclonal PAX-8 (MRQ-50) never stains normal parathyroid and rim of PGs, it may help in the differential diagnosis of proliferated parathyroid lesions as a considerably sensitive and relatively specific marker by staining hyperplasic parathyroid, adenomas and the thyroid.

The effects of four different suture materials on penile tissue of rats.

Several types of suture materials are being used for the correction of penile curvature and this study was designed to compare histopathological changes on penile tissue among different suture materials. A total of 30 male Sprague-Dawley rats were divided into five groups and right cavernosal body was sutured with 5/0 sutures (ETB: polyethylene terephthalate; PRL: polypropylene; VCR: polyglactine; and PDS: polydioxanone). An identical needle (3/8-13 mm cutting) was passed through the cavernosal bodies in the sham group (SHAM). After 3 weeks, all rats were killed and penile tissues were examined to assess the level (0-3) of inflammation, granuloma formation and fibrosis. There was a statistically significant difference among five groups regarding inflammation, granuloma formation and fibrosis levels (P<0.01 for all). The histological changes in the PRL group were not different from the SHAM group. Although the levels of granulation and fibrosis in the PDS group were also similar to the SHAM group, inflammation level was significantly higher. The inflammation, granulation and fibrosis levels were the highest in the ETB group. VCR caused similar levels of granulation and fibrosis to ETB. In conclusion, PRL suture is associated with the least histopathological change in the penile tissue. PDS can theoretically be a reasonable alternative to PRL as it causes similar levels of granulation and fibrosis.

Simultaneous determination of valsartan and hydrochlorothiazide in tablets by first-derivative ultraviolet spectrophotometry and LC.

First-derivative ultraviolet spectrophotometry and high-performance liquid chromatography (HPLC) were used to determine valsartan and hydrochlorothiazide simultaneously in combined pharmaceutical dosage forms. The derivative procedure was based on the linear relationship between the drug concentration and the first derivative amplitudes at 270.6 and 335 nm for valsartan and hydrochlorothiazide, respectively. The calibration graphs were linear in the range of 12.0-36.1 microg x ml(-1) for valsartan and 4.0-12.1 microg x ml(-1) for hydrochlorothiazide. Furthermore, a high- performance liquid chromatographic procedure with ultraviolet detection at 225 nm was developed for a comparison method. For the HPLC procedure, a reversed phase column with a mobile phase of 0.02 M phosphate buffer (pH 3.2)-acetonitrile (55: 45; v/v), was used to separate for valsartan and hydrochlorothiazide. The plot of peak area ratio of each drug to the internal standard versus the respective concentrations of valsartan and hydrochlorothiazide were found to be linear in the range of 0.06-1.8 and 0.07-0.5 microg x ml(-1), respectively. The proposed methods were successfully applied to the determination of these drugs in laboratory-prepared mixtures and commercial tablets.