Clinicopathological Features of Cutaneous Findings of SARS-CoV-2 Infection.

Objective: In December 2019, severe acute respiratory syndrome coronavirus-2, which emerged in Wuhan, China, spread rapidly and created a pandemic. Coronavirus disease-2019 (COVID-19) can affect different organ systems, including the skin. Recently, COVID-19 cases with skin lesions of different clinicopathological features have been published. This study aimed to present the histopathological features of 19 COVID-19 cases with cutaneous findings and discuss them in light of the literature. Methods: Skin biopsy specimens of 19 patients with skin rashes associated with COVID-19 were evaluated histopathologically and clinically. Results: Clinical manifestations of rashes developed in eight female, seven male, and four pediatric patients with COVID-19. Urticaria/urticarial vasculitis (n=7), maculopapular eruption (n=7), panniculitis (n=2), purpuric eruptions (n=2), and livedoid-like lesions were noted. Histopathologically, besides the inflammatory findings, the most striking feature was that the vessels were more or less affected in almost all cases. Conclusions: Cutaneous lesions associated with COVID-19 are increasingly being reported. We believe that every data presented about this disease, which has many unknowns, will shed light on future research. Every case can lead us a new way.

Evaluation of Auditory Changes in Patients Undergoing Temporomandibular Joint Discectomy.

PURPOSE: Discectomy is one of the preferred temporomandibular joint (TMJ) surgical procedures for the treatment of internal derangements when conservative and minimally invasive treatments have failed. The purpose of the current study is to investigate whether a TMJ discectomy operation influences auditory function and clinical variables. METHODS: This prospective study was composed of patients who underwent a TMJ discectomy operation between 2016 and 2020. Auditory function was evaluated with pure tone audiometry, tympanometry, and acoustic reflex tests at preoperatively (T0), postoperative first week (T1), first month (T2), and third month (T3). Clinical parameters including maximum mouth opening (MMO) and TMJ pain were also evaluated at T0, T1, T2, T3, and sixth month (T4). RESULTS: The study consisted of 17 patients (5 males, 12 females) with a mean age of 42.65. A significant reduction in visual analogue scale (VAS) pain scores and MMO values compared to baseline values was achieved in all follow up periods (PT0-T1= .001; PT0-T2/T3/T4 < .001). In pure tone audiometry, a significant increase in T1-T0 comparisons at 1000 Hz, 2000 Hz, 6000 Hz, 8000 Hz frequencies, and pure tone average (P = .008; P = .005; P = .012; P = .002; P = .001) was observed. In T3-T0 comparisons, a statistically significant decrease was observed in pure tone thresholds at 125 Hz and 8000 Hz frequencies (P = .008; P = .01). There was no statistically significant difference in middle ear pressure and compliance values at T1, T2, and T3 compared to T0 (P > .05). Type C tympanogram was seen in 3 patients at T1 and in 1 patient at T2. Acoustic reflex tests were positive in all patients. CONCLUSIONS: Although mild changes occurred in auditory tests in the early postoperative period, TMJ discectomy procedure has no permanent effect on auditory function.

Evaluation of the perioperative effects of dexmedetomidine on tympanoplasty operations.

PURPOSE: This randomized double-blind study aimed to evaluate the effects of dexmedetomidine on hemodynamic parameters and the quality of surgery and recovery criteria in tympanoplasty operations. MATERIALS AND METHODS: A total of 75 patients 18-55 years undergoing tympanoplasty, who were graded as American Society of Anesthesiologists physical status I-II, were randomly divided into three groups. Group 1 included patients receiving remifentanil alone, Group 2 included patients receiving dexmedetomidine + remifentanil and Group 3 included patients receiving dexmedetomidine + ½ remifentanil. Anesthesia was induced with propofol and cisatracurium. For maintenance of anesthesia, a mixture of 2-2.5% sevoflurane, 40-60% oxygen/air was used. The groups were compared in terms of hemodynamic parameters, surgical area, recovery criteria, modified Aldrete, pain scores, additional analgesic requirements and adverse effects. RESULTS: Mean arterial pressure and heart rate values of Group 1 were higher at the time of intubation, incision, spontaneous breathing and extubation compared to Group 2 and Group 3. Surgical field satisfaction was higher in Group 2 and Group 3 than Group 1. Spontaneous breathing, eye opening and verbal cooperation times were shorter in Group 3 compared to Group 2. Eye opening and verbal cooperation times were longer in Group 2 compared to Group 1. The 30-minute modified Aldrete scores was higher in Group 3 compared to Group 1. There was no difference between the groups in terms of postoperative pain and adverse effects. CONCLUSION: The use of dexmedetomidine during tympanoplasty operations may provide better hemodynamic control and surgical view, may provide faster recovery and may reduce remifentanil consumption.

Hyperbaric oxygen therapy in the treatment of complications of irradiation in laryngeal cancer.

One of the standard treatments in laryngeal cancer is radiotherapy (RT). Many short- and long-term complications can occur in the region that has received radiotherapy. Definitive treatment of the emerging complications is still debatable, and treatment is challenging for radiation oncologists and ear nose throat specialists. Recently, hyperbaric oxygen treatment (HBOT) has become a promising alternative for the treatment of these complications. The aim of this report is to discuss the effectiveness of HBOT in the treatment of late-term RT-related potential complications in a patient with laryngeal cancer. We applied HBOT for a 58-year-old male patient with laryngeal cancer for the treatment of laryngeal oedema, and dyspnoea that developed one year after RT. In a decompression chamber at 2.4 atm pressure, the patient was made to breath 100% oxygen with a mask for 90 minutes. At the beginning, HBOT was planned for 30 days; however, it was terminated upon improvement of the symptoms at the 19th session. The symptoms, which developed one year after RT, were relieved completely with HBOT, and the patient is maintaining his life without any complaint under our control. The HBOT can be an alternative treatment for late-term complications developed after radiotherapy. It can be especially used for laryngeal oedema, and dyspnoea related to the field of radiotherapy.

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts.

OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

Pleomorphic Rhabdomyosarcoma Arising from True Vocal Fold of Larynx: Report of a Rare Case and Literature Review.

We present an extremely rare case of a pleomorphic rhabdomyosarcoma of the true vocal fold. The histopathological diagnosis was confirmed by immunohistochemistry. The patient was treated with radical surgery including total laryngectomy and radical neck dissection followed by postoperative radiotherapy. The clinicopathologic features of this rare malignancy are discussed together with a review of the literature. This case report and literature review highlights the more favorable prognosis of pleomorphic rhabdomyosarcoma in the larynx than in other locations.

Inverted follicular keratosis successfully treated with imiquimod.

Inverted follicular keratosis is a rare benign tumor of the follicular infundibulum characterized by exo-endophytic growing. It is thought to be a rare variant of the seborrheic keratosis. The diagnosis of inverted follicular keratosis is generally established histopathologically because clinical differentiation from other lesions is difficult. Herein, we present one such rare case, successfully treated with topical 5% imiquimod cream.

Immunohistochemical analysis of Bax and AIF in colorectal tumors.

BACKGROUND/AIMS: This study had three aims. The first was to determine whether Bax (Bcl-2-associated X protein) and AIF (apoptosis-inducing factor) are expressed in tissue sections of colorectal tumors. The second was to ascertain whether there is any difference in Bax and AIF expression between colorectal polyps, adenomas, and carcinomas. The third aim was to determine whether there is any difference between Bax and AIF expression in colorectal tumors. MATERIALS AND METHODS: Bax and AIF expression were determined in 20 hyperplastic polyps (HPs), 20 adenomatous polyps (APs), 20 samples of colorectal carcinomas, and 20 samples of normal mucosa by immunohistochemical methods. RESULTS: The staining level of Bax and AIF in adenomas and carcinomas was significantly higher than in normal tissues (P<0.01). There was also a significant difference between HPs and APs (P<0.01). The level of Bax and AIF in carcinomas was higher than in adenomas, and the difference was of statistical significance (P<0.01). CONCLUSION: This study may be of interest in future research to confirm whether the changed expression of Bax and/or AIF between benign and malignant tumors can provide valuable information for the evaluation of colon or other tumors.

Nasobronchial interaction.

Upper and lower airways can be considered as a unified morphofunctional unit. In this paper, nasobronchial interactions are evaluated based on literature.To discuss nasobronchial interactions, literature review from PubMed since 1982 is evaluated. Data base was including the terms "nasobronchial interaction, nasal and bronchial". Asthma and rhinosinusitis may be associated with environmental factors and immunological predisposition. Treatment of rhinosinusitis may decrease asthma exacerbations. It was concluded that "one airway, one disease"-concept may be accepted when considering naso-bronchial interaction. Asthma treatment should also mean treating the nose as good as treating patients with nasal symptoms. To reach the succesful results it should be associated with evaluation of lung functions.

Relation of stem cell markers ALDH1 and CD44 with clinicopathological factors in urothelial carcinomas of urinary bladder.

Molecular studies are ongoing in regards to superficial urothelial carcinoma of the bladder (UCB) either to define targeted therapy or to better select aggressive therapy candidates and also to delineate the outcome of the disease. In this study, we aimed to present the impact of ALDH1 and CD44 as stem cell markers in tumorigenesis and their prognostic value in urothelial carcinoma. We investigated ALDH1 and CD44 immunohistochemically in paraffin-embedded material of 125 non-muscle-invasive (NMI) cases in 163 UCB patients. In the NMI-UCB subgroup, we found ALDH1 to be significantly correlated with all poor prognostic factors, including high stage (≥pT2), high grade, recurrence and progression development and poor survey (P=0.001) in contrast to CD44 expression (P>0.05). Although ALDH1 expression had a good correlation with a poor clinical course of UCB, it could be used as a molecular marker to determine the best treatment strategy and could contribute to the development of targeted therapies.

Erythema multiforme like allergic contact dermatitis associated with laurel oil: a rare presentation.

Allergic contact dermatitis is a common skin disease, which affects approximately 20% of the population. This reaction may present with several clinical manifestations. Erythema multiforme-like allergic contact dermatitis is a rare type of non-eczematous contact dermatitis, which may lead to difficulty in diagnosis.Essential oil of Laurus nobilis is widely used in massage therapy for antiinflammatory and analgesic effects. Laurus nobilis induced contact dermatitis has been reported in the literature but an erythema multiforme-like presentation is rare.

Rhabdomyosarcoma of the upper lip in an adult patient.

Rhabdomyosarcoma (RMS) is a high-grade, malignant mesenchymal neoplasm. These tumors represent the most common soft tissue sarcomas of children and adolescents. RMS is uncommon on the lip and it is rarely seen in adults. Here, we report a rare case of primary RMS, embryonal type, occurring on the upper lip in a 27-year-old female.

Pyodermatitis vegetans after total colectomy.

Pyostomatitis-pyodermatitis vegetans (PPV) is a rare dermatological manifestation of inflammatory bowel disease, characterized by erythematous, vesiculopustular, exudative, annular, and/or vegetating plaques over the intertriginous regions that may precede or appear at the same time as the mucosal lesions. Systemic corticosteroids, dapsone, sulfasalazine, azathioprine, cyclosporine, and subtotal/total colectomy are the most common treatment options. A 16-year-old male patient presented to our outpatient clinic with a four months history of thickly crusted erosions on his trunk, back, and lower extremity. He had ulcerative colitis for four years and total colectomy was done seven months ago. Clinical and histopathological examination of his lesions were consistent with pyostomatitis vegetans. Although subtotal/total colectomy has been reported as a treatment option for PPV, lesions reappeared three months after total colectomy in our patient.

Efficacy of sublingual immunotherapy for house dust mite allergic rhinitis.

In the present study, we investigated the outcomes of sublingual immunotherapy (SLIT) in house dust mite-induced allergic rhinitis (HDM-AR) patients. In this prospective, multicentric study, 186 patients with AR who had positive skin prick test results for HDMs were included. The patients were administered SLIT using Staloral 300 for 1 year. Evaluation of the patients regarding symptom scores, clinical findings and Rhinitis Quality of Life Questionnaire (RQLQ) scores was performed at baseline, and then at 6 and 12 months of therapy. Our results showed that, for all of the evaluated items (symptom scores, clinical findings and RQLQ scores), 12-month values were significantly lower than those at 6 months and baseline. Similarly, 6-month values were significantly lower than those at baseline. There were no complications in any of our patients. SLIT for HDM-AR is a treatment modality that can be used safely. We obtained better results than expected, and the treatment showed a positive psychological effect; the patients believed that SLIT was the final step of treatment and, which made them feel better.

Upper airway obstructions and chronic otitis media: a clinical study.

PURPOSE: To investigate if pathologies causing upper airway obstructions are correlated with chronic otitis media. MATERIALS AND METHODS: One hundred fourteen patients with chronic otitis media and 114 healthy controls were enrolled in this study. Nasal septal deviation, Friedman and Mallampati scores were assessed for upper airway obstructions. Chronic suppurative otitis media was classified into tubotypmanic (n=80) and atticoantral (n=34) subtypes. Number of patients with septal deviation with a convexity to the same side as the affected ear in each CSOM subgroup was compared with chi-square test. The mean Mallampati and Friedman scores in tubotympanic disease group, atticoantral disease group and healthy controls were compared using Kruskal-Wallis test. RESULTS: Septal deviation occurred more frequently on the same side of ear pathology in patients with tubotympanic chronic suppurative otitis media (p=0.0005). Such a difference was not observed between the controls and patients with atticoantral chronic suppurative otitis media (p=0.718). No significant difference was noted between patients and controls in terms of Mallampati and Friedman scores (p=0.602 and p=0.836, respectively). Subtypes of chronic suppurative otitis media were not different from each other in terms of Mallampati and Friedman scores either (p=0.718 and p=0.708). CONCLUSION: Our results indicate that septal deviations may commonly occur on the same side with chronic otitis media. Therefore, septal deviations must be carefully investigated during the preoperative assessment of patients with CSOM. Elucidation of any possible causal relationship calls for further trials in larger series.

Giant ulcerative dermatofibroma.

Dermatofibroma is a slowly growing common benign cutaneous tumor characterized by hard papules and nodules. The rarely seen erosions and ulcerations may cause difficulties in the diagnosis. Dermatofibrosarcoma protuberans, which is clinically and histopathologically of malignant character, displays difficulties in the diagnosis since it has similarities with basal cell carcinoma, epidermoid carcinoma, and sarcomas. Head and neck involvement is very rare. In this study, a giant dermatofibroma case, which is histopathologically, ulcerative dermatofibroma, the biggest lesion of the head and neck region and seen rarely in the literature that has characteristics similar to dermatofibrosarcoma protuberans, has been presented.

Investigation of apelin expression in endometriosis.

BACKGROUND: Apelin is a mitogenic peptide; it has functions in vessel formation and cell proliferation. In this study we aimed to evaluate the serum and tissue levels and local expression pattern of apelin in eutopic and ectopic endometrium from patients with and without endometriosis and to compare the proliferative and secretory phase differences. METHODS: Thirty women with endometriosis and 15 women without endometriosis undergoing surgery for benign indications as control group were included in the study. Serum and tissue concentrations and proliferative and secretory phase expression patterns of apelin were evaluated in the ectopic and eutopic endometrium using immunoassay and immunohistochemistry methods. The results were compared with Mann-Whitney U test. The p-values smaller than 0.05 were considered as statistically significant. RESULTS: Apelin expression was detected in eutopic and ectopic endometrium of women with endometriosis and endometrium of control group. Intense immunoreactivity of apelin was observed in glandular cells of eutopic and ectopic endometrial tissues of women with endometriosis and endometrium of control group during secretory phase (p<0.01). In both groups, tissue concentrations of apelin were higher than of the serum (p=0.03) but, there were no significant differences between the two groups for tissue and serum concentrations of apelin. CONCLUSION: Apelin expression showed cyclic changes in eutopic and ectopic endometrium. Its expression may be related to menstrual changes of angiogenesis in endometrium of women.