Comparison of the Diagnostic Utility of Manual Screening and the ThinPrep Imaging System in Liquid-Based Cervical Cytology.

OBJECTIVE: To compare the diagnostic results of the ThinPrep manual method (TPMM) and ThinPrep automated method (TPAM) in liquid-based cytology and present the advantages and disadvantages of both methods. MATERIAL AND METHOD: A total of 1.500 randomized ThinPrep Pap tests that were screened manually and archived in 2015 were reviewed by a blinded researcher manually and by the ThinPrep automatic method. RESULTS: There was a 83.3% increase in the detection of ASCUS (Atypical squamous cells of undetermined significance) with the TPAM compared to the TPMM, and with respect to the reference results, the accuracy was higher for the TPAM than for the TPMM. We also noted a 33.3% increase in the rate of LSIL (Low grade squamous intraepithelial lesion) and 20% increase in the rate of HSIL (High grade squamous intraepithelial lesion) by the TPAM. Concordance was best between the TPAM and reference cytologic diagnoses. The sensitivity was higher for the TPAM and the specificity was similar for both methods. The false positive rate was higher for the TPAM than the TPMM but the false negative rate was higher for the TPMM. We determined a 30% gain in screening time per smear by the TPAM. However, rejection of many samples by the system, especially because of air bubbles, was a limitation of the TPAM. CONCLUSION: The TPAM has advantages over the TPMM as well as disadvantages such as limiting features and a high false positive rate. The TPAM should be supported by the manual method to decrease the false positive rate.

Effects of suture tecnique on mesh shrinkage.

OBJECTIVE: Polypropylene meshes are one of the most frequently used patches in inguinal hernia repairs. This material was proved to be not completely inert, and may cause inflammatory responses like foreign body reactions. One of the physical results of these inflammatory reactions against the mesh is mesh shrinkage which is responsible for recurrence and pain. In this study, we aimed to investigate the effects of the suture technique on mesh shrinkage. METHODS: 36 animals were used for the study. Subjects were divided into 3 groups. In the first group the mesh (onlay) was not fixated by any means. In the second group, mesh was placed on the abdomen wall, after which the mesh was fixated with interrupted suturing. In the third group, continuous suturing was applied after the placement of the mesh. Mesh shrinkage was measured macroscopically, and the mesh site reaction was evaluated microscopically. At the end of the second month, 18 subjects were sacrificed again to conduct the same procedure. RESULTS AND CONCLUSION: When meshes are used for hernia repairs, shrinkage may be observed in meshes placed on fascia. In the first group without mesh fixation, mesh shrinkage was more significant in the second month compared to the first month. The amount of shrinkage of without fixation group was found to significantly differ during the second month from interrupted and continuous suture groups. Even though statistically not significant, fixation of the mesh with interrupted sutures seems to be more advantageous compared to fixation with continuous sutures.

Gastrointestinal stromal tumors: A clinical and histopathological presentation of 27 cases.

OBJECTIVE: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that express type 3 tyrosine kinase receptors and are thought to develop from the neoplastic transformation of the interstitial Cajal cells. The present study was performed to morphologically and immunohistologically evaluate GISTs, to compare their qualities using a GIST risk categorization system, and to identify the diagnostic and prognostic parameters of GISTs. MATERIAL AND METHODS: A total of 27 patients with GISTs underwent treatment and were followed up at the Gaziosmanpasa Taksim Training and Research Hospital. Descriptive statistics was used to calculate the mean and median values. Survival analysis was performed by the Kaplan-Meier method. The analyses were performed using the SPSS version 22.0 software. RESULTS: The mean follow-up time was 3.5 (5 months to 13 years) years. The mean age was 60.4 (29-82) years. The tumors were localized in the stomach (62.9%), extraintestinal areas (14.8%), intestine (7.4%), esophagus (7.4%), and rectum (7.4%). Twenty-four patients were classified according to the Fletcher system. Of these patients, 7 (25.9%) were classified as very low risk, 8 (29.6%) as low risk, 7 (25.9%) as intermediate risk, and 2 (7.4%) as high risk. Twenty-four patients underwent surgery. Of the 3 patients who did not undergo surgery, 1 had metastatic disease at the time of diagnosis, and 2 had mini- or micro-GISTs in the stomach. On endoscopic surveillance, all tumors remained stable. Three out of the 27 patients were lost to follow-up. Two patients developed recurrence, and 1 patient died of GIST. CONCLUSION: We analyzed the clinical and pathological characteristics of GIST. The most common site of tumor origin was the stomach. The size, mitotic index, and Ki-67 values were to be found high in intermediate- and high-risk groups and metastatic diseases.

Subcutaneous Oleomas Following Sunflower Oil Injection: A Novel Case and Review of Literature.

Liquid foreign material injection has been used as an early medical intervention since the end of nineteenth century for the augmentation of body shape. Nowadays, these types of procedures have been abandoned by health professionals due to late onset of serious complications. However, it is still misused by some subcultures such as bodybuilders, passive homosexuals, transsexuals, and patients with mental illness. This article discusses a male patient who injected himself with a large amount of sunflower oil, which became complicated by an inflammatory response-abscess formation and sclerosing lipogranuloma of breasts. The radiologic and pathologic signs of this entity are discussed with a review of the relevant literature. Lack of suspicion of this entity may cause a great delay in establishment of definitive diagnosis, giving rise to prominent morbidity and mortality. It is necessary to know the diagnosis and treatment of this phenomenon because illegal substances that cause factitial panniculitis are widely available on websites and threaten thousands of people, which is anecdotally referred in medical literature. Chronic or recurrent lesions of a bizarre or atypical morphology should alert the physician to this artificial phenomenon. Radiologic findings are most important criteria for diagnosis because self-injection is denied by the patient.

Idiopathic Intrahepatic Cholestasis as an Unusual Presentation of Hodgkin's Disease.

Intrahepatic cholestasis in the form of paraneoplastic phenomena is an uncommon presentation of Hodgkin's lymphoma (HL). Herein we report the diagnosis of mixed type HL-related idiopathic intrahepatic cholestasis in a 73-year-old man presenting with jaundice, after the inguinal lymph node biopsy indicative of mixed cellular type HL and liver biopsy consistent with intrahepatic cholestasis, following several diagnostic interventions including surgery for suspected extrahepatic obstructive cholestasis. Our findings emphasize the value of early liver biopsy in the diagnostic algorithm along with consideration of HL-related idiopathic intrahepatic cholestasis as a diagnosis of exclusion in cholestatic jaundice of obscure origin.

P53, KI-67, CD117 expression in gastrointestinal and pancreatic neuroendocrine tumours and evaluation of their correlation with clinicopathological and prognostic parameters.

BACKGROUND/AIMS: Gastrointestinal and pancreatic neuroendocrine tumors (GEPNETs) originate from the cells of the endocrine system. Their molecular genetic mechanism of development and progression is complex and remains largely unknown. The purpose of this study was to review the gastrointestinal and pancreatic neuroendocrine tumors and to evaluate p53, Ki-67 and CD 117 expressions with their clinicopathological correlations. MATERIALS AND METHODS: Twenty-one patients were reviewed and classified as having well-differentiated neuroendocrine neoplasm (WDET, Grade I), well-differentiated neuroendocrine carcinoma (WDEC, Grade II) and poorly differentiated neuroendocrine carcinoma (PDEC, Grade III). We performed immunohistochemical tests to characterize the expession of the immunoreactivity for synaptophysin, chromogranin, p53, Ki67 and CD 117. RESULTS: Median age of 21 patients was 43 years. Thirteen (61.9%) patients were male and eight (38.1%) patients were female. Tumors were located in the stomach (38.1%), appendix (38.1%), duodenum (4.8%), ileum (4.8%), colon (9.5%), and pancreas (4.8%). CONCLUSION: There was a statistically significant difference between well-differentiated endocrine neoplasm (Grade I), and well-differentiated endocrine carcinoma (WDEC, Grade II) and PDEC for Ki-67 >20% (p<0.001) (Pearson chi-square test). There was a statistically significant difference between WDET (Grade I), WDEC (Grade II) and PDEC (Grade III) for p53 positivity (p<0.05) (Pearson chi-square test).

Analysis of the factors that have an effect on hypocalcemia following thyroidectomy.

OBJECTIVE: The incidence of and risk factors for hypocalcemia following thyroidectomy were evaluated in this study. MATERIAL AND METHODS: One hundred and ninety thyroidectomy patients were evaluated retrospectively for factors that might contribute to postoperative hypocalcemia; age, hyperthyroidism, malignancy, the extent of surgery (total/near total/subtotal thyroidectomy), cervical lymph node dissection, and incidental parathyroidectomy. RESULTS: The rate of transient hypocalcemia/hypoparathyroidism was 19.47%, with a permanent hypoparathyroidism rate of 4.74%. Factors affecting the development of transient hypocalcemia were found as being operated for hyperthyroidism, and use of total thyroidectomy as the surgical method. Total thyroidectomy increased the risk of postoperative hypocalcemia by 3.16 fold. Patients undergoing operations for hyperthyroidism had a 2.3 fold increase, and those undergoing total thyroidectomy had a 3.16 fold risk of postoperative hypocalcemia. CONCLUSION: Hyperthyroidism surgery and total thyroidectomy lead to a higher risk of developing early postoperative or transient hypocalcemia. According to our results, no significant relationship could be established between any of the study parameters and persistent hypocalcemia.

Preventive effects of enoxaparin and hesperidin in cerulein-induced acute pancreatitis in rats.

BACKGROUND/AIMS: Acute pancreatitis accounts for almost 250.000 hospital admissions annually in the United States. Most promising treatment approaches are preventive; however, little is known about the early factors initiating acute pancreatitis. We aimed to evaluate the preventive effects of enoxaparin and hesperidin in cerulein-induced acute pancreatitis. PATIENTS AND METHODS: We used 70 Wistar albino rats for this study. Rats were divided into 7 groups: control group, and groups that were administered cerulein(Group 2), enoxaparin (Group 3), hesperidin (Group 4), cerulein with enoxaparin (Group 5), cerulein with hesperidin (Group 6), and cerulein with both enoxaparin and hesperidin (Group 7). Edema formation; leukocyte infiltration; measurement of the amylase level, pancreatic tissue weight, and pancreatic tissue oxidative capacity; and chemiluminescence using luminol, lucigenin, and nitric oxide levels as indices of tissue oxidative capacity were used to evaluate pancreatitis. RESULTS: Acute edematous mild pancreatitis was induced in groups 2, 5, and 6 by cerulein injections. Enoxaparin and hesperidin significantly decreased (p < 0.001) all the tested parameters in these rats. Enoxaparin and hesperidin did not offer complete protection but showed 50% decrease in edema formation. The preventive agents showed no superiority to each other. Further, when enoxaparin and hesperidin were used in combination, no significant additive effects with regard to anti-inflammatory and anti-oxidative actions were present. CONCLUSION: We showed that both enoxaparin and hesperidin exerted significant preventive effects in all the parameters related to acute pancreatitis in our experimental rat model.

Erosive esophagitis worsens reflux signs and symptoms in asthma patients without affecting pulmonary function tests.

OBJECTIVES: To determine whether erosive esophagitis (EO) worsens reflux signs and symptoms and affects pulmonary function test in asthma patients. METHODS: Sixty asthma patients with gastroesophageal and laryngopharyngeal reflux symptoms were included. Spirometry, reversibility test, esophagogastroscopy, laryngoscopy, and esophagogastroscopic biopsies were conducted. RESULTS: EO was diagnosed in 25% (n = 15) of the patients. The remaining 45 patients were placed into the non-erosive esophagitis (NEO) group. Of the 15 EO patients, grade 1 esophagitis was identified in 75% (n = 9), grade 2 in 12.5% (n = 3), and grade 3 in 12.5% (n = 3). Pulmonary function test results were not significantly different between the EO and NEO groups. Gastroesophageal and laryngopharyngeal reflux symptoms such as regurgitation, dysphagia, dyspnea, globus sensation, dysphonia, and sore throat were more frequent in EO patients than in the NEO group. The reflux finding score (RFS) was 7.33 and 4.55 in EO and NEO patients, respectively (p < .001). Posterior commissure hypertrophy was the most common laryngoscopic finding in both of the groups followed by diffuse laryngeal edema, erythema, and pseudosulcus. CONCLUSIONS: Gastroesophageal and laryngopharyngeal reflux symptoms were more frequent in EO patients than in the NEO group. The laryngoscopic findings of laryngopharyngeal reflux were more severe and the RFS was significantly higher in EO patients than in NEO patients. The presence of EO seems to be associated with an increase in reflux without affecting pulmonary function as EO did not cause a significant decrease in pulmonary function tests.

Long-term histologic changes in nasal mucosa after total laryngectomy.

Objective. To determine the long-term histopathologic changes in nasal mucosa and the relationship between progression of the histopathologic changes and the duration without air current stimulation. Material and Method. Biopsies were taken from the inferior turbinates of 11 laryngeal cancer patients after total laryngectomy. Specimens were stained with hematoksilen-eosin and several histopathologic parameters were examined under light microscopy. Results. All of the patients demonstrated at least one histopathologic abnormality (100%, n = 11). Goblet destruction and stromal fibrosis were the most common findings (81%, n = 9), followed by focal epithelial atrophy and subepithelial seromusinous gland destruction (45%, n = 5), neovascularization and congestion (36%, n = 4), complete epithelial atrophy and mixoid degeneration (27%, n = 3). According to the duration between laryngectomy and biopsy, patients were grouped in to three: group 1; less than 12 months (36%, n = 4), group 2; 12-36 months (18%, n = 2), and group 3; more than 36 months (45%, n = 5). Only congestion was found to be decreased as the duration increased (P < .005). Conclusion. In laryngeal cancer patients histopathologic changes occur in nasal mucosa eventuate due to the cessation of air current stimulation, however there was no relation between progression of the histopathologic findings and the duration of cessation.

Impact of ligating gonadal or adrenal collateral veins with the left renal vein on renal function and histology in right-nephrectomized rats.

BACKGROUND: In cases of trauma to the left renal vein (LRV), its ligation near the inferior vena cava (IVC) is considered, but the consequences are not always good. We investigated the role of collateral venous drainage after ligation of the LRV by studying the renal function and histology after ligation of the LRV near the IVC alone or with ligation of the gonadal or adrenal collaterals, in right-nephrectomized (RN) rats. MATERIAL AND METHODS: Ligation of the LRV near the IVC alone (group 1) or with ligation of the adrenal (group 2) or gonadal (group 3) collaterals was studied in RN Wistar rats (n=18 per group). The renal histopathology (ischemic cortical necrosis) and functional status (urea, creatinine, sodium, and potassium) were compared. RESULTS: In RN rats, the results were better when ligating the LRV near the IVC alone or with the adrenal collaterals [mortality 4/18 (22.2%) and 3/18 (16.7%), respectively] than when ligating the LRV near the IVC plus the gonadal collaterals [mortality 15/18 (83.3%)] (p<0.0001). All early deaths occurred within three days and resulted from serious histopathological (ischemic cortical necrosis) and functional (increased urea, creatinine, and potassium; decreased sodium) renal damage. CONCLUSION: In right-nephrectomized rats, the LRV near the IVC and the adrenal collateral can be ligated, while the gonadal collateral should be preserved.

Pharmacological preconditioning with erythropoietin reduces ischemia-reperfusion injury in the small intestine of rats.

AIMS: Considering the implications that arose from several recent experimental studies using recombinant human erythropoietin in rodents, erythropoietin has been regarded as a pharmacological preconditioning agent. The purpose of the present study was to evaluate whether erythropoietin has a preconditioning effect against ischemia and reperfusion injury in the small intestine of the rat. MAIN METHODS: Intestinal ischemia was induced in male Wistar rats by clamping the superior mesenteric artery for 30 min, followed by reperfusion for 180 min. Recombinant human erythropoietin (1000 or 3000 U/kg) or vehicle was administered intraperitoneally 24 h prior to ischemia. After collection of ileal tissue, evaluation of damage was based on measurements of the accumulation of polymorphonuclear neutrophils by technetium-99m-labeled leukocyte uptake, content of malondialdehyde, reduced glutathione, contractile responses to agonists, and an evaluation of histopathological features in intestinal tissue. KEY FINDINGS: Treatment with erythropoietin 24 h before ischemia significantly reduced the tissue content of malondialdehyde and increased that of reduced glutathione. Pretreatment also significantly suppressed leukocyte infiltration into the postischemic tissue, as evidenced by the lower content of myeloperoxidase and technetium-99m-labeled leukocytes. Physiological and histopathological improvements were also significant with the rHuEpo treatment. SIGNIFICANCE: Results of the present study indicate that rHuEpo is an effective preconditioning agent in ischemic injury of the small intestine. Protection provided by recombinant human erythropoietin is closely related to the inhibition of oxidative stress and leukocyte infiltration, which might be among the possible protective mechanisms of erythropoietin in intestinal ischemia and reperfusion.

[pH value and potassium level of diagnostic peritoneal lavage fluid in the early diagnosis of acute mesenteric ischemia secondary to arterial occlusion in rats]. / Siçanlarda arteriyel oklüzyona bagli akut mezenterik iskeminin erken tanisinda diyagnostik peritoneal lavaj sivisinda pH ve potasyum.

BACKGROUND: In this experimental study we evaluated the pH and potassium changes of the peritoneal irrigation fluid in the early phase of mesenteric ischemia. METHODS: The Wistar albino rats were assigned randomly to 5 equal groups of 10 rats: sham operation, 30, 60, 120 and 180 minutes ischemia by arterial occlusion. We enregistred the ranges of pH and potassium in peritoneal irrigation fluid and serum pH. RESULTS: Lower pH and increased potassium levels in peritoneal irrigation fluid were observed in 30 and 60 min ischemia groups. In 120 and 180 ischemia groups the level of pH continued to be lower and potassium level increased gradually, the serum pH were markedly lower in these groups. Histological analysis showed a positive correlation between the intestinal injury and ischemia time. CONCLUSION: In contrast to sham group, increase in potassium and decrease in in pH levels in peritoneal irrigation fluid were seen in 30 and 60 min ischemia groups. The decrease of serum pH was enregistred after 120 min of ischemia. In early phase the measurement of potassium and pH in peritoneal irrigation fluid may be an early diagnostic tool for mesenteric ischemia.

AT1 receptor blocker candesartan-induced attenuation of brain injury of rats subjected to chronic cerebral hypoperfusion.

One of common pathophysiological states associated with central nervous system is chronic cerebral hypoperfusion (CH) that frequently occurs in conditions such as vascular dementia and Alzheimer's disease. Long term blockage of angiotensin II type 1 (AT(1)) receptor provides protection from ischemia induced injury of brain as well as reduction of cerebrovascular inflammation. Examining effect of the blockage on reduced glutathione (GSH), ascorbic acid (AA), and lipid peroxidation were of purpose in the present study. Modeling CH, rats were subjected to permanent occlusion of common carotid arteries bilaterally. AT(1 )receptor antagonist, candesartan, was given daily for 14 days after surgery. CH caused a significant increase in lipid peroxidation and decrease in GSH content of cerebral hippocampal tissue with no change in AA level. Candesartan (0.5 mg/kg, oral) not only reduced lipid peroxidation but also restored GSH significantly besides elevating AA and improving histopathological alterations. In conclusion, long term AT(1 )receptor blockage may be considered as novel therapeutic approach for protection from damage associated with CH. Underlying mechanism(s) may in part be related to suppressing oxidative stress and preserving brain antioxidant capacity.

Attenuation of contractile dysfunction by atorvastatin after intestinal ischemia reperfusion injury in rats.

Growing number of studies implicate that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, or statins, have beneficial effects on ischemia/reperfusion injury that are unrelated to their cholesterol-lowering action. In the present study, we aimed to evaluate possible effects of atorvastatin on oxidative stress, neutrophil accumulation, and contractile response of terminal ileum segments in rats subjected to intestinal ischemia/reperfusion. Intestinal ischemia/reperfusion model was generated by clamping the superior mesenteric artery for 30 min followed by reperfusion for 3 h. Oral administration of atorvastatin at a dose of 10 mg/kg/day lasted 3 days just before induction of intestinal ischemia. At the end of reperfusion period, terminal ileum samples were removed to determine the concentrations of malondialdehyde, reduced glutathione, and myeloperoxidase. Samples were collected also to assess histopathological alterations and contractile response to agonists. Ischemia/reperfusion significantly decreased contractile responses, and this decrease was attenuated by atorvastatin. Pretreatment with atorvastatin caused remarkable decrease in both oxidative stress and neutrophil accumulation. Atorvastatin appeared to be restoring amount of reduced glutathione back to about control level. Furthermore, the pretreatment lowered mucosal damage at histopathological level. Our results suggested that pretreatment with atorvastatin attenuated intestinal muscle dysfunction associated with ischemia/reperfusion. This remarkable effect of atorvastatin is accomplished at least by decreasing oxidative stress and neutrophil accumulation as well as preventing the depletion of reduced glutathione.

The effect of epidermal growth factor on anastomosis, fascia, and skin wound healing.

BACKGROUND: The effect of epidermal growth factor (EGF) on gastrojejunostomy (anastomosis), fascia, and skin wound healing in rats was investigated. METHODS: The animals (rats) were separated into two main groups. In the first group (control group n: 23), rats were fed on standard diet and tap water without administration of EGF. In the second group (EGF group, n: 19), EGF was added to the diet. Skin, fascia, and anastomosis wounds were created on three different locations via laparotomy and gastrojejunostomy in all rats. In both groups, the rats divided into three subgroups were sacrificed on the 3rd, 7th, and 21st days post operatively. Tensile strength of skin and fascia and bursting pressure strength were measured for wound healing in both groups on 3rd, 7th, and 21st days. RESULTS: Anastomosis tensile strength of EGF group on the 3rd day of postoperation was found to be significantly higher than that of the control group and when we compared anastomosis bursting pressure, fascia tensile strength, and skin tensile strength in both groups, we did not find any significant differences. CONCLUSION: The measurements indicated that on the 3rd day EGF administered group, which had a more remarkable fibroblastic activity at gastrojejunostomy site, was superior to the control group only in terms of anastomosis breaking tensile strength.