Dopamine-secreting giant adrenal ganglioneuroma: clinical and diffusion-weighted magnetic resonance imaging findings.

We report a case of a dopamine-secreting giant primary adrenal ganglioneuroma (GN) in a 29-year-old male patient. Although the patient was clinically silent, the 24-hour urine levels of dopamine, normetanephrine, homovanillic acid and vanillyl mandelic acid were elevated. Abdominal ultrasonography and magnetic resonance imaging showed a large solid tumor with calcifications and a slightly lobular edge on the left adrenal gland. A tumor, 13 x 23 x 25 cm in size, was completely resected without morbidity. A 2-year follow-up with computed tomography showed that the postoperative course of the patient was uneventful.

The impact of rosacea on quality of life: effects of demographic and clinical characteristics and various treatment modalities.

BACKGROUND: Rosacea has a major psychosocial impact on a patient's life. OBJECTIVES: To determine the impact of rosacea on patient quality of life, the relationship of quality of life scores to clinical and demographic variables, and the change in quality of life following various treatments. METHODS: Patients' demographic and clinical characteristics were recorded at their initial examination and their response to treatment and side-effects were recorded additionally at their follow-up examination. Rosacea severity was scored for each of four signs from 0 to 3. Patients were requested to complete Dermatology Life Quality Index (DLQI) questionnaires. RESULTS: A total of 308 patients took part in this study. Mean ± SD DLQI total score at the initial visit was 6·93 ± 5·18 and was related to patients' age, sex, age at disease onset, subjective symptoms, triggering factors, previous treatments, rosacea severity scores and patients' self-assessment of ease of living with rosacea. Of these 308 patients, 164 completed the DLQI following treatment. Mean ± SD post-treatment DLQI score was 4·36 ± 4·82. Post-treatment scores were also related to sex, type of treatment modality, development of side-effects, improvement of rosacea, rosacea severity scores and patients' self-reported ease of living with rosacea. Topical metronidazole, oral tetracycline and oral isotretinoin were observed to reduce signs and symptoms of rosacea and DLQI scores significantly at this repeat examination. CONCLUSIONS: Rosacea affects patients' lives to a moderate extent, and this can be assessed by using DLQI. DLQI is also sensitive to quality of life changes brought about by treatment of rosacea. As a preliminary result we can say that topical metronidazole, oral tetracycline and oral isotretinoin seem to improve quality of life of patients by improving lesions of rosacea more efficiently than other therapeutic agents.

Correlation of proliferating cell nuclear antigen and bcl-2 expression with tumor front grading and metastasis in laryngeal squamous cell carcinoma.

This study was designed to examine the immunohistochemical expression of proliferating cell nuclear antigen (PCNA) and bcl-2 protein in 45 cases with advanced laryngeal squamous cell carcinoma who had undergone total laryngectomy with unilateral modified radical neck dissection, and the relation of this expression to some prognostic factors such as tumor front grading and neck lymph node metastases. Sections were reevaluated for routine histologic grade, tumor front grading and neck lymph node metastases, and were stained with monoclonal antibodies against PCNA and bcl-2. Significant correlation was present between the severity of PCNA expression and incidence of lymph node metastasis (p<0.05). No correlation was found between the severity of PCNA expression and tumor front grading. Bcl-2 expression did not associate with either parameters. In conclusion, PCNA is important in predicting prognosis and no association is present between the bcl-2 protein expression and prognostic factors.

Morphometric measurements of the cranium in patients with Chiari type I malformation and comparison with the normal population.

BACKGROUND: To determine the degree of development of the posterior fossa and signs of occipital dysplasia in patients with Chiari type I malformation by morphometric measurements. METHODS: In 22 patients with Chiari type I malformation, distance, surface area and angle values reflecting the degree of development of the posterior fossa were measured and compared with the measurements of 21 normal subjects. FINDINGS: In patients with Chiari type I malformation, the depth of the posterior fossa, the length of the clivus reflecting development of the basi-occiput and Klaus' index were significantly shorter than in normal subjects (p<0.001, p=0.007, and p<0.001, respectively). The ratios of the depth of the posterior fossa to the height of the supratentorial region and Twining's line reflecting anteroposterior distance of the posterior fossa were also significantly smaller in the Chiari group (p<0.001 for both). In sagittal section, the surface area of the bony part of the posterior fossa and the ratio of this area to the area of the supratentorial region were significantly smaller than in normal subjects (p=0.038 and p=0.002, respectively). The angle measurements of the cranial base (basal angle, Boogard's angle and nasion-basion-opisthion angle) showed that there was an evident tendency for platibasia in the Chiari group (p=0.04, p=0.004, p<0.001, respectively). In addition, it was shown by measuring tentorium-twining's line angle that the tentorium was steeper in the Chiari group than normal subjects. INTERPRETATION: These results support the opinion, which claims the existence of underdevelopment of the occipital bone and posterior fossa in patients with Chiari type I malformation.

Giant polypoid tumor of the esophagus.

A patient with a giant polypoid tumor of the esophagus, measuring 22 cm in length is described in this report. The patient presented with cough attacks and respiratory distress. Diagnostic and therapeutic intervention required aggressive airway management, radiographic and endoscopic evaluation, and definitive surgical treatment. Benign esophageal tumors are rarely seen and originate from the upper third of esophagus, frequently close to the cricopharyngeus muscle. They may attain giant proportions. A variety of clinical presentations are described, the most serious being asphyxia secondary to laryngeal obstruction. We observed a giant esophageal tumor which was interpreted as angiofibromyolipoma that caused laryngeal obstruction. We present the clinical picture and histopathological findings of the tumor.

Alkaptonuria with lumbar disc herniation: a report of two cases.

STUDY DESIGN: Two cases of lumbar disc herniation with alkaptonuria are presented. OBJECTIVES: To present a probable clinical course of lumbar disc herniation with alkaptonuria, a rare metabolic disease. SUMMARY OF BACKGROUND DATA: Although lumbar disc disease is a common clinical occurrence in alkaptonuria, lumbar disc surgery is needed rarely in this disease. A patient with alkaptonuria without ochronotic signs is also rarely seen. METHODS: The cause, clinical presentation, diagnostic techniques and treatment of alkaptonuria with lumbar disc disease are reviewed. RESULTS: The symptoms of the patients disappeared after surgery, and there were no symptoms on follow-up. CONCLUSION: Alkaptonuria frequently occurs in association with lumbar disc disease. In patients with no other signs of alkaptonuria or ochronosis, early detection of the disease is important to treat involvement of other systems (e.g., cardiovascular and urinary).

[Traumatic lesions of the corpus callosum]. / Travmatik korpus kallozum lezyonlari.

AIM: To determine the diagnostic values of magnetic resonance imaging and computed tomography and characteristics of the lesions in traumatic lesions of the corpus callosum. CASES AND METHODS: In 49 cases with traumatic lesions of the corpus callosum whose Glasgow Coma Scale (GCS) scores were 12 or under, presence and characteristics of the lesions of corpus callosum were evaluated retrospectively. All of the cases had both of MRI and CT scans at early posttraumatic periods. RESULTS: In 20 patients (40.8%) there were 31 lesions. There were lesions in only 7 of 20 patients that had lesions in MRI. Despite most of lesions (87%) were nonhemorrhagic in MRI, 3 of 7 lesions (42.8%) were nonhemorrhagic in CT. Lesions were limited to the splenium in 7 of 20 patients (35%). In other cases there were lesions at anterior regions of corpus callosum with or without splenial lesions. There were more lesions of brain stem and subcortical white matter in patients with corpus callosum trauma than ones without, but differences were not statistically significant. CONCLUSIONS: Traumatic lesions of the corpus callosum are frequently seen in moderate and severe head injury. Most of the lesions are nonhemorrhagic and localized in splenium. The diagnostic value of MRI is rather high than of CT in traumatic lesions of corpus callosum.

Hepatitis C in haemodialysis and nonuraemic patients: a histopathological study.

Hepatitis C virus (HCV) is the major cause of posttransfusion non-A, non-B hepatitis. Haemodialysis patients carry the risk of HCV infection. The aim of this study is to compare the morphological changes related to chronic HCV infection found in haemodialysis and nonuraemic patients. Liver biopsies from nine haemodialysis patients and 37 patients with normal renal function were studied. This study shows that haemodialysis patients may have less active and progressive chronic hepatitis C than patients with normal renal function. The number of patients in this study is limited, therefore further studies are needed for definite conclusion.

Cathepsin B, p53 expression and AgNORs in transitional cell carcinoma.

The aim of this study was to assess the relation between silver-strained nucleolar organizer regions (AgNOR), tumor stage, tumor grade and p53 expression with cathepsin B staining in transitional cell carcinoma of bladder. Tissue sections from 64 transitional cell carcinomas of the bladder were evaluated for the relation between AgNOR, tumor stage, tumor grade and p53 expression with cathepsin B staining in the neoplastic and stromal cells. Mean AgNOR values were significantly higher and the presence of p53 expression were different in cathepsin B positive and negative tumor and stromal cells. Although the number of cases is limited, this pilot study shows that cathepsin B staining may have a prognostic value in transitional cell carcinoma, but more studies are needed for a definite conclusion.

Histopathological characteristics of chronic hepatitis C virus infection in Turkey.

Hepatitis C virus (HCV) is the major cause of posttransfusion non-A, non-B hepatitis. The aim of this study is to describe the morphological changes related to HCV infection found in Turkey and compare the similarities and differences with the previous reports. Liver biopsies from 44 patients with HCV infection were studied. Chronic active hepatitis was the most common (56.8%) histopathological lesion. Most of the cases (n = 15, 34.1%) with chronic active hepatitis showed mild activity and mean HAI was 5.5 in these cases. The presence of sinusoidal lymphocytes (79.5%) and Kupffer cell proliferation (68.2%) were the most common histological features. We could not find any publication about histopathological characteristics of HCV infection from Turkey in MEDLINE database. This study shows that histopathological changes seen in patients with chronic HCV infection in Turkey is comparable with the literature, but more histopathological studies including genotyping of HCV and objective criteria to evaluate histopathological changes of chronic HCV infection are needed for definite conclusion.