Comparison of the Effect of Platelet-rich Plasma (PRP) and Fat Graft on Autologous Bone Grafting in a Randomized-controlled Experimental Skull Model.

Gold standard method for the treatment of critical-sized bone defects is the autogenous bone grafting procedure. A number of new and potentially useful adjuncts currently are being investigated to enhance the success of bone grafting. We propose to evaluate the effect of the most known and easily obtained 2 biological materials, fat graft and platelet-rich plasma (PRP), on bone graft healing. Twenty-seven New Zealand male rabbits were included in this randomized, controlled study. Two-sided 15-mm diameter bone defects were created in the parietal bones and the bones taken were replaced right-to-left and vice versa with 1 control group, 1 fat graft applied group, and the last one PRP applied group. Histologic evaluation and 3-dimensional maxillofacial computerized tomography were performed and bone density was calculated. In radiologic analysis, bone density was significantly different in the PRP group compared with the control and fat graft group in the 12th week ( P <0.05). In histologic scoring analysis, the PRP group had a better score than the control and fat graft group, while the fat graft group was worse than the control group in the 6th week ( P <0.05). The addition of PRP had a positive effect whereas fat graft had a negative effect on bone graft healing compared with the control group.

Is it tuberculosis mastitis or granulomatous mastitis? A thirteen-year experience at a university hospital.

BACKGROUND: Granulomatous mastitis (GM) is a rare inflammatory disease of the breast. Tuberculosis mastitis (TM), one of the causes of GM, is a rare form of extrapulmonary tuberculosis. The clinical, radiological, and histopathological findings of TM and GM are similar, and sometimes it is difficult to make a distinction between these disease states. In this study, we aimed to evaluate the clinical and radiological features, diagnostic techniques, treatment modalities and treatment outcomes of the patients with GM and TM. METHODS: The data of the patients with confirmed GM by histopathologic examination of biopsy specimens between 2007 and 2020 were retrospectively analyzed. Demographic features, main complaints, physical findings, radiological and laboratory data, treatment modalities, and treatment outcomes were recorded. RESULTS: Sixty-eight GM patients with a mean age of 35.8 (18-63) years were evaluated. The patients had a mass lesion, pain, ulceration,and abscess in their breasts. All of the cases were female. Ultrasonographic examinations were performed on 62 cases. Abscess and/or sinus tract formation was detected in 34, heterogeneous hypoechoic mass in 15, heterogeneous parenchyma or parenchymal edema in 15, axillary lymphadenopathy in 18 and cysts in 13 patients. A total of 10 patients were lost to follow-up. Twenty-six patients underwent surgery for their breast lesions or had antibiotherapy (n = 13) or corticosteroid therapy (n = 7). Eleven (16.1%) patients were diagnosed with TM. These patients were evaluated by clinical examination, chest radiography, and tuberculin skin test. Acid-fast bacilli (AFB) staining and culture were negative in all cases. The diagnosis of TM was based on histopathological evaluation results. Eight of the 11 patients achieved complete remission with antituberculosis treatment. DISCUSSION: The etiological diagnosis of GM must be based on a multidisciplinary approach. Tuberculosis mastitis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis.

HER-2/Neu and Hormone Receptor Analysis in Breast Carcinomas and Their Association with Clinicopathologic Parameters.

OBJECTIVE: Invasive breast carcinomas of no special type (IC-NST) are the heterogeneous tumours showing distinct prognostic features even in patients with similar clinicopathological characteristics. To date, many clinicopathological data have been analyzed to make a guess about prognosis and to determine treatment modality. In this study, HER-2/neu status was analyzed by using both immunohistochemical (IHC) and fluorescence in situ hybridization (FISH) methods, and its correlations with hormone receptor status and clinicopathological parameters were investigated. MATERIALS AND METHODS: The study was included 112 female patients with diagnosis of IC-NST. FISH for HER-2/neu was applied in only primary tumour tissues, while IHC analyses for HER-2/neu, estrogen (ER) and progesterone receptors (PR) were applied on both primary and metastatic lymph node foci. The results were compared with appropriate statistical methods. RESULTS: Our rates of HER-2/neu overexpression and gene amplification in the overall study group were 22.3 and 25%, respectively. In the metastatic group, these rates were higher than those of the overall study group (34% and 40%, respectively). Gene amplification rate of the axilla positive group was 40%, while this rate in non-metastatic group was 6.7% (p=0.015). Overexpression and amplification results were compliant (χ2=77,591, p<0.001). The concordance rates in HER-2/neu negative and overexpression groups were 95.3% and 88%, respectively. Our false negativity rate was 4.7%. While 36% of score 3+ cases were ER positive, 67.1% of HER-2/neu negative cases showed ER positivity (p=0.01). The increase of gene amplification rate in ER negative cases over 50 years age was more than two times and statistically significant (p=0.014). CONCLUSION: The concordance rates between the results of IHC and FISH in the HER-2 negative and the overexpression categories were compatible with the literature and lower than the literature, respectively. In the case of ER negativity, the patient's age over 50 years was associated with a higher rate of gene amplification.

Large Cell Carcinoma with Adenocarcinoma in Lung.

Large cell neuroendocrine carcinoma (LCNC) is a rare and aggressive cancer accounting for 3% of all lung cancers. A small percentage of LCNC called combined LCNC, can be seen in combinations with other lung tumor types. Multimodal therapy is proposed for this type of tumor but there is no any significant therapy since it is very rare tumor. This patient was a 66-year male and a heavy smoker with no symptoms of lung disease. Computed tomography core biopsy showed suspected adenocarcinoma. Right lower lobectomy was performed with mediastinal lymph node dissection via mini thoracotomy. The tumor was diagnosed as combined LCNC with adenocarcinoma. The patient was discharged on the seventh postoperative day and sent to the oncology clinic for chemotherapy. There has been no recurrence for eight months after surgery.

Immunohistochemical Analysis of the Extrinsic Apoptosis Process in the Non-Neoplastic and Neoplastic Prostate.

OBJECTIVE: Deviations in the apoptotic process have been demonstrated in prostate carcinogenesis. We aimed to evaluate especially the process of extrinsic apoptosis in the spectrum of neoplastic lesions of the prostate epithelium so as to reveal the variations in the apoptotic process. MATERIAL AND METHOD: The study included 20 benign prostatic hyperplasia, 8 high-grade prostatic intraepithelial neoplasia and 82 prostatic carcinoma patients. Immunohistochemistry was performed on sections obtained from materials of suprapubic prostatectomy, tru-cut biopsy, transurethral resection and radical prostatectomy. While Fas and FasL were evaluated in glandular and stromal areas, DcR1 and FLIP were evaluated in only glandular areas. Intensity and extent of immunostaining for Fas and FasL antibodies were separately scored and both scores were summarized. The total score of ≥ 4 both for Fas and FasL, expressions of FLIP and DcR1determined in more than 5% of glandular areas were accepted as positive. RESULTS: Glandular FasL positivity was observed in 63.8 and 20% of the cases with prostatic carcinoma and benign prostatic hyperplasia, respectively (p=0.001). The loss of stromal Fas expression in PCa was obvious (p < 0.001). FLIP positivity was more frequently seen in high-grade prostatic intraepithelial neoplasia and PCa. CONCLUSION: In prostatic carcinoma, decreased stromal Fas expression, contrary to higher glandular FasL positivity, supports the assertion that sensitivity of epithelial and stromal cells to apoptosis and their protective pathways against apoptosis undergo alterations. Increased FLIP expressions in high-grade prostatic intraepithelial neoplasia and prostatic carcinoma can also be interpreted accordingly.

A rare large mutation involving two exons of the SP-B gene in an infant with severe respiratory distress.

Takci S, Anuk-Ince D, Louha M, Couderc R, Çakar N, Köseoglu RD, Ates Ö. A rare large mutation involving two exons of the SP-B gene in an infant with severe respiratory distress. Turk J Pediatr 2017; 59: 483-486. Hereditary surfactant protein-B (SP-B) deficiency is a rare autosomal recessive disease of newborn infants causing severe respiratory failure and death within the first year of life. The most common cause of SP-B deficiency is a frameshift mutation in exon 4 (121ins2) in the gene encoding SP-B. We report a term infant with unremitting respiratory distress who was unresponsive to all treatment modalities. The parents were consanguineous and a term sibling of the infant had died due to respiratory failure without a certain diagnosis. In the first step of the diagnostic work-up, common genetic mutations for SP-B, surfactant protein C and ATP-binding cassette s3 were absent, however sequencing of SP-B gene revealed a large homozygous genomic deletion covering exon 8 and 9. In this case report, we aimed to emphasize further genetic evaluation in all cases suggestive of surfactant dysfunction, even if common mutations are absent.

The effects of melatonin and caffeic acid phenethyl ester (CAPE) on fracture healing under ischemic conditions.

OBJECTIVE: The aim of this study was to investigate the effects of antioxidant molecules melatonin and caffeic acid phenethyl ester (CAPE) on fracture healing under ischemic conditions. METHODS: A right tibia fracture was created and fixed with an intramedullary pin in forty four male Wistar-albino rats. The rats were then randomly allocated to fracture, fracture-ischemia, fracture- ischemia-melatonin, and fracture-ischemia-CAPE groups. Ischemia was created by clamping femoral arteries four and a half hours. Animals were killed and radiographic, histological and biomechanical evaluation was performed sixth week after surgery. RESULTS: The radiological and histological scores of the fracture-ischemia-CAPE group were significantly better than the fracture- ischemia group at 6th week follow-up. Complete radiographical and histological healing of all fractures was detected in all groups. There was a significant difference between the maximum fracture force between the groups (fracture-ischemia

A rare cause of pericardial effusion: giant cell arteritis.

Giant cell arteritis is a granulomatous vasculitis characterized by medium or large sized vessel involvement. Although extracranial branches of the carotid artery are typically involved, involvement of aorta and its major branches can also be seen. Cardiac involvement has been encountered less frequently and pericardial effusion is rarely encountered. In this paper, a case has been presented in which pericardial effusion was determined during the examination and diagnosis was giant cell arteritis.

Effect of radiofrequency microtenotomy on degeneration of tendons: an experimental study on rabbits.

INTRODUCTION: Radiofrequency microtenotomy is used to enhance healing by increasing vascularity in the degenerated tendon. In the present study, the effect of radiofrequency microtenotomy (Rf-mt) treatment on tendon degeneration was investigated. MATERIALS AND METHODS: A total of 32 New Zealand rabbits were enrolled in the current study. Experimental degeneration was performed by injecting prostaglandin E1 (PGE1) into the bilateral Achilles tendons of rabbits. After excluding 4 rabbits with an infection on the injection site, 4 other rabbits were sacrificed to define the histopathologic changes in the tendons. The remaining 24 rabbits were divided into 2 groups: the control group and the Rf-mt group. In the control group, the Rf-mt device was only applied to the Achilles tendon without running the device. In the Rf-mt group, the Rf-mt device was applied bilaterally at the fourth energy level for 500ms to an area within 2cm proximal to the insertion site at 0.5cm intervals in order to form a grid. Six rabbits from each group were sacrificed at 6 and 12 weeks. The Achilles tendons were evaluated histopathologically by a modified Movin scale and by immunohistopathologic staining for vascular endothelial growth factor and type 4 collagen. RESULTS: After the PGE1 injection, findings similar to chronic degenerative tendinopathy were observed. The Rf-mt group showed significant improvement in vascularity in the histopathological and immunohistochemical examination (P<0.05). However, there was no significant difference in healing between the control and Rf-mt groups (P>0.05). CONCLUSIONS: Rf-mt treatment increases vascularity in degenerated tendons but does not create difference to facilitate the healing process comparing control group.

The effect of carvedilol on serum and tissue oxidative stress parameters in partial ureteral obstruction induced rat model.

Although the pathological mechanism underlying kidney damage is not completely understood, it has been reported that reactive oxygen species (ROS) formed during ureteral obstruction may play an important role in this process. Carvedilol has been used in a limited number of studies examining oxidative injury. The aim of this study was to investigate the effect of carvedilol on serum and tissue oxidative stress parameters in the partial unilateral ureteral obstruction (PUUO)-induced rat model. To our knowledge, the protective effects of carvedilol in the PUUO-induced rat model have not been reported. Twenty-six male Wistar albino rats, age 5.5 to 6 months and weighing 250 to 300 g, were used in this study. The rats were randomly divided into three groups. In Group 1 (n = 9), the control group, a sham operation was performed. In Group 2 (n = 8), the PUUO group, the left ureter was embedded into the psoas muscle to create PUUO and maintained for 7 days. In Group 3 (n = 9), carvedilol was orally administered to the rats (2 mg/kg). After the establishment of PUUO, carvedilol was given for the following 7 days. After partial unilateral ureteral obstruction, a nephrectomy was performed to determine the blood and tissue levels of superoxide dismutase (SOD), malondialdehyde (MDA), protein carbonyl (PC), and nitric oxide (NO). The median SOD, MDA, PC, and NO levels in the tissues were 0.006 U/mg protein, 5.11 nmol/g protein, 4.31 nmol/mg protein, and 0.337 µmol/g protein in the control group, respectively. There was a significant increase in tissue SOD (p = 0.014), MDA (p = 0.002), and NO (p = 0.004) levels in Group 2. However, a statistically significant difference was not observed in PC (p = 0.847) enzymatic activity in Group 2. When compared with Group 2, carvedilol treatment caused a reduction in NO (p = 0.003), and PC (p = 0.001) activities in Group 3. The serum SOD (p = 0.004), MDA (p = 0.043), PC (p = 0.043), and NO (p = 0.001) levels were significantly different in Group 3 compared with Group 2. Administration of carvedilol also reduced the detrimental histopathologic effects caused by PUUO. According to histopathological examination of the renal tissues, the inflammation rates were 22.2%, 87.5% and 33.3% in Groups 1, 2, and 3, respectively (p < 0.05). The results of the present study show that partial unilateral ureteral obstruction caused oxidative stress in the serum and kidney tissues of rats, and treatment with carvedilol reduced the harmful effects of ureteral obstruction.

A lacrimal sac mass with bloody discharge.

We report a 38-year-old man who presented with a 7-year history of a mass in the right medial canthal region. He had several episodes of dacryocystitis, epiphora and bloody discharge. A cystic lesion was defined on MRI. Lacrimal sac excision was performed and a dark red mass was extirpated. External dacryocystorhinostomy and bicanalicular silicone tube intubation was performed. The polypoid lesion was diagnosed as an inflammatory polyp. Benign and malignant tumors of the lacrimal sac may have similar clinical findings on presentation. Preoperative ancillary testing may help us to have an idea of the nature of the lesion but histopathological examination is still the gold standard. Ophthalmologists should remember this similarity and be careful especially while performing endoscopic or laser-assisted dacryocystorhinostomy.

Ischemic skin necrosis following terlipressin therapy: report of two cases and review of the literature.

Terlipressin is a synthetic vasopressin analogue that is used in the treatment of bleeding esophageal varices and hepatorenal syndrome in patients with cirrhosis. Hepatorenal syndrome is a form of renal failure seen in patients with cirrhosis, with fatal outcomes. Ischemic adverse effects related to terlipressin are rarely observed. Herein, two cases who developed ischemic skin necrosis due to terlipressin usage are presented. Terlipressin therapy was started in two cirrhotic patients with presumptive hepatorenal syndrome. During the therapy, ecchymotic and necrotic changes were observed on the scrotal regions of both patients. Skin lesions were relieved after terlipressin therapy. Biopsy results were consistent with ischemia. Even if seen rarely, possible emergence of ischemic complications must be considered.

Simvastatin improves spinal fusion in rats.

OBJECTIVE: Statins stimulate bone formation by inducing the expression of bone morphogenetic proteins (BMP-2). The aim of our study was to investigate the effects of orally administered simvastatin on spinal fusion in rats. METHODS: Twenty rats were randomized into a spinal fusion group (SF) (n=10) or a spinal fusion and oral simvastatin administered group (SFS) (n=10). A spinal fusion was performed between L4-L6 representing two levels. Simvastatin (120 mg/kg/day) was administered orally in the SFS group. The rats were killed at the end of the 12 week study period. RESULTS: Manual palpation revealed two moderate fusions in the SF group. The SFS group did not reveal any signs of pseudoarthrosis. An average three-point bending force causing failure of fusion revealed results of 148.80±39.403 Newtons and 123.80±28.479 Newtons in SFS and SF groups, respectively (p>0.05). Histological examination revealed better fusion grades in the SFS group (mean: 9.30±0.949) than in the SF group (mean: 6.80±2.044) (p=0.003). Radiographic examination revealed Grade C fusion in two levels and Grade A fusion in 18 levels in the SF group. In the SFS group, Grade C fusion was detected in one level and Grade A fusions in 19. CONCLUSION: Our results suggest that simvastatin can promote spinal fusion and can be used as an adjunct to spinal fusion procedures in an elderly population with high cholesterol levels.

[Overlooked primary hyperparathyroidism presented with fractures: case report]. / Kiriklarla gelen atlanmis primer hiperparatiroidi olgusu: Olgu Sunumu.

In the present paper, we report a female patient with multiple cystic lesions of bone arising from the primary hyperparathyroidism and pathological femur and contralateral tibia fractures at the level of these cystic lesions (osteitis fibrosa cystica). The patient's history revealed that she was admitted to a medical center with vague symptoms such as sudden onset of dyspepsia, loss of appetite, myalgia, arthralgia, fatigue, and weight loss six years ago but no disease was diagnosed. Loss of appetite and loss of weight continued. She had been walking only by assisted ambulation for the last year. However, primary hyperparathyroidism was overlooked until our examination. The fractures were managed by interlocking nailing and grafting after confirming with biopsy that the fractures were due to osteitis fibrosa cystica. The fractures healed uneventfully. In conclusion, it is essential to evaluate patients with these vague symptoms with full biochemical screening and radiological examination for the early detection of the disease.

[Protective effects of melatonin on ischemia-reperfusion injury of skeletal muscle]. / Melatoninin iskelet kasi iskemi-reperfüzyon yaralanmasi üzerine koruyucu etkisi.

OBJECTIVES: In this study, we investigated the antioxidant protective effects of melatonin on skeletal muscles of Wistar albino-type rats with acute ischemia/reperfusion (I/R) injury. MATERIALS AND METHODS: Twenty-eight Wistar albino-type male rats weighing between 334 to 422 g were included in this experimental study. The rats were randomly allocated into three groups including sham, I/R and I/R + melatonin groups, respectively. Limb ischemia was achieved by clamping femoral arteries. After a two-hour ischemia period followed by 1.5-hour reperfusion, muscle samples were collected for biochemical analysis and histopathological examination. RESULTS: Muscle tissues of I/R groups revealed significantly higher antioxidant enzyme (superoxide dismutase, glutathione peroxidase, catalase) activities, and increased levels of malondialdehyde, nitric oxide, and protein carbonyl content compared to the control group (p<0.001). Levels of these parameters in muscle revealed significant reductions in the I/R + melatonin group compared to the I/R group (p<0.001). Histopathological examination of ischemic muscles in the I/R group showed significant degeneration and inflammation compared to the control group whereas melatonin administered ischemic muscles showed significant reduction in degeneration and inflammation compared to the I/R group (p<0.001). CONCLUSION: In the present skeletal muscle acute I/R injury model, protective effects of melatonin against reperfusion injury have been revealed. We suggest that the protective effect of melatonin against I/R damage in cases of extremity injuries with acute vascular compromise, extremity surgery with prolonged tourniquet time and acute compartment syndrome should be investigated with clinical trials.

Osteoid osteoma of the trapezium: case report.

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.

[Joint immobilization increases reactive oxygen species: an experimental study]. / Eklem immobilizasyonu reaktif oksijen ürünlerini artirmaktadir: Deneysel çalisma.

OBJECTIVES: It has been shown that reactive oxygen species (ROS) contribute to the onset and progression of osteoarthritis. We investigated cartilage destruction and oxidative stress parameters in the blood and synovial fluid of knee joints of rabbits exposed to varying periods of immobilization. METHODS: Twenty-eight mature New Zealand albino male rabbits were divided into four groups equal in number. In three groups, the knees were immobilized with a rigid cast for 3, 6 and 9 weeks, respectively. The cartilaginous tissue of the femoral condyles and tibial plateau were analyzed with respect to total count, total volume, and numerical density of chondrocytes using stereohistological methods. Antioxidant activities of superoxide dismutase (SOD), catalase (CAT), and glutathion peroxidase (GSH-Px), and oxidative stress parameters including nitric oxide (NO) and malondialdehyde (MDA) levels were measured in the plasma and synovial fluid. RESULTS: Compared to the control group, total count and total volume of chondrocytes in the femoral condyle and tibial plateau showed significant decreases, while numerical density showed a significant increase at 3 weeks of immobilization. Subsequent immobilization periods resulted in significant decreases in all these parameters, being most remarkable compared to the control group at the end of nine weeks (p<0.001). In plasma and knee joint synovial fluid, all antioxidant enzyme activities (SOD, CAT, and GSH-Px) and oxidative stress parameters (NO and MDA) showed consistent increases compared to the control group throughout the immobilization period (p<0.001). CONCLUSION: Increased levels of ROS in the blood and synovial fluid might result in cartilage destruction and ROS may be one of the potential factors involved in the etiopathogenesis of osteoarthritis. Prolonged joint immobilization should be avoided in the treatment of orthopedic diseases.