Damaging Effects of Total Parenteral Nutrition Formula on Vascular Endothelium.

OBJECTIVES: Sepsis in one of the most serious complications that can occur during total parenteral nutrition (TPN) procedures. In this experimental study, we investigated the effects of TPN, with or without lipid emulsion, on vascular endothelial damage. METHODS: In total, 50 rabbits were used, divided into 5 groups of 10 each. TPN with lipids (group 1), TPN without lipids (group 2), and 0.09% saline (group 3) were given for 10 days via a central venous catheter. Group 4 received no treatment other than placement of a central venous catheter for 10 days. Group 5 was a control group. At the end of day 10, rabbits were sacrificed and tissue samples of liver, kidney, and inferior vena cava were prepared and examined by immunohistochemical methods for vascular cellular adhesion molecule (VCAM)-1 expression. RESULTS: In tissue sections of liver, kidney, and inferior vena cava, VCAM-1 activity was increased prominently in TPN with and without lipids compared with the control group. VCAM-1 activity in the TPN with lipids group was decreased versus the TPN without lipids group (P > 0.05). CONCLUSIONS: The TPN procedure results in vascular endothelial cell damage not only in the vein where the solution is introduced but also in other parts of the vascular system. Even if it is not statistically significant, lipids in the TPN formula may decrease this endothelial cell damage, as shown by immunohistochemistry.

Traumatic thrombosis of internal carotid artery sustained by transfer of kinetic energy.

A 31-year-old male patient with a fatal thrombosis of the internal carotid artery caused by gun shot injury was presented in this case report. The patient was referred to the hospital with a diffuse edema on his left cheek. On otolaryngologic examination, there was a bullet entrance hole at the left mandibular corpus. No exit hole could be found. The finding from his axial computed tomography of neck and paranasal sinuses was normal. On neurological examination, a dense right hemiparesis was observed. In his cerebral angiogram, left common carotid artery was totally obliterated. Diffuse ischemia was observed in the left cerebral hemisphere. Despite intensive interventions, the patient died 4 days after the accident. In the autopsy, a large thrombosis was obtained in the left common carotid artery. This case emphasizes a fatal kinetic energy effect in vascular structures. It is stressed that a gun shot injury could be fatal with its indirect kinetic energy effects at subacute phase.

Benign fibrous histiocytoma arising from the intercostal space.

Benign fibrous histiocytoma is a tumor of unknown etiology that is believed to be of mixed fibroblastic and histiocytic origin. Deep benign fibrous histiocytomas are most commonly found in the lower limbs or the head and neck region; it is relatively rare that they are seen in the intercostal space. Only six case reports of this entity are described in the literature. We report a 20-year-old woman who suffered from a painless swelling in the left chest wall, with a computed tomographic correlation. The lesion was totally excised, and histopathology revealed a benign fibrous histiocytoma. This is the first case of a benign fibrous histiocytoma that arose from the intercostal space reported in the English-language literature. The six cases reported in the medical literature are also discussed.

Primary xanthofibroma in the calcaneus: a case report.

Xanthoma or xanthofibroma is a lesion, characterized by foamy histiocytes (xanthoma cell) and is mostly seen in soft tissue. Xanthoma may also occur in in the skeletal system of patients with an abnormal lipid metabolism. We present a 22-year-old man with primary xanthofibroma in the calcaneus, who was treated by curettage and grafting of the lesion.

Parachordoma: a recurrent case and review of the literature.

Parachordoma is an uncommon tumor of soft tissue, and the origin is not clear. Recurrence and metastasis are rarely seen. A piecemeal mass measuring 7x4x3 cm was excised from a 28-year-man who had presented with pain and swelling of the right shoulder for 5 years. Histopathologically, the tumor was composed of cells with clear eosinophilic cytoplasm and an epithelioid appearance in a myxoid stroma separated by fibrous tissue with mild pleomorphism and mitotic activity. Tumoral cells were immunoreactive for cytokeratin 8/18, EMA, S-100 and vimentin, immunohistochemically. Recurrence was seen one year after the initial diagnosis. Areas of increased mitotic activity and atypical mitoses were observed in the recurrent tumor. We report this case as recurrence occurred earlier than usual and exhibited malignant features.

[Evaluation of cystic echinococcosis cases given a histopathologic diagnosis from 2002 to 2007 in Diyarbakir]. / 2002-2007 yillari arasinda Diyarbakir'da histopatolojik tani alan kistik ekinokokkozis olgularinin degerlendirilmesi.

Echinococcosis is a common parasitic disease manifesting as cyst formation in humans and animals, caused by the platyhelminth, Echinococcosis and it is an important health problem in our country. The aim of this study was to acquire knowledge about the topographic features, the prevalence of cystic echinococcosis and to predict its frequency in the Diyarbakir region. From 2005 to 2007, 234 patients who had been given a histopathological diagnosis of cystic echinococcosis were analysed retrospectively. Based on the pathological records age, sex and location of the parasite were evaluated, and if a patient had the parasite in more than one location, it was counted as one. Female patients constituted 60.25% of the cases, and males, 39.74%. The average age of the patients was 27.01 years (28.2 years in females and 25.3 years in males). The most frequent location of echinococcus was in the liver (44.01%), and the second in the lung (31.19%). In general the characteristics of the patients correlated with the characteristics of previous literatures results but the age of the patients when diagnosed was earlier than that previously reported in the literature. Cystic echinococcosis was found to be an important public health problem in Diyarbakir region. For the eradication of echinococcosis it is necessary to get reliable data, and to implement an appropriate eradication program.

A multicentric, hyaline vascular variant of Castleman's disease associated with B cell lymphoma: a case report.

INTRODUCTION: Three histological variants (hyaline vascular, plasma cell, and mixed) and two clinical types (localized and multicentric) of Castleman's disease have been described. The risk of progression to lymphoma is higher in multicentric Castleman's disease and is associated with poorer outcomes and higher mortality rate. Multicentric Castleman's disease often requires systemic therapy. Complete resection of the involved node in localized Castleman's disease is curative, with no reported recurrences. CASE PRESENTATION: We report a case of a 66-year-old female with systemic symptoms and bilateral cervical lymph nodes which were initially diagnosed as the hyaline vascular variant of Castleman's disease and two years later after the initial diagnosis she was confirmed to B cell lymphoma. Following the treatment with radiation therapy to the cervical area and combination chemotherapy complete response was achieved. CONCLUSION: Although it has rarely been reported, the malignant potential of the Castleman's disease must be kept in mind.

Histopathologic diagnosis of thyroid tuberculosis.

BACKGROUND: Thyroid tuberculosis is rarely encountered. Due to the absence of specific signs and symptoms, the diagnosis is difficult without histopathologic examination of surgical material. In this study, we aim to present histopathologic findings of our patients with thyroid tuberculosis. METHODS: We retrospectively reviewed 800 thyroidectomy specimens from the pathology laboratories of two medical centers that were obtained over a 5-year period. We reviewed clinical and laboratory data, fine-needle aspiration cytology smears, and 4-microm formalin-fixed paraffin-embedded hematoxylin-eosin sections and Erlich Ziehl Nelsen-stained sections of granulomatous thyroiditis. RESULTS: We found nine cases of granulomatous thyroiditis and detected five cases of thyroid tuberculosis. Thyroid ultrasound revealed hypoechoic nodules ranging between 1.3 and 2.5 cm in all patients with thyroid tuberculosis. Fine-needle aspiration cytology smears, which showed thyrocytes, macrophages, and lymphocytes with a colloid background, were nonspecific. Microscopic examination of all thyroids revealed granulomas of different sizes, which were composed of Langhans' giant cells, epithelioid histiocytes, and lymphocytes around caseation necrosis. In Erlich Ziehl Nelsen-stained sections of three cases, bacilli were seen. Bacilli were identified in the microbiology culture of the remaining two patients. CONCLUSIONS: Thyroid tuberculosis is diagnosed by histopathologic examinations and microbiologic cultures. When granulomatous thyroiditis is encountered, tuberculosis should be kept in mind and Erlich Ziehl Nelsen staining should be performed for prompt diagnosis.

Hemangioma of the sternum.

Primary tumors of the sternum are rare and most of them are malignant. Benign lesions are typically chondromas, bone cysts, or hemangiomas. Among these tumors, hemangiomas are extremely rare. We report a rare case of hemangioma of the sternum. The patient was successfully treated with complete resection of the tumor and sternum stability was obtained by polypropylene mesh and methylmethacrylate.

Primary mucosa-associated lymphoid tissue lymphoma of hypopharynx.

Mucosa-associated lymphoid tissue lymphomas are low-grade B-cell lymphomas that arise from a number of extranodal sites, including both nonmucosal and mucosal organs such as the hypopharynx. We reported a patient with a primary hypopharynx mucosa-associated lymphoid tissue lymphoma presenting with a swallowing dysfunction and severe throat pain. The clinical, radiologic, and histopathologic findings are presented. The patient was followed up for 5 years and treated with nonspecific antibiotics, chemotherapy, and radiation therapy. Because of prevertebral fascia invasion at the initial presentation, surgical treatment was not preferred. The last biopsies of the hypopharynx revealed no evidence of lymphoid infiltrate. Mucosa-associated lymphoid tissue lymphoma involving the hypopharynx is rare and there is no consensus on its treatment. The treatment protocol is presented and the relevant literature is reviewed.

Arrhythmogenic right ventricular dysplasia cases in forensic autopsies.

Arrhythmogenic right ventricular dysplasia or cardiomyopathy (ARVD or ARVC) is an increasingly recognized entity with clinical and forensic implications. This is the first series documenting ARVD in 5 separate cases in forensic autopsies from Turkey declared as natural sudden cardiac death following complete autopsy and toxicologic analysis. There was a male preponderance (M/F=4), with a mean age of 50.

Expression of glucose transporter protein-1 (Glut-1) in ocular surface squamous neoplasia.

PURPOSE: To examine the expression of glucose transporter protein-1 (GLUT-1) in ocular surface squamous neoplasia and to study its relationship with degree of neoplasia and cell proliferation index (Ki-67 labeling index). METHODS: Twelve cases diagnosed as ocular surface squamous neoplasia (4 invasive and 8 intraepithelial tumors) at Inonu University Faculty of Medicine, Department of Pathology, were included in this study. There were 3 squamous cell carcinomas, 1 basosquamous cell carcinoma, and 8 conjunctival intraepithelial neoplasms. Immunohistochemically, GLUT-1 and Ki-67 antibody staining were performed. RESULTS: GLUT-1 membranous immunoreactivity was seen in all tumors except in 1 case. GLUT-1 immunostaining was observed in all layers of the neoplastic epithelium of squamous cell carcinoma. Intense staining for GLUT-1 was determined in the upper two thirds of the severe dysplastic squamous epithelium. Although immunoreactivity for Ki-67 nuclear antigen was present throughout the epithelium, it was higher in the lower two thirds. Ki-67 labeling index ranged between 6% and 80%, and the mean value was 35% for invasive tumors and 20% for intraepithelial tumors. CONCLUSIONS: Marked GLUT-1 and Ki-67 immunoreactive cells throughout the neoplastic epithelium of ocular surface squamous neoplasia were observed. In most cases, it was observed that GLUT-1 expression was severe in cases having >10% Ki-67 labeling index. These findings indicate that glucose uptake was increased in dysplastic cells, especially by GLUT-1. To our knowledge, this is the first study on the subject in the literature, and further studies with more cases are needed with GLUT-1 and other GLUT members.

Urethral polyps in children: a review of the literature and report of two cases.

A solitary polyp of the urethra is a rare benign fibroepithelial growth and has often been described in boys. Its occurrence in girls is exceptional. In the present paper, two children with solitary polyps of the urethra are presented and discussed. The first case was an 18-month-old boy with a posterior urethral polyp arising from the posterior urethra and extending to the bladder. It was excised by cystostomy because of an unsuccessful endoscopic removal attempt. The second case was a 2-year-old girl with an interlabial mass arising from the posterior wall of urethra and protruding from the external urethral meatus. It was excised transurethrally.

Effect of melatonin and atenolol on carbon monoxide cardiotoxicity: an experimental study in rats.

The aim of this study was to define the characteristics of heart rates and myocardial changes in rats exposed to carbon monoxide (CO), and the effects of reoxygenation, atenolol (a beta-blocker) and melatonin after sublethal CO intoxication. Widespread use of beta-blockers in cardiology practice and growing literature on the positive effect of melatonin in ischaemia reperfusion lead us to question their effects in case of CO intoxication. Rats were exposed to CO. After sublethal intoxication the rats were reoxygenated with ambient air. Subsequently blood values, electrocardiographic recordings and pathological changes were examined for each groups. Five rats died after CO intoxication in the control group: no myocardial changes were seen in light microscopy. However, myocardium of seven reoxygenated rats presented contraction bands. Seven reoxygenated rats pretreated with atenolol had a higher number of contraction bands of myocardial cells. Seven reoxygenated rats pretreated with melatonin had more contraction bands than reoxygenated rats, and heart rate recordings of these animals revealed a profund and sustained bradycardia. Thus, melatonin and atenolol appear to have some adverse effects in CO intoxication on the myocardial cells.

The level of endothelin-1 and nitric oxide in patients with chronic viral hepatitis B and C and correlation with histopathological grading and staging.

BACKGROUND AND AIM: The aim of this study was to estimate the serum levels of endothelin-1 (ET-1) and nitric oxide (NO) and to analyze the correlation of their levels with histopathological grading and staging of the liver in patients with chronic hepatitis B (CHB) and C (CHC). METHODS: Eighty-nine patients who were either HBsAg positive (45 CHB patients, 34 inactive carriers (IC)) or had CHC (10 patients) and 36 healthy volunteers as a control group were included in this study. Fifty patients from the CHB (n=43) or CHC (n=7) groups with elevated serum alanine transaminase (ALT) levels underwent a liver biopsy. Histological activity was scored according to Ishak's activity and the fibrotic index. The ET-1 serum concentration was determined with a commercially available ELISA assay kit. Total nitrite was measured by the Griess reaction as an index for NO production. RESULTS: Serum levels of ET-1 and NO were significantly increased in CHB patients (7.67+/-4.00pg/ml and 172.44+/-50.30mumol/l, respectively) compared with the IC group (3.99+/-5.42pg/ml and 114.68+/-32.22mumol/l, respectively) and the control group (3.05+/-0.65pg/ml and 58.61+/-24.18mumol/l, respectively) (p<0.0001). The CHC patients also had significantly higher serum levels of ET-1 (5.92+/-4.24pg/ml) and NO (147.50+/-55.84mumol/l) compared to the control group (p<0.0001 and <0.001, respectively). Linear regression analysis identified that the level of ET-1 was an independent variable that correlated significantly with the stage score (r(2)=0.348, p<0.0001) in CHB patients but there was no correlation in the CHC group. CONCLUSION: ET-1 and NO levels were increased in chronic hepatitis and there was a significant correlation between the ET-1 level and the stage in CHB patients.

Inhibition of experimental proliferative vitreoretinopathy with protein kinase C inhibitor (chelerythrine chloride) and melatonin.

PURPOSE: To investigate whether a protein kinase C (PKC) inhibitor and melatonin prevent proliferative vitreoretinopathy (PVR). METHODS: Twenty pigmented rabbits were used in this study. All rabbits except controls received an intravitreal injection of 0.15 ml (75,000 units) of platelet-rich plasma into their left eye. The animals were divided into four groups: group I was treated with intravitreal injection of 0.1 ml (100 micromol/ml) of PKC inhibitor (chelerythrine chloride), group II received 1 ml (4 mg/kg) of intraperitoneal melatonin for 3 days, group III received nothing (blank group), and group IV (control group) received only 0.5 ml of 1% ethanol intraperitoneally for 3 days. Proliferative changes were graded in a masked fashion by indirect ophthalmoscopy for a 15-day follow-up period. The malondialdehyde (MDA), reduced glutathione (GSH) and total nitrite levels were measured in the vitreous humor. RESULTS: The grades of PVR were A and B in group I and II, treated with PKC inhibitor and melatonin, respectively. The PVR grade in the blank group was C-D. The mean MDA level in group I (4.2 +/- 0.9 micromol/l) was significantly lower than in the blank group (6.0 +/- 1.0 micromol/l; p < 0.05). The mean GSH level in group I (66.3 +/- 8.8 micromol/l) was not significantly different from that in the blank group (p > 0.05). The MDA and GSH levels in group II were 3.2 +/- 0.7 and 70.1 +/- 13.3 micromol/l, respectively. Both these levels were significantly different from those of the blank group (p < 0.05). The NO levels in both treatment groups were significantly lower than in the blank group (p < 0.001). CONCLUSION: These findings suggest an inhibitory effect of PKC inhibitor and melatonin on PVR. The inhibition of PVR development was associated with lower MDA and NO levels with higher GSH levels in the treatment groups.

Effects of resveratrol, raloxifene, tibolone and conjugated equine estrogen on vaginal squamous cell maturation of ovariectomized rats.

OBJECTIVE: The effects of estrogen replacement therapy, selective estrogen receptor modulators, or tibolone on vaginal squamous cell maturation in postmenopausal women are not well established. Resveratrol (3,5,4'-trans-trihydroxystilbene) has been shown to bind the estrogen receptor in rat uteri. The aim of this study was to cytologically evaluate vaginal smears from ovariectomized rats treated with resveratrol, raloxifene, tibolone and conjugated equine estrogen, and to compare each drug with regard to vaginal epithelial maturation. MATERIAL AND METHODS: Forty-two bilaterally ovariectomized Wistar albino rats were equally randomized into 6 groups: (1) control sham-operated rats; (2) ovariectomized rats administered 0.1% ethanol; (3) ovariectomized rats administered resveratrol at a dose of 5 mg/kg/day p.o.; (4) ovariectomized rats administered conjugated equine estrogen (CEE) at a dose of 0.1 mg/kg/day p.o.; (5) ovariectomized rats administered tibolone at a dose of 0.25 mg/kg/day p.o., and (6) ovariectomized rats administered raloxifen at a dose of 1 mg/kg/day p.o. Administration of drugs started 5 days after bilateral ovariectomy and continued for 35 days. After 35 days of treatment a vaginal smear was obtained from each rat. Smears were stained with the usual Papanicolaou method, and observed with a light microscope by an experienced cytopathologist. Cytological grading was made according to the extent of parabasal, intermediate, superficial and anuclear squamous cells. RESULTS: Ovariectomized rats had lower scores for superficial and anuclear cells when compared to sham-operated rats (p < 0.05). The CEE group had higher scores for superficial and anuclear cells than those of the ovariectomized, raloxifene and tibolone groups (p < 0.05). The resveratrol-treated rats had higher scores for superficial cells but lower scores for parabasal cells than ovariectomized rats (p < 0.05). The raloxifene and tibolone groups had the same scores for intermediate, superficial and anuclear cells but lower scores for parabasal cells compared to ovariectomized rats. CONCLUSION: The results of our study suggest that resveratrol offsets the reduction in vaginal stratification generally observed after oophorectomy.