Differential Effects of Small Molecule WNT Agonists on the Multilineage Differentiation Capacity of Human Mesenchymal Stem Cells.

Human bone marrow-derived mesenchymal stem cells (MSCs) are promising candidates for cell-based therapies, but loss of expansion and differentiation potential in vitro limits their applicability. Recently we showed that WNT3A protein promoted MSC proliferation and enhanced their chondrogenic potential, while simultaneously suppressing the propensity of the cartilage to undergo hypertrophic maturation. Since WNT3A protein is costly and rapidly loses its activity in culture, we investigated the possibility of replacing it with cheaper commercially available WNT agonists, specifically lithium chloride (LiCl), CHIR99021 (CHIR), SKL2001, and AMBMP. Of these, we found that only CHIR and LiCl stimulated MSC proliferation. Moreover, CHIR enhanced the chondrogenic capacity of MSCs, whereas LiCl predominantly increased the osteo- and adipogenic capacity. The different WNT agonists also differentially impacted the surface marker profile of the MSCs, possibly explaining the observed differences. Moreover, CHIR suppressed the hypertrophic propensity of the MSC-derived cartilage after in vivo implantation to an extent approaching that of WNT3A protein. These results indicate that CHIR may be a promising alternative for WNT3A protein for certain applications of human bone marrow-derived MSCs.

Comparison of risk of malignancy indices; RMI 1-4 in borderline ovarian tumor.

PURPOSE: The aim of this study was to evaluate prognostic values of the risk of malignancy index (RMI)/1-4 in patients with borderline ovarian tumors (BOTs). METHODS: The study consisted of 50 patients with BOT diagnosed and treated between 2005-2010 and 50 patients with benign adnexal massses between 2009-2010 as a control comparison group in the retropsective study. Preoperative serum CA125, U score, tumor size (S), and menopausal status were recorded. The RMI 1-3 was calculated according to the formula; UxMxCA125 and RMI4 formulation was; UxMxCA125xS. S equaled 1 for tumor size <7 cm and was 2 when size a 7 cm. The RMI 1-4 indices were calculated for all patients together with the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA). The performances of RMI indices were evaluated by McNemar's test and determined the best score cutoff value by the receiver operating characteristic (ROC) curve. RESULTS: The mean age, median value of CA125, ultrasound score, menopausal status, median values of RMI 1-4 of BOTs were statistically higher than benign adnexal masses. The sensitivity of RMI 1-4 was 26, 36, 62, and 60% at cutoff 200 level, respectively. The areas under curve of RMI 1-4 were found to be 0.676, 0.665, 0.668 and 0.734, respectively. DA of RMI 1-4 was found to be 56, 59, 50, and 71, respectively. When RMI 1-4 indices were compared with each other RMI 4 was the best RMI for BOTs. CONCLUSION: RMI 4 was the best predictive RMI for preoperative discrimination of BOT at a cutoff level of 200.

Comparison of tumor markers and clinicopathological features in serous and mucinous borderline ovarian tumors.

OBJECTIVE: The aim of this study was to assess tumor markers and clinicopathological findings of patients with serous and mucinous borderline ovarian tumor (BOT) features. METHODS: The study consisted of 50 patients that were diagnosed with and treated for BOT between 2005-2010 in three centers. CA125, CA19-9, and CA125+CA19-9 levels and clinicopathological features were compared in serous and mucinous histotypes. In serous and mucinous BOTs, correlations between tumor markers and demographics such as age, menopausal status, parity, clinical findings (stage, relapse, adjuvant chemotherapy, cytology, lymph node involvement and tumoral morphology (cystic-solid content, papilla, septation) were evaluated. RESULTS: There were no significant differences between serous and mucinous tumors in the clinicopathological features such as stage, tumor markers, age, menopausal status, or cytology. In serous BOTs we found a significant relation between elevated CA125+ CA19-9, CA19-9 and recurrence (p < 0.05). Also there was a significant relation between elevated CA125+ CA19-9, CA19-9 and cytology positivity (p < 0.05). We found a significant relation in serous BOTs between elevated CA125+CA19-9, adjuvant chemotherapy and lymph node metastases (p < 0.05). Also In mucinous BOTs with papilla formation we found a significant relation between elevated CA125 and CA125+ CA19-9 (p < 0.05). There was significant relation between cytology positivity and elevated CA19-9 in mucinous BOTs (p < 0.05). CONCLUSION: Serum tumor markers of serous and mucinous BOTs were different in relation to their clinicopathological features. This may reflect differences of serous and mucinous BOTs.

Anatomical analysis of azygos vein system in human cadavers.

The azygos system veins vary greatly in their mode of origin, course, tributaries, anastomoses and termination. Therefore, we aimed to investigate the types of azygos system in this study. Our research was made in Anatomy departments on 48 conserved cadavers aging between 27-70 years, of which 35 were males and 13 females. In the research, the diameters and levels of the azygos vein, the hemiazygos vein, the accessory hemiazygos vein and the superior intercostal vein were investigated. The subjects were classified in Anson's system with a basis of vertical and horizontal connections in the azygos venous system the classification included primitive or embryological types, transient type, unicolon type as three basic types and their eleven subgroups. According to this classification (amongst 48 cadavers), one (2.1%) of our subjects was found to be Type I, 44 (91.7%) of them were found to be Type II, and one (2.1%) was found to be Type III. These values were similar to those in the literature, however two (4.2%) subjects did not fit in any otherwise defined groups and were named as atypic group. It is very important to identify the variations of the azygos system in the computed tomography and magnetic resonance imaging of mediastinum. The abnormal azygos venous system may easily be confused with aneurysm, lymphadenopathy and other abnormalities like tumor. It is important to keep these kinds of variations in mind while performing the mediastinal operations or surgery of large vessels.

A case of connected superior and middle trunks of the brachial plexus or with abnormal upper trunk.

During treatment of tumors of nerve sheaths, such as schwannomas and neurofibromas, neurosurgeons should be aware of variations and aberrant formations of brachial plexus. Variations of the branches of brachial plexus are common, but its variations in the level of the roots and trunks are rare. Variations regarding lower trunk were founded more frequent in previous studies. An unusual variant of the brachial plexus was found unilaterally during routine dissection of a 75-year-old male cadaver. It was observed that middle trunk was connected to superior trunk. Deep cervical artery originating from subclavian artery passed between C6 and C7 roots. Similar variations in the brachial plexus were not observed on the contralateral side. In available literature, only two similar bilateral cases were reported. The details of this variation and its clinical significance were discussed. Knowledge about these rare variations in the trunks is very useful in surgical practice and anesthesia.

The position of the mandibular canal and histologic feature of the inferior alveolar nerve.

The inferior alveolar nerve is the one of the large branches of the mandibular division of the trigeminal nerve. It is vulnerable during surgical procedures of the mandible. Despite its importance, no anatomical and histological examination has been conducted to provide a detailed cross-sectional morphology of the mandibular canal according to dental status. Therefore, the present study aimed to identify the position of the mandibular canal through direct measurement and to determine the branches of the inferior alveolar nerve through histologic examination. The area between the anterior margin of the third molar and the anterior margin of the second premolar of dentulous, partially dentulous, and edentulous hemimandible specimens (n = 49) from 26 human cadavers was serially sectioned into seven segments, and specific distances were measured using digital calipers. Following this, 5-microm cross-sections were prepared along the mandibular canal and mental foramen, and examined by fluorescence microscopy. The mandibular canal was located at a mean distance of 10.52 mm above the inferior margin of the mandible. The mean maximum diameters of the mandibular canal, inferior alveolar nerve, inferior alveolar artery, and inferior alveolar vein were 2.52, 1.84, 0.42, and 0.58 mm, respectively. This study found that the inferior alveolar nerve often gives rise to several branches at each level (range 0-3). To minimize the risk of injury, knowledge of the small branches of the nerve and of the detailed findings regarding the position of the mandibular canal reported here should be considered when planning mandibular surgery, especially during implant placement.

Length of the styloid process and anatomical implications for Eagle's syndrome.

The styloid process is a bony projection, located just anterior to the stylomastoid foramen, the normal length of which is approximately 20-25 mm. Elongation of the process may cause various clinical symptoms such as neck and cervicofacial pain, described as Eagle's syndrome. The present study aimed to determine the mean length of the styloid process on cadavers, panoramic radiographs, and dry skulls, and to investigate the incidence of the elongated styloid process, while assessing the elongation in relation to Eagle's syndrome. When the measurements from the panoramic radiographs were assessed, the mean length of the styloid processes in males and females on the right and left sides were found to be the following: 25.78 + or - 5.68 mm; 22.69 + or - 3.68 mm, 25.80 + or - 5.75 mm; and 22.75 + or - 3.65 mm, respectively. The males had greater styloid process lengths than the females, and the differences in length on both the right and left sides were statistically significant. Descriptive statistics and comparison results according to age groups were determined. There was no statistically significant difference between right or left styloid process lengths according to age groups. The mean length of the styloid process of the cadavers and dry bones was 22.54 + or - 4.24, and there was no significant difference between the right and left sides of the cadavers and dry bones. The incidence of the elongated styloid process was determined as 3.3%, and the elongations revealed a female dominance. The average length of the elongated styloid process was 36.06 + or - 6.12 mm, while the mean length of the styloid processes of the subjects reporting Eagle's syndrome was 40 + or - 4.72 mm. The results of this morphological study will assist clinicians in the diagnosis of Eagle's syndrome.

Perineural invasion in early-stage cervical carcinoma.

PURPOSE: Evaluation of the association between perineural invasion (PNI) and predictive and prognostic factors in early-stage cervical carcinoma patients treated with surgery. METHODS: Fifteen PNI (+) and 21 PNI (-) early-stage cervical carcinoma patients, primarily treated by surgery, were evaluated retrospectively. Patients' complete blood counts and biochemistry tests, tumoral prognostic parameters, PNI status, postoperative treatment, recurrence and survival data were obtained from the records. RESULTS: The percentage of mean depth of stromal invasion was significantly higher in the PNI (+) group (p < or = 0.05). Vaginal (p < or = 0.05) and uterine (p < or = 0.01) invasion of the tumor were significantly more prevalent in the PNI (+) group. Lymphovascular space invasion, in particular lymphatic invasion (p < or = 0.05), but not vascular invasion (p > 0.05) was significantly more prevalent in the PNI (+) group. CONCLUSION: PNI is closely related with stromal invasion in percentage, vaginal and uterine involvement and lymphatic invasion of the tumor.

Peritoneal tuberculosis mimicking peritoneal carcinomatosis.

PURPOSE: The data of 11 peritoneal tuberculosis (TB) patients is discussed in an attempt to better understand this disease. METHODS: Nine patients with clinical features mimicking ovarian cancer and two with infertility were evaluated retrospectively. RESULTS: The mean age was 40.8 +/- 18.3 years. None had any past/family history of TB. Abdominal swelling and pain, appetite loss, nausea/vomiting, and primary infertility were the most common complaints. Chest X-ray suggested TB in one cachexic patient. Six patients had ovarian/primary peritoneal cancer on laparotomy. Laparoscopy was performed to determine therapeutic modality in one patient and for primary infertility in one patient. Three patients were not operated because of suspected TB in one and neoadjuvant chemotherapy in two with poor performance scores. They underwent peritoneal or omental biopsies; histopathology revealed caseous granulomatous TB lesions. Mycobacterium tuberculosis was identified in only two ascitic fluid cultures. CONCLUSION: Peritoneal TB should be suspected in endemic areas, especially in young patients considered to have peritoneal carcinomatosis.

The presence of Helicobacter pylori in cervical preinvasive lesions.

PURPOSE: Helicobacter pylori (H. pylori) is believed to play a role in several gynecological and obstetric pathologies since the cervical mucosa resembles the gastric environment. The microorganism is expected to infect the upper genital tract via the oral-genital and fecal-genital routes. METHODS: We studied 35 cases with benign, ASCUS, ASC-H, LSIL and HSIL pap-smear results. The presence of H. pylori in the uterine cervix and active infection were investigated with the H. pylori stool antigen test. Biopsy specimens were stained with hematoxylin-eosin and Warthin-Starry stains to find H. pylori in cervical tissue. Seroprevalence was investigated by using ELISA for H. pylori IgG and IgA. RESULTS: The H. pylori seroprevalence was 65.7%; further, 17.1% of the cases had an active infection. H. pylori was not found in the cervix or the cervicovaginal secretions. CONCLUSION: The cervix is not a reservoir for H. pylori, and the microorganism does not appear to be transmitted through the fecal-genital route.

Clinical and anatomical aspects of possible mylohyoid nerve injury during genioplasties.

Damage to the cutaneous branch of the mylohyoid nerve (CBMN) during genioplasties is possible but rare. The aim of this cadaveric study was to demonstrate possible mechanisms of injuring the CBMN during genioplasties. Mandibulotomy access was used to carry out sublingual and lateral cervical dissections on 10 formalinized cadavers with a mean age of 65 years. The length of the mylohyoid nerve was measured at three sections on the mandible. The posterior section of the mylohyoid nerve was 8.7+/-0.5 mm; the middle section was 14.5+/-0.9 mm and the anterior section was 15.6+/-1.2 mm in length. The submental skin island of 7 specimens had unilateral innervation by the CBMN. The bilateral innervation pattern was detected in 3 of the specimens. Damage to the sensory and the motor branches of the mylohyoid nerve can occur during genioplasties by transaction of the soft tissue pedicle attached to the mental spine and inferior border of the symphis. Surgeons should pay attention during dissection and osteotomy of the chin to avoid complications of the mylohyoid nerve and its branches.

A case with three primary tumors of the ovary, endometrium and gallbladder.

A case with three synchronous tumors is presented. A 52-year-old patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, bilateral pelvic and paraaortic lymph node dissection, and partial omentectomy for endometrial carcinoma accompanied by an adnexal mass. She further underwent cholecystectomy for a perioperative incidental suspicious nodule on the serosal surface of the gallbladder. Histopathology revealed a uterine endometrioid adenocarcinoma, a mucinous adenocarcinoma of the gallbladder, and an ovarian endometrioid carcinoma with a clear cell component. The progress of the patient until the time of death is discussed.

A case of hepatoid carcinoma of the ovary.

A 50-year-old female was admitted with abdominal distention. Her serum CA125 level was elevated. Ultrasonography and computerized tomography showed adnexal tumoral masses with intraperitoneal metastases but no hepatic parenchymal involvement. She was operated on and histopathological and immunohistochemistry findings indicated ovarian hepatoid tumor. We present this case of ovarian hepatoid tumor and discuss the two-year disease progression from diagnosis to death.

Anatomical and functional aspects of ligaments between the malleus and the temporomandibular joint.

The aim of this paper is to investigate the anatomical topography and the relationship between the ligaments, malleus and temporomandibular joint (TMJ) and to determine the role of these ligaments on the movement of the malleus. The malleus, incus, petrotympanic fissure (PTF), chorda tympani, anterior malleolar ligament (AML), discomallear ligament (DML), malleomandibular ligament, sphenomandibular ligament and articular disc were explored in 15 skulls. Traction and tension tests were carried out to clarify their role in malleolar movement. In 12 of the cases, two separate ligaments were connected to the anterior of the malleus, whereas a single ligament from the anterior of the malleus to the PTF was observed in 3 cases. In 12 cases, the DML united the retrodiscal tissues. In the other 3 cases, the medial and the lateral parts of the ligament were connected to the retrodiscal tissue after passing through the PTF. The thickness of the ligaments differed among specimens. When tension was applied to the DML no malleolar movement occurred, but when the AML was overstretched, significant movement was observed in 5 cadavers; little movement in 6 cadavers, and no movement in 4 cadavers. This study suggests that extreme stretching of the condyle in conjunction with the ligaments between the ossicles of the inner ear and the TMJ could be the reason for unexplained otological problems.

Maternal serum mannose-binding lectin in severe preeclampsia.

PURPOSE: We aimed to investigate the level of serum mannose-binding lectin (MBL) in severe preeclamptic patients, women with uncomplicated pregnancies, and healthy reproductive-age females and its impact on gestational age at delivery and birth weight. METHODS: Serum MBL levels were measured in 27 severe preeclampsia patients (Group 1), 27 patients with uncomplicated pregnancies (Group 2), and 25 healthy reproductive-age women (Group 3). RESULTS: The mean serum MBL was significantly higher (p < or = 0.05) in Group 1 than in Groups 2 and 3, while the levels in Groups 2 and 3 did not significantly differ. The mean gestational age at delivery and mean birth weight were significantly lower in Group 1. In Group 1, serum MBL was negatively correlated (p < or = 0.05) with the gestational age at delivery and birth weight. CONCLUSION: Serum MBL increased in preeclampsia and was negatively correlated with the gestational age at birth and birth weight, indicating an underlying immunopathogenesis.

Double superior vena cava.

Duplication of superior vena cava (SVC) is a rare anomaly. The incidence of double SVC in general population is 0.3% whereas in patients with congenital heart disease it varies between 10-11%. Double SVC cases have clinical importance if especially the one on the left side drains into the left atrium. Moreover, double SVC is surgically important in the presence of congenital heart disease. In this article, we presented adult patients who incidentally diagnosed with double SVC, one drained into the right atrium while the other into the left atrium and discussed the embryologic basis of these patent vessels.

Results of cisplatin, adriamycin and etoposide chemotherapy in patients with recurrent and metastatic endometrial cancer.

The efficacy of the combination treatment of cisplatin, adriamycin and etoposide were retrospectively evaluated in 26 recurrent or metastatic endometrial cancer patients. One hundred and twenty-three treatment courses were observed. Patients received 20 mg/m2 cisplatin and 80 mg/m2 etoposide by continuous i.v. infusion for three days and adriamycin 40 mg/m2 i.v. the second day. Treatment courses were repeated every four weeks. Megestrol acetate, 160 mg/day, was added in six patients who had positive progesterone receptors. Ten (38.5%) women had complete and three (11.5%) patients had partial response with an overall response rate of 50%. Median follow-up was 24 months. Surviving patients were alive for four months and six years. Toxicity was mainly hematological and gastrointestinal ulcerations and stomatitis were also observed.

Accessory suprarenal gland: report of a case.

The suprarenal glands are normally located at the superomedial aspect of the kidneys. Accessory cortical masses are seen in approximately half of the newborn but usually disappear later. Several cases with accessory cortical tissues located near the main suprarenal glands have been reported but their usual locations have been rarely described. Here we report a case with accessory cortical tissue located on the right in the retrocrural space with compression symptoms. Such a lesion may be confused with lymphadenopathy radiologically.