An experimental rat model of electric shock injury with isolated electric shock and water conduction: the histopathological changes on the skin and internal organs and the effect on biochemical parameters.

It is difficult to determine the cause of death in electric shock injuries when no trace can be determined on the skin, and this is accepted as a reason for negative autopsy. We aimed to determine useful parameters in the definition of the cause of deaths associated with electric shock and particularly those formed with water conduction. This study used a total of 42 rats, applied with fatal electric shock formed of isolated electric shock at 220 V and with water conduction. The serum NT-ProBNP and H-FABP levels were examined together with histopathological changes in the brain, cerebellum, brainstem, heart, liver and skin and the Bax, caspase-3 and HSP-60 antibody status in these tissues. A statistically significant difference was determined between the groups in respect of the serum H-FABP values and the immunohistochemical staining of the samples taken from the organs. In conclusion, this study is the first in literature with an experimental model of electric shock with water conduction. Using immunohistochemical and biochemical markers in deaths associated with isolated electric shock and electric shock with water conduction, the results of this study can contribute to the clarification of one of the reasons for negative autopsy in forensic medicine.

A 9-year retrospective review of lightning deaths from the Eastern Anatolian Region of Turkey.

In this study, deaths from lightning strikes in Eastern Turkey revealed distinct patterns in lifestyle and physical injury. Farmers, sailors, and those engaged in outdoor sports are all at risk of being struck by lightning. Death from a lightning strike is associated with cardiovascular and central nervous system damage. This study examines cases of autopsies that were performed on bodies that had suffered a lightning strike, including sociodemographic data, burns on the body, injured regions, histopathological findings, and causes of death. This retrospective evaluation included 17 cases. The cases comprised 88.2% males and 11.8% females, with a mean age of 41.5 years. The person's occupation was farmer in 29.4% of the cases and shepherd in 70.6%. Their deaths occurred most frequently in the summer months. Deaths associated with lightning strikes are more frequent in east of Turkey than in other regions, as agriculture and livestock are common sources of income. The majority of the victims among the cases were males working outside because of their occupations. Histopathologically, subarachnoid fresh bleeding was seen in five cases, subpleural fresh bleeding in the lungs in five cases, and interlobular rupture in the lungs in three cases. Deaths associated with lightning strikes have been correlated with a low level of education in this subject. This study is the largest case study of deaths associated with lightning strikes in Turkey.

Coexistence of tuberculosis and extranodal marginal zone lymphoma of the thyroid gland: Case report and literature review.

Introduction: Primary thyroid tuberculosis (TB) is rare even in countries where TB disease is endemic, with the prevalence ranging from 0.1 to 1.15%. Primary thyroid lymphoma is uncommon, and the majority of lymphomas arising in the thyroid gland are non-Hodgkin's lymphomas of B-cell origin, of which about 25% is extranodal marginal zone B cell lymphoma (MALToma). Case presentation: An 86-year- old Turkish female patient with thyroid nodules and cervical lymphadenopathies presented with large multinodular goiter and compressive symptoms. Total thyroidectomy and central lymph node dissection were performed. The revised histological and immunohistochemical revealed the coexistence of thyroid TB and MALToma. The patient received an anti-TB treatment for six months before a revised histopathological examination. About seven months after anti-TB treatment, the patient died due to an unknown cause. Clinical discussion: Although six cases of thyroid TB and papillary thyroid cancer have been documented in the medical literature, no cases of TB and MALToma coexistence have been published so far, to our knowledge. Another essential feature of this study is that the initial pathological examination was reported as thyroid TB. A subsequent re-examination revealed that the patient had both TB and MALT lymphoma. Conclusion: We discuss this rare association and the dilemma encountered in the diagnosis and management of this patient with a review of the literature.

Management and Survival Analysis of Gastrointestinal Neuroendocrine Tumors by Different Tumor Characteristics: Tertiary Center Experience.

BACKGROUND: Gastrointestinal neuroendocrine tumor (GI-NET) is a group of neoplasia consisting of amine and acid producing cells with different hormonal profiles. Although the entire GIS accounts for about 2% of tumors, recent research reveals that the incidence rate has increased. Given the increasing incidence in GI-NETs, more and more extensive research is needed on this subject. In this regard, the demographic and clinicopathological features of the patients diagnosed with GI-NET and their relationship with survival were investigated in the present study. METHODS: Thirty-four patients diagnosed with GI-NETs between January 2009 and December 2019 at the Department of Gastroenterology, Inonu University Faculty of Medicine were analyzed retrospectively. Gender, age, tumor localization, metastasis status, tumor number, tumor diameter, tumor grade, Ki-67 index, and the relationships of these factors with overall survival were examined. RESULTS: Of the patients, 61.8% included in the study were male and 38.2% were female. The average age of the patients was 60.74 years. The most common tumor location was in the stomach (26.5%) and liver (26.5%). Apart from this, 17.6% of NETs were seen in the pancreas, 11.8% in the colon, 8.8% in the rectum, 5.9% in the small intestine, and 2.9% in the appendix. No significant relationship was observed between tumor location and gender (p = .326) and age (p = .641). The tumor diameter ranged from 0.2 cm to 13.91 cm, but the average tumor diameter was 3.84 cm. Solitary tumor was found in 51.5% of cases and multiple tumors in 48.5% of cases. The most common grade was Grade 1 with 41.2% of occurrence. The average of Ki-67 index was 18.36%. There was metastasis in 52.9% of cases. The rate of medical treatment was 48.5%. The median overall survival time of the patients was 23.1 months. In addition, 1-year overall survival was 74.9%, 2-year overall survival was 44.6%, and 5-year overall survival was 35.7%. A statistically significant difference was found between tumor grade and the presence of metastasis, and the overall survival (p = .003 and p = .005). CONCLUSIONS: The tumor grade and the presence of metastasis in gastrointestinal neuroendocrine tumors were found to be the most important prognostic factors affecting overall survival.

Shaken baby syndrome resulting in death: a case series.

BACKGROUND: The aim of this study was to raise the awareness of all healthcare personnel, primarily Emergency Department physicians, forensic physicians, and paediatricians about cases of shaken baby syndrome (SBS), which can be difficult to diagnose, require a high level of suspicion in diagnosis and there is a high likelihood of missed diagnosis. METHODS: A retrospective examination was made of 3400 forensic cases applied with autopsy between 2012 and 2018 to the Forensic Medicine Institution of Malatya Group Directorate. RESULTS: Of the total cases, 113 were aged < 2 years and head trauma was determined in 35. Eight cases were determined as SBS. Of the 8 cases that resulted in death, 75% were male and the mean age was 8.3 months. The trauma had been perpetrated by the father in 50% of cases. There was a history of seizure in 67.5% of the infants and 75% were taken to the Emergency Department with cardiopulmonary arrest. Subdural hematoma and subarachnoid hemorrhage were determined in 37.5% of the cases, subdural hematoma, subarachnoid hemorrhage and intracranial hemorrhage in 50%, and epidural hemorrhage and subarachnoid hemorrhage in 12.5%. In the microscopic examination of the medulla spinalis, focal subdural fresh bleeding was seen in 50% of cases. Bleeding around the optic nerves was determined in 37.5% of cases bilaterally and in 37.5% unilaterally. Retinal hemorrhage was determined in all the cases, which was bilateral in 75%. CONCLUSIONS: The actual worldwide incidence of SBS is not known, and in Turkey, it is thought to be much higher than has been determined. The most important reason for this is thought to be that the diagnosis of child abuse is difficult and physicians do not have a sufficient level of knowledge.

Cytomegalovirus associated severe pneumonia in three liver transplant recipients.

INTRODUCTION: Cytomegalovirus (CMV), is the most common opportunistic infection, remains a cause of life-threatening disease and allograft rejection in liver transplant (LT) recipients. The purpose of this case series is to state that CMV may lead to severe pneumonia along with other bacteria. METHODOLOGY: CMV pneumonia was diagnosed with the thoracic computed tomography (CT) scan findings, bronchoscopic biopsy, real time quantitative Polymerase Chain Reaction (qPCR) and clinical symptoms. For extraction of CMV DNA from the clinical sample, EZ1 Virus Mini Kit v2.0 (Qiagen, Germany) was used, and aplification was performed with CMV QS-RGQ Kit (Qiagen, Germany) on Rotor Gene Q 5 Plex HMR (Qiagen, Germany) device. RESULTS: All recipients had severe pneumonia, leukopenia, thrombocytopenia and at least two-fold increase in transaminases on seventh, twenty-eighth and twenty-second days after surgery, respectively. Thoracic CT scan revealed as diffuse interstitial infiltration in the lung parenchyma. Bronchoscopy, Gram-staining and culture from bronchoalveolar lavage (BAL) fluid were performed in all of them. During bronchoscopy, a bronchial biopsy was administered to two recipients. One recipient could not be performed procedure because of deep thrombocytopenia. PCR results were positive from serum and BAL fluid. Bronchial biopsy was compatible with CMV pneumonia. However, Pseudomonas aeruginosae was found in two cases and Klebsiella pneumoniae in one case BAL fluid cultures. CONCLUSIONS: CMV pneumonia can be seen simultaneously with bacterial agents due to the indirect effects of the CMV. It should be kept in mind that CMV pneumonia may cause severe clinical courses and can be mortal.

Clinicopathological Features of Two Extremely Rare Hepatocellular Carcinoma Variants: a Brief Review of Fibrolamellar and Scirrhous Hepatocellular Carcinoma.

PURPOSE: We aimed to distinguish between fibrolamellar hepatocellular carcinoma and scirrhous hepatocellular carcinoma histopathologically. METHODS AND RESULTS: In this review, fibrolamellar hepatocellular carcinoma and scirrhous hepatocellular carcinoma two specific and rare variants of hepatocellular carcinoma, which are difficult to diagnose histopathologically are discussed. CONCLUSION: The clinical, radiological, gross, histopathological, immunohistochemical, and molecular features of these two tumors, which are defined by the World Health Organization (WHO), are mentioned.

Cytoprotective effects of molsidomine against methotrexate-induced hepatotoxicity: an experimental rat study.

INTRODUCTION AND AIM: Methotrexate (Mtx) is an antineoplastic and immunosuppressive drug that may cause hepatotoxicity, whereas molsidomine (Mol) is a vasodilating and antioxidant agent. This study aimed to investigate the potential protective effects of Mol in Mtx-induced liver toxicity in rats. MATERIALS AND METHODS: Forty Wistar albino rats were equally divided into five groups: control, Mol, Mtx, Mol-Mtx, and Mtx-Mol. Following treatment, the animals were sacrificed, and liver tissue samples were histopathologically evaluated using Roening grading and Bcl-2 antibody staining. Tissue oxidants, antioxidants, and serum transaminases were measured and statistically compared across all groups. RESULTS: No hepatic fibrosis or steatosis was observed in any of the groups. In the Mtx group, grade 2 liver injury and score 2 Bcl-2 antibody staining were observed; however, in the Mol-Mtx group, these were lower (grade 1, score 1). There were no statistically significant differences in serum transaminase levels among groups. Malondialdehyde levels were higher in all rats that received Mtx, but no differences in myeloperoxidase levels were observed among the groups. Levels of tissue antioxidants, including superoxide dismutase, glutathione (GSH) peroxidase (GSH-Px), and reduced GSH, were significantly higher in the Mol-treated and Mol pre-treated groups. Catalase (CAT) levels were elevated in all Mol-treated groups, but only in that group were CAT levels statistically significantly higher than in the control group. CONCLUSION: Our results suggest that some oxidant levels could increase following Mtx administration in the liver, possibly contributing to liver damage, whereas Mol could mitigate the histopathological and biochemical effects of hepatotoxicity. However, molecular studies are required to understand the exact mechanisms of these alterations.

The Role of CD90 in the Differential Diagnosis of Pleural Malignant Mesothelioma, Pulmonary Carcinoma and Comparison with Calretinin.

Pleural Malignant Mesothelioma (MM) is a fatal disease that has been associated with asbestos exposure. Differential diagnosis between the pleural infiltration of pulmonary carcinomas and MM is rather difficult particularly for epitheloid type mesothelioma.We aimed to investigate the utility of CD90, a cancer stem cell marker, in the differential diagnosis of MM and lung carcinoma, its prognostic significance and compare its value with that of Calretinin. Ninety pathology specimens including MM (n:30), pulmonary adenocarcinoma (n:30) and pulmonary squamous cell carcinoma (n:30) were used in this study. Immunohistochemical comparision of CD 90 and Calretinin was made in all groups. Calretinin was positive in 20 cases with MM (64.5 %), and was negative in 10 (32.3 %). CD 90 was positive in 25 of these cases (80 %) and negative in 5 (16 %). On the other hand pulmonary adenocarcinomas and squamous cell carcinomas showed positivity with CD90, 63,6 % and 73 %, respectively. We think that CD 90 has no place in the differential diagnosis between mesothelioma and pulmonary carcinoma because of the low specificity in spite of the high sensitivity.

Abdominopelvic actinomycosis associated with an intrauterine device and presenting with a rectal mass and hydronephrosis: a troublesome condition for the clinician.

Actinomycosis is an uncommon, chronic, granulomatous disease that can be mistaken for a malignant tumor. Abdominopelvic actinomycosis constitutes about 20% of all actinomycosis cases and may mimic malignancy, tuberculosis, or other abdominopelvic inflammatory diseases. This condition is more prevalent in women who use an intrauterine device. We treated a 44-year-old woman who presented with vaginal discharge, right flank pain, dysuria, and difficulty with defecation. She had anorexia and weight loss (8 kg) during the previous 2 months and had a history of intrauterine device use for 12 years. Clinical, radiologic, and endoscopic examinations revealed a rectal mass and right hydronephrosis. Rectal biopsy showed nonspecific colitis. Laparotomy showed a mass that was invading and obstructing the pelvic orifice. Surgery included total abdominal hysterectomy, bilateral salpingo-oophorectomy, appendectomy, low anterior resection, and Hartmann colostomy. Histopathologic evaluation of surgical specimens showed actinomycosis originating from the tubo-ovarian structures and invading the rectal wall. The patient was placed on penicillin for 6 months, and then had closure of the colostomy with no complication.

[Case report: primary renal hydatic cyst]. / Olgu sunumu: primer renal hidatik kist.

Hydatic cyst is a prevalent parasitic disease in Mediterranean region, Middle East and Australia. Its diagnosis is sometimes problematic because of nonspecific complaints and unavailability of any positive result in a routine laboratory analysis. In this study, an primary right renal hydatic cyst which was found in a young female has been presented. The multilocular cyst was completely removed by total nephrectomia surgery. A late diagnosis due to unclear clinic manifestations was considered to be the main reason for the loss of the organ. It will be beneficial to consider a renal hydatic cyst when the patients with blurred flank pain are encountered.