Effects of repeated intravenous doses of tranexamic acid on closed tibial fracture healing: Experimental study based on the rat model.

OBJECTIVE: The aim of this study was to assess the effects of tranexamic acid on fracture healing in the rat tibia closed fracture model. METHODS: Sixty-four male Sprague-Dawley rats were included in this study, where closed fracture and intramedullary nailing were performed on their right tibial diaphyses. They were divided into 2 main groups, the experimental group, which was given weekly tranexamic acid injections, and the control group, which received no additional treatment. Eight rats from each group were sacrificed and evaluated for fracture healing at the first experimental group and control group, second experimental group and control group, third experimental group and control group, and fourth experimental group and control group weeks. Fracture healing was radiologically assessed according to the "Spencer Index" and "Lane and Sandhu Scoring System," and histologically evaluated according to the scoring system devised by Huo et al. Results: According to the Spencer Index, the mean union score was statistically significantly higher in the E3 group than in the third con- trol group (P = .014). Furthermore, the mean union score was statistically significantly higher in the fourth experimental group compared to the fourth control group (P=.047). According to the Lane and Sandhu Scoring System, only the mean union scores of the E3-4 groups were statistically significantly higher than the mean union scores of the C3-4 groups (P=.048). There was no histological difference between groups in terms of union, according to the criteria defined by Huo et al (P > .05). CONCLUSION: This study showed us that repeated intravenous administrations of tranexamic acid had no negative effect on fracture heal- ing in the rat tibia fracture model. Although tranexamic acid demonstrated better radiological healing in the late period, it had no effect on histological union.

Development of an Animal Model for Type II Sulcus (Sulcus Vergeture).

OBJECTIVES: To develop a reproducible experimental animal model for sulcus vergeture in rabbits. STUDY DESIGN: Experimental animal study. MATERIAL METHOD: We evaluated three methods of inducing sulcus in twelve New Zealand white rabbits to produce a sulcus model. Experimental groups comprised: group 1 (n = 4) underwent submucosal injury following endolaryngeal epithelial incision; group 2 (n = 4) received submucosal injury via thyrotomy; group 3 (n = 4) received submucosal injury via thyrotomy, followed with horizontal mucosal lateralization suture. Right vocal folds of the rabbits underwent surgery to produce sulcus vocalis and left vocal folds were used for the comparison. In the sixth week after the procedure, the rabbits were sacrificed and the larynxes were harvested and analyzed histopathologically. RESULTS: No animals in group 1 or 2 developed sulcus vocalis. Sulcus formation was observed in all rabbits in group 3, under endoscopic examination and microscopic sulcus formation was demonstrated for the first, second, and third rabbits. An epithelial depression area was seen at the glandular ductal opening zone for the fourth rabbit, but it could also be accepted as a sulcus formation. CONCLUSION: We successfully developed a reproducible survival model for sulcus using a submucosal injury via thyrotomy, followed with a horizontal mucosal lateralization suture. This model provides the groundwork for future research into the applicability of new approaches for sulcus management.

Decellularization of Trachea With Combined Techniques for Tissue-Engineered Trachea Transplantation.

OBJECTIVES: The purpose of this study is to shorten the decellularization time of trachea by using combination of physical, chemical, and enzymatic techniques. METHODS: Approximately 3.5-cm-long tracheal segments from 42 New Zealand rabbits (3.5±0.5 kg) were separated into seven groups according to decellularization protocols. After decellularization, cellular regions, matrix and strength and endurance of the scaffold were followed up. RESULTS: DNA content in all groups was measured under 50 ng/mg and there was no significant difference for the glycosaminoglycan content between group 3 (lyophilization+deoxycholic acid+de-oxyribonuclease method) and control group (P=0.46). None of the decellularized groups was different than the normal trachea in tensile stress values (P>0.05). Glucose consumption and lactic acid levels measured from supernatants of all decellularized groups were close to group with cells only (76 mg/dL and 53 mg/L). CONCLUSION: Using combination methods may reduce exposure to chemicals, prevent the excessive influence of the matrix, and shorten the decellularization time.

Pseudoangiomatous Stromal Hyperplasia in Core Needle Biopsies of Breast Specimens.

BACKGROUND: Pseudoangiomatous stromal hyperplasia (PASH) is a benign lesion of myofibroblasts that is composed of a network of slit-like channels that resemble vascular spaces. The aims of this study were to document the frequency of PASH in core needle biopsy specimens (CNBS) of the breast, to describe which histopathologic findings coexist with PASH and to examine any endothelial cell differentiation. MATERIALS AND METHODS: We reevaluated hematoxylin and eosin-stained sections of all CNBS that were obtained during a 1-year period. First, we performed CD34 and CD31 immunostainings to highlight the areas of PASH, then performed D2-40/podoplanin (lymphatic endothelial marker) and Fli-1 (vascular endothelial cell marker) immunostains. RESULTS: The total number of CNBS was 412. Areas of PASH were noted in 37 of the 412 cases (9%), with a mean age of 38.5 years. The lesions that were described in association with PASH were "benign breast parenchyma with stromal fibrosis" (17/37; 46%), "fibroepithelial tumors" (17/37; 46%), "columnar cell changes (CCC)" (2/37; 5%), and "invasive carcinoma" (1/37; 3%). There were 2 cases of CCC within the foci of PASH (direct contact with PASH), and 8 additional cases of CCC that coexisted in the same specimen but were not in direct contact. There was no staining for D2-40 or Fli-1 within PASH foci. CONCLUSION: PASH lesions occurred with a frequency of 9% in CNBS and were mostly in association with benign breast lesions in premenopausal women. CCC was determined as an accompanying epithelial lesion within or near PASH areas. No obvious immunopositivity compatible with endothelial cell differentiation was revealed.

Malignant Phyllodes Tumor Including Aneurysmal Bone Cyst-Like Areas in Pregnancy - a Case Report and Review of the Literature.

BACKGROUND: Malignant phyllodes tumors of the breast are rare biphasic neoplasms. Only few cases related to pregnancy have been reported. CASE REPORT: A 37-year-old woman presented with swelling and pain in her left breast as well as hyperemia on the breast skin, 4 weeks after labor. In her family history, her aunt and maternal cousin had had a breast cancer diagnosis. Clinical evaluation of the patient was consistent with a breast abscess. Therefore, abscess drainage and biopsy from the cavity wall were performed. However, the biopsy was diagnosed as malignant phyllodes tumor. An evaluation by ultrasonography showed a well-defined hypoechoic mass with many cystic spaces covering the entire breast tissue. Therefore, a simple mastectomy was performed. Microscopic examination revealed a high-grade malignant phyllodes tumor. Additionally, bone cyst-like areas in the form of sponge-like blood-filled non-endothelialized spaces were observed. CONCLUSIONS: Since the breasts become larger due to the physiological changes during pregnancy, any underlying breast lesions may be obscured. Therefore, clinical breast examination in the first visit of pregnancy is important.

Supraglottic Kaposi's Sarcoma in HIV-Negative Patients: Case Report and Literature Review.

This paper presents a case report of an HIV-negative, supraglottic Kaposi's sarcoma patient. The 80-year-old male patient was admitted with complaints of hoarseness, difficulty in swallowing, and a stinging sensation in his throat for approximately six months. The endoscopic larynx examination revealed a lesion which had completely infiltrated the epiglottis, reached right aryepiglottic fold, was vegetating, pink and purple in color, multilobular, fragile, and shaped like a bunch of grapes, and partially blocked the bleeding airway passage. The case was discussed by the hospital's head-neck cancer committee and a surgery decision was made. A tracheotomy was performed under local anesthesia before the operation due to respiratory distress and endotracheal intubation difficulty. Direct laryngoscopy showed that the mass was limited in the supraglottic area, had invaded the entire left aryepiglottic fold and one-third of the front right aryepiglottic fold, and completely covered epiglottis. It should be remembered that although rare, Kaposi's sarcoma may be encountered in larynx malignancy cases. Disease-free survival may be achieved through local excision and postoperative radiotherapy.

Impact of platelet-rich plasma injection timing on healing of Achilles tendon injury in a rat model.

OBJECTIVE: The aim of this study was to evaluate the impact of the timing of platelet-rich plasma (PRP) application on the healing of Achilles tendon injury in a rat model. METHODS: Fifty-four female Sprague-Dawley rats were divided into 4 groups: PRP preparation group (n=6); Achilles tendon tear and 150 µL of PRP received on the day following the injury (PRP day 0, group 1, n=16); Achilles tendon tear and 150 µL of PRP received on the third day following injury (day 3 , group 2, n=16); Achilles tendon tear and 150 µL of saline received on the day following injury (PRP day 0, group 3, n=16). Rats were sacrificed at 3 weeks. Consequently, biomechanical and histologic analyses were performed. RESULTS: According to histological evaluation, inflammation, fibroblast density, epitenon thickness, and collagen fiber were significantly higher in group 1 than in group 2 (p<0.05). Biomechanical testing results of group 1 and group 2 were inferior to the control group, while the differences were not significant (p>0.05). CONCLUSION: Based on histological criteria, results of the present study suggest that immediate injection of PRP for tendon injury improves tendon healing in rats. Although the use of PRP is well recognized in orthopedic surgery, we aimed to highlight the importance of immediate application of PRP for acute tendon injury.

Human olfactory stem cells for injured facial nerve reconstruction in a rat model.

BACKGROUND: The purpose of this study was to show the efficacy of olfactory stem cells for injured facial nerve reconstruction in a rat model. METHODS: Olfactory stem cells were isolated from the olfactory mucosa of human participants. A 2-mm excision was performed on the right facial nerve of all rats. Reconstruction was performed with a conduit in group 1 (n = 9); a conduit and phosphate-buffered saline in group 2 (n = 9); and a conduit and labeled olfactory stem cell in group 3 (n = 9). Rats were followed for whisker movements and electroneuronography (ENoG) analyses. RESULTS: The whisker-movement scores for group 3 were significantly different from other groups (p < .001). ENoG showed that the amplitude values for group 3 were significantly different from group 1 and group 2 (p = .030; p < .001). Group 3 showed marked olfactory stem cell under a fluorescence microscope. CONCLUSION: This study suggests that olfactory stem cells may be used as a potent cellular therapy for accelerating the regeneration of peripheral nerve injuries. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2011-E2020, 2016.

Temporal Bone Localized Chondroblastoma.

Chondroblastoma is a highly destructive tumor originating from immature cartilage cells. Although chondroblastoma is defined as a benign tumor, it may exhibit malign tumor behaviors such as invasion or metastasis on neighboring structures. Magnetic resonance (MR) image is a solid mass lesion, which included heterogeneous hypointense in T2A and heterogeneous minimal hyperintense in T1A with destructive expansile characteristics and millimetric calcifications. Temporal bone chondroblastomas may complicate the diagnosis because of their different histologic characteristics. Microscopically, chondroblastic cell nests and calcification of locally "chicken wire" type around the cells are observed. These tumors secrete s-100 and vimentin and are used for differential diagnosis. In this study, a temporal bone localized chondroblastoma case is presented.

Nodule-Forming Pseudoangiomatous Stromal Hyperplasia of the Breast: Report of Three Cases.

Pseudoangiomatous stromal hyperplasia (PASH) is a benign proliferative entity of mammary stroma. It is generally found as an incidental finding. It may rarely present as a palpable nodule. Three patients, who were 29, 45, and 58 years of age, were referred to our clinic with nodule and pain in the breast. The physical examinations and ultrasound findings of all three patients were consistent with fibroadenoma. Core biopsies were performed and reported as "benign breast parenchyma including stromal fibrosis." PASH areas were noted in one case. The excision specimens were observed as solid nodular masses with smooth external surfaces and white in colour. Microscopically, well-demarcated hyalinized stroma, including slit-like pseudovascular spaces lined by bland spindle cells, was observed. Immunohistochemically, these cells showed positive staining for CD34 and negative staining for CD31. Nodule-forming PASH mostly confuses with fibroadenoma with respect to clinical examination and radiological findings. Definite diagnosis requires histopathological verification. Differential diagnosis should be made with low grade angiosarcoma, fibroepithelial tumors, and myofibroblastoma.

Matrix-Producing Carcinoma of the Breast: Case Report.

Matrix-producing carcinoma (MPC) is an uncommon variant of metaplastic carcinoma. It was first described by Wargotz and Norris in 1989 as invasive breast carcinoma with direct transition to cartilaginous stroma without intervening spindle cell component. Since then, several studies, mostly in the form of case reports or case series, have been reported and the origin of tumor cell, importance of appropriate terminology for the tumor, histopathological differential diagnosis, benign breast lesions that the tumor could correlate with, and prognosis and consequently the treatment modalities have been discussed. A 43-year-old woman referred to our clinic with a lump in her left breast. Physical examination and radiological findings were consistent with malignancy. Core biopsy of the lesion was reported as "invasive breast carcinoma" and then breast-conserving surgery with sentinel lymph node dissection were performed. The case was diagnosed as MPC of the breast. The literature findings imply epithelial cell (ductal and/or myoepithelial) nature of this tumor. The prognosis is still controversial. Histopathological evaluation of sufficiently sampled surgical excision material is important to recognize and make a correct diagnosis.

In vivo tissue-engineered allogenic trachea transplantation in rabbits: a preliminary report.

Conventional tracheal reconstruction techniques are not successful at restoring functional units in situations with extensive damage involving more than half the length of the trachea. For the first time, we investigated in vivo tissue-engineered trachea regeneration from a decellularized cadaveric trachea matrix with seeded adult adipose tissue-derived mesenchymal stem cells (MSCs) and investigated the integration of the matrix into the recipient tracheal side. For the procedure, 1.8-cm grafts were prepared from 3.5-cm tracheas of three donor rabbits. Then, tracheal grafts were rendered nonimmunogenic using a decellularization technique. MSCs isolated from recipient rabbit adipose tissue were cultured and marked before being seeded in the decellularized matrix. A total of 1.8 cm of the recipient tracheas was replaced with either a decellularized tracheal matrix (group 1) or tracheal matrix-seeded MSCs (group 2). Rabbits survived 17 ± 2 days in the first group, and the causes of death were separation in the anastomosis region, airway obstruction, and infection. In the second group, animals were sacrificed on the 30th, 60th, and 90th days of follow-up. Histopathological analysis revealed the integration of MSCs seeded-decellularized cadaveric tracheas to the recipient tracheal sides and increased angiogenesis. The MSCs were traced by fluorescence microscopy in the ciliated epithelium, under the epithelium, and in the cartilage of the integrated new trachea. Tracheas generated by autologous cells and tissue-engineering techniques will be a great source for the treatment of life-threatening tracheal injuries after the completion of related studies.

Paratesticular sarcomas: A report of seven cases.

Primary tumors of the paratesticular region are rare, with paratesticular sarcomas constituting a major proportion of these tumors, particularly in the elderly. The paratesticular region consists of mesothelial, various epithelial and mesenchymal cells and may therefore give rise to a number of tumors with various behaviors. Defining the association between the paratesticular mass and the testicle, and differentiation between benign and malignant masses using radiology is challenging, therefore the mass is usually considered to be malignant and radical orchiectomy with high ligation is performed. The present study reports the cases of seven patients with tumors of the paratesticular region and presents the clinical and significant histological features of the tumors. In total, two patients suffered from dedifferentiated liposarcoma (DDLS), two exhibited leiomyosarcoma, two exhibited low-grade fibromyxoid sarcoma and one case of undifferentiated pleomorphic sarcoma was identified. Radical orchiectomy with high ligation was performed in five cases; simple orchiectomy was performed in one case and excisional biopsy was performed in the remaining case. A leiomyosarcomatous and epithelial membrane antigen (EMA) positive whorl pattern was observed during microscopy in the two DDLS cases. Additionally, one of the low-grade fibromyxoid sarcoma patients exhibited pleomorphism and mitosis in focal areas. To the best of our knowledge, the present study is the second time low-grade fibromyxoid sarcoma cases with paratesticular localization have been reported in the literature. Of the seven cases, four patients succumbed to the disease, one patient is living with the disorder and the two cases of DDLS are living without the disease. Paratesticular sarcomas are often aggressive and a multidisciplinary approach is required for the diagnosis and treatment of these tumors.

Comparison of the effects of topical fusidic acid and rifamycin on wound healing in rats.

Wound healing is an active and dynamic process that begins from the moment of injury. Any delay in the initiation of the response to injury can prolong the healing process. The aim of this study was to investigate the effects of topically applied fusidic acid and rifamycin on wound healing in a full-thickness wound model. Ten female Sprague-Dawley rats, aged 4 months and weighing 200-250 g, were used. Four rifamycin (R), four fusidic acid (F) and four control (K) areas were generated on their backs by using a 5-mm punch biopsy pen. On the 4th, 7th, 14th and 21st days, biopsies were taken from each wound area of all the rats. Fusidic acid group demonstrated a statistically significant increase of collagen and intensity of fibroblast proliferation on the 21st day of wound healing, whereas in the rifamycin group, healing time was, as expected, similar to physiological wound-healing phases. Despite the limited number of subjects, topical fusidic acid was found to delay wound healing by prolonging fibroblast proliferation.

Eleven years of itching: a case report of crusted scabies.

Crusted scabies is a rare and highly contagious form of scabies that is characterized by uncontrolled proliferation of mites in the skin, extensive hyperkeratotic scaling, crusted lesions, and variable pruritus. We report the case of a 48-year-old man with an 11-year history of pruritic, hyperkeratotic, psoriasiform plaques and widespread erythematous papules that was diagnosed as crusted scabies.

[Multiloculated epidermoid cyst of spleen: a case report]. / Dalagin Multiloküle Epidermoid Kisti: Olgu Sunumu.

Splenic epidermoid cyst is a rare cystic disease of spleen. Primary cysts of the spleen lined by epithelium or endothelium are usually seen in young adults. A 23-year-old woman with abdominal distension presented at the surgery outpatients of our hospital. Splenomegaly was detected on physical examination and elective surgery was performed. The multiloculated cyst was 10x6 cm on macroscopic examination and creamy material was drained. Immunohistochemical examination of the cyst lined with epithelium was Cytokeratin and CEA positive and calretinin, BerEP4, HBME-1 and F8 negative and it was reported as 'epidermoid cyst'. We discussed the etiopathogenesis of our case in light of the theories regarding its development.

Effects of Ibuprofen on orthotopic glioma model in rats.

OBJECTIVE: To determine the effects of ibuprofen (Ibp) on the vessel proliferation and necrosis in a rat glioma model. STUDY DESIGN: Experimental, randomized interventional trial. PLACE AND DURATION OF STUDY: 1st Neurosurgery Clinic in Bakirkoy Mental Diseases Hospital, Bakirkoy, Istanbul, Turkey, in the year 2010. METHODOLOGY: After stereotactic injection of C6/LacZ rat glioma cells into the Wistar rats brain, the rats were randomly assigned to two treatment groups (group 1, control; group 2, Ibp treatment). Rats were sacrificed 18 days after treatment, and number of intra-/peri-tumoural vessels, microendothelial proliferations, immunohistochemistry and necrotic area were evaluated. RESULTS: Ibp treatment significantly decreased tumour tissue, intratumoral vessel number and total tumour area level. The level of Ki67 was significantly decreased in the tumour tissue of group 2. Additionally, the total necrotic area / total tumour volume (%) was significantly less in the tumour tissue of the ibuprofen-treated rats compared to the controls. CONCLUSION: The data show that the Ibp produced an important reduction in glioma tumour cell proliferation in the rat model.

A synchronous occurrence of urothelial carcinoma with abundant myxoid stroma and inverted papilloma of the urinary bladder.

Abundant myxoid stroma rarely occurs in urothelial carcinomas, and may cause diagnostic challenges when cells with eosinophilic cytoplasm forming nests and cords in a myxoid background are seen, particularly in the absence of typical carcinomatous appearance. Microscopic examination of transurethral resection specimen of a 71-year-old male patient revealed non-cohesive oval or elongated tumor cells with eosinophilic cytoplasm arranged in cord-like filigree pattern in an abundant myxoid stroma. Immunohistochemically the tumor was positive for cytokeratin 7, cytokeratin 20, and 34BE12. About 90 to 100% nuclear staining was observed with p63, p53, and Ki-67. A second neoplasm with a flat overlying urothelial epithelium and a complete inverted cellular growth pattern was also noted. The neoplasm exhibited less than 2% and 10% nuclear staining with Ki-67 and p53, respectively. Considering histological, histochemical, and immunohistochemical findings, a diagnosis of synchronous urothelial carcinoma with abundant myxoid stroma and inverted papilloma was made.

Combination hyperbaric oxygen and temozolomide therapy in C6 rat glioma model.

PURPOSE: Temozolomide (TMZ) has anti-tumor activity in patients with malignant glioma. Hyperbaric oxygen (HBO) may enhance the efficacy of certain therapies that are limited because of the hypoxic tumor microenvironment. We examined the combined effects of TMZ-HBO in a rat glioma model. METHODS: After stereotactic injection of C6/LacZ rat glioma cells into the Wistar rats brain, the rats were randomly assigned to three treatment groups [group 1, control treatment; group 2, TMZ alone; group 3, a combination of TMZ and HBO]. Rats were sacrificed 18 days after treatment, and number of intra-/peri-tumoral vessels, microendothelial proliferations, immunohistochemistry and necrotic area were evaluated. RESULTS: Tumoral tissue was stained only sparsely with GFAP. Temozolomide treatment was significantly decreased in tumor tissue intratumoral vessel number / total tumor area level. The level of Ki67 was significantly decreased in the tumor tissue of the group 3. Additionally, the total necrotic area / total tumor volume (%) was decreased significantly in tumor tissue of the group 3 rats compared to group 1 and 2. CONCLUSION: The combination of hyperbaric oxygen with temozolomide produced an important reduction in glioma growth and effective approach to the treatment of glioblastoma.