Incidence of gestational trophoblastic disease in Tokat province, Turkey.

OBJECTIVE: This study investigated the incidence of gestational trophoblastic disease (GTD) in Tokat province, Turkey. MATERIAL AND METHODS: The medical records of patients who had been diagnosed and treated at one university hospital, six government hospitals, and one specialist hospital in Tokat province between January 2005 and December 2012 were evaluated retrospectively. RESULTS: During the study period, there were 59,754 births and GTD was diagnosed in 73 cases. The calculated GTD incidence was 1.22/1000. The mean age of the patients diagnosed with GTD was 28.6±7.3 (range 17-51) years. In GTD, complete moles occurred in 26%, partial moles in 74%, and no invasive moles, choriocarcinomas, or placental site trophoblastic tumours were found. Only two patients received chemotherapy (methotrexate). There was no mortality associated with the disease during follow-up. CONCLUSION: The incidence of GTD in Tokat province was 1.2 per 1000 births. Early diagnosis, treatment, and follow-up play a critical role in preventing the morbidity and mortality associated with disease. The incidence of GTD, which has a high recovery rate with adequate treatment and follow-up, can be determined from regional and community-based research.

Tularemia in differential diagnosis of cervical lymphadenopathy: cytologic features of tularemia lymphadenitis.

OBJECTIVE: Tularemia can cause cervical lymphadenopathy. Fine-needle aspiration (FNA) cytology is the first step in the workup for cervical lymphadenopathy; however, little has been published regarding the cytomorphological features of tularemia lymphadenitis. The aim of this study was to evaluate the FNA cytology of tularemia lymphadenitis. STUDY DESIGN: Review of medical records identified 36 patients with serologically proven tularemia, and who had undergone lymph node FNA. In each case, the original May-Grünwald-Giemsa-stained FNA smears from enlarged cervical lymph node were reevaluated. RESULTS: Suppuration and cytolysis were frequent cytological findings. Twenty-three (63.8%) of the 36 cases were assessed as suppurative inflammation. In 10 of these cases (27.8% of the total), cytolysis was prominent. In 7 cases (19.4%) the smears featured microgranulomas as well as suppuration, and 2 of these (5.6%) also featured giant cells. In 1 case (2.8%), there was caseous necrosis. In 2 cases (5.6%), the cytopathological findings were consistent with reactive lymphoid hyperplasia. Three aspirates (8.3%) were inadequate for evaluation. CONCLUSION: Cytopathological findings on FNA of tularemia lymphadenitis are nonspecific; however, in regions where tularemia is endemic, this disease should be considered in the differential diagnosis for suppurative lymphadenitis.

[Atypical teratoid rhabdoid tumor: case report]. / Atipik teratoid rabdoid tümör: olgu sunumu.

Atypical teratoid rhabdoid tumor is a rare highly malignant embryonal tumor of the central nervous system that is often seen in early childhood. It is very important to distinguish it from other brain tumors because it has a very poor prognosis and there are differences in its treatment. A case of atypical teratoid rhabdoid tumor in a six-week-old male baby is presented. The tumor was located at posterior fossa. Histopathologically, the tumor has rhabdoid tumor cells and mesenchymal components beside the undifferentiated small cells. While EMA, vimentin, synaptophysin and smooth muscle actin have been stained with immunohistochemical staining, desmin, chromogranin, CD 99 and CD 56 have not been stained. The patient died four months after surgery despite the chemotherapy given. In conclusion, morphological characteristics can vary to a large extent that it is difficult to recognize atypical teratoid rhabdoid tumor. Immunohistochemical panel and molecular genetic study will help to establish the correct diagnosis.

Effect of antibiotic lavage in adhesion prevention in bacterial peritonitis.

BACKGROUND: Intra-abdominal adhesions remain a major clinical problem. Previously, rifamycin lavage was used to prevent adhesion formation in the septic abdomen. The aim of our study was to test the effectiveness of intraperitoneal application of alternate antibiotics in an abdominal sepsis model. METHODS: Sixty Wistar-albino rats were randomly divided into 6 equal groups. Bacterial peritonitis was induced using caecal ligation and puncture model in all groups. Group 1 was an untreated control. The peritoneum was lavaged with isotonic saline in Group 2, with imipenem in Group 3, with ceftriaxone in Group 4, with cefazolin in group 5 and with metronidazole in group 6. Four weeks after the surgery, intra-abdominal adhesions were graded, tensile strength of the adhesions was measured and histopathological examinations were performed. RESULTS: Imipenem, ceftriaxone and cefazolin significantly reduced adhesion formation (p<0.001) with significantly reduced fibrosis scores (p=0.013). Adhesion formation was greatest in the metronidazole treatment group. The breaking force of adhesions was significantly reduced in Groups 4 and 5 (p<0.001). Although, the inflammation scores were similar between groups (p=0.058), grade 3 inflammation scores were only seen in control, saline and metronidazole-treatment groups. CONCLUSION: According to these data, cephalosporins may be effective in preventing adhesion formation in septic abdomens. These antibiotics need to be evaluated in a clinical trial.

Intraarticular Hyaluronic Acid Injection after Microfracture Technique for the Management of Full-Thickness Cartilage Defects Does Not Improve the Quality of Repair Tissue.

OBJECTIVE: Tissue repair that occurs after microfracture does not include hyaline-like cartilage. Therefore, other treatment modalities must be combined with microfracture to improve repair tissue quality. In this study, we combined exogenous hyaluronic acid with microfracture. DESIGN: Thirty mature New Zealand rabbits were randomly divided into 3 groups as control, microfracture (MF), and microfracture and hyaluronic acid (MFHA). Four-millimetre full-thickness cartilage defects were created in the medial femoral condyle of each rabbit. Microfracture was performed on defects in the MF and MFHA groups. At 1 week following surgery, 1 mL of saline was injected into the knees of the control and MF groups, whereas 1 mL (15 mg/mL) hyaluronic acid was injected into the knees of the MFHA group 3 times weekly. At 6 months postsurgery, defects were evaluated according to the ICRS (International Cartilage Repair Society) and Wakitani scales. RESULTS: According to the ICRS and Wakitani scales, the quality of repair tissue was improved in MF and MFHA groups as compared the control group (P = 0.001 and 0.001, respectively). No significant difference was observed between the MF and MFHA groups (P = 0.342). CONCLUSIONS: According to the model in this study, no beneficial effect was obtained when HA injection was combined with microfracture in the treatment of full-thickness cartilage defects.

[Combination of microfracture and periosteal transplantation techniques for the treatment of full-thickness cartilage defects]. / Tam kalinlikta kikirdak defektlerinin tedavisinde mikrokirik ve periost transplantasyon tekniklerinin birlikte kullanimi.

OBJECTIVES: Microfracture and periosteal transplantation techniques were combined in order to enhance the quality of repair for the treatment of full-thickness cartilage defects. METHODS: In 40 mature New Zealand white rabbits, a full-thickness cartilage defect of 4 mm was induced on the weight-bearing surfaces of the medial condyles of the right femur. The rabbits were randomly divided into four groups equal in size. Control animals remained untreated following defect induction. Two groups were either treated with periosteal transplantation or the microfracture technique, while the fourth group underwent combination of the two techniques. All the animals were immobilized for two weeks postoperatively. At the end of 12 weeks, the animals were sacrificed and the specimens were removed for evaluation according to the criteria of the ICRS scale (International Cartilage Repair Society), and with respect to newly regenerated cartilage areas and the number of viable chondrocytes. RESULTS: Specimens treated with the combination of the two techniques exhibited significant differences from the other groups in all criteria of the ICRS scale (surface, matrix, cellular distribution, cell viability, and cartilage mineralization) except for subchondral bone criteria. In addition, the mean number of viable chondrocytes and newly regenerated cartilage areas were the highest in this group (p=0.0001). CONCLUSION: Due to markedly improved quality of repair, the combination of the microfracture and periosteal flap techniques seems to be more effective than either of the techniques used alone in the treatment of cartilage defects.

Effects of calcitonin and alendronate on distraction osteogenesis.

In this experimental animal study the effects of calcitonin and alendronate on distraction osteogenesis are investigated. Forty-five mature female New Zealand type rabbits were used. Rabbits were randomized into three groups, each consisting of 15 animals. Under optimal operating conditions a pre-reconstructed circular external fixator was applied to the right tibia of rabbits, and osteotomy was performed with a Gigli saw just below the tibial tuberosity. During the ten days of distraction, a placebo was administered for group I (control group), group II received 10 U of calcitonin, and group III was treated with alendronate (0.5 mg/kg/day) gavages. Rabbits were examined histologically (at the third and eighth weeks, according to Huddlestone et al.), radiologically (at the third, sixth, and eighth weeks, according to Lane and Sandhu), and mechanically (at the eighth week, as torsional loading). During the first three weeks, the groups did not differ much with regard to radiological parameters. However, in the calcitonin and alendronate groups improved histological scores were detected compared with the control group. Radiological images obtained at the end of six weeks demonstrated improved consolidation in the calcitonin and alendronate groups compared with the control group. At the end of eight weeks postoperatively, radiological and histological parameters did not differ among the groups, while torsional failure load was found to be much improved in the calcitonin group (p=0.006). During the distraction osteogenesis period, calcitonin and alendronate affected the quality of regenerate favourably. This effect is sustained until the end of the consolidation period. However, this finding needs to be supported by experimental and human studies.