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To evaluate the effects of intracameral drugs and dyes on rat corneal endothelial apoptosis and cell morphology.The right eyes of 72 rats were injected intracamerally with 1% lidocaine, 0.01% adrenaline, triamcinolone acetonide (TA) 4 mg/mL, 1% trypan blue (TB), 0.5% indocyanine green (ICG), and fortified balanced salt solution as control. Corneal samples were taken 1 day and 1 week post-injection. Corneal endothelial apoptosis was assessed by the TUNEL technique, and the ratio of apoptotic cells in each group was compared with the control. Corneal endothelial cell morphology was evaluated in each specimen by transmission electron microscopy.The mean apoptotic endothelial cell ratio was significantly higher at 1 day and 1 week after intracameral adrenaline injection when compared to controls (p=0.03 and 0.021, respectively). TB caused a significantly higher apoptotic cell ratio when compared to controls at 1 week after injection (p=0.043). Lidocaine caused a higher apoptotic cell ratio compared to TA and ICG at 1 week, although not statistically significant (p=0.058, 0.09, 0.69, respectively). In all experimental specimens, transmission electron microscopy showed morphological changes associated with apoptosis.This study showed that intracameral adrenaline, TB, and lidocaine injections may have toxic effects on corneal tissue, as indicated by ultrastructural and histopathological alterations. Therefore, these agents should be used with caution in intraocular surgery.

Aim: To evaluate the effects of fresh onion juice on female infertility. Background: Onion contains several antioxidants and has been used for the subfertile woman to achieve pregnancy by herbalists. Objective: This study was carried out to investigate the effects of fresh onion juice on ovarian folliculogenesis and implantation in rats. Methods: Female albino rats were divided into two groups: 5-day (one estrus cycle) and 10-day treatment (two estrus cycles) groups. The animals in the two groups were then divided into subgroups of the control group, 1 cc onion juice and 2 cc onion juice, each containing seven rats. At the end of the 5th and 10th days, ovarian volume and weight were measured, and the primordial, antral, and atretic follicles, and corpus lutea were counted. Vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS) were evaluated both in the ovaries and in the endometrium immunohistochemically. Results: In the 5-day treatment group, ovarian weight and the antral follicle count were significantly higher in the 2 cc onion juice subgroup than the control group (p Conclusion: The results of our study showed that fresh onion juice could increase the number of antral follicles, which is an indicator of enhanced folliculogenesis.

OBJECTIVES: Minimally-invasive parathyroidectomy (MIP) is a surgical procedure that reduces the duration of operation, hospital costs, and hypocalcemia, and shortens the length of hospital stay. This study addressed the important procedural details of the radioguided occult lesion localization (ROLL)-MIP technique and evaluated the consequences of the learning curve from a series of patients. PATIENTS AND METHODS: A total of 80 patients who underwent ROLL-MIP for a single parathyroid adenoma were included into this retrospective study. In order to analyze the effect of the learning curve, these subjects were then divided into 2 groups per time period and the operative times were compared. Group A consisted of 22 previously reported patients who served as the control group. Group B consisted of 58 consecutive patients. RESULTS: Serum calcium and parathyroid hormone (PTH) levels were normalized in all of the patients within 2 days and remained normal during the follow-up period (31 ± 18.5 months). None of the patients who underwent ROLL-guided parathyroidectomy suffered temporary or permanent recurrent laryngeal nerve injuries. Mean operation time (time from incision to excision of the adenoma) was 23 ± 6 min in Group A and 18 ± 7 min in Group B. Mean operative times were significantly shorter in group B. CONCLUSION: The success of MIP administered with the ROLL technique in a single adenomatous patient was quite high. This method seems especially valuable in patients with atypically located or small adenomas.

In this study, we evaluated our early results of liver transplantation for hepatocellular carcinoma. Between January 2003 and June 2006, 26 patients (4 women and 22 men; age, 1.1-65 years) with preoperatively diagnosed or incidental hepatocellular carcinoma (HCC) underwent liver transplantation at our center. Inclusion criteria (independent of tumor size and number of tumor nodules) were no invasion of major vascular structure and no evidence of extrahepatic disease. In 13 of the patients, tumors were beyond the Milan criteria. At this writing, with a mean follow-up of 16.5 months (range, 1-31 months), all patients are doing well with excellent graft function. The longest survival is 2.5 years, and our patient survival rate is 100%. There has been only one tumor recurrence that was 4 months after liver transplantation. Liver transplantation provides long patient and disease-free survival, even in patients with HCC that exceeds the Milan criteria.

Background: Ginger (Zingiber officinale) is a well known and extensively used antioxidant in traditional remedies. In this study, we aimed to investigate the effects of ginger powder on ovarian folliculogenesis and implantation in rats. Methods: There were two study groups. In the 5-day treatment group (one estrous cycle), 100 mg ginger powder, 200 mg ginger powder or distilled water was given for 5 days to the three subgroups each containing seven rats. In the 10-day treatment group, same doses were given for 10 days (two estrous cycle) to the three subgroups each containing seven rats. At the end of the 5th and 10th days, ovarian volumes, ovarian weights, primordial follicles, antral follicles, atretic follicles, and corpus luteum counts were assessed. To evaluate the angiogenic effects of ginger, vascular endothelial growth factor (VEGF) and for the antioxidant effects of ginger endothelial nitric oxide synthase (eNOS) were examined in the ovaries and in the endometrium immunohistochemically. Results: In the 5-day treatment group, antral follicle count and ovarian stromal VEGF were significantly high in the 100 mg ginger subgroup in comparison to the control group (p

Thyroid hemiagenesis is a rare congenital pathology and it is secondary to a defect which occurs during embryonic development of the thyroid tissue. Usually, diagnosis is incidentally made by imaging study of the neck or during diagnosis of a related thyroid gland disease. Absence of the left lobe is observed in near all cases, but involvement of the right lobe has also been reported in the literature, albeit very rare. Although true prevalence is not known, the reported prevalence ranges from 1/1900 to 1/2675. Presence of thyroid nodules, subacute thyroiditis, Hashimoto’s thyroiditis and Grave’s disease in thyroid hemiagenesis has previously been reported in the literature. Combination of thyroid papillary cancer and thyroid hemiagenesis is rarely reported. In this report, we present the case of papillary cancer in a solitary nodule in a hemiagenetic thyroid gland in a patient with Hashimoto’s thyroiditis and treatment modalities thereof.

Minimally invasive parathyroidectomy (MIP) constitutes one of the main surgical approaches for the patient with primary hyperparathyroidism (PHPT) caused by a single parathyroid adenoma. The purpose of the study was to investigate the feasibility of radioguided occult lesion localization (ROLL) for MIP and the potential effects of the method in histopathologic evaluation.Twenty-two patients, diagnosed with PHPT biochemically and candidates for surgery, underwent ROLL-guided MIP (ROLL-MIP). Parathyroid adenomas were searched for and identified with the guidance of an intraoperative gamma probe. The final diagnosis was confirmed by histopathologic analysis. All specimens were analyzed for the presence of parenchymal hemorrhage, congestion, neutrophil leukocyte infiltration, necrosis, cystic degeneration, subcapsular hematoma, subcapsular fibrin/neutrophil leukocyte infiltration, and disarray of the fibrous capsule of adenoma.All injected lesions were effectively located over the skin with very high count rates depending on the injected activity and location of the lesion. Serum calcium and parathyroid hormone (PTH) levels normalized in all patients and stayed within the normal range during the follow-up period. None of the patients who underwent ROLL-MIP suffered temporary or permanent recurrent laryngeal nerve injuries. The mean operative time was 23 ± 7 min. Parenchymal hemorrhage, congestion, subcapsular hematoma, and fibrin/neutrophil leukocyte infiltration were common histopathologic features.The use of ROLL-MIP in patients with PHPT due to a single parathyroid adenoma in the neck is technically safe and effective. It is more valuable in scintigraphy-negative patients when parathyroid adenoma is either demonstrated on ultrasonography by typical findings or confirmed by PTH washout. The ROLL-MIP technique does not impair the postoperative histopathologic examination of the parathyroid glands.

Objectives/Hypothesis To achieve injectable tissue-engineered cartilage using a commercially available fibrin sealant, and to determine the most suitable fibrin glue concentration, cartilage source, and cultured chondrocyte concentration. Study Design Animal research. Methods A total of 28 immuncompetent New Zealand white rabbits were divided into four groups. The cultured chondrocytes from different anatomical sources carried in fibrin glue with and without aprotinin in different concentrations of fibrinogen and thrombin (Tisseell), were injected into forehead and interocular regions of the rabbits. The new tissue formation was harvested at 8 weeks and analyzed through gross and histological analysis. Results The new tissue formations were found in round, elliptical, and flat forms. The mean value of Tisseell and cell suspension was 0.8 cc in all of the rabbits' injection regions, but the mean volume of the samples in which immature cartilage matrix and mature cartilage was 0.1 cc. In the 20 of the 55 injection regions of rabbits (36, 36%), mature and/or immature cartilage formation were observed. We observed inflammatory reactions, abscess formation, and foreign body reactions around the new cartilage tissue of tissue-engineered cartilage. The comparison of results using different cartilage sources, chondrocyte concentrations, or different fibrin glue concentrations did not show any significant difference. Conclusions We observed that changing the concentrations of ingredients of commercially available fibrin glue, the source of the cartilage, or the cultured chondrocyte concentration did not have significant effect on neocartilage formation. Level of Evidence N/A. Laryngoscope, 123:2986–2992, 2013

Objective The purposes of this study were to establish the distribution of thyroid lesions that were seen in Hatay (a province of southern Turkey), to review the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of thyroid nodules and to correlate the FNAC results with the histopathology of the excised specimens, especially in indeterminate cases. Methods Data on patient cytology were retrieved by a retrospective search of all thyroid FNAC specimens that had been evaluated at the Department of Pathology, Antakya Public Hospital, Hatay, Turkey between January 2009 and February 2011; 1021 thyroid FNAC samples were reviewed and interpretations were recorded according to the Bethesda system for reporting thyroid cytopathology (TBSRTC). The results of adequate FNAC samples were compared with the histological diagnoses in the cases in which surgery was performed, and the malignancy rates, especially in indeterminate categories, were calculated. Results Of the 1021 FNAC samples, 697 (68.3%) were benign, 122 (11.9%) were non-diagnostic, 100 (9.8%) were atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS), 41 (4%) were follicular neoplasm/suspicious for follicular neoplasm (FN/SFN), 36 (3.5%) were suspicious for malignancy (SM) and 25 (2.4%) were malignant. In 219 cases, there was follow-up histology. Rates of malignancy were as follows: benign, 0%; AUS/FLUS, 12.7%; FN/SFN, 35.0%; SM, 91.4%; malignant, 100%. Conclusions In our study, the cytohistological correlation of benign and malignant lesions was 100%. In the indeterminate categories, we recommend that clinicians should evaluate both the clinical and radiological findings of patients in addition to the FNAC results.

Adult-type granulosa cell tumors (AGCT) account for 1-2% of all ovarian tumors and 95% of granulosa cell tumors. In AGCT, at the time of peritoneal washing, tumor cells are rarely seen to exfoliate and FIGO stage is raised from IA/IB or IIA/IIB to stage IC or IIC despite the absence of a gross intraepithelial tumor. Patients with positive peritoneal washing cytology must be followed up for pelvic recurrence and metastasis. A more sensitive cytologic evaluation, histopathologic correlation and immunohistochemical staining can advance our practice. Here, we describe a case of AGCT with the emphasis on cytologic features observed in specimens obtained from peritoneal washing fluid.

Background Recently, it has been recognized that drug-induced hypersensitivity syndrome (DIHS) is associated with reactivation of human herpesvirus-6 (HHV-6), Epstein–Barr virus (EBV) and cytomegalovirus (CMV). However, whether those viruses have a role in the development of cutaneous drug reactions (CDRs) other than DIHS is not known. Objective To investigate the role of HHV-6, EBV and CMV infections in the etiopathogenesis of different types of CDRs. Methods Eighteen patients with diagnosis of CDR according to the clinical and histopathological findings were evaluated. Real-time polymerase chain reaction (PCR) was used for the detection of EBV, CMV, and HHV-6 DNA in lesional skin biopsy specimens; EBV and CMV DNA in serum samples; and HHV-6 DNA in peripheral blood mononuclear cells. Results The genome of HHV-6 was detected only in the lesional skin of two patients with DIHS. Epstein–Barr virus and CMV DNA in the skin lesions, EBV and CMV genomes in the serum samples, and HHV-6 DNA in the peripheral blood mononuclear cells were negative in all patients. Limitations The patient population was small and did not include all types of CDRs. Also, we had only two patients with DIHS. We had not been able to measure the increase in anti-viral IgG titers in serial serum samples. Conclusion Epstein–Barr virus and CMV infections do not seem to have a role in the etiopathogenesis of CDRs including DIHS. The association between HHV-6 infection and CDRs is likely to be limited to DIHS.

In this study, we evaluated the expression of Fragile Histidine Triad (FHIT) in basal cell carcinoma (BCC). The FHIT locus was found to be altered in numerous types of cancer [6,7,18,20,22,25,26]. However, we found only one study dealing with FHIT expression in BCC [11]. In our study, we used immunohistochemical methods for the evaluation of FHIT expression in tissue samples of 42 BCC cases. The control group was formed by intradermal melanocytic nevi (IMN). Ki-67 labeling index was used to compare cellular proliferation of BCC with internal and external controls. The study group was further separated into two subgroups, according to the intensity of FHIT staining. The Ki-67 indexes of these subgroups were also compared with each other. As a primary result, there was no significant decrease in FHIT expression in early lesions of BCC. As a second finding, there was no correlation between the intensity of FHIT staining and Ki-67 labeling index. As a third finding, there was no difference in Ki-67 labeling index between early lesions of BCC and non-neoplastic epidermis. The results were unexpected, since FHIT expression has been reported to be lost in an above mentioned study [11]. We concluded that FHIT expression remains to be positive, at least in early lesions of BCC.

Specific chromosome abnormalities and genetic changes in hepatocellular carcinoma (HCC) have been demonstrated by conventional cytogenetic studies or molecular cytogenetic approaches like comparative genomic hybridization and loss of heterozygosity analyses. HER-2/Neu amplification and expression has been studied as a molecular target for treatment of HCC, and there are conflicting results. We aimed to determine HER-2/Neu status in archive materials of HCC patients by fluorescence in situ hybridization (FISH). Among the 35 patients, 2 had HER-2/Neu amplification and 3 had increased chromosome 17 copy number. All these patients had grade 2 or 3 tumor with a diameter of 3-12 cm. We conclude that although HER-2/Neu amplification is not the primary mechanism in the development of liver tumors, it might play a role in one of the steps of multistage carcinogenesis.

AIM: Marker chromosomes are structurally abnormal chromosomes which can not be identified by conventional cytogenetic methods. The incidence of marker chromosomes in prenatal diagnosis has been reported to be between 0.04% and 0.15%. Here, we aimed to report a case with marker chromosome mosaicism detected in prenatal diagnosis. CASE PRESANTATION: The fetal karyotype of a patient whose amniotic fluid was sent to our laboratory for increased risk of Down Syndrome in maternal serum screening was found to be 47,XX,+mar[4]/46,XX[27]. In order to evaluate the mosaicism in a different tissue, cord blood sampling was performed and the result revealed a 47,XX,+mar[15]/46,XX[85] karyotype. After verifying the parental karyotypes as normal, the parents were informed about de novo unbalanced chromosome abnormalities; who then decided to terminate the pregnancy. Minor abnormalities were examined on macroscopic pathological examination of the fetus. CONCLUSION: The fetal abnormality was evaluated as de novo mosaic marker chromosome. Information about the genetic condition and the risk for the current and future pregnancies was given to the couple during genetic counseling. The second pregnancy of resulted in a live born baby with a normal karyotype.

During the first episode of acute cellular rejection (ACR) after liver transplantation, centrilobular changes in liver biopsy specimens may be possible indicators of subsequent episodes of ACR, early chronic rejection, or acute graft loss. The purpose of this study was to identify differences between the histopathological findings in liver biopsy specimens obtained during the first rejection episode in patients who subsequently developed further episodes of ACR and those who did not. The histopathological findings in 22 patients who had a single episode of acute rejection (group 1) were compared with those in 23 patients who had multiple episodes of acute rejection (group 2). Only the first liver biopsy samples of the latter group were taken into consideration. We assessed the predictive value of centrilobular necrosis, central vein endothelialitis, pericentral inflammation, hepatocellular ballooning, cholestasis, hepatocellular apoptosis, lobular inflammation, the degree of portal eosinophilia, and characteristic portal tract features in poor responders to antirejection treatment. The time to the first episode of ACR and the rejection activity index were similar in patients in both groups. Hepatocellular apoptosis, hepatocellular ballooning, and central vein endothelialitis were common features of both groups. The incidences of pericentral inflammation, centrilobular necrosis, and portal eosinophilia were significantly higher in patients in group 2 than in those in group 1 (P < 0.05). Patients with pericentral inflammation, centrilobular necrosis, and marked portal eosinophilia during an initial episode of acute rejection may be more likely to develop subsequent episodes of ACR.

Solitary fibrous tumour (SFT) is one of the rare tumours which arise from visceral pleura. Klemperer and Rabin first described SFT as a distinct clinical entity among primary pleural tumoUrs in 1931. Approximately 820 cases have been reported in literature to date. The management of patients with SFT is complete resection of the tumour and follow up of the patient to detect any possible late recurrence. In the present paper, we report two cases of pedunculated solitary fibrous tumours of the pleura that appeared as a wandering chest nodule to which surgical resection undertaken at our hospital. The aim is to summarise our experience in the management of solitary fibrous tumour.

We report a 13-month-old girl with primary intrarenal neuroblastoma initially diagnosed as Wilms' tumor. Intrarenal neuroblastoma is exceedingly rare in pediatric age that may masquerade as Wilms' tumor clinically and radiographically and it is important to differentiate for management.

Living-donor liver transplantation is another treatment option to cadaveric liver transplantation in adult recipients. We report the outcomes of 49 right lobe adult living-donor liver transplantations performed at our institution between April 2003 and June 2006. The mean age of the recipients was 41.7 +/- 12.5 years. The median graft-to-recipient weight ratio was 1.2% +/- 0.4%. In recipients, the mean operative time was 10.6 +/- 2.7 hours. The mean number of blood transfusions administered was 4.1 +/- 5.1 units. The mean time spent in the intensive care unit was 2.3 +/- 1.5 days. In recipients, five vascular and five biliary complications occurred during the early postoperative period, and four vascular and two biliary complications developed in the late postoperative period. Thirteen of the 49 recipients died within 4 months of surgery. The mean age of the donors was 36.6 +/- 9 years. In the donors, the mean operative time was 6.4 +/- 1.6 hours, mean residual liver volume was 43.3% +/- 6.1%, and the mean hospital stay was 9.5 +/- 4.5 days. Two donors required an intraoperative blood transfusion. None of our donors died, but six complications occurred in four donors. The mean postoperative follow-up was 13.4 +/- 9.6 months. In conclusion, in Turkey, as in other countries, organ demand exceeds organ availability. Graft size presents a problem for adult recipients, but right lobe living donor transplant may be a life-saving option for these recipients when performed by experienced surgical teams.

Fibroadenomas are the most common benign breast lesions in adolescent and young women. It is most frequently observed in the 3rd decade. Although it is considered benign, evidence of malignant transformation is available. Cancer development may be from ground of fibroadenoma or near breast tissue. A case of a fibroadenoma coexisting with an invasive ductal carcinoma of the breast in a 31-year-old female is presented. The patient presented with the chief complaint of having a palpable mass in her right breast for the last 10 years. Mammography revealed a mass with microcalcifications. Core biopsy was performed, and the results indicated an invasive carcinoma. Breast-conserving surgery with sentinel lymph node biopsy was performed. The pathological features revealed a fibroadenoma coexisting with an invasive ductal carcinoma. This case suggests that clinicians and radiologists should always pay attention to the associated malignant imaging characteristics whenever a mass was followed up as fibroadenoma.

Although the observation of breast vascular tumors is rare, the most common tumor is hemangioma in the benign group, and these tumors are observed incidentally in lumpectomy or mastectomy specimens during histological examinations. They are classified into capillary, cavernous, and venous hemangiomas. Cavernous hemangioma is the most common subtype. Cavernous hemangiomas are benign vascular tumors, which malformation from mature blood vessels. Hemangiomas in the benign group may show a suspicion of ductal carcinoma in situ (DCIS) in mammographic analysis. Ultrasonography (US) and magnetic resonance imaging (MRI) are the most useful imaging methods for analyzing the structure of breast vessels. In this case, a 54-year-old female who have any complaint. Scanning mammography (MG) detected the tumor, but physical examination and US could not identify the mass. According to the MG analysis, the lesion was evaluated as BIRADS 4b, and the patient underwent excisional biopsy after wire localization. Pathological analysis revealed cavernous hemangioma.

We described six children with heritable liver disease and hepatocellular carcinoma treated with living-related liver transplantation. Underlying liver diseases were type-1 tyrosinemia (three patients), progressive familial intrahepatic cholestasis type II (two patients), and Wilson's disease (one patient). Two of the tumors were found incidentally during liver transplantation. Number of nodules was 12, 15, 3, 2, and 1 (in two patients). Three patients were treated with chemotherapy before the procedure. Chemotherapy was not given to any patient after liver transplantation. The mean follow-up was 17.7 +/- 6 months (range: 7-24). All patients are tumor recurrence free. Both graft and patient survival rates are 100% at a median of 18.5 months follow-up. Physicians in charge of treating children with heritable liver disease should screen them periodically for the development of hepatocellular carcinoma. Liver transplantation may offer these children better survival rates.

Elevated serum levels of hepatocyte growth factor (HGF) have been documented in patients on chronic hemodialysis (HD) and with chronic hepatitis (CH). The aim of this study was to determine the presence and density of HGF in liver tissue and the source of this factor in HD patient with CH.Seventy-five hepatic needle-biopsy specimens were investigated, 11 from CH patients (Group 1) and 44 from CH patients on HD (Group 2), plus 20 liver biopsies obtained from healthy individuals as controls (Group 3). All specimens were analyzed immunohistochemically with an HGF antibody.Groups 1 (CH only) and 2 (CH + HD) had significantly (p0.05) more HGF-positive nonparenchymal cells than the control group. Also, specimens from CH-only patients (Group 1) had significantly (p0.05) more positive staining than those from CH patients on HD (Group 2). Groups 1 and 2 had similar results for grading of CH and fibrosis score. No association was found between the number of HGF-positive cells and necroinflammatory or fibrosis score.The expression of HGF in liver tissue in CH patients on HD was much lower than in CH-only patients. The extrahepatic tissue might be the source of increased HGF serum levels in HD patients.

Background Renal transplant recipients are prone to accelerated atherosclerosis secondary to immunsuppressants, which may decrease graft survival. We sought to analyze the effects on renal graft survival of atherosclerotic degeneration in the renal artery and the influence of angiotensin-converting enzyme (ACE) endothelial constitutive nitric oxide synthase (ecNOS) gene polymorphisms. Methods and patients Thirty three renal transplant recipients (25 men) of mean age 28.4 ± 9.6 years, received organs from 11 living related donors and were followed for at least 36 months. Genotyping was performed for the insertion/deletion ACE (I/D), angiotensin (AGT) (M→T, 235), angiotensine 1 receptor (A→C, 1166), angiotensin 2-receptor (A→G, 1223), and ecNOS (b→a, intron4) gene polymorphisms. Renal artery biopsies were performed during transplantation surgery to analyze the presence of atherosclerosis. Results Pathological examination indicated that 18 donor specimens and nine recipient specimens had atherosclerotic degeneration. Survival analysis (36 months) indicated that graft survival rates of recipients who had atherosclerosis in the renal artery and who received an organ from donors with an atherosclerotic renal artery were shorter than in their counterparts ( P = .02, P = .04, respectively). Comparison of genetic variations of recipients revealed that CC/TC variation of AGT was higher in patients with atherosclerosis (81% vs 53%, P = .03). There was no significant difference between groups in means of other gene polymorphisms. Conclusion Renin-angiotensin system gene polymorphism analysis of patients in renal transplantation waiting list may provide information about allograft survival and posttransplant atherosclerotic degeneration at graft vasculature of young transplant recipients.

A reliable diagnostic test for Helicobacter pylori is important in clinical practice and research. The ideal diagnostic test for H. pylori should be sensitive, specific, and cost-effective. Helicobacter pylori resistance to clarithromycin is a common reason for failure of eradication therapy. The aim of this study was to evaluate the fluorescent in situ hybridization (FISH) method to detect H. pylori and determine clarithromycin resistance in formalin-fixed, paraffin-embedded gastric biopsy specimens. One hundred seventeen gastric biopsy specimens from patients with dyspepsia were examined for the presence of H. pylori by conventional culture, FISH, and histopathological methods. A set of fluorescent-labeled oligonucleotide probes binding to either H. pylori 16S rRNA or 23S rRNA sequences were used for FISH analysis. Phenotypic antibiotic susceptibilities of the isolates were tested using the Epsilometer test method (E test). Helicobacter pylori was detected in 70 of 117 biopsy specimens by histopathological examination and FISH, whereas it was detected in 47 specimens by culturing. Histopathology and FISH techniques failed to identify H. pylori in 1 biopsy sample isolated by culture. Clarithromycin resistance was found in 11 of 46 H. pylori isolates using the E test method. All of the phenotypic resistance measurements of isolates were correlated with genotypic clarithromycin resistance. Eleven clarithromycin-resistant strains were identified by FISH. The diagnosis of H. pylori infection and the determination of clarithromycin resistance in formalin-fixed, paraffin-embedded specimens using FISH is promising because it provides a rapid, reliable, and culture-independent diagnosis.Key words: Helicobacter pylori, clarithromycin resistance, FISH.

Kaposi's sarcoma (KS) is an angioproliferative condition that accounts for 6% of all malignancies in organ transplant patients. When we review the literature, the results of the studies comparing the different stages and the proliferative activity of the tumor are challenging. However, we found no previous study on Ki-67 protein expression in KS that correlates skin and organ lesions. In the current study, we investigated whether there is a correlation on the proliferative activity between skin and internal organ lesions in KS. Proliferative activity of 13 biopsy specimens of KS was assessed immunohistochemically using the monoclonal antibody MIB-1 (Ki-67). Mann-Whitney U test is used for statistical analysis and a P value.05 was considered significant. Seven of 13 cases were skin and six were internal organ KS. For skin lesions, the mean MIB-1 proliferation index was 14.5%, and it was 13% for organ lesions. There was no significant association between skin and internal organ KS in regard to MIB-1 PI (P.05). The findings suggested that the proliferative activity in KS does not differ in skin and organ lesions. On the other hand, it should be considered that the number of cases in our study was limited and further studies with a larger series are needed.

Objectives/Hypothesis The study aimed to detect the changes in adult rabbit nasal septal tissues after application of nasal pack or trans-septal suture as performed during septoplasty. Study Design Randomized double-blind animal study. Methods Thirty-three adult albino Vienna rabbits were assigned into the following groups: control, suture, and nasal pack. The mucoperichondrium at one side of the nasal septum was elevated and then put into place again over the cartilage and fixed with either a nasal pack or an absorbable trans-septal suture. The nasal packs were removed 48 hours after insertion. Rabbits were killed 6 weeks after the procedure. The nasal septa were stained with hematoxylin and eosin and examined by means of light microscopy for mucosal changes (inflammation or damage) and for thicknesses of the mucosa, the perichondrium, and the cartilage. Results Both intranasal packs and sutures caused significant mucosal inflammation and damage when compared with the control group (χ2 test, P < .05). The mucosal thickness did not change, but the perichondrial thickness for both the nasal pack group and the suture group increased (Mann-Whitney U test, P < .05). Also, the septal cartilage thickness was not significantly different between the suture and the nasal pack groups, but the suture group had a thinner septal cartilage than the control group (Mann-Whitney U test, P < .05). Conclusion The septal suture is an efficient and useful method for clinching the septal flaps over the septal cartilage. In addition, it has nearly the same effects as nasal packs on the histological appearance of the nasal septum and does not cause discomfort for the patient. The septal suture can be a preferred alternative to intranasal packing.

Abstract. When flaps are indicated for early wound closure in extensive burns, and there is limited unburned local tissue to design these, one option may be to use a partial-thickness burned area as a flap for construction in the acute phase. This study examined the proportions of superficial and deep partial-thickness burned skin that can safely be included in an island flap. Eighty male Wistar rats were divided into four groups, with varying extent of burning of the right epigastric flap site: group 1, 50% superficially burned; group 2, 100% superficially burned; group 3, 50% deeply burned; and group 4, 100% deeply burned. In each group the left epigastric flaps served as controls. The superficially burned flaps in groups 1 and 2 healed at 2–4 weeks, and the deeply burned flaps in groups 3 and 4 healed at 4–6 weeks postoperatively. In all cases hair grew on the burned flap sites, and the flaps healed in such a way that they were almost impossible to distinguish, even after the hair was shaved at week 8. It was observed that the superficially burned flaps healed perfectly without scarring, but small portions of the deeply burned flaps developed scars. In conclusion, superficially and deeply burned island flaps survived completely in this animal model, even when the entire flap surface was burned. In the future, under appropriate conditions the transfer of partial-thickness burned tissue as flaps may provide a good alternative for reconstruction of the acute burn wound.

The association between gastroesophageal reflux disease and end-stage renal disease remains unclear. We aimed to assess the prevalence of gastroesophageal reflux disease and also to identify possible pathogenetic factors in the development of reflux in symptomatic end-stage renal disease patients.The study involved 42 end-stage renal disease patients with upper GI symptoms (group I) and 46 age- and sex-matched controls who did not have renal disease but had the same symptoms (group II). Endoscopy, endoscopic biopsies, and 24-h esophageal pH studies were used to diagnose gastroesophageal reflux disease. Subjects were also investigated for Helicobacter pylori gastritis and GI amyloidosis.The prevalences of gastroesophageal reflux disease in the two groups were similar (81% vs 84.8%, p = 0.423). The prevalence of H. pylori infection was significantly lower in group I than in group II (38.1% vs 67.4%, p = 0.01). There were II cases of GI amyloidosis in group I. Multivariate logistic regression analysis in group I showed that GI amyloidosis (OR = 7.28, 95% CI = 1.13-46.93), chronic ambulatory peritoneal dialysis treatment (OR = 5.54, 95% CI = 1.01-30.43), and absence of H. pylori infection (OR = 3.75, 95% CI = 1.01-13.9) were significantly associated with reflux esophagitis.Upper GI symptoms are important in predicting gastroesophageal reflux disease in end-stage renal disease patients. Chronic ambulatory peritoneal dialysis, GI amyloidosis, and absence of H. pylori infection seem to be risk factors for the development of gastroesophageal reflux disease in end-stage renal disease patients.

In this short report, we present the succesfull surgical traetment of a patient who had an echocardiographic diagnosis of left ventricular mass during her routine controls. This patient was treated by surgical excision of the ventricular mass and after the pathological examination the diagnosis was “myxoma like sclerotic calcified mass”. The postoperative course was uneventful, and the patient was discharged on day 7 of surgery. The follow-up period lasted for 2 years without any event and the echocardiograms revelaed no residual or reccurrent lesions. Surgical resection of intracardiac masses are necessary and safe treatment options but there is not a standardization about the type of surgical options. The localization of the mass has the key role in determining the type of the surgical approach. In this case, aortotomy provided a good access and facilitated the exposure of this rare myxoma like sclerotic calcified mass.

Patients suffering from chronic renal failure (CRF) are at increased risk for contracting tuberculosis (TB) due to their impaired immunity. In this patient group, extrapulmonary involvement is more common than the pulmonary form of TB, and symptoms tend to be milder and less distinctive than those seen in the general population. Pyomyositis secondary to TB is relatively rare. We report a case of TB pyomyositis in the setting of CRF. The nonspecific symptoms that are typical of CRF patients with TB make it particularly difficult to establish the diagnosis in this patient group. In order to avoid diagnostic delays, which may increase the risk of complications and mortality, TB should be kept in mind in any case of ongoing fever and infection that does not respond to seemingly appropriate therapy. In addition, TB should always be suspected in endemic areas, even in the absence of osseous involvement.

Systemic amyloidosis is not a single disease, but the product of a variety of diseases. Amyloid proteins are insoluble fibrils that are deposited extracellularly in many organ tissues. They stain with Congo red and appear apple green under polarized light. Definitive diagnosis and classification ofamyloidosis requires histologic examination of tissue samples. Gastrointestinal tract involvement is common, and all parts of the system can be affected Immunohistochemical studies have shown that amyloid deposited in the gastrointestinal system is most often of the AA, A kappa, or A lambda types. Another type of amyloidprotein, beta-2 microglobulin (beta2M), predominantly affects the musculoskeletal system, and is usually seen in patients who have been on long-term hemodialysis. Mixed systemic amyloidosis (beta2M and AA) is seen only rarely in these patients. In this study, we attempted to answer why this is so, and examined whether or not mixed amyloidosis is related to amyloidogenesis. We studied gastrointestinal tissues from 78 chronic renal failure patients who had systemic amyloidosis with gastrointestinal involvement. A total of 115 endoscopic samples and 1 jejunal resection specimen were analysed immunohistochemically. Immunohistochemical testing using a panel of antisera directed against two major amyloid fibril proteins (AA-Monoclonal, Dako-, and beta2M-Polyclonal, Dako-) showed that all samples contained AA amyloid, but not beta2M type protein. These findings can be explained by the patients' relatively short average duration of hemodialysis and the predominance of endoscopic biopsy samples in our study.

The aim of this study was twofold; first, we evaluated the influence of hepatitis C virus (HCV) and iron deposition on hepatic stellate cells (HSCs), and second, we determined the influence of HSCs on the development of interstitial fibrosis (IF) in renal allografts. Thirty chronic HCV positive patients bearing renal allografts underwent liver biopsies, which were scored for iron deposition and the number of HSCs. We evaluated the density of tumor necrosis factor-alpha (TNF-alpha) in liver biopsies and the expression of transforming growth factor-beta (TGF-beta) on tubules of renal allografts from the same patients. We examined the development of IF in renal allografts at 12 and 24 months after the reference biopsy. The density of HSCs was significantly greater among patients with compared with those without iron deposits (P.01). TNF-alpha expression was localized mainly to liver sinusoidal cells; in some cases, it was also expressed in hepatocytes. Patients with higher-grade TNF-alpha expression in the liver showed higher-grade alpha-smooth muscle antibody (alpha-SMA)-positive HSCs (P.001). In parallel, an increasing amount of HSCs in the liver increased the incidence of IF in the renal allograft at 12 (P.01) and 24 (P.01) months after the reference biopsy. In addition, the expression of TGF-beta on renal allograft tubules were increased with greater grades of alpha-SMA-positive HSCs in liver (P.01). In conclusion, HCV infection seemed to trigger the development of IF in renal allografts by augmenting TGF-beta secretion through activation of HSC.

Congenital leukemia is rare, and is frequently diagnosed as a form of acute myeloid leukemia at, or immediately after birth. Some infections, viral in particular, can mimic clinical signs and/or laboratory findings of congenital leukemia. This is the first documented case of candidemia resembling leukemia.

Hepatocellular carcinoma (HCC) is one of the rare tumors with well-defined risk factors. The multifactorial etiology of HCC can be explained by its complex molecular pathogenesis. In the current study, the methylation status of 7 genes involved in DNA repair mechanisms, namely MLH1, PMS2, MSH6, MSH2, MGMT, MSH3, and MLH3, was investigated in tumor samples from HCC patients, using the methylation-specific-multiplex ligated probe amplification method and the results were correlated with available clinical findings. The most common etiological factor in these cases was the presence of hepatitis B alone (47.2%). Among the 56 cases that were studied, promoter methylation was detected in at least one of the genes in 27 (48.2%) cases, only in 1 gene in 13 (23.2%) cases, and in >1 gene in 14 (25%) cases. Of the 7 genes investigated, methylation was most frequently observed in MSH3, in 14 (25%) cases. Methylation of at least 1 gene was significantly more frequent in patients with single tumors than multifocal tumors. There were significant differences regarding hepatitis B status, Child Class, tumor number, grade, and TNM stage in cases where PMS2 methylation was detected. Our results suggest that methylation of genes involved in mismatch repair may be responsible in the pathogenesis of HCC, and evaluating changes in multiple genes in these pathways simultaneously would be more informative. Despite being a robust and relatively inexpensive method, the methylation-specific-multiplex ligated probe amplification assay could be more extensively applied with improvements in the currently intricate data analysis component.

Hepatitis C virus (HCV) infection is common in patients with end-stage renal disease. The severity of liver damage, including fibrosis, in these cases varies widely. Although many investigators have searched for noninvasive alternatives to liver biopsy for evaluating the extent of liver fibrosis, no useful noninvasive predictors have been found. Currently, liver biopsy is essential to assess the degree of fibrosis. The aim of this retrospective study was to investigate a range of clinical and laboratory parameters in HCV-infected hemodialysis (HD) patients and identify possible predictors of fibrosis. Ninety-five consecutive HD patients with HCV infection underwent liver biopsy. Each specimen was evaluated for fibrosis stage. Correlations were sought between the degree of fibrosis and the age, HD duration, time since first possible HCV exposure, body mass index, HCV RNA titer, serum ferritin level, and serum alanine aminotransferase (ALT) level. The analysis revealed no significant correlations between fibrosis stage and the parameters investigated (mean age: r = .017, P = .89; mean HD duration: r = .066, P = .576; body mass index r = .231, P = .152; HCV RNA titer: r = .015, P = .091; serum ferritin: r = .134, P = .32; serum ALT r = .108, P = .927). Links with serum ALT were reevaluated with upper normal levels arbitrarily set at 30 IU/L and 20 IU/L, but these analyses also revealed no correlations between fibrosis stage and ALT level (P = .98 and P = .449, respectively). Therefore liver biopsy is still essential for accurate assessment of liver pathology in HD patients with HCV.

Contains fulltext : 109493pub.pdf (Publisher’s version ) (Closed access) For several years, the lack of consensus on definition, nomenclature, natural history, and biology of serrated polyps (SPs) of the colon has created considerable confusion among pathologists. According to the latest WHO classification, the family of SPs comprises hyperplastic polyps (HPs), sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs). The term SSA/P with dysplasia has replaced the category of mixed hyperplastic/adenomatous polyps (MPs). The present study aimed to evaluate the reproducibility of the diagnosis of SPs based on currently available diagnostic criteria and interactive consensus development. In an initial round, H&E slides of 70 cases of SPs were circulated among participating pathologists across Europe. This round was followed by a consensus discussion on diagnostic criteria. A second round was performed on the same 70 cases using the revised criteria and definitions according to the recent WHO classification. Data were evaluated for inter-observer agreement using Kappa statistics. In the initial round, for the total of 70 cases, a fair overall kappa value of 0.318 was reached, while in the second round overall kappa value improved to moderate (kappa = 0.557; p < 0.001). Overall kappa values for each diagnostic category also significantly improved in the final round, reaching 0.977 for HP, 0.912 for SSA/P, and 0.845 for TSA (p < 0.001). The diagnostic reproducibility of SPs improves when strictly defined, standardized diagnostic criteria adopted by consensus are applied.

Aim Dyspeptic symptoms may not allow clinicians to differentiate organic and functional gastrointestinal disorders. According to our dyspeptic patients' answers to dyspepsia questionnaire, we aimed to define the symptom scores directing organic dyspepsia (OD) before upper gastrointestinal endoscopy. Patients and methods One hundred sixty-one patients (ages 10-17 years, mean 13.5 ± 2.3 years, male/female: 2/3) with chronic upper gastrointestinal system symptoms lasting for at least 3 months were enrolled. Patients with predominated reflux symptoms were excluded by 24-hour pH monitoring. Before upper gastrointestinal endoscopy, severity and incidence of 8 gastrointestinal symptoms (epigastric pain, upper abdominal discomfort, retrosternal pyrosis, bitter or sour taste in mouth, halitosis, belching, nausea, and early satiety) were measured by 5-point Likert scale. Total score indicated severity score multiplied by incidence score. Antral biopsy samples were obtained. OD is defined as peptic ulcer, erosive esophagitis, erosive or nodular gastritis, and erosive duodenitis in endoscopy and/or moderate to severe antral gastritis in histology. Functional dyspepsia (FD) is defined as normal findings/mucosal hyperemia in endoscopy and/or mild antral gastritis in antral histology. We evaluated the relation among severity and incidence scores of each dyspeptic symptom in patients with OD or FD. Age, sex, body mass index, drug history, nutritional habits, the quality of life related to dyspepsia were also investigated in patients with OD and FD. Results According to patients' histological and endoscopic findings, 100 (62%) patients were in the OD group and 61 (38%) patients were in the FD group. Of the dyspeptic complaints, the severity, incidence, and total scores of epigastric pain were significantly correlated with dyspepsia type (respectively, P = 0.042, P = 0.028, and P = 0.005). Of 93 patients who had an epigastric pain severity of 4 and 5 (namely, moderate to severe pain), 65 (70%) patients were in the OD group and 28 (30%) patients were in the FD group. Of 68 patients who had an epigastric pain severity of 0 to 3 (no epigastric pain or mild pain), 33 (48.5%) were in the OD group and 35 (51.5%) were in the FD group, and the difference was statistically significant (P = 0.042). After analyzing the total scores of 8 dyspeptic symptoms, one by one or in different combinations, we could not find a threshold (cutoff) score value that was able to indicate OD definitely. Age, sex, body mass index, and nutritional habits were not significantly different between patients with OD or FD. Nocturnal abdominal pain, pain before meals, and resolution of symptoms after meals or ingestion of antacid drugs were not significantly related to OD. Nocturnal abdominal pain was observed to be higher in the group with moderate to severe gastric inflammation. Conclusions In the present study, the severity, incidence, and total scores of epigastric pain were significantly related to OD; however, a cutoff value of dyspepsia symptom score for differentiation of OD and FD could not determined. In our study, Likert dyspepsia scale was not beneficial in differentiation of the OD/FD groups. We suggest that the Likert dyspepsia scale should be redesigned for children or the same scale should be applied in a larger cohort of dyspeptic children.