AB1039 LL-37, IL-36, GALECTIN-3 AND TLR-3 LEVELS IN IDIOPATHIC GRANULOMATOUS MASTITIS

Background:

Idiopathic granulomatous mastitis (IGM) is a non-infectious inflammatory disorder of the breast characterized by non-caseous granulomas. It is a chronic granulomatous inflammatory disease frequently seen in young fertile women, the cause of which has not been clearly understood. Immunosuppressive agents and surgical interventions are used in the treatment.

LL-37 is a cathelicidin-derived antimicrobial peptide with immunomodulatory properties that are effective in innate immunity. In addition, IL-36, galectin-3, TLR-3 are effective in autoimmunity with proinflammatory properties.

Objectives:

With this study, we aimed to investigate the potential alterations of LL-37, IL 36, Galectin 3 and TLR-3 levels in IGM.

Methods:

35 female patients with biopsy-confirmed IGM and 35 healthy controls were included in the study. The serum samples of the subjects LL-37, IL 36, Galectin 3 and TLR-3 levels were studied using the Elisa method. While studying LL 37 and Galectin 3 levels in the tissue, samples of 10 patients who underwent mammoplasty for cosmetic reasons were used for the control group. Ten patients whose paraffin blocks were eligible for re-study were included in the study for tissue examinations. Based on the prevalence (0.1: <%25,- 0.4:%26-50, 0.6:%51-75, 0.9:%76-100) and severity (0: no, +0.5: very little, +1: little, +2: medium, +3: severe) of immunoreactivity in staining, histoscore was created (histoscores = prevalence x severity).

The data were evaluated using appropriate statistical analysis and p <0.05 was considered statistically significant.

Results:

When the patient and control groups included in the study were compared, there was no significant difference in age. In serum samples, LL 37, IL 36, Galectin 3 and TLR 3 levels were statistically significantly lower in IGM group compared to the control group (p <0.001 for each) (Table-1). In biopsy samples, LL 37 level was found to be significantly lower in IGM group compared to the control group (p <0.001). However, no significant difference was detected in Galectin 3 levels in tissue studies (Table-2).

Conclusion:

In our study, we found that the levels of LL 37, IL 36, Galectin 3 and TLR 3 decreased in serum samples in IGM disease whose etiology was not clearly understood. In addition, we showed that in patients with IGM, LL 37 levels decreased at the tissue level. Studies have shown that in cases of severe sarcoidosis, LL 37 deficiency is reduced both in level and gene expression. So they thought, deficiency of cathelicidin LL 37 may impede resolution of inflammation in the tissue of patients with severe form disease.

References:

[1]Barna, Barbara P et al. “Alveolar macrophage cathelicidin deficiency in severe sarcoidosis.” Journal of innate immunity vol. 4,5-6 (2012): 569-78.

[2]Al-Khaffaf, Bilal et al. “Idiopathic granulomatous mastitis: a 25-year experience.” Journal of the American College of Surgeons vol. 206,2 (2008): 269-73.

Table 1.

LL 37, IL 36, Galectin 3 and TLR 3 levels in serum samples

IGM(N:35)CONTROL (N:35)PAge35,92 ± 5,1934,03 ± 3,810,08LL 37 (ng/ml)5,20 ± 5,4840,05 ± 31,97<0,001IL 36 (pg/ml)294,74 ± 125,94864,71 ± 442,39<0,001Galectin 3 (ng/ml)3,61 ± 3,1615,53 ± 10,14<0,001TLR 3 (pg/ml)931,49 ± 443,864019,36 ± 2599,51<0,001

IGM: Idiopathic granulomatous mastitis

Table 2.

Evaluation of LL-37 and Galectin 3 levels with histoscores in biopsy samples

IGM (N:10)CONTROL (N:10)PLL 370,006 ± 0,0250,140 ± 0,516<0,001Galectin 30,293 ± 0,2010,400 ± 0,2900,32

Disclosure of Interests:

None declared

AB1333-HPR FIBROMYALGIA SYNDROME IN MEDICAL STUDENTS

Background:

At the university, students begin to be responsible for their own life decisions and lifestyles. First year students are required to adapt especially to a new learning environment and to cope with the academic and social demands of vocational education. High academic expectations are stressful and can pose a risk to students mental and physical health. Anxiety and depression are among the most common psychiatric problems among students.

Objectives:

The aim of this study is to evaluate the prevalence of fibromyalgia syndrome (FMS) in medical students and to compare students from engineering faculty.

Methods:

392 (284 faculty of medicine, 108 faculty of engineering) students selected from Firat University Faculty of Medicine and Engineering were included in the study. Hospital Anxiety and Depression Scale (HADS) forms were filled in for all participants. Anxiety and depression among students of medical and engineering were examined. Moreover, 2016 ACR FMS classification criteria was used to select the student who have FMS.

Results:

In our sample, 185 (47.1%) and 207 (52.9%) of participants were male and female, respectively. HADS anxiety and HADS depression scores were significantly higher in engineering students than in medical students (mean HADS anxiety and depression scores were 9.07; 10.29, p= 0.007 and 7.61; 8.52, p= 0.039, respectively). While a significant difference was found among medical and engineering students in terms of HADS anxiety and depression scores in men (p<0.001 and p= 0.006), no significant difference was found in women (p= 0.676 and p= 0.278). On the other hand, 46 (16.1%) of medical students and 13 (11.7%) of students from engineering faculty have FMS (p=0.170).

Conclusion:

FMS prevalences are similar in the medical students and students from engineering faculty. However, anxiety and depression are more common among male engineering students than medical students. This may be related to future employment anxiety among students from engineering faculty.

References:

[1]Cheung T, et al. Depression, Anxiety and Symptoms of Stress among Baccalaureate Nursing Students in Hong Kong: A Cross-Sectional Study. Int J Environ Res Public Health. 2016 Aug 3;13(8).

Disclosure of Interests:

None declared

Significance of H3K27M mutation with specific histomorphological features and associated molecular alterations in pediatric high-grade glial tumors

PURPOSE

Pediatric high-grade gliomas (pHGGs) constitute almost 15% of all childhood brain tumors. Recurrent mutations such as H3K27M mutation in H3F3A and HIST1H3B genes encoding histone H3 and its variants were identified in approximately 30% of pediatric glioblastomas. This study aimed to ascertain the morphological and molecular characteristics of pHGGs with H3K27M mutation.

METHODS

In total, 61 cases of pHGGs (anaplastic astrocytoma, 12; glioblastomas, 49) from four university hospitals were studied. The histomorphological features were examined and immunohistochemistry was performed to evaluate the mutation status of H3K27M, ATRX, IDH1, BRAF V600E, and p53 genes.

RESULTS

The study comprised 25 females and 36 males (age range, 1-18 years) with a clinical follow-up of up to 108 months. From the total, 31 patients were positive for H3K27M mutation located in the midline, mostly in the pons and thalamus. H3K27M mutation was commonly associated with ATRX loss (32.3%) and p53 (74.2%) immunoreactivity with a co-expression rate of 25.8%. While IDH1 mutation was not detected in pHGGs with H3K27M mutation, BRAFV600E mutation was rarely observed. Among the various histomorphological features, increased number of mitosis, increased Ki-67 proliferation index, and palisading and geographical necrosis along with small cell patterns were significantly associated with the H3K27M wild-type tumors. Focal infarct-like necrosis and pilomyxoid morphology was significantly associated with these tumors.

CONCLUSION

H3K27M mutation occurs exclusively in pHGGs arising from the midline and presents with varied histomorphological features ranging from low-grade pilomyxoid astrocytoma to highly pleomorphic glioblastoma along with ATRX loss and p53 mutations.

Preoperative Somatostatin Analogue Treatment Might Trigger Apoptosis and Autophagy in Tumor Tissues of Patients with Acromegaly: A Pilot Study

OBJECTIVE

To evaluate the effect of preoperative somatostatin analog (SRL) treatment on proteins associated with apoptosis and autophagy in patients with acromegaly and to determine factors correlating with these parameters.

METHODS

Ex-vivo tumor samples of 11 SRL-treated and 9 SRL-untreated patients were retrospectively included in the study. Apoptotic and autophagic proteins were determined via immunohistochemical staining and apoptosis was evaluated via in situ DNA end labeling (TUNEL).

RESULTS

TUNEL, caspase-3, and ATG-5 immunopositivity was significantly increased (p<0.01, p=0.01, p=0.01, respectively), survivin and beclin-1 immunopositivity was significantly decreased (p=0.03, p=0.02, respectively) in SRL-treated patients as compared with SRL-untreated controls. Ki-67 index was decreased significantly in the SRL-treated group (p=0.01). Significant positive correlations were detected between TUNEL and caspase-3 immunopositivity (r=0.577, p<0.01), and between survivin and beclin-1 immunopositivity (r=0.503, p=0.03). Age at diagnosis, preoperative GH, IGF-1 levels, tumor size, and invasion status were not found to affect TUNEL positivity nor did they correlate with caspase-3, survivin, beclin-1, ATG-5 immunopositivity (p>0.05 for all). Preoperative SRL treatment was the only factor that had a significant effect on TUNEL positivity (adjusted R²=0.39, p=0.02). Preoperative treatment duration was positively correlated with TUNEL and caspase-3 immunopositivity (r=0.526, p=0.02; r=0.475, p=0.04, respectively) and negatively correlated with survivin immunopositivity (r=-0.533, p=0.01).

CONCLUSIONS

Somatostatin analog treatment might induce apoptosis, increase autophagy, and decrease cell proliferation in GH-secreting adenomas. Also, proteins related to cross-talk between autophagy and apoptosis are upregulated after SRL treatment.

Proximal muscle weakness as a result of osteomalacia associated with celiac disease: a case report

A 24-year-old woman suffering from back and hip pain with difficulty in walking was reported. She had proximal muscle weakness. Laboratory findings led to the diagnosis of osteomalacia. Positivity of antibodies strengthened suspicion of celiac disease. In patients with proximal muscle weakness, osteomalacia should be considered in differential diagnosis even in a young woman.

INTRODUCTION

A 24-year-old woman suffering from back pain, bilateral hip pain, and difficulty in walking was reported. Her symptoms had started in the first trimester of pregnancy.

METHODS

In her physical examination, proximal muscle weakness and waddling gait pattern were determined. Her lumbar spine and hip MRI revealed no obvious pathological findings. Electromyography showed a myophatic pattern.

RESULTS

Physical examination, normal values of creatine kinase, and muscle biopsy were supplied to exclude the diagnosis of primer muscle diseases. Laboratory findings led to the diagnosis of osteomalacia with normal renal function. Gastrointestinal symptoms and positivity of anti-gliadin and anti-endomysium antibodies strengthened the suspicion of celiac disease as a cause of the osteomalacia. The diagnosis of celiac disease was confirmed with duodenal mucosal biopsy.

CONCLUSION

In patients with proximal muscle weakness and waddling gait pattern, osteomalacia should be considered in differential diagnosis even in a young woman and underlying disease should be investigated.

Sudden death due to a rare brain tumor: an autopsy case

Sudden death in persons with intracranial neoplasms is a rare mechanism of death detected in the forensic autopsies. 10 years-old girl was brought to a local clinic death shortly after analgesic therapy for headache. Autopsy findings showed a large, solid cerebellar mass. Histological diagnosis was pilomyxoid astrocytoma, low-grade tumor with features alike to pilocytic astrocytomas. In this case report we present and discuss rare autopsy case of pilomyxoid astrocytoma from medicolegal point of view.

KEYWORDS

sudden death - brain - pilomyxoid astrocytoma - autopsy.

Xanthomatous hypophysitis

Xanthomatous hypophysitis (XH) is the rarely seen primary form of hypophysitis. The histological differential diagnosis includes other causes of hypophysitis, Erdheim-Chester disease (ECD), Langerhans cell histiocytosis, Rosai-Dorfman disease and plasma cell granulomas. We present a 39-year-old woman admitted to our department with headache, menstrual irregularity and galactorrhea. The MRI revealed a lesion with a central cystic/necrotic region and a diameter of almost 1cm. Histologic examination showed an inflammatory infiltrate of numerous foamy histiocytes, surrounding the necrotic tissue. On immunohistochemical sections, infiltrating foamy cells stained strongly positive for CD68, and negative for CD1a and S100. After establishing the diagnosis of XH, the patient underwent glucocorticoid treatment. XH should be considered in the differential diagnosis of pituitary lesions. Since XH is rare, it is difficult to assess the efficacy of medical/surgical treatment of this entity accurately.

The diagnostic utility of maspin in the distinction between malignant mesothelioma and pulmonary adenocarcinoma

Immunohistochemistry is frequently employed to differentiate between malignant mesothelioma (MM) and pulmonary adenocarcinoma (AC) infiltrating the pleura, but there is uncertainty as to which antibodies are most useful. The present study investigated the presence of the serine protease, maspin, in epithelioid MMs and evaluated the diagnostic utility of maspin for the differential diagnosis between epithelioid MM and pulmonary AC with pleural involvement. The results showed more frequent maspin immunostaining among AC cases compared with MM cases. Maspin positivity was significantly higher among AC cases with respect to both the extent and intensity of staining. A significant difference also existed between the two tumour types with respect to the overall maspin score. Despite these findings, the sensitivity and specificity of maspin positivity to detect AC were only 59% and 73%, respectively, indicating that detection of maspin is of no value for the differential diagnosis of AC and MM.

Giant cell tumor of the frontal bone in an 18-month-old girl: a case report

INTRODUCTION

Giant cell tumors (GCT) are benign, but locally aggressive primary bone neoplasms, that frequently occur in the epiphyses of the long bones. Less than 1% of all GCTs primarily involve the skull where they are preferentially seen in the sphenoid and temporal bones. In the pediatric age group they are exceptionally rare.

CASE REPORT

The authors report the management of a GCT involving the frontal bone in an 18-month-old girl. The patient underwent wide surgical excision of the lesion and remains free of clinical and radiological evidence of tumoral recurrence thirty months after treatment.

CONCLUSION

Although rare, GCTs should be taken into consideration as a differential diagnosis of rapidly enlarging cranial mass lesions in pediatric patients. Gross total surgical excision eliminates the potential risks of adjuvant radiotherapy. However, considering the aggressive nature and potential malignancy of these lesions, careful long-term clinical and imaging follow-up is recommended.

The relationship between histomorphological characteristics and Ki-67 proliferation index in meningiomas

OBJECTIVES

This study had two aims. The first was to use the Ki 67 proliferation index (Ki-67 PI) to study the relationship between the proliferation potential and histopathological features such as mitosis, necrosis, loss of architecture, small cell change, hypercellularity, pleomorphism, brain invasion, dura invasion, bone invasion, and histological grade. The second aim was to compare primary and recurrent meningioma with respect to morphological characteristics and Ki-67 PI values.

BACKGROUND

Meningiomas are tumors whose histological features do not predict their biological behavior. Despite their slow growth and even after total resection, recurrence may occur

METHODS

A total of 245 meningioma cases in whom Ki-67 PI was studied were included in the study. The cases were assessed with respect to 10 morphological characteristics, and a possible significant relationship between these and Ki 67 PI was statistically tested.

RESULTS

We found a statistically significant relationship between Ki-67 PI and mitotic activity, necrosis, loss of architecture, small cell change, brain invasion. In contrast to brain invasion, no significant relationship was present between dura or bone invasion and Ki-67 PI. We identified asignificant increase in the histological grade, mitotic activity and Ki-67 PI value of recurrent tumors, as compared to primary ones

CONCLUSION

Ki-67 PI values overlap in different grades. This overlapping might be due to the heterogeneity of biological activity within the tumor tissue (Tab. 2, Fig. 7, Ref. 21).

Non small cell lung cancer within the small cell lung cancer radiotherapy field after 11 years

A 71-year-old male was diagnosed with a non-small cell lung cancer (NSCLC) within the radiotherapy field that was used for the treatment of a small cell lung cancer (SCLC) 11 years ago. At the initial diagnosis in 1996 the patient had limited-stage SCLC located in the right upper lobe of the lung with mediastinal involvement. He received 4 cycles of chemotherapy and then mediastinal radiotherapy. With a complete response after chemoradiotherapy he was given prophylactic cranial radiotherapy. After 11 years of disease-free period a new mass in left lower lobe of the lung was detected. Bronchoscopic biopsy showed second lung cancer with epidermoid histology. Although the incidence of a second lung cancer is higher in SCLC survivors, this is a unique case in the literature with second NSCLC developing in the previously irradiated side of limited-stage SCLC.

Simulating the Effects of Deep Saline Aquifer Properties for CO2 Sequestration

Abstract

CO2 is one of the hazardous greenhouse gases causing significant changes to the environment. The sequestering of CO2 in a suitable geological media can be a feasible method to avoid the negative effects of CO2 emissions into the atmosphere. A numerical model was developed regarding CO2 sequestration in a deep saline aquifer. A compositional numerical model using CMG software (GEM) was employed to study the ability of the selected aquifer to accept and retain large quantities of CO2 injected in a supercritical state for long periods of time (up to 200 years).

Supercritical CO2 is a one-state fluid which exhibits both gas- and liquid-like properties. In this study, supercritical CO2 was sequestered in three forms in a deep saline aquifer. It was assumed to be supplied in an isothermal condition during the injection and sequestration processes and we ignored porosity and permeability changes due to mineralization. Also, CO2 adsorption was not considered in our numerical model. Gas bubble formation, dissolution of CO2 in brine and precipitation of CO2 with calcite mineral in aquifers have been discussed. The CO2 gas bubble displaces the formation water with immiscible behaviour. During and after displacement, the gravitational effects cause the CO2 to rise and accumulate under the caprock. Both vertical and horizontal permeability ratios and initial pressure conditions were the most dominating parameters affecting CO2 saturation in the three layers, whereas the CO2 injection rate influenced CO2 saturation in layers two and three since CO2 was injected from layer three at the bottom of the reservoir.

Introduction

CO2 sequestration is the capture of, separation and long-term storage of CO2 in underground reservoirs for environmental purposes. CO2 is one of the hazardous greenhouse gases causing significant changes in global temperature and sea levels(1), which could have negative consequences for people in many parts of the world. Scenarios for stabilizing atmospheric CO2 at reasonable levels will eventually require substantial cuts in overall emissions over the next few decades(1,2). If usage of fossil fuels is to continue at current levels while avoiding undesirable climate change, technical means need to be found to reduce the carbon dioxide emitted to the atmosphere in the production and consumption of fossil fuels(3).

CO2 sequestration can be regarded as one possible solution for reducing CO2 emissions in a form where they will not reach the atmosphere.

Disposal environments for CO2 sequestration can be divided into four different categories. Oceans, terrestrial basins, a biological environment and geologic formations are the candidates for the disposal of CO2. Among these alternatives, geologic formations can be regarded as the best possible environment to sequester CO2 because of the fact that the storage of CO2 in geologic formations is a self-containing and volumetrically efficient process.

In geologic formations, CO2 can be sequestered in porous or non-porous media. Depleted oil and gas reservoirs, aquifers and coal beds can be categorized as porous media, whereas salt caverns and lined rock caverns can be regarded as types of non-porous media.

The R110C mutation in Notch3 causes variable clinical features in two Turkish families with CADASIL syndrome

Mutations in Notch3 gene are responsible for the cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). It is a late onset neurological disorder recognized by recurrent strokes and dementia. We describe here the clinical and molecular findings of three unrelated Turkish families with CADASIL syndrome. Two of the families were identified to have the same mutation, p.R110C (c.C328T), located in exon 3 of the Notch3 gene. Interestingly, the phenotypic expression of the disease in these two families was markedly different in severity and age of onset implicating additional genetic and/or non-genetic modulating factors involved in the pathogenesis. In addition, we identified the novel p.C201R (c.T601C) mutation in exon 4 of the Notch3 gene in a proband of the third family with two consecutive stroke-like episodes and typical MRI findings. Mutations described here cause an odd number of cysteines in the N-terminal of the EGF domain of Notch3 protein, which seems to have an important functional effect in the pathophysiology of CADASIL. The phenotypic variability in families carrying the same molecular defect as presented here makes the prediction of prognosis inconceivable. Although DNA analysis is effective and valuable in diagnosing approximately 90% of the CADASIL patients, lack of genotype-phenotype correlation and prognostic parameters makes the presymptomatic genetic counseling very difficult.

Correlation of endothelial nitric oxide synthase and vascular endothelial growth factor expression with malignancy in patients with astrocytic tumors

PURPOSE

Many characteristics of malignant brain tumors (increased vascular permeability, vasodilatation, neovascularisation and free radical injury to the tumor and adjacent normal tissues) are believed to be mediated by nitric oxide (NO) synthetized by endothelial NO synthase (eNOS). Overexpression of vascular endothelial growth factor (VEGF) is associated with several central nervous system (CNS) diseases and tumors. Our aim was to study immunohistochemically the coexpression of eNOS and VEGF in astrocytic tumors and to analyse their possible correlation with tumor grade, angiogenesis and proliferation index.

MATERIALS AND METHODS

Sections from 120 randomly selected patients with supratentorial astrocytic tumors [38 glioblastomas (GB), 22 anaplastic astrocytomas (AA) and 20 low-grade astrocytomas (LA)], also including oligodendrogliomas (n=20) and mixed oligoastrocytomas (n=20), were immunostained with monoclonal antibodies for eNOS and VEGF using the avidin-biotin method. The proliferative potential was assessed as the MIB-1 staining index for tumor cells.

RESULTS

There was positive correlation between eNOS and VEGF expressions and histological grade (p<0.05) in terms of intensity and extent of immunoreactivity distribution. Oligodendrogliomas showed significantly less VEGF and eNOS immunoreactivity compared to pure astrocytomas (p<0.05).

CONCLUSION

Overexpressions of eNOS and VEGF in astrocytic tumors were significantly correlated with histological grade, proliferative potential and malignant transformation. The expression of VEGF in a necrotic and ischemic tumor such as GB is more intense and diffuse than low-grade astrocytomas. These findings suggest that eNOS overexpression in tumor vasculature would be precipitated by transformation into an angiogenic phenotype in the process of neovascularisation in astrocytic tumors.

Autocrine motility factor receptor expression implies an unfavourable prognosis in resected stage I pulmonary adenocarcinomas

BACKGROUND

Pulmonary adenocarcinomas constitute a different histological subtype among the histological subtypes of non small cell lung carcinomas by showing comparably unfavourable rates of prognosis and different immunobiological features. Autonomous motility of tumour cells plays an important role in the regulation of local invasion and distant metastasis of tumour lesions which have great impact on overall survival. AMF (Autocrine motility factor) is a tumour secreted cytokine that stimulates motility during invasion and metastasis via its receptor, AMFR. We conducted an immunohistochemical study to investigate AMFR expression in pulmonary adenocarcinomas and its effect on survival.

MATERIAL AND METHODS

We assessed AMFR expression using a monoclonal antibody (3F3A) in a total of 32 surgical specimens with stage I pulmonary adenocarcinomas that underwent curative resection. We analyzed AMFR expression as a possible prognostic factor on survival and its correlations with clinicopathological features.

RESULTS

A total of 19 (59.3%) specimens showed AMFR expression. The 3-year survival rates of AMFR positive and AMFR negative patients were 47.3% and 84.6%, respectively, which was a significant difference (P = 0.0197). The univariate predictors of surgical outcome were AMFR expression (P = 0.032) and perineural invasion (P = 0.038). However, multivariate analysis revealed AMFR expression (P = 0.045) as the only independent prognostic factor.

CONCLUSIONS

AMFR expression predicts an unfavourable surgical outcome in patients with stage I pulmonary adenocarcinomas.

Experimental study of rapid versus slow sagittal sinus occlusion in dogs

BACKGROUND

Clinical, radiological, postmortem and experimental studies are not enough for the definition of pathophysiological differences between rapid and slow-progressing cerebral venous system obstruction.

AIMS

An experimental study was conducted to set some physiopathological differences between rapid and slow occlusion of the superior sagittal sinus.

SETTINGS AND DESIGN

Eighteen dogs categorized into 3 groups were chosen as test subjects. The three groups were the rapid occlusion, slow occlusion and the control study groups and each group had six subjects.

MATERIAL AND METHODS

Intracranial pressure values, histopathological findings, and the degree of cerebral edema formation, estimated by measuring the water content ratio of the brain and the angiographic results in the 2 different groups of subjects that underwent rapid and slow superior sagittal sinus obstruction were compared with that of the control subjects.

STATISTICAL ANALYSIS

Statistical analysis was performed using GraphPad Prisma V.3 statistical software. Variables of the 3 groups were compared using non-parametric Kruskal Wallis ANOVA test and multiple comparisons were made using Dunn's multiple test. The comparison of initial and terminal intracranial pressure values obtained before and after the sinus occlusion, was made using the Wilcoxon test. A probability value of less than 0.05 was regarded as significant.

RESULTS AND CONCLUSIONS

Comparison of the water content ratio of the brain in the 3 groups, the difference between the initial and terminal intracranial pressure values of the rapid occlusion study group, and the difference between the terminal intracranial pressure values of the 3 groups was statistically significant (P<0.05). Dunn's Multiple Comparison Test yielded significant differences in the water content ratio of the brain and in the intracranial pressure values between the rapid occlusion study group and the control group (P<0.05). Moreover, histopathological and radiological examination disclosed more prominent brain edema findings, and less apparent collateral venous flow in the rapid occlusion study group than in the slow occlusion one. To conclude, the clinical severity of sinus occlusion seems directly related to the quickness of the occlusion and the capacity of the collateral venous system.

Atypical intradural spinal tuberculosis: report of three cases

OBJECTIVE

To report three cases of intradural spinal tuberculosis (TB) by calling attention to atypical forms of spinal TB.

SETTING

A University Hospital, Istanbul, Turkey.

METHODS

Histopathological, radiological, surgical and physical examination findings of three patients with spinal TB were retrospectively reviewed.

RESULTS

Based on histopathological, surgical and radiological findings, diagnosis of intramedullary abscess had been made in the first case and early and late phases of arachnoiditis in the other two patients, respectively. The clinical outcome was evaluated as satisfactory for the patient with intramedullary abscess who had been treated with medical and surgical interventions. The remaining two patients with arachnoiditis, who had been treated by shunting or simple decompression, had a relatively less favorable clinical outcome.

CONCLUSION

Spinal TB, in its atypical forms, is a rare clinical entity and low index of suspicion on the part of the surgeon may result in misdiagnosis such as neoplasm. In cases presenting with an intraspinal mass lesion, possibility of a tuberculous abscess and/or a granuloma should be considered in the differential diagnosis.

Capillary haemangiomas of the spinal cord: report of two cases

The clinicopathological features of two cases of capillary haemangioma of the spinal cord are described. The presenting symptoms were similar to those of common intradural, intramedullary tumours or tumour-like mass lesions. Radiological features of these two lesions resembled other vascular lesions of the spinal cord. The patients underwent surgery, and recoveries were good. Histologically, the lesions resembled capillary haemangioma of superficial tissues that are composed of lobules of small capillaries with feeding vessels. A fibrous capsule enveloped the lesions. Capillary haemangiomas of the central nervous system are rare. Awareness of their existence may help the surgeon to avoid misdiagnosis and overtreatment of these benign tumour-like lesions.

A brachial aneurysm in childhood caused by Ehlers-Danlos syndrome

A case of an 11-year-old boy with Ehlers-Danlos syndrome (EDS) type IV is presented. He was referred with a pulsatile mass above the right antecubital fossa and Doppler revealed a saccular aneurysm. Excision and ligation of the brachial artery aneurysm was performed. The diagnosis was confirmed by skin fibroblast cultures and histopathologic evaluation. We conclude that arteriography should be avoided in EDS and color-Doppler should be the sole means of diagnosis. Ligation rather than arterial reconstruction should be preferred.

Metastatic cardiac myxoma

A 22-year-old woman who had a history of three cardiac operations and a bilateral femoral embolectomy for recurrent cardiac myxoma and myxoma embolism, respectively, was accepted to our clinic with multiple immobile peripheral masses. One of them was compressing the left common femoral artery. This mass was extirpated. Pathology examination revealed myxoma. Chemotherapy was given to the patient and regression of the masses was observed.

Tracheal reconstruction using alcohol-stored homologous cartilage and autologous cartilage in the rabbit model

OBJECTIVE

Reconstruction of laryngotracheal stenosis continues to pose a significant challenge. Cartilage grafts have been in use for almost a century, but despite good clinical results, many questions concerning the survival and growth of implanted cartilage persist. To reduce donor site morbidity, the use of homologous cartilage has been investigated. This study compared alcohol-stored homologous auricular cartilage with autologous auricular cartilage for anterior graft laryngotracheal reconstruction in a rabbit model.

METHODS

Autologous and alcohol preserved homologous auricular cartilage was transplanted to the resected anterior tracheal wall of the twenty New Zealand rabbits. Rabbits were sacrificed 6 weeks after surgery and histologic analysis was performed on the implanted cartilage grafts.

RESULTS

The autografts were significantly more likely than the homografts to demonstrate viable cells (95% vs. 30%, P<0.05) and less likely to exhibit significant resorption, fibrosis or necrosis (P<0.05). Resorption and necrosis were most common in areas of trauma to the graft. Complete epithelialization occurred in all of the autografts but in only 65% of the homografts (P<0.05). New cartilage formation and integration of the implanted grafts was poor with both types of grafts.

CONCLUSION

Autologous cartilage appears to have better survival than alcohol preserved homologous cartilage when used for anterior graft laryngotracheal reconstruction in a rabbit model.

Idiopathic granulomatous hypophysitis: are there reliable, constant radiological and clinical diagnostic criterias?

Idiopathic granulomatous hypophysitis is a rare inflammatory disease of unknown aetiology; few cases are reported. We review the clinical presentation and radiological characteristics of these cases and our own experience with three new surgical cases, to determine diagnostic criteria. MRI of three cases revealed sellar lesions extending into the chiasmatic cistern. Their shape varied, from dumbbell to spherical and elliptical. All were isointense with the brain on T1-weighted images and gave heterogeneously high signal on T2-weighted images. Contrast enhancement was homogeneous in one case and heterogeneous in another. The pituitary stalk could not be identified. There was no dural enhancement. The sphenoid sinus mucosa was thickened in two cases and normal in one.

The primitive neuroectodermal tumor of the heart

A young man was admitted to hospital with dyspnea, malaise, chest pain and night sweating. Investigative studies revealed a cystic mass lesion originating from the heart. Surgical exploration of the tumor showed that it was unresectable and pathology of the biopsy material was primitive neuroectodermal tumor. Medical literature concerning this unusual type of tumor is reviewed.

An experimental study of skin flap associated with muscle: is muscle nourishment possible through the musculocutaneous perforators?

An experimental study was planned to examine whether the blood supply of muscle would be maintained by reverse flow from the cutaneous arteriolar microcirculatory system via the musculocutaneous perforators. A flap model containing both muscle and skin based on the inferior superficial epigastric vessels was designed with the blood supplied directly from the cutaneous arteriolar microcirculatory system. A total of 154 male Wistar Albino rats were divided into three groups. Group I included the standard vertical rectus abdominis musculocutaneous flap based on the superior deep epigastric vessels (N = 48). Group II included the acute cutaneous muscle flap (N = 53). Group III contained the delayed cutaneous muscle flap (N = 53). Skin flap survival area, muscle scintigraphy with technetium-99m-methoxy-isobutyl-isonitrile, microangiography, and histopathological examination of the flaps were conducted. The mean percentage of surviving skin paddle area was 96.4 +/- 5.2%, 84.9 +/- 21.6%, and 91.0 +/- 16.8% in groups I, II, and III respectively. There was no significant difference between groups. Microangiography revealed the blood flow from skin to muscle through the musculocutaneous perforators. The radioisotope uptake of the muscle flap was expressed as A percentage of the intact contralateral muscle. Mean uptake in group I was 90.1 +/- 4.9% immediately after flap elevation, 62.5 +/- 13.5% on day 2, and 88.3 +/- 12.0% on day 7. These values were 53.7 +/- 7.1%, 63.6 +/- 14.1%, and 89.2 +/- 18.1% in group II, and 64 +/- 7.8%, 75.5 +/- 9.8%, and 92.8 +/- 40.1% in group III. Radioisotope uptake in group I was significantly higher than groups II and III immediately after flap elevation (p < 0.05, analysis of variance), whereas there was no significant difference on days 2 and 7. Histopathological examination revealed surviving muscle tissue without marked atrophy. There was no marked difference between groups histopathologically. These results indicate that muscle tissue may survive by reverse flow through the musculocutaneous perforators when elevated with an axial skin flap.

Evaluation of oxidative stress in experimental colitis: effects of L-arginine-nitric oxide pathway manipulation

In this study it was of interest to evaluate the impact of nitric oxide (NO) modulation by administration of arginine/NAME, on oxidative stress in experimental colitis induced by 2,4,6-trinitrobenzenesulfonic acid. Arginine was used to increase NO levels while NAME lowered oxidant levels. Histopathological findings of colon revealed mucosal inflammation in all groups but significantly higher with arginine alone. The levels of NO and of thiobarbituric acid-reactive substances (TBARS, a marker of lipid peroxidation) were observed to be significantly higher in the arginine-administered group compared to glycine, and these levels were found to decrease on administration of NAME to both glycine- and L-arginine-administered groups. Glutathione peroxidase (GSH-Px) activity and glutathione (GSH) levels were significantly higher in arginine administered group compared to glycine. Significantly higher CuZn superoxide dismutase (CuZn-SOD) activity was observed in the L-arginine + L-NAME group compared to arginine. Data show that NO plays a role in oxidant damage found in experimental colitis and that the use of NAME may potentially inhibit injury.

Surgical outcome of epilepsy patients evaluated with a noninvasive protocol

Surgery is now an accepted treatment for some medically intractable epilepsies. Presurgical evaluation is particularly important for the localization of the epileptogenic zone, which may necessitate sophisticated imaging techniques and intracranial electroencephalogram (EEG) recordings. If patients are carefully selected, however, successful results can be achieved with noninvasive evaluation methods. Seventy-seven patients were operated on for intractable seizures. All patients underwent EEG, neuropsychological, psychiatric, and magnetic resonance imaging investigations. Ictal EEG-video recording was performed in all nonlesional and in some lesional cases that had discordant data. Selective amygdalo-hippocampectomy was performed on patients with mesial temporal lobe epilepsy (MTLE), an extended or a limited lesionectomy was performed on patients with structural lesions, and a lesionectomy with deafferentation was performed on two patients with West syndrome. Electrocorticography was not used. Temporal lobe directed surgery was performed in 63.6% of the cases. The pathological examinations of all cases showed hippocampal sclerosis (HS) in 43%, tumor or tumor-like lesions in 36%, and cortical dysplasia in 5% of patients. After a mean follow-up of 17 months (range, 2-53), 75% of the patients were seizure-free with or without aura and 15% had a marked improvement, whereas 10% did not benefit from surgery. Neuropsychological outcome of patients with MTLE and HS also showed worthwhile results. Our patients, who were evaluated without pre- and perioperative intracranial recordings and other sophisticated techniques, had an outcome comparable to those in other series from more experienced centers. Our experience indicates that successful results, especially for patients with MTLE-HS and lesion-related epilepsies, can be obtained at centers with limited resources if the diagnoses and evaluation procedures are performed carefully.

Thymosin alpha-1: evidence for an antiatherogenic effect

In the present study, the effects of thymosin alpha1 on lipid peroxidation were studied in an in vivo model of experimental hypercholesterolemia. In groups II-IV, rabbits were fed a high-cholesterol diet 2% (w/w) for 10 weeks. Thereafter, rabbits in group III were fed a normal diet for another 14 days and those in group IV were given a normal diet plus 25 microg/kg thymosin alpha1 intraperitoneally every other day for the same period. At the end of this period, plasma and erythrocyte lipid levels and susceptibility of erythrocytes to lipid peroxidation were determined in all groups. Hypercholesterolemic rabbits had high plasma and erythrocyte lipid peroxide (TBARS) levels compared to control animals fed a normal diet. Plasma and erythrocyte TBARS levels significantly decreased in the thymosin-alpha1-injected rabbits. In thymosin-alpha1-treated animals (group IV), most of the lipid plaques were replaced by fibrous tissue. These findings suggest that thymosin alpha1 may have some beneficial effects on the treatment of atherosclerosis by normalizing blood lipid levels and by substantially protecting endothelial cells against free radical injury.

Chiasmatic low-grade glioma presenting with sacral intradural spinal metastasis

Leptomeningeal metastasis of low-grade gliomas in children has been documented in several series, both at the time of diagnosis and at relapse. The authors report a unique case of chiasmatic low-grade astrocytoma presenting with signs and symptoms related to the metastatic site rather than the primary site. In this respect, the possibility of appearance of symptoms and signs related to leptomeningeal dissemination preceding the signs and symptoms belonging to the primary site should be considered in this type of benign tumours.

The distribution of extracellular matrix proteins and CD44S expression in human astrocytomas

Aims of the study were: 1. to establish the prevalence of CD44 protein expression in human astrocytomas; 2. to compare the distribution of the extracellular matrix in these tumors; 3. to investigate the relation between CD 44, the extracellular matrix proteins and the histological grade of the tumor. CD44, Type IV Collagen (Col IV), Laminin (LN), Fibronectin (FN), and Tenascin (TN) expression were detected by immunohistochemistry in formalin fixed paraffin embedded tissue samples of 52 astrocytic tumors: 35 glioblastomas (GB), 7 Anaplastic astrocytomas (AA) and 10 astrocytomas (A). The localization of Col IV was observed in the basement membrane of the vessel walls in most of the astrocytomas (88.4%) with a similar pattern obtained with LN staining. 7 of 10 A (70%), 2 of 7 AA (28%) and 9 of 35 GB (25.7%) showed LN positivity. There was a negative correlation between LN expression and tumor grade (p=0.03). FN was either localized in the basement membrane or showed thick multi-layered immunoreactivity of the vessel walls. FN expression was seen in 6 A (60%), 4 AA (57%) and all of 35 GB (100%). The FN distribution was not uniform and its staining intensity showed decrease in GB. 3A (30%), 3 AA (42%), 27 GB (77.1%) showed TN expression in the vessel walls and in some tumor cells of 19 GBs. TN expression was positively correlated with the degree of vascular endothelial proliferation in GB (p<0.05). The expression of CD44s wasseen as plasma membrane positivity of glioma cells in 5 of 10A (50%), 3 of 7AA (42.3%) and 29 of 35 GB (82.8%). The intensity of immunoreaction was quite strong especially near the vessels. There was a good correlation between TN and CD44s expression in human astrocytic tumors (p=0.005). No relationship was observed between GFAP, ECM proteins and CD44s expression. Both CD44s and TN expression showed increase with malignancy in astrocytomas. These findings indicated that the histological malignancy of the astrocytomas was correlated with expression of TN and CD44s. It was suggested that in astrocytomas there was a biological relationship only between CD44 and TN, but none with the other ECM proteins. TN may play a role in angiogenesis in human astrocytic tumors.

A cardiac papillary fibroelastoma with chordal location

Papillary fibroelastomas, which were initially incidental findings at autopsy and surgery, are now being recognized with increasing frequency with the widespread use of echocardiography. Because of their embolic potential, an aggressive treatment approach is generally accepted. We report a papillary fibroelastoma located at the chorda of the anterior mitral leaflet that underwent conservative follow-up for 8 years without any complications. Because most of the cardiac papillary fibroelastoma cases reported are incidental findings, the question of whether symptomless fibroelastomas must be removed or other factors contribute to the embolic nature of the selected cases remains a challenge for the future.

Cerebral candidiasis presenting as a mass lesion

The authors report of a case of pseudotumour caused by Candida species without evidence of any underlying disease. No portal of entry of the infection was found. Total removal followed by treatment with flucanazole resulted in a favorable outcome. We discuss the differential diagnosis of a huge calcified intracranial mass lesion without any soft tissue component.

Blood degradation products play a role in cerebral ischemia caused by acute subdural hematoma

The pathogenesis of ischemic brain lesions with traumatic hematoma is multifactorial. It has been suggested that the presence of subdural hematoma in patients with severe head injury is associated with elevated intracranial pressure and higher mortality. In this study we created acute subdural mass in the rats by injecting 250 microliters of autologous blood and silicone oil into the subdural space. The goal of this study was to determine the effect of subdural hematoma versus silicone oil on the adjacent brain parenchyma. Twenty-four hours after the injection, of the hematoma in the subdural space in rats produced an extensive zone of underlying ischemic damage but silicone oil did not. This study has shown that pressure alone caused by silicone oil is insufficient to cause significant neuronal damage or loss.

Familial Lafora body disease of late onset: report of four cases in one family and a review of the literature

Lafora body disease is one cause of progressive myoclonus epilepsy. It typically presents in the second decade with generalized seizures, myoclonus and then intellectual decline. Death is usual within 10 years. Diagnosis may be made by biopsy of skin, muscle, liver or brain. We present four siblings who were normal until their mid-twenties, but then developed intellectual decline, followed by myoclonus. Although a rare form of Lafora body disease has been described that follows a more benign course, may be of later onset, and whose pathology is subtly different, this family is so far unique in terms of the late presentation of otherwise typical Lafora body disease.

Craniopharyngioma extended into the posterior fossa

A 7-year-old girl with a craniopharyngioma with a rare extension into the posterior fossa is presented. MRI revealed a solid calcified mass in the sellar and suprasellar region with a cyst expanded to the posterior fossa up to the foramen magnum and causing hydrocephalus and brainstem displacement. The tumor was removed totally with right pterional approach.

Intramedullary tuberculous abscess: a case report

STUDY DESIGN

This case report shows an intramedullary thoracic spinal cord abscess secondary to Mycobacterium tuberculosis in a 7-year-old boy with chronic progressive paraparesis and hypesthesia below T10.

OBJECTIVES

The treatment of this patient involved drainage of pus followed by appropriate chemotherapy.

SUMMARY OF BACKGROUND DATA

Abscess and tuberculomas of the spinal cord are rare entities. They are indistinguishable from neoplasms. The possibility of tubercular abscess or granuloma should be kept in mind when an intraspinal mass is found, provided that the clinical history is unusual for tumor.

METHODS

A left T7-T8 hemilaminectomy was performed. A quantity of pus was drained through a small myelotomy. A small specimen was taken, and antituberculosis treatment was given after surgery.

RESULTS

Excellent clinical outcome was obtained with a combination of medical and surgical management.

CONCLUSION

The treatment of intramedullary abscess consists of surgical evacuation of the pus. Appropriate treatment offers a favorable prognosis even in cases with severe deficits.

A new aneurysm wrapping material: polyglactin 910 + fibrin sealant

Aneurysms experimentally induced by using the silver nitrate coagulation method in 10 Wistar Albino rats are wrapped with Polyglactin 910 and Fibrin Sealant. 6 weeks later the rats are sacrificed and compared with the control group. In the group in which Polyglactin 910 and Fibrin Sealant were used as the wrapping material, non-specific inflammatory granulation tissue development around the aneurysms is observed. We suggest that a Polyglactin 910 and Fibrin Sealant combination can be used as a wrapping material in the treatment of aneurysms where clipping is not possible.

Cytologic changes induced by 131I in the thyroid glands of patients with hyperthyroidism; results of fine needle aspiration cytology

Cytological changes in the thyroid glands of 120 patients who had received 131I treatment for hyperthyroidism were examined in detail. The cytological material was obtained by fine needle aspiration cytology. The patients were divided into four groups according to the amount of time elapsed after the 131I treatment. The control groups were selected from euthyroid patients with hypoactive or non-functional solitary nodules and patients with Graves' disease who had not received 131I therapy. The thyrocytes revealed degenerative changes in the immediate period after cessation of treatment. One year after the treatment some non-specific changes, such as oxyphilic metaplasia and regeneration, were seen. No malignant change has been observed clinically or cytologically during up to 20 years of follow up since receiving 131I.

Right atrial thrombus mimicking myxoma and bilateral pulmonary artery aneurysms in a patient with Behçet's disease--a case report

A case of Behçet's disease, in which superior vena cava syndrome was the presenting feature is reported. Magnetic resonance imaging and echocardiography revealed a mass lesion in the right atrium. This patient developed bilateral pulmonary artery aneurysms postoperatively and represents one of the bizarre manifestations of Behçet's disease.

The role of lipid peroxidation and calcium in galactosamine induced toxicity in the rat liver

Liver homogenate and subcellular fractional levels of lipid peroxides, homogenate glutathione (GSH) and calcium contents and hepatic plasma membrane Ca(2+)-ATPase activity were determined in rats, 12, 18, 24 and 48 hours after treatment with a single dose of 1 g/kg galactosamine. Lipid peroxides and calcium levels in liver homogenate and subcellular fractions were found to increase, but hepatic GSH content and Ca(2+)-ATPase activity were observed to decrease reversibly.

Silver binding nucleolar organizer regions in adrenocortical neoplasia

The possible contribution of the silver colloid technique for staining nucleolar organizer regions in the distinction between benign and malignant adrenocortical neoplasms was investigated. Nine cases of adenoma, eight cases of carcinoma, nine cases of hyperplasia and four normal adrenal cortex specimens were examined. The mean silver binding nucleolar organizer region (Ag-NOR) value in adenoma was 4.29, and in carcinoma 7.16 (P less than 0.001). Adenomas with diameters greater than 3 cm had significantly higher Ag-NOR counts than smaller adenomas. For normal cortex, the mean Ag-NOR value was 2.05 and in hyperplasia, 3.62. The results indicate that the Ag-NOR technique can help in differential diagnosis between benign and malignant adrenocortical lesions and thus may have a prognostic value.

Alterations in some lipid components and Ca2+ ATPase activity in brain of rats fed an atherogenic diet

Male Wistar rats were fed an atherogenic diet for four months to investigate possible diet-induced lipid alterations and brain Ca2+ ATPase activity. Total cholesterol and triglyceride levels were found to be increased significantly in both serum and brain while the phospholipid level was decreased in both. The distribution of serum cholesterol between high-density and low-density lipoproteins was altered when compared to control rats with a decrement in HDL-cholesterol and a pronounced increment in LDL-cholesterol. The atherogenic diet resulted in about 50% depression in brain Ca2+ ATPase activity. It is concluded that alterations in ion transport and neurotransmitter release may be expected due to pronounced inhibition of brain Ca2+ ATPase activity in rats fed an atherogenic diet.