Interesting case: Endosteal formation of new bone around a Kirschner wire in long term follow up of a patient with mandibular Ewing sarcoma.
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Bone Wires↗
Biomedical subjects
E Ozer
Publications and source records attributed to E Ozer.
Tumour vascularity is of prognostic significance in adult, but not paediatric astrocytomas.
Astrocytomas are the commonest type of brain tumours in adults and children. Although the most reliable prognostic indicators have been shown consistently to be patient age and tumour histological grade, biological progression in these tumours is inevitable and the overall prognosis has remained poor. Due to the evidence that vascular changes are important histological features of astrocytomas, the aim of this study was to investigate prognostic significance of tumour vascularity in paediatric and adult astrocytomas. Study population consisted of 70 patients (45 adult and 25 children) with histologically proven diagnosis of astrocytoma with no history of previous therapy. Histological quantification of tumour vascularity was performed using three different methods: microvessel density, vascular grading and Chalkley counting. Histological classification and grading were also assessed using the World Health Organization system. In contrast to the results in paediatric astrocytomas, tumour vascularity in adult tumours correlated significantly with postoperative survival by univariate analysis (P < 0.05). Microvessel density appeared to be an independent indicator of prognosis by multivariate analysis (P = 0.001). Likewise, patients with microvessel density of 70 or greater had significantly shorter survival than the remaining group (P < 0.001). Patient age and tumour histological grade were also correlated with survival. We conclude that histological quantification of tumour vascularity is a significant prognosticator in adult astrocytomas, but not in children. Our data do not support the validity of applications of antiangiogenic agents in paediatric astrocytic tumours, particularly pilocytic astrocytomas.
Adolescent↗
Inhibition of vascular endothelial growth factor-induced retinal neovascularization by retinoic acid in experimental retinopathy of prematurity.
Vascular endothelial growth factor (VEGF) has an important role in the pathogenesis of retinopathy of prematurity (ROP) and inhibition of VEGF expression in the neovascular phase might prevent destructive neovascularization in ROP. It is suggested that retinoids exert a highly potent antiangiogenic activity by inhibiting VEGF expression. The aim of this study was to demonstrate the preventive effect of retinoic acid (RA) on the VEGF-induced retinal neovascularization in a rat model of ROP. Wistar albino rats were placed into incubators at birth and exposed to an atmosphere alternating between 50 % and 10 % O(2) every 24 hours. After 14 days, the animals were removed to room air and received either an intraperitoneal injection of RA (5 mg/kg/day) (n=9) or saline (n=4) daily for six days, and sacrificed at 21 days. Other rats (n=4) were raised in room air and served as age-matched controls. The globe of each eye was cut through the cornea and embedded in paraffin. Serial sections were stained with hematoxylin-eosin for quantification of neovascular nuclei. The avidin-biotin peroxidase method was performed for evaluation of VEGF expression. The average number of neovascular nuclei was significantly lower in the control group compared to that in the ROP groups. In addition, it significantly decreased in the RA-treated ROP group compared to that of the saline-administrated ROP group. VEGF immunostaining was overall negative in room air-exposed rats. The VEGF immunostaining score significantly decreased in the RA-treated ROP group compared to that in the saline-administered ROP group. RA treatment might be beneficial in preventing neovascularization resulting from oxygen-induced retinopathy by downregulation of VEGF expression.
Animals↗
Erythropoietin attenuates lipopolysaccharide-induced splenic and thymic apoptosis in rats.
Apoptosis of lymphoid tissues during sepsis is well documented and linked to the pathobiology of organ failure and death. In this study, we evaluated the effect of a single dose of recombinant erythropoietin (EPO) on thymic and splenic apoptosis in an endotoxic sepsis model. Young male Wistar rats were divided into 3 groups and administered intraperitoneally (IP) either normal saline; lipopolysaccharide (LPS) 10 mg/kg; or EPO (5000 U/kg) 30 min before lipopolysaccharide. Six hours following LPS administration animals were sacrificed. Apoptosis was assessed by hematoxylin-eosin staining, terminal deoxynucleotide transferase-mediated fluorescein-dUTP nick end labeling (TUNEL), and caspase-3 immunostaining. When compared with animals given LPS, animals pretreated with EPO displayed reduced splenic and thymic TUNEL positivity of 44+/-3 (p<0.05) and 143+/-4 (p<0.05) nuclei per high power field (hpf), respectively. Caspase-3 positivity was also significantly reduced in the spleen and thymus, with 31+/-4 (p<0.05) and 93+/-3 (p<0.05) positive stained nuclei per hpf, respectively. Serum nitrite levels were elevated in animals given lipopolysaccharide. Pretreatment with EPO attenuated the increase in nitrite levels; however, this did not reach statistical significance. We conclude that a single dose of recombinant erythropoietin can reduce thymic and splenic apoptosis associated with lipopolysaccharide administration.
Animals↗
Microbiology of sinusitis and the predictive value of throat culture for the aetiology of sinusitis.
A prospective study of throat cultures and maxillary sinus aspirates from children with chronic sinusitis (n = 21), acute sinusitis (n = 28) or a clinical diagnosis of chronic adenoiditis (n = 41) was performed. Seventy-two bacterial pathogens were isolated from sinus aspirates from 52% of the study population. Haemophilus influenzae was most common pathogen, followed by Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and group A streptococci. Quantitative throat cultures had positive predictive values of 41%, 53% and 75% for H. influenzae, Strep. pneumoniae and M. catarrhalis, respectively, while negative predictive values were 93-98%, indicating that these three pathogens do not cause sinusitis when absent from the throat.
Adenoids↗
Relation between actinomycosis and histopathological and clinical features of the palatine tonsils: a comparative study between adult and pediatric patients.
OBJECTIVE: To find out the incidence of actinomyces in the palatine tonsil of the adult and pediatric patients, and evaluate our results relevant to the clinical diagnoses and histopathological features of tonsillectomy specimens. METHODS: The medical records of 1820 tonsillectomies, which were performed in the Department of Otolaryngology between 1987 and 2002 were retrospectively reviewed. The paraffin embedded specimens of the patients were also obtained for histopathologic assessment, and Hematoxylin-Eosin stained sections re-evaluated mainly for cryptitis and actinomycosis. RESULTS: There was actinomyces in 122 (6.7%) of 1820 patients, of whom 62 were adult and 60 were pediatric patients. That is, actinomyces was present in 62 (10.9%) of 568 adult patients, and 60 (4.8%) of 1252 pediatric patients. The rate of actinomyces was significantly higher in adults than children (p < 0.01). There was no correlation between the clinical diagnoses and the histopathologic parameters assessed (p > 0.05). On histopathology, the cryptitis was encountered in 53 (85%) of 62 adult patients and 47 (78%) of 60 pediatric patients with actinomyces (p > 0.05). The rate of cryptitis was significantly higher in the presence of actinomyces both in adult and pediatric patients (p < 0.05). CONCLUSION: There was no correlation between the clinical diagnosis of tonsillar disease and the presence of actinomycosis both in adult and pediatric patients. Histopathologic findings of adult and pediatric tonsillectomy material was similar except for the higher rate of actinomycosis in the adults than in children. However, cryptitis was a substantial finding in the presence of actinomycosis. Based on the significant association of cryptitis with actinomycosis, cyptitis can be considered a histopathologic indicator for tonsillar actinomycosis.
Actinomycosis↗
Demonstrated rapid growth of a corpus callosum cavernous angioma within a short period of time.
Cavernous angiomas are uncommon central nervous system vascular malformations. They occur in the corpus callosum very rarely. In this study we report a case of corpus callosum cavernous angioma which demonstrated rapid growth within a short period of time. Corpus callosum cavernous angiomas have distinct features regarding growth and should be treated more carefully by giving more importance to surgical removal rather than a conservative approach.
Brain Neoplasms↗
Gemcitabine-induced vasculitis in advanced transitional cell carcinoma of the bladder.
BACKGROUND: Gemcitabine (GEM) is an alternative chemotherapeutic agent for patients with metastatic bladder cancer. It is believed to be a well-balanced agent, having acceptable toxicity and enhanced antitumor activity. The integration of GEM into the initial chemotherapy plan for these patients is still being developed. CASE REPORT: The patient, male, aged 56 years, was suffering from a transitional cell carcinoma of the bladder. Due to frequent local superficial recurrences, radical cystectomy with pelvic lymphadenectomy and continent ileal diversion was performed. Four years after the operation a left inguinal lymphadenopathy was noted and metastatic bladder carcinoma was confirmed on biopsy. Cytotoxic therapy combining GEM and cisplatin and local external irradiation therapy was initiated. The patient developed extensive necrotising vasculitis with muscle damage after the second course of therapy. Chemotherapy was stopped immediately but this was not enough to relieve the symptoms of severe myalgia and swelling, and additional treatment consisting of cyclophosphamide and prednisolone was initiated. CONCLUSION: Although GEM seems to be relatively safe, some unexpected complications may occur during treatment. This case is not common, but it reinforces the need for careful attention to any new symptoms that seem to be unassociated with the primary disease. Prompt evaluation of such symptoms should be carried out in patients receiving GEM therapy.
Antimetabolites, Antineoplastic↗
Induced hypotension for tympanoplasty: a comparison of desflurane, isoflurane and sevoflurane.
BACKGROUND AND OBJECTIVES: This prospective, randomized, double-blinded study was designed to compare the effects of desflurane, isoflurane and sevoflurane when combined with remifentanil for induced hypotension on surgical conditions and operative field during tympanoplasty. METHODS: Sixty patients undergoing tympanoplasty were enrolled in the study. The patients were randomized into three groups of 20 each to receive the inhalation anaesthetics desflurane, isoflurane or sevoflurane. Propofol 2 mg kg(-1) was administered for induction of anaesthesia in all groups. All patients received a continuous infusion of remifentanil which was titrated between 0.2 and 0.5 microg kg(-1) min(-1) to achieve a mean blood pressure (BP) of 60-70 mmHg. Nitroglycerine was infused if this BP could not be achieved. Arterial pressures were recorded continuously throughout the operation. Surgical conditions were assessed every 20 min by the blinded surgeon using a six-point category scale (0-5). RESULTS: One patient in the desflurane group and two patients in isoflurane group required nitroglycerine to maintain desired mean BP. Sustained controlled hypotension was sufficient in all of the groups throughout surgery. Category scale scores were < or =3 throughout the study, except one patient in the sevoflurane group who had a score of 4 at the 60th minute of the operation. No difference was found among groups when haemodynamic parameters and surgical category scale scores were compared. There were no postoperative respiratory and circulatory complications. CONCLUSION: Desflurane, sevoflurane or isoflurane combined with remifentanil provided adequate induced hypotension and similar operating conditions and any of them could be safely and equally used in anaesthesia for tympanoplasty.
Adolescent↗
Testis fixation in prepubertal rats: fibrin glue versus transparenchymal sutures reduces testicular damage.
Experimental studies have shown that different suture materials used in testis fixation cause some degree of inflammation in the testis. This study was planned to compare the histological changes that were caused by fibrin glue which is a tissue sealant and by silk and polypropylene for transparenchymal testis fixation. 28 prepubertal rats were divided into 4 groups. Testis was fixed to the tunica vaginalis by fibrin glue in group 1, by silk in group 2 and by polypropylene in group 3. Group 4 was planned as a control. Testicular inflammation and seminiferous tubular diameter were evaluated for histological changes. The least inflammation was observed in the fibrin glue group, while the most inflammation occurred in the silk group. Seminiferous tubular diameter was 241.55 +/- 45.90 in the fibrin glue group, 151.90 +/- 8.34 in the silk group and 161.36 +/- 9.96 in the polypropylene group. In conclusion, fibrin glue, when used for testis fixation, causes less inflammation and less destruction of seminiferous tubular diameter compared with silk and polypropylene.
Animals↗
Neurotological status in Behçet's disease and its ophthalmological correlates.
OBJECTIVE: To assess neurotological status and its ophthalmological correlates in Behçet's disease. STUDY DESIGN: A cross sectional study in which 17 patients with Behçet's disease and 13 healthy controls were included. PATIENTS AND METHODS: The patients were divided into two groups: those with and without end stage ocular involvement. Neurotological status was evaluated with audiological tests (pure tone and speech audiometry, tympanometry, short increment sensitivity index, tone decay, and evoked response audiometry), and Dix-Halpike positional testing. RESULTS: The positional test was normal. The audiological test results of the patients with and without end stage ocular involvement were not significantly different (p>0.05). A sloping audiogram with bilateral symmetric and mild sensorineural hearing loss was the main audiogram obtained. There was no relationship between the presence or absence of the end stage ocular involvement and the otological parameters studied excluding I-III interval on evoked response audiometry (p>0.05). CONCLUSION: Although the main underlying pathogenetic factor in Behçet's disease is the autoimmune vasculitis, the mechanisms involved in the pathogenesis of neurological and ocular damage may be different. Alternatively, the differential involvement of certain organ systems may not reflect the nature of the disease process itself, but rather the manner in which each organ responds to injury.
Adult↗
Assessment of mastoid air cell size versus sigmoid sinus variables with a tomography-assisted digital image processing program and morphometry.
We assessed the mastoid air cell size and variables of the sigmoid sinus in healthy ears and ears with chronic otitis media (COM). Thirty-eight patients with unilateral COM [15 with cholesteatoma (COM/+) and 23 without cholesteatoma (COM/-)], and 20 subjects with healthy ears, were included in the study. Assessment was performed using a quantitative digital image processing computed tomography (CT) program, and the volume of the mastoid bone was measured using the morphometric method of Cavalieri. In both COM/+ and COM/- patients the sigmoid to suprameatal spine distance and mastoid size were greater on the healthy side than on the diseased side ( p<0.05). The distance and area were significantly greater in the healthy control subjects than in either the healthy or the diseased ears of the patients with COM ( p<0.05). In the healthy ears of COM patients, there was significant correlation between the sigmoid to suprameatal spine distance and air cell size and mastoid volume ( p<0.05). In the diseased ears of COM patients, this correlation was absent ( p>0.05). The sigmoid sinus shape was of the half-moon type (62%), protrusive type (22%) and saucer type (16%). The digital image processing CT program allowed us to estimate the individual area of the air and soft tissue filled mastoid air cells. The mastoid size in both intact and disease ears of COM patients was smaller than in the healthy controls. The mastoid size may be determined genetically. However, environmental factors such as infection may also affect the mastoid size. Therefore, both genetic and environmental factors may be related to COM as far as the size of the mastoid air cells is concerned.
Adult↗
Körner's septum (petrosquamosal lamina) and chronic ear disease.
To assess the clinical significance of Körner's septum (KS) or petrosquamosal (PS) lamina in different chronic ear pathologies, a surgical and anatomic study was carried out, in which the significance of KS was assessed in various otologic diseases. Of 639 patients who underwent ear surgery between 1998 and 2001, 426 were included in the study. The diagnoses were chronic otitis media without cholesteatoma (COM), tympanosclerosis (TS), adhesive otitis media (AOM) and cholesteatoma (COL) in 160, 100, 70 and 96 patients respectively. The operative records of the patients were reviewed for the presence of KS. There was antral blockage by KS in all patients who also had Cog (the middle portion of the PS lamina). KS was mostly seen in cases of TS. The prevalence of KS was not significantly different when the result of the COM group was compared with that of the COL and AOM groups ( p>0.05). The prevalence of KS was significantly higher in patients with TS than in those with COM. Both antral and epitympanic blockages were more prevalent in cases of TS than in those of COM (chi(2) =3.9, p =0.04 and chi(2) =6.6, p =0.01 respectively). There is a significant association between the presence of KS and TS. Based on this finding, it is recommended that a mastoidectomy be performed in cases of severe tympanosclerosis in order to remove KS. How the removal of this anatomic impact will affect the natural course of the disease is still a question that needs further investigation.
Adolescent↗
Cyclosporine A toxicity in association with reduced renal mass.
The long-term effect of cyclosporine A (CsA) in male Wistar rats with reduced renal mass was studied. The aim of the study was to highlight the relationship of CsA effect on rats, simulating patients with two functioning kidneys (eg, heart, liver transplant recipients) and one kidney (renal transplant recipients). The Wistar rats were subjected to unilateral nephrectomy (Unx, n = 14) and to 5/6 nephrectomy (STnx, n = 14). Half of these rats and half of the sham operated ones (control, n = 13) were administered CsA (10 mg/kg/d) for 28 days IP. The serum creatinine (S(CR)), total protein (S(P)), and urine protein (U(P)) values as well as the whole blood CsA levels were determined on the 28th day of the study. The remnant kidneys were evaluated by image analyses and semiquantitative methods after sacrifice on the 28th day. In the three non-CsA-treated groups (Unx, STnx, and control) S(CR) was significantly higher in STnx rats than in Unx rats (P =.011). Percent of renal scarring (PRS) was significantly higher in Unx (P =.02) and in STnx rats (P =.017), compared with the control group. Among CsA-treated three groups S(CR) was significantly higher in STnx rats compared with Unx (P =.017). In addition, segmental sclerosis rate (SSR) was higher in STnx rats, compared with the control group (P =.008), whereas S(P) was higher in the control group (P =.005). When CsA-treated groups were compared with non-CsA-treated ones, U(P) of the Unx rats not receiving CsA were significantly higher than the Unx rats receiving CsA (P =.026). Also, U(P) was higher in non-CsA-treated groups (P =.014), whereas S(CR) (P =.001), S(P) (P =.001), and PRS (P =.001) were higher in CsA-treated rats. In conclusion, we suggest that preserved renal mass is not enough to prevent CsA toxicity and that CsA should be administered to patients with both kidneys (eg, heart, pancreas recipients) as carefully as to patients with one functioning kidney (renal transplant recipients).
Animals↗
Influence of total intravenous and inhalational anaesthesia on haemostasis during tympanoplasty.
BACKGROUND: Surgical trauma leads to systemic changes in haemostasis. Haematological changes activated by surgery may become so prominent that changes caused by anaesthesia might be hidden or underestimated. Therefore, we have undertaken a prospective study to compare the behaviour of selected factors involved in the coagulation and fibrinolytic systems. METHODS: Forty healthy adult patients scheduled for otological surgery were enrolled in the study. Upon receiving informed consent, they were randomly assigned to receive either inhalational (IA) or total intravenous anaesthesia (TIVA). Platelet function (PFA100TM), disseminated intravascular coagulopathy (DIC) panel, and generalized d-dimer (GFC) were studied during certain periods of anaesthesia to identify the changes in haemostasis. RESULTS: Statistically, no significant change in DIC parameters were encountered between the two groups. No statistical difference was found between the two groups in the measured coagulation parameters, but statistically GFC showed slight activation in the 1st hour of surgical intervention. CONCLUSION: Presuming a minimal traumatic effect of surgical procedure on the determined variables, we conclude that different anaesthetic techniques have a negligible effect on platelet activation and fibrinolysis. The clinical relevance of coagulation activation and fibrinolysis during different anaesthetic techniques remains to be investigated.
Adult↗
Does sucralfate prevent apoptosis occurring in the ischemia/reperfusion-induced intestinal injury?
BACKGROUND/PURPOSE: We have shown in a previous study that sucralfate is beneficial in the prophylaxis and treatment of hypoxia/reoxygenation-induced intestinal injury. The aim of this study is to investigate whether sucralfate has any effect on the prevention of apoptosis in the ischemia/reperfusion (I/R)-induced intestinal injury. METHODS: Rats were randomized into three groups. Group 1 and 2 were subjected to I/R. Group 1 (treatment group) received sucralfate while group 2 (treatment control group) did not. Group 3 served as a normal control group (sham group). The terminal ileum was harvested for histopathologic investigation by light microscopy. The presence of apoptotic enterocytes (DNA fragmentation in cell nuclei) was detected by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick-end-labeling (TUNEL) reaction. RESULTS: In treatment control group, 3 of 7 rats had severe inflammation. None of the sucralfate-treated rats showed severe inflammation, 6 of them only showed mild inflammatory changes (p < 0.05). The apoptotic percentage was found to be 37.1 +/- 9.4 in the sucralfate-treated group (group 1), whereas it was 45.4 +/- 3.9 in the untreated group (group 2) (p < 0.05). The sham group had a completely normal intestinal architecture. CONCLUSIONS: The present study shows that 1) the experimental model of I/R-induced intestinal injury induces enterocyte apoptosis; 2) sucralfate decreases enterocyte apoptosis in the experimental model of I/R-induced intestinal injury which may play a key role in the pathophysiological events leading to failure of the intrinsic gut barrier defense mechanisms.
Animals↗
Changes of Ki-67 index in squamous cell carcinoma of the cervix during the early course of radiotherapy and prediction of prognosis.
PURPOSE: To determine whether changes in the Ki-67 index during the early course of radiotherapy could predict the prognosis in squamous cell carcinoma of the uterine cervix and be of value in clinical practice. MATERIALS AND METHODS: Biopsy specimens from 23 cases of histologically confirmed squamous cell carcinoma of the cervix were stained with anti-Ki-67 monoclonal antibody prior to radiotherapy and after 9 Gy. The correlation between the Ki-67 index, local control and distant metastasis was determined by Spearman's correlation test. RESULTS: Median age of the patients was 49. According to the FIGO staging system four patients had Stage IIA, 16 had Stage IIB, one had Stage IIIA and two had Stage IIIB disease. Among the whole group brachytherapy was applied to 17 patients (17/23) and weekly cisplatin (40 mg/m2) was applied to 15 patients (15/23). The mean Ki-67 index prior to radiotherapy and after 9 Gy for the entire group were 58.5% and 46.0%, respectively. The Ki-67 index after 9 Gy decreased in most of the patients (74%). During a median follow-up of 23 months four patients developed local recurrence and four patients developed distant metastasis. No significant correlation was detected among the local control and changes in Ki-67 index after 9 Gy, whereas there was a moderate correlation between distant metastasis and changes in Ki-67 index after 9 Gy (r = 0.51, p = 0.01). CONCLUSION: The Ki-67 index can be used safely as a proliferation marker in cervical carcinomas, and changes in the Ki-67 index during the early course of radiotherapy may predict the metastatic potential. However prospective studies including a large number of patients with long-term follow-up are necessary to confirm the clinical utility of this marker in cervical cancer.
Adult↗
Prognostic significance of nuclear morphometry in renal cell carcinoma.
OBJECTIVE: To assess nuclear morphometry as a predictor of prognosis in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: The study included 65 consecutive patients with RCC who underwent radical nephrectomy and were followed up for a median (range) of 80 (27-138) months. Nuclear morphometry was assessed using a computer-assisted image analysis system on histological sections and characterized by five nuclear variables (area, perimeter, major and minor diameter, and form factor). From the patients' records and pathology specimens, the clinicopathological prognostic variables (histological type, Fuhrman grade and pathological stage) were recorded. The proliferative activity was assessed using immunohistochemical staining with Ki-67 antibody. RESULTS: Higher values of mean nuclear area, perimeter, and major and minor diameter were significantly related to higher nuclear grade, proliferative activity and advanced tumour stage. They were significant predictors of disease progression and survival, together with grade, stage, sarcomatoid histology and proliferative activity. Of all significant prognostic factors predicting progression-free survival, only stage was independent (T4 vs T1, hazard ratio 6.55, 95% CI 1.63-26.13, P=0.008). CONCLUSION: Although the significance of these preliminary results must not be overstated, nuclear morphometry might provide significant prognostic information in predicting survival and tumours at high risk of progression in RCC.
Adult↗