Canan Altunkaya

Fine-Needle Aspiration of Follicular Patterned Lesions of the Thyroid: Diagnosis, Management, and Follow-Up according to Thyroid Bethesda System

Objective: The goal of this study was to report an experience with thyroid fine-needle aspiration (FNA) cases that can be placed into National Cancer Institute-designated thyroid FNA diagnostic categories for follicular patterned lesions divided into three diagnostic categories: follicular lesion of undetermined significance/atypia of undetermined significance (AUS/FLUS), suspicious for follicular neoplasm (SFON), and suspicious for malignancy. Study Design: The study cohort included 4,284 cases for the period between January 2007 and July 2011 and all available follow-up data was obtained. All cases classified as ‘atypical’ and ‘rule out follicular neoplasm’ were included in the AUS/FLUS category (n = 3,903), whereas cases classified as ‘suspicious for’ or ‘consistent with follicular or Hürthle cell neoplasm’ (n = 381) were included in the SFON diagnostic category and compared with histopathologic follow-up. Results: During this period, 14,628 thyroid FNAs were reported in 12,238 patients. Repeat FNA (RFNA) was performed in 1,366/3,903 (35%) patients classified as AUS/FLUS. Histologic outcome data was available in 1,756/3,903 (45%) cases diagnosed as AUS/FLUS and 243/381 (64%) cases diagnosed as SFON. The rate of malignancy in AUS/FLUS cases with and without RFNA was 29 and 14% respectively, and it was 26% in SFON cases. Conclusion: The current data shows that the malignancy rates differ between categories and AUS/FLUS cases are best managed by RFNA for selection of cases that can benefit from surgical excision.

The effects of scalpel, harmonic scalpel and monopolar electrocautery on the healing of colonic anastomosis after colonic resection

Purpose In our study, the effects of harmonic scalpel, scalpel, and monopolar electrocautery usage on the health and healing of colon anastomosis after resection was investigated. Methods In this study, 120 female albino Wistar rats were divided into 3 groups each containing 40 rats. Group A, resection with scalpel; group B, resection with monopolar electrocautery; group C, resection with harmonic scalpel. The groups were divided into 4 subgroups consisting of 10 rats and analysed in the postoperative 1st, 3rd, 5th, and 7th days. Anastomotic bursting pressures, hydroxyproline levels and histopathological parameters were surrogate parameters for evaluating wound healing. Results The tissue hydroxyproline levels did not show any significant difference between the groups and subgroups. The mean bursting pressure of group A on the 5th day was significantly higher than groups B and C (P < 0.001). When the fibroblast and fibrosis scores were evaluated, scores of group C on the 5th day were significantly higher than the other groups, but the results of bursting pressures and biochemical parameters did not support the fibroblast and fibrosis scores. There were not any significant differences between the groups in other histopathologic parameters. Conclusion The use of monopolar electrocautery needs more attention since the device causes tissue destruction. The obliterating effect of harmonic scalpel on luminal organs is an important problem, especially if an anastomosis is planned. Despite the disadvantages of scalpel, its efficacy on early wound healing is better than the other devices.

Effectiveness of thymoquinone, zeolite, and platelet-rich plasma in model of corrosive oesophagitis induced in rats

Purpose The effectiveness of platelet-rich plasma (PRP), thymoquinone, and zeolite in corrosive esophageal burns was investigated in a rat model. Methods Four groups were comprised as containing 10 rats in each group. For group I, oesophagitis was induced and no other procedure was performed (control group). For group II, oesophagitis was induced and thymoquinone was administered for 1 week via oral gavage once a day (thymoquinone group). For group III, oesophagitis was induced for 1 week via oral gavage once a day (PRP group). For group IV, oesophagitis was induced and zeolite was administered for 1 week via oral gavage once a day (zeolite group). On the 10th day, the rats were sacrificed under anaesthesia and venous blood sampling was performed from the vena portae. The oesophaguses were totally excised. Biochemically, interleukin (IL)-1B, IL-6, TNF-α, and MCP-1 were examined from venous blood. Inflammation score was evaluated histopathologically in oesophageal tissue that was collected. Results There was a statistically significant difference among groups in terms of IL-1, IL-6, MCP levels, compared to the control group; median IL-1, IL-6, MCP levels of thymoquinone, PRP, and zeolite groups were statistically significantly lower. There was a statistically significant difference among groups in terms of inflammation scores, compared to group I; median inflammation scores of groups II, III and IV were statistically significantly lower thymoquinone. Conclusion PRP, and zeolite exhibited positive effect on recovery in oesophagitis by reducing inflammation in the involved segment.

The effect of mesenchymal stem cell use on intra-abdominal adhesions in a rat model

Purpose Intra-abdominal adhesions (IAA) are among the most frequently seen pathologies in general surgery practice with an increased morbidity and mortality. In the present study, we investigated the effect of locally applied mesenchymal stem cells (MSCs) on IAA. Methods Twenty-four Wistar Albino rats were used in the study. The rats were divided into three groups including: Sham, control, and MSCs group. On day 0, cecum was reached under anesthesia in all groups, except the Sham group. Scraping with a sponge was performed until petechial bleeding occurred. The control group received no treatment. In the stem cell group, MSCs were applied topically immediately after surgery on adhesions. The rats were sacrificed on day 10 and colon tissues and blood samples were collected for macroscopic, histopathological, and biochemical analysis. Results In our study, E-selectin, P-selectin, TNF-α and IL-1 levels were statistically significantly lower in the MSC group than the control group, while the sham group has the lowest levels. In both the macroscopic and histopathological analyses (Zühlkes scale), the least amount of adhesion was observed in the Sham group. In addition, although there was less adhesion in the MSC group than the control group, the difference did not reach statistical significance. Conclusion Topical MSC application immediately after surgery suppresses the inflammatory process. However it was found to be ineffective in histopathological and macroscopic examinations performed on the 10th day.

An Unusual Cause of Unilateral Hydronephrosis: Invasive Colonic Amebiasis

A 62-year-old man was admitted to our hospital with complaints of abdominal pain and rectal bleeding. Although the colonoscopic examination was highly suggestive of a carcinoma, the histopathological examinations were consistent with chronic inflammation. CT examination revealed a solid lesion from cecum to the ascending colon with right urethral invasion. Percutaneous right nephrostomy was performed for grade 2–3 hydronephrosis. Three days after hospitalization, ileus developed and right hemicolectomy was performed. During surgery we observed that the lesion had invaded the middle part of ureter. So the middle part of ureter was removed with side-to-side urethral anastomosis and 6F double-J catheter was placed. The histopathological findings of resected specimen were consistent with ameboma. Reviewing the literature unilateral hydronephrosis due to colonic amebiasis has not been reported.

Platelet-Rich Plasma May Offer a New Hope in Suppressed Wound Healing When Compared to Mesenchymal Stem Cells

Background: The present study investigated the effectiveness of platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) in wound healing suppressed by corticosteroid in rats. Methods: Forty rats were separated into four groups. To disrupt the wound-healing processes, intraperitoneal single dose 10 mg/kg methylprednisolone was administered to all rats with the exception of Sham-S group. Then, full-thickness incision was performed to the abdominal skin of all animals, and PRP or MSCs were applied to the incision line except the Sham-S and Sham-M group animals. Ten days later, all animals were sacrificed to investigate: tissue collagenization, inflammation, and re-epithelialization grades histopathologically; and tissue hydroxyproline (HP), interleukin-1β (IL-1β), tumor necrosis factor-α levels biochemically. Results: Collagenization (p = 0.003) and inflammation grade (p = 0.002) values were higher in PR group. Tissue HP level value was found to be high in MC group (p < 0.001). Tissue IL-1β level value of Sham-M group was lower than those of other groups (p < 0.001). Conclusions: This preliminary study revealed that PRP could improve the histopathological grades in wound healing which was suppressed by corticosteroid in rats, while MSCs could show their therapeutic effects via biochemical route. These positive effects were more salient in PR group.

ERRATUM: Correction of funding statement in ACKNOWLEDGEMENTS section. Effectiveness of thymoquinone, zeolite, and platelet-rich plasma in model of corrosive oesophagitis induced in rats

[This corrects the article on p. 396 in vol. 92, PMID: 28580343.].

Skin punch biopsy sectioning: before or after tissue processing?

We intended to study whether there is a meaningful difference in microscopic examination between dividing a biopsy section into two equal parts before tissue processing (first method) or after (second method).

Comparison of Conjunctival Cytological Alterations following Conventional and Sutureless Sclerotomies.

Purpose: To assess the alterations in conjunctival impression cytology following 23-gauge transconjunctival sutureless versus conventional pars plana vitrectomy. Patients and Methods: Sixty consecutive patients were enrolled in the study. Conjunctival impression cytology was performed on 30 eyes (of 30 subjects) with 23-gauge transconjunctival sutureless vitrectomy and on 30 eyes (of 30 subjects) with conventional vitrectomy. Conjunctival impression cytology was performed preoperatively on the 1st day and in the 3rd month after the surgery. Impression cytology specimens of each group were graded and scored using a range of 0-3 according to Nelsons method. Results: In the conventional pars plana vitrectomy group, statistically significant alterations in the conjunctival impression cytology were detected on the 1st postoperative day (p = 0.001) and in the 3rd postoperative month (p = 0.001), whereas in the 23-gauge transconjunctival sutureless pars plana vitrectomy group, statistically significant changes were observed on the 1st postoperative day. However, no significant changes were observed in the following 3 postoperative months (p = 0.08). Conclusion: The properties of impression cytology were altered in the early postoperative period after sutureless and conventional vitrectomy. These changes were improved in the sutureless vitrectomy group only. Sutureless vitrectomy also had an advantageous effect on the conjunctival cytological changes and conjunctival structure.

Acute appendicitis and cecal diverticulitis in a young woman

Dear Editor, Although most people with diverticular disease of the colon remain asymptomatic, about 10–25% of those patients will ultimately progress to diverticulitis, and of these 15% will develop significant complications. Sigmoid colon is the most frequently involved part of colon and isolated cecal diverticula occurs very rarely. The aetiology of cecal diverticulitis remains unclear. Preoperative diagnosis might be so difficult, as symptoms and signs of cecal diverticulitis can mimic acute appendicitis. The reported frequency of cecal diverticulitis is about 1 in 300 appendectomies without appendicitis. Presence of both acute appendicitis and cecal diverticulitis in the same patient simultaneously has not been reported before. A 20-year-old woman was referred to our ED with pain in the right lower abdomen since the other day. Severity of pain was progressive and it was radiating from periumblical region to the right lower quadrant. She had also nausea and vomiting but not fever or change in bowel habits. Her past medical history was unremarkable. On physical examination, bowel sounds were normoactive. She had muscular defence at palpation on right lower quadrant. Laboratory tests including complete blood counts, renal and liver tests were all within the normal limits. Abdominal plain X-ray radiograph was unremarkable. Abdomen ultrasonography was also not diagnostic. With clinical suspicion of acute appendicitis, operative exploration of the abdomen was decided. At laparotomy, both appendicitis and cecal diverticulitis was diagnosed. She underwent diverticulectomy and appendectomy. Histological examination of the surgical specimens confirmed the diagnosis of acute appendicitis and cecal diverticulitis (Figs 1,2). She had no problems at the postoperative period and she was discharged at the third day of hospitalization. Ninemonth follow up was uneventful. Diverticulosis of colon is common in general population. It is estimated that half of the population older than age 50 years has colonic diverticula. Right-sided diverticula occur more often in younger patients than do left-sided diverticula, and are more common in people of Asian descent than in the other populations. The majority of colonic diverticula are false diverticula in which the mucosa and muscularis mucosa have herniated through the colonic wall. Solitary diverticulum of the cecum is thought to be congenital lesion arising as a saccular projection during the sixth week of embryonic development. Our case had true cecal diverticulum demonstrating its congenital origin (Fig. 1). As cecal diverticulitis presents with pain at right lower quadrant, it might interfere with acute