Esin Kotiloglu

Gastric histopathology, iron status and iron deficiency anemia in children with Helicobacter pylori infection

Objectives Helicobacter pylori has been established as a major cause of gastritis and peptic ulcer disease in adults and children. H. pylori infection may also have a role in the development of some extragastrointestinal diseases, including iron deficiency anemia. The aim of this study is to investigate H. pylori-related changes in gastric physiology and histology and the relationship of these changes to iron deficiency anemia in children. Methods Fifty-two patients with gastrointestinal complaints were studied. Hematologic parameters, 3-day vitamin C and iron consumption, serum gastrin levels, and gastric juice ascorbic acid levels were compared in patients with and without H. pylori infection. Dietary intake of vitamin C and iron, serum gastrin, gastric juice ascorbic acid content, and gastric histology were compared in patients with H. pylori infection and anemia and in patients with H pylori infection and no anemia. The CagA status of the H. pylori organisms was evaluated. Results Twenty-eight of 52 patients had H. pylori. Thirty-one patients had iron deficiency anemia. H. pylori infection was associated with low serum iron levels. H. pylori gastritis was associated with a decrease in the gastric juice ascorbic acid level. Infection with CagA-positive strains was associated with a greater decrease in gastric juice ascorbic acid than infection with CagA-negative strains. However, the gastric juice ascorbic acid levels of patients with H. pylori and anemia were not different from those of non-anemic patients with H. pylori. Among patients with H. pylori infection, pangastritis was twice as common in those with anemia than in those without anemia. Conclusions H. pylori infection was associated with a decrease in gastric juice ascorbic acid concentration, and this effect was more pronounced in patients with the CagA-positive strain. Pangastritis was more common in patients whose H. pylori. infection was accompanied by anemia.

Skin manifestations of rheumatoid arthritis: a study of 215 Turkish patients.

Objective  To investigate the frequency and clinicopathological features of skin involvement in rheumatoid arthritis (RA), to find out whether early and aggressive disease‐modifying treatment is changing the spectrum towards a milder disease pattern.

Diagnosis of liver cirrhosis in children based on colour doppler ultrasonography with histopathological correlation

Background. Changes in hepatic architecture in cirrhosis and chronic active hepatitis affect liver vascular haemodynamics. Objective. To determine the criteria for the diagnosis of liver cirrhosis using Doppler US. Materials and methods. Twenty-two children with liver disease of unknown histology were prospectively examined and compared with eight normal children. Doppler US of portal vein velocity, arterio-portal velocity ratio, loss of reverse flow component in the hepatic vein and hepatic artery visualisation were examined prior to liver biopsy. Doppler results were compared with histological activity indices. Twelve patients had cirrhosis and ten had chronic active hepatitis. Results. The most sensitive method (83 %) for the assessment of cirrhosis was portal vein velocity less than 20 cm/sec. Arterio-portal velocity ratio (greater than 3) and hepatic artery visualisation were less sensitive (75 % and 33 % respectively) but specificity was 100 % for all three methods. When these three methods were evaluated together, sensitivity increased to 91 % and accuracy to 96 %. Loss of reverse flow component was less specific (77 %) but was sensitive (75 %). Conclusions. Portal vein velocity, arterio-portal vein ratio and hepatic artery visualisation together were reliable in diagnosis of cirrhosis in the paediatric age group.

Kidney loss due to periureteral fibrosis and ureteral obstruction secondary to migration of subureterically injected calcium hydroxylapatite

Vesicoureteral reflux (VUR) is one of the significant urologic diseases of childhood and its endoscopic treatment is a viable option in terms of both simplicity and reduced morbidity. However, despite intensive research, no ideal injection material that yields the best long-term results with the least side effects has been introduced as yet. Synthetic calcium hydroxylapatite is one of the materials that has recently been under trial. Although favorable short-term success rates have been reported with the subureteric injection of calcium hydroxylapatite without any side effects, this case report shows its potential to migrate. To our knowledge, we present the first case where the migration of subureterically injected calcium hydroxylapatite resulted in periureteral fibrosis, ureteric obstruction and subsequent renal loss.

Primary cardiac angiosarcoma.

Primary malignant cardiac tumors are extremely rare neoplasms. About three‐quarters of all cardiac tumors are histologically benign. A 24‐year‐old man presented to the hospital with dyspnea and chest pain. A solid, dense, nonhomogeneous and rough‐surfaced mass (89 × 90 × 36 mm) with protrusion into the right heart cavities was observed on transthoracic echocardiography. The findings were confirmed by transesophageal echocardiography and magnetic resonance imaging. The histopathology of the mass confirmed a diagnosis of angiosarcoma. No evidence of an extracardiac origin of the tumor was found by radiological body imaging. The patient died 2 months after presentation to the hospital.

Mucoepidermoid carcinoma of the bronchus: A rare entity in childhood

Mucoepidermoid cancer (MEC) of the bronchus is composed of an admixture of mucus secreting, intermediate and squamous cell types. 2 Although the clinical features of the bronchial MEC are identical to those in adults, such as recurrent pneumonia, cough and/or hemoptysis, the diagnosis is often unsuspected in children because of the rarity of the condition. Here, we report a 13-year-old boy with MEC located at the left lower lobe orifice that presented with recurrent pneumonia.

AgNOR values are not helpful in the differential diagnosis of pituitary adenomas

Nucleolar organizer regions (NOR) are chromosomal segments in which ribosomal RNA is encoded. AgNOR technique, which reveals these regions, has rarely been used in the diagnosis and preceding the prognosis of pituitary adenoma. The purpose of this study was to determine and evaluate the correlation of hormonal profile with AgNOR counts, the correlation of recurrence with AgNOR counts, and to determine the consistency between the evaluations of the two independent observers. This study covers 33 patients with pituitary adenoma. The slides were stained with hematoxylin and eosin. Silver colloid method was used for NOR, and immunohistochemistry for hormone expressions. Consistency was significant between the two pathologists (for hormonal profile, the Kappa test was used and P<0.001; for AgNOR count, intra-class correlation coefficient was 0.83). There was no significant correlation between mean AgNOR counts and hormone expressions (P>0.05), and there was also no correlation between mean AgNOR counts and tumor sizes (P>0.05). While no difference between recurrent and non-recurrent patients was found with respect to mean AgNOR numbers (P>0.05), nucleolar silver staining in the form of AgNOR clusters was more frequently detected in recurrent cases.

Testicular Biopsy during Orchidopexy Procedure: Does It Have an Adverse Effect on Fertility?

Introduction: The aim of this study is to evaluate the effect of the gonadal biopsy procedure on fertility and histology of the experimentally created undescended testis. Materials and Methods: Thirty Wistar-Albino rat litters were divided into three groups. In the first two groups, undescended testes were obtained by dividing the right gubernaculum in the first 48 h and the third group constituted the sham group. When the rats were 30 days old, orchidopexy was performed in the first group (O), whereas orchidopexy and testicular biopsy were performed in the second group (OB). After the fertility study all rats were sacrificed at week 11 and testicular weights, mean seminiferous tubular diameters (MSTD) and mean testicular biopsy scores (MTBS) were measured. Results:One testis in the O group and three testes in the OB group were atrophied and these rats were excluded from the study. Testicular weights, MSTD and MTBS values of the operated side in the O and OB groups were lower than those in the sham group. There was a statistically significant difference between the MSTD values of the ipsilateral testes in the OB group and sham group (p < 0.05). MTBS values of the ipsilateral testes in the O and OB groups were <8. There was no difference in all parameters in the contralateral testes between all groups (p > 0.05). All the evaluated rats were fertile. While there was no difference in number of fetuses and fertility scores between the O and OB group, however, the differences were significant between each of these groups and the sham group (p < 0.05). Conclusion:Testicular biopsy in the unilateral undescended testis model results in limited histological changes without affecting the fertility.

Acute effect of inhaled budesonide on bronchial inflammation in asthmatic rats

Although anti-inflammatory potency of inhaled corticosteroids is well established, little is known about their role in the acute phase. The aim of this study was to compare the acute anti-inflammatory effect of inhaled budesonide with systemic dexamethasone on allergen-induced inflammatory changes in asthmatic rats. Eighty-four Sprague Dawley rats were divided into four groups; group I (control, n = 24), group II (ovalbumin sensitized, n = 24), group III (systemic dexamethasone, n = 24), and group IV (budesonide, n = 12). All groups except group I were given ovalbumin aerosol challenges 14 days after sensitization with ovalbumin. The same procedure was applied to the control group using 0.9% saline. Group III received dexamethasone 0.3 mg/kg intraperitoneally and group IV received inhaled budesonide 10 mL (0.5 mg/mL) twice before the challenge. Eight hours after the challenge, bronchi of all the rats were evaluated for the degree of peribronchial inflammation. The most severe inflammation was seen in 8 of 24 rats (33%) in the second group, in 1 of 24 rats (4%) in the third group, and in 1 of 24 rats (4%) in the control group. None of the rats in group IV showed severe inflammation. No statistically significant difference was detected with respect to the presence of 3+ inflammation between the control vs. dexamethasone-, control vs. budesonide-, and dexamethasone vs. budesonide-receiving groups. Budesonide administration via nebulizer prior to exposure to an allergen may attenuate bronchial inflammation as effectively as systemic dexamethasone in rats.