Gokhan Gedikoglu

Melanotic neuroectodermal tumor of infancy: report of two cases and review of literature.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, distinctive neoplasm containing melanin; it primarily affects the maxilla of the infants during the first year of life. Approximately 150 instances of this tumor are reported in the medical literature. Genesis of the tumor is obscure and the diagnosis is challenging for the pathologist. Two cases operated by the first author are presented, and the diagnostic features and treatment alternatives of MNTI discussed.

Tumor thickness as a predictor of cervical lymph node metastasis in squamous cell carcinoma of the lower lip.

Tumor thickness is a relatively new prognostic factor that has been investigated for lower lip cancer. This study was performed in 27 patients, 13 of whom had histopathologically confirmed cervical metastasis, to investigate whether tumor thickness could be used as a predictor of cervical lymph node metastasis. The mean tumor thickness of those cases with neck metastasis was 5.60 mm (SD = 2.24), and the mean thickness of cases without neck metastasis was 3.79 mm (SD = 1.68). The difference between tumor thicknesses of both groups was found to be statistically significant (P < 0.05). The tumor thickness of 5 mm was determined as a cutoff point, above which the cervical lymph node metastasis rate was significantly increased. As a conclusion, tumor thickness is an objective histopathologic factor that is easily reproducible; it significantly influences cervical lymph node metastasis in lower lip cancer, and it may be used in the assessment of prognosis. (Otolaryngol Head Neck Surg 2000;122:139–42.)

The effects of bosentan, aminoguanidine and L-canavanine on mesenteric blood flow, spleen and liver in endotoxaemic mice

The modulatory effects of a non-selective endothelin receptor antagonist, bosentan, were investigated together with those of relatively selective inducible nitric oxide synthase inhibitors, aminoguanidine and L-canavanine, on mesenteric blood flow decrease, liver and spleen injury elicited by endotoxaemia. Swiss albino mice (20-40 g) were administered intraperitoneally bosentan (3, 10 or 30 mg kg(-1)), aminoguanidine (15 mg kg(-1)) or L-canavanine (20 or 100 mg kg(-1)) 10 min before they received saline or Escherichia coli endotoxin (10 mg kg(-1)). After 4 h, the mice were anaesthetized, mesenteric blood flow values were measured, spleen and liver weight/body weight ratios were determined and the organs were examined histopathologically. Endotoxin decreased mesenteric blood flow (ml min(-1), saline: 3.0 +/- 0.2; endotoxin: 2.2 +/- 0.2: n = 10, P < 0.05), increased the weight of liver (g per kg body weight, saline: 47.5 +/- 2.0; endotoxin: 60.8 +/- 1.9: n = 10, P < 0.05) and spleen (g per kg body weight, saline: 3.9 +/- 0.5; endotoxin: 8.6 +/- 0.9; n = 10, P < 0.01) while it inflicted significant histopathological injury to both organs. Bosentan was ineffective at 3 mg kg(-1) but at 10 and 30 mg kg(-1) doses, it abolished all the deleterious effects of endotoxin without exception. Aminoguanidine blocked most of the effects of endotoxin except those on spleen. In contrast, L-canavanine blocked only the endotoxin-induced increase in liver weight but itself increased spleen weight and failed to block any other effects of endotoxin. Thus, it can be speculated that the beneficial effects of aminoguanidine are produced largely by mechanisms other than selective inducible nitric oxide synthase inhibition since L-canavanine was not fully effective. The beneficial effects of endothelin inhibition by using bosentan in endotoxaemia can be further exploited for the understanding and the therapy of sepsis-related syndromes.

The effect of temporary hemiepiphyseal stapling on the growth plate: a radiologic and immunohistochemical study in rabbits.

The purpose of this study was to investigate the effect of temporary hemiepiphyseal stapling on the bone geometry and proliferative activity of the physis in immature rabbits. Proximal medial epiphyseal stapling of the right tibia was performed in 46 6-week-old New Zealand white rabbits. The rabbits were assigned randomly into two groups. In group 1, the staples were inserted extraperiosteally and the rabbits were killed at the end of 3 weeks. In group 2, the staples were fixed subperiosteally (group IIA) or extraperiosteally (group IIB), the staples were removed at the end of 3 weeks, and the rabbits were killed at the end of 6 weeks. The articular line-diaphysis angle (ALDA) was significantly increased with 3 weeks of stapling. After the removal of staples, while ALDA continued to worsen in group IIA, it improved in group IIB. Bone was observed to bridge the physis in group IIA. However, the proliferative activity of the physis continued. Temporary hemiepiphyseal stapling is a safe and effective method for control of physeal growth of long bones before skeletal maturity. However, it is of paramount importance not to disturb the periosteum during stapling.

Prognostic significance of histopathological parameters in cancer of the larynx

Abstract In this study we investigated the prognostic significance of differentiation, the mode of tumor invasion to surrounding tissues, the microscopic appearance of tumor, peritumoral lymphocytic infiltration and cartilage involvement according to disease-free survival, and the recurrence and presence of cervical lymph node metastasis in cancer of the larynx. Only the mode of tumor invasion to surrounding tissues was significantly related to survival (P < 0.05). The patients with “well-defined margin” tumors survive significantly longer than those with “groups of cells, no distinct margin.” Patients with supraglottic tumors and a mode of invasion other than “well-defined margin” have a significantly higher risk of recurrence (P < 0.05) and therefore require adjuvant therapy. Patients with poorly differentiated, cartilage invading, ulcerative supraglottic tumors, and patients with glottic tumors having diffusely infiltrating margins, certainly need elective neck dissection (P < 0.05). According to the multivariant analysis, none of the factors significantly affect disease-free survival independently (P > 0.15). According to multiple logistic regression and cox regression analysis, in decreasing order of significance, the mode of invasion, microscopic tumor appearance and lymphocytic infiltration significantly affect the recurrence and time between surgery and the development of recurrence independently (P < 0.15).

Arterial thrombosis leading to intestinal infarction in a patient with Behçet’s disease associated with protein C deficiency

Behçets disease may be a possible cause of both occlusive and aneurysmal arterial involvement as well as recurrent venous thrombosis. A case of Behçets disease complicated with vascular involvement leading to intestinal infarction is presented. A 41-yr-old man suffering from Behçets disease for 15 yr presented with a 2-day history of severe abdominal pain and bloody diarrhea. Intestinal infarction secondary to thrombosis of the superior mesenteric artery had been diagnosed during surgical exploration 3 yr previously. He was started on anticoagulation with nutritional support. The patient was readmitted with severe diarrhea and malabsorbtion symptoms 3 yr after intestinal resection. A thrombus located in the posterior wall of the infrarenal portion of aorta was detected by aortography and ultrasonography. Although thrombosis is a relatively common complication of Behçets disease caused by vasculitis, protein C deficiency, which is a pertinent laboratory finding in this case, might be a secondary factor in the thrombotic event. This is the first case reported of mesenteric artery thrombosis leading to bowel infarction and abdominal aorta thrombosis associated with protein C deficiency.

Prognostic Significance of Depth of Invasion in Cancer of the Larynx

To determine the prognostic significance of depth of invasion in laryngeal cancer, the depth of invasion of tumor was measured with an ocular micrometer on the laryngectomy specimens of 94 surgically treated patients with T1, T2, and T3 laryngeal cancer and was expressed in millimeters. There was a significant negative correlation between the depth of invasion and disease‐free survival. The tumors with no clinical involvement of regional lymph nodes in neck (N0 neck) had significantly less depth of invasion than those with involvement (N+ neck). The tumors with pathologically confirmed cervical lymph node metastasis had significantly more depth of invasion than those without metastasis. For tumors with a depth of invasion equal to or greater than 3.25 mm, the rate of cervical metastasis in this study has always been significantly higher than for those with a depth of invasion less than 3.25 mm (P < .05). The mean depths of invasion for cases with and without recurrence were not significantly different. According to the multivariate analysis, depth of invasion (P = .047) and patient age (P = .113) significantly affected the disease‐free survival independently. The depth of invasion did not significantly affect the recurrence and the interval between surgery and the development of recurrence (P > .15). The depth of invasion should be measured in every laryngectomy specimen. The depth of invasion influences the cervical metastasis and disease‐free survival significantly but does not affect the recurrence rate. The depth of invasion plays an independent role in determining the disease‐free survival.

C-erbB-2 expression and prognostic significance in osteosarcoma

C‐erbB‐2 is postulated as a prognostic biological marker for osteosarcoma (OST). We investigated c‐erbB‐2 expression status in osteosarcomas and its prognostic significance.

Prognostic significance of Langerhans cell infiltration in cancer of the larynx

OBJECTIVE: Determine the effect on prognosis of Langerhans cell infiltration in cancer of the larynx. STUDY DESIGN AND SETTING: Retrospective review of 72 surgically treated patients with T1–3 lesions. The streptavidin-biotin method to determine Langerhans cell infiltration, which was graded as 1+, 2+, and 3+. RESULTS: A higher degree of Langerhans cell infiltration was significantly associated with less cervical lymph node metastasis, longer disease-free survival, less locoregional recurrence, and less clinical N-positivity (P < 0.05). According to multivariant analysis, Langerhans cell infiltration was independently related to disease-free survival and recurrence (P < 0.05). CONCLUSIONS: Langerhans cell infiltration is prognostically important in cancer of the larynx. More intense infiltration is significantly related to prolonged disease-free survival, less locoregional recurrence, less cervical lymph node metastasis, and less clinical N-positivity. SIGNIFICANCE: Langerhans cell infiltration may be determined on a biopsy specimen and this information may be useful in deciding about elective neck dissection. Patients with mild infiltration may have a higher risk of locoregional recurrence, shorter disease-free survival, and therefore they suggest a poor prognosis.

The etiologic distribution of thrombophilic factors in chronic portal vein thrombosis.

Goals We aimed to prospectively investigate the full etiologic contributors to portal vein thrombosis. Background Portal vein thrombosis in the absence of liver disease is a rare cause of portal hypertension with a different clinical course and management strategy. The etiologic distribution of this interesting clinical picture is important as far as diagnostic and management issues are concerned. Study After the application of exclusion criteria, 59 patients were included in the study who had normal liver functions, normal liver histology and studied the thrombophilia factors of both acquired factors and congenital factors like protein C, protein S, antithrombin levels with the mutations. Results In all, 23.7% of the patients were found to have acquired thrombophilia factors like myeloproliferative disorders and cyst hydatid disease, whereas 22.1% of the patient population was found to harbor no identifiable cause of thrombophilia, which we termed as idiopathic. One or more causes of thrombophilia were identified in 46 patients. There were 27 patients with protein C deficiency, 18 patients with protein S deficiency. The antithrombin deficiency was found in 17 patients. The factor V Leiden mutation was found in 7 patients. There was 1 patient with homozygote mutation, whereas the remaining 6 patients were heterozygotes. There were 3 patients with prothrombin mutation who were heterozygote for this mutation. Conclusions Complete investigation of thrombophilia is crucial to delineate the outline of thrombophilic risk factors to estimate the rethrombosis risk and for further management concerns.