Ilyas Ozardali

A Survey of Trachoma: The Histopathology and the Mechanism of Progressive Cicatrization of Eyelid Tissues

The aim of this study is to demonstrate the spectrum of conditions encompassed by the term ‘trachomatous cicatrization of eyelid tissue’, to discuss the mechanisms of scar tissue formation and to describe sequelae in this potentially blinding condition. Specimens of eyelid tissues were taken from 27 upper eyelids of 21 patients with entropion who underwent surgical procedures and 2 post-mortem upper eyelids with severe trachomatous entropion. Upper palpebral conjunctival swabs and biopsy specimens were taken from 5 patients with active trachoma and they were examined by fluorescence microscopy and routine histopathological methods. Conjunctival impression cytology samples were collected in all patients. In specimens taken from patients with active trachoma the inflammatory infiltrate was organized as lymphoid follicles in the underlying stroma and impression cytology showed cytoplasmic elementary bodies. In specimens taken from patients with scarring trachoma light microscopy studies showed subepithelial fibrous membrane formation, squamous metaplasia and loss of goblet cells, pseudogland formation in conjunctiva, degeneration of orbicularis oculi muscle fibres, subepithelial vascular dilatation, localized perivascular amyloidosis and subepithelial lymphocytic infiltration. Accessory lachrymal glands and the ducts of glands were compromised by subepithelial infiltration and scarring. The contraction of the subepithelial fibrous tissue formed by collagen fibres and anterior surface drying are the main factors contributing to the chronic cicatrization and entropion formation.

Management of non-neoplastic ovarian cysts with sclerotherapy.

Objective: To evaluate sclerotherapy with alcohol and erythromycin in the management of simple ovarian cysts. Methods: Twenty‐four simple ovarian cysts were subjected to sclerotherapy with alcohol and erythromycin. All procedures were performed under local anesthesia and in an outpatient setting. Cytological examination was carried out in all cases and two patients were excluded from the study because of suspicious cytological results. The patients were followed up monthly with color Doppler sonography for more than 12 months. Results: Cyst fluid was serous in 17 cases and dark‐chocolate colored in seven cases. The volume of aspirated fluid ranged from 100 to 220 ml. The size of ovarian masses and cyst‐wall thickness ranged from 5.5 to 8.5 cm and 1.5 to 5 mm, respectively. Cytological analysis of 15 cysts revealed acellular sediment, seven cysts were compatible with endometrioma, and two were reported as suspicious. During the 12‐month follow‐up, seven cyst recurrences were detected. Conclusion: Aspiration and sclerotherapy with alcohol and erythromycin are followed by a relatively high recurrence rate when the aspirate is bloody. However, patients with a simple cyst that is painful or liable to torsion could benefit from sclerotherapy. Such patients, who are at low risk for malignancy, are relieved with sclerotherapy while avoiding surgery.

The treatment of severe trachomatous dry eye with canalicular silicone plugs.

Purpose To evaluate the effects of temporary canalicular occlusion with silicone plugs on trachomatous dry eye patients who were on maximal tolerable medical therapy.Methods Forty-four trachomatous dry eye patients who had Schirmer testing with topical anaesthetic measuring 5 mm or less and a tear film break-up time of 5 s or less were included. After the lacrimal efficiency test with dissolvable collagen punctal plugs, silicone canalicular plugs were placed in 22 trachomatous dry eye patients. The other 22 patients in the untreated control group were allowed to continue their medical therapy. Pretreatment and post-treatment evaluations included subjective patient assessment, rose Bengal and fluorescein staining, tear film break-up time, Schirmer testing, conjunctival impression cytology and goblet cell counting.Results Six months after plug placement, 18 eyes (82%) of 22 patients had subjective improvement and all these patients successfully wore plugs for at least 6 months. There were statistically significant differences between the pretreatment and post-treatment test results including rose Bengal and fluorescein staining scores, tear film break-up times and Schirmer testing measurements. Impression cytology showed improvement of squamous metaplasia in 17 eyes (77%). Eight of the patients (36%) were able to decrease dependency on topical therapy. Ten of the patients (45%) completely stopped using artificial tears. There were statistically significant differences between the two groups in the total symptom scores, staining scores, tear film break-up time, Schirmer testing, impression cytology scores and goblet cell counts.Conclusion In cases where topical tear supplementation is insufficient to relieve the signs and symptoms of severe dry eye and the lacrimal puncta have not already been closed by the trachomatous cicatrising process, occlusion of the canaliculi may be useful to prevent drainage of both natural and artificial tears. Canalicular occlusion improves the objective signs and subjective symptoms and may significantly decrease dependency on tear supplements in selected patients.

Efficacy of topical cyclosporine A in the treatment of severe trachomatous dry eye.

Purpose:  The purpose of this study was to evaluate the efficacy of topical cyclosporine A (CsA) treatment in patients with severe trachomatous dry eye.

Aspiration and alcohol sclerotherapy: a novel method for management of Bartholin’s cyst or abscess

OBJECTIVE To investigate the efficiency and safety of alcohol sclerotherapy of Bartholins cyst or abscess by comparing it with silver nitrate insertion. STUDY DESIGN Twenty-two patients with unilateral Bartholins cyst or abscess were randomized into one of the treatment groups according to diameter of cyst or abscess. Group I consisted of 12 patients who were treated with alcohol sclerotherapy and Group II included 10 patients who were treated with silver nitrate insertion. In both groups, treatments were conducted under local anesthesia and in an outpatient setting. The patients were checked for morbidity of operations every 3 days until complete healing was observed and then followed up monthly for over 24 months. RESULTS The mean duration of procedure was 7+/-2 min in group I and 15+/-3 min in group II. Healing time was 4.8+/-1.3 days in group I and 9.2+/-2.5 days in group II. In group I although 10 patients showed complete healing without any early or late morbidity; two patients suffered from severe vulval pain, edema and echymosis, and then developed a total cyst necrosis. Healing in these patients completed with mild scar formation. Only one recurrence was documented during 24 months follow-up period. All patients in group II complained labial pain, four of them suffered from severe labial pain, edema, and echymosis. Healing in these patients was completed with moderate scar formation. Follow-up of 24 months revealed no recurrence in this group. CONCLUSION Alcohol sclerotherapy of Bartholins cyst or abscess is as effective as silver nitrate application and is associated with less complication. It may be ideal, safe and attractive treatment modality for this gynecological disease.

Three-Day Course of Oral Azithromycin vs Topical Oxytetracycline/Polymyxin in Treatment of Active Endemic Trachoma

PURPOSE The aim of this study on endemic trachoma was to carry out a comparison of azithromycin (3-day course, oral dose of 10 mg/kg per day) with conventional treatment (topical oxytetracycline/polymyxin ointment; twice a day for 2 months) in a rural area near Sanliurfa, Turkey. METHODS Ninety-six subjects with active trachoma were randomly assigned conventional or azithromycin treatment. Subjects were examined 1, 2, 3, and 6 months after the start of treatment. Clinical findings were recorded for each eye. Swabs were taken from upper eyelids 3 and 6 months after the start of treatment for direct fluorescein antibody test. RESULTS By six-month follow-up, trachoma had resolved clinically in 43 (89.58%) of the 48 subjects who received azithromycin, compared with 33 (68. 75%) of the 48 who were treated conventionally. Microbiological success rates (direct fluorescein antibody test negativity) were 83. 33% in the azithromycin group and 62.50% in the conventional therapy group. Compliance with both treatments was good. By 6 months, 14.58% of the subjects in azithromycin group and 33.33% of the subjects in the topical treatment group were reinfected. There were significant differences in the efficacy of the treatment effects and the re-emergence of disease between the two treatment groups. Azithromycin was well-tolerated. CONCLUSIONS These results indicate that azithromycin may be an effective alternative for patients with active trachoma. As a systemic treatment, a 3-day course oral dose has important potential for trachoma control.

Basal cell carcinoma in a leishmanial scar

A 50-year-old male farmer presented a minimally ulcerated and crusted central lesion 1 cm in diameter within a leishmanial scar on the left cheek (Fig. 1a). In his history, cutaneous leishmaniasis (CL) was prominent, which had spontaneously healed 40 years before, leaving a visible scar. There was no past history of any other skin cancers. He had outdoor occupation and wrinkled, actinic damaged facial skin. A 5-mm punch biopsy was taken from the lesion, and histological examination revealed a peripherally located focus of basal cell carcinoma (BCC) in a small area, and pseudoepitheliomatous hyperplasia in the remaining area. At that time, the patient refused further therapy. Two years later, the patient was re-admitted with the lesion enlarged on the leishmanial scar and having become a 3-cm noduloulcerating, firm tumour with an elevated pearly translucent border and centrally bleeding crust (Fig. 1b). The lesion was excised with a wide margin. Histopathological examination confirmed the diagnosis of BCC with a nest of basal neoplastic cells in the dermis. Surgical margins were tumour free. Severe solar changes were observed in the dermis adjacent to the tumour (Fig. 2). BCC is the commonest human cancer, and its incidence is increasing worldwide. Most BCCs occur on the head and neck, particularly on the upper central part of the face. In addition, some BCCs occur on the nonsun-exposed trunk and extremities. The causal relationship between UV exposure and BCC is not as clear as that between UV exposure and squamous cell carcinoma (SCC). Previous therapeutic radiation, chronic exposure to arsenic, and chronic ulcers predispose patients to the development of BCC, though this occurs much less commonly in this setting than does SCC. In addition, an association between BCC and scar tissue has been noted in several reports. The most common scar types associated with BCC are previous vaccination and small pox scars, while burn and surgical scars are associated with fewer cases. The question of how scars undergo malignant transformation is much debated, and the answer remains elusive. The long latent period between the time of injury and the development of carcinoma often makes it difficult to prove any direct relationship. The poor vascularity and elasticity of scar tissue may render the overlying epithelium more susceptible to injury and carcinogens. It is unlikely that trauma alone induces carcinogenesis. In the case presented here, a BCC developed in a 50year-old man at the site of a leishmanial scar 40 years after healing. Histological examination of the tumour revealed severe actinic damage to the tissues adjacent to the neoplasm, attesting to the role played by both factors in the induction of this tumour. This finding, coupled with the history of an atrophic scar, most probably accounts for the development of the BCC in this patient. Effective host– parasite interaction in CL results in local tissue destruction, ulceration and scar formation. The association of CL with the subsequent development of malignancy at the site of the previous lesion is rarely reported. There have been a few cases involving CL and malignancy, such as a 17-year-old boy with CL and BCC and a 53-year-old man with BCC arising in a leishmanial scar. We concluded that CL is not a premalignant lesion, as there have been very few cases of BCC and no case of SCC reported. Histologic examination in our case showed actinic damage in the surrounding uninvolved areas of the dermis. Thus, the development of a subsequent malignant neoplasm should be considered a rare but possible sequela of CL due to atrophic scar and chronic solar trauma.

Oxidative and Antioxidative Status in the Testes of Rats with Acute Epididymitis

Introduction: Epididymitis is an inflammation or infection of the epididymis, a convoluted duct that lies on the posterior surface of the testicle. Oxidative stress due to excessive production of reactive oxygen species in epididymitis, impaired antioxidant defense mechanisms, or both, precipitates a range of pathologies that are currently believed to negatively affect the male reproductive function. How oxidative stress affects the testes isstill unknown. We aimed to investigate the oxidative and antioxidative status of testes of rats with unilateral acute Escherichia coli epididymitis. Methods: The study included 36 male Wistar albino rats which were divided into three groups. In the epididymitis group (n = 12), an E. coli suspension was injected into the right ductus deferens of rats, and the same amount of saline was injected in the saline groups (n = 12). No surgery was performed in the control group (n = 12) for baseline values. Rats were sacrificed after 24 h and the epididymes and testes removed. The infection was confirmed by histopathologic evaluation and microbiological tests. The oxidative status of testes was evaluated by measuring myeloperoxidase (MPO) activity, and antioxidative status was evaluated by measuring total antioxidant response (TAR) and total antioxidant capacity levels (TAC). Results: MPO activity in both the ipsilateral and contralateral testes of the epididymitis group was significantly higher than those of the saline and control groups (p <0.05). The TAR and TAC levels in both testes were also significantly elevated in the epididymitis group versus the two other groups (p <0.05). Conclusions: Acute epididymitis causes an increase of oxidative stress in the ipsilateral and contralateral testes, but this condition is strived for to tolerate the increase of endogenous antioxidants.

Familial cutaneous collagenoma : New affected family with prepubertal onset

Two siblings presented with clinical and histopathological findings of familial cutaneous collagenoma which is a rare connective tissue nevus, inherited in an autosomal‐dominant pattern. A 13‐year‐old girl had oval‐round, soft, painless papules, 5–10 mm in size and a total of 9–10 on her abdomen and flanks. Skin biopsy demonstrated dense, coarse collagen fibers in the dermis and a decrease in elastic fibers. Doppler echocardiography indicated an atrioseptal defect of the secundum type. Her 9‐year‐old brother was also examined; four lesions were discovered on his back but he was otherwise normal. Our cases comprise the sixth affected family to be reported in the medical published work and all lesions had appeared prepubertally.

High rate of seropositivity of Chlamydia pneumoniae IgA in male patients with nonalcoholic steatohepatitis.

The aim of this study was to investigate if there was any relationship between nonalcoholic steatohepatitis and the rate of Chlamydia pneumoniae seropositivity in a male population. Fifteen men with nonalcoholic steatohepatitis and 20 healthy men were enrolled in the study. The seropositivity rate of Chlamydia pneumoniae immunoglobulin A in the nonalcoholic steatohepatitis and control groups was 53.3 and 5%, respectively. The rate of Chlamydia pneumoniae immunoglobulin A positivity was significantly higher in the nonalcoholic steatohepatitis group than the controls (P = 0.002), while such a difference did not occur for Chlamydia pneumoniae immunoglobulin G positivity (P > 0.05). There is an association between nonalcoholic steatohepatitis and persistent Chlamydia pneumoniae infection as a probable causative or triggering agent. These findings suggest that further studies are necessary to clarify this association.