Nihal Kilinç

Neuroprotective effect of N-acetylcysteine and hypothermia on the spinal cord ischemia–reperfusion injury

The purpose of this study was to investigate the effect of N-acetylcysteine (NAC) on spinal cord ischemia-reperfusion (I-R) in rabbits. Thirty rabbits were divided into five equal groups, group I (sham-operated, no I-R), group II (control, only I-R), group III (I-R+NAC), group IV (I-R+hypothermia), group V (I-R+NAC+hypothermia). Spinal cord ischemia was induced by clamping the aorta both below the left renal artery and above the aortic bifurcation. Forty-eight hours postoperatively, the motor function of the lower limbs was evaluated in each animal according to Tarlov Score. Spinal cord samples were taken to evaluate the histopathological changes. The sham-operated rabbits (group I) showed no neurologic deficit (Score=4). Paraplegia (Score=0) developed in all rabbits in the control group (group II). Administration of 50 mg/kg of NAC (group III) resulted in significant reduction of motor dysfunction (Score=3.1+/-1.3, p=0.002). Application of hypothermia alone (group IV) showed significant recovery of motor functions (Score=3.0+/-1.1, p=0.002), and combination of hypothermia and 50 mg/kg of NAC (group V) showed complete recovery of lower limb motor function (Score=4, p=0.001). Histologic examination of the spinal cord in rabbits with paraplegia revealed several injured neurons. The cords of animals with no motor function deficits showed only minimal cellular infiltrates in the gray matter, and there was good preservation of nerve cells. NAC showed protective effects of the spinal cord. Moderate hypothermia alone also showed protective effects. Combined use of NAC and hypothermia resulted in highly significant recovery of spinal cord function.

A severe hepatitis flare in an HBV-HCV coinfected patient during combination therapy with Α-interferon and ribavirin

We report a reactivation of hepatitis B virus infection and a severe hepatitis flare in a patient with chronic hepatitis due to dual infection with hepatitis B and C viruses during combination therapy with alpha-interferon and ribavirin. Pretreatment, HCV was the dominant virus, with detectable serum HCV-RNA but undetectable HBV-DNA. The patient responded to therapy, with the disappearance of HCV-RNA and normalization of serum alanine aminotransferase (ALT) at months 1 and 6. In the seventh month of therapy, an ALT flare was observed, and serum HBV-DNA became detectable. The patient had a severe hepatitis flare leading to impending hepatic failure. Treatment was discontinued and the patient had marked clinical and biochemical improvement and recovered with normalization of liver function test results within 1 month. Two months later, serum HBV-DNA was again undetectable, both by hybridization and polymerase chain reaction (PCR) assays. The patient had a rapid progression to cirrhosis in a year. At month 24, 17 months after the end of therapy, serum HCV-RNA reappeared, with a level of 2.4 × 105 copies/ml. In conclusion, severe HBV reactivation may occur during interferon plus ribavirin therapy in patients with chronic hepatitis C who are also hepatitis B surface antigen (HBsAg)-positive, and thus more careful monitoring than usual should be considered. Longterm follow-up is recommended, because very late HCV relapses may occur in coinfected patients. These data exemplify the complexity of viral dominance in patients infected with multiple hepatitis viruses, and this has significant importance for treatment decisions. Lamivudine may be administered early in HCV-RNA/HBsAg-positive patients who are at high risk of liver failure once reactivation of HBV occurs during interferon therapy.

Whole-Body Exposure of Radiation Emitted from 900 MHz Mobile Phones Does Not Seem to Affect the Levels of Anti-Apoptotic bcl-2 Protein

The purpose of the present study was to investigate the anti-apoptotic bcl-2 protein in rat brain and testes after whole-body exposure to radiation emitted from 900 MHz cellular phones. Two groups (sham and experimental) of Sprague-Dawley rats of eight rats each were used in the study. Exposure began approximately 10 min after transferring into the exposure cages, a period of time when rats settled down to a prone position and selected a fixed location inside the cage spontaneously. For the experimental group, the phones were in the speech condition for 20 min per day for 1 month. The same procedure was applied to the sham group rats, but the phones were turned off. Immunohistochemical staining of bcl-2 was performed according to the standardized avidin-biotin complex method. The results of this study showed that 20 min of the radiation emitted from 900 MHz cellular phones did not alter anti-apoptotic bcl-2 protein in the brain and testes of rats. We speculate that bcl-2 may not be involved in the effects of radiation on the brain and testes of rats.

Primary gastric adenocarcinoma in a 2.5-year-old girl

Abstract.Primary gastric adenocarcinoma is extremely rare in children. Here, we report an additional case of primary adenocarcinoma, located at the lesser curvature in a girl at the age of 2.5 years. She had no family history and no apparent underlying cause for the tumor. She died 4 months after admission despite complete resection of the mass and chemotherapy.

Coagulation parameters in the patients with Fournier's Gangrene.

Aim: In this prospective study, we aimed to determine the coagulation parameters in the patients with Fournier’s gangrene. Methods: The study group is consisted of 12 consecutive Fournier’s gangrene patients (11 men and 1 woman) and control group is consisted of patients with Periurethral abscess (n=2), Scrotal abscess (n=4) and Epididimorchitis (n=4). Fibrinogen, protein C, protein S,␣antithrombin III, lupus anticoagulant, cardiolipin IgG and IgM, prothrombin time-international normalized ratio, activated partial thromboplastin time, platelet count, proaccelerin, antihemophilic globulin (FVIII), albumin, and calcium were evaluated in all subjects. Tissue specimens were taken from Fournier’s gangrene patients. These specimens were tested for arterial and venous thrombosis using light microscopy. Results: All of the patients with Fournier’s gangrene had both arterial and venous thrombosis in tissue specimens. The levels of fibrinogen and FVIII were high, the level of protein C was low in 12 patients. Lupus Anticoagulant was positive 11 of 12 patients. Conclusions: According to our findings, we think that some coagulation parameters (FVIII, Lupus anticoagulant, protein C, fibrinogen) may be diagnostic for Fournier’s gangrene.

Influence of the Platelet-Activating Factor Receptor Antagonist BB-882 on Intra-Abdominal Adhesion Formation in Rats

Postoperative intra-abdominal adhesion formation is a major clinical problem. We aimed to examine the preventive effect of treatment with the platelet-activating factor (PAF) antagonist (lexipafant, BB-882) on experimentally induced intra-abdominal adhesion formation in rats. Twenty male Sprague-Dawley rats weighing 250 and 290 g were studied. Generation of adhesions in rats by brushing a 1-cm2 area of the cecum and the peritoneum on the right side of the abdominal wall was followed by intra-abdominal administration of saline and 5 mg/kg in a volume of 0.2 ml PAF receptor antagonist BB-882. After 45 days, formation of adhesions was graded and histological evaluation was processed. The severity of adhesions was significantly less in the BB-882 group than in the control group (p < 0.001, p < 0.05). The average adhesion scores in the control and BB-882 groups were 3.2 ± 0.6 and 0.6 ± 0.6, respectively, and the difference between both groups was found to be significant (p < 0.0001). The number of polymorphonuclear leukocytes and fibrotic areas was significantly decreased in the BB-882 group when compared to the control group (p < 0.001, p < 0.002). In conclusion, this study confirms the efficacy of BB-882 in the prevention of postoperative intra-abdominal adhesions in a rat model.

Cardiac Hydatic Cyst Causing Cerebral Emboli in a Child

AbstractCardiac hydatic cyst is rarely encountered. In this article, a case of hydatid cyst localized in the left ventricle causing cerebral emboli is reported.

Aggressive angiomyxoma of the female pelvis and the labium

Aggressive angiomyxoma is an extremely uncommon neoplasm of the female pelvis and perineum. In 1883, Virchow first introduced the entity of soft tissue myxomata (1). A century later in 1983, Steeper and Rosai presented nine cases of a distinctive soft tissue tumor in the female genitalia and pelvic soft tissues, and termed it ‘aggressive angiomyxoma’ (AAM) (2). Approximately 94 cases had been described until 1996, and Fetsch et al. reported the largest series of AAM (3). Despite its benign histological appearance, although it does not metastasize, AAM demonstrates a pronounced tendency for aggressive local, often multiple recurrences (4). It is histologically characterized by a predominantly myxoid stroma and an abundance of thinand thick-walled vascular channels (5). In our first case, isolated labial AAM including pedicle was 45 15 7 cm, which was the largest in the labial area, whereas, in literature, the largest size was reported to be 60 20 cm in the pelvic gluteal region (6). In literature, there is no evidence that AAM originating from Douglas’ pouch extended into the abdomen. We herein report two cases of this rare condition. The first one was the largest labial AAM, and the second orginated from Douglas’ pouch and extended into the abdomen.

Sistemik kemoterapi sonrası uzun dönemli remisyonla seyreden intestinal MALT lenfoma: Olgu sunumu

MALT lenfoma cesitli organlarda ortaya cikan ekstranodal lenfomanin bir turudur. MALT lenfoma ozellikle dusuk grade olanlar cerrahi rezeksiyon, radyoterapi ve kemoterapi sonrasi siklikla nuks etme egilimindedir. Bu olgu sunumunda sistemik kemoterapi sonrasi uzun donemli remisyonla seyreden intestinal MALT lenfoma olgusu sunulmustur. 27 yasinda erkek hasta klinigimize karin agrisi, kilo kaybi ve ates sikayetleri ile basvurdu. Yapilan fizik muayenesinde batinda tum kadranlarda hassasiyeti mevcuttu. Endoskopik incelemede ise duodenumda noduler gorunum mevcuttu. Batin tomografisinde sol hipokondriumda barsak duvar kalinlasmasi mevcuttu ve cok sayida mezenterik lenfadenopatisi vardi. Duodenum biyopsisinde lamina propriayi infiltre eden sentrosit benzeri hucreler mevcuttu. B hucre yuzey belirteclerinden CD20 pozitif saptandi. Helikobakter pylori negatifti. Hastaya dusuk dereceli MALT lenfoma tanisi konuldu. 6 kur CHOP kemoterapisi sonrasi 4. yilda hastada klinik, endoskopik, histolojik ve radyolojik remisyon hali mevcuttu. Sonuc olarak dusuk grade MALT lenfomada lokalize hastalikta ilk tedavi secenegi cerrahi olmasina ragmen sadece CHOP kemoterapisi ile bazi vakalarda uzun sureli remisyon saglamak mumkun olabilir.

A giant lymphangioma circumscriptum on the anterior axilla: A case report.

Lymphangioma is a rare benign proliferative lymphatic lesion that appears in chronic lymphedematous states in a variety of settings. Lymphangioma circumscriptum consists of clinically thin-walled, translucent vesicles appearing in groups most commonly located on the axilla, chest, mouth, and tongue. A 12-year-old male patient had been suffering from itching, pink-red colored, translucent vesicular lesions overlying the anterior axilla since birth. The lesions had slowly grown in size and number over the years. The patient had no history of trauma, or cellulites. The physical examination revealed clusters of pink-red colored vesicles, which released a clear exudate when punctured. The lesion was 50×120 mm in size. The lesion was totally excised and repaired with Z-plasty. Histopathological examination revealed slight epidermal acanthosis and enlarged lymph in the upper dermis, impinging directly onto the epidermis. These lymphatics were lined only by endothelium. The lower dermis and sub-cutis contained abnormally large muscle-coated vessels containing a proteinaceous fluid. Six months later, there was no recurrence and a cosmetically and functionally acceptable postoperative result was obtained.