Nuket Eliyatkin

Effect of hyperbaric oxygen treatment on tendon healing after Achilles tendon repair: an experimental study on rats.

OBJECTIVE The aim of this study was to investigate the effects of hyperbaric oxygen treatment on early tendon healing in the treatment of Achilles tendon ruptures. METHODS Fifty-six male Wistar albino rats were randomized and divided into two groups. Intratendinous betamethasone was administered preoperatively for degeneration in 28 rats and isotonic saline injection was administered to the remaining 28 rats. The Achilles tendons of all rats were sutured following tenotomy. Fourteen rats from each group were then selected and received hyperbaric oxygen therapy. The Achilles tendons were removed, biomechanically evaluated and histopathologically studied on the 11th postoperative day. The biomechanical properties and amount of fibrosis, inflammation and vascularization were compared between the groups receiving hyperbaric oxygen therapy and those not. RESULTS Histopathological study showed the amount of fibrosis was significantly higher in the hyperbaric oxygen therapy group than in the control group without the hyperbaric oxygen therapy. The amount of inflammation and vascularization were significantly higher in the steroid administration group than in the no-steroid group. There was a significant difference in the biomechanical properties of the groups in terms of maximum force, stiffness, elastic modulus and maximum allowable stress. CONCLUSION Hyperbaric oxygen therapy creates a positive histological and biomechanical effect on tendon healing after Achilles tendon repair.

Properties of Synchronous Versus Metachronous Bilateral Breast Carcinoma with Long Time Follow Up.

BACKGROUND Breast cancer is the most common cancer type among women with increasing incidence rates, improved prognosis and survival. According to the localization of the tumor, breast cancer is designated as unilateral (UBC) or bilateral (BBC). BBC can be classified as synchronous (SBBC) or metachronous (MBBC) based on the time interval between the diagnosis of the first and the secondary tumors. According to the guideline of WHO 2012, BBC is generally defined as SBBC when contralateral breast carcinoma is diagnosed within 3 months. The aim of this study was to compare the characteristics and patterns of metastasis of BBC patients with UBC. MATERIALS AND METHODS A cohort of 768 patients with breast cancer treated at the Turkish Ministry of Health-Izmir Bozyaka Research and Training Hospital between 1976 and 2012 were studied. Survival analysis was performed comparing UBC and BBC patients. In addition, evaluations were performed in patients with SBBC and MBBC sub-groups. We used a 3-months interval to distinguish metachronous from synchronous. RESULTS When clinical and histopathological parameters were statistically evaluated, ER status, event-free and overall survival were found to be significant between UBC and BBC patients. In comparison of SBBC and MBBC patients, age, histological type of tumor, event-free and overall survival were found to be significant. CONCLUSIONS BBC cases were found to show worse prognosis than UBC cases. Among BBC, SBBC had the worst prognosis based on overall survival rates.

Protective effect of Pycnogenol on cisplatin-induced ototoxicity in rats.

Abstract Context: Pycnogenol®, which is French maritime pine bark extract, is a potent antioxidant. It is used in medical conditions caused by oxidative stress. Cisplatin (cis-diamminedichloroplatinum II) is an antineoplastic agent. However, its serious side effects such as ototoxicity limit its usage. Objective: Antioxidants can be used to prevent ototoxicity. We investigated the effect of Pycnogenol® on cisplatin-induced ototoxicity. Materials and methods: Rats were randomly assigned to four groups of five. Distortion product-evoked otoacoustic emissions (DPOAE) test was performed for each rat. The experimental groups were as follows: Control Group, Pycnogenol® Group: 10 mg/kg Pycnogenol® intraperitoneally for 7 days, Cisplatin Group: intraperitoneally 15 mg/kg single injection of cisplatin on the fifth day, Cisplatin + Pycnogenol® Group: intraperitoneally 10 mg/kg Pycnogenol® treatment for 7 days, additionally on the fifth day, 15 mg/kg single injection of cisplatin was given. On the eighth day, DPOAE was re-performed and rats were sacrificed. Apoptosis was evaluated histopathologically. Results: Mean percentage of apoptotic cells was 1.5, 3, 30 and 11% in organ of Corti and 2, 2, 40, 15% in spiral ganglion neurons in Control Group, Pycnogenol® Group, Cisplatin Group and Cisplatin + Pycnogenol® Group, respectively. Cisplatin Group and Cisplatin + Pycnogenol® Group were significantly different when compared to Control Group histopathologically both in organ of Corti and spiral ganglion neuron (p <0.001, p = 0.019, p = 0.001, p = 0.015). DPOAE results showed that Cisplatin + Pycnogenol® Group was significantly different when compared to Cisplatin Group at 3, 6 and 8 kHz (p < 0.05). Conclusion: Pycnogenol protected against cisplatin ototoxicity. Also, pycnogenol is not ototoxic.

Microarray analysis of the genes associated with osteitis in chronic rhinosinusitis.

Although numerous studies have examined epithelial remodeling in chronic rhinosinusitis (CRS), bone remodeling (osteitis) has only recently gained attention as a potential significant contributor to the pathophysiology of recalcitrant CRS. The purpose of this study was to compare gene expression profiles between osteitic bone and the adjacent diseased mucosa in patients with CRS to determine which genes affect mucosal and bony remodeling.

Evaluation of Lapatinib and Trastuzumab for Ototoxic Effects.

OBJECTIVE Trastuzumab and lapatinib are widely used chemotherapeutic agents. Our aim in this study was to assess the possible ototoxicity of these chemotherapeutic agents. MATERIALS AND METHODS Forty-eight rats were divided into six groups: Group 1 (control, n=8) received intraperitoneal saline for 7 days. Group 2 (n=8) and Group 3 (n=8) received 10 mg/kg and 30 mg/kg single doses of intraperitoneal trastuzumab, respectively. Lapatinib was administered by oral gavage to Group 4 (n=8) at 100 mg/kg/day and to group 5 (n=8) at 300 mg/kg/day for 7 days. Group 6 (n=8) received only one dose of 10 mg/kg intraperitoneal trastuzumab; subsequently, Group 6 received one dose of lapatinib at 100 mg/kg/day by oral gavage for 7 days. Before any medication was administered, distortion product emissions (DPOAE) were obtained. DPOAE tests were performed again on the rats on day 7, after which the mastoid bullas were harvested. The apoptosis degree was evaluated by the terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) procedure. RESULTS The lapatinib 300 and lapatinib+trastuzumab groups (p=0.008 and p=0.001, respectively) were significantly different from the control group according to the spiral ganglion TUNEL. Apoptosis in the organ of corti was statistically different compared with the control group in the lapatinib 100, lapatinib 300, and lapatinib+trastuzumab groups (p=0.035, p=0.001, and p<0.001, respectively). Trastuzumab induced damage in only the organ of corti; however, lapatinib induced damage in both the organ of corti and spiral ganglion. The degree of the damage in the organ of corti was high when trastuzumab and lapatinib were concomitantly used. Supporting this data, a reduction in DPOAE amplitudes was observed during the combined usage of the drugs. CONCLUSION Administering trastuzumab and lapatinib causes ototoxic effects.

Molecular Classification of Breast Carcinoma: From Traditional, Old-Fashioned Way to A New Age, and A New Way

Breast carcinoma comprises a group of diseases with specific clinical, histopathologic and molecular properties. Traditional classification use morphology to divide tumors into separate categories with differing behavior and prognosis. However, there are limitations of traditional classification systems, and new molecular methods are expected to improve classification systems. Molecular subtypes of breast carcinomas have been characterized in the last 11 years, and have been studied extensively. Much of the information accumulated in recent years, and molecular taxonomy seems to be still developing and undergoing change. The main question is whether new molecular techniques such as gene expression profiling will be accepted as gold standard in determining breast cancer subtypes, and whether molecular classification is useful in specific subtypes of breast cancer as it is in ductal carcinoma (nonspecific type). In addition, critical review of the literature reveals major problems such as poor definition, lack of reproducibility and lack of quality control in current molecular techniques and classifications. Therefore, current molecular approaches are not yet used in routine clinical practice and treatment guidance since they are immature and can even lead to incorrect assessment.

[Rapidly-growing nodular pseudoangiomatous stromal hyperplasia of the breast: case report].

Pseudoangiomatous stromal hyperplasia is a benign proliferative lesion of the mammary stroma that rarely presents as a localized mass. Pseudoangiomatous stromal hyperplasia is characterized by a dense, collagenous proliferation of the mammary stroma, associated with capillary-like spaces. Pseudoangiomatous stromal hyperplasia can be mistaken with fibroadenoma on radiological examination or with low-grade angiosarcoma on histological examination. Its main importance is its distinction from angiosarcoma. The presented case was a 40-year-old woman who was admitted with a rapidly growing breast tumor. Physical examination revealed an elastic-firm, well-defined, mobile and painless mass in her right breast. Mammograms revealed a 6.7 x 3.7 cm, lobulated, well-circumscribed mass in her right breast but no calcification. Sonographic examination showed a well-defined and homogenous mass, not including any cyst. Based on these findings, a provisional diagnosis of fibroadenoma was made. Considering the rapid growth history of the mass, tumor excision was performed. The excised tumor was well demarcated and had a smooth external surface. Histological examination revealed the tumor to be composed of markedly increased fibrous stroma and scattered epithelial components (cystic dilatation of the ducts, blunt duct adenosis). The fibrous stroma contained numerous anastomosing slit-like spaces. Isolated spindle cells appeared intermittently at the margins of the spaces resembled endothelial cells. Immunohistochemical staining showed that the spindle cells were positive for CD34 and negative for Factor VIII-related antigen. The lesion was diagnosed as nodular pseudoangiomatous stromal hyperplasia.

Sigmoid kolon ve lenf düğümünde ekstragenital endometriozis

Brucellosis, is an endemic disease in our country, may lead to bacteremia and cause different clinic manifestations. A 44-year-old male patient admitted to our policlinic with high fever, shivering, chilling, pollacuria, and left costovertebral pain, and interned with diagnosis of acute pyelonephritis. Subsequently, acute pyelonephritis due to acute brucellosis was detected in the clinical and laboratory examination. Antibiotic treatment for brucellosis was given to patient for eight week and after treatment full recovery was seen. Patients with brucellosis may refer with symptoms of acute pyelonephritis in endemic areas for brucellosis. By using brucellos serologies to patients who have the symptoms of acute pyelonephritis may available in the diagnosis of this rare complication in areas where brucellosis is endemic.Objectives: Internal splinting is defined as early tendon transfer performed during or just after nerve repair followsing nerve injury and is a controversial issue. The objecstives of internal splinting are avoiding the use of long term external splinting, avoiding permanent hand deformities until the injured nerve is reinnervated and supporting sensorial recovery. In this paper we present our clinical cases of internal splinting and discuss the results in terms of indications, timing, advantages, and disadvantages of internal splinting. Materials and Methods: We applied internal splinting in 11 patients, 3 patients with radial nerve injury and 8 patients with ulnar nerve injury. Internal splinting was performed contemporarily with the nerve repair in 5 pastients, in 2 weeks following nerve repair in 1 patient and in 4 weeks following nerve repair in 5 patients. Pronator teres was transferred to extensor carpi radialis brevis and flexor carpi radialis was transferred to extensor digitorum communis in radial nerve injuries. Omer\s superficial Y technique and its modification were used for ulnar nerve injuries. Results: Patients were followed up for at least 1 year with physical examination and electroneuromyelography and recovery of sensorial and motor functions were achieved in all of them. Conclusion: We concluded that internal splinting is usesful for avoiding external splint usage and preventing the establishment of hand deformity until recovery of the nerve. The contribution of internal splinting to sensorial recovery was noteworthy as stated in the literature but the lack of control group and the small number of our cases was limited to come to a definite conclusion. We did not experience any disadvantage of internal splinting.

Ophthalmic adverse effects of nasal decongestants on an experimental rat model

PURPOSE To investigate the potential effects of chronic exposure to a nasal decongestant and its excipients on ocular tissues using an experimental rat model. METHODS Sixty adult male Wistar rats were randomized into six groups. The first two groups were control (serum physiologic) and Otrivine® groups. The remaining four groups received the Otrivine excipients xylometazoline, benzalkonium chloride, sorbitol, and ethylene diamine tetra acetic acid. Medications were applied into both nostrils twice a day for 8 weeks. Before the rats were sacrificed, epithelial staining, the Schirmer test, and intraocular pressure measurements were performed under ketamine/xylasine anesthesia (50 and 5 mg/kg, respectively). RESULTS Epithelial defects and dry eye were common findings in all study groups. Cataracts developed in two cases clinically. Histopathological evaluation revealed many different pathological alterations in all parts of the ocular tissues such as corneal edema, polypoid proliferation and hyalinization of the vessel wall, cystic formation of the lens, retinal nerve fiber layer degeneration, and corpora amylacea formation of the lacrimal gland. CONCLUSIONS Prolonged usage of the nasal decongestant xylometazoline and its excipients may cause ophthalmic problems such as dry eyes, corneal edema, cataracts, retinal nerve fiber layer, and vascular damage in rats. Although these results were obtained from experimental animals, ophthalmologists should keep in mind the potential ophthalmic adverse effects of this medicine and/or its excipients and exercise caution with drugs containing xylometazoline, ethylene diamine tetra acetic acid, benzalkonium chloride and sorbitol for patients with underlying ocular problems.

HER2 positivity is increasing according to the ASCO/CAP 2013 criteria

Objective: Following American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) ASCO/CAP 2007 convention, ASCO/CAP came together again in the year 2013 and published a guideline. This guideline has been commonly introduced into clinical practice. Method: In line with the 2007, and 2013 ASCO/CAP guidelines, recommendations of HER2 evaluation, we reanalyzed 76 cases with breast carcinoma using IHC, and also CISH methods. Besides, all cases were evaluated using chromogenic in situ hybridization (CISH) methods. Results: A total of 25 cases were IHC 3+ according to both 2007, and 2013 guidelines. Based on 2007 ASCO/CAP HER2 evaluation 23 cases had IHC 2+ scores, while according to 2013 guideline 18 IHC 2+ cases were switched to IHC 3+ group. Based on 2007 ASCO/CAP HER2 evaluations 18 IHC+, and 10 IHC 0 cases were found. Eight IHC 1+ cases were switched to IHC 2+, and 4 cases to IHC 0 groups. Based on 2007 ASCO/CAP HER2 evaluations 25 cases were included in the IHC 3+ group, while according to 2013 ASCO/CAP HER2 evaluations, 43 cases were assessed as IHC3 +. Conclusion: Based on updated evaluation recommendations of ASCO/CAP 2013, some of the IHC2 + cases switched to IHC3 + group which encountered us as the most predominant change.