Pınar Uyar Göçün

Near Infrared Spectroscopy to Diagnose Experimental Testicular Torsion: Comparison With Doppler Ultrasound and Immunohistochemical Correlation of Tissue Oxygenation and Viability

PURPOSE Near infrared spectroscopy measures tissue oxygenation even when there is complete cessation of blood flow. We evaluated near infrared spectroscopy to diagnose testicular torsion and blindly compared its accuracy with that of Doppler ultrasound. We also compared it by immunohistochemical evaluation of hypoxia and cell viability. MATERIAL AND METHODS Rats were randomized to 4 groups, including group 1-720-degree unilateral torsion, group 2-360-degree unilateral torsion, group 4-sham operation and group 4-720-degree unilateral torsion followed by surgical torsion reduction at minute 180. Near infrared spectroscopy and Doppler ultrasound were done blindly at minutes 0, 5, 30, 60, 180 and 400. All torsed and contralateral testicles were excised for pathological examination using hypoxia inducible factor-α for hypoxia and the TUNEL test for apoptosis. We compared all groups with the contralateral testis and the sham operated group. RESULTS All blinded, near infrared spectroscopy measurements correctly identified the torsed testis after minute 5. Median oxygen saturation in groups 1 and 2 was significantly different compared to that in the sham operated group after minute 5. In group 4 near infrared spectroscopy detected detorsion with the loss of a significant oxygen saturation difference between the affected and the contralateral testicle after detorsion. At minute 400 median oxygen saturation in group 4 was not statistically different compared to that in the sham operated group (p = 0.09) but it was significantly different compared to that in groups 1 and 2 (p <0.001). In each torsed testis oxygen saturation was at least 18.75% lower than in the contralateral testis. In groups 1 and 2 hypoxia inducible factor-α staining in torsed testicles was significantly greater than that in the contralateral organ and the sham operated group. In group 4 hypoxia inducible factor-α staining after detorsion was significantly decreased compared to that in groups 1 and 2. There was no significant difference in the apoptotic index between the experimental and the contralateral testis or the sham operated group. CONCLUSIONS Near infrared spectroscopy is as effective but quicker than Doppler ultrasound for detecting testicular torsion without a radiologist. Near infrared spectroscopy accurately reveals oxygen saturation, which is more vital than blood flow, on which Doppler ultrasound focuses.

Resection of a huge tufted angioma of orbit and orbitocranial mesh reconstruction.

BACKGROUND AND STUDY AIMS Tufted angiomas (TAs) are rare, benign vascular neoplasms of childhood mainly localized in the skin and subcutaneous tissues. TAs are progressive, slowly growing, and characteristically involve superficial or deep muscle fascia tissue. TAs are frequently seen before the age of 5 years (60 to 70%) and have no sex predominance. TA following pregnancy or TA among immunosuppressive drug users was rarely reported in literature. TA is extremely rare in patients older than 60 years. PATIENT A 73-year-old man presented with right eye pain, redness, burning sensation, swelling, and double vision. On physical examination, his right eye was protruding, hyperemic, and there was a supraorbital palpable mass extending to the lateral orbital wall. Cranial computed tomography and magnetic resonance imaging revealed a heterogeneously enhancing right intraorbital retrobulbar capsulated lesion with intracranial extension. The patient underwent surgery. TA was proven histopathologically. CONCLUSION We report the first TA of the orbit with orbital and cranial bone destruction, frontotemporal extension, and loss of vision due to optic nerve compression. The surgical treatment and orbitocranial mesh reconstruction following neurosurgical gross total removal of the lesion is discussed. TAs should be considered in the differential diagnosis of intraorbital tumors. TAs usually persist throughout life but cause no serious symptoms when they are located in the upper thorax, neck, and shoulders. TAs located in the orbit should be excised.

Ultrasound-guided thyroid nodule fine-needle biopsies--comparison of sample adequacy with different sampling techniques, different needle sizes, and with/without onsite cytological analysis.

INTRODUCTION The aim of this study was to compare the diagnostic adequacy of thyroid samples obtained by aspiration or capillary biopsy techniques, with 22 or 27 gauge needles, and with or without on-site cytological analysis (OCA). MATERIAL AND METHODS Four hundred patients with thyroid nodules underwent ultrasound (US)-guided fine-needle biopsies. Patients were divided into eight groups according to needle size (22 vs. 27 gauge), biopsy technique (aspiration vs. capillary), and whether or not OCA was performed. Sample adequacy rates were calculated for each group and subgroups and compared using chi-square tests. RESULTS When all nodes were evaluated (n = 400), the adequacy rate was significantly greater with the capillary than with the aspiration technique (97% vs. 91.5%, p = 0.032) and when OCA was than was not performed (97% vs. 91.5%, p = 0.032). When only solid nodules were evaluated (n = 205) the adequacy rate was also significantly greater with the capillary than with the aspiration technique (98.9% vs. 89.7%, p = 0.008) and when OCA was than was not performed (97.9% vs. 89.6%, p = 0.014). In contrast, the adequacy rate was similar for 22 and 27 gauge needles (94.2% vs. 93.1%, p = 0.733). CONCLUSIONS Optimal results were obtained with the capillary technique and OCA. The capillary technique and OCA should be the preferred approach in thyroid nodule biopsy, optimising adequacy rates and patient comfort.

Resolution of inflammatory colitis with pegfilgrastim treatment in a case of severe congenital neutropenia due to glucose 6 phosphatase catalytic subunit-3 deficiency.

Glucose 6 phosphatase catalytic subunit-3 (G6PC3) deficiency is a heterogenous disorder characterized by severe congenital neutropenia and a variety of extrahematopoietic manifestations. Inflammatory bowel disease like colitis is an uncommon complication of G6PC3 deficiency, described only in adolescent and adults. Herein, we describe inflammatory colitis in a 10-year-old girl with severe congenital neutropenia due to G6PC3 deficiency while she was on a high-dose filgrastim. Switching from filgrastim to (pegylated filgrastim) Pegfilgrastim led to rapid resolution of colitis, weight gain, and decreased infections. Pegfilgrastim seems to be a better remedy for treatment of G6PC3 deficiency complicated with inflammatory bowel disease.

Four different malignancies in one patient: a case report

Cancer survivors have a higher risk of new primary cancer, in the same or in another organ, than the general population. We report a 78-year-old women who has metachronous quadruple adenocarcinoma, includes bilateral breast cancer, ovarian cancer and retroperitoneal neuroendocrine carcinoma. The development of second cancer in cancer survivors can be expected but third or higher order malignancies are rare.

Neuroprotective effect of systemic and/or intravitreal rosuvastatin administration in rat glaucoma model.

AIM To evaluate the neuroprotective effect of rosuvastatin, in a rat experimental glaucoma model. METHODS Ocular hypertension was induced in right eyes of Long-Evans rats (n=30) by cauterization of three episcleral veins. Left eyes were defined as controls. Rats were divided into five groups: oral rosuvastatin, intravitreal rosuvastatin, oral+intravitreal rosuvastatin, intravitreal sham and glaucoma without intervention. Rats were sacrificed at day 14. Retinal ganglion cell (RGC) number was assessed by histopathological analysis. Terminal deoxynucleotidyl transferase-mediated dUTP-nick end-labeling (TUNEL) staining and the expression of glial fibrillary acidic protein (GFAP) in RGC layer was also examined. RESULTS A significant intraocular pressure (IOP) elevation was seen (P=0.002). Elevated IOP resulted in a significant decrease in number of RGCs in group 5 (70.33±8.2 cells/mm(2)) when compared with controls (92.50±13.72 cells/mm(2); P=0.03). The RGC number in group 1 (92.4±7.3 cells/mm(2)) was significantly higher than group 5 (P=0.03). The numbers of RGC in groups 2, 3 (57.3±8.2 cells/mm(2), 60.5±12.9 cells/mm(2)) were comparable with that of group 5 (P=0.18 and P=0.31). The apoptosis rates with TUNEL staining were also parallel to RGC number. Animals with experimentally induced glaucoma showed an increase in retinal GFAP immunoreactivity. CONCLUSION Decrease in RGC loss and apoptosis suggest the neuroprotective potential of oral rosuvastatin treatment in a rat model of ocular hypertension. However intravitreal rosuvastatin showed a contrary effect and further studies are required.

Evaluation of apoptotic caspase levels in estimation of the wound age

Abstract Objectives: We aimed to investigate the potential use of the expression of apoptotic signaling pathway genes of rat in skin wound age estimation. Material and methods: For this purpose, we formed cutting tool injuries using a scalpel in an experimental model. Then, we assessed Caspase 3, 8 and 9 mRNA levels by using quantitative real-time PCR and protein levels by using immunohistochemistry in rat skin wounds. In addition, we used TUNEL assay to detect apoptotic cells. Results: We observed that Caspase 3 mRNA level significantly increased (2.1±0.4 folds) on day 3 (p<0.05) and Caspase 8 mRNA level significantly increased (1.8±0.2 folds) on day 5 (p<0.05). Caspase 9 mRNA level increased (1.9±0.1 folds) on day 3 and (2.5±0.4 folds) on day 5 (p<0.05). The percentage values of polymorphonuclear leukocytes (PMNLs) and inflammatory mononuclear cells (IMCs) were observed after immunohistochemical staining by Caspase 3, 8, 9 antibodies. Our immunohistochemistry results were found to be consistent with the mRNA results observed. We reported a statistically significant increase in Caspase 3, 8 and 9-positive cells on days 3 and 5 after immunohistochemical staining as well. Conclusion: Our results suggest that time-dependent features of apoptotic factors might offer a potential tool in estimating wound age.

Epigenetic silencing of the tumor suppressor genes SPI1, PRDX2, KLF4, DLEC1, and DAPK1 in childhood and adolescent lymphomas

ABSTRACT The aim of the study was to investigate the expression and methylation status of seven distinctive genes with tumor suppressing properties in childhood and adolescent lymphomas. A total of 96 patients with Hodgkin Lymphoma (HL, n = 41), Non-Hodgkin Lymphoma (NHL, n = 15), and reactive lymphoid hyperplasia (RLH, n = 40, as controls) are included in the research. The expression status of CDKN2A, SPI1, PRDX2, DLEC1, FOXO1, KLF4 and DAPK1 genes were measured with QPCR method after the RNA isolation from paraffin blocks of tumor tissue and cDNA conversion. DNA isolation was performed from samples with low gene expression followed by methylation PCR study specific to promoter regions of these genes. We found that SPI1, PRDX2, DLEC1, KLF4, and DAPK1 genes are significantly less expressed in patient than the control group (p = 0.0001). However, expression of CDKNA2 and FOXO1 genes in the patient and control groups were not statistically different. The methylation ratios of all genes excluding the CDKN2A and FOXO1 were significantly higher in the HL and NHL groups than the controls (p = 0.0001). We showed that SPI1, PRDX2, DLEC1, KLF4 and DAPK1 genes are epigenetically silenced via hypermethylation in the tumor tissues of children with HL and NHL. As CDKN2A gene was not expressed in both patient and control groups, we conclude that it is not specific to malignancy. As FOXO1 gene was similarly expressed in both groups, its relationship with malignancy could not be established. The epigenetically silenced genes may be candidates for biomarkers or therapeutic targets in childhood and adolescent lymphomas.

Comparison of corneal collagen cross-linking (PACK-CXL) and voriconazole treatments in experimental fungal keratitis

To compare the antifungal efficacy of corneal collagen cross‐linking with photoactivated riboflavin (PACK‐CXL) and voriconazole in experimental Fusarium solani and Candida albicans keratitis models.

Ciliary Tissue Transplantation in the Rabbit Eye: Does the Localization of the Graft Affect Survival?

Purpose: To examine whether ciliary body transplantation is applicable, the graft is viable and the localization of the graft material affects graft survival. Methods: Fifteen female New Zealand white rabbits were used. Three of them were used as donors, and a ciliary body graft was prepared from their enucleated eyes. There are two groups in the study according to the localization of the ciliary body graft in the anterior chamber. The graft was placed on the iris surface close to the pupil margin in group 1 and adjacent to the anterior chamber angle in group 2. Immunosuppressive treatment with cyclosporine A was given to the rabbits of both groups. The rabbits were sacrificed 1 month after ciliary transplantation, and their eyes were enucleated. After fixation, the graft and the surrounding tissue were examined by a pathologist macroscopically and microscopically with hematoxylin and eosin staining. Results: One month after the transplantation, the treated eyes remained inflammation free, and the transplants seemed to be viable with evident vascularization and without hemorrhage and necrotic tissue. When we compared groups 1 and 2, there were no statistically significant differences in the histopathological findings between the groups. The grafts were found to be similar with normal ciliary tissue in regard to necrosis, hemorrhage and fibrosis, and there were no statistically significant differences in inflammatory cell density and in the epithelial cell morphology between the normal ciliary tissue and the grafts. Conclusion: Transplantation of allograft ciliary tissue either onto the surface of the iris or the anterior chamber angle under immunosuppression could be an effective treatment for chronic ocular hypotony.