Rengin Ahiskali

An unusual cause of hydropic gallbladder and biliary colic — Heterotopic pancreatic tissue in the cystic duct: Report of a case and review of the literature

We present herein an unusual case of heterotopic pancreas in the cystic duct with hydrops of the gallbladder and concomitant chronic pancreatitis of the heterotopic tissue. A review of the relevant literature is discussed following the presentation of this case.

Histopathologic effects of lipid content of enteral solutions after pulmonary aspiration in rats

OBJECTIVE We compared the pulmonary histopathologic effects of different enteral formulas with various lipid contents during the subacute period of aspiration in rats. METHODS Fifty Wistar albino rats, weighing 180 to 300 g, were randomly assigned to one of five groups (n = 10). Anesthesia was induced with an intraperitoneal injection of 100 mg/kg of ketamine hydrochloride, rats were intubated endotracheally with a 16-gauge angiocatheter, and 0.9% saline (group 1, control), Impact (group 2), Jevity (group 3), Biosorb Energy Plus (group 4), or Pulmocare (group 5) with a lipid content of 0, 28, 39.3, 58, or 93.3 g/L, respectively, was injected into the lungs in a volume of 3 mL/kg. Seven days later, rats were killed, and lungs with trachea were removed en bloc for histopathologic examination. For histopathologic assessment, slides were examined for the presence of peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation. The degree of severity was assessed by using a 4-point scale. One-way analysis of variance and Student-Newman-Keuls test were used for statistical analysis. RESULTS Peribronchial inflammatory cell infiltration was present in all groups but was significantly more severe in group 2 than in groups 1, 4, and 5 (P < 0.05). Alveolar edema was statistically higher in group 2 than in group 1 (P < 0.05). Alveolar septal infiltration was statistically higher in group 4 than in group 1. Alveolar histiocytes were statistically higher in groups 2 and 3 (P < 0.01) and groups 4 and 5 (P < 0.05) than in group 1. Alveolar exudate, interstitial fibrosis, granuloma, and necrosis formation were absent in all groups. CONCLUSION The pulmonary histopathologic effects of aspiration of Impact were severe peribronchial inflammatory cell infiltration (greater than aspiration of Biosorb and Pulmocare), abundant alveolar histiocytes, and alveolar edema in comparison with aspiration of saline, even though Impact had the lowest lipid content of all studied formulas. We concluded that the tissue damage occurring after pulmonary aspiration of Impact is more severe than after aspiration of Pulmocare.

Epithelioid hemangioendothelioma with multiple organ involvement

Epithelioid hemangioendothelioma is a rare vascular neoplasm of uncertain malignant potential. Various reports document metastatic or concurrent epithelioid hemangioendothelioma in several sites, most commonly with combined lung and liver involvement. The concurrent involvement of multiple sites at presentation may cause diagnostic problems because epithelioid hemangioendothelioma can mimic other neoplastic processes. Although it is a chemoresistant disease, chemotherapy is usually advised for patients with metastatic or concurrent involvement. Here we document the presentation, treatment, and outcome of two cases with concurrent involvement of the lung and liver.

Prevalence of HPV infection by cytologic diagnosis and HPV DNA extraction and prevalence of the HPV genotypes detected in urban Turkish women

To evaluate the prevalence of the different human papillomavirus (HPV) genotypes in women seen at 2 Marmara University Hospital gynecologic outpatient clinics in Istanbul, Turkey.

Sodium fusidate-poly(D,L-lactide-co-glycolide) microspheres: Preparation, characterisation and in vivo evaluation of their effectiveness in the treatment of chronic osteomyelitis

Purpose: The aim of this study was to prepare poly(D,L-lactide-co-glycolide) (PLGA) microspheres containing sodium fusidate (SF) using a double emulsion solvent evaporation method with varying polymer:drug ratios (1:1, 2.5:1, 5:1) and to evaluate its efficiency for the local treatment of chronic osteomyelitis. Methods: The particle size and distribution, morphological characteristics, thermal behaviour, drug content, encapsulation efficiency and in vitro release assessments of the formulations had been carried out. Sterilized SF-PLGA microspheres were implanted in the proximal tibia of rats with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis. After 3 weeks of treatment, bone samples were analysed with a microbiological assay. Results: PLGA microspheres between the size ranges of 2.16–4.12 µm were obtained. Production yield of all formulations was found to be higher than 79% and encapsulation efficiencies of 19.8–34.3% were obtained. DSC thermogram showed that the SF was in an amorphous state in the microspheres and the glass transition temperature (Tg) of PLGA was not influenced by the preparation procedure. In vitro drug release studies had indicated that these microspheres had significant burst release and their drug release rates were decreased upon increasing the polymer:drug ratio (p < 0.05). Based on the in vivo data, rats implanted with SF-PLGA microspheres and empty microspheres showed 1987 ± 1196 and 55526 ± 49086 colony forming unit of MRSA in 1 g bone samples (CFU/g), respectively (p < 0.01). Conclusion: The in vitro and in vivo studies had shown that the implanted SF loaded microspheres were found to be effective for the treatment of chronic osteomyelitis in an animal experimental model. Hence, these microspheres may be potentially useful in the clinical setting.

Solitary fibrous tumor of the kidney

Solitary fibrous tumors are rare spindle cell neoplasms usually arising in the pleura. They have, however, also been reported at extrapleural locations. Solitary fibrous tumor (SFT) of the kidney is rare. Despite its rarity, histological diagnosis of solitary fibrous tumor is crucial to avoid misdiagnosis with other more aggressive tumors arising in the kidney. We report a solitary fibrous tumor of the left kidney that presented as a malignant tumor in a 51‐year‐old woman, and include clinical and radiographic findings. The tumor was well circumscribed and composed of spindle cells in a collagenous stroma. Immunohistochemistry showed reactivity for vimentin, CD 34, BCL‐2 protein and CD99. Immunohistochemical stains for cytokeratin, S‐100, desmin, α‐smooth muscle actin and HMB‐45 were negative. A diagnosis of SFT was made based on light microscopy and immunohistochemistry.

Results of paclitaxel (day 1 and 8) and carboplatin given on every three weeks in advanced (stage III-IV) non-small cell lung cancer

BackgroundBoth paclitaxel (P) and carboplatin (C) have significant activity in non-small cell lung cancer (NSCLC). The weekly administration of P is active, dose intense, and has a favorable toxicity profile. We retrospectively reviewed the data of 51 consecutive patients receiving C and day 1 and 8 P chemotherapy (CT) regimen in advanced stage NSCLC to evaluate the efficacy and toxicity.MethodsPatients treated in our institutions having pathologically proven NSCLC, no CNS metastases, adequate organ function and performance status (PS) ECOG 0–2 were given P 112.5 mg/m2 intravenously (IV) over 1 hour on day 1 and 8, followed by C AUC 5 IV over 1 hour, repeated in every three weeks. PC was given for maximum of 6 cycles.ResultsMedian age was 58 (age range 39–77) and 41 patients (80%) were male. PS was 0/1/2 in 29/17/5 patients and stage was IIIA/IIIB/IV in 3/14/34 patients respectively. The median number of cycles administered was 3 (1–6). Seven patients (14%) did not complete the first 3 cycles either due to death, progression, grade 3 hypersensitivity reactions to P or lost to follow up. Best evaluable response was partial response (PR) in 45% and stable disease (SD) in 18%. Twelve patients (24%) received local RT. Thirteen patients (25%) received 2nd line CT at progression. At a median follow-up of 7 months (range, 1–20), 25 (49%) patients died and 35 patients (69%) progressed. Median overall survival (OS) was 11 ± 2 months (95% CI; 6 to 16), 1-year OS ratio was 44%. Median time to progression (TTP) was 6 ± 1 months (95% CI; 4 to 8), 1-year progression free survival (PFS) ratio was 20%. We observed following grade 3 toxicities: asthenia (10%), neuropathy (4%), anorexia (4%), anemia (4%), hypersensitivity to P (2%), nausea/vomiting (2%), diarrhea (2%) and neutropenia (2%). Two patients (4%) died of febrile neutropenia. Doses of CT were reduced or delayed in 12 patients (24%).ConclusionsP on day 1 and 8 and C every three weeks is practical and fairly well tolerated outpatient regimen. This regimen seems to be comparably active to regimens given once in every three weeks.

The value of ultrasound elastography in differentiation of malignancy in thyroid nodules.

We aimed to determine the value of ultrasound elastography (US-E) using carotid artery pulsation in differentiation of malignant and benign thyroid nodules. One hundred ten nodules were evaluated by US-E, and stiffness scores were compared to biopsy results. When cutoff for malignancy was determined as score 4, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 95%, 40%, and 100%, respectively. We suggest fine needle aspiration biopsy to be performed in all score 4 nodules, while biopsy may be unnecessary in score 1 nodules. Benign biopsy result in a score 4 nodule should suggest radiological-pathological disagreement, and repeat biopsy should be recommended.

Thyroid fine needle aspiration biopsy: Do we really need an on-site cytopathologist?

PURPOSE The aim of this single center study is to evaluate the effectiveness of performing ultrasound-guided thyroid fine-needle aspiration biopsies (FNAB) performed by the radiologist alone without an on-site cytopathologist. MATERIALS AND METHODS In this prospective randomized study, 203 patients with single nodules measuring 10mm or more underwent ultrasound-guided FNAB: 102 patients underwent FNAB performed by the radiologist accompanied by a cytopathologist (control group); 101 patients underwent FNAB by the radiologist alone (study group). In both groups biopsy time, specimen adequacy ratio, total aspiration number, cytopathologists cytological diagnosis time (t1), cytopathologists total time consumption (t2) were evaluated. RESULTS Mean total biopsy time was 8.74 ± 2.31 min in the study group and was significantly shorter than the control groups 11.97 ± 6.75 min (p=0.004). The average number of aspirations per patient in the study group was 4.00 ± 0; compared to the control groups 3.56 ± 1.23 this was significantly higher (p=0.001). t1 of the study group was 307.48 ± 226.32s; compared to 350.14 ± 247.64 s in the control group, there was no statistically significant difference (p=0.137). t2 of the study group was 672.93 ± 270.45 s; compared to the control group (707.03 ± 258.78 s) there was no statistically significant difference (p=0.360). Diagnostic adequacy of aspirated specimens was reassessed in the pathology laboratory. In the study group, 84 out of 101 aspirations and in the control group 89 out of 102 aspirations was determined as adequate with no statistically significant difference (p=0.302). CONCLUSIONS We believe that in centers where a cytopathologist is not available, ultrasound-guided thyroid FNAB can be adequately performed by an experienced radiologist who was effectively trained in smear preparation.

Macroscopic complete resection is not associated with improved survival in patients with malignant pleural mesothelioma

Objective: Macroscopic complete resection (MCR) is the recommended surgical strategy in malignant pleural mesothelioma. Our objective was to analyze whether MCR influences survival in malignant pleural mesothelioma. Methods: Between 2002 and 2016, 154 patients underwent pleurectomy decortication (n = 90), extrapleural pneumonectomy (n = 42), or exploratory/diagnostic procedures (n = 22) in a single institution. Patient data were recorded in a prospective database. Patients who underwent surgical resection (n = 132) were analyzed according to MCR as a whole group and after propensity score matching based on gender, age, histology, clinical T and N status, adjuvant chemotherapy, and trimodality treatment. Kaplan‐Meier survival and univariate and multivariate analyses were performed. Results: Median age was 56 years (range, 26 to 80 years) and 62 were women. One hundred ten had epithelioid histology. MCR was achieved in 75 patients (49%). In‐hospital mortality was seen in 7 patients (4.5%). Preoperative chemotherapy was applied in 32 patients. One hundred thirty‐three patients underwent adjuvant treatment (45 had chemoradiation). Mean follow‐up was 21 ± 19 months. Overall median survival, 2‐year, and 5‐year survivals were 18.1 months, 36%, and 16%, respectively. There was no difference in median survival between patients who underwent MCR (21.4 months) and who did not (16.3 months) (P = .6). Following propensity score matching (23 patients in each group), median survivals were similar (13.3 vs 14.2 months; P = .63). Conclusions: MCR was not associated with improved survival in malignant pleural mesothelioma. We need to clearly define MCR and identify subgroups of patients who would benefit from this principle because minimal versus extensive and location of gross residual disease may have different influences on survival.