Resit Dogan Koseoglu

Comparison of Adhesive Properties of Five Different Prosthetic Materials Used in Hernioplasty

This experimental study was designed to assess and to compare intra-abdominal adhesions following the use of five commercially available prosthetic mesh grafts in the repair if abdominal wall defects. Sixty Wistar albino rats were randomly divided into six groups (n = 10). A 2 × 1 cm defect at abdominal wall was created and defects were closed either primarily or with one of the following prosthetic mesh grafts: monofilament polypropylene, polytetrafluoroethylene, sodium hyaluronate/carboxymethylcellulose-coated polypropylene, polypropylene/polyglactin 910 composite, or resorbable hydrophilic collagen-coated multifiber polyester. The severity of adhesions was graded, tensile strengths of adhesions were measured, and histopathological grades of inflammation and fibrosis were evaluated. Polypropylene mesh resulted in more adhesion formation in comparison to primary repair and other grafts used in this study, except polypropylene/polyglactin 910 composite mesh. In addition, the highest tensile strength of omental adhesions was detected in the polypropylene group (χ2 = 26.249; p =. 0001). Polyester composite mesh caused the least adhesion formation among the groups. Sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polyester composite meshes revealed the highest fibrosis scores (χ2 = 50.776; p =. 0001). The highest inflammatory activity was detected in the polytetrafluoroethylene mesh group (χ2 = 16.564; p =. 005). Thus, sodium hyaluronate/carboxymethylcellulose-coated polypropylene and polytetrafluoroethylene meshes following polyester composite mesh were the minimal adhesion-forming grafts in this study. Disadvantages of the polytetrafluoroethylene mesh were lower fibrotic activity and higher inflammatory reaction to the graft.

An assessment of the effects of two types of bioresorbable barriers to prevent postoperative intra-abdominal adhesions in rats

PurposeThis study assessed and compared the efficacy of two types of bioresorbable membranes in the prevention of postoperative adhesion under clean contaminated and bacterial peritonitis conditions using a cecal ligation and puncture model in rats.MethodsWistar albino rats (n = 72) were divided into six groups. Bacterial peritonitis was induced using a cecal ligation and puncture model in groups 2, 4, and 6. Groups 1, 3, and 5 served as controls for clean contaminated procedures in the absence of bacterial peritonitis. Groups 1 and 2 were the untreated clean contaminated and bacterial peritonitis groups and served as controls for the effect of the bioresorbable membranes in each condition. In groups 3 and 4, a 1.5 × 3 cm USP glycerol/sodium hyaluronate/carboxymethylcellulose membrane was wrapped around the cecal resection area and a 2 × 4 cm membrane was left under the incision. The oxidized regenerated cellulose membrane was similarly applied in groups 5 and 6. Four weeks later, the adhesions were evaluated. In addition, fibrosis and inflammation were observed histopathologically.ResultsAdhesion development (P = .008), fibrosis (P = .008), and inflammation (P = .0001) differed among the groups. Both materials increased adhesion formation in the bacterial peritonitis condition. Increased fibrotic activity was detected in all material-applied groups under both conditions. In addition, more inflammation was detected in the groups that received the application of a material, especially in the presence of bacterial peritonitis.ConclusionNeither material prevented adhesions in clean contaminated conditions. Moreover, they increased adhesion formation in bacterial peritonitis.

Keratosis lichenoides chronica treated with acitretin plus narrowband ultraviolet B phototherapy

Dear Editor, A 19-year-old Caucasian male presented for evaluation of an 8-year history of a pruritic rash, localized on the face and extremities, and which was resistant to topical corticosteroids. The physical examination revealed symmetrical violaceous lichenoid keratotic papules on the upper and lower extremities which tended to display a reticulated, linear, and confluent pattern on the hands and feet. Rosacea-like papular lesions were also noted on the face (Figs 1,2). Laboratory studies, including complete blood count, hepatic and renal function tests, and urinalysis, were all within normal limits. Histopathological examination of a punch biopsy specimen revealed epidermal hyperplasia with irregular elongation of rete ridges, parakeratosis and orthokeratosis, as well as colloid bodies. The basal layer of the epidermis showed vacuolization and spongiosis. A band-like lymphocytic cell infiltration with a predilection for the dermal–epidermal junction, occasional melanophages and dilated lymphatic channels, were visualized in the upper dermis (Fig. 3). A diagnosis of keratosis lichenoides chronica (KLC) was established based on the clinical and histopathological features and oral acitretin (1 mg/kg/day) plus narrowband ultraviolet B (NB-UVB) treatment, thrice weekly, was initiated. Complete clearance of the facial lesions and regression of the lesions on the extremities were noted 2 months after treatment commenced (Fig. 1b). There was no recurrence of the lesions during a 12-month follow-up period. Also known as Nekam’s disease, KLC is a rare, progressive and chronic dermatosis of unknown etiology. KLC is a rare entity with approximately 60 cases reported in the published work. Clinically, the papular lesions of KLC are usually distributed symmetrically, with a linear or reticulate pattern, which is observed mainly on the extensor aspect of the extremities. Facial papular lesions may occasionally reveal a rosacea-like eruption. Because the lesions on the dorsum of the hands revealed a symmetrical, linear and reticular pattern; the clinical aspect of the facial papules was compatible with a rosacea-like pattern of KLC in our patient. Mucous membrane involvement is detected in 50% of cases. Palmoplantar keratoderma and nail changes, such as yellow discoloration, thickening, ridging of the nail plate and hyperkeratosis of the nail bed, may be observed in up to 30% of the patients. Such palmoplantar keratoderma and nail changes were not present in our patient. The characteristic histopathological features include irregular acanthosis or atrophic changes in the epidermis, local hyperkeratosis and parakeratosis, intraepidermal keratotic plugs, a band-like lichenoid infiltrate consisting of lymphocytes and histiocytes that obscures the dermal–epidermal junction in the upper dermis, colloid bodies and basal layer vacuolization. The course of the disease is chronic and progressive, extending over many years. Some lesions, however, may disappear spontaneously. Complete spontaneous remission is very rare and has been reported in only two cases. Improvement with natural sunlight is more common and the severity of cutaneous involvement in most patients improves during the summer months. The treatment of KLC is a matter of debate. Topical and systemic corticosteroids, anti-malarials, dapson, tetracycline, cyclosporine and methotrexate have been shown to be ineffective in most reported cases. Oral acitretin, isotretinoin, etretinate, psoralen and ultraviolet A (PUVA), retinoid PUVA and topical calcipotriol have been utilized with mixed results. In our patient, we achieved resolution of the pruritus,

Eccrine angiomatous hamartoma of the fingers with nail destruction

and fibrosis (with increased fibroblast chemotaxis, proliferation and collagen synthesis) in SSc and of fibrosis in sarcoidosis. Increased plasma, BAL and urine levels of endothelin-1 have been reported to be correlated with disease activity in patients with sarcoidosis. Our data indicate that sarcoidosis-related increased blood levels of endothelin-1 may have played a role in the deterioration of vascular clinical manifestations in our patient with lcSSc: following treatment, our patient concomitantly exhibited improvement of SSc-related vascular clinical manifestations and decreased plasma levels of endothelin-1. Finally, the present case also underscores that bosentan is a useful therapy in complicated Raynaud’s phenomenon (with digital ischaemic ulcers) in SSc, as our patient exhibited resolution of multiple fingertip ulcers after institution of bosentan therapy; our findings are in accordance with those of Korn et al. who found a 48% reduction in the mean number of new digital ulcers in patients under bosentan. Because our patient also showed improvement of sarcoidosis (as evidenced by PFT and CT scans of the lungs), we further suggest that bosentan may be useful in management of pulmonary sarcoidosis; although these data remain to be confirmed, this finding is of particular interest as high-dose corticosteroids (>15 mg daily) are not a safe therapy for sarcoidosis in SSc, and may result in increased risk of SSc-related onset of renal crisis. Several clinical trials are currently under way to evaluate the efficacy of bosentan in pulmonary fibrosis.

The effect of carvedilol on serum and tissue oxidative stress parameters in partial ureteral obstruction induced rat model

Although the pathological mechanism underlying kidney damage is not completely understood, it has been reported that reactive oxygen species (ROS) formed during ureteral obstruction may play an important role in this process. Carvedilol has been used in a limited number of studies examining oxidative injury. The aim of this study was to investigate the effect of carvedilol on serum and tissue oxidative stress parameters in the partial unilateral ureteral obstruction (PUUO)‐induced rat model. To our knowledge, the protective effects of carvedilol in the PUUO‐induced rat model have not been reported. Twenty‐six male Wistar albino rats, age 5.5 to 6 months and weighing 250 to 300 g, were used in this study. The rats were randomly divided into three groups. In Group 1 (n = 9), the control group, a sham operation was performed. In Group 2 (n = 8), the PUUO group, the left ureter was embedded into the psoas muscle to create PUUO and maintained for 7 days. In Group 3 (n = 9), carvedilol was orally administered to the rats (2 mg/kg). After the establishment of PUUO, carvedilol was given for the following 7 days. After partial unilateral ureteral obstruction, a nephrectomy was performed to determine the blood and tissue levels of superoxide dismutase (SOD), malondialdehyde (MDA), protein carbonyl (PC), and nitric oxide (NO). The median SOD, MDA, PC, and NO levels in the tissues were 0.006 U/mg protein, 5.11 nmol/g protein, 4.31 nmol/mg protein, and 0.337 μmol/g protein in the control group, respectively. There was a significant increase in tissue SOD (p = 0.014), MDA (p = 0.002), and NO (p = 0.004) levels in Group 2. However, a statistically significant difference was not observed in PC (p = 0.847) enzymatic activity in Group 2. When compared with Group 2, carvedilol treatment caused a reduction in NO (p = 0.003), and PC (p = 0.001) activities in Group 3. The serum SOD (p = 0.004), MDA (p = 0.043), PC (p = 0.043), and NO (p = 0.001) levels were significantly different in Group 3 compared with Group 2. Administration of carvedilol also reduced the detrimental histopathologic effects caused by PUUO. According to histopathological examination of the renal tissues, the inflammation rates were 22.2%, 87.5% and 33.3% in Groups 1, 2, and 3, respectively (p < 0.05). The results of the present study show that partial unilateral ureteral obstruction caused oxidative stress in the serum and kidney tissues of rats, and treatment with carvedilol reduced the harmful effects of ureteral obstruction.

Simvastatin improves spinal fusion in rats

OBJECTIVE Statins stimulate bone formation by inducing the expression of bone morphogenetic proteins (BMP-2). The aim of our study was to investigate the effects of orally administered simvastatin on spinal fusion in rats. METHODS Twenty rats were randomized into a spinal fusion group (SF) (n=10) or a spinal fusion and oral simvastatin administered group (SFS) (n=10). A spinal fusion was performed between L4-L6 representing two levels. Simvastatin (120 mg/kg/day) was administered orally in the SFS group. The rats were killed at the end of the 12 week study period. RESULTS Manual palpation revealed two moderate fusions in the SF group. The SFS group did not reveal any signs of pseudoarthrosis. An average three-point bending force causing failure of fusion revealed results of 148.80±39.403 Newtons and 123.80±28.479 Newtons in SFS and SF groups, respectively (p>0.05). Histological examination revealed better fusion grades in the SFS group (mean: 9.30±0.949) than in the SF group (mean: 6.80±2.044) (p=0.003). Radiographic examination revealed Grade C fusion in two levels and Grade A fusion in 18 levels in the SF group. In the SFS group, Grade C fusion was detected in one level and Grade A fusions in 19. CONCLUSION Our results suggest that simvastatin can promote spinal fusion and can be used as an adjunct to spinal fusion procedures in an elderly population with high cholesterol levels.

Expressions of p53, cyclinD1 and histopathological features in basal cell carcinomas

BACKGROUND We planned this study to analyze probable associations between p53, cyclinD1, Ki67 and histopathological features in basal cell carcinomas (BCC). METHODS Histological differentiation types, histological growth patterns and tissue responses were analyzed in 50 cases of BCC. In immunohistochemical analysis, p53, cyclinD1 and Ki67 antibodies were investigated. P53 expression was evaluated based on a cut-off value of 25% positivity. CyclinD1 expression was graded from 0 to 3+ according to the percentage of positive nuclear staining. The percentage of positively staining cells for Ki67 was recorded. RESULTS The following significant correlations were detected. Solid infiltrative type differentiation was related to the infiltrative histological growth pattern. The rates of p53 positivity and severe fibrosis in the groups of mixed and infiltrative growth patterns were higher than others. Besides, p53-positive cases showed more severe fibrosis and had a higher mean value for Ki67 index. Epidermal p53 and cyclinD1 clones in normal epidermal areas adjacent to tumors were noticed in 42% and 52% of the cases, respectively. CONCLUSIONS P53 expression seems to be related to Ki67 index and some histopathological features of BCC, such as infiltrative histological growth pattern and probably fibrosis.

Orbital metastasis of prostate cancer: a case report.

We report a case with metastatic orbital cancer secondary to prostatic adenocarcinoma. After initiation of total androgen blockade, the visual complaints, pain and periorbital swelling regressed dramatically within 2 months of treatment. However, the disease subsequently progressed and the patient died 12 months after diagnosis.

Osteoid Osteoma of the Trapezium: Case Report

Osteoid osteoma is a benign bone tumor representing approximately 10% of all benign bone tumors. Although osteoid osteoma of the long bones and carpus is frequent, the location in the trapezium is extremely rare. We found only one other report in the literature regarding osteoid osteoma of the trapezium.

Adenocarcinoma Originating from a Mature Teratoma of the Testis

Malignant transformation in testicular teratomas has been reported very rarely in the literature. Although testicular teratomas in childhood are regarded as benign neoplasms, these tumors, if left untreated until advanced ages, may present the risk of malignant transformation. We report a case of differentiated adenocarcinoma originating from colonic glands in primary testicular teratoma.