Serap S. Inalöz

The effect of urokinase in preventing the formation of epidural fibrosis and/or leptomeningeal arachnoiditis

BACKGROUND Epidural fibrosis and leptomeningeal adhesion formation are among the common causes of failed back surgery syndrome. Urokinase has been commonly used in treating aneurysmal subarachnoid hemorrhage and intracerebral hematoma. METHODS In a rat model, the potential of local urokinase in preventing the production of epidural fibrosis due to bleeding was investigated. RESULTS A reduction of approximately 48% in leptomeningeal adhesion formation with the use of urokinase was demonstrated. Adhesion score was 2.300 in the control group and 0.700 in the urokinase treated group on day 42 of the postoperative period. CONCLUSIONS It can be concluded that urokinase has the important effect of preventing the formation of leptomeningeal adhesion, but many more extensive studies clearly need to be done before such material can be clinically used.

Effect of Vitamin A against Methotrexate-Induced Damage to the Small Intestine in Rats

Objective: The aim of the present study was to examine whether or not the administration of vitamin A (VA) protects against methotrexate (MTX)-induced damage to small intestinal epithelium. Materials and Methods: Sixty-three male Wistar albino rats, 10–12 weeks old, weighing 240–280 g, were divided into three groups: (1) controls, (2) rats receiving MTX treatment alone, and (3) rats receiving MTX plus VA treatment. A single dose of MTX (20 mg/kg MTX in 20 ml vehicle) was administered to the rats intraperitoneally. For MTX plus VA treated groups, retinol palmitate (VA) 5,000 IU/kg dissolved in 0.5 ml sunflower oil was administered by intragastric tube 3 days prior to MTX treatment and continued till the rats were sacrificed. The control group was treated with vehicle. Both control and MTX-alone groups were also treated with sunflower oil as a placebo. The rats were sacrificed on the 2nd, 4th and 6th day after MTX treatment. Tissue samples from the jejunum were taken for histopathological analysis. Results: MTX treatment induced villus shortening and fusion, epithelial atrophy, crypt loss, inflammatory infiltrate in the lamina propria, and goblet cell depletion. The pre- and post-treatment administration of VA decreased the severity of jejunal damage caused by MTX treatment. Conclusion: Our results confirmed that administration of VA decreased the MTX-induced damage to the small intestine. This protective effect of VA may have clinical applications in cancer chemotherapy.

Comparison of microsuturing to the use of tissue adhesives in anastomosing sciatic nerve cuts in rats

The purpose of this study was to investigate and to compare the effects of microsuturing to that of tissue adhesives (Tisseel®) on the healing of anastomosing peripheral nerve incisions.Forty-five Wistar-Albino rats were placed in special cages and separated into three groups (n = 15). In the control group, biliteral sciatic nerves were explored but no incision was made. In the first experimental group, bilateral sciatic nerves were incised and end-to-end anastomosing was performed by microsuturing the epineurium. In the second experimental group, tissue adhesive (Tisseel®) was used alone in anastomosing the sciatic nerve cuts. Assessments of the healing processes were demonstrated by 1. electromyography (EMG), 2. measuring the electrical responses of the anastomosed nerves after electrical stimuli, 3. histopathological examination.Statistical analysis of the EMG findings showed that the Tisseel group was the closest in the healing process to the control group. After applying electrical stimuli to the dissected nerves, the resistance value of the Tisseel group was nearest to those of the control group. The histopathological examinations showed highly degenerative nervebundles and prominent foreign body granuloma at the anastomosed sites of the microsutured group. The granulomatous inflammation was observed to be much less in the Tisseel group.We conclude that the healing effect of Tisseel was found to be superior to that of microsmuring as demonstrated by the findings of EMG, electrical responses of the anastomosed nerves, and histopathological examination.

Congenital non-familial unilateral basaloid follicular hamartoma

Basaloid follicular hamartoma is not a well‐recognized clinical entity and has often been diagnosed as trichoepithelioma or basal cell carcinoma. It is a unique benign follicular tumour which comprises a variety of clinical manifestations. We present the case of a 24‐year‐old male with unilateral basaloid follicular hamartoma present at birth and later misdiagnosed as basal cell carcinoma. Histological features of basaloid follicular hamartoma are not always diagnostic and clinico‐pathological correlation is particularly important to distinguish this benign hamartoma from other basaloid tumours including basal cell carcinoma. Continuous follow‐up of our patient did not reveal any clinical or histological malignant transformation.

Atypical familial Papillon-Lefèvre syndrome.

The Papillon–Lefèvre syndrome is a rare autosomal recessive disorder. Consanguinity seems a notable prerequisite. Papillon–Lefèvre syndrome manifests in the first 6 months of life with rapidly progressive periodontitis and severe alveolar bone destruction leading to early loss of both the deciduous and permanent teeth in association with palmo‐plantar hyperkeratosis. We present two unusual cases of familial Papillon–Lefèvre syndrome, one of whom has only late onset of mild skin lesions and the other has severe skin lesions and relatively mild periodontal disease. A number of other cases recently described have also had atypical features.

Coexistence of tumor of the follicular infundibulum with an unusual trichilemmal tumor.

Tumor of the follicular infundibulum (TFI) is a rare epithelial tumor, and its histogenesis is still somewhat debatable. The diagnosis of TFI cannot currently be made before biopsy, and it is most often misdiagnosed as basal cell carcinoma (BCC). A 78-year-old woman presented to the dermatology clinic with a slightly erythematous nodule surrounded by fine telangiectasia on her right temple. Histopathologic examination of the lesion revealed an epithelial tumor with a plate-like growth pattern as is typical of TFI. In the same specimen, an unusual trichilemmal tumor with multiple epidermal connections was observed adjacent to the foci of TFI. The lobular tumor was composed of a large mass of keratinocytes with pale cytoplasm arranged as sheets and interconnecting ribbons. Several cells with hyperchromatic nuclei and small foci of compact cornification were also noted within the bulk of the tumor. The histopathologic features of the unusual tumor were reminiscent of BCC with trichilemmal differentiation or desmoplastic trichilemmoma.

Coexistence of chronic discoid lupus erythematosus and sensorineural deafness

To the Editor: Lupus erythematosus (LE) is a multisystem disorder with a spectrum from relatively benign, self-limited, cutaneous, discoid-like eruption (DLE) to severe systemic disease (SLE) [I]. Discoid lupus erythematosus lesions are mostly localised on the neck or head, or both in chronic cases. Widespread DLE is a very rare disorder; when it occurs with systemic manifestations it is called DLE-SLE subset. We present a rare case of solely localised DLE coexisting with sensorineural deafness. A 27-year-old woman was diagnosed as having DLE of 8 years duration with a butterfly type rash mainly on the nose, malar region and forehead which was aggravated by the sun. The lesion was characterised by a scaly, erythematous, telangiectatic, patchy atrophic rash having with follicular plugging (Fig. 1). Clinical diagnosis of DLE was confirmed by histopathology. Laboratory investigations revealed no major abnormality. Topical steroids with sunscreens were tried without success. Her con-