Seyma Ozkanli

The relation of matrix metalloproteinase 1, 2, 3 expressions with clinical and radiological findings in primary and recurrent lumbar disc herniations.

AIM In this study, our aim was to examine if matrix metalloproteinase expressions (MMP-1, MMP-2, MMP-3) in patients operated with a lumbar disc hernia diagnosis are different in terms of clinical and neuroradiological findings. MATERIAL AND METHODS The study included 80 patients treated with micro discectomy for lumbar disc hernia. Degeneration was scored via magnetic resonance (MR) images. MMP-1, MMP-2, and MMP-3 antibodies were used for immunohistochemical evaluation of degenerated disc materials. MMP expressions were compared between primary and recurrent cases, and correlation analysis was conducted. RESULTS Discectomy material showed higher expression of MMP-1 and MMP-3 in cases of recurrent lumbar disc herniation than in primary herniation. There was no significant relationship between MMP expression and MR degeneration score. CONCLUSION MMP-1 and MMP-3 expressions were significantly higher in recurrent cases in terms of magnetic resonance degeneration score. We assume that the higher co-expression of MMP-1 and MMP-3 might be used in targeted treatment regiemens in patients with recurrent LDH.

The cutoff level of free/total prostate specific antigen (f/t PSA) ratios in the diagnosis of prostate cancer: A validation study on a Turkish patient population in different age categories

We investigated an optimal cutoff level of free/total PSA ratios (f/t PSA) in predicting prostate cancer in different age groups, focusing on the avoidance of unnecessary prostate biopsies. A total of 4955 men were enrolled into the study. Serum tPSA, fPSA, and f/t PSA ratios were determined for the study population. All males who had suspicious digital rectal examination and tPSA > 4 ng/mL underwent transrectal ultrasonography‐guided prostate biopsy. Receiver operating characteristic (ROC) curves for each group were generated by plotting the sensitivity versus 1‐specificity for the f/t PSA ratio. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were obtained using various f/t PSA ratio cutoffs for different age groups. There were 657 patients with a PSA level of 4–10 ng/mL. According to sensitivity and specificity f/t% PSA cutoff points were determined to be 10%, 15%, 15%, and 10% in 50–59 years, 60–69 years, >70 years, and all ages categories, respectively, in patients with initial PSA level of 4–10 ng/mL. f/t PSA ratio had an area under the curve (AUC) value of 0.81 (95% confidence level: 0.80–0.82) for all age groups in detecting prostate cancer. f/t PSA ratio has an AUC value of 0.669 (0.632–0.705) in detecting prostate cancer among patients with a PSA level of 4–10 ng/mL. Ten percent of f/t PSA ratio had the highest specificity with PLR and 30% f/t PSA ratio had the highest sensitivity with lower NLR in the all‐age categories. The current study shows that the use of f/t PSA ratio in patients with PSA levels of 4–10 ng/mL should enhance the specificity of PSA screening and decrease the number of unnecessary biopsies. The age‐related changes warrant further investigation in a large, multicentric, and multinational population to improve the clinical use of f/t PSA cutoffs.

The protective effects of tadalafil on renal damage following ischemia reperfusion injury in rats

Ischemia‐reperfusion injury can cause renal damage, and phosphodiesterase inhibitors are reported to regulate antioxidant activity. We investigated the prevention of renal damage using tadalafil after renal ischemia reperfusion (I/R) injury in rats. A total of 21 adult male Wistar albino rats were randomly divided into three groups of seven, including Group 1‐control, Group 2‐I/R, and Group 3‐tadalafil + I/R group (I/R‐T group) received tadalafil intraperitoneally at 30 minutes before ischemia. Inducible nitric oxide synthase, endothelial nitric oxide synthase, malondialdehyde, and total antioxidant capacity levels were evaluated, and histopathological changes and apoptosis in the groups were examined. Tadalafil decreased malondialdehyde levels in the I/R group and increased the total antioxidant capacity level. Histopathological and immunohistochemical findings revealed that tadalafil decreased renal injury scores and the ratios of injured cells, as measured through apoptotic protease activating factor 1, inducible nitric oxide synthase, and endothelial nitric oxide synthase levels. We suggest that tadalafil has protective effects against I/R‐related renal tissue injury.

Erythrodermic pityriasis rubra pilaris: Dramatic response to infliximab therapy

Pityriasis rubra pilaris is a chronic papulo-squamous skin disorder characterized by skin and nail involvement.[1] The exact etiology is unknown. Vitamin A deficiency, infections, trauma and impaired immune responses are among the suggested causes.[2] A variety of topical and systemic treatment options are available.[3] This case is reported due to a dramatic response obtained with infliximab therapy, when various other systemic medications failed to produce a therapeutic response.

Osseous Metaplasia and Bone Marrow Elements in a Case of Renal Cell Carcinoma

Renal cell carcinoma with osseous metaplasia and bone marrow elements is a relatively rare event in these tumors. We discuss pathological differential diagnosis for this tumor with a review of the literature on this unusual case.

Evaluation of Crohn’s disease activity by MR enterography: Derivation and histopathological comparison of an MR-based activity index

AIMS To compose a qualitative magnetic resonance imaging (MRI) activity index showing Crohn disease (CD) activity, and to compare magnetic resonance enterography (MRE) findings with histopathology results. MATERIALS AND METHODS Twenty-six patients (11 male and 15 female; mean age 36.7) who had MRE and colonoscopic biopsy between October 2011 and August 2012 were included in the study. On MRE the following parameters were evaluated: bowel wall thickness, bowel wall T2 signal, bowel wall contrast enhancement pattern and degree, length and number of involved bowel segments, perimural T2 signal, mesenteric inflammation, mesenteric lymph nodes and complications of CD. Each parameter was scored to calculate MRI activity index. Biopsy specimens were retrospectively evaluated, histopathologic and endoscopic acute inflammmation scores (AIS, eAIS) were calculated. Each parameter and total MRI activity index were compared with the pathology scores (AIS, eAIS) by Mann-Whitney U test and Spearman correlation. RESULTS Statistically significant positive correlation was found between AIS and eAIS, mural thickness and eAIS. Moderate correlation was found between MRI activity index and eAIS, mural enhancement degree and eAIS; and poor correlation was found between mesenteric inflammation score and eAIS, MRI activity index and AIS, however they were not statistically significant. CONCLUSIONS In CD, bowel wall thickness measured by MRE is best correlated with the histopathologic results which are accepted as the reference standard. In cases with high MRI activity index, eAIS is also generally high. MRI activity index which is measured simply and noninvasively can be used in the follow up of CD.

The co-occurrence of lichen sclerosus et atrophicus and celiac disease

A 53-year-old female patient was admitted to our clinic for generalized hypo/hyper-pigmented, partially firm and sclerotic plaques with undefined borders. As the skin biopsy taken from the lesion was compatible with lichen sclerosus et atrophicus (LSA), the patient was treated with ultraviolet A1 (UVA1) treatment. Upon follow-up, she developed abdominal pain and diarrhea. Further investigation (including endoscopic and laboratory tests) showed signs consistent with celiac disease. After 30 sessions of UVA1 treatment, the skin lesions partially regressed. We present this case because the co-occurrence of LSA and celiac disease is very rare.

Correlation of matrix metalloproteinase (MMP)-1, -2, -3, and -9 expressions with demographic and radiological features in primary lumbar intervertebral disc disease

Degeneration of IVD is a progressive and irreversible process and can be evaluated with immunohistochemical examination or radiological grading. MMPs are a family of proteolytic enzymes and involved in the degradation of the matrix components of the IVD. We aimed to compare MMP-1, -2, -3, and -9 expressions with demographic features, visual analogue scale (VAS), Oswestry Disability Index (ODI) and radiological (MRI) grades. The study involved 60 participants. We recorded data about age, complaint, radiological imaging, expression levels of MMP-1, -2, -3, and -9, ODI and VAS for back pain retrospectively. Intervertebral disc degeneration was graded on a 0-5 scale according to the Pfirrmann classification. As a result of the study, the median age was 52.09±12.74years. There were statistical significances between age and MMP-1, and MMP-2. There was a close correlation between grade and MMP-9. We found correlation between the VAS and the MMP-9 expression. In addition, there was relationship between expression of MMP-2 and MMP-1, MMP-3, MMP-9. In conclusion, the expressions of MMP-1 and -2 are increased with aging. There was no relationship between radiological evaluation of IVDD and aging. Increased expression of MMPs affected IVDD positively. The relationship with MMPs is not explained. This study adds to our understanding of the interaction between MMPs and IVDD.

Comparison of TLR-2, TLR-4, and antimicrobial peptide levels in different lesions of acne vulgaris.

Abstract Context: Recent studies have shown that tolls like receptors (TLRs) and antimicrobial peptides (hBD-1, cathelicidin) play an important role in the pathogenesis of acne vulgaris (AV). Objective: To evaluate and report the expression of TLR-2, TLR-4, hBD-1 and cathelicidin in different regions of skin in AV. Participants: This study was performed in 80 patients with AV and a control group of 20 healthy individuals. Material and methods: Skin biopsies were performed from 20 papular, 20 pustular, 20 comedonal and 20 nodular lesions of patients and 20 healthy volunteers. Expression levels of TLR-2, TLR-4, hBD-1 and cathelicidin in four separate areas (epidermis, dermis, inflammation region and skin appendages) were evaluated by immunohistochemical method. Further, these parameters were compared between different skin lesions. Results: A significant difference was found between the levels of staining of TLR-2, TLR-4 and hBD-1 from the epidermis, inflammation region, dermis and skin appendages (p < 0.05). Levels of cathelicidin were different in only the inflammation region (p < 0.05). The level of TLR-2 in the epidermis with nodules was lower than the papules and comedones (p < 0.05). Levels of TLR-2 in the inflammation and dermis of the cases with papules were significantly higher when compared to pustules (p < 0.05). The levels of staining of TLR-4 in the dermis with comedones were significantly lower compared to the cases with papules (p < 005). The level of hBD-1 in the epidermis region of comedones was significantly higher compared to nodules (p < 0.05). The expression of cathelicidin in the inflammation region of comedones was significantly low (p < 0.05). Conclusion: It is thought that TLR-2, TLR-4, hBD-1 and cathelicidin play an important role in the pathogenesis of AV and in the development of different acne types. We think that, better results could be obtained in treatment of AV with different treatment options targeted in regulation of TLR-2, TLR-4, hBD-1 and cathelicidin release.

Periorbital discoid lupus: a rare localization in a patient with systemic lupus erythematosus

A 40-year-old female patient with a 5-year history of systemic lupus erythematosus was referred to our policlinic with complaints of erythema, atrophy, and telangiectasia on the upper eyelids for 8 months. No associated mucocutaneous lesion was present. Biopsy taken by our ophthalmology department revealed discoid lupus erythematosus. Topical tacrolimus was augmented to the systemic therapeutic regimen of the patient, which consisted of continuous antimalarial treatment and intermittent corticosteroid drugs. We observed no remission in spite of the 6-month supervised therapy. Periorbital discoid lupus erythematosus is very unusual and should be considered in the differential diagnosis of erythematous lesions of the periorbital area..