Yamaç Erhan

Comparison of three methods in surgical treatment of pilonidal disease

Background: The present study was designed to compare three methods that are still used for the surgical treatment of pilonidal disease: marsupialization, primary midline closure and skin flaps.

Effects of levosimendan and dobutamine on experimental acute lung injury in rats

The effects of levosimendan on acute lung injury induced by peritonitis and abdominal hypertension in the early stages of sepsis in rats were investigated. Twenty-four adult male Wistar rats were randomized into: (1) sham, (2) subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture, then treated by dobutamine, (3) subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture, then treated by levosimendan, and (4) controls subjected to abdominal hypertension and peritonitis induced lung injury using cecal ligation and puncture with no treatment. In the control and levosimendan groups, cecal ligation and puncture resulted in moderate IL-1beta immunolabelling in lung tissue; marked IL-1beta immunolabelling was demonstrated in the dobutamine group. TNF-alpha immunolabelling was negative in both the sham and levosimendan groups, but moderate and weak immunoreactivities were observed in the dobutamine and control groups, respectively. There were almost no TUNEL positive cells in the sham, but they were prominent in the control. TUNEL positive cells were significantly less in the levosimendan treated lungs when compared to control and dobutamine groups. Immunoreactivity of eNOS was stronger in the dobutamine group when compared with the levosimendan group. In addition, iNOS immunoreactivity was strongly detected in the control group; this immunoreactivity was less in the levosimendan group than the dobutamine group. In this experimental sepsis model, treatment with levosimendan had a marked effect on attenuating or decreasing apoptosis and inflammation in the lung.

p53 and Ki‐67 Expression as Prognostic Factors in Cystosarcoma Phyllodes

We have reviewed the histopathological, clinical outcome and immunohistochemical status in 21 women with cystosarcoma phyllodes (CSP) tumors of the breast. We assessed 12 tumors as histopathologically benign and 9 tumors as malignant. The median patient ages in benign and malignant CSP tumors were 39.6 and 45.4 years of age, respectively. The stromal cellularity, stromal cellular atypism, high mitotic activity, atypic mitoses, stromal overgrowth, infiltrative tumor contour, and heterologous stromal elements were significant features of the malignant CSP tumors. Benign CSP tumors were predominantly of fibroadenomatous architecture with cellular stroma (mild or moderate) and some distortion and elongation of glandular elements. Five malignant CSP tumors were stained positively with p53, and 6 malignant CSP tumors were stained immunohistochemically with Ki‐67. All benign CSP tumors were negatively stained for p53 and Ki‐67. The patients with benign CSP tumors were treated with local excision (n = 11) and with subcutaneous mastectomy (n = 1). Malignant CSP tumors were treated with wide local excision (n = 1), partial mastectomy (n = 1), simple mastectomy (n = 2), and modified radical mastectomy (n = 5). Two patients with a high mitotic rate and high values of p53 and Ki‐67 received additional radiotherapy and chemotherapy. One case had liver metastasis. This tumor had high mitotic figures, stromal overgrowth, severe stromal cellularity, and 20% Ki‐67 and mild p53 positivity. We suggest that p53 and Ki‐67 can play an important role in predicting prognosis and yielding additional therapy besides conventional prognostic factors in the treatment of the CSP patients.

A Case of Large Mucinous Adenocarcinoma Arising in a Long-Standing Fistula-in-Ano

Background: Chronic anal fistulas are not rare conditions, however, the development of a carcinoma in a long-standing fistula-in-ano is rare. Methods: The case of a 77-year-old male with a large perianal mucinous adenocarcinoma arising in a long-standing fistula-in-ano is presented. Results: Perianal biopsy revealed mucinous adenocarcinoma. Abdominal CT, double contrast barium examination and flexible sigmoidoscopy revealed no other tumoral lesion in the colon and rectum. Conclusion: The patient underwent abdominoperineal resection including wide tumor excision on the gluteal region. The final reconstruction was performed by bilateral gracilis musculocutaneous flaps. Due to clinical and histopathological evidence it was thought that a curative resection had been performed. To date he is clinically disease free.

Effects of ocreotide on intestinal mucosa in rats with portal hypertensive enteropathy.

To clarify the effects of long-term ocreotide (a long-acting somatostatin analogue) treatment on mucosal changes in a rat model of portal hypertensive enteropathy, groups of male Swiss albino rats (n=15 each) were randomly assigned to one of three treatment arms. These were: sham laparotomy+twice daily subcutaneous saline 0.5 mL (Group 1); portal hypertension induction+twice daily subcutaneous saline 0.5 mL (Group 2); and portal hypertension induction+subcutaneous ocreotide 100 microg/kg/12h (Group 3). After 12 weeks of treatment, jejunal and ileal tissue specimens were obtained and evaluated histopathologically (villus/crypt ratio, mean diameter of dilated vessels, mucosal edema, and fibromuscular proliferation in the lamina propria) and immunohistochemically (vascular endothelial growth factor (VEGF), von Willebrand factor (F8), and cluster of differentiation 34 (CD34) labelling). In jejunal specimens, the villus/crypt ratio was markedly lower in Group 2 (2.38+/-0.46 microm) than in Group 1 (5.07+/-2.25 microm) or Group 3 (4.97+/-2.19 microm); mean diameter of dilated vessels was markedly higher in Group 2 (43.30+/-5.71 microm) than in Group 1 (33.53+/-4.00 microm) or Group 3 (36.76+/-3.96 microm); mucosal edema and fibromuscular proliferation were universally absent in Group 1 when compared with the other groups. There were statistically significant differences (p<0.05) between Groups 1 and 2 for villus/crypt ratio, mean diameter of dilated vessels, VEGF immunolabelling intensity, and CD34 immunolabelling intensity; between Groups 1 and 3 for mean diameter of dilated vessels, VEGF immunolabelling intensity, and CD34 immunolabelling intensity; and between Groups 2 and 3 for villus/crypt ratio, mean diameter of dilated vessels, and VEGF immunolabelling intensity. In ileal tissue specimens, the villus/crypt ratio was markedly lower in Group 2 (5.51+/-0.67 microm) than in either Group 1 (7.19+/-2.18 microm) or Group 3 (7.62+/-2.58 microm); mean diameter of dilated vessels was markedly higher in Group 2 (46.36+/-4.77 microm) than in either Group 1 (36.43+/-4.57 microm) or Group 3 (41.31+/-4.70 microm); while mucosal edema was absent in Group 1, it was present in Group 2 and Group 3; and fibromuscular proliferation was universally absent. There were statistically significant differences (p<0.05) between Groups 1 and 2 for villus/crypt ratio and mean diameter of dilated vessels; between Groups 1 and 3 for mean diameter of dilated vessels; and between Groups 2 and 3 for villus/crypt ratio, mean diameter of dilated vessels, and VEGF immunolabelling intensity. Together, these findings indicate that ocreotide treatment ameliorates histomorphological changes in a rat model of portal hypertensive enteropathy.

Double acute appendicitis in appendical duplication.

Duplication of the vermiform appendix is a rare congenital abnormality and usually found incidentally during laparotomy. The Modified Cave-Wallbridge classification is used to describe the location of the appendixes in relation to each other and to the cecum as well as the extent of the duplication. We report a 45-year-old patient who underwent laparotomy for acute abdominal pain. The operative finding was double acute appendicitis in appendical duplication. The appendixes were removed separately, as it was type B duplication. Since appendectomy is the most common abdominal operation, all surgeons should keep this rare clinical entity in mind.

445 CHRONIC PAIN AFTER LICHTENSTEIN AND POSTERIOR MESH HERNIA REPAIR

Complex regional pain syndrome (CRPS) is characterized by diffuse pain, swelling, vasomotor instability, trophic changes and severe functional impairment of the affected extremity. About 75% of the patients with CRPS have spontaneous pain with hyperalgesia or allodynia. In this report we present a case having CRPS type-I but without any pain and hyperalgesia or allodynia. The subject was a 57 years old female patient who had a distal radius fracture after a fall. Her wrist was immobilized in a cast for six weeks and afterwards she was referred to our department for physical therapy. She had complaints such as; swelling, hyperhidrosis, restriction of finger and wrist movements and tremor in her injured hand but she had no pain. Our examination confirmed restriction of wrist and finger movements, hyperhidrosis, and tremor and also her hand was warm and swollen. But there was no allodynia and hyperalgesia. The patient did not report any pain at the follow-up controls, assessed by visual analog scale. Zyluk scoring system was used for diagnosis and clinical severity of CRPS type-I. Patient was treated with successfully with physical therapy and she did not develop pain during follow-up. Some patients with CRPS type-1 may have no pain in spite of severe sudomotor, vasomotor and motor signs and symptoms. In the literature there are few articles reporting CRPS with no pain and all of them were in lower extremities. It should be noted that CRPS type-I with no pain can also occur in upper extremities.

Two different extramammary neoplasms metastatic to the breast.

Metastatic tumors in the breast are quite rare. In large studies they have been reported to constitute 0.4% - 2.0% of all breast malignancies. Mammary metastases as the first manifestation of extramammary malignant disease are even more rare. Aside from hematopoetic and lymphoreticular malignancies such as lymphoma and leukemia the three most common tumors metastasizing to the breast are malignant melanoma lung cancer and prostatic carcinoma. (excerpt)

DIAGNOSTIC RELIABILITY OF COMBINED APPROACH OF PHYSICAL EXAMINATION, MAMMOGRAPHY AND FINE-NEEDLE ASPIRATION BIOPSY IN PATIENTS WITH BREAST CANCER

Breast cancer is a common malignancy in females. For that reason the disease has to be suspected when one encounters a solid mass in the breast. Until recently in order to find out the actual nature of the lump both excisional biopsy and histopathologic examination were thought to be essential. Nowadays fine-needle aspiration biopsy (FNAB) is performed to evaluate the solid mass in the breast and by using this technique individual characteristics of each cell can lead to diagnosis. But it is reported that erroneous diagnosis is more common with FNAB than with excisional biopsy and histopathologic examination. Despite the recent advances in diagnostic techniques physical examination is still the first step in breast cancer diagnosis and it is the most widely used method. Mammography and FNAB should follow. However the accuracy rate of mammography alone is especially low for the evaluation of small masses. Therefore FNAB has become of use as an important adjunctive diagnostic procedure and it is used along with physical and mammographic examinations. Some authors report that the rate of correct diagnosis rises sometimes up to 100% when these three methods are applied together. The aim of the present study is to detect the diagnostic reliability of a combined approach with physical examination mammography and FNAB in patients with breast cancer. (excerpt)