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A Retrospective Evaluation of the Epithelial Changes/Lesions and Neoplasms of the Gallbladder in Turkey and a Review of the Existing Sampling Methods: A Multicentre Study
No full textObjective: As there is continuing disagreement among the observers on the differential diagnosis between the epithelial changes/lesions and neoplasms of the gallbladder, this multicentre study was planned in order to assess the rate of the epithelial gallbladder lesions in Turkey and to propose microscopy and macroscopy protocols.
Material and Method: With the participation of 22 institutions around Turkey that were included in the Hepato-Pancreato-Biliary Study Group, 89,324 cholecystectomy specimens sampled from 2003 to 2016 were retrospectively evaluated. The numbers of adenocarcinomas, dysplasias, intracholecystic neoplasms/adenomas, intestinal metaplasias and reactive atypia were identified with the review of pathology reports and the regional and countrywide incidence rates were presented in percentages.
Results: Epithelial changes/lesions were reported in 6% of cholecystectomy materials. Of these epithelial lesions, 7% were reported as adenocarcinoma, 0.9% as high-grade dysplasia, 4% as low-grade dysplasia, 7.8% as reactive/regenerative atypia, 1.7% as neoplastic polyp, and 15.6% as intestinal metaplasia. The remaining lesions (63%) primarily included non-neoplastic polypoids/hyperplastic lesions and antral/pyloric metaplasia. There were also differences between pathology laboratories.
Conclusion: The major causes of the difference in reporting these epithelial changes/lesions and neoplasms include the differences related to the institute's oncological surgery frequency, sampling protocols, geographical dissimilarities, and differences in the diagnoses/interpretations of the pathologists. It seems that the diagnosis may change if new sections are taken from the specimen when any epithelial abnormality is seen during microscopic examination of the cholecystectomy materials
A novel mutation c.2010delG of CLCN5 gene associated with Dent disease-1 in an 11-year-old male with nephrolithiasis and nephrocalcinosis
No full textDent's disease-1 (CLCN5 gene) is a rare X-linked recessive tubulopathy characterized by low molecular weight proteinuria, hypercalciuria, nephrolcalcinosis or nephrolithiasis, proximal tubular dysfunction and renal failure in adulthood. Females are carriers and usually mildly affected. We present an 11-year-old child with nephrocalcinosis and nephrolithiasis with c.2010delG (or p.Asp671fs) mutation in CLCN5 gene which had not previously been reported in the Dent's disease-1. © 2018 National Academy of Pediatric Science and Innovation. All rights reserved
Perivascular epithelioid cell tumor outgrowth from the liver
No full textINTRODUCTION: Perivascular epithelioid celltumor (PEComa) is a rare mesenchymal neoplasia and can be found in various body sites. On the other hand, hepatic PEComa is very rare, with only a few studies having reported hepatic malignant PEComa. There is no gold standard regarding the use of diagnostic imaging studies. The diagnosis of hepatic PEComa is made by a positive immunohistochemical staining for HMB45 and Melan A. Herein, we discussed the therapeutic and follow-up process of a symptomatic hepatic PEComa case.
PRESENTATION OF CASE: A 22-year-old woman presented with a palpable mass in abdomen. A computerized tomographic examination showed a giant hepatic mass of left lobe origin, which was excised surgically. The pathology result was reported as a PEComa.
DISCUSSION: The diagnostic approach, treatment modalities, and follow-up procedures are not standard. The main treatment modality for PEComa is surgical excision with adequate surgical margin.
CONCLUSION: A longer follow-up is required for patients with hepatic PEComa because the nature of the disease is not entirely clear. (C) 2018 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd
Neuronal regeneration in injured rat spinal cord after human dental pulp derived neural crest stem cell transplantation
No full textOBJECTIVE: This study aimed to analyze the effect of human Dental Pulp-Neural Crest Stem Cells (hDP-NCSCs) delivery on lesion site after spinal cord injury (SCI), and to observe the functional recovery after transplantation.
METHODS: Neural Crest Stem Cells (NCSCs) were isolated from human Dental Pulp (hDP). The experimental rat population was divided into four groups (n = 6/24). Their behavioral motility was scored regularly. After 4-weeks, rats were sacrificed, and their spinal cords were examined for Green Fluorescent Protein (GFP) labeled hDP-NCSCs by immunofluorescence (IF) staining.
RESULTS: In early post-injury (p.i) period, the ultrastructure of spinal cord tissue was preserved in Group 4. The majority of cells forming the ependymal region around the central canal were found to be hDP-NCSCs. While the grey-and-white-matter around the ependymal region was composed of e.g. GFP cells, with astrocytic-like appearance. The scores showed significant motor recovery in hind limb functions in Group 4. However, no obvious change was observed in other groups. C
ONCLUSION: Cells e.g., mesenchymal (Vimentin+) which express GFP+ cells in the gray-and-white-matter around the ependymal region could indicate the potential to self-renewal and plasticity. Thus, transplantation of hDP-NCSCs might be an effective strategy to improve functional recovery following spinal cord trauma (Fig. 10, Ref. 32). Text in PDF www.elis.sk
Prevalence of Anal Incontinence and Constipation in Female Patients with Urinary Incontinence
No full textObjective: To investigate the prevalence of anal incontinence and constipation in patients with urinary incontinence.
Materials and Methods: Adult female patients who presented with the complaint of urinary incontinence were evaluated with anal incontinence and constipation assessment survey prepared on the basis of "the International Consultation on Incontinence Questionnaire-Short Form", "the Overactive Bladder 8-Question Awareness Tool" and "the Rome 3" criteria.
Results: Two hundred female patients with urinary incontinence were evaluated. The patients were in the age group of 18-88 with the average age of 55.24 +/- 16.86 standard deviation. Stress incontinence was present in 19.5%, urge incontinence in 36% and mixed incontinence in 44.5% of the subjects. Seventy-seven percent of patients presented with flatal incontinence, 7.5% with fecal incontinence and 52.5% presented with constipation. There was no difference between sub-groups created according to age groups and types of urinary incontinence in terms of frequency of gastrointestinal symptoms. The incidence of constipation was statistically significantly higher in patients presenting with findings of urinary incontinence for more than 1 year and in those with overactive bladder (p< 0.01 and p< 0.001, respectively).
Conclusion: Flatal incontinence was found in 77%, fecal incontinence in 7.5% and constipation in 52.2% of female adult patients with urinary incontinence. The incidence of constipation was higher at the level of statistical significance in patients presenting with findings of urinary incontinence for more than 1 year and in those with overactive bladder
Clinicohistopathological features and treatment outcomes of neuroendocrine tumors: a single center experience
No full textPurpose: Tumor and patient characteristics of neuroendocrine tumors (NET) significantly change between geographical locations that probably induced by environmental and genetic factors throughout the world. Therefore, reporting single center experience may help clarifying epidemiological view and improving decision-making process.
Materials and Methods: We performed retrospective analysis of 115 patients of NETs those who followed by Baskent University, department of Medical Oncology and department of General Surgery to record patients and tumors characteristics, treatment modalities, survival rates, and prognostic factors.
Results: Median overall survival (OS) time for all group and localized NETs were 44 and 24 months, respectively. Most common primary site was found as gastrointestinal system and then pancreatic region. Curative surgical resection rate was 46% and 8.5% of patients presented with carcinoid syndrome. Liver metastasis was far the most common metastatic site compared to lung, bone, and lymph node metastasis. Over 70 percent of patients were treated with chemotherapy and somatostatin analogs.
Conclusion: Patients with higher grade, male gender, and advanced age (>65 years old) had poor survival rate. However, relatively low number of patients and less usage of (<10%) of new treatment modalities created limitations for producing future directions from our study
Evaluating clonidine response in children and adolescents with attention-deficit/hyperactivity disorder
No full textAttention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood, which is generally treated with stimulant and non-stimulant medications. However, 10-30% of patients in clinical setting do not present with adequate response to initial stimulant treatment. Thereby, clonidine may be considered for those patients who have failed to respond to psychostimulant/atomoxetine monotherapy or as an augmentation for inadequate response/comorbidity. This observational study evaluated its effectiveness as a single drug in ADHD cases unresponsive to previous treatment trials. Seventeen ADHD cases that were non-responders to stimulant, non-stimulant and combination therapy for the primary symptoms of ADHD were included in the study. Four cases dropped out before follow up, leaving thirteen cases who were administered immediate release clonidine treatment alone with a mean dose of 0.2 +/- 0.05 mg/day at baseline. The trial lasted for 12 weeks, and treatment outcomes were evaluated by the Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S) and the Clinical Global Impressions-Severity (CGI-S) and Improvement (CGI-I) scales. Mean age of the sample was 12.5 years (SD = 3.0) and eleven of the subjects had another comorbid psychopathology. Only two cases were evaluated as "very much improved", while another patient was judged to be "minimally improved" after 12 weeks of clonidine treatment. Attrition during follow-up was associated with higher median scores on the hyperactivity and impulsivity subscales (Mann-Whitney U test, p = 0.02). According to the T-DSM-IV-S, CGI-S, and CGI-I scales, clonidine treatment by itself had minimal benefits in this sample of treatment of refractory cases with ADHD evaluated at the study center. Clonidine is not available in Turkey pharmaceutical marketing system and patients' access to drug is limited. Our results provide first data regarding the use of clonidine in Turkish ADHD patients
Early Life Markers to Predict the Risk for Frequent Wheezing in Infants; Going on a Mysterious Road with an Old Friend, "The Eosinophil"
No full textObjective: In most cases of asthma, wheezing symptoms start in early childhood. Although there are studies evaluating the factors that play a role in the development of childhood asthma, the predictive markers for frequent wheezing in early childhood are still unclear. The aim of our study was to investigate the relation between the wheezing episodes and the familial, prenatal, and postnatal risk factors, and the sensitivity of serum eosinophilic cationic protein (ECP) and eosinophil levels for predicting frequent wheezing.
Materials and Methods: Fifty-seven children with acute wheezing and fifty healthy children aged between 1-36 months were included in the study. The children who had >= 3 episodes of wheezing in the next year after presentation were classified as the frequent wheezing group and those with fewer episodes were classified as the infrequent wheezing group. Administration of a comprehensive questionnaire about risk factors for wheezing; blood sampling for serum total IgE, ECP, eosinophil count, food and inhaled specific IgE levels and RSV/adenovirus serology; and skin prick tests were performed. Oral provocation tests were applied in cases of suspected food allergy.
Results: Male gender (p=0.024), low socioeconomic level (p=0.046), initiation of milk formula (p=0.009) and eggs (p=0.018) before the fourth month, the presence of mold / umidity at home (p=0.023), eczema (p= 7.9 mu g/L at enrollment had higher risk of frequent wheezing than those with serum ECP 7.9 mu g/L (p=0.008). The sensitivity of ECP >= 7.9 mu g/L for frequent wheezing was 75.9% and the specificity was 68.7%. Similarly, serum total IgE (>= 154 IU/ml) and total eosinophil count (>= 390 /mm3) were found to be significantly higher in infants in the frequent wheezing group than the other groups (p=0.049, p=0.019). The multivariate analysis showed that the risk of frequent wheezing was 6.6 fold higher in children with a serum ECP level >= 7.9 mu g /L and 5.3 fold higher in the presence of RSV / adenovirus infection (p=0.026, p=0.038, respectively).
Conclusion: In conclusion, our study suggested that the increase in serum ECP levels and the presence of RSV / denovirus infection significantly increased the risk of frequent wheezing in children with acute wheezing attacks
Percutaneous Balloon Kyphoplasty Vertebral Augmentation for Compression Fracture Due to Vertebral Metastasis: A 12-Month Retrospective Clinical Study in 72 Patients
No full textBackground: Vertebral compression fracture is common in osteoporosis, but can also occur due to bone metastases, for which current treatment options are limited and include bone-strengthening with cement and supportive care. Kyphoplasty is a surgical method of bone augmentation that can reduce pain, stabilize vertebral bone, and restore some or all of the vertebral body height. The aim of this study was to investigate the clinical results of balloon kyphoplasty in the correction of vertebral deformity due to metastatic vertebral compression fracture.
Material/Methods: A retrospective clinical study included 72 patients (82 vertebral bodies) with metastases resulting in vertebral compression fracture, treated by percutaneous balloon kyphoplasty; 9 patients were found incidentally to have vertebral metastases. Bone mineral density (BMD) levels were measured. Patient responses from questionnaires, including the visual analog scale (VAS) for pain intensity, and the Oswestry Disability Index (ODI) for disability, were scored. The local kyphosis angle (KA) and the vertebral height ratio (VHR) were measured. All patients were followed up for 12 months. The initial postoperative and 12-month postoperative values, and the preoperative and postoperative values were compared.
Results: Following balloon kyphoplasty, the KA, VHR, VAS, and ODI scores significantly improved at the final 12-month follow-up compared with preoperative levels (p<0.05, and p<0.001). There was cement leakage in 6 procedures (8.3%) and adjacent segment fracture in 11 procedures (15.2%).
Conclusions: Balloon kyphoplasty was an effective method to reduce pain, reduce disability, and improve quality of life by eliminating kyphotic deformity in pathological vertebral compression fractures due to vertebral metastases
Osseous outgrowth on the buccal maxilla associated with piezosurgery-assisted en-masse retraction: A case series
No full textPiezoelectric surgery is a novel surgical approach used in orthodontic treatment for rapid tooth movement. This paper presents a case series wherein osseous outgrowths were observed in response to piezosurgery-assisted en-masse retraction. Sixteen patients requiring upper premolar extractions were treated with miniscrew-supported en-masse retraction and received minimally invasive decortication via piezosurgery. Computed tomography (CT) of the maxillary anterior region was performed to investigate the nature of the outgrowths. In 8 of the 16 patients, hemispheric or disc-shaped osseous outgrowths were observed on the sites where piezosurgery was performed during retraction. CT images revealed that these outgrowths were alveolar bone. This case series presents a previously unreported osseous response to piezosurgery-assisted tooth movement during orthodontic treatment. The response is mostly transient and is observed in 50% of the treated patients, suggesting a bone turnover that can be assessed clinically and radiographically