Acoustic neurinoma with intratumoral bleeding

The Authors present a case of acoustic neurinoma which has caused intratumoral bleeding. Although acoustic neurinomas are about 8-10% of all intracranial tumors there are only few cases about acoustic neurinomas causing hemorrhage. Pathologic changes of intratumoral vessels in tumors larger than 2 cm were considered to be a cause of the hemorrhage. This rare pathology must be remembered as one of the causes of the intracranial bleeding.     

Complications of percutaneous nephrostolithotomy

In 224 patients, renal stones were removed from the urinary tract using either direct extraction with a basket or forceps (59 patients), ultrasonic lithotripsy (164 patients), or infusion chemotherapy (one patient). Residual stone fragments were present more frequently in patients treated with ultrasonic lithotripsy (27%) than with direct extraction (5%). Other complications included hemorrhage (eight patients), catheter dislodgement (four patients), large amounts of urine extravasation (three patients), glycine ascites (three patients), infection (two patients), pneumothorax (one patient), and a prolonged ileus (one patient). More complications occurred among the first 50 patients than the last 50 patients, even though more difficult cases, including patients with staghorn calculi, were accepted during the latter period. Although a learning curve exists, complications can be minimized by attempting to treat more favorable cases during the initial experience.     

Effect of mitomycin C on ciliary body and intraocular pressure with various application depths: an experimental study

BACKGROUND: To evaluate the effects of mitomycin C (MMC) on intraocular pressure (IOP) and ciliary body via transmission electron microscopy when applied under conjunctiva or different depths of sclera, without performing any filtering surgery. METHODS: Thirty-six eyes of 36 New Zealand albino rabbits were used in this study. MMC was prepared in a concentration of 0.4 mg/mL and 0.05 cc (20 microg) was soaked in preprepared sterile surgical sponges. Six groups each consisting of six eyes were formed and IOP was measured preoperatively. Group 1 was the control group: the superior conjunctiva was opened and only irrigated with balanced salt solution (BSS). In group 2, MMC soaked sponges were applied under the conjunctiva. In groups 3 and 4, a scleral flap of approximately 1/3 scleral thickness was prepared and in groups 5 and 6, and a scleral flap of approximately 2/3 scleral thickness was prepared, all with a standard size of 4 x 4 mm. MMC soaked sponges were applied under these areas for 5 min in eyes in groups 3 and 5 followed by an irrigation of the relevant areas with 10 cc BSS, whereas only irrigation with BSS was done in groups 4 and 6 as control groups. No filtering procedure was performed in any of the eyes. Eyes were enucleated on the 30th day following measurement of IOP and the ciliary body regions were evaluated using transmission electron microscopy. Kruskal-Wallis test was used for the statistical assessment of IOP between groups. RESULTS: The deep scleral flap group (group 5) showed statistically significantly more IOP reduction than both the superficial scleral flap group (group 3; P = 0.004) and the subconjunctival group (group 2; P = 0.002) on postoperative day 30. Electron microscopic evaluation of the surgical groups revealed a wide range of different histopathological effects due to different MMC application methods. The histopathological changes were more evident in the group 5, where MMC was applied under deep scleral flap. CONCLUSIONS: Subscleral application of MMC seems to provide greater IOP decrease than subconjunctival application, possibly caused by a more significant ciliary body toxicity. This may be the beginning of a non-penetrating, easy to perform and safe method to decrease IOP in glaucoma patients, which the authors call 'toxic ciliary ablation surgery'. However, the long-term results and complications must be assessed with further studies.     

Changes in intraocular pressure and corneal and retinal nerve fiber layer thicknesses in hypothyroidism

PURPOSE: To evaluate the changes in intraocular pressure (IOP), corneal thickness (CT), and retinal nerve fiber layer thickness (RNFLT) in patients with hypothyroidism before and after treatment. METHODS: A complete ophthalmic examination including visual acuity, IOP, anterior segment, and fundus examination together with CT and RNFLT measurements were performed for each patient with newly diagnosed hypothyroidism, at the initial diagnosis and the third and ninth months of the L-thyroxine treatment. Wilcoxon signed rank test and Spearman's correlation test were used for statistical evaluation of the results. RESULTS: A total of 56 eyes of 28 patients were included in the study. The mean IOP and CT values were found to decrease with medical treatment (p = 0.000). There was no significant change in any of the RNFLT parameters measured with scanning laser polarimeter after L-thyroxine treatment (Wilcoxon, p > 0.05). The change in IOP levels was not correlated with the change in thyroid hormone levels (Spearman's correlation test, p > 0.05). The mean increase in serum free T3 and serum free T4 levels and the mean decrease in serum TSH levels at the ninth month of the therapy were found to be correlated with the decrease in CT in the left eyes (Spearman's correlation test, R > 0.4 and p < 0.05). CONCLUSIONS: Hypothyroidism seems to cause a reversible increase in CT and IOP. IOP changes may be secondary to CT changes. RNFLT parameters measured with scanning laser polarimeter do not seem to be affected by hypothyroidism. When the CT is taken into account and the IOPs corrected for CT, the prevalence of glaucoma in hypothyroidism may not be as high as previously reported. This issue should be taken into account while assessing glaucoma in patients with hypothyroidism.     

Intrahepatic bile duct and portal vein anatomy revisited

Seventeen normal cadaver livers were studied to assess the anatomic relationship of bile ducts to portal veins. The common bile duct, main portal vein, and hepatic artery were cannulated and injected with air, dilute contrast medium, and mineral oil, respectively. The livers were placed in anatomic position and examined with computed tomography. In the lateral segment of the left hepatic lobe, the bile ducts were anterior to the portal vein in seven cases, posterior in seven, and tortuous (ie, both anterior and posterior) in three. In the medial segment of the left lobe, the bile ducts were anterior in four cases, posterior in four, tortuous in three, and not seen in six. In the right lobe, the bile ducts were anterior in nine cases, posterior in five, tortuous in one, and not seen in two. In the porta hepatis, the bile ducts were anterior in ten cases, posterior in one, tortuous in five, and not seen in one. Histologic findings confirmed the anterior and posterior location of the bile ducts relative to the portal veins. These findings contradict the commonly held view of intrahepatic bile ducts being anterior to the portal vein and are clinically significant for techniques such as bile duct drainage.     

Tumor specific cytotoxicity and telomerase down-regulation in prostate cancer by autologous dendritic cells loaded with whole tumor cell antigens

ObjectivesWe investigated the efficacy of cytotoxic activity of whole tumor cell-antigen loaded dendritic cells in the treatment of hormone refractory prostate cancer.Materials and methodsFrom 10 patients with HRPC, peripheral blood samples were obtained and cultured with GM-CSF and IL-4 to provide differentiation of peripheral blood mononuclear cells (PBMs) into dendritic cells (DCs). DC phenotype was confirmed by flow cytometry (MHC class II HLA-DR, CD80, CD86, CD83, CD14 expression analysis). Subsequently, whole tumor cell lysates of LNCaP, DU-145, and PC-3 lines were incubated with DCs. Direct antitumoral activity of induced DCs and activation of PBM cells by these DCs was assessed by lactate dehydrogenase (LDH) cytotoxicity assay. Post-treatment changes in the telomerase gene expression of tumor cells were investigated by real time RT-PCR analysis.ResultsLDH activity was highest in the PC-3 cell line (9.5%) and lowest in the DU-145 line (3.2%). Co-incubation of PBMs with activated DCs resulted in a significant increase at the levels of cytotoxicity in all cell lines. Likewise, incubation of tumor cells with activated DCs caused significant down-regulation of telomerase gene expression in all cell lines. Most pronounced suppression was in the LNCaP cell line (decrease by 97.1%). The decrease in the level of telomerase gene expression in DU-145 and PC-3 cell lines was 80% and 70%, respectively.ConclusionsCytotoxic immune response to prostate cancer-associated antigens can be elicited in vitro in patients with HRPC using an allogeneic tumor cell-based strategy. DC-based active immunotherapy appears as an effective treatment method in the pre-clinical setting and further phase I/II trials are warranted.     

Kidney loss due to periureteral fibrosis and ureteral obstruction secondary to migration of subureterically injected calcium hydroxylapatite

Vesicoureteral reflux (VUR) is one of the significant urologic diseases of childhood and its endoscopic treatment is a viable option in terms of both simplicity and reduced morbidity. However, despite intensive research, no ideal injection material that yields the best long-term results with the least side effects has been introduced as yet. Synthetic calcium hydroxylapatite is one of the materials that has recently been under trial. Although favorable short-term success rates have been reported with the subureteric injection of calcium hydroxylapatite without any side effects, this case report shows its potential to migrate. To our knowledge, we present the first case where the migration of subureterically injected calcium hydroxylapatite resulted in periureteral fibrosis, ureteric obstruction and subsequent renal loss.     

Neuroprotective effect of topically applied brimonidine tartrate 0.2% in endothelin-1-induced optic nerve ischaemia model

BACKGROUND: To investigate the neuroprotective effects of topically applied brimonidine tartrate 0.2% (BMD), an alpha(2)-receptor agonist, on the retinal ganglion cell (RGC) layer and inner nuclear layer (INL) of rabbit retina in endothelin-1 (ET-1)-induced optic nerve (ON) ischaemia model. METHODS: Osmotic minipumps were surgically implanted into one eye of 16 New Zealand Albino rabbits to deliver ET-1 at the constant rate of 0.5 microL/h for 2 weeks. Eyes were divided into four groups. ET-1 was given with (Group 3) and without topical BMD therapy (Group 1). Groups 2 and 4 were taken as controls. Rabbits were sacrificed at day 14. Morphological alterations, total cell number and proportion of cells undergoing apoptosis in INL and RGC layer were assessed by histopathological analysis to determine the survival of the cells of the INL and RGC layer. RESULTS: Endothelin-1 led to severe reduction of cells in both the RGC layer and INL in Group 1 (P < 0.05). In Group 3, the total cell number and the proportion of cells undergoing apoptosis in the RGC layer were comparable with the control group (Group 4), whereas the former was found to be higher and the latter was found to be lower than those recorded for Group 1. However, the total cell number in the INL was found to be lower in Group 3 compared with that of Group 4, despite topical BMD therapy (P < 0.05). CONCLUSIONS: Topically applied BMD seems to be neuroprotective and antiapoptotic in the ET-1-induced ON ischaemia model, especially for RGCs. BMD might be used as an adjuvant agent for its neuroprotective effects in hypoxic-ischaemic conditions such as diabetic retinopathy, normotensive glaucoma and other retinal vascular occlusive conditions which require further investigations.