High angiogenic potential in an in vivo rat corneal model is associated with shorter disease-free survival in low-grade oligodendrogliomas

This study aimed to examine the association between time to tumor recurrence, angiogenic potential and tumor contrast-enhancement. Tumor samples were taken from 20 patients with low-grade oligodendroglioma and examined for their angiogenic potential using an in vivo rat corneal model of angiogenesis. Patients were evaluated for tumor contrast enhancement prior to surgical excision using MRI and they were followed for tumor recurrence. Patients who had tumors without contrast enhancement had longer disease-free survival (median time to tumor recurrence, 72 months) compared to those who had tumors with contrast enhancement (median, 42 months; p = 0.0068). Based on corneal angiogenesis assay results, a high angiogenic potential was associated with a significantly shorter disease-free survival. Our findings suggest that radiological contrast enhancement and a high angiogenic potential based on an invivo corneal angiogenesis assay were related to a shorter disease-free survival. This might have important prognostic implications in patients with low-grade oligodendrogliomas.     

Amelanotic malignant melanoma of the uterine cervix diagnosed by cervical smear

The melanocytic cells of the cervical epithelium are capable of forming the complete spectrum of melanocytic lesions, from benign lentigines to melanoma. Primary malignant melanoma of the uterine cervix is a rare neoplasm with aggressive behavior. The absence of melanin pigment can lead to misdiagnosis as carcinomas, sarcomas, or lymphoma. Immunohistochemical studies should be used for confirmation. In order to consent the cervix as a primary site, exclusion of any other probable primary sites of melanoma is needed. Here, we present a 61‐year‐old female patient with postmenopausal vaginal bleeding. After cervical smear, diagnosis was confirmed by cervical punch biopsy. Diagn. Cytopathol. 2016;44:535–537. © 2016 Wiley Periodicals, Inc.     

Posterior all-pedicle screw instrumentation combined with multiple chevron and concave rib osteotomies in the treatment of adolescent congenital kyphoscoliosis

Background contextCongenital kyphoscoliosis is a disorder that often requires surgical treatment. Although many methods of surgical treatment exist, posterior-only vertebral column resection with instrumentation and fusion seem to have become the gold standard for very severe and very rigid curves. Multiple chevron and concave rib osteotomies have been previously reported to be effective in the treatment of neglected severe idiopathic curves. We hypothesized that this method may also be used successfully in the treatment of congenital kyphoscoliosis.PurposeTo evaluate the effectiveness and safety of multiple chevron osteotomies combined with concave rib osteotomy and posterior pedicle screw instrumentation.Study designRetrospective chart review in the spine service of a large university hospital.Patient sampleAdolescent patients undergoing a specific surgical treatment for the indication of rigid congenital kyphoscoliotic deformity.Outcome measuresRadiographic images were used for the measurement of deformity correction. The Turkish version of the Scoliosis Research Society 22 (SRS-22) Patient Questionnaire has been used as a clinical outcome measure in the patient population.MethodsA retrospective chart review was performed. Patients admitted to Hacettepe Hospital Spine Center during the period of 2005 to 2009 were included. Criteria for inclusion were as follows: adolescent age group (10–16 years); congenital kyphoscoliosis; formation and/or segmentation defect of at least two vertebral motion segments; surgical treatment of deformity by posterior all-pedicle screw instrumentation, multiple chevron osteotomies, and multiple concave rib osteotomies; follow-up of at least 24 months; and a complete set of preoperative, postoperative, and follow-up standing posteroanterior and lateral full spinal radiographs. The patients' hospital records and X-rays were reviewed. Duration of surgery, intraoperative blood loss, postoperative transfusion requirements, postoperative stay in postanesthesia care unit (PACU), time of hospitalization, and complications were recorded. Deformity in both coronal and sagittal planes was analyzed for correction and maintenance of the correction in preoperative, postoperative, and follow-up radiographs. Patients' health-related quality of life was assessed using the SRS-22 questionnaire at the final follow-up.ResultsEighteen patients met the inclusion criteria. Their average age was 13.6 years (range, 11–16 years). Chevron osteotomies were performed at apical segments (three to seven levels) and concave rib osteotomies at Cobb-to-Cobb (five to eight levels). No patient had preoperative cord compression because of the sharply angulated deformity or neurologic deficit. The average preoperative scoliosis was 66.0° (range, 31°–116°), 52.4° (range, 22°–85°) on flexibility X-rays, and became 24.9° (range, 12°–52°) postoperatively. The average preoperative global kyphosis (T2–T12) of 75.9° (range, 50°–106°) became 49.5° (range, 18°–66°). The average preoperative local kyphosis of 71.9° (range, 35°–114°) became 31.4° (range, ?44° to 64°). The average intraoperative bleeding was 989 cc, surgical time was 292 minutes, and intraoperative transfusion was 2.3 units. The maximum PACU stay was overnight. There were no neurologic complications except one pneumothorax and one pneumonia. The average follow-up was 34.3 months. At follow-up, average scoliosis was 27.5° (range, 10°–50°), global kyphosis was 50.3° (range, 28°–73°), and local kyphosis was 36.9°(range, ?36° to 58°). Performed on the last follow-up, the average scores for the five domains of SRS-22 were 4.3, 4.4, 4.2, 4.1, and 4.8 for function, pain, self-image, mental health, satisfaction, and total, respectively.ConclusionsMultiple chevron and concave rib osteotomies with posterior instrumentation provide an acceptable rate of deformity correction and maintenance of correction at 2 years with acceptable intraoperative bleeding, surgical time, postoperative morbidity, and rate of complications. It can be considered as an alternative in the treatment of rigid congenital curves involving more than three levels or multiple curves separated by at least two segments that would otherwise require multiple vertebral resections.     

Bone marrow examination in patients with immune thrombocytopenia: is there anything different in older patients?

Immune thrombocytopenia (ITP) is a disorder characterised by immune‐mediated accelerated platelet destruction and suppressed platelet production. In the bone marrow examinations of patients with ITP, some investigators found megakaryocyte numbers to be increased while others have found them to be normal. Although recent guidelines recommend against bone marrow examinations in typical ITP patients, the recent introduction of thrombopoietin receptor agonists as an effective treatment for ITP has refocused attention on abnormalities of bone marrow megakaryocytes. In this study, we retrospectively analysed the bone marrow aspiration, flow cytometry‐CD45 side scatter (SSC) and biopsy results of our patients with ITP by dividing them into two groups according to age (<60 yr and ≥60 yr). Ninety eight newly diagnosed ITP patients were included in the study. CD45 SSC results were recorded as percentages of normoblasts, granulocytes, lymphocytes, monocytes and myeloid/erythroid ratio. Length of the biopsy specimen, cellularity, presence of dysplasia or fibrosis with number, morphology and distribution of megakaryocytes were recorded. In group 1, there were 49 patients. Mean age was 41.31 ± 12.77 yr. In group 2, there were 49 patients. Mean age was 70.78 ± 7.88 yr. Megakaryocyte numbers on bone marrow aspirates were not recorded in most patients, so we could not comment on this point. Flow cytometry results and bone marrow findings were similar between two groups. In conclusion, there is no difference between bone marrow examinations of young and older patients with ITP, and biopsy should not be recommended in typical ITP patients as already mentioned in guidelines.     

Sequential radial artery grafting three-vessel coronary artery disease

Our objective was to compare the results of revascularization by sequential radial artery (RA) grafting with a left anterior descending left internal mammary artery (LIMA)-RA t-composite grafting technique. Patients were grouped as those with proximal anastomoses performed on the ascending aorta (Group A; n = 38), and those with proximal anastomoses performed on the LIMA as t-grafts (Group T; n = 13). Neither of the two groups revealed any mortality. The average number of grafts was lower in Group T (2.23 +/- 0.43 in group T and 2.85 +/- 0.69 in group A, p < 0.05). The results of the control coronary artery angiographies were superior in Group A. The patency rate of the RA grafts was 96.8% in Group A. Of the 20 distal anastomoses performed with RA grafts in 8 patients from Group T, nine (45%) were found to be patent. The patency rates of RA grafts with sequential distal anastomoses were found to be better when the proximal anastomosis was performed on the ascending aorta rather than on the LIMA. In conclusion, sequential distal anastomosis of RA grafts seem to be safe and effective when proximal anastomoses are performed on the ascending aorta.     

The evaluation of left ventricular systolic and diastolic functions in patients with Friedreich ataxia. A pulse tissue Doppler study

Friedreich's ataxia (FRDA), the most common subtype of early onset hereditary ataxia, is an autosomal recessive neurodegenerative disorder caused by unstable GAA expansions. Two-dimensional, pulse, and pulse tissue Doppler echocardiographic examinations were performed on 21 patients with GAA expansion. There was no association between left ventricle ejection fraction, tissue Doppler systolic s wave, and left ventricle diastolic functions examined by pulse and tissue Doppler. The septum thickness of patients with Friedreich's ataxia was significantly increased when compared with that of the control group and wall thickness was found to be associated with GAA repeats. In patients with FRDA, despite a correlation between genetic abnormality with left ventricular early and late diastolic parameters, global diastolic functions were preserved when examined by tissue Doppler.