The neocartilaginous formation with hydroxyl-apatite in injection laryngoplasty: an experimental study on rabbit model

Adductor paralysis or the pathologies occurring after laryngeal surgery such as scarring or atrophy of the vocal cords cause glottic insufficiency during phonation. Injection laryngoplasty has been a widely accepted technique due to lower morbidity of the procedure and the applicability via endoscope in the treatment of these pathologies. Various materials have been used in injection laryngoplasty. The primary expectations in these techniques are the persistence of injected material long enough, without resorbtion or any cause of serious tissue response and having beneficial effects in reinforcing the glottic tissue. In the present study, we used large molecular-sized calcium hydroxyl-apatite (CaHA) particles in injection laryngoplasty to observe the effects of the material in the laryngeal tissues under the light microscopic examination. The study was performed on 12 rabbits in four groups. After injecting Ca₁₀ (PO4)₆(OH)₂ (Coaptite^®) into their vocal folds, the rabbits were killed at certain intervals, in the 1st week (group 1) in the 1st month (group 2) in the 3rd month (group 3) and in the 6th month (group 4). Larynges were removed and processed for light microscopic observations. Our observations revealed that this material induced the new cartilage formation without a serious tissue response in the larynges. Formation of a new cartilage tissue was the most significant, but an unexpected outcome of the study. The injected material inducing a neocartilage formation without any tissue reaction persisted long enough in the laryngeal tissues. Although neocartilage formation may interfere the vocal fold vibrations, providing glottic closure in the phonation with a durable material will be an important gain.     

Human leukocyte antigens in Turkish pediatric celiac patients

With the aim to determine the frequency of human leukocyte antigen phenotypes of celiac disease in Turkey, thirty celiac patients fulfilling the European Society of Pediatric Gastroenterology and Nutrition criteria were included in the study. The mean age of the study population was 5.8 +/- 4.3 years and of the control subjects was 32.6 +/- 6.7 years. The human leukocyte antigens -A, -B, -DR and -DQ were studied serologically by micro lymphocytotoxic reaction. It was found that human leukocyte antigens A-25(10), -B8, -DR18(3) and -DQ2 were more significantly frequent in the celiac population than in the control group. Children with antigen -B8 showed a five times higher risk for celiac disease and those with antigen -DQ2 showed a nine times higher risk. It was determined that human leukocyte antigen -B4 had a protective role in celiac disease. The study suggests that the human leukocyte antigen -A25(10) is a phenotype particularly encountered in Turkish pediatric celiac patients.     

Intravascular papillary endothelial hyperplasia of the mandibular lingual mucosa

In 1923, Masson1 described an unusual papillary endothelial proliferation that he named as "hemangioendotheliome vegetant intravasculaire". In 1976, Clearkin and Enzinger2 coined the term intravascular papillary endothelial hyperplasia (IPEH) that is now in use. This term refers to the presence of endothelium lined papillary projections within a vascular space. Characteristically, the papillary structures are composed of a single layer of swollen or plump endothelial cells without cellular pleomorphism, mitotic activity or necrosis.     

Relation between retinal vein occlusions and axial length.

AIMS: To evaluate the ocular axial length as a risk factor for development of central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). METHODS: Ocular axial lengths were measured, by A-scan ultrasonography, in 17 patients with CRVO and 41 patients with BRVO and compared with those of contralateral unaffected eyes and 66 age matched controls. RESULTS: In 17 patients with CRVO the mean axial length of affected eyes was 22.25 (SD 0.19) mm and of unaffected eyes was 22.61 (0.13) mm. In 41 patients with BRVO the mean axial length of affected eyes was 22.89 (0.11) mm and of unaffected eyes was 22.99 (0.12) mm. CONCLUSION: These findings confirm that the axial lengths in CRVO and BRVO were significantly shorter than in the controls. This significant difference may be a risk factor in the development of CRVO and BRVO.     

Trefoil factor expression in biliary epithelium of graft-versus-host disease of the liver after allogeneic hematopoietic cell transplantation

BACKGROUND: The aims of this study were to determine the presence of trefoil factor family-3 (TFF3) expression in biliary epithelial cells (BECs) of chronic graft-versus-host disease (cGVHD) of the liver after allogeneic hematopoietic cell transplantation, to compare such expression in chronic liver diseases (CLD) with/without predominantly biliary disease, and to assess the effect of bile duct injury on the degree of TFF3 expression in BECs of cGVHD. METHODS: A total of 82 paraffin-embedded liver biopsy samples were reviewed. These samples were basically divided into two distinct groups according to the presence of ductal injury: group 1 with CLD and predominantly biliary disease (n=26: 17 cGVHD and 9 primary biliary cirrhosis [PBC]) and group 2 with CLD and predominantly parenchymal liver disease (n=56: 20 steatohepatitis and 36 chronic viral hepatitis). Group 2 was used as the controls. Immunohistochemistry was performed using a polyclonal anti-TFF3 antibody. Real-time quantitative PCR was used for the detection of TFF3 mRNA expression. RESULTS: Positive TFF3 immunohistochemical staining and the presence of TFF3 messenger RNA gene expression was demonstrably higher in group 1 than that in group 2 (P<0.0001 and P<0.05, respectively). No significant difference in terms of positive TFF3 stained BECs between GVHD and PBC samples was observed (P>0.05). The extent of TFF3 expression in GVHD samples with severe ductal injury were significantly more common than that of GVHD samples with mild/moderate ductal injury (P<0.0001). CONCLUSIONS: The expression of TFF3 in cGVHD of the liver is increased in response to bile duct damage and repair. Such expression seems to be related the severity of ductal injury.     

The roles of HRCT and clinical parameters in assessing activity of suspected smear negative pulmonary tuberculosis

BACKGROUND: Smear-negative pulmonary tuberculosis (SNPTB) constitutes a major problem in countries with a moderate or high TB prevalence. The value of high-resolution computed tomography (HRCT), chest x-ray and other clinical findings in determining activity of SNPTB were investigated. METHODS: The study population consisted of 85 patients with suspected SNPTB, of whom 52 were confirmed as active pulmonary TB according to either culture positivity for Mycobacteriun tuberculosis or demonstration of caseous granulomatous inflammation. The remaining 33 patients accepted inactive TB sequel. RESULTS: Cough and expectoration were significantly frequent in inactive group whereas chest pain was detected higher in active patients. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of HRCT in detecting disease activity were 88, 88, 92, 83 and 88%, respectively. Centrilobular nodules, other non-calcified nodules, consolidation and cavity were significantly higher on HRCT in active group. Chest x-ray scores that were graded 1 to 3 showed a linear trend for the disease activity. CONCLUSIONS: HRCT has good diagnostic value in detecting activity of SNPTB, and some clinical findings may help in predicting the activity.     

Risk of developing fibroadenoma with the use of cyclosporine A in renal transplant recipients

To investigate the effect of cyclosporine A (Cyc A) on the development of fibroadenomas, 30 renal transplant patients and 20 chronic renal failure patients on dialysis were breast examined with ultrasonography and/or mammography. Of the renal transplant patients, 17 were receiving Cyc A-based combination therapy for immunosuppression. All patients were female with the age range of 29.7+/-9.2 years in the transplant group and 33.95+/-9.91 in the dialysis group. Eight of the 17 patients receiving Cyc A had fibroadenomas, 5 of them having bilateral lesions. None of the other patients, those on dialysis and on non-Cyc A combination therapy had fibroadenomas. A significant difference for fibroadenoma incidence in patients receiving Cyc A combination immunosuppression was found.     

Are Discrete Coronary Artery Fistulae Different from Coronary Arteriovenous Malformations?

AIM: To delineate whether coronary arteriovenous malformations have different properties than classical discrete coronary artery fistulae. METHODS: Group 1 included 17 patients with discrete coronary fistula that represents a coronary artery fistula draining into any cardiac chamber. Group 2 included six patients with coronary arteriovenous malformations representing extensive coronary artery malformation. Cardiopulmonary bypass was used in 12 of the Group 1 patients and 5 in Group 2. RESULTS: There was no operative mortality in either group. Following a hemodynamically nonsignificant residual fistulous communication, which was detected by repeat coronary angiography in Group 2; we changed our surgical technique of suture ligation on beating heart. Then we preferred pulmonary arteriotomy and sutured the orifice of coronary arteriovenous malformations from within the chamber. CONCLUSIONS: Coronary arteriovenous malformations have different morphology and also complex progression properties when compared with discrete coronary artery fistulae. Surgical repair of coronary arteriovenous malformation should be done by suturing the multiple drainage holes inside the draining chamber. Suture ligation of coronary arteriovenous malformation is difficult due to the fragile vessel.     

Acute Thrombosis of Inferior Vena Cava in a Pregnant Woman Presenting with Sciatica:A Case Report

A 20-year-old pregnant woman was admitted to our department with symptoms of deep venous thrombosis in the left lower extremity and excessive lumbar pain. Low-molecular-weight heparin was administered. She recovered with this treatement, however, severe lumbar pain continued. A lumbar magnetic resonance imageg showed dilated epidural veins compressing the roots and acute thrombosis of the inferior vena cava extending to renal veins. During the same period she had acute deep venous thrombosis in her right leg. An urgent venous thrombectomy was performed. Sciatica and deep venous thrombosis resolved after the operation. Low-molecular-weight heparin was administered until the end of her pregnancy.