Ovarian transplantation in humans: indications, techniques and the risk of reseeding cancer

Laboratory research on ovarian cryopreservation and transplantation began in the 1950s leading to clinical studies in the 2000s. The research that was performed during this half century indicated that cryopreserved ovarian tissue has the potential to restore fertility in women who face premature ovarian failure due to chemotherapy, radiotherapy or surgery. To date, ovarian function has been restored in at least four women. Even though no pregnancies have been reported so far from these clinical studies, animal studies indicate that this is a valid prospect for humans. Future clinical trials will determine on a larger number of patients the longevity of ovarian grafts, normality of hormone production and ovarian follicle development, possibility and safety of pregnancy, and the safety of auto-transplantation in cancer patients. However, the major improvement in the efficiency of ovarian transplantation is anticipated to come from research exploring the revascularization process.     

Effect of intraurethral papaverine on penile erection in rats

OBJECTIVES: The aim of this study is to investigate erectile response to intraurethral administration of papaverine in rats. MATERIAL AND METHODS: Male Sprague-Dawley rats were used in this study. Under urethane anesthesia, penis was exposed and intracavernous pressure (ICP) was recorded through a 23-gauge needle, which was inserted into right corpus cavernosum. Effects of intraurethral application of incremental doses of 0.2 ml papaverine gel (4-17.5 mg) on intracavernosal pressure were observed and compared with those of 0.4 mg papaverine applied into corpus cavernosum. Mean arterial blood pressure (MABP) and heart rate were also monitored. RESULTS: The mean basal ICP was 8.9 +/- 1.8 mm Hg. Intraurethral administration of papaverine did not increase ICP at any doses used in this study. After intracavernous injection of papaverine (0.4 mg), a significant increase in the ICP occurred from resting (8.9 +/- 1.8 mm Hg) to a peak at 57.5 +/- 9.9 mm Hg and persisted for 22.3 +/- 6.7 minutes (p < 0.05). The latter application significantly decreased MABP (22.3 +/- 3.1 mm Hg; p < 0.05). CONCLUSIONS: Intraurethral administration of papaverine does not seem to be an alternative to other erectile dysfunction treatment modalities. However, further studies on animals are necessary at higher concentrations or in combination with other mucosal enhancers to increase the effect of intraurethral administration of papaverine.     

Intraosseous malignant peripheral nerve sheath tumor with local recurrence,lung metastases and death

Malignant peripheral nerve sheath tumor (MPNST) is almost always seen in soft tissue. Skeletal involvement by MPNST is uncommon and usually results from secondary invasion. Primary MPNSTs are exceptionally rare. We report a surgically proven case of intraosseous MPNST, with local recurrence and lung metastasis during follow-up. The imaging and histological features of the case are described and the literature on the subject briefly reviewed.     

Radiologic aspects of abdominal hydatidosis in children: a study of 31 cases in Turkey

OBJECTIVE: To determine the location and radiological characteristics in children with abdominal hydatid disease (HD). MATERIALS AND METHODS: Thirty-one children (average age: 7.2 years) with abdominal HD were studied. The number, location, diameter and internal architecture of the cysts were assessed with abdominal ultrasonography (US) and computed tomography (CT). Density measurements and enhancement patterns were determined on CT. RESULTS: Twenty-one children had hepatic HD. The remaining 10 children had both hepatic and extrahepatic cysts. There were splenic cysts in five children, peritoneal cysts in two children and combined splenic and peritoneal cysts in three children. The most common site of the cysts was the liver (64%), followed by the spleen (20%) and the peritoneal cavity (16%). The seven intraabdominal cysts, which were not detected by US, were 20 mm or less in diameter. CONCLUSION: CT may demonstrate additional small intrahepatic or unsuspected extrahepatic cysts. Although rare, splenic or peritoneal hydatidosis should be included in the differential diagnosis of a cystic splenic or peritoneal lesion. Familiarity with atypical locations of HD may be helpful in making a prompt, accurate diagnosis. We think that in particular patients, especially those who had diagnostic problem and who are under surgical planning, CT should be performed additionally.     

Unexpected gallbladder cancer during laparoscopic cholecystectomy

Background/Purpose In the present study, we investigated the effectiveness of surgeons in determining incidental gallbladder pathologies at laparoscopic cholecystectomy (LC).Methods This study included 548 patients with gallstones who underwent LC between May 1, 2001 and October 15, 2003. The surgeon made an incision on the gallbladder wall for inspection, and palpated the mucosa after removing the gallbladder from the abdominal cavity to look for unsuspected pathologies. If an abnormal mucosa was observed or palpated, it was marked with a silk suture and then histopathologic examination was performed.Results Fifty of 548 LC specimens were found to be suspi-cious by the surgeon. Histopathological examination of frozen sections revealed incidental pathologies in 15 of these specimens. Strikingly, 5 of these specimens were considered to have gallbladder cancer (GBC). The other incidental pathologies were consistent with adenomyomatosis, xanthogranulomatous cholecystitis, and fibroepithelial and hyperplastic polyps. Four of the other 498 specimens revealed incidental pathologies at definitive histopathological examination, and all of them were consistent with gastric metaplasia. The sensitivity and specificity of the procedure was 78.9% and 93%, respectively.Conclusions A simple prosedure; that is, incision and inspection, and palpation of the gallbladder, seems to be useful for the diagnosis of incidental gallbladder pathologies.     

The development of osteosarcoma following radiotherapy for fibrous dysplasia

Sarcoma arising from fibrous dysplasia (FD) is rare and it is more common in polyostotic type. In this case report, we present a 41-year-old male patient who developed osteosarcoma of the left tibia 28 years after the initial diagnosis and 20 years after radiation therapy for FD. He underwent above-knee amputation, but died eight months after surgery. This case suggests that radiotherapy has no beneficial effect in the treatment of FD and that it may be associated with the development of sarcoma.     

Total lymphocyte count in peripheral blood of peritoneal dialysis patients: relationship to clinical parameters and outcome

BACKGROUND: Total lymphocyte count (TLC) is used as a nutritional status measurement. The impact of TLC on mortality in peritoneal dialysis (PD) patients is controversial. This study aimed at evaluating the effect of TLC on mortality, and assessing the relationship between TLC and nutritional status, anemia and erythropoietin (EPO) response, acute-phase response, dialysis adequacy and volume status in PD patients. METHODS: Seventy-three PD patients were monitored for 3 yrs from the beginning of the treatment. Data recorded for each patient included demographic features, comorbidity, TLC, blood biochemistry, systolic and diastolic blood pressures (BP), indices of dialysis adequacy and nutritional status, total fluid removal and mortality. Adjusted mortality risk for TLC was estimated using the Cox's regression models composed by TLC and one covariate having a value p<0.05 in univariate analysis. RESULTS: The 3-yr patient survival rates were significantly different among the TLC quartiles. The adjusted TLC was found, generally, to be a significant predictor of death in reduced Cox's models, except in models composed of TLC and total fluid removal or serum albumin. The receiver operating characteristics (ROC) analysis demonstrated that TLC provided a significant prediction of mortality. TLC correlated positively to total fluid removal, serum albumin, triglyceride and hematocrit, and negatively correlated to BP, high peritoneal transport and EPO-need. It did not correlate to other measures of nutritional status, dialysis adequacy and acute-phase response. Fluid removal and serum triglyceride were independent predictors of TLC in multivariate analysis. CONCLUSIONS: Our findings suggest that TLC can be used as a simple prognostic tool in PD patients; however, the association between TLC and mortality is confounded by other prognostic factors. Volume status could be a more important factor affecting the TLC than nutritional status.     

Occupational safety: effects of workplace radiofrequencies on hearing function

BACKGROUND: The effects of radio frequency (RF) and microwave radiation on humans have been the subject of continuous investigation. Clinical investigations related to occupational RF/microwave exposure have been reported by investigators (1). Since one of the major groups occupationally exposed to RF and microwave radiation includes those working in radio broadcasting and TV transmitter stations, this study investigates whether RF affects auditory systems of people exposed to RF. METHODS: The study is carried out with people working in radio broadcasting stations and living in employee residential houses close to the broadcasting stations. All subjects in the control group were similar in age, work regime, socioeconomic status, and lack of experience in working with RF sources. Brainstem Evoked Response Audiometer (BERA) and Pure Tone Audiometry (PTA) were used to measure the effects of RF under investigation on hearing functions of the subjects. In BERA measurements, I-III, III-V and I-V interpeak latencies were evaluated. In pure tone audiometric measurements, 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and 8000 Hz frequencies of hearing threshold were measured in subjects of experimental and control groups. Interpeak latencies and bone conduction hearing thresholds of subjects in the experimental group were compared with those of the control group. RESULTS: BERA results showed that I-III, I-V and III-V interpeak latencies of people occupationally exposed to RF were not higher than subjects in control groups (p>0.05). Results of BERA indicated no statistically significant differences between exposure and control subjects. In audiometric evaluation, hearing threshold of people occupationally exposed to RF were found higher than the control group subjects for frequencies of 4000 Hz and 8000 Hz in terms of bone and air conduction of right and left ear (p < 0.01). CONCLUSIONS: The results of traditional audiometer indicated that RF promotes sensorineural hearing loss and affects cochlea parts related to 4000 Hz and 8000 Hz. These findings may have immediate implications and considerations for workplace safety in order to provide an occupationally safe environment to employees working in such settings.     

Accessory soleus muscle

Accessory soleus muscle is an uncommon anatomical variant that may present as a soft-tissue mass in the posteromedial region of the ankle. It is congenital in origin but usually presents in the second or third decade of life. Although it is a rare entity, accessory soleus muscle should be included in the differential diagnosis of soft-tissue swelling of the ankle. Awareness of the clinical presentation and specific findings of computed tomography, magnetic resonance imaging, and electromyography help with diagnosis without surgical exploration. We describe a 30-year-old patient with accessory soleus muscle. Magnetic resonance imaging features of the case are described, and the literature is briefly reviewed.