Synchronous squamous cell carcinoma of the stomach, the lung and the skin

BACKGROUND: The incidence of multiple primary cancers is reported to be 0.3-4.3%. CASE REPORT: A 70-year-old man was admitted to the hospital because of fatigue, weight loss, epigastric pain with melena. A biopsy taken from a tumoral lesion in the gastric corpus revealed squamous cell carcinoma. A nodular lesion was also detected on the nasal columella and biopsy from this lesion also showed squamous cell carcinoma. Computed tomography performed as a part of metastatic work-up revealed a lesion in the left pulmonary lower lobe. Bronchoscopic biopsy from this lesion also demonstrated squamous cell carcinoma. RESULTS: We report a case with synchronous squamous cell carcinoma of the lung, skin and stomach and discuss the multiple synchronous occurrence of carcinoma with the same histopathology in different sites with a review of the literature.     

Immune function in children with classical phenylketonuria and tetrahydrobiopterin deficiencies

BACKGROUND: An increased susceptibility to infections has been observed in some patients with phenylketonuria (PKU), which is not well known whether it is due to alterations of plasma essential amino acid concentrations or to some other factors. OBJECTIVE: This study is designed to establish B cell and T cell functions in 44 children with classical PKU and tetrahydrobiopterin (BH4) deficiencies and the effects of too high plasma phenylalanine (PA) concentrations (16.53 to 30.54 mg/dL) on the same parameters. DESIGN: B and T cell functions of 33 children with classical PKU (divided into two groups based on fasting mean plasma PA concentrations: Group-I = 20.9 +/- 3.7 mg/dL, Group-II = 3.8 +/- 1.02 mg/dL), and 11 children with BH4 deficiencies (Group III) were studied. The results were compared between the groups and referenced with previously reported values from healthy controls. RESULT: Delayed type skin hypersensitivity responses to purified protein derivative (PPD) in Group I and phytohaemagglutinin (PHA) in Group I, III were lower than the other groups and healthy controls. Plasma IgG and IgM concentrations of Group I was lower than the reference values. Although mean serum zinc and iron levels of all patients were lower than published values of healthy children, zinc and iron deficiencies in Group I, III were much more prominent as compared to Group II. CONCLUSION: The somewhat low plasma IgG concentrations in Group I may be related to the very high plasma PA levels, however the role of zinc deficiency as a causal factor can not be ruled out. BH4 metabolism defects do not appear to affect the same parameters. Impaired delayed skin hypersensitivity responses in Group I and III can be explained by severe serum zinc deficiency. In the light of this study, we conclude that in order to establish a causal relationship between PKU and immune functions, further studies need to be conducted after the correction of micro-nutrient status of such children.     

Protective effect of melatonin on beta-cell damage in streptozotocin-induced diabetes in rats

The aim of the present study was the evaluation of possible protective effects of melatonin against beta-cell damage in streptozotocin-induced diabetes in rats. Malondialdehyde levels and glutathione peroxidase activity were measured in pancreatic homogenates. Pancreatic beta-cells were examined by immunohistochemical methods. Streptozotocin was injected intraperitoneally at a single dose of 60 mg/kg for induction of diabetes. Melatonin (200 microg/kg/day, ip) was injected for 3 days prior to administration of streptozotocin; these injections were continued until the end of the study (4 weeks). Streptozotocin induced a significant increase in malondialdehyde levels (p < 0.01) and a significant decrease in glutathione peroxidase activity (p < 0.05) in pancreatic tissue. Degeneration of islet cells and weak immunohistochemical staining of insulin was observed in diabetic rats. Treatment of diabetic rats with melatonin markedly reduced malondialdehyde production (p < 0.05) and increased glutathione peroxidase activity (p < 0.01) without affecting hyperglycemia. Increased staining of insulin and preservation of islet cells were apparent in the melatonin-treated diabetic rats. These data suggest that melatonin treatment has a therapeutic effect in diabetes by reduction of oxidative stress and preservation of pancreatic beta-cell integrity.     

Ileal orthotopic neobladder in women: The first experiences from Turkey and our modifications

The lower urinary tract reconstruction with an ileal neobladder in woman is not very often but has been recently introduced centers. We report 8 female patients with ileal orthotopic neobladders after cystectomy. Patients and methods: Between 1995 to 1999, 7 female patients with organ confined invasive bladder cancer and 1 female patient with severely contracted bladder secondary to tuberculosis were operated. While standard radical cystectomy was done in 7 patients with bladder cancer, only simple cystectomy was performed in patient with contracted bladder. Detubularized ileal W-neobladder with antirefluxive ureteroileal reimplantation were used as a procedure and reservoirs are connected to the proximal urethra in all patients. Cystoscopy and biopsy was done routinly in the bladder neck and there were no tumour and CIS in any patient. Results: The mean age was 65.4 years (53–70) and the mean postoperative follow-up time was 31.8 months (6–48). There was no perioperative or early postoperative (first one month) mortality. Early postoperative complications included acute renal failure in 1 patient (12.5%), deep vein thrombosis in 1 patient (12.5%) and leakage from the pouch in 2 patients (25%). In one patient (12.5%), ileo-pouchal fistula was seen in sixth month and reoperated. Although there was not hypercontinence, one patient (12.5%) had totally incontinence. All other patients had normal micturition and no residual urine. Urethral recurrence was not seen in this postoperative follow-up period but pelvic recurrence and then distant metastases were found in one case (12.5%). Conclusions: The results of ileal orthtopic neobladder after radical or simple cystectomy in appropriate female patients are satisfactory. But certainly, we need the more experiences and studies about this subject. This revised version was published online in September 2006 with corrections to the Cover Date.     

The effect of overlapping on the primary stability of osteochondral grafts in mosaicplasty

Our goal was to determine the primary stability of overlapping osteochondral grafts used in mosaicplasty by studying the effect of overlapping in an ex vivo model. Osteochondral grafts, 10 mm in diameter, were transplanted from the trochlea of cow femurs to the weight-bearing area of the lateral femoral condyle with 0, 15, or 30% overlap. The grafts were pushed in with a probe at a rate of 2 mm/min, and load (N)-displacement (mm) curves were recorded. In Group I (control, 0% overlap), insertion 1 and 2 mm below the cartilage level could be reached at 572.3 +/- 273.6 and 999.3 +/- 427.6 N, respectively. In Group II (15% overlap), insertion 1 and 2 mm below the cartilage level could be reached at 263.6 +/- 91.7 and 746.6 +/- 88.0 N, respectively. In Group III (30% overlap), insertion 1 and 2 mm below the cartilage level could be reached at 179.4 +/- 31.2 and 657.0 +/- 106.5 N, respectively. The loads that were necessary to produce a 1-mm dent in the grafts were significantly different between Groups I and II and Groups I and III (p < 0.05). These results suggest that stability may be reduced by graft overlapping in mosaicplasty surgery. The results of this ex vivo animal study contribute to a more complete understanding of the primary stability of osteochondral grafts in an overlapping position as well as postoperative protocols.     

A case of unsuspected leiomyosarcoma diagnosed following laparoscopy-assisted vaginal hysterectomy performed for presumed myoma after GnRH treatment

A 37-year-old woman who had received two courses of gonadotropin-releasing hormone (GnRH) analogue for preparation to hysteroscopic resection of a presumed submucous myoma after a benign endometrial sampling had no improvement of bleeding episodes and no regression in the size of the myoma. The patient chose to have a hysterectomy and laparoscopic hysterectomy was performed uneventfully. The mass, consisting of haemorrhagic and necrotic tissues, was found to be located intramurally with dimensions 8×6 cm. Pathological diagnosis was leiomyosarcoma, as examination of the specimen showed diffuse cytologic atypia with coagulative necrosis and 7–8 mitosis per high-power field. The possibility of delaying the definitive treatment of leiomyosarcoma by giving GnRH analogue to patients who were presumed to have myomas should be considered, even in young patients.     

The use of leeches in the management of a ring avulsion injury

Ring avulsion injury presents a spectrum of injury and the treatment varies accordingly from simple suture to amputation. In the current patient, we present a case that has a ring avulsion injury with intact bones, pulleys, flexor tendons, and one digital artery. The problems were venous insufficiency on nearly total avulsed skin and mallet type deformity due to extensor tendon laceration. The avulsed finger skin was sutured in place with interrupted skin sutures and leeches were applied to relieve venous congestion. The result was satisfactory.