Pituitary macroadenomas (>3cm) in young adulthood: Pathologic and proliferative characteristics

Background There are scarce data regarding the significance of the tumor size, hormonal activity and size of the pituitary tumor of the young; therefore, the study was designed to define the relation of the hormonal status of the large pituitary adenomas. Objective We compared those features with tumors of the elderly (>40) with the young patients, and analyzed the clinicopathologic and proliferative features of pituitary macroadenomas in young adulthood (≤40). Methods 20-year archives of pituitary tumors in our clinics were reviewed and macroadenomas with diameter ≥3cm were included in the study. We identified 46 pituitary adenomas and immunohistochemically stained them with pituitary hormones, p53 and Ki-67. Twenty-four cases were ≤40-year with an age range of 11–40 years (mean 28.0). Twenty-two cases were >40 with an age range of 44–78 years (mean 58.8). Results In the young patient group, 15 (62.5%) were functional adenomas (6 prolactinomas, six growth hormone [GH], one adrenocorticotrophic hormone [ACTH] adenoma, two multihormonal [GH+ACTH]) and nine (37.5%) were either gonadotrophic or null cell adenomas. In the elderly group, five (22.7%) were functional adenomas (two adrenocorticotrophic hormone [ACTH] adenoma, one prolactinoma, one growth hormone [GH], one multihormonal [GH+ACTH]) and 17 (77.3%) were either gonadotrophic or null cell adenomas. Ki-67 proliferation index in adenomas of the young was approximately two-folds higher than the elderly (2.7% vs. 1.2%). Conclusion In both groups, rare p53 positivity was identified. In conclusion, pituitary macroadenomas of the young show hormonal expression frequently with relatively high Ki-67 proliferation indices

A pediatric patient with eosinophilic esophagitis presenting with candida esophagitis: Case report

Eozinofilik özofajit, özofagus disfonksiyonu ve özofageal biyopsi örneklerinde eozinofilik inflamasyon ile karakterize klinikopatolojik bir tanıdır. Klinik bulgular yaş gruplarına göre değişmekle birlikte irritabilite, gıda reddi, büyüme geriliği, kusma, regürjitasyon, göğüs-karın ağrısı, katı gıda disfajisi ve mide yanmasını içerir. Eozinoflik özofajitli hem çocuk hem yetişkin hastalarda sıklıkla eşlik eden alerjik hastalıklar (örneğin astım, egzama, besin alerjisi, alerjik rinit) bulunur. Kandida özofajijti, özofagusun kandidiyal enfeksiyonu olup çocukluk çağında çoğunlukla immün yetmezliği olan hastalarda bildirilmektedir. İmmün yetmezliği olmayan çocuklarda çok nadir görülen bir klinik durum olup tedavi edilmeyen kronik gastroözofageal reflü hastalığı ile ilişkili olabileceği bildirilmektedir. Yedi yaşında, inek sütü protein alerjisi ile takipli, dispeptik yakınmalar ve reflü semptomları başlaması nedeniyle özofagogastroduodenoskopi yapılan ve candida özofajiti ile eozinofilik özofajit tanısı alan erkek bir hasta sunulmuştur. Özofagus mukozasının kronik hasarlanmasıyla giden hastalıklarından eozinofilik özofajit ve immün yetmezliği olmayan kişilerde genellikle sağlıksız özofagus mukozası zemininde fırsatçı enfeksiyon olarak ortaya çıkan kandida özofajiti literatürde ilk kez birlikte bildirilmişlerdir. Klinisyenlerin eozinofilik özofajitli hastalarda kandida özofajitinin de olabileceğini akılda tutmaları gerekmektedir.Eosinophilic esophagitis is a clinicopathological diagnosis characterized by eosinophilic inflammation in esophageal biopsy specimens and esophageal dysfunction. Clinical findings vary according to age groups, but includes irritability, food rejection, failure to thrive, vomiting, regurgitation, chest-abdominal pain, solid food dysphagia and heartburn. Both children and adult patients with eosinophilic esophagitis frequently present with concomitant allergic diseases (eg, asthma, eczema, allergic rhinitis). Candida esophagitis is a candidial infection of the esophagus and is often reported in patients with immunodeficiency in childhood. It is a very rare clinical condition in children without immune deficiency and is reported may to be associated with untreated chronic gastroesophageal reflux disease. A 7-year-old male patient, who was followed up with cow's milk protein allergy, underwent esophagogastroduodenoscopy for dyspeptic complaints and reflux symptoms, was diagnosed as candida esophagitis and eosinophilic esophagitis and in this article is presented. Eosinophilic esophagitis, one of the diseases associated with chronic damage of the esophageal mucosa and candida esophagitis, which usually occurs as an opportunistic infection on the ground of unhealthy esophageal mucosa in people without immunodeficiency, has been reported together for the first time in the literature. Clinicians should keep in mind that patients with eosinophilic esophagitis may also have candida esophagitis

Relationship between Histopathological Stages of Liver and Albumin-Bilirubin Score in Hepatitis B Infection

Aim: In this study, sensitivity and specificity of the albumin-bilirubin (ALBI) score were investigated to detect significant liver fibrosis, and these findings were then compared to fibrosis-4 (FIB-4) and aspartate aminotransferase to platelet ratio index (APRI) scores.Material and Methods: A total of 69 patients were included in the study. Of these patients, 54 (78.3%) were male and 15 (21.7%) were female. Serology, molecular analysis, biochemical parameters, and pathology results of the patients who underwent a liver biopsy due to a chronic hepatitis B virus (HBV) infection, were retrospectively evaluated. ALBI, APRI, and FIB-4 scores were calculated. To predict the fibrosis stage, F?2 and F?4, ALBI, APRI, and FIB-4 scores were investigated using the receiver operator characteristic (ROC) curve analysis.Results: The area under the ROC curve with 95% confidence interval (CI) for the ALBI, APRI, and FIB-4 scores were 0.613 (95% CI: 0.463-0.762, p=0.160), 0.658 (95% CI: 0.513-0.803, p=0.040), and 0.731 (95% CI: 0.570-0.891, p=0.004), respectively, to predict the F?2, and 0.758 (95% CI: 0.544-0.971, p=0.090), 0.604 (95% CI:0.451-0.757, p=0.490), and 0.923 (95% CI: 0.856-0.990, p=0.005), respectively, in prediction of F?4. The sensitivity and specificity rates of the ALBI score were 61.1% and 64.7%, respectively, for the cut-off value of -2.81 in predicting F?2, and 75.0% and 70.8% for the cut-off value of -2.78 in predicting F?4.Conclusion: ALBI scores can be used to detect F?2 in patients with chronic HBV. However, it is not yet clear whether this approach is superior to other non-invasive methods for detecting F?4

Can Human Recombinant Epidermal Growth Factor Improve Ischemia and Induce Healing of Anastomosis in an Experimental Study in a Rabbit Model?

Purpose: Anastomotic leaks following intestinal operations may cause devastating effects on patients. Ischemia may also occur at the intestinal walls in the presence of strangulations. In this study, we examined the effects of human recombinant (Hr)-epidermal growth factor (EGF) given at a single intramural dose into the intestinal walls and daily intraperitoneal cavity on ischemia and the healing process of anastomosis. Materials and Methods: Sixteen male New Zeland white rabbits were randomly divided into four groups (n = 4 in each group). In Group 1, two different segments of ileum were identified and, then, transected and the free ends were sutured each other. In the other groups, ischemia was induced by ligating the mesenteric vascular arcade. After the ischemic induction, Group 2 received intramural injections of %0.9 saline, Group 3 received intramural injections of a single dose of EGF, and Group 4 received intramural and intraperitoneal injections of EGF. Bursting pressures and tissue hydroxyproline levels were analyzed. Necrosis, fibroblastic activity, collagen deposition and neovascularization were also studied. Results: The mean levels of bursting pressures in Group 4 (148.6 ± 25.3 mmHg) were higher than Group 2 (70 ± 21.5 mmHg) (p = 0.001). The mean level of bursting pressures was not statistically significant between Group 1 (170.1 ± 35 mmHg) and Group 4 (p = 0.073). Hydroxyproline levels in Group 2 were lower than Groups 3 and 4. There was a statistically significant difference in the mucosal ischemia, mucosal healing and degree of adhesion, but not in the mural anastomotic healing among the groups. Conclusions: Intramural injection with daily intraperitoneal administration of low-dose EGF enhances the bursting pressure and collagen accumulation in ischemic anastomosis, improving many histological variables associated with ischemic intestinal anastomosis

Prevention of Intraabdominal Adhesions: An Experimental Study Using Mitomycin-C and 4% Icodextrin

Background: Intraabdominal adhesions remain a significant cause of morbidity and mortality. Moreover, intraabdominal adhesions can develop in more than 50% of abdominal operations. Aims: We compared the anti-adhesive effects of two different agents on postoperative adhesion formation in a cecal abrasion model. Study Design: Experimental animal study. Methods: Forty Wistar albino type female rats were anesthetized and underwent laparotomy. Study groups comprised Sham, Control, Mitomycin-C, 4% Icodextrin, and Mitomycin-C +4% Icodextrin groups. Macroscopic and histopathological evaluations of adhesions were performed. Results: The frequencies of moderate and severe adhesions were significantly higher in the control group than the other groups. The mitomycin-C and Mitomycin-C +4% Icodextrin groups were associated with significantly lower adhesion scores compared to the control group and 4% Icodextrin group scores (p=0.002 and p=0.008, respectively). The adhesion scores of the Mitomycin-C group were also significantly lower than those of the 4% Icodextrin group (p=0.008). Conclusion: Despite its potential for bone marrow toxicity, Mitomycin-C seems to effectively prevent adhesions. Further studies that prove an acceptable safety profile relating to this promising anti-adhesive agent are required before moving into clinical trial