The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

INTRODUCTION: Acute mesenteric ischemia (AMI) is an abdominal-vascular emergency which is rare and has high mortality rates (60-80 %) due to late diagnosis (1-3). Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1). MATERIALS AND METHODS: In this study, we used male Wistar-Albino rats weighing 250-300 grams obtained from Pamukkale University Experimental Research Laboratory. Animals were exposed to light-dark cycles for 12 hours and had free access to food and water. They were kept in cages for 7 days to stabilise their intestinal flora. In animals of group I, nothing was made other than taking 0.5 ml blood intracardially. In other animals, abdomen was reached with midline laparotomy and superior mesenteric artery (SMA) was located. In group II (operative control group), SMA was isolated and manipulated but was not ligated. In Group III (intestinal ischemia group), SMAwas isolated and ligated with 3/0 silk tie distally to the aorta. After this process, intestinal ischemia was achieved which was confirmed by paleness and pulselessness of intestines, caecum and right colon. Later on, abdomen was closed with double 3/0 polyglactin sutures. At postoperative 1st, 4th and 6th hours 0.5 ml blood was taken intracardially from the animals in groups II and III in order to quantify D-dimer and L-lactate levels. LABORATORY TESTS: D-dimer: Blood samples which were put into tubes containing sodium citrate, were seperated from plasma with centrifugation at 4000 rpm for 7 minutes. L-lactate: Blood L-lactate levels were determined from blood taken into capillary tubes with the help of immobilised enzyme electrode technology using YSI 1500 Sport portative lactate analyzer (Yellow Springs Instruments Inc., Ohio-USA). HISTOPATHOLOGIC VERIFICATION: Two cm long intestinal samples were taken from animals in which SMA was ligated in order to achieve mesenteric ischemia and these samples were fixed in 10 % formol. DISCUSSION: As a result, in rats with SMA occlusion serum D-dimer levels were not increased significantly when compared either in the group or with the basal values of the control group and values in operative control group. Therefore, it is concluded that D-dimer is not a useful marker for early diagnosis of AMI. On the other hand, it is revealed that blood L-lactate levels began to increase significantly following 4th hour of mesenteric ischemia and it is shown that this increase continued at the 6th hour. In addition, considering the utmost importance of the early diagnosis in patients with the clinical suspicion of AMI, L-lactate seems to be a suitable marker to use in emergency departments because it is achieved with a portable device that gives fast and accurate results. Nevertheless, our results are need to be supported by clinical studies with larger patient series (Tab. 2, Fig. 11, Ref. 39). Text in PDF www.elis.sk

A Case of Familial Lichen Amyloidosis

Familial lichen amyloidosis which is also referred to familial primary cutaneous amyloidosis is a rare clinical variant of cutaneous amyloidosis. Lichen amyloidosis is characterized by persistent, pruritic, small brown papules often located on anterior surfaces of legs which show tendency to form plaques. Amyloid deposits would be identified in papillary dermis in histopathological examination. In our clinic, a 42 year old woman with a widespread involvement describing that similar skin findings were present in her both daughters, elder brother and her nephew was evaluated with suspicion of lichen amyloidosis. In histopathological examination of the involved skin, because of determining amyloid deposits in papillary dermis the case was cited as lichen amyloidosis. Our case was searched for the accompanying diseases such as atopic dermatitis, chronic urticaria, lichen planus, multiple endocrine neoplasia and Kimura disease. The family history of our patient was consistent with autosomal dominant inheritance. Familial lichen amyloidosis has been reported as cases with autosomal dominant inheritance from Russia, Germany, United Kingdom and South America. The genetic researches over familial lichen amylodiosis are limited to the cases with multiple endocrine neoplasia. In this rarely reported cases, further genetical researches are necessary in order to determine the responsible gen locus. (Turkderm 2008; 42: 137-9

Value of p53 protein in biological behavior of basal cell carcinoma and in normal epithelia adjacent to carcinomas

Mutations in p53 gene are the most frequent gene alterations in human cancer. In this study, we have used the monoclonal antibody (DO7) to evaluate the role of the p53 gene mutation in the progression of basal cell carcinomas towards invasion. We tested the positivity for p53 protein in tumor cells in six cases of basosquamous cell carcinoma (BSCC), in twelve cases of infiltrative basal cell carcinoma (IBCC) and twenty-four cases of non-infiltrative basal cell carcinoma (NIBCC) in order to evaluate its potential prognostic significance. We also tested the expression of p53 protein in normal epithelia adjacent to carcinomas in order to determine its role in tumor progression. p53 protein staining with some peripheral accentuation was identified in 42,9% of all groups. No correlation was found between the immunreactivity of p53 protein and recurrence, pattern of tumor, diameter of the tumors and sex. However, there were statistically significant differences in positivity of p53 protein in normal epithelia adjacent to carcinomas and age of patients (t value: 2,21; p: 0,034). Results of the study suggest that the increase in p53 mutation frequency of morphologically normal epidermis was related to age and was independent of the degree of differentiation of BCC. © 2000 W B. Saunders and Company Ltd on behalf of the Ar£nyi Lajos Foundation

Morbid obezitede gastrik histopatolojik bulgular ve Ghrelin ekspresyonu

Objective: The role of Ghrelin, also known as the appetite hormone, is not fully explained in the development of morbid obesity. Plasma Ghrelin level is low in obese and high in slim subjects. Ghrelin-expressing cells were investigated histopathologically in the stomach of morbid obese patients in this study. Tissue Ghrelin expression was also compared with various parameters such as the distribution of endocrine cells, age, gender, body mass index, preoperative plasma Ghrelin level and presence of accompanying diseases. Material and Method: The study included 33 morbidly obese patients, and 8 non-obese control patients. Plasma Ghrelin levels were measured preoperatively. Sleeve gastrectomy resection materials of 33 cases were evaluated with histopathological and immunohistochemical (Ghrelin and Chromogranin-A) techniques. The results were statistically evaluated by nonparametric tests. Results: Histopathological findings observed in sleeve gastrectomy resection materials were interstitial lymphocytic infiltration (63.6%), hyperplasia of lymphoid follicles in the lamina propria (60.7%) and microvesiculation / dilatation of parietal cells (57.6%). The number of Ghrelin immunopositive cells in the gastric mucosa in females was significantly higher compared to males (p=0,007). Additionally, the number of Ghrelin immunopositive cells was significantly higher at the fundus-proximal corpus compared to the distal corpus of the stomach (p=0.0001). No significant correlation was found between Ghrelin-chromogranin immunopositive endocrine cell distribution and preoperative plasma Ghrelin levels and endocrine cell hyperplasia. Conclusion: Our study confirms that Ghrelin producing cells are most dense in the proximal stomach. Increased number of Ghrelin expressing cells in the gastric mucosa in females compared to males suggests that gender may also be a factor in determining the method for treatment of morbid obesity

Investigation of HER-2 codon 655 single nucleotide polymorphism frequency and c-ErbB-2 protein expression alterations in gastric cancer patients

Aim: To investigate both whether the risk of gastric cancer is associated with the Ile/Val single nucleotide polymorphism (SNP) of human epidermal growth factor receptor-2 (HER-2) transmembrane domain-coding region at codon 655 and the suggested existence of HER-2 expression in gastric cancer cases in a Turkish patient group. Methods: Polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) strategy was used to analyze the presence of HER-2 SNP at codon 655. c-erbB-2 expression pattern was analyzed by immunohistochemistry. The results were compared between gastric carcinoma group and chronic gastritis group, as well as between clinicopathological parameters and carcinoma. Results: Results showed that Ile/Val genotype accounted for 20% within the Turkish gastric carcinoma group, and none in chronic gastritis group, and this genotyping was associated with stage IV gastric cancers (P = 0.04). Positive membranous HER-2 immunoreactivity, on the other hand, accounted for 24% within the Turkish gastric carcinoma group and none from chronic gastritis cases; further, it was correlated with intestinal type carcinomas (P = 0.007), and stage III-IV carcinomas (P = 0.004). Conclusion: These observations imply that the tested HER-2 SNP may participate in the development and progression of gastric cancer. Thus, after confirming these results with large sample groups, HER-2 codon 655 SNP and/or c-erbB-2 overexpression may also be used as a poor prognostic indicator for gastric carcinomas. © 2006 The WJG Press. All rights reserved

Retrospective long-term results and prognostic factors of treatment for colorectal cancer

To evaluate retrospectively 5-10 year overall survival rate in patients with colorectal cancer treated with or without adjuvant therapy for early stage and analyze the impact of some prognostic factors on clinical outcome we retrospectively reviewed 56 patients treated with only surgery, postoperative or preoperative 5-fluorouracil-based chemotherapy and radiotherapy. The following prognostic factors were considered at univariate analyses: age, sex, tumor location, pathological, tumoural and nodal stage, surgical procedure, pathological specimen margins and adjuvant treatment if applied. The 5 and 10 year actuarial rates for overall survival (OS) were 66% and relapse free survival (RFS) rates were 83% and 58% respectively for all patients. Five years survival was 100%, 73% and 44% respectively for stages I, II and III (p< 0.01). Five years survival for N0, NI and NII disease were 81.3%, 75% and 0% respectively (p< 0.01). Better prognosis was observed for colon cancer compared to rectal and rectosigmoid tumors: 5 years survival rates 90%, 70% and 40% respectively (p< 0.01). Univariate analysis showed that nodal disease, location of tumor in a subsite of colon, pathological stage and surgical procedure had an impact on survival. Our retrospective study showed a good 5-10 year overall survival. Factors as individual pN2, tumor location and advanced pathological stage negatively influenced survival rates. In our opinion to achive better results especially in N2 cancer and rectal and rectosigmoid tumors, especially use of appropriate chemoradiation protocols and new high art radiation technology must be considered in clinical studies in advance

Pseudoxanthoma elasticum: A pediatric case

Pseudoxanthoma elasticum (PXE) is a multisystemic, metabolic and autosomal recessive inherited disorder affecting especially elastic fibers of skin, retina and blood vessels. The prevalence varies from 1:25,000 to 1:100,000. The average age of onset is 13.5 years. Yellowish papules 1-3 mm in diameter and plaques merging as linear or reticular pattern are mostly on antecubital fossae, popliteal fossae, inguinal region, lower clavicle, neck, axilla, flexural regions as umbilicus and trauma sites. Of the patients, 85% have eye involvement. The first symptom of eye involvement is spot retinal pigmentation. Cardiovascular complications occur usually in adults. The most common and early cardiovascular complication is intermittent claudication. There is no specific treatment for skin signs. Lifestyle changes may have important effects on prognosis. A male patient with 3-year history of yellowish papules on his neck and 1-year history of yellowish papules on his groins, was presented in this case report. This 7-year-old patient received a diagnosis of PXE based on medical story, clinical examination and histopathological findings. This case was presented as PXE is a rare disease and should be diagnosed by the clinician at early ages. © 2015 by Turkish Society of Dermatology

Surgical treatment of classic kaposi's sarcoma in the lower extremity

Objective: Classic Kaposi's sarcoma is an indolent, angioproliferative tumor that is usually observed in the lower extremities of elderly men. Depending on their stages, skin lesions are maculonodular or vegetative ulcerated masses. Visceral organ or lymph node involvement may rarely occur. There is no gold standard treatment for local diseases. Surgical excision, radiotherapy, chemotherapy, and cryotherapy can be performed. This retrospective study aimed to evaluate the long-term results of surgical excision and skin graft repair of stage I and II classic Kaposi's sarcoma skin lesions around the foot and ankle. Material and Methods: Eleven patients were included. The patients' age and gender, location of lesion, surgical treatment, follow- up period, and recurrence were evaluated by retrospectively examining patient records. For the surgical treatment, the lesion was excised with a 0.5-cm safe skin margin. The defect area was repaired with full-thickness skin grafts that were obtained from the inguinal region in all patients. Results: Eight of the patients were male and three were female. The average age of the patients was 69 (54-84) years. All patients were completely cured. The average follow-up period was 1.8 (1-3) years. No recurrence was observed in any of the patients at the end of the follow-up period. Conclusion: Classic Kaposi's sarcoma skin lesions in the lower extremity can be completely cured by surgical excision, with no recurrence risk. After surgical excision, using a full-thickness skin graft for repairing primary cutaneous defects, particularly those in the soles, is a simple and reliable method