Mehmet Yıldızhan 1 , İzzet Koçak2, Sevin Kırdar3, Nil Çulhacı4 1 Department of Urology, Ankara City Hospital, Ankara 2 Department of Urology, Adnan Menderes University, Medicine Faculty, Aydin 3 Department of Microbiology, Adnan Menderes University, Medicine Faculty, Aydin 4 Department of Pathology, Adnan Menderes University, Medicine Faculty, Aydin, Turkey Human Papillomavirus and urothelial bladder carcinoma Detection of Human Papillomavirus using polymerase chain reaction methods in transitional urothelial bladder cancer

Isolated pulmonary metastasis is observed in 2%-3% of prostate cancer cases but a complete treatment algorithm was not established for these patients. This study aimed to present a case of isolated pulmonary metastasis during the follow-up after radical prostatectomy, in which recurrence was not detected for 2 years after metastasectomy. The patient was on follow-up without any treatment for 22 months, with an unobservable prostate-specific antigen value. Metastasectomy in oligometastatic disease has emerged as a treatment option in recent years but is not considered a standard treatment. Literature contribution is necessary for oligometastatic disease definition to clarify its nature and compare treatment options.

INTRODUCTION:There are many significantfactors in testicular injury which determine the prognosis in testicular torsion. Reperfusion injury following detorsion also has a significant effect on testicular injury.This study was planned considering that with the implementation of intermittent reperfusion and hypothermia, reperfusion injury can be reduced, and such an application might have a positive effect on testicular tissue in the long term. MATERIALS AND METHODS:Forty adult male rats were divided into five groups as follows: Sham(Sh)(n = 8), Torsion(T)(n = 8), Intermittent reperfusion(IR)(n = 8), Hypothermia(H)(n = 8), and Intermittent reperfusion+hypothermia(IR+H)(n = 8). Except forGroup Sh, the left testicle was taken out of the scrotum in all groups, rotated three times counterclockwise, fixed back in the scrotum, and left for four hours.After four hours, and just before reperfusion, the testicle's detorsion was performed while holding the vascular structures in the proximal part of the torsed segment with an atraumatic vessel clamp, and thus, not allowing reperfusion in Groups T, IR, H, and IR+H. In Group T, the clamp was released immediately. In Group H, an ice-bag cooling was performed around the testis, and the clamp was released when the tissue temperature was reached and kept constant at 4 °C. In Group IR, the clamp was released, allowing reperfusion of five seconds, followed by reclamping, providing an ischemic status for ten seconds; this procedure was repeated ten times. In Group H+IR,an ice-bag cooling was performed around the testis, and the clamp was released when the tissue temperature was reached and kept constant at 4 °C. Then, reperfusion was applied for 5 s, followed by 10 s ischemia with reclamping. This procedure was repeated ten times.Tissue blood flow was provided for60 days of reperfusion in all groups. After 60 days, both testicles were excised under anesthesia in all living rats, and samples ofthe left testicle werereserved for biochemical and pathological examinations. At the end of the procedure, all animals were sacrificed by a high dose of anesthesia. RESULTS:It was biochemically and histopathologically determined that the tissues were preserved in the experimental groups compared to Group T, which was statistically significant (p < 0.05).However, no experimental group's superiority over each other was determined both biochemically and histopathologically (p > 0.05). CONCLUSION:Our long-term experimental study revealed that all methods were protective in testicular torsion. The authors believe that these methods can be applied in clinical practice because of their ease of application and no additional cost. On the other hand, the results of our study should further be supported by other experimental studies.

Objective: Gleason scoring is the grading system which strongly predicts the prognosis of prostate cancer. However, even being one of the most commonly used systems, the presence of different interobserver agreement rates push the uropathologists update the definitons of the Gleason patterns. In this study, we aimed to determine the interobserver agreement variability among 7 general pathologists, and one expert uropathologist from 6 different centers. Methods: A set of 50 Hematoxylin & Eosin stained slides from 41 patients diagnosed as prostate cancer were revised by 8 different pathologists. The pathologists were also grouped according to having their residency at the same institute or working at the same center. All pathologists' and the subgroups' Gleason scores were then compared for interobserver variability by Fleiss' and Cohen's kappa tests using R v3.2.4. Results: There were about 8 pathologists from 6 different centers revised all the slides. One of them was an expert uropathologist with experience of 18 years. Among 7 general pathologists 4 had surgical pathology experience for over 5 years whilst 3 had under 5 years. The Fleiss' kappa was found as 0.54 for primary Gleason pattern, and 0.44 for total Gleason score (moderate agreement). The Fleiss' kappa was 0.45 for grade grouping system. Conclusion: Assigning a Gleason score for a patient can be problematic because of different interobserver agreement rates among pathologists even though the patterns were accepted as well-defined.

Purpose: This study investigated the possible beneficial effect of hyaluronic acid (HA) on traumatic urethral healing. Methods: A total of 40 adult male Wistar rats were randomized into four groups: control, sham (serum physiologic; SF group), HA 1.8%, and HA 3%. A tiny hook was introduced and drawn at the 12 o’clock position into the urethra for the SF and HA groups to create a urethral inflammation model. Either SF or HA was applied intraurethrally for 5 consecutive days. After a 15-day follow-up period (21st day of the study), penile tissue was harvested and evaluated histopathologically. Results: None of the groups showed inflammation at the end of study. Pathological findings such as calcification, hemorrhage, and stenosis were observed in the wound healing and these findings were present in all trauma groups. A significant increase in tissue thickness was observed in the group treated with saline (p = 0.004). No statistically significant difference was found in the two groups receiving HA treatment compared to the SF group. Conclusion: These data suggest that HA does not provide a beneficial effect on the connective tissue repairment when it is applied locally during the acute period of urethral injury for 5 consecutive days. There is a need for further studies in which the duration of drug use is extended or the dosage is increased.

Objective: Ulcerative colitis is an immonologically mediated chronic intestinal disorder, which is characterized with inflammation, oxidative stress, apoptosis.Our study was aimed to investigate the effects of alpha lipoic acid administered orally or as colonic enema in trinitrobenzene sulfonic acid-induced ulcerative colitis.Methods: Forty-two Wistar Albino rats were divided into five groups.Intracolonic corn oil was administered in the Control Group.After induction of colitis with trinitrobenzene sulfonic acid,and corn oil via gavage (Sham Group), alpha lipoic acid 200 mg/kg/day via gavage (ALA Gavage Group), intracolonic alpha lipoic acid 200 mg/kg/day (ALA Enema Group), and intracolonic corn oil (Corn Oil Enema Group) were administrated.On the eighth day of the study, colonic specimens were evaluated and scored for the presence of macroscopic and microscopic lesions.Results: In the microscopic evaluation, total scores of Sham and Corn Oil Enema Groups were higher than those of the Control Group (p<0.05).The score of ALA Gavage Group was not different from Control Group (p>0.05).No significant pathological mucosal changes were detected in ALA Gavage Group, and significantly lower macroscopic scores and blood MDA levels were found when compared to Sham Group (p<0.05). Conclusion:We determined the positive effects of alpha lipoic acid on histopathological and biochemical parameters in the rat experimental colitis model when administered via gavage.However, we did not determine any positive effect when we administered alpha lipoic acid intrarectally.We can suggest that alpha lipoic acid, when administered orally, may be helpful for prolongation of remission in patients with inflammatory bowel disease, for reducing the frequency of enterocolitis in patients with Hirschsprung disease, and for prevention of necrotizing enterocolitis after further studies.

Introduction Reperfusion injury after detorsion in testicular torsion is a clinical problem. This study was planned to investigate the protective effect of intermittent reperfusion in hypothermia-applied testicles. Materials and methods A total of 40 adult male rats were used, and 5 groups were created: sham (Sh; n = 8), torsion (T; torsion-detorsion) (n = 8), intermittent reperfusion (IR; n = 8), hypothermia (H; n = 8), and intermittent reperfusion+hypothermia (H+IR; n = 8). The left testicle was removed in all groups except in the Sh group, and it was rotated 3 times counterclockwise, fixed in the scrotum, and left for 4 h. After 4 h, the testicle was detorsioned in the groups T, IR, H, and H+IR. During detorsion, an atraumatic vessel clamp was applied in the proximal part of the vascular structures to prevent any reperfusion of the testicle. The clamp was opened immediately in the group T. In the group IR, the clamp was opened, a reperfusion of 5 s was applied; then, the clamp was closed again, and ischemia was created for 10 s; this procedure was repeated 10 times. In the group H, an ice bag cooling was performed around the testis. The tissue temperature was kept constant at 4 degrees C using a digital thermometer control. The testicle was cooled using an ice bag in the group H+IR; the same procedure was applied to the IR group. In all groups, reperfusion was performed for 1 h at the end of these procedures. The left testicle was removed from all rats; a portion of each testicle was separated for biochemistry testing, and some was separated for histopathological evaluation. At the end of the procedure, intracardiac blood was taken to examine oxidative stress parameters. At the end of the procedure, all animals were sacrificed after administration of a high dose of anesthesia. Results The authors observed that the tissue was preserved in the experimental groups and this was statistically significant (p<0.05). It was detected that the tissues were also histopathologically and significantly preserved in the groups IR, H, and H+IR. However, both biochemically and histopathologically, there was no superiority of hypothermia, intermittent reperfusion, or combined application (p>0.05). Discussion Both hypothermia and intermittent reperfusion alone protect tissue from IR damage. But no studies have been found in which these applications were used together. And as a result of this work, the combination of both methods did not show superiority over the effect they showed when they were used separately. The authors think that these methods can be applied clinically because of their ease of application and no additional costs; however, it should be supported by other studies.

Introduction: Ischemia in ovarian torsion and subsequent reperfusion has significant effects on fertility in the long term. The most important reason for these changes is thought to be a reperfusion injury rather than ischemia. We aimed to evaluate whether the reperfusion injury following ovarian detorsion could be reduced by hypothermia and intermittent reperfusion. Materials and Methods: Forty adult female rats were divided into five groups as follows: Sham (Sh) (n = 8), torsion detorsion (control TD) (n = 8), progressive reperfusion "gradual detorsion" (GD) (n = 8), hypothermia (H) (n = 8) and the progressive reperfusion + hypothermia (GD + H) (n = 8). In all rats, except for the Sh group, the left ovary was rotated counter clockwise 1080 degrees and fixed to the abdominal wall by three 5-0 non-absorbable sutures followed by the closure of the laparotomy. After 30 h, reperfusion was achieved following the detorsion of the ovaries. In both the control TD and H groups, the torsed ovaries were detorsed. H group, however, was subjected to hypothermia with ice packs 30 min before and during the detorsion. Tissue temperature was kept constant at 4 degrees C, controlled by a digital thermometer. In the GD group, the torsed ovary and pedicle were detorsed by 360 degrees, followed by a 5 min pause. This procedure was repeated twice until a complete detorsion was achieved. GD + H group underwent hypothermia with ice packs 30 min before the procedure and the torsed ovary and pedicle were detorsed by 360 degrees. After a 5 min pause, we repeated this process twice to provide full detorsion. The tissue temperature was constantly held at 4 degrees C. In the hypothermia groups, we applied hypothermia for an additional 30 min after detorsion and then left the rats at normal body temperature during reperfusion. We followed the rats in all groups for 60 days. Then we excised the left ovaries of all rats through laparotomy and spared some of the ovaries for biochemical and pathological examination. Intracardiac blood was taken at the end of the procedure and it was sent to the biochemical laboratory to assess oxidative stress markers. Finally, all the animals were sacrificed with high-dose of anesthesia. Results: Evaluation of the results revealed that oxidative stress markers were significantly lower, and antioxidant parameters were higher in the experimental groups compared with the control TD group (p < 0.05). Histopathologically, we found that tissues were preserved in GD, H, GD + H groups (p < 0.05). When we compared the groups among each other, both biochemical and histopathological values in GD + H group showed that the tissue was preserved from oxidative damage, albeit the difference did not reach a level of significance. Discussion: Several studies have shown that both hypothermia and intermittent reperfusion protect tissue from IR damage in the early period. However, as far as we know there is no study on long-term outcomes of both practices. Our study showed that both hypothermia and intermittent reperfusion alone protect tissue from IR damage in the long term. However, it did not show the superiority of the combination of both methods compared to that of individual application. The advantages of these methods lie in their easy application and cost-effectiveness. We believe that our study will serve as a base for future studies on the subject. (c) 2019 Elsevier Inc. All rights reserved.

Aim: To evaluate the role of using 18 Gauge (G) and 20G sharp needles in ultrasonography (US)-guided percutaneous liver mass biopsy regarding diagnostic success and efficacy is aimed. Materials and Methods: Sixty patients who underwent US-guided liver mass biopsy using 18G and 20G cutting needles were included in the study. Definite diagnosis was established based on results of histopathological examinations of the biopsied lesions, follow-up clinical and imaging findings and for performed patients the results of repeated biopsy. In addition, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for 18G and 20G needles. Results: Among 60 liver masses, definite diagnosis was malignant in 54 (90%) masses and benign in 6 (10%) masses. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 90.7%, 100.0%, 100.0%, 75.0%, and 91.6%, respectively, for the liver mass biopsies performed with 18G needles. These values were 87.0%, 100.0%, 100.0%, 66.7%, and 88.3%, respectively, for the liver mass biopsies performed with 20G needles. No significant difference was determined between the results found for the use of 18G needle and 20G needle in US-guided cutting needle biopsy performed in hepatic masses (p=0.540) Conclusion: The present study demonstrated that 18G and 20G sharp needles had similar diagnostic success and efficacy in US-guided percutaneous biopsy of liver mass lesions. Owing to its fine calibration, 20G sharp needle can be preferred in high-risk patient groups, particularly in those with bleeding disorder.

Cardiac tumors are rarely encountered pathologies, but they may have versatile and different clinical implications. Cardiac papillary fibroelastomas are the third most common primary heart tumors and these are often diagnosed incidentally. When these tumors cause symptoms, they often emerge with cerebral embolic events or myocardial ischemia. Surgical resection of the tumor is recommended to eliminate the risk of embolism and sudden death for symptomatic cases and when the tumor originates from the left side of the heart and mobile. In this case report, we present valve-sparing complete resection of a cardiac papillary fibroelastoma arising from aortic valve which causes neurological symptoms.

Drug-induced liver damage is a frequently encountered clinical table caused by many drugs. Cetirizine is a widely preferred and prescribed antihistaminic agent for allergic disorders due to its non-sedative properties. In view of the literature, we present four cases of hepatotoxicity due to cetirizine use. We conclude that in patients with high levels of liver enzymes of unknown origin, cetirizine as well as other hepatotoxic drugs should be reconsidered.

Cystic nephroma is a rare benign cystic tumour of the kidney and is usually diagnosed with unilateral involvement. It typically arises from the renal parenchyma and is often treated with nephrectomy. It is usually detected in males between 3 months and 2 years of age. In this article, we present a case report of 19-month-old girl who presented with a cystic mass in the right kidney found by clinical and imaging techniques and underwent right total nephrectomy. The pathologic examination confirmed a cystic nephroma. In conclusion, cystic nephroma should be considered in the differential diagnosis when an infant has a unilateral cystic kidney.

Cystic nephroma is a rare benign cystic tumour of the kidney and is usually diagnosed with unilateral involvement. It typically arises from the renal parenchyma and is often treated with nephrectomy. It is usually detected in males between 3 months and 2 years of age. In this article, we present a case report of 19-month-old girl who presented with a cystic mass in the right kidney found by clinical and imaging techniques and underwent right total nephrectomy. The pathologic examination confirmed a cystic nephroma. In conclusion, cystic nephroma should be considered in the differential diagnosis when an infant has a unilateral cystic kidney.

Aim: Classical punch biopsy instrument can cut cutaneous and subcutaneous tissue in shape of a cylinder but cannot cut the base of it. Then the tissue needs to be pulled to cut the base and this pulling procedure can damage the specimen. To overcome these problems, a new device is designed and produced. Our purpose is to experimentally compare this new device with the regular punch biopsy instrument. Material and Method: The new device consists of two pieces. First piece has a blade to cut the tissue cylindrically and a body to vacuum it. The flat blade in the second piece cuts the base of the sample smoothly. Four biopsies on the dorsal area of 10 rats were performed. Two biopsies were done by regular punch biopsy instrument while the other two were done with new device, randomly. It was investigated if both instruments optimally removed the base of the tissue and how much the tissue had damaged. Results: Classical punch biopsy instrument performed ideal excision in all 20 biopsies, while the new device performed ideal excision in 18 out of 20 biopsies. The difference was statistically insignificant (p=0,487). While evaluating the damages on biopsy sites, the difference was also statistically insignificant (p=0,432). Conclusions: This new semiautomatic skin biopsy device is produced both for damage free excision of the tissue and for optimal healing process of the biopsy site. Our first experiment results are comparable with the regular method and the device needs to be developed for better outcome.

Colorectal cancer (CRC) is the third most frequent malignancy. Many factors such as NF-κB, matrix metalloproteinase-1 (MMP-1), p53, and Ki-67 are likely to be involved in its development and progression. Lymph node metastases indicate increased tumor burden and tumor cell heterogeneity and affect both the treatment strategies and the prognosis. In this study, expressions of NF-κB, MMP-1, p53, and Ki-67 were between the primary tumors and lymph node metastases in 110 Dukes' stage C, CRC cases by immunohistochemical methods, related to patients' clinical outcomes. NF-κB, p53, and Ki-67 expressions were significantly higher in the metastatic lymph nodes compared to the primary tumor tissues (P = 0.04, P = 0.04, and P = 0.01, resp.). In the metastatic lymph nodes NF-κB expression was correlated with both p53 (r = 0.546, P = 0.003) and Ki-67 (r = 0.586, P = 0.0001) expressions. The univariant and multivariant analyses showed that only “pT stage” preserved an independent prognostic significance for recurrence-free survival rates and 5-year overall survival rates (P < 0.001 for both). Metastatic cells can acquire different biological characteristics compared to their primaries. Elucidation of properties acquired by metastatic cells is important in order to better determine prognosis, reverse drug resistance, and discover new treatment alternatives.

Angiomatoid fibrous histiocytoma is a rare soft tissue tumor of uncertain differentiation and low metastatic potential, which occurs predominantly in children and young adults. It occurs mostly within the extremities, trunk, head and neck. It can be associated with systemic manifestations such as anemia, pyrexia and malaise. Its morphology is distinct, with an outer shell of lymphoid tissue, sheets of dendritic-like tumor cells with bland nuclei and blood-filled cystic cavities. Herein, we present a case of angiomatoid fibrous histiocytoma with systemic symptoms before any mass was clinically detectable, arising in the scalp of a 10-year-old girl.