Submucosal Connective Tissue Research Articles

Oral Focal Mucinosis of the Tongue: A Rare Localization for a Rare Entity.

Oral focal mucinosis (OFM) is a rare connective tissue disorder that is characterized by the excessive production of hyaluronic acid due to myxoid degeneration of submucosal connective tissue. The disorder typically presents as an asymptomatic nodule or mass in the gingiva or hard palate, and OFM of the tongue is even more unusual. In this report, we present a case of OFM on the tongue in a 72-year-old female patient who presented with a symptomatic lump that had been growing for 6 months on the dorsum of her tongue. The patient reported discomfort and pain while speaking and swallowing, and the lump was visually apparent on examination. OFM is a benign condition that does not have any specific clinical or radiographical features that distinguish it from other more common oral lesions, such as lipoma or fibroma. Therefore, histopathological examination is essential for a definitive diagnosis. The management of OFM typically involves surgical excision of the lesion. In this case, complete surgical removal of the lesion under general anesthesia was performed, and the patient was followed up for 10 months postoperatively. During the follow-up period, there was no evidence of recurrence, and the patient reported significant improvement in her symptoms. In conclusion, OFM is a rare connective tissue disorder that can occur in the oral cavity. Although OFM of the tongue is even rarer, it should be considered in the differential diagnosis of oral lesions. Histopathological examination is essential for definitive diagnosis, and surgical excision is typically the preferred treatment modality.

Top Ten Lymphoproliferative Lesions Not to Miss When Evaluating Oral Ulcer Biopsies.

Oral ulcers represent afull thickness lossof the mucosal epithelium leading to exposure of the submucosal connective tissue. These are common and usually self-limited lesions, although they may sometimes result from neoplasms, most commonly squamous cell carcinoma. Lymphoproliferative disorders may be difficult to diagnose in apthous ulcers since they mimic reactive inflammation. This review presents ten rare oral lymphoid proliferations which should not be missed when assessing oral ulcer biopsies. The ten lesions include several with diagnostic cells which look similar to the histiocytes of a reactive inflammatory ulcer, including Rosai-Dorfman disease, reticulohistiocytoma, Langerhans cell histiocytosis, and traumatic ulcerative granuloma. Other lesions, such as EBV-positive mucocutaneous ulcer, extranodal marginal zone lymphoma of mucosal-associated lymphoid tissue, and plasmablastic lymphoma have lymphoid and/or plasma cell differentiation that mimic the reactive lymphocytes and plasma cells foundin reactive ulcers. Two dendritic cell lesions, follicular dendritic cell sarcoma and blastic plasmacytoid dendritic cell neoplasm, both have distinct phenotypes which are required to make an accurate diagnosis. Each of these lesions are diagnosed by evaluating their histology, along with their phenotypic profile, which is sometimes enhanced by pertinent molecular findings.

Idiopathic gingival enlargement: A brief review and case report

Idiopathic gingival enlargement is a heterogenous group of disorders characterized by progressive enlargement of the gingiva caused by an increase in submucosal connective tissue elements. Many cases are iatrogenic and some are inherited or idiopathic. We present a case of idiopathic gingival enlargement to highlight the etiological factors, radiographic and histological features

Compression Optical Coherence Elastography for Assessing Elasticity of the Vaginal Wall under Prolapse after Neodymium Laser Treatment

Early stages of pelvic organ prolapses are mainly associated with the pelvic floor disfunction as a result of elasticity changes in the connective tissues including the vaginal wall. In this study, for the first time we used a compression optical coherence elastography (C-OCE) method for assessing elasticity of the vaginal wall under prolapse conditions after intravaginal neodymium (Nd:YAG) laser treatment. C-OCE was used for a comparative ex vivo study of vaginal wall average values of stiffness (elastic Young’s modulus) in patients with age norm (n = 6), stage I–II prolapse (n = 5) without treatment and stage I–II prolapse post 1–2 months Nd:YAG laser treatment (n = 10). To verify the C-OCE data, the structural features of the submucosal connective tissue were identified morphometrically by Van Gieson staining using quantitative textural analysis of the state of collagen bundles. The results of a comparative evaluation of C-OCE and histological images demonstrate a statistically significant tissue stiffness decrease in vaginal wall prolapse compared to the age norm (73.5 ± 18.9 kPa vs. 233.5 ± 48.3 kPa; p < 0.05). This agrees with the histologically revealed increase in the space between the bundles of collagen fibers, which leads to a decrease in the uniformity of their arrangement. After Nd:YAG laser treatment, we observed statistically significant connective tissue stiffness increase compared to vaginal wall prolapse without treatment (152.1 ± 19.2 kPa vs. 73.5 ± 18.9 kPa; p < 0.05), which was associated with an increase in the local thickness of the collagen bundles, a change in their orientation, and an increase in the uniformity of their arrangement. The obtained results indicate that the C-OCE can be a robust method for detecting the early stages of vaginal wall prolapse and assessing the elastic modulus increase in the vaginal wall after laser treatment.

AMYLOIDOSIS OF THE TONGUE: A CASE REPORT

Amyloidosis is characterized by the deposition of amyloid fibrils in tissues and organs. This study presents a case of amyloidosis of the tongue. A 65-year-old male patient presented with an irregular and hardened swelling in the lateral tongue, causing significant macroglossia. The patient also demonstrated significant dyspnea and lower extremity edema. Diagnostic hypotheses were malignant tumor and oral manifestation of systemic disease. An incisional biopsy was performed and revealed extracellular deposition of amorphous, eosinophilic, hyaline-like material in the submucosal connective tissue. To confirm the presence of amyloid, staining with Congo red was performed, which showed peach red color on light microscopy and apple green birefringence on polarized light microscopy. The patient was referred to the rheumatology department but died 15 days after diagnosis. Amyloidosis is a rare disease and requires early diagnosis due to the possibility of systemic involvement.

Complete response to combination therapy using nivolumab and ipilimumab for metastatic, sarcomatoid collecting duct carcinoma presenting with high expression of programmed death-ligand 1: a case report

BackgroundCollecting duct carcinoma and sarcomatoid renal cell carcinoma are tumors with poor prognosis. Immune checkpoint inhibitors have been established as the standard treatment for advanced renal cell carcinoma. Some cases of remission of collecting duct carcinoma and sarcomatoid renal cell carcinoma have been reported using immune checkpoint inhibitor interventions. Specifically, sarcomatoid renal cell carcinoma expresses high levels of programmed death-ligand 1, an immune checkpoint protein, and immune checkpoint inhibitors have been reported to be highly effective for treating sarcomatoid renal cell carcinoma.Case presentationWe describe the case of a 70-year-old Japanese male who underwent radical right nephrectomy for a right renal mass identified on computed tomography. The pathological examination demonstrated that the renal mass was urothelial carcinoma and collecting duct carcinoma with sarcomatoid changes, and programmed death-ligand 1 was highly expressed with a tumor proportion score of more than 10%. There was no evident submucosal connective tissue invasion in the urothelial carcinoma component, and collecting duct carcinoma was diagnosed as primary cancer. The tumor–node–metastasis classification was pT3aN0, venous invasion 1, lymphovascular invasion 0, and Fuhrman nuclear grade 4. Two months after the nephrectomy, multiple metastases were observed in both lungs, the right hilar lymph node, and the S6 segment of the right liver lobe. We initiated first-line combination therapy with nivolumab (240 mg, fixed dose) and ipilimumab (1 mg/kg). One day after administration, the patient developed drug-induced interstitial pneumonia, thus we applied steroid injections. After one administration of immunotherapy, the metastatic lesion showed complete response within 6 months, which was maintained after 3 years.ConclusionWe report the first case of complete response to a single dose of combination therapy with nivolumab and ipilimumab for metastatic collecting duct carcinoma with sarcomatoid changes and high expression of programmed death-ligand 1. This case suggests high expectations for immune checkpoint inhibitors as treatment for sarcomatoid-transformed renal carcinoma tumors that express high levels of programmed death-ligand 1.

Lipoid proteinosis: Review of Indian cases.

Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the deposition of amorphous hyaline material in the dermis and submucosal connective tissue. To date <500 cases of LP have been described and oral manifestations described in a very few reports. Indian cases are much less reported and reviewed. Hence, here review of 51 Indian LP cases along with a case of histologically proven LP in 12-year-old male patient with typical skin, ocular, laryngeal, oral and radiographic features is done. Cases from 1969 to 2021 were collected using keyword LP on google and google scholar and Indian cases were analyzed afterward. Review with case presentation regarding oral manifestations will help the oral physician to diagnose LP in early stage.

Cecal epidermoid cyst: a neonatal case with clinicopathological consideration

BackgroundOnly 10 cases of cecal epidermoid cyst (CEC) have been reported in the literature. Furthermore, its pathogenesis remains unclear. We report a rare case of congenital CEC in neonate, and discuss its clinicopathological findings.Case presentationA cystic lesion was incidentally identified in the retroperitoneal area of the abdominal right lower quadrant during a routine prenatal ultrasonography (US), prompting an ileocolectomy 3 days after birth. This congenital cyst was composed of mucosal lining cells and submucosal connective tissues, and the inner lining mucosa was composed of stratified squamous epithelium and focally mucin-producing ciliated epithelium. Based on the macroscopic and microscopic findings, the cystic lesion was diagnosed as a congenital cecal epidermoid cyst.ConclusionsThe management of a fetal abdominal mass should be tailored individually, considering that epidermoid cysts can occur in the cecum during the perinatal period. We report the clinicopathological findings in this case, including its possible pathogenesis.

Labial and buccal minor salivary glands of the dog - location, three-dimensional arrangement and histology.

ObjectiveTransplantation of minor salivary glands (MSGs) to the conjunctiva is a treatment option for patients suffering from dry eye disease. As there is not enough information about labial and buccal MSGs in dogs, the aim of this study was to provide evidence of the presence of these glands and to investigate their spatial arrangement and excretory ducts.MethodsThe oral mucosa of the lower lip of 4 dogs and the whole lower jaw of 1 dog were used for histological and microCT analysis. Presence, number, volumes and the tissue depth of MSGs were assessed.ResultsHistological analysis showed that compact tubulo‐acinar glands were located in the submucosal connective tissue. MicroCT images revealed that 9 to 21 MSGs were arranged in a single row at the level of the dental alveolae. The volume of the MSGs increased from rostral to caudal and the total volume of glandular tissue per animal ranged from 35.01 mm3 to 549.43 mm3. The mean tissue depth of MSGs ranged from 0.57 mm to 1.37 mm (upper surface of glands) and between 1.43 mm and 3.09 mm (lower surface of the glands). Excretory ducts left the dorsal part of the glands and ran in dorso‐rostral direction.ConclusionsThe location, number and volume of the labial and buccal MSGs in the dog could be detected and described using microCT scans and histology. The present results can provide valuable information for future transplantation of labial MSGs as therapeutic measure against keratoconjunctivitis sicca.

Патоморфологические аспекты стриктур уретры различной этиологии

Introduction The study of the structure of strictures of various etiologies is an open and uncertain issue of modern urology. Aim To evaluate the morphological and immunohistochemical structure of strictures of various etiologies. Materials and methods The study involved postoperative tissue of a pathologically altered urethra of 110 patients aged 23 to 74 years who underwent treatment at the University Clinic of Urology, Russian National Research Medical University. N.I. Pirogova (2014-2018) with Ds: urethral stricture. Morphological study: Van-Gieson staining; hemotoxylin - eosin. Immunohistochemical study: mouse monoclonal antibodies to muscle and connective tissue markers (Smooth Muscle Actin, Vimentin, Calponin) and inflammation markers (CD45R, CD58, CD138, CD20, CD3) were used as primary antibodies in all reactions. Results According to the revealed morphological changes, the material was divided into three groups: group I (n=27) - active inflammation; group II (n=33) - the predominant development of connective tissue with low activity of inflammation; group III (n=50) - mixed (chronic mild inflammation, an even amount of connective tissue). In a morphological study of idiopathic urethral strictures, it was noted that the multicolumnar epithelium was replaced by a multi-layer flat epithelium with a weakly pronounced keratinization. Inflammatory changes were mild, including the submucosal connective tissue and the spongy body. Spongiofibrosis is accompanied by a significant reduction in the vascular bed of both venous sinuses and arteries. The same changes were observed in the inflammatory genesis of urethral strictures. In the study of strictures with traumatic etiology, a restructuring of the cylindrical epithelium was observed. In cases with severe inflammation in the mucosa, the changes were atrophic-hyperplastic in nature with reactive cell atypia. Conclusion urethral Strictures in men have a specific etiological factor, but the pathogenesis of urethral lesions can be divided into: post-traumatic and post-inflammatory.

Persistence of postoperative pain due to extrusion of endodontic obturator plastic carrier: A report of two cases treated with a periradicular microsurgical approach

The aim of the present study was to describe two clinical cases showing postoperative pain associated with the use of plastic carrier obturation system and apical bone fenestration. The patients were treated by surgical access and apicoectomy through a modern technique (using magnification and microsurgical approach), thus removing the direct contact between obturation material and submucosal connective tissue. The surgical interventions were carried on without the occurrence of any complication. Postsurgical adverse sequelae were negligible. After few weeks from the surgery, all symptoms disappeared. Radiographic healing was observed after 48 months. The presence of apical bone fenestration could be the cause of persistent pain after root canal treatment. The contact between plastic carrier and submucosal connective tissue could be the direct cause of spontaneous pain even in absence of periapical infection. Since the clinical diagnosis could be difficult, the use of tridimensional radiology could be justified. Surgical approach, by the removal of the contact between the carrier and connective tissues, can be considered a viable option to treat these particular affections.

Extrahepatic bile duct reconstruction in pigs with heterogenous animal-derived artificial bile ducts: A preliminary experience.

BACKGROUNDExtrahepatic biliary duct injury (BDI) remains a complicated issue for surgeons. Although several approaches have been explored to address this problem, the high incidence of complications affects postoperative recovery. As a nonimmunogenic scaffold, an animal-derived artificial bile duct (ada-BD) could replace the defect, providing good physiological conditions for the regeneration of autologous bile duct structures without changing the original anatomical and physiologic conditions.AIMTo evaluate the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI in pigs.METHODSEight pigs were randomly divided into two groups in the study. The animal injury model was developed with an approximately 2 cm segmental defect of various parts of the common bile duct (CBD) for all pigs. A 2 cm long novel heterogenous animal-derived bile duct was used to repair this segmental defect (group A, ada-BD-to-duodenum anastomosis to repair the distal CBD defect; group B, ada-BD-to-CBD anastomosis to repair the intermedial CBD defect). The endpoint for observation was 6 mo (group A) and 12 mo (group B) after the operation. Liver function was regularly tested. Animals were euthanized at the above endpoints. Histological analysis was carried out to assess the efficacy of the repair.RESULTSThe median operative time was 2.45 h (2-3 h), with a median anastomosis time of 60.5 min (55-73 min). All experimental animals survived until the endpoints for observation. The liver function was almost regular. Histologic analysis indicated a marked biliary epithelial layer covering the neo-bile duct and regeneration of the submucosal connective tissue and smooth muscle without significant signs of immune rejection. In comparison, the submucosal connective tissue was more regular and thicker in group B than in group A, and there was superior integrity of the regeneration of the biliary epithelial layer. Despite the advantages of the regeneration of the bile duct smooth muscle observed in group A, the effect on the patency of the ada-BD grafts in group B was not confirmed by macroscopic assessment and cholangiography.CONCLUSIONThis approach appears to be feasible for repairing a CBD defect with an ada-BD. A large sample study is needed to confirm the durability and safety of these preliminary results.

Diagnostic challenges of intra-operative frozen consultation for gastrointestinal signet ring cell carcinoma†.

Signet ring cell carcinoma (SRCC) is challenging to recognise on intra-operative frozen sections, with known high false-negative rates. The objective of this study was to investigate common factors contributing to discrepancies between intra-operative frozen diagnoses and those made upon review of permanent sections, and summarise our experiences gained and lessons learned on minimising errors on intra-operative frozen diagnoses of gastrointestinal SRCC. We retrospectively examined our pathology database from 25 May 2000 to 1January 2018 and re-reviewed intra-operative frozen sections and permanent haematoxylin and eosin (H&E) slides for specimens confirmed with SRCC on permanent sections. This study includes 83 specimens taken from 50 patients, with an accuracy of 85.5%. Main common factors causing discordance or deferral in recognising SRCC between intra-operative frozen procedures and permanent sections include: (i) resemblance of clusters of SRCC cells with a myxoid background; (ii) disguise as normal or reactive cells (histiocytes, macrophages, large reactive lymphocytes, plasma cells or adipocytes) due to their relatively clear or depleted cytoplasmic mucin; and (iii) histological sampling errors, leading to misses of small foci of SRCC on frozen section slides. An accurate diagnosis of SRCC during intra-operative frozen consultations remains challenging. Based on our experiences and lessons, the most important strategies to reduce diagnostic errors are: (i) understanding the unusual histomorphological features of SRCC cells on frozen sections including, but not limited to, intracellular mucin depletion, absence of desmoplasia and no adjacent pre-cancer changes; and (ii) close attention to abrupt transition from normal architecture (e.g. glandular or submucosal loose connective tissue) to myxoid and/or inflammatory-like appearance, which potentially harbours SRCC.

S1864 Cricopharyngeal Per Oral Myotomy (C-POEM) for Treatment of a Cricopharyngeal Bar: A Novel Technique

INTRODUCTION: Primary cricopharyngeal achalasia is a rare functional pathology and sub-type of traditional achalasia. While the exact etiology is unknown, it is characterized by a lack of pharyngeal contraction, improper coordination between the pharynx and upper esophageal sphincter (UES) or the inability of the UES to relax. The majority of the UES is made up of the cricopharyngeal muscle. Traditional treatment modalities include pneumatic dilatation, Botox injection and surgical myotomy. Cricopharyngeal per oral myotomy (C-POEM) can be an effective alternative minimally invasive procedure for patients before opting for more invasive surgical procedures. CASE DESCRIPTION/METHODS: A 76-year-old female presented with dysphagia for both liquid and solids. She was found to have cricopharyngeal achalasia on esophageal manometry. Past medical/surgical history included hypertension, hysterectomy and cholecystectomy. Pre-procedure esophagram visualized a non-relaxing cricopharyngeus muscle and was recommended to undergo C-POEM. A submucosal injection of ORISE lifting gel was used to elevate the mucosa to provide cushion for entry at the site of the initial dissection. The initial mucosal incision was made transversely using a Hybrid Knife I-Type. Then submucosal tunneling began through dissection of submucosal fibrous and connective tissues. The submucosal dissection was used to identify the cricopharyngeal bar. Once, submucosal tunneling was complete. circular myotomy of the cricopharyngeal muscle was performed along the longitudinal axis of the submucosal tunneling. Bleeding was minimal throughout the procedure and cautery was used effectively for hemostasis. The defect was closed using 3 endoscopic clips. Follow up endoscopy did show a healed scar from the tunnel entry. The upper esophageal sphincter was inspected with no cricopharyngeal bar re-occurrence. The patient's cricopharyngeal bar dysphagia was completely resolved. DISCUSSION: We have demonstrated the safety and efficacy of the POEM procedure in patients with cricopharyngeal bar. Along with more traditional therapeutic options, the C-POEM should be considered a viable alternative in patients suffering from cricopharyngeal bar.Figure 1.: Pre-POEM esophagram displaying a non-relaxing cricopharyngeus muscle.Figure 2.: Continued submucosal dissection to the cricopharyngeus muscle layer.Figure 3.: Myotomy of the cricopharyngeal muscle layer.

LOCALIZED ORAL AMYLOIDOSIS: A CASE REPORT

Amyloidosis is characterized by an amyloid deposition. Localized amyloidosis is limited to the affected site without association of any systemic alteration. This report describes a localized oral amyloidosis in a nonsmoking and nonalcoholic 67-year-old man. The lesion was presented as a painless, normal-colored and slow-growing nodule involving the right hard palate with 12-month evolution time. An incisional biopsy was performed, and the histopathologic analysis revealed extracellular amorphous and eosinophilic deposition similar to hyaline material in submucosal connective tissue, consistent with amyloid material. Special Congo red staining evidenced red-peach color in light microscopy and apple-green birefringence under polarized light microscopy, confirming the diagnosis. The patient did not demonstrate any systemic manifestation of the disease. Surgical excision was realized, and he is under follow-up for 7 months with no signs of recurrence.

Idiopathic gingival fibromatosis

Gingival fibromatosis (GF) is a heterogenous group of disorders characterized by progressive enlargement of the gingiva caused by an increase in submucosal connective tissue elements. Many cases are iatrogenic; some are inherited while others are idiopathic. We describe a case of ten year old girl brought from the department of pedodontics to periodontics with the chief complaint of gradual and progressive enlargement of both upper and lower gingival tissues from the age of 2 years. Gingivectomy was performed quadrant-wise under local anesthesia to restore the patient’s esthetics and functional/ masticatory needs. Key Words: Gingiva, Fibromatosis, Gingivectomy

Akt and estrogen receptor expression in nasal polyps.

Nasal polyps (NP) is a common chronic inflammatory disease of the mucous membranes in the nose and paranasal sinuses. The underlying mechanisms of pathologic conditions to NP formation remains unclear. The aim of this study is to evaluate the expression of Akt and estrogen receptor (ER) in nasal polyps. We respectively obtained 20 nasal polyp tissue and 15 concha from patients undergoing endoscopic polyp biopsy and turbinate resection. All samples were fixed in 10% formalin for 24 h and embedding in paraffin was using routine protocol for histological prepation. Sections 5 μm thick were cut and stained H&E. Tissue samples were stained with anti-ER and anti-Akt primary antibody, ER and Akt were evaluated immunohistochemically. There is a relationship between the estrogen receptor and PI3K/Akt signaling pathway in malignansy. In this study, it showed the effect of estrogen on the activation of Akt signaling pathway in nasal polyps. Mann- Whitney-U test was applied to evaluate the statistical differences between nasal polyp and control group, (P < 0.05) was accepted as significant. In H&E stained sections we observed a lot of inflamatory cells and eosinophils in the mucosa, submucosal connective tissue and around the glandular epithelium in nasal polyps. The mucosa and submucosal connective tissue was seen normally in control group in H&E stained. We determined that ER and Akt were intensely expressed in nasal polyps. Expression is localized especially in epithelial and glandular epithelium cells and submucosal connective tissue. In contrast, expression of ER and Akt were mildly expressed in turbinate resection samples. The expression of ER and Akt might be important factors in nasal polyp pathogenesis and may shed new light on clinical approaches in nasal polyp treatment.

The evaluation of inflammatory, anti-inflammatory and regulatory factors contributing to the pathogenesis of COPD in airways

IntroductionChronic obstructive pulmonary disease (COPD) is a progressive chronic disease leading to obstructive lung airways and airflow limitations. The background of COPD is extensive cytopathology and histopathology orchestrated by mostly chronic inflammation with the local release of inflammatory, anti-inflammatory and regulatory mediators, as well as further remodeling and shaping of local architecture. Inflammatory mechanisms are provided by complex intercellular signalling networks and regulation of locally occurring immune responses. Material and methodsIn this study, lung tissue specimens obtained from 33 COPD patients and 49 control patients were analysed. Tissue samples were examined by hematoxylin and eosin staining. Immunoreactive cells positive for interleukin (IL)-1α (IL-1α), IL-4, IL-6, IL-7, IL-8, IL-10, IL-12, and tumour necrosis factor-α (TNF-α) were detected by an immunohistochemistry (IHC) method. ResultsWe evaluated overall higher numbers of IL-7, IL-8 and IL-10 (mostly from few (0/+) to almost abundance (++++)) and overall less numbers of IL-1α and IL-6 (mostly from no positive (0) to numerous to abundance (+++/++++)) immunoreactive cells in airway epithelium and connective tissue of COPD affected lung. Furthermore, we evaluated statistically significant (P < 0.05) higher numbers of immunoreactive cells located in control group airway epithelium for IL-4, IL-6, IL-7, IL-10, and IL-12 compared to mucosal and submucosal connective tissue. Moreover, in COPD group airway epithelium for IL-1α, IL-4, IL-6, IL-7, IL-8, and IL-10. We found no statistically significant difference between the numbers of IL-12 and TNF-α immunoreactive cells in airway epithelium and connective tissue of COPD affected lung. In comparison with the control group, we found statistically significant (P < 0.05) higher numbers of immunoreactive cells positive for all examined markers in COPD group. ConclusionsIncreased numbers of IL-1α, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12, and TNF-α immunoreactive cells highlight the local significance of these markers in COPD pathogenesis. Moreover, the pattern with dominance of immunoreactive cells in COPD affected airway epithelium over connective tissue is highlighting the essentials of epithelium in inflammatory signalling.

Hemorrhoidectomy: Per- and Post-Operative Pain Status and Patient Comfort After the Administration of Two Different Techniques

Hemorrhoids are a normal part of human anatomy, consisting of mucosa, submucosal fibroelastic connective tissue, smooth muscles and blood vessels. Hemorrhoidal disease typically manifests with severe symptoms and requires surgery in 10-20% of the patients. The study included 50 patients with grade III and IV internal Hemorrhoidal disease that presented to our General Surgery department. After obtaining a written informed consent from each patient, the 50 patients were randomly divided into 2 groups on even or odd numbers according to the order of hospitalization: Group I (n = 25) included the patients with odd numbers that underwent electrotherapy and Group II (n = 25) included the patients with even numbers that underwent Ferguson hemorrhoidectomy. Spinal block was performed. Patients were assessed with VAS (visual analogue scale). The results of the study were statistically significant (p<0.05) in terms of operation time, duration of hospital stay, recurrence development and pain score in Group I. We believe that electrocoagulation therapy with dirct current is highly successful in the treatment of internal hemorrhoids, reduces hospitalization time and recurrence rate, provides less pain and more patient comfort.

Effect of Mitomycin - C and Triamcinolone on Preventing Urethral Strictures.

ABSTRACTUrethral stricture is a common disease with high recurrence rate. Several manipulations were defined to prevent the recurrence but the results were disappointing. This study aimed to evaluate the efficacy of triamcinolone and mitomycin-C on urethral stricture formation and their effect on inhibition of urethral fibrosis. A total of 24 New Zealand rabbits were divided into 3 groups. Urethras of rabbits were traumatized with pediatric resectoscope. Resection area was irrigated with 10mL saline, swapped with a cotton wool soaked with 0.5mg/mL MMC and injected by 40mg triamcinolone in groups 1, 2 and 3 respectively. Retrograde urethrogram was performed at 28th day of procedure and the urethra was removed for histopathologic evaluation. There were significant differences in urethral diameters and in lumen reduction rate between the control and study groups (p<0.001). Compared to control group, all treatment groups showed mild fibrosis, less collagen bundle irregularity, and lower numbers of fibroblasts (p=0.003). The Tunnel assay showed that the number of apoptotic cells in the submucosal connective tissue was quantitatively higher in control groups (p=0.034). In the view of efficacy and safety, MMC and triamcinolone have the potential to replace the use of stents, clean intermittent catheterization, or long term catheters following internal urethrotomy. There were no statistically significant differences between two agents in terms of preventing urethral stricture formation in the present study. Mitomycin C and triamcinolone decreased the recurrence rates of urethral stricture.