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Purpose: To investigate the pathophysiology of punctal stenosis based on histopathological features, and to assess the correlation between histopathological findings and treatment outcomes in primary punctal stenosis., Methods: A total of 43 eyes of 34 consecutive patients with primary punctal stenosis were included in this prospective study. Punctum specimens obtained by rectangular three-snip punctoplasty (TSP) were examined based on the multilayered structure of the epithelium and subepithelial histopathology. The correlation between the histopathological findings and treatment outcomes was evaluated., Results: A total of 61.8% of the patients were female and had an average age of 62.4 (41-81) years. Based on the histopathological examination, all 43 puncta consisted of non-keratinized stratified squamous epithelia. Subepithelial pathology demonstrated inflammation in 10 puncta (23.3%), fibrosis in 19 puncta (44.2%) and both inflammation and fibrosis in 11 puncta (25.6%). There was a moderate relationship between the presence of subepithelial fibrosis and symptom duration ( r  = 0.4, p  = 0.03). The surgical success was 88.4% at the mean of 12.4 ± 3.5 months follow-up. The surgical success was clinically lower in the puncta with exhibited fibrosis, although it was not statistically significant ( p  = 0.6)., Conclusion: Although the findings for almost all punctum specimens were consistent with fibrosis, inflammation or both, subepithelial fibrosis was detected as the most common histopathological feature. Clinically lower surgical success rates in puncta exhibiting fibrosis may be associated with a longer duration of symptoms and excessive postoperative healing response.

Aim: To demonstrate progression of acute and chronic endocrinopathies in a kaolin-induced hydrocephalus model using light microscopy., Material and Methods: Adult male Sprague-Dawley rats (n = 48) were divided into six groups. Hydrocephalus was induced by intracisternal injection of kaolin solution in the acute and chronic kaolin groups, whereas an identical volume of sterile saline was injected into the sham groups., Results: Somatotropic cell concentrations were lower in the kaolin groups compared with their controls, but there was no difference in somatotropic cell concentration between the acute and chronic kaolin groups. Corticotropic cell concentrations were higher in the acute kaolin and sham groups compared with acute controls. Thyrotropic cell numbers were higher in the acute sham and kaolin groups compared with their controls, and although thyrotropic cell concentations were higher in the acute kaolin group than the acute sham group. No differences were observed between the acute and chronic controls and sham and kaolin groups regarding mammotropicand gonadototropic cell concentations., Conclusion: Somatotropic cells are most affected by hydrocephalus that causes pituitary dysfunction, and this effect was more prominent under acute and chronic phases.

The aim of this study was to evaluate the effectiveness of 2.5 % NaOCl at different temperature and time intervals on Enterococcus faecalis and Candida albicans-infected human roots. A total of 112 root cylinders prepared from extracted single-rooted humans were infected by E. faecalis (Group A, n = 56) or C. albicans (Group B, n = 56); 3 root cylinders served as negative controls. Both groups were further divided into 6 subgroups according to three contact times (30 s, 1 min, 5 min) with NaOCl at two different temperatures (25 or 37 °C). Microorganism growth was controlled at the 24th and 48th hours. Statistical analysis was performed using the Chi-square test. While NaOCl at 25 °C for 5 min was the most effective irrigation regimen to eliminate E. faecalis (p < 0.001), NaOCl at 37 °C for 5 min exhibited significantly superior antifungal properties (p < 0.05). At the same contact times, difference in the temperature of NaOCl did not affect the growth of either E. faecalis or C. albicans. As a result, the irrigation time of NaOCl was more effective than the temperature to eliminate E. faecalis, while pre-heating of NaOCl to 37 °C increased its effectiveness on C. albicans at 5 min contact time.

Objective: The use of tampons after nasal septum surgery is important for both prevention of postoperative bleeding and stabilization of the nasal flaps and the septum. One of the most important factors in achieving rapid postoperative recovery is the choice of the nasal tampon material, among many, to produce minimal damage on the nasal mucosa. In this study, the histopathological effects of the glove finger and merocel tampons, which are commonly used in clinical applications, have been investigated on the nasal mucosa of rabbits., Materials and Methods: In this study, merocel and glove finger tampons were used for nasal packing in one-sided nasal cavities of 16 adult New Zealand rabbits. The animals were randomized into two groups, each consisting of eight animals. The tampons were removed after 48 hours., Results: Histological examination showed that if the merocel was in a glove finger, it did not create any damage to mucosal integrity and lamina propria. However, in the group where merocel was used directly, the epithelium of the nasal mucosa was shortened and demonstrated loss of cilia and in four of the eight specimens, it was partly from lamina propria., Conclusion: It is concluded that the use of merocel in glove finger tampon leads to a lesser degree of damage in the lamina propria, and may facilitate rapid mucosal wound healing postoperatively.

The purpose of this study was to evaluate the feasibility of prefabrication of periosteal grafts, alone or with oxidised cellulose (surgicel), which was an osteoinductive material using femoral vasculature. Fifteen white New Zealand rabbits were used in both femoral regions (30 grafts), and randomly divided into three groups including five rabbits (10 grafts): the control group, the periosteal graft group, and the periosteal graft+surgicel group. A periosteal graft, 30 x 40 mm in size, was obtained from the calvarium of each rabbit. The periosteal graft taken was divided into two equal parts, 20 x 30 mm. All these periosteal grafts were sutured in the shape of tube. In all rabbits, femoral vasculature and periosteal tube was Included in a silicone tube. Additionally, in the control group, femoral vasculature was cut above and below the silicone tube, whereas in the periosteal graft+surgicel group, surgicel was added to the periosteal graft. The results were evaluated macroscopically and histopathologically in the second (two rabbits for each group - 4 grafts) and fourth week (3 rabbits for each group - 6 grafts). In the second week, In all three groups, while no osteoid tissue that indicated osteogenesis developed, it was seen that inflammation and increased vascularity occurred. Surgicel was observed to be absorbed in the periosteal graft+surgicel group. In the fourth week, fibrotic tissue was developed whereas inflammatory tissue disappeared; any osteoid tissue or lamellar bone was not accompanied in all three groups. In conclusion, we do not believe that periosteum was able to survive as a graft, and we found that neovascularization occurred too slowly to preserve the bone forming qualities of the periosteum. We suggested that it could not be prefabricated, being taken away from its donor site although surgicel was used as a stimulating material.

In nerve injuries, if it is not possible to reinnervate muscle by using neurorrhaphy and nerve grafting technique, reinnervation should be provided by the use of neuroization-directly implanting motor nerve into muscle. A comparative study of three techniques of neurotization is presented in rabbits. In this experimental study, a total of 40 white New Zealand rabbits were used and divided into four groups, each including 10 rabbits. In the first group (control--Group 1), only surgical exposure of the gastrocnemius muscle, main muscle nerve (tibial nerve), and peroneal nerve was done, without any injury to the nerves. In the second group (direct neurotization group--Group 2), the tibial nerve was transected, and the peroneal nerve, which had already been divided into fascicles, was implanted into the lateral head of the gastrocnemius muscle aneural zone. In the third group (dual neurotization group--Group 3), the tibial nerve which had been transected and re-anastomosed, and the peroneal nerve were implanted into the lateral head of the gastrocnemius muscle. In the last experimental group (hyperneurotization group--Group 4), fascicles of the peroneal nerve were implanted into the lateral head of the gastrocnemius, preserving the tibial nerve. Six months later, changes in the histologic pattern and the functional recovery of the gastrocnemius muscle were investigated. It was found that functional recovery was achieved in all neurotization groups. Groups with the tibial nerve transected had less muscular weights than those of groups with the tibial nerve intact. EMG recordings showed that polyphasic and late potentials were frequently seen in groups with the tibial nerve transected. Degeneration and regeneration of myofibrils was observed in such groups as well. New motor end-plates, including vesicles, were formed in a scattered manner in all neurotization groups. As a result, the authors conclude that direct and dual neurotization techniques are useful in peripheral nerve injuries, if it is not possible to reinnervate muscle by using neurorraphy and nerve grafting, and that there is no suggested superiority among these techniques.

Clinical and experimental studies have been conducted to improve the survival of venous flaps. As a result of these studies, although various survival mechanisms were raised, none obtained satisfactory information. Venous stasis, and the resultant venous thrombosis, is a factor that decreases the survival of venous flaps. In this study, we evaluated the effects of two antiinflammatory agents, etodolac and etofenamate, on the survival of unipedicled venous flaps. In this study, 35 male New Zealand white rabbits (3,500-4,000 g) (70 ears) were used. Perichondrocutaneous flaps, 3 x 4.5 cm in size, were designed and raised, keeping the central veins intact in the middle of venous flap. Central arteries and nerves were ligated and transected both proximally and distally, to prepare unipedicled venous flaps. A silicone sheet was placed between the cartilage tissue and flap, to prevent blood flow and revascularization beneath. The subjects were divided into seven groups, consisting of five rabbits (10 ears). In the negative control group (group I), the single vascular pedicle of venous flaps, central veins were ligated and flaps sutured into their own place as the composite graft. In the positive control group (group II), after venous flaps were prepared, normal saline, 0.2 mL, was given subcutaneously. In the first of five experimental groups (group III), unfractionated heparin (100 U/day) was given subcutaneously. In the second experimental group (group IV), etodolac (5 mg/kg/day) was given subcutaneously. In the third experimental group (group V), etophenamate (5 mg/kg/day) was given orally through a feeding tube. In the fourth experimental group (group VI), parnaparin (5 anti-Xa U/kg/day) was given subcutaneously. In the fifth experimental group (group VII), nadroparin (5 anti-Xa U/kg/day) was given subcutaneously, about 7 days postoperatively. At the eighth postoperative day, surviving areas of venous flaps were measured, and the results were evaluated by Kruskal-Wallis ANOVA and Mann-Whitney U-test (P < 0.05). Biopsies were also taken from the flaps for histological evaluation of border of necrotic tissue. Surviving areas of unipedicled venous flaps were larger in experimental groups than those in negative and positive control group (P < 0.05). However, comparison of the experimental groups demonstrated no statistically significant difference (P > 0.05). We concluded that all pharmacological agents used in the experimental groups succeeded in increasing the survival of unipedicled venous flaps. Survival of the unipedicled venous flap was higher in venous flaps than that of composite graft, clearly showing the importance of the venous pedicle., (Copyright 2001 Wiley-Liss Inc. MICROSURGERY 21:350--356, 2001)