Fluorescein sodium-guided surgery in glioblastoma multiforme: a prospective evaluation

We have evaluated the influence of fluorescein-guided resection on gross total resection (GTR) and survival in a series of patients with GBM. Group 1 consisted of 47 patients given fluorescein and group 2 comprised 33 patients, on whom fluorescein was not used. Median survival time was 43.9 weeks in the patients given fluorescein and was 41.8 weeks in the non-fluorescein group. There was no statistically significant difference in survival between the two groups. However, the extent of resection had a powerful influence on the median survival time. Survival was 34.3 weeks after partial resection and 46.5 after GTR. Our data shows that the use of fluorescein injection is a simple procedure, which allows a significant increase in the number of patients having GTR (83 vs. 55%). Our findings are similar to a recently published multicentre Phase III randomized trial in which 5-aminolevulinic acid was used to facilitate resection of malignant glioma.

[Antimicrobial resistance profiles of community-acquired uropathogenic Escherichia coli isolates during 2004-2006 in a training hospital in Istanbul]

In order to reveal the antimicrobial resistance profiles against first-line antimicrobial agents in community-acquired acute uncomplicated urinary tract infections (UTIs), resistance patterns were determined for 1664 Escherichia coli strains collected between 2004 and 2006 in GATA Haydarpasa Training Hospital, Istanbul, Turkey. Of the isolates 38.2% were found to be susceptible to all of the tested antimicrobial agents, while the resistance rate to single antibiotic was 13.5%. Highest prevalence of antimicrobial resistance was observed for ampicillin (AMP) (49%), followed by amoxycillin-clavulanic acid (AMC) (34%), sulphamethoxazole/trimethoprim (SXT) (34%) and ciprofloxacin (CIP) (18%). The rate of multidrug resistant isolates was 33.5% and 48.4% of them were co-resistant. Resistance against two antimicrobials was identified in 244, against three antimicrobials in 205, against four antimicrobials in 160, against five antimicrobials in 63 and against six antimicrobials in 23 strains. Most frequent phenotypes indicating resistance against two, three and four antimicrobial agents were AMP/AMC (5.7%), AMP/AMC/SXT (5.4%) and AMP/AMC/cephazolin/SXT (2.6%), respectively. Extended spectrum beta-lactamase (ESBL) activity was detected in 40 (2.4%) of the isolates. Most prominent increases in resistance prevalence during the study period were observed for AMP (from 52% to 63%), AMC (from 33% to 45%) and CIP (from 15% to 22%). These results show that resistance to AMP, AMC and SXT are frequent in community-acquired E. coli strains and empirical initial treatment with these agents will most probably be inappropriate in our region.

Primary Cranial Vault Lymphoma Presenting As a Traumatic Subdural Hematoma

OBJECTIVE AND IMPORTANCE

The authors present a rare case of a primary cranial vault lymphoma, mimicking a subacute subdural hematoma after head trauma.

CLINICAL PRESENTATION

A 78-year-old woman was admitted to the hospital with progressive left hemiparesis, headache and a gradually increasing soft lump over the right parietal region 1 week after head trauma due to falling from a high place. A computed tomography (CT) scan demonstrated a hyperdense parieto-occipital subdural and subgaleal lesion together with marked midline shift and white matter edema.

INTERVENTION

Considering her trauma story and clinical progression, the patient underwent an emergency operation with the diagnosis of subdural hematoma. However, the lesion was found to be of a tumors nature and the histopathological diagnosis was high-grade malignant non-Hodgkin's lymphoma.

CONCLUSION

The authors emphasize the rarity of primary cranial vault lymphoma and its importance in the differential diagnosis of cranial vault mass lesions extending either intra- or extracranially. This case may be considered as another example where magnetic resonance imaging (MRI) is the ultimate definitive test in the emergency ward whenever CT demonstrates any findings which are unclear.

Abnormal bony protuberance of anterior atlas causing dysphagia. A rare congenital anomaly

STUDY DESIGN

A Case report.

OBJECTIVE

To report an exceedingly rare case of dysphagia caused by abnormal bony protuberance of anterior atlas.

SETTING

Kocaeli University Faculty of Medicine, Departments of Neurosurgery and Otorhinolaryngology.

METHOD

Radiological examinations revealed a large anterior abnormal bony tuberance of atlas in an 11-year-old boy who complained of dysphagia of 5 years donation.

RESULT

The anterior bony tuberance of the atlas was resected by a transoral approach. Histopathological examination of the surgical specimens showed normal bone tissue. Resection resulted in complete resolution of the dysphagia.

CONCLUSIONS

Dysphagia can be caused by disorders of the cervical spine. These disorders are usually seen in elderly adults. In the pediatric population, spinal abnormality is an exceedingly rare cause of dysphagia. Abnormal inductive signals from the adjacent notocord and ventral neural tube may play role in the pathogenesis of this abnormal bony protuberance.

Association of spondylocostal dysostosis and type I split cord malformation

In reports on children with congenital segmental costovertebral malformations who showed neural tube defects, cases with type I split cord malformation are quite rare. Up to now such association has been reported only in two cases with Jarcho-Levin syndrome. Here, a 7-year-old girl presenting with spondylocostal dysostosis and type I split cord malformation is reported. To the best of our knowledge, this is the first case documented in the literature. The association of segmental costovertebral malformations and neural tube defects is discussed. Genetic and embryological studies are also briefly reviewed.

Comparison of skin tests to aeroallergens in Ankara and Seoul

BACKGROUND

The environment contains many allergenic proteins, and skin test reactivity to aeroallergens may be different among people living in different regions.

OBJECTIVE

To compare skin test results of Turkish and Korean patients with respiratory allergies.

METHODS

The charts of 304 (160 male, 144 female) patients from Ankara, Turkey, and 208 (111 male, 97 female) patients' charts from Seoul, Korea, who had undergone skin prick tests were reviewed. Skin tests were classified as positive when the allergen-induced wheal size was the same size or larger than that caused by histamine.

RESULTS

Grass pollens were found to be major allergens more often in Ankara than in Seoul (74.34% vs. 15.87%, p < 0.001). Skin test reactivities in Ankara were significantly lower (p < 0.001) than in Seoul to weed (6.91% vs. 37.50%) and tree pollens (4.61% vs. 39.42%). Allergic reactions to indoor allergens were significantly higher (p < 0.001) in Seoul than in Ankara: house dust mites (HDM) (83.17% vs. 32.90%), cockroaches (45.67% vs. 1.97%), and cats (17.79% vs. 1.65%).

CONCLUSION

Due to the different aeroallergen environment, the positive skin test results were different in both cities: grass pollens were the most common allergens in Ankara, while patients from Seoul reacted more commonly to indoor allergens, especially to HDMs and cockroaches.

Multiple sclerosis and coexisting intradural extramedullary spinal cord tumour: a case report

We report the coexistence of multiple sclerosis (MS) and an intradural extramedullary spinal cord tumour in a 46-year-old woman with a 2-year history of MS. The patient presented with right hemitrunk and lower extremity paraesthesias, urinary incontinence, and intermittent lower right back and abdominal pain, which did not respond to pulse steroid therapy. A spinal magnetic resonance imaging (MRI) study revealed an intradural extramedullary spinal cord tumour in the lower thoracic spine, later diagnosed as schwannoma. We call attention to this rare association of MS and a spinal cord tumour, and emphasize the need for scrutiny of new and uncommon symptoms during the follow-up of MS patients.

Survey of the use of complementary and alternative medicine among Turkish cancer patients

OBJECTIVES

To measure the frequency of use of complementary and alternative medicine (CAM) among patients with malignancy undergoing or following conventional treatment, to determine demographic characteristics associated with the use of CAM, and to find out how benefits, if any, were perceived by patients.

DESIGN

A 35-item survey questionnaire administered to 305 return patients with malignancy.

SETTING

Clinical wards of the Oncology and Haematology departments of Gülhane Military Medical Academy, Ankara, Turkey.

METHODS

Questionnaire-based measures of demographics, motives, expectations and effects of using CAM, and types and reported perceived benefits of CAM practised on patients with malignancy.

RESULTS

The majority of return patients (n = 186, 61.0%) used at least one CAM practice; and birthplace, educational status, and family type were significant factors in such behaviour.

CONCLUSIONS

Patients with malignancy born in villages, having less education and living in large families were more likely to use folk medicine. More than half of those using CAM (n = 99, 53.2%) reported as benefits the feelings of either strengthening of the body, being in good psychological condition, or the disappearance of several symptoms.

Localization of neural cell adhesion molecule (N-CAM) immunoreactivity in adult rat tissues

Neural cell adhesion molecule (N-CAM) mediates homophilic adhesion between cells and heterophilic adhesion between cells and extracellular matrix in a Ca2+-independent manner. N-CAM is widely expressed during development and plays a crucial role in cell division, migration, and differentiation, but its expression is restricted in adults. The distribution of N-CAM immunoreactivity in adult rat tissues was investigated in the present study. N-CAM immunoreactivity was present in the nervous system in the molecular layer of the cerebellum, ependymal cells surrounding the central canal, axons of the white matter, and in Lamina X of the gray matter of the spinal cord. N-CAM immunoreactivity also was found in autonomic nerves. In the digestive system, N-CAM immunoreactivity was found in the stratified squamous epithelium and nerve plexus of the esophagus, glandular cells of the stomach and pylorus, lamina propria, and epithelium of the villi of the duodenum, jejunum, and ileum. N-CAM immunoreactivity was demonstrated in the secretory cells of the adenohypophysis, islets of Langerhans, and acinar cells of the exocrine pancreas. Alveolar cells of the lung were also N-CAM immunoreactive. In the urinary system, N-CAM immunoreactivity was seen in the proximal convoluted tubules of the kidney. In the male reproductive system, N-CAM immunoreactivity was demonstrated in the nerve plexus around the urethral epithelium and in the nerve fibers around the smooth muscle cells of the corpus cavernosum penis. In the visual system, N-CAM immunoreactivity was seen in the epithelial cells of the corpus ciliaris. Cornea and lens epithelium also showed positive immunoreactivity. Our results suggest that cells in many tissues and organs of the adult rat synthesize N-CAM.

Protective effects of vitamin E and selenium on the renal morphology in rats fed high-cholesterol diets

The histopathological effects of cholesterol and the protective effects of vitamin E and selenium (Se) on renal histology were examined in Sprague-Dawley rats. Light-microscopic evaluation of the renal cortex revealed: glomerular fibrosis, cellular and mesangial proliferation, capillary obliteration and cholesterol crystals in the tubular lumina of the cholesterol-fed group. These results suggest that oxidated LDL (O-LDL) is a cytotoxic factor which stimulates mesangial cell and matrix proliferation. Ultrastructurally, small and large lipid vacuolization in intracapillary lumina, adhesion of epithelial foot processes, mesangial foam cells and polymorphonuclear leukocytes were seen in the cholesterol-fed group. In the groups fed cholesterol + vitamin E, cholesterol + Se and cholesterol + vitamin E + Se, morphological improvements were observed. It appeared that an excess in O-LDL, reactive oxygen species and growth factors might play an important role in the pathogenesis of glomerulosclerosis. In addition, it was concluded that antioxidant therapy may prevent LDL oxidation and generation of free radicals.

Comparative effects of valproic acid sodium for Chiari-like malformation at 9 and 10 days of gestation in the rat

Our study was conducted to compare structural changes of brain exposed to 500 mg/kg valproic acid sodium (VA) at 10 days of gestation and 2x600 mg/kg VA at 9 days of gestation for Chiari-like malformation (CLM). Brains, each still in the cranium, were placed under the dissecting microscope in such a way that the midsagittal surface for angular morphology was seen, and video images were recorded for both study groups. Distances and angles in each brain were then measured on video image photographs both manually and by means of a computer. The vertebral arch distances following exposure to 500 mg/kg VA at 10 days of gestation were measured. VA on day 9 of gestation group was not followed by significantly different angular morphology or point-to-point distances from those in fetuses exposed to saline. In contrast, the angle formed between the frontal pole and cerebellum at the pons is more -acute in animals treated with VA 500 mg/kg on day 10 of gestation than in controls, but the distances were not reduced. However, the group exposed to VA 500 mg/kg on day 10 of gestation appeared to have sustained only minimal effects on the vertebral arch distances; specifically, spina bifida aperta was not produced in this group. These analyses may indicate that the anterior neural tube is more sensitive to the mechanism of action by which VA produces neural tube defects (NTDs) than is the posterior neural tube. Also, we can conclude that in these rat models, experimental CLM does not correspond to the Chiari malformation (CM) type 2. An animal model has its own species specificity and teratogenic environment, and the embryopathogenesis of NTD in the experimental animal model may not be directly applicable to the human condition.

Expression of insulin-like growth factor in the placenta of intrauterine growth-retarded human fetuses

Many cases of intrauterine growth retardation (IUGR) are the result of placental and fetal tissue insufficiency. Insulin-like growth factor-I (IGF-I) is known to play a role in placental and fetal growth. An immunocytochemical study was performed to localize IGF-I peptides in human placenta and umbilical cords of normal (n = 3) and IUGR (n = 3) fetuses. The peripartum fetal conditions were evaluated as well. Immunoreactive IGF-I was detected in the cytotrophoblast, syncytiotrophoblast, amnion, endothelial cells of fetal capillaries and in the decidua in both normal and IUGR placental tissue. A more robust immunostaining and increased numbers of positively stained cells were found in the decidua of IUGR placenta (p < 0.001). Intense immunostaining was also found in endothelial cells, smooth muscle cells and fibroblasts of the umbilical vein. IGF-I immunoreactivity was also present in stroma (Hofbauer cells and/or fibroblasts) of IUGR villi. Our results indicate that expression of IGF-I is high in specific sites in placenta and umbilical cords, which indicates a paracrine and/or endocrine function. The increased expression of IGF-I in placenta of IUGR fetuses indicates its involvement in restoring normal growth by means of a positive feed-back mechanism.

Valproic acid sodium-induced spina bifida occulta in the rat

The antiepileptic drug valproic acid is a wellknown teratogenic agent; its main target organ is the neuroepithelium neural tube, although skeletal malformations have also been described. The goal of our investigations was to determine whether there is a direct relationship between high doses of valproic acid and vertebral arch openings. On day 9 of gestation, rats were treated with either 0.3 ml physiologic saline or 600 mg/kg valproic acid (VA) given once in the morning and once in the evening (7 h between doses) for a total of 1200 mg/kg. For the teratological investigations, fetuses were examined at 21 days of gestation. Spina bifida occulta was demonstrated in double-stained fetal skeletons by measuring the distance between the, cartilaginous ends of each vertebral arch. The most important finding was the very high rate of spina bifida occulta observed with this application regimen. Spina bifida aperta was not observed in our study. A low rate of exencephaly was observed in the treated group (3%). The difference between the control and treated groups was statistically highly significant from the first thoracic to fifth sacral level. The effects of VA are most pronounced from thoracic 9 to the upper lumbar region. The largest gap in vertebral arches was found in the first and second lumbar vertebrae in the VA-treated group. These findings suggest that the peak concentration of VA in the maternal plasma and high bolus administration of VA may be more important for spina bifida occulta than the total dose and infusion of VA.

Combination therapy of imipramine with oxybutynin in children with enuresis nocturna

PURPOSE

The treatment approach for enuresis is controversial due to the lack of consensus as to the exact causes of nocturnal enuresis. Despite various treatment modalities, pharmacotherapy still appears to be the common choice. The aim of this prospective study was the evaluation of the efficacy of combination therapy (imipramine and oxybutynin) in patients with enuresis nocturna.

PATIENTS AND METHODS

This prospective study was done with 77 monosymptomatic nocturnal enuretics between July 1996 and December 1998.

RESULTS

Even though there is no statistically significant difference between combination therapy (imipramine plus oxybutynin) and monotherapy, clinical data showed that combination therapy is more effective.

CONCLUSIONS

We conclude that combination of imipramine with oxybutynin is a safe and new choice in the treatment of nocturnal enuresis.

Segmental costovertebral malformations: association with neural tube defects. Report of 3 cases and review of the literature

Patients with spondylocostal dysostosis (SCD) have vertebral abnormalities and numerical or structural rib anomalies that produce thoracic asymmetry. Rib anomalies and dysmorphism are the typical features that differentiate this syndrome from spondylothoracic dysostosis (STD). Jarcho-Levin syndrome is a severe form with involvement of the whole vertebral column. Other associated findings such as congenital heart defects, abdominal wall malformations, genitourinary malformations and upper limb anomalies may be found; in addition, neural tube defects (NTDs) have been associated with this malformation. SCD is transmitted both in a recessive form and as a dominant defect. We report on 3 children with SCD; 2 also had NTDs. All of them were studied with X-rays and spinal magnetic resonance (MR), and over the same period they underwent multidisciplinary clinical functional evaluation. One of our cases with NTD also presented polythelia, which has not previously been described in patients with SCD. The common association of segmental costovertebral malformations with NTDs could be related to an early gastrulation genomic defect, or one after gastrulation, when there are two independent somitic columns. The latter sometimes progresses and then involves primary and secondary neurulation. Also, the association of SCD with NTDs could be related to the interaction of different genes, resulting in this complex phenotype. Therefore, additional genetical and embryological studies are necessary to provide evidence of an etiological link between SCD and NTD.

Reconstruction of the middle cerebral artery after excision of a giant fusiform aneurysm

A patients with a giant fusiform aneurysm of the left inferior trunkus of the middle cerebral artery (MCA) is presented. The size of the aneurysm was 5 cm at its largest diameter. Retrograde flow was well developed. After the application of temporary clips the aneurysm was excised and microsurgical reconstructions were undertaken. Adequate flow in the reconstructed MCA trunkus was maintained. This rare case is discussed in the light of the literature.

Glossopharyngeal neuralgia: a study of 6 cases

Glossopharyngeal neuralgia is a rare disease. In this report; six cases of glossopharyngeal neuralgia have been studied. At first, drug therapy was used in all of the 6 cases. In 2 of the 6 cases which were resistant to medical therapy intracranial section of the 9th nerve as well as the upper two rootlets of the 10th nerve were performed. This resolved the symptoms completely. One of these two cases, had, in addition to pain paroxyms, hypotension, bradycardia and syncope, which were controlled by temporary cardiac pacemaker. In the other 4 cases, drug therapy was able to control the paroxysms of pain. In addition, two patients with weight loss and one patient with bradycardia rapidly responded to drug therapy as well. Reviewing the literature, we discuss the medical and surgical treatment of glossopharyngeal neuralgia and possible mechanisms of associated cardiovascular disturbances.

Effect of thyrotropin-releasing hormone on Na(+)-K(+)-Adenosine triphosphatase activity following experimental spinal cord trauma

The effect of thyrotropin-releasing hormone (TRH) on spinal cord Na(+)-K(+-adenosine triphosphatase (Na+-K+-ATPase) activity after spinal cord injury was evaluated in rats. The rats were injured by compression of the cord at T-10 for 1 minute with a 50-g clip. Saline in the placebo group (n = 8) and TRH (0.6 mg per dose) in the TRH group (n = 9) were administered intraperitoneally as bolus injections in two doses, at 45 and 120 minutes after the injury. The Na(+)-K(+)-ATPase activity level in the TRH group was significantly higher (p = 0.024) than in placebo group. These results indicate a possible role for TRH treatment in spinal cord injury.

Epidermoid tumor of the occipital bone

Intradiploic epidermoid tumor of the occipital bone was presented. There were neither intracranial extensions nor neurologic deficits. The lesion started as a painless mass under the scalp. The total removal of the tumor was associated with a good prognosis.

Epidermoid cyst of the brain stem. Case report

Brain stem epidermoid cysts are extremely rare lesions. Only nine cases have been reported. Management of the epidermoid cyst is decompression of cyst contents and removal of cyst capsule. But in some cases resection of the cyst may result in a poor outcome because of cyst wall adhesion into the brain stem.

Aneurysm of an azygos anterior cerebral artery: report of two cases and review of the literature

Aneurysm of an azygos anterior cerebral artery is rare. Two cases are presented. In case 2, the coexistence of arachnoid cyst with this aneurysm is reported. Literature is reviewed.

Clinical and radiological evaluation of angiographically occult, calcified intracranial vascular malformation. Case report

In this study, we present an angiographically occult, calcified intracranial vascular malformation. This lesion is rare and has some therapeutic difficulties and different approaches by authors. In this article, we also discuss the clinical, radiological characteristic features of this lesion. We pay attention on the totally calcified malformation.

Primary intraosseous meningioma of the temporal bone in an infant. A case report

Primary intraosseous meningioma of the skull bone is a very rare entity. Although it can occur at any age, it is very rare in children. We present a case and review the literature.