Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study.

In the present study we aimed to demonstrate the efficacy of short-term pretreatment with finasteride in patients undergoing transurethral resection of the prostate (TUR-P). For this purpose 40 patients with BPH, who were candidates for TUR-P, were randomized into two groups. The first group (n=20) received 5 mg finasteride/day for 4 weeks prior to surgery and the second group (n=20) remained as the control. Patients who underwent prior prostate or urethral surgery and had a diagnosis of prostate cancer or chronic renal failure, patients who received finasteride, aspirin, coumadin or similar anticoagulant drugs prior to surgery and patients who had capsule perforations or open sinuses during the surgery were excluded from the study. All patients had a normal digital rectal examination and PSA values less than 4 ng/ml. As we look at the results there was no statistically significant difference between the finasteride group and control group regarding age, IPSS, PSA, prostate volumes, preoperative serum hemoglobin, hematocrit values and mean operating times and used irrigating fluids. The total amount of bleeding and bleeding per gram resected tissue were significantly lower in the finasteride group regardless of prostate volume. Furthermore the decrease in the hemoglobin and hematocrit values was higher in the control group. As a conclusion four weeks of finasteride pretreatment provided a significant decrease in peroperative bleeding regardless of prostate volume without any major side effects.

Experimental trigeminal glycerol injection in dogs: histopathological evaluation by light and electron microscopy.

We investigated the effects of percutaneous gasserian glycerol injection in dogs and reviewed the histopathological changes. Experiments were performed in 16 adult healthy mongrel dogs. In group 1 (8 dogs) normal saline and in group 2 (8 dogs) pure glycerol was injected in the right trigeminal ganglion. After these procedures, dogs in each group were sacrificed after 24 h (3 dogs), 7 days (3 dogs), 21 days (2 dogs). The trigeminal ganglion and nerve of both sides were removed by using microsurgical techniques and examined by light and electron microscopy. Group 1: in all sections, nerve cells, myelinated and nonmyelinated fibers revealed normal patterns with slight fibrosis. Group 2: in all sections, myelinated fibers showed disintegration and swelling of the myelin sheath, rupture of axon continuity, destruction of basal lamina, deformation of the myelin-axon relationship by both light microscopy and electron microscopy. The sections examined by electron microscopy also showed axonolysis in nonmyelinated fibers. The changes after 7 and 21 days were less prominent than after 24 h. In the left sides, there are no pathological changes. Glycerol has a neurolytic effect on the dog's trigeminal ganglion. These effects were not specific and selective for myelinated and nonmyelinated nerve fibers.

Migration of pacemaker lead into the spinal venous plexus: case report with special reference to Batson's theory of spinal metastasis.

OBJECTIVE AND IMPORTANCE: Migration of a foreign material via venous routes into the spinal canal is a very rare incidence. We report the second case in which a foreign body has migrated into the spinal canal via the venous route. CLINICAL PRESENTATION: This 35-years-old man presented with sudden onset of severe low back pain and pain in the right leg four months after an unsuccessful attempt to remove a disconnected cardiac pacemaker lead via the femoral vein. Direct lumbar x-ray demonstrated the broken lead of the cardiac pacemaker at the entrance of the right L5 foramen which was also demonstrated by lumbar CT. SURGICAL INTERVENTION: After right L5 hemilaminotomy, the pacemaker lead was found in a vein of the anterior spinal venous plexus just beneath and lateral to the right L5 root. After dissecting it from the surrounding adipose tissue, the embolised pacemaker lead was taken out. CONCLUSION: We present a case report and review of the literature on migration of foreign material into the spinal canal, factors effecting the flow directions in the spinal veins. This case may be the first evidence that proved Batson's theory of spinal metastases in man.

Intrasphenoidal migration of a premaxillary Kirschner wire.

OBJECTIVE: The use of Kirschner wire for the fixation of premaxilla is a well-known method in bilateral cleft lip surgery. We report a case in which the Kirschner wire of the premaxillary fixation had migrated intrasphenoidally. RESULTS AND CONCLUSIONS: The foreign body was accidentally discovered during a cephalometric analysis and was taken out surgically through an upper lip sulcus incision. Although the wire remained asymptomatic for 10 years, it constituted a potential danger for intracranial migration.

Neurocutaneous melanosis associated with Dandy-Walker malformation. case report and review of the literature.

Neurocutaneous melanosis is a rare dysmorphogenesis associated with single or multiple giant pigmented cutaneous nevi and diffuse involvement of the leptomeninges anywhere in the central nervous system (CNS). It is interesting that almost 8-10% of patients had associated Dandy-Walker malformation in the literature, suggesting a common origin of the developmental abnormalities. In this article, we present a 2-year-old patient with neurocutaneous melanosis associated with Dandy-Walker malformation. We reviewed the literature and discuss the pathogenesis based on the preferred hypotheses so far.

Secondary multiple intracranial hydatid cysts caused by intracerebral embolism of cardiac echinococcosis: an exceptional case of hydatidosis. Case report.

The authors present an extremely rare case of secondary multiple cerebral echinococcosis caused by presumed intracerebral and arterial embolism of cardiac hydatidosis in a 7-year-old girl. The first manifestations were symptoms of raised intracranial pressure. Unfortunately, before the primary ruptured echinococcosis cyst was detected in the myocardium of the left ventricle, the patient underwent nine operations over an 8-year period for hydatid embolism affecting the brain and the femoral artery and was treated with concurrent mebendazole therapy. The combined therapy would not have been successful without removal of the intracardiac hydatid cyst. This case is unusual because of the multiplicity of intracranial hydatid cysts and its embolic origin from cardiac echinococcosis. The present case is believed to be the first one in which the development of an embolism in the brain was studied by magnetic resonance imaging.

Microsurgical removal of a free segment of microcatheter in the anterior circulation as a complication of embolization.

Endovascular therapy for cerebral arteriovenous malformations, although generally accepted to be a safe procedure, is not without risks. We present a patient with a 20 cm free segment of a catheter in the anterior circulation as a complication of embolization. This is a very rare complication. To our knowledge, only six cases have been reported in the literature. We believe this to be the first reported case of this complication treated surgically via craniotomy and arteriotomy.

Factors affecting morbidity and mortality following surgical intervention in patients with intracranial meningioma.

BACKGROUND: Meningiomas usually grow slowly but they may cause recurrences despite surgical resection. The impact of clinical, neuroradiological and surgical characteristics on operative morbidity and mortality of patients operated on for intracranial meningioma was analysed. METHODS: A series of 450 patients operated on for intracranial meningiomas at the Department of Neurosurgery, Hacettepe University Hospital during the period 1964-1992 is reported. The surgical results were analysed with regard to intracranial site, extent of removal, histological type, and different time periods. Computed tomography (CT) and magnetic resonance imaging (MRI) facilitated the diagnosis and helped with the planning of treatment. RESULTS: Two hundred and ninety-two patients were examined with both CT and MRI. Overall mortality was 4% but showed a decline from 9% in the pre-CT era to 3% in the post-CT era and to 1% in the past 3 years. CONCLUSIONS: Operative mortality and recurrence rates are affected by the intracranial location of the tumour, histological type, and extent of tumour removal. Emphasis is also given to the importance of the introduction of the imaging techniques, and the microsurgical techniques with the Cavitron ultrasonic surgical aspirator (CUSA), laser, and/or bipolar coagulator which have further improved the operative mortality and recurrence rates.

Twenty-five years experience in the treatment of trigeminal neuralgia. Comparison of three different operative procedures in forty-nine patients.

A series of 49 patients with trigeminal neuralgia (TN) were treated by three different surgical procedures: (1) peripheral ablative procedures in 10 patients; (2) percutaneous rhizotomy in 17 patients and (3) intracranial rhizotomy (IR) in 22 patients. On the basis of surgical treatment, the concept that neurovascular compression is a mechanical factor in the aetiology of TN was supported in 14 to 18 patients who underwent posterior fossa exploration. The results support the conclusion that retromastoid craniectomy with IR is the procedure of choice for the majority of patients with TN.

Impairment of motor coordination in mice after ingestion of aluminum chloride.

The mechanisms of aluminum (Al) neurotoxicity is of increasing interest. Al compounds are known to produce neurological and behavioral abnormalities in some mammalian species. The present study was designed to determine the effects of Al chloride on the skilled motor performance in mice on the rota-rod treadmill. Al chloride, depending on the duration of treatment, produced an impairment of the motor coordination ability in mice.

Solitary dural plasmacytoma: case report.

Solitary intracranial plasmacytomas are exceedingly rare. Before this case report, only 14 cases of solitary dural and 4 cases of intracerebral plasmacytomas had been reported in the literature. We present a case of solitary plasmacytoma originating from the right frontal dura mater in a 52-year-old man; we also review the literature on the previous cases. To our knowledge, our patient is the first patient with a solitary dural plasmacytoma to be examined with magnetic resonance imaging.

Congenital nasal encephalocele: a review of 35 cases.

Congenital encephaloceles are rare lesions which are usually seen in the occipital region, in the West. They may rarely be seen in the frontal region and they have distinct diagnostic features, together with several other pathological conditions occurring in this region. In order to emphasize these points, a retrospective analysis of 35 cases which have been operated on in our clinic, is made in this study. The findings are compared with the data obtained from the literature.

Determination of aluminum levels in the kidney, liver, and brain of mice treated with aluminum hydroxide.

In the present study, aluminum (Al) accumulation has been examined after aluminum loading in mice. The kidney, liver, and brain aluminum levels for mice that had been treated orally with aluminum hydroxide for 105 d and for the control group were determined using graphite furnace atomic absorption spectrophotometry (GFAAS) following an acid digestion. Matrix modifier consisted of 2% Triton X-100 and 2% Mg (NO3)2. Al loaded mice showed a significant increase in tissue aluminum levels, relative to the control group.

Primary spinal extradural hydatid disease: report of a case with magnetic resonance characteristics and pathological correlation.

A rare case of hydatid disease of the lumbar extradural area and of the paravertebral muscles is reported. The patient underwent surgery, resulting in complete recovery. The limitations of computed tomography and the benefits of magnetic resonance imaging in forming a diagnosis are discussed. Magnetic resonance has been found to be an invaluable tool, not only in detecting the soft tissue extent of the disease but also in delineating the viability of hydatid cysts.

Efficacy of ampicillin/sulbactam combination in experimental shunt infections caused by Staphylococcus epidermidis. A light and scanning electron microscope study.

In this study, the efficacy of ampicillin/sulbactam combination in reactions of periventricular tissue of the lateral ventricle induced by the presence of infected (Staphylococcus epidermidis) silicone rubber shunt tubing was examined by using light and scanning electron microscopy. It was demonstrated that reactive changes to implants had occurred in periventricular tissue in the control group. In infected shunt tubing without given prophylactic antibiotic group, generalized meningitis and ventriculitis, loss of integrity of ependymal cells, numerous inflammatory cells, bacterial colonies, exuda and even pus were seen. It was also shown that rarely inflammatory reactions, minimal disintegration of ependymal cells, no bacterial colonies, and phagocytes were present in the group which was given prophylactic ampicillin/sulbactam combination per and postoperatively. We think that ampicillin/sulbactam combination is very effective in prevention and treatment of shunt infections.

Reaction of rabbit lateral periventricular tissue to non-infected and infected (Staphylococcus epidermidis) shunt tubing implants. A light and transmission electron microscope study.

The reactions of periventricular tissue of the lateral ventricle to non-infected and infected (Staphylococcus Epidermidis) silicone shunt tubing were examined by light and transmission electron microscopy. It was shown that reactive changes occurred in periventricular tissue in response to the implant of sterile shunt tubing. On the other hand in infected implanted silicone shunt tubing, proliferation of inflammatory cells within the ventricle and periventricular tissue, loss of integrity of the ependyma, glial cell proliferation, and excessive extracellular oedema were demonstrated. Proliferation of ependymal cells combined with inflammatory responses may be a factor in the pathogenesis of infected shunt obstruction.

Craniosynostosis: a review of 143 surgically-treated cases.

In this study, 143 cases of craniosynostosis are presented. There were 109 males and 34 females. The major complaints were skull deformity (92 patients), proptosis (38 patients) and microcephalus (32 patients). Neurological examination revealed the presence of optic atrophy in 24 patients and papilledema in 20 patients. Seventy-four patients (53%) had three or more suture closures, with the sagittal suture being the most commonly involved (20% of patients). All patients underwent surgery. Suture removal was performed in 131 patients (91.7%), suture removal plus orbital decompression in 34 (23.8%), and linear craniectomy plus wrapping in 12 (8.3%). The reoperation rate was 6.2 percent. During the follow-up period, preoperative papilledema and proptosis improved in 88.2 and 78.9 percent of patients, respectively. Skull deformity disappeared in 46.9 percent of patients, but remained unchanged in 16.6 percent.

The role of lipid peroxidation in the genesis of vasospasm secondary to subarachnoid hemorrhage.

The aim of this study is to find out the possible trigger role of lipid peroxidation in vasospasm. Haemoglobin-free washed erythrocyte membranes (erythrocyte ghost) corresponding to 2.5 mg membrane protein was mixed with 0.5 umol NADPH 3 umol ADP, 4 umol ferrous sulphate and injected into the cisterna magna of cats to stimulate lipid peroxidation in vivo (Group 1). The second group was injected lml/kg whole blood and the control group 1 ml/kg saline. Angiographic studies revealed significant vasospasm in five cats in group 1. Severe vasospasm was seen in six cats in group 2. A significant increase in lipid peroxidation was observed in groups 1 and 2, compared to the control group. These results may suggest that free radical products may play an important role in the complex genesis of vasospasm in subarachnoid haemorrhage.