Long-term predictive value of cardiac biomarkers in patients with COVID-19 infection.

OBJECTIVE: Several studies have investigated the association between cardiac biomarkers and short-term prognosis in the COVID-19 infection. However, the data on the predictive value of cardiac biomarkers to predict long-term prognosis in COVID-19 infection are limited. We aimed at determining the relationship between N-terminal brain-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-TnI) as cardiac biomarkers and in-hospital/long-term outcomes in COVID-19 infection. PATIENTS AND METHODS: The study included a total of 916 patients with confirmed COVID-19 infection. The primary outcome was in-hospital and 1-year mortality. The secondary outcome was intensive care need at admission or the need to be transferred to the intensive care unit later on. RESULTS: The study included 498 (54.4%) males and 418 (45.6%) females with a mean age of 55.1±18.5 years. The patients with known heart failure (HF), COVID-19-related HF, acute renal failure (ARF), chronic kidney disease (CKD), diabetes mellitus, hypertension, coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD)/asthma, high CO-RADS score (≥ 4), lower EF, higher hs-TnI, and NT-proBNP levels had increased in-hospital and 1-year mortality. After multivariate analysis, NT-proBNP, hs-TnI, CKD, ARF, diabetes mellitus, and CAD were independent predictors of in-hospital and 1-year mortality. After ROC analysis, NT-proBNP cut-off levels of 1022.50 (sensitivity 87.5%, specificity 87.1%) and 1008 (sensitivity 88.6%, specificity 88.0%) were found to predict in-hospital and 1-year mortality, respectively. Hs-TnI cut-off levels of 49.6 (sensitivity 88.6%, specificity 88.9%) and 34.10 (sensitivity 83.8%, specificity 84.1%) were found to predict in-hospital and 1-year mortality, respectively. CONCLUSIONS: The current study suggests that NT-proBNP and hs-TnI can be used as valuable cardiac biomarkers to predict short-term and long-term parameters in COVID-19 infection.

Do Ginger Extract, Natural Honey and Bitter Chocolate Remineralize Enamel Surface as Fluoride Toothpastes? An In-Vitro Study.

BACKGROUND: In recent literatures, much attention has been given to natural products for their health benefits. AIMS: In this study, the objective was to measure the efficacy of the ginger-honey-chocolate mixture as the remineralization effect has been shown in the literature previously and to evaluate the individual contributions of this mixture; ginger, natural honey, bitter chocolate separately on remineralization of initial enamel caries lesion. MATERIALS AND METHODS: All specimens were divided into eight groups as: Ginger (Arifoglu®, Turkey) in powder form, (n = 8); Ginger-Honey-Chocolate (n = 8); Natural honey (Balparmak Plateau Blossom Honey®, Turkey) (n = 9); Bitter chocolate (Nestlé®, Switzerland) (n = 8); MI Paste (GC, Japan) (n = 8); Paradontax (Sensodyne, Glaxosmithklein, USA) (n = 9); Pronamel (Sensodyne, Glaxosmithklein, USA) (n = 9); Control (n = 9) groups. Samples were carried out five pH cycles along 7 days at 37°C for each group. During pH cycling, blocks were put in a demineralization (6 h) and a remineralization solution (18 h). The treatment consisted of 1 min. interaction of enamel surfaces with agent/deionized slurries (1:3 w/w) on a daily basis. The surface microhardness (SMH) was determined before and after pH cycling with a Digital Micro-Vickers Hardness Tester (Wilson Wolpert; Europe BV, 401 MVD, Netherlands). Mineral changes were determined by using FluoreCam® and recovery values were calculated as SMHR% and FΔ%, respectively. RESULTS: All groups showed an enhanced remineralization. There was no significant difference in terms of FΔ% (F = 1.223, P = 0.304) and SMHR% (F = 0.709, P = 0.664) between all groups. CONCLUSION: The herbals (ginger, honey, and bitter chocolate) examined in this study gave promising results with a high remineralization potential.

Behçet Disease serum is immunoreactive to neurofilament medium which share common epitopes to bacterial HSP-65, a putative trigger.

Autoimmune and dysimmune inflammatory mechanisms on a genetically susceptible background are implicated in the etiology of Behçet's Disease (BD). Heat-shock protein-65 (HSP-65) derived from Streptococcus sanguinis was proposed as a triggering factor based on its homology with human HSP-60. However, none of the autoantigens identified so far in sera from BD share common epitopes with bacterial HSP-65 or has a high prevalence. Here, we report that sera from BD patients are immunoreactive against filamentous neuronal processes in the mouse brain, retina and scrotal skin in great majority of patients. By using matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) and peptide mass fingerprinting, Western blotting and peptide blocking experiments, we have identified neurofilament medium (NF-M) as the probable antigen for the serologic response observed. Clustal Omega analyses detected significant structural homology between the human NF-M and bacterial HSP-65 corresponding to amino acids 111-126, 213-232 and 304-363 of mycobacterial HSP-65, which were previously identified to induce proliferation of lymphocytes obtained from BD patients. We also found that sera immunoreactive against NF-M cross-reacted with bacterial HSP-65. These findings suggest that NF-M may be involved in autoimmunity in BD due to its molecular mimicry with bacterial HSP-65.

Evaluation of Radiopacity of Bulk-fill Flowable Composites Using Digital Radiography.

New flowable composites that may be bulk-filled in layers up to 4 mm are indicated as a base beneath posterior composite restorations. Sufficient radiopacity is one of the several important requirements such materials should meet. The aim of this study was to evaluate the radiopacity of bulk-fill flowable composites and to provide a comparison with conventional flowable composites using digital imaging. Ten standard specimens (5 mm in diameter, 1 mm in thickness) were prepared from each of four different bulk-fill flowable composites and nine different conventional flowable composites. Radiographs of the specimens were taken together with 1-mm-thick tooth slices and an aluminum step wedge using a digital imaging system. For the radiographic exposures, a storage phosphor plate and a dental x-ray unit at 70 kVp and 8 mA were used. The object-to-focus distance was 30 cm, and the exposure time was 0.2 seconds. The gray values of the materials were measured using the histogram function of the software available with the system, and radiopacity was calculated as the equivalent thickness of aluminum. The data were analyzed statistically (p<0.05). All of the tested bulk-fill flowable composites showed significantly higher radiopacity values in comparison with those of enamel, dentin, and most of the conventional flowable composites (p<0.05). Venus Bulk Fill (Heraeus Kulzer) provided the highest radiopacity value, whereas Arabesk Flow (Voco) showed the lowest. The order of the radiopacity values for the bulk-fill flowable composites was as follows: Venus Bulk Fill (Heraeus Kulzer) ≥ X-tra Base (Voco) > SDR (Dentsply DeTrey) ≥ Filtek Bulk Fill (3M ESPE). To conclude, the bulk-fill flowable restorative materials, which were tested in this study using digital radiography, met the minimum standard of radiopacity specified by the International Standards Organization.

Oral health and related factors in a group of children with cystic fibrosis in Istanbul, Turkey.

BACKGROUND: Cystic fibrosis (CF) patients can be considered as high caries risk patients because they frequently consume sugar-rich food between meals and they have a high intake of sugar containing syrups, aerosols, and salivary flow reducing medication. Variable caries prevalences were reported in CF patients in previous studies. There are no studies related to CF and salivary thromboplastic activity, which can be presented as a marker of wound healing and bleeding tendency of oral cavity. OBJECTIVE: The aim of this study was to compare oral health status and salivary pH, flow rate, and thromboplastic activity in children with CF and healthy controls. MATERIALS AND METHODS: A sample of 35 children with CF (23 girls and 12 boys), and 12 healthy control subjects (6 girls and 6 boys) were selected. Caries experience, oral hygiene, and dental erosion were assessed. Salivary flow rate, pH, thromboplastic activity, and total protein content were determined. Differences between the groups were evaluated using Chi-square test with a significance level set at 0.05. RESULTS: The differences between children with CF and healthy controls in tooth brushing frequency, use of fluoride tablets, caries experience, dental erosion index, oral hygiene index, salivary flow rate and total protein levels were not statistically significant (P > 0.05). Salivary thromboplastic activity of the CF group was significantly lower than the healthy controls (P < 0.01). CONCLUSION: Large population studies may be necessary to establish the role of salivary thromboplastic activity in children with CF considering our findings related to the decreased salivary thromboplastic activity, which may indicate delayed oral wound healing process.

Microleakage of new glass ionomer restorative materials in permanent teeth.

AIM: The aim of this in vitro study was to evaluate the microleakage of the new glass ionomers ChemFil Rock and IonoluxAC in comparison to Fuji IX GP Extra and the composite Aelite LS Posterior in permanent teeth. MATERIALS AND METHODS: Class V standardised U-shaped cavities were made on a total of 40 freshly extracted teeth and restored with different glass ionomer materials (4 groups of 10 samples each). After thermocycling, the teeth were immersed in 0.5% basic fuchsin for 24h. They were then sectioned in the buccolingual direction. Microleakage was assessed for the occlusal and gingival margins under a microscope at 40x magnification. RESULTS: There were significant differences among the materials used (p=0.000). While there was no dye penetration in the Fuji IX GP EXTRA group, which behaved similarly to the composite resin group, ChemFil Rock showed less microleakage than Ionolux AC. The Wilcoxon rank test showed no significant differences in the occlusal and gingival scores between the groups (p>0.05). CONCLUSION: Although cavities filled with a conventional glass ionomer (Fuji IX GP Extra) had significantly less leakage than cavities filled with the new glass ionomers (ChemFil Rock and Ionolux AC), these results do not reflect all the variables present in vivo conditions. As the in vitro evaluation of new materials does not always reveal their full limitations or possibilities, clinical testing of new systems remains the ultimate proof of effectiveness.

6-Phosphofructo-2-kinase (PFKFB3) promotes cell cycle progression and suppresses apoptosis via Cdk1-mediated phosphorylation of p27.

The control of glucose metabolism and the cell cycle must be coordinated in order to guarantee sufficient ATP and anabolic substrates at distinct phases of the cell cycle. The family of 6-phosphofructo-2-kinase/fructose-2,6-bisphosphatases (PFKFB1-4) are well established regulators of glucose metabolism via their synthesis of fructose-2,6-bisphosphate (F2,6BP), a potent allosteric activator of 6-phosphofructo-1-kinase (Pfk-1). PFKFB3 is overexpressed in human cancers, regulated by HIF-1α, Akt and PTEN, and required for the survival and growth of multiple cancer types. Although most functional studies of the role of PFKFB3 in cancer progression have invoked its well-recognized function in the regulation of glycolysis, recent observations have established that PFKFB3 also traffics to the nucleus and that its product, F2,6BP, activates cyclin-dependent kinases (Cdks). In particular, F2,6BP stimulates the Cdk-mediated phosphorylation of the Cip/Kip protein p27 (threonine 187), which in turn results in p27's ubiquitination and proteasomal degradation. As p27 is a potent suppressor of the G1/S transition and activator of apoptosis, we hypothesized that the known requirement of PFKFB3 for cell cycle progression and prevention of apoptosis may be partly due to the ability of F2,6BP to activate Cdks. In this study, we demonstrate that siRNA silencing of endogenous PFKFB3 inhibits Cdk1 activity, which in turn stabilizes p27 protein levels causing cell cycle arrest at G1/S and increased apoptosis in HeLa cells. Importantly, we demonstrate that the increase in apoptosis and suppression of the G1/S transition caused by siRNA silencing of PFKFB3 expression is reversed by co-siRNA silencing of p27. Taken together with prior publications, these observations support a model whereby PFKFB3 and F2,6BP function not only as regulators of Pfk-1 but also of Cdk1 activity, and therefore serve to couple glucose metabolism with cell proliferation and survival in transformed cells.

Knowledge and attitudes of Turkish endodontists towards digital radiology and cone beam computed tomography.

INTRODUCTION: The aim of this study was to assess the knowledge and attitudes of Turkish endodontists toward digital radiological imaging (DRI) and cone-beam computed tomography (CBCT). MATERIALS AND METHODS: One hundred and fifty questionnaires were distributed. Questionnaires were given to a sample of endodontists and PhD students in endodontics who attended the 11 th International Congress of the Turkish Endodontic Society in Istanbul in 2012. Following the congress, the same questionnaires were sent electronically to endodontists who did not attend the congress. The participants were asked to answer 28 multiple-choice questions concerning their knowledge and practice regarding recent imaging techniques. The questions were subdivided into 2 main topics; general information; general approach to digital imaging. The statistical analysis was carried out by an χ2-test to compare the means at a significance level of P < 0.05. RESULTS: The response rate for this study was 74%. The mean age of the endodontists who participated in this study was 32.74 ± 10.40 (range 22-61 years). Of the endodontists, 76.6% used digital imaging techniques (DUEs) in their clinics. Statistically significant differences were found between the DUEs and endodontists not using digital imaging (NDUEs), regarding age, gender, graduation year and place of employment ( P < 0.01). Endodontists 40-years-old and above had significantly lower knowledge of CBCT compared to the younger groups ( P = 0.001). CONCLUSIONS: The number of endodontists using digital imaging has been increasing in Turkey. The findings of the present study highlighted the need for adapting to new technologies via continuing education.

Related factors of dental caries and molar incisor hypomineralisation in a group of children with cystic fibrosis.

AIM: To investigate dental caries and molar incisor hypomineralisation (MIH)-related factors such as treatment, diet, brushing and salivary factors in children with cystic fibrosis (CF) compared with healthy peers. STUDY DESIGN: A cohort study was performed. METHODS: This study was performed on 30 CF children comprising patients at the Faculty of Medicine and 30 control children recruited from the Dental School. Salivary factors, dental caries, MIH, daily diet, brushing habits were analysed. Statistical analysis was calculated by SPSS for Windows. RESULTS: Decay missing filled teeth (DMF-T) score was 4.6 ± 4.0 in CF and 7.7 ± 2.7 in control (p = 0.001). 43% of CF children with MIH were found to use antibiotics, but no significant difference in the caries experience was found with antibiotic usage (p > 0.05). DMF-T of CF adolescents (23%) who use Tobramycin was 7 ± 3.5. DMF-T of CF children (20%) who take other antibiotics was 2.5 ± 3.5, but no statistical difference was found (p = 0.054). Saliva pH, salivary flow rate, and buffering capacity were not found statistically significant (p > 0.05). STATISTICS: Percentage arithmetic mean value, standard deviation, independent sample t test, Fisher's exact test, Chi-square test and Mann-Whitney U test were used, while a p value of <0.05 was considered statistically significant. CONCLUSIONS: Medication and diet could be considered as a risk factor for dental caries and factors such as salivary pH, good oral hygiene could play a protective role for oral health CF children. MIH frequency and lower caries experience seen in CF children could be due to salivary factors or pharmacological treatment they take. The multidisciplinary approach team would be advantageous in the management of children with CF and oral health should be under control during early years of life by paediatric dentists.

Vincristine modulates the expression of Ki67 and apoptosis in naturally occurring canine transmissible venereal tumor (TVT).

We investigated eight adult dogs that were brought to veterinary clinics with a history of transmissible venereal tumors (TVT). Our goal was to demonstrate the occurrence of apoptosis and the cessation of cell proliferation at every phase of scheduled chemotherapy for naturally occurring TVT. Tissue samples were collected immediately after weekly treatments with vincristine sulfate and processed for histological purposes. Sections 5 µm thick were stained by the TUNEL reaction for apoptosis and immunostained for Ki67 as a proliferation marker. We observed that after vincristine applications, tumor cell proliferation ceased and apoptosis increased. Ki67 HSCORE values were significantly lowered after the first and second treatments with the chemotherapeutic agent compared to controls, whereas TUNEL HSCORE values were significantly higher after two applications of vincristine compared to controls. Our results suggest that scheduled vincristine sulfate applications stabilize the induction of tumor regression by inducing apoptosis and preventing cell proliferation.

Effects of capsaicin on nitric oxide synthase isoforms in prepubertal rat ovary.

Nitric oxide (NO) has emerged as an important intra-ovarian regulatory factor. We investigated effects of low dose capsaicin (CAP) treatment on the different NOS isoforms in prepubertal rat ovaries. Fifteen 21-day-old female Sprague-Dawley rats were divided randomly into three groups. The first group received no treatment, the second group received 0.5 mg/kg/day CAP dissolved in the vehicle, and the third group was treated with the vehicle only. The animals were euthanized by ether inhalation after 15 days and their ovaries were excised. Ovaries were fixed in 10% neutral buffered formalin and embedded in paraffin. Sections were processed for standard immunohistochemistry using the labeled streptavidin-biotin technique for expression of nNOS, eNOS and iNOS. We demonstrated that CAP induced expression of NOS isotypes including eNOS, iNOS and nNOS in prepubertal rat ovaries. CAP may lead to release of NO either directly from nerves or indirectly by evoking release from other cells via the action of neuropeptides that are released from afferent terminals and are involved in regulating female reproductive function.

The effect of low level laser therapy on pain during dental tooth-cavity preparation in children.

AIM: To evaluate the effect of low level laser therapy on pain during cavity preparation with laser in paediatric dental patients. STUDY DESIGN AND METHODS: The study was carried out on 10 children aged 6 to 9 years old for a total of 20 primary molar teeth. For laser preparation an Er: YAG laser was used. Half of the preparations were treated by low level laser therapy (LLLT) before laser preparation and the remaining half without LLLT (non-LLLT) before laser preparation. All cavities were prepared by ER:YAG laser, restored with light-cured composite resin following the application of acid etching and bonding agent. Children were instructed to rate their pain on the visual analogue scale (VAS) from 0 to 5 points. Statistical analyses were performed using Mann Whitney U test. RESULTS: VAS Median (min-max) scores were 1(0-2) for LLLT and 3(1-4) for the non-LLT treated children. Between LLLT and non- LLLT groups results were statistically significant (p<0.01). CONCLUSIONS: The use of LLLT before cavity preparation with laser decreased pain in paediatric dental patients.

The effect of laser-activated Acidulated Phosphate Fluoride on enamel submitted to erosive solution only: an in vitro preliminary evaluation.

AIM: The purpose of this in vitro study was to evaluate the potential effect of laser therapy on the prevention of erosive demineralisation either alone or combined with acidulated phosphate fluoride gel on human enamel. It was hypothesized that such a treatment would decrease enamel solubility. STUDY DESIGN: Efficacy of 2940 nm Er:YAG laser with preset parameters--alone or combined with APF (Acidulated Phosphate Fluoride) gel--was tested on freshly extracted human permanent molars. MATERIALS AND METHODS: Ten sound human third molars were sectioned into 5 surfaces (2 x 3 mm) with hard tissue microtome and were randomly allocated into different treatment groups as follows. The Vicker's hardness of each surface was obtained at the baseline. Group 1, negative control group: no treatment. Group 2, positive control group: only 1.23% APF gel (Denti-Care gel, Medicom) 1 minute application. Group 3: irradiated with surface modification mode (2940 nm, 1.2j/cm², 10 Hz, 300 µm) Er:YAG laser. Group 4: Er:YAG laser application following 1.23% APF gel. Group 5: 1.23% APF gel following Er:YAG laser application. The demineralisation process was obtained by immersion of specimens in a soft drink for 10 minutes and then the Vickers hardness was reevaluated. STATISTICS: For statistical analyses within groups the Kruskal Wallis test was used, while for comparing groups the paired sample t test (significance p<0.05) was used. RESULTS: The difference in microhardness values of each group obtained following the treatments was not statistically significant (p>0.05). Beside, no statistical difference was found in Vickers value related to the application of fluoride prior or after laser therapy. Conclusion Er:YAG laser irradiation alone or combined with APF decreased the enamel solubility but combined treatment did not show any significant additional effect.

Dystonia in neurodegeneration with brain iron accumulation: outcome of bilateral pallidal stimulation.

Neurodegeneration with brain iron accumulation encompasses a heterogeneous group of rare neurodegenerative disorders that are characterized by iron accumulation in the brain. Severe generalized dystonia is frequently a prominent symptom and can be very disabling, causing gait impairment, difficulty with speech and swallowing, pain and respiratory distress. Several case reports and one case series have been published concerning therapeutic outcome of pallidal deep brain stimulation in dystonia caused by neurodegeneration with brain iron degeneration, reporting mostly favourable outcomes. However, with case studies, there may be a reporting bias towards favourable outcome. Thus, we undertook this multi-centre retrospective study to gather worldwide experiences with bilateral pallidal deep brain stimulation in patients with neurodegeneration with brain iron accumulation. A total of 16 centres contributed 23 patients with confirmed neurodegeneration with brain iron accumulation and bilateral pallidal deep brain stimulation. Patient details including gender, age at onset, age at operation, genetic status, magnetic resonance imaging status, history and clinical findings were requested. Data on severity of dystonia (Burke Fahn Marsden Dystonia Rating Scale-Motor Scale, Barry Albright Dystonia Scale), disability (Burke Fahn Marsden Dystonia Rating Scale-Disability Scale), quality of life (subjective global rating from 1 to 10 obtained retrospectively from patient and caregiver) as well as data on supportive therapy, concurrent pharmacotherapy, stimulation settings, adverse events and side effects were collected. Data were collected once preoperatively and at 2-6 and 9-15 months postoperatively. The primary outcome measure was change in severity of dystonia. The mean improvement in severity of dystonia was 28.5% at 2-6 months and 25.7% at 9-15 months. At 9-15 months postoperatively, 66.7% of patients showed an improvement of 20% or more in severity of dystonia, and 31.3% showed an improvement of 20% or more in disability. Global quality of life ratings showed a median improvement of 83.3% at 9-15 months. Severity of dystonia preoperatively and disease duration predicted improvement in severity of dystonia at 2-6 months; this failed to reach significance at 9-15 months. The study confirms that dystonia in neurodegeneration with brain iron accumulation improves with bilateral pallidal deep brain stimulation, although this improvement is not as great as the benefit reported in patients with primary generalized dystonias or some other secondary dystonias. The patients with more severe dystonia seem to benefit more. A well-controlled, multi-centre prospective study is necessary to enable evidence-based therapeutic decisions and better predict therapeutic outcomes.

Gamma-knife radiosurgery in the treatment of trigeminal schwannomas.

BACKGROUND: Trigeminal nerve schwannomas account for 0.07%-0.28% of all intracranial tumours. Advances in skull base surgery have led to more aggressive resection of these tumours, but surgery may associated with development of new neurological deficits. METHODS: In this report, we analyse the long-term results 15 patients with newly diagnosed or residual/recurrent trigeminal schwannoma who underwent gamma-knife treatment. FINDINGS: During a mean 61 months of follow-up, MRI revealed reduction of tumour size in 13 and no size change in 2 patients. The tumour growth control rate was 100% and only 1 patient had transient facial numbness and diplopia. CONCLUSIONS: For patients with small to moderate size trigeminal schwannomas, gamma-knife radiosurgery is associated with good tumour control and a minimal risk of adverse radiation effects.

Efficacy of gamma-knife surgery for treating meningiomas that involve the superior sagittal sinus.

BACKGROUND: Meningiomas involving the superior sagittal sinus (SSS) are among the most challenging tumors to treat. Authors of some recent series have advocated total removal with SSS reconstruction. However gamma-knife surgery is a reasonable choice for these tumors. PATIENTS: This study focused on 43 cases of meningioma invading the SSS that were treated with gamma-knife therapy. Twenty-eight patients had undergone previous resection. The follow-up period after radiosurgery ranged from 24 to 86 months (median, 46 months). The median marginal dose was 15 Gy. RESULTS: During follow-up, 22 (51%) tumors decreased in size, 16 (37%) remained unchanged, and 5 (12%) expanded. The overall rate of tumor control with radiosurgery was 89%. CONCLUSION: When a small meningioma involves the SSS and the sinus is patent, the first-line treatment should be radiosurgery. If the tumor is large and the sinus is patent, we recommend gross total resection with no removal of SSS. If postoperative or follow-up MR imaging demonstrates residual tumor or recurrence, gamma-knife surgery should be performed. If a large meningioma has completely obliterated the SSS, our policy is to remove the tumor and all sinus tissue without reconstructing the SSS.

Intraoperative MR imaging: preliminary results with 3 tesla MR system.

UNLABELLED: Aim of this study is to present the initial clinical experience with 3 tesla intraoperative MR (ioMR). MATERIAL AND METHODS: The 3T MRI suite is built adjacent to the neurosurgical operation theatre. The magnet room and the operation theatre are interconnected by a door and both RF-shielded. Before the operation, the magnet (3T Trio, Siemens) and the console rooms are disinfected. Whenever imaging is needed during the operation, the door is opened and the patient is transferred from the operation table to the magnet cradle. Axial, sagittal and/or coronal TSE T2, SE T1 and 3D Flash T1 weighted images (4-6 mm section thickness, 1 mm interslice gap) are obtained according to the lesion. Total examination time is approximately 10 minutes. RESULTS: Twenty-six patients were examined with ioMR. There were ten female and seven male patients. Lesions were pituitary adenoma in 10, low grade glial tumor in 9, meningioma and high grade glial tumor in 2 each and metastasis, haemangioblastoma and chordoma in one each. Follow-up time was 1 to 9 months. In 16 patients the first intraoperative examination revealed gross total tumor excision. However, in 10 patients due to tumor remnants surgical intervention was continued and a second examination revealed gross total tumor excision in all. Postoperative routine MR examinations confirmed total tumor excision in all patients. No complication occurred in this series. CONCLUSION: This small group of patients examined with ioMR demonstrated that the procedure is simple, helpful in achieving gross total tumor excision without complications.

Microvascular decompression for trigeminal neuralgia: a long-term follow-up study.

In this report, we present our experience with microvascular decompression (MVD) as treatment for trigeminal neuralgia (TN) and discuss factors related to recurrence after this procedure. Between 1986 and 2004, 90 patients underwent MVD for treatment of idiopathic TN at the Marmara University Department of Neurosurgery and Marmara University Neurological Sciences Institute. Individuals with atypical and secondary forms of TN were excluded from the study. The patient characteristics, work-up findings, observations during surgery, and results of MVD for the 90 cases are reviewed. In 87 (97%) of the patients, exposure of the pontocerebellar angle revealed a vascular structure compressing the trigeminal nerve. In the patients with vascular compression, the problem vessel was an artery in 80 (92%) cases and a vein in 7 (8%) cases. In 77 cases, all symptoms were completely resolved by the operation. Ten patients experienced significant partial relief, and the intensity of the residual pain in these cases was not severe enough to require medication. Three patients experienced no improvement after MVD. There was no mortality associated with MVD in the 90 cases. The findings for our series of 90 patients with TN who underwent MVD indicate that this operation is an effective and reliable treatment for this condition. We recommend MVD as the first-line surgical approach for patients with TN who do not respond to medical management.

Spinal meningiomas: evaluation of 41 patients.

AIM: Spinal meningiomas are relatively frequent intraspinal tumors. They constitute 25-46% of all primary spinal neoplasms. METHODS: Forty-one patients with spinal meningiomas surgically treated between 1986 and 2001 are reviewed in this report. There were 32 females and 9 males, aged 16 to 73 years old. Tumor location was cervical in 7 cases and thoracic in 34 cases. All tumors were intradural. All of the patients were operated by laminectomy in prone position. RESULTS: Total excision was achieved in 40 (98%) patients and subtotal excision in 1(2%). The majority of the tumors were meningothelial (42%) or psammomatous (25%). There was no surgical mortality. Four patients (10%) suffered from morbidity: One patient with CSF fistula, 1 deep venous thrombosis, 1 case with paraparesis and 1 wound infection was seen. Neither multiple meningiomas nor malign meningiomas were seen in our series. CONCLUSIONS: Spinal meningiomas are benign tumors and should be excised totally. If the preoperative neurological status is not complicated, fairly good outcome can be achieved.

Ectopic pituitary adenoma located at the pituitary stalk. Case report.

Suprasellar located ectopic pituitary adenomas are unusual tumors. We report a rare case of suprasellar prolactinoma arising from the pars tuberalis in a 37-year-old woman. Menstrual disregulation and bitemporal hemianopsia were the main complaints. Blood tests revealed hyperprolactinemia. In magnetic resonance the tumor was totally supradiaphragmatic. Pterional craniotomy and total tumor excision was performed. The pituitary stalk was preserved. Histopathologic diagnosis was a pituitary adenoma immunoreactive for prolactin. Pituitary hormonal functions returned to normal at 6 months postoperatively. No complications were seen in the postoperative period. An ectopic adenoma should be suspected in a patient with suprasellar tumor and hyperprolactinemia. Surgical excision of this tumor may result with normal pituitary functions and normal visual acuity.