Late effects of childhood ALL treatment on body mass index and serum leptin levels.

BACKGROUND: It is well known that survivors of acute lymphoblastic leukemia (ALL) show a tendency to become overweight. Cranial irradiation (CRT), is considered to be the primary risk factor for development of obesity. AIMS: The aim of our study was to evaluate body mass index (BMI) and serum leptin levels in survivors of childhood ALL. METHODS: Subjects (Group I) consisted of 93 survivors of childhood ALL (53 males > or = 9 years old, 40 females > or = 8 years old) diagnosed between January 1975 and December 2002 in the Hematology-Oncology Division in Cerrahpasa Medical Faculty, Istanbul University after a follow up 10.21 +/- 4.90 (mean +/- SD) years. Fifty healthy individuals of similar chronological age were taken as controls (29 males, 21 females). Seventy-four subjects had received radiotherapy (Group IA) and 19 had not (Group I B). RESULTS: In Group I, BMI was significantly higher than in Group II (21.65 +/- 4.02 vs 20.31 +/- 3.49, p = 0.04). However, BMI was significantly higher only in Group I A (21.83 +/- 4.27) than in Group II (p = 0.032). Leptin levels were significantly higher in Group I A females than in Group II females. There was a significant correlation between BMI-SDS and serum leptin levels in group IA females. CONCLUSIONS: Leukemia treatment leads to obesity. Higher leptin levels in girls may suggest that sex may be a differentiating factor for this late effect.

A high-position basilar top aneurysm approached via third ventricle: case report.

The authors report a subfrontal transventricular approach to a high-position basilar top aneurysm considered to be inaccessible by conventional pterional or subtemporal techniques. This special technique may be preferred in the case where a megadolichobasilar artery coexists with such an aneurysm as it has the advantage of protecting the brain from the detrimental effects of strong retraction.

Intracranial extradural hydatid cysts: report of three cases.

Intracranial extradural hydatid cysts are a rare occurrence with unclear pathogenesis. Three different cases are reported and the postoperative courses are discussed. Of the 11 cases found in the literature, all eight cases whose sex and age were reported are men, and seven of the eight are clustered in between the second and fourth decades.

Expression analysis and clinical correlation of aquaporin 1 and 4 genes in human hippocampal sclerosis.

Mesial temporal sclerosis (MTS) is the most frequent cause of drug resistant symptomatic partial epilepsy. The mechanism and genetic background of this unique pathology are not well understood. Aquaporins (AQP) are regulators of water homeostasis in the brain and are expressed in the human hippocampus. We explored the role of AQP genes in the pathogenetic mechanisms of MTS through an evaluation of gene expression in surgically removed human brain tissue. We analyzed AQP1 and 4 mRNA levels by quantitative real-time polymerase chain reaction and normalized to ABL and cyclophilin genes, followed by immunohistochemistry for AQP4. Relative expressions were calculated according to the delta Ct method and the results were compared using the Mann-Whitney U test. Brain specimens of 23 patients with epilepsy who had undergone surgery for MTS and seven control autopsy specimens were investigated. Clinical findings were concordant with previous studies and 61% of the patients were seizure-free in the postoperative period. AQP1 and 4 gene expression levels did not differ between MTS patients and control groups. Immunofluorescence analysis of AQP4 supported the expression results, showing no difference. Previous studies have reported contradictory results about the expression levels of AQP in MTS. To our knowledge, only one study has suggested upregulation whereas the other indicated downregulation of perivascular AQP4. Our study did not support these findings and may rule out the involvement of AQP in human MTS.

The effects of chronic alpha-tocopherol administration on lipid peroxidation in an experimental model of acute spinal cord injury.

Most of the numerous experimental studies to research pathophysiological changes following acute spinal cord injury suggest a two-step mechanism of damage to the spinal cord in which the primary (direct) or mechanical injury caused by the trauma initiates secondary (indirect) or progressive autodestructive injury of the cord. During recent years, free oxygen radical generation and lipid peroxidation have been considered to be responsible for secondary autodestructive injury. Alpha tocopherol occupies an important and unique position in the overall antioxidant defense. Alpha tocopherol-depleted animals are generally more susceptible to the adverse effects of environmental agents than are supplemented animals. This study was planned to study the effectiveness in counteracting this autodestructive process by supplementing alpha-tocopherol in rats maintained on a nutritionally adequate diet, and also to evaluate whether it will provide additional protection or not. Eighty healthy Wistar rats (treatment and controls) were included. The treatment group received 100 mg/kg alpha tocopherol each day, intraperitoneally for seven days. Using a standard acute spinal cord trauma model in Wistar rats trauma was applied, an malondialdehyde (MDA) which is a lipid peroxidation product was measured in the traumatized spinal cord at various times following the trauma in order to indirectly evaluate the lipid peroxidation and generation of free oxygen radicals in a time sequence. Statistical analysis of the values demonstrated that malondialdehyde formation in the alpha-tocopherol administered group was significantly lower than in the control group. These findings indicate that longterm administration of alpha-tocopherol may be useful to decrease lipid peroxidation following acute spinal cord trauma.

A new ventriculocisternal shunt technique in treatment of noncommunicating hydrocephalus: a technical note with a brief discussion of the literature.

Ventriculo-cisternostomy is an established procedure for the treatment of noncommunicating hydrocephalus, if the underlying pathology cannot be removed. In cases in which the foramina of Monro and the proximal part of the third ventricle are obstructed, it is not possible to make a communication between the internal and external CSF-spaces by perforation of the floor of the third ventricle, the so-called third ventriculo-cisternostomy. For such cases the authors describe a new method of drainage of both lateral ventricles to the interpeduncular cistern. This new method has been used successfully in a case with obstructive hydrocephalus of both lateral ventricles, caused by a pilocytic astrocytoma of the optic chiasma and hypothalamus with obstruction of both foramina of Monro.

Gliofibroma: immunohistochemical analysis.

A case of gliofibroma occurring in an adult patient as a large circumscribed supratentorial tumor is reported. The bimorphic pattern was substantiated and further analyzed by immunohistochemistry. Some evidence in favor of collagen production by mesenchymal and/or inflammatory cells leading to a progressive fibrous replacement of the glial cells in this particular tumor type is presented.

Evaluation of effects of magnesium sulphate in reducing intraoperative anaesthetic requirements.

BACKGROUND: The present randomized, placebo-controlled, double-blind study was designed to assess the effect of peroperatively administered i.v. magnesium sulphate on anaesthetic and analgesic requirements during total i.v. anaesthesia. METHODS: Eighty-one patients (36 women, 45 men) undergoing elective spinal surgery were included in one of two parallel groups. The magnesium group received magnesium sulphate 30 mg kg(-1) as a bolus before induction of anaesthesia and 10 mg kg(-1) h(-1) by continuous i.v. infusion during the operation period. The same volume of isotonic solution was administered to the control group. Anaesthesia was maintained with propofol (administered according to the bispectral index) and remifentanil (adjusted according to heart rate and arterial blood pressure) infusions. RESULTS: A significant reduction in hourly propofol consumption was observed with magnesium administration. For example, the mean infusion rate of propofol in the second hour of the operation was 7.09 mg kg(-1) h(-1) in the control group vs 4.35 mg kg(-1) h(-1) in the magnesium group (P<0.001). The magnesium group required significantly less remifentanil (P<0.001) and vecuronium (P<0.001). No side-effects were observed with magnesium administration. CONCLUSION: The administration of magnesium led to a significant reduction in the requirements for anaesthetic drugs during total i.v. anaesthesia with propofol, remifentanil and vecuronium.

Lipid peroxidation in experimental spinal cord injury: time-level relationship.

Damage which occurs following spinal traumas is often irreversible. During recent years free oxygen radicals formed due to the pathological changes following neural tissue ischemia have been identified as being responsible for the ethio-pathogenesis of such damage. In our experimental study, model lesions are formed in spinal cords of rats by standard trauma. Malondialdehyde (MDA), a lipid peroxidation product, was measured in the spinal tissues distal to the trauma in order to examine indirectly the time-quantity relationship of free oxygen radicals in the area. For this study 60 rats in six groups, including one control group, were used to determine the formation of MDA. Under a surgical microscope, the spines of all rats were exposed by C5-Th6 laminectomy, and pressure was applied to the spinal cords of animals, except the members of the control group, at the level of C7 by a Yasargil aneurysm clip. MDA was measured in spinal cord tissues in order to determine free oxygen radicals at the first and fifteenth minutes and at the first, second, and fourth hours. The statistical evaluation of the findings revealed a significant increase in MDA, starting from the 15th minute after the compression, reaching a maximum at 1 hour, and then decreasing. This observation may provide an important guide for studies on prevention of neural destruction.

Long-term follow-up and results of thirty pediatric intracranial hydatid cysts: half a century of experience in the Department of Neurosurgery of the School of Medicine at the University of Istanbul (1952-2001).

A series of 30 documented cases of intracranial hydatid cyst out of 33 pediatric and 45 total patients admitted to the Department of Neurosurgery of the School of Medicine at Istanbul University within the years 1952-1996 is presented. The pediatric population consisted of 73% of the series. Twenty patients (66%) are alive and well after a follow-up period of 8-45 years (mean 21.5 years). Six patients (20%) died and 4 (13%) were lost to follow-up. There were 3 early postoperative deaths (10%), 2 being in the pre-CT era. In 4 cases (13%), brain involvement was secondary, and 2 cases (7%) had multiple intracranial hydatid cysts. Age ranged from 4 to 16 years, with a mean of 10.4. There were 5 intraventricular (17%) and 2 (7%) intracranial extradural settlements. No children with posterior fossa hydatid cyst, primary skull hydatidosis or concomitant spinal involvement were detected. One patient (3%) presented with "rhinorrhea" which in fact was a hydatid fluid leak. Preoperative pseudocerebellar syndrome, convulsion and extrapyramidal signs were seen in 6 patients each (20%). Five patients (17%) had permanent visual deficits, 3 being in pre-CT era. Out of 29 patients operated on, hydatid birth with intact cyst removal was achieved in 18 cases (62%), with no other manipulation needed. This rate has increased to 70% in the CT era. Intraoperative accidental rupture occurred in 8 cases (28%), of which 7 were localized frontally or had a frontal involvement (88% of the ruptured cases). Of the patients with intraoperative rupture, 5 are dead (63%) and they were all primary. In contrast, all 3 cases alive with intraoperative rupture are secondary. Three cases were punctured on purpose (10%). Four of the operated patients (14%) required long-term antiepileptic therapy, 3 having no preoperative seizures. Only 1 patient required a shunt (3%). Four cases had recurrence, all with intraoperative cyst rupture (14%). The long-term evaluation of the results yielded an overall mortality rate of 21%. Routine use of CT after the 80s decreased the rate to 14%. With the analysis of 50 years of data, it is strongly concluded that brain involvement in pediatric hydatid disease is a primary process if delayed diagnosis and insufficient treatment of extraneural hydatidosis are prevented.