Hydrocephalus in encephalocele.

OBJECTIVE: Encephalocele is a rare congenital neural tube defect (NTD) characterized by herniation of intracranial contents through a defect in the skull. In our study, encephalocele was diagnosed in our clinic and its association with hydrocephalus was evaluated. The effect of this association on the prognosis was discussed. PATIENTS AND METHODS: Patients who underwent surgery and follow-up with the diagnosis of encephalocele in the neurosurgery clinic of our hospital in an 8-year period from 2013 to 2021 were retrospectively examined. RESULTS: Patient records were obtained from the case notes of patients who underwent excision and repair for encephalocele. Of the 78 patients included in the study, 88.4% underwent surgery in the neonatal period. Moreover, 47% of the patients are male, and 31% are female. Encephalocele was present in 62.8% of patients and meningocele in 37.2%. Furthermore, 82.1% of encephalocele sacs were located in the occipital region. Chiari type 3 malformation was present in 57.6% of patients. Hydrocephalus developed in 56.4% of patients. There was an additional syndrome in 10.3% of the cases. The most common additional syndromes were corpus callosum dysgenesis with 39.7% and colpocephaly with 29.5%. The additional disease was present in 43.6% of patients. Preoperative and postoperative examination findings of more than half of patients were normal, but 33.3% were apathetic. Furthermore, 67.9% of patients, who underwent complete repair, survived, and 32.1% died. Hydrocephalus was present in 73.5% of patients with encephalocele (p<0.05). Hydrocephalus developed in 77.8% of patients with Chiari type 3 malformation (p<0.05). Hydrocephalus was found in 88.0% of patients with Ex (p<0.05). CONCLUSIONS: Encephalocele, which is a subgroup of NTD, differs clinically by its location and accompanying additional anomalies. In encephaloceles, the risk of morbidity and mortality can only be reduced with the multidisciplinary approach. Hydrocephalus and Chiari type 3 malformation are common in patients with encephalocele. These associations adversely affect the prognosis of the disease. Further research should be conducted on the evaluation of risk factors of NTD and methods of prevention from NTD. In this regard, we recommend that the training be repeated at certain intervals and that people's awareness should be raised.

Surgical management of sporadic hemangioblastomas located in the posterior fossa of brain.

PURPOSE: Hemangioblastomas (HBs) are highly vascular tumors, constituting 2%-3% of central nervous system (CNS) tumors. Surgery is a treatment option for HBs. The purpose of this study was to evaluate the demographic, clinical, and radiological findings of patients with HBs who were operated on via microsurgical technique at our clinic and to determine the findings specific to HBs and evaluate their pathological findings and confirmation. METHODS: We evaluated age, gender, initial complaints and duration of 100 patients (50 female and 50 male patients), presence of cranial nerve deficits, magnetic resonance imaging, data (localization, presence of hydrocephalus, tumor size, enhancement pattern, and cystic and solid component features), resection rates, pathological findings (grade, Ki-67 ratio, and staining results), recurrence, special conditions of patients, and the final status of patients in this study. RESULTS: Mean age was 39.08 ± 14.77 years and 66.7% of the patients presented with cerebellar findings. Five of the cases were located in the brainstem, five were located in the cerebellopontine angle, and two were in the cerebellar cortex. In all patients, gross total resection was performed using arteriovenous malformation repair. CONCLUSIONS: Surgical intervention of small and cystic tumors can be performed safely with en bloc resection along with preoperative detailed imaging, improved microsurgical techniques, and an extensive understanding of anatomical and vascular structures. On the contrary, patients with a brainstem invasion and solid structure present surgical difficulties due to arteriovenous malformation-like vascularizations; therefore, gross total resection is the optimal treatment in HBs.

Plasma tissue factor levels and salivary tissue factor activities of periodontitis patients with and without cardiovascular disease.

The association between periodontal and cardiovascular disease has received considerable attention. Studies have demonstrated a higher incidence of atherosclerotic complications in patients with periodontal disease. Tissue factor (TF) has been known as a key initiator of the coagulation cascade, and the TF pathway is the primary physiological mechanism of initiation of blood coagulation. Recently, it has been shown that the circulating pool of TF in blood is associated with increased blood thrombogenicity in patients with coronary artery disease (CAD). Various tissues and saliva have been known to have TF activity. Consequently, the aim of this study was to investigate plasma TF levels and TF activity of saliva in periodontitis patients with and without diagnosed CAD. Twenty-six patients with a diagnosis of CAD and 26 systemically healthy patients were examined in the dental clinic, and the Community Periodontal Index Treatment Needs (CPITN) scores were recorded. Plasma TF levels were determined using commercially available ELISA kit. Salivary TF activities were determined according to Quick's one-stage method. Plasma TF levels were significantly increased in patients with CAD when compared with the control group. There was no difference in salivary TF activities between the 2 groups, but there was a strong and negative correlation between salivary TF activities and CPITN indexes in both groups. In order to determine the possible role of TF activity as a salivary marker in CAD and periodontitis and to fully understand the negative correlation between salivary TF activities and CPITN, TF activity of gingival crevicular fluid that may also affect saliva can be evaluated.

Key-string segmentation algorithm and higher-order repeat 16mer (54 copies) in human alpha satellite DNA in chromosome 7.

A new key-string segmentation algorithm for identification of alpha satellite DNAs and higher-order repeat (HOR) units was introduced and exemplified. Starting with an initial key string, we determine the dominant key string and HOR. Our key-string algorithm was used to scan the recent GenBank data for human alpha satellite DNA sequence AC017075.8 (193 277 bp) from the centromeric region of chromosome 7. The sequence was computationally segmented into one HOR domain (super-repeat domain) and two non-HOR domains. Dominant key-string GTTTCT provided segmentation in terms of alpha monomers. The HOR is tandemly repeated in 54 copies in the super-repeat (HOR) domain. Five insertions and three deletions in the HOR structure associated with a dominant key string were identified. Concensus HOR was constructed. Divergence of individual HOR copies from concensus amounts to 0.7% on the average, while divergence between 16 monomer variants within each HOR is on the average 20%. In the front and back domain, 199 monomer variants were identified that are not organized in HOR and diverge by 20-40%.

The effect of nifedipine and verapamil on rhythmic contractions of human isolated ureter.

The effect of calcium antagonists nifedipine and verapamil on spontaneous rhythmic contractions of human isolated ureter obtained from donor subjects undergoing kidney transplantation was investigated in comparison with a nonsteroidal antiinflammatory drug indomethacin. Stop-times i.e. the time elapsing from application, were determined for each drug. The rank order of potency at 10(-8) and 10(-7) M concentrations of the drugs was: nifedipine > verapamil > or = indomethacin. However, no significant difference of the stop-times was observed at 10(-6) M concentration of the drugs tested. The rhythmic contractions were re-activated by PGF2 alpha after stoppage with indomethacin but not with nifedipine or verapamil. These results suggest that not only endogenous PG synthesis but also an influx of calcium from the extracellular space is responsible for the spontaneous rhythmic activity of human ureter. The beneficial effects of using calcium antagonists in the treatment of ureteric colic is discussed.

In situ prone ESWL for the treatment of lower ureteral stones: experience with 28 patients.

Twenty-eight patients with lower ureteral stones underwent in situ extracorporeal shock wave lithotripsy (ESWL) in the prone position over the period of 7 months between March 1990 and September 1990. For stone disintegration the spark gap shock wave lithotripter Tripter XI (Direx) was used. Satisfactory disintegration was achieved in 93 per cent of patients. The stone-free rate at 12 weeks was 82 per cent, and 11 per cent had residual fragments less than or equal to 4 mm in diameter. Twenty-one per cent of patients required repeat treatments. For only 2 patients general anaesthesia was required (7 per cent). There were no remarkable complications except for haemospermia which resolved spontaneously 15 days after treatment. It was concluded that in situ prone ESWL is an effective and safe procedure for the treatment of lower ureteral stones.

In situ extracorporeal shock wave lithotripsy for upper ureteral stones: experience with 65 patients.

A total of 65 patients with 67 upper ureteral stones underwent in situ extracorporeal shock wave lithotripsy (ESWL) between March 1990 and September 1990. For stone disintegration the electrohydraulic shock wave lithotripter Tripter XI (Direx) was used. Eighty-seven per cent of stones showed satisfactory disintegration after the first treatment and a further 9 per cent after repeat treatments. The stone-free rate at 12 weeks was 85 per cent. General anaesthesia was needed in only 12 per cent of patients. The retreatment rate was 13 per cent. It was concluded that in situ ESWL is an effective procedure with negligible morbidity for treating upper ureteral stones.

Transferrin receptor activity as a marker in transitional cell carcinoma of the bladder.

An immunohistochemical staining method was used to study transferrin receptors (TFR) in bladder tissue from 10 patients with benign conditions and 33 with bladder cancer. All patients with bladder cancer were followed up by cystoscopy at intervals of 3 months (mean follow-up period 11 months). The relationship between TFR activity and recurrence rates was investigated. It was not possible to demonstrate TFR in normal bladder mucosa except for the proliferating cells of the basal layer. TFR activity in malignant tissue correlated well with the histological grade and pathological stage of the tumour. Patients with low grade superficial tumours showing TFR activity had a higher recurrence rate than those with no TFR activity. It was concluded that TFR activity in low grade superficial bladder tumours is a useful marker for predicting the recurrence rate.

Screening of asymptomatic siblings of patients with vesicoureteral reflux.

Familial trait in vesicoureteral reflux (VUR) has been revealed in many studies. This paper reports on 36 siblings of 25 patients operated for vesicoureteral reflux at our Department. Siblings aged 2 to 21 years were evaluated by urine examination, urine culture and voiding cystourethrogram (VCU) for VUR. All of the siblings were asymptomatic and VUR was found in only 4 of them (11%), unilateral in 3 cases and bilateral in one case. It is concluded that evaluation of siblings for VUR will be suitable for revealing the presence of urinary infection, and assessing them by VCU at the time they are first seen.

Correlation between intracavernous papaverine injection, Doppler analysis and cavernosography in impotent patients.

Forty-four patients with impotence were evaluated by intracavernous papaverine injection, penile brachial index (PBI) determination and dynamic cavernosography. The correlation between these diagnostic procedures and their diagnostic value were investigated. It was concluded that the papaverine test is an efficient diagnostic procedure and can be used as the first step for the routine work-up of impotent patients.

Sclerosing lipogranuloma of the penis. A case report.

Sclerosing lipogranuloma of the male genitalia is a rather uncommon condition presenting with subcutaneous masses of the penis and the scrotum. The masses are composed of granulomatous tissue formed around an either exogenous or endogenous lipomatous substance. In case of incomplete resection the masses show a rapid recurrence, thus mimicking a neoplastic lesion. On the basis of a case report a review of this entity in the literature is presented here.

Diclofenac sodium and spasmolytic drugs in the treatment of ureteral colic: a comparative study.

Forty-nine patients with ureteral colic were included in this prospective double-blind study investigating the analgesic efficacy and side effects of a prostaglandin synthetase inhibitor Diclofenac sodium (Voltaren) versus a spasmolytic drug Tropenzilium bromide (Palerol). The analgesic efficacy and side effects of the calcium antagonist Nifedipine (Nidilat) applied sublingually in ureteral colic were also investigated. It was concluded that diclofenac sodium was more efficient for relieving pain due to acute ureteral obstruction and had fewer side effects than spasmolytic drugs. Nifedipine proved to have an analgesic effect equivalent to that of Tropenzilium bromide.

Histopathological pattern in prostatic adenocarcinomas: is it a prognostic criterion?

A total of 152 patients with prostatic carcinoma were evaluated retrospectively. Sections prepared from paraffin blocks were examined and all cases were scored according to the Gleason grading system. Prostatic adenocarcinomas were categorized into 3 different groups of histopathological patterns; acinar, ductal and mixed. The relationships between histopathologic pattern and symptoms, clinical findings, clinical stage, Gleason scores and local or systemic progression were investigated. It was found that patients with mixed pattern tumours presenting at later stages with more severe symptoms of prostatism had higher Gleason scores and higher progression rates compared to patients with tumours having acinar pattern.

DMSA renal scanning versus urography for detecting renal scars in vesicoureteral reflux.

32 children admitted to Hacettepe University Hospital for surgical treatment of vesicoureteral reflux (VUR) between 1987 and 1988 were included in this prospective double-blind study. All patients underwent intravenous urography (IVU), voiding cystouretrography and 99mTc DMSA renal scanning. The sensitivity and specificity of the DMSA scan and IVU for detecting renal scarring were investigated. With regard to the presence of renal scarring, the sensitivity and specificity of IVU and DMSA were not found to be statistically different. But when the scars were scored, DMSA was found to have a higher scoring index compared to IVU. In patients who were candidates for surgical management of VUR, renal scars could be detected both by IVU and DMSA scan but, for the follow-up, the DMSA scan was found to be the investigation of choice.

Raveron versus placebo in the conservative treatment of benign prostatic hyperplasia (BPH).

Thirty patients with BPH were randomized into two groups to receive Raveron and placebo for 6 weeks. The subjective and objective signs associated with BPH were evaluated before and after treatment. There was no significant difference between the effects of Raveron and placebo.

Effect of arterial pressure and inheritance on the sodium excretory capacity of normal young men.

1. In normal young adult sons of normotensive parents the rate of renal sodium excretion is highly correlated with mean arterial pressure after a large intravenous isotonic fluid load. The correlation appeared to strengthen with time and was improved when the rate of sodium excretion was corrected for variations in the rate of glomerular filtration. 2. There was no such correlation in normal, age-matched sons of hypertensive parents. 3. In eight of the 20 normotensive sons of hypertensive parents studied, the rate of renal sodium excretion per unit of mean arterial pressure was significantly higher than in the sons of normotensive parents. 4. Because the sons of hypertensive parents are much more likely to become hypertensive than those of normotensive parents, we suggest that an abnormality of renal sodium handling precedes the development of demonstrable hypertension.

The inhibiton of adrenergically provoked renin release by salbutamol in man.

1 The beta-adrenoceptor agonist salbutamol is shown to have antagonist properties by its effect on adrenergically provoked renin release in normal people. 2 It significantly reduces the rate of renin secretion provoked by either endogenous (85 dregrees head-up tilt) or exogenous (isoprenaline infusion) adrenergic stimulation. 3 Because renin is relatively simple to measure, and because in acute studies its release is relatively uninfluenced by the vagaries of direct and reflex cardiovascular effects, we suggest that, in the characterization of drugs which act on adrenergic beta-receptors, an assessment of their effects on renin release would be useful.

Vasovagal hypotension and vasopressin release.

Mild vasovagal hypotension occurred in two normal male volunteers during insertion of indwelling venous cannulae. In spite of a rapid intravenous fluid load (3.6-4.6 litres in 90 min) both subjects passed little urine for 100 min. When the experiment was repeated without vasovagal hypotension, a rapid large diuresis followed the fluid load. The prolonged oliguria after vasovagal hypotension was the result of vasopressin release. This was demonstrated by measuring vasopressin in the blood and urine and by observing the renal response to a water load. The observation in man that a mild transient hypotensive episode may reduce urine flow for 100 min has clinical significance.