The effects of Advanced Glycation End Products (RAGE)-374T/A and Gly82Ser variants and soluble-RAGE levels to obesity in children.

In recent years, studies related to advanced glycation end products (AGE) and their interaction with their receptors (RAGE) have advanced our knowledge of the roles of these molecules in different diseases. However, studies concerning AGE-RAGE interaction in obesity are limited and the results are conflicting. RAGE gene is located on 6p21.3, has several polymorphic sites including -374T/A, a functional polymorphism in the promoter region, and Gly82Ser, present within the ligand-binding domain. In the present study, the determination of possible risks in the development of obesity according to RAGE polymorhisms and plasma levels of RAGE (sRAGE) was aimed. 87 obese and 78 healthy children were included in this study. Genomic DNA was isolated with salting-out procedure. RAGE polymorphisms were analyzed by PCR based techniques. In contrast to Gly82Ser, -374T/A allelic and genotypic frequencies were not different between study groups. Ser(SerSer+GlySer genotype) allele frequency was higher in obese cases than controls (74.20%→25.80%,OR:2.573,95%CI:1.789-3.699;p<0.01). In obese cases, blood glycose (92.50±2.80→87.00±1.16; p=0.025) and HDL-C (46.14±2.75→39.84±1.82;p=0.057) levels were higher than TT genotype carriers. As for Gly82Ser polymorphism, HDL-C (p=0.004) and FT4 (p=0.020) levels were different in obese cases, the order was SerSer>GlySer>GlyGly for HDL-C, and opposite for FT4. Besides, Ser carriers had lower insulin (p=0.038) and homa-IR (p=0.081) levels than GG genotype. sRAGE levels were different between obese and control seperately or in combination with RAGE polymorphisms (p<0.05), the order of sRAGE was TT>TA>AA for -374T/A and SerSer>GlyGly>GlySer for Gly82Ser. According to our results SerSer genotype could have significant effects on sRAGE levels, and increased sRAGE levels and Gly82Ser polymorphism either combinatorially or seperately increased the propensity towards obesity.

Association between emotional and behavioral problems and metabolic control in children and adolescents with Type 1 diabetes.

OBJECTIVE: We aimed to investigate the differences in emotional and behavioral problems and to explore the association between the level of psychiatric problems and the metabolic control in Type 1 diabetes. METHODS: The children with Type 1 diabetes (no.=42) and the "healthy" control group (no.=42), their parents and endocrinology specialist completed the forms prepared for the study. The parents completed the Child Behavioral Checklist (CBCL/4- 18). RESULTS: The groups had significant differences in CBCL activities (p<0.001), social competence (p<0.001), total competences (p<0.001), withdrawal (p=0.036), anxiety/depression (p=0.033), social problems (p=0.009), and aggressive behavior (p=0.04) scores. We did not find significant differences in CBCL scores between the groups with good, moderate and bad metabolic control (p>0.05). DISCUSSION: The parents of children with Type 1 diabetes reported emotional and behavioral problems significantly more. We did not find any significant association between the level of metabolic control and the emotional and behavioral problems.

Tentorial meningioma on follow-up presenting with sudden deterioration due to intra- and peritumoral hemorrhage.

Almost all meningiomas presenting with intracranial hemorrhage in the literature were admitted with symptoms relating to the hemorrhage and there were no prehemorrhage scans which demonstrated the actual size and apperance of the meningioma. This is a very rare report of a case with a tentorial meningioma documented with pre- and posthemorrhage scans.

Distal middle cerebral artery aneurysms. Endovascular treatment results with literature review.

SUMMARY: Intracranial aneurysms of the distal intracranial arteries are uncommon lesions which are difficult to treat with surgical techniques. Distal middle cerebral artery (MCA) aneurysms constitute approximately 5% of all MCA aneurysms.We report the results of our coil embolization for the treatment of distal MCA aneurysms. Eleven patients (four men and seven women, average age 37 years) with distally located MCA aneurysms were treated. Four of the aneurysms were fusiform in shape and the remainder were saccular. Seven of the aneurysms were in the dominant hemisphere. Four of the seven patients who had saccular aneurysms were treated with selective aneurysm embolization. The remaining seven patients were treated with aneurysmal sac and parent artery coiling. All patients had good retrograde flow into the peripheral branches of the occluded artery. All the procedures were completed successfully without any additional neurological deficits. Coil embolization is a safe and effective technique for the treatment of distal MCA aneurysms. If the parent artery cannot be preserved, pial collaterals can supply adequate blood to prevent neurological deficits.

Transtentorial approach to the posterior temporomedial structures.

The supracerebellar transtentorial (SCTT) approach, a modification of the infratentorial supracerebellar approach, facilitates simple and minimally invasive access to posterior temporomedial structures without requiring retraction of the temporal or occipital lobe. The SCTT approach was used in 16 patients over a 3-year period. Eleven patients harbored tumors confined to, or located mainly within, the posterior hippocampal formation, three patients harbored aneurysms (one ruptured posterior cerebral artery [PCA] aneurysm at the P2-P3 junction, one ruptured giant PCA [P2] aneurysm, and one giant basilar artery-superior cerebellar artery aneurysm), one patient had juvenile-type moyamoya disease, and one patient suffered from medically intractable epilepsy. In these patients, the SC

Surgical therapy for lumbar spinal stenosis: evaluation of 300 cases.

Although lumbar spinal stenosis syndrome is extremely common, considerable controversy continues to surround its classification, diagnosis, and treatment. In this article, we retrospectively analyzed the clinical, radiological, and surgical characteristics of 300 patients operated on in our clinics with the diagnosis of lumbar spinal stenosis. Surgical therapy and outcome are discussed with respect to the known facts. After clinical and radiological evaluation, 300 patients were diagnosed with lumbar spinal stenosis. All patients underwent laminectomy and bilateral foraminotomy at the stenotic level. Surgical outcomes were evaluated as very good, good, same, and poor according to the clinical findings. Ninety percent of the surgically treated patients demonstrated very good and good outcomes. Our conclusion in lumbar spinal stenosis diagnosed by objective clinical and radiological findings is that decompressive laminectomy and extensive foraminotomy without instrumentation allow a good outcome.

Pituitary adenomas: results of 684 surgically treated patients and review of the literature.

BACKGROUND: The outcome of patients with pituitary adenomas who were treated surgically with or without postoperative radiotherapy was analyzed. The purpose of this study was to determine the factors that strongly influence (A) tumor control, (B) the efficacy of surgery, and (C) radiotherapy based on the hormonal activity of adenomas and its invasion characteristics. METHODS: Between 1982-1996, 684 patients with the diagnosis of pituitary adenoma were operated on. The mean age was 38 years and the mean follow-up time was 40.5 months. A total of 516 patients who were followed for more than 1 year were studied to analyze the effect of treatment modalities and invasion characteristics on tumor control. There were 297 patients with prolactinomas, 118 patients with somatotropinomas, 45 with corticotropinomas, 17 with mixed adenomas, two with thyrotropinomas, and 205 with null cell adenomas. All patients were classified according to Hardy's modified radiological classification scheme and analyzed in invasive and noninvasive groups individually based on this classification system. In the early postoperative period, 230 of these patients were given conventional radiotherapy with a mean dose of 4400 cGy. The following factors were analyzed for prognostic significance in tumor control: the effects of surgery and radiotherapy based on tumor types and invasion characteristics, the existence of histologically proven invasion of the dura mater overlying the sellar floor, and the early results of topical bromocriptine application in macroprolactinoma patients. RESULTS: Overall surgical complications and mortality rate were similar to those of large series reported in the literature. Except for the invasive somatotropinomas and null cell adenomas, statistical analysis demonstrated the ineffectiveness of radiotherapy on tumor control. We did not detect any positive correlation between the recurrence rate and mean recurrence time or dural invasion of the sellar floor. Topical bromocriptine application seemed to improve tumor control in 21 selected macroprolactinoma patients. CONCLUSION: Conventional radiotherapy is not as effective as expected, considering its adverse effects. The increased side effects of radiotherapy in cases with supra-parasellar extension, especially to the optic pathway and hypothalamus, limit its benefits, which could be demonstrated only in invasive somatotropinomas and null cell adenomas. In contrast with our current beliefs, tumoral infiltration of the sellar dura mater is not a prognostic factor for recurrence and therefore should not be a criterion for radiotherapy after surgery. Topical application of bromocriptine into the sellar cavity after tumor removal seems to provide superior results compared with the conventional treatment modalities.

Isolated sphenoid sinus abscess: clinical and radiological failure in preoperative diagnosis. Case report and review of the literature.

BACKGROUND: Isolated sphenoid sinusitis and abscess formation is a rare entity, which can lead to misdiagnosed or improperly treated patients and an unfavorable outcome. Invasion of the skull base and cavernous sinus usually causes cranial nerve palsies, suggesting a neoplasm at the initial presentation. CASE DESCRIPTION: A case of isolated abscess in the sphenoid sinus is reported. The complete destruction of the clivus and its unexceptional radiological data, in addition to the absence of clinical and laboratory evidence of infection, led us to misdiagnose a possible clival chordoma during preoperative evaluation. The patient underwent an endonasal-transsphenoidal procedure for diagnosis and surgical removal. Surgical drainage and prolonged antimicrobial treatment resulted in complete clinical recovery. CONCLUSION: Its close proximity to vital structures and slender bony structures may allow the infection to disseminate, with serious neurological complications. On the other hand, the variable clinical presentations and radiological data usually cause delayed or missed diagnosis in these cases. This emphasizes the importance of documentation of this unusual entity and its radiological manifestations.

Infection as a cause of spinal cord compression: a review of 36 spinal epidural abscess cases.

A retrospective survey of 36 cases treated in the Department of Neurosurgery, Hacettepe University Hospitals since 1970 was performed. Clinical presentation, aetiology and outcome of this rare disease compared to recently published series. All cases were admitted with signs of neural compression. Clinical and laboratory data suggesting an infectious origin were present only in 4 cases. Radiological investigation including magnetic resonance imaging in 10 patients, were not confirmative for an epidural abscess except for two cases. All cases underwent urgent surgical decompression and tuberculous abscess either in granulation or pus form was found in the majority. Overall mortality rate was 5.8%. Outcome was closely related to the neurological condition on admission rather than the underlying infectious origin. When compared with recently reported series, our cases demonstrated a significant divergence in terms of clinical presentation, pathogenesis and outcome. The most probable reason for this discrepancy is that risk factors for compromised immunity or systemic infection were much less than the other series and mycobacterium tuberculosis is the responsible agent in the majority which has a much more favourable outcome than non-spesific infections.

No apparent role for neutrophils and neutrophil-derived myeloperoxidase in experimental subarachnoid haemorrhage and vasospasm: a preliminary study.

OBJECTIVE: The literature contains investigations and discussion of the role of neutrophils and neutrophil-derived myeloperoxidase (MPO) in inflammatory processes, local ischaemia, and ischaemia-reperfusion injury models. Our aim was to determine whether the same roles existed for neutrophils and the system involving neutrophil-derived MPO in experimental subarachnoid haemorrhage (SAH) and associated ischaemia. MATERIAL AND METHOD: Forty-eight adult New Zealand white rabbits were divided into six groups of eight. The first SAH model was applied to 16 animals. Eight of these rabbits were sacrificed after 48 hours (Group 1) and the remaining eight were killed after 96 hours (Group 2). The second SAH model applied to another 16 rabbits, which were sacrificed in two groups at the above time periods, forming Groups 3 and 4, respectively. There were two groups of 8 control animals, one group per SAH model, and these rabbits were sacrificed after 48 hours. We carried out histopathological studies using haematoxylin and eosin (H&E) stain, elastin stain, MPO immunohistochemistry, and determination of basilar artery cross-sectional diameter. We also did biochemical analysis of cerebral hemisphere and brainstem specimens, measuring tissue lipid peroxidase and MPO activity. Results were compared between the groups and with their related controls. RESULTS: In contrast to previous experimental findings in local ischaemia and ischaemia-reperfusion models, we found no histopathological or biochemical evidence to suggest a role for neutrophils and neutrophil-derived MPO in relation to subarachnoid haemorrhage and resultant vasospasm. Although we confirmed the successful induction of significant vasospasm and observed the clinical evidences of subsequent ischaemia, there was no notable accumulation of neutrophils or activity of neutrophil-derived MPO in the tissues studied. This suggests that the biological process induced by SAH follows a different pattern from that seen in local ischaemia and ischaemia-reperfusion injury.

Investigation and comparison of the effects of rehabilitation on balance and coordination problems in patients with posterior fossa and cerebellopontine angle tumours.

BACKGROUND: This study was planned to investigate and compare the effects of acute rehabilitation programme on balance and coordination problems in patients with posterior fossa and cerebellopontine angle tumours. METHODS: This study was carried out at Hacettepe University, School of Physical Therapy and Rehabilitation, neurosurgical rehabilitation unit on 40 patients whose ages varied between 18-60 years. Subjects were subdivided into two groups. Group I consisted of 20 patients with posterior fossa tumour, while the group II was composed of 20 patients with cerebellopontine angle tumour. Patients were evaluated according to the localisation of the tumour, the number of the surgical operations, the level of the surgical excision of the tumour, percent of having shunt, radiotherapy and chemotherapy. Balance problems were assessed according to Mokken's functional independence assessment scale in 5 selected positions and standing balance was also evaluated according to the method of Bohannon. The rehabilitation of the patients included balance and coordination training. The patients were re-evaluated before their discharge and the results of the two evaluations were compared. RESULTS: A significant improvement was found in the second group when pre- and post-treatment evaluations were compared. There were more coordination problems in group 1 in the pretreatment period. Both groups showed significant improvement of coordination problems after the treatment. However, this improvement was more obvious in the second group (p<0.05). There was a negative significant correlation between the decrease of balance problems and the amount of the tumour excided (I Group r=-0.51, II Group r=-0.57). CONCLUSIONS: It can be concluded that rehabilitation approaches are effective in balance and coordination problems observed in both tumour groups, but the responses to treatment are more obvious in the cerebellopontine angle tumours, which have better prognosis.

Prolactin secreting pituitary adenomas: analysis of 429 surgically treated patients, effect of adjuvant treatment modalities and review of the literature.

OBJECTIVE: We performed this retrospective analysis to determine the efficacy of surgery and radiotherapy over hormonal and volumetric control of prolactinomas, many of which had failed during dopa-agonist therapy. In the same analysis, the efficiency of topical bromocriptine application as a preliminary study was compared with standard treatment modalities. MATERIALS AND METHODS: Between 1982-1997, 429 prolactinoma patients who underwent surgery at Hacettepe University Neurosurgery Department and at Bayindir Medical Center were included in this study. All patients were classified according to Hardy's classification scheme and were further divided into 'invasive' and 'non-invasive' groups based on this radiological classification system. The mean follow-up time was 38.4 months. One hundred and thirty five patients had peroperative bromocriptine application into the sellar cavity and these, either receiving radiotherapy (RT) or not, were analysed separately from the other 294 patients. In the early post-operative period, 104 of these patients were given conventional radiotherapy with median dose of 4500 cGy. We focused on the effects of surgery and radiotherapy over volumetric and hormonal tumour control on the basis of invasion characteristics and the early results of topical bromocriptine application in macroprolactinoma patients; and compared our results with the literature. RESULTS: Statistical analysis revealed that radiotherapy was not effective over hormonal and volumetric tumour control for prolactinomas. We did not observe any correlation to dural invasion of the sellar floor, recurrence, and the disease-free survival time. Topical bromocriptine application seemed to improve the volumetric control in 135 selected macroprolactinoma patients but not hormonal response compared with the standard treatment modalities. CONCLUSION: Conventional radiotherapy is not as effective as expected for prolactinomas and should not be preferred considering its adverse effects. Tumoural infiltration of the sellar dura mater is not a prognostic criterion for recurrence expectation and, therefore, should not be a criterion for radiotherapy after surgery. After subtotal removal, postoperative dopa-agonist therapy should be considered even if the patient was intolerant or resistant to previous treatment since surgery seems to improve patients' drug tolerance and cooperation due probably to the lower dose requirement. The early results of topical bromocriptine application seem to improve volumetric tumour control but this should not be accepted as a judgement since we need to wait for later results and to expand the sample size for more reliable interpretation.

Cervical actinomycosis causing spinal cord compression and multisegmental root failure: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: Epidural invasion and the resulting cord compression are clinical entities not usually associated with actinomycosis, and we found only 11 reported cases of cord compression caused by Actinomyces infection in the literature. Only one reported case was described as actinomycosis with epidural granuloma (14, 16), whereas in the other cases, epidural macroabscess (phlegm) formation caused the symptoms. Histopathological demonstration of the inflammatory granulation tissue and gram-positive sulfur-containing filamentous bacteria are important for the diagnosis of actinomycosis, because the clinical and microbiological studies cannot always demonstrate the causative microorganism and primary infection source. CLINICAL PRESENTATION: In this article, a case of Actinomyces infection causing cervical cord compression is presented. Precise diagnosis was accomplished using specific histopathological studies of the surgical specimens; such a precise diagnosis cannot always be achieved using preoperative investigations and microbiological studies. The treatment modalities and the patient's outcome are also discussed. CONCLUSION: As shown by hematoxylin and eosin stain, in contrast to the Nocardia species, Actinomyces filaments histopathologically are basophilic in nature and terminate in eosinophilic clubs as a predictive feature. The clinical and radiological findings closely resemble metastatic tumors and other infectious processes. A differential diagnosis is also emphasized in this article, along with a review of the literature.

Aneurysms of the distal anterior cerebral artery: report of 14 cases and a review of the literature.

BACKGROUND: Distal anterior cerebral artery aneurysms are rare and compose about 4.5% of all intracranial aneurysms. They generally arise at the bifurcation of the pericallosal and callosomarginal arteries. Their surgical approach is different from those of other anterior circulation aneurysms. These aneurysms present some special difficulties for neurosurgeons, including narrow exposure in the interhemispheric fissure, dense adhesions between the cingulate gyri, difficulty in controlling the parent artery, and the association of multiple aneurysms and vascular anomalies. METHODS: Between January 1975 and May 1996, 14 cases of saccular aneurysms of the distal anterior cerebral artery were operated at the University of Hacettepe. The clinical presentations, neuroradiological findings, and operative approaches of these aneurysms were analyzed. In addition, the clinical series and isolated case reports in the English literature were also extensively reviewed. RESULTS: The incidence of the aneurysms in this location was 2.8% of a total of 494 surgically treated cases in our center. Of 14 patients, eight were women and six were men. Multiple aneurysms were found in five patients (35%). All patients were operated via the interhemispheric route. Thirteen patients had good outcome and one patient died. CONCLUSIONS: We believe that all difficulties related to distal anterior cerebral artery aneurysms can be minimized with sufficient knowledge of microsurgery and surgical anatomy, using microtechniques and experience.

Thoracic outlet compression syndrome: clinical evaluation and surgical results of 94 cases.

Thoracic outlet compression syndrome (TOCS) is not a rare entity. It needs to be recognized, and patients need to be analysed from a neurologic perspective. In this paper, 94 patients with TOCS admitted to Hacettepe University Hospitals, between the years 1975-1988, have been analysed in respect to age, sex, signs, symptoms and surgical techniques. A review of the literature in the management of TOCS has been made. We experienced no operative mortality and a 12% morbidity rate. We believe that more attention should be given to this diagnosis and treatment to relieve symptoms.