The association between calreticulin and glucagon-like peptide-1 expressions with prognostic factors in high-grade gliomas.

OBJECTIVE: The aim of this study is to present the expressions of Calreticulin (CALR) and Glucagon-like peptide-1 (GLP-1) in high-grade gliomas and to further show the relation between the levels of these molecules and Ki-67 index, presence of Isocitrate dehydrogenase (IDH)-1 mutation, and tumor grade. PATIENTS AND METHODS: A total of 43 patients who underwent surgical resection due to high-grade gliomas (HGG) (grades III and IV) were included. The control group comprised 27 people who showed no gross pathology in the brain during the autopsy procedures. Adequately sized tumor samples were removed from each patient during surgery, and cerebral tissues were removed from the control subjects during the autopsy procedures. Each sample was stored at -80°C as rapidly as possible until the enzyme assay. RESULTS: Patients with high-grade gliomas showed significantly higher levels of CALR and significantly lower levels of GLP-1 when compared to control subjects (P = 0.001). CALR levels were significantly higher, GLP-1 levels were significantly lower in grade IV gliomas than those in grade III gliomas (P = 0.001). Gliomas with negative IDH-1 mutations had significantly higher CALR expressions and gliomas with positive IDH-1 mutations showed significantly higher GLP-1 expressions (P = 0.01). A positive correlation between Ki-67 and CALR and a negative correlation between Ki-67 and GLP-1 expressions were observed in grade IV gliomas (P = 0.001). CONCLUSIONS: Our results showed that higher CALR and lower GLP-1 expressions are found in HGGs compared to normal cerebral tissues.

Investigation of Neuroprotective Effect of Shilajit Extract in Experimental Head Trauma Model Created in Rats.

AIM: To investigate the neuroprotective effect of shilajit extract in experimental head trauma. MATERIAL AND METHODS: Three groups of 33 Sprague Dawley Albino strain male rats were included in the study. Group 1 (n=11): trauma but not treated. Group 2 (n=11): trauma and treated with 0.5 mL / rat saline Group 3 (n=11): 150 mg / kg shilajit extract was administered intraperitoneally in the treatment of trauma. Following the head trauma, the indicated treatments were applied to the 2nd and 3rd groups at the first, twenty-four and forty-eighth hours. Brain tissues and blood samples were taken after the control animals were sacrificed at the 72nd hour in all groups after trauma. Sections prepared from cerebral cortex and ca1 region were examined with hematoxylin eosin and luxol fast blue staining. Total antioxidant capacity, total oxidant capacity and oxidative stress index were measured from blood samples taken after routine procedures. RESULTS: The number of red neurons and the severity of edema were significantly higher in both the cerebral cortex and the ca1 region in the group treated with trauma only and in the group administered saline after trauma compared to the group that received shilajit extract after trauma. The total antioxidant capacity increased significantly in blood samples taken only from the group treated with trauma and saline in post-trauma treatment compared to the group given post-traumatic shilajit extract, while shilajit extract given due to traumatic brain injury significantly decreased the total oxidant capacity and oxidative stress index values compared to the other groups. CONCLUSION: Shilajit extract has been shown to have a neuroprotective effect in the treatment of acute traumatic brain injury. Our study showed that shilajit may be a useful option in the treatment of secondary brain injury, in humans.

Is there a relationship between middle concha bullosa and ethmoid roof asymmetry? / Existe uma relação entre a concha média bolhosa e a assimetria do teto etmoidal?

Abstract Introduction The middle turbinate and ethmoid roof are intranasal structures and may have many anatomical variations. These structures, which serve as anatomical markers during functional sinus surgery, are important for preventing complications and performing a proper surgery. Knowledge of anatomical variations will increase surgical success and reduce complications. Objective We aimed to investigate the presence of asymmetry in the ethmoidal roof and anatomical variation in patients with and without concha bullosa. Methods In this study, the files of patients who underwent paranasal computed tomography between 2012 and 2018 were analyzed retrospectively. The patients were divided into two groups, as patients with and without concha bullosa. Differences between the two groups in terms of age, gender, septum deviation, ethmoid artery dehiscence, ethmoid roof asymmetry were examined. Results The 369 patients included in our study were divided into two groups; those with concha bullosa and those without concha bullosa. The mean age of the patients with concha bullosa was 36.1 ± 13.4 (min-max: 12-74) and the mean age of patients without concha bullosa was 37.5 ± 14.3 (min-max: 10-81). The ethmoid roof depths were compared between the two groups and a significant difference was observed (p < 0.001). The ethmoid roof depth was higher in the group with concha bullosa (p < 0.001). Conclusion The results of our study indicate that the ethmoidal roof tends to be higher in patients with middle concha bullosa.

Resumo Introdução A concha média e o teto etmoidal são estruturas intranasais e podem apresentar muitas variações anatômicas. Essas estruturas, usadas como marcadores anatômicos durante a cirurgia sinusal funcional, são importantes para evitar complicações e para a feitura adequada da cirurgia. O conhecimento das variações anatômicas aumenta o sucesso cirúrgico e reduz as complicações. Objetivo Investigar a presença de assimetria no teto etmoidal e variações anatômicas em pacientes com e sem concha bolhosa. Método Os prontuários dos pacientes submetidos à tomografia computadorizada de seios paranasais entre 2012 e 2018 foram analisados retrospectivamente. Os pacientes foram divididos em dois grupos, pacientes com e sem concha bolhosa. As diferenças entre os dois grupos em termos de idade, sexo, desvio do septo, deiscência da artéria etmoidal e assimetria do teto etmoidal foram avaliadas. Resultados Os 369 pacientes incluídos em nosso estudo foram divididos em dois grupos: com concha bolhosa e sem concha bolhosa. A média de idade dos pacientes com concha bolhosa foi de 36,1 ± 13,4 (mín-máx: 12-74 anos) e a média de idade dos pacientes sem concha bolhosa foi de 37,5 ± 14,3 (mín-máx: 10-81 anos). As profundidades do teto etmoidal foram comparadas entre os dois grupos, observou-se diferença significante (p < 0,001). Observou-se que a profundidade do teto etmoidal foi maior no grupo com concha bolhosa (p < 0,001). Conclusão O resultado do nosso estudo indica que pacientes com concha média bolhosa tendem a apresentar uma maior profundidade do teto etmoidal.

Parapharyngeal prestyloid vagal paraganglioma.

Vagal paragangliomas (VPs) are rare tumors arising from paraganglionic tissue within the vagal nerve's perineurium. Usually, benign vascular tumors, VPs tend to invade the surrounding structures. Herein, we report the case of a VP presenting as a neck mass, which was evaluated as a glomus caroticum tumor preoperatively. A 65-year-old female complaining of a left-sided neck mass and intermittent hoarseness was assessed and operated on for possible glomus caroticum tumor. During the tumor excision, the vagal nerve was also involved, and hence, sacrificed. Histopathological examination revealed an encapsulated tumor associated with a nerve and ganglion and immunohistochemical staining tested positive for succinate dehydrogenase, confirming the diagnosis of VP. Postoperative residual hoarseness was corrected by vocal rehabilitation. While evaluating a retropharyngeal prestyloid neck mass, a VP should always be considered. Surgical excision involving vagal scarification, followed by vocal rehabilitation may be the appropriate treatment strategy.

Is there a relationship between middle concha bullosa and ethmoid roof asymmetry?

INTRODUCTION: The middle turbinate and ethmoid roof are intranasal structures and may have many anatomical variations. These structures, which serve as anatomical markers during functional sinus surgery, are important for preventing complications and performing a proper surgery. Knowledge of anatomical variations will increase surgical success and reduce complications. OBJECTIVE: We aimed to investigate the presence of asymmetry in the ethmoidal roof and anatomical variation in patients with and without concha bullosa. METHODS: In this study, the files of patients who underwent paranasal computed tomography between 2012 and 2018 were analyzed retrospectively. The patients were divided into two groups, as patients with and without concha bullosa. Differences between the two groups in terms of age, gender, septum deviation, ethmoid artery dehiscence, ethmoid roof asymmetry were examined. RESULTS: The 369 patients included in our study were divided into two groups; those with concha bullosa and those without concha bullosa. The mean age of the patients with concha bullosa was 36.1 ±â€¯13.4 (min-max: 12-74) and the mean age of patients without concha bullosa was 37.5 ±â€¯14.3 (min-max: 10-81). The ethmoid roof depths were compared between the two groups and a significant difference was observed (p < 0.001). The ethmoid roof depth was higher in the group with concha bullosa (p < 0.001). CONCLUSION: The results of our study indicate that the ethmoidal roof tends to be higher in patients with middle concha bullosa.

Association of rs2228570 Polymorphism of Vitamin D Receptor Gene with Lumbar Degenerative Disc Disease.

AIM: To investigate the association between the vitamin D receptor (VDR) gene rs2228570 FokI polymorphism and the development of lumbar degenerative disc disease (LDDD) in the Turkish population. MATERIAL AND METHODS: This was a prospective case-control study that included 45 patients with LDDD and 49 healthy individuals (control group). The clinical investigations of the LDDD patients consisted of neurological examinations, lumbar magnetic resonance imaging studies, visual analog scale (VAS) scores, and Oswestry Disability Index scores. The VDR gene rs2228570 FokI polymorphism was analyzed via a real-time polymerase chain reaction. RESULTS: Individuals with the VDR GG genotype had a significantly increased risk of LDDD, while those with the AG genotype had a significantly decreased risk. In addition, the A allele may have a protective effect against LDDD in the Turkish population. Moreover, the VAS pain results showed that the GG genotype had a significantly higher score than the others. CONCLUSION: VDR rs2228570 AG genotype is at a decreased risk and the GG genotype is at an increased risk of LDDD in the Turkish population. Since genetic polymorphisms often show ethnic differences, further functional studies are needed to evaluate the genotype and phenotype correlations in large cohorts of various ethnicities.

Prognosis of Hormonal Deficits in Empty Sella Syndrome Using Neuroimaging.

AIM: We have evaluated the anatomic measurements on sellar area of patients who were radiologically diagnosed with empty sella to determine the relation between the amount of pressure on the adenohypophysis and hormonal imbalances. MATERIALS AND METHODS: Sixty-one cases were diagnosed with empty sella and had hormone tests and hypophysis magnetic resonance (MR). The cases were categorized into two groups - patients with hypophyseal hormone anomaly and patients without hormone anomaly. We have measured interclinoid distance, anteroposterior distance from the anterior diaphragm sella to the pituitary stalk, depth of the sella turcica, craniocaudal distance of the optic chiasm from the diaphragm sella, the heights of the right and left adenohypophysis, subcutaneous fat thickness measured orthogonal to the coronal suture and posteriorly at the level of C2-C3 for two groups on hypophysis and cranial MR imaging MRI. RESULTS: Twenty-five hormone-positive cases (40.9%) (hormone test were abnormal) and 36 hormone-negative cases (59.1%) (hormone tests were normal) were included in the study. The most common hormone abnormality was thyroid-stimulating hormone, T3 and T4 deficiency in 12 cases (48%) and increase in prolactin level in 7 cases (28%). Right adenohypophysis height was 1.54 ± 0.840 mm for the 1st group, and 1.96 ± 0.83 mm for the 2nd group. The left adenohypophysis height was 1.66 ± 0.80 mm for the 1st group, and 1.94 ± 0.94 mm for the 2nd group. It was found out that the thickness at right and left side in the hormone-positive group diminished significantly. CONCLUSION: Adenohypophysis height and distance between stalk and optic nerve were good determiner for hormone defect.

Spinal paragangliomas: Surgical treatment and follow-up outcomes in eight cases.

Paragangliomas are neuro-endocrine tumors originating from the adrenal gland. They are usually benign and nonfunctioning, rarely seen in central nervous system. More than 90% of central nervous system paragangliomas are manifested as carotid and glomus jugulare tumors. Spinal paragangliomas are quite rare.The study was conducted through retrospective analysis of the files of the patients who had undergone surgery with pre-diagnosis of spinal intradural tumor between 2011 and 2017 and diagnosed with paraganglioma.A total of 8 patients (4 females and 4 males) were included in the study. Mean age of the patients was 51.1 years (28-64). Time to admission was mean 6.5 months (3 weeks-24 months). Recurrence was not observed in 7 patients, 1 patient is being followed up due to residual tumor.Treatment may be achieved through recognizing malignant transformation in patients who were not diagnosed histopathologically. We consider that quality of life of the patients may be improved through this way.

Osteoma Originating from Mastoid Cortex.

Mastoid osteomas are very rare and defined as benign masses growing gradually in size. Temporal bone computed tomography is the examination of choice for their diagnosis and differentiation. Surgical resection is used to treat mastoid osteomas causing cosmetic deformity. Prognosis is good in cosmetic and curative aspects, and recurrences are very rare. No case of malign transformation has been reported. In this study, an adult patient who was treated because of a mastoid osteoma is presented with review of the current literature.

Comparison of Endolymphatic Duct Dimensions and Jugular Bulb Abnormalities Between Meniere Disease and a Normal Population.

BACKGROUND: The pathogenesis of Meniere disease (MD) has not been fully understood. According to the widely accepted theory, imbalances due to overproduction and/or impaired absorption of endolymph may cause endolymphatic hydrops, which is the hallmark pathological finding in MD. Some developmental temporal bone abnormalities may impair endolymph circulation and absorption, and these abnormalities could be a part of MD pathophysiology. However, structural features of the temporal bone cannot explain MD pathophysiology definitively. The authors aimed to determine the length and width of the endolymphatic duct (ED) along with jugular bulb (JB) abnormalities in MD patients and normal controls using high-resolution computed tomography, and to discuss the results supporting and opposing endolymphatic hydrops based on the data obtained. METHODS: Thirty-six ears of 18 patients with unilateral MD and 34 ears of 17 normal subjects were enrolled. Jugular bulb abnormalities and ED dimensions were evaluated in 3 groups: affected and unaffected ears of MD patients, and healthy controls. The ED dimensions and JB abnormalities were evaluated with high-resolution computed tomography. RESULTS: The ED was found to be significantly shorter and narrower in the affected ears of the MD patients than in the healthy control group. In addition, more JB abnormalities were detected in the affected ears of the MD patients than in the healthy control group. However, there was no difference between the affected and unaffected ears of the MD patients. CONCLUSION: Structural ED abnormalities and JB abnormalities may be predisposing factors for the development of Meniere disease, but cannot fully explain MD pathophysiology.

Bilateral Nasolabial Cyst as a Rare Case Report.

The etiology, clinical features, and treatment of an extremely rare case of a bilateral nasolabial cyst have been evaluated in this report. A 60-year-old female presented to our clinic with a pain-free swelling above the upper lip for a year and obstruction of the left nasal cavity for two months. On undergoing a physical ENT examination, she showed bulging of both nasal fossae and effacement of the bilateral nasolabial groove with a fluctuating smooth mass. A paranasal sinus CT scan showed a smooth, ovoid mass of 20×13 mm at the right side and 26×22 mm at the left side occupying the floor of the nasal fossa and restricted to the soft parts of the premaxillary region, without any bony destruction. The patient underwent surgical excision under general anesthesia via sublabial approach. Histopathology confirmed the diagnosis of bilateral nasolabial cyst. The patient was asymptomatic during 18-month of postoperative follow-up. Bilateral nasolabial cysts should be considered in the differential diagnosis of cystic masses of the nasal vestibule and deformities of the premaxillary region. Although endonasal endoscopic cyst marsupialization is a relatively new treatment, surgical resection with the sublabial approach is the treatment of choice.

The role of ultrasonography in the imaging of body packers comparison with CT: a prospective study.

PURPOSE: This study investigated the sonographic properties of drug packets containing narcotic drugs and the diagnostic role of ultrasonography in detecting body packing in comparison with CT. METHODS: Forty-five suspects admitted to our hospital for diagnosis and management were routinely evaluated by non-contrast CT for the presence of drug packets. A single radiologist blind to CT data independently performed the abdominal ultrasonographic scans. RESULTS: Thirty-five of 45 suspects were carrying packets. In positive cases, two types of packets with different properties were noted. Twenty-eight cases had type 1 packets (solid form drug) and 7 had type 2 packets (liquid form cocaine). The sensitivity, specificity, positive, and negative predictive values of ultrasonography for detecting drug packets were 91%, 70%, 91%, and 70%, respectively. Ultrasonography accurately determined the presence or absence of packs in 39 of 45 suspects. CONCLUSION: Ultrasonography was found to have a high sensitivity but a low specificity in suspected cases. A negative ultrasonography cannot rule out the diagnosis of body packing. However, it may be preferred as the initial imaging method or for follow-up of suspected cases as a radiation-free, easy-to-use, and inexpensive technique.

Effects of contrast material on the metabolite ratios in single-voxel MR Spectroscopy of intraaxial brain tumors.

AIM: The purpose of our study was to determine whether the administration of contrast material affects the results of MR Spectroscopy (MRS) in different intraaxial brain tumors. MATERIALS AND METHODS: Thirty-three patients (median range 46.72 ± 2.95, range 9-77) with intraaxial brain tumors underwent MRS before and 5 min after intravenous administration of gadolinium based contrast material at the standard dose of 0.1 mmol/kg (Gadodiamide or Gd-DOTA). Metabolite ratios (N-acetyl aspartate (NAA)/Creatine (Cr), Choline (Cho)/Cr, and NAA/Cho) were calculated. RESULTS: There was no significant difference between the pre and postcontrast MRS spectra as regards to NAA/Cr (p:0.4), Cho/Cr (p:0.2), and NAA/Cho (p:0.2) ratios obtained from the intraaxial brain tumors. CONCLUSION: Contrast material administration did not change the metabolite ratios of MRS. Contrast administration would be useful in guiding voxel localization in MRS evaluation of intraaxial brain tumors.

Lumbar gossypiboma.

Gossypiboma is a mass formed by a retained surgical sponge and reactive tissue. The cases with gossypiboma are usually asymptomatic or with nonspecific symptoms, which delay diagnosis for months or years after surgery. We describe imaging findings in a 43-year-old woman with a symptomatic retained surgical sponge in a lumbar laminectomy site. Ultrasonography, computed tomography, magnetic resonance imaging (MRI), and diffusion-weighted MRI were performed. Gossypiboma should be considered in the differential diagnosis of a mass in a patient with a history of prior surgery. Diffusion-weighted MRI may provide important data for differential diagnosis of gossypiboma. With diffusion-weighted MRI, gossypiboma may be distinguished from an abscess by its low signal intensity and increased apparent diffusion coefficient (ADC) as compared to high signal intensity with low ADC in cases of abscess.

Acute subdural hematomas caused by ruptured aneurysms: experience from a single Turkish center.

AIM: Although an aneurysmal rupture typically presents on computed tomography (CT) imaging as only a subarachnoid hemorrhage (SAH), it may be associated with spontaneous (nontraumatic) subdural hemorrhage (sSDH). The purpose of this paper is to discuss the clinical and radiological characteristics, as well as a potentially dangerous situation in the diagnosis and the management of this life-threatening condition. MATERIAL AND METHODS: The Department of Neurosurgery at Inonu University (Turgut Ozal Medical Center) (TOMC) maintains a prospective database of all patients treated for intracranial aneurysms since 1999. Using this database, we obtained patients with ruptured aneurysms who presented with sSDH on CT imaging. RESULTS: 687 patients with radiographically documented ruptured aneurysms were admitted from January 2000 through January 2009. Of these, eleven patients presented with sSDH. The incidence of aneurysmal rupture with sSDH is 1.6 % in our series. CONCLUSION: Acute sSDH on cranial CT should be considered for an urgent workup of a ruptured aneurysm, even in the absence or presence of SAH finding. CT angiography has advantages over cerebral digital substraction angiography (DSA) and may be a reasonable alternative to latter modality in the diagnosis, triage, and treatment planning in patients with sSDH.

Isolated internal auditory artery aneurysm.

Anticoagulant therapy is effective and prevents death in more than 95% of patients with pulmonary embolism following deep vein thrombosis. We report a patient who developed deep vein thrombosis following rupture of a dissecting aneurysm of the internal auditory artery. The parent artery was occluded before anticoagulant therapy as a prophylactic measure to prevent intracranial haemorrhage. We discuss some of the clinical features, therapeutic difficulties, and pitfalls in the management of internal auditory artery aneurysm complicated by deep vein thrombosis.

Prevalence and outcome of congenital heart disease in patients with neural tube defect.

A prospective clinical study was designed to establish the risk factors, the prevalence, and the progress of congenital heart defects in children with neural tube defects. Study included 90 children with a mean age of 13.5 +/- 30.4 months. There were 53 (59%) patients with spina bifida occulta and 37 (41%) patients with spina bifida aperta. The overall prevalence of congenital heart disease was 27.8% (40.5% in spina bifida aperta and 18.9% in spina bifida occulta; P = .024). There was no statistically significant difference for maternal age, usage of periconceptional folate, and maternal diabetes between the patient and control groups. The authors conclude that congenital heart defects are more common than reported in neural tube defects, and screening echocardiograms are warranted. This should be kept in mind especially in patients requiring minor or major surgical procedures. Furthermore, routine obstetric examination and therefore the use of periconceptional folic acid during pregnancy is still lacking in our country.

Comparative neuroprotective effect of sodium channel blockers after experimental spinal cord injury.

Spinal cord injury (SCI) results in loss of function below the lesion. Secondary injury following the primary impact includes a number of biochemical and cellular alterations leading to tissue necrosis and cell death. Influx of Na(+) ions into cells has been postulated to be a key early event in the pathogenesis of secondary traumatic and ischemic central nervous system injury. Previous studies have shown that some voltage-sensitive sodium channel blockers provide powerful neuroprotection. The purpose of the present study was to compare the neuroprotective effect of three sodium channel blockers-mexiletine, phenytoin and riluzole--after SCI. Ninety rats were randomly and blindly divided into five groups of 18 rats each: sham-operated group, trauma group (bolus injection of 1 mL physiological saline intraperiteonally [i.p.]), mexiletine treatment group (80 mg/kg, i.p.), phenytoin treatment group (200 mg/kg, i.p.) and riluzole treatment group (8 mg/kg, i.p.). Twenty-four hours after injury, the rats were killed for determination of spinal cord water content and malondialdehyde (MDA) levels. Motor function scores of six rats from each group were evaluated weekly for six weeks. Then the rats were killed for histopathological assessment. Although all the treatment groups revealed significantly lower MDA levels and spinal cord edema than the trauma group (p<0.05), the riluzole and mexiletine treatment groups were better than the phenytoin treatment group. In the chronic stage, riluzole and mexiletine treatment achieved better results for neurobehavioral and histopathological recovery than phenytoin treatment. In conclusion, all the tested Na(+) blockers had a neuroprotective effect after SCI; riluzole and mexiletine were superior to phenytoin.

Do sodium channel blockers have neuroprotective effect after onset of ischemic insult?

OBJECTIVE: Cerebral ischemia causes a series of pathophysiologic events that may result in cerebral infarct. Some neurons are more vulnerable to ischemia, particularly pyramidal neurons in the hippocampal CA1 region. Pharmacologic intervention for treatment of cerebral ischemia aims to counteract secondary neurotoxic events or to interrupt the progression of this process. In the present study, we compare the neuroprotective effects of sodium channel blockers (mexiletine, riluzole and phenytoin) and investigate whether they have neuroprotective effect when given after ischemic insult. METHODS: A transient global cerebral ischemia model was performed in this study by clipping bilateral common carotid arteries during 45 minutes. Riluzole (8 mg/kg), mexiletine (80 mg/kg) and phenytoin (200 mg/kg) were injected into the rats intraperitoneally 30 minutes before or after reperfusion. Lipid peroxidation levels and cerebral water contents were evaluated 24 hours after ischemia. Histopathologic assessment of hippocampal region was determined 7 days after ischemia. RESULTS: Riluzole, mexiletine and phenytoin treatment after global ischemia significantly decreased water content of the ischemic brain (p<0.05 for each). No significant difference was observed in cerebral edema among the drug treatment groups (p>0.05). When pre-treatment and post-treatment groups were compared with each other, only riluzole pre-treatment group revealed better result for cerebral edema (p<0.05). Pre-treatment with these drugs revealed significantly better results for the malonyldialdehyde (MDA) level and the number of survival neuron on the hippocampal region than the post-treatment groups. CONCLUSION: It is demonstrated that riluzole, mexiletine and phenytoin are potent neuroprotective agents in the rat model of transient global cerebral ischemia, but they are more effective when given before onset of the ischemia.