Making stereotactic radiosurgery decisions by calculating the probability of perilesional edema in cavernomas.

OBJECTIVE: Stereotactic radiosurgery is a therapeutic modality for cavernomas that is associated with certain adverse effects, such as perilesional edema. In this study, we aimed to estimate the presentation of perilesional edema using imaging techniques, considering its location, proximity to major venous and arterial structures, size, depth, and eloquent location. PATIENTS AND METHODS: The radiographic evaluation included their sizes, localization of the lobes, whether they were in the deep or superficial regions, eloquent areas, and their proximity to the major arteries and venous sinuses. RESULTS: As the size increased, the time to edema increased at the same rate (r=0.972, p=0.001). We determined that the duration of edema increases as it attaches to the great venous structures, and edema occurs over a longer time (r=-0.761, p=0.001). Cavernomas >13 mm had a high probability of causing edema (p=0.0014). Edema occurred with a high probability in patients with an arterial distance <5.69 mm and a venous/arterial distance ratio >8.93 (specificity 100%, selectivity 98.2%). CONCLUSIONS: When recommending stereostatic radiosurgery treatment, the possibility of edema formation should be calculated based on the location, size, and proximity of the cavernoma to the vascular structures, and the choice of treatment should be made accordingly.

The factors that cause penile shortening after plication surgery in patients with congenital penile curvature: [[es]]Los factores causantes del acortamiento de pene después de la cirugía con plicatura en pacientes con incurvación peneana congénita.

OBJECTIVE: Congenital penile curvature is defined as the non-straightness of the penis without any urethral or penile pathology. We aimed to evaluate the factors that cause penile shortening after plication surgery in patients with congenital penile curvature. METHODS: Between November 2010 and December 2020, we retrospectively reviewed patients with CPC undergoing tunica albuginea plication surgery. Before the procedure, patients' age, curvature location and degrees, as well as penile length were recorded. After the treatment, penile lengths were measured and recorded again. Early and late period results were recorded. RESULTS: Plication surgery was performed in 130 patients. The median age was 24 years. Seventy-six patients had ventral curvature, 22 had dorsal curvature, 32 had lateral curvature. Average shortening of penile length in patients with curvature below 30° was: ventral 8-16 mm, dorsal 6-13 mm, lateral 5-12 mm. Patients with curvatures above 30° were: ventral 12-22 mm, dorsal 8-20 mm, lateral 2-12 mm. CONCLUSION: Penile length shortening after plication is inevitable. Curvature degree and direction are factors affecting penile length after surgery. Therefore, patients and relatives should be informed in more detail about this complication.

Los factores causantes del acortamiento de pene después de la cirugía con plicatura en pacientes con incurvación peneana congénita / The factors that cause penile shortening after plication surgery in patients with congenital penile curvature

Objetivo La incurvación peneana congénita se define como la incurvación del pene en ausencia de patología uretral o peneana. Nuestro objetivo es evaluar los factores causantes del acortamiento del pene después de la plicatura en pacientes con incurvación peneana congénita. Métodos Entre noviembre de 2010 y diciembre de 2020 revisamos de forma retrospectiva a los pacientes con incurvación peneana congénita que se sometieron a una cirugía mediante técnica de plicatura de la túnica albugínea. Antes del procedimiento, se registró la edad de los pacientes, la ubicación y los grados de la desviación y la longitud del pene. Tras el tratamiento se midió y registró de nuevo la longitud del pene. Se registraron los resultados de los períodos inicial y final. Resultado Se realizó cirugía con plicatura en 130 pacientes. La media de edad era de 24 años. Setenta y seis pacientes tenían incurvación ventral, 22 dorsal y 32 lateral. El acortamiento medio de la longitud del pene en aquellos pacientes con incurvación inferior a 30° fue: ventral 8-16 mm, dorsal 6-13 mm, lateral 5-12 mm. En los pacientes con incurvación superior a 30° fue: ventral 12-22 mm, dorsal 8-20 mm, lateral 2-12 mm. Conclusión El acortamiento del pene después de la plicatura es inevitable. El grado y la dirección de la desviación son factores que afectan la longitud del pene después de la operación. Por lo tanto, los pacientes y sus familiares deben recibir información detallada sobre esta complicación (AU)

Objective Congenital penile curvature is defined as the non-straightness of the penis without any urethral or penile pathology. We aimed to evaluate the factors that cause penile shortening after plication surgery in patients with congenital penile curvature.Methods Between November 2010 and December 2020, we retrospectively reviewed patients with CPC undergoing tunica albuginea plication surgery. Before the procedure, patients’ age, curvature location and degrees, as well as penile length were recorded. After the treatment, penile lengths were measured and recorded again. Early and late period results were recorded. Results plication surgery was performed in 130 patients. The median age was 24 years. Seventy-six patients had ventral curvature, 22 had dorsal curvature, 32 had lateral curvature. Average shortening of penile length in patients with curvature below 30° was: ventral 8-16 mm, dorsal 6-13 mm, lateral 5-12 mm. Patients with curvatures above 30° were: ventral 12-22 mm, dorsal 8-20 mm, lateral 2-12 mm. Conclusion Penile length shortening after plication is inevitable. Curvature degree and direction are factors affecting penile length after surgery. Therefore, patients and relatives should be informed in more detail about this complication (AU)

Covid-19 phobia in prehospital emergency medical services workers in Turkey.

Background: The COVID-19 (coronavirus disease-2019) outbreak has its social, economic, and political effects on wider society, as well as physical and mental health effects on individuals. The psychological and social impacts are more apparent and common on emergency health care workers who have close contact with patients. Aim: Our study aims to investigate coronaphobia in emergency health care workers. Subjects and Methods: A cross-sectional study was carried out in July 2020 with 253 people working under the Bingöl 112 Provincial Ambulance Service Chief of Staff. The data of the study were collected using a questionnaire including sociodemographic characteristics, working conditions, pandemic process, and the Coronavirus-19 Phobia Scale. P < .05 was considered statistically significant. Results: The mean total score of COVID-19 phobia in 112 employees was 58.03 ± 18.78. The sub-dimension scores are psychological 21.92 ± 6.19, somatic 10.83 ± 5.68, social 15.98 ± 5.60, and economic 9.28 ± 4.18. Psychological and social sub-dimension scores and total COVID-19 phobia score of women, the somatic sub-dimension score of married people, all sub-dimension scores, and total COVID-19 phobia score of those who had contact with COVID-19-positive patients were found to be significantly higher (P < .05). Conclusions: Close contact with patients, working conditions, and the heavy schedule of nightshifts increase psychological and social fear in emergency health care workers. It is important to provide psychosocial support to emergency health care workers during the pandemic period.

Association of frontal and maxillary bone fractures and concomitant craniocerebral injuries in patients presenting with head trauma.

Background: Maxillofacial fractures and craniocerebral injuries are common in patients with head trauma. These are injuries with high mortality and morbidity. Therefore, patients with head trauma should be evaluated early with a multidisciplinary approach. Aim: The association between frontal and maxillary bone fractures and concurrent craniocerebral injuries were investigated in patients presenting with head trauma in this study. The data of the patients were analyzed retrospectively. Methods and Material: Age and gender distributions were evaluated in frontal and maxillary fractures. Concomitant craniocerebral injuries were investigated. Craniocerebral injuries were grouped as pneumocephalus, extra-axial, intra-axial injuries and brain edema. Craniocerebral injuries in frontal and maxillary fractures were compared statistically. Results: Frontal bone and maxillary bone fractures were detected in 24% and 95% of the patients. Coexistence of pneumocephalus and intra-axial injuries in frontal bone fracture was statistically significant. The association of frontal posterior wall fractures with pneumocephalus and parenchymal contusion was found to be statistically significant. In addition, the association of craniocerebral injuries were evaluated and statistically significant ones were determined. Conclusion: The presence of maxillofacial fractures in patients presenting with head trauma increases mortality and morbidity. Craniocerebral injuries can be life-threatening and delay the treatment of facial fractures. Upper facial bone fractures are significantly more common in craniocerebral injuries.

Analysis of cerebellum with magnetic resonance 3D T1 sequence in individuals with chronic subjective tinnitus.

Tinnitus is a symptom in which the patient can hear ringing, buzzing and similar sounds in the ear for 3 months longer. In our study, we aimed to analyse the cerebellum volume and cerebellum connections in patients with chronic tinnitus using VolBrain program. A total number of 10 patients and 10 otherwise healthy peoples records were then enrolled. Volumetric analysis was performed with automated segmentation of the cerebellum and its lobules, using magnetic resonance imaging (MRI). The mean volumes of 10 cerebellar volume were compared between the tinnitus and control groups. Quadrangular lobular portion of the cerebellum, the flocculonodular part and the volume of the central cerebellar lobule were decreased in the tinnitus group. White and grey matter decreased and the amygdala size was increased. We found statistically important volumetric changes in our study. VolBrain can be used in the future for analysing, diagnosis and treatment tinnitus patients. We recommend to use this practical, free of charge and easy programme to analyse for tinnitus patients. This may provide us with practical and useful information about the disease. In patients with tinnitus, the volume loss was 17.48% in the quadrangular lobe, 21% in the central lobule, and 9.33% in the total cerebellum volume.

BDNF and NGF gene polymorphisms and urine BDNF-NGF levels in children with primary monosymptomatic nocturnal enuresis.

INTRODUCTION: The pathophysiology and genetic influences in nocturnal enuresis have not been fully elucidated. Delayed neuronal maturation has been suggested as a pathogenetic mechanism in primary monosymptomatic nocturnal enuresis (PMNE). Brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) are neurotrophins affecting maturation of the nervous system. OBJECTIVE: The aim of this preliminary study was to investigate BDNF and NGF gene polymorphisms and urine levels of BDNF and NGF in children with PMNE as a first time. STUDY DESIGN: The single-nucleotide polymorphisms of BDNF (rs6265:G > A:Val66Met; rs8192466:C > T:Thr2Ile) and NGF (rs6330:C > T:Ala35Val, rs11466112:C > T:Arg221Trp) were investigated by comparing 104 children with PMNE and 140 healthy control subjects. Children with non-PMNE were excluded. DNA isolation and detection of polymorphisms were performed by real-time polymerase chain reaction. In addition, urine BDNF and NGF levels of 47 PMNE and 29 healthy children were measured by enzyme-linked immunosorbent assay method and normalized to urine creatinine (Cr) concentration for comparisons. RESULTS: There were no differences in genotype and allele frequencies of BDNF rs6265 and NGF rs6330 polymorphisms between patients with PMNE and the control group (P > 0.05). No mutant alleles were found in BDNF rs8192466 and NGF rs11466112 polymorphisms in either group. Children with PMNE had higher urine BDNF/Cr (0.020 ± 0.010 vs 0.010 ± 0.002; P = 0.008) and NGF/Cr ratio (3.01 ± 1.87 pg/mg vs 1.77 ± 0.26 pg/mg; P = 0.002) compared with the control subjects. However, no significant differences were found in BDNF/Cr and NGF/Cr values between GG, GA, and AA genotypes of BDNF rs6265 polymorphism and CC and CT genotypes of NGF rs6330 polymorphism (P > 0.05). DISCUSSION: In this study, no association of BDNF and NGF gene polymorphisms with PMNE was found, and urine neurotrophin concentrations were not directly influenced by investigated polymorphisms. Although, previously increased urine neurotrophin secretion has been found in detrusor overactivity, bladder inflammation, and dysfunctional voiding, this preliminary results also showed an increase in neurotrophins in PMNE. Higher urine neurotrophin levels may be related to delayed and continued neuronal maturation or increased production of neurotrophins in the bladder. The increased urine neurotrophins in PMNE may be an indicator of increased sensory nerve excitability of the bladder, contributing to the development of enuresis. CONCLUSION: This study showed that investigated neurotrophin gene polymorphisms did not make a significant contribution to the development of PMNE, but urine levels of neurotrophin gene products were higher in PMNE. Owing to the complexity and heterogeneity of genotype-phenotype relationships in enuresis, further studies are needed in PMNE.

Breast Reduction Using the Superomedial Pedicle- and Septal Perforator-Based Technique: Our Clinical Experience.

BACKGROUND: Adequate tissue removal must be performed for symptom relief following reduction mammoplasty. However, this is not always possible in patients with gigantomastia because the pedicle is planned wider and the breast cannot be sufficiently reduced to prevent compromising the blood supply to the pedicle. To maximize blood circulation to the nipple-areola complex in our patients, the pedicle was planned to include the internal thoracic artery branches coming from both the second and third interspaces and the intercostal artery branches coming from the fourth and fifth intercostal spaces. METHODS: A total of 185 patients underwent reduction mammoplasty with the superomedial pedicle- and septal perforator-based technique. The mean weight of excised tissue was 928.77 g from the right breast and 899.92 g from the left, whereas the mean distance of nipple-areola transfer was 11.52 cm on the right breast and 11.27 cm on the left. RESULTS: Complications developed in 11 patients (5.94%): hematoma occurred in three patients, partial loss of areola and fat necrosis in five patients, and wound dehiscence in three patients. CONCLUSIONS: The pedicle included vessels of both superomedial and septum origin without any disruption in circulation. Consequently, the blood supply of the nipple-areola complex was preserved. Furthermore, in cases where the pedicle was long, intercostal perforators were identified and the pedicle was narrowed thoroughly; thus, the breast was reduced to the desired volume while minimizing the risk of complications. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Association of epicardial fat thickness with clinical and polysomnographic parameters in non-obese obstructive sleep apnoea patients.

OBJECTIVES: This study aimed to investigate the relationship of epicardial fat thickness with severity of obstructive sleep apnoea, and clinical and polysomnographic parameters, and to determine independent predictors for epicardial fat thickness. METHODS: A total of 84 patients with a body mass index of less than 30 kg/m2 and suspected sleep-disordered breathing were included in the study. The correlations of epicardial fat thickness with polysomnographic and clinical data, and severity of obstructive sleep apnoea, were investigated. RESULTS: Mean epicardial fat thickness was 3.75 ± 1.07 mm in the study group (n = 62) and 2.97 ± 0.62 mm in the control group (n = 22) (p < 0.001). There were significant positive correlations between epicardial fat thickness and: apnoea/hypopnoea index, oxygen desaturation index 3 and minimum oxygen saturation, as well as with age, body mass index, and neck and waist circumferences. CONCLUSION: Non-obese obstructive sleep apnoea patients have thicker epicardial fat compared to controls. Oxygen desaturation index 3 has a strong correlation with epicardial fat thickness and is an independent predictor of it.

USE OF NEUTROPHILS TO LYMPHOCYTES RATIO AS AN INFLAMMATION MARKER IN PATIENTS WITH CHRONIC TONSILLITIS.

The aim of this study was to assess the neutrophil to lymphocyte ratio (NLR) as an inflammation marker in patients with chronic tonsillitis and to compare the NLR values to other inflammation markers, such as antistreptolysin-O (ASO), C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR). Thirty patients aged between 4 and 15 y.o. who had undergone surgery for chronic tonsillitis were included in this retrospective study. Blood samples including haemogram, ASO, CRP and ESR were taken from the patients the day before and one month after the surgery and were analysed retrospectively. Preoperative ASO values were 170±75.5 U, CRP values were 7.6±5 mg/L, ESR values were 15.7±10 mm/H and NLR values were 0.9±0.2. Postoperative ASO values were 140.9±58.5 U, CRP values were 6.8±3.4 mg/L, ESR values were 12.5±5.4 mm/H and NLR values were 1.2±0.4. Statistically significant decreases were observed in the white blood cell count (WBC), lymphocytes, ASO and ESR results, with increase in NLR values after the surgery (p<0.05). The neutrophil and CRP values after the surgery have shown statistically insignificant decrease (p>0.05). The NLR values were compared with the ASO, CRP and ESR values, which were used as inflammation markers. Negative correlation was found between decrease in ASO and ESR and increase in the NLR values after the surgery.

THE USEFULNESS OF MONITORING THE NEUTROPHIL TO LYMPHOCYTE RATIO IN PATIENTS WITH PERIPHERAL VERTIGO.

The purpose of this study was to evaluate the usefulness of the neutrophil to lymphocyte ratio (NLR) in a differential diagnosis and follow-up of patients with peripheral vertigo. Twenty patients with benign positional paroxysmal vertigo (BPPV) and 20 patients diagnosed with vestibular neuritis (VN) were included in the study. Serum samples were analysed at the initial presentation and on the seventh day of admission retrospectively. The WBC (white blood cell) count was 10500±2100 /mm3, the neutrophil count was 4700±1100/mm3, the lymphocyte count was 5000±1200/mm3 and the NLR was 0.9±0.2 in the VN group. In patients with BPPV, the WBC count was 9200±1300/mm3, the neutrophil count was 5200±1200/mm3, the lymphocyte count was 3100±1200/mm3 and the NLR was 1.9±0.9. The NLR was lower in patients with VN than in patients diagnosed with BPPV. The WBC and lymphocyte count was significantly higher in the patients with VN than in the patients diagnosed with BPPV. Within the first week of admission, the WBC and lymphocyte counts in patients with VN decreased, and the NLR was more elevated than at the admission. It is highly recommended that NLR is used in the diagnosis and follow-up of the most commonly observed aetiological factors of peripheral vertigo, BPPV and VN.

Effect on patient anxiety of lidocaine infiltration into nasal packing after septoplasty: prospective, controlled study.

OBJECTIVE: This prospective, controlled study investigated the effect on patient anxiety of lidocaine infiltration into nasal packing following septoplasty. METHODS: The study included 50 patients who underwent septoplasty operation. Patient anxiety levels were measured 24 hours pre-operatively; 48 hours post-operatively, before saline or lidocaine infiltration; and 15 minutes after lidocaine or saline infiltration into the packing. The patients were asked to mark their level of pain during pack removal on a visual analogue scale. RESULTS: Hamilton Anxiety Scale scores for lidocaine infiltration patients were: 15.1 ± 7.4 pre-operatively; 16 ±7.6 post-operatively, before infiltration; and 13.7 ± 6.6 at 15 minutes after infiltration. The scores for saline infiltration patients were: 16.3 ± 6.8 pre-operatively, 16.4 ± 5.5 before infiltration and 16.1 ± 6.1 after infiltration. The visual analogue scale pain score was 5.3 ± 2.0 in the lidocaine study group and 7.5 ± 1.8 in the control saline group. CONCLUSION: Infiltration of lidocaine into nasal packing significantly reduced patient pain. Patients developed mild to moderate anxiety before nasal packing removal. Use of techniques without nasal packing can be recommended after septoplasty to ease patient post-operative discomfort.

Sudden bilateral hearing loss after spinal anaesthesia.

BACKGROUND: Spinal anaesthesia is one of the most widely used regional anaesthesia techniques. Sudden bilateral hearing loss following spinal anaesthesia has only been reported in a few cases. CASE REPORT: This paper reports the case of a 50-year-old woman who developed sudden bilateral hearing loss following spinal anaesthesia for hallux valgus orthopaedic surgery. This is followed by a literature review. RESULTS: The patient's hearing improved almost completely on the morning of the 3rd day following surgery. No recurrence of hearing loss, tinnitus or vertigo was reported during the six-month follow-up period. CONCLUSION: Some complications regarding hearing may emerge after spinal anaesthesia. The possibility of hearing loss after spinal anaesthesia should be taken into consideration. Complaints such as hearing loss, tinnitus or vertigo should be taken seriously when reported, and the patient should be referred to an ENT clinic. This will ensure early diagnosis and treatment.

Altered Stem Cell Receptor Activity in the Ovarian Surface Epithelium by Exogenous Zinc and/or Progesterone.

BACKGROUND: Ovarian surface epithelium (OSE) has the characteristics of a stem cell and the potential for differentiation. Previous studies on this subject have succeeded in deriving oocytes from OSE stem cells, leading to the belief that OSE could be used for infertility treatment. METHODS: Each rat (n = 10) was subjected to zinc and/or progesterone injection for 5 days after conception. After a 6-day implantation period, ovarian tissues were removed and comprehensive immunohistochemical analysis of stem cell markers was conducted: Sox2, Klf4, Oct3/4, c-Myc, CD117, CD90, SSEA-1 and Notch pathway analysis; Notch1, Jagged1, and Delta1 in the OSE and ovarian stromal cells were evaluated after treatment with zinc, progesterone, or both. RESULTS: Progesterone moderately affected Sox2 expression (p < 0.001), while zinc application strongly affected Klf4 and Oct3/4 and immunoreactivity (p < 0.001). CD90 immunoreactivity was decreased in the OSE and stroma of the progesterone group (p = 0.006) compared with the zinc (p = 0.244) and zinc/progesterone groups (p = 0.910). On the other hand, SSEA-1 showed moderate staining in the OSE and weak staining in stromal cells in animals treated with zinc (p = 0.727), progesterone (p = 0.626), and zinc/progesterone (p = 0.371), with no differences compared with control. Zinc application affected Notch pathway immunoreactivity, with a significant increase in Notch1 (p = 0.0015) and Jagged1 (p < 0.001). CONCLUSIONS: The expression of putative stem cell markers in the OSE was verified and stem cell receptor activity was raised in the OSE and ovarian stromal cells by zinc and progesterone. Thus, this increased expression allows the therapeutic use of zinc and progesterone in ovary-related infertility and brings a different perspective to reproductive medicine.

Extravesical approach in paraureteral bladder diverticulum: a case report.

Bladder diverticulaeare herniations of bladder mucosa through fibers of the detrusor muscle. We present the extravesical approach to a case of paraureteral bladder diverticulum in a six-year-old boy who had a history of recurrent urinary infection. In case of recurrent urinary complaints, the possibility of presence of a bladder diverticulum should be kept in mind. Voiding cystourethrogram is helpful for the differential diagnosis of the bladder diverticulum. Excision by extravesical approach of the paraureteral bladder diverticulum is a good choice.

Can striae be used as a marker for the prediction of pelvic organ prolapse?

OBJECTIVE: To investigate the relationship between two connective tissue pathologies: striae and pelvic organ prolapse (POP). STUDY DESIGN: Four hundred and eighty-eight women who had undergone gynaecological surgery were divided into two groups. The study group (n=244) consisted of symptomatic patients with POP, and the control group (n=244) consisted of cases who underwent surgery for benign gynaecological conditions without evidence of POP. The groups were compared in terms of the presence, intensity and severity of striae, as well as their general characteristics. RESULTS: The presence of striae (p=0.001), number of striae (p=0.001) and Davey score (p=0.00001) were significantly higher in the study group, and the absence of striae was more common in the control group (p=0.00001). According to multivariate analysis, the presence of striae, an increased number of striae (>15) and a Davey score >2 increased the risk of POP 1.29 fold (p=0.03, 95% confidence interval [CI] 1.14-1.35), 1.19 fold (p=0.04, 95% CI 1.14-1.25) and 2.51 fold (p=0.01, 95% CI 1.66-3.78), respectively. CONCLUSION: Striae may serve as a promising marker for POP. In particular, women who develop striae should be cautious about their risk for developing POP in the future, and should be informed about preventive methods for POP.

Contact radiator burn subsequent to spinal anaesthesia.

An unusual case is reported in which a patient sustained a third-degree burn of the plantar surface of the right foot as the result of contact with a heating radiator. This occurred when the patient fell asleep in his hospital bed after knee surgery. Spinal anaesthesia is easy to perform, and the risk factors, though present, are not serious. Such accidents are not infrequent and care should be taken to prevent them.

Does high maternal first trimester iron status have an effect on the 50 g oral glucose test?

We aimed to test the hypothesis that 1st trimester high body iron status is associated with a high positive 50 g oral glucose tolerance test. In this study, 29 pregnant women with positive 50 g oral glucose tolerance test were compared with 94 negative 50 g OGTT patients as the control group in terms of 1st trimester iron status. Both groups had similar age, weight, height, body mass index and also median gravidity and parity values. Our results showed that there were no differences between groups in mean haemoglobin, haematocrit, serum iron, serum ferritin, total iron binding capacity and transferrin. Since it seems that free radicals have much influence on oxidative stress and glucose metabolism, prospective, randomised clinical trials should be designed to demonstrate the possible relation between maternal iron status and glucose intolerance.