Two cases of macrocephaly and immune deficiency

Macrocephaly describes a head circumference greater than two standard deviations above the mean and is a feature of a number of genetic syndromes. Here we report on two patients with microcephaly, immune deficiency and anemia. In addition, one case had periventricular leukomalacia and the other case had myelinisation delay in periventricular white matter development. These cases may represent a distinct new syndrome.     

A Rare Cause of Renovascular Hypertension: Takayasu Arteritis with Only Renal Artery Involvement

Takayasu arteritis is a chronic inflammatory disease that affects mainly the aorta, main branches of aorta, and pulmonary arteries with unknown etiology. Disease affecting solely the renal arteries is rare. We will present a case that had hypertension, hypokalemia, and metabolic alkalosis where the etiology was type 2 Takayasu arteritis, affecting renal arteries.     

The use of a combined technique in reduction mammaplasty (inferior pyramidal and superior glandular techniques)

The management of mammary hypertrophy is a developing process. The common surgical options for reduction mammaplasty include amputation with free nipple graft as well as the bipedicled, inferior pedicle and vertical pedicle techniques. All techniques are used widely. Disadvantages of these procedures include nipple areola necrosis, insensitivity, hypopigmentation, and poor breast projection. Even with the standard modifications of the original techniques, the resultant breast and nipple may be wide and flat. The purpose of this study was to assess whether combined inferior pyramidal pedicle and superior glandular pedicle reduction mammaplasty can optimize nipple and breast projection. Attention will focus on the viability and sensation of the nipple areola complex. Nine patients with mammary hypertrophy were studied. The change in nipple position ranged from 7 to 13 cm. The amount of tissue removed from each breast ranged from 500 to 1150 g. Nipple/areola sensation was retained in all cases with the exception of one breast. Nipple/areola necrosis or hypopigmentation were not observed. Optimal central breast projection was maintained in all patients, and postoperative evaluation was carried out at 12 and 22 months. The patient satisfaction was very high.     

CT-guided transthoracic biopsy: histopathologic results and complication rates

PURPOSE

We aimed to investigate the effectiveness and complications of transthoracic CT-guided biopsy techniques.

METHODS

A total of 94 CT-guided percutaneous transthoracic biopsy procedures performed in 85 patients were retrospectively evaluated. Core biopsy technique was used in 87 procedures and transthoracic fine-needle aspiration biopsy was used in seven procedures.

RESULTS

Diagnostic results were achieved in 79 of 94 biopsy procedures. Pathology results were malignant in 54 patients, suspicious for malignancy in three patients, benign in five patients, and benign nonspecific in 17 patients. Specific diagnoses were obtained in 59 patients (62.8%) using core biopsy, but no specific diagnosis could be reached with transthoracic fine-needle aspiration biopsy. Complications included pneumothorax in 27 patients (28.7%) and parenchymal hemorrhage during and after the procedure in eight patients (8.5%).

CONCLUSIONS

CT-guided percutaneous transthoracic needle biopsy is a highly accurate procedure for histopathological diagnosis of thoracic masses. In addition, percutaneous transthoracic biopsy has an acceptably low complication rate and it reduces the need for more invasive surgical procedures.Since the beginning of the 21st century, lung cancer has been cited as one of the most common causes of death (1). World Health Organization declared lung cancer as the first leading cause of death in men and second in women, among all types of cancers (2).Percutaneous transthoracic biopsies are performed either using fine-needle aspiration biopsy (transthoracic fine-needle aspiration biopsy, TTFNAB) method or using the incisional or core biopsy method. Incisional biopsy and core biopsy are used to obtain a part of tissue from the lesion for histological diagnosis. On the other hand, TTFNAB is used to obtain aspiration material, which is used for cytological examination and lesion diagnosis (3, 4).Indications of transthoracic needle biopsy include solitary and multiple pulmonary nodules, mass lesions, persistent focal infiltration, consolidation, presence of cavities and abscesses, pleural lesions, and mediastinal and hilar mass diagnosis (3, 5).The aim of this study was to investigate the technique, suitability, and complications in CT-guided transthoracic biopsy of lung masses.     

The effect of temporary hemiepiphyseal stapling on the growth plate: a radiologic and immunohistochemical study in rabbits

The purpose of this study was to investigate the effect of temporary hemiepiphyseal stapling on the bone geometry and proliferative activity of the physis in immature rabbits. Proximal medial epiphyseal stapling of the right tibia was performed in 46 6-week-old New Zealand white rabbits. The rabbits were assigned randomly into two groups. In group 1, the staples were inserted extraperiosteally and the rabbits were killed at the end of 3 weeks. In group 2, the staples were fixed subperiosteally (group IIA) or extraperiosteally (group IIB), the staples were removed at the end of 3 weeks, and the rabbits were killed at the end of 6 weeks. The articular line-diaphysis angle (ALDA) was significantly increased with 3 weeks of stapling. After the removal of staples, while ALDA continued to worsen in group IIA, it improved in group IIB. Bone was observed to bridge the physis in group IIA. However, the proliferative activity of the physis continued. Temporary hemiepiphyseal stapling is a safe and effective method for control of physeal growth of long bones before skeletal maturity. However, it is of paramount importance not to disturb the periosteum during stapling.     

Microvascular decompression as a surgical management for trigeminal neuralgia: long-term follow-up and review of the literature

This retrospective study summarizes our experience based on treating 62 patients with trigeminal neuralgia treated with microvascular decompression. All patients had typical trigeminal neuralgia symptoms, with 24 of them (38%) having failed to benefit from other previous treatment paradigms. We excluded subjects with atypical and/or secondary forms of trigeminal neuralgia. Follow-up duration ranged from 5 months to 10 years 6 months, with recurrence being identified in three patients (4.8%).We found that the superior cerebellar artery is the leading offending vessel in our cases (33.9%; 21 patients). Interestingly, seven patients (11.3%) underwent an early reoperation 12-48 h later after the first operation was deemed ineffective. This subgroup recovered satisfactorily following isolation of the pathogenic vessels. Overall, no mortality was observed in our patients, and the only permanent morbidity outcome was a case of facial nerve palsy (1.6%). We conclude that microvascular decompression and its reapplicaiton for patients who showed no pain relief immediately after the first decompression are safe and effective treatments for trigeminal neuralgia.     

Radiographic changes in the lumbar spine in former professional football players: a comparative and matched controlled study

Heavy physical work and activity lead to degenerative changes, especially in the lumbar spine. We aimed to find out the occurence of radiographic changes (vertebral osteophytes, heights of lumbar dicsc, concavity index) and abnormalities of the lumbar spine in former professional football (association football or soccer) players according to their specialization (goalkeeper, defender, midfielder, forward) in their past professional sport life. We included 70 male former professional football players and 59 men as the control group. The football players group consisted of 15 defenders (21%), 29 midfielders (41%), 18 forwards (26%) and 8 goalkeepers (12%). Their mean professional football life was 11.04 years and the mean time period after their retirement was 13.87 years. Radiographs of both groups were taken to measure the disc height, concavity index and to determine osteophytes and abnormalities of the lumbar spine. FFbH-R score was assessed for daily activities. The mean FFbH-R score of football players was lower than that of the control group (P = 0.005). The total number of osteophytes in the player group was higher than in the control group (P = 0.001). The mean disc height of L1–L2 in football players was higher than in the control group (P = 0.045). The mean disc height of T12–L1 in goalkeepers was higher than in forward players (P = 0.019). The mean concavity index of L1 in forward players was lower than in defenders (P = 0.018). The mean disc heights of T12–L1 and L2–L3 were both higher in players whose professional sport life was >10 years than in players with ≤10 years (P = 0.018, P = 0.016). The mean disc height of L5–S1 was higher in players who had continued sport activity after retirement (P = 0.025). No statistically significant result was obtained with the rest of the variables. Playing football is heavy work. The decreased height of lumbar discs and the lower value of concavity index of forward players are because the lumbar spine of forward players is loaded more than in the rest of the players. Presented in part orally at Eurospine 2006, İstanbul, Turkey, 25–28 October 2006. Presented in part as poster at XXXVI Scientific Congress of Polish Orthopaedic and Traumatology Society, Katowice, Polland, 28–30 September 2006.     

The effects of female age on the outcome of testicular sperm extraction and intracytoplasmic sperm injection in infertile patient with azoospermia

Introduction: Testicular sperm extraction (TESE) is well-defined procedure for surgical sperm retrieval in obstructive and non-obstructive azoospermia. This study was focused on the effectiveness of testicular sperm extraction and intracytoplasmic sperm injection (ICSI) for azoospermic men with different female age subgroups.Materials and methods: A total of 107 men with azoospermia underwent TESE and ICSI treatment. The women were examined in three groups 20–29, 30–34 and 35 years or older. The main outcome in this study was fertilization and pregnancy rates with TESE and ICSI.Results: Spermatozoa were successfully retrieved during 97 of 107 (90.7%) TESE attempts, resulting in the fertilization of 286 of 563 (50.4%) injected metaphase II oocytes. Two hundred and fifty-five of them were transferred (89.8%). The clinical pregnancy rate and ongoing pregnancy rate per embryo transfer were 22.5% and 20.6% respectively. When comparing the fertilization and pregnancy rates, it was observed that women between the ages of 20–29 years had significantly higher pregnancy rates than women over 34 years of age (p < 0.05).Conclusion: The female age is a major factor in determining successful implantation in ICSI.     

Comparison of the Exposure Obtained by Endoscope and Microscope in the Extended Trans-Sphenoidal Approach

Objective: Trans-sphenoidal surgery is often combined with other approaches for the treatment of middle cranial base tumors. By combining a maxillotomy with trans-sphenoidal approach, significantly wider exposure to these regions is gained. However, endoscope-assisted techniques have also been used for sellar and parasellar and upper clival regions. Methods: An extended trans-sphenoidal approach was performed on 10 cadaver heads using the operating microscope and was repeated with a 0-degree endoscope. The mean horizontal and vertical distances were measured and pictured for each technique, and both distances were compared using a parametric paired Student's t-test. Results: The mean horizontal distances in the 10 specimens were 19.5 ± 1.8 mm by microscope and 27.5 ± 2.2 mm by endoscope, and the mean vertical distances were 25.8 ± 1.9 mm by the microscope and 34.5 ± 3.5 mm by the endoscope. Conclusion: The aim of this study was to quantify the amount of exposure obtained with an extended trans-sphenoidal approach and to compare both endoscopic and microscopic techniques. Using the endoscope in conjunction with the operating microscope may provide additional exposure and better access in skull base surgery.