Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance

Background

Only limited attention has been paid to the anatomy and clinical importance of the falcine venous plexus. The aim of this study was to evaluate the falcine venous plexus anatomically using scanning electron microscopy (SEM), and to provide guidance for neurosurgical approaches.

Methods

Latex or ink was injected into the superior and inferior sagittal sinus. The falcine venous plexus lying within the connective tissue of the falx cerebri was observed by dividing the falx into thirds (anterior, middle and posterior). Further, the SEM appearance of the falcine venous plexus was evaluated.

Results

The anterior third of the falx cerebri consisted of small diameter falcine venous vessels. These vessels were localized close to either the superior or inferior sagittal sinus, and none extended as far as mid-falx cerebri levels in any of the 16 cases. They communicated with either superior or inferior sagittal sinuses, but not with both of these sinuses. In the middle third of the falx cerebri, the majority of the vessels of the falcine venous plexus had larger diameter compared to those of the anterior third. These vessels extended the length of the falx cerebri levels. They communicated with both superior and inferior sagittal sinuses. In the posterior third of the falx cerebri, the vessels of the falcine venous plexuses had the largest diameter and were located at the junction of the inferior sagittal sinus and the straight sinus. They were localized at the lower two-thirds of the falx cerebri. In all cases, the dense venous networks communicated with the inferior sagittal sinus but not with the superior sagittal sinus. The falcine venous plexus observed in the posterior third of the falx cerebri was denser than in the anterior and middle portions. The SEM revealed small vessels whose diameter ranged between 42 and 138 μm. The vessels of the falcine venous plexus in the anterior third had a mean diameter of 0.42?±?0.1 mm, in the middle third a mean diameter of 0.87?±?0.17 mm, and in the posterior third, 1.38?±?0.21 mm.

Conclusion

The falcine venous plexus is a network of venous channels that exists within the connective tissue of the falx; the sizes and patterns of communication of these structures showed regional differences. Neurosurgeons should be aware of the regional differences when making an incision or puncturing the falx during a surgical approach.     

Effect of sex steroids on soleus muscle response in hypocalcemic medium (in vitro)

Purpose

Postoperative hypocalcemia is a frequently encountered complication of thyroid surgery. Since hypocalcemic symptoms are closely associated with sex, the aim of this study is to investigate the effects of sex steroids on muscle tissue under hypocalcemic conditions.

Methods

Six groups consisting of control male (M), control female (F), gonadectomized male (M−), gonadectomized female (F−), estradiol-applied gonadectomized male (MX), and testosterone-applied gonadectomized female (FX) rats were used. Contraction recordings were obtained from soleus muscle flaps. Maximal tension (PT), frequency required for 50% of PT (F50), contraction velocity at F50 (V50), and changes in contraction values (d[PT], d[F50], d[V50]) between normocalcemic and hypocalcemic conditions were calculated.

Results

d[PT], d[F50], and d[V50] were significantly higher in M− and MX groups compared with control M group. Whereas d[PT], d[F50], and d[V50] parameters of the F− group were significantly higher than control F group, d[F50] and d[PT] of the FX group showed no significant change and d[V50] for the FX group was significantly lower. A comparison of control groups showed that d[PT], d[F50], and d[V50] of the F group were significantly higher than those of the M group.

Conclusion

Whereas absence of both testosterone and estradiol caused an increase in hypocalcemia-induced changes in contraction parameters of rat skeletal muscle, presence or application of testosterone clearly stabilized contraction parameters.     

Primary hepatic neuroendocrine tumor: Five cases with different preoperative diagnoses

Neuroendocrine tumors, also known as carcinoid tumors, behave like benign tumors; however, they show the characteristics of carcinoma. While more than 80% of the neuroendocrine tumors found in the liver are metastatic, primary hepatic neuroendocrine tumors are very rare. Five patients with hepatic mass who admitted to our clinic between August 2003 and July 2007 were treated surgically. Ultrasonography, computerized tomography and magnetic resonance imaging were performed in all patients. Endoscopy and colonoscopy were conducted to exclude malignancy of other sites. Hepatectomy was carried out in all patients. Diagnosis was confirmed with immunohistochemical examination. The five patients treated surgically were diagnosed as primary hepatic neuroendocrine tumor histopathologically. Abdominal pain was the most common complaint of all patients. Hepatectomy was conducted in all patients due to tumors originating from the liver lobes. Only one patient (Case 2) underwent transarterial chemoembolization before hepatectomy to reduce tumor bleeding. Owing to tumor recurrence on the left lobe of the liver in Case 2, transarterial chemoembolization was performed four years after hepatectomy. R0 resection was achieved in two patients (Cases 1 and 3). In conclusion, primary hepatic neuroendocrine tumors are very rare and asymptomatic tumors. Thus, high-sensitive laboratory and imaging examinations are required. At present, hepatectomy remains the main treatment for primary hepatic neuroendocrine tumor.     

Clinical outcome and endothelial loss following prepupillary and retropupillary implantation of iris claw intraocular lenses

Purpose

Iris claw intraocular lenses (IOLs) were successfully used for the management of aphakia in patients that lack capsular support. The aim of this study was to compare the clinical outcome of prepupillary and retropupillary implantation of these IOLs.

Methods

The files of the 26 patients that had an iris claw IOL implantation between 2010 and 2020 were retrospectively reviewed. Detailed ophthalmological examination findings including corrected distance visual acuity (CDVA), intraocular pressure, endothelial cell counts, slit lamp and dilated fundus examination findings were specifically tabulated. Intraoperative and postoperative complications were also specifically recorded.

Results

There were 18 patients in the prepupillary implantation group and eight patients in the retropupillary implantation group. Age and gender distribution were similar between the groups. CDVA significantly increased in prepupillary and retropupillary implantation groups (p?=?0.001 and p?=?0.012, respectively). Median endothelial cell loss was 6.7% in prepupillary group and 7.2% in retropupillary group. The only intraoperative complication was iridodialysis (n?=?1). Postoperative complications included retinal detachment (n?=?1), cystoid macular edema (n?=?2) and IOL tilt (n?=?1). All of these complications occurred in the prepupillary implantation group.

Conclusion

Prepupillary and retropupillary implantation of iris claw IOLs resulted with similar visual gain and endothelial loss rates in a follow-up time of 6 months. There was an insignificant trend toward a reduced complication rate following retropupillary implantation.

     

Lateral internal sphincterotomy versus 0.25 % isosorbide dinitrate ointment for chronic anal fissures: a prospective randomized controlled trial

Purpose

To compare the healing properties of lateral internal sphincterotomy (LIS) and isosorbide dinitrate (ISDN) ointment for chronic anal fissure.

Methods

Patients with a chronic anal fissure were randomly assigned to a group treated with ISDN ointment (n = 105) or a group treated with LIS (n = 102). The same investigators examined the patients in a blinded manner, 1, 2, 3, 6, and 12 months after the treatments.

Results

The anal fissure had healed completely by 4 weeks in 64.7 versus 92.2 %, and by 6 months in 77.1 versus 97.1 % of the ISDN and LIS group patients, respectively. At 12 months, the recurrence rates were 4.8 versus 1 % for the ISDN and LIS groups, respectively, and the success rates of the treatments were 72.4 versus 96.1 %, respectively. Six patients in the LIS group experienced minor fecal incontinence, and seven (6.7 %) patients in the ISDN group experienced headaches that responded well to paracetamol.

Conclusion

ISDN ointment was reported by all patients to be easy to use. Although its success rate was lower than that of surgery, ISDN can be offered to selected patients with a chronic anal fissure, as it has a low recurrence rate and rare side effects are rare.     

Plasma D -Lactate Levels in Diagnosis of Appendicitis

We investigated the possible use of D -lactate as a predictor in the diagnosis of appendicitis. C-reactive protein level (CRP) and leukocyte counts were also evaluated. Venous blood D -lactate, CRP, and leukocyte counts were measured preoperatively in 53 patients undergoing surgery for appendicitis, as well as in 20 healthy subjects. Levels of all three parameters in the surgical patients were significantly higher than in the control group ( p < .05). Previous studies have shown that venous D -lactate is more specific to the intestine than CPR or leukocyte count. Based on our data, venous D -lactate, which had the lowest false-negative rate among these laboratory parameters, may be a useful diagnostic marker for appendicitis. None of these parameters were helpful in identifying the type of the appendicitis.     

Circulating endothelial cells in pediatric renal transplant recipients

Background

An increase in the number of circulating endothelial cells (CEC) indicates endothelial damage and the risk of cardiovascular disease. The aim of our study was to investigate the association of CEC with various clinical parameters in pediatric renal transplant recipients.

Methods

CEC, defined as CD45^?CD146⁺, were enumerated by flow cytometry from the peripheral blood of 50 pediatric renal transplant recipients and 20 healthy controls. Clinical parameters, including renal function tests, fasting blood glucose, serum cholesterol and triglyceride, cyclosporine A (CsA) (trough and 2nd-hour) and tacrolimus (tac) trough blood levels and their association with CEC numbers were analyzed.

Results

CEC numbers of patients were higher than those of controls (respectively, 128?±?89 cells/ml (42–468 cells/ml), 82?±?33 cells/ml (32–137 cells/ml), p?=?0.024). There was a statistically significant negative correlation between CEC numbers and glomerular filtration rate (GFR) (r?=??0.300, p?=?0.012). There was also a statistically positive association between CEC numbers and transplant duration as well as cyclosporine trough level (respectively, r?=?0.397, p?=?0.004, r?=?0.714, p?=?0.004). CEC numbers in patients on tac and CsA were similar (p?=?0.716).

Conclusions

Our results demonstrate that renal transplant recipients with high CsA trough blood level, longer transplant duration, and lower GFR, are at greater risk of developing endothelial damage.