Treatment effect of sibutramine compared to fluoxetine on leptin levels in polycystic ovary disease.

Weight reduction on its own is observed to cause improvement in some of the abnormalities seen in patients with polycystic ovary syndrome (PCOS). With respect to this observation, we studied the possible effects of different serotonin reuptake inhibitors (fluoxetine and sibutramine) on serum leptin levels that might play a role in the obesity component seen in patients with PCOS. In a random design, sixteen patients were assigned to fluoxetine and sibutramine for a period of 10 days. In both treatment groups, no significant differences were observed between pre-treatment and post-treatment values in insulin levels (p > 0.05). There was no significant difference between pretreatment and post-treatment serum leptin levels in the fluoxetine treatment group (p > 0.05). However, a significant reduction was observed in the serum leptin levels at the end of treatment in the sibutramine group (p < 0.05). The observed difference in the serum leptin response to the treatment effect of sibutramine compared to fluoxetine seems to be due to a mechanism independent of serotonin reuptake inhibition, possibly to the thermogenic effect of the sibutramine itself. Further studies with larger groups are warranted, to examine the mechanism of the weight-reducing effect of sibutramine. Detailed analyses of basal metabolic activity and change in serum leptin levels should be carried out.     

Association of a sylvian arachnoid cyst and trigonocephaly in a developing child: importance and management

Introduction Trigonocephaly and arachnoid cysts are two different entities that may cause intracerebral pressure elevation: one by space occupying and the other by space restriction. The true incidence of association of trigonocephaly and sylvian arachnoid cyst is not known. We present a rare case of trigonocephaly associated with a sylvian arachnoid cyst in a patient that underwent forehead reconstruction and fenestration of the arachnoid cyst in the same operation.Case report Investigation of an 11-month-old girl suffering from triangular appearance of the forehead since birth revealed metopic suture synostosis and type II sylvian arachnoid cyst. Neurological examination was normal. There were no seizure history and no other systemic malformation that could be a part of any syndromes associated with cranial synostosis. Forehead reconstruction with forehead advancement for trigonocephaly and fenestration of the arachnoid cyst to the basal cisterns were performed in the same operation. Satisfactory outcome was achieved.Conclusion The coexistence of craniosynostosis and arachnoid cyst is rare. They can be treated surgically in a single session.     

Sellar-Parasellar Brown Tumor: Case Report and Review of Literature

Brown tumors are the end stage of primary or secondary hyperparathyroidism. Such lesions are rare because hyperparathyroidism is now usually diagnosed and treated before they develop. Skeletal bone is most frequently involved, whereas sellar-parasellar involvement is extremely rare. We report a patient with a brown tumor involving the sellar-parasellar region associated with primary hyperparathyroidism. The patient's clinical history and biochemical and radiological tests were used for the diagnosis. Excision of the sellar-parasellar mass enabled histopathological confirmation and surgical decompression of neural structures. After the transsphenoidal surgery, excision of a parathyroid adenoma normalized the patient's metabolic status. Brown tumors are rarely associated with complications but occasionally may compress neural structures such as the optic nerve as they enlarge.     

Mitomycin C, 5-fluorouracil, and cyclosporin A prevent epidural fibrosis in an experimental laminectomy model

This study examined the preventive effects of the local application of mitomycin C (MMC), 5-fluorouracil (5-FU), and cyclosporine A (CsA) in minimizing spinal epidural fibrosis in a rat laminectomy model. Thirty-two 2-year-old male Wistar albino rats, each weighing 400 ± 50 g, were divided into four equal groups: sham, MMC, 5-FU, and CsA. Each rat underwent laminectomy at the L5–L6 lumbar level. Cotton pads (4 × 4 mm²) soaked with MMC (0.5 mg/ml), 5-FU (5 ml/mg), or CsA (5 mg/ml) were placed on the exposed dura for 5 min. Thirty days after surgery, the rats were killed and the epidural fibrosis, fibroblast density, inflammatory cell density, and arachnoid fibrosis were quantified. The epidural and arachnoid fibroses were reduced significantly in the treatment groups compared to the sham group. Fibroblast cell density and inflammatory cell density were decreased significantly in the MMC and 5-FU groups, but were similar in the sham and CsA groups. The decreased rate of epidural fibrosis was promising. Further studies in humans are needed to determine the short- and long-term complications of the agents used here. Presented as special poster in 2006 Annual Meeting of the Spine Society of Europe, October 25–28, İstanbul, Turkey.     

A case report: Leukaemic infiltration and hyperplasia of the prostate

Leukaemic infiltration of prostate with hyperplasia is a rare manifestation and is usually found in known cases of leukaemia, but it may be the first sign of an undiagnosed leukaemia. In this report, a rare case of leukaemic infiltration of the prostate in a 64-year-old man is represented. This revised version was published online in August 2006 with corrections to the Cover Date.     

Management of intrabiliary rupture of hydatid cyst of the liver

Thirty-six patients with intrabiliary rupture of hepatic echinococcal cysts were managed between 1974 and 1993. Clinical findings, skin tests, serologic tests, and imaging techniques were used to establish the diagnosis. Twenty-five (69.4%) patients had pain, 24 (66.6%) jaundice 22 (61.1%) fever, 20 (55.5%) chills, 10 (27.7%) malaise, and 7 (19.4%) other symptoms as the major causes of admission. All patients underwent choledochotomy and T-tube drainage. Treatment directed to the cyst was cystectomy and capittonage, cystectomy and drainage, and partial hepatectomy in 22, 12, and 2 patients, respectively. Omentoplasty was added to the treatment in 10 patients. Seven (19.4%) patients had complications. The period of hospitalization for patients with and without complications was 34.6±18.1 and 15.1±2.7, days, respectively. This study indicates that better results are obtained in patients with cystic lesions of the liver by avoiding percutaneous puncture or biopsy, the early use of ultrasonography and computed tomography, evacuation of the cyst together with its germinative membrane and the involved biliary tract under adequate care to avoid spillage into the peritoneal cavity, treating the remaining cavity according to its location, size, and the presence of infection, and decreasing the pressure in the biliary tract by T-tube drainage.

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Resumen Treinta y seis pacientes con ruptura intrabiliar de un quiste equinocóccico fueron manejados entre 1974 y 1993. Se utilizaron los hallazgos clínicos, pruebas cutáneas, pruebas serológicas y técnicas de imagenología para establecer el diagnóstico. Como causa principal de la hospitalización, 25 (69.4%) pacientes presentaban dolor, 24 (66.6%) ictericia, 22 (61.1%) fiebre, 20 (55.5%) escalofríos, 10 (27.7%) malestar general y 7 (19.4%) otros síntomas. La totalidad de los pacientes fue sometida a coledocotomía y drenaje con tubo en T. El tratamiento específico contra el quiste consistió en cistectomía y capitonaje, cistectomía y drenaje y hepatectomía parcial en 22,12 y 2 pacientes, respectivamente. Se añadió omentoplastia en 10 pacientes; 7 (19.4%) de los casos desarrollaron complicaciones. El período de hospitalización en los pacientes con y sin complicaciones fue de 36.6±18.1 y 15.1±2.7 días, respectivamente. El presente estudio indica que se logran mejores resultados en el manejo de las lesiones quísticas del hígado evitando la punción o biopsia percutáneas; utilizando precozmente el ultrasonido y la tomografía computadorizada; practicando la evacuación del quiste junto con su membrana germinativa y del tracto biliar afectado bajo con meticuloso cuidado para evitar la contaminación de la cavidad peritoneal; haciendo tratamiento de la cavidad residual de acuerdo con su ubicación, tamaño y la presencia de infección; y disminuyendo la presión en el tracto biliar mediante drenaje con tubo en T.

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Résumé Trente-six patients ayant une rupture dans les voies biliaires d'un kyste hydatique ont été traités entre 1974 et 1993. Les données cliniques, les tests cutanés, sérologiques et des techniques d'imagerie ont été utilisées pour arriver au diagnostic. Vingt-cinq (69.4%) patients se sont plaints de douleur, 24 (66.6%) d'ictère, 22 (61.1%) de fièvre, 20 (55.5%) de frissons, 10 (27.7%) de malaise et 7 (19.4%) d'autre symptômes comme motif d'hospitalisation. Tous les patients ont eu une cholédochotomie et un drainage par drain de Kehr. Le traitement du kyste a été une kystectomie associé à un capitonnage, une kystectomie associé à un drainage et une hépatectomie partielle chez 22, 12 et deux patients, respectivement. On a ajouté une omentoplastie chez 10 patients. L'évolution a été compliquée chez sept (19.4%) patients. La durée d'hospitalisation avec et sans complications a été de 3.6±18.1 et 15.1±2.7 jours, respectivement. Cette étude indique que de meilleurs résultats sont obtenus lorsque l'on s'abstient de la ponction percutanée ou de biopsie percutanée, lorsque l'on utilise l'échographic et la tomodensitométrie pour le diagnostic à un stade précoce, lorsque l'on évacue le kyste et enlève la membrane germinative et la portion de la voie biliaire intéressée, sans déversement du contenu dans la cavité péritonéale, lorsque l'on traite la cavité résiduelle selon son site, la taille du kyste et la présence d'infection, et lorsque l'on diminue la pression dans la voie biliaire par un drainage externe.

     

A composite neural network model for perseveration and distractibility in the Wisconsin card sorting test.

A composite artificial neural network model is proposed to simulate the performance of the Wisconsin Card Sorting Test. The Wisconsin Card Sorting Test is a test of executive functions where prefrontal deficits are matched to some quantitative measures such as percentage of perseverative errors and number of failures to maintain set. In this work, the proposed model is used to simulate the performances of healthy subjects and patients with prefrontal involvement particularly on these measures. The model is designed in such a way that one of the subsystems, namely, the Hopfield network, serves as the working memory and the other, the Hamming block, as the hypothesis generator. The results show that the proposed relatively simple model is capable of simulating the wide range of the performances of both normal subjects and prefrontal patients on the Wisconsin Card Sorting Test. While lowering the Hamming distance in the Hamming block gave rise to progressively more perseverative responses, changing the threshold vector of the Hopfield network resulted in more set maintenance failures. The former manipulation disrupts the abstraction or mental flexibility and the latter sustained attention or perseverance both of which are the major functions of the prefrontal system.     

Rhinorrhoea from a frontal encephalocele after reduction of high intracranial pressure

Acquired non-traumatic frontal sinus encephaloceles are very rare lesions that are usually caused by a tumour or hydrocephalus. We present a 31-year-old woman with a frontal sinus encephalocele who developed rhinorrhoea after a ventriculo-peritoneal shunt to treat her hydrocephalus and underwent radiotherapy for a tectum tumour.     

Subclinical Anterior Horn Cell Involvement in Juvenile Myoclonic Epilepsy

Summary: Although clinical signs of muscle wasting and weakness were not present, electromyographic (EMG) evidence of subclinical anterior horn cell involvement of spinal cord was noted in 5 patients with juvenile myoclonic epilepsy (JME). Quantitative interference pattern analysis of EMG recorded from the anterior tibial muscle showed that the ratio (amplitude:turn/turn:second, A:T/T:S) was significantly increased in 10 patients with JME and 12 patients with lower motor neuron disorders (LMND) as compared with those of 22 normal subjects and 15 patients with frequent generalized tonic-clonic seizures (GTC). Subclinical anterior horn cell involvement detected by EMG techniques can be related to a genetically determined component of JME.