An investigation of the conus medullaris termination level during the period of fetal development to adulthood.

The spinal cord fills the length of the vertebral canal at the early period of intrauterine term. It is reported to extend to the level of the third lumbar vertebra at birth, because the vertebral column is growing more rapidly in the longitudinal direction than the spinal cord. The present investigation aimed to determine the changes in the termination level of conus medullaris (TLCM) from fetus to adulthood in a total of 285 individuals who had no defects in the central or peripheral nervous system, and were obtained from our Faculties of Medicine and Konya Maternity Hospital between 1992-1995. The age distribution was as follows: 36 fetuses, 20 prematures and 50 neonates, 51 children aged 1 to 7 years and 128 adults aged 15 to 68 years. In this study, for fetuses, prematures, neonates and children the TLCM was determined using ultrasonography. In addition, microdissection was used in fetuses to confirm the results obtained from the above technique. Also, magnetic resonance imaging was used in adults. During fetal life the end of the conus altered its levels from S5 to L3 vertebrae. The tip of the conus medullaris of the prematures and neonates ranged from L1 to L3 vertebrae. The tip of the conus medullaris in the children lay between the Th12 and L3 vertebrae, and in the adults it was between the Th12 and L2 vertebrae. There were slight differences between the prematures and neonates in terms of the TLCM. We concluded that there are differences in the TLCM between the age groups and therefore, especially in prematures and infants the determination of the tip of conus medullaris might be important for preventing postoperative neurological complications.     

Efficacy of combination therapy with biofeedback and dapoxetine in lifelong premature ejaculation treatment: a prospective randomized study

International Urology and Nephrology - Premature ejaculation (PE) is a common sexual dysfunction that significantly affects the quality of life of the patient and their partner. We aimed to compare...     

The Value of P Dispersion on Predicting Atrial Fibrillation After Coronary Artery Bypass Surgery; Effect of Magnesium on P Dispersion

Atrial fibrillation (AF) is a frequent arrhythmia complicating cardiac surgery, and generally occurs within the first week after surgery. Although there are some etiological mechanisms to explain the postoperative AF, the exact mechanisms of AF are not well clarified. In the present study, we would like to show the effect of MgSO₄ infusion on P duration and P dispersion, and its relation with AF complication in patients undergoing coronary artery bypass grafting. The patients were randomly allocated into two groups. Group A consisted of 93 patients to whom 1.5 g/day MgSO₄ infusion in 100 mL 0.9 NaCl solution (25 mL/hr) were applied the day before surgery, just after operation, and once daily for 4 days following surgery. Group B consisted of 55 control patients to whom 100 mL 0.9 NaCl solution (25 mL/hr) were applied at the same time points. Magnesium level was measured before the treatment and daily for the postoperative four days. As a result, AF developed in 2% of cases in group A, and in 36% of cases in group B (p < 0.001). Comparing the patients who developed AF, and who did not, no difference was detected with regard to baseline P max, P min, P dispersion and fourth day P min. But fourth day P max and P dispersion of patients who developed AF were significantly higher than who did not. Baseline Mg level were similar for those who developed AF, and who did not, but fourth day Mg level was significantly lower in AF group. As a result, our opinion that Mg infusion significantly decreased the incidence AF after cardiac bypass surgery was confirmed. And it's also clear that beneficial effect of MgSO₄ is associated with its decreasing effect on P dispersion.     

Topotecan in platinum-resistant epithelial ovarian cancer

BACKGROUND: Topotecan has been emerged as a new promising anticancer drug for patients with ovarian cancer. METHODS: In this study, patients who were treated with topotecan were reviewed retrospectively. A total of 26 patients was included the study. All patients had received platinum-based regimens previously. Topotecan was administered a dose of 1.5 mg/m(2) intravenously 30 min daily for 5 days and repeated every 21 days. RESULTS: The response rates were 30% by CA-125 level and 29% in clinic evaluation. Median duration of response was 8 (3-15) months, median progression-free interval was 12 (4-30) months and median overall survival was 15 (4-36) months. Grade 3-4 neutropenia occurred in 58% of the patients (38% of the courses) and trombocytopenia in 29% of the patients (12% of the courses). Nonhematological toxicities were mild. There was no drug-related death. CONCLUSION: Topotecan is considered as a reasonable option for treatment of patients with platinum refractory recurrent ovarian cancer.     

Determinants and definition of abdominal obesity as related to risk of diabetes, metabolic syndrome and coronary disease in Turkish men: a prospective cohort study

We aimed to investigate determinants of abdominal obesity and its clinical impact on metabolic syndrome (MS), diabetes (DM) and coronary heart disease (CHD) in men. METHODS: Prospective evaluation of 1638 male participants (aged 48.5+/-12.3), representative of Turkey's men who have a high prevalence of MS. For components of MS, criteria of NCEP guidelines were adopted, modified for abdominal obesity. Follow-up constituted 9650 person-years. RESULTS: Insulin level (relative risk [RR] 1.40 for doubling), C-reactive protein (CRP) and heavy smoking (protective) were independent predictors of newly developing abdominal obesity. High triglyceride and low HDL-cholesterol were significantly associated already with waist girth quartile II, apolipoprotein B with quartile III. Waist girth significantly predicted future MS from quartile II on, independent of insulin resistance (IR) by homeostatic model assessment, whereby its hazard ratio (HR, 2.6) exceeded double that of HOMA. CRP independently predicted MS. Age-adjusted HR of waist girth (1.59) was significant in predicting DM. Age- and smoking-adjusted top waist quartile conferred significant risk for incident CHD (RR 1.71) but not for overall mortality. As judged by sensitivity and specificity rates for future CHD, DM and MS, abdominal obesity was most appropriately defined with a waist girth of >or=95 cm, and an action level 1 of >or=87 cm was proposed for MS in this population. CONCLUSIONS: Serum insulin, CRP levels and (inversely) heavy smoking are predictors for abdominal obesity in Turkish men. Atherogenic dyslipidemia and elevated blood pressure are associated significantly already with modest rises in waist girth adjusted for age and smoking. Abdominal obesity shows substantial independence of IR in the development of MS. Increasing waist girth was predictive of MS, more strongly than of DM. Risk for CHD imparted by abdominal obesity is essentially mediated by risk factors it induces.     

Treatment strategies for coronary lesions in Takayasu arteritis patients - case report and review of the literature

Takayasu arteritis is type of vasculitis that usually affects the aorta and its major branches. While coronary involvement is seen infrequently, treatment strategy is less clear. Here, we report a case of a 45 year-old woman with Takayasu arteritis who underwent a Y-graft coronary bypass surgery four years previously. We present the long-term follow-up this patient, with a literature review. and we discuss treatment strategies.     

Synovial sarcoma in the right atrium and right ventricle

A metastatic synovial sarcoma in the right atrium and ventricle is described. A 36-year-old man was admitted to our hospital with generalized fatigue, dyspnoea, and precordial pain. Transthoracic echocardiography demonstrated a metastatic tumour in both the right atrium and right ventricle and revealed obstruction of the inflow tract of the right ventricle caused by a metastatic right atrial tumour. Thoracic computed tomography revealed a pleural-based paravertebral mass in the left intrathoracic cavity and multiple pulmonary nodules in both lungs. Cardiac surgery was performed for palliative treatment due to right cardiac failure and a risk of fatal embolization. The patient died 12 months after the cardiac surgery.