Transcortical-transventricular approach in colloid cysts of the third ventricle: surgical experience with 26 cases

Colloid cysts of the third ventricle account for 0.5–2% of all intracranial tumors. The treatment of these benign tumors remains controversial, and the best surgical option has not yet been determined. Between 1995 and 2002, 27 patients with colloid cysts of the third ventricle presented at our clinic. Twenty-six underwent transcortical-transventricular approaches. One refused surgical treatment. There was no surgical mortality. The main morbidity was epileptic seizures in two patients. Overall outcome was good in all patients. The mean follow-up period was 3.4 years. There were no tumor recurrences. The transcortical-transventricular approach can be used safely to excise third ventricle colloid cysts with low risk of mortality and morbidity.     

A new testis prosthesis material: polymethylmethacrylate

INTRODUCTION: Silicone has been the standard prosthesis material for the last three decades but new materials are being searched because of the known disadvantages of silicone such as migration and high cost. We wanted to test in rats whether or not polymethylmethacrylate could be an alternative to silicone. MATERIALS AND METHODS: We prepared polymethylmethacrylate and silicone testis prostheses which were similar to testis size of rats. Eleven rats were implanted with polymethylmethacrylate, 11 others were implanted with a silicone prosthesis and sham operation was performed in 10 rats. Three months later the scrotums of the animals were removed with the prosthesis for a quantitative analysis of the chronic inflammation and fibrotic reaction and to measure the thickness of the capsule. RESULT: Rejection and infection were not observed in any of the prosthesis-implanted rats. Both prosthesis groups displayed increased vascularization, hemosiderin accumulation and fibrotic and hyalinized tissue formation that replaced the muscle. Chronic inflammation was measured and found to be higher in the polymethylmethacrylate group and the difference was not found to be significant. The average thicknesses of the capsules around the polymethylmethacrylate and silicone groups were found to be 58.4 and 46.8 microm, respectively, and that difference was not significant again. CONCLUSIONS: In the short term polymethylmethacrylate was equally well tolerated, but the low cost of polymethylmethacrylate made it more advantageous.     

Delay in neurovenous flaps: experimental and clinical experience

The objective of this study was to examine the effects of the standard surgical delay in the flaps based on the cutaneous branches of the vascular axis around a superficial sensory nerve. The delay procedure was experimentally tested in rats and subsequently used in patients.In the experimental study, the survival of a delayed inferior epigastric neurovenous flap was compared with that of a nondelayed inferior epigastric neurovenous flap. One type of clinically applicable delay pattern (standard bipedicled technique) was employed. A 3 x 3 cm flap was raised in 20 female Wistar rats assigned randomly to 2 groups. Each group consisted of 20 flaps. The standard bipedicled delay pattern increased the percentage survival of the delayed inferior epigastric neurovenous flap. The survival percentage of the delayed flaps was 59.8 +/- 185.0 (P < 0.5). The histologic findings of the skin revealed that our delay procedure enhanced the perfusion of the flap by dilating the arterial network.Stimulated by our experimental findings, we used the island bipedicled surgical flap delay or combined strategic-standard delay in the distally pedicled sural flap successfully on 9 cases.     

Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes

This study analyzes the effects of fluid resuscitation in the crush victims of the Bingol earthquake, which occurred in May 2003 in southeastern Turkey. Questionnaires asking about demographic, clinical, laboratory, and therapeutic features of 16 crush victims were filled in retrospectively. Mean duration under the rubble was 10.3 +/- 7 h, and all patients had severe rhabdomyolysis. Fourteen patients were receiving isotonic saline at admission, which was followed by mannitol-alkaline fluid resuscitation. All but two patients were polyuric. Admission serum creatinine level was lower than and higher than 1.5 mg/dl in 11 and 5 patients, respectively. Marked elevations were noted in muscle enzymes in all patients. During the clinical course, hypokalemia was observed in nine patients, all of whom needed energetic potassium chloride replacement. Four (25%) of 16 victims required hemodialysis. Duration between rescue and initiation of fluids was significantly longer in the dialyzed victims as compared with nondialyzed ones (9.3 +/- 1.7 versus 3.7 +/- 3.3 h, P < 0.03). Sixteen fasciotomies were performed in 11 patients (68%), nine of which were complicated by wound infections. All patients survived and were discharged from the hospital with good renal function. Early and vigorous fluid resuscitation followed by mannitol-alkaline diuresis prevents acute renal failure in crush victims, resulting in a more favorable outcome.     

Auditory event-related potentials in panic and generalised anxiety disorders

In this study, we aimed to investigate event-related potential (ERP) changes in panic disorder (PD) and generalised anxiety disorder (GAD) and to determine whether two disorders are different from each other in terms of endogenous potentials. A total of 35 outpatients who fully met DSM-III-R criteria for PD (8 males and 27 females) were included in this study as the PD group. The GAD group consisted of 30 subjects (5 males and 25 females) who met DSM-III-R GAD criteria. The control group consisted of 29 healthy age and sex-matched volunteers (5 males and 24 females) having no history of psychiatric or neurological illness. ERPs were recorded by using auditory "odd-ball two-tone discrimination task" method. It was found that there was significant prolongation in P3 latency in the PD group compared to the GAD and control groups. Our study suggests that there are some disturbances in early information processing in patients with PD but not with GAD.     

Hemostatic cervical suturing technique for management of uncontrollable postpartum haemorrhage originating from the cervical canal

OBJECTIVE: To evaluate the efficacy and safety of a novel cervical suturing technique for management of uncontrollable postpartum haemorrhage originating from the cervical canal. STUDY DESIGN: Cervical suturing was performed on three women to control intractable postpartum haemorrhage originating from the cervical canal and not responding to classic management. Haemostatic cervical suturing by using no. 1 chromic catgut is a new surgical technique which approximates anterior and posterior cervical lips. It controls cervical haemorrhage by attachment and compression of the haemorrhage site of the cervical lips and lower uterine segment. RESULTS: The procedure was effective in all cases and hysterectomy was not needed in any case. No complication occurred and the survival rate was 100%. The procedure required no special expertise or extraordinary equipment. CONCLUSION: Cervical suturing technique for management of postpartum haemorrhage originating from the cervical canal is an easy, safe and highly effective conservative surgical technique that may be alternative to hysterectomy.     

Distribution patterns of TGF-alpha, laminin and fibronectin and their relationship with folliculogenesis in rat ovary

Many growth factors are considered to be involved in regulatory functions in the ovary. Specific factors mediate local cell-cell interactions in relation to follicle development. As a result of the complexity of the estrous cycles in experimental models, it is not easy to determine the role of a growth factor such as transforming growth factor alpha (TGF-alpha) in the system. Moreover, little is known about possible interactions of TGF-alpha and laminin and fibronectin in basement membranes during estrous cycles in relation to follicle development. Therefore, the present study was designed to investigate distribution patterns of TGF-alpha, laminin and fibronectin and their possible roles during follicle maturation in normal rat ovary. Ovaries were obtained from 6 adult virgin female rats and fixed in buffered neutral formalin. TGF-alpha, laminin, and fibronectin distribution patterns were evaluated using 5-7-microm-thick serial sections using the immunoperoxidase method. It was found that TGF-alpha was predominantly localised in nuclei of oocytes. Varying amounts of TGF-alpha were found in granulosa cells and interstitial thecal cells which form follicles. In addition, laminin and fibronectin were found predominantly in vascular walls, outer layers of granulosa cells and basement membranes of cuboidal/columnar surface epithelium of rat ovary. Therefore, we suggest that TGF-alpha is involved in follicular maturation. Moreover, because laminin was found to be present in between parenchymal follicle cell layers, we suggest that they were attached to supportive stromal cells by fibronectin. As TGF-alpha is associated with follicles and their relationship with the extracellular matrix, TGF-alpha may also induce formation of basement membranes which contains laminin and fibronectin components.     

Comparison of changes in diastolic functions after aortic valve replacement with freestyle stentless porcine xenografts in patients with restrictive and nonrestrictive physiology

In this study, the effect of valve replacement on diastolic parameters was evaluated preoperatively and postoperatively at 3, 6, and 12 months by comparing diastolic parameters in patients after aortic valve replacement with freestyle stentless porcine xenografts for aortic stenosis. Depending on deceleration time (DT) and isovolumetric relaxation time (IVRT) with preoperative echocardiographic assessment, patients were divided into two groups: restrictive physiology (DT < or = 150 msec and IVRT < 100 msec, 20 patients), and nonrestrictive physiology (DT > 150 msec and IVRT > or = 100 msec, 27 patients). Although left ventricular mass index significantly decreased in both groups, improvement in DT, IVRT, and ejection fraction occurred only in patients with restrictive physiology. As a result, the patients with restrictive diastolic characteristics had more benefit than the patients with nonrestrictive physiology after aortic valve replacement.