Secretory meningiomas

Secretory meningiomas are a rare meningioma subtype. Among meningiomas, the frequency of secretory meningiomas is 1.6%. Unlike other meningioma types, most of the patients were female (ratio 3:1). No recurrence was reported during the 24–180 months follow-up period of our secretory meningiomas in which, a low level of 0.3% Ki-67 proliferative index was reported. In this meningioma subtype, the percentage of cases with positive progesterone receptor is 33%. With carcinoembryonic antigen, cytokeratin and epithelial membrane antigen, in all the cases positivity was observed in both, the inclusions and the cells surrounding them. With human milk fat globulin 2, a high ratio (92%) of positivity was observed. Majority of the cases were negative with CA125, only three of the cases had suspicious positivity. Distribution of inclusions was irregular and their positive reactions showed varying staining features. Positivity with alpha-1-antitripsin was seen not only in the inclusions but also in some meningothelial cells as well. Ubiquitin was positive in inclusions of the 83% of cases. Staining features of the inclusions pointed out the possibility of them being in a varying age and/or content. Secretory meningiomas are a different type compared to other meningiomas, not only with their histological features but also with their clinical features as well.     

A simple model of breast carcinoma growth may provide explanations for observations of apparently complex phenomena

BACKGROUND: There has been great debate regarding the importance of ductal carcinoma in situ (DCIS) in the breast. Autopsy results that demonstrate a much greater number of these lesions compared with the number of invasive carcinomas, and the numbers of deaths from breast carcinoma each year have been cited as evidence that DCIS rarely leads to invasion and death. These analyses have overlooked the fact that, to sustain a rate of detection each year, there would have to be a reservoir of undetected breast carcinomas growing in the population. The authors developed a simple model that makes this clear. In addition, complex phenomena have been suggested to explain why invasive breast disease may grow more rapidly among very young women and more slowly among the very old. A simple model provides some insight that may simplify the explanation of these observations. METHODS: The simple model of breast carcinoma growth assumes that there are three types of breast carcinoma that begin each year in a cohort of women. It assumes that all breast carcinomas begin as DCIS and take 9 years to go from a single cell to an invasive lesion for the slowest growing lesions, 6 years for intermediate growing DCIS lesions, and 3 years for fast-growing DCIS lesions. Furthermore, once an invasive clone forms, the model assumes that it will double in 60 days for fast-growing lesions, 120 days for intermediate growing lesions, and 180 days for slow-growing lesions. Three new tumors begin to grow in each successive year (one of each type). The model uses simple vectors that are defined by the size of the tumors and the time since tumor initiation, and it assumes that all tumors are detected when they reach 2 cm in greatest dimension. The model can be used to show graphically how many undetected tumors (DCIS as well as invasive carcinomas) there may be in the population to sustain the detection of three invasive tumors each year. RESULTS: Using the assumptions described above, the model showed that, by the time the first slow-growing breast carcinoma reaches 2 cm in greatest dimension, there will be 29 other slow-growing tumors that have not reached that size (9 DCIS and 20 smaller invasive carcinomas), 19 moderately growing tumors (6 DCIS and 13 smaller invasive carcinomas), and 9 fast-growing tumors (3 DCIS and 6 smaller invasive carcinomas). This means that, for every three breast tumors that reach 2 cm, the model predicted that there would be another 57 tumors (39 smaller invasive carcinomas and 18 DCIS) that would be undetected "below the surface". The model showed clearly that faster growing tumors would be expected to predominate among the youngest women, because they are the first to "reach the surface"; and, if the number of newly initiated tumors decreases with age, then there will be more of the slowest growing tumors that are left to reach the surface among the oldest women in the population. CONCLUSIONS: Even if the authors' assumptions are incorrect, their model made it clear that, to diagnose several breast carcinomas per 1000 women each year means that there have to be many more undetected carcinomas in the population to sustain the rate of detection. Although the model did not prove that DCIS may become potentially invasive and lethal, it did demonstrate that, even if all of these in situ lesions become invasive and lethal, many more DCIS lesions would have to be expected in the population than the number of invasive carcinomas detected each year and the number of deaths from breast carcinoma each year. Furthermore, the model provided a simple, purely mechanical illustration that may explain the preponderance of faster growing breast carcinomas among very young women and the preponderance of slower growing tumors among elderly women.     

The effects of hypertonic NaCl (7.5%) in dogs with induced acute pulmonary artery obstruction

The study was performed on 11 female and 9 male dogs to investigate the effect of hypertonic NaCl in severe hypotension and shock caused by acute pulmonary artery obstruction. The investigation was performed in Dicle University Healt Research Center (DUHRC). The youngest subject was six months old and the oldest was two years old. Their mean body weight was found as 19 kg. All the subjects were operated under general anesthesia. Invasive measurements of arterial pressure were performed through the right femoral artery by monitorization. All subjects were performed left thoracotomy, entrance to thorax was through 5th intercostal space, and first left then right pulmonary artery were circumferenced loosely with tape. After this, mean pulmonary artery pressures are recorded with the help of monitor by inserting canulla into the pulmonary artery. Pulmonary artery pressures at 3rd, 5th, 10th, 13th, 15th, 18th and 21st minutes after ligation of right main pulmonary artery and left lower lobe pulmonary artery, and mean artery pressures are recorded. Sodium nitroprusside is given to half of the subjects and nitroglycerine is given to the other half in order to lower pulmonary hypertension. Pulmonary arterial pressure measurements following administration of these drugs are recorded. 7.5% of NaCl infusion to subjects is performed in case of hypotension and shock. Isotonic NaCl solution is used in the control group. Mean arterial pressures in group receiving sodium nitroprusside + 7.5% NaCl solution are found significantly higher statistically when compared to group receiving sodium nitroprusside + 0.9% NaCl isotonic solution. Difference in mean arterial pressures were not found statistically significant in the group receiving nitroglycerin + 7.5% NaCl when compared to group receiving nitroglycerin + 0.9% NaCl solution.     

Use of recombinant factor VIIa in a preterm infant with coagulopathy and subdural hematoma.

Activated recombinant factor VIIa was administered to a preterm infant with bleeding diasthesis and a huge subdural hematoma that could not be controlled by the blood products. The coagulation tests were normalized the following day. Recombinant factor VIIa can be a choice in selected cases with intractable bleedings unesponsive to conventional replacement therapy.     

Robotic Endocrine Surgery: State of the Art

Over the last decade, developments in technology have led a rapid progress in robotic endocrine surgery applications. Robotics is attractive to the surgeon because of the three-dimensional image quality, articulating instruments, and stable surgical platform. Safety and effectiveness of robotic adrenalectomy and thyroidectomy have been shown in many studies. While these robotic procedures offer better ergonomics for the surgeon, they provide similar outcomes compared to the laparoscopic approach for adrenalectomy and better cosmetic results versus the conventional option for thyroidectomy. Recently, while the robotic approach for adrenalectomy has been popularized, enthusiasm for robotic thyroidectomy has decreased. In the present review we aim to describe emerging robotic procedures and review the literature regarding outcomes.     

A cse of Rathke''s cleft cyst presenting with diabetes insipidus

Rathke's cleft cysts (RCCs) are considered to arise from the remnants of Rathke's pouch, an invagination of the stomodeum. They classically described as benign epithelium lined intrasellar cysts containing mucoid material, and also found in 2–33% of routine autopsy series. The most common presenting symptoms are visual impairment, hypothalamic dysfunction, hypopituitarism and headache. Diabetes insipidus has been described in patients with RCC. Very few cases presented with only diabetes insipidus in adults. To our knowledge, our patient is the first case of RCC presenting with only diabetes insipidus in childhood. A 9-year-old girl presented with diabetes insipidus. The physical, neurological and endocrinological examinations were normal, except for diabetes insipidus. Magnetic resonance imaging scan revealed a hyperintense lesion with supra sellar extension in the posterior pituitary both on T1 and T2 weighted images. Subtotal excision of RCC was performed via transsphenoidal surgery. However, diabetes insipidus persisted after the surgery.     

Successful intra-arterial thrombolytic therapy for a right middle cerebral artery stroke in a 2-year-old supported by a ventricular assist device

Embolic stroke is a common complication in patients on ventricular assist devices in both adults and children. The reported incidence of strokes in children supported by VAD's varies from 7 to 38%. The rapid increase in recent years in the availability of both adult and pediatric VADs will likely add to the overall prevalence of strokes in patients being bridged to heart transplant. Strokes in this population can be lethal as they frequently necessitate withdrawal of the extracorporeal device support and withdrawal from the organ transplant waiting list. We present a case of a fully anti-coagulated 29-month-old supported on a Berlin EXCOR LVAD (Berlin, Germany) with embolic stroke which was treated successfully with direct thrombolysis with recombinant tissue plasminogen activator. This is the first report which uses intra-arterial thrombolytics while on a ventricular assist device in a pediatric patient.