Pediatric neurosurgical techniques in the 15th century

The renowned Turkish surgeon Serefeddin Sabuncuo?lu (1385-1468 AD), delineates management of various pediatric neurosurgical diseases such as head trauma, spinal trauma, and intrauterine and infantile hydrocephalus, as well as basic surgical principles in his textbook Cerrahiyyetü'l Haniyye, which consists of three chapters dealing with a variety of surgical specialities. The sections on neurosurgery are still relevant to modern medicine. The book combines previous knowledge of Greek, Roman, Arabic, and Turkish surgery. Today, Sabuncuo?lu is recognized as a pioneer of pediatric neurosurgery.     

DNA methylation or histone modification status in metastasis and angiogenesis-related genes: a new hypothesis on usage of DNMT inhibitors and <Emphasis Type="Italic">S</Emphasis>-adenosylmethionine for genome stability

Metastasis is a leading cause of mortality and morbidity in cancer. This process needs angiogenesis. The biology underlying cancer, metastasis, and angiogenesis has been investigated so as to determine the therapeutic targets. Invasive and metastatic cancer cells have undergone numerous genetic and epigenetic changes, manifested by cytoskeletal changes, loss of adhesion, and expression of proteolytic enzymes that degrade the basement membrane. Additionally, in endothelial cells, some epigenetic modifications occur during the formation of angiogenesis. Researchers have used some methylation inhibitors, histone deacetylase inhibitors, or methylating agents (such as S-adenosylmethionine, SAM) against cancer and angiogenesis. Although they are effective to beat these diseases, each one results in differentiation or changes in genome structure. We review epigenetically modified genes related with angiogenesis and metastasis in cancer and endothelial cells, and suggest a new proposal. This hypothesis has discussed the importance of the usage of DNA methylation inhibitors together with SAM to prevent tumor progression and genome instability or changes resulting in additional diseases.     

Testicular involvement of sarcoidosis diagnosed by gallium-67 scintigraphy

Gallium-67 scintigraphy helped to determine the extent of systemic sarcoidosis and demonstrated testicular involvement in a 32-year-old black man who presented with ataxia, weight loss, and a left testicular mass. To our knowledge, this is the first case of testicular sarcoidosis demonstrated by gallium-67 scintigraphy in a patient with systemic sarcoidosis. Offprint requests to: A. Cahid Civelek     

Arthroscopic meniscal repair using T-fix

We evaluated the arthroscopic meniscal repair using T-fix and present our preliminary results. The series included 47 consecutive patients who underwent meniscal repair using T-fix. Mean follow-up was 26 months (range 12-42 months). The overall number of T-fixes used in the repairs was 163, with a mean of three (range two to five) per patient. Patients were evaluated according to the modified Marshall scoring system. Results were rated as excellent in 32, good in 10, fair in 2, and poor in 3 patients. Second-look arthroscopy was performed in 18 patients as the part of our protocol. In 15 patients meniscal tears were considered to be healed, according to Henning's criteria. Six of those who underwent anterior cruciate ligament reconstruction healed completely. There were no neurovascular complications. Repair of the menisci using T-fix proved successful and reliable. In view of satisfactory functional results and the observation of healing of tears on second-look arthroscopy, we believe that preservation and repair of menisci should be attempted in appropriate cases.     

Methotrexate and misoprostol used alone or in combination for early abortion

The purpose of this study was to compare the outcome and side effects of using the drugs methotrexate and misoprostol, alone or in combination, to induce abortion. A total of 108 subjects who had requested elective termination of pregnancy and medical abortion at 9 weeks gestation or less were randomized into three groups. The first group received 50 mg/m² intramuscular (IM) methotrexate on day 1 and, if the hCG level had risen by >50% of the initial level on day 4, a second dose was given. They were then followed-up at weekly intervals up to day 21. Group 2 received 800 μg vaginal misoprostol on day 1 and, if ultrasound showed a gestational sac on day 4, they received a repeat dose and were re-examined on day 7. Group 3 received 50 mg/m² methotrexate intramuscularly followed 3 days later by 800 μg vaginal misoprostol and were re-examined on day 7. Complete abortion occurred in 25 (69%) of the 36 subjects in group 1, 21 (58%) of the 36 subjects in group 2, and 32 (89%) of the 36 subjects in group 3. The complete abortion rate in group 3 was significantly higher than that of both group 1 and group 2 (p <0.05). The incomplete abortion rate was significantly higher in group 2 as compared with both of the other groups (p <0.05). There were significant differences between the mean gestational age of the successful abortions and the failures in group 1 (no abortion occurred at more than 49 days gestation), but not in groups 2 or 3. Vaginal bleeding in subjects who successfully aborted began within 16 ± 4 days in group 1 after the first dose, and within 24 h in 18 (86%) of the 21 subjects in group 2 and 27 (84%) of the 32 subjects in group 3 after the misoprostol dose. The drugs caused no serious or prolonged side effects. The combination of methotrexate and misoprostol is a more effective abortifacient regimen than when either drug is used alone.     

Periapical health related to the type of coronal restorations and quality of root canal fillings in a Turkish subpopulation.

OBJECTIVE: The purpose of this study was to evaluate the relationship between the quality of root canal fillings and type of permanent coronal restorations and their association with the periapical status in a Turkish subpopulation. STUDY DESIGN: There were 1268 endodontically treated teeth from 280 panoramic radiographs that were evaluated. Two observers assessed the radiographs using an x-ray viewer with 2 times magnification. Teeth were classified according to the type of restorations. The quality of root canal fillings were evaluated according to the criteria determined by Tronstad et al. Apical status was assessed by the Periapical Index scores (PAI) proposed by ?rstavik et al. Chi-square test was used for statistical analysis. RESULTS: There were 59.5% of endodontically treated teeth that showed healthy periapex. Teeth with good endodontic treatment showed statistically significant high healthy periapex rates regardless of the type of the restoration. In addition, the evaluation of the entire material also showed that the roots with posts had significantly more periapical pathosis than roots without posts (P = .001). CONCLUSIONS: It can be concluded that, although the quality of the root canal filling plays a key role in the outcome of endodontic therapy, the type of restoration can also be a contributing factor in the treatment outcome.     

Apoptosis seems to be the major process while surface and neural ectodermal layers detach during neurulation

Objective The aim of this study is to demonstrate the process of detaching neural and surface ectodermal layers soon after the neurulation completes. Materials and methods Specific pathogen-free chicken egg embryos were used to investigate the neurulation procedure. Ten eggs were saved as controls. The other ten eggs were opened at the 30th hour of embryo development and cultured with Z-VAD-FMK (peptide caspase inhibitor) to investigate the results of the apoptosis inhibition. Embryos were placed and developed up to 48 h in the culture medium. To detect apoptotic cells between neural and surface dermal layers, immunoreactivity of p53 and terminal uridine deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay were used. Results While the control group shows positive immunoreactivity of p53 and TUNEL-positive apoptotic cells at the site where the neural folds detach from the surface ectoderm, no TUNEL activity and no detachment were detected in the apoptosis-inhibited group. Conclusion As inhibition of apoptosis prevented the detachment of the neural and surface ectodermal layers from each other at the end of the neurulation, inhibition of apoptosis seemed to cause a considerable embryological error accounted for congenital dermal sinus tractus maldevelopment. This paper was presented at the 35th annual meeting of International Society of Paediatric Neurosurgery, 9–14 September 2007, Liverpool, England.     

Paraganglioma of the thoracic spine.

A 49-year-old man was admitted to hospital for treatment of a T10-11 paraspinal lesion, which was detected incidentally. He had suffered from facial flushing and palpitations associated with hypertension for many years. MRI confirmed the presence of a large, well-demarcated tumour in the left paraspinal area of the T10-11 vertebral bodies. Grossly complete excision was achieved without neurological complications. Post-operatively, the patient was normotensive with no adrenergic symptoms.