Active shrinkage protects neurons following axonal transection

Trauma, vascular events, or neurodegenerative processes can lead to axonal injury and eventual transection (axotomy). Neurons can survive axotomy, yet the underlying mechanisms are not fully understood. Excessive water entry into injured neurons poses a particular risk due to swelling and subsequent death. Using in vitro and in vivo neurotrauma model systems based on laser transection and surgical nerve cut, we demonstrated that axotomy triggers actomyosin contraction coupled with calpain activity. As a consequence, neurons shrink acutely to force water out through aquaporin channels preventing swelling and bursting. Inhibiting shrinkage increased the probability of neuronal cell death by about 3-fold. These studies reveal a previously unrecognized cytoprotective response mechanism to neurotrauma and offer a fresh perspective on pathophysiological processes in the nervous system.

Effects of amantadine and topiramate on neuronal damage in rats with experimental cerebral ischemia-reperfusion

BACKGROUND

Ischemia-reperfusion models are used to evaluate treatment options that may minimize cellular damage after ischemia.

OBJECTIVES

To investigate the effects of amantadine and topiramate on apoptosis and cellular oxidative damage.

MATERIAL AND METHODS

This experiment was performed using 30 male Wistar albino rats. The right internal carotid artery was identified and clamped with an aneurysm clip under general anesthesia, except for animals in the control group. After 10 min of occlusion, the aneurysm clip was removed, allowing reperfusion. After reperfusion and a waiting period of 12 h, the test and control groups were intraperitoneally administered the following solutions: the sham group received 10 mg/kg of isotonic solution, the amantadine group received 20 mg/kg of amantadine, the topiramate group received 40 mg/kg of topiramate, and the amantadine-topiramate group received 20 mg/kg of amantadine and 40 mg/kg of topiramate. After 24 h, the rats were euthanized.

RESULTS

Apoptosis was evaluated using the TUNEL method. Total antioxidant status (TAS), total oxidant status (TOS), total thiol, and ischemia-modified albumin (IMA) levels were measured in both brain tissue and serum samples. The rate of apoptosis in the sham and amantadine groups increased significantly compared to the control group and the non-ischemic counter hemisphere. In the amantadine-topiramate group, both serum TAS and tissue thiol levels decreased. Tissue TOS levels were significantly higher in the topiramate group compared to all other test groups. Tissue TAS levels were significantly higher in the amantadine group compared to all other test groups.

CONCLUSIONS

This experimental ischemia-reperfusion model revealed that topiramate reduces apoptosis in the early period after ischemia and that its combination with amantadine does not provide additional benefits against cell death. However, topiramate did not have an inhibitory effect on the oxidative stress biomarkers used in our study (TAS, TOS, IMA, and thiol). Studies that reveal the neuroprotective mechanism of action and long-term effects of topiramate are needed to complement this study.

A new definition about the relationship of intercellular fluid in the brain with the mandibular and parotid lymph nodes

This study was carried out to reveal the relationship of the brain with both the mandibular lymph node (MLN) and parotid lymph node (PLN) by the hyperspectral fluorescence imaging techniques of Qdot 800 (QD) nanoparticles using in vivo. This relationship of the brain with both lymph nodes offers the preliminary morphological definition of lymphatic drainage. QD was injected into the left parietal brain lobe of each rat at a depth of 2.50 mm. In 65% of the rats that were imaged in vivo, signals were received first from the right MLN and PLN, and then from the left MLN and PLN. In contrast, in two female rats, the first signal was received from the right PLN. There was no difference between the female and male rats overall. The most noteworthy finding of this study was that the tracer injected into the left parietal lobe reached the right mandibular and parotid lymph nodules earlier. This result indicates a different and unknown pathway in the brain that communicates with the lymph nodes. Moreover, this study shows that these lymph nodes pathways can be used in the treatment of diseases such as brain trauma, cerebral edema, and Alzheimer's disease (AD).

Transfer and Integration of Breast Milk Stem Cells to the Brain of Suckling Pups

Beside its unique nutritional content breast milk also contains live cells from the mother. Fate of these cells in the offspring has not been adequately described. In this study, we aimed to detect and identify maternal cells in the suckling’s blood and the brain. Green fluorescent protein expressing transgenic female mice (GFP+) were used as foster mothers to breastfeed wildtype newborn pups. One week and two months after the birth, blood samples and brains of the sucklings were analyzed to detect presence of GFP+ cells by fluorescence activated cell sorting, polymerase chain reaction and immunohistochemistry on the brain sections and optically cleared brains. The tests confirmed that maternal cells were detectable in the blood and the brain of the pups and that they differentiated into both neuronal and glial cell types in the brain. This phenomenon represents breastfeeding – induced microchimerism in the brain with functional implications remain to be understood.

Isolation and culture of adult mouse vestibular nucleus neurons

Background/aim: Isolated cell cultures are widely used to study neuronal properties due to their advantages. Although embryonic animals are preferred for culturing, their morphological or electrophysiological properties may not reflect adult neurons, which may be important in neurodegenerative diseases. This paper aims to develop a method for preparing isolated cell cultures of medial vestibular nucleus (MVN) from adult mice and describe its morphological and electrophysiological properties.Materials and methods: Vestibular nucleus neurons were mechanically and enzymatically isolated and cultured using a defined medium with known growth factors. Cell survival was measured with propidium iodide, and electrophysiological properties were investigated with current-clamp recording.Results: Vestibular neurons grew neurites in cultures, gaining adult-like morphological properties, and stayed viable for 3 days in culture. Adding bovine calf serum, nerve growth factor, or insulin-like growth factor into the culture medium enhanced neuronal viability. Current-clamp recording of the cultured neurons revealed tonic and phasic-type neurons with similar input resistance, resting membrane potential, action potential amplitude, and duration. Conclusion: Vestibular neurons from adult mice can be cultured, and regenerate axons in a medium containing appropriate growth factors. Culturing adult vestibular neurons provides a new method to study age-related pathologies of the vestibular system.

Effects of exposure to 2100 MHz GSM-like radiofrequency electromagnetic field on auditory system of rats

Introduction

The use of mobile phones has become widespread in recent years. Although beneficial from the communication viewpoint, the electromagnetic fields generated by mobile phones may cause unwanted biological changes in the human body.

Objective

In this study, we aimed to evaluate the effects of 2100 MHz Global System for Mobile communication (GSM-like) electromagnetic field, generated by an electromagnetic fields generator, on the auditory system of rats by using electrophysiological, histopathologic and immunohistochemical methods.

Methods

Fourteen adult Wistar albino rats were included in the study. The rats were divided randomly into two groups of seven rats each. The study group was exposed continuously for 30 days to a 2100 MHz electromagnetic fields with a signal level (power) of 5.4 dBm (3.47 mW) to simulate the talk mode on a mobile phone. The control group was not exposed to the aforementioned electromagnetic fields. After 30 days, the Auditory Brainstem Responses of both groups were recorded and the rats were sacrificed. The cochlear nuclei were evaluated by histopathologic and immunohistochemical methods.

Results

The Auditory Brainstem Responses records of the two groups did not differ significantly. The histopathologic analysis showed increased degeneration signs in the study group (p = 0.007). In addition, immunohistochemical analysis revealed increased apoptotic index in the study group compared to that in the control group (p = 0.002).

Conclusion

The results support that long-term exposure to a GSM-like 2100 MHz electromagnetic fields causes an increase in neuronal degeneration and apoptosis in the auditory system.

The acute effect of pseudoephedrine on choroidal thickness

PURPOSE

To investigate the acute effects of pseudoephedrine (PE) on choroidal thickness in healthy young patients.

METHODS

Fifty patients with nasal and sinus congestion who were prescribed 60 mg oral PE at the otolaryngology department were recruited for this study. The enhanced depth imaging (EDI) optic coherence tomography (OCT) (Spectralis OCT; Heidelberg Engineering, Heidelberg, Germany) choroidal thickness measurements were performed at baseline and 1, 3 and 6 hours at 7 points.

RESULTS

The right eyes of 50 healthy subjects (22 women and 28 men) were included in this study. The mean choroidal thickness at fovea was 293.12 μm, 279.80 μm, 295.80 μm, and 294.52 μm at baseline, 1, 3 and 6 hours respectively. A significant reduction in choroidal thickness versus baseline was observed at all points at 1 hour.

CONCLUSIONS

The choroidal thickness decreased 1 hour after oral administration of PE and returned to baseline thickness at 3 hours. We suppose that this transient decrease might be associated with vasoconstriction due to activation of sympathetic alpha adrenoceptors.

Evaluation of antiproliferative and antimetastatic effects of heparin and erythropoietin on B16f10 melanoma cell line

A number of chemotherapeutic agents and treatment strategies have been developed or designed to treat cancer patients. However, chemotherapeutic regimens frequently cause side-effects, one of which is anemia, a severe clinical problem for cancer patients. Erythropoietin is commonly used to treat anemia and reduce blood transfusions in cancer patients. Another agent which has potential use in cancer therapy is heparin, a glycosaminoglycan with a negative charge, known to increase the clearance of tumor cells from the blood in mice and also has anti-metastatic effects. In this current study, we investigated the effects of rEpo and heparin either as single agents or in combination on B16F10 melanoma cells. Contrary to our expectations based on the previous in vitro and in vivo studies, we have not found a significant growth-promoting effect of rEpo on B16F10 cells. We have also not observed a significant cytotoxic effect of heparin on B16F10 melanoma cell as assayed by MTT test (p > 0.05). However, heparin did significantly prevent the migration/proliferation of B16F10 cell in the wound assay as compared to the control cells after 24 h of incubation (p < 0.001). In addition, this effect of heparin was not prevented when rEpo was present in the medium in the wound assay (p < 0.01 as compared to the control). These results suggest that heparin may have a therapeutic potential as an anti-metastatic drug for cancer.

Consequences of neurite transection in vitro

In order to quantify degenerative and regenerative changes and analyze the contribution of multiple factors to the outcome after neurite transection, we cultured adult mouse dorsal root ganglion neurons, and with a precise laser beam, we transected the nerve fibers they extended. Cell preparations were continuously visualized for 24 h with time-lapse microscopy. More distal cuts caused a more elongated field of degeneration, while thicker neurites degenerated faster than thinner ones. Transected neurites degenerated more if the uncut neurites of the same neuron simultaneously degenerated. If any of these uncut processes regenerated, the transected neurites underwent less degeneration. Regeneration of neurites was limited to distal cuts. Unipolar neurons had shorter regeneration than multipolar ones. Branching slowed the regenerative process, while simultaneous degeneration of uncut neurites increased it. Proximal lesions, small neuronal size, and extensive and rapid neurite degeneration were predictive of death of an injured neuron, which typically displayed necrotic rather than apoptotic form. In conclusion, this in vitro model proved useful in unmasking many new aspects and correlates of mechanically-induced neurite injury.

Determination of hormones inducing oocyte maturation in Chalcalburnus tarichi (Pallas, 1811)

Chalcalburnus tarichi is an endemic cyprinid species living in the Lake Van basin, in eastern Anatolia, Turkey. The present study was undertaken to determine which hormones induce oocyte maturation in C. tarichi. The levels of 17alpha,20beta,21-trihydroxyprogesterone (20beta-S), progesterone (P), 17alpha-hydroxyprogesterone (17alpha-HOP), 11-deoxycortisol (11-DOC), and 17alpha-hydroxy-20beta-dihydroprogesterone (17,20beta-P) were measured in fish caught from Lake Van and the Karasu River, and injected with human chorionic hormone (hCG) (1,000 and 1,500 IU/kg). Oocytes of fish caught from the lake were also incubated in vitro with different doses (50, 200, and 1,000 ng/ml) of 20beta-S, 17alpha-HOP, 11-DOC, and 17,20beta-P. 11-DOC was found to be the most effective hormone among those measured for inducing oocyte maturation in vivo and in vitro. 17,20beta-P could not be determined in the plasma of any fish in vivo (P < 0.05). 1,000 IU/kg dose of hCG given by injection caused a statistically significant increase in all plasma hormone levels (P < 0.05). It was found that there was a significant decrease in the P level only at 1,500 IU/kg dose of hCG injected (P < 0.05), while the level of other hormones increased at this dose (P < 0.05). It was also determined that all the hormones were effective in germinal vesicle breakdown (GVBD) in in vitro oocyte culture (P < 0.05). However, 11-DOC was found to be the most effective hormone in GVBD at a dose of 200 ng/ml (70% GVBD). In conclusion, 11-DOC synthesized during final oocyte maturation in C. tarichi was found to be a potent inducer of GVBD, which shows that 11-DOC may be described as an oocyte maturation steroid in this species.

Comparison of techniques for long-term storage of fat grafts: an experimental study

BACKGROUND

Absorption of autologous fat graft in the recipient area necessitates recurrent fat transplantation. Harvesting extra tissue during the first operation and storing it for future use is considered a solution to this problem.

METHODS

Fat tissue was removed from the inguinal region of 40 Swiss albino mice, which were arranged into four equal groups, and treated as follows: immediately transplanted to the donor animal; dry-frozen; immersed in glycerol; or frozen in liquid nitrogen. The grafts that were frozen or immersed in glycerol were stored at -35 degrees C for 6 months and then transplanted to their original donors. Transplantations were performed by injecting the fat under the scalp. Viability of the fat tissue was evaluated with the MTT reduction test before transplantation, and histology of the transplanted tissue was examined at the end of the study.

RESULTS

: The viability and histology of grafts frozen in liquid nitrogen were similar to those of fresh tissue, whereas with other methods the grafts had a considerable loss of viability during storage that was reflected in the low number of adipocytes and high proportion of vacuolar and fibrotic areas.

CONCLUSION

Freezing fat grafts in liquid nitrogen and storing them at -35 degrees C is an effective way of preserving tissue for future use, with clear superiority over other methods.

The effect of non-enzymatic glycation of extracellular matrix proteins on axonal regeneration in vitro

Non-enzymatic glycation of peripheral nerve extracellular matrix (ECM) may contribute to the development of diabetic distal sensory neuropathy (DNP). We investigated the relative importance of glycation of collagen types I and IV, laminin and fibronectin in DNP-related impairment in peripheral nerve regeneration. Dorsal root ganglia (DRGs) from young adult mice were embedded in collagen type I modified by 10% substitution with normal or glycated forms of the proteins and incubated for 3 days. Outgrowth of axons and migration of cells into the ECM were quantified. Mean length of growing axons was significantly reduced by glycation of laminin and collagen type IV. The sum of lengths of all axons from each DRG was greatly reduced with glycated laminin, collagen types IV and I. Glycation of fibronectin had no effect on axonal growth. The number of migrating cells was not affected by glycation. We conclude that non-enzymatic glycation of laminin and collagen types IV and I (in decreasing order) impairs peripheral nerve regeneration in vitro.

Analgesic and hepatotoxic effects ofOnonis spinosa L

The present study investigated the analgesic and hepatoprotective activities of a water extract of Ononis spinosa L. (OS) in mice. Analgesic activity was based on the pain thresholds measured with the tail-flick test before administration at 30, 90 and 150 min. The results were analysed with one-way variance analysis. The extract of Ononis spinosa showed analgesic activity equivalent to aspirin at 30 and 90 min and even higher than aspirin with the 50 mg/kg dose. At a dose of 100 mg/kg OS showed an analgesic effect equivalent to aspirin at all time points.The hepatoprotective influence of OS on carbon tetrachloride (CCl(4))-induced acute liver toxicity was also studied. The extract had no significant effect on the increased levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and bilirubin in CCl(4) treated animals (p > 0.05). Thus, the results reveal that the extract of OS had no hepatoprotective effect on CCl(4)-induced acute liver toxicity.

Effect of leukemia inhibitory factor in experimental cisplatin neuropathy in mice

In this study, the effect of leukemia inhibitory factor (LIF) on cisplatin (CDDP)-induced neuropathy was evaluated. Mice were treated with CDDP, 2 mg/kg i.p. twice a week nine times. During the last week some of the mice were also injected with LIF, 2 mug/kg s.c. every other day for a total of four injections. Development of neuropathy was evaluated with changes in tail flick latency and sensory nerve conduction velocity (NCV). At the end of the treatment period dorsal root ganglia (DRG) were microscopically examined. Some of the DRGs were explanted into extracellular matrix, covered with culture medium and incubated for 3 days. During and at the end of the incubation, cellular migration and axonal outgrowth from the DRGs were quantified. LIF proved effective in reversing the increase in tail flick latency (p<0.05) and improving the reduction in NCV induced by CDDP. CDDP led to smaller nuclear and somatic size in neurons, while with LIF, the latter was restored to control values (p<0.01). No apoptotic nucleus was observed among DRG neurons while very few and moderate numbers detected among satellite and Schwann cells, respectively. With LIF, none of the cells had apoptosis. CDDP caused a decrease in the number of migrating cells and in the length of outgrowing axons while LIF treatment restored both capacities (p<0.05) In conclusion, in CDDP-induced neuropathy, LIF was found to be effective in correcting some functional and morphological deteriorations related with major involvement of Schwann cells.

Multidimensional long-term time-lapse microscopy of in vitro peripheral nerve regeneration

In order to test the effectiveness of a new advanced time-lapse microscopy imaging and image processing and analysis system, and to do quantitative and qualitative temporal analyses of in vitro peripheral nerve regeneration, long-term time-lapse imaging of cultures of mouse dorsal root ganglia (DRGs) was performed. DRGs were placed in a Petri dish, covered with collagen gel, their attached peripheral nerves were cut in the middle, creating a gap, and the dish was filled with culture medium. Six preparations were kept on the time-lapse imaging system, which provides a suitable incubation environment and enables to capture images from multiple coordinates at x,y,z axes at desired time intervals for 13 days. In general, the time-lapse imaging system proved quite stable and efficient, although some improvements are certainly required. Two main components of peripheral nerve regeneration, outgrowth of axons and activities of resident cells, were examined. Axons started to grow during the first hour of incubation with a 16.5 microm/h rate and showed the slowest rates (0.7 microm/h) on days 8 and 9, after which they resumed higher speeds again. The first cell came out of the proximal end of the cut nerve on the second day and it was a Schwann cell (SC), which was the prominent cell type in the preparations throughout the experiment. SCs were higher in number (83.15% of all cells) but slower in migration (3.4 vs. 7.3 microm/h, P < 0.001) than other cells. Other observed characteristics of axonal outgrowth and cellular activity and interactions between axons and the cells are discussed.

The effect of Ginkgo extract EGb761 in cisplatin-induced peripheral neuropathy in mice

Neuroprotective effect of Ginkgo biloba extract EGb761 in cisplatin (cis-diamminedi-chloroplatinum, or CDDP)-induced peripheral neuropathy was investigated. Swiss albino mice were treated with CDDP, 2 mg/kg ip twice a week for nine times. One group of the animals also received EGb761 in the drinking water at an estimated dosage of 100 mg/kg per day. Two other groups received vehicle (control) or EGb761 only. Development of neuropathy was evaluated with changes in sensory nerve conduction velocity (NCV). Following the treatments, dorsal root ganglia (DRGs) were microscopically examined and some were cultured for 3 days. EGb761 proved effective in preventing the reduction in NCV (P < 0.0001) caused by CDDP. CDDP caused a decrease in the number of migrating cells (P < 0.01) and in the length of outgrowing axons (P < 0.01) while EGb761 treatment prevented the latter. CDDP led to smaller nuclear and somatic sizes in neurons (P < 0.01), while with EGb761 co-administration, both were close to control values. Animals having EGb761 only had similar results with controls. In conclusion, EGb761 was found to be effective in preventing some functional and morphological deteriorations in CDDP-induced peripheral neuropathy.

Evolving experience in the management of pleural empyema

The objective of this study was to determine treatment strategies for children admitted with pleural empyema. We reviewed the medical records of 93 consecutive patients with pleural empyema who presented in the last three years. Mean age was 3.8 years (range 3.5 months to 14 years) and the male to female ratio was 52 : 41. The left side was involved in 51 (54.8 %) cases and there was only one case with bilateral effusion. After the chest X-ray and analysis of pus obtained by thoracocentesis, the initial treatment modality was chest tube drainage in 81 (87 %) patients. Children required chest tube drainage for an average of 11.9 +/- 4.8 days. Out of the 81 children, 6 needed thoracotomy due to organized pleural fluid and another 4, who developed loculated pleural effusions, were treated with intrapleural urokinase (UK) administration. Twelve children, who had a delayed presentation with organized loculated pleural fluid and pleural thickening, underwent decortication and one, who was found to have a foreign body, found during surgery, needed an upper lobe resection. Medical management with adequate chest tube drainage and appropriate antibiotics has resulted in full resolution in the majority of patients with empyema. In cases of loculated pleural effusions identified at the early stages of the chest tube drainage, intrapleural UK administration was found to be a safe and efficient treatment modality. Thoracotomy should be reserved for late and organized empyema cases.

Management of esophagogastric corrosive injuries in children

There has been an increase in the number of patients admitted to our hospital with caustic esophageal injuries during the last five years. The aim of this study was to analyze the complications and results of the treatment of corrosive esophagogastric injury. Between 1990 and 2000, 120 caustic ingestion accidents were admitted to our unit. The mean age was 4 years, with a 2 : 1 male to female ratio. The average time between the caustic ingestion and admission to hospital was 14.9 days. The ingested substances were alkali in 80.9 % and acid in 19.1 % of the cases. Stenosis of the esophagus developed in 31 (25.8 %) and gastric outlet obstruction (GOO) in 6 (5 %) patients. Management of the esophageal stricture consisted of dilatation in 28 patients. Three children underwent colonic interposition without a dilatation attempt. Six children were lost to follow-up; 4 patients were successfully treated; 13 patients were still in the dilatation program at the time of writing with 6 improving and 2 patients waiting for interposition surgery; 4 patients underwent colonic interposition and 1 patient underwent resection of the stenotic part of the esophagus. Among the patients in the dilation program, we observed 4 esophageal perforations. Three of them were treated medically and further dilatations were carried out, while one was managed by colonic interposition. The treatment modalities for GOO cases consisted of pyloroplasty in 3, Billroth I in 2 and balloon dilation of the pylorus in 1 child. Although balloon dilatation of the esophagus carries the risk of perforation, it should be the first line of treatment in suitable cases. GOO cases may require surgical therapy following a detailed endoscopic evaluation.

A case of prenatally diagnosed fetal neurenteric cyst

The combination of a thoracic cystic mass with vertebral anomalies on prenatal ultrasound suggests a neurenteric cyst. The outcome of such cysts mostly depends on the extent of the displacement and functional impairment of the adjacent organs and of the associated central nervous system defects. We present a case of a neurenteric cyst diagnosed on prenatal ultrasound at 34 weeks of gestation which was treated successfully in the early neonatal period.

Orbital manifestation of multiple myeloma: case report

Orbital involvement is a rare manifestation of multiple myeloma. Therefore, the correct diagnosis and appropriate management are usually difficult and generally require biopsy. We report a 60-year-old woman having multiple myeloma with orbital involvement. Right orbitozygomatic craniotomy was carried out and the mass lesion was removed. After the histological examination, the diagnosis of multiple myeloma was confirmed. The clinical course and the treatment modalities of this entity are discussed in view of the literature.

Lateral intrathoracic meningocele associated with a spinal intradural arachnoid cyst

A case of lateral intrathoracic meningocele associated with a spinal intradural arachnoid cyst is reported and the cases from the literature are reviewed. Both of these lesions were detected by magnetic resonance imaging and treated surgically. Intrathoracic meningoceles are often asymptomatic and diagnosed incidentally during the evaluation of an unrelated pathology. A patient with a spinal intradural arachnoid cyst may present with paraparesis mimicking an intradural tumor, and lateral intrathoracic meningocele may seldom accompany this lesion. A comprehensive radiological examination must be conducted and a higher index of suspicion by neurosurgeons is necessary.

Corrosive injury-induced gastric outlet obstruction: a changing spectrum of agents and treatment

METHODS

During the last 5 years, 61 children were admitted to the authors' hospital because of corrosive substance ingestion, and among them 6 patients were seen with gastric outlet obstruction. Two of them had ingested acid substances, and the other 4 had ingested alkali corrosives. The mean age was 2.9 years (range, 1.5 to 3). Their common complaint was postprandial vomiting, which had begun 3 weeks after the event (range, 1 week to 10 weeks). Endoscopic evaluation and barium contrast radiographies were performed at admission. Four patients had a pyloric stricture, 1 had an antral stricture, and another had an antropyloric stricture. Balloon dilatation of the pylorus (in 1 patient), pyloroplasty (in 3 patients), and Billroth I procedures (in 2 patients) were performed. The mean follow-up period was 22 months (range, 6 weeks to 48 months). One patient, who had undergone a Billroth I procedure, underwent reoperation because of intestinal obstruction 3 months later. On follow-up they are all free of symptoms.

CONCLUSIONS

The treatment of gastric outlet obstruction caused by corrosive ingestion should be treated surgically. Although endoscopic and radiologic evaluation helps to determine the time and necessity, once the diagnosis is confirmed, early definitive surgical intervention should be performed, and the type of the surgery depends mostly on the findings of the surgeon at laparotomy. Endoscopic balloon dilatation of the pylorus maybe attempted in suitable cases. Special care should be given to prevent children from accidental corrosive ingestion.

The relation between human leukocyte antigen (HLA) distribution and intestinal obstruction and adhesions in childhood: preliminary report

To investigate the association between the human leukocyte antigen (HLA) system and adhesions causing intestinal obstruction in childhood in order to determine whether HLA profiles can be used to identify and screen individuals at risk for intestinal adhesions, clinical and laboratory evaluations were done in a total of 42 (F:M = 27:15) patients. The mean age was 6.11 +/- 3.2 years (0.6-13 years). The patients were tested for HLA phenotype in two groups; the HLA phenotype distribution and relative risk (RR) for adhesions were determined. The study patients were children operated upon due to acute abdominal emergencies. Group 1 included patients who needed readmission after the surgery due to intestinal obstruction (n = 19), group 2 patients had no readmission for any reason following surgery (n = 23). Of the 19 patients in group 1, 9 were treated only medically and 10 needed surgical intervention. Among the patients in whom medical treatment was initiated (n = 14), 5 needed surgery during follow-up. There was an increased RR for certain HLA subtypes (A24 [9], HLA11, DR11 [5], B22) in patients presenting with intestinal obstruction due to adhesions. Among these, A24 (9) and DR11 (5) were statistically significant (P < 0.05) compared with the control group. Several possible mechanisms could link the HLA system with disease, especially those in which the immune response is suspected to be involved, but the questions of how the inflammatory response is initiated and the role of proinflammatory cytokines remain unclear. Future research developments are likely to focus on increased understanding of the molecular biology of the major histocompatibility complex and its biological function in the immune response and adhesion formation and intestinal obstruction. It is possible that HLA profiles can be used to identify individuals at risk for intestinal adhesions in the future.

Esophageal replacement using the colon: a 15-year review

Colonic interposition is a treatment option in childhood when esophageal replacement (ER) is necessary. We reviewed 18 children who underwent ER by colon between 1984 and 1999. There were 5 with esophageal atresia and 13 with corrosive esophagitis; 15 had long-term follow-up (mean 38 months). Three procedures were performed by the Waterston technique and 12 by the retrosternal technique. ER was completed in a single stage in all but 1 patient. Pyloroplasty or antireflux surgery were not done routinely during colonic interposition. As early complications, we observed 11 cervical leaks and 2 pulmonary problems. As late complications, there were 4 redundancies, 3 gastrocolic refluxes, 2 cervical anastomotic stenoses, and 1 each intestinal obstruction due to adhesions, cologastric stricture, cosmetic deformity of the thorax, and bulging of the neck. Six patients with complications required secondary surgery. There were 4 deaths, 2 of them unrelated to the surgery. Cervical leakage, which was the most commonly observed problem, healed well. We believe the colon is still one of the best substitutes for the esophagus and that there is no need to perform a routine pyloroplasty or antireflux procedure as an adjunct to the primary surgery.

A morphological study in broiler chick hearts

The normally developing cardiovascular system of the chicken resembles that of the human. The purpose of the present study is to investigate some macroscopic and microscopic similarities between the chick and the human heart. For this study 20 adult and 10 newborn Broiler chickens were used. The heart and great vessels were routinely fixed in 10% formaldehyde in a phosphate buffer. Five adult and five newborn chicks hearts were embedded in paraffin. All section were examined by light microscopy. The atrioventricular valve of 15 adult chick hearts were examined macroscopically. While some structures previously reported were determined, two different properties of the mural leaf which are chordae tendineae in its posterolateral region anchoring at the right ventricle and its widening from the anterior to posterior commissure was also observed.

Anorectal manometry during the neonatal period: its specificity in the diagnosis of Hirschsprung's disease

In this study the reliability of anorectal manometry (ARMM) in Hirschsprung's disease (HD) in the neonatal period is evaluated. ARMM was performed in 59 patients (age ranging between 2 to 90 days) in whom HD was suspected. Rectal biopsy was performed in 23 newborn whose rectoanal inhibitory reflex (RAIR) was not identified in the ARMM study and in 13 RAIR-positive newborn due to strong clinical signs supporting HD or persistence of symptoms during their follow-up. Other RAIR-positive patients were followed up to 4 months to 3.5 years and no problems were encountered. Among the 36 newborn with rectal biopsies, if the results were compared to ARMM studies, there were one false-positive and two false-negative results. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ARMM in the diagnosis of HD are 91.6%, 95.6%, 84.6% and 91.6% respectively. We conclude that ARMM can be used as a screening test in patients in whom HD is suspected during the neonatal period, but for definitive diagnosis it must be combined with other diagnostic tests.

Hydatid disease of the liver in childhood

The records of 100 children with hydatid disease were reviewed retrospectively from 1978 to 1997; 43 were girls and 57 were boys. The mean age was 9.14 years; 61 patients had 124 hepatic cysts. Presenting symptoms were asymptomatic abdominal masses, found masses incidentally during ultrasonography (US), or acute abdomen. Plain X-ray films, US, or computerized tomography (CT) are sufficient for diagnostic evaluation in endemic areas. In the differential diagnosis, laboratory investigations such as the Casoni and Weinberg tests, indirect hemagglutination, eosinophilia, and ELISA were also used. These tests may give negative results, however, in some patients with hydatid disease. The mean follow-up time was 10.5 years (range 1-18 years), the mean duration of hospitalization 7 days. The complication rate was 3.6%. Mortality was 3.27% and occurred after the administration of formaldehyde and hypertonic scolicidal agents. Hydatid disease of the liver can be treated medically in selected patients; conservative surgical approaches that save as much parenchyma as possible, such as partial cystectomy and capitonnage, are indicated in the other cases.

Foot drop following brain tumors: case reports

Three cases with foot drop following brain tumors in patients suffering from parasagittal pathology are reported. Foot drop was the first complaint in the patients in our series. We generally notice foot drop as a sign of lumbar disc herniation or peroneal nerve lesions but rarely foot drop may also occur with brain lesions.

Primary multiple cerebral hydatid cysts: case report with CT and MRI study

We present a case of a patient with multiple cerebral hydatidosis. We could not find any other origin of hydatidosis. In the light of the radiodiagnostic and biochemical findings, we assessed this case as a primary cerebral hydatidosis. The cysts were delivered completely. Two months after operation, the patient's neurological examination and control MRI were normal.

Cyst of the mesencephalon (neuroepithelial cyst?): review and case report

A case of a mesencephalic region cyst is reported. Neuroepithelial cysts are rare benign lesions that may be asymptomatic or may appear as space-occupying mass lesion. The pathogenesis and principles of diagnosis and management of these rare lesions are reviewed.

Intrasellar gangliocytoma resembling pituitary adenoma

Cushing's disease resulting from intrasellar gangliocytomas is very rare and only three cases have been reported to date. All of the cases were female. We present a fourth case of Cushing's disease resulting from intrasellar gangliocytoma. Computed tomography and magnetic resonance imaging scans showed a pituitary macrotumor with suprasellar extension. A greenish-gray colored homogenous tumor was subtotally removed by a transcranial approach. Histological diagnosis was gangliocytoma. To the best of our knowledge, this is the first reported instance of a tumor causing Cushing's disease in a man in the absence of a pituitary adenoma component.

Hydatid disease of the spine

Spinal hydatid cyst was diagnosed in four patients, aged between 21 and 35 years, three male and one female between 1983 and 1993. In three patients, the cysts were epidural and in one intra-vertebral. All patients presented with symptoms of spinal cord compression. Surgical treatment was performed in all of the patients. One patient who relapsed showed evidence of cure after a second operation, and was given mebendazole (Vermox). Histological examination was performed in all of the patients.

Evaluation of impotent men with intracorporeal injection of papaverine and colour Doppler ultrasound

Fifty impotent patients have been evaluated with intracorporeal injection of papaverine and colour Doppler ultrasound. The papaverine tests were negative in 34 of 50 patients. Nineteen of 34 patients with negative papaverine results showed normal colour Doppler findings. In 14 of 16 patients with positive papaverine results the colour Doppler analysis revealed normal structure and functions. Correlation between intracorporeal papaverine injection and colour Doppler ultrasound results was found in 59% (p < 0.01). We concluded that intracorporeal papaverine injection is an effective, simple diagnostic test for beginning evaluation of impotent men. However, this screening test should be supported by colour Doppler ultrasound.

Uterus didelphys with unilateral obstructed hemivagina and renal agenesis on the same side

A rare condition, complete or incomplete duplication of uterus and cervix with unilateral vaginal obstruction, is usually associated with ipsilateral renal agenesis. In such kinds of Müllerian and Wolffian duct anomalies as the one reported here with accumulation of menstrual blood in the obstructed vagina, the patient usually complains of a pelvic mass and associated severe and increasing dysmenorrhea. A case, diagnosed and treated at our Department, is presented.

Extensive intestinal aganglionosis

Extensive aganglionosis very close to the ligament of Treitz and total intestinal aganglionosis are rare forms of Hirschsprung's disease. In these cases, nutrition, fluid, and electrolyte balance are a problem. Although the myectomy-myotomy technique of Ziegler appears hopeful, no effective surgical method has been put into the practice for the treatment of these rare forms of Hirschsprung's disease. We report four cases with extensive intestinal aganglionosis, one of which was total intestinal aganglionosis with involvement of the stomach.

[Classification of functional orthopaedic appliances in our opinions]

Appliances which are used for functional orthopedic therapy, is called as functional orthopedic appliances. So far, it has been constructed many appliances for functional treatment. But among these appliances, only activators were classified by STOCKFISH, H. in terms of construction specialty at his laboratory. Whole functional appliances were arranged by Gürsoy, N. and Perkün, F. according to the organ which their functional balance pas spoiled by these appliances (according to the soft and hard tissue of organs) and Proffit, W. classified functional appliances in terms of the tissues which support them. In fact, these appliances should be classified according to the force they apply and their effect mechanism. Classification of functional appliance according to the force they apply: I- Pure functional appliance, II-Mechano-functional appliance. I- Pure functional appliance: A) Activators, B) Regulators. II-Mechano-functional appliance: A) Fixed, B) Removable. Classification of functional appliances according to the their effect mechanism: I- Activators, II- Regulators. I- Activators are separated two: A) Pure functional, B) Mechano-functional, and these are divided into sub-divisions. II- Regulators are separated three: A) Oral screens, B) Lip bumpers, C) Frankel appliance (4 type). We believe that, every two classification which were shown before at two charts, will be useful to our colleagues.