Precise Measurement of the D^{0} and D^{+} Lifetimes at Belle II

We report a measurement of the D^{0} and D^{+} lifetimes using D^{0}→K^{-}π^{+} and D^{+}→K^{-}π^{+}π^{+} decays reconstructed in e^{+}e^{-}→cc[over ¯] data recorded by the Belle II experiment at the SuperKEKB asymmetric-energy e^{+}e^{-} collider. The data, collected at center-of-mass energies at or near the ϒ(4S) resonance, correspond to an integrated luminosity of 72  fb^{-1}. The results, τ(D^{0})=410.5±1.1(stat)±0.8(syst)  fs and τ(D^{+})=1030.4±4.7(stat)±3.1(syst)  fs, are the most precise to date and are consistent with previous determinations.

Search for B^{+}→K^{+}νν[over ¯] Decays Using an Inclusive Tagging Method at Belle II

A search for the flavor-changing neutral-current decay B^{+}→K^{+}νν[over ¯] is performed at the Belle II experiment at the SuperKEKB asymmetric energy electron-positron collider. The data sample corresponds to an integrated luminosity of 63  fb^{-1} collected at the ϒ(4S) resonance and a sample of 9  fb^{-1} collected at an energy 60 MeV below the resonance. Because the measurable decay signature involves only a single charged kaon, a novel measurement approach is used that exploits not only the properties of the B^{+}→K^{+}νν[over ¯] decay, but also the inclusive properties of the other B meson in the ϒ(4S)→BB[over ¯] event, to suppress the background from other B meson decays and light-quark pair production. This inclusive tagging approach offers a higher signal efficiency compared to previous searches. No significant signal is observed. An upper limit on the branching fraction of B^{+}→K^{+}νν[over ¯] of 4.1×10^{-5} is set at the 90% confidence level.

Evaluation of lung densitometric and volumetric changes in silicosis patients using three-dimensional software for multidetector CT and the relationship with profusion scores

AIM

To evaluate the density and volume changes in the lungs of silicosis patients and their relationship with the disease severity classification of the International Labor Organization (ILO).

MATERIALS AND METHODS

The multidetector computed tomography (CT) images of 44 patients diagnosed with silicosis and 32 controls that underwent thoracic CT due to trauma were evaluated. Patients with silicosis were divided into three categories according to the ILO classification. Data related to the total lung volume, total lung mean density, lung opacity score, percentage of lung high opacity, and mean density in the lower and upper lobes were obtained using three-dimensional (3D) software.

RESULTS

There was no significant difference between the total lung mean densities of the silicosis and control groups (p=0.213); however, a significant difference was observed between the two groups in terms of the total lung volume (p<0.0001). According to the ILO classification, there was a significant difference between the disease severity categories in relation to the percentage of lung high opacity (p=0.000005). A strong correlation was detected between disease severity and high opacity percentage (p<0.0001, r=0.804). According to the ILO classification, there was also a significant difference between disease severity categories in terms of the lung opacity score (p=0.000144), as well as a moderate correlation between disease severity and opacity score (p<0.0001, r=0.580).

CONCLUSION

Total lung volume is a CT finding that shows variation in exposure to crystalline silica. The percentage of high opacity determined using multidetector CT is an effective parameter in evaluating disease severity.

Transitions between COPD groups: A cross-sectional study in Turkey

INTRODUCTION

Since GOLD 2017 separates spirometry results from 'ABCD' groups, there have been some changes to the stages of COPD patients. Our aim was to investigate the shifts in COPD groups after GOLD 2017.

METHODS

COPD patients from outpatient clinics of 3 hospitals in Turkey were stratified into old and new ABCD groups according to exacerbation history, mMRC evaluation and spirometry results for both GOLD 2011 and 2017 assessments. Treatment protocols were also evaluated if they were suitable for both classifications.

RESULTS

There were 578 patients (334 men, 244 women) with a mean age of 65.21±10.42. The distribution of patients from group A to D was 28%, 15%, 15%, 42% (GOLD 2011) and 36%, 22%, 7% and 35% (GOLD 2017) respectively. There were shifts from group C to A (53.4%) and D to B (18.4%). The treatment suitability was 66.3% in GOLD 2011 and 60.9% in GOLD 2017. The most common inappropriate treatment protocol was triple therapy. Presence of exacerbations in last year, mMRC score, FEV1 level (p < 0.01 for three parameters) and proportion of males (p = 0.029) were statistically significantly higher in groups C and D of GOLD 2017 compared with new patients in group A and B of GOLD 2017 (shifted from GOLD 2011's C-D groups).

CONCLUSION

There were shifts from group C to A and D to B with GOLD 2017, which means some high-risk COPD patients were reclassified into low-risk groups. Despite guideline updates, there are still many COPD patients with overtreatment. To our knowledge, this is the first study examining transitions between COPD groups after GOLD 2017 in Turkey.

Search for Axionlike Particles Produced in e^{+}e^{-} Collisions at Belle II

We present a search for the direct production of a light pseudoscalar a decaying into two photons with the Belle II detector at the SuperKEKB collider. We search for the process e^{+}e^{-}→γa, a→γγ in the mass range 0.2<m_{a}<9.7  GeV/c^{2} using data corresponding to an integrated luminosity of (445±3)  pb^{-1}. Light pseudoscalars interacting predominantly with standard model gauge bosons (so-called axionlike particles or ALPs) are frequently postulated in extensions of the standard model. We find no evidence for ALPs and set 95% confidence level upper limits on the coupling strength g_{aγγ} of ALPs to photons at the level of 10^{-3}  GeV^{-1}. The limits are the most restrictive to date for 0.2<m_{a}<1  GeV/c^{2}.

Analysis of posterior circulation diameters depending on age, sex and side by computed tomography angiography

BACKGROUND

Posterior circulation of brain is important because of vital organs' blood supply provided by them. In this study, we evaluate the relationship of posterior circulation measurements with age, gender and side by using computed tomography angiography (CTA) images.

MATERIALS AND METHODS

A total 199 brain CTA examinations were retrospectively analysed for all posterior circulation arteries (vertebral artery, basilar artery, posterior cerebral artery [PCA], superior cerebellar artery [SCA], anterior inferior cerebellar artery, and posterior inferior cerebellar artery [PICA]) to compare the difference based on age, gender and side.

RESULTS

There is no correlation between age and the mean diameters of all vessels (p > 0.05). The mean diameter of left vertebral artery was higher than right vertebral artery in all genders (p = 0.004 for males and p < 0.001 for females). The mean diameter of left SCA and PICA were higher than right SCA and PICA in females (p = 0.032 and p = 0.027, respectively). The mean diameters of basilar, left PCA, left SCA, left vertebral, right PCA, right SCA, right PICA and right vertebral artery were higher in males and that differences were statistically significant (p < 0.001, p = 0.002, p = 0.006, p = 0.004, p = 0.001, p = 0.003, p = 0.002, and p = 0.006, respectively).

CONCLUSIONS

The posterior circulation vessel diameter is not affected by aging. The mean diameters of basilar artery, both PCAs, both SCAs, right PICA, both vertebral arteries were higher in males. The mean diameter of left vertebral artery is higher than that of right vertebral artery in all genders.

Relationship of vascular variations with liver remnant volume in living liver transplant donors

BACKGROUND

In this study, we investigated the relationship between the portal vein and hepatic artery variations and the remaining liver volume in living donors in liver transplantation.

MATERIALS AND METHODS

In the study, triphasic abdominal computed tomography images of 180 live liver donor candidates were analysed retrospectively. Portal veins were divided into four groups according to the Nakamura classification and seven groups according to the Michels classification. The relationship between vascular variations and remnant liver volume was compared statistically.

RESULTS

According to the Nakamura classification, there were 143 (79.4%) type A, 23 (12.7%) type B, 7 (3.9%) type C and 7 (3.9%) type D cases. Using the Michels classification, 129 (71%) type 1, 12 (6.7%) type 2, 24 (13%) type 3, 2 (2.2%) type 4, 10 (5.6%) type 5, 1 (0.6%) type 6, and 2 (1.1%) type 7 cases were detected. There was no significant difference in the percentage of the remaining volume of the left liver lobe between the groups (p = 0.055, p = 0.207, respectively).

CONCLUSIONS

Variations in the hepatic artery and portal vein do not affect the remaining liver volume in liver transplantation donors.

Aneurysmal Bone Cyst after Femoral Derotational Osteotomy: A Case Report

Aneurysmal bone cysts rather than local aggressive lesions of the bone which may arise in any part of the axial or appendicular skeleton. Although several theories are available in the literature, the pathogenesis is still conflicting. We report an exceptional case of an aneurysmal bone cyst in the distal femur of a female cerebral palsy patient who underwent bilateral distal femoral derotational osteotomy and plate-screw fixation operations when she was 11 years old. Twenty-four months after the operation, radiographs showed a cystic lesion in the distal portion of the right femur around the osteotomy site. The diagnosis of Aneurysmal Bone Cyst (ABC) was made and the lesion was treated by curettage with cement application. After 36 months of follow-up, there was no recurrence. This is the first case reported in literature which raises the possibility that an osteotomy could be a cause in the development of an aneurysmal bone cyst.

Is there relationship between excision repair cross-complementation 1 expression level and response to treatment and prognosis in an advanced stage lung cancer treated with cisplatin-based chemotherapy?

AIM

It is important to know the tumor resistance against cisplatin before the treatment of non-small cell lung cancer (NSCLC). The purpose of this study was to evaluate the response to treatment and survival in patients with NSCLC treated with cisplatin-based chemotherapy according to excision repair cross-complementation 1 (ERCC1) expression.

MATERIALS AND METHODS

Among 119 patients treated with cisplatin and vinorelbine or docetaxel, 39 (32%) patients enrolled who have enough tumor tissue to analyze ERCC1 expression. ERCC1 expression defined as negative in score 0-1, positive in score 2-3.

RESULTS

There was no difference between ERCC1 positive and negative groups (P = 0.63). Mean survival was 14.7 months (95% confidence interval [CI]; 10.0-19.3 month) in ERCC1 negative group, 10.9 months (95% CI; 7.4-14.3 month) in ERCC1 positive group (P = 0.23). Progression free survival was 7.9 months in ERCC1 negative group (95% CI; 5.8-9.9 months), 6.2 months in ERCC1 positive group (95% CI; 4.0-8.5 months) (P = 0.27).

CONCLUSION

Identification of ERCC1 expression level of tumor tissues in NSCLC patients before treatment was not useful in prediction of treatment response and prognosis.

The Effect of Sagittal Plane Deformities after Tibial Plateau Fractures to Functions and Instability of Knee Joint

PURPOSE OF THE STUDY

The objective of this study is to evaluate the effect of posterior tibial slope after fracture healing on antero-posterior knee laxity, functional outcome and patient satisfaction.

MATERIAL AND METHODS

126 patients who were treated for tibial plateau fractures between 2008-2013 in the orthopedics and traumatology department of our institution were evaluated for the study. Patients were treated with open reduction and internal fixation, arthroscopy assisted minimally invasive osteosynthesis or conservative treatment.

RESULTS

Mean posterior tibial slope after the treatment was 6.91 ± 5.11 and there was no significant difference when compared to the uninvolved side 6.42 ± 4,21 (p = 0.794). Knee laxity in anterior-posterior plane was 6.14 ± 2.11 and 5.95 ± 2.25 respectively on healthy and injured side. The difference of mean laxity in anterior-posterior plane between two sides was statistically significant.

DISCUSSION

In this study we found no difference in laxity between the injured and healthy knees. However Tegner score decreased significantly in patients who had greater laxity difference between the knees. We did not find significant difference between fracture type and laxity, IKDC functional scores independent of the ligamentous injury.

CONCLUSION

In conclusion despite coronal alignment is taken into consideration in treatment of tibial plateau fractures, sagittal alignment is reasonably important for stability and should not be ignored.

Evaluation of plasma fibronectine level as a probable indicator for tympanosclerosis

OBJECTIVES

Wound healing, epithelial regrowth and collagen synthesis are very important factors in the repair of the traumatised tympanic membrane. The aim of the present study was to determine the role of plasma fibronectine in the aetiopathogenesis of tympanosclerosis.

METHODS

This prospective study included 58 patients with and 49 without tympanosclerosis. No inflammation or trauma was noted in either patient group. All patients underwent otoscopic and otomicroscopic examination, and the degree of tympanosclerosis was graded from mild (stage I) to severe (stage III). Following otological examination, blood samples were taken for plasma fibronectine measurement.

RESULTS

Following otoscopic and otomicroscopic examinations, patients' tympanosclerosis was graded as follows: 18 patients were stage I; 29 were stage II; and 11 were stage III. Statistical analyses revealed that the plasma fibronectine concentrations were significantly lower in the study group compared with the control group (p = 0.031). In addition, fibronectine levels were lowest in the patients with severest tympanosclerosis (p = 0.0001 in each comparison).

CONCLUSION

The results of the present study show that serum fibronectine is important in the development and severity of tympanosclerosis.

Is there a role of free oxygen radicals in primary male osteoporosis?

OBJECTIVE

There is not enough evidence about the relationship between free radicals and male osteoporosis. In this study we investigated the role of free oxygen radicals and antioxidants on male osteoporosis in 31 male patients with primary osteoporosis and 21 subjects as controls.

METHODS

Bone mineral densities (BMD) of the lumbar and femoral neck region were evaluated using dual energy X-ray absorbsiometry. Serum malondialdehyde (MDA) and nitric oxide (NO) levels and superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities were measured by analytical methods. In addition, serum osteocalcine and C telopeptide levels were determined to evaluate bone turnover MDA and NO levels and SOD activity were significantly increased (p < 0.05) in osteoporotic males.

RESULTS

There was a negative correlation between SOD and lumbar BMD levels (r= -0.328; p = 0.021). The same trend was observed between NO and lumbar BMD (r = -0.473; p = 0.001) and femoral neck BMD values (r = -0.540; p = 0.000). There was no significant correlation between free radical levels and bone turnover markers.

CONCLUSION

The data indicate an increase in free oxygen radical levels. As a result, antioxidant defenses would compromise in primary male osteoporotic patients. Therefore, it may be suggested that oxidative stress plays an important role in the pathophysiology of primary male osteoporosis.

The urinary 5-hydroxyindole acetic acid and plasma nitric oxide levels in irritable bowel syndrome: a preliminary study

BACKGROUND AND AIMS

Postprandial increase of 5-hydroxytryptamine (5-HT) has been implicated in irritable bowel syndrome (IBS). There is evidence that nitric oxide (NO) may act as a mediator of 5-HT-evoked secretions in the colon. Our aim is to investigate the role of urinary 5-hydroxyindole acetic acid (5-HIAA) and plasma NO levels (with diarrhoea) in IBS patients.

METHODS

Nineteen (with constipation) IBS patients (group 1), 22 IBS patients (group 2) and 18 healthy controls (group 3) were included in the study. The diagnosis of IBS was made according to the Rome I Criteria. The urine was collected for determination of 5-HIAA and venous blood was collected from each subject for the measurement of plasma NO levels.

RESULTS

The levels of urinary 5-HIAA mmol/day and plasma NO mmol/l of group 1 (22.4 +/- 2.2 and 29.4 +/- 2 respectively) were significantly higher than group 3 (14.2 +/- 2.3 and 21.3 +/- 2.1 respectively) (p = 0.036 and p = 0.019 respectively). The NO level of group 1 was also significantly higher than group 2 (21.8 +/- 1.9) (p = 0.021). The 5-HIAA level of group 1 was higher than group 2 (15.2 +/- 2.1) and the difference was marginally significant (p = 0.055). There was no difference between group 2 and group 3 with respect to 5-HIAA and NO levels.

CONCLUSIONS

The results of this preliminary study lend support to the involvement of 5-HT in some symptomatology of diarrhoea predominant IBS. Furthermore, NO may be one of the effector mediators of the 5-HT-induced symptoms in these patients.

CT in differential diagnosis of benign and malignant pleural disease

BACKGROUND

CT plays a valuable role in assessment of patients with a wide variety of diseases of the pleura, and pulmonologists should be aware of the significance of different CT findings for the differential diagnosis of benign and malignant pleural diseases.

METHODS

155 patients with pleural disease who had undergone CT scans of the lungs and thorax before treatment were enrolled. We retrospectively reviewed CT findings in 146 patients with proven pleural disease.

RESULTS

Fifty-nine of the cases were malignant, 87 of them had benign pleural diseases. CT findings that were helpful in distinguishing malignant from benign pleural disease were: 1) pleural nodularity; 2) rind; 3) mediastinal pleural involvement; and 4) pleural thickening greater than 1 cm. The sensitivities and specificities were 37%/97%, 22%/97%, 31%/85%, 35%/87%, respectively. CT findings differentiating malignant pleural mesothelioma from metastatic pleural disease were identified. Findings for malignant mesothelioma were as follows: 1) involvement of interlobar fissure (sensitivity 30%, specificity 92%), 2) pleural thickening greater than 1 cm (sensitivity 60%, specificity 77%). Whereas, findings for metastatic pleural disease were mediastinal/hilar lymph node enlargement and lung parenchymal involvement (P < .05).

CONCLUSION

CT is helpful in the differential diagnosis of pleural diseases, particularly in differentiating malignant from benign conditions and metastatic pleural disease from malignant mesothelioma.

The diagnostic importance of prolactin subgroups in patients with stalk mass

In some situations, the identification of subgroups of patients with elevated serum prolactin (PRL) levels on the basis of different forms of PRL present in the blood, may be complementary to generally accepted and performed biochemical and radiological examinations in addition to a thorough clinical evaluation. Further analysis of elevated PRL subgroups is advisable especially for cases lacking the signs of amenorrhea and galactorea harboring a space occupying lesion in the sellar region. We present the case report of a patient with a high ratio of macroprolactin with regard to total serum PRL harboring a radiologically confirmed stalk mass lesion. An appropriate treatment plan for this patient is discussed.

Prognostic value of matrix metalloproteinases (MMP-2 and MMP-9) in Hodgkin's and non-Hodgkin's lymphoma

Matrix metalloproteinases (MMPs) are responsible for the degradation of extracellular matrix and have an important role in tumour metastases. We investigated the role of MMP-2 and MMP-9 in Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). The serum samples of patients with HD (n = 12), NHL (n = 30) and healthy control (n = 22) were analysed for MMP-2 and MMP-9. An immunoassay method was used for the determination of MMP-2 and MMP-9 levels. No statistical significance was found between HD and NHL groups for levels of MMP-2. There were no relation between MMP-2, MMP-9 levels and clinical characteristics of patients. The mean MMP-9 levels were found to be 555.6 +/- 140 ng/ml, 446.6 +/- 53.6 ng/ml and 111.2 +/- 10.3 ng/ml in HD, NHL and control groups, respectively. Our results suggest that MMP-9 levels are substantially increased in HD and NHL when compared with controls and may probably be used for distinguishing the benign diseases from malign lymphomas.

The role of nitric oxide and lipid peroxidation in patients with Plasmodium vivax malaria

In this study, we investigated the role of nitric oxide metabolism and lipid peroxidation in patients with P. vivax malaria. The levels of nitrite and nitrate were analyzed using a procedure based on the Griess reaction and malondialdehyde levels which index of lipid peroxidation was determined by thiobarbituric acid reaction. The levels of nitrite/nitrate and malondialdehyde in patients were higher than controls and found to be statistically significant (p < 0.001). We performed this study to determine whether nitric oxide and lipid peroxidation is produced during blood-stage P. vivax malaria. This present study shows that lipid peroxidation occurs in P. vivax malaria. The levels of nitric oxide are associated with lipid peroxidation in this disease.

Levels of malondialdehyde, glutathione and ascorbic acid in idiopathic thrombocytopaenic purpura

BACKGROUND

Idiopathic thrombocytopaenic purpura (ITP) is an autoimmune disorder, which causes an acute or chronic thrombocytopenia, and may result in potentially life-threatening haemorrhage. Oxidative damage may be involved in the pathogenesis of autoimmune diseases. Antibodies to bind to membrane lipids and platelet destruction may play a role on lipid peroxidation in ITP.

OBJECTIVES

To investigate the posible role of lipid peroxidation and antioxidants in patients with ITP.

DESIGN

The levels of plasma and erythrocyte malondialdehyde (MDA), erythrocyte glutathione and ascorbic acid were analysed in patients with ITP. METHODS. The MDA levels were performed according to the method of Bidlack WR. Plasma MDA, erythrocyte glutathione and ascorbic acid levels were carried out according to the methods of Ohkawa H, Beutler E and Bauer JD, respectively.

RESULTS

The erythrocyte and plasma MDA levels in patients with ITP were found to be 9.52+/-4.65, 3.03+/-1.44 (p<0.001) and in control group were found to be 2.49+/-0.57, 1.03+/-0.28 nmol/ml (p<0.001), respectively. Erythrocyte glutathione was found to be 3.71+/-0.82, 6.26+/-0.66 micromol/gr Hb (p<0.001). Ascorbic acid levels of these groups were 1.09+/-0.25, 1.70+/-0.33 mg/dl (p<0.001).

CONCLUSION

The oxidative damage is involved in the pathogenesis of ITP. In patients with ITP, the platelet destruction and bleeding may play significant role on elevation of lipid peroxidation and reduction of antioxidant capacity. Further studies on oxidant and antioxidant status of ITP are also needed to confirm these results.

Effect of trapidil, an antiplatelet and vasodilator agent on gentamicin-induced nephrotoxicity in rats

This study was carried out to evaluate the effect of trapidil, an antiplatelet and vasodilator drug, on the nephrotoxicity by an aminoglycoside, gentamicin, in rats. Forty female Wistar rats were divided into six different groups. One group served as a control group and the other groups were treated as follows: gentamicin (50 mg kg(-1) twice daily)-treated, gentamicin plus trapidil (4 or 20 mg kg(-1) daily)-treated and only trapidil-treated (4 or 20 mg kg(-1) daily) groups. Serum urea, creatinine and nitrite/nitrate levels were measured. Moreover, histopathological as well as electron microscopic examinations were performed. At a lower dose (4 mg kg(-1)) trapidil did not prevent the development of renal tubular damage by gentamicin. However, a higher dose of trapidil (20 mg kg(-1)) inhibited the ability of gentamicin to increase the levels of creatinine and urea. Furthermore, both light and electron microscopic evaluation confirmed the nephroprotective effect of the higher dose of trapidil. The level of the stable nitric oxide (NO) metabolite, nitrite, was also increased by trapidil. In conclusion, trapidil at a higher dose may protect against gentamicin nephrotoxicity. The mechanism underlying trapidil nephroprotection is not known, but may result from the antagonism of platelet-derived growth factor (PDGF), vasodilatation, inhibition of trombosit aggregation, and/or NO release.

Serum L-carnitine levels and lipoprotein compositions in chronic viral hepatitis patients

OBJECTIVES

The aim of this study was to evaluate the serum L-carnitine levels and its effect on lipoproteins in chronic viral hepatitis B or C patients.

DESIGN AND METHODS

Blood samples were taken from 41 patients and 30 healthy subjects after 12 h fasting.

RESULTS

Patients' serum L-carnitine levels (11.19 +/- 6.67 mg/L) (p < 0.0001) and hepatic enzyme activities (AST and ALT) (49.02 +/- 42.80 and 58.35 +/- 57.51 U/L) (p < 0.0005) were significantly higher than controls'. Serum total (3.85 +/- 0.82 mmol/L), LDL (2.08 +/- 0.76 mmol/L) and HDL (1.02 +/- 0.29 mmol/L) cholesterol levels were significantly lower in patients (p < 0.01). On the other hand triglyceride levels (1.65 +/- 0.85 mmol/L) were significantly higher in patients (p < 0.05).

CONCLUSIONS

The higher L-carnitine levels of patients may result from the leakage of hepatic cellular carnitine. If there is a decreased hepatic cellular carnitine levels, this may affect the transport of acetyl moiety for cholesterol synthesis and alter lipoprotein composition. Further investigation is needed for hepatic tissue L-carnitine levels.

The Levels of Sera Malondialdehyde, Erythrocyte Membrane Na+-K+/Mg++ and Ca++/Mg++ Adenosine 5' Triphosphatase in Patients with Sickle Cell Anemia

The various membrane abnormalities of sickle erythrocytes may result from excessive accumulation of oxidant damage. We measured the sera levels of malondialdehyde, products of lipid peroxidation, Na+-K+/Mg++ Adenosine 5' triphosphatase (ATPase) and Ca++/Mg++ Adenosine 5' triphosphatase, erythrocyte membrane enzymes, in patients with sickle cell anemia and compared their levels with that of normal controls. MDA, Na+-K+/Mg++ and Ca++/Mg++ ATPase levels of control groups were 0.90 ± 0.04 nmol/mL, 168 ± 12.9 and 140.6 ± 8.2 nmol Pi/mg prot/hour, respectively. MDA, Na+-K+/Mg++ and Ca++/Mg++ATPase levels of patients were 2.02 ± 0.01 nmol/mL, 127.0 ± 8.4 and 110.0 ± 9.6 nmol Pi/mg prot/hour, respectively. Our experimental results showed that there was a significant increase in MDA levels of patients with sickle cell anemia as compared with that of the controls. However, erythrocyte membrane Na+-K+/Mg++ and Ca++/Mg++ ATPase levels of patients with sickle cell anemia were significantly lower than the, Na+-K+/Mg++ and Ca++/Mg++ ATPase levels of normal controls.

Posterior fossa epidural hematomas: observations on a series of 73 cases

The posterior fossa is an uncommon site for epidural hematomas. Clinical progress is silent and slow, but the deterioration is sudden and quick to become fatal if not promptly treated. Early recognition is therefore extremely important. The recommended treatment for posterior fossa epidural hematoma is surgical evacuation soon after the diagnosis, since the posterior fossa contains vital structures. However, conservative management under close clinical and radiological supervision can be applied in patients without mass effect. In our study, a review of 73 cases with posterior fossa epidural hematoma among a total number of 737 patients with epidural hematoma is presented, and a new neuroradiological classification is proposed in order to determine the appropriate type of treatment. In this series, 14 patients were treated conservatively, while 59 required surgery. The conservatively treated 9 pediatric and 5 adult patients, and 51 of the 59 surgically treated cases, in other words a total of 65 of the 73 patients, showed excellent recovery; 4 patients treated surgically had a moderate disability, and 4 patients died (overall mortality 5.4%). The critical factors influencing outcome were the neuroradiological class, the level of consciousness just before the operation, and the other systemic and/or intracranial traumatic lesions. In this study, the critical observation was that the neuroradiological findings were earlier, more reliable and predictive than the clinical findings. Therefore, based upon the obliteration of perimesencephalic cisterns and/or displacement of the fourth ventricle, a new neuroradiological classification was designed for decision-making in management.

Surgical anatomy and morphometric analysis of the optico-chiasmatic apparatus, optic canal and sphenoid ridge

An anatomical study was performed in order to obtain help for orientation regarding the cranial base approaches to the anterior cranial base. Cranial base approaches were studied in 8 adult cadaver heads, and morphometric measurements critical in these approaches were achieved in 76 dry skulls. Importance of the surgical anatomy of the opticochiasmatic apparatus, optic canal, sphenoid ridge, and anterior clinoid was emphasised in this study. Observations from the dissections and operative approaches, and measurements between various points were recorded in a specifically designed software, and these data helped both to understand the local anatomy and the relationship to the intimate structures better and to decide the head position, the degree and direction of safe bony removal, and the direction of the operative approach during the surgery. Considerations important in the selection of these structures, anatomical landmarks and distances were discussed.

Surgical anatomy and morphometric analysis of the occipital condyles and foramen magnum

Surgical anatomy that provides the basis for dealing with lesions arising in the lower clivus and ventral foramen magnum was reviewed in 8 adult cadaver heads and 76 dry skulls. The extreme lateral transcondylar approach was performed in cadavers; the morphometric analysis was studied in both the cadavers and the skulls. The landmarks, distances and structures were selected in order to guide the surgical operations in this area. In the paper, surgical approaches to this region are reviewed, and the results are discussed from the standpoint of surgical importance.

Surgical anatomy of the temporal bone and measurements of the skull base for transpetrosal approaches

Transtemporal approaches exposing the petroclival region require extensive drilling of the petrous bone. This is only possible with an understanding of the three dimensional anatomy of the temporal bone and the cranial base. The purpose of this study is to review the topographic anatomy of the petrous bone and peripetrous region, with emphasis on the relationships critical to the lateral approaches for posterior and lateral skull base. To understand the surgical anatomy and the cranial base approaches to this area, 8 cadaveric heads and 76 dry skulls were studied. Cadaveric dissections were performed, and morphometric data from measurements of the relationships of the surface landmarks in the petroclival region were provided. The results and the observations could be useful to understand the anatomy better, and to estimate the degree and direction of a safe bony removal for the most radical transpetrosal surgery.

Multiple pregnancies obtained by testicular spermatid injection in combination with intracytoplasmic sperm injection

Recent studies have shown that the injection of spermatid cells into the human oocyte can result in normal fertilization, embryo development and even delivery of live, healthy offspring. In our study, 23 azoospermic cases with severe spermatogenetic defects in their testicular biopsy are presented. The serum follicle stimulating hormone (FSH) concentrations and histopathological results of these males have been documented and compared in terms of fertilization and embryo development. The mean FSH value of the azoospermic males was 15.8 +/- 2.3 mIU/l, ranging from 1.6 to 39 mIU/l. Elongated spermatids were used in three cases only, as these more mature forms were mostly present in the testicular sample. In the remaining 20 cases, only round spermatids were found for use in intracytoplasmic sperm injection (ICSI). The fertilization rate with two pronuclei was 31.3%. The fertilization rate was found to be as high as 71% in three patients in the elongating and elongated spermatids group and as low as 25.6% in the round spermatid group. A few immature, non-motile spermatozoa were seen in only two cases from the elongated spermatid group. However, in the remaining cases, no spermatozoa were observed. The number of pronuclear (PN) arrest was quite high when only round spermatids were used (36.1%). Total fertilization failure was observed in two cases from the round spermatid group with Sertoli cell only and germ cell aplasia. A total of three pregnancies was achieved in 23 cases (13.0%), two from the elongated spermatid group and one from the round spermatid group. One biochemical pregnancy with a round spermatid resulted in an early spontaneous abortion and surprisingly, the remaining pregnancies were achieved with elongated spermatids resulting in multiple pregnancies. One twin and one triplet pregnancy were established following four embryo transfers in each patient. The twin pregnancy resulted in a live birth with two healthy babies; unfortunately, the triplet pregnancy ended in an abortion at 11 weeks. The use of testicular spermatids in the treatment of non-obstructive azoospermia may give hope by offering a novel treatment model. In cases with very severe spermatogenetic defect, even multiple pregnancies can be achieved with elongated spermatid cells by yielding a high implantation rate. However, the efficiency of round spermatids in achieving fertilization and pregnancy was disappointing.

Clomiphene citrate challenge test in the assessment of ovarian reserve before controlled ovarian hyperstimulation for intracytoplasmic sperm injection

The objective of this study is to evaluate the performance of clomiphene citrate (CC) challenge test to predict diminished ovarian reserve before controlled ovarian hyperstimulation for intracytoplasmic sperm injection (ICSI). The 198 women who underwent the CC challenge test fulfilled the following criteria; over 35 years of age, removal of one ovary or previous ovarian surgery, the presence of ovarian endometrioma or previous poor response to ovarian hyperstimulation. Of the patients tested, 141 were found to have a normal CC challenge test while 57 had an abnormal result. The cancellation rate of the cycle with a poor response was significantly higher in women with an abnormal test (36.8%) than in those with a normal test (19.8%) (P < 0.05). The sensitivity of CC test for cycle cancellation was found to be 43% with a specificity of 76%, positive and negative predictive values of 37 and 80%, respectively. The estradiol values on hCG day, the number of retrieved oocytes and metaphase II oocytes and the rate of transfer cycles were significantly lower in females with an abnormal test. Women with normal test results had higher pregnancy rates per embryo transfer than those with abnormal test results (21.5 vs. 13.3%) and the predictive value of an abnormal test for failing to conceive was 93% (53/57) with a sensitivity of 31%, specificity of 84% and negative predictive value of 15.6%. Of 57 women with an abnormal test result, 25 (43.8%) were abnormal due only to an elevated day 10 or 11 value of FSH, which could not be detected using only basal FSH screening. In this group, the cancellation rate (48 vs. 19.8%, P < 0.01), the rate of transfer cycles (48 vs. 72.3%, P < 0.05) and the mean number of retrieved oocytes (4.9 +/- 2.5 vs. 6.4 +/- 3.1, P < 0.01) were all significantly different from normal test group. Although the rate of pregnancies per started cycle (8 vs. 15.6%) did not show a statistically significant difference, this is most probably due to the low number of patients. In conclusion, an abnormal CC challenge test is a good predictor of diminished ovarian reserve and it is better than a basal FSH concentration on day 3. It provides valuable information for both patients as to their chances of achieving a pregnancy and also for the medical team deciding on options for stimulation protocols.

Pregnancies achieved with testicular and ejaculated spermatozoa in combination with intracytoplasmic sperm injection in men with totally or initially immotile spermatozoa in the ejaculate

The efficacy of intracytoplasmic sperm injection (ICSI) employing testicular and ejaculated spermatozoa was assessed in 24 couples with totally or initially immotile spermatozoa. No criteria were employed in selecting which patients would be treated with testicular or ejaculated spermatozoa. The men were chosen at random. Testicular spermatozoa obtained by testicular sperm extraction were used in 14 and ejaculated spermatozoa were used in 10 of these couples. In all cases. asthenozoospermia was total in their basal semen sample. In 12 male partners, spermatozoa were totally immotile before and after Percoll gradient fractionation (totally immotile). In the remaining 12 men, spermatozoa initially showed a total absence of motility; however, some of the spermatozoa had showed very poor motility (0. 1%) after Percoll gradient fractionation and a 1.5-2.0 h incubation period (initially immotile). Of these 24 total asthenozoospermic males, 14 also had total teratozoospermia. The fertilization and cleavage rates in the testicular and ejaculated sperm groups were 53. 5 and 96.3 and 54.5 and 94.4% respectively. One cycle resulted in complete fertilization failure, and in 23 embryo transfer cycles a total of 10 pregnancies were obtained (41.6%). Eight pregnancies were achieved in the testicular sperm group, while only two pregnancies were obtained in the ejaculated sperm group. Four pregnancies, two from the ejaculated sperm group and two from the testicular sperm group, resulted in clinical abortions in the first trimester. Of the remaining six pregnancies, two have already resulted in healthy births and four pregnancies are now in the second or third trimester in the testicular sperm group. Using testicular spermatozoa in combination with ICSI can be an alternative mode of treatment in cases with totally or initially immotile spermatozoa in the ejaculate. Very low pregnancy rates have been obtained and no ongoing pregnancy has been achieved using ejaculated spermatozoa in these cases.