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A Different Result of Minor Head Trauma; Aggressive Periosteal Reaction
(Galenos Publishing House, 2025) Altunrende, Muhittin Emre; Ekin, Elif Evrim; Kımıloğlu, Elife
While the literature reports cases of calvarial lytic lesion, the association with aggressive periosteal reaction is rare. There are various opinions about the mechanics and treatment of these lesions. This article discusses a case of periosteal reaction, which caused a calvarial lytic lesion after minor head trauma, within the framework of existing literature. © 2025 The Author.
Amantadine’s Neuroprotective Effects in Rabbit Spinal Cord Ischemia/Reperfusion Model
(Turkish Neurosurgical Society, 2024) Ünlüler, Caner; Kuru Bektaşoğlu, Pınar; Ergüder, Berrin İmge; Arıok, Ata Türker; Ermutlu, İlçim; Gürer, Bora; Kertmen, Hayri
AIM: To examine the effects of amantadine, a drug with neuroprotective and anti-inflammatory activities on oxidative stress, tissue necrosis, apoptosis, and neurological recovery in an experimental rabbit spinal cord ischemia-reperfusion injury (SCIRI) model. MATERIAL and METHODS: A total of 32 rabbits were randomized into five groups: control, ischemia, vehicle, methylprednisolone (MP), and amantadine (AMT) (n=8/each). At 24th-hour neurological examination was performed, spinal cord tissues were collected, and biochemical and histopathological examinations were performed. RESULTS: When ischemia and vehicle groups were compared with control group, significant increase was seen in serum and tissue caspase-3, malondialdehyde (MDA), and myeloperoxidase (MPO) levels (p<0.001); significant decrease was seen in serum and tissue catalase (CAT) levels (p<0.001); and significant increase was seen in serum xanthine oxidase (XO) levels (p<0.001). When the ischemia group and the MP and AMT groups were compared, low serum and tissue caspase-3 levels (p<0.001), high serum and tissue CAT levels (p<0.001), significantly low serum XO levels (p<0.001), low serum and tissue MDA levels (p<0.05) and tissue MPO levels (p<0.001) were found. Both AMT and MP groups showed decreased histopathological score and higher number of normal neurons (p<0.001) compared to ischemia group. Both AMT and MP showed better modified Tarlov scores compared to the ischemia group (p<0.001). CONCLUSION: Our study found that AMT had antioxidant, anti-inflammatory, anti-apoptotic, and neuroprotective effects on SCIRI. We used biochemical, microscopic, and ultrastructural approaches to demonstrate these effects. AMT might be a candidate medication for SCIRI prophylaxis and treatment. © (2024), (Turkish Neurosurgical Society). All rights reserved.
Artificial intelligence in reproductive endocrinology: an in-depth longitudinal analysis of ChatGPTv4’s month-by-month interpretation and adherence to clinical guidelines for diminished ovarian reserve
(Springer, 2024) Gürbüz, Tuğba; Gökmen, Oya; Devranoğlu, Belgin; Madenli, Asena Ayar
Objective: To quantitatively assess the performance of ChatGPTv4, an Artificial Intelligence Language Model, in adhering to clinical guidelines for Diminished Ovarian Reserve (DOR) over two months, evaluating the model’s consistency in providing guideline-based responses. Design: A longitudinal study design was employed to evaluate ChatGPTv4’s response accuracy and completeness using a structured questionnaire at baseline and at a two-month follow-up. Setting: ChatGPTv4 was tasked with interpreting DOR questionnaires based on standardized clinical guidelines. Participants: The study did not involve human participants; the questionnaire was exclusively administered to the ChatGPT model to generate responses about DOR. Methods: A guideline-based questionnaire with 176 open-ended, 166 multiple-choice, and 153 true/false questions were deployed to rigorously assess ChatGPTv4’s ability to provide accurate medical advice aligned with current DOR clinical guidelines. AI-generated responses were rated on a 6-point Likert scale for accuracy and a 3-point scale for completeness. The two-phase design assessed the stability and consistency of AI-generated answers over two months. Results: ChatGPTv4 achieved near-perfect scores across all question types, with true/false questions consistently answered with 100% accuracy. In multiple-choice queries, accuracy improved from 98.2 to 100% at the two-month follow-up. Open-ended question responses exhibited significant positive enhancements, with accuracy scores increasing from an average of 5.38 ± 0.71 to 5.74 ± 0.51 (max: 6.0) and completeness scores from 2.57 ± 0.52 to 2.85 ± 0.36 (max: 3.0). It underscored the improvements as significant (p < 0.001), with positive correlations between initial and follow-up accuracy (r = 0.597) and completeness (r = 0.381) scores. Limitations: The study was limited by the reliance on a controlled, albeit simulated, setting that may not perfectly mirror real-world clinical interactions. Conclusion: ChatGPTv4 demonstrated exceptional and improving accuracy and completeness in handling DOR-related guideline queries over the studied period. These findings highlight ChatGPTv4’s potential as a reliable, adaptable AI tool in reproductive endocrinology, capable of augmenting clinical decision-making and guideline development. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024.
Assessment of in vitro dynamics of pathogenic environmental Acanthamoeba T4 and T9 genotypes isolated from three recreational lakes in Klang Valley, Malaysia over the HaCaT cell monolayer
(IWA Publishing, 2024) Halim, Rohaya Abdul; Halim, Hasseri; Hussain, Rosnani Hanim Mohd; Aazmi, Shafiq; Khan, Naveed Ahmed; Siddiqui, Ruqaiyyah; Anuar, Tengku Shahrul
Free-living amoebae of the genus Acanthamoeba are causative agents of keratitis and amoebic encephalitis. They are widely found in various ecological environments. Therefore, the present study brings results that can help to better understand the genotypes of the environmental isolates and their pathogenicity. This study procured 26 Acanthamoeba isolates from three recreational lakes in 2022. Polymerase chain reaction amplification was performed on positive Acanthamoeba samples. The thermotolerance, osmotolerance, and cytopathogenicity in human keratinocyte (HaCaT) cells of the samples were also evaluated. The phylogenetic analysis demonstrated that 12 isolates were of genotype T4, two (T9), six (T17), four (T8), and one each from T5 and T11. The thermo- and osmotolerance assays indicated that eight Acanthamoeba samples were potentially pathogenic. Two T4 and one T9 genotype also recorded 33-, 42-, and 133-kDa serine-type proteases, respectively. The HaCaT cell monolayer revealed that three T4 and one T9 samples achieved cytopathic effects within the 50–100% range, hence significantly cytotoxic. The lactate dehydrogenase secretion results demonstrated that three (T4) and one (T9) sample exhibited exceptional toxicity (over 40%) compared to the other samples. The responses of Acanthamoeba members with similar genotypes to pathogenicity indicator assays varied considerably, rendering correlation of pathogenicity with specific genotypes challenging. © 2024 The Authors.
A rare case of multiple gastric duplication cysts in an adult
(Erkan Mor, 09.10.2024) Zulfikaroglu, Baris; Akgul, Ozgur; Ozmen, Mehmet Mahir
Intestinal duplications are rare developmental anomalies that can occur anywhere along the gastrointestinal tract. Gastric duplication cysts are uncommon congenital anomalies and are rarely diagnosed in adults. However, diagnosis of the condition in an adult can be difficult as it is usually asymptomatic, or the symptoms are nonspecific. Here we report a rare case of symptomatic gastric duplication cysts in an adult who was treated successfully with surgical resection.
Continuous Renal Replacement Therapy (CRRT) Protocol in Critically Ill Children
(Galenos Yayınevi, 24.09.2024) Koker, Alper; Yaman, Ayhan; Akkuzu, Emine; Duyu, Muhterem; Akcay, Nıhal; Dalkıran, Tahir; Besci, Tolga
Amaç: Çocuk yoğun bakım ünitelerinde sürekli renal replasman tedavisi (SRRT), şiddetli akut böbrek hasarının tedavisi ve/veya sıvı dengesi, asitbaz ve metabolik düzensizlikte sıklıkla kullanılmaktadır. Bu tedavinin uygulamasında; kateter seçiminden, kullanılan antikoagülasyon yöntemine kadar çeşitli teknik zorluklarla karşılaşılmakta ve komplikasyonlar görülebilmektedir. Bu çalışmayı yapmaktaki amacımız, SRRT endikasyonları ve komplikasyonlarını değerlendirmek, kullanılan iki farklı antikoagülasyon yöntemini karşılaştırarak deneyimlerimizi paylaşmaktır. Gereç ve Yöntem: Bu çalışmada, bir üniversite hastanesinin 3.basamak çocuk yoğun bakım ünitesinde (ÇYBÜ) Ekim 2020 ile Eylül 2021 tarihleri arasında Sürekli Renal Replasman Tedavisi uygulanan hastaların verileri geriye dönük olarak değerlendirildi. Bulgular: Hastaların ortanca yaşı 120 ay (2-204) ve 16’sı kızdı (%47,1). Sürekli renal replasman tedavisi uygulanan 22 (%64,7) hastada bölgesel sitrat antikoagülasyonu, 12 (%35,3) hastada ise heparin antikoagülan kullanıldı. SRRT endikasyonları sırasıyla, akut böbrek yetmezliği (11, %32,4), sıvı yüklenmesi (9, %26,5), metabolik asidoz /elektrolit bozukluğu (7, %20,6), tümör yıkım sendromu (5, %14,7), hiperamonyemi (1, %2,9), intoksikasyon (1, %2.9) idi. Sitrat kullanılan grupta filtre tipinden bağımsız devre ömrü ortalama 50,1±22 saat iken heparin grubunda bu süre ortalama 28,5±16,6 saat olarak bulundu (p=0,01). Serum kalsiyum düzeyi sitrat grubunda heparin grubuna göre anlamlı olarak daha yüksek tespit edildi (p=0,005). Sonuç: Bölgesel sitrat antikoagülasyon kullanımı filtre ömrünü uzatmaktadır. Bu durumun karşılaşılabilecek teknik problemleri ve iş yükünü azalttığını, maliyete belirgin katkı sağladığını düşünmekteyiz.
The effect of the distance between mesh and the urethra on sexual function in patients who underwent transobturator tape
(Galenos Yayınevi, 25.11.2024) Sahin, Fatih; Doğan, Ozan
Objective: To evaluate the effect of mesh-urethra distance on sexual function in continent patients who underwent transobturator tape (TOT) surgery due to isolated stress urinary incontinence (SUI). Material and Methods: Continent patients who had undergone TOT surgery for SUI were eligible. Objective treatment for SUI was defined as the absence of urine leakage during a stress test. Translabial perineal ultrasound was performed six months after surgery. The successful surgical group was split into two subgroups based on the distance from the posterior of the urethra at the bladder neck to the nearest proximal edge of the tape: <5 mm and >5 mm. In addition to these, band percentile, the descent of bladder neck and urethra length measured by perineal ultrasound, pubo-urethral distance, urethral thickness, detrusor thickness, cystocele descent, rectal descent, and uterine descent were evaluated. Preoperative and postoperative results of the standardized and internationally valid incontinence questionnaires Incontinence Questionnaire Urinary Incontinence Short Form and Female Sexual Function Index (FSFI) were compared between groups. Results: Eighty-two patients were included. The postoperative FSFI scores for the >5 mm group were significantly lower than those of the <5 mm group, including the postoperative FSFI average, all subscales except lubrication, and average change scores due to the operation (p<0.001). There was no statistically significant relationship between the percentile occupied and postoperative FSFI score (p=0.553), and the FSFI preoperative-postoperative difference was not significant (p=0.905). Conclusion: Sexual functions are more affected in patients with a mesh-urethra distance >5 mm as measured by perineal ultrasound. (J Turk Ger Gynecol Assoc. 2024; 25: 124-31)
DERM12345: A Large, Multisource Dermatoscopic Skin Lesion Dataset with 40 Subclasses
(Nature Research, 2024) Yılmaz, Abdurrahim; Yaşar, Şirin Pekcan; Gençoglan, Gülsüm; Temelkuran, Burak
Skin lesion datasets provide essential information for understanding various skin conditions and developing effective diagnostic tools. They aid the artificial intelligence-based early detection of skin cancer, facilitate treatment planning, and contribute to medical education and research. Published large datasets have partially coverage the subclassifications of the skin lesions. This limitation highlights the need for more expansive and varied datasets to reduce false predictions and help improve the failure analysis for skin lesions. This study presents a diverse dataset comprising 12,345 dermatoscopic images with 40 subclasses of skin lesions, collected in Turkiye, which comprises different skin types in the transition zone between Europe and Asia. Each subgroup contains high-resolution images and expert annotations, providing a strong and reliable basis for future research. The detailed analysis of each subgroup provided in this study facilitates targeted research endeavors and enhances the depth of understanding regarding the skin lesions. This dataset distinguishes itself through a diverse structure with its 5 super classes, 15 main classes, 40 subclasses and 12,345 high-resolution dermatoscopic images. © The Author(s) 2024.
Comparison of the Effects of Anaesthesia Methods Used in Caesarean Delivery on Neonatal Cerebral and Renal Oxygenation: A Randomised Controlled Trial
(Multidisciplinary Digital Publishing Institute (MDPI), 2024) Arslan, Ülkü; Kavrut Öztürk, Nilgün; Kavaklı, Ali Sait; Dağdelen, Hatice Özge
Background: During a newborn’s adaptation to extrauterine life, many changes take place that are influenced by various factors. The type of delivery and anaesthesia strategy utilised during labour can modify these adaptive modifications. In this regard, this study was designed to compare the effects of general and spinal anaesthesia on cerebral and renal oxygenation after elective caesarean deliveries. Methods: This randomised controlled study comprised sixty parturient women who were over 18 years old and had a gestational age between 37 and 41 weeks. All participants had an ASA (American Society of Anesthesiologists) classification of II. Neonatal cerebral (CrSO2) and renal (RrSO2) regional oxygen saturations were assessed using near-infrared spectroscopy. Additionally, the 1st–5th min Apgar scores, preductal and postductal peripheral oxygen saturation (SpO2), and perfusion index were recorded in both the general anaesthesia and spinal anaesthesia groups. Results: There was no statistically significant difference between the two groups in terms of CrSO2 or RrSO2 values. The values of CrSO2 and RrSO2 in both groups showed a significant rise from the 10th to the 15th min, respectively. Conclusions: General and spinal anaesthesia techniques used for cesarean delivery have similar effects on neonatal cerebral and renal oxygenation. © 2024 by the authors.
The effect of ultrasound-guided erector spinae plane block on postoperative opioid consumption and respiratory recovery in laparoscopic sleeve gastrectomy: a randomized controlled study
(Springer, 2024) Karaveli, Arzu; Kaplan, Serdar; Kavaklı, Ali Sait; Koşar, Mehmet Nuri; Mayir, Burhan
Background The aim of this prospective, randomized, controlled study was to evaluate the effect of ultrasound (US)-guided bilateral erector spinae plane (ESP) block on postoperative opioid consumption and respiratory recovery in patients with obesity undergoing laparoscopic sleeve gastrectomy (LSG). Methods The study was conducted on 40 patients scheduled for LSG. The patients were randomly allocated into either the ESP block group or the control group. The US-guided bilateral ESP block was performed preoperatively. The control group received no intervention. Results Postoperative median [IQR] tramadol consumption was significantly lower in the ESP block group [150.0 [100-200] mg vs 450.0 [400-500] mg, p < 0.0001]. Postoperative spirometric variables were significantly impaired in both groups, compared with preoperative variables (p < 0.0001). Intraoperative median [IQR] fentanyl consumption was 200.0 [200-200] mu g in the ESP block group, and 350.0 [300-400] mu g in the control group (p < 0.0001). Postoperative mean pain scores at rest and during movement were significantly lower in the ESP block group, at all time points (p < 0.05). In terms of mean arterial PH, Horowitz ratio, and PaCO2, there was no statistically significant difference between the groups (p > 0.05). None of the patients experienced postoperative respiratory adverse events and/or block-related complications. Conclusions US-guided bilateral ESP block significantly reduced both intraoperative and postoperative analgesic consumptions and provided effective postoperative pain control for patients with obesity undergoing bariatric surgery. Following bariatric surgery, all patients' postoperative pulmonary functions deteriorated. The effect of US-guided bilateral ESP block on postoperative respiratory recovery could not be clearly demonstrated. Randomized controlled studies with a larger patient population are necessary.
Machine Learning May Be an Alternative to BIPSS in the Differential Diagnosis of ACTH-dependent Cushing Syndrome
(Endocrine Society, 2025) Demir, Ahmet Numan; Ayata, Değer; Öz, Ahmet; Sulu, Cem; Kara, Zehra; Şahin, Serdar; Özaydın, Dilan; Korkmazer, Bora; Arslan, Serdar; Kızılkılıç, Osman; Çiftçi, Sema; Çelik, Özlem; Özkaya, Hande Mefkure; Tanrıöver, Necmettin; Gazioğlu, Nurperi; Kadıoğlu, Pınar
Context: Artificial intelligence research in the field of neuroendocrinology has accelerated. It is possible to develop noninvasive, easy-to-use and cost-effective procedures that can replace invasive procedures for the differential diagnosis of adrenocorticotropin (ACTH)-dependent Cushing syndrome (CS) by artificial intelligence. Objective: This study aimed to develop machine-learning (ML) algorithms for the differential diagnosis of ACTH-dependent CS based on biochemical and radiological features. Methods: Logistic regression algorithms were used for ML, and the area under the receiver operating characteristics curve was used to measure performance. We used Shapley contributed comments (SHAP) values, which help explain the results of the ML models to identify the meaning of each feature and facilitate interpretation. Results: A total of 106 patients, 80 with Cushing disease (CD) and 26 with ectopic ACTH syndrome (EAS), were enrolled in the study. The ML task was created to classify patients with ACTH-dependent CS into CD and EAS. The average AUROC value obtained in the cross-validation of the logistic regression model created for the classification task was 0.850. The diagnostic accuracy of the algorithm was 86%. The SHAP values indicated that the most important determinants for the model were the 2-day 2-mg dexamethasone suppression test, greater than 50% suppression in the 8-mg high-dose dexamethasone test, late-night salivary cortisol, and the diameter of the pituitary adenoma. We have also made our algorithm available to all clinicians via a user-friendly interface. Conclusion: ML algorithms have the potential to serve as an alternative decision-support tool to invasive procedures in the differential diagnosis of ACTH-dependent CS. © The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved
Efficacy of omentopexy on complications of laparoscopic sleeve gastrectomy
(Springer, 2024) Kara, Yalçın Burak; Özel, Yahya; Yardımcı, Samet
Background Laparoscopic sleeve gastrectomy (LSG) is a commonly performed type of bariatric surgery. Early complications of LSG include bleeding, leakage, pulmonary embolism, and surgical site infections. Most surgeons try to implement preventive methods, such as omentopexy. Staple line-imbrication, which has a difficult learning curve, often prevents complications. This study aimed to evaluate the effect of omentopexy on patients with imbricated LSG.Material and Methods The study applied a retrospective data analysis design to patients who underwent LSG between 2020 and 2023. All patients' staple lines were imbricated, and patients were then divided into two groups: omentopexy group and control group. Patients' demographic features, such as age, gender, height, weight, body mass index(BMI), bleeding, leakage, and reoperations, were recorded and examined retrospectively.Results A total of 1356 patients were included in the study (540 in omentopexy, 816 in control), of which the mean age was 37.9 +/- 10.5 years, 82.3% were women, and mean BMI was 40.9 +/- 5.8 kg/m2. The mean bleeding rate was 1.0% (1.3-0.7%), the mean leakage rate was 0.2% (0.2-0.2%, respectively), and the mean reoperation rate was 0.6% (0.7% and 0.5%, respectively). No statistically significant differences were observed.Conclusion Omentopexy is a technique that is widely used to prevent staple line complications. According to our study, omentopexy applied to an imbricated stapler line increased the operation time but did not affect bleeding or leakage ratios. This is the first study to evaluate the effect of omentopexy on imbricated staple lines. The findings of the study indicate that omentopexy has no additional benefit on early complications when using staple-line imbrication.
Emerging therapies against Naegleria fowleri
(Taylor & francis ltd, 2024) Siddiqui, Ruqaiyyah; Lloyd, David; Alharbi, Ahmad M.; Khan, Naveed Ahmed
Introduction Naegleria fowleri is a free-living protist pathogen. Given the opportunity, it can produce infection of the central nervous system. It is distressing that the brain-eating amoebae, Naegleria fowleri remains one of the lethal parasites resulting almost always in death, despite advances in antimicrobial chemotherapy and supportive care. Areas covered The overall aim is to present a timely review of our current understanding of emerging therapies and priorities. By searching bibliographic databases (PubMed) for the available peer-reviewed research literature, herein, we discuss current advances, challenges and opportunities pertinent in the development of therapeutic interventions. Expert opinion The prospect of exploring repurposed drugs in combination with nanotechnology and a theranostic approach to concurrently achieve diagnosis and drug delivery will offer promise in the rational development of effective therapies to counter N. folweri-associated fatal brain infections.
Evaluation of the effect of morphological structure on dilatational tracheostomy interference location and complications with ultrasonography and fiberoptic bronchoscopy
(MDPI, 2024) Bulut, Esin; Yıldız, Ülkü Arslan; Cengiz, Melike; Yılmaz, Murat; Kavaklı, Ali Sait; Arıcı, Ayşe Gülbin; Öztürk, Nihal
Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly performed minimally invasive intensive care unit procedure worldwide. Methods: This study evaluated the percentage of consistency between the entry site observed with fiberoptic bronchoscopy (FOB) and the prediction for the PDT level based on pre-procedural ultrasonography (USG) in PDT procedures performed using the forceps dilatation method. The effect of morphological features on intervention sites was also investigated. Complications that occurred during and after the procedure, as well as the duration, site, and quantity of the procedures, were recorded. Results: Data obtained from a total of 91 patients were analyzed. In 57 patients (62.6%), the USG-estimated tracheal puncture level was consistent with the intercartilaginous space observed by FOB, while in 34 patients (37.4%), there was a discrepancy between these two methods. According to Bland Altman, the agreement between the tracheal spaces determined by USG and FOB was close. Regression formulas for PDT procedures defining the intercartilaginous puncture level based on morphologic measurements of the patients were created. The most common complication related to PDT was cartilage fracture (17.6%), which was proven to be predicted with maximum relevance by punctured tracheal level, neck extension limitation, and procedure duration. Conclusions: In PDT procedures using the forceps dilatation method, the prediction of the PDT intervention level based on pre-procedural USG was considerably in accordance with the entry site observed by FOB. The intercartilaginous puncture level could be estimated based on morphological measurements.
Evaluating YouTube Videos With Prophylactic Mastectomy Content in Terms of Their Quality and Reliability
(2025) Altıntaş, Tansu; Bilgi Kırmacı, Mehlika
Aim: Purpose of this study is to investigate the quality and reliability of YouTube video contents on prophylactic mastectomy. Material and Methods: The search terms "prophylactic mastectomy," "prophylactic mastectomy surgery," "preventive surgery for breast cancer," "risk-reducing mastectomy," and "prophylactic mastectomy and breast reconstruction" were searched on YouTube. The uploader, video content, length (seconds), upload date, number of days since upload date, number of views, number of comments, and likes were recorded and evaluated. Finally, the videos included in the study were evaluated using modified Quality Criteria for Consumer Health Information (DISCERN) and Global Quality Scale (GQS). Results: The total number of views of the 50 videos reviewed in the study was found as 3.674.469. The mean DISCERN score of the two observers was calculated as 3.35 ± 1, and the videos were found to be of medium reliability. The mean GQS score of all videos was 3.39 ± 0.9 and the videos were of medium quality. The researchers gave 1-2 points (misleading) to 7 (14%) videos, 3 points (somewhat helpful) to 20 (40%) videos, 4 points (beneficial) to 16 (32%) videos, and 5 points (excellent) to 7 (14%) videos. Conclusion: In our study, we found that the videos uploaded by doctors were of good quality, the videos uploaded by health channels were of medium quality, and the videos uploaded by patients were of poor quality and misleading. The videos with health contents should be evaluated by the relevant specialists, and only useful videos should be broadcast. Copyright © 2025 Tansu Altintas and Mehlika Bilgi Kirmaci. The Breast Journal published by John Wiley & Sons Ltd.
External Auditory Canal Transillumination-Guided Middle Fossa Approaches: An Anatomical Feasibility Study
(Lippincott Williams and Wilkins, 2025) Şahin, Mustafa; Güngör, Abuzer; Doǧruel, Yücel; Luzzi, Sabino; Yılmaz, Adem; Türe, Uğur
BACKGROUND AND OBJECTIVES: The middle fossa approaches are tremendously versatile for treating small vestibular schwannomas, selected petroclival meningiomas, midbasilar trunk aneurysms, and lesions of the petrous bone. Our aim was to localize the internal acoustic canal and safely drill the petrous apex with these approaches. This study demonstrates a new method to locate the internal acoustic canal during surgery in the middle fossa. METHODS: The microsurgical anatomy of the middle fossa floor was studied in 11 formalin-fixed and silicone-injected cadaveric heads. Extradural dissection of the skull base was completed from the posterior to the anterior side. A zero-degree rigid endoscope was inserted perpendicularly into the external auditory canal. The light beam was first directed through the tympanic membrane, avoiding injury to the tympanic membrane. The room lights were dimmed to provide a clearer view of the transilluminated bony area. Drilling was performed with transillumination guidance. RESULTS: The transilluminated area included the tympanic and mastoid tegmen up to the arcuate eminence. The nonilluminated area was bounded posteriorly by the arcuate eminence, laterally by the greater superficial petrosal nerve, and posteromedially by the petrous ridge. In all specimens, drilling the transition line between the Kawase triangle and the transilluminated area unroofed the internal auditory canal (IAC). No transillumination of the carotid canal was seen after anterior petrosectomy in any of the specimens. The entire contents of the IAC were preserved in both anterior petrosectomy and unroofing of the IAC. CONCLUSION: In this anatomical study, transillumination of the external auditory canal proved to be feasible, accurate, and safe in guiding the middle fossa approaches. The ease of implementation and cost-effectiveness of the technique may suggest a possible application in operative scenarios. © Congress of Neurological Surgeons 2025. All rights reserved.
Medical management of chronic subdural hematoma with low-dose hydrocortisone: a case series
(Springer Science and Business Media Deutschland GmbH, 2024) Gürses, Muhammet Enes; Ülgen, Meriç; Gökalp, Elif; Gecici, Neslihan Nisa; Güngör, Abuzer; Türe, Hatice; Türe, Uğur
Chronic subdural hematomas (cSDH) are often managed with a burr-hole craniostomy and drainage, but surgery is associated with elevated mortality, morbidity, and recurrence. Despite reports of steroid use for such patients, its efficacy and feasibility are still debated. We present our patient series treated with low-dose hydrocortisone. We retrospectively reviewed data from patients treated with hydrocortisone between 2017 and 2023. Demographics, clinical and radiological data were collected. Of 27 patients identified, nine required a burr-hole craniotomy for an average volume of 120.23 cm3, average midline shift of 9 mm, and neurological deficits. Eighteen met the criteria for inclusion. The mean age was 78.5 years; 13 were male. None had severe symptoms requiring urgent intervention. Except for one with a Karnofsky Performance Scale score of 70, all could maintain normal activity before treatment. The mean baseline volume was 52.6 cm3. Midline shift, present in six, averaged 6.8 mm. Patients underwent treatment for an average of 5.15 months. Nine had complete resolution within 3 months, while nine required longer treatment, including one who needed 9 months for a re-bleed after a fall. Paired t-tests indicated significant reductions in hematoma volumes at the second week (p = 0.01), first month (p < 0.0001), and third month (p < 0.0001) of treatment. No complications occurred and the post-treatment Karnofsky scores ranged from 90 to 100. Treatment for cSDH should be tailored to the patient. Low-dose hydrocortisone is safe and effective in asymptomatic patients, those with mild to moderate symptoms, and those who are either unsuitable for or decline surgical intervention. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.
Prostate tissue ablation and drug delivery by an image-guided injectable ionic liquid in ex vivo and in vivo models
(American association advancement science, 2024) Demirlenk, Yusuf M.; Albadawi, Hassan; Zhang, Zefu; Atar, Dila; Çevik, Enes; Keum, Hyeongseop; Kim, Jinjoo; Rehman, Suliman; Gündüz, Şeyda; Graf, Erin; Mayer, Joseph L.; Dos Santos, Pedro R.; Oklu, Rahmi
Benign prostatic hyperplasia and prostate cancer are often associated with lower urinary tract symptoms, which can severely affect patient quality of life. To address this challenge, we developed and optimized an injectable compound, prostate ablation and drug delivery agent (PADA), for percutaneous prostate tissue ablation and concurrently delivered therapeutic agents. PADA is an ionic liquid composed of choline and geranic acid mixed with anticancer therapeutics and a contrast agent. The PADA formulation was optimized for mechanical properties compatible with hand injection, diffusion capability, cytotoxicity against prostate cells, and visibility of an x-ray contrast agent. PADA also exhibited antibacterial properties against highly resistant clinically isolated bacteria in vitro. Ultrasound-guided injection, dispersion of PADA in the tissue, and tissue ablation were tested ex vivo in healthy porcine, canine, and human prostates and in freshly resected human tumors. In vivo testing was conducted in a murine subcutaneous tumor model and in the canine prostate. In all models, PADA decreased the number of viable cells in the region of dispersion and supported the delivery of nivolumab throughout a portion of the tissue. In canine survival experiments, there were no adverse events and no impact on urination. The injection approach was easy to perform under ultrasound guidance and produced a localized effect with a favorable safety profile. These findings suggest that PADA is a promising therapeutic prostate ablation strategy to treat lower urinary tract symptoms.
Can We Predict Gastric Leaks after Laparoscopic Sleeve Gastrectomy by Evaluating the Complete Blood Count on Postoperative Day 1?
(Lippincott Williams and Wilkins, 2024) Seyit, Hakan; Gökçal, Fahri; Alış, Halil
Introduction: We assessed whether postoperative day-1 (POD-1) complete blood count (CBC) test parameters, including red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit (PCT), platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), could identify patients with gastric leaks after laparoscopic sleeve gastrectomy (LSG). Methods: Patients with postoperative gastric leaks (n=36) and patients with no complications who were selected by age-sex-BMI matching (n=254) were included in the study. The levels of RDW, MPW, PCT, PLR, and NLR were compared between groups in univariate analyses. Receiver operating characteristic (ROC) curve analysis was run for CBC parameters with a P-value<0.05 in univariate analyses. The area under the curve (AUC) was evaluated, and a cutoff value was determined. Sensitivity, specificity, likelihood ratio (LR), positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: The level of PCT was significantly lower, while levels of PLR and NLR were significantly higher in patients with postoperative gastric leaks as compared with those without (P<0.05). The AUC of both PCT and PLR was <0.750, while the AUC of NLR was 0.911. NLR cutoff at 3.6 yielded 80% sensitivity, 92% specificity, and an LR of 10. In the study cohort, PPV of 59%, NPV of 97%, and an accuracy of 90% were found. Conclusions: Our results suggest that NLR at POD-1, with a cutoff value of 3.6, is a useful indicator of postoperative gastric leak who underwent LSG. We recommend the use of this easily calculated parameter in clinical practice. © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Human adapted prosomeric model: a future for brainstem tumor classification
(Elsevier, 2024) Munoz-Gualan, Alberth Patricio; Güngör, Abuzer; Cezayirli, Phillip Cem; Rahmanov, Serdar; Gürses, Muhammet Enes; Puelles, Luis; Türe, Uğur
This study reevaluates the conventional understanding of midbrain anatomy and neuroanatomical nomenclature in the context of recent genetic and anatomical discoveries. The authors assert that the midbrain should be viewed as an integral part of the forebrain due to shared genetic determinants and evolutionary lineage. The isthmo-mesencephalic boundary is recognized as a significant organizer for both the caudal midbrain and the isthmo-cerebellar area. The article adopts the prosomeric model, redefining the whole brain as neuromeres, offering a more precise depiction of brain development, including processes like proliferation, neurogenesis, cell migration, and differentiation. This shift in understanding challenges traditional definitions of the midbrain based on external brain morphology. The study also delves into the historical context of neuroanatomical models, including the columnar model proposed by Herrick in 1910, which has influenced our understanding of brain structure. Furthermore, the study has clinical implications, affecting neuroanatomy, neurodevelopmental studies, and the diagnosis and treatment of brain disorders. It emphasizes the need to integrate molecular research into human neuroanatomical studies and advocates for updating neuroanatomical terminology to reflect modern genetic and molecular insights. The authors propose two key revisions. First, we suggest reclassifying the isthmo-cerebellar prepontine region as part of the hindbrain, due to its role in cerebellar development and distinct location caudal to the genetically-defined midbrain. Second, we recommend redefining the anterior boundary of the genetically-defined midbrain to align with genetic markers. In conclusion, the authors highlight the importance of harmonizing neuroanatomical nomenclature with current scientific knowledge, promoting a more precise and informed understanding of brain structure, which is crucial for both research and clinical applications related to the human brain.

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