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Digital subtraction angiography (DSA) is the best method of evaluating carotid cavernous fistulas (CCF). DSA, however, has the disadvantage of being an invasive procedure. Computerized tomography (CT) angiography which is noninvasive, have been shown to provide more information about the size and location of fistulas. As a new method, Bone-Subtraction CT Angiography (BSCTA), than conventional CT angiography, is a method that improves the detection and interpretation of vascular lesions near to the cavernous segment of carotid artery. In this case report, we report a case of a dural carotico-cavernous fistula (CCF), appearances of pre and postembolization BSCTA images, confirmed by on DSA. As far as we know, CCF demonstrated by BSCTA has not been reported yet.

Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. The most common forms of systemic amyloidosis are primary amyloidosis (PA) of light chains and secondary amyloidosis (SA) caused by chronic inflammatory diseases such as rheumatoid arthritis (RA). Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. In SA, the deposition of amyloid associated (AA) protein is associated with atrophy of thyroid follicles. The clinical picture of these patients is characterized by rapid, painless thyroid gland enlargement which may be associated with dysphagia, dyspnea, or hoarseness. Thyroid function is not impaired in most cases. Although amyloid goitre secondary to systemic amyloidosis due to chronic inflammatory diseases is relatively common, specifically related to RA is much more uncommon one and it is reported less in the literature. In this report, A 52-old-year female patient with amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis is presented.

Purpose of Review: The article reviews the current evidence and the role of elective Cesarean section in the prevention of pelvic floor disorders (PFDs)., Recent Findings: Recent studies have revealed that operative vaginal delivery is an important risk factor for PFDs. The cause of PFD is multifactorial. Pregnancy itself also increases the PFDs. Elective Cesarean section carries diminished risk for stress urinary incontinence. Pelvic floor muscle training should be offered to all women in their first pregnancy as a preventive strategy., Summary: The health provider should not offer elective Cesarean section to a pregnant woman without any prior risk of pelvic organ disorder for the prevention of urinary stress incontinence, anal incontinence, or pelvic organ prolapsus weighing the risks of Cesarean section.

Purpose: The current study investigated the potential therapeutic efficiency of atosiban, an oxytocin receptor antagonist, in an experimental endometriosis model., Methods: Endometriosis was surgically induced in 35 female rats during estrus. Four weeks after this procedure, relaparotomy was performed. The viability and dimensions of the endometriosis foci were recorded. Rats were then randomly divided into three groups. In the first group (n = 8), a daily dose of 0.2 ml 0.9 % NaCl was injected intraperitoneally (i.p.) (control cases). In the second and third groups (n = 8 and n = 8), 0.5 mg/kg/day i.p. atosiban and 1 mg/day i.p. diltiazem were given, respectively. At the end of the treatment, laparotomy was performed, and the dimensions of the endometriosis foci were recorded. The endometrial implants were processed for histological and immunohistochemical studies. The volumes of endometriotic implants were measured, and immunohistochemical analyses were performed, and compared between the groups., Results: After the treatment with atosiban, volumes of endometriotic implants decreased significantly. Proliferating cell nuclear antigen expression levels were significantly reduced in the atosiban and diltiazem groups compared with the control group., Conclusions: In a rat endometriosis model, atosiban, an agent used for the first time for the medical treatment of endometriosis, has shown significant therapeutic efficiency.

The aim of this study was to evaluate the influence of different surface treatments (air abrasion, acid etching, laser irradiation) on the surface roughness of a lithium-disilicate-based core ceramic. A total of 40 discs of lithium disilicate-based core ceramic (IPS Empress 2; Ivoclar Vivadent, Schaan, Liechtenstein) were prepared (10 mm in diameter and 1 mm in thickness) according to the manufacturer's instructions. Specimens were divided into four groups (n = 10), and the following treatments were applied: air abrasion with alumina particles (50 μm), acid etching with 5% hydrofluoric acid, Nd:YAG laser irradiation (1 mm distance, 100 mJ, 20 Hz, 2 W) and Er:YAG laser irradiation (1 mm distance, 500 mJ, 20 Hz, 10 W). Following determination of surface roughness (R(a)) by profilometry, specimens were examined with atomic force microscopy. The data were analysed by one-way analysis of variance (ANOVA) and Tukey HSD test (α = 0.05). One-way ANOVA indicated that surface roughness following air abrasion was significantly different from the surface roughness following laser irradiation and acid etching (P < 0.001). The Tukey HSD test indicated that the air abrasion group had a significantly higher mean value of roughness (P < 0.05) than the other groups. No significant difference was found between the acid etching and laser irradiation (both Er:YAG and Nd:YAG) groups (P > 0.05). Air abrasion increased surface roughness of lithium disilicate-based core ceramic surfaces more effectively than acid-etching and laser irradiation.

Background and Purpose: An analysis of the current nuclear medicine (NM) status and future demand in Turkey in line with the international benchmarks was conducted to establish a comprehensive baseline reference., Methods: Data from all NM centers on major equipment and manpower in Turkey were collected through a survey and cross-checked with the primary research and governmental data. Data regarding manpower currently working were obtained from the relevant academic centers and occupational societies., Results: The current numbers of NM laboratories, NM specialists, gamma cameras, PET/CT scanners, radioiodine treatment units for thyroid cancer are 217, 474, 287, 75 and 39, respectively. There was personnel and equipment need underestimated in the field compared to developed countries. Equipment insufficiency was more significant in the Ministry of Health (MoH) hospitals. These gaps should be eliminated with strategic planning of equipment and NM laboratories. Currently, the number of the PET/CT devices is at the level of the developed countries. The number of specialists in the field should reach the expected goal in 2023. By 2023, Turkey will need around 820 NM specialists, 498 gamma cameras and 99 PET/CT devices. In addition, further studies should be made regarding other related staff, particularly for health physicians, radiopharmacists and NM technicians., Conclusion: There is an insufficiency of personnel and equipment in Turkey's NM field. Comprehensive strategic planning is required to allocate limited resources and the purchase of the equipment and employment policies should be structured as part of " National Special Feature Requiring Health Service Plan".

Objective: Diagnosis of prelabour rupture of membranes (PROM) may be challenging. Conventional diagnostic methods such as speculum examination, ferning pattern, and pH detection are not satisfactorily accurate. Two relatively new, commercially available rapid bedside immunoassay strip tests, for placental alpha microglobulin-1 (PAMG-1) and insulin-like growth factor binding protein-1 (ILGFBP-1), are alleged to be more accurate. We compared the diagnostic efficacy of PAMG-1 and ILGFBP-1 immunoassay tests and combined conventional clinical diagnostic methods in PROM., Study Design: 167 pregnant women with signs and/or symptoms of PROM were prospectively evaluated with a combination of conventional clinical tests including speculum examination, nitrazine, ferning pattern, and pooling, in addition to PAMG-1 and ILGFBP-1 immunoassays. Differences in sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the diagnostic methods were compared., Results: Although the PAMG-1 assay was more accurate, the PAMG-1 immunoassay, ILGFBP-1 immunoassay, and combined conventional clinical diagnosis were, in fact, all highly accurate with no significant difference in sensitivity, specificity, PPV, NPV, or accuracy., Conclusion: Both rapid bedside strip tests may be used in clinical practice with similar efficacy in diagnosing PROM, particularly as a backup when diagnosis is still in doubt following a combination of conventional diagnostic methods., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Introduction and Hypothesis: The aim of this study is to compare the pelvic floor muscle strength after vaginal delivery vs. after cesarean section., Methods: Five groups of 50 cases each were designated as follows: nullipara (control group), spontaneous vaginal delivery (SVD), repeat SVD (SVD-R), cesarean section (CS), and repeat CS (CS-R). Perineometric measurements, stress urinary incontinence (SUI) symptoms, pelvic organ prolapse quantification examinations, and Incontinence-Specific Quality of Life Questionnaire (IQOL) were evaluated., Results: In all delivery groups, pelvic muscle strength was significantly lower than the control group (65.10 ± 15.69, 56.29 ± 17.39, 54.28 ± 20.08, 56.82 ± 17.62, and 57.92 ± 16.45 (cm H(2) ± SD) for the control, SVD, SVD-R, CS, and CS-R groups, respectively; p < 0.05). However, no significant difference was found among the delivery groups. There were significant differences in SUI symptoms between the control (2%) and SVD-R (26%) groups and between the SVD (10%) and SVD-R groups (p < 0.001 and p = 0.037, respectively). No statistically significant correlations between IQOL and perineometric measurements were noted (r = 0.097 and p = 0.598)., Conclusions: Pregnancy increases postpartum muscle weakness independent of the mode of delivery. Increased SUI symptoms are associated with vaginal delivery.

The aim of this study was to evaluate the influence of different surface treatments (air abrasion, acid etching, and laser irradiation) on the surface roughness and bond strength of a low fusing ceramic. Thirty-six discs of low fusing ceramic (Finesse, Ceramco) were prepared (10 mm in diameter and 2 mm in thickness) according to the manufacturer's instructions. Specimens were divided into three groups (n = 12), and the following treatments were performed: Air abrasion with alumina particles (50 μm), acid etching with 5% HF and Nd:YAG laser irradiation (distance: 1 mm, 100 mJ, 20 Hz, 2 W, and 141.54 J/cm(2)). Following determination of surface roughness (R(a)) by profilometry, specimens were examined with scanning electron microscopy (SEM). The luting cement (Clearfil Esthetic Cement) was bonded to the ceramic specimens using Teflon tubes. After 24 h of water storage, shear bond strength test was performed using a universal testing machine at a crosshead speed of 1 mm/min. The data were analyzed with two-way analysis of variance (ANOVA) and Tukey HSD tests (α = .05). Two-way ANOVA indicated that surface roughness was significantly affected by surface treatments (p < .001). Tukey honestly significant difference (HSD) indicated that the air abrasion group had a significantly higher mean value (p < .05) than the other groups. Shear bond strength was significantly affected by surface treatments (p < .001). Tukey HSD indicated that the air abrasion group had a significantly higher mean value (p < .05) than the other groups. No significant difference was found between the acid-etching and laser-irradiation groups (p > .05). The SEM image of the laser irradiation surface appeared to be relatively smooth as compared to the images of other the groups. Air abrasion of low-fusing porcelain surfaces was effective in improving the bond strength as compared to the acid-etching and laser-irradiation methods.

Objective: To evaluate the association between maternal height and cervical length in the first and second trimesters in low-risk asymptomatic pregnant women., Study Design: Maternal height and cervical length of 146 asymptomatic women with singleton pregnancies at low risk for preterm birth were measured during the first and second trimesters. Preterm birth was defined as birth before <37 gestational weeks. Correlations between maternal height and cervical length measurements were determined using Pearson correlation analysis. The women were also divided into three groups based on height percentiles: <25% (Group I), 25-75% (Group II) and >75% (Group III). Cervical lengths were compared among groups. Correlations between cervical length and maternal height and statistically significant differences in cervical length among height percentile groups were the main outcomes., Results: Maternal height was positively but weakly correlated with first and second trimester cervical lengths (p=0.047, r=0.167 and p=0.039, r=0.197 respectively). The mean first trimester cervical lengths were significantly different between the groups (p=0.04). There were no significant differences, however, in the mean second trimester cervical lengths among the three groups although the difference was close to significance (p=0.06)., Conclusion: Although our results indicate a relationship between maternal height and cervical length in our population, maternal height seems to have only limited value in identifying women to be screened for shorter cervical length in a low risk asymptomatic population., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Profuse bleeding from the lower uterine segment secondary to placenta praevia/accreta during caesarean delivery is a challenging problem in obstetrics. We present our experiences using intrauterine Foley balloon tamponade for the conservative management of post-partum haemorrhage from the lower uterine segment. Intraoperative haemostasis was achieved in all women who were unresponsive to other conservative methods. Foley balloon tamponade may be considered in the management of lower uterine segment bleeding at caesarean delivery., (© 2011 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2011 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Palliative care is an emerging topic in Turkey within recent years. Currently, there are only few number of palliative care services across the country and majority of the centers are pain control units. Morphine consumption rate per capita is low, accessibility and availability of morphine products are also limited. One of the main headings of Turkish Cancer Control Programme 2009-2015 is palliative care and a serial palliative care unit implementation with continuous training programmes is planned to be finalized until 2015. This article reviews the current palliative care situation in Turkey, opioid availability in Turkey and also briefly summarizes Pallia-Turk Project which is unique with respect to many different aspects for implementation, and can be a good model for many other countries that still did not have such an implemented palliative care program.

Background: Gonadotropins, as ovulation-inducing drugs, have been used widely to treat infertility. An epidemiologic correlation between infertility therapy and ovarian cancer development has been reported. However, the effect of gonadotropins in the formation of reproductive tract cancers is controversial., Objective: The aim of the study was to determine the in vivo genotoxic effects of gonadotropins on rat reticulocytes., Methods: In this prospective, randomized, controlled study, rats were randomly assigned to 1 of 5 groups. The calculated rat doses of 0.65 human menopausal gonadotropin (hMG), 0.95 hMG, 0.65 follitropin beta (FB), 0.95 FB, or normal saline (control group) were injected, respectively. These calculated rat doses (U/g) are based on average human gonadotropin doses of 150 and 225 IU/d for a 70-kg woman given in 2-mL saline (the control group received 2 mL of saline). Injections were administered once per day for 5 days, followed by 5 days of rest. Each treatment was repeated for 6 estrus cycles in the rats for a total of 12 estrus cycles. Six months after the last day of the 12(th) cycle, the rats were euthanized. Bone marrow tissues were removed, and pluripotent reticulocyte cells with micronuclei, nuclear buds, and binuclear abnormalities were analyzed using an in situ micronuclei assay under light microscopy. The proportion of micronucleated cells, cells with anaphase bridge, nuclear buds, and other nuclear abnormalities were measured., Results: The number of cells with nuclear buds and binuclear abnormalities in the hMG 225 and FB 225 groups was significantly higher (P < 0.05) than that from the hMG 150, FB 150, and control groups in the cytogenetic analysis of bone marrow stem cells. An increased rate of genotoxicity in all gonadotropin groups versus that of placebo was found., Conclusion: In rats, the micronucleus genotoxicity assay suggests a dose-dependent gonadotropin effect on genomic instability in bone marrow stem cells in vivo.

Background and Purpose: An analysis of the current radiotherapy status in Turkey was conducted to establish a comprehensive baseline. Turkey's future demand analysis in view of international benchmarks was conducted. Moreover, the ministerial plans are shared to present an example for making a comprehensive planning in developing countries., Methods: The data from all radiotherapy centers in Turkey was collected through a survey and cross-checked with primary research and government data. Survey covered the status of radiotherapy centers in terms of major equipment and personnel. Data regarding manpower currently working is obtained from relevant academic centers and occupational associations., Results: The latest ministerial registry data demonstrated 150,000 new cancer cases each year with 400,000 patients living with cancer in Turkey. Around 100,000 patients are estimated to need radiotherapy each year--a figure expected to reach around 170,000 by 2023. The current numbers for radiotherapy centers, megavoltage equipment, radiation oncologists, medical physicists and radiotherapy technicians are 90, 186, 446, 130 and 600 respectively. By 2023, Turkey will need around 680 radiation oncologists, 624 medical physicists, 2,650 radiotherapy technicians and 379 megavoltage machines., Conclusion: Turkey faces a slight oversupply of radiation oncologists in contrast to undersupply in megavoltage machines and other personnel. Careful planning is required to allocate limited resources. The purchase of the equipment and employment policies should be structured as part of national cancer control program.

Objective: To determine the effects of pinealectomy on endometrial explants in rats and evaluate the activity of superoxide dismutase (SOD) and catalase (CAT) and the levels of malondialdehyde (MDA) in the rat endometriosis model., Study Design: Rats with experimentally induced endometriosis were randomly divided into three groups after second-look laparotomies. Group 1 (pinealectomy, n = 8) and Group 2 (pinealectomy+melatonin, n = 8) underwent pinealectomies after the second-look laparotomies. Group 3 was presented as control group (vehicle solution+without pinealectomy (n = 6)). Melatonin was administered intraperitoneally for 4 weeks in Group 2, whereas an equal volume of vehicle solution was given to Groups 1 and 3. Evaluation of the volume of the endometrial explants, histopathological examination and preservation of explant epitheliums according to the scoring system were undertaken., Results: There was a statistically significant increase in spherical explant volumes of Group 1 compared to Groups 2 and 3. In Group 1, the level of MDA was significantly higher and SOD and CAT activity was significantly lower compared to Groups 2 and 3. A statistically significant increase in the epithelial lining scores of explants was noted in Group 1 compared to Groups 2 and 3., Conclusion: The effects of pinealectomy on the progression of endometriosis explants were reversed by melatonin., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

Leiomyomas of the external genitalia are uncommon soft tissue tumors. We report the case of a 47-year-old woman with perineal leiomyomas mimicking Bartholin's gland mass according to the preoperative magnetic resonance imaging (MRI) findings. Leiomyomas in the vulvar region should be differentiated from complicated Bartholin's gland cysts and preoperative MRI findings may be misleading. The complete surgical excision should be the choice of treatment.

Up to now, there have been only a few reported cases of Mucosa-associated lymphoid tissue (MALT) lymphomas arising in the rectum. Its clinical presentation is indistinguishable from that of rectal carcinoma but the treatment is apparently different. Symptoms of primary lymphomas involving the rectum include; anorexia, weight loss, change in bowel habits, obstruction, and bleeding. These symptoms are not disease specific and can be seen in many other gastrointestinal disorders. Patients with polypoid masses may present with obstruction symptoms. In this rare case, a female patient admitted to the emergency service with prolapsus of a rectal mass.The optimal treatment of rectal MALT lymphoma is not well defined yet, given the rarity of the disease. Surgical resection of the localized lesion and following adjuvant chemotherapy has proved to be an effective treatment option. However, a close and long-lasting follow-up is important.

Objective: To compare the prevention of adhesion formation by type I collagen or melatonin solutions in the rat model., Study Design: A total of 40 female Wistar albino rats were randomly assigned to four groups-type I collagen, melatonin, vehicle control and sham groups. Following midline laparotomy, a standard injury was made on the right uterine horn using bipolar cautery. The animals in the sham group underwent midline laparatomy only. One milliliter of type I collagen, melatonin or vehicle control was instilled onto the injured area immediately before abdominal closure. Fourteen days after the surgery, the type and extent of adhesion formation as well as the uterine horn tissue superoxide dismutase (SOD) and catalase (CAT) activity, and malondialdehyde (MDA) levels were measured., Results: Both the type and extent of adhesion formation were significantly lower in the type I collagen and melatonin groups compared to the control group. The tissue SOD and CAT activity was significantly higher, and MDA levels were significantly lower in the type I collagen and melatonin groups compared to the control group., Conclusion: Intraperitoneal administration of type I collagen or low dose melatonin solution onto the injured areas may be an attractive adjuvant to reduce postoperative adhesion formation.

Computed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening.

Introduction: The Cerecyte coils were developed to improve long-term stability of embolized cerebral aneurysms by producing an increased fibrous reaction over the neck of the aneurysms. We report our preliminary clinical experience with mid-term follow-up., Materials and Methods: Seventy-eight consecutive patients with 84 intracranial aneurysms treated exclusively with Cerecyte coils were included in this study. Forty-eight aneurysms were ruptured and 36 were incidental. Twenty-two aneurysms were small with (<10 mm) small neck (<4 mm) (SASN); 55 were small with wide neck (>or=4 mm) (SAWN); six were large (10-25 mm) (L); and one was giant (G) (>25 mm). The embolization technique was the same with that in standard bare coiling., Results: Immediate post-procedure angiography demonstrated complete aneurysm occlusion in 69%, neck remnant in 29.8% and incomplete occlusion in 1.2%. Follow-up angiography was obtained in 80 aneurysms in a period of time ranging from 6 months to 2 years. The overall recanalization rate was 11.3%, and the re-treatment rate was 6.3%; in the subgroup analysis, recanalization rates were 4.5% in S/S; 9.8% in S/W; and 33.3% in large aneurysms. The only giant aneurysm also showed recanalization. Procedure-related morbidity and mortality rates were 2.6% and 1.3%, respectively., Conclusions: Our midterm results showed a relatively low rate of recurrence compared to those reported for platinum coils with morbidity and mortality rates comparable to those with standard bare platinum coils. The efficacy of Cerecyte coils in the long term will be specifically addressed by the ongoing randomized Cerecyte coil trial.

Aim: To compare the effects of treatment of H pylori-infected individuals with the effects of treatment of individuals as well as all H pylori-infected family members., Methods: H pylori-positive patients with similar demographic specifications were prospectively randomized with respect to treatment, with a triple regimen of either patients and all H pylori-positive family members living togetherI (group I) or patients only (group II). Nine months after treatment, all patients were assessed for H pylori positivity., Results: There were 70 H pylori-positive patients in each group; patients in groups I and II lived with 175 and 190 H pylori-positive relatives, respectively. Age, sex and H pylori positivity rate were similar in both groups of relatives. Nine months after 14 d standard triple therapy, H pylori positivity was 7.1% in group I patients and 38.6% in group II patients [P < 0.01, OR = 8.61 95% confidence interval (CI): 2.91-22.84]., Conclusion: The present results indicate bad environmental hygienic conditions and close intra-familial relationships are important in H pylori contamination. These findings indicate all family members of H pylori-positive individuals should be assessed for H pylori positivity, particularly in developing countries where H pylori prevalence is high; they also suggest patients, their spouses and all H pylori-positive family members of H pylori-positive individuals should be treated for H pylori infection.

Introduction: Chronic reflux of gastric content to the esophagus causes retrosternal burning, pain, and regurgitation, and results in histopathologic changes that may culminate in adenocarcinoma. Insufficiency of the lower esophageal sphincter and hiatal hernia are the two principal causative factors. In this paper, we present the early results of a new antireflux operation in pigs., Materials and Methods: The status of physiologic reflux was determined in 5 pigs (approximately 40-45 kg) with 24-hour pH monitorization. Under endoscopic guidance, a trocar was inserted into the stomach (similar to the percutaneous endoscopic gastrostomy technique). The endoscope was put into the retroflexed position; a mucomuscular pursestring suture was placed around the endoscope at the cardia and tied. Ten days later, pH monitorization was repeated to evaluate the effectiveness of the method. Late postoperative results have been reevaluated by 24-hour pH monitorization in the sixth month., Results: The procedure achieved statistically significant improvements in total reflux time, number of reflux periods, number of long reflux periods, the longest reflux period, and the DeMeester score. The preoperative and postoperative DeMeester scores of the individual animals were 179.24-0.94, 11.48-0.98, 68.4-3.74, 132.2-46.49, and 38.72-5.86, respectively. Even though there appeared to be a slight increase in the pH monitorization levels after 6 months, these results did not reach significant degrees, and compared to the physiological reflux, the results were remarkable., Conclusions: The results obtained showed considerable decreases in physiologic reflux in all animals. We believe that this endoluminal, laparoendoscopic operation can be used in the treatment of gastroesophageal reflux disease as a minimally invasive method.

Introduction: We evaluated the safety and efficacy of the Angio-Seal closure device used to close arterial puncture sites in patients who had undergone diagnostic cerebral angiography and neurointerventional procedures., Methods: A total of 1,443 Angio-Seal devices were placed in 1,099 patients in the Interventional Neuroradiology Unit between May 2005 and August 2006. Of these, 670 were interventional and 745 were diagnostic cerebral angiographic procedures. In 28 patients bilateral puncture of the femoral arteries was performed for endovascular treatment. In 167 patients 286 repeat diagnostic procedures were performed and 30 interventional procedures were followed by re-closure with an Angio-Seal device at the time of repeat puncture., Results: The procedural success rate for antegrade closures was 99.7% for all procedures. The device failed in 5 of 745 diagnostic procedures (0.7%). Major complication occurred in one patient only (0.13%) in the diagnostic group. No minor complications were observed in this group. In the interventional group, the major complication rate was 1.4% (10 of 698 closures) and the minor complication rate was 2.4% (17 of 698 closures). However, in the subgroup of patients with cerebral aneurysms who received heparin in combination with antiplatelet agents after the procedure, the major complication rate was 5.3%, but in the carotid/vertebral stenting group it was 0.8%., Conclusion: Our experience in a relatively large series of patients shows that the use of the Angio-Seal STS vascular closure device is safe and effective in patients undergoing cerebral diagnostic angiography and neurointerventional procedures with an acceptable rate of complications, although the complication rate was higher in the group of patients who received heparin and/or antiplatelet medication.

Object: Stent-assisted embolization is an alternative endovascular treatment method for wide-necked intracranial aneurysms. Currently available stents have the limitations of poor radial force, difficult delivery systems, and lack of full retrievability. The authors report on their preliminary experience with the use of a new, fully retrievable, self-expanding neurovascular stent, which has a high radial force and easy delivery system, combined with coil or Onyx embolization for the treatment of wide-necked aneurysms, including 6-month follow-up data., Methods: Fifteen patients with 18 wide-necked intracranial aneurysms were treated using the SOLO stent system and detachable platinum coils. Aneurysms were located at the posterior communicating artery (seven lesions), midbasilar artery (one lesion), internal carotid artery (ICA) bifurcation (one lesion), ICA-ophthalmic artery segment (eight lesions), and posterior cerebral artery (one lesion). Eleven aneurysms were small, six were large, and one was giant. Only one of these aneurysms was in the acute stage of subarachnoid hemorrhage; balloon remodeling alone failed to keep the coils in the aneurysm sac., Results: Only one stent required retrieving and repositioning after it had been fully deployed, and retrieval was easy and successful. No thromboembolic complication, dissection/rupture, or vasospasm occured during stent placement. Follow-up angiograms obtained at 6 months posttreatment in the 18 aneurysms demonstrated that all stents were patent with no evidence of intimal hyperplasia or stenosis. In all cases but one, 100% lesion occlusion was observed at the 6-month control angiography examination. Only one aneurysm had recanalized., Conclusions: The fully retrievable self-expandible SOLO stent is a feasible, secure, and effective system with a high radial force and ease of delivery in treating wide-necked intracranial aneurysms in combination with coil embolization.

Chilaiditi syndrome is the interposition of the colon between the diaphragma and the liver. In general, patients are asymptomatic, but some patients have been associated with gastrointestinal and respiratory symptoms. A 5-month-old infant boy was admitted to the hospital with a history of cough, cyanosis and recurrent respiratory distress that had persisted during the preceding 2 months. The chest X-ray revealed an elevation of the right hemidiaphragma caused by the presence of a dilated colonic loop below. Computed tomography showed a hepatodiaphragmatic interposition of the colon, leading to the diagnosis of Chilaiditi syndrome. The patient was conservatively treated with oxygen, fluid supplementation and stool softeners. We conclude that this rare syndrome should be kept in mind when young patients present with recurrent respiratory distress.

Background: Bone marrow mesenchymal stem cells (MSCs) can be used for myocardial repair following myocardial infarction. Increased expression of stromal cell-derived factor-1 (SDF-1) by an ischemic myocardium attracts CXCR4+ stem cells toward it. CXCR4, the receptor for SDF-1, is important in the migration, homing, and survival of hematopoietic stem cells. Although low levels of CXCR4 expression were found in minor subpopulations of cultured MSCs, most MSCs do not express CXCR4. To optimize the migration and survival of human MSCs, we expressed the CXCR4 gene in these cells using retroviral transduction., Materials and Methods: We isolated and cultured MSCs from healthy volunteers and transduced them with a retroviral vector containing either CXCR4 and green fluorescent protein (GFP; CXCR4/GFP vector) or GFP alone (control vector). Flow cytometry confirmed successful transduction and GFP and CXCR4 expression. We used a transwell migration system to study MSC migration to SDF-1. We used Annexin V and propidium iodide stains to assess cell survival before and after the survival challenge., Results: Flow cytometry showed that, on average, 83.4+/-17.7% of transduced MSCs expressed CXCR4. Compared with control MSCs, MSCs transduced with CXCR4 showed significantly more migration toward SDF-1, threefold greater at 3 h and more than fivefold greater at 6 h. Mesenchymal stem cells transduced with CXCR4 showed no significant difference in survival under normal to serum-deprived growth conditions., Conclusion: Mesenchymal stem cells can be efficiently transduced to express CXCR4, and transduced MSCs migrate rapidly toward SDF-1. CXCR4 expression does not render survival advantage to MSCs under serum-deprived conditions.

Objectives: The objective was to determine the value of office hysteroscopy in the diagnosis of endometrial hyperplasia by comparing the patients who had hysteroscopic diagnosis of hyperplasia with the results of histopathologic examinations, and to try to describe the visual criteria., Material and Methods: Two hundred and sixteen premenopausal and 114 postmenopausal patients who were admitted to the endoscopic surgery department between January 2000 and March 2001 were enrolled. Visual diagnoses of endometrial hyperplasia with office hysteroscopy were compared with the histopathological results of the endometrial specimen., Results: Pathology confirmed 50 of the 70 hysteroscopically-diagnosed hyperplasia patients. The positive predictive value of office hysteroscopy was 71.4% and the negative predictive value was 95.4% in the diagnosis of endometrial hyperplasia., Conclusion: The accuracy of hysteroscopic evaluation of the uterine cavity is extremely encouraging. Office hysteroscopy, which has a high diagnostic reliability and minimal discomfort, appears to be an ideal method of diagnosis and follow-up of patients with endometrial hyperplasia.

A new entity manifested by severe congenital neutropenia associated with osteoporosis and recurrent bone fracture is described in a family. A possible role for a new recognized cytokine system involved in bone remodeling, the osteoprotegerin/receptor activator of nuclear factor-kappa B ligand, is suggested., (Copyright 2002 Wiley-Liss, Inc.)

Background: Umbilical-cord blood from unrelated donors who are not HLA-identical with the recipients can restore hematopoiesis after myeloablative therapy in children. We studied the use of transplantation of umbilical-cord blood to restore hematopoiesis in adults., Methods: Sixty-eight adults with life-threatening hematologic disorders received intensive chemotherapy or total-body irradiation and then transplants of HLA-mismatched umbilical-cord blood. We evaluated the outcomes in terms of hematologic reconstitution, the occurrence of acute and chronic graft-versus-host disease (GVHD), relapses, and event-free survival., Results: Of the 68 patients, 48 (71 percent) received grafts of umbilical-cord blood that were mismatched for two or more HLA antigens. Of the 60 patients who survived 28 days or more after transplantation, 55 had neutrophil engraftment at a median of 27 days (range, 13 to 59). The estimated probability of neutrophil recovery in the 68 patients was 0.90 (95 percent confidence interval, 0.85 to 1.0). The presence of a relatively high number of nucleated cells in the umbilical-cord blood before it was frozen was associated with faster recovery of neutrophils. Severe acute GVHD (of grade III or IV) occurred in 11 of 55 patients who could be evaluated within the first 100 days after transplantation. Chronic GVHD developed in 12 of 33 patients who survived for more than 100 days after transplantation. The median follow-up for survivors was 22 months (range, 11 to 51). Of the 68 patients, 19 were alive and 18 of these (26 percent) were disease-free 40 months after transplantation. The presence of a high number of CD34+ cells in the graft was associated with improved event-free survival (P=0.05)., Conclusions: Umbilical-cord blood from unrelated donors can restore hematopoiesis in adults who receive myeloablative therapy and is associated with acceptable rates of severe acute and chronic GVHD.

Background/aims: Mirizzi syndrome is a rare benign complication of long-standing cholelithiasis and neither diagnostic modality nor clinical feature has a 100% sensitivity and specificity. The objective of our study was to call attention to the importance of this rare syndrome with its miscellaneous treatments., Methodology: Between January 1992 and June 1997, a total of 8 (4 females and 4 males) patients, who were operated and diagnosed as Mirizzi syndrome, were retrospectively evaluated., Results: The mean age was 53.75 years. During the same time period 0.98% of the total 812 cholelithiasis patients were Mirizzi syndrome. The ultrasound was used in 7, computed tomography (CT) in 4 and endoscopic retrograde cholangiopancreatography (ERCP) in 2 cases. Ultrasound allowed the detection of cholelithiasis in all, but proximal bile duct dilatation in only 71% of cases. CT detected the non-specific findings of syndrome in 75% of cases. In 2 patients, because of the difficulties due to the patients themselves and the technical management problems. ERCP could not detect the pathology properly. In 2 of 5 type I patients, we performed only cholecystectomy and in another 2 cholecystectomy plus T-tube drainage. In 1 case, due to major hepatic duct injury during surgery, cholecystectomy plus hepaticojejunostomy over the Y-stent was performed. Biliary fistula developed in 1 patient with T-tube drainage and was successfully managed with conservative treatment. In all type II patients we preferred cholecystectomy plus choledochoduodenostomy and all of them were free of complications., Conclusions: If there is no question about the security of the common bile duct at surgery in type I patients, we recommended cholecystectomy, otherwise cholecystectomy plus exploration of common bile duct and/or drainage should be the procedure of choice. However, in type II patients cholecystectomy plus choledochoduodenostomy is a safe and effective procedure to perform.

Myelosuppression is the dose-limiting toxicity for nitrosourea chemotherapy. This toxicity predominantly involves modification of the O6 position of guanine with an alkyl moiety. The enzyme responsible for repair of O6-alkylguanine adducts, O6-alkylguanine-DNA alkyltransferase (alkyltransferase), is expressed at low levels in bone marrow (BM) cells. High alkyltransferase expression prevents the cytotoxicity and carcinogenicity of nitrosoureas in several transgenic and in vitro gene transfer models. We used gene transfer using a novel myeloproliferative sarcoma virus (MPSV) based retrovirus (vM5MGMT) to express the human alkyltransferase cDNA (MGMT) in human and murine hematopoietic cells. Transduced K562 cells had very high levels of alkyltransferase expression and significantly increased resistance to 1,3-bis (2-chloroethyl) nitrosourea (BCNU) as compared with untransduced K562 cells. Primary murine BM progenitors showed a high transduction efficiency with vM5MGMT and have increased BCNU resistance in vitro. After BM transplantation with vM5MGMT-transduced BM cells and BCNU treatment of these mice, BM, spleen and thymus had a 10- to 40-fold increase in alkyltransferase expression that persisted for at least 23 weeks posttransplantation. Progenitor cells procured from mice expressing high levels of alkyltransferase also had increased resistance to BCNU. Thus, an MPSV-based retroviral vector transduces mouse and human hematopoietic cells at high efficiency and results in high levels of gene expression both in vitro and in vivo. Overexpression of the alkyltransferase protein may protect hematopoietic progenitors from nitrosourea-induced myelosuppression.