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This cross-sectional study was conducted with a total of 82 people who were working in the accommodation establishments in the province of Karaman. The aim of the study is to investigate the effect of the transformational and transactional leadership perception on the perception of the innovation performance. This study is a kind of quantitative research design. In the research, 6 questions for demographic information, transformational leadership scale (20 questions), transactional leadership scale (16 questions) and innovation performance scale (5 questions) were performed as data collection form. Frequency, explanatory factor analysis, confirmatory factor analysis, correlation analysis and multiple regression analysis were applied to the data obtained. As a result, while a positive relationship was found between the perception of transformational leadership and innovation performance, no relationship was found between the perception of transactional leadership and the perception of innovation performance. From this point of view, it can be suggested to hire mainly the transformational leadership type managers in the accommodation enterprises, Karaman il genelinde faaliyet gösteren konaklama işletmelerinde çalışan personelin dönüşümcü ve etkileşimci liderlik algılarının yenilik performansı algılarına etkisinin belirlenmesi amacıyla kesitsel tipte planlanan bu araştırma toplam 82 kişi ile yürütülmüştür. Araştırma nicel araştırma desenindedir. Araştırmada veri toplama formu olarak demografik bilgileri içeren 6 soru, dönüşümcü liderlik ölçeği (20 soru), etkileşimci liderlik ölçeği (16 soru) ve yenilik performansı ölçeği (5 soru) uygulanmıştır. Veriler frekans, açıklayıcı faktör analizi, doğrulayıcı faktör analizi, korelasyon analizi ve çoklu regresyon analizlerine tabi tutulmuştur. Sonuç olarak dönüşümcü liderlik ve yenilik performansı algıları arasında pozitif yönde bir ilişkiye rastlanırken etkileşimci liderlik algısı ile yenilik performansı algısı arasında herhangi bir ilişkiye rastlanılmamıştır. Buradan hareketle konaklama işletmelerinde dönüşümcü liderlik tipinde yöneticilerin istihdamına ağırlık verilmesi gerektiği önerilebilir.

Karaman ili kamu kurumlarında çalışan personelin itibar yönetimi ve personel güçlendirme algıları arasındaki ilişkinin belirlenmesi amacıyla planlanan bu araştırma 287 kamu personeli ile gerçekleştirilmiştir. Araştırmada veri toplama formu olarak demografik bilgileri içeren 6 soru, itibar yönetimi ölçeği (20 soru) ve personel güçlendirme ölçeği (24 soru) kullanılmıştır. Elde edilen verilerin yorumlanması için SPSS21 programında sayı, yüzde, ortalama, standart sapma, en küçük, en büyük değerler gibi tanımlayıcı istatistiklerden yararlanılmıştır. Yine veriler ANOVA, Kruskall Wallis, T testi, Korelasyon analizleri ile değerlendirilmiş, ileri düzey analizler için de Bonferroni testi kullanılmıştır. Araştırma bulgularına göre itibar katsayısı ve personel güçlendirme değişkenleri arasında pozitif yönde anlamlı ilişki bulunduğu belirlenmiştir. Sonuç olarak; itibar katsayısı ölçeğinden alınan puanların eğitim durumu, kadro türü ve medeni durum değişkenlerinden etkilendiği, personel güçlendirme ölçeğinden alınan puanların çalışılan kurumdan etkilendiği anlaşılmıştır. Ayrıca, her iki ölçekten alınan puanların cinsiyet, yaş ve iş tecrübesi değişkenlerinden etkilenmediği tespit edilmiştir.

Karaman ili imalat sektöründe faaliyet gösteren iki farklı fabrikada çalışan işgörenlerin yalın yönetim, motivasyon, iş tatmini ve yetenek yönetimi algılarının belirlenmesi amacıyla kesitsel tipte, tanımlayıcı ve ilişki arayıcı olarak planlanan bu araştırma, 199 mavi yakalı üzerinde gerçekleştirilmiştir. Araştırmada veri toplama formu olarak demografik bilgileri içeren 5 soru, yalın yönetim bilgi sahipliğini sorgulayan 1 soru, Minnesota doyum ölçeği, motivasyon ölçeği, yetenek yönetimi algısı ölçeği ve yalın yönetim algısı ölçeği uygulanmıştır. Elde edilen verilerin yorumlanması için SPSS yazılımında tanımlayıcı istatistikler ve ANOVA, K. Wallis, T-testi, Korelasyon analizleri ile değerlendirme yapılmış, ileri analiz için Bonferroni testi kullanılmıştır. Araştırma bulgularına göre; ölçekler ile yaş, eğitim durumu ve iş tecrübesi arasında istatistiksel olarak anlamlı sonuçlara ulaşılmıştır. Ayrıca cinsiyet ve medeni durumun iş tatmini ile arasında anlamlı farklılık bulunmadığı ve ölçek puanlarının korelasyonuna göre ölçekler arasında pozitif yönde anlamlı ilişki bulunduğu saptanmıştır.

Aim: to discuss seizure outcomes of patients with invasive electroencephalography (EEG) monitorization (IEM) following their epilepsy surgery at our centre. Material and Methods: forty-seven patients suffering from refractory epilepsy and who were evaluated by invasive EEG were included in this retrospective study at Istanbul Faculty of Medicine from 2003 to 2017. We examined the Video EEG and invasive EEG monitorization, cranial MRI, SPECT, PET and neuropsychological tests of all patients. Postoperative seizure outcome results were evaluated according to Engel classification. The factors affecting seizure outcomes were discussed. Results: twenty-six of the patients were female (55.3%), 21 were male (44.7). The average age was 32.0 (+/- 12.4). Forty-three patients had surgery and the average age of these patients was 26,6 (+/- 11.15). 38.3% of the patients had hippocampal sclerosis (HS), 23.4% had focal cortical dysplasia (FCD), 8.5% had a tumor, 14.9% had sequela lesion and 14.9% had unknown etiology. Postoperative seizure status according to the Engel classification showed that 81.6% of the patients were class I, 10.5% were class II, 2.6% were class III and 5.3% were class IV. Conclusion: a significant relation was statistically determined between structural MRI lesion and favorable seizure outcome (p0.05). We argue that IEM is an essential examination for favorable outcomes for determining the epileptogenic zone and/or the proximity of the functional structures., NA

Örgütsel davranış literatüründe gün geçtikçe daha popüler kavramlar olmaya başlayan narsizm ve sinizmin kökenleri, birçok araştırmada Antik Yunana dayandırılmaktadır. Bu dayanımda narsizmin kaynağı Narkissos miti ile sinizmin kaynağı ise kinizm felsefesi ile bağdaştırılmaktadır. Her ne kadar baskın referanslar bu yönde olsa da bu durumun yanlış bir aktarımdan ibaret olduğunu savunan araştırmalara da rastlamak mümkündür. Narsizm ve sinizmin, mitoloji, örgütsel davranış ve psikoloji gibi birbirinden farklı disiplinlerde çalışılıyor olması tartışmaların sonuçsuz kalmasına neden olmaktadır. Buradan hareketle araştırmanın amacı; narsizm ve sinizm kavramlarının yüzyıllarca gelişen kültürel yapısına ve bu kavramların -modern dünya ile bağdaşımı noktasında- yanlış aktarımı olasılığına ilişkin çekincelerin dile getirilmesini kapsamaktadır., The origins of narcissism and cynicism, which are becoming more and more popular concepts in the organizational behavior literature, are based on Ancient Greece in many studies. In this strength, the source of narcissism is associated with the myth of Narcissus, and the source of cynicism is associated with the philosophy of cynicism. Although the dominant references are in this direction, but it is possible to come across studies that argue that this situation consists of a wrong transmission. The fact that narcissism and cynicism are studied in different disciplines such as mythology, organizational behavior and psychology causes the discussions to be inconclusive. From this point of view, the aim of the research is; it includes expressing the reservations about the cultural structure of the concepts of narcissism and cynicism that have developed over the centuries and the possibility of wrong transmission of these concepts in terms of their compatibility with the contemporary world.

Başta göç unsuru ve teknolojik ilerlemeler nedeniyle farklı özelliklere sahip bireylerin bir arada çalışması alışılageldik bir durum haline getirmiştir. Bu durum ise farklılıkların yönetilmesi gerekliliğini ortaya çıkarmıştır. Öte yandan örgütlerin üretkenliğinin göstergelerinden örgütsel yaratıcılık ve yenilik performansı kavramları rekabet avantajı sağlayan önemli unsurlardandır. Farklı grupların etkin yönetilmesi güçlü ekiplerin oluşumunu destekleyecek böylelikle yenilik ve yaratıcılığın gelişimine katkı sağlanabilecektir. Farklılıkların yönetimi algısının örgütsel yaratıcılık ve yenilik performansına olası etkisinin belirlenmesine yönelik yapılan bu araştırma Karaman ilinde faaliyet gösteren bir tekstil firmasının 100 işgöreni ile gerçekleştirilmiştir. Anket tekniği ile toplanan veriler doğrultusunda yapısal eşitlik modellemesi yol analizine göre farlılıkların yönetimine ilişkin algının örgütsel yaratıcılık ve yenilik performansında etkili olduğu sonucuna ulaşılmıştır.

Türkiye ekonomisinde planlama süreci ilk olarak Sanayi Planları ile başlamış ve İkinci Dünya Savaşından sonraki dönemlerde ise Kalkınma Planları ile devam etmiştir. Bölgesel gelişmelerin ülke ekonomisi açısından taşıdığı önem, hazırlanan planların şekillendirilmesinde etkili olmuştur. Bu bağlamda geri kalmış yörelerin sosyo-ekonomik bakımdan gelişmiş bölgelerle benzer bir konuma getirilebilmesi için çok sayıda proje hazırlanmıştır. Bu araştırma, Konya Ovası Projesi (KOP), Güneydoğu Anadolu Projesi (GAP), Doğu Anadolu Projesi (DAP) ve Doğu Karadeniz Projesi’nin (DOKAP) enerji ve çevre konularını içeren kısımları ile Birleşmiş Milletler (BM) Sürdürülebilir Kalkınma Hedefleri (SKH) arasındaki uyumun değerlendirilmesini konu edinmektedir. Turkey's economy in the planning process started with the first Industrial Plan and the Second World War continued in subsequent periods with the Development Plans. The importance of regional developments in terms of the country's economy has been influential in shaping the prepared plans. In this context, a number of projects have been prepared in order to bring the backward regions to a similar position from the socio-economically developed regions. Our work has been carried out between the parts of the Konya Plateau Project (KPP), the Southeastern Anatolia Project (SAP), the Eastern Anatolia Project (EAP) and the Eastern Black Sea Project (EBSP) including the energy and environment issues and the United Nations Sustainable Development Goals evaluation of harmony.

The mission of the loan associations is simply to convert deposits collected with lower interest rates, into credits with higher interest rates. However, return of this cycle involves high potential of risk. In order to minimize the risk, several financial models are utilized. Since these models are insufficient, new models are required to be developed. The purpose of this study is to compile literature reviews on credit risk measurement methods used for assessment of credit demands. The method used is literature scan. This scan was conducted with printed publications and articles from the databases scanned. The information is compiled from these sources. It is discussed that risk mitigation should be given importance instead of guarantee, for evaluation of credit demands with Basel II criteria. A credit requesting entity's future prediction by examining financial statements can only be possible utilizing financial statements analysis techniques (comparative financial statements analysis, vertical analysis, ratio analysis and cash flow statements) together. As a consequence, in 2009 a software ,named "Scoring Model" has been developed for giving credit decisions which uses the techniques together mentioned above. This software merely based on a model is proposed to be integrated into banking system after being reprogrammed as commercial software.

Objective: To report perioperative complications in fully endoscopic lumbar discectomy (FELD). Methods: From September 2010 to November 2016, 835 patients underwent FELD. In total, 865 disc levels were operated on. Of the 835 patients, the transforaminal (TF) approach was used in 174 patients, while 691 patients were operated on using the interlaminar (IL) approach. Surgical complications occurred in 47 patients, which were retrospectively analyzed. Results: Neurological deficits occurred in six patients. In four of these six patients, deficits resolved spontaneously. In one patient, symptoms resolved after a laminectomy procedure. In only one case, the neurological deficit was permanent. Seven patients complained of dysesthesia, which resolved spontaneously with medical treatment in four patients. In the remaining two patients, dysesthesia symptoms improved after epidural and foraminal injections. Dural tears were encountered in 26 patients. Pudendal neuralgia occurred in three patients. 'Itvo cases showed wound infection. The other complications comprised one disc infection, one retroperitoneal hematoma and one wrong level surgery. Conclusion: The FELD procedure has a steep learning curve and it is a difficult procedure to master. Surgeons should be aware of complications that can occur with the FELD procedure, most of which resolve spontaneously. (C) 2017 Sociedad Espanola de Neurocirugia. Published by Elsevier Espana, S.L.U. All rights reserved. WOS:000411655800003 28532963 Q4

Object Traumatic posterior fossa epidural hematoma (PFEDH) is rare, but among children it may have a slightly higher incidence. With the widespread use of CT scanning, the diagnosis of PFEDH can be established more accurately, leading to an increased incidence of the lesion and possibly to a better patient prognosis. This study presents 40 pediatric cases with PFEDH. Methods The authors assessed the type of trauma, clinical findings on admission, Glasgow Coma Scale scores, CT findings (thickness of the hematoma, bone fracture, compression of the fourth ventricle, and ventricle enlargement), type of treatment, clinical course, and prognosis. Early postoperative CT scans (within the first 6 hours) were obtained and reviewed in all surgical cases. Results Twenty-nine patients underwent surgery and 11 patients received conservative therapy and close follow-up. All patients fared well, and there was no surgical mortality or morbidity. Conclusions Based on the data in this large series, the authors conclude that PFEDH in children can be treated in experienced centers with excellent outcome, and there is no need to avoid surgery when it is indicated.

Risks related to rebleeding of a ruptured intracranial aneurysm have decreased. However, ischemic neurologic deficits related to vasospasm are still the leading causes of mortality and morbidity. It is well known that vasospasm is a dynamic process affected by various factors. The severity of vasospasm in animal models and clinical observations differ from each other. This variability has not been completely explained by blood and blood degradation products. Therefore, metabolites released from the damaged vessel wall during the bleeding are thought to play an important role in vasospasm.To test this hypothesis, we used 46 male Wistar rats that were divided into 7 groups and administered one of the following to cisterna magna: venous blood, arterial blood, arterial wall homogenate, venous wall homogenate, combined mixture of arterial blood and artery wall homogenate, or combined mixture of venous blood and venous wall homogenate. Brainstems of the rats were excised, and the basilar arteries were harvested for morphometric measurements.There were significant differences between the degree of vasospasm caused by arterial and venous blood (P.0001). The intraluminal area of the basilar artery was significantly narrower after application of arterial blood, artery wall homogenate, or their combination (49% +/- 1%) than after venous groups (30% +/- 1.9%) (P.0001).The results of this experiment demonstrated that metabolites from vessel walls play as important roles in the pathophysiology of vasospasm as blood and blood degradation products. Further investigation of these metabolites will improve our understanding of vasospasm, pathophysiology, and its treatment.

The present randomized, placebo-controlled, double-blind study was designed to assess the effect of peroperatively administered i.v. magnesium sulphate on anaesthetic and analgesic requirements during total i.v. anaesthesia.Eighty-one patients (36 women, 45 men) undergoing elective spinal surgery were included in one of two parallel groups. The magnesium group received magnesium sulphate 30 mg kg(-1) as a bolus before induction of anaesthesia and 10 mg kg(-1) h(-1) by continuous i.v. infusion during the operation period. The same volume of isotonic solution was administered to the control group. Anaesthesia was maintained with propofol (administered according to the bispectral index) and remifentanil (adjusted according to heart rate and arterial blood pressure) infusions.A significant reduction in hourly propofol consumption was observed with magnesium administration. For example, the mean infusion rate of propofol in the second hour of the operation was 7.09 mg kg(-1) h(-1) in the control group vs 4.35 mg kg(-1) h(-1) in the magnesium group (P0.001). The magnesium group required significantly less remifentanil (P0.001) and vecuronium (P0.001). No side-effects were observed with magnesium administration.The administration of magnesium led to a significant reduction in the requirements for anaesthetic drugs during total i.v. anaesthesia with propofol, remifentanil and vecuronium.

Most of the numerous experimental studies to research pathophysiological changes following acute spinal cord injury suggest a two-step mechanism of damage to the spinal cord in which the primary (direct) or mechanical injury caused by the trauma initiates secondary (indirect) or progressive autodestructive injury of the cord. During recent years, free oxygen radical generation and lipid peroxidation have been considered to be responsible for secondary autodestructive injury. Alpha tocopherol occupies an important and unique position in the overall antioxidant defense. Alpha tocopherol-depleted animals are generally more susceptible to the adverse effects of environmental agents than are supplemented animals. This study was planned to study the effectiveness in counteracting this autodestructive process by supplementing alpha-tocopherol in rats maintained on a nutritionally adequate diet, and also to evaluate whether it will provide additional protection or not. Eighty healthy Wistar rats (treatment and controls) were included. The treatment group received 100 mg/kg alpha tocopherol each day, intraperitoneally for seven days. Using a standard acute spinal cord trauma model in Wistar rats trauma was applied, an malondialdehyde (MDA) which is a lipid peroxidation product was measured in the traumatized spinal cord at various times following the trauma in order to indirectly evaluate the lipid peroxidation and generation of free oxygen radicals in a time sequence. Statistical analysis of the values demonstrated that malondialdehyde formation in the alpha-tocopherol administered group was significantly lower than in the control group. These findings indicate that longterm administration of alpha-tocopherol may be useful to decrease lipid peroxidation following acute spinal cord trauma.

Objective To evaluate the clinical outcomes of patients with lumbar disc disease undergoing fully endoscopic surgery at a single clinic. Methods Between August 2009 and January 2012, 163 patients (74 men and 89 women) underwent fully endoscopic lumbar discectomy. All patients were followed for 1 year after surgery. The Oswestry Disability Index and a visual analog scale were used to analyze outcomes. Results During the follow-up period, 114 (70%) patients had no complaints, 30 (18%) patients had occasional pain, and 19 (12%) patients had no improvement. During postoperative follow-up, 8 patients required repeat surgery for recurrence or residual fragments. Postoperatively, 4 patients experienced dysesthesia, which completely resolved in time. Neurologic deterioration occurred in 5 patients, 4 of whom recovered completely without any intervention. Dural tears occurred in 6 patients. Conclusions Fully endoscopic interlaminar or transforaminal surgeries are safe and effective treatment modalities for lumbar disc herniations. Despite the difficulties of acquiring this new technique, good results can be achieved with sufficient experience.

Objective Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique. Methods A series of 10 consecutive cases of unilateral OND was reviewed. Between December 2008 and December 2012 these patients underwent the endoscopic approach without nerve sheath opening. Presenting symptoms, neurological examination findings, magnetic resonance venography imaging results, fundoscopic and visual acuity examination findings, and automated perimetry test results were recorded. Perioperative results, including complications and length of hospital stay, were evaluated. Findings at follow-up evaluations were also recorded. Results This report is the first series of unilateral OND performed using the endoscopic approach. The mean patient age was 34.1 years (range, 9–49 years); there were nine female and one male patients. Visual impairment was the main symptom in this patient group, whereas headache was a secondary complaint. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with the most visual failure. Mean follow-up was 28.4 months (range, 8–55 months). The visual field defects and visual acuity improved in eight of nine patients, whereas papilloedema improved in seven of nine patients. Also headaches resolved in four of seven patients. There were no complications in this relatively small series. Conclusions The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.

Ventriculo-cisternostomy is an established procedure for the treatment of noncommunicating hydrocephalus, if the underlying pathology cannot be removed. In cases in which the foramina of Monro and the proximal part of the third ventricle are obstructed, it is not possible to make a communication between the internal and external CSF-spaces by perforation of the floor of the third ventricle, the so-called third ventriculo-cisternostomy. For such cases the authors describe a new method of drainage of both lateral ventricles to the interpeduncular cistern. This new method has been used successfully in a case with obstructive hydrocephalus of both lateral ventricles, caused by a pilocytic astrocytoma of the optic chiasma and hypothalamus with obstruction of both foramina of Monro.

BACKGROUND We investigated the individual and combined effects of magnesium sulphate, which is an N-Methyl-D aspartate receptor antagonist (NMDA), and z-LEHD-FMK, which is a caspase 9 inhibitor, on the genesis of secondary injury in a rat spinal cord injury model. We aimed to minimize the effects of secondary injury in spinal cord trauma by choosing these two agents which served to block the two major mechanisms of cell loss, apoptosis and necrosis. METHODS The drugs were given to the subjects according to their groups, either in singular or combined fashion. For motor examination, the subjects were kept under close clinical evaluation for five days. Histopathological examination and the emerging spinal cord samples were prepared with haematoxylene-eosin and Tunel techniques. RESULTS A statistically significant difference in favor of the treatment groups has been found between the treatment and control groups in terms of histological data. However, there was no difference in the evaluation of motor examination between trauma and treatment groups. CONCLUSION We have found no difference between the individual and combined uses of MgSO4 and z-LEHD-FMK in the prevention of secondary injury; however, there were better histological results in the treatment groups compared to trauma and control groups which gives us hope for future investigations.

Mesial temporal sclerosis (MTS) is the most frequent cause of drug resistant symptomatic partial epilepsy. The mechanism and genetic background of this unique pathology are not well understood. Aquaporins (AQP) are regulators of water homeostasis in the brain and are expressed in the human hippocampus. We explored the role of AQP genes in the pathogenetic mechanisms of MTS through an evaluation of gene expression in surgically removed human brain tissue. We analyzed AQP1 and 4 mRNA levels by quantitative real-time polymerase chain reaction and normalized to ABL and cyclophilin genes, followed by immunohistochemistry for AQP4. Relative expressions were calculated according to the delta Ct method and the results were compared using the Mann-Whitney U test. Brain specimens of 23 patients with epilepsy who had undergone surgery for MTS and seven control autopsy specimens were investigated. Clinical findings were concordant with previous studies and 61% of the patients were seizure-free in the postoperative period. AQP1 and 4 gene expression levels did not differ between MTS patients and control groups. Immunofluorescence analysis of AQP4 supported the expression results, showing no difference. Previous studies have reported contradictory results about the expression levels of AQP in MTS. To our knowledge, only one study has suggested upregulation whereas the other indicated downregulation of perivascular AQP4. Our study did not support these findings and may rule out the involvement of AQP in human MTS.

Damage which occurs following spinal traumas is often irreversible. During recent years free oxygen radicals formed due to the pathological changes following neural tissue ischemia have been identified as being responsible for the ethio-pathogenesis of such damage. In our experimental study, model lesions are formed in spinal cords of rats by standard trauma. Malondialdehyde (MDA), a lipid peroxidation product, was measured in the spinal tissues distal to the trauma in order to examine indirectly the time-quantity relationship of free oxygen radicals in the area. For this study 60 rats in six groups, including one control group, were used to determine the formation of MDA. Under a surgical microscope, the spines of all rats were exposed by C5-Th6 laminectomy, and pressure was applied to the spinal cords of animals, except the members of the control group, at the level of C7 by a Yaşargil aneurysm clip. MDA was measured in spinal cord tissues in order to determine free oxygen radicals at the first and fifteenth minutes and at the first, second, and fourth hours. The statistical evaluation of the findings revealed a significant increase in MDA, starting from the 15th minute after the compression, reaching a maximum at 1 hour, and then decreasing. This observation may provide an important guide for studies on prevention of neural destruction.

Traumatic acute subdural hematoma is the most lethal of all head injuries.In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity.Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%.According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient's age.

In many pituitary tumor, immunohistochemical studies have been shown to be correlated with different aspects of tumor behavior.There is no study up to date in which markers of Ki-67, p53, VEGF were evaluated concomitantly in GH-secreting adenomas.This study aims to determine which marker has a major role in tumor behavior and whether these markers have a cut-off value to distinguish invasive adenoma from non-invasive pituitary adenoma.Fourty-seven acromegalic patients operated by the same neurosurgeon were included in this study.Twenty-one patients(5micro/16 macro) had non-invasive adenomas and 26 had invasive macroadenomas.Eight patients(6 invasive macroadenomas, 2 microadenomas) were treated with OCT-LAR until one month prior to surgery with treatment duration range of 3-11 months.These patients were excluded from the study group as the noninvasive and invasive adenomas were compared.A separate analysis was performed in invasive adenomas to compare OCT(+) and OCT(-)patients.Both Ki-67 and p53 expressions showed no correlation with the invasive character of adenomas, but VEGF expression in invasive adenomas was significantly higher with respect to noninvasive group.Our study has taken intermediate staining (25 %)for VEGF as a cut off value for invasive adenomas.It was also observed that the decrease in VEGF staining in OCT pretreated invasive adenomas was significantly more than those not treated with OCT.VEGF becomes an independent stimulator of angiogenic growth and progression for GH-secreting adenomas with25% cytoplasmic immunoreactivity.This cut-off value may be useful in determination of prognosis and appropriate treatment strategy.A short term preoperative OCT treatment may be useful as adjunctive therapy especially for locally invasive GH- secreting adenomas.

Bu calismada kredi kurumlari icin bir kredi degerlendirme modeli gelistirilmistir. Kredi taleplerinin degerlendirilmesi konusunda bankalar basta olmak uzere hemen hemen tum kredi kurumlarinin genelinde paket programlar kullanilmaktadir. Ancak bu paket programlar ozellikle oran analizlerini kullanarak kredi cozumleri uretmeye yonelik gelistirilmislerdir. Oysa mali tablolar analiz tekniklerinin birlikte kullanilmasi daha etkin sonuclar verebilecektir. Gelistirilen bu model ile mali tablolar analiz tekniklerinden; karsilastirmali tablolar analizi, dikey analiz teknigi, oran analizleri ve nakit akim tablosu ayri ayri analiz edilmektedir. Daha sonra elde edilen sonuclarin yorumlanmasiyla isletmenin bugunku ve gelecek bakisiyla likidite, kârlilik, borc odeme gucu gibi mali yapisi gorulebilmektedir. Her analiz teknigi icin ayri bir puan hesaplanmis, olusan tum puanlar uzerinden tek bir kredi notu elde edilmistir. Butun bu islemlerin ardindan isletmenin kredi notu Puanlama Modeli tarafindan otomatik hesaplanmakta ve Puanlama Modeli Olcegi’ndeki kredi notuna karsilik gelen kararin onerilmesiyle surec sona ermektedir.

Temporal lobe epilepsy is the most common form of intractable partial epilepsy in adults with hippocampal sclerosis accounting for the majority of cases. Selective amygdalo-hippocampectomy (SEAH) is suggested as a safe and effective surgical procedure with the advantage of a better cognitive outcome.We prospectively documented 56 consecutive patients with medically refractory medial temporal lob epilepsy. Candidates for surgery were determined as those with characteristic clinical and imaging findings, ictal recordings, and neuropsychological evaluation. A standard SEAH was performed and hippocampal sclerosis was histologically confirmed.In our study 76.7% of patients were classified as Engel I and 62.2% as ILAE I at their last follow up. Overall, at the last follow-up, 51.8% of patients were seizure-free since surgery (Engel 1a and ILAE 1a), 25% had stopped antiepileptic treatment, and another 52% had decreased either the dosage or number of antiepileptic drugs. 86.3% of the patients with abnormality on neurocognitive tasks showed improvement at the end of the 6 months post surgery.SEAH is a safe and effective surgical procedure without the necessity of a larger resection and further invasive methods.

Background Intracranial aneurysms are rare in the pediatric population. Differences in epidemiology, clinical features and surgical results are underreported. In this study, we aimed to evaluate in retrospect our experience with pediatric intracranial aneurysms in the Neurosurgery Department, Istanbul Faculty of Medicine.

Object The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure. Methods The study was conducted in 30 fresh cadavers. Results The common carotid artery bifurcation was mostly found at the level of C-4 (78%). The inferior belly of the omohyoid muscle was seen to cross the sternocleidomastoid muscle at the C5–6 disc level along the entire C-6 vertebral body. To reach the lower cervical region, the sacrifice of this muscle makes the procedure easier. The facial vein drained into the internal jugular vein mostly at the level of C3–4 (54%). The superior ganglion of the cervical sympathetic chain was located at the C-4 vertebra, but the location of the intermediate ganglion exhibited some variation. The vertebral artery entered the transverse foramen of C-6 in 27 cadavers (90%), the transverse foramen of C-7 in two cadavers (7%), and the transverse foramen of C-4 in one cadaver (3%). Because the inferior thyroid artery crossed the C6–7 interspace obliquely, the course of the inferior thyroid artery may complicate the procedure. The C-5 uncinate process was shortest and narrowest and had the greatest distance from the medial edge of the process to the anterior tubercle (p < 0.001). Conclusions Understanding the qualitative anatomy of this region not only improves the safety of anterior and anterolateral cervical spine surgery but also allows adequate decompression of neural elements and resolution of the other pathological processes of this region. In this fresh cadaveric study, our goal was to improve the approach and decrease the incidence of complications.

Background Traumatic EDHs of the posterior cranial fossa are rare and have a higher mortality than supratentorial localizations. Early diagnosis of TEHPCF and prompt surgical evacuation provide excellent recovery. Active use of cranial CT scanning has taken a major role in the diagnosis, surgical indication, close observation, and strategy planning. As a result, better prognosis is achieved. In this study, we represent our results and experiences in the management of TEHPCF. Methods Between 1993 and 2006, 65 patients with TEHPCF were treated in Istanbul University Faculty Of Medicine, Neurosurgery and Emergency Surgery Departments. The hospital records of these patients were analyzed retrospectively. Results Of 65 patients, whose diagnosis and management decisions were determined by cranial CT scans, 53 were treated through surgery and 12 by conservative methods. Of the 53 surgically treated patients, 2 (3%) patients died, and 2 (3%) other patients remained moderately disabled during their discharge. As a result, 61 (94%) of 65 patients had excellent recovery. Conclusion When compared with the literature, our mortality rate was superior to other previously reported studies. In our opinion, this is a result of extensive use of the cranial CT scan together with aggressive surgery. Patients with occipital trauma should be evaluated using cranial CT scans, and those showing mass effect should be immediately treated surgically. The patients that have no mass effect on CT scans can be closely observed by planned serial control CT scans.

Background This is a report of 5 patients treated surgically for SCMs. Methods During the period from 1998 to 2003, 5 patients (4 male and 1 female) harboring SCMs were treated surgically (all of them underwent complete surgical removal). Patients' ages ranged between 22 and 57 years (mean age, 46 years). Median duration of symptoms was 31 months (1-120 months). Diagnosis was made by MRI scan showing lesions in length of 1 to 6 cm in diameter (mean length, 2.9 cm). Three lesions were found in the cervical, one in the upper dorsal, and one in the lower dorsal cord. One of them was located extradurally, one of them intradural extramedullary, and 3 of them intramedullary. Results An MRI examination showing total removal was performed postoperatively in each patient (the postoperative MRI examinations revealed total removal in all cases). The follow-up period ranged from 1 to 4 years (mean, 27 months). All patients showed clinical improvement, with 3 of them worsening early in the postoperative period but doing better in long-term follow-up (although 3 of 5 patients had worse neurological examinations in the early postoperative period, all recovered in long-term follow-up and clinically improved relative to preoperative status). Conclusion Neurological status of the patients can worsen in the early postoperative period, causing intramedullary operation; but it usually improves relative to preoperative status. Surgical removal seems to be a safe and a promising way of treatment of symptomatic SCMs.

A series of 30 documented cases of intracranial hydatid cyst out of 33 pediatric and 45 total patients admitted to the Department of Neurosurgery of the School of Medicine at Istanbul University within the years 1952–1996 is presented. The pediatric population consisted of 73% of the series. Twenty patients (66%) are alive and well after a follow-up period of 8–45 years (mean 21.5 years). Six patients (20%) died and 4 (13%) were lost to follow-up. There were 3 early postoperative deaths (10%), 2 being in the pre-CT era. In 4 cases (13%), brain involvement was secondary, and 2 cases (7%) had multiple intracranial hydatid cysts. Age ranged from 4 to 16 years, with a mean of 10.4. There were 5 intraventricular (17%) and 2 (7%) intracranial extradural settlements. No children with posterior fossa hydatid cyst, primary skull hydatidosis or concomitant spinal involvement were detected. One patient (3%) presented with ‘rhinorrhea’ which in fact was a hydatid fluid leak. Preoperative pseudocerebellar syndrome, convulsion and extrapyramidal signs were seen in 6 patients each (20%). Five patients (17%) had permanent visual deficits, 3 being in pre-CT era. Out of 29 patients operated on, hydatid birth with intact cyst removal was achieved in 18 cases (62%), with no other manipulation needed. This rate has increased to 70% in the CT era. Intraoperative accidental rupture occurred in 8 cases (28%), of which 7 were localized frontally or had a frontal involvement (88% of the ruptured cases). Of the patients with intraoperative rupture, 5 are dead (63%) and they were all primary. In contrast, all 3 cases alive with intraoperative rupture are secondary. Three cases were punctured on purpose (10%). Four of the operated patients (14%) required long-term antiepileptic therapy, 3 having no preoperative seizures. Only 1 patient required a shunt (3%). Four cases had recurrence, all with intraoperative cyst rupture (14%). The long-term evaluation of the results yielded an overall mortality rate of 21%. Routine use of CT after the 80s decreased the rate to 14%. With the analysis of 50 years of data, it is strongly concluded that brain involvement in pediatric hydatid disease is a primary process if delayed diagnosis and insufficient treatment of extraneural hydatidosis are prevented.

Intracranial extradural hydatid cysts area rare occurrence with unclear pathogenesis. Three different cases are reported and the postoperative courses are discussed. Of the 11 cases found in the literature, all eight cases whose sex and age were reported are men, and seven of the eight are clustered in between the second and fourth decades.

The authors report a subfrontal transventricular approach to a high-position basilar top aneurysm considered to be inaccessible by conventional pterional or subtemporal techniques. This special technique may be preferred in the case where a megadolichobasilar artery coexists with such an aneurysm as it has the advantage of protecting the brain from the detrimental effects of strong retraction.