Resolution of neurogenic arterial hypertension after suboccipital decompression for Chiari malformation. Case report

A Chiari malformation Type I may remain asymptomatic until the patient has reached adulthood and acute presentation of symptoms occurs. In several clinical and experimental studies it has been shown that essential hypertension is associated with vascular compression of the brainstem, particularly of the rostral ventrolateral medulla oblongata. Nevertheless, two cases of Chiari malformation and neurogenic arterial hypertension have been reported. In this article the authors describe a patient with Chiari malformation Type I and neurogenic arterial hypertension. A simple suboccipital decompression not only provided neurological improvement, but also led to resolution of the hypertension. In cases of Chiari malformation and concomitant neurogenic arterial hypertension, careful preoperative clinical and neuroimaging assessments may reveal the cause of the arterial hypertension. Resolution of neurogenic arterial hypertension may be expected even in a case of simple suboccipital decompression.     

Adolescent varicocele repair: long-term results and comparison of surgical techniques according to optical magnification use in 100 cases at a single university hospital

PURPOSE: We review the long-term results of varicocele repair, and compare the complication rates of varicocelectomy techniques according to optical magnification use in adolescents with varicocele at a single university hospital. MATERIALS AND METHODS: We prospectively studied 100 males 7 to 19 years old with clinical palpable varicocele. Of the patients 52 (52%) underwent left unilateral varicocelectomy and 48 (48%) underwent bilateral varicocelectomy. Varicocelectomy was performed using a microscope in 49 patients (79 sites), loupe magnification in 25 (35 sites) and no magnification in 26 (34 sites) using either a subinguinal or inguinal approach. Postoperative complications were compared in all patients based on technique. Preoperative and postoperative serum hormone values and semen parameters were compared in 33 patients. RESULTS: Mean postoperative followup was 30.4 +/- 13.06 months (12 to 65). Total motile sperm count increased from 22.6 million +/- 5.16 million to 64.53 million +/- 12.3 million postoperatively, which was statistically significant (p = 0.002). Postoperative recurrence rates were 0% in cases managed by microsurgical varicocelectomy, 2.9% in those where loupe magnification was used and 8.8% in those where no magnification was used. Postoperative hydrocele rates in these cases were 0%, 2.9% and 5.9%, respectively. The highest rates of recurrence and hydrocele were observed in cases where no magnification was used, compared to those managed by microsurgery (p = 0.03 and p = 0.116, respectively). CONCLUSIONS: Adolescent varicocele repair improves semen parameters and is a safe method with low recurrence and low complication rates. Our study suggests that the postoperative complication rate significantly decreases with use of higher magnification, such as microscopy. Microsurgical varicocele repair is the best technique with the lowest postoperative rates of recurrence and hydrocele in the treatment of adolescent varicoceles.     

Herophilus of Chalcedon: a pioneer in neuroscience

A review of the history of ancient medicine reveals that most of the knowledge is concentrated in the studies of a few scientists. The best-known names include Hippocrates, Rufus of Ephesus, Celsus, and Galen. The survival of their works throughout the ages has been the most important factor contributing to their popularity. However, there are other scientists who made great contributions to science, but whose writings have been lost or destroyed over the course of time. As a result, their names are not as well known as those of others and the value of their contributions is not appreciated. With the improvement of communication technology in the past 50 years, links between the studies of ancient science can be made more effectively and scientists who have remained hidden under the shade of time have begun, after thousands of years, to receive the appreciation they deserve. In the field of neuroscience, the historical record focuses on Galen of Pergamon. But, when his marvelous works are carefully studied, it is interesting to note two names he frequently referenced: Herophilus (335-280 BC) and Erasistratus (310-250 BC). These two scientists were the first to place scientific value on the dissection of the human body. Herophilus is considered the father of scientific anatomy, and Erasistratus was the first experimental physiologist. Attracted by the prospect of material advancement and eminent students, both migrated from their homes in Asia Minor to Alexandria. The works of Herophilus and Erasistratus have been lost entirely, but some details of their teachings may be recovered from the writings of Galen. In this study, we focus on Herophilus, a master of ancient medicine, whose important discoveries about the human body formed the basis for positive science and the foundation for neuroscience.     

Foreign body asphyxiation in children

We aimed to investigate the frequency and epidemiological features of deaths due to foreign body asphyxiation (FBA) in childhood, over 1990-2003. Of the victims, 14 (63.6%) were male and 8 (36.4%) females. The mean age of the victims was 2.2 +/- 0.6 years. There were 20 (90.9%) children between 1 and 3 years, and two other cases at 2/12 and 5 years of ages. All aspirations had occurred at home. Eight (36.4%) of the victims were dead on arrival, 11 (50%) on intervention, and 3 (13.6%) after complications. Food material was the most commonly aspirated foreign body in 81.8% of the cases, nuts being the most common (50%). Food asphyxiation remains a common problem particularly in children between 1 and 3 years of age in our region. These fatal accidents can be prevented by parental education and early recognition and management of the situation.     

Evaluation of cerebral blood flow volume using color duplex sonography in patients with untreated panic disorder

The aim of this study was to compare cerebral blood flow (CBF) using color duplex sonography in panic disorder and normal controls. We report 24 untreated patients and 20 healthy subjects. State-Trait Anxiety Inventory, Beck Depression Inventory, Beck Anxiety Inventory, and Symptom Check List-90 were completed on each subject. The internal carotid artery (ICA) and vertebral artery (VA) of both sides were explored with a 7.5-Mhz linear array transducer. CBF volume and mean ICA flow velocity were significantly higher in patients than normal subjects adjusted for age. However, we could not find a statistically significant difference in flow volume and velocity of VA and the sum of bilateral ICA volume between patients and controls adjusted for age. There was also no correlation between CBF volume and the other radiological data with STAI scores. In conclusion, we found that independent of anxiety levels, CBF volume has increased in panic disorder patients. In addition, color duplex sonography is a non-invasive and easily applicable technique and it is a preferable alternative to quantify CBF volume.     

Transfusion requirements during cadaveric and living donor pediatric liver transplantation

Surgical techniques that have been used during liver transplantation (LT) together with patient's coagulation profile and institutional practices are reported to have an effect on transfusion requirements. The aim of this study is to evaluate the transfusion requirement in both cadaveric (CDLT, n = 22) and living donor (LDLT, n = 24) pediatric LT performed in our institution. Balanced general anesthesia was used for all patients. Transfusion requirements were met to maintain a hemoglobin concentration of 8-10 g/dL, platelet level >50 x 10(3)/mL, prothrombin time <20 s and hemodynamic course with observing heart rate, arterial and central venous blood pressures and hourly urine output. Blood loss was replaced by using whole blood. Both groups' perioperative total blood and fresh-frozen plasma (FFP) volumes transfused, fluid requirements and hemodynamic courses, standard coagulation profile and metabolic variables determined in time periods of operations, patients' preoperative characteristics, operative features and postoperative events were compared. The mean transfusion requirements were 37.1 +/- 33.4 and 74.8 +/- 90.8 mL/kg of whole blood (p = 0.059) and 34.5 +/- 24.9 and 51.5 +/- 59.7 mL/kg of FFP for CDLT and LDLT, respectively (p = 0.519). The mean ages and mean body weights of the CDLT patients were higher than LDLT patients (9.7 +/- 5.3 vs. 6.6 +/- 4.4 yr, p = 0.015 and 32.4 +/- 17.7 vs. 21.0 +/- 14.8 kg, p = 0.032, respectively) while the mean operation time (493 +/- 135 vs. 323 +/- 93 min, p = 0.0001) and PELD score (13.1 +/- 11.2 vs. 20.1 +/- 11.8, p = 0.036) were higher for LDLT. In the entire population, multiple regression analysis showed that age, body weight and operation time have a significant combined effect on blood consumption (r2= 0.29, p = 0.003) meanwhile operation time was found to be an effective single variable (p = 0.002). None of the single or combined variables was found to have a significant effect on FFP consumption (r2= 0.17, p = 0.63) and crystalloid use (r2= 0.19, p = 0.11). Hemodynamic courses of both groups were similar. The incidences of metabolic acidosis and hypothermia during the anhepatic periods were higher in the CDLT group (p < 0.05). However, transfusion requirement in the ICU were higher in LDLT group [6.9 +/- 2.2 (n = 6) vs. 18.6 +/- 19 (n = 11) mL/kg, p < 0.05] after LT. As a result of this study in a pediatric patient population, no statistical significance was found in whole blood transfusion and FFP requirements between CDLT and LDLT. Duration of the operation was the primary factor effecting transfusion volume showing the importance of continued small volume losses during uncomplicated LT in this small sized patient population. Transfusion need for pediatric LT should be individualized for each patient based on the intraoperative conditions including surgical and patient features.