Anil Dolgun

Is diffusion-weighted imaging useful in grading and differentiating histopathological subtypes of meningiomas?

PURPOSE Meningiomas are mostly benign, however atypical or malignant subtypes with more aggressive clinical course and higher recurrence rates can also be seen. The purpose of this study was to determine whether histopathological subtypes of meningiomas could be assessed preoperatively using apparent diffusion coefficient (ADC) values. MATERIALS AND METHODS Conventional magnetic resonance (MR) and diffusion-weighted (DW) imaging of 177 adult patients with pathologically proven meningiomas were retrospectively evaluated. Tumor size and the degree of associated edema were noted. The signal intensity of the lesions on DW imaging was evaluated and graded. Mean ADC values were obtained as the mean of measurements from three regions of interests within the mass. ADC ratios of meningioma/contralateral normal appearing subcortical parietal white matter were also calculated. RESULTS The histopathological analysis revealed 135 benign, 37 atypical and 5 malignant lesions. With classification according to the subtype, the mean ADC values and ratios of benign meningiomas were as 0.99±0.12×10(-3) mm(2)/s and 1.22±0.07, respectively. ADC values for atypical and malignant groups were both 0.84±0.1×10(-3) mm(2)/s. The ADC ratios were 1.05±0.1 and 0.96±0.2 for atypical and malignant subtypes, respectively. There was no statistically significant difference between the mean ADC ratios of the three subtypes (ANOVA test; P≥0.05). Gender, age of the patients and tumor size showed no statistically significant difference between the different histological groups. CONCLUSION DW MR imaging was not found to have any additional value in determining histological behaviour nor in differentiating histopathological subtypes of meningiomas.

CT assessment of asymptomatic hip joints for the background of femoroacetabular impingement morphology

PURPOSE The purposes of this study were to assess the presence of cam and pincer morphology in asymptomatic individuals with a negative femoroacetabular impingement test, and to determine and compare the ranges of alpha angle using two measurement methods. MATERIALS AND METHODS In total, 68 consecutive patients who underwent abdominopelvic computed tomography (CT) for reasons other than hip problems were the patient population. Patients who had a positive femoroacetabular impingement test were excluded. Alpha angle measurements from axial oblique (AN) and radial reformat-based images (AR) from the anterior through the superior portion of the femoral head-neck junction, as well as femoral head-neck offset, center-edge angle, acetabular version angle measurements, and acetabular crossover sign assessment, were made. RESULTS Overall prevalences of cam (increased alpha angle, decreased femoral head-neck offset) and pincer morphology (increased center-edge angle, decreased acetabular version) were 20.0%, 26.8%, 25.8%, and 10.2% of the hips, respectively. The mean AR ranged from 41.64° ± 4.23° to 48.13° ± 4.63°, whereas AN was 41.10° ± 4.44°. The values of AR were higher than AN, and the difference was statistically significant (P <0.001). The highest AR values were measured on images from the anterosuperior section of femoral head-neck junction. CONCLUSION In asymptomatic subjects, higher alpha angle values were obtained from radial reformatted images, specifically from the anterosuperior portion of the femoral head-neck junction compared with the axial oblique CT images. Other measurements used for the assessment of cam and pincer morphology can also be beyond the ranges that are considered normal in the general population.

Evaluation of palatal donor site haemostasis and wound healing after free gingival graft surgery

AIM Evaluating effectiveness of a medicinal plant extract (MPE) in achieving haemostasis and early wound healing at free gingival graft (FGG) donor site in a randomized controlled fashion. METHODS Forty patients requiring FGG at lower anterior area were randomly assigned into two groups. FGG was performed to all patients and following graft procurement; wet gauze (WG) was applied alone (control: WG group) or with MPE (test: MPE + WG group) for haemostasis. Donor site working time, bleeding (BLE), colour match (CM), pain, epithelization (EP) and sensation loss (SL) were evaluated. RESULTS Thirty-three participants completed a 6-month period study. In the test group, primary BLE was shorter (p < 0.001) and fewer individuals showed secondary BLE during 3 days (p < 0.001). During the 6 days, pain scores were higher in WG patients (p < 0.05). Later on, no inter-group difference was observed. EP was relatively faster (p < 0.001) and CM was slightly better (p < 0.05) in MPE + WG group. CONCLUSION MPE provided faster and continuous haemostasis that made a positive contribution to the early soft tissue healing to some extent but due to limitations; further trials are needed to demonstrate the efficiency of this material.

Carcinoma of the Oral Tongue: A Case Series Analysis of Prognostic Factors and Surgical Outcomes

PURPOSE To identify factors affecting the clinical course and survival of patients with squamous cell carcinoma of the tongue. MATERIALS AND METHODS One hundred thirty-eight patients who were treated with surgical excision of primary tongue cancer and neck dissection were analyzed retrospectively. The study had a median follow-up period of 23 months. Univariate and multivariate statistical analyses for prognostic risk factors were performed using the Cox regression method. Survival curves were processed with the Kaplan-Meier method. RESULTS The 138 patients (73 male, 65 female) had a median age of 60 years. The 5-year overall, disease-specific, and relapse-free survival rates were 81%, 73%, and 71%, respectively. Tumor thickness greater than 8 mm was the only independent prognostic factor indicating a poor prognosis in overall survival (P = .049). Presence of involved lymph nodes indicated a tendency toward a poorer prognosis in disease-specific survival (P = .026) and relapse-free survival (P = .043). CONCLUSIONS The present findings indicated that tumor thickness greater than 8 mm and lymph node metastasis were independent predictors of worse survival in patients with squamous cell carcinoma of the tongue. Because similar regional recurrence rates were observed in selective and radical neck dissections, supraomohyoid neck dissection is supported as a primary treatment for patients with clinical N0 tumor.

The Adjunctive Effect of Platelet-Rich Fibrin to Connective Tissue Graft in the Treatment of Buccal Recession Defects: Results of a Randomized, Parallel-Group Controlled Trial.

BACKGROUND Platelet-rich fibrin (PRF) is an autologous preparation that has encouraging effects in healing and regeneration. The aim of this trial is to evaluate the effectiveness of coronally advanced flap (CAF) + connective tissue graft (CTG) + PRF in Miller Class I and II recession treatment compared to CAF + CTG. METHODS Forty patients were treated surgically with either CAF + CTG + PRF (test group) or CAF + CTG (control group). Clinical parameters of plaque index, gingival index, vertical recession (VR), probing depth, clinical attachment level (CAL), keratinized tissue width (KTW), horizontal recession (HR), mucogingival junction localization, and tissue thickness (TT) were recorded at baseline and 3 and 6 months after surgery. Root coverage (RC), complete RC (CRC), attachment gain (AG), and keratinized tissue change (KTC) were also calculated. RESULTS All individuals completed the entire study period. At baseline, mean VR, HR, CAL, KTW, and TT values were similar (P >0.05). In both groups, all parameters showed significant improvement after treatment (P <0.001), and except TT (P <0.05), no intergroup difference was observed at 6 months after surgery. The amount of RC and AG, but not KTC and CRC, was higher in the PRF-applied group (P <0.05). CONCLUSIONS According to the results, the addition of PRF did not further develop the outcomes of CAF + CTG treatment except increasing the TT. However, this single trial is not sufficient to advocate the true clinical effect of PRF on recession treatment with CAF + CTG, and additional trials are needed.

Diagnostic accuracy of the constructive interference in steady state sequence alone for follow-up imaging of vestibular schwannomas.

BACKGROUND AND PURPOSE: Vestibular schwannoma (VS) is a benign, slow-growing tumor, and radiologic monitoring is an acceptable alternative to surgery in small lesions and in elderly patients. MR imaging with contrast is the study of choice in the follow-up of these lesions. However, gadolinium-based contrast agents have side effects and should be used only when definitely indicated. The purpose of this study was to evaluate the diagnostic accuracy of the constructive interference in steady state (CISS) sequence used without postcontrast sequences for the follow-up imaging of VS. MATERIALS AND METHODS: MR imaging examinations of 18 patients were retrospectively evaluated by 2 radiologists. VS masses were measured on both CISS and the postcontrast images by each observer. For each patient, the masses were also assessed qualitatively for possible progression between every consecutive study. RESULTS: Fifty MR images of 18 patients were evaluated. Patients had 1–5 follow-up studies. The mean time interval between the consecutive studies was 23 months (6–55 months). The sensitivity, specificity, and accuracy of the CISS sequence for the detection of progression were 100%. There was good interobserver and intraobserver (CISS and postcontrast) correlation. The CISS sequence had, however, limited sensitivity for the detection of changes in the internal architecture. CONCLUSIONS: Noncontrast CISS-only technique may be a viable alternative to routine contrast-enhanced sequences for the follow-up of overall lesion size in patients with VS; however, treatment-related changes internal to the tumor are less noticeable using the CISS sequence.

A current analysis of caregivers’ approaches to fever and antipyretic usage

INTRODUCTION The aim of this survey was to investigate the current knowledge, attitudes, and practices of febrile childrens caregivers about fever, antipyretic usage, and temperature measurement methods in a tertiary care hospital. METHODOLOGY A 41-item questionnaire was administered to a convenience sample of febrile childrens caregivers in face-to-face interviews by two research assistants from January 2012 through June 2012 in an urban region of Turkey. RESULTS A total of 1,032 caregivers completed the interview. Approximately one-third of caregivers considered a temperature of less than 37.8°C (100°F) to be a fever, and 13% of all respondents would give antipyretics for a body temperature ≤ 37.8°C. Furthermore, 76% of parents would wake their children from sleep to administer antipyretics. Although a high proportion (89.5%) of respondents believed that fever had harmful effects, 10.5% considered fever to be beneficial. Alternating use of acetaminophen and ibuprofen (44%) and giving antipyretics routinely (71%) before and after immunizations were common parental practices and generally advised by pediatricians. Parents with higher levels of education were more likely to consider fever to be beneficial and to treat fever with antipyretics, and less likely to seek medical attention for mild fever. Most caregivers stated that they were unsure about the right site (90%) and thermometer type (95%) for temperature measurement. CONCLUSIONS Persistent fever anxiety and excessive antipyretic usage may be heightened by the lack of knowledge regarding accurate temperature measurement methods with digital thermometers in our population. Parental education may positively affect the approach to fever and antipyretic usage.

Assessment of skin photoaging with reflectance confocal microscopy

Increased interest in antiaging methods, mandates a development of reliable noninvasive technique to assess skin aging. In this study, we aimed to determine the effects of photoaging at histopathologic resolution by means of reflectance confocal microscopy.

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists’ diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted κ values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders.

Default mode network connectivity is linked to cognitive functioning and CSF Aβ1–42 levels in Alzheimer’s disease

BACKGROUND Changes in the default mode network (DMN) activity are early features of Alzheimers disease (AD) and may be linked to AD-specific Aβ pathology. METHODS Cognitive profiles; DMN connectivity alterations; and cerebrospinal fluid (CSF) amyloid beta (Aβ)1-42, total tau, phosphorylated tau 181, and α-synuclein levels were studied in 21 patients with AD and 10 controls. RESULTS DMN activity is altered in AD. Posterior cingulate cortex (PCC) functional connectivity with other parts of DMN was related to cognitive function scores. The reduction of connectivity of the dorsal PCC with the retrosplenial cortex on the right side was closely related to decreased CSF Aβ1-42 levels in patients with AD. CONCLUSIONS The dorsal PCC and retrosplenial cortex may have special importance in the pathogenesis and cognitive findings of AD.