Radiological staging in neuroblastoma : computed tomography or magnetic resonance imaging?

Purpose: To compare the effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) in the staging of neuroblastomas according to the International Neuroblastoma Risk Group Staging System (INRGSS). Material and methods: In this single-centre retrospective study we identified a total of 20 patients under the age of 18 years, who were admitted to our hospital with neuroblastoma between January 2005 and May 2018, and who had both CT and MRI examination. The INRGSS stages of tumours were evaluated by CT scan and MRI. Then, stages of tumours were described according to the INRGSS for CT and MRI, separately. The Spearman rank correlation test was used for statistical analysis. The p-value < 0.05 was considered as statistically significant. Results: The median age was 11 months, and the age range was one month to nine years. In our results; both MRI and CT were significant in the determination of radiological staging of NBL, p < 0.001 and p = 0.002, respectively. MRI was superior to CT in radiological staging. MRI was also superior for the detection of intraspinal extension, involvement of multiple body compartments, metastatic disease, and bone marrow infiltration. CT was more useful to consider the relationship between tumours and vascular structures. Conclusions: MRI and CT have high diagnostic accuracy rates in the staging of pre-treatment neuroblastomas. MRI is important in pre-treatment evaluation of neuroblastomas because of the higher detection of metastases as well as the lack of ionising radiation

Morbidly adherent placenta and cesarean section methods. A retrospective comparative multicentric study on two different skin and uterine incision

Objectives: Morbidly adherent placenta (MAP) is one of leading causes of maternal mortality, with an increasing rate because of repeated cesarean sections (CS). The primary objective of this study is to compare two techniques of skin and uterine incisions in patients with MAP, evaluating the maternal fetal impact of the two methods. Retrospective multicentric cohort study.Material and methods: A total of 116 women with MAP diagnosis were enrolled and divided in two groups. Group one, comprised of 81 patients, abdominal entry was performed by Pfannenstiel skin incision plus an upper transverse lower uterine segment (LUS) incision (transverse-transverse), which was 2–3 cm above the MAP border, with the uterus in the abdomen. In group two, comprised of 35 patients, abdominal entry was performed by an infra-umbilical midline abdominal incision, by vertical-vertical technique, and the pregnant uterus was incised by a midline incision (vertical) from the fundus till the border of the MAP. Total surgery time, blood loss, blood product consumption, total hospital stay, cosmetic outcomes, and postoperative complications were investigated.Results: Total time of surgery was significantly shorter in group 1 (p &lt; 0.05). Intraoperative blood loss was higher in group 2. Difference between preoperative and postoperative Hb and Htc levels were 3.30 ± 1.04 and 12.99 ± 5.07 respectively (p = 0.012; p = 0.033). The use of erythrocyte suspension (ES), fresh frozen plasma (FFP), and cryoprecipitate and thrombocyte suspension (TS) were found to be significantly lower in patients of group 1than vertical-vertical group (p = 0.008, p = 0.009, p = 0.001, p = 0.001, respectively). There was no difference in terms of total length of hospital stay between groups.Conclusions: In a subgroup of patients diagnosed for MAP, the transverse-transverse incision resulted in less bleeding, less blood and blood product use, and had better cosmetic results than vertical-vertical incision. Moreover, the total time of surgery, crucial for MAP patients, seems to be shorter also in transverse-transverse incision than in vertical-vertical incision

Essays in economic growth, political economy and institutions

This dissertation analyzes the effects of political and economic institutions on economic development and growth. The first essay develops an overlapping-generations political economy model to analyze the incentives of various social groups to finance human capital accumulation through public education expenditures. The contribution of this study to the literature is that it helps explain the observed differences in the economic growth performance of natural resource-abundant countries. The results suggest that the preferred tax rates of the manufacturers on one hand and the political coalition of manufacturers and landowners, on the other hand, are equal to the socially optimal tax rate. However, we show that owners of natural resources prefer an excessively high tax rate, which suppresses aggregate output to a suboptimal level. The second essay examines the relationship between the political influence of different social classes and public education spending in panel data estimation. The novel contribution of this paper to the literature is that I proxy the political power and influence of the natural resource owners, manufacturers, and landowners with macroeconomic indicators. The motivation behind this modeling choice is to substantiate the definition of the political power of social classes with economic fundamentals. I use different governance indicators in the estimations to find out how different institutions mediate the overall impact of the political influence of various social classes on public education spending. The results suggest that political stability and absence of violence and rule of law are the important governance indicators. The third essay develops a counter argument to Acemoglu et al. (2010) where the thesis is that French institutions and economic reforms fostered economic progress in those German regions invaded by the Napoleonic armies. By providing historical data on urbanization rates used as proxies for economic growth, I demonstrate that similar different rates of economic growth were observed in the regions of France in the post-Napoleonic period as well. The existence of different economic growth rates makes it hard to argue that the differences in economic performance in the German regions that were invaded by the French and those that were spared a similar fate follow from regional differences in economic institutions

Coexistence of myositis, transverse myelitis, and Guillain Barré syndrome following Mycoplasma pneumoniae infection in an adolescent

Guillain-Barré syndrome (GBS) and transverse myelitis may occur coexistently in the pediatric population. This may be explained by a shared epitope between peripheral and central nervous system myelin. Coexistent transverse myelitis, myositis, and acute motor neuropathy in childhood have not been previously described. We describe a 14-year-old female patient with transverse myelitis, myositis, and GBS following Mycoplasma pneumoniae infection. She presented with weakness and walking disability. Weakness progressed to involve all extremities and ultimately, she was unable to stand and sit. Based on the clinical findings, a presumptive diagnosis of myositis was made at an outside institution because of high serum creatine kinase level. The patient was referred to our institution for further investigation. Magnetic resonance imaging of spine revealed enhancing hyperintense lesions in the anterior cervicothoracic spinal cord. The electromyography revealed acute motor polyneuropathy. Serum M. pneumoniae IgM and IgG were positive indicating an acute infection. Repeated M. pneumoniae serology showed a significant increase in Mycoplasma IgG titer. The patient was given intravenous immunoglobulin for 2 days and clarithromycin for 2 weeks. She was able to walk without support after 2 weeks of hospitalization. This paper emphasizes the rarity of concomitant myositis, transverse myelitis, and GBS in children

The role of MRI- based texture analysis to predict the severity of brain injury in neonates with perinatal asphyxia

Objective: To evaluate the efficacy of the MRI- based texture analysis (TA) of the basal ganglia and thalami encephalopathy (HIE) from mild HIE in neonates. Methods: This study included 68 neonates (15 with mild, 20 with moderate- to- severe HIE, and 33 control) were born at 37 gestational weeks or later and underwent MRI in first 10 days after birth. The basal ganglia and thalami were delineated for TA on the apparent diffusion coefficient (ADC) maps, T1-, and T2 weighted images. The basal ganglia, thalami, and the posterior limb of the internal capsule (PLIC) were also evaluated visually on diffusion- weighted imaging and T1 weighted sequence. Receiver operating characteristic curve and logistic regression analyses were used. Results: Totally, 56 texture features for the basal ganglia and 46 features for the thalami were significantly different between the HIE groups on the ADC maps, T2-, and T2 weighted sequences. Using a Histogram_ entropy log 10 value as >1.8 from the basal ganglia on the ADC maps (p < 0.001; OR, 266) and the absence of hyperintensity of the PLIC on T1 weighted images (p = 0.012; OR, 17.11) were found as independent predictors for moderateto-severe HIE. Using only a Histogram_ entropy log 10 value had an equal diagnostic yield when compared to its combination with other texture features and imaging findings. Conclusion: The Histogram_entropy log 10 value can be used as an indicator to differentiate from moderate to severe to mild HIE. Advances in knowledge: MRI- based TA may provide quantitative findings to indicate different stages in neonates with perinatal asphyxia

Lung density analysis using quantitative computed tomography in children with pectus excavatum

Purpose: To evaluate the mean lung density in children with pectus excavatum (PE) and to assess the correlation between the cardiac rotation angle, Haller index, pulmonary function test, and lung density. Material and methods: This retrospective study included 33 children with PE and 31 healthy controls. The densities of lung parenchyma were evaluated by quantitative computed tomography (CT). Three lung levels were determined: T4 vertebra level, T10 vertebra level, and the level of the measurement of the cardiac rotation angle. The cardiac rotation angle and the Haller index were calculated. All measurements were done by 2 radiologists, independently. Student's t-test or the Mann-Whitney U test, intraclass correlation coefficients, Pearson or Spearman's rank correlation coefficient, and Kruskal-Wallis test were used for statistical analysis. A p-value less than 0.05 was considered as statistically significant. Results: All the lung levels in the PE group had lower mean densities than healthy children, with statistical significance in the right lung at the T10 vertebra level (−818.60 ± 33.49 HU, −798.45 ± 40.24 HU; p = 0.028). There was a correlation between the cardiac rotation angle and the Haller index (r = 0.593; p < 0.001). There were no correlations between mean lung density and cardiac rotation angle, Haller index, and pulmonary function tests. Conclusions: The lower mean lung densities were found in PE, especially in the right lower lobe. The parenchymal aeration should be considered independently from the severity of PE

Decreased Right Hippocampal Volumes and Neuroprogression Markers in Adolescents with Bipolar Disorder

Objectives: The aim of the present study was to assess differences and correlations between the hippocampal volumes (HCVs), serum nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) levels in adolescents with bipolar disorder (BP) compared to healthy controls. Methods: Using structural magnetic resonance imaging, we compared HCVs of 30 patients with euthymic BP who were already enrolled in a naturalistic clinical follow-up. For comparison, we enrolled 23 healthy controls between the ages of 13 and 19. The boundaries of the hippocampus were outlined manually. The BDNF and NGF serum levels were measured with the sandwich ELISA. Results: The groups did not differ in the right or left HCVs or in the NGF or BDNF serum levels. However, negative correlations were found between the right HCVs and the duration of the disorder and medication and positive correlations were found between the duration of the medications and the NGF and BDNF levels in the patient group. Additionally, positive correlations were found between the follow-up period and left normalized HCVs in both the BP and lithium-treated groups. Conclusions: The right HCVs may vary with illness duration and the medication used to treat BP; NGF and BDNF levels may be affected by long-term usage. Further research is needed to determine whether these variables and their structural correlates are associated with clinical or functional differences between adolescents with BP and healthy controls. (C) 2015 S. Karger AG, Base

Pediatric paravertebral tumors: analysis of 96 patients

Purpose: The most important complication of paravertebral tumors is cord compression (CC), which is an oncologic emergency. Early and appropriate intervention is important in terms of reducing morbidity and mortality. Here, we report our clinical experience with paravertebral tumors. Methods: The files of patients who were followed up for benign/malignant paravertebral tumors between 1988 and 2022 were evaluated retrospectively. Results: There were 96 patients with paravertebral tumors. The median age at diagnosis was 5 years (1 month–17 years). The male/female ratio was 1.13. The median time to diagnosis was 4 weeks (0–28 weeks). The most common presenting complaint was pain (62.5%). The diagnosis distribution was as follows: sympathetic nervous system (SNS) tumors (n: 38), soft tissue sarcomas (STS) (n: 23), Langerhans cell histiocytosis (LCH) (n: 12), central nervous system (CNS) tumors (n: 9), germ cell tumor (n: 6), lymphomas (n: 4), and benign tumors (n: 4). Sixty-five patients (67.7%) had CC, 40% of whom received chemotherapy as first-line treatment. Decompression surgery was performed in 58.5% of the patients. For patients with CC, 26 patients had advanced disease at admission. Serious neurologic sequelae were observed in seventeen (17.7%) patients. Conclusion: Pain and neurological findings in childhood are warning signs for paravertebral tumors and CC. A detailed neurologic examination and radiodiagnostic imaging should be performed, and a definitive diagnosis should be made quickly. Anticancer treatment should be planned multidisciplinary. Decompression surgery should be discussed for patients with severe neurological deficits. Childhood cancers are chemosensitive; if possible, treatment should be initiated with chemotherapy to avoid neurological sequelae