Clinical and radiologic features and their relationships with neurofunctional scores in patients with acute cerebellar infarct

Background: Cerebellar infarct is a rare condition with very nonspecific clinical features. The aim of this study was to assess the full spectrum of the clinical characteristics, neuroimaging findings and neurofunctional analyses of cerebellar infarction, and the relationship between them. Materials and Methods: Data were collected from 59 patients admitted to our department during an 8-year period. We retrospectively analyzed the relationship between demographic characteristics, clinical symptomatology, etiological factors, functional condition, vascular distribution, frequency of subcortical white matter lesions (WMLs), and concomitant lesion outside the cerebellum in patients with acute cerebellar infarct (ACI) at time of admission. Results: The mean age in our series was 65.2 years, with most being male (57.6%). The posterior inferior cerebellar (PICA) artery was the most commonly affected territory at 62.7%. There was concomitant lesion outside the cerebellum in 45.7%. The main etiology in PICA was cardioembolism. While mean National Institutes of Health Stroke Scale on admission was 2.08 ± 1.67 in study group, modified Rankin Scale (mRS) on admission was detected to be mRS1 (n: 44, 74.5%) and mRS2 (n: 12, 20.3%) most frequently. Fourteen (35%) patients were detected to be in Fazekas stage 0; 11 (27.5%) patients in Fazekas stage 1; 6 (15%) patients in Fazekas stage 2; and 9 (22.5%) patients in Fazekas stage 3. Conclusion: Cerebellar infarct is very heterogeneous. The other cerebral area infarcts which accompany ACI negatively affect neurologic functional scores. Although it is difficult to detect the relationship between WMLs and neurologic functional severity, timely detection of risk factors and their modulation may be associated with prevention and treatability of WMLs, and this may be one of the important points for prevention of stroke-related disability

Musical mirror-symmetrical movement tasks: comparison of rhythm versus melody-playing

Bimanual mirror-symmetrical movement (MSM) is relatively easy to control movement. Different MSM tasks may have different activations and interhemispheric interactions. The purpose of this study is to compare anatomo-physiological features such as hemispheric activations and dominance of two different MSMs, namely melody-playing and rhythm. We examined functional MRI (fMRI) recordings in a group of fifteen right-handed pianists performing two separate tasks: bimanual rhythm and bimanual melody-playing on two different keyboards with standard key order for right hand and reversed for left hand, which allows homolog fingers' movements. Activations and laterality indices on fMRI were examined. The results show that significant cerebellar activations (especially in anterior cerebellum) in both groups. Significant primary sensorimotor cortical activations are observed in the melody-playing group. While there are also bilaterally symmetric activations, and laterality indices suggest overall lateralization towards the left hemisphere in both groups. Activations in the left fronto-parietal cortex, left putamen and left thalamus in conjunction with right cerebellar activations suggest that the left cortico-thalamo-cerebellar loop may be a dominant loop. Dynamic causal modeling (DCM) indicates the presence of causal influences from the left to the right cerebral cortex. In conclusion, melody-playing with bimanual MSM is a complex in-phase task and may help activate the bilateral cortical areas, and left hemisphere is dominant according to laterality indices and DCM results. On the other hand, bimanual rhythm is a simpler in-phase task and may help activate subcortical areas, which might be independent of the voluntary cortical task

Psychiatric Symptoms, Aggression, and Sexual Dysfunction Among Patients With Benign Anal Conditions

Introduction The aim of this study was to investigate the incidence of general psychiatric symptoms, aggression levels, and sexual dysfunction in patients with benign anorectal diseases and compare the results with those of healthy control subjects. Methods We prospectively enrolled consecutive adult patients who presented for treatment of benign perianal diseases and healthy control subjects between June 2017 and December 2018. All patients had either grade 3 or 4 hemorrhoidal disease or perianal fistula with active discharge who had not undergone previous anorectal surgery. We also included a control group with benign subcutaneous lumps presenting for minor surgery. We used the Symptom Checklist-90-Revised Form to evaluate general psychiatric symptoms, the Buss-Perry Aggression Questionnaire (BPAQ) to evaluate aggression levels, and the Arizona Sexual Experiences Scale to evaluate sexual dysfunction. Results A total of 563 patients were assessed for eligibility; after exclusions, 94 with anal fistula, 89 with hemorrhoids, and 59 healthy control subjects were enrolled. The groups were similar with regard to age, gender, and educational level. Physical and verbal aggression, anger, and total BPAQ score were significantly higher in patients with perianal fistula than in those with hemorrhoidal disease and healthy control subjects (P .001). Conclusion This study suggests that patients with perianal fistula have higher levels of aggression than healthy control subjects and those with hemorrhoidal disease. One must bear this in mind during preoperative patient evaluations and obtaining informed consent. Further studies are needed to investigate the reason for this association and potential causality

CT-guided tractography is a safe and complementary diagnostic tool in the management of penetrating abdominal trauma

Summary: Background/Objective: Despite extensive published research, the surgical approach to penetrating abdominal trauma patients is still under debate. Computed tomography-guided tractography (CTT) is an imaging modality in which water soluble iodinated contrast medium is administered into the site of the injury in the CT unit. The aim of this study was to determine the diagnostic accuracy of the CTT. Methods: A retrospective evaluation was made of patients admitted to the Emergency Department with penetrating abdominal trauma and who underwent CTT. Contrast enhanced abdominal CT and CTT reports, surgical findings and clinical results were examined. Results: Evaluation was made of a total of 101 patients comprising 89 males (88.1%) and 12 females (11.9%). CTT was determined to have 92.8% sensitivity, 93.6% specificity, 97% positive predictive value, and 85.5% negative predictive value. In 27 patients (26.7%) where the CTT indicated passage through the peritoneum, no parenchymal organ injury was present. Only one patient (2.9%) without peritoneal penetration on CTT had organ injury at exploration. No procedure-related morbidities developed. Conclusion: CTT is a safe imaging modality for the evaluation of hemodynamically stable patients. Compared to other imaging modalities, there is clearer demonstration of whether or not the peritoneum is intact. However penetration on CTT does not exactly correlate with organ injury. Keywords: Computed tomography guided tractography, Penetrating abdominal trauma, Therapeutic trauma laparotomy, Negative laparotom

TAFI gene polymorphisms in patients with cerebral venous thrombosis

Gene polymorphisms of thrombin activatable fibrinolysis inhibition (TAFI) factor have been investigated in various studies in terms of etiology (recurrence) and treatment (fibrinolytic effect) of thrombus formation. Cerebral venous thrombosis (CVT) is a life-threatening disease observed in young persons. Fifty-nine patients with CVT and 100 healthy control subjects were enrolled in the case/control study. The association between TAFI gene polymorphisms -438G > A, +505A > G and +1040C > T and cerebral venous thrombosis was investigated. It was found that frequencies of polymorphic genotype and allele were not different in patients than in control group and that they were not significant for cerebral venous thrombosis

P-wave Dispersion for Predicting Paroxysmal Atrial Fibrillation in Acute Ischemic Stroke

Background: Detection of paroxysmal atrial fibrillation (PAF) in acute ischemic stroke patients poses diagnostic challenge. The aim of this study was to predict the presence of PAF by means of 12-lead ECG in patients with acute ischemic stroke. Our hypothesis was that P-wave dispersion (Pd) might be a useful marker in predicting PAF in patients with acute ischemic stroke.Methods: 12-lead resting ECGs, 24-hour Holter recordings and echocardiograms of 400 patients were analyzed retrospectively. PAF was detected in 40 patients on 24-hour Holter monitoring. Forty out of 360 age and gender matched patients without PAF were randomly chosen and assigned as the control group. Demographics, P-wave characteristics and echocardiographic findings of the patients with and without PAF were compared.Results: Maximum P-wave duration (p=0.002), Pd (p&#60;0.001) and left atrium diameter (p=0.04) were significantly higher in patients with PAF when compared to patients without PAF. However, in binary logistic regression analysis Pd was the only independent predictor of PAF. The cut-off value of Pd for the detection of PAF was 57.5 milliseconds (msc). Area under the curve was 0.80 (p&#60;0.001). On a single 12-lead ECG, a value higher than 57.5 msc predicted the presence of PAF with a sensitivity of 80% and a specificity of 73%.Conclusion: Pd on a single 12-lead ECG obtained within 24 hours of an acute ischemic stroke might help to predict PAF and reduce the risk of recurrent strokes.</p

The effect of silymarin on hepatic regeneration after partial hepatectomy: Is silymarin effective in hepatic regeneration?

Aim: Silymarin from Silybum marianum was found to reduce liver injury. The aim of the present study was to investigate the effects of silymarin on hepatic regeneration in partially hepatectomized rats. Methods: Thirty Wistar-Albino rats were divided into 3 groups of 10 animals as sham, control and experimental groups. In the sham group (n=10) abdominal incision was closed after laparotomy. In the control group (n=10), the rats underwent 70% hepatectomy after laparotomy. In the experimental group (n=10) after partial 70% hepatectomy, silymarin (200 mg/kg/d) were given to rats for 10 days. Rats in three groups were sacrificed on 10 days. Aspartate (AST) and alanine transaminase (ALT), gamma glutamyl transferase (GGT), ALP, LDH and total bilirubin levels were measured using intracardiac blood samples. Tissue malondialdehyde (MDA) and tissue glutathion (GSH) and Superoxide dismutase (SOD) levels were measured. To reveal the increase in the mass of the remnant liver tissue in the control and experimental groups relative weight of the liver was calculated. Histopathological analysis of the liver was performed using a semi-quantitative scoring system. Results: A statistically significant difference among three groups was not shown for AST and ALT levels. A statistically significant difference was found between the groups as for total bilirubin and gamma glutamyl transferase levels. Increases in relative liver weights were seen with time in Groups 2 and 3. A statistically significant difference was not found for tissue malondialdehyde, Glutathion and Superoxide dismutase levels between hepatectomy and hepatectomy + silymarin groups. On liver tissue sections of the rats in the hepatectomy + silymarin group, increased regeneration and lipid peroxidation were observed accompanied by decreased antioxidant response. Conclusion: It has been observed that silymarin with many established functions such as antiproliferative, anti-inflammatory and energy antioxidant effects, does not contributed to proliferative regeneration of the liver-which has very important metabolic functions-after partial hepatectomy; instead it will decrease serum levels of transaminases. © 2015, Int J Clin Exp Med.All rights reserved

One misfortune is better than thousands of pieces of advice: the warning role of rectal bleeding

Objective: Rectal bleeding is one of the most important symptoms of colorectal cancer that fast-tracks the patients consultation with a physician. This study aims to assess the warning role of rectal bleeding in a risk group for colorectal cancer. Besides, the relationship among awareness, various socio-demographic criteria and the reasons for visiting or not visiting the physician was evaluated among greater than or equal to 40 years old. Methods: This descriptive study was conducted thousand one hundred and sixteen (1116) individuals greater than or equal to 40 years old. Awareness of rectal bleeding as a warning sign in participating individuals was assessed by a questionnaire in addition to their family history of cancer or polyps and reasons for visiting or not visiting a physician. Results: A prior history of rectal bleeding was found in 51.9% of subjects. Among those with rectal bleeding history, the rate of visiting a physician due to this bleeding was 49.7%. No statistically significant relationship was found between the frequency of those who contacted their physician and gender, education or age. The frequency of visiting a physician was significantly higher among individuals with a family history of colorectal cancer as compared with no family history and was directly proportional to the degree of family relationship (p = 0.007). Conclusion: Even rectal bleeding does not raise enough attention for visiting a physician. Therefore, public education and screening still have paramount importance in the prevention of colorectal cancer. [Arch Clin Exp Surg 2019; 8(1.000): 15-20