Mezial temporal lob epilepsili olgularda wada testi ve ameliyat öncesi/amaliyat sonrası bellek ilişkisi

Objectives: To study the correlation between Wada memory test and neuropsychometric tests which were applied preoperatively to mesial temporal lobe epilepsy patients associated with hippocampal sclerosis (MTLE-HS) who had undergone selective amygdalohippocampectomy and find out the effects of early onset epileptic seizures on atypical memory dominance. Methods: Drug-resistant 27 patients (16 left, 11 right MTLE-HS) had video EEG, cranial MRI and Wada test preoperatively. Weschler visual subtest and verbal memory processing tests were applied to all patients before surgery and the first year after the operation. Results: The number of left hemisphere memory dominant patients was 6 (22.2%) and the number of atypical memory dominant patients was 21 (77.8%) according to the Wada test. There was a significant difference between the two groups when compared for epileptic seizure onset age; (p=0.042), and also a significant diffference when compared for HS (right/left) side (p=0.002). When we analyzed the correlation between preoperative and postoperative verbal and nonverbal tests and left memory Wada dominance; in verbal memory processing tests ‘delayed recall’ scores between groups were significant (p=0.042), on the other hand in patients with atypical memory dominance ‘total learning’ scores between groups were significant (p<0.001). Conclusion: As a result, we found that the earlier the onset of seizures, the more atypical the memory dominance (right or bilateral). The Wada test was effective for assessing verbal memory; on the other hand, it was inadequate for assessing visual memory dominance. If the scores of ‘delayed recall’ in verbal memory were high in the patients with typical verbal dominance and ‘total learning’ scores in the patients with atypical verbal dominance, the scores also tended to rise after the operation.Amaç: Selektif amigdalohippokampektomi yapılan hipokampal sklerozla ilişkili mesial temporal lob epilepsili (HS-MTLE) hastalarda ameliyat öncesi dönemde yapılan Wada testi ile nöropsikometrik testler arasındaki ilişkiyi inceleyerek erken yaşta başlayan epilepsi nöbetlerinin belleğin atipikleşmesi üzerindeki etkilerini araştırmak. Gereç ve Yöntem: Medikal tedaviye dirençli 27 hastaya (16 sol, 11 sağ HS-MTLE) cerrahi oncesi video EEG, kranial manyetik rezonans görüntüleme, Wada testi ile ameliyat öncesi ve sonrası birinci yılda Weschler görsel subtest ve sözel bellek süreçleri testleri uygulanmıştır. Bulgular: Wada bellek testinde sol hemisfer dominant bulunanlarn sayısı 6 (%22.2), atipik yerleşimli olanların sayısı 21 (%77.8) idi. Bellek dominansı sol ve atipik olanlarda nöbet başlama yaşı (p=0.042), ve HS (sağ/sol) tarafı açısından karşılaştırıldığında da anlamlı fark saptanmıştır (p=0.002). Yine sol bellek dominant olanlar ile ameliyat öncesi ve sonrası verbal ve nonverbal testler arasındaki korelasyona bakıldığında sözel bellek süreçleri testlerinden ‘gecikmeli hatırlama’ puanları arasında anlamlı ilişki bulunurken (r=0.829; p=0.042) atipik bellek dominansı olanlarda ‘toplam öğrenme’ puanları arasında anlamlı ilişki bulunmuştur (r=0.731; p<0.001). Sonuç: Nöbet başlama yaşı ne kadar düşükse bellek dominansı o kadar atipiktir (sağ veya bilateral). Wada testi sırasında yapılan bellek değerlendirmesi verbal belleği değerlendirmede etkili ancak görsel belleği değerlendirmede yetersizdir. Tipik bellek dominansı olanlarda ‘gecikmeli hatırlama’, atipik olanlarda ‘toplam öğrenme ’ puanları başlangıçta yüksek ise, ameliyat sonrası dönemde de yükselme göstermektedir

The IDENTIFY study: the investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer - a multicentre observational study

Objective To evaluate the contemporary prevalence of urinary tract cancer (bladder cancer, upper tract urothelial cancer [UTUC] and renal cancer) in patients referred to secondary care with haematuria, adjusted for established patient risk markers and geographical variation. Patients and Methods This was an international multicentre prospective observational study. We included patients aged ≥16 years, referred to secondary care with suspected urinary tract cancer. Patients with a known or previous urological malignancy were excluded. We estimated the prevalence of bladder cancer, UTUC, renal cancer and prostate cancer; stratified by age, type of haematuria, sex, and smoking. We used a multivariable mixed-effects logistic regression to adjust cancer prevalence for age, type of haematuria, sex, smoking, hospitals, and countries. Results Of the 11 059 patients assessed for eligibility, 10 896 were included from 110 hospitals across 26 countries. The overall adjusted cancer prevalence (n = 2257) was 28.2% (95% confidence interval [CI] 22.3–34.1), bladder cancer (n = 1951) 24.7% (95% CI 19.1–30.2), UTUC (n = 128) 1.14% (95% CI 0.77–1.52), renal cancer (n = 107) 1.05% (95% CI 0.80–1.29), and prostate cancer (n = 124) 1.75% (95% CI 1.32–2.18). The odds ratios for patient risk markers in the model for all cancers were: age 1.04 (95% CI 1.03–1.05; P < 0.001), visible haematuria 3.47 (95% CI 2.90–4.15; P < 0.001), male sex 1.30 (95% CI 1.14–1.50; P < 0.001), and smoking 2.70 (95% CI 2.30–3.18; P < 0.001). Conclusions A better understanding of cancer prevalence across an international population is required to inform clinical guidelines. We are the first to report urinary tract cancer prevalence across an international population in patients referred to secondary care, adjusted for patient risk markers and geographical variation. Bladder cancer was the most prevalent disease. Visible haematuria was the strongest predictor for urinary tract cancer

Evaluation of the Frequency of Obesity and Demographic Characteristics of Children with Primary Monosymptomatic Nocturnal Enuresis

Aim: Enuresis is a common problem in childhood. Our aim in our study was to evaluate the relationship between monosypmtomatic nocturnal enuresis and obesity

Evaluation of the Frequency of Obesity and Demographic Characteristics of Children with Primary Monosymptomatic Nocturnal Enuresis

Methods: Seventy healthy children and 70 nocturnal enuresis patients were compared in terms of age, gender, body weight, height, body mass index (BMI), BMI standard deviation score, obesity, maternal age and education level, father’s age and education level, number of children in the family, consanguinity between parents, and the economic status of the family. The patients with enuresis nocturna were divided into two groups: group 1: normal weight children, and group 2: overweight and obese children. Similar comparisons were made between these two subgroups. Relationship between the urinary incontinence frequency and general and family characteristics of patients with nocturnal enuresis were investigated. Results: There were no statistically significant differences between nocturnal enuresis patients and controls in terms of general, familial characteristics and obesity (p>0.05). Normal weight children were found to have lower median age and parents’ median age, worse economic situation and more frequent urinary incontinence compared to overweight and obese children. In addition, a relationship was detected between the frequency of enuresis and economic status (p=0.004). Conclusion: Our results showed that the frequency of obesity was not increased in patients with nocturnal enuresis compared to normal population. Larger sample studies are needed to assess the relationship of obesity with nocturnal enuresis

Anaplastic oligoastrocytoma: previous treatment as a possible cause in a child with acute lymphoblastic leukemia

The authors present a 14-year-old patient who developed an anaplastic oligoastrocytoma of the left parietal lobe 9 years after a successful treatment of acute lymphoblastic leukemia (ALL). He had a history of induction chemotherapy, intrathecal methotrexate and prophylactic whole brain irradiation (1,800 cGy in 10 fractions over 2 weeks)

Evaluation of the Frequency of Obesity and Demographic Characteristics of Children with Primary Monosymptomatic Nocturnal Enuresis

Methods: Seventy healthy children and 70 nocturnal enuresis patients were compared in terms of age, gender, body weight, height, body mass index (BMI), BMI standard deviation score, obesity, maternal age and education level, father’s age and education level, number of children in the family, consanguinity between parents, and the economic status of the family. The patients with enuresis nocturna were divided into two groups: group 1: normal weight children, and group 2: overweight and obese children. Similar comparisons were made between these two subgroups. Relationship between the urinary incontinence frequency and general and family characteristics of patients with nocturnal enuresis were investigated. Results: There were no statistically significant differences between nocturnal enuresis patients and controls in terms of general, familial characteristics and obesity (p>0.05). Normal weight children were found to have lower median age and parents’ median age, worse economic situation and more frequent urinary incontinence compared to overweight and obese children. In addition, a relationship was detected between the frequency of enuresis and economic status (p=0.004). Conclusion: Our results showed that the frequency of obesity was not increased in patients with nocturnal enuresis compared to normal population. Larger sample studies are needed to assess the relationship of obesity with nocturnal enuresis