We have evaluated the influence of fluorescein-guided resection on gross total resection (GTR) and survival in a series of patients with GBM. Group 1 consisted of 47 patients given fluorescein and group 2 comprised 33 patients, on whom fluorescein was not used. Median survival time was 43.9 weeks in the patients given fluorescein and was 41.8 weeks in the non-fluorescein group. There was no statistically significant difference in survival between the two groups. However, the extent of resection had a powerful influence on the median survival time. Survival was 34.3 weeks after partial resection and 46.5 after GTR. Our data shows that the use of fluorescein injection is a simple procedure, which allows a significant increase in the number of patients having GTR (83 vs. 55%). Our findings are similar to a recently published multicentre Phase III randomized trial in which 5-aminolevulinic acid was used to facilitate resection of malignant glioma.
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Experience is the important point in reduction of the complications and in the effectiveness of the surgical procedure in pituitary surgery. Endoscopic pituitary surgery differs from microscopic surgery, since it requires a steep learning curve for endoscopic skills. In this article, we evaluate our learning curve in two groups, as early and late experience. Purely endoscopic transsphenoidal operations were performed on 78 patients, which were retrospectively reviewed and grouped as early and late experience groups. We used the purely endoscopic endonasal approach to the sella that was performed via an anterior sphenoidotomy, without the use of a transsphenoidal retractor. All patients with adenomas were evaluated considering operation time, endocrinology, ophthalmology, total removal and, especially, modifications of standard technique. On the basis of the experience gained with the use of the endoscope in transphenoidal surgery over the years, modifications can be performed on the different phases of the endoscopic approach. Reviewing our cases in two groups of period due to our experience showed that the effectiveness of endoscopic surgery increases and operation time decreases. In our study, we identified a learning curve in endoscopic pituitary surgery.
AIm:The effect of memantine administration on hippocampal neurons of the infantile rats with kaolin induced hydrocephalus was investigated. mAterIAl and methOds: Hydrocephalus was induced by injecting kaolin into the cisterna magna of 3-weeks old Sprague-Dawley rat pups. One group received a single daily dose of 20mg/kg memantine i.p. following hydrocephalus induction for a period of two weeks. By the end of the two-week period, animals were radiologically evaluated by magnetic resonance imaging and then sacrificed to get their cerebrums removed. Both immunohistochemical analysis of nitric oxide synthase activity and quantification of spared neurons in CA1, CA2 and CA3 regions of hippocampus were performed. results:In hydrocephalus-induced rats considerable neuronal loss associated with significantly increased nitric oxide synthase immunoreactivity were determined in all hippocampal regions. However, memantine treated rats showed significantly higher number of spared neuron counts and reduced nitric oxide synthase immunoreactivity in CA1 and CA2 regions compared with the non-treated rats. COnClusIOn:The findings of the study show that hippocampal neurons may constitute important targets for injury secondary to hydrocephalic process in experimental infantile hydrocephalus. Early anti-excitotoxic treatment with memantine seems to have a neuroprotective effect especially in the CA1 and CA2 subunits of the hippocampus.KeywOrds: Hippocampus, Hydrocephalus, Memantine, Neuroprotection, Rat ÖZ AmAÇ: İnfant sıçanda kaolin ile oluşturulan hidrosefali modelinde memantin tedavisinin hipokampal nöronlar üzerindeki etkisi araştırılmıştır. yÖntem ve GereÇ: Üç haftalık Sprague-Dawley türü sıçan yavrularında sisterna magna içerisine kaolin süspansiyonu enjeksiyonu ile hidrosefali oluşturulmuştur. Hidrosefali indüksiyonunu takiben bir grup deneğe iki hafta süreyle günlük 20mg/kg dozunda intraperitoneal yolla memantin verilmiştir. İki haftalık sürenin bitiminde tüm denekler manyetik rezonans görüntüleme ile incelendikten sonra sakrifiye edilerek serebrumları çıkartılmış ve hipokampus CA1, CA2 ve CA3 bölgelerinde sağlam nöron sayımı ile birlikte nöronal nitrik oksit sentaz aktivitesinin immünhistokimyasal analizi yapılmıştır.BulGulAr: Hidrosefali oluşturulan gruplarda tüm hipokampal bölgelerde anlamlı nitrik oksit sentaz immünoreaktivitesi artışı ile birlikte nöron sayısında farkedilir azalma gözlenmiştir. Ancak memantin uygulanan deneklerin CA1 ve CA2 bölgelerinde nöron sayılarındaki azalmanın ve nitrik oksit sentaz immünoreaktivitesi artışın anlamlı düzeyde daha az olduğu saptanmıştır. sOnuÇ: Bu deneysel infantil hidrosefali çalışmasının sonuçları, hipokampal nöronların hidrosefalik sürece ikincil gelişen hasarlanma açısından önemli hedefler olduğunu göstermektedir. Memantin ile yapılan erken anti-eksitotoksik tedavinin özellikle hipokampus CA1 ve CA2 bölgeleri üzerinde nöron-koruyucu etki gösterdiği söylenebilir
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