SUMMARYPurpose: An International League Against Epilepsy (ILAE) consensus classification system for focal cortical dysplasias (FCDs) has been published in 2011 specifying clinicopathologic FCD variants. The aim of the present work was to microscopically assess interobserver agreement and intraobserver reproducibility for FCD categories among an international group of neuropathologists with different levels of experience and access to epilepsy surgery tissue. Methods: Surgical FCD specimens covering a broad histopathology spectrum were retrieved from 22 patients with epilepsy. Three surgical nonepilepsy specimens served as controls. A total of 188 slides with routine or immunohistochemical stainings were digitalized with a slide scanner to allow Internet-based microscopy review. Nine experienced neuropathologists were invited to review these cases twice at a time gap of 3 months and different orders of case presentation. The 2011 ILAE FCD consensus classification served as instruction. Kappa analysis was calculated to estimate interobserver and intraobserver agreement levels. In a third evaluation round, 21 additional neuropathologists with different experience and access to epilepsy surgery reviewed the same case series.

In the field of neurosurgery, often the dura mater cannot be sutured, and consequently, it requires a duraplasty procedure using a dural fascial graft. Since 1890, various materials have been researched as dura mater substitutes. Amniotic membrane, for example, is suitable as a dural graft material and has been used in neurosurgery since 2012. However, there has been little research on human patient's dural healing after the use of amniotic membrane in their duraplasty procedure. To address this gap, a clinical experimental study was undertaken to evaluate the human dural healing of 16 patients who had undergone duraplasty in decompressive craniectomy surgery at Dr. Soetomo General Hospital, Surabaya. The amniotic membrane allograft, was sutured to cover the dural defect for eight randomly chosen patients (Group I). The fascial autograft from the temporal muscle had been applied for eight other patients (Group II). Between 10 and 20 weeks after surgery, the patients underwent cranioplasty and dural healing evaluation by cerebrospinal fluid (CSF) leakage testing through the edge of the dural defect. The fibrocyte infiltration around the edge of the dural defect was examined histologically. Statistical analysis, using an independent t-test, was performed with a confidence interval of 95%. The results of the clinical and histological analysis suggest that an amniotic membrane graft was able to provide watertight dural closure and adequate fibrocyte infiltration comparable with that provided by temporalis muscle fascia. This study shows that using an amniotic membrane in neurosurgery has a potential advantage over an alternative dural healing.

Objectives To determine the inhibition effect of epigallocatechin gallate (EGCG) and green tea extract on neuronal necroptosis based on necroptosis morphology. Methods In vivo study was performed on male Rattus norvegicus middle cerebral artery occlusion (MCAO) model divided into five groups, MCAO-control groups, EGCG 10 mg/kg BW/day, EGCG 20 mg/kg BW/day, EGCG 30 mg/kg BW/day, and green tea extract 30 mg/kg BW/day for 7 days treatment. MCAO model was made by modification method using Bulldog clamp. After 7 days of treatment, all R. norvegicus were sacrificed. After that, examination using Hematoxylin–Eosin stain was conducted to look at necroptosis morphology in each group. Results We found that there are significant differences between control group and the other three groups (EGCG 20 mg/kg BW/day, EGCG 30 mg/kg BW/day, and green tea extract (p<0.05). There is a significant correlation between the number of neuron cell necroptosis and both EGCG and green tea extract (p<0.05). The correlation is negative, which means both EGCG and green tea extract will decrease the number of neuron cell necroptosis. EGCG will decrease neuron cell necroptosis starting from the dose of 20 mg/kg BW/day. EGCG 30 mg/kg BW/day produces the best result compared to other doses. Conclusions Camellia sinensis (green tea) with its active compound EGCG decreases neuronal necroptosis morphology in MCAO models.

Background: Multiple primary malignancies (MPMs), especially coexistence of renal cell carcinoma (RCC) and glioblastoma multiforme (GBM), are rare. The most likely clinical diagnosis in patient with tumor in another organ is metastatic brain tumor. Although GBM is the most common brain tumor, it is rarely coexistent with other malignancies. Case Description: A 64-year-old female presented with headache and dizziness, along with abdominal pain for 2 weeks before being admitted. The abdominal computed tomography (CT) scan showed a kidney tumor. The patient developed left hemiplegia, and the brain CT scan showed an intracranial tumor. The patient suggested for radical nephrectomy and craniotomy tumor removal. Histopathology of the kidney and brain tumor revealed two different features, which showed RCC and GBM. Immunohistochemistry result confirmed the diagnosis of GBM and IDH1 wild type; coexistent with clear cell RCC. Conclusion: The coexistence of carcinoma and glioma should be regarded as coincidental cases if it did not accomplish the criteria for tumor-to-tumor metastasis or proven to be a genetic syndrome. This case report provides an addition to the literature about double primary malignancy in a single patient. More studies are needed to confirm whether they have causal relationship or merely coincidental findings.

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Neurological damage in brain injury occurs due to secondary brain injury. Kencur extract has antioxidant potential with total phenolic and flavonoid content including luteolin apigenin and is expected to reduce MDA expression to prevent secondary injury. This study is an experimental laboratory. The treatment of all samples was carried out simultaneously using a post-test-only control group design. Based on the ANOVA test, the significance value of the Kencur extract treatment group was 0.000 (p<0.05) indicating that there was a difference in MDA expression in brain-injured rats without kencur extract with brain-injured rats and given kencur extract. In the 24-hour and 48-hour time groups, a significance value of 0.488 (p> 0.05) showed no significant difference in MDA expression. Then the Kencur extract treatment group with a time group of 0.117 (p> 0.05) showed no significant difference in MDA expression. There was a significant difference in the expression of MDA in brain-injured rats without kencur extract with brain-injured rats and given kencur extract. There were no significant differences in the MDA expression in the 24-hour and 48-hour time groups and the Kencur extract treatment group and the 24-hour and 48-hour time groups.

Meningioma is not uncommon case; however, the differentiation of high-grade from low-grade meningioma is important. The rate of recurrence of grade I meningioma is 7-20%, but in grade II meningioma is 30-40% and in grade III 50-80%. Non-invasive MRI techniques that can differentiate high-grade from low-grade meningiomas before surgery are useful for surgical planning and subsequent treatment. We present a review article and some case studies of low-grade (WHO grade I) and high-grade (WHO grade II and grade III) meningioma with conventional MRI and continue with advanced MRI; we performed diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) value, dynamic susceptibility contrast (DSC), dynamic contrast-enhanced (DCE) magnetic resonance (MR) perfusion and 3D ASL. From these three cases show that advanced magnetic resonance imaging with ADC value, DSC, DCE, and 3D arterial spin-labelling (ASL) is an essential sequence to differentiate high-grade from low-grade meningioma.

Introduction: Perforated peptic ulcer (PPU) is able to increase the risk of mortality and morbidity. This study used Boey and practical scoring system of mortality in patients with perforated peptic ulcer (POMPP) scoring systems to assess risk mortality of the patients. Every parameter has a value to add up 1 point in Boey and POMPP score. Methods: This observational study used medical records of PPU patients who came to Dr. Soetomo General Hospital in emergency state and being operated and treated at surgical inpatient care facility in 2016. The data were analyzed retrospectively. The sampling technique in this study was done by total sampling. Results: Most of PPU patients had the average age of 59.56 years old and 71.79% of the patients were male. Both analyzing results of Boey and POMPP scoring systems were not statistically significant to predict mortality risk of the patients. Even so, the results of Boey scoring system tended to have a positive correlation with mortality risk (0%, 37.50%, 52.94%, and 100%) with 17 patients (43.59%) had mortality. Conclusion: While Boey and POMPP score are most commonly used to predict outcome for PPU patients in Dr. Soetomo General Hospital, considerable variations in risk of mortality were shown. Therefore, both Boey and POMPP score had its own advantages and disadvantages. Further prospective research is needed to test the validity of Boey and POMPP scoring systems, thus the scoring systems can be used in daily hospital practice in patients with PPU.