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    Comparison of serum and tissue values of miRNAs related to autophagy in glial brain tumors and metastases other than lmphoma
    (2019) Geyik, Murat; Nazik, Mert; Ucler, Necati; Erkutlu, İbrahim; Alptekin, Mehmet; Atadag, Ali; Nehir, Ali
    Aim: Central nervous system tumors are seen in both children and adults, and most of these tumors cause disability and death. Current studies are focused on the molecular pathogenesis to identify new targets for the diagnosis and follow-up of patients. In this study, we investigated whether serum micro ribonucleic acid (miRNA) values could be used as biomarkers of these tumors by examining miRNA levels associated with autophagy in serum and tissue. Material and Methods: We included 27 patients who underwent surgery at our clinic and were diagnosed with glial tumor or metastasis other than lymphoma after pathological examination. The serum and tissue levels of miRNAs associated with autophagy were compared, and correlations between the obtained values were determined using Student’s t-test. Results: Based on histopathological examination, there were 14 glioblastomas, 3 oligodendrogliomas, 2 anaplastic astrocytomas, 2 carcinoma metastases, 2 pilocytic astrocytomas, 1 anaplastic ependymoma, 1 anaplastic oligodendroglioma, 1 diffuse astrocytoma, and 1 ependymoma. Serum Ct values were significantly higher than tissue Ct values. Correlations were found between serum and tissue levels of 5 miRNA subtypes. In addition, we could not determine the Ct value in some serum samples for 5 of the 12 miRNA subtypes. Conclusion: Although correlations were found between serum and tissue miRNA levels in the literature, we did not find any reasonable correlation, which might be explained by the less number of patients in our study. Therefore, considering the results of this study, we believe it is too early to determine that miRNAs cannot be biomarkers of brain tumors.
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    What is the optimum time to decompressive surgery in the patients with malignant middle cerebral artery infarction?
    (2019) Yucetas, Seyho Cem; Ucler, Necati; Kafadar, Safiye; Cakir, Tayfun; Kilinc, Suleyman
    Aim: In the patients with malignant middle cerebral artery (MCA) infarctions, the mortality was as high as 70% with conservative treatment. Decompressive craniectomy (DC) was shown to decrease mortality especially in 48 hours. We aimed to investigate both the effect of decompression time and the size of craniectomy on the mortality in this patient group. Material and Methods: 45 adult patients underwent to DC due to malignant MCA infarction were evaluated in this study. The demographic and clinical features were recorded retrospectively. The patients were splitted into three groups: Group 1, DC in the first 24 hours; group 2, in 24-48th hours; group3, in 48-96th hours of the admission. The size of craniectomy was the same as the infarct (standard), or it was two centimeters larger than the size of infarct (larger). Results: Of all patients, 53.3% (n=24) was female; and mean age of the sample was 67.38±4.76. 66.7% (n=30) of the patients died due to malign MCA infarction. The size of craniectomy was larger in 26.7% (n=12), and was standard in the others. Mean time to surgery was 43.07±29.87 hours. Mortality rate was minimum in group 2 (p=0.01). The patients undergoing to larger craniectomy survived longer than the others, but the difference was non-significant (p=0.06). Conclusion: We suggested that not the approach of “surgery as soon as possible” but the surgery between 24-48th hours of the admission would be the optimal approach. This issue is especially important, because earlier or later interventions not only have a less benefit on the outcome but also may lead several unnecessary complications.