Fatih Ersay Deniz

Comparison of the Diagnostic Utility of Electromyography, Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging in Idiopathic Carpal Tunnel Syndrome Determined by Clinical Findings

BACKGROUND Carpal tunnel syndrome (CTS) is the most common nerve entrapment syndrome. It is sometimes difficult to diagnose, and a late diagnosis may result in permanent nerve damage. Electromyography (EMG), ultrasonography (US), magnetic resonance imaging (MRI), and computed tomography (CT) may be performed for the diagnosis. The diagnostic accuracy of these tests is well documented, but most of these studies accept EMG as the gold standard. OBJECTIVE To evaluate the diagnostic accuracy of EMG, MRI, CT, and US for the diagnosis of carpal tunnel syndrome with the use of clinical findings as the gold standard. METHODS Patients suspected to have CTS on presentation to the outpatient clinic were evaluated. The tests were performed after a detailed physical examination. Both wrists of the 69 patients in the study were investigated. RESULTS : The diagnostic accuracies of all the tests were found to be sufficient. Although EMG seemed to have the highest sensitivity and specificity, there was no statistically significant difference between the tests. CONCLUSION EMG or US could be used as the first-step test in most cases. If they are both available, EMG should be the first choice. They may be performed together when diagnosis is challenging. CT may especially be preferred for bone-related pathological conditions, whereas MRI may be preferred for soft tissue-related pathological conditions. Even though imaging studies have been proven to be powerful diagnostic tools for CTS, no conclusive information currently exists to support replacing EMG with imaging studies.

Biomechanics of thoracic short versus long fixation after 3-column injury.

OBJECT Posterior screw-rod fixation for thoracic spine trauma usually involves fusion across long segments. Biomechanical data on screw-based short-segment fixation for thoracic fusion are lacking. The authors compared the effects of spanning short and long segments in the thoracic spine. METHODS Seven human spine segments (5 segments from T-2 to T-8; 2 segments from T-3 to T-9) were prepared. Pure-moment loading of 6 Nm was applied to induce flexion, extension, lateral bending, and axial rotation while 3D motion was measured optoelectronically. Normal specimens were tested, and then a wedge fracture was created on the middle vertebra after cutting the posterior ligaments. Five conditions of instrumentation were tested, as follows: Step A, 4-level fixation plus cross-link; Step B, 2-level fixation; Step C, 2-level fixation plus cross-link; Step D, 2-level fixation plus screws at fracture site (index); and Step E, 2-level fixation plus index screws plus cross-link. RESULTS Long-segment fixation restricted 2-level range of motion (ROM) during extension and lateral bending significantly better than the most rigid short-segment construct. Adding index screws in short-segment constructs significantly reduced ROM during flexion, lateral bending, and axial rotation (p < 0.03). A cross-link reduced axial rotation ROM (p = 0.001), not affecting other loading directions (p > 0.4). CONCLUSIONS Thoracic short-segment fixation provides significantly less stability than long-segment fixation for the injury studied. Adding a cross-link to short fixation improved stability only during axial rotation. Adding a screw at the fracture site improved short-segment stability by an average of 25%.

Biomechanical evaluation of posterior thoracic transpedicular discectomy

OBJECT The authors investigated the biomechanical properties of transpedicular discectomy in the thoracic spine and compared the effects on spinal stability of a partial and total facetectomy. METHODS Human thoracic specimens were tested while intact, after a transpedicular discectomy with partial facetectomy, and after an additional total facetectomy was incorporated. Nonconstraining pure moments were applied under load control (maximum 7.5 Nm) to induce flexion, extension, lateral bending, and axial rotation while spinal motion was measured at T8-9 optoelectronically. The range of motion (ROM) and lax zone were determined in each specimen and compared among conditions. RESULTS Transpedicular discectomy with and without a total facetectomy significantly increased the ROM and lax zone in all directions of loading compared with the intact spine (p < 0.008). The segmental increase in ROM observed with the transpedicular discectomy was 25%. The additional total facetectomy created an insignificant 3% further increase in ROM compared with medial facetectomy (p > 0.2). CONCLUSIONS Transpedicular discectomy can be performed in the thoracic spine with a modest decrease in stability expected. Because the biomechanical behavior of a total facetectomy is equivalent to that of a medial facetectomy, the additional facet removal may be incorporated without further biomechanical consequences.

Orbital metastasis of prostate cancer: a case report.

We report a case with metastatic orbital cancer secondary to prostatic adenocarcinoma. After initiation of total androgen blockade, the visual complaints, pain and periorbital swelling regressed dramatically within 2 months of treatment. However, the disease subsequently progressed and the patient died 12 months after diagnosis.

Spontaneous third ventriculostomy in chronic obstructive hydrocephalus

IntroductionSpontaneous ventriculostomy is a rare condition, and only few cases are reported. Cine magnetic resonance imaging can demonstrate the flow from the ventriculostomy.Case reportA 25-year-old woman with a known tectal glioma and hydrocephalus was proved to have spontaneous third ventriculostomy.

A rare brain developmental anomaly in a patient with Usher’s syndrome

We report a rare brain developmental anomaly in Usher’s syndrome. We present a 43-year-old male with visual disturbance, hearing loss, and headache. Retinitis pigmentosa and sensorineural hearing loss were determined and he was diagnosed with Usher’s syndrome according to the clinical findings. Magnetic resonance imaging showed an arachnoid cyst on the left temporal lobe, cavum septum pellucidum et vergae. Uneventful cataract surgery was performed in both eyes. He was suggested to be followed up periodically for the arachnoid cyst and to use a hearing device. Although auditory and visual disturbances are the typical findings of this syndrome, it may affect other parts of the central nervous system as well. Morphological abnormalities of central nervous system and related disorders can be seen in patients with Usher’s syndrome.

Atypical Teratoid Rhabdoid Tumor: Case Report / Atipik Teratoid Rabdoid Tümör: Olgu Sunumu

ÖZ Atipik teratoid rabdoid tümör sıklıkla erken çocukluk çağında görülen, santral sinir sisteminin nadir malign embriyonel tümörüdür. Prognozunun çok kötü olması ve tedavi farklılıkları nedeni ile diğer beyin tümörlerinden ayrımının yapılması çok önemlidir. Altı haftalık erkek bebekte görülen atipik teratoid rabdoid tümör olgusu sunulmuştur. Tümör posterior fossa yerleşimlidir. Histopatolojik olarak tümörde rabdoid hücreler ve undifferansiye küçük hücreler yanında mezenşimal bileşen bulunmaktadır. İmmünhistokimyasal olarak EMA, vimentin, sinaptofizin ve düz kas aktini ile boyanma olurken, desmin, kromogranin, CD 99 ve CD 56 ile boyanma olmamıştır. Olgu uygulanan kemoterapiye rağmen, operasyon tarihinden dört ay sonra kaybedilmiştir. Sonuç olarak çok kötü prognoza sahip olan atipik teratoid rabdoid tümörde morfolojik özellikler tanınmasını güçleştirecek şekilde değişken olabilir. İmmünhistokimyasal panel ve moleküler genetik çalışma doğru tanının konulmasında yardımcı olacaktır. ABSTRACT Atypical teratoid rhabdoid tumor is a rare highly malignant embryonal tumor of the central nervous system that is often seen in early childhood. It is very important to distinguish it from other brain tumors because it has a very poor prognosis and there are differences in its treatment. A case of atypical teratoid rhabdoid tumor in a six-week-old male baby is presented. The tumor was located at posterior fossa. Histopathologically, the tumor has rhabdoid tumor cells and mesenchymal components beside the undifferentiated small cells. While EMA, vimentin, synaptophysin and smooth muscle actin have been stained with immunohistochemical staining, desmin, chromogranin, CD 99 and CD 56 have not been stained. The patient died four months after surgery despite the chemotherapy given. In conclusion, morphological characteristics can vary to a large extent that it is difficult to recognize atypical teratoid rhabdoid tumor. Immunohistochemical panel and molecular genetic study will help to establish the correct diagnosis.

Assessing the effects of lumbar posterior stabilization and fusion to vertebral bone density in stabilized and adjacent segments by using Hounsfield unit

Background Computed tomography (CT) with Hounsfield unit (HU) is being used with increasing frequency for determining bone density. Established correlations between HU and bone density have been shown in the literature. The aim of this retrospective study was to determine the bone density changes of the stabilized and adjacent segment vertebral bodies by comparing HU values before and after lumbar posterior stabilization. Methods Sixteen patients who had similar diagnosis of lumbar spondylosis and stenosis were evaluated in this study. Same surgical procedures were performed to all of the patients with L2-3-4-5 transpedicular screw fixation, fusion and L3-4 total laminectomy. Bone mineral density measurements were obtained with clinical CT. Measurements were obtained from stabilized and adjacent segment vertebral bodies. Densities of vertebral bodies were evaluated with HU before the surgeries and approximately one year after the surgeries. The preoperative HU value of each vertebra was compared with postoperative HU value of the same vertebrae by using statistical analysis. Results The HU values of vertebra in the stabilized and adjacent segments consistently decreased after the operations. There were significant differences between the preoperative HU values and the postoperative HU values of the all evaluated vertebral bodies in the stabilized and adjacent segments. Additionally first sacral vertebra HU values were found to be significantly higher than lumbar vertebra HU values in the preoperative group and postoperative group. Conclusions Decrease in the bone density of the adjacent segment vertebral bodies may be one of the major predisposing factors for adjacent segment disease (ASD).

Which Biomarker is most Effective to Determine Severity of Acute Head Trauma in the Experimental Animal Head Trauma Model

AIM Because of the need for effective method to determine the severity of head trauma, the importance of biomarkers is recognized recently. This study aims to analyze the values of sera levels of some biomarkers and the relation with their tissue levels in acute head injury. MATERIAL AND METHODS In this study, rats were divided into three groups (mild head trauma, severe head trauma and control group). All rats were anaesthetized. Weightdrop method was used as trauma method. Blood samples were obtained five minutes after trauma when the acute effects of trauma occurred. Then whole brains of rats were excised. Levels of biomarkers were investigated in the sera samples and homogenized brain tissues biochemically. RESULTS Significant differences in the sera GFAP (p=0.015) and insulin (p=0.011) levels were observed. Very significant difference in the sera nNOS level was observed. Extremely significant difference in the tissue IL-6 (p < 0.001) level was observed between all groups. CONCLUSION Sera nNOS and tissue IL-6 are the best biomarkers to predict trauma severity. Sera GFAP and insulin are also capable to show trauma severity in the very acute period of postinjury. Tissue levels of the biomarkers except insulin are higher than their sera levels.