Gunhan Karakurum

Seprafilm® interposition for preventing adhesion formation after tenolysis: An experimental study on the chicken flexor tendons

BACKGROUND Hyaluronic acid and its derivatives have become increasingly popular for preventing adhesions in primary tendon repair. Their use in tenolysis, however, has not been established yet. The purpose of the current study was to evaluate the efficacy of Seprafilm, a combination of carboxymethylcellulose membrane and hyaluronate, in prevention of adhesion formation after tenolysis. MATERIALS AND METHODS Thirty chickens were initially operated on their right central toes in order to constitute an experimental setting of postoperative flexor tendon adhesion. They were then randomly assigned to 3 groups at 6 weeks. Group 1 received no further procedure, group 2 underwent simple tenolysis with physiologic saline injection, and group 3 had tenolysis with Seprafilm interposition. RESULTS Group 3 scored a significantly higher average gliding excursion value than the other groups. Histologic examination corroborated the biomechanical data. CONCLUSION Seprafilm was effective in preventing adhesions after tenolysis.

Neurotologic manifestations of the fibromyalgia syndrome

The purpose was to assess otologic symptoms, and audiologic and vestibular findings in fibromyalgia (FM) syndrome. Twenty-four female patients with FM syndrome (FMS) were included in the study. The assessments were based on history, physical examination, audiometry, bithermal caloric testing and auditory brainstem response (ABR) testing. Dizziness was the most common complaint of the patients, and was followed by tinnitus, hearing loss and vertigo. Almost 50% of the patients had some sort of otologic symptoms.Dix-Halpike maneuver proved positional rotary vertigo in 5 (20.8%) patients. The audiometry results of 23 patients were normal. None of the patients had abnormal bithermal caloric testing. Although there were a variety of ABR abnormalities, the ABR results of the patients with and without cochleovestibular symptoms were not significantly different (p<0.05). In conclusion, FM patients can complain otologic symptoms even though they do not have any clinically or audiologically detectable ear disease. A neural disintegration or some other events related to neural mediators may be the mechanisms involved in the pathogenesis of otoneurologic as well as systemic manifestations of the disease that possibly leads to abnormal perception of the stimuli coming from internal or external environment.

Multidisciplinary evaluation of occult spinal dysraphism in 47 children

Objective: To present the clinical (urologic, orthopedic and neurologic) and urodynamic findings of 47 children suffering from occult spinal dysraphism, together with the long-term follow-up results obtained with various treatment modalities. Material and Methods: Between 1997 and 2000 a total of 47 children (27 girls, 20 boys; male:female ratio 1.3) referred to the Urology and/or Pediatrics Departments with symptoms and signs of closed spina bifida were enrolled in the study program. All patients underwent routine assessment of the urinary tract, including detailed anamnesis, physical examination and radiologic evaluation (X-ray, renal bladder ultrasonography and sacral MRI). In addition to video-urodynamic evaluation of the lower urinary tract, all patients were also evaluated by the Orthopedic Department with respect to possible lower extremity deformities. Results: The age range of the children was 2 months to 16 years (mean 6.9 years). At first referral, 23 children were found to have normal urinary and fecal continence after toilet training; among the other presenting symptoms and signs, 34% of patients demonstrated recurrent urinary tract infections and 38.2% had abnormal findings on urinary tract investigations. Evaluation of urodynamic parameters before and after conservative treatment demonstrated an increase in age-related bladder capacity in 34 patients and detrussor instability had been cured in 23/30 patients (p < 0.05). Overall, bladder capacity was found to be normal in 40 children following conservative management (p < 0.05). The conservative approach proved to be effective in 40 children (85.1%), and intravesical instillation therapy with oxybutynine hydrochloride was successful in one of the remaining seven children (14.2%). Bladder augmentation was performed in six children (12.7%) in whom conservative measures were ineffective. Conclusions: In the light of our findings and the literature data it is obvious that a multidisciplinary approach together with early urologic evaluation to determine the extent of neurologic involvement of the lower urinary tract is essential to ensure a successful treatment outcome and to prevent the occurrence of serious functional and structural complications. Clinical, radiologic and video-urodynamic assessments should be performed to define the neuro-urologic pathophysiology and to provide management guidelines and a baseline for future comparison.

Tramadol use for axillary brachial plexus blockade.

BACKGROUND We investigated the effects of tramadol added to the mixture of local anesthetic for axillary brachial plexus blockade (ABB) in patients to have undergone hand and forearm surgery. MATERIALS AND METHODS Forty patients from the ASA classification I and II, between 18 and 60 y of age, were included in this randomized double-blind study. Group C: levobupivacaine (150 mg) + lidocaine (200 mg) (n = 20), Group T: levobupivacaine (150 mg), + lidocaine (200 mg) + tramadol (100 mg) (n = 20). Intravenous midazolam of 0.02 mg/kg was given for premedication. ABB was performed with 42 mL mixture of local anesthetic, using peripheral nerve stimulator. The duration of onset of motor and sensory blockades was recorded. The postoperative first analgesic need, sedation, and satisfaction score and side effects were recorded. RESULTS There was no significant difference between the groups regarding intraoperative visual analog scale (VAS), hemodynamics, adverse effects, sedative and analgesic requirement, and the patient satisfaction. The development of motor block at the median nerve on the 5th min (P = 0.03) and at the ulnar nerve on 10th and 15th min in Group T were (P = 0.01, P = 0.03, respectively) considerably longer than that in Group C. CONCLUSIONS Adding 100 mg of tramadol to the combination of levobupivacaine and lidocaine during ABB could not provide an important clinical effect in patients undergoing hand and forearm surgery.

Primitive neuroectodermal tumour of the mandible.

Primitive neuroectodermal tumors (PNETs) are relatively rare tumors. Tumors that once would have been diagnosed as Ewings sarcoma are now often designated as peripheral neuroepithelioma or synonymously PNET. Herein we report the first case of PNET of the mandible in a 6-year-old female who was admitted to the hospital with a two-months history of painless, progressively enlarging lower jaw mass.

Clinical Comparison of Effectiveness of Epidural Triamcinolone and Betamethasone in Discal Radiculalgia: A Prospective, Randomized Study

Objectives: This study was planned to compare the efficacies of epidural betamethasone and triamcinolone injections in discal radiculalgia. Methods: Seventy patients complaining unilateral discal radiculalgia with acute discogenic pain were included in the study. The patients were randomly assigned to two groups. All patients received a single 20 ml epidural dose of steroid and 0.125 percent bupivacaine combination. The patients in group 1 and group 2 received betamethasone [14 mg] and triamcinolone [80 mg] by epidural injections, respectively. After the epidural steroid injection, the efficacy of treatment was assessed with visual analog scale [VAS], straight leg elevation test [0° = worst, 85° = best], and Oswestry Disability Index. The injection was repeated at the end of the second week, in case of partial improvement, and at the end of the sixth week if the recovery from pain was still incomplete. All patients were given amitriptyline [10 to 50 mg/day orally] for a period of six months. Results: There were 40 patients in group 1 and 30 patients in group 2. Significant improvement was observed in both groups regarding the results of VAS, straight leg elevation test, and the Oswestry Disability Index at the first week of the treatment. The VAS values at first, second, and sixth weeks were significantly lower in group 2 than in group 1 [P < 0.0001]. Conclusion: Although, not statistically different in both groups at the final follow-up, we believe that triamcinolone is preferrable in an epidural steroid injection (ESI) procedure because of its short-term advantages.

Vascularized pedicled iliac crest graft for selected total hip acetabular reconstructions: a cadaver study

Bone grafting is an essential part of most total hip acetabular reconstructions. There are a limited number of surgical options, each with inherent disadvantages for the management of structural acetabular defects. In this cadaver study, the authors aimed to evaluate the availability of vascularized pedicled iliac crest graft for the purpose of acetabular reconstruction. The hip joints, ilia and deep circumflex iliac artery pedicles of six adult preserved cadavers were dissected bilaterally. A segment of the iliac crest was elevated on the vascular pedicle and its access to different parts of the acetabulum was evaluated. The average pedicle length was sufficient for coverage of the superior and anterior acetabular walls. The access to the posterior wall, however, required modification of the bone size. A vascularized pedicled iliac crest graft is suitable for the reconstruction of selected acetabular deficiencies.

The Addition of Low-dose Mivacurium to Lidocaine for Intravenous Regional Anesthesia

ABSTRACT Objectives: The current study aimed to evaluate low dosage of mivacurium added to lidocaine for intravenous regional anesthesia [IVRA]. Methods: The present study used a double-blind methodology. The study group comprised 60 patients with the American Society of Anesthesiologists physical status I and II, who were scheduled to undergo carpal tunnel release as an outpatient procedure. Patients were randomly divided into two groups. In the mivacurium group [Group M; N = 30], intravenous regional anesthesia was achieved using 6 mg of mivacurium with lidocaine 3 mg/kg diluted with saline to a total volume of 40 ml; in the control group [Group C; N = 30] 3 mg/kg lidocaine was diluted with saline to a total volume of 40 ml. The onset and recovery time of sensory and motor blocks, intraoperative–postoperative visual analog scale, and verbal rating scale, tourniquet pain, satisfaction score, analgesic requirement, hemodynamic variables, and side effects were noted. Results: Group M showed significantly shorter sensory block and motor block onset time, longer motor block recovery time, and decreased analgesic requirement during the 24-hour postoperative period. Conclusions: Despite the longer motor block recovery, the addition of a low dose of mivacurium to lidocaine for IVRA accelerated the sensory and motor blocks onset and improved the postoperative analgesia without important perioperative adverse effects. We demonstrated that the addition of a low dose of mivacurium to lidocaine for IVRA provided a significant clinical benefit by shortening the sensory and motor blocks onset, providing sufficient muscle relaxation, and also reducing postoperative analgesic consumption without any serious adverse effects.

Biopsy of vertebral tumour metastasis for diagnosing unknown primaries

Purpose. To examine patients with vertebral tumour metastasis using transpedicular biopsy for diagnosing unknown primary tumours. Methods. 13 men and 8 women aged 41 to 80 (mean, 61) years with vertebral tumour metastasis of unknown primary origin underwent transpedicular biopsy of the affected vertebra. Results. The origins of the primary tumours were lung cancer (n=6), prostate cancer (n=5), colorectal cancer (n=5), kidney cancer (n=4) and lymphoma (n=1). All the specimens matched pathological characteristics of their corresponding primary tumours, except in one patient. This 42-year-old man had stage-4 colon cancer, in whom the pathologic findings could not enable differentiation between colon and prostate cancer. Conclusion. Transpedicular biopsy of the vertebra is a cost-effective diagnostic tool for evaluating unknown primary tumours.

Transient neurologic syndrome after spinal anesthesia with epidural steroid treatment.

BACKGROUND Transient neurologic syndrome (TNS) is a rare complication of spinal and epidural anesthesia. It is defined as paradoxic postoperative back pain radiating to the lower extremities with no neurologic deficits. Because it is a self-limited disease, the treatment is usually symptomatic and consists of NSAIDs and injections of a neuromuscular-blocking drug at the trigger points. The syndrome may be resistant to this treatment regimen and may last for several months, resulting in a long convalescence. CASE SUMMARY A 63-year-old Turkish woman (height, 165 cm; weight, 71 kg) underwent hemorrhoidectomy in the jackknife position using spinal anesthesia. No adverse events occurred during puncture or surgery or in the immediate postoperative recovery period. Recovery from the sensory and motor block was normal. Twenty-four hours after surgery, lower limb and plantar pain developed with no sensory or motor deficit. Neurologic examination revealed normal motor and sensory function. Electroneuromyography showed partial denervation potential of muscles innervated by the left sciatic nerve. The symptoms were suggestive of TNS. Combination oral NSAID treatment with amitriptyline (25 mg/d) and gabapentin (1200 mg/d) was initiated. Because the pain still persisted 6 weeks after surgery, epidural steroid injection with triamcinolone acetate (80 mg) with isotonic saline was administered, resulting in definite pain relief (visual analog scale score = 0). CONCLUSIONS Epidural steroid treatment was effective in this patient with TNS resistant to treatment with NSAIDs, amitriptyline, and gabapentin. Future studies are needed to evaluate this treatment.