Hakan Şimşek

Effect of hyperbaric oxygen therapy on the duration of treatment of spinal tuberculosis.

The aim of this retrospective study was to investigate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment and rate of radiological improvement in the management of spinal tuberculosis. We reviewed a total of 51 patients with tuberculous spondylitis of the spine who were treated by percutaneous abscess drainage or radical surgical debridement with chemotherapy, and of whom 16 randomly selected patients also received adjuvant HBO therapy and 35 did not. Serological markers were monitored in the course of treatment. Percutaneous needle biopsy was performed on each patient before treatment. Spine and chest radiographs, CT scans and MRI were performed. Infection control was achieved in all patients and no recurrence occured. To our knowledge this is the first reported series of patients with spinal tuberculosis treated with HBO therapy as an adjunct to antituberculous chemotherapy. This combination provided earlier clinical and radiologic improvement than chemotherapy alone.

Patient presenting with frontal subperiosteal abscess and headache: a case of Pott’s puffy tumour

Abstract Chronic sinusitis can be complicated with erosion of anterior or posterior wall of the sinus; causing Pott’s puffy tumour in the anterior, or epidural abscess in the posterior communication. A 65-year old man with a painful swelling in his forehead is presented. Pott’s puffy tumour was diagnosed. CT, MRI, and DTI studies were obtained. Epidural or dural involvement was not present. In the first operation, anterior wall of the frontal sinus wall was opened. Osteomyelitis debridement was performed and the frontonasal duct was enlarged endoscopically. Antibiotics were commenced and were continued for 6 weeks. In the second operation, nasal septum deviation was fixed. Postoperative course was uneventful. The presented case suggests that treatment of sinus osteomyelitis should comprise immediate surgical drainage and osteomyelitis debridement followed by long-term administration of antibiotics. MRI study with contrast should be obtained to rule out epidural abscess and dural infiltration.

Recurrent carpal tunnel syndrome: Evaluation and treatment of the possible causes

AIM To investigate the causes of the recurrent carpal tunnel syndrome (CTS) and implemented surgical interventions. METHODS Four hundred and eighty-seven patients, who were diagnosed with CTS and underwent surgical intervention between October 2016 and September 2007, were evaluated in this retrospective study. The age, gender, physical evaluation findings, electrophysiological examination reports and implemented surgical treatment methods were analyzed. RESULTS Thirty-nine of the cases were operated due to recurrent CTS. Further examination of the patients with recurrent CTS revealed that ten cases had diabetic polyneuropathy, three cases had hypothyroidism, two cases had rheumatoid arthritis and one case had systemic amyloidosis. Postoperative electromyography confirmed the neuropathy was due to systemic diseases. The remaining 23 patients with recurrent CTS did not have any systemic disease and all of them had applied previously to another health center. CONCLUSION We concluded that the recurrence rates in CTS might be decreased with exploration and incision of the entire transverse ligament. Damage to the motor and sensory branches of the median nerve could be avoided with an incision on the ulnar side.

A new multipartite plate system for anterior cervical spine surgery; finite element analysis

Abstract Background: There are numerous available plates, almost all of which are compact one-piece plates. During the placement of relatively long plates in the treatment of multi-level cervical pathologies, instrument related complications might appear. In order to overcome this potential problem, a novel ‘articulated plate system’ is designed. We aimed to delineate finite element analysis and mechanical evaluations. Material and methods: A new plate system consisting of multi partite structure for anterior cervical stabilization was designed. Segmental plates were designed for application onto the ventral surface of the vertebral body. Plates differed from 9 to13 mm in length. There are rods at one end and hooks at the other end. Terminal points consisted of either hooks or rods at one end but the other ends are blind. Finite element and mechanical tests of the construct were performed applying bending, axial loading, and distraction forces. Results: Finite element and mechanical testing results yielded the cut off values for functional failure and breakage of the system. Conclusions: The articulated system proved to be mechanically safe and it lets extension of the system on either side as needed. Ease of application needs further verification via a cadaveric study.

Late presentation of missed aorta-caval fistula as arteriovenous malformation following lumbar disc surgery

Arteriovenous malformation in the abdomen following excision of lumbar intervertebral disc is the nightmare of the spinal surgeons [1–3]. A 56-year-old man was admitted to the emergency service with heart failure and atrial fibrillation symptoms. Abdominal computerized tomography with contrast and magnetic resonance angiography images were obtained. An aortacaval fistula that later grew into a giant arteriovenous malformation was discovered (Figs. 1 and 2). Then, he underwent consecutive repair procedures at the cardiovascular surgery department [2,4,5]. The patient’s medical history record shows he had a lumbar discectomy operation 4 months before the onset of his cardiac problems. This case emphasizes the importance of paying special attention to any overt hemorrhage that has originated from the disc space although it might have been controlled during surgery. References