Hamza Karabag

Intraoperative perineural infiltration of lidocaine for acute postlaminectomy pain: preemptive analgesia in spinal surgery.

Study Design Prospective, cohort, and clinical study. Summary of Background Data It was proven that effective control of postoperative pain in lumbar disk surgery improves the patients recovery. Despite the many advances in surgical and nonsurgical techniques, the most accurate approach in pain relief is still under debate. Objective In this study, our aim was to determine whether neural root blockade before the onset of noxious stimuli could inhibit the production of pain. Methods Forty-five patients undergoing unilateral 1 spinal level (lumbar 5) hemipartial laminectomy were included in the study. In 20 of the patients (group 2), 0.5 mL 2% lidocaine was infiltrated onto the neural root immediately after the exposure; the 25 patients in the control group (group 1) were not injected. All patients were monitored regarding pain determination using a visual analog scale, and the exact time of analgesic requirement during the first postoperative day was noted. Total analgesic dose given during the first postoperative day was also recorded. Results Perineural lidocaine infiltration extended the early postoperative analgesic period. Although the pain was not completely suppressed, the lidocaine infiltration helped to manage the postoperative pain more effectively. The patients (group 2) who received lidocaine infiltration intraoperatively onto the neural root had a statistically significant longer time before analgesia requested (P<0.001) and also required significantly less analgesic when compared with the control group (P<0.001). Conclusions For preemptive analgesia for acute postoperative pain in laminectomy surgery, which remains a major concern, we suggest that lidocaine infiltration onto the dorsal neural sheath immediately before retraction of the root may extend the time before analgesia requested and the total analgesic drug consumption.

Unusual Location of Hydatid Cysts in Pediatric Patients

Objective/Aims: To emphasize the importance of diagnosis and treatment of unusually localized hydatid cysts in pediatric cases. Methods: Hydatid cyst patients of two departments were listed who had undergone surgery between January 2001 and December 2008. Of the 7 pediatric patients, 3 were chosen as the ones with unusual localization. Cyst removal with Dowling’s technique was performed in 2 cases and total removal of the cyst wall was achieved after cyst aspiration in the other patient. Results: Two patients did not show any signs of recurrence. Some of the cranial multiple cysts of the patient who had undergone her first surgery in another clinic with cyst rupture were successfully removed in our clinic. Six months later, she was admitted with spinal seedings. Conclusion: Hydatid cyst removal without rupture should be the surgical goal in all cases. Radiological evaluation is of utmost importance for differential diagnosis. When a cystic lesion is found in the central nervous system on radiological evaluation, hydatid disease must be considered in countries where the disease is endemic and surgery is to be planned emergently especially for pediatric cases with increased intracranial pressure. The study focuses on the strategy for the correct diagnosis and the appropriate treatment of unusually localized hydatid cysts.

Intraoperative supratentorial epidural haematoma during removal of a huge posterior fossa dermoid cyst.

Epidural haematomas may occur following cranial operations, and most of them are located near the craniotomy or burr-hole areas. There are very few cases of supratentorial epidural haematoma following the resection of giant tumours located in the posterior fossa. In this case report, we present a patient who developed an acute left temporoparietal epidural haematoma in the perioperative period during the excision of a huge dermoid cyst in the posterior fossa.

Infected Primary Paraspinal Hydatidosis with Water Lily Sign

BACKGROUND Primary muscular hydatidosis is extremely rare, and the diagnosis of the infected muscular hydatid cyst can be difficult due to atypical clinical and radiological findings. CASE REPORT We present herein an interesting case of a 24-year-old man with primary infected muscular hydatid cyst located in the paraspinal muscles eroding the right lamina of C6 vertebra that was diagnosed with water lily sign on computed tomography. CONCLUSION Water lily sign is a pathognomonic imaging finding for hydatidosis, and defined when free-floating endocyst is seen. Cyst hydatid should always be considered in the differential diagnosis of any soft tissue mass of the patients from endemic regions.

Diffuse Idiopathic Skeletal Hyperostosis Causing Dysphagia: A Case Report

Diffuse idiopathic skeletal hyperostosis is a noninflammatory systemic disease characterized by the osteophyte formation of vertebrae and ossification of various extraspinal ligaments. Although DISH is a relatively common disease, cervical involvement causing dysphagia is rare. In this report, we present such a case. The clinical features, diagnosis and the treatment of DISH are also discussed.

Evaluation of ceruloplasmin levels in patients with lumbar disc herniation

BACKGROUND Chronic inflammation is believed to have a role in the development of lumbar disc herniation (LDH). Ceruloplasmin (CP), an acute phase protein, is known to limit inflammation. OBJECTIVE To evaluate CP levels in patients with LDH. METHODS Thirty-five patients with LDH and 35 healthy individuals were enrolled in the study. Participants were divided into two groups; group 1 (n = 35) consisted of patients with LDH, and group 2 (n = 35) consisted of healthy subjects. Surgery specimens were taken from all patients who underwent LDH-related surgery. CP levels were measured in both blood and tissue samples. Pain intensity was evaluated using a visual analog scale (VAS). RESULTS There were no significant differences in gender, age, or body mass index between the control and LDH patients (p > 0.05 for all). Compared with the control patients, LDH patients had significantly higher serum CP levels (p < 0.001). In LDH patients, tissue CP levels were significantly higher than serum levels (p < 0.001). According to bivariate analysis, the serum CP levels were significantly correlated with the VAS score in group 1 (r = 0.491, p = 0.003). CONCLUSIONS The present study showed that CP levels increased in both the serum and the tissues of patients with LDH compared to patients without LDH, possibly as a consequence of LDH-associated inflammation.