Ömer Satici

Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes.

SummaryBackground. The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment.Method. All studies that had a minimum 5 years or more (≥5 years) mean duration of follow-up were included in the review. The identified studies were evaluated independently by two authors for quality using a modified inclusion criteria. The evaluated outcome measures of this study were, the initial acute pain relief (APR), follow-up pain free period and recurrence rates as well as complications. In comparisons of the data, the Student’s t-test, Chi-square followed by Pearson’s risk analysis tests were used. Kaplan–Meier actuarial analysis of pain free-survival curves were constructed for each surgical option that had enough data.Findings. Twenty-eight studies, mostly including microvascular decompression (MVD) and radiofrequency thermorhizotomy (RF-TR), that met the inclusion criteria were included in the review. The efficacy of MVD and percutaneous balloon microcompression (PBC) were similar (Odds ratio = 0.15, P > 0.05), and their effects were superior to those of the other modalities (P < 0.001). Although RF-TR provided a high initial pain relief, its average pain free rate was 50.4% for a mean follow-up of 5 years. The recurrence rate was high after RF-TR (46%), while the lowest recurrence rate (18.3%) was after MVD (P < 0.001). Within the long-term follow-up period recurrence of pain affects at least 19% of patients who undergo any surgical treatment for TN.Conclusions. The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient’ satisfaction with the lowest rate of pain recurrence.

The effect of aprotinin on ischemia-reperfusion injury in an in situ normothermic ischemic lung model

OBJECTIVES In the context of the physiopathology of damage due to ischemic preservation and reperfusion injury following preservation, we aimed to demonstrate the positive effects of the addition of aprotinin, a serine protease inhibitor, to low potassium dextran (LPD), used as a single-flush solution in normothermic ischemic animal models, on lung protection and the prevention of reperfusion injury. METHODS In the study, 21 New Zealand white rabbits were used as experimental subjects. The subjects were ventilated with the assistance of a manual mechanical ventilator at 30 breaths/min and 10 ml/kg tidal volume. Lung protection solution was supplied to the pulmonary artery via a catheter. After applying the solution, ischemia was carried out for 120 min. At the end of this period, reperfusion was carried out for 90 min. The subjects were divided into three groups of seven subjects each. In the control group, pulmonary perfusion solution was not employed, whereas in the second group LPD was employed, and in the third group LPD and aprotinin (LPD+A) were perfused. Blood gas analysis, bronchoalveolar lavage (BAL) fluid examination, tissue malondialdehyde (MDA) level analysis and morphological examinations were performed. RESULTS The LPD+A group showed the significantly highest levels of oxygenation at the 15th and 60th minutes of reperfusion (297+/-76.7 and 327+/-97.4 mmHg) in comparison to the LPD (157+/-20.6 and 170+/-53.6 mmHg) and control (64+/-8.4 and 59+/-7.2 mmHg) groups (P<0.001). The LPD+A group showed the significantly lowest levels of alveolar-arterial oxygen difference at the 60th minute of reperfusion (389+/-15 mmHg) in comparison to the LPD (478+/-19 mmHg) and control (542+/-23) groups (P<0.001). The BAL fluid neutrophil percentage was significantly lower in the LPD+A group (22+/-2.4%) compared to the LPD (31+/-6.1%) and control (38+/-2.4%) groups. MDA levels were significantly lower in the LPD+A group (119.8+/-5.3 nmol MDA/g) when compared to the LPD (145.06+/-9.5 nmol MDA/g) and control (147.3+/-3.9 nmol MDA/g) groups (P<0.05). Morphological examinations revealed pathological lesions and alveolar hemorrhaging in all samples, with the LPD+A group having statistically more significant levels than the LPD and control groups (P<0.005). The LPD+A group had a significantly lower percentage of pathological lesions and alveolar hemorrhage grade values than the LPD and control groups (P<0.005). CONCLUSIONS It was observed that the addition of aprotinin to LPD solution as a pulmonary flush solution in an in situ normothermic ischemic lung model prevents reperfusion injury by means of various mechanisms and also protects the morphological, functional and biochemical integrity of the lung. In our view, therefore, the addition of aprotinin to lung protection solution will provide positive results in lung transplantation protocols.

Comparison of the Effectiveness of Some Pleural Sclerosing Agents Used for Control of Effusions in Malignant Pleural Mesothelioma: A Review of 117 Cases

Background and Objectives: Management of malignant pleural mesothelioma (MPM) has been an important clinical issue regardless of the treatment modality employed. We aimed to investigate the efficacy of oxytetracycline (OT), Corynebacterium parvum (CP), and nitrogen mustard (NM) in the management of pleural effusion associated with MPM. Methods: One hundred and seventeen patients who had stage-2 MPM or over according to the Butchart staging system and unilateral or bilateral pleural effusion took part in the study. The patients received either OT (35 mg/kg), CP (7 mg), or NM (0.4 mg/kg) through a chest tube for pleurodesis. The association between several clinical parameters and patient survival was also investigated. Results: OT was applied to 59, CP to 29 and NM to 29 cases. A statistical analysis of the results obtained by these agents have demonstrated that OT (30 days, 81%; 90 days, 76.2%) and CP (30 days, 86.2%; 90 days, 79.3%) led to a significantly higher rate of successful pleurodesis as compared to NM (30 days, 48.2%; 90 days, 41.3%; p <0.05). Although the procedure was generally well tolerated by the patients, the NM-treated group experienced significantly more nausea-vomiting (46.1%) and hypotension (35.8%) compared to patients who received OT (nausea-vomiting and hypotension 4.3%; p < 0.001) and CP (nausea-vomiting and hypotension 5.1%; p < 0.001). Furthermore, we found that thrombocytosis, chest pain and weight loss were significantly associated with poor prognosis, whereas epithelial type had a positive effect on survival. Conclusion: These results suggest that OT and CP may be used as effective sclerosing agents for pleurodesis in the control of pleural effusions associated with MPM, without major side effects.

Brucellosis in pregnancy

This study was undertaken in order to evaluate the effect of brucellosis in pregnancy. The serum agglutination test, Coombs and/or blood culture systems were used in the diagnosis of brucellosis. From July 2003 to September 2010, the clinical and delivery patterns of 40 healthy pregnant women were compared with 39 pregnant women who had brucellosis. There were no birth defects, anomalies or mortalities. We observed that brucellosis in pregnancy increases the incidence of preterm delivery (P = 0.01) and low birth weight (P = 0.001) from that seen in general deliveries. A cephtriaxone/rifampicin combination was found to be the most effective treatment in pregnant women infected with brucellosis (P = 0.004). Brucellosis in pregnancy has no effect on the incidence of congenital malformations or stillbirths. Preterm delivery and low birth weight can be seen as pregnancy outcomes in brucellosis. Appropriate antimicrobial therapy of brucellosis in pregnancy will reduce morbidity and prevent complications.

The levels of copper, zinc and magnesium in type II diabetic patients complicated with foot infections

Changes in levels of trace elements and magnesium (Mg) may contribute to progression of diabetes mellitus (DM) and development of the complications. The aim of this study was to measure the levels of Copper (Cu), Zinc ( Zn), Mg and Cu/Zn ratios in diabetic foot infected patients (DFI) compared to controlled diabetic patients and healthy controls. 50 patients complicated with DFI, 50 controlled diabetic patients without any complications and 100 age and sex matched healthy subjects were enrolled in the study. Fasting plasma glucose, HbA1c, Cu, Zn and Mg were measured. One-Way ANOVA test was used to compare three different groups. Correlations between different variables were analysed using Pearson’s correlation coefficients(r). The mean values of Cu and Zn were higher in patients with DFI and DM compared to controls (P < 0.001). Cu/Zn ratios were higher in DM compared to DFI and control groups (P < 0.001). Serum Mg levels were lower in all diabetic patients. Elevation of Cu in DFI and DM groups was positively correlated with Cu/Zn ratios and elevation of Zn is negatively correlated. Our findings indicate an association between increased Zn concentrations and DFI.

Beyin cerrahisi yogun bakım ünitesi enfeksiyon etkenleri ve antibiyotik duyarlılıkları

Osteoporoz ve romatizmal hastaliklar gozun tum tabakalarini etkileyen bulgular ile karsimiza cikmaktadir. Eriskin ve Juvenil Romatoid Artrit, Sjogren Sendromu, Ankilozan Spondilit siklikla goz bulgulari ile beraberlik gosteren romatizmal hastaliklardir. Goz bulgulari siklikla sistemik hastaligin semptomlarina onculuk etmektedirler. Bu hastaliklarda en sik olarak uveit, iridosiklit, vitritis, keratit, sklerit, anterior iskemik optik noropati ve retinal vaskulit gibi okuler inflamasyon bulgulari gorulmektedir. Okuler inflamasyon hastaligin kendisinden kaynaklanabilecegi gibi bu hastaliklarin tedavisinde kullanilan ilaclara bagli olarak da karsimiza cikabilmektedir. Bu calismada osteoporoz ve en sik goz bulgusu izlenen romatizmal hastaliklarin okuler bulgulari literatur esliginde arastirildi.Mirizzi syndrome is an unusual complication of gallstone disease and occurs in approximately 1% of these patients. Some cases can not be identified preoperatively, despite modern imaging techniques. Today, treatment of Mirizzi syndrome is surgical. If Mirizzi syndrome is present, the risk of bile duct injury increases, particularly during laparoscopic surgery. Therefore, preoperative or intraoperative diagnosis is important. Here, we presented a 29 year-old woman with obstructive jaundice who diagnosed as cholelithiasis and choledocholithiasis. Preoperative endoscopic retrograde cholangiography relieved the common bile duct stone but cound not diagnosed the Mirizzi syndrome preoperatively. During laparoscopy, the diagnosis of Mirizzi syndrome was suspected early and the procedure was converted to open cholecystectomy and T-tube to common bile duct. There was no bile duct injury and postoperative course was uneventful.Lenfomalarda akciger tutulumu primer ve sekonder olmak uzere iki sekilde gorulmektedir. Lenfoma hucreleri, akcigerin degisik bolgelerini, yogun bicimde infiltre edebilmektedir. 57 yasinda erkek hastanin 6 aydir devam eden gogus agrisi, boyunda sislik, halsizlik, oksuruk ve balgam yakinmalari mevcuttu. Hasta, hepatosplenomegali, son bir ayda kilo kaybi, ates ve boynunun sol yaninda buyuyen agrili sislik nedeniyle klinigimize yatirildi. Fizik muayenede, boyunda agrili lenfadenopati saptandi. Solunum sistemi muayenesinde sagda solunum seslerinin siddetinde azalma, yer yer krepitan raller mevcuttu. PA akciger grafisinde sag parahiler bolgede non homojen yaygin infiltrasyon saptandi. Toraks tomografisinde ise sag akcigerde santralde hava bronkogrami izlenen konsolide alan, periferde noduler ve retikulonoduler, sol akciger alt lop posterobazal segmentte ve sol akciger ust lop apikoposterior segmentte birkac adet noduler lezyon, paratrakeal lenf bezi ve lokalize alveoler diffuz infiltrasyonlar saptandi. Servikal lenf nodunu histolojik incelenmesinde yuksek grade buyuk hucreli Non-Hodgkin lenfoma tanisi kondu. Hasta 6 siklus CEOP kuru aldi. Kemoterapi tamamlandiktan sonra yapilan incelemelerde daha once varolan akciger lezyonlarinin tumunun kayboldugu goruldu. Bu vaka sistemik non-Hodgkin lenfoma seyri sirasinda akcigeri tutulumu gelisen ve tek basina kemoterapi ile uzun sureli remisyona giren bir nadir olgudur.In this study, we are presenting the results of cytogenetic analysis and molecular cytogenetic analysis (FISH) of the couple and their family, who were referred to our genetic diagnostic laboratory and had bad obstetrics history. We found a normal karyotype (46,XY) in male, and A de novo complex chromosome rearrangement found in a phenotypically normal female was characterized by G-bands, FISH with probes. Her chromosome structure was 46,XX,der(18;22)(18pterrp11.1::22p11.1rqter) del(18)(:p11.1rqter). To determine the parental origin of translocation, we examined the individuals of the family, and we found that the translocation was de novo. We concluded that this carrier family might be due to the unbalanced distribution of translocation, during gamete formation and prenatal diagnosis recommended for their future pregnancies.

DO OZONE AND BORIC ACID EFFECT MICROLEAKAGE IN CLASS V COMPOSITE RESTORATIONS

ABSTRACT The aim of this in vitro study was to evaluate the effects of chlorhexidine gluconate (2%), sodium hypochloride (2.5%), ozone gas, and boric acid at different concentrations (1%, 3%, 5%, and 7%) on microleakage from composite restorations. In a total of 80 extracted human canine teeth, a class V cavity was opened on the buccal surface and the samples were separated into eight groups. In the control group, no procedure was applied for cavity disinfection, then composite restoration (Z250, 3M) was made using single-stage, self-etch adhesive (Single Bond 3M). In the other groups, seven different disinfectants were used, then the cavity was restored. The teeth were split into two in the buccolingual direction, parallel to the long axes. Stain penetration was examined under stereomicroscope and scored. Examination with SEM was made on one sample from each group, selected at random. Statistical evaluations were made using Dunnett C Post Hoc Comparison and Kruskal–Wallis H tests. In the occlusal region evaluation, the groups with the lowest level of leakage were the 3% and 5% boric acid groups, and the highest levels of microleakage were determined in the chlorhexidine group and the 1% boric acid group. In the gingival region, the lowest level of microleakage was in the 5% boric acid group and the highest levels were determined in the 1% and 7% boric acid groups. Boric acid disinfectants used at suitable concentrations were not seen to create a risk in respect of microleakage.