Semih Keskil

Observation of 95 patients with extradural hematoma and review of the literature

The authors review the cases of 95 patients with extradural hematoma managed at Gazi Hospital in the last 4 years. The common factors in craniocerebral traumas, the time interval between admittance and trauma, the interval between admittance and operation, and the location of hematomas are determined. The arterial origins demonstrated at operation in extradural hematomas are described. The interactions between all these factors and mortality are discussed. Availability of computed tomography scanning accounts for the present mortality rate of 9.4% when compared with the mortality rate of 33% for conventional diagnostic facilities.

Head trauma and leucocytosis

SummaryA prospective analysis of 153 cases of head trauma was conducted with respect to their white blood cell counts. A white blood cell count exceeding 20×106/l is associated with a poor clinical grade on admission and with a 96% mortality as opposed to that of a 23% mortality for those with slightly lower or slightly above normal white blood cell count. The sensitivity for this level is a mortality of 96% while the specificity is 77%.

A New Coated Bipolar Coagulator: Technical Note

Summary Background. Sometimes charring or popping occurs and the bipolar blades get stuck to the vessel. Methods. The tips of one of the many commercially available bipolar forceps were coated in a striped manner with Teflon −50 μ in thickness. Results. The new bipolar coagulator coated with Teflon reduced the incidence of tissue sticking. Conclusions. Experience with this instrument was still quite limited, but preliminary results were promising.

Clinical significance of acute traumatic intracranial pneumocephalus

Among 1142 patients with head injuries hospitalized in the Neurosurgery Department of Gazi University Medical School during the period between 1979 and 1992, 583 had initial CT scans. A retrospective analysis of these initial CT images revealed intracranial air on admission in only 21 cases. These were classified as acute traumatic intracranial pneumocephalus: a potentially serious complication of head injury.CT scans were re-evaluated so as to reveal whether air was situated in the epidural, subdural, or subarachnoid spaces or intracerebrally; whether associated space-occupying lesions were present; and whether the air bubbles were single or multiple. Clinical data such as the presence of persistant rhinorrhea and/or otorrhea, tension pneumocephalus, severity and type of trauma, and outcome were also assessed to determine the significance of this rare finding.

Early phase alterations in endothelium dependent vasorelaxation responses due to aneurysm clip application and related manipulations

SummaryMechanically induced vasoconstriction observed throughout surgery and in the immediate postoperative period was investigated to assess the effects of various microsurgical manipulations.Factors such as the type of aneurysm clip, duration of temporary clipping and peri-adventitial tissue stripping were the variables in this study. Microsurgical clips were applied on guinea pig “cervical carotid arteries” in which peri-adventitia had been removed microsurgically. Arterial rings were removed immediately after surgery. Endothelium dependent relaxations were measured and morphological investigations were performed using light microscopy.It was observed that as the clip application period increased, relaxation responses decreased. Peri-adventitial tissue stripping caused a marked decrease in the relaxation responses in all types of the clips. Microvascular clips, in spite of their lower closing forces, had the greatest deleterious effect on relaxation responses of the vessel, in both normal and peri-adventitial tissue stripped. When the peri-adventitial tissue of the vessel had been stripped, convolutions of the lamina elastica interna were found to be lost in parallel with the decreased tonus of the artery. In the vessels subjected to clipping endothelial denudation and cracking took place.As a conclusion it can be stated that both peri-adventitial tissue stripping and microvascular clip application have deleterious effects in the early postoperative period. While choosing clips from minimal occlusion force tables, care must be taken to choose clips with less width; and while performing microvascular anastomosis, temporary clips with a lesser width must be used in place of microvascular clips. Adventitial stripping must not be unnecessarily generous during microvascular anastomosis.

Sella turcica fractures in a trauma series and their clinical significance

BACKGROUND Fractures in the region of the sella turcica (ST) are usually associated with severe blunt head trauma and may produce many complications. The true incidence is difficult to assess since there have been only about 30 cases reported in the literature. METHODS A total of 470 computed tomography (CT) sections--with optimum bone window images of skull bone--of 1600 head trauma patients who were admitted between 1979 and 1992, inclusive, to the Neurosurgery Department of Gazi University Medical School were analyzed retrospectively. RESULTS There were a total of 17 patients with a fracture of the ST, constituting an incidence of 3.6%, and there was a preponderance of children. CONCLUSIONS Computed tomography was very helpful in assessing the extent of ST fractures. In our cases, these fractures were not associated with a high complication or death rate, although a cerebrospinal fluid fistula was present in 53%.

Moderate head injuries in children as compared to other age groups, including the cases who had talked and deteriorated

SummaryPatients defined as having a moderate head injury on the basis of Glasgow Coma Scale scores within the ranges of 9 to 13 after acute nonsurgical procedures were selected. Almost 1600 cases were hospitalized in the Neurosurgery Department. The cases were admitted through the Emergency Unit of Gaz University Medical School, Ankara, Turkey during the period between 1979 and 1992.The group studied consisted of 231 selected patients assessed separately in paediatric, adult and elderly age groups. Possible risk factors such as: GCS score, anisocoria, unilateral or bilateral fixed pupils, impaired oculocephalic reflexes, presence of multiple systemic injuries, aetiology of head trauma, presence of linear or depressed skull fractures, space occupying mass on CT or operation was also assessed.Subarachnoid haemorrhage turned out to be the only independent significant risk factor in predicting mortality. The data about the patients who have “talked and deteriorated” were also reported so as to assisst physicians charged with the care of trauma victims.

Primary amyloidosis of an extraocular muscle

Minimal proptosis with limitation of left upward gaze in a 34-year-old female was due to primary amyloidosis of the extraocular muscle.