Ümit Özkan

Timing of Shunt Surgery in Childhood Tuberculous Meningitis with Hydrocephalus

Hydrocephalus is a common complication of tuberculous meningitis (TBM) in children. The aims of this study are to review our experience of hydrocephalus in childhood TBM and to evaluate the effect of the timing of ventriculoperitoneal shunting (VPS) on the final outcome. In this study, 156 patients with TBM and hydrocephalus were reviewed retrospectively between 1990 and 2000. Patients’ ages ranged from 6 months to 15 years, with a mean age of 4.1 years. There were 85 boys, and the male-to-female ratio was 1.19:1.0. Sixty-two percent of the children were younger than 6 years old. VPS was performed 2 days after the diagnosis in 100 patients, and in the remaining 56 patients, 3 weeks after the diagnosis. The average follow-up period was 8.5 months. Good recovery or minor sequelae was seen in 82 patients (52.6%), and 51 died (12.3%). The timing of the VPS procedure and cerebral complications had an effect on the final outcome. Early VPS gave a better outcome in mild and moderate hydrocephalus (p = 0.040). This study has shown that early surgical procedure for mild/moderate hydrocephalus has a positive effect on the morbidity and mortality of hydrocephalus in childhood TBM (p = 0.014, p = 0.040, respectively). In severe hydrocephalus, there was a tendency for early shunting to have a positive effect on morbidity, although this did not reach statistical significance.

Analysis of 107 civilian craniocerebral gunshot wounds

Abstract.In this study, we present a retrospective analysis of 107 cases due to civilian craniocerebral gunshot wounds that were treated by the medical faculty of Dicle University during a period of 7 years (January 1993 to January 2000). Twenty patients died at the hospital, and the deaths were determined to result from direct effects of brain damage. Coma was the best prognostic guideline. Diffuse brain damage and ventricular injury, particularly infections, were associated with poor outcome.

Comparison of microsuturing to the use of tissue adhesives in anastomosing sciatic nerve cuts in rats

The purpose of this study was to investigate and to compare the effects of microsuturing to that of tissue adhesives (Tisseel®) on the healing of anastomosing peripheral nerve incisions.Forty-five Wistar-Albino rats were placed in special cages and separated into three groups (n = 15). In the control group, biliteral sciatic nerves were explored but no incision was made. In the first experimental group, bilateral sciatic nerves were incised and end-to-end anastomosing was performed by microsuturing the epineurium. In the second experimental group, tissue adhesive (Tisseel®) was used alone in anastomosing the sciatic nerve cuts. Assessments of the healing processes were demonstrated by 1. electromyography (EMG), 2. measuring the electrical responses of the anastomosed nerves after electrical stimuli, 3. histopathological examination.Statistical analysis of the EMG findings showed that the Tisseel group was the closest in the healing process to the control group. After applying electrical stimuli to the dissected nerves, the resistance value of the Tisseel group was nearest to those of the control group. The histopathological examinations showed highly degenerative nervebundles and prominent foreign body granuloma at the anastomosed sites of the microsutured group. The granulomatous inflammation was observed to be much less in the Tisseel group.We conclude that the healing effect of Tisseel was found to be superior to that of microsmuring as demonstrated by the findings of EMG, electrical responses of the anastomosed nerves, and histopathological examination.

The results of rehabilitation on motor and functional improvement of the spinal tuberculosis

OBJECTIVES To evaluate the result of rehabilitation on motor and functional improvement in spinal tuberculosis. METHOD Prospective case study. Data were collected from 47 patients with spinal tuberculosis medically and/or surgically treated, and rehabilitated over 6 months of period, after spinal decompression and fusion. The main outcome measures were motor development of the patients who were evaluated at the beginning, in the 1st week, in the 3rd month, and in the 6th month. Functional development of the patients was evaluated at the beginning and in the 6th month. Functional assessment was made according to Modified Barthel Index (MBI), and motor examination was made according to American Spinal Injury Association (ASIA). RESULTS The study population consisted of 47 patients (22 males and 25 females) mean aged 37.9 +/- 18.3 years (range 5-76 years). The most common site of spinal tuberculosis was the thoracic region. Localized back pain, paraparesis, sensory dysfunction and fever were typical clinical manifestations. Surgical management was performed as anterior or posterior drainage of abscess and/or stabilization of the spine. The rehabilitation program was performed in all patients during the preoperative, early postoperative and late postoperative 6 month periods. Muscle-strengthening exercises on necessary localization such as pectoral, abdominal, lower extremities; truncal and sacrospinal extensors were started for the rehabilitation. The motor score for the lower limbs and the MBI scores for activities of daily living (ADL) and mobility improved significantly (P < 0.001). The self-care and mobility categories of the MBI on admission; were 14.8% severely dependent and 10.6% independent. However, at the end of the rehabilitation program, 4.2% were severely dependent and 70.2% independent. IN CONCLUSION Early diagnosis and appropriate medical and/or surgical treatment together with a rehabilitation program will improve the life quality of patients with spinal tuberculosis.

Spontaneous migration of a bullet into the brain

We report the case of a 20-year-old man with a gunshot injury as an example of spontaneous migration of a metallic foreign body within the brain. Computed tomography (CT) showed the bullet in the left temporoparietal region. At 10 days follow-up, CT revealed that the bullet had migrated posteriorly, due to the effect of gravity, lodging in the occipital lobe. Although there are a few literature reports of spontaneous migration of a bullet within the brain, this case was unique as the patient was fully conscious without any neurological deficit.

Quadruplets hydatid cysts in brain ventricles: a case report

An 18-year-old male patient with a hepatic hydatic cyst was admitted with cephalgia and gait disturbances. Radiological examination showed a cystic lesion in his liver and four cystic masses, 2-8 mm in diameter, in the right lateral brain ventricle. All cysts were removed without rupture by way of a right transparietal-transventricular approach, using an ellipsoid forceps designed by ourselves. Albendazole was given postoperatively. Postoperative outcome was excellent in this case except for transient left hemiparesis. To our knowledge, this is the first case of four hydatid cysts in the lateral brain ventricle.

Coexistence of a cerebellopontine epidermoid cyst with a pituitary adenoma.

We report on an 18-year-old girl with the coexistence of an epidermoid cyst in the cerebellopontine angle (CPA) with a pituitary adenoma. The clinical course and histopathological characteristics were reviewed. The patient presented with headache, vision loss and amenorea. Computerised tomographic (CT) scan and magnetic resonance imaging (MRI) examinations demonstrated a solid sellar lesion with supra-sellar extension. There was another mass lesion in the CPA with prepontine extension. The tumours were removed surgically. Histopathological examination revealed an epidermoid cyst in the prepontine area and a pituitary adenoma in the sellar region. This has been the second case to be reported in the literature with the coexistence of an epidermoid cyst and a pituitary adenoma.

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.

Protective Effects of Intralipid and Caffeic Acid Phenyl Esther (CAPE) on Neurotoxicity Induced by Ethanol in Rats.

AIM Ethanol causes oxidative degradation of the mitochondrial genome in the brain. This effect could contribute to the development of brain injury in some alcoholic patients. We investigated the protective effect of caffeic acid phenyl esther (CAPE) and intralipid (IL) on oxidative stress and neurotoxicity induced by ethanol intake. MATERIAL AND METHODS The forty-eight rats were randomly divided into seven groups. Ethanol was administered for acute toxicity. IL and CAPE were administered immediately after ethanol intake. Total oxidant status (TOS), total antioxidant status (TAS), and oxidative status index (OSi) were evaluated and histologic examination of cerebellum and brain tissue with Hematoxylin-Eosin and immuno-histochemical dyes was performed. RESULTS In the ethanol group, TAS levels were significantly lower than the other groups and this finding indicates that the toxic effect of ethanol reduces antioxidant levels. In the ethanol group, TOS levels were significantly higher than the other groups. These results showed that ethanol induced oxidative stress. IL treatment increased TAS levels, and CAPE decreased TOS levels against ethanol toxicity. There was correlation between TAS and TOS levels. Also, histopathologic results confirmed these biochemical results. CONCLUSION CAPE and IL treatment could be effective course of therapy to enhance therapeutic efficacy and may provide a promising approach for the treatment of neurotoxicity and oxidative stress induced by ethanol in clinic.

A study made by using actigraphy regarding the effects on sleep of cervical disk herniation surgery

AIM To analyze the relationship between the severity of pain and sleep disorder using wrist actigraphy in patients with cervical disc herniation (CDH). MATERIAL AND METHODS Fifty patients with the diagnosis of CDH underwent subjective tests and actigraphic analysis in preoperative period, and at the end of postoperative first week and postoperative first month. The data of the subjective tests and actigraphic analysis were compared. RESULTS There was a strong and statistically significant negative correlation between the subjective tests of Visual Analog Scale (VAS) for Pain 0-1-2 and the objective parameters of Sleep Onset Latency (SOL) 0-1-2 (rs= -0.798, p=0.009 - rs= - 0.832, p=0.006 - rs=- 0.710, p=0.004). There was a positive correlation between the subjective tests of VAS for Pain 0-1-2 and the objective parameters of Sleep Efficiency (SEF) 0-1-2 (rs=0.721, p=0.006 - rs= 0.768, p=0.001 - rs= 0.748, p=0.001). CONCLUSION Actigraphy may be used for the evaluation of cervical disc surgery, as an alternative and objective test for sleep disorders.