Yahya Turan

Evaluation of risk factors affecting hospital-acquired infections in the neurosurgery intensive care unit.

The aim of the present study was to identify nosocomial infections (NIs), and their associated risk factors, in patients treated in the neurosurgery intensive care unit (NICU) of our hospital. Patients determined to have NIs between January 2008 and December 2012 were included in the study. Each patients age, gender, microbiological culture results, underlying conditions, type of NIs, device utilization, total parenteral nutrition, reason for hospitalization, Glasgow score, and treatment were recorded and evaluated using statistical analysis. Risk factors for NIs were analyzed with a logistic regression model. During the five-year period, 60 NI episodes were detected in 56 out of 1643 patients. The mean age of the patient population was 33.3 (1–79) years. Of the patients, 22 were female and 34 were male. The overall incidence rate (NIs/100) and incidence density (NIs /1000 days of stay) of NIs were 3.65% and 6.5/1000 patient days, respectively. Regardless of the year of surveillance, the three most commonly detected NIs were bloodstream infection, shunt infection, and ventilator-associated pneumonia. No statistically significant difference was detected between infected and uninfected patients in terms of sex, age, blood transfusions, or mannitol and steroid use (p ≥ 0.05). In the present study, Glasgow scores, the frequency of prior usage of broad-spectrum antibiotics, and NICU stay durations were significantly higher among patients with infections (p < 0.001). Univariate analysis demonstrated that a low Glasgow score, re-operation, and use of mechanical ventilation were risk factors for NIs. We identified low Glasgow coma scores, long hospital stay duration, use of wide spectrum antibiotics, mechanical ventilation, total parenteral nutrition, and re-operation as risk factors for NIs.

Posterior Epidural Migration of a Sequestered Lumbar İntervertebral Disc Fragment.

AIM Posterior epidural migration of a sequestered lumbar intervertebral disc fragment (PEMSLIDF) is an extremely rare condition published so far only as case reports or small case series (ranging between 2 to 8 cases). Diagnosing this condition is often challenging and the diagnosis is usually made intraoperatively. The affected patients usually suffer cauda equina syndrome (CES). In the present study, we aimed to discuss the clinical and radiological findings, types and features of surgical therapies, and outcomes of 9 patients with PEMSLIDF. MATERIAL AND METHODS This study included 9 (0.36%) patients with PEMSLIDF among 2470 patients who underwent lumbar disc hernia surgery between August 2002 and September 2012. The preoperative clinical and radiological properties of the patients were evaluated. The postoperative outcomes were assessed using neurological examination, radiological imaging, visual analog scale (VAS) and modified Odom criteria. RESULTS As far as we know, this study is the largest case series examining the characteristics of PEMSLIDF. Seven (77.8%) of our patients were male and 2 (22.2%) were female and they had a mean age of 49.5 years (range 28-70 years). The mean duration from symptom onset to hospital admission was 7.4 days. Seven patients had CES. All patients underwent sequestrectomy and discectomy via posterior microsurgery. The patient outcomes were evaluated by the Modified Odom criteria and the outcome was excellent in two (22.2%) patients, good in 4 (44.5%), fair in 2 (22.2%), and poor in 1 (11.1%). CONCLUSION The entire free fragment can usually be excised via the posterior microsurgery technique. Early surgical treatment is of great importance to prevent more serious neurological deficits.

Co-occurrence of lumbar spondylolysis and lumbar disc herniation with lumbosacral nerve root anomaly

Lumbosacral nerve root anomalies are the leading cause of lumbar surgery failures. Although co-occurrence of lumbar spondylolysis and disc herniation is common, it is very rare to observe that a nerve root anomaly accompanies these lesions. A 49-year-old male patient presented with sudden-onset right leg pain. Examinations revealed L5/S1 lumbar spondylolysis and disc herniation. At preoperative period, he was also diagnosed with lumbosacral root anomaly. Following discectomy and root decompression, stabilization was performed. The complaints of the patient diagnosed with lumbosacral root anomaly at intraoperative period were improved at postoperative period. It should be remembered that in patients with lumbar disc herniation and spondylolysis, lumbar root anomalies may coexist when clinical and neurological picture is severe. Preoperative and perioperative assessments should be made meticulously to prevent neurological injury.

Omurilik yaralanmaların patofizyolojisi

Correspondence: Tevfik Yılmaz, Department of Neurosurgery, Faculty of Medicine, Dicle University, Diyarbakır, TURKEY Email: kartaltevfik@hotmail.com Received: 27.08.2013, Accepted: 01.12.2013 Copyright

Efficacy of dexamethasone on penicillin-induced epileptiform activity in rats: An electrophysiological study

Corticosteroids are extensively used in treatment of many diseases. In neurosurgery practice, dexamethasone (DEX) is commonly used particularly in cerebral edema secondary to brain tumors, head trauma, and central nervous system infections. There are some uncertainties surrounding the secure use of DEX in patients with epilepsy or seizures induced by diseases of the central nervous system such as head trauma and brain tumors. Despite its extensive use, the effect of DEX on epileptiform activity is unclear. In this study the effect of DEX on epileptiform activity was investigated in rats. The effects of 1, 3, and 10mg/kg DEX on epileptiform activity was compared with effects of antiepileptic drugs commonly employed in treatment of epilepsy, namely phenytoin (PHT) 50mg/kg and levetiracetam (LEV) 50mg/kg that were administered intraperitoneally for 1 week. All groups were administered intracortical penicillin (500IU) to induce epileptiform activity. DEX at the doses of 3mg/kg and 10mg/kg significantly reduced spike frequencies compared to the initial values. In conclusion, we think that DEX can effectively decrease the epileptiform activity.

Three-dimensional analysis of foramen magnum and its adjacent structures.

AbstractThe goal of this effort is to evaluate the anatomy of the foramen magnum (FM) using 3-dimensional computed tomography (3D CT), and determine whether or not the anatomical features of vascular structures and condylar foramen (CF) affect the types of FM.The CT angiography records of 101 patients (44 men and 57 women) were retrospectively examined in this study. Details of the FM, CF, and the vertebral and basilar arteries were examined using maximum intensity projection and 3D rendering images. The average age of the 101 patients was 45.28 ± 16.3 years. The 8 types of FM, in order of their frequency of occurrence, are as follows: round (19 cases; 18.8%), 2 semicircles (18; 17.8%), egg-shaped (15; 14.9%), hexagonal (14; 13.9%), tetragonal (11; 10.9%), oval (11; 10.9%), pentagonal (9; 8.9%), and irregular (4; 4%). There was no statistically significant relationship between the anatomical features of the vertebral and basilar arteries and the CF with the different types of FM (P ≥ 0.05). In our study, the diameter of the anteroposterior (AP) FM was 34.7 ± 3.6 mm, and the transverse (T) diameter was 29.5 ± 2.5 mm. The AP and T diameters were significantly higher in men than in women (P = 0.006 and P ⩽ 0.001, respectively).Our study revealed that 3D CT is a safe and easy method for visualizing the anatomical structure of the FM and neighboring structures. Furthermore, this study was the first to demonstrate that there is no correlation between the 8 types of FM and the vertebral artery, basilar artery, and CF.

Surgical therapy of a vertebral artery aneurysm with saccular and fusiform segments.

Abstract Vertebral artery aneurysms form a group of aneurysms having high rates of rebleeding, morbidity, and mortality, poor treatment outcomes, as well as low rate of surgical treatment. Examinations for subarachnoid bleeding revealed a vertebral artery aneurysm with a diameter of 12 mm in a 67-year-old man who presented with headache. The vertebral artery aneurysm with saccular and fusiform segments was shrunk and clipped via lateral left suboccipital approach. No neurologic deficit was present at the postoperative period. Control digital subtraction angiography showed complete shrinkage of aneurysm with continued blood flow and no residue. Clinical findings, treatments, and surgical approaches of VA aneurysms are different from anterior and posterior circulation aneurysms. Microneurosurgical clipping is the most effective treatment of vertebral artery aneurysms in suitable cases. Although endovascular intervention is commonly applied as therapeutic modality for patients with vertebral artery aneurysm, researchers have also emphasized that saccular vertebral aneurysms with fusiform extension can also be surgically treated in suitable cases.

Local Tissue Electrical Resistances in Transpedicular Screw Application in the Thoracolumbar Region.

AIM To determine local tissue electrical resistance differences generated during a screw pass from the pedicle to another tissue rather than determining all individual electrical tissue resistance values. MATERIAL AND METHODS We attempted to measure electrical resistance values of regional tissues in addition to fluoroscopic imaging during application of fixation via a transpedicular screw. We also attempted to detect local tissue electrical resistance alterations in case of malposition of the screw inside the pedicle. For this purpose, local tissue electrical resistances of 10 transpedicular tracks opened with standard track openers bilaterally in 5 vertebrae, and of spinal cord accessed by puncturing the medial walls of three vertebrae in a cadaver were measured. These resistance differences were not only measured in human cadaveric tissue but also in 36 pedicles belonging to a total of 18 vertebrae between Th 1-S1 vertebrae of a sheep cadaver. Both medial and lateral walls were drilled to measure local tissue resistance differences in a sheep cadaver. RESULTS Our results indicated that local tissue electrical resistance changes were statistically significant in both human and sheep cadaver. CONCLUSION It is possible to prevent screw malposition using a simple and cheap electrical resistance measurement. Local tissue electrical resistance measurement during transpedicular screw insertion is a safe, simple, cheap, and practical method.

Kaza ile üzerine cisim düşmesine bağlı hastaneye başvuran hastaların değerlendirilmesi

Amac: Ozellikle cocuklarda olmak uzere ev, is ve dis ortamlarda meydana gelen kazalar, yaralanma ve olum nedenlerinin basinda gelmektedir. Bu calismada amac, kaza ile uzerine cisim dusmesine bagli hastanemize bas- vuran hastalarin degerlendirilmesidir. Yontemler: Bu calismamizda kaza ile uzerine cisim dus- mesine bagli 2012-2014 yillari arasinda hastanemize basvuran 135 hastanin dosyalari retrospektif olarak incelendi. Bu hastalarin yas, cinsiyet, olayin nedeni olarak uzerine dusen cismin turu, yeri, zamani ve olum nedenleri analiz edildi. Bulgular: Hastalarin 82 ( %60,7)’i erkek, 53 (%39,3)’u kadin ve yas ortalamasi 18,8 (0-79 yil) olarak bulundu. En fazla hasta %57,8 (78 hasta) ile cocuk yas grubunda ( 0-18 yas) bulunmaktadir. Dusen cismin turu bakimindan degerlendirildiginde sirasiyla %18,5 (25 hasta) ile televizyon, %15,6 (21 hasta) ile tas ve %11,1 (15 hasta) ile demirden yapilmis cisimler ilk uc sirayi paylasmaktadir. Kazanin meydana geldigi yer olarak ele alindiginda en fazla kazanin 85 vaka (%62,9) ile evde oldugu gorulmektedir. Kazanin meydana gelme zamanina bakildiginda en fazla 93 vaka (%68,9) ile yaz mevsiminde meydana geldigi gorulmektedir. Sonuc: Bu calismada elde edilen veriler, ozellikle cocuklarin maruz kaldigi bu tur kazalari onleme programlarina katki saglamaktadir. Anahtar kelimeler: Cisim dusmesi, cocuk kazalari, is kazalari, cocuk olum nedenleri, ev kazalari

A modified technique for the treatment of isthmic spondylolisthesis.

AIM To describe a modified technique for the treatment of single level, isthmic spondylolisthesis (IS) MATERIAL and METHODS Forty-two patients who underwent posterior lumbar interbody fusion (PLIF) with spinolaminar autologous bone graft for the treatment of isthmic spondylolisthesis between May 2007 and November 2011, were retrospectively reviewed. All patients underwent total removal of the spinolaminar process, total discectomy and endplate decortication, and proper size spinolaminar autologous bone graft was sequentially inserted into the disc space with posterior instrumentation. Outcomes of the study included visual analogue scale (VAS), Oswestry disability index (ODI), and radiographic fusion. RESULTS The average duration of follow-up was 3.5 years. Neither has implant failure been observed nor has revision been required so far. The mean Oswestry Disability Index improved from 53% to 9.5%, and visual analog scale for back pain from 8.5 to 3.8 at the first month and 1.3 at the sixth month postoperatively. Visual analog scale for leg pain from 8.3 to 1.4 at the first month and 0.8 at the sixth month postoperatively. All patients had clinical and radiographic evidence of solid fusion without any need for revision. CONCLUSION The modified posterior lumbar interbody fusion and posterior instrumentation technique is a safe and effective treatment for isthmic spondylolisthesis.