Efficacy of Optic Nerve Sheath Fenestration in Patients with Increased Intracranial Pressure

Objectives:To evaluate the effectiveness of optic nerve sheath fenestration (ONSF) on visual functions in patients with increased intracranial pressure (İİP).Materials and Methods:The medical records of 24 eyes of 17 patients who had İİP due to idiopathic intracranial hypertension, cerebral venous sinus thrombosis, or intracranial cyst and underwent ONSF surgery to prevent visual loss were evaluated. Pre- and postoperative visual acuity, optic disc images, and visual field findings were reviewed.Results:The mean age of the patients was 30.4±8.5 years, and 88.2% were female. The patients’ mean body mass index was 28.67±6.1 kg/m2. The mean follow-up time was 24±12.1 months (range: 3-44). At postoperative 3 months, the mean best-corrected distance visual acuity had improved in 20 eyes (83.3%) and stabilized in 4 eyes (16.7%) compared to preoperative values. In visual field mean deviation, an improvement was observed in 10 eyes (90.9%), while 1 eye (9.1%) eye remained stable. Optic disc edema decreased in all patients.Conclusion:This study indicates that ONSF has beneficial effects on visual function in patients with rapidly progressive visual loss caused by increased intracranial pressure

Treatment of adolescent idiopathic scoliosis with global (ROD) derotation maneuver using pedicle screws

Introduction: Adolescent idiopathic scoliosis is a three dimensional deformity. For the treatment of deformity, nature of deformity should be well understood and treatment strategy has to be directed to the coronal, sagittal and axial components of deformity. Global Derotation (GD) maneuver is based on simple rod derotation from concave side aiming to correct the deformity on coronal, sagittal and axial profile. In this report we reviewed AIS surgery results treated by global derotation maneuver with all pedicle screw instrumentation.Material& Methods: Between 2003 and 2011, 253 patients had been operated using GD technique.80 of 253 patients was included to our study. The patients routinely evaluated with preoperative-postoperative and last follow up standing ortho-x-rays. Coronal and sagittal profile parameters measured on x-rays with digital software using Cobb method. Rotational component of the deformity was measured according to Nash-Moe method at the apical vertebra.Results: 80 patients (71 female ; 9 male)had been followed up average 19,8 (7-37) months. Patients age average were 15,1(12-21) at operation date. Coronal cobb angle measure in thoracic curves preoperative were 48,9° decreased to mean 3,2° postoperatively. The mean coronal thoracolumbar curve were 45,8° preoperatively and decreased to mean 2°. Apical vertebra rotation measure regressed to mean 0,68 (0-1). Thoracic kyphosis showed downward tendency from mean 37,8° to mean 27,8°.Conclusion: Rod derotation technique enable to correct coronal and axial profile. Coronal Cobb angle improvement seen obviously with correction of axial profile rotation. Sagittal hypokyphotic effect of GD should be kept in mind

Karın ağrılı hastalarda ortalama trombosit hacmi bir belirteç olarak kullanılabilir mi?

Amaç: Kolay elde edilebilirlik ve yaygın kullanım imkanı akut karın ağrılı hastaların erken tanısında biyokimyasal belirteçleri oldukça önemli hale getirmektedir. Bu çalışmada akut karın ağrısı ile acil servise başvurup yatışı yapılan hastalarda ortalama trombosit hacmi MPV ’nin tanısal değerinin araştırılması planlandı. Gereç ve Yöntem: Ocak 2012 -Mart 2013 tarihleri arasında acil servise başvuran 812 hasta ile 45 sağlıklı kişinin kayıtları retrospektif olarak incelendi. Kayıtlardan olguların; yaş, cinsiyet, fizik muayene bulguları, 5.gün MPV, platelet, nötrofil lenfosit oranı, lökosit, C-reaktif protein CRP ile MPV değerleri aralarındaki ilişki incelendi.Bulgular: Çalışmaya alınan hastaların 467’sini %57,5 erkekler, 345’ini %42,5 kadınlar oluşturmuştur. Hastaların yaş ortalamaları 53,09±0,75’dir . Hastaların kesin tanıları incelendiğinde en sık safra kesesi ve koledok patolojileri %18,7 , ikinci sırada nonspesifik karın ağrısı %17,3 , üçüncü ise ileus-volvulus %13,8 idi. Çalışmaya alınan 812 hastanın 5. gün MPV ortalama değeri 8,358±1,046 fL, platelet değerleri ortalama 246,82±91,3 u/L, nötrofil lenfosit oranı ortalama değeri 10,025±12,75 u/L olarak bulundu. Çalışmadaki akut karın ağrılı hasta grubunda giriş MPV değerleri ortalama 7,869±1,071 fL, sağlıklı kontrol grubu MPV değerleri ortalama 8,47±1,058 fL olup, hasta grubunun ortalama MPV düzeyi, sağlıklı bireylerden daha düşüktü. Sonuç: Pankreatit ve ileus-volvulus tanısı alan hastalarda MPV’nin tanıya yardımcı bir belirteç olabileceğini düşünmekteyi

Recurrent and Massive Life Threatening Epistaxis due to Nasal Heroin Usage

Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use

Traumatic superior orbital fissure syndrome

Objective: Traumatic superior orbital fissure syndrome is a rare complication that occurs in association with craniofacial trauma. In the present case, there were no associated orbital fractures or other lesions to explain.Methods: We present a-16-year-old patient with total ophthalmoplegia, ptosis, and anesthesia of the upper eyelid and forehead 6 hours after a reported trauma to the left eye. We measured the width of the superior orbital fissure on the horizontal plane including the optic canal using computed tomography scans.Results: Radiological examinations did not reveal any orbital fractures. However, the superior orbital fissure on the affected side was only 1.86 mm, increasing susceptibility to indirect trauma.Conclusions: A narrow superior orbital fissure may play a role for superior orbital fissure syndrome altering the transmitted force from the trauma and edema

Dominant ve dominant-olmayan el ile fakoemülsifikasyon (katarakt cerrahisi) sonuçları

Aim: The aim was to present the outcomes of phacoemulsification surgery with dominant and non-dominant hands. Methods: Eighty eyes of 72 patients undergoing phacoemulsification with a temporal clear corneal incision were included in the study by reviewing their medical records and were divided into two groups. Forty of operated eyes were right eyes and forty were left ones. We operated right eyes with dominant (right) hand, and left eyes with non-dominant (left) hand through a temporal clear corneal tunnel. The patients were followed up at week 1 st and month 1 st and 3rd. Keratometry and specular microscopy were performed preoperatively, at month 1 st and 3rd after surgery. We recorded the total volume of fluid used, phaco time and cumulative dissipated energy. We calculated surgically-induced astigmatism using vector analysis. Results: There was no statistically significant difference in intraoperative and postoperative outcomes between phacoemulsification surgeries performed with dominant and non-dominant hands. Conclusion: Phacoemulsification surgeries can be carried out with non-dominant hand and with excellent outcomes.Amaç: Sağ ve sol el ile yapılan fakoemülsifikasyon sonuçlarımızı sunmaktır. Yöntemler: Kliniğimizde temporal korneal insizyonla katarakt operasyonu olan 72 hastanın 80 gözü dahil edilmiştir. Kırk göz sağ el ile, 40 göz sol el ile opere edilmiştir. Hastaların 1 hafta,1 ay ve 3 ay sonra takipleri yapılmıştır. Hastalar 1. ve 3. ay kontrollerinde keratometri ve speküler mikroskopi ile değerlendirilmiştir. Fakoemülsifikasyon zamanı, kümülatif kullanılan enerji, total kullanılan sıvı kaydedilmiştir. Cerrahi ile indüklenen astigmatizma vektör analizi kullanılarak karşılaştırılmıştır. Bulgular: Sağ ve sol el ile yapılan fakoemülsifikasyonlarda; intra ve postoperatif sonuçlar istatistiksel farklılık göstermemiştir. Sonuç: Fakoemülsifikasyon; dominant-olmayan el ile de yapıldığı zaman iyi sonuçlar çıkabilir