Thoracolumbar burst fractures requiring instrumented fusion: Should reducted bone fragments be removed? A retrospective study

Background Thoracolumbar burst fractures are common clinical entity encountered in neurosurgical practice, accounting for 10–20% of all spinal fractures. Clinical picture could be devastating due to severe neurological deficits which lead the patients dependent both socially and emotionally. Materials and methods This study compared two groups of patients who were operated because of thoracolumbar burst fracture secondary to spinal trauma in terms of neurologic deficits, degree of improvement, and radiologic measurements at one-year follow-up. The first group (group I) included the patients who underwent posterior total laminectomy, peroperative reduction of intracanal bone fragments, and posterior spinal instrumentation and the second group (group II) included the patients who underwent total laminectomy, and spinal instrumentation without reduction of free bone fragments. Results Neither group showed significant correlation with any measurement parameter. Radiological assessments and clinical improvements did not disclosed significant difference between the two groups at one-year follow-up. Conclusion Retropulsion of free bone fragments extend the time of surgery and causes complications. This study found that there is no need to retropulse the bone fragments in the spinal canal in patients with unstable burst fractures who underwent total laminectomy and posterior long segment stabilization

Akinetic Mutism Following Bilateral Anterior Cerebral Artery Territory Infarction Due to Aneurysm: A Case Report

BACKGROUND AND PURPOSE: Bilateral anterior cerebral artery (ACA) territory infarction is rare localization in stroke which should always prompt a search for an anterior communicating artery (ACoA) aneurysm. The common neurological manifestations are contralateral weakness predominate in the lower extremite, behavior disturbance, motor inertia, muteness, incontinence, grasp reflex, diffuse rigidity, akinetic mutism. CASE DESCRIPTION: We describe a 38-year-old woman presented with a left sided hemiparesia and decrease of speech for last days. She was a smoker and morbide obese. She had no any diagnosed disease. Her neurological examination had weakness of left extremites affected leg more than the arm and akinetic mutism like as no spontaneously speech and move and grasp reflex. CT showed bilateral ACA infarction which included cingulate gyrus, the right side more than left and subarachnoid hemorrhage in the interhemispheric fissure. MRI angiography showed the appearance of AcoA aneurysm. CONCLUSION: We report a patient with bilateral infarction in the ACA which a rare localization and clinicians must be alert to exist AcoA aneurysm which may bleed, different symptoms and signs like as akinetic mutism, primitive reflexes

Venous reflux: Measurement variability due to positional difference

AMAÇ Bu çalışmanın amacı femoral venlerin değerlendirilmesinde pozisyon ve manevraların etkisini araştırmaktı. GEREÇ VE YÖNTEM Yirmi iki-elli yedi yaşları arasında 50 sağlıklı kişide (25 erkek, 25 kadın), ana femoral ven (AFV) ve yüzeyel femoral vende (YFV) supin ve ayakta venöz reflü araştırıldı. Supin pozisyonda sadece Valsalva manevrası ile venöz reflü provoke edildi. Denekler ayakta incelenirken sırasıyla [1] Valsalva manevrası, [2] kompresyon ve salınım manevrası uygulandı. Her üç yöntemle venöz reflü süreleri kaydedildi. AFV değerlendirildiğinde, supin pozisyonda 29 ekstremitede (%29), 1 saniyenin üstünde reflü vardı. Bu 29 ölçümün 19'u 1-1.9 sn, 8'i 2-2.9 sn reflü sürelerine sahipti. Denekler ayağa kaldırılınca 1 saniyeden uzun süren reflü prevalansları belirgin derecede azaldı (%5). Reflü prevalansları 0.5 saniyenin altında (fizyolojik reflü) ayakta kompresyon manevrasında %97 iken, ayakta ve supin Valsalva ile sırasıyla %84 ve %27 idi. Ayakta iken YFV'de de 05 sn ve 1 sn'den uzun reflü prevalansları ayakta, supin pozisyona oranla düşüktü. Ortalama reflü süreleri AFV'de supin pozisyonda 1.3 sn iken, ayakta kompresyon ve Valsalva manevraları için sırasıyla 0.7 ve 0.4 sn; YFV'de sırasıyla 0.5 sn, 0.3 sn ve 0.2 sn idi. SONUÇ Supin pozisyonda yapılan inceleme ile femoral venlerde yanlış pozitif reflü tanı konma olasılığı yüksektir. Supin pozisyonda 1 saniyenin üzerinde süren reflülerde hastaların ayakta incelenmesi daha doğru sonuç verecektir. Ayakta kompresyon ve salınım manevrası en düşük yanlış pozitif reflü prevalansı ile venöz yetmezlik değerlendirmesinde en güvenilir yöntemdir.PURPOSE: The purpose of this study was to evaluate the role of the subject's position and two different maneuvers in the reflux measurements in femoral veins. MATERIALS AND METHODS: Venous reflux times in the common femoral vein (CFV) and superficial femoral vein (SFV) were studied in 50 healthy subjects (25 women, 25 male) aged between 22-57 years-old while the subjects were in supine and standing positions. Reflux was provocated only by Valsalva maneuver (VM) when the subject was lying down, whereas it was provocated by [1] Valsalva maneuver and [2] compression and release maneuver, respectively, when the subject was standing. Reflux times were recorded with each of the three methods. RESULTS: Regarding CFV, a reflux time of 1 second or more was recorded in 29 limbs (29%) only in the supine position. Of these 29 measurements, 19 were between 1 and 1.9 sec and 8 between 2 and 2.9 sec. When the subjects were examined in the standing position, the prevalence of reflux lasting more than 1 sec substantially decreased (5%). The prevalence of reflux lasting less than 0.5 sec was 97% with standing compression maneuver, 84% with standing VM and 27% with supine VM. Similarly, prevalence of reflux of longer than 0.5 sec or 1 sec was lower in the standing position than in the supine position in SFV. In CFV, mean reflux time was 1.3 sec in the supine position, whereas it was 0.7 sec and 0.4 sec with standing compression and standing Valsalva maneuvers, respectively. Corresponding values in SFV were 0.5 sec, 0.3 sec and 0.2 sec, respectively. CONCLUSION: The probability of making a false positive diagnosis of pathological reflux is high with supine examinations. When an examination in the supine position reveals a reflux time of longer than 1 second, making the patient stand up is expected to yield more reliable results. Compression and release maneuver, with its lowest false positive reflux prevalence, is the most reliable method in the evaluation of venous insufficiency

The visual scoring of emphysema with high-resolution computed tomography examination: intraobserver and interobserver correlations

Amaç: Amfizem değerlendirmesinde genellikle hard-copy film veya BT ekranı üzerinde subjektif görsel değerlendirme kullanılmaktadır. Bu yöntemde gözlemciler arası ve gözlemci içi uyumsuzluk kantitatif analizlere oranla yüksektir. Bu çalışmanın amacı density mask yöntemi kullanılarak segmentasyon analizi ile elde edilen amfizematöz parankim görüntüleri ile konvansiyonel görüntülerin gözlemciler arası ve gözlemci içi subjektif skorlamaya etkisini araştırmaktır. Gereç ve Yöntem: Çalışmada 10’u amfizemli 7’si sağlıklı birey incelendi. YRBT kesitleri iki gözlemci tarafından standart hard-copy filmden ve amfizematöz parankim pencerelerinde amfizemin yaygınlığı ve şiddeti olmak üzere skorlandı. Her hastada total amfizem skorları hesaplandı ve gözlemciler arası ve gözlemci içi korelasyona bakıldı. Bulgular: Gözlemcilerin yaptıkları skorlamada; yaygınlık skorlarında 19 skorda, şiddet skorlarında 30 skorda artış izlendi. Gözlemciler arasında hem konvansiyonel hem de segmentasyon penceresinde korelasyon vardı. Ayrıca gözlemciler arası korelayona benzer şekilde gözlemci içi korelasyon da izlendi. Sonuç: Amfizemli hastalarda YRBT incelemesinin amfizematöz parankim penceresinde görsel skorlanması kolay uygulanabilir bir metodolojidir. Bu metod ile gözlemciler arasındaki uyum artmakta ve gözlemcilerin tekrar eden değerlendirmelerindeki uyumsuzluk azaltmaktadır.Purpose: The subjective visual assessment is usually used on the hard-copy film or CT monitor for assessment of emphysema. This method has a higher interobserver and intraobserver discrepancy than quantitative analyzes. In this study, the effect of interobserver and intraobserver discrepancy was investigated on subjective visual scoring of conventional images and emphysematous parenchyma images which is gained with the density mask method. Material and Methods: In this study, ten emphysematous patient and seven healthy subjects were examined. HRCT images were scored on the standard hard-copy film and emphysematous parenchymal window settings as the distribution and severity of emphysema by two observers. Total emphysema score was calculated for each patient and the interobserver and intraobserver correlations were evaluated. Results: An increase was observed in 19 scores of distribution and 30 scores of severity. The interobserver correlation was observed in both conventional images and emphysematous parenchyma images. In addition, an intraobserver correlation was also observed similar to interobserver correlation. Conclusion: The visual scoring methodology of patients with emphysema can be easily applicable in HRCT examination of emphysematous parenchymal window. Intraobserver correlation was increased, and the concordance was reduced in repeated assessments of physicians with this method

The visual scoring of emphysema with high-resolution computed tomography examination: intraobserver and interobserver correlations

Amaç: Amfizem değerlendirmesinde genellikle hard-copy film veya BT ekranı üzerinde subjektif görsel değerlendirme kullanılmaktadır. Bu yöntemde gözlemciler arası ve gözlemci içi uyumsuzluk kantitatif analizlere oranla yüksektir. Bu çalışmanın amacı density mask yöntemi kullanılarak segmentasyon analizi ile elde edilen amfizematöz parankim görüntüleri ile konvansiyonel görüntülerin gözlemciler arası ve gözlemci içi subjektif skorlamaya etkisini araştırmaktır. Gereç ve Yöntem: Çalışmada 10’u amfizemli 7’si sağlıklı birey incelendi. YRBT kesitleri iki gözlemci tarafından standart hard-copy filmden ve amfizematöz parankim pencerelerinde amfizemin yaygınlığı ve şiddeti olmak üzere skorlandı. Her hastada total amfizem skorları hesaplandı ve gözlemciler arası ve gözlemci içi korelasyona bakıldı. Bulgular: Gözlemcilerin yaptıkları skorlamada; yaygınlık skorlarında 19 skorda, şiddet skorlarında 30 skorda artış izlendi. Gözlemciler arasında hem konvansiyonel hem de segmentasyon penceresinde korelasyon vardı. Ayrıca gözlemciler arası korelayona benzer şekilde gözlemci içi korelasyon da izlendi. Sonuç: Amfizemli hastalarda YRBT incelemesinin amfizematöz parankim penceresinde görsel skorlanması kolay uygulanabilir bir metodolojidir. Bu metod ile gözlemciler arasındaki uyum artmakta ve gözlemcilerin tekrar eden değerlendirmelerindeki uyumsuzluk azaltmaktadır.Purpose: The subjective visual assessment is usually used on the hard-copy film or CT monitor for assessment of emphysema. This method has a higher interobserver and intraobserver discrepancy than quantitative analyzes. In this study, the effect of interobserver and intraobserver discrepancy was investigated on subjective visual scoring of conventional images and emphysematous parenchyma images which is gained with the density mask method. Material and Methods: In this study, ten emphysematous patient and seven healthy subjects were examined. HRCT images were scored on the standard hard-copy film and emphysematous parenchymal window settings as the distribution and severity of emphysema by two observers. Total emphysema score was calculated for each patient and the interobserver and intraobserver correlations were evaluated. Results: An increase was observed in 19 scores of distribution and 30 scores of severity. The interobserver correlation was observed in both conventional images and emphysematous parenchyma images. In addition, an intraobserver correlation was also observed similar to interobserver correlation. Conclusion: The visual scoring methodology of patients with emphysema can be easily applicable in HRCT examination of emphysematous parenchymal window. Intraobserver correlation was increased, and the concordance was reduced in repeated assessments of physicians with this method

Pneumosinus Dilatans Case Mimicking OrbitalPathology In Patient With Visual Loss

Pneumosinus dilatans is an abnormal localized dilatation of paranasal sinuses. Although cranial magnetic resonance imaging can help for differentiation of paranasal sinuses, variations maybe misdiagnosed as a lesion. Susceptibility artifacts may be formed around tissues where the magnetic field sensitivity differs and these can be easily recognized. Atypical appearance atthese susceptibility artifacts can cause pseudolesion appearances that in turn cause misdiagnoses.If the artifact do not differentiation from the lesion, computed tomography should be performed.For this reason, in the differential diagnosis of lesions especially close to the paranasal sinuses, benign formations like sinus variations should be kept in mind in the cranial and orbital MRI.In this case, we aimed to present a case diagnosed at pneumosinus dilatans in control cranial computed tomography evaluation who came with loss of vision and is found pseudolesion appearance in orbital region neighbourhood in MRI

Radiation in the orthopedic operating theatre

Objective: The aim of the study was to determine the amount of radiation exposure in the orthopedic operating theater, to show that the radiation dose was decreased with distance from the tube, and to inform personnel about protective measures. Methods: Ionised radiation was measured in the orthopedic operating theater where fluoroscopy was used between 18 February 2014 and 02 June 2014. Four dosimeters were placed at the head and foot of the operating table and at 200 cm from those areas at a height of 60 cm vertical to the floor. Results: At the end of 104 days, the total values were determined as 90.5 mrem at the foot of the table, 68.17 mrem at the head of the table, 7.5 mrem at 200 cm from the foot of the table, and 5.17 mrem at 200 cm from the head of the table. A significant decrease was observed in the values determined at a distance from the radiation source. Conclusion: The rate of radiation determined in the dosimeters decreased when distance from the radiation source increased. During the use of fluoroscopy in orthopedic surgery, the wearing of lead aprons, neck protectors, and glasses, in addition to maintaining a distance from the tube, will reduce the radiation exposure of individuals

The benefit of expiratory-phase quantitative CT densitometry in the early diagnosis of chronic obstructive pulmonary disease

WOS: 000316061000002PubMed: 22261851PURPOSE We aimed to compare the inspiratory and expiratory quantitative computed tomography (CT) densitometric data of healthy volunteers, individuals with chronic obstructive pulmonary disease (COPD) risk, and COPD patients to aid in the early diagnosis of COPD. MATERIALS AND METHODS Of the study patients, 14 were healthy volunteers (Group I), 12 were patients at risk for COPD (Group II), and 13 were COPD patients (Group III). The high-resolution CT was performed at three levels (the upper, middle, and lower parts of the lungs). All images were evaluated with a specific program for the segmentation of pulmonary parenchyma. The mean lung density (MLD) was measured, and the emphysema index (EI) was calculated using this program. RESULTS Both MLD values and calculated EI ratios showed significant differences between Groups I and III, and Groups II and III in both expiratory and inspiratory phases (P < 0.05). However, in the comparison of healthy volunteers and patients at risk for COPD (Group I and II), only expiratory-phase MLD values showed statistically significant difference (P < 0.001). CONCLUSION In patients at risk for COPD, expiratory-phase MLD measurements can be used as an early diagnostic method

Spontaneous rupture of intracranial dermoid tumor in a patient with vertigo : computed tomography and magnetic resonance imaging findings

Background: Congenital dermoid cysts are very rare, constituting less than 1% of intracranial tumors. Spontaneous rupture of dermoid tumor is a potentially serious complication that can lead to meningitis, seizures, cerebral ischemia and hydrocephalus. Occasionally, dermoid tumors are incidentally discovered on computed tomography (CT) of the brain or magnetic resonance imaging (MRI) following unrelated clinical complaints. They are also discovered during radiologic investigations of unexplained headaches, seizures, and rarely olfactory delusions. Case Report: In this report we describe a patient complaining of vertigo caused by spontaneous rupture of dermoid cyst, preoperatively diagnosed by CT and MRI. Cranial CT revealed a dense fatty lesion adjacent to the posterolateral parasellar region on the left with multiple small, dense fat droplets scattered in the subarachnoid space corresponding to a dermoid cyst rupture. Cranial MRI sections revealed a lesion with mixed-signal-intensity and multiple hyperintense droplets scattered through the cerebellar surface on the left. No enhancement was found on axial T1-weighted MRI after intravenous Gadolinium administration. Diffusion weighted image (DWI) and apparent diffusion coefficient map studies exhibited explicit restricted diffusion. Discussion: Many studies and literature case reports concerning the rupture of dermoid cyst have been reported. However, multimodal imaging of this rare pathology in the same patient is uncommon. Although dermoid cysts are pathognomonic in appearance on a CT examination, the MRI is also of value in helping to understand the effect of extension and pressure of the mass. DWI is also important for support of the diagnosis and patient follow-up

A patient with hepatocellular carcinoma treated by transcatheter arterial chemoembolization: Case report

Hepatoselüler karsinom karaciğerin en sık görülen primer tümörüdür ve tüm dünyada insidansı gittikçe artmaktadır. Bilinen tedavi yöntemleri cerrahi rezeksiyon ve karaciğer transplantasyonudur. Mikrokateter ve mikrotel teknolojisindeki inanılmaz gelişmeler transkateter arteryel kemoembolizasyon (TAKE) tedavisini cerrahi rezeksiyon ve transplantasyona alternatif duruma getirmiştir. TAKE kısaca tümör besleyicilerine mikrokateter ve mikrotellerle girilerek kemoterapötik ilaçların sadece tumoral lezyonun içine verilmesi ve işlem sonunda tümör besleyicilerinin tıkanması olarak tarif edilir. Biz de hepatoselüler karsinom tanısı alan ve TAKE ile tedavi edilen 62 yaşındaki erkek hastayı sunuyoruz.A Patient With Hepatocellular Carcinoma Treated by Transcatheter Arterial Chemoembolization: Case Report Hepatocellular carcinoma is the most common primary liver cancer and its prevalence increases worldwide. Transcatheter arterial chemoembolization is an alternative therapy comparing surgical resection and transplantation because of advanced technology in the microcatheter and microwire system. As a technique, feeding artery of the tumoral lesion is catheterized by microcatheter and microwire, then performed chemoembolic drugs into tumor via microcatheter. In the end, feeding artery of the tumor is occluded with particular embolization particles. We present a 62-year-old patient with hepatocellular carcinoma treated by transcatheter arterial chemoembolization