Effects of topically applied contractubex® on epidural fibrosis and axonal regeneration in injured rat sciatic nerve

AIM: To investigate the effects of Contractubex (R) (Cx) on peripheral nerve regeneration and scar formation. MATERIAL and METHODS: A surgical procedure involving sciatic nerve incision in 24 adult male Sprague-Dawley rats followed by epineural suturing was performed. In weeks 4 and 12 following surgery, macroscopic, histological, functional, and electromyographic examinations of the sciatic nerve were conducted. RESULTS: No significant difference was found between the Cx group and the control group in terms of sciatic function index (SFI) and distal latency results at week 4 (p>0.05). However, significant improvements in the Cx group were observed in SFI amplitudes and nerve action potentials at week 12 (p<0.001 and p<0.001, respectively). Significant improvements were found in the amplitudes of nerve action potentials in the treatment group after weeks 4 and 12 (p<0.05 and p<0.001, respectively). Macroscopically and histopathologically, epidural fibrosis decreased (p<0.05 and p<0.001, respectively). For both measurement times, the treatment group had significantly higher numbers of axons (week 4, p<0.05; week 12, p<0.001), and the treatment group had better results regarding its axon area (weeks 4 and 12, p<0.001) and myelin thickness (weeks 4 and 12, p<0.05). CONCLUSION: Cx, which is applied topically in peripheral nerve injury, affects axonal regeneration and axonal maturation positively and reduces the functional loss

Retained surgical sponge in differential diagnosis of paraspinal soft-tissue mass after posterior spinal surgery: Report of eight cases

Background: In the postoperative period of posterior spinal surgery, surgeons usually encounter a wide spectrum of complications, including retained surgical sponge, gossypiboma. Materials and Methods: Retrospective review of case records of eight patients diagnosed with gossypiboma with emphasis on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Results: All the eight patients presented with low back pain and/or symptoms of infection, such as draining from the incision site, fever, and tenderness. The diagnosis was confirmed by the imaging findings on MRI with gadolinium enhancement. Conclusion: Retained paravertebral surgical sponges are seldom reported due to medicolegal implications. Awareness of this complication among neurosurgeons and radiologists is essential to avoid unnecessary morbidity

Spinal Textiloma (Gossypiboma): A Report of Three Cases Misdiagnosed as Tumour

Background: Textile products commonly used in surgery (e.g., sponges or gauze) have been known to cause complications after spinal surgery. Associated complications usually arise months or even years after the primary surgery. In case of spine surgery, these bodies are often detected during neuroradiological evaluations to investigate reported back pain; however, this complication often remains asymptomatic. Aims: The research is intended to increase awareness among both spinal surgeons and neuroradiologists of this potential complication. Study Design: Retrospective study. Methods: This study is a retrospective case series of three patients with retained surgical textile products who had been misdiagnosed with spinal tumour. The medical records of the patients were reviewed and demographic data, clinical aspects, initial diagnosis, surgical procedures, time interval between previous operation and onset of symptoms, laboratory findings, radiological findings, treatment, and outcome were analysed. Results: The three patients included two women and one man aged between 64 and 67 years. All patients had a previous surgery for lumbar disc herniation. The time from the previous surgical procedures to presentation ranged from 3 to 17 years. All patients presented with non-specific lower back pain and/or radiculopathy without clinical findings of infection. Laboratory parameters were otherwise normal. All three cases had been misdiagnosed as a spinal tumor based on magnetic resonance imaging findings. During new surgical procedures, gauze bandages, i.e., surgical textiles left during a previous operation, were found. Conclusion: Textiloma is an important and rarely mentioned potential neurosurgical complication that may remain asymptomatic for years. They are more common in obese patients, after emergency surgery, and with unplanned changes in surgical procedure such as bleeding and unintended neurosurgical complications. Neuroradiological findings are variable and non-specific; thus, patients could be misdiagnosed with a spinal tumor or abscess. Likewise, in patients with a history of spinal surgery, spinal abscesses, haematomas, hypertrophic scars, fibrosarcomas, rhabdomyosarcomas, and schwannomas should definitely be considered in the differential diagnosis and considered when planning diagnostic procedures. Appropriate antibiotic therapy is recommended when a suppurative complication is present or suspected. Textiloma is a medico-legal complication that can be prevented by the education of surgical staff, the counting method (preoperatively, at closure, and at the end), and use of products with radiopaque barcodes

The cheapest way of the pain management after lumbar spinal surgical procedures: Cold pack application

İnsanlığın var olduğu dönemden günümüze, ağrı ve onun tedavisi tıbbın en önemli konusu olmuştur. Ağrı tedavisi için birçok yöntem uygulanmıştır. Spinal cerrahide tedavinin temel amacı da hastanın ağrısını geçirmek, günlük aktivitesine en kısa sürede dönmesini sağlamaktır. Ancak uygulanan tedaviden bağımsız olarak postoperatif şiddetli ağrı ortaya çıkar. Özellikle paravertebral kaslarda otomatik ekartörlerin uzun süreli kullanımı ve inflamatuar doku yanıtı bunda etkilidir. Bu sebeple postoperatif kuvvetli nonsteroid ve narkotik analjezikler kullanılmak zorunda kalınmaktadır. Uygulanan tedavilerin yan etkileri dışında mali açıdan da bir başka problemi yanında getirmektedir. Amaç: Yumuşak doku travmalarında ağrı ve ödemi azaltmak için buz tedavisi uygulaması bilinen çok eski bir yöntemdir. Bizde bu çalışmamızda hastaların uzamış paravertebral kas ekartasyonuna bağlı postoperatif ağrılarını soğuk kompresyon uygulaması ile azaltmayı, hasta memnuniyetini arttırmayı ve verilen ilaç dozlarını azaltmayı hedefledik. Metot: Kliniğimizde lomber spinal cerrahi yapılmış 60 hasta üzerinde randomize prospektif klinik çalışma yaptık. Cerrahi süresi, paravertebral kas ekartasyon süresi, nonsteroid veya narkotik analjezik kullanımı kaydedildi. Ağrı seviyeleri VAS skorlama yöntemi ile ölçüldü. Grup1 hastalara postoperatif 3 gün süreyle günde 4 defa 20 dakikalık seanslar halinde soğuk kompresyon uygulandı. Soğuk kompresyon uygulaması; piyasadan temin edilmiş olan 300g’ lık standart buz aküleriyle, hasta lateral dekübit pozisyonda iken cerrahi yara yeri pansumanı üzerinden bilateral paravertebral kasları kapatacak şekilde lokal uygulandı. Grup 2 (kontrol grubu) hastalar sadece medikal tedavi aldı. Postoperatif VAS24, VAS48, VAS72 değerleri körleme olarak kaydedildi. Sonuç: Çalışma ve Kontrol gruplarının VAS0 değerleri arasında istatistiksel olarak anlamlı bir fark yoktur (p>0,05).Gruplar arası VAS24-48-72 değerleri arasında istatistiksel olarak anlamlı bir fark vardır (p<0,05). Uzamış paravertebral kas ekartasyonuna bağlı gelişen postoperatif bel ağrılarının tedavisinde soğuk kompresyon uygulaması basit, ucuz, güvenli ve etkili bir yöntem olup hastaların postoperatif ağrılarını ve narkotik analjezik ihtiyaçlarını azaltmaktadır. Spinal cerrahinin farklı uygulamalarında bu metot denenebilir.The main purpose of surgical treatment of lumbar spine is to relieve the patient's pain, and to return the daily activity as soon as possible comfortably. In the postoperative period, severe pain due to long term use of paravertebral automatic retractors and inflammatory response occurs. We have to use nonsteroidal antiinflammatory drugs and narcotic analgesics for the pain. Besides the side effects of this treatment, another problem is encountered in financial viable. After soft tissue trauma to reduce pain and edema, ice applications is a well-known method. In our study, we aim to reduce the postoperative pain which depends on prolonged retraction of paravertebral muscles with the cold compression application, and to increase patient satisfaction and to reduce the dose of the drugs. We performed a prospective randomized study on 60 patients underwent the lumbar spinal surgery in our clinic. Duration of surgery and paravertebral muscle retraction, use of narcotic analgesics or nonsteroidal anti-inflammatory drugs were recorded. Pain levels were measured by VAS scoring. Patients in group 1 (study group) were applied cold compression postoperative 4 times a day for 3 days in case of 20-minute sessions. Cold compression application was performed with 300g standards ice packs which are commercially available. Ice packs were applied locally through the surgical wound dressing covering bilateral paravertebral muscles while the patient is in lateral decubitus position. Patients in group 2 (control group) received only medical treatment. Postoperative VAS 24, 48, 72 time values were recorded. There is no statistically significant difference between the VAS 0 value of the control and study groups (p > 0,05). There is a statistically significant difference between the VAS 24, 48, 7 2 values of the control and study groups (p < 0.05). Cold compression therapy in the treatment of postope r ative back pain due to prolonged paravertebral muscle retraction is simple, inexpensive, safe and effective method of postoperative pain and narcotic analgesic needs of patients decreases.This method can be tried in different areas of spinal surgery. © Gülhane Askeri Tip Akademisi 2016

Rare cervical meningomyelocele in newborn

Nöral tüp defektleri (NTD), medulla spinalis ve kraniyumu kapsayan ve yenidoğan döneminde en sık saptanan konjenital malformasyonlardan birisidir. Nöral arkın kapanmasının tam gerçekleşememesi nedeni ile meningomyelosel, meningosel, spina bifida okülta, sirengomiyeli, dermal sinüs traktı ve tethered kord gelişebilmektedir. Yenidoğanda meningomyelosel yaygın görülebilmekte, genellikle folik asit eksikliği, genetik eğilim ve gebelik sürecinde alınan bazı ilaçlara bağlı oluşabilmektedir. Genellikle, lumbosakral bölgede görülür, servikal bölge lokalizasyonu nadirdir. Doğum sonrası, servikal bölgede kese görülmesi üzerine servikal magnetik rezonans (MR) görüntüleme ile değerlendirilen ve servikal meningomyelosel tesbit edilen yenidoğan kız bebek meningomyelosel lokalizasyonunun servikal bölgede olması ve nadir görülmesi nedeni ile sunmayı uygun gördük.Neural tube defects (NTD) are one of the most frequently seen congenital malformations covering the spinal cord and cranium in the neonatal period. Myelomeningocele, meningocele, spina bifida occulta, syringomyelia, dermal sinus tract and tethered cord can develop due to incomplete neural arch closure. Meningocele is commonly seen in newborns. It may occur usually due to folic acid deficiency, a genetic tendency and certain drugs taken during pregnancy. It is usually seen in the lumbosacral region but the cervical region is a rare localization. A newborn baby girl was evaluated by cervical magnetic resonance (MR) imaging. The MR findings show cervical myelomeningocele sac and she is diagnosed as having myelomeningocele. We present the case, due to localization of the meningomyelocele and its rarity

Central Nervous System Involvement of T-cell Prolymphocytic Leukemia Diagnosed with Stereotactic Brain Biopsy: Case Report

Prolymphocytic leukemia (PLL) is a generalized malignancy of the lymphoid tissue characterized by the accumulation of monoclonal lymphocytes, usually of B cell type. Involvement of the central nervous system (CNS) is an extremely rare complication of T-cell prolymphocytic leukemia (T-PLL). We describe a case of T-PLL presenting with symptomatic infiltration of the brain that was histopathologically proven by stereotactic brain biopsy. We emphasize the importance of rapid diagnosis and immediate treatment for patients presenting with CNS involvement and a history of leukemia or lymphoma

A Direct Carotid-Cavernous Fistula due to Penetrating Trauma by a Knitting Needle to the Temporal Region

Traumatic carotid-cavernous and #64257;stulas (CCF) usually occur after closed head injuries. In addition, CCFs can also be caused by penetrating injuries with stab or gunshot injuries. We present the case of traumatic CCF that was caused with a knitting needle directly penetrating through the temporal region. A 46-year-old man consulted with a progressive left swollen eye. His head computed tomography (CT) revealed a left temporal lobe contusion and fracture of the left temporal bone. Digital subtraction angiography (DSA) showed a direct high-flow fistula (Type-A lesion). After the balloon occlusion test, which was well tolerated by the patient, the internal carotid artery was occluded by the interventional radiologist. A review of the literature demonstrated that all of the traumatic CCFs occurred due to penetrating stab injuries through the orbita. To our knowledge, such a case has not been previously reported. [Arch Clin Exp Surg 2012; 1(4.000): 261-264