Posterior fossa epidural hydatid cyst in the adult

Hydatid cyst is an important parasitic disease especially in endemic regions. Hydatid cysts are most commonly found in the liver and lungs and only 1% to 2% of the cysts reach the brain. Intracranial hydatid cysts are usually supratentorial and majority of cases are children and young adults. In this case report, a 55-yearold woman who lives in rural area in Turkey, admitted to our clinic with severe headache, neck pain, gait disturbance, and vomiting. Her neurological examination revealed cerebellar ataxia and left dysmetria. Radiological findings were compatible with hydatid cyst. On the 3rd of antihelmintic therapy, the patient underwent suboccipital craniotomy and epidural cyst was excised using Dowling technique without rupture of the cyst wall. Patient’s symptoms improved postoperatively. Although hydatid cyst in posterior fossa is a very rare entity, it should be kept in mind in patients with intracranial cystic lesions who live in endemic regions

The importance of costoclavicular space on possible compression of the subclavian artery in the thoracic outlet region: a radio-anatomical study

OBJECTIVES: The purposes of this study were to identify possible compression points along the transit route of the subclavian artery and to provide a detailed anatomical analysis of areas that are involved in the surgical management of the thoracic outlet syndrome (TOS). The results of the current study are based on measurements from cadavers, computed tomography (CT) scans and dry adult first ribs. METHODS: The width and length of the interscalene space and the width of the costoclavicular passage were measured on 18 cervical dissections in 9 cadavers, on 50 dry first ribs and on CT angiography sections from 15 patients whose conditions were not related to TOS. RESULTS: The average width and length of the interscalene space in cadavers were 15.28 ± 1.94mm and 15.98 ± 2.13 mm, respectively. The widths of the costoclavicular passage (12.42 ± 1.43mm) were significantly narrower than the widths and lengths of the interscalene space in cadavers (P < 0.05). The average width and length of the interscalene space (groove for the subclavian artery) in 50 dry ribs were 15.53 ± 2.12mm and 16.12 ± 1.95mm, respectively. In CT images, the widths of the costoclavicular passage were also significantly narrower than those of the interscalene space (P 0.05). CONCLUSIONS: Our results showed that the costoclavicular width was the narrowest space along the passage route of the subclavian artery. When considering the surgical decompression of the subclavian artery for TOS, this narrowest area should always be kept in mind. Since measurements from CT images and cadavers were significantly similar, CT measurements may be used to evaluate the thoracic outlet region in patients with TOS

Morphometric Evaluation of Coccyx with Microcomputed Tomography (Micro CT) and Computed Tomography (CT) Technology

Aim%253A We investigated the coccyx anatomy accurately in detail by microcomputed tomography (micro CT) and computed tomography (CT) to contribute to the data related to the coccyx anatomy and the potential clinical contribution of these datas in the treatment of coccyxs pathologies. Material and Methods%253A Twenty coccyges from embalmed cadavers were examined with a micro CT device. The inferior part of the sacrum and coccyx together with the surrounding soft tissue was removed safely. The tissue was scanned with a micro CT device, and all parameters were measured with micro CT image viewer programs. CT images of 29 patients without coccyx pathology were measured with OsiriX programs. Measured morphometric parameters with micro CT and CT were evaluated using statistical methods. Results%253A Generally, the morphometric parameters as mean values were larger in males than in females. Mean values for vertical length and coccyx width were higher for CT compared with micro CT images. Coccyx was more flat in the frontal plane in females. There were statistically significant differences between the micro CT and CT images regarding mean vertical length, width, lateral deviation angle, and sacrococcygeal angle and length of the vertebrae (p lt%253B 0.05). There were no statistically significant differences in number and width of the vertebrae (p gt%253B 0.05). Conclusion%253A We suggest that examining the normal coccyx morphology will help to better understand and treat the pathologic conditions of the coccyx. We believe our findings will contribute to the data related to the coccyx anatomy

Colocação segura de pinos percutâneos em fraturas subcapitais do quinto metacarpo: um estudo anatômico Safe percutaneous pinning for subcapital fifth metacarpal fractures: an anatomical study

OBJETIVOS: Durante o tratamento de fraturas fechadas do colo do metacarpo do dedo mínimo (fraturas do boxeador) usando fixação percutânea com fio K transversal e outros procedimentos, pode ocorrer lesão iatrogênica do ramo digital dorsal do dedo mínimo (RDDDM) do ramo dorsal do nervo ulnar (RDNU). Neste estudo, visamos descrever a relação do RDDDM do RDNU e os pontos de inserção na face lateral do quinto metacarpo durante fixação percutânea com fio K transversal de fraturas subcapitais. MÉTODOS: Foram realizadas dissecações e medições desse ramo depois de colocação de pino transversal percutâneo na parte distal do quinto osso do metacarpo em dez mãos de cadáveres fixadas em formalina. RESULTADOS: Os resultados desse estudo confirmam a grande proximidade da trajetória do pino e desse ramo, e demonstram sua possível lesão iatrogênica durante a fixação do fio K no quinto metacarpo. CONCLUSÕES: Para evitar a penetração desse nervo e limitar as chances de lesão iatrogênica, é importante conhecer o trajeto desse nervo. Os autores descrevem os pontos de inserção anatômica e acreditam que com uso do conhecimento da anatomia das fraturas subcapitais do quinto metacarpo, elas podem ser tratadas sem risco de déficits sensoriais futuros.OBJECTIVES: When treating closed fractures of the neck of the little finger metacarpal (boxer fractures) with percutaneous transverse K-wire fixation and other procedures, there may be iatrogenic injury to the dorsal digital branch to the little finger (DDBLF) of the dorsal branch of the ulnar nerve (DBUN . In this study we aimed to describe the relationship of the DDBLF of the DBUN and the insertion points on the external side of the fifth metacarpal during percutaneous transverse K-wire fixation of subcapital fractures. METHODS: Dissections and measurements regarding this branch were performed after percutaneous transverse pinning to distal part of fifth metacarpal bones in ten cadaver hands formalin fixed. RESULTS: The results of this study confirm the close proximity of the trajectory of the with this branch and demonstrate its potential iatrogenic injury during K-wire fixation of the fifth metacarpal. CONCLUSIONS: To avoid penetration of this nerve and limit the chances of iatrogenic injury it is important to know its course. The authors describe the anatomical insertion points and believe that using the anatomical knowledge, subcapital fifth metacarpal fractures can be treated without risk of sensory deficits

Body weight changes of preterms in the postnatal period

Aim: Survival and complications are very sensitive in preterm infants. Any negative situation in the preterms can lead to unintended consequences. In this study, it was aimed to analyze the data on demographic characteristics, complications, morbidity, mortality, and weight monitoring information of a high number of preterm neonates.Material and Methods: A total of 1091 preterm newborns born before the 37th gestational week in our tertiary care hospital were included in the study. All data were analyzed from hospital records. The weights of the newborns at birth, on the 7th, 15th, and 30th days were recorded..Results: Of the newborns, 39 (3.6%) died within 30 days after delivery. The cesarean section rate was 91.7%. While 7.9% of the preterms had birth weight below 1000 grams, the preterm rate in normal birth weight (>2500 g) was 15.6%. The mean birth weight was 1909.76 g, the first day mean weight loss was 0.6%, the first 3-day mean weight loss was 3.8% and the first 7-day mean weight loss was 2.5%.The mean birth weight in late preterm infants was significantly lower than in those who were born in the following weeks, while the mean birth weight in late preterm births was significantly higher than in those born before (p<0.001).Discussion: We found that preterm infants and those with lower birth weight had a worse prognosis, and that weight gain after birth was associated with prognosis. We believe that data obtained from our study may be a guide for clinicians and researchers

Thoracodorsal and Lateral Thoracic Arteries in Coronary Bypass Surgery as an Alternative Arterial Graft: A Morphological Study

Amaç: A. thoracica interna ve v. saphena magna günümüzde en sık kullanılan koroner by-pass greftleridir. Arteryel greftler, venöz greftlere göre daha iyi açık kalma oranlarına sahiptir. A. thoracica interna ve v. saphena magna'nın kullanılamayacağı veya daha önceki operasyonda kullanıldığı, ayrıca birden fazla koroner artere aynı anda by-pass gerektiren veya birden fazla grefte ihtiyaç duyulan durumlarda halen alternatif arteryel greftlere ihtiyaç vardır. Gereç ve Yöntem: Bu çalısmada, yas ortalaması 56,676,38 olan 9 erkek kadavradan bilateral olarak elde edilen, a. thoracica lateralis ve a. thoracodorsalis'in koroner by-pass operasyonlarında greft olarak kullanıma uygun olup olmadıklarının ortaya konulması amaçlandı. Bu arterlerin bas, orta ve son kısımlarına ait morfolojik özellikler (boy, lümen çapı, tunica intima ve media kalınlıkları, lamina elastica interna ve externa'nın özellikleri, tunica media tabakasının elastik ve düz kas dokusu içeriği) a. thoracica interna, a. radialis ve koroner arterlerin (r. interventricularis anterior, r. circumflexus, a. coronaria dextra) morfolojik özellikleriyle karsılastırıldı. Bulgular: A. thoracica lateralis ve a. thoracodorsalis'in iyi gelismis lamina elastica interna'ya sahip oldukları saptandı. Ayrıca a. thoracica lateralis ve a. thoracodorsalis'nin tunica intima ve media kalınlıkları genellikle a. thoracica interna ve a. radialis'in tunica intima ve media kalınlıklarına benzer veya daha ince olduğu görüldü. Bu bulgular, her iki arterin koroner by-pass cerrahisinde greft olarak kullanılabilmesi açısından olumlu özellikler olarak değerlendirildi. Sonuç: A. thoracica lateralis'in boy ve lümen çapı, tek basına serbest greft olarak kullanım için yeterli bulunmazken, a. thoracodorsalis ise yeterli bulundu. Bununla birlikte her iki arterin, diğer greftlerle birlikte kompozit greft (Y greft gibi) uygulamalarında, boy ve lümen açısından yeterli olabileceği sonucuna varıldı.By-pass Cerrahisi. Objectives: Today, the internal thoracic artery and great saphenous vein are the most used coronary bypass grafts. Patency of the arterial grafts is better than vein grafts. Alternative arterial grafts are needed in the following cases: when the internal thoracic artery and great saphenous vein cannot be used or they were used in the previous operations, when more than one coronary artery is needed for grafting, or more than one graft is neded at the operation. Material and Methods: This study aims to reveal whether lateral thoracic and thoracodorsal arteries taken from 9 male cadavers at 56,67±6,38 years old, bilaterally are available to be used as a graft in coronary bypass surgery. The morphologic properties (length, lumen diamater, thickness of tunica intima and media, properties of internal and external elastic lamina, elastic and smooth muscle component of tunica media) of the proximal, middle and distal parts of these arteries are compared with internal thoracic, radial and coronary arteries's (anterior interventricular branch, circumflex branch, right coronary artery). Results: It is determined that the lateral thoracic and thoracodorsal arteries have well-developed internal elastic lamina. Furthermore thickness of tunica intima and externa of the lateral thoracic and thoracodorsal arteries are observed to be similar or thinner than of the internal thoracic and radial arteries. These data are evaluated as positive properties in terms of using both of these arteries as graft in coronary bypass surgery. Conclusions: Length and lumen diameter of thoracodorsal artery are found adequate while lateral thoracic artery is not found adequate for single free graft. Neverthless, both of these arteries are found suitable to be used as composite grafts (as Y graft) with other grafts in terms of lenght and lumen diameter

Use of pimecrolimus to prevent epidural fibrosis in a postlaminectomy rat model Laboratory investigation

Object. Epidural fibrosis is the scar tissue formed over the dura mater after a laminectomy. Extensive epidural fibrosis may be an important underlying cause of failed back syndrome. Pimecrolimus, an ascomycin derivative, is one of the new classes of immunomodulating macrolactams and was specifically developed for the treatment of inflammatory diseases. This study examined the preventive effects of the local application of pimecrolimus in minimizing spinal epidural fibrosis in a rat laminectomy model

Therapeutic Plasma Exchange for Neurologic Disorders: Single Center Experiences

Giriş: Terapötik plasma değişimi(TPD) kan elemanlarının ayrılması, plazmanın değişimi ve ardından özellikle kırmızı kan hücreleri olmak üzere diğer kan komponentlerinin hastaya geri verilmesine dayalı bir tedavi yöntemidir. İmmun patogenezin rol oynadığı nörolojik hastalıklarda TPD etkili bir tedavidir. Bu çalışmada farklı nörolojik hastalık gruplarında merkezimizde uygulanan TPD tedavilerine alınan yanıtların literatür bilgileri eşliğinde tartışılması amaçlanmıştır. Materiyal-Metod: 2010-2014 tarihleri arasında hastanemiz nöroloji yoğunbakım ünitesi ve aferez merkezinde TPD tedavisi uygulanan hastaların verileri retrospektif olarak değerlendirilmiştir. Sonuçlar: Hasta grubunu 17 Nöromyelitis Optika, 4 Guillain-Barre sendromu, 3 Myastenia Gravis, 2 Multipl Skleroz, 5 paraneoplastik ensefolapati, 1 akut dissemine ensefalomyelit, 1 akut hemorajik lökoensefalopati, 2 transvers myelit, 1 kronik inflamatuar demyelinizan polinöropati ve 1 Multifokal edinsel demiyelinizan sensori ve motor nöropati tanılı hasta oluşturmakta idi. Ortalama TPD seans sayısı 6 idi(1-25 aralığında). Toplam TPD seans sayısı 236 saptandı. Tartışma: İmmunpatogenezin rol oynadığı nörolojik hastalıklarda TPD tedavi seçenekleri arasında yer almaktadır. Guillain-Barre sendromu ve Myastenia Gravis hastalıklarında TPD birinci basamak tedavi seçeneklerinden biri olarak kabul edilmektedir. almaktadır. Nöromyelitis Optika hastalarında merkezimizde TPD uygulaması ile elde ettiğimiz yanıtlar ışığında TPD'nin bu hasta grubunda da birinci basamak tedavi seçenekleri arasında yer alabileceğini düşünmekteyiz.Introduction: Therapeutic plasma exchange (TPE), is a procedure that involves separating the blood, exchanging the plasma and returning the other components, primarily red blood cells, to the patient. TPE is an effective treatment in neurologic diseases with immune pathogenesis. We report our single center experience about TPE in patients with different kind of neurologic diseases. Material- Method: We reviewed the medical records of 37 patients who had been consecutively treated by TPE between 2010 and 2014 at Neurologic Intensive Care Unit and The Apheresis Center. Results: Neurologic indications included neuromyelitis optica (NMO) (17 patients), GuillainBarre syndrome (GBS) (4 patients), myastenia gravis (MG) (3 patients), multiple sclerosis (MS) (2 patients), paraneoplastic encephalopathy (5 patients), acute disseminated encephalomyelitis (ADEM) 1 patient, acute hemorrhagic leucoencephalopathy 1 patient, transverse myelitis (2 patients), chronic inflammatory demyelinating polyneuropathy (CIDP) (1) and multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) 1 patient. The median TPE session number was 6 . Total number of TPE procedures in all cases was 236. Discussion: In neurological diseases with immune pathogenesis TPE must always be kept in mind as a treatment option. TPE is widely accepted as a first line treatment for GBS and MG. According to our experience NMO is the third disease in which TPE must be admitted as the first therapeutic option

Surgical Anatomy and Bifurcation Patterns of the Popliteal Artery: An Anatomical Study

Comert, Ayhan/0000-0002-9309-838X; Esmer, Ali Firat/0000-0003-2511-9879WOS: 000266016400006Objective: To clarify the anatomy of the popliteal artery and to determine key variations in the bifurcation patterns of the popliteal artery. Material and Methods: The popliteal fossae of 28 (12 right and 16 left) fixed lower extremities were carefully dissected, and the arterial pattern from the distal edge of the adductor hiatus (AH) to the proximal portion of each leg was documented. A digital caliper was used to measure the arterial length. The transverse plane between the distal edges of the femoral condyles (FCs), which is easily located, was used as reference. Results: The mean length of the popliteal artery (PA) from the AH to the FCs was 9.26 +/- 1.63 cm on the right side and 10.08 +/- 2.12 cm on the left side, while the mean distance from the FCs to the site of bifurcation into the anterior and posterior tibial arteries was 7.20 +/- 1.98 cm on the right side and 6.69 +/- 1.15 cm on the left. The average arterial length from the level of the FCs to the site of origin of the peroneal artery was 10.01 +/- 1.78 cm on the right side and 9.18 +/- 1.07 cm on the left side, and the PA/extremity ratio was 0.21 +/- 0.04 on the right side and 0.22 +/- 0.04 on the left. Variable patterns of adult popliteal artery termination were observed. Conclusion: The data presented here can help reduce the complication rate and improve the success rate of both urgent and elective vascular procedures, which often require exposure of the popliteal artery