Evaluation Results of the Cases Applied to the Emergency Unit with Cause of Head Trauma

Giriş: Kalıcı hasara ve ölüme neden olan beyin ve omurilik yaralanmaları gelişmiş toplumlarda önemli bir sağlık sorunu oluşturmaya devam etmektedir. Kazalar yaralanmaların en önemli nedenini oluşturmaktadır. Çalışmamızın amacı kafa travmalarının sıklığını, nedenlerini ve sonuçlarını incelemek, oluşan patolojik bulguların önemini vurgulamaktır. Gereç ve Yöntem: 2 Kırıkkale Üniversitesi Tıp Fakültesi acil bölümüne 2015- 2016 tarihleri arasında kafa travması nedeni ile Beyin cerrahisi bölümünce değerlendirilen ardışık 100 olgunun tanımlayıcı analizleri gerçekleştirildi. Bu hastaların 69'u erkek, 31'i bayandı. Hastaların çekilen Kranial Bilgisayarlı Tomografileri "Marshall skoru" ile analiz edildi. Hastaların yaş, cins, kafa travma nedenleri, geliş Glaskow Koma Skoru (GKS) ve Glaskow Outcome Skorları (GOS) kayıt edildi. Bulgular: Hastaların Marshall skoru %94 ünde Grade I idi. Dört olguda Grade II, 1 olguda Grade III, 2 olguda ise Grade IV idi. Geliş GKS %92'sinde 15, altı olguda 14, iki olguda 3 idi. GOS'ları ise 96 olguda 5, bir olguda 3, üç olguda 1 idi. Olguların yaş ortalaması 34.222.2 (Yaş aralığı: 1-83 yıl) idi. Olguların cinsiyet grubuna göre kaza nedenlerine bakıldığında erkeklerde araç dışı trafik kazası (ADTK), (%13'e karşılık %6.5), darp (%11.6'ya karşılık %3.2) bayanlara göre daha fazla gözlenmekteydi. Buna karşılık kadınlarda ise, araç içi trafik kazası (AİTK) (%45.2'ye karşılık %23.2) erkeklerden daha fazla gözlemlenmiştir. Kadınlarda düşme sonucunda yaralanma erkeklerden biraz daha yüksekti. Sonuçlara bakıldığında 16-30 yaş dışındaki tüm gruplarda kafa travmasının en sık nedeni düşme olarak saptandı. 16-30 yaş grubunda ise kafa travmasından en fazla AİTK sorumluydu. Sonuç: Her yaş grubunda en sık travma nedeni olarak düşmenin saptanmasının etiyolojisinde bölgenin kırsal özellikleri nedeniyle tarımla geçinen bir bölge olduğu düşünülmüştür. Yaşam koşullarının iyileştirilmesi ve ekonomik düzeyin yükseltilmesi ile yapılacak ergonomik çalışmalar bu sonucun çözümüne katkıda bulunacaktır.Introduction: Brain and spinal cord injuries causing permanent damage and death continue to present a significant health problem in developed societies. Accidents are the most important cause of injuries. Our aim in our study is to examine the frequency, causes and consequences of head trauma and to emphasize the importance of pathological findings. Material and Methods: Descriptive analyzes of 100 consecutive patients evaluated by the Neurosurgery applied for the cause of head trauma between the dates of 2015 and 2016 in the emergency department of Kırıkkale University Faculty of Medicine were performed. Patients were 69 males and 31 females. Patients' cranial computerize tomography (CT) analyzed with the Marshall score. Patients' age, sex, causes of head trauma, glaskow coma score (GCS) and GOS (glaskow outcome score) were noted. Results: The Marshall score of the patients was 94% grade I, 4% grade II, 1% grade III, 2% grade IV. GCS was arrival 92% at 15.6% at 14.2% at 3. GOS was arrival 96% at 5.1% at 3.3% at 1. The mean age of the cases was 34.2±22.2 (1-83 years). According to the gender group, the incidence of car accidents (6.5% vs. 13%) and fights (3.2% vs. 11.6%) were more frequent in males than females. In contrast, female traffic accidents (45.2% vs. 23.2%) were observed more frequently than males. As a result of falling in females, the injury was higher than males. The results show that the greatest cause of head trauma in all groups outside the age range of 16-30 years is falling. In the 16-30 age group, the traffic accidents was responsible. Conclusion: It is thought that in the etiology of falling as the most frequent cause of trauma in every age group, it is a region that goes to agriculture due to the rural characteristics of the region. Ergonomic studies to improve living conditions and raise the economic level will contribute to the solution of this result

Strain and Shear Wave Elastography in Diagnosis of Retrobulbar Neuritis

Background: In the early stages of retrobulbar neuritis (RN), the optic disc appears normal on ophthalmoscopy. Therefore, the diagnosis of RN is usually made clinically. However, imaging tools are needed for precise diagnosis of RN, and usually MRI is used. In this study, we investigated the diagnostic performance of strain elastography (SE) and shear wave elastography (SWE) in patients with RN. Elastography is a new sonographic technique and a noninvasive ultrasound method for evaluating the elastic properties of tissues based on static compression: the elastographic techniques of SE compress the tissues axially, and SWE uses waves that are generated by transducers and interact with the tissue. Methods: The study included 40 eyes of 20 patients with sudden visual loss, who were diagnosed with RN. The eyes of the patients were divided into 2 groups: the eye with a diagnosis of RN was the group of RN eyes, and the healthy second eye was the group of control eyes. Ophthalmologic examination, orbital and brain MRI, SE, and SWE were performed. SE color mapping was divided into 3 types: blue-hardest tissue (Type 1), blue/green-hard tissue (Type 2), and green-intermediate tissue (Type 3). All patients were treated with high-dose corticosteroids. The measurements of SE and SWE were made immediately after diagnosis and 1 month after treatment. Results: The mean age of 11 male and 9 female patients was 38.3 ± 12.2 years. At the time of diagnosis, the mean shear wave values for the control eyes were 18.47 ± 7.26 kPa (kilopascals), and the mean shear wave values for the RN eyes were 37.21 ± 8.24 kPa. There was a statistically significant difference between the control and RN eyes at the time of diagnosis (P < 0.001). The mean shear wave value was 19.92 ± 4.77 kPa in the RN eyes after treatment. There was a statistically significant difference in values at the time of diagnosis and after treatment (P < 0.001). Strain types found in the RN eyes before treatment were Type 1 in 60% of eyes, Type 2 in 25%, and Type 3 in 15%; at the end of the treatment, Type 2 was observed in 25% of eyes and Type 3 in 75%, while Type 1 was not observed. Conclusions: SE and SWE may be important alternative diagnostic tools in the diagnosis of RN

Results of Surgical Treatment of Intracranial Abscess

Giriş: İntrakranyal apselerde cerrahi tedavi sonuçlarımızı sunmaktır. Gereç ve Yöntem: 2005-2016 tarihleri arasında Kırıkkale Üniversitesi Tıp Fakültesi Beyin ve Sinir Cerrahisi kliniğinde intrakranial abse tanısı ile tedavi edilen 11 olgu retrospektif olarak incelendi. Bu çalışmada, intrakranial apseli hastaların şikâyetleri, apsenin meydana geliş şekli, apsenin yerleşimi ve bulguların dağılımı incelendi. Hastalara uygulanan cerrahi yaklaşım şekilleri ve sonuçları karşılaştırıldı. Cerrahi teknik olarak Stereotaksik Burrhole'den aspirasyon veya kraniektomi ile drenaj ve kapsül eksizyonu uygulandı. Bulgular: Onbir hasta çalışmaya alındı. Hastaların yaşları 11-63 yaş arasındaydı. Ortalama yaş 333 idi. Hastaların şikayetleri, görülme sıklığına göre, 7 hastada (%63.6) bilinç bulanıklılığı, 4 hastada (%27.2) bulantı-kusma, daha az oranda baş ağrısı, kuvvetsizlik, ateş ve baş dönmesi şikayetleri vardı. Hastaların abse lokalizasyonları genellikle temporal semptomların başlaması sonrası kliniğimize başvuru süreleri, ortalama 23.65 gün'dü. Cerrahi olarak 11 hastanın 7'sine (%63.6) Burr-holle ile abse drenajı, 2 hastaya kraniektomi ile abse drenajı ve 2 hastaya kapsül eksizyonu (%18.1) operasyonu yapıldı. Operasyon öncesi ve sonrası radyolojik olarak Kranial Bilgisayarlı Tomografi (BT) çekildi. Klinik takipte laboratuar analizi olarak CBC, Sedimantasyon, hsCRP düzeylerine bakıldı. Operasyon sırasında abse materyalinden kültür gönderildi. Hastaların GOS (Glaskow outcome scala) puanlaması 8 hastada 5 (%72.7), bir hastada 4 (%9.09), bir hastada 2 (%9.09) ve bir hastada 1 (%9.09) puan olarak hesaplandı. Sonuç: İntrakranial abselerin cerrahisinde uygulanan cerrahi yaklaşımlardan abse aspirasyonu ile kapsül eksizyonu arasında GOS oranı açısından belirgin bir fark görülmedi. Ek olarak cerrahi sonrası takiplerde apse boyutun 2 cm'in altında ise Kranial BT takibine ihtiyaç olmadığı, medikal tedavi ve CRP düzeyi takibinin tek başına yeterli olduğu görüldü.Introduction: We aim to present our results of surgical treatment of intracranial abscess. Material and Methods: In our study, between the years 20052016 at Kirikkale University Faculty of Medicine, Neurosurgery department was performed. Intracranial abscess treated with the diagnosis of 11 patients were evaluated retrospectively. Intracranial abscess, their complaints, occurrence form of abscesses, abscesses and examined the distribution of the settlement findings. Surgical forms applied to patients and compared. Stereotactic aspiration or Burr-hole craniectomy from the surgical drainage technique were excised and capsules. Results: 11 patients were enrolled in the study. The ages of the patients ranged from 11-63 years old. The average age was 33±3. Patients' complaints, according to the incidence; 7 patients (63.6%) consciousness turbidity,4 patients (27.2%), nausea and vomiting, to a lesser extent, headache, weakness, fever and dizziness complaints. Abscess localization of the patients were generally located in the temporal lobe. After the onset of symptoms of patients to our clinic application period, the average 23.6±5 days. Surgery in 11 patients and 7 patients with (63.6%) abscesses with Burr-hole to 2 craniectomy patients with abscesses and 2 patients with capsular excision (18.1%) operations were performed. Preoperative and postoperative radiographic Cranial Computed Tomography (CT) was performed. As laboratory analysis in the clinical follow-up CBC, Sedim, hsCRP levels were measured. Culture sent the abscess material during the operation. Patients GOS (Glasgow outcome scale) score of 8 patients in 5 (72.7%), one patient in 4 (9.09%) to a patient in 2 (% 9.09) and a patient 1 (% 9.09) were calculated as points. Conclusion: Intracranial abscess of the surgical approach in the surgical excision of the capsule with the aspiration of the abscess was not observed a significant difference in the rate of GOS. In addition, post-surgical follow-up less than 2 cm in size of the abscess, Cranial CT is not needed to follow, and CRP levels were seen in follow-up medical treatment alone is enough

Strain and Shear Wave Elastography in Diagnosis of Retrobulbar Neuritis

WOS:000539245000010PubMed: 31022061Background: In the early stages of retrobulbar neuritis (RN), the optic disc appears normal on ophthalmoscopy. Therefore, the diagnosis of RN is usually made clinically. However, imaging tools are needed for precise diagnosis of RN, and usually MRI is used. In this study, we investigated the diagnostic performance of strain elastography (SE) and shear wave elastography (SWE) in patients with RN. Elastography is a new sonographic technique and a noninvasive ultrasound method for evaluating the elastic properties of tissues based on static compression: the elastographic techniques of SE compress the tissues axially, and SWE uses waves that are generated by transducers and interact with the tissue. Methods: The study included 40 eyes of 20 patients with sudden visual loss, who were diagnosed with RN. The eyes of the patients were divided into 2 groups: the eye with a diagnosis of RN was the group of RN eyes, and the healthy second eye was the group of control eyes. Ophthalmologic examination, orbital and brain MRI, SE, and SWE were performed. SE color mapping was divided into 3 types: blue-hardest tissue (Type 1), blue/green-hard tissue (Type 2), and green-intermediate tissue (Type 3). All patients were treated with high-dose corticosteroids. The measurements of SE and SWE were made immediately after diagnosis and 1 month after treatment. Results: The mean age of 11 male and 9 female patients was 38.3 +/- 12.2 years. At the time of diagnosis, the mean shear wave values for the control eyes were 18.47 +/- 7.26 kPa (kilopascals), and the mean shear wave values for the RN eyes were 37.21 +/- 8.24 kPa. There was a statistically significant difference between the control and RN eyes at the time of diagnosis (P < 0.001). The mean shear wave value was 19.92 +/- 4.77 kPa in the RN eyes after treatment. There was a statistically significant difference in values at the time of diagnosis and after treatment (P < 0.001). Strain types found in the RN eyes before treatment were Type 1 in 60% of eyes, Type 2 in 25%, and Type 3 in 15%; at the end of the treatment, Type 2 was observed in 25% of eyes and Type 3 in 75%, while Type 1 was not observed. Conclusions: SE and SWE may be important alternative diagnostic tools in the diagnosis of RN

Is strain elastography beneficial for isoechoic cholangiocarcinomas?

WOS: 000393177800019PubMed: 27981289

Advanced Magnetic Resonance Imaging Findings of Renal Hydatid Cyst

Hydatid Cyst, a serious health problem in the developing countries, is a zoonotic infection formed by echinococcus. Though liver or lung involvement is often, kidney involvement is rarely seen and represents for only 2 to 3 per cent of all cases of hydatid disease. In our case who had multiple cysts in liver and large, solitary cyst in the kidney. We aimed to present magnetic resonance spectroscopy (MRS) and diffusion weighted magnetic resonance (DWI) findings of the hydatid cysts. Though there are MRS studies about brain involvement there is no MRS and DWI study in the renal hydatid disease. The mean ADC (apparent diffusion coefficient) value of the renal hydatid cyst was 2554x10-6 mm2/s on DWI and high signal intensity was detected compared with the renal parenchyma. MR spectroscopy at TE of 31 shows prominent alanine peak in addition to small amino acid peaks. MRI is utilized to evaluate the complications and to plan treatment of disease. Advanced MRI studies such as DWI and MRS can provide supplementary information both in the post-treatment period and in the diagnosis by bringing non-invasive approaches. [Med-Science 2014; 3(4.000): 1743-50

EVALUATION OF THE OLFACTORY BULB VOLUME ANF OLFACTORY SULCUS DEPTH IN PATIENTS WITH CHRONIC STROKE

AMAÇ: Bu çalışmada, kronik dönemdeki inme geçirmiş hastaların olfaktör bulbus (OB) hacimleri ve olfaktör sulcus (OS) derinliğini değerlendirmek amaçlandı. GEREÇ VE YÖNTEM: Bu çalışma retrospektif ve olgu kontrol çalışması olarak planlandı. Kronik dönemde (>6 ay) inme geçirmiş hastaların OB hacimleri ve OS derinliği ölçümü, manyetik rezonans görüntüleme 1.5-tesla MRG sistemi (Philips MRI Systems, Achieva Release 3.2 Level 2013-10-21, Philips Medical) ile standart kafa coili kullanılarak yapıldı. OB hacim ve OS derinliği ölçümleri, yağ baskılı T2 koronal kesitler kullanılarak yapıldı. İnmeli hastaların verileri sağlıklı kontrol grubu ile karşılaştırıldı. BULGULAR: Çalışmaya, yaş ortalaması 47.7±10.7 yıl olan 45 (21 erkek, 24 kadın) inme geçirmiş hasta ile yaş ortalaması 44.5±8.7 yıl olan 45 (19 erkek-26 kadın) sağlıklı kontrol dahil edildi. İnme grubu ile kontrol grubu karşılaştırıldığında sağ (34.8±10.1 vs. 44.0±7.4 mm3) ve sol OB (34.9±10.0 vs. 49.1±6.2 mm3) hacimlerinin ortalama değerlerinin inme geçirmiş grupta kontrollere göre belirgin olarak azaldığı görüldü. Olfaktör sulkus derinliği ise sağda gruplar arasında değişiklik göstermezken (7.0±0.0 vs. 7.0±0.7 mm) ve solda inmeli grupta daha yüksek bulundu (7.1±0.9 vs. 6.7±0.6 mm). SONUÇ: İnme sonrası kronik dönemdeki hastalarda olfaktör bulbus hacimlerinin azaldığı görüldü.OBJECTIVE: The aim of this study was to evaluate the olfactory bulb (OB) volume and olfactory sulcus (OS) depth in patients with chronic stroke. MATERIAL AND METHODS: This study was designed as a case-control and retrospective study. OB volumes and OB depth of the patients with chronic stroke (>6 months) were measured using a 1.5 tesla MRI machine (Philips MRI Systems, Achieva Release 3.2 Level 2013-10-21, Philips Medical) with a standard head coil. OB volumes and OS depth were measured by using fat suppressed T2 coronal images. The data of the stroke patients were compared to the healthy control subjects. RESULTS: The study included 45 (21 male/24 female) post-stroke patients with the mean age of 47.7±10.7 years and 45 (19 male/26 female) healthy control subjects with the mean age of 44.5±8.7 years. Right (34.8±10.1 vs. 44.0±7.4 mm3) and left (34.9±10.0 vs. 49.1±6.2 mm3) OB volumes were significantly lower in the stroke group than in the control group. Olfactory sulcus depth was similar between the groups on the right side (7.0±0.0 vs. 7.0±0.7 mm), however it was higher in the stroke group on the left side (7.1±0.9 vs. 6.7±0.6 mm). CONCLUSIONS: Patients with chronic stroke seem to have decreased OB volumes compared to the healthy control

Can Achilles tendon be used as a new distal landmark for coronal tibial component alignment in total knee replacement surgery? An observational MRI study

WOS: 000391846300001PubMed: 28144149Background: In total knee arthroplasty, it is better to use more than one reference point for correct alignment of the components. By measuring the distances of Achilles tendon (AT) and other conventional landmarks from the mechanical axis in magnetic resonance imaging (MRI) of the ankle, we aimed to demonstrate that, as a novel landmark which can help for correct alignment in the coronal plane, AT is a better option than other landmarks. Materials and methods: This retrospective study was done on 53 ankle MRIs that met the criteria for inclusion to the study among 158 ankle MRIs. After identification of the mechanical axis, the distances of distal landmarks, which were extensor hallucis longus tendon (EHLT), tibialis anterior tendon (TAT), dorsalis pedis artery (DPA), AT, extensor digitorum longus tendon (EDLT), and malleoli, were measured from the mechanical axis and were statistically evaluated. Results: In proximal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 2.64 +/- 1.62 mm lateral; EHLT, 3.89 +/- 2.45 mm medial; DPA, 4.69 +/- 2.39 mm medial; TAT, 8.24 +/- 3.60 mm medial; and EDLT, 14.2 +/- 4.14 mm lateral (P<0.001). In distal measurements, the distances of the landmarks to the mechanical axis (on average) were AT, 1.99 +/- 1.24 mm medial; EHLT, 4.27 +/- 2.49 mm medial; DPA, 4.79 +/- 2.10 mm medial; TAT, 12.9 +/- 4.07 mm medial; and EDLT, 12.18 +/- 4.17 mm lateral (P<0.001). Conclusion: In this study, the mechanical axis line, which is the center of talus, passes through the AT. Our MRI investigations showed that the AT, EHLT, DPA, and malleolar center (3-5 mm medial) may help in correct alignment

Changes of normal appearing optic nerve head on diffusion-weighted imaging in patients with diabetic retinopathy

WOS: 000394732700009PubMed: 27886608Purpose: To investigate whether there is any change by measuring ADC values particularly of the optic nerve head (ONH) in patients with diabetic retinopathy (DR). Material and methods: ADC values at the ONHs was measured in 56 patients and 68 controls. Results: ADC values of ONHs were significantly higher in patients with DR compared to controls (p = 0.011). ADC values in patients with macular edema were higher than those without macular edema (p = 0.017). Conclusion: DWI of ONHs can be useful in cases where it is difficult to assess macular edema during fundus examination, especially in diabetic patients with cataract. (C) 2016 Elsevier Inc. All rights reserved

Changes in the Anatomical Nomenclature of Sella Turcica: Turkish Saddle

WOS: 000443684600006Background: 'Sella turcica' was first described in 1543. The "De humani corporis fabrica" is the name of a book by Andreas Vesalius that first described the 'sella turcica'. After this date, it was called the 'sella ephippi', 'sphenoidis sella', or 'sella equine'. In 1627, the famous anatomist Adrianus Spigelius developed the current definition of the term. Discussion: The Ottoman military power was at its highest level and a serious threat to Europe at the time so it was indicative of the sense of Turkish power to use 'sella turcica' as a medical term. Spigelius had investigated Turkish daily life, art, and culture in the sixteenth century, and Turks were common exemplars of an orientalist fashion that was being pioneered in Europe, which may be how this term came about. 'Sella' was used because of its similarity to the Turkish saddle; other such similarities included the amygdala and pear, hippocampus and almond, and priformis and seahorse. Conclusion: In this study, the anatomical, hormonal, and historical characteristics of 'sella turcica' are reviewed