A coinsidence, a chance or a misfortune? Hangman's fracture

William R. Francis and Bassam El-Effendi shared a common ground: they were the first individuals to classify Hangman's Fractures. Interestingly, although they were unaware of each other, they classified and published their findings in the same year, published in the same edition of the same journal (but on different pages). This new classification system was a chance for notoriety for El-Effendi, yet it was a misfortune for Francis. Both physicians graduated in 1973 (from different universities). Also fellows at different universities in 1981, they were also both unaware they studied the same topic. Coincidentally, their paths crossed in the same edition of a journal where their studies were published in the same year, which was unprecedented in the literature. One classification scheme is well-known while the other is almost completely unheard of for no apparent reason other than chance for one and misfortune for the other

COCCYDYNIA: A NARRATIVE REVIEW OF PATHOPHYSIOLOGY, ETIOLOGY AND TREATMENT

Pain and discomfort in the coccyx or tailbone area is called as coccydynia or coccygodynia. Despite its small size, the coccyx, which forms the terminal of the spine, has an important role to support the balanced distribution of body weight, especially in the sitting position, due to its relationship with the surrounding muscles, ligaments and bone structures. The problems of this area for various reasons manifests itself with localized discomfort and pain in the sacrococcygeal region. Our aim in this paper is to review the etiology, pathophysiology, clinical findings, diagnosis and treatment methods of coccydynia in light of the current literature

Isolated Unilateral Temporalis Muscle Hypertrophy: A Case Report and Review of the Literature

Isolated unilateral temporalis muscle hypertrophy is a very rare pathology that nine cases have been reported to date. We report the 10th case of this rare condition and a review of the literature. Swelling of the masticatory muscles may be isolated or may be present together. Reactive and nonreactive causes are accused for the etiology. Significant pathologies accompany non-reactive causes. Some reactive causes are parafunctional jaw habits, excessive gum chewing, and bruxism. Biopsy is the gold standard method of differentiating between reactive and nonreactive causes. The treatment can be tailored according to the biopsy results. Medical treatment, surgery and Botulinum toxin A (BtA) injection are available to treat the reactive causes. BtA therapy is the most effective option. There is no clear information in the literature about the size of swelling in untreated patients. We did not apply an extra treatment after the patient’s biopsy except nonsteroidal antiinflammatory drug. The patient is being followed up with no increase in swelling

Hammering Nail to the Head for Suicide; A Case Report and Literature Review

Suicide is the process that an individual ends his/her own life, and usually methods providing a quick death are chosen. The most common methods are jumping from heights and firearm shots. However, in some suicide attempts, some unusual methods are used. These can be seen in patients with psychiatric disorders such as severe depression and schizophrenia. The idea of suicide by hammering nail into the head is uncommon because it is a method that cannot lead to a quick death and cause suffering. Beside these, it does not lead to death with a single action. We present a case of a young male patient who attempted suicide with hammering nail into the head and review the literature on this subject

Comparison of Wiltse and classical methods in surgery of lumbar spinal stenosis and spondylolisthesis

Aim Minimally invasive approaches to posterior lumbar surgery are available today that can enhance patient comfort by greatly reducing tissue damage and offer better clinical results. However, such methods have not yet gained widespread popularity despite their significant advantages. This study compares the Wiltse method and the classical method of lumbar surgery based a cohort, clinical study of 57 patients. The patients all had degenerative lumbar spinal stenosis and/or spondylolisthesis and had developed multifidus muscular atrophy. Materials and methods We enrolled 57 patients admitted to our clinic between April 2012 and September 2013 with a diagnosis of degenerative lumbar spinal stenosis and/or spondylolisthesis. These were treated with the classic posterior approach (n=26) or the Wiltse method (n=31). Findings In the classical method group, the ratio of female to male patients was 20/6 and the mean age was 58.19±10.17 years. A comparison of preoperative and postoperative multifidus muscle cross-sectional measurements (average of right and left) revealed a 36.09% atrophy level in the classical method group and a 26.34% atrophy level in the Wiltse group (p<0.01). However, atrophy development was 18.82% higher in the classical method group (p<0.05) relative to the Wiltse group. Conclusion The Wiltse method is less invasive and causes less tissue damage. It reduces the change of hemorrhage and multifidus muscles and offers a shorter duration of hospitalization with less pain

Traumatic Transient Herniation Concomitant with Tonsillar Hemorrhagic Contusion in a Child

Downward displacement of cerebellar tonsils more than 5 mm below the foramen magnum is named as Chiari type I malformation and named benign tonsillar ectopia if herniation is less than 3 mm. It does not just depend on congenital causes. There are also some reasons for acquired Chiari Type 1 and benign tonsillar ectopia/herniation. Trauma is one of them. Trauma may increase tonsillar ectopia or may be the cause of new-onset Chiari type 1. The relationship between the tonsil contusion and its position is unclear. We present a case of pediatric age group with tonsillar herniation with a hemorrhagic contusion. Only 1 case has been presented so far in the literature. A case with unilateral tonsil contusion has not been presented to date. We will discuss the possible reasons for taking the place of the tonsils to the above level of the foramen magnum in the follow-up period, by looking at the literature

The Effect of Technological Devices on Cervical Lordosis

PURPOSE: There is a need for cervical flexion and even cervical hyperflexion for the use of technological devices, especially mobile phones. We investigated the effect of this use on the cervical lordosis angle.MATERIAL AND METHODS: A group of 156 patients who applied with only neck pain between 2013–2016 and had no additional problems were included. Patients are specifically questioned about mobile phone, tablet, and other devices usage. The value obtained by multiplying the year of usage and the average usage (hour) in daily life was determined as the total usage value (an average hour per day x year: hy). Cervical lordosis angles were statistically compared with the total time of use.RESULTS: In the general ROC analysis, the cut-off value was found to be 20.5 hy. When the cut-off value is tested, the overall accuracy is very good with 72.4%. The true estimate of true risk and non-risk is quite high. The ROC analysis is statistically significant.CONCLUSION: The use of computing devices, especially mobile telephones, and the increase in the flexion of the cervical spine indicate that cervical vertebral problems will increase even in younger people in future. Also, to using with attention at this point, ergonomic devices must also be developed

The Necessity of Follow-Up Brain Computed-Tomography Scans: Is It the Pathology Itself Or Our Fear that We Should Overcome?

AIM: This study aimed to make a retrospective analysis of pediatric patients with head traumas that were admitted to one hospital setting and to make an analysis of the patients for whom follow-up CT scans were obtained.METHODS: Pediatric head trauma cases were retrospectively retrieved from the hospital’s electronic database. Patients’ charts, CT scans and surgical notes were evaluated by one of the authors. Repeat CT scans for operated patients were excluded from the total number of repeat CT scans.RESULTS: One thousand one hundred and thirty-eight pediatric patients were admitted to the clinic due to head traumas. Brain CT scan was requested in 863 patients (76%) in the cohort. Follow-up brain CT scans were obtained in 102 patients. Additional abnormal finding requiring surgical intervention was observed in only one patient (isolated 4th ventricle hematoma) on the control CTs (1% of repeat CT scans), who developed obstructive hydrocephalus. None of the patients with no more than 1 cm epidural hematoma in its widest dimension and repeat CT scans obtained 1.5 hours after the trauma necessitated surgery.CONCLUSION: Follow-up CT scans changed clinical approach in only one patient in the present series. When ordering CT scan in the follow-up of pediatric traumas, benefits and harms should be weighted based upon time interval from trauma onset to initial CT scan and underlying pathology

Surgical anatomy of the presacral area

Abstract Objective L5-S1 instabilities can be Wxated using minimally invasive presacral approach. The close relationship between the sacrum and neurovascular as well as intestinal structures may complicate the procedure during this approach. This requires knowledge regarding the normal anatomy of the presacral area to avoid the iatrogenic injuries. The aim of this study was to measure the distance between the sacrum and the structures anterior to it. Materials and methods The measurements were performed on ten cadavers Wxed with formaldehyde and ten MR imaging studies on individuals without any pathology in the presacral area. The distances between the sacrum and the presacral structures (i.e., middle and lateral sacral arteries, sympathetic trunks, internal iliac arteries and veins, and colon/rectum) were measured. Results Cadaver study showed that the middle sacral artery was located on the right side in 55.0%, on the left side in 31.7%, and on the midline in the 13.3% of cases. The distance between the sacral midline and middle sacral artery was found to be 8.0 § 5.4, 9.0 § 4.9, 8.7 § 6.0, 8.6 § 6.4, and 4.7 § 5.0 mm at the levels of S1-2, S2-3, S3-4, S4-5, and S5-coccyx, respectively. The distance between the sacral midline and the sympathetic trunk ranged between 22.4 § 5.8 and 9.5 § 3.2 mm in diVerent levels between S1 and coccygeal level. The study also showed that the distance between the posterior wall of the intestine (colon/rectum) and the ventral surface of the sacrum can be as close as 11.44 § 7.69 mm on MR images. Conclusion This study showed that there was close distance between the sacral midline and the structures anterior to it. The close relationships, as well as the potential for anatomical variations, require the use of sacral and presacral imaging before presacral approach