Atipik hipofiz adenomu olgularının insidansı, hormonal dağılımı ve postoperatif takibi

AMAÇ: Hipofiz adenomu tanısı ile operasyon uygulanan olgularımızdan patoloj ik tanısı atipik hipofiz adenomu olanların görülme sıklığı, hormonal aktivitesi ve postoperatif takipleri araştırılmıştır. YÖNTEM ve GEREÇlER: Kliniğimizde Ocak 2009 - Mayıs 2012 tarihleri arasında endoskopik endonasal transsfenoidal yolla opere edilen 146 hipofiz adenomu olgusundan WHO 2004 kriterlerine göre patoloj isi atipik hipofiz adenomu olarak saptanan 13 olgu çalışmaya dahil edildi. BUlGULAR: Histoloj ik olarak 133 hasta tipik hipofiz adenomu (%91,1), 13 hasta ise atipik hipofiz adenomu (%8,9) idi. Bu hastaların 10 tanesi erkek (%76,9), 3 tanesi kadındı (%23,1). Yaş dağılımı 27 ile 80 arasında idi (ortalama 52.7). Dokuz olgu nonsekretuar adenom (%69,3), 3 olgu prolaktinoma (%23,1), 1 olgu ise somatostatinoma (%7,6) idi. Dört olguda hipofizer apopleksi mevcuttu (%30,7). Tipik hipofiz adenomlu hastalardan 11 tanesinde nüks saptanırken (%8,2), atipik hipofiz adenomlu olgulardan ise 5 tanesinde nüks adenom (%38,4) nedeniyle tekrar operasyon yapıldı. SONUÇ: Atipik hipofiz adenomları iyi bir patoloj ik inceleme yapıldığında çok da nadir görülen adenom tipi değildir. Tümör rekürrensinde tek başına belirleyici olmamakla birlikte tipik adenomlara göre çok daha yüksek oranda rekürrense neden olduğu unutulmamalıdır. Bu yüzden bu hastalarda total tümör eksizyonu, eğer mümkün olmuyorsa postoperatif daha yakın takip ile ek tedavi uygulamalarının kullanılması gereklidir.AIM: To assess the incidence, hormonal activity and postoperative follow up of the cases that are histopathologically diagnosed as atypical pituitary adenoma (APA) in our series. MATERIAL and METHODS: In this study, 13 atypical pituitary adenoma cases, by the WHO 2004 criteria, among the 146 pituitary adenoma patients operated on in our clinic between January 2009 and May 2012 by endoscopic endonasal transsphenoidal approach were included. results: In histological studies, 133 cases were diagnosed as typical pituitary adenoma (91.1%) and 13 cases were APAs (8.9%) of which 10 were male (76.9%) and 3 were female (23.1%), ranged between 27 and 80 (mean 52.7) ages. Histopathological distribution of APAs was 9 non- secretory adenomas (69.3%), 3 prolactinomas (23.1%) and 1 somatostatinoma (7.6%). Asymptomatic pituitary apoplexy was diagnosed in 4 cases (30.7%). Eleven cases of typical pituitary adenomas (8.2%) and 5 cases of the atypical pituitary adenomas (38.4%) were re-operated due to tumor recurrences. CONCLUSION: Accurate histopathological examination shows that atypical pituitary adenoma is not a rare disease. Although it is not the only determinant, APAs are more prone to recurrence than typical adenomas. In our opinion, if total resection is not possible for the patients with APA, close postoperative follow up and additional curative therapy modalities are needed

Biochemical analysis for neuroprotective effects of ganoderma lucidum in experimental rat spinal cord trauma model

Objective: Injury of the spinal cord is studied in two separate mechanisms as primary and secondary injuries. During the secondary injury,spinal cord damage and related neurological defects could increase mostly because of oxidative damage. Treatments targeting this process arepromising for reducing neuronal damage. Ganoderma lucidum (GL) has the potential to suppress the inflammatory response and oxidative stress.The aim of this study is to determine the neuroprotective effect of traditional GL hot-water extract during the secondary spinal cord injury (SCI)period on an experimental rat spinal trauma model by measuring the biochemical parameters.Materials and Methods: A total of 34 rats were distributed randomly into 4 groups as trauma, vehicle, low-dose medication group (low-DMG)and high-dose medication group (high-DMG). A modified Walsh-Tator clip was applied extradurally to form an experimental SCI model. GL liquidextract was performed in medication groups with low and high (10 times higher) oral doses. Spinal cord specimens were collected after 5 daysof treatment for biochemical analysis.Results: In the low-DMG, both diphenypicrylhydrasyl (DPPH) and malondialdehyde (MDA) values were found statistically negligible whencompared with the trauma group. Comparison of the Low-DMG and vehicle group showed a significant change in DPPH value, but an insignificantchange in MDA value. A statistically significant positive change in both DPPH and MDA values was found in High-DMG when compared to traumaand vehicle groups.Conclusion: Prevention of secondary SCI is very important, since the neurological condition of the patients may get worse during this period.Dose-dependent positive results were obtained in the favor of GL in terms of both antioxidant efficacy and prevention of lipid peroxidation afterSCI. The results of this biochemical study is supporting the previous studies and showing that GL has the potential of reducing posttraumaticoxidative damage in the spinal cord when given at the appropriate dose

Urgent operation improves weakness in cauda equina syndrome due to lumbar disc herniation

WOS: 000499639000003PubMed: 31663070Objectives: This study aims to examine the effect of surgical timing on the sphincter function and improvement of motor function in patients with cauda equine syndrome (CES) due to lumbar disc herniation (LDH). Patients and methods: Between January 2005 and December 2013, a total of 33 patients (18 males, 15 females; mean age 48.6 +/- 2.2 years, range, 24 to 73 years) who underwent lumbar spinal surgery and were diagnosed with CES due to LDH were retrospectively analyzed. Data including demographics, muscle weakness, sensory deficit, sphincter control, LDH level, time from the initiation of symptoms to admission, and time to surgery were documented. The latest muscle weakness, sensory deficits, and sphincter control were also recorded. The patients were divided into two groups according to the rate of muscle strength improvement and data including age, sex, and operation time were compared. Results: The weakness remained unchanged in 11 (33.3%), improved in 13 (39.4%), and returned to normal in nine (27.3%) patients. Sphincter control resolved in five patients. Sensory loss resolved in two patients. While admission duration was shorter in the group with improved muscle strength (p=0.02), there was no significant difference in the time to surgery (p=0.63). Logistic regression analyses revealed that only the admission within 0 to 24 hours was significant for the muscle strength improvement (regression coeeficient [B]=2.83, standard error [SE]=0.86, p=0.006). Conclusion: A significant improvement in the motor strength can be achieved in patients with CES who are operated within 24 hours. On the other hand, patients with CES should be received surgery immediately when first seen, regardless of the time, since the muscle strength is slightly improved

Endoskopik endonazal transsfenoidal cerrahi sırasında oluşan geniş kafa tabanı defektine bağlı beyin omurilik sıvısı kaçağı tamirinde otolog fibrin yapıştırıcı kullanımı

AMAÇ: Endoskopik endonazal trassfenoidal cerrahi (EETC) sonrasında gelişen postoperatif beyin omurilik sıvısı (BOS) kaçağı bu prosedürün morbidite ve mortalitesini arttıran bir faktördür. Bu prospektif çalışma postoperatif BOS kaçağının ve buna bağlı komplikasyonların engellenmesi amacıyla otolog fibrin yapıştırıcı kullanımının ilk örneğidir. YÖNTEM ve GEREÇLER: Ekim 2010 ile Haziran 2012 arasında endoskopik endonazal transsfenoidal yaklaşım ile ameliyat edilen 200 olgu retrospektif olarak değerlendirildi ve çalışmaya dahil edildi. Bunlar arasından bazal sisternler veya ventriküller ile ilişkisi olan geniş diafragma sella defekti veya geniş kafa tabanı defekti bulunan toplam 55 hasta seçildi. Hastalar genişletilmiş veya klasik endoskopik endonazal transsfenoidal yaklaşım ile opere edildi. Kafa tabanı tamiri tüm olgularda çok katmanlı tamir yöntemi ile otolog fibrin yapıştırıcı kullanılarak gerçekleştirildi. EETC’nin bir komplikasyonu olan BOS kaçağının insidansı analiz edildi. BULGULAR: Hastaların yaş dağılımı 20 ile 83 (ortalama 49.3) arasında idi. Bunlardan 25’i (%46) erkek, 30’u (%54) kadındı. Tüm hastalarda suprasellar veya parasellar uzanım gösteren tümör bulunmaktaydı. İki hastada (%3.6) postoperatif BOS kaçağı saptandı. Otolog fibrin yapıştırıcıya bağlı herhangi bir komplikasyon veya allerjik reaksiyona rastlanmadı. SONUÇ: Çok katmanlı tamir ile birlikte otolog fibrin yapıştıcı kullanımının, EETC sonrası gelişebilecek BOS kaçağının engellenmesinde güvenli ve etkin bir teknik olduğunu düşünmekteyiz.AIM: Postoperative cerebrospinal fluid (CSF) leak following endoscopic endonasal transsphenoidal surgery (EETS) is associated with increased morbidity and mortality. This prospective study is the first evaluation of using autologous fibrin sealant for preventing postoperative CSF leak and related complications. MATERIAL and METHODS: 200 endoscopic endonasal transsphenoidal approaches were included in the study and reviewed retrospectively from September 2010 to June 2012. A total of 55 patients who have large skull base and diafragma sella defects, connected with basal cisterns or ventricles, were chosen for the study. The patients were operated via extended or classical endoscopic endonasal transsphenoidal approach. The skull base has been repaired using AFS combined with multilayer reconstruction in all cases. The incidence of CSF leak as a complication of EETS was analyzed. results: The ages of the patients ranged from 20 to 83 years (mean 49.3 years). There were 25 (46%) male patients and 30 (54%) females. All patients had tumors with suprasellar or parasellar extension. Postoperative CSF leak was determined in 2 patients (3.6%). There were no complications and allergic reactions associated with the use of AFS. CONCLUSION: Using of AFS combined with multilayer reconstruction technique is a safe and effective method to prevent CSF leak in large defects following EETS