A short history of the microsurgery training and research laboratory at Gulhane Military Medical Academy

Microsurgical techniques have played a crucial role in the development of neurosurgery and microsurgical education has an involuting role to gain surgical competence in neurosurgery. Microsurgery laboratory at Gulhane Military Medical Academy (GMMA) was established in 1985 by Prof. Erdener Timurkaynak within the Research-Development Building. From the beginning, education of the surgeons in microsurgery has been regarded as the essential function of this center, but many experimental and anatomical researches have also taken place in this laboratory. Over the past twenty-five years, 288 courses had been held in the microsurgical laboratory and more than 1000 surgeons from different fields and specialties were trained. Many of them conducted hundreds of research projects and published scientific papers during this period. This laboratory enters in the 21st century as a dynamic research and education center committed to the continuing delivery of education, as well as ongoing research of microsurgery for the coming 100 years

The evaluation of the effects of steroid treatment on the tumor and peritumoral edema by DWI and MR spectroscopy in brain tumors

Objective To investigate the effects of dexamethasone on brain tumor and peritumoral edema by different sequences of magnetic resonance imaging (MRI). Materials and methods MRI was performed in 28 patients with brain tumor. Patients were divided into the 3 groups based on the histological diagnosis; Group I: high-grade glial tumor, Group II: low-grade glial tumor, and Group III: brain metastasis. The measurements of peritumoral edema volume and apparent diffusion coefficient (ADC) values were performed while the peak areas of cerebral metabolites were measured by spectroscopy in groups I and II. The changes in edema volumes, ADC values and cholin/creatine peak areas were compared. Results The volume of peritumoral edema was decreased in groups I and II, but increased in group III after dexamethasone treatment. These changes were not statistically significant for 3 groups. ADC value was decreased in group I and increased in groups II and III. Changes in ADC values were statistically significant. Cholin/creatine peak areas were decreased after dexamethasone in groups I and II, but these changes were also not significant. Conclusion Dexamethasone has no significant effect on the volume of peritumoral edema in glial tumor and metastasis. Moreover, dexamethasone increases the fluid movements in low grade gliomas and metastases, decreases in high grade gliomas. However, more comprehensive clinical studies are needed to show the effects of dexamethasone on brain tumors and peritumoral edema

Surgical outcomes of the brachial plexus lesions caused by gunshot wounds in adults

<p>Abstract</p> <p>Background</p> <p>The management of brachial plexus injuries due to gunshot wounds is a surgical challenge. Better surgical strategies based on clinical and electrophysiological patterns are needed. The aim of this study is to clarify the factors which may influence the surgical technique and outcome of the brachial plexus lesions caused by gunshot injuries.</p> <p>Methods</p> <p>Two hundred and sixty five patients who had brachial plexus lesions caused by gunshot injuries were included in this study. All of them were male with a mean age of 22 years. Twenty-three patients were improved with conservative treatment while the others underwent surgical treatment. The patients were classified and managed according to the locations, clinical and electrophysiological findings, and coexisting lesions.</p> <p>Results</p> <p>The wounding agent was shrapnel in 106 patients and bullet in 159 patients. Surgical procedures were performed from 6 weeks to 10 months after the injury. The majority of the lesions were repaired within 4 months were improved successfully. Good results were obtained in upper trunk and lateral cord lesions. The outcome was satisfactory if the nerve was intact and only compressed by fibrosis or the nerve was in-contunuity with neuroma or fibrosis.</p> <p>Conclusion</p> <p>Appropriate surgical techniques help the recovery from the lesions, especially in patients with complete functional loss. Intraoperative nerve status and the type of surgery significantly affect the final clinical outcome of the patients.</p

Kardiyak resenkronizasyon tedavisine yanıtın öngörülmesinde sistemik bağışıklık-inflamatuvar indeksinin rolü

Aim: Cardiac resynchronization therapy (CRT) is a reliable treatment modality in patients with systolic dysfunction. However, not every patient appears to benefit from CRT. The systemic immune inflammation index (SII) is closely linked to the poor prognosis of various cardiovascular disorders. However, there is no study investigating whether SII has predictive value in determining response to CRT in dilated cardiomyopathy patients. Therefore, we intend to investigate the association between SII and response to CRT. Methods: A total of 220 patients (mean age 61.2±10.8 years; 120 men) implanted with CRT were involved in this study. Echocardiographic and laboratory measurements were evaluated prior to CRT. Response to CRT was determined as a≥ 15% decrease in left ventricular end-systolic volume at one-year follow-up. Results: Patients grouped as CRT responders and non-responders. Of these, 143 (64.6%) were considered to be CRT responders, while the remaining 77 (33.4%) were non-responders. Female sex (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS duration (OR: 1.224, CI: 1.158-1.335 p<0.001), and SII (OR: 0.996 CI: 0.995-0.997 p<0.001) were shown to be independent predictors of CRT response in multivariate analysis. A cut-off value of SII >825 estimated no response to CRT with 80% sensitivity and 75% specificity. Conclusions: SII was associated with unresponsiveness to CRT. Therefore, it may be used to determine optimal patient selection for CRT implantation in routine clinical practice.Amaç: Kardiyak resenkronizasyon tedavisi (KRT), sistolik disfonksiyonu olan hastalarda güvenilir bir tedavi yöntemidir. Ancak, KRT'nin faydası belli hasta grupları ile sınırlıdır. Sistemik immün inflamatuvar indeks (SII), çeşitli kardiyovasküler bozuklukların kötü prognozu ile ilişkilidir. Bununla birlikte, dilate kardiyomiyopati hastalarında SII'nin KRT'ye yanıtı belirlemede prediktif değeri olup olmadığını araştıran bir çalışma bulunmamaktadır. Bu nedenle, bu çalışmada SII ile KRT'ye yanıt arasındaki ilişkiyi araştırmak amaçlandı. Yöntemler: Bu çalışmaya KRT implante edilen toplam 220 hasta (ortalama yaş 61,2±10,8 yıl; 120 erkek) dahil edildi. KRT öncesi ekokardiyografi ve laboratuvar ölçümleri değerlendirildi. KRT'ye yanıt, bir yıllık takipte sol ventrikül sistol sonu hacminde ≥ %15 azalma olarak belirlendi. Bulgular: Hastalar, KRT'ye yanıt verenler ve yanıt vermeyenler olarak gruplandırıldı. Bunlardan 143'ü (%64,6) KRT'ye yanıt veren olarak kabul edilirken, kalan 77'si (%33,4) yanıt vermeyendi. Kadın cinsiyet (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS süresi (OR: 1.224, CI: 1.158-1.335 p<0.001) ve SII (OR: 0.996 CI: 0.995-0.997 p<0.001) çok değişkenli analizde KRT yanıtının bağımsız öngörücüleri olarak bulundu. SII >825'lik bir sınır değeri, %80 duyarlılık ve %75 özgüllük ile KRT'ye yanıt olmadığını öngördürmüştür. Sonuç: Bu çalışmada SII’nin KRT'ye yanıtsızlığı öngördüğü gösterilmiştir. Bu nedenle SII rutin klinik uygulamada KRT implantasyonu için optimal hasta seçimini belirlemede kullanılabilir

Quantitative assessment of left atrial functions by speckle tracking echocardiography in hypertensive patients with and without retinopathy

Purpose:The association between hypertensive retinopathy and left atrial(LA) impairment is unknown. Accordingly, it was aimed to investigate the possiblerelationship between hypertensive retinopathy and LA phasic functions by means oftwo-dimensional speckle-tracking echocardiography (2D-STE).Methods:A total of 124 hypertensive patients and 27 control subjects were includedin the study. LA reservoir strain (LAS-S), LA conduit strain (LAS-E), and LA boosterstrain (LAS-A) parameters were used to evaluate LA myocardial functions.Results:Hypertensive patients (with and without retinopathy) displayed an obviousreduction in the LA reservoir strain (LAS-S),and LA conduit strain (LAS-E). Moreover,further impairment in LA reservoir and conduit strain was found in patients withhypertensive retinopathy than in the isolated hypertensive patients. There were nosignificant differences in LA booster strain (LAS-A) among the three groups. ImpairedLAS-S(OR: 0.764, CI: 0.657–0.888, andp< 0.001), LAS-E(OR: 0.754, CI: 0.634–0.897,andp=0.001), and hypertension (HT) duration (OR: 2.345, CI: 1.568–3.507, andp< 0.001) were shown to be independent predictors of hypertensive retinopathy.Conclusion:Impaired LA reservoir and conduit strain may be used to predict hyper-tensive patients at higher risk of developing hypertensive retinopathy, and to deter-mine which patients should be followed more closely for hypertensive retinopath

Limited Dorsal Myeloschisis with and without Type I Split Cord Malformation: Report of 3 Cases and Surgical Nuances

Limited dorsal myeloschisis (LDM) is a rare form of spina bifida which is characterized by a fibroneural stalk between the inner part of the skin and the spinal cord. It may be associated with split cord malformation (SCM). Diagnosis and management of this complex malformation is challenging. We presented 3 different cases of LDM. Two of them were associated with Type I SCM and the other had no associated malformation. All of them were evaluated radiologically just after the birth and underwent surgical treatment under intraoperative neuromonitoring. They were discharged without any complication. Newborns with spinal cystic lesions should be carefully evaluated for spinal malformations after the birth and treated surgically as soon as possible in order to prevent neurological and urological complications secondary to tethered cord syndrome. Surgical technique in LDM-SCM patients is quite different than the patients with solitary LDM

Relationship between individual payload weight and spondylolysis incidence in Turkish land forces

OBJECTIVE The aim of this study was to investigate the relationship between lumbar spondylolysis and payload weight between different combat units of Turkish land forces (TLF). METHOD The authors reviewed clinical and radiological data of the military personnel with low-back pain (LBP) admitted to their clinic between July 2017 and July 2018. Age, BMI, average payload weight, and military service unit were recorded. CT scans were evaluated for pars interarticularis fractures and spondylolisthesis, whereas MRI studies were evaluated for spondylolisthesis, Modic-type endplate changes, or signal loss on T2-weighted images compatible with disc degeneration. RESULT Following exclusion, a total of 642 all-male military personnel were included. Of these personnel, 122 were commandos, 435 were infantry, and 85 were serving in the artillery units. Bilateral pars interarticularis fracture was noted in 42 commandos (34.42\%) and 2 infantrymen (0.45\%). There was no spondylolysis in the artillery units. There was no multiple-level spondylolysis and the most common level of spondylolysis was L5. Commandos had a significantly higher incidence of spondylolysis and more average payload weight (p < 0.001). Twelve patients (27.2\%) with spondylolysis had accompanying MRI pathologies at the same level, whereas 32 patients (72.7\%) had no accompanying MRI pathologies. CONCLUSIONS Increased payload weight in military personnel is associated with spondylolysis, and commandos in the TLF have significantly heavier payloads, which causes an increased rate of spondylolysis compared to other units. Additionally, spondylolysis without adjacent-level changes on MRI could be undiagnosed. LBP in active military personnel who have a history of carrying heavy payloads should be evaluated extensively with both MRI and CT scans

Metastatic germ cell testicular tumor of the eye and brain: Case report

We report a simultaneous vitreous oculi and brain metastases from a non-seminomatous testis tumor, which is unique in the peer-reviewed literature. Intraorbital metastatic tumors are rarely encountered pathologies. Testis as a primary site for orbital metastases is even rarer as compared to more common other primary sites such as breast, prostate, kidney, lung and skin. Besides, orbital metastases mostly involve periorbital structures and metastasis to vitreus is relatively rare. If present, simultaneous metastases to brain and orbit from an embrional germ cell tumor of testis may be a grave sign for prognosis, as our patient was lost within few months despite intensive modern chemotherapy, radiotherapy and surgical resection. © 2005 Published by Elsevier Ireland Ltd