Multilevel Noncontiguous Spinal Fractures: Surgical Approach towards Clinical Characteristics

Study DesignThe study retrospectively investigated 15 cases with multilevel noncontiguous spinal fractures (MNSF).PurposeTo clarify the evaluation of true diagnosis and to plane the surgical treatment.Overview of LiteratureMNSF are defined as fractures of the vertebral column at more than one level. High-energy injuries caused MNSF, with an incidence ranging from 1.6% to 16.7%. MNSF may be misdiagnosed due to lack of detailed neurological and radiological examinations.MethodsPatients with metabolic, rheumatologic diseases and neoplasms were excluded. Despite the presence of a spinal fracture associated clearly with the clinical picture, all patients were scanned within spinal column by direct X-rays, computed tomography and magnetic resonance imaging. When there were ≥5 intact vertebrae between two fractured vertebral segments, each fracture region was managed with a separated stabilization. In cases with ≤4 intact segments between two fractured levels, both fractures were fixed with the same rod and screw system.ResultsThere were 32 vertebra fractures in 15 patients. Eleven (73.3%) patients were male and age ranged from 20 to 64 years (35.9±13.7 years). Eleven cases were the American Spinal Injury Association (ASIA) E, 3 were ASIA A, and one was ASIA D. Ten of the 15 (66.7%) patients returned to previous social status without additional deficit or morbidity. The remaining 5 (33.3%) patients had mild or moderate improvement after surgery.ConclusionsThe spinal column should always be scanned to rule out a secondary or tertiary vertebra fracture in vertebral fractures associated with high-energy trauma. In MNSF, each fracture should be separately evaluated for decision of surgery and planned approach needs particular care. In MNSF with ≤4 intact vertebra in between, stabilization of one segment should prompt the involvement of the secondary fracture into the system

Bankacılık denetleme ve düzenlemesinin içselleştirilmesi : bir dinamik denge yaklaşımı

Cataloged from PDF version of article.Thesis (M.S.): Bilkent University, Department of Economics, İhsan Doğramacı Bilkent University, 2017.Includes bibliographical references (leaves 40-42).This thesis presents a modi ed dynamic general equilibrium model by introducing a supervisory and regulatory agent (RS) that is responsible for setting the level of bank regulation and supervision quality ( ) in order to ensure the banking sector's long term pro tability. We solve the model to examine the e ects of on the optimizing agents, which are households, rms and banks. The level of bank regulation and supervision quality a ects households, through the fraction of savings that are deposited in the banking system; rms, through the fraction of performing loans that they get from the banks; and banks, through the degree of law enforcement on the banks. Our model yields a unique equilibrium with the expected outcomes; that is to say, bank regulation and supervision quality a ects the steady state levels of capital and output positively; and a ects the steady state rates of deposit and loan interest negatively. We also examine the comparative statics of the steady state level of capital, the steady state rates of deposit and loan interest with respect to the rest of the model parameters.by Oğuz Kaan Karakoyun.M.S

POSTERIOR APPROACH IN TRAUMATIC THORACIC AND THORACOLUMBAR SPONDYLOPTOSIS

Objective: Traumatic spondyloptosis a 100 % or more subluxation of a vertebral unitover another inferior unit in the sagittal or coronal plane is a very rare pathology. Inthis study, clinical findings and follow-up results of 12 patients with spondyloptosisthat occurred after a high-energy trauma were evaluated.Material and Methods: Twelve cases with the thoracic and thoracolumbar regiontraumatic spondyloptosis at two separate centres in the city of Gaziantep between2010 and 2016 were examined retrospectively. The clinical and radiological results,additional system injuries and long-term results of the patients were evaluated.Results: The mean age of the patients (9 men and 3 women) was 30.4. The causesof trauma were falling down from a height (8 cases) and a traffic accident (4 cases).Spondyloptosis was detected at the upper thoracic level in two cases (Th3-4 andTh4-5); Th9-10, one case; Th10- 11, four cases; Th11-12, three cases and Th12-L1,two cases. Pre- and postoperative neurological status of all cases was ASIA A. In allcases, 5 levels of fixation were performed after reduction with posterior intervention.In addition, 2 patients died; specifically, one patient with thoracic trauma and one withembolism due to deep vein thrombosis at the third month post-op. Severe fusion wasobserved in 9 of our living patients and 1 had a moderate fusion.Conclusion: Acute thoracolumbar spondyloptosis can only be achieved via a posteriorapproach. The intense intercostal area can be used for a fusion bed

Anti-edematous, anti-inflammatory and neuroprotective effect of etanercept in acute stage in experimental head injury

WOS: 000403589400001PubMed: 28530785BACKGROUND: To study the anti-edematous, anti-inflammatory, and neuroprotective effect of etanercept in the model of experimental head injury. METHODS: In this study, 40 male-adult Spraque-Dawley rats, with weight ranging from 250g to 300g, were used. The rats are divided into groups as control; non-penetrating trauma; trauma + NS; post-traumatic normal saline; trauma + D; post-traumatic dexamethasone and trauma + E. All medicines were given into peritoneum. After applying trauma and medicine, rats were decapitated in the 24th hour and the samples were studied histopathologically. RESULTS: In the study, a statistically significant difference was observed between the groups of trauma + NS and trauma dexamethasone according to the variables of edema and inflammation, but no difference was observed according to the variables of neuronal damage, astrocytic damage, and glial apoptosis. Moreover, a significant difference was observed between groups of Trauma + NS and trauma+ etanercept and between the groups of trauma + dexamethasone and trauma + etanercept in terms of all variables. CONCLUSION: It was observed that etanercept has anti-edematous, anti-inflammatory, and neuroprotective effect on the rats which experienced traumatic brain injury

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