A large choroid plexus cyst diagnosed with magnetic resonance imaging in utero: a case report

The incidence of choroid plexus cysts represents approximately 1% of fetal anomalies. We describe a case in which fetal ultrasonography and fetal magnetic resonance scans were used to identify a large choroid cyst in a fetus without the use of a diagnostic amniocentesis to detect aneuploidy. After birth, the child underwent surgery. In conclusion, the nature of prenatal intracranial cysts should be fully evaluated and differentiated between choroid plexus cysts and other types of cysts. We believe that a detailed evaluation of detected cysts and other structural brain abnormalities are essential. Prenatal magnetic resonance scans clearly can decrease the need for risky procedures, such as an amniocentesis, in the evaluation of antenatal choroid plexus cysts

Remote cerebellar hemorrhage following resection of a supratentorial tumor: a case report

Remote cerebellar hemorrhage after supratentorial surgery is rare, ranging between 0.08% and 0.29% in adults and children. However, it is extremely rare in children. This phenomenon underlying mechanisms remain obscure. A 14-year-old male child patient had a history of right focal seizures and underwent craniotomy for a left frontal mass (Dysembryoplastic Neuroepithelial Tumor). First hours post recovery period, the patient was somnolent and had right hemiparesis. Postoperative Computer Tomography and magnetic resonance imaging findings revealed that the patient had developed remote cerebellar hemorrhage. He was treated conservatively, and was free of neurological deficits

A comparative study on the use of membrane bioreactor (MBR) and activated sludge followed by ultrafiltration (CAS/UF) processes for advanced treatment of industrial wastewater

With increasing industrial wastewater reuse, due to inadequate water resources, membrane technology has shown results of very high efficiency in a wide range of reuse purposes and reverse osmosis (RO) pre-treatment. In the present study, the performance of two pilot-scale CAS/UF and MBR to polished effluent wastewater of an industrial town treatment plant were evaluated and compared in a continuous 43-day period. According to the test results, the removal efficiency of total suspended solids (TSS) for both reactors was nearly 100%. Nevertheless, the MBR improved the Chemical oxygen demand (COD) and the total dissolved solids (TDS) by nearly 3% and 5%, respectively. Total nitrogen (TN) and total phosphorus (TP) removals of approximately 31% and 20% in The MBR-based process and 24% and 18% in the CAS/UF module were obtained. Analysis of heavy metal concentration indicated that Cr, Pb, and Ni, which were in both soluble and particle forms, could be adequately eliminated by each system, while Cu, which was mainly in a soluble form, had a lower removal rate (32% and 51% in CAS/UF and MBR, respectively). Besides, since the silt density index (SDI) value for most of the samples was less than 3, both reactors can be used as RO pre-treatment systems

L5 vertebrectomy for the surgical treatment of tumoral and traumatic lesions of L5 vertebra

We retrospectively reviewed the clinical characteristics and the surgical results of seven patients treated with L5 vertebrectomy. The pathologies, clinical characteristics, preoperative and postoperative radiological findings, surgical techniques, and instrumentation for seven patients operated on between 1998 and 2009 are presented in this article. Biopsies were performed on all patients except those involving trauma. Patients were followed up at three-month intervals in the first year, at 6-month intervals in the second year, and on a regular basis afterward. One patient had a traumatic L5 burst fracture; the other six had tumoral pathologies in the L5 vertebrae. One tumoral lesion was a chordoma, another was a hemangioma, and the remaining four were metastatic lesions. Radiotherapy and chemotherapy were performed for the metastatic tumor patients during the postoperative period. Patients with renal cancer and chordoma survived for 3 years; patients with lung cancer and bladder cancer survived for 1 year; and patients with breast cancer survived for 16 months. The lumbosacral region presents significant stabilization problems because of the presence of sacral slope. In our opinion, if the lesion involves only the L5 vertebra, anterior cage-filled bone cement or bone graft should be performed, as dictated by the pathology and posterior transpedicular instrumentation. If the lesion involves the L4 vertebra or the sacrum and the L5 vertebra, the instrumentation can be extended to cover other segments with sacral attachments. The present cases involved only L5 vertebra and treatment with short-segment stabilization covering the anterior and posterior columns

Operating Room World: One Day Challenges and Interactions

When sun rises, the hyperactive day begins in operation room (OR). Management of OR needs regular programs for human and material resources. For deciding about OR programs, there should be requirement to obtaining information of multidisciplinary stakeholders (1). It appears that we go to OR, we enter to new world in new time zone and time will stand here (2). It is well known that trained staff are required for coordination between OR and several departments and providing advanced patient care. The major duties of these personnel, especially surgery and anesthesia nursing included to keep patient safety and navigation of various type of surgery throughout their course. OR staff work in closed, relatively isolated environment and spent several hours of their life here! (3). I think that OR environment looks like fish aquarium, we swim in it and everyone has her or his responsibilities, move toward our unit. It seems crowd but substantially beautiful picture. Stress is a main challenge in OR, that is, the personnel must communicate with each other and patients (4), Raji et al concluded in their study that in academic areas is even more in personnel communication, practice, feelings and humiliating experience fields and they must determine priority in few times and coping with their stress (5). Surgeons and anesthesiologists complete this scenario. However, what are the final goal of these precise efforts? It is clear that improving of efficiency plays key role in OR, it can be achieved by increasing work or lowering costs. Parish et al suggested that to prevent delays in post-anesthesia care unit (PACU) and discharge time, it is important to select proper anesthetic techniques, especially because of growing number of outpatient surgery and anesthesia (6- 8). Costs for maintenance of OR environment, numbered staff and different instruments. Start time is a cornerstone of OR (9). On the other hand, nurses of OR interpret efficiency as improvement of knowledge and training for patient care whereas OR manager understands efficiency as production per minute or completing programs (10). Although usage of simpler devices and dressing can help to save time, it means to compromise of any unnecessary parameters which do not affect results. "Eliminate and streamline" are OR mention (11). Oh, I forgot writing about cancellation and its consequences. Cancellation of planned operations is main and long- standing occurrence in OR. It has significant financial, psychological and social implication on patients and their families. The reasons for cancellation vary among between different countries such as lack of medically fitting for operation, lack of bed, unnecessary interventions and occasionally, patient turning up for surgery. Some of them are avoidable but remainder are not (12). So, we have very little knowledge about sound levels in OR environment (13). Now, this time is afternoon, all surgeries were terminated, patients were transported to their departments. You can sit and drink a cup of tea in your pavilion because emergency cases can arrive at any time

A combined diagnosis and treatment algorithm for spine infection management: A single-center experience

Background and objectiveSpinal infection (SI) is an infectious disease affecting the vertebral column, spinal cord, and adjacent structures. The infection can occur following interventions or spontaneously. The aim of this study was to highlight the importance of employing a methodological approach for the accurate and rapid diagnosis of SI and to share information on the most effective treatment method, which involves using a diagnostic -treatment algorithm that can help with SI management.MethodologyThis study included 50 patients diagnosed with SI between 2016 and 2020. The treatment follow-up period was limited to six months, and the study was conducted as a retrospective cohort analysis. The sample consisted of 22 female patients and 28 male patients, and the mean age of the patients was 50.2 years. All patients received diagnosis and treatment according to the algorithm described in this article.ResultsIn the study group, 60% of patients had an infection in the lumbar spine, 4% in the thoracal spine, 12% in the cervical spine, and 8% in the sacral spine. Previously operated patients were diagnosed on the 30.16th day on average. A total of 19 patients (38%) had no history of undergoing surgery. Radiologically, the most common finding was spondylodiscitis/discitis (32%). Osteomyelitis was detected in one (2%) patient. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly isolated organism in culture results and was detected in 13 patients (26%). The culture results of 12 patients (24%) were negative. The number of patients with active SI who were unstable and stabilized at the time of diagnosis was 11 (22%), and stabilization materials were removed in two patients (4%). In the 6th month of control, the patients did not have any complaints, signs of an infection, or unstable vertebral column.ConclusionsWe conclude that the combined algorithm we recommend for the diagnosis and treatment of patients with SI can prevent negative deviation and is an effective treatment for this condition

Lumbar dynamic stabilization with 2-stage surgery: early results

Background: Screw loosening, which is a major problem in dynamic systems, can be easily overcome with 2-stage surgery. In this article, the clinical and radiological results of patients undergoing dynamic stabilization with a Dynesys device in 2 stages are discussed. Methods: A total of 10 male and 13 female adult patients were included in this single-center retrospective study conducted between 2018 and 2021. The mean age of the patients was 65.6 years. All of the patients had pain complaints that affected their daily lives. Bone density T scores were determined with the dual-energy x-ray absorptiometry method before patients were admitted for surgery. In the first surgery, Dynesys system pedicle screws were inserted. After 6 months of osteointegration, Dynesys system spacers and elastic bandages were placed. Preoperative, early postoperative, and late postoperative visual analog pain scale (VAS) scores and Oswestry Disability Index (ODI) scores were determined and statistically compared. Results: Patients were followed for an average of 30 months. Complications and recurrence were not observed. Neurological deficits were not observed after patients recovered from anesthesia. Significant improvement was observed in the ODI and VAS parameters in the preoperative (ODI: 66.2%, VAS: 7.8), early postoperative (ODI: 20.3%, VAS: 2.4), and late postoperative (ODI: 6.8% and VAS: 1.1) periods. Symptomatic improvement was seen in all patients. No screw breakage or loosening was detected by radiological evaluation in any of the patients during the 2-year follow-up period. Conclusions: In our experience, the insufficiency of the proximal and distal end screws is eliminated when 2 stages of dynamic system stabilizations are completed after osteointegration of the screws

Clinical Results of Anterior Odontoid Screw Fixation for Type II Odontoid Fractures

AmAÇ: Çalışmada, Tip II odontoid fraktürü tanısı alan 31 olgu bildirilmiştir. Olguların hepsi anterior transodontoid vida fiksasyonu ile tedavi edilmiş ve klinik sonuçları bildirilmiştir. yÖNTEm ve GEREÇLER: Çalışma, VKV Amerikan Hastanesi Nöroşirürji Bölümü'nde 1998-2012 yılları arasında travmatik tip II odontoid kırığı nedeniyle anterior transodontoid fiksasyon ile cerrahi tedavi uygulanan 31 hastanın retrospektif klinik analizleri yapılmıştır. Tüm olguların yaş, cinsiyet, travma nedeni, teşhis zamanı, cerrahi girişim öncesi ve sonrasında nörolojik muayeneleri, takip süresi değerlendirilmiştir. Olguların nörolojik durumları Frankel skalasına göre sınıflandırılmıştır. BuLGuLAR: Dört hastaya 2 adet transodontoid vidası yerleştirildi. Hastanede kalış süresi ortalama 3,35 gün idi. 1 hastada postop takibinde füzyon oluşmaması nedeniyle ikinci bir operasyon ile posteriordan oksipitoservikal füzyon yapıldı. İşlem sırasında ve sonrasında damar yaralanması, vida malpozisyonu, enfeksiyon, nörolojik bozulma gibi komplikasyonlar izlenmedi. Hastalar ameliyat sonrasında ortalama 36 ay takip edildi. Hastaların erken ve geç dönemde radyolojik görüntülemeleri yapıldı. soNuÇ: Postoperatif dönemde hastaların takiplerinde tatmin edici füzyon oranı ve hasta konforunun daha iyi olduğunu saptadık. Tip II odontoid kırıklarının cerrahi tedavisinde minimal invaziv yöntem olan transodontoid vida ile fiksasyonun yüksek avantajlarından dolayı ilk seçenek olabileceğini düşünüyoruz.AIm: In this study, 31 patients with a diagnosis of Type II odontoid fractures were reported. All patients were treated with anterior transodontoid screw fixation and clinical outcomes were reported. mATERIAL and mETHods: In this study, the retrospective clinical analysis of 31 patients with traumatic type II odontoid fractures who were treated through anterior transodontoid fixation in Neurosurgery Department at VKV American Hospital between 1998 and 2012 was performed. The age, sex, cause of injury, diagnosis time, neurological examination before and after surgery, follow-up period were evaluated. The neurological status of patients was classified according to the Frankel scale. REsuLTs: In 4 patients, 2 transodontoid screws were inserted. The mean hospital stay was 3.35 days. Posterior occipito-cervical fusion was done in 1 patient due to the lack of fusion in the first operation. No vascular injury, screw malposition, infection, neurologic deterioration, or complications were observed during the peroperative and postoperative stage. The mean postoperative follow-up period was 36 months after surgery. Radiological imaging of patients were performed at the early and late postoperative stage. CoNCLusIoN: We found satisfying fusion rates and better patient comfort during the postoperative period. We think that stabilization and fusion through a transodontoid screw is a minimal invasive method

Primary central nervous system lymphoma presenting as a pure third ventricular lesion: a case report

<p>Abstract</p> <p>Introduction</p> <p>Primary central nervous system lymphomas are infrequently occurring lymphomas that account for only 0.3-1.5% of all intra-cranial neoplasms in patients without acquired immune deficiency syndrome. However, a pure third ventricle lymphoma is extremely rare. Here, we discuss the similar radiological appearances of lesions localized in the third ventricle and the importance of accurately diagnosing primary central nervous system lymphomas for favorable treatment outcomes.</p> <p>Case presentation</p> <p>A 38-year-old Caucasian man from Turkey presented with a severe headache lasting for three months that failed to respond to any medication. Both severity and duration of the symptoms increased gradually, resulting in vomiting, nausea and gait disturbance that accompanied the headache for three weeks. Neuro-imaging studies showed a lesion located solely in the third ventricle, resulting in partial obstruction of the foramen of Monro. The pre-operative diagnosis was a colloid cyst. Following the surgical procedure, the results of pathological and immunochemical assays revealed that the pre-operative diagnosis was incorrect and that the lesion was a primary central system lymphoma.</p> <p>Conclusion</p> <p>Pure third ventricle lymphomas are extremely rare and are exceptionally localized. It is important to be aware of, and to differentiate between, other possible third ventricular lesions that may mimic the same radiological appearance. Accurate diagnosis is necessary for selecting appropriate treatment modalities.</p

Disc Rehydration after Dynamic Stabilization: A Report of 59 Cases

Study DesignA retrospective study investigating decrease in the nucleus pulposus signal intensity or disc height on magnetic resonance imaging (MRI) and disc degeneration.PurposeAlthough a degenerated disc cannot self-regenerate, distraction or stabilization may provide suitable conditions for rehydration and possible regeneration. This study aimed to evaluate clinical outcomes and disc regeneration via MRI in a series of patients with degenerative disc disease (DDD) who underwent lumbar stabilization with a dynamic stabilization system (DSS).Overview of LiteratureA dynamic system provides rehydration during early DDD.MethodsFifty-nine patients (mean age, 46.5 years) who undedwent stabilization with DSS for segmental instability (painful black disc) between 2004 and 2014 were retrospectively evaluated. All patients underwent MRI preoperatively and 12 months postoperatively. Intervertebral disc (IVD) degeneration grades at the implanted segment were categorized using the Pfirrmann classification system. Patients were followed for a mean of 6.4 years, and clinical outcomes were based on visual analog scale (VAS) and Oswestry disability index (ODI) scores.ResultsSignificant improvements in back pain VAS and ODI scores from before surgery (7 and 68%, respectively) were reported at 6 (2.85 and 27.4%, respectively) and 12 months postoperatively (1.8 and 16.3%, respectively). Postoperative IVD changes were observed in 28 patients. Improvement was observed in 20 patients (34%), whereas progressive degeneration was observed in eight patients (13.5%). Thirty-one patients (52.5%) exhibited neither improvement nor progression. Single Pfirrmann grade improvements were observed in 29% of the patients and two-grade improvements were observed in 5%.ConclusionsOur observations support the theory that physiological movement and a balanced load distribution are necessary for disc regeneration. We conclude that DSS may decelerate the degeneration process and appears to facilitate regeneration