Who owns these tissues? General principles on the use of material submitted to pathology departments for healthcare, education and research purposes Bu dokular kime ait? Patoloji bölümlerine gönderilen dokuların saǧlık hizmeti, eǧitimi ve araştırmaları i̇çin kullanımında genel i̇lkeler

The study of human tissues procured through invasive procedures for diagnostic and treatment purposes constitutes one of the most important functions of pathology departments worldwide. The final diagnosis, determination of appropriate therapy and detailed insight on many diseases are possible only through the analysis of these tissues with the use of modern analytical techniques. While these statements present no controversy, the laws and regulations on how to use these tissues for diagnostic, educational and research purposes are woefully insufficient and cause significant debate. In addition to the lack of principles that define the possession and use of these tissues, there are a number of prejudices in our country that are not consistent with the scientific and medical facts. This study aims to frame the problems arising in this matter and provides a review of the rules, experience and legislation in various countries with a discussion of some examples. We aim to provide ideas on the general fundamental principles that should be incorporated in future legislation in our country. We also hope that our study initiates a healthy discussion of this critical topic

Who Owns These Tissues? General Principles on the Use of Material Submitted to Pathology Departments for Healthcare, Education and Research Purposes

The study of human tissues procured through invasive procedures for diagnostic and treatment purposes constitutes one of the most important functions of pathology departments worldwide. The final diagnosis, determination of appropriate therapy and detailed insight on many diseases are possible only through the analysis of these tissues with the use of modern analytical techniques. While these statements present no controversy, the laws and regulations on how to use these tissues for diagnostic, educational and research purposes are woefully insufficient and cause significant debate. In addition to the lack of principles that define the possession and use of these tissues, there are a number of prejudices in our country that are not consistent with the scientific and medical facts. This study aims to frame the problems arising in this matter and provides a review of the rules, experience and legislation in various countries with a discussion of some examples. We aim to provide ideas on the general fundamental principles that should be incorporated in future legislation in our country. We also hope that our study initiates a healthy discussion of this critical topic

Surgical treatment of thoracic disc disease via minimally invasive lateral transthoracic trans/retropleural approach: analysis of 33 patients

Thoracic disc herniations are associated with serious neurological consequences if not treated appropriately. Although a number of techniques have been described, there is no consensus about the best surgical approach. In this study, the authors report their experience in the operative management of patients with thoracic disc herniations using minimally invasive lateral transthoracic trans/retropleural approach. A series of 33 consecutive patients with thoracic disc herniations who underwent anterior spinal cord decompression followed by instrumented fusion through lateral approach is being reported. Demographic and radiographic data, perioperative complications, and clinical outcomes were reviewed. Forty disc levels in 33 patients (18F/15M; mean age, 52.9) were treated. Twenty-three patients presented with myelopathy (69 %), 31 had radiculopathy (94 %), and 31 had axial pain (94 %). Among patients with myelopathy, 14 (42.4 %) had bladder and/or bowel dysfunction. In the last eight cases (24 %), the approach was retropleural instead of transpleural. Patients were followed up for 18.2 months on average. The mean length of hospital stay was 5 days. None of the patients developed neurological deterioration postoperatively. Among 23 patients who had myelopathy signs, 21 (91 %) had improved postoperatively. The mean preoperative visual analog scale pain score, Oswestry Disability Index score, SF-36 PCS, and mental component summary scores were 7.5, 42.4, 29.6, and 37.5 which improved to 3.5, 33.2, 35.5, and 52.6, respectively. Perioperative complications occurred in six patients (18.1 %), all of which resolved uneventfully. Minimally invasive lateral transthoracic trans/retropleural approach is a safe and efficacious technique for achieving adequate decompression in thoracic disc herniations in a less invasive manner than conventional approaches

Successful Treatment of a Very Rare Angiosarcoma Involving the Lumbar Spine Via En-Bloc Resection and Radiotherapy: Case Report

Angiosarcomas are rare malignant vascular tumors that comprise only approximately 2% of all soft tissue sarcomas. They are mainly located in the head and neck area and spinal involvement is particularly very uncommon, reported only in occasional case reports or as single cases as part of a clinical series. There is therefore limited data in the literature regarding the optimum treatment strategy. Due to the aggressive nature of these lesions total resection is challenging and the overall survival time is short. In this report the authors report the successful management of a 37-year-old male harbouring spinal angiosarcoma involving the L2 level via en-bloc resection and adjuvant radiotherapy. The patient is disease-free at the 4th year follow-up and the radiological investigations are without the evidence of local recurrence, metastasis or implant failure. En bloc resection of spinal angiosarcomas can significantly improve survival and the surgical treatment should aim for this whenever possible

Bilateral ophthalmic segment aneurysm clipping with one craniotomy: operative technique and results

AIM: Surgical indications for ophthalmic segment aneurysms are getting narrower due in part to success of endovascular techniques like flow diverters. Wide necks, large size, intraluminal thrombus, optic nerve compression or recurrence after endovascular therapy make the case for surgical treatment. Bilateral aneurysms are less established but worth considering surgical indication. Our objective is to review a series of bilateral ophthalmic segment aneurysms managed through a single craniotomy, describe the surgical technique and evaluate the results. MATERIAL AND METHODS: Between 1997 and 2012, 11 patients with bilateral ophthalmic segment aneurysms were treated through a single craniotomy at UCSF Medical Center. An intradural clinoidectomy was performed to expose and clip the ipsilateral aneurysm. Medially and superiorly projecting contralateral aneurysm could be clipped through the interoptic triangle without clinoidectomy. Indocyanin green videoangiography was performed routinely. RESULTS: Eleven patients harboring 22 ophthalmic segment aneurysms were treated with a single craniotomy. Complete neck occlusion was achieved in 96 % of aneurysms. One patient presenting with subarachnoid hemorrhage Hunt-Hess grade 5 died from vasospasm complications. The remaining 10 patients had good outcomes (mRS ≤ 2) after a mean 2.2 years follow up. There were no recurrences after surgical treatment. CONCLUSION: Decompressing the optic nerve, completely occluding the aneurysm neck, providing a durable repair and avoiding antiplatelet agents are the well established advantages of microsurgical management. This experience demonstrates safety and feasibility of contralateral clipping of carefully selected ophthalmic segment aneurysms, thus pointing another advantage of surgical clipping when bilateral aneurysms are diagnosed