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

Total resection of inferiorly located sacral chordoma with posterior only approach: case report and review of the literature

Chordoma is a primary sacral neoplasm of ectodermal origin and makes up %1-4 of all primary bone tumors. It is usually present on the midline cerebrospinal axis and the most common locations are the spheno-clival region and the sacrum. The treatment of primary sacral tumors represents a challenge because of a large tumor mass at presentation and a hemorrhage risk in surgery. Sacral tumors may present a difficult problem to the surgeon who desires to obtain a clear margin of excision. Using the retrorectal fat tissue as a cleavage line in the posterior approach guides the neurosurgeon to resect the tumor totally and reduce the hemorrhage in sacral chordomas. In this case report, we tried to discuss the advantages of using of retrorectal fat tissue as a cleavage line in sacral chordomas under the literature.Kordoma ektodermal kaynaklı primer sakral neoplazmdır ve tüm primer kemik tümörlerinin %1-4’ünü oluşturur. Genellikle serebrospinal aksın orta hattında bulunurlar ve çoğunlukla yerleşim yerleri sfenoklival bölge ve sakrumdur. Primer sakral tümörlerin tedavisi; ilk ortaya çıktıklarında büyük bir kitle oluşturmuş olmaları ve cerrahide kanama riskleri nedeniyle çözülmesi gereken bir sorun olarak durmaktadır. Sakral tümörler, net bir eksizyon sınırı sağlamak isteyen cerrahlar için zorlu bir problem oluşturur. Posterior yaklaşımda retrorektal yağ dokusunun klavaj hattı olarak kullanılması; beyin cerrahına tümörün tümüyle rezeke edilmesi için yol gösterir ve sakral kordomalarda kanamayı azaltır. Bu olgu sunumunda, sakral kordomalarda retrorektal yağ dokusunun klavaj hattı olarak kullanılmasının yararlarını literatür eşliğinde tartışmak istedik

Evaluating synergy between marbofloxacin and gentamicin in Pseudomonas aeruginosa strains isolated from dogs with otitis externa

The aim of this study was to determine antimicrobial susceptibility of Pseudomonas aeruginosa strains to marbofloxacin and gentamicin, and investigate the possible synergistic, additive, indifferent or antagonistic effects between the two agents. P. aeruginosa strains can develop resistance quickly against certain antibiotics if used alone, thus the need emerges to find synergistic combinations. A total of 68 P. aeruginosa strains isolated from dogs were examined. In order to describe interactions between marbofloxacin and gentamicin the checkerboard microdilution method was utilized. The MICs (minimum inhibitory concentrations) for marbofloxacin and gentamicin were in the range 0.25–64 mg/L and 0.25–32 mg/L, respectively. The combination of marbofloxacin and gentamicin was more effective with a MIC range of 0.031–8 mg/L and a MIC90 of 1 mg/L, compared to 16 mg/L for marbofloxacin alone and 8 mg/L for gentamicin alone. The FIC (fractional inhibitory concentration) indices ranged from 0.0945 (pronounced synergy) to 1.0625 (indifference). Synergy between marbofloxacin and gentamicin was found in 33 isolates. The mean FIC index is 0.546, which represents a partial synergistic/additive effect close to the full synergy threshold. In vitro results indicate that marbofloxacin and gentamicin as partially synergistic agents may prove clinically useful in combination therapy against P. aeruginosa infections. Although marbofloxacin is not used in the human practice, the interactions between fluoroquinolones and aminoglycosides may have importance outside the veterinary field

Single left coronary artery with separate origins of proximal and distal right coronary arteries from left anterior descending and circumflex arteries – a previously undescribed coronary circulation

A single left coronary artery with right coronary artery arising from either left main stem (LMS) or left anterior descending artery (LAD) or circumflex artery (Cx) is an extremely rare coronary anomaly. This is the first report of separate origins of proximal and distal RCA from LAD and circumflex arteries respectively in a patient with a single left coronary artery. This 57 year old patient presented with unstable angina and severe stenotic disease of LAD and Cx arteries and underwent urgent successful quadruple coronary artery bypass grafting. The anomalies of right coronary artery in terms of their origin, number and distribution are reviewed

In-Vitro Activity of Polymyxin B, Rifampicin, Tigecycline Alone and in Combination against Carbapenem-Resistant Acinetobacter baumannii in Singapore

OBJECTIVE: Carbapenem-resistant Acinetobacter baumannii (CR-AB) is an emerging cause of nosocomial infections worldwide. Combination therapy may be the only viable option until new antibiotics become available. The objective of this study is to identify potential antimicrobial combinations against CR-AB isolated from our local hospitals. METHODS: AB isolates from all public hospitals in Singapore were systematically collected between 2006 and 2007. MICs were determined according to CLSI guidelines. All CR-AB isolates were genotyped using a PCR-based method. Clonal relationship was elucidated. Time-kill studies (TKS) were conducted with polymyxin B, rifampicin and tigecycline alone and in combination using clinically relevant (achievable) unbound concentrations. RESULTS: 31 CR AB isolates were identified. They are multidrug-resistant, but are susceptible to polymyxin B. From clonal typing, 8 clonal groups were identified and 11 isolates exhibited clonal diversity. In single TKS, polymyxin B, rifampicin and tigecycline alone did not exhibit bactericidal activity at 24 hours. In combination TKS, polymyxin plus rifampicin, polymyxin B plus tigecycline and tigecycline plus rifampicin exhibited bactericidal killing in 13/31, 9/31 and 7/31 isolates respectively at 24 hours. Within a clonal group, there may be no consensus with the types of antibiotics combinations that could still kill effectively. CONCLUSION: Monotherapy with polymyxin B may not be adequate against polymyxin B susceptible AB isolates. These findings demonstrate that in-vitro synergy of antibiotic combinations in CR AB may be strain dependant. It may guide us in choosing a pre-emptive therapy for CR AB infections and warrants further investigations

In vitro antimicrobial effects of aztreonam, colistin, and the 3-drug combination of aztreonam, ceftazidime and amikacin on metallo-β-lactamase-producing Pseudomonas aeruginosa

<p>Abstract</p> <p>Background</p> <p>There are limited choice of antimicrobial agents to treat infection with metallo-<it>β</it>-lactamase-producing <it>Pseudomonas aeruginosa</it>. We evaluate the antimicrobial effects of aztreonam alone, colistin alone and the 3-drug combination of aztreonam, ceftazidime and amikacin on 23 strains of metallo-<it>β</it>-lactamase-producing <it>P. aeruginosa </it>by time-killing tests.</p> <p>Methods</p> <p>Strains used were from different hospitals in Japan and had different pulse-field gel electrophoresis patterns by restriction with <it>Spe</it>I. The minimum inhibitory concentrations of 11 antimicrobial agents (piperacillin, piperacillin/tazobactam, imipenem, meropenem, aztreonam, ceftazidime, amikacin, tobramycin, arbekacin, ciprofloxacin and colistin) were determined using the agar dilution test. The effects of aztreonam, colistin and the combination of aztreonam, ceftazidime and amikacin were determined by time-killing studies.</p> <p>Results</p> <p>Bacteriostatic effects after 6 hours of drug exposure were observed in 12 strains (52.2%) of 23 strains of metallo-<it>β</it>-lactamase-producing <it>P. aeruginosa </it>with 48 mg/l aztreonam, in 19 strains (82.6%) with the 3-drug combination of 16 mg/l aztreonam, 16 mg/l ceftazidime, and 4 mg/l amikacin, and in 23 strains (100%) with 2 mg/l colistin. Bactericidal effects after 6 h drug exposure were observed in 1 strain (4.3%) with 48 mg/l aztreonam, in 8 strains (30.4%) with the 3-drug combination and in all 23 strains (100%) with 2 mg/l colistin.</p> <p>Conclusion</p> <p>Evaluation of <it>in vitro </it>antimicrobial effects on metallo-<it>β</it>-lactamase-producing <it>P. aeruginosa </it>revealed relatively good effects of the 3-drug combination of aztreonam, ceftazidime and amikacin and marked effects of colistin.</p

Hyperdominant left anterior descending artery continuing across left ventricular apex as posterior descending artery coexistent with aortic stenosis

We describe, in a 61 year old man, with coexistent aortic stenosis, the anomalous origin of posterior descending artery (PDA) from a stenotic left anterior descending (LAD) artery, as its continuation across the left ventricular apex, in the presence of a normally arising and atretic proximal right coronary artery. The patient underwent mechanical aortic valve replacement and triple coronary artery bypass grafting and made an uneventful recovery. To the best of our knowledge, origin of PDA as a continuation of LAD across the left ventricular apex in the presence of a normally arising but atretic proximal right coronary artery has never been described in literature before. There is one previous case report of continuation of LAD as PDA across the left ventricular apex in a patient with single left coronary coronary artery with an absent right coronary ostium. As the blood supply to the entire interventricular septum is derived from this "hyperdominant" LAD system, stenosis of LAD can be catastrophic. A review of literature of the anomalies of right coronary artery and, in particular, of its anomalous origin from LAD and its coexistence with aortic stenosis, is presented

Definitions and incidence of cardiac syndrome X: review and analysis of clinical data

There is no consensus regarding the definition of cardiac syndrome X (CSX). We systematically reviewed recent literature using a standardized search strategy. We included 57 articles. A total of 47 studies mentioned a male/female distribution. A meta-analysis yielded a pooled proportion of females of 0.56 (n = 1,934 patients, with 95% confidence interval: 0.54–0.59). As much as 9 inclusion criteria and 43 exclusion criteria were found in the 57 articles. Applying these criteria to a population with normal coronary angiograms and treated in 1 year at a general hospital, the attributable CSX incidence varied between 3 and 11%. The many inclusion and exclusion criteria result in a wide range of definitions of CSX and these have large effects on the incidence. This shows the need for a generally accepted definition of CSX

Kayseri pancarı ekicileri kooperatifi ortaklarının memnuniyetlerinin belirlenmesi

Tarımsal üretimin ekonomik olarak başarıya ulaşması, teknik üretim yapılması ve sosyalolarak da üreticilerin etkin olabilmeleri için üreticilerin örgütlenmiş olmaları gerekmektedir. Üreticilerin tarımsal üretimlerinde en etkili örgütlenmeleri tarımsal kooperatifler ile mümkün olmaktadır. Kayseri Pancar Ekicileri Kooperatifi de pancar üreticilerinin tarımsalolarak örgütlendiği, pancar üretiminin yanı sıra diğer konularda da üretim karşılığı mal ve hizmet aldığı kooperatiflerden birisidir.' Bu araştınnanın amacı, Kayseri Pancar Ekicileri Kooperatifi ortaklarının memnuniyetlerinin belirlenmesi ve buna yönelik üreticilere uygulanacak yönetim politikalarında sürdürülebilir meınnuniyeti kalıcı kılmak için üretici için temel memnun edici unsurları tespit etmektir. Bu araştırmanın ana materyalinin Kayseri Pancar Ekicileri Kooperatifi ortakları ile karşılıklı görüşülerek yapılan anketlerden elde edilen veriler oluşturmaktadır. Çalışmanın tüm üreticileri kapsaması amacıyla Kayseri Şeker fabrikası A.Ş' nin üretim yaptığı Kayseri, Sivas ve Yozgat'ta bulunan 12 Bölge Müdürlüğündeki 170 üreticiyle görüşülmüştür. Anket çalışmasında kooperatif ortaklarının genel bilgileri, ortaklara ait işletmelerin genel bilgileri, kooperatıf memnuniyetini etkileyecek olan ekonomik faktörler, kültürel faktörler, sosyal faktörler, kooperatif özellikleri ve başarı faktörü olmak üzere toplamda 8 bölümden oluşturulmuştur. Elde edilen verilere basit tanımlayıcı istatistikler faktör analizi ve yapısal eşitlik modellemesi uygulanmıştır. Araştırma bulgularında faktör analizi sonucunda, Kayseri Pancar Ekicileri Kooperatifi ortaklarının memnuniyetlerirıin belirlenınede kullanılan 17 maddelik ölçekten rotasyon sonucu 5 faktör belirlenmiştir, Bu faktörler, "kooperatife duyulan güven", "kooperatifin ekonomik faydası", "kooperatifin sosyal faydası", "kooperatife duyulan inanç", ve "kooperatifin başarısı" dır. faktör analiz sonuçlarına göre yapısal eşitlik modeli uygulanmasıyla birlikte "kooperatife duyulan güven", "kooperatife duyulan inanç" ve "kooperatif başarısı" arasında anlamlı bir ilişki olduğu ortaya çıkmıştır