Metastatik Beyin Tümörlerinin Mikrocerrahi Yönetiminde Sodyum Fluorescein Boyamanın Cerrahi Sonuçlara Etkileri

Aim: We investigated the reflection of tumor dyeing (staining), an auxiliary technique for the resection of metastases, which are the most prevalentgroup among brain tumors, via microsurgery.Materials and Methods: Twenty one patients, who were operated under surgical white light, and 27 patients who were operated via sodiumfluorescein (FL) dyeing (staining) due to metastatic brain tumors were evaluated retrospectively. The gross total resection (GTR) rates, surgical time,amount of blood loss, and the duration of hospital stay for both groups were compared. The contribution of FL dyeing (staining) to surgery wasevaluated for the group with FL dyeing (staining).Results: The study comprised of 48 patients in total. The median age of patients was 61.5 years (minimum: 20, maximum: 80), the average age was59.1±11.8 years. There was no difference between the group with FL dyeing and the one without dyeing in terms of gender, age, tumor size, GTRrates and surgical time. Blood loss and duration of hospital stay in the FL used group was significantly less. In the group with FL dyeing (staining)(92.5%), this method contributed to the surgery by giving yellow highlights.Conclusion: It has been found out that in the surgery of metastatic brain tumors, FL dyeing decreases the blood loss, shortens the surgical time, andaids in the differentiation of tumor glial tissue.Amaç: Beyin tümörleri içerisinde en sık görülen grup olan metastazların mikrocerrahi ile çıkartılmasında yardımcı bir teknik olan tümör boyamanın cerrahi sonuçlarımıza yansımasını araştırdık. Gereç ve Yöntem: Metastatik beyin tümörü nedeni ile mikrocerrahi yöntem ile beyaz ışık altında opere edilen 21 hasta ve sodyum fluorescein (FL) boyama kullanılan 27 hasta retrospektif olarak değerlendirildi. Her iki grubun gross total rezeksiyon (GTR) oranları, cerrahi süreleri, kan kaybı miktarları, hastanede kalış süreleri karşılaştırıldı. FL kullanılan grupta boyamanın cerrahiye yaptığı katkı değerlendirildi. Bulgular: Çalışmaya toplamda 48 hasta alındı. Hastaların medyan yaşı 61,5 (minimum: 20 maksimum: 80) yıl, ortalama yaşı 59,1±11,8 yıl idi. FL kullanılmayan ve kullanılan gruplarda cinsiyet, yaş, tümör büyüklüğü, GTR oranları ve cerrahi süre açısından fark yoktu. FL kullanılan grupta kan kaybı miktarları ve hastanede kalış süresi belirgin şekilde azdı. FL kullanılan grupta yirmi beş hastada (%92,5) FL sarı röfle vererek cerrahiye katkı sağlamıştır. Sonuç: Metastatik beyin tümörlerinin cerrahisinde FL boyama kan kaybını ve cerrahi süreleri azaltmakta, tümör glial doku ayrımında cerraha yardımcı olmaktadır

The Impacts of Intraoperative Ultrasonography Use on Resection Rate in Cases of Brain Tumor

Aim:Intraoperative ultrasonography is an accessible and cost-effective monitoring technique that provides a simultaneous view with minimum risk. Despite these advantages, it is still not in use. This study aimed to identify whether the ultrasonography technique would be advantageous for both surgeons in the preoperative period and patient in the postoperative period in cases where intraoperative ultrasonography was used.Materials and Methods:This retrospective study included data of the cases (n=113) diagnosed with a brain tumor in Tekirdağ Namık Kemal University Hospital between January 01, 2015 and December 31, 2020. The cases operated without using ultrasonography (n=38) formed the control group (group 1), while the cases operated by using ultrasonography (n=75) formed the study group (group 2). In all cases selected randomly, the amount of bleeding during the operation, length of the operation and postoperative stay in the hospital, and residue tumor amount were compared. Data obtained were evaluated statistically. The results were presented in mean±standard deviation and/or percentage (frequency). The alpha significance value was accepted as 0.05) between age (p=0.61), gender (p=0.74), and size of the tumor (p=0.27). It was observed that the average length of the operations of the cases in group 2 was shorter than that of group 1 (p=0.03), and this result was statistically significant (p<0.05). It was reported that the amount of bleeding of the cases in group 2 was also statistically significant (p<0.05) as against group 1. The gross total resection rate of cases in group 1 was calculated as 73.7% while it was 89.3% in group 2. It was understood that the amount of residue in group 2 compared to group 1 was statistically less (p<0.05) in a significant way (p=0.03). In addition to all these, it was found that the length of stay in group 2, which included cases operated with ultrasonography, was shorter than in group 1, which included cases operated without using ultrasonography (p=0.01).Conclusion:The use of intraoperative ultrasonography helps the surgeon by identifying resection margin and revealing the relationship between surrounding neural and vascular structures, thus increasing surgical safety. At the same time, the use of ultrasonography decreases the length of operation, amount of bleeding, and length of stay in the hospital, and increases gross total resection rates

The Effects of Sodium Fluorescein Dyeing of Metastatic Brain Tumors on Surgical Outcomes under Microsurgical Operation

Aim:We investigated the reflection of tumor dyeing (staining), an auxiliary technique for the resection of metastases, which are the most prevalent group among brain tumors, via microsurgery.Materials and Methods:Twenty one patients, who were operated under surgical white light, and 27 patients who were operated via sodium fluorescein (FL) dyeing (staining) due to metastatic brain tumors were evaluated retrospectively. The gross total resection (GTR) rates, surgical time, amount of blood loss, and the duration of hospital stay for both groups were compared. The contribution of FL dyeing (staining) to surgery was evaluated for the group with FL dyeing (staining).Results:The study comprised of 48 patients in total. The median age of patients was 61.5 years (minimum: 20, maximum: 80), the average age was 59.1±11.8 years. There was no difference between the group with FL dyeing and the one without dyeing in terms of gender, age, tumor size, GTR rates and surgical time. Blood loss and duration of hospital stay in the FL used group was significantly less. In the group with FL dyeing (staining) (92.5%), this method contributed to the surgery by giving yellow highlights.Conclusion:It has been found out that in the surgery of metastatic brain tumors, FL dyeing decreases the blood loss, shortens the surgical time, and aids in the differentiation of tumor glial tissue

Beyin Tümörü Olgularında İntraoperatif Ultrasonografi Kullanımının Rezeksiyon Oranına Etkisi

Amaç: İntraoperatif ultrasonografi eş zamanlı görüntü sağlayan, kolay erişilebilen, minimum riskli ve uygun maliyetli bir görüntüleme tekniğidir. Bu özelliklerine rağmen halen yaygın kullanılmamaktadır. Bu araştırmada intraoperatif ultrasonografi kullanılan olgularda, ultrasonografi tekniğinin hem preoperatif dönemde cerraha hem de postoperatif dönemde olguya faydasının olup olmayacağının araştırılması amaçlandı. Gereç ve Yöntem: Bu retrospektif araştırmaya 01 Ocak 2015 ve 31 Aralık 2020 tarihleri arasında, Tekirdağ Namık Kemal Üniversite Hastanesi’nde beyin tümörü tanısı alan olgulara (n=113) ait veriler dahil edildi. Ultrasonografi kullanılmadan opere edilen olgular (n=38) kontrol grubunu (grup 1) oluşturuyorken, ultrasonografi kullanılarak opere edilen olgular (n=75) çalışma grubunu (grup 2) oluşturdu. Randomize olarak seçilen tüm olgularda, cerrahi esnasında gözlemlenen kanama miktarları, cerrahi süreleri ile postoperatif hastanede kalış süreleri ve rezidü tümör miktarları karşılaştırıldı. Elde edilen veriler istatistiksel olarak değerlendirildi. Sonuçlar ortalama±standart sapma ve/veya yüzde (frekans) cinsinden sunuldu. %95 güven aralığında değerlendirilerek elde edilen verilerin gruplar arası karşılaştırmalarında, alfa anlamlılık değeri 0,05). Grup 1’e oranla grup 2’de yer alan olguların cerrahi süre ortalamasının daha az olduğu (p=0,03) ve bu sonucun istatistiksel olarak anlamlı olduğu gözlemlendi (p<0,05). Grup 1’e oranla grup 2’de yer alan olgulara ait kanama miktarlarının da yine istatistiksel olarak anlamlı olduğu raporlandı (p<0,05). Grup 1’de yer alan olgularda gross total rezeksiyon oranı %73,7 olarak hesaplanırken grup 2’de bu oranın %89,3 olduğu görüldü. Grup 2’de rezidü miktarının grup 1’e oranla istatistiksel olarak anlamlı derecede (p=0,03) daha az olduğu anlaşıldı (p<0,05). Tüm bunlara ek olarak ultrasonografi kullanılan olguların yer aldığı grup 2’deki olguların hastanede kalış süresinin, ultrasonografi kullanılmayarak opere edilen grup 1’de yer alan olgulara oranla daha az sürede olduğu anlaşıldı (p=0,01). Sonuç: İntraoperatif ultrasonografi kullanımı ile rezeksiyon sınırı belirleme, çevre nöral ve damarsal yapılarla ilişkiyi ortaya koyarak cerraha yardımcı olup, cerrahi güvenliği artırmaktadır. Aynı zamanda ultrasonografi kullanımı cerrahi süreyi, kanama miktarını, hastanede kalış sürelerini azaltmakta ve gross total rezeksiyon oranlarını artırmaktadı

A case report of brain abscess caused by carbapenem- resistant Klebsiella pneumoniae

The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case

Geriatrik popülasyonda omurga cerrahisinin en yaygın nedeni olan lomber stenozda ağrı ve nörojenik kladikasyo kontrolü

OBJECTIVES: The authors aim to present when to do physical therapy or surgery in geriatric patients with degenerative lumbar stenosis. METHODS: The authors retrospectively analyzed 250 patients who underwent physical therapy due to lumbar degenerative stenosis between December 2014 and April 2017. The patients were divided into two groups: Central canal stenosis and lateral recess/foraminal stenosis groups. Visual analogue scale and neurological claudication values of both patient groups were evaluated before and after physical therapy. The association between comorbid diseases and the frequency of surgery was also evaluated. RESULTS: 142 of the patients were female and 108 were male, and the mean age of these patients was 69 years. The mean onset of symptoms was 55 months. In the visual analog scale value of patients after physical therapy, the authors observed decreases of 4-6° in patients with central canal stenosis and 2-3° in patients with lateral recess/foraminal stenosis. In addition, the authors observed that patients with lateral recess/foraminal stenosis together with diabetes mellitus benefit less from physical therapy. CONCLUSION: Physical therapy and rehabilitation play an important role in the treatment of lumbar stenosis. Physical therapy is the primary treatment option for patients who do not have motor muscle strength losses and incontinence and who have pain control through medications. The authors can consider surgical interventions in patients with lateral recess/foraminal stenosis who do not benefit from physical therapy at a satisfactory level.Amaç: Çalışmada, dejeneratif lomber stenozu olan geriatrik hastalarda ne zaman fizik tedavi veya cerrahi yapılacağının araş-tırılması amaçlandı. Gereç ve Yöntem: Aralık 2014 ile Nisan 2017 tarihleri arasında lomber dejeneratif stenoz nedeniyle fizik tedavi gören 250 hasta retrospektif olarak analiz edildi. Hastalar santral kanal darlığı ve lateral reses/foraminal darlık olmak üzere iki gruba ayrıldı. Her iki hasta grubunun vizüel analog skala ve nörolojik kladikasyo değerleri fizik tedavi öncesi ve sonrası değerlendirildi. Komorbid hastalıklar ile ameliyat sıklığı arasındaki ilişki de değerlendirildi. Bulgular: Hastaların 142’si kadın 108’i erkek olup, yaş ortalaması 69’du. Semptomların ortalama başlangıcı 55 aydı. Fizik tedavi sonrası hastaların vizüel analog skala değerlerinde santral kanal darlığı olan hastalarda 4–6°, lateral reses/foraminal stenozu olan hastalarda 2–3° düşüşler gözlemlendi. Ayrıca, diabetes mellitus ile birlikte lateral reses/foraminal stenozu olan hastaların fizik tedaviden daha az fayda sağladığı tespit edildi. Sonuç: Fizik tedavi ve rehabilitasyon lomber darlığın tedavisinde önemli bir rol oynamaktadır. Motor kas gücü kayıpları ve inkontinansı olmayan ve ilaçlarla ağrı kontrolü olan hastalar için fizik tedavi birincil tedavi seçeneğidir. Fizik tedaviden tatmin edici düzeyde fayda görmeyen lateral reses/foraminal stenozlu hastalarda cerrahi girişim düşünebilir

Investigation of serum E-Cadherin, VEGF121, Survivin, Tenascin C and Tetraspanin 8 levels in patients with glioblastoma

OBJECTIVE: The aim of this study is to determine biomarkers, which may be used in order to understand the pathophysiology, the diagnosis, progression surveillance/monitoring, and treatment efficacy of high graded glial tumors.BACKGROUND: Radiological imaging in the diagnosis and relapse surveillance of glial tumors is sometimes insufficient. There is need for additional methods of diagnosis and surveillance in order to rule out contradictory circumstances.METHOD: Using enzyme like immune sorbent assay method, E-Cadherin, Tenascin C, Tetraspanin 8, Survivin and VEGF121 levels were investigated in serum and tumor tissues of 28 patients diagnosed with pathological glioblastoma, and in the serum of 26 healthy individuals. Correlation between tumor tissue values and Ki67 percentage, and P53 mutation, and difference between unhealthy and healthy serum levels were sought.RESULTS: It was found out that E-Cadherin and VEGF 121 levels in the unhealthy serum were high in comparison to the control group (p 0.05). CONCLUSION: EC and VEGF121 are biomarkers, which have the potential to be used in the diagnosis, recurrence and treatment follow-up in high graded glial tumors (Tab. 2, Fig. 1, Ref. 37). Text in PDF www.elis.s

Diklofenak Sodyum ve Montelukast Sodyumun Travmatik Omurilik Yaralanmalarında Akut Enflamasyon Üzerindeki Koruyucu Etkileri: Sıçanlarda Deneysel Bir Çalışma

Amaç: Bu çalışmanın amacı travmatik omurilik yaralanmasında (T-SCI) diklofenak sodyum (DF) ve montelukast sodyumun (ML) akut enflamasyon üzerindeki koruyucu etkilerini araştırmaktır. Gereç ve Yöntem: Kırk Sprague-Dawley sıçanı rastgele beş gruba ayrıldı. Kontrol grubuna herhangi bir müdahale yapılmazken, travma grubuna SCI uygulandı. Kalan üç gruba travma sonrası diklofenak sodyum (tDF), ML (tML) ve tDF+ML intraperitoneal yolla uygulandı. Sıçanlar sakrifiye edildikten sonra hem omurilik hem de dura içeren doku örnekleri histopatolojik incelemeye tabi tutuldu ve ödem, nekroz, enflamatuvar hücreler, apoptoz, nöron hasarı ve kanama açısından skorlandı. Bulgular: Kontrol ve travma grupları arasındaki histopatolojik değişikliklerde gruplar arasında anlamlı fark bulundu (p0,05). Kontrol grubu ile gruplar arasında ödem farkı olmayan grubun tDF grubu olduğu görüldü (p=0,059). Enflamatuvar hücreler incelendiğinde hücre miktarının en az tDF grubunda olduğu izlendi (p=0,068). Nekroz (p=0,1), apoptoz (p=0,061) ve nöral hasar durumunun (p=0,139) tDF+ML kombine grubunda en az olduğu görüldü. Kanama miktarı açısından gruplar arasında anlamlı bir fark yoktu (p>0,05). Sonuç: DF’nin tek başına kullanımı ödem ve enflamatuvar hücre sayısını azaltırken, DF+ML’nin birlikte kullanımının T-SCI’da nekroz, apoptoz ve nöral hasar gelişimini azalttığı saptandı

Postoperative analgesic effect of bupivacaine infiltration following lumbar disc surgery

Objectives: Effectiveness of 0.5% bupivacaine administered onto dura, under lumbar superficial fascia andsubcutaneous tissue on postoperative pain control was analyzed in patients undergoing lumbar microdiscectomy.Methods: Sixty adult patients scheduled to undergo elective, single-level lumbar discectomy were randomlydivided into four groups: the control group (Control), the subcutaneous tissue group (Group C), which received20 ml of 0.5% bupivacaine in the subcutaenous tissue, the superficial fascia group (Group F), which received12 ml bupivacaine in the subcutaneous tissue and 8 ml in the space below the lumbar superficial fascia, andthe dura group (Group D), which received a total of 20 ml (100 mg) of bupivacaine, consisting of 10 ml in thesubcutaneous tissue, 8 ml in the space below the lumbar superficial fascia, and 2 ml on the dura. Visual AnalogScale Values (VAS) on postoperative 0, 15, 30, 45 minutes, at 1, 2, 4, 6, 12 and 24th hour and time of the firstanalgesic need were evaluated for all patients and recorded.Results: While mean VAS value measured at min 0 (as soon as the patient awakened) was 2.3 ± 1.2 in GroupD; it was 2.7 ± 0.9 in Group C; 2.7 ± 1.0 in Group F and 3.1 ± 0.6 in control group (p = 0.232). At the end of1th hour, mean VAS value was recorded as 2.8 ± 1.0 in Group D; 3.6 ± 1.5 in Group C; 3.6 ± 1.1 in Group Fand 4.4 ± 1.1 in control group (p = 0.005). In Group D, 0.5% bupivacaine administered as 2, 8, 10 ml ontodura, fascia and subcutaneously was detected to provide significantly lower VAS values and significantly longerfirst analgesic need time.Conclusions: 0.5% bupivacaine administered onto dura, under lumbar superficial fascia and in subcutaneoustissue was detected to be a simple, effective and safe method in lumbar microdiscectomy operations

Postoperative analgesic effect of bupivacaine infiltration following lumbar disc surgery

Objectives: Effectiveness of 0.5% bupivacaine administered onto dura, under lumbar superficial fascia andsubcutaneous tissue on postoperative pain control was analyzed in patients undergoing lumbar microdiscectomy.Methods: Sixty adult patients scheduled to undergo elective, single-level lumbar discectomy were randomlydivided into four groups: the control group (Control), the subcutaneous tissue group (Group C), which received20 ml of 0.5% bupivacaine in the subcutaenous tissue, the superficial fascia group (Group F), which received12 ml bupivacaine in the subcutaneous tissue and 8 ml in the space below the lumbar superficial fascia, andthe dura group (Group D), which received a total of 20 ml (100 mg) of bupivacaine, consisting of 10 ml in thesubcutaneous tissue, 8 ml in the space below the lumbar superficial fascia, and 2 ml on the dura. Visual AnalogScale Values (VAS) on postoperative 0, 15, 30, 45 minutes, at 1, 2, 4, 6, 12 and 24th hour and time of the firstanalgesic need were evaluated for all patients and recorded.Results: While mean VAS value measured at min 0 (as soon as the patient awakened) was 2.3 ± 1.2 in GroupD; it was 2.7 ± 0.9 in Group C; 2.7 ± 1.0 in Group F and 3.1 ± 0.6 in control group (p = 0.232). At the end of1th hour, mean VAS value was recorded as 2.8 ± 1.0 in Group D; 3.6 ± 1.5 in Group C; 3.6 ± 1.1 in Group Fand 4.4 ± 1.1 in control group (p = 0.005). In Group D, 0.5% bupivacaine administered as 2, 8, 10 ml ontodura, fascia and subcutaneously was detected to provide significantly lower VAS values and significantly longerfirst analgesic need time.Conclusions: 0.5% bupivacaine administered onto dura, under lumbar superficial fascia and in subcutaneoustissue was detected to be a simple, effective and safe method in lumbar microdiscectomy operations