Case report on the development of a brucellosis-related epidural abscess

Brucellosis is an endemic disease in developing countries. The most commonly observed complications include bone-joint involvement, particularly sacroiliitis and spondylitis. Epidural abscesses caused by brucellosis are a rare complication. We describe the case of a 33-year-old man presenting with high fever, back pain, and weakness. At physical examination, the patient was found to be paraparetic. At thoracic MRI, spondylodiscitis and epidural abscess with significant cord compression were observed. In laboratory examinations, Rose Bengal and tube agglutination tests were positive in patient's serum for brucellosis, and specific antibiotherapy was initiated. Total laminectomy was performed and the abscess was aspirated. The biopsy sample was consistent with chronic non-specific inflammation in acute abscess. No growth was detected in the abscess or blood cultures. Following surgery, medical treatment was initiated and, at six weeks' follow-up, clinical and MRI findings indicated that he had recovered. The diagnosis of spinal epidural abscess due to brucellosis should be considered among differential diagnoses in endemic regions. Early diagnosis and specific treatment are important to prevent later complications

Neutrophil-to-Lymphocyte Ratio as a Marker in Patients with Non-arteritic Anterior Ischemic Optic Neuropathy

Background: Non-arteritic anterior ischemic optic neuropathy (NAION) is the most common acute optic neuropathy in patients over the age of 50 and is the second most common cause of permanent optic nerve-related visual loss in adults after glaucoma. Although the precise cause of NAION remains elusive, the etiology of NAION is believed to be multifactorial. Aims: To evaluate the utility of neutrophil-to-lymphocyte ratio (NLR) as a simple and readily available prognostic factor for clinical disease activity in patients with NAION. Study Design: Case-control study. Methods: Forty-five patients with the diagnosis of NAION and 50 age- and sex-matched controls with/without any systemic or ocular diseases except cataract were retrospectively enrolled in the study. Demographic characteristics and laboratory findings including complete blood count of all patients and control subjects were obtained from the electronic medical record. The neutrophil and lymphocyte counts were recorded and the NLR was calculated. Results: White blood cell, neutrophil, NLR and platelet values of the NAION patients were significantly higher than those of the controls (p<0.001, p<0.001, p=0.004, p=0.037, respectively). Initial NLR values were negatively correlated with initial and the third month best corrected visual acuity levels in the study group. The optimum NLR cut-off point for NAION was 1.94. Conclusion: NLR could be considered as a new inflammatory marker for assessment of the severity of inflammation in NAION patients with its quick, cheap, easily measurable property with routine complete blood count analysis

The efficacy of xenon light endoillumination on vitreoretinal surgery

Amaç: Çalışmamızda 23 gauge transkonjonktival pars plana vitrektomi tekniği ile vitreoretinal cerrahi uygulanan hastaların, xenon ışık kaynağı kullanılarak yapılan ameliyatlarının geriye dönük olarak incelenerek ameliyat süresi, anatomik başarı ve komplikasyonların incelenmesi amaçlanmaktadır. Gereç yöntem: Afyon Kocatepe Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalında Ocak 2010 ile Aralık 2010 tarihleri arasında, Xenon ışık kaynağı kullanılarak gerçekleştirilen 23 gauge pars plana vitrektomi ameliyatı yapılan 135 hastanın 135 gözü çalışmaya dahil edildi. Yirmi üç gauge pars plana vitrektomi tekniği ile vitreoretinal cerrahi uygulanan hastaların kayıtları geriye dönük olarak incelenerek hastaların yaş, cinsiyet, ameliyat endikasyonları, anestezi şekli, anatomik başarı, cerrahinin süresi, gelişen komplikasyonlar, kullanılan göz içi tamponat türü araştırıldı. Bulgular: Hastaların 62’si (% 45.9) erkek, 73’ü (% 54.1) kadındı. Yaş ortalaması 52.4±12.23 yıl idi. Xenon ışık kaynağı kullanılarak gerçekleştirilen 23 gauge pars plana vitrektomi ameliyatı yapılan hastalarda anatomik başarı oranı yüksek olup 134 hastada anatomik başarı elde edilmiş, yalnızca 1 gözde anatomik başarı sağlanamadı. Ortalama ameliyat süresi 65.56±25.78 dakika idi. Gerçekleştirilen pars plana vitrektomi ameliyatlarının 58’inde (% 43) herhangi bir retinal tamponat kullanılmayıp, geri kalan ameliyatlarda kullanılan göz içi tamponatlar ise; 46 (% 34) hastada silikon, 11 (% 8.1) hastada hava, 10 (% 7.4) hastada C3F8 gazı ve 10 (% 7.4) hastada SF6 gazıydı. Xenon ışık kaynağı kullanılarak gerçekleştirilen 23 gauge pars plana vitrektomi ameliyatı yapılan hastalarda ameliyat esnasında gelişen komplikasyonlar 10 (% 7.4) hastada iatrojenik retinal yırtık, 1 (% 0.7) hastada koroid dekolmanı ve 1 (% 0.7) hastada suprakoroidal hemoraji idi. Geriye kalan 123 (% 91) hastanın ameliyatı esnasındaysa herhangi bir komplikasyon gelişmedi. Hiçbir hastada anesteziye bağlı bir komplikasyona rastlanmadı. Sonuç: Xenon ışık kaynağı, ciddi intraoperatif komplikasyonlar gelişmeksizin daha kısa süreler içinde 23 gauge transkonjonktival pars plana vitrektominin yapılabilmesi için yeterli aydınlanma ile yüksek görüntü kalitesi sağlayabilir.Purpose: In our study we aimed to evaluate retrospectively the operation time, anatomical success and complications in patients undergoing vitreoretinal surgery with 23 gauge transconjunctival pars plana vitrectomy technique using xenon light source Material and Methods: One hundred thirty five eyes of 135 patients undergoing 23 gauge transconjunctival pars plana vitrectomy using XENON light source were included into the study between the January 2010 and December 2010 in the Kocatepe University Department of Ophthalmology. After the retrospective review of the files of all the patients who underwent vitreoretinal surgery with 23 gauge transconjunctival pars plana vitrectomy, age, gender, indication for surgery, type of anesthesia, anatomical success, operation time, complications, and type of intraocular tamponade were analyzed. Results: Patients were consisted of 62 men (45.9%) and 73 women (54.1%). Mean age was 52.4±12.23 years. The anatomical success rate in patients who have underwent 23 gauge transconjuntival pars plana vitrectomy with XENON light source was quite high with 134 patients who had achieved anatomically successful outcome except one patient in whom anatomical success could not be obtained. Mean operation time was 65.56±25.78 minute. In 58 (43%) of operations, any intraocular tamponade was not used. In the remaining eyes, silicon tamponade was used in 46 eyes (34%), air in 11 eyes (8.1%), C3F8 gas in 10 eyes (7.4%) and SF6 gas in 10 eyes (7.4%). The complications developed during the pars plana vitrectomy using XENON light source were iatrogenic retinal tear in 10 patient (7.4%), choroid detachment in one patient (0.7%), suprachoroidal hemorrhage in one patient (0.7%). In the remaining eyes (91%), no complication developed during the operation. No anesthesia related complication occurred in none of the patients. Conclusion: XENON light source may provide sufficient illumination with higher quality of image to perform 23 gauge small incision transconjunctival pars plana vitrectomy within shorter operation times by avoiding severe intraoperative complications