Jeden z gigantów neurochirurgii odszedł od nas ponad dekadę temu, a w literaturze neurochirurgicznej nie poświęcono mu większej uwagi

One of the giants of neurological surgery left us over a decade ago. Charles George Drake died September 15, 1998 in London, Ontario after an extended bout with lung cancer. Although he will always be identified with taking posterior fossa aneurysm surgery from the realm of the daring to the domain of the routine, his contributions were much broader. Clinical neurosciences have been blessed in the past century by the life and works of Drake. In the neurosurgical world, the achievements of Drake are very well known and have been well recorded. Unfortunately, in the past decade since his passing, only one paper has been published about him and his contributions to neurosurgery. This is a historical paper regarding Charles George Drake that attempts to (1) remember Drake as a pioneer; (2) to evaluate lessons that we have learned from him; and (3) to address the question ‘What made him great?’. As per Drake's teachings, this paper is meant to articulate the unique perspectives Charlie provided with respect to how we learn our craft, maintain the integrity of reporting, and implement suggestions as to how we may progress into the future. In conclusion, it is our hope that this paper will bring to life the unique character of Drake and his unprecedented blend of genius, creativity, technical skill, introspection, and ever-present humility for all international neurosurgeons to appreciate.Charles George Drake, jeden z gigantów neurochirurgii, zmarł przed ponad 10 laty. Chociaż jego nazwisko będzie zawsze kojarzone z wprowadzeniem do praktyki chirurgicznego leczenia tętniaków tylnego dołu czaszki, wkład Drake'a w neurochirurgię jest znacznie szerszy. Niestety, w ciągu dekady od jego odejścia opublikowano tylko jeden artykuł poświęcony jego życiu i wkładowi w neurochirurgię. Niniejszy historyczny artykuł dotyczący Charlesa George'a Drake'a podejmuje próbę upamiętnienia go jako pioniera, poddania ocenie pozostawionej przez niego spuścizny i odpowiedzi na pytanie, co uczyniło go wielkim. Mamy nadzieję, że artykuł ten przybliży środowisku neurochirurgów wyjątkowy charakter Drake'a i cechujące go bezprzykładne połączenie geniuszu, kreatywności, sprawności technicznej, wglądu i nieodłącznej skromności

Management of priapism: Results of a nationwide survey and comparison with international guidelines

Objective: The aim of this study is to evaluate current urologic practice regarding the management of priapism in Turkey and compare with international guidelines. Methods: Urologists and urology residents were invited to an online survey consisting of 30 multiple-choice questions on priapism-related clinical practices that were considered most important and relevant to practices by using Google Forms. Results: Total number of responses was 340. Respondents reported that they recorded a detailed patient’s medical history and physical examination findings (n = 340, 100%) and laboratory testing, which includes corporal blood gas analysis (n = 323, 95%). Participants announced that they performed Doppler ultrasound for 1/4 cases (n = 106, 31%), but 22% of the participants (n = 75) replied that they performed in >75% of cases. Participants (n = 311, 91%) responded that the first-line treatment of ischemic priapism is decompression of the corpus cavernosum. Moreover, most respondents (n = 320, 94%) stated that sympathomimetic injection drugs should be applied as the second step. About three-quarters of respondents (n = 247, 73%) indicated adrenaline as their drug of choice. Phosphodiesterase type 5 inhibitors seems to be the most preferred drug for stuttering priapism (n = 141, 41%). Participants (n = 284, 84%) replied that corpora-glanular shunts should be preferred as the first. A large number of participants (n = 239, 70%) declared that magnetic resonance imaging can be performed in cases with delayed (>24 hours) priapism to diagnose corporal necrosis. Most of the participants (84%) responded that penile prosthesis should be preferred to shunts in cases with delayed (>48 hours) priapism. Conclusion: It would be appropriate to improve the training offered by professional associations and to give more training time to the management of priapism during residency

Acute cholangitis and pancreatitis caused by fasciola hepatica: a case report

Fasciola hepatica Türkiye'de endemik bir parazittir. Bu parazit genellikle sığır ve koyunlarda enfeksiyona yol açar. Ancak endemik bölgelerde insanlar, kontamine içme suyu ve sebze tüketimi nedeni ile bu parazit için tesadüfen konak olabilmektedir. Kronik Fasciola hepatica infeksiyonu biliyer obstrüksiyon ve inflamasyona neden olmaktadır. Aynı zamanda, biliyer fasciolosis asemptomatik de olabilir. Bu gibi olgularda teşhiste ERCP önemli rol oynar ve güvenle kullanılmaktadır. Özellikle endemik bölgelerde konvansiyonel yöntemlerle etkeni saptanamayan olgularda Fasciola hepatica gibi paraziter enfestasyonlar akla gelmelidir. Bu çalışmada, Fasiola hepatikanın sebep olduğu bilier obstrüksiyona sekonder tıkanma sarılığı ile başvuran 37 yaşında bayan hasta sunulmaktadır. Hasta bulantı, kusma, karın ağrısı ve sarılık şikayeti ile acil polikliniğine başvurdu. Akut kolonjit ve pankreatit tanısı konulan hastaya ERCP yapıldı. ERCP' nin başarılı olmaması üzerine ameliyata alınan hastaya kolesistektomi ve koledok eksplorasyonu yapıldı. Safra kesesi ve koledok içerisinden parazit çıkartılan hasta, postoperatif dönemde şifa ile taburcu edildi.become a host of this parasite by ingesting contaminated water and plants in endemic areas. Chronic Fasciola hepatica infestation is known to cause biliary obstruction and inflammation. Also, biliary fasciolosis may be asymptomatic. ERCP plays an important role in the diagnosis of the disease and can be used safely in these cases. Especially in cases that could not be diagnosed by conventional methods, parasitic infestations such as Fasciola hepatica should be kept in mind, in endemic areas. We report a case of a 37-year-old lady with obstructive jaundice secondary to biliary obstruction with Fasciola hepatica. Our patient admitted to the emergency unit with the compliants, nausea, vomiting, abdominal pain and jaundice. An ERCP recommended because of acute cholangeitis and pancreatitis. ERCP coluldn't performed effectively, so the case operated, and cholecystectomy and choledoc exploration performed. In the operation, the parasites removed from the gall bladder and common bile duct. Our patient discharged after hospital care postoperatively without any complication

Toxic Anterior Segment Syndrome following Phacoemulsification Secondary to Overdose of Intracameral Gentamicin

Objective. To report a case of toxic anterior segment syndrome (TASS) that was caused by inadvertent anterior chamber and cornea stromal injection with high dose gentamicin following cataract surgery. Methods. Case report. Results. We report a 72-year-old female patient who developed TASS that was caused by high dose gentamicin (20 mg/0.5 mL), which was inadvertently used during the formation of the anterior chamber and hydration of the corneal incision. Unlike previous cases, hyphema and hemorrhagic fibrinous reaction were seen in the anterior chamber. Despite treatment, bullous keratopathy developed and penetrating keratoplasty was performed. The excised corneal button was sent for histopathological examination. Conclusions. Subconjunctival gentamicin is highly toxic to the corneal endothelium and anterior chamber structures. Including it on the surgical table carries a potentially serious risk for contamination of the anterior chamber

The efficacy of fibrin glue to control hemorrhage from the gallbladder bed during laparoscopic cholecystectomy

Amaç: Laparoskopik kolesistektomi sırasında safra kesesi yatağından gelişen ve klasik yöntemlerle durdurulamayan kanamalarda fibrin yapıştırıcı uygulama deneyimimizi sunmak.Gereç ve Yöntemler: Laparoskopik kolesistektomi uygulanan 382 hastadan, safra kesesi yatağında kanama meydana gelen ve konservatif yöntemlerle durdurulamayan ve bu nedenle de fibrin glue kullanılan 14 hasta retrospektif olarak incelendi.Bulgular: Fibrin yapıştırıcı kullanılan hastaların 10'u (%71) kadın, 4'ü (%29) erkekti. Hastaların ortalama yaşı 55,7 idi. 14 hasta da semptomatik safra kesesi taşı nedeniyle ameliyat edildi. On üç hastada (%92) yandaş bir hastalık mevcuttu. Kanamanın kontrol altına alınarak hemostazın sağlanması için harcanan zaman ortalama olarak 23,9 dakika olarak saptandı. Hemoglobin değeri 8 mg/dL altına düşen 2 hastaya kan transfüzyonu yapıldı. Bir hastada fibrin yapıştırıcı kullanılmasına rağmen kanama kontrolü sağlanamadı ve açık cerrahiye geçildi.Sonuç: Laparoskopik kolesistektomi yapılan hastalarda, karaciğerde safra kesesi yatağından meydana gelen kanamalarda fibrin yapıştırıcı uygulanmasının açığa geçme oranlarını düşürdüğü saptanmış olup bu konu ile ilgili daha geniş çalışmalara da ihtiyaç duyulmaktadırObjective: The aim of the study is to report our experience with fibrin glue application in the management of bleeding from the gallbladder bed during laparoscopic cholecystectomy, which could not be controlled by conventional methods.Material and Methods: Three hundred eighty-two patients underwent laparoscopic cholecystectomy. Fourteen patients with bleeding from the gallbladder bed, which could not be controlled by conventional methods, were analyzed retrospectively.Results: Fibrin glue was used in 10 patients, 6 (71%) were female and 4 were (29%) male. The mean age was 55.7 years. Fourteen patients were operated for the presence of symptomatic gallstones. Thirteen patients (%92) had a concomitant pathology. The mean time spent to maintain hemostasis was 23.9 minutes . Blood products were used in two patients with hemoglobin under 8 mg/dL. Hemostasis could not be achieved in a patient despite fibrin glue application, and the operation was converted to open surgery. Conclusion: The application of fibrin glue for bleeding from the gallbladder bed during laparoscopic cholecystectomy can reduce conversion rates, further studies including more patients are require

Factors Effecting Morbidity And Mortality in Obstructing Colorectal Cancers

Aim:The aim of this study is sharing the morbidity and mortality rates and risc factors efecting the morbidity and mortality rates of patients underwent emergency operation in our clinic.Materials and Methods:Between January 2008 - July 2012 eighteen patients, 10 men and 8 women, who operated because of obstructive colorectal cancer, were reviewed. Patients were examined fora ge, sex, complication, operation type, morbidity and mortality. The effects of age, sex and tumor location on morbidity and mortality were examined.Results:Mean age of patients was 66 ± 8,6. Ten patients were elder than 70 (% 56,6). Complet obstruction was seen in 16 patients (% 88,8). In one patient perforation was seen wtih obstrucion (% 5,6). Hartmann’s procedure was performed for 12 patients (% 66,7), loop colostomy was performed for two patients (% 11,2), right hemicolectomy was performed for two patients (% 11,2), total colectomy with ileorectal anastomosis was performed for 1 patient (% 5,6), right hemicolectomy with end ileostomy was performed for 1 patient (% 5,6). Morbidity was seen in 5 patients (% 27,8). Mortality was seen in two patients (% 11,2). Both patients with mortality were elder than 70 (p=0.21). There weren’t any significant difference for sex and tumor’s location.Conclusion:Morbidity and mortality rates increases in patients whom underwent emergency surgery for obstructive colorectal cancer. Being elder patient is one of the reasons. And also accompanied complications like perforation searously increase mortality and morbidity

Factors Effecting Morbidity And Mortality in Obstructing Colorectal Cancers

Bu çalışmanın amacı obstrüksiyon yapmış kolorektal kanserler nedeniyle kliniğimizde acil şartlarda ameliyat edilen hastalardaki morbidite ve mortalite oranlarını ve bunlara etki eden faktörleri sunmaktır. Materyal ve Metod Ocak 2008 - Temmuz 2012 yılları arasında mekanik bağırsak tıkanıklığına neden olmuş kolorektal kanser nedeniyle ameliyat edilen 10 erkek ve 8 kadın olmak üzere 18 hasta retrospektif olarak değerlendirildi. Hastalar yaş, cinsiyet, komplikasyon, yapılan ameliyat, morbidite, mortalite açısından incelendi. Yaşın, cinsiyetin ve tümör yerleşiminin morbidite üzerine olan etkileri incelendi. Bulgular Hastaların yaş ortalaması 66 ± 8,6 idi. 70 yaş üzerinde 10 (% 56,6) vardı. Hastaların 16’sında komplet bir obstrüksiyon izlendi (% 88,8). Bir hastada obstrüksiyonla beraber perforasyon mevcuttu (% 5,6). On iki hastaya Hartmann prosedürü (% 66,7) uygulanırken, 2 hastaya loop kolostomi (% 11,2), 2 hastaya sağ hemikolektomi (% 11,2), 1 hastaya total kolektomi ileorektal anastomoz (% 5,6), 1 hastaya sağ hemikolektomi uç ileostomi (% 5,6) uygulandı. Beş hastada morbidite izlendi (% 27,8). İki hastada mortalite izlendi (% 11,2). Morbidite görülen tüm hastalar 70 yaş üzerindeydi (p=0.21). Cinsiyete göre ve tümörün yerleşim yerine göre ise morbidite oranları açısından anlamlı fark yoktu. Sonuç Obstrüktif kolorektal kanser nedeniyle acil operasyona alınan hastalarda mortalite ve morbidite izlenme olasılığı artmaktadır. Bunun nedenlerinden birisi hastaların daha çok ileri yaşlarda olmalarıdır. Ayrıca hastalarda perforasyon gibi eşlik eden bir komplikasyon varlığı mortalite ve morbiditeyi ciddi ölçüde arttırmaktadır.Aim The aim of this study is sharing the morbidity and mortality rates and risc factors efecting the morbidity and mortality rates of patients underwent emergency operation in our clinic. Materials and Methods Between January 2008 - July 2012 eighteen patients, 10 men and 8 women, who operated because of obstructive colorectal cancer, were reviewed. Patients were examined fora ge, sex, complication, operation type, morbidity and mortality. The effects of age, sex and tumor location on morbidity and mortality were examined. Results Mean age of patients was 66 ± 8,6. Ten patients were elder than 70 (% 56,6). Complet obstruction was seen in 16 patients (% 88,8). In one patient perforation was seen wtih obstrucion (% 5,6). Hartmann’s procedure was performed for 12 patients (% 66,7), loop colostomy was performed for two patients (% 11,2), right hemicolectomy was performed for two patients (% 11,2), total colectomy with ileorectal anastomosis was performed for 1 patient (% 5,6), right hemicolectomy with end ileostomy was performed for 1 patient (% 5,6). Morbidity was seen in 5 patients (% 27,8). Mortality was seen in two patients (% 11,2). Both patients with mortality were elder than 70 (p=0.21). There weren’t any significant difference for sex and tumor’s location. Conclusion Morbidity and mortality rates increases in patients whom underwent emergency surgery for obstructive colorectal cancer. Being elder patient is one of the reasons. And also accompanied complications like perforation searously increase mortality and morbidity

Relations between castration and male and female rat's bladder wall, trigon and proximal urethra on endothelial, inducible and neuronal nitric oxide levels

Amaç: Kastrasyonun alt üriner sistem dokuları (mesane, trigon ve üretra) üzerinde olan etkilerini nitrik oksit düzeyinde araştırmak ve daha sonra kastrasyon uygulanan hastalarda fosfodiesteraz inhibitörleri ile ilgili yapılacak klinik çalışmalara ışık tutmak ve alt üriner sistem semptomlarının gelişiminde belirgin rolü olan testosteron ve nitrik oksit arasındaki muhtemel ilişkilere kapı aralamaktır. Gereç ve Yöntem: Bu çalışmada toplam 32 adet albino spraque dowley cinsi rat kullanıldı. Ovariektomi, orşiektomi yapılan ve kontrol grubutüm hayvanlardan farklı dokular etiket kod numaraları ve grup adları verilerek içinde % 10'luk formaldehitbulunan ve ağzı sızdırmayan özel şişelere bırakıldı. Histopatolojik ve immünohistokimyasal inceleme icin nitrik oksit antikorları ile boyama yapmak amacıyla alınan mesane ve üretra dokuları rutin takip işlemlerden geçirilip bloklandı. Bloklanan dokular 4-5 mikron kesitlerinde kesilip nitrik oksit antikorları ile boyanıp uygun görülen yerler fotoğraflandı. Bulgular: Kontrol ve kastre rat grupları arasında eNOS ve nNOS aktivitesi açısından mesane gövde ve trigon bölümünde yapılan histolojik ve immünhistokimyasal boyamalarda anlamlı sonuçlar elde edilmiştir. iNOS açısından anlamlı veriler bulunamamıştır. Kontrol ve orşiektomize rat gruplarında eNOS ve nNOS aktivitesi için proksimal üretrada yapılan histolojik ve immünhistokimyasal boyamalarda anlamlı sonuçlar elde edilmiştir. Dişi rat gruplarında üretra kısa olması nedeniyle net doku elde edilememiştir. Sonuç: Yapılan çalışmada istatistiksel anlamlı sonuçlar elde edilmiş olup NO ve NOS enzim çeşitlerinin mesane ve üretrada kastrasyondan etkilendiği gözlenmiştir. Sonuç olarak aşırı aktif mesane veya alt üriner sistem semptomlarının tedavisinde yer alması için bu çalışmalar ürodinamik verilerle desteklenmeli ve sonrasında tedavi yolunda umut ışığı olmaya devam etmelidir. Klinik olarak NO bazındaki mekanizmalar normal miksiyonun korunmasında ve üriner inkontinansta önemli olabilir. Bu mekanizmaların pelvik cerrahi veya spinal yaralanmalar sonrası gelişen işeme disfonksiyonu ve inkontinansın kısmi sorumlusu olabilir. Bu sorumluluk ileri çalışmalar ile daha da desteklenirse bu alanlardaki tedavi seçeneği olarak NOS agonistleri veya NO donörleri tedavideki yerini bulabilir. Objective: To investigate the effects of castration to nitric oxide levels in lower urinary tract tissues (bladder, trigone and urethra), and then shedding light on clinical trials in patients undergoing castration to be associated with phosphodiesterase inhibitors. We aimed to illuminate testosterone significant role in the development of lower urinary tract symptoms and possible relationship between nitric oxide. Material and Method: In this study, a total of 32 albino Sprague Dawley rats were used. The different tissues which taken from ovariectomy, orchiectomy was performed and all the animals of the control group was left to special tube in which 10% formaldehyde found in label given code numbers and group names. Histopathological and immunohistochemical examination of the bladder and urethra taken to make tissue staining with nitric oxide antibodies were blocked after passed from routine procedures. Justified stained tissues were photographed and where appropriate nitric oxide antibodies cut in 4-5 micron sections. Results: In control and castrated rat groups significant results in histological and immunohistochemical staining of trigone of the bladder and body section in terms of eNOS and nNOS activity were obtained. There are no significant data in terms of iNOS. In control and orchiectomy rats groups made eNOS and nNOS activity in the proximal urethra for histological and immunohistochemical staining were obtained significant results. In female rats group tissue could be obtained due to the shorter urethra. Conclusion: In the study are statistically significant results were obtained in NO and NOS types of bladder and urethra were affected by castration. As a result, to take place in the treatment of overactive bladder or lower urinary tract symptoms, these studies should be supported by urodynamic data and then could continue to be a glimmer of hope on the way of treatment. NO mechanisms may be clinically important in maintaining normal urination and urinary incontinence. These mechanisms may be partly responsible for voiding dysfunction and urinary incontinence which developed after pelvic surgery or spinal injuries. Thus, in this cases if further studies supports these findings the treatment can be possible with NOS agonists or NO donor

The Effect of Different Metabolic Syndrome: Definitions on the Relationship Between Metabolic Syndrome and LUTS in Men With Benign Prostatic Enlargement

WOS: 000391542300018PubMed: 26993995Because various criteria are used to define metabolic syndrome (MetS), this study examines the most relevant definition for patients with benign prostatic enlargement (BPE). Most studies regarding the link between MetS and BPE/ lower urinary tract symptoms (LUTS) have used the National Cholesterol Education Program Adult Treatment Panel III criteria for diagnosis, while a few have used criteria from the International Diabetes Federation and/or American Heart Association. Patients with LUTS due to BPE are classified as having MetS or not by the aforementioned three definitions. Prostate volume, International Prostate Symptom Score, storage and voiding subscores, maximum urinary flow rate, and the postvoid urine of patients with and without MetS were compared separately in the three different groups. Surgical and medical treatment prevalence was also compared between three groups. No matter which definition was used, the International Prostate Symptom Score, the storage and voiding symptom scores, prostate volume, prostate-specific antigen, and postvoid urine were significantly higher in the patients with MetS. the maximum urinary flow rate was similar between patients with and without MetS, according to all three different definitions. There was no significant difference in the aforementioned parameter between patients with MetS diagnosed with the three different definitions. Irrespective of which definition was used, the surgical treatment rate was not significantly different in patients diagnosed with than without MetS, or between the patients with MetS diagnosed with the three different definitions. the authors suggest that it does not matter which of the aforementioned three definitions is used during the evaluation of MetS in men with BPE/LUTS

CT-Based Determination of Ureteral Stone Volume: A Predictor of Spontaneous Passage

WOS: 000367996100006PubMed: 26207417Introduction and Objectives: Which ureteral stone can pass spontaneously? It is hard to answer this question exactly. the size and location of the stone are the most important predictors. However, there is still a considerable gray zone that needs to be clarified. We try to identify the role of stone volume (SV) in the prediction of spontaneous passage (SP). Materials and Methods: Seventy-eight patients with a solitary ureteral stone were retrospectively evaluated. Ureter SV measurements were taken in three planes and were calculated using the following formula: V=(X)x(Y)x(Z)x0.52. SVs, and the longest diameters (LDs) were compared between patients who passed stones spontaneously and those who needed intervention. Results: the SVs and LDs were significantly lower in patients who passed stones spontaneously than in patients who required intervention (41.235.5 vs 128.1 +/- 91.1mm(3), p=0.001; 5.7 +/- 1.8 vs 7.4 +/- 1.7mm, p=0.001). the optimum cutoff values were 7.0mm and 52.6mm(3) for the LD and SV, respectively. For those stones of 7mm, the volumes of the stones that could and could not pass did not differ significantly. However, the volume of the stones >7.0mm that could pass was significantly higher than of those that could not. SP was 30.6% for stones >7mm; however, when we removed the stones >52.6mm(3), SP increased to 75% for stones higher than 7mm (p=0.001). Conclusions: To classify ureteral stones using only one parameter such as stone diameter may lead to heterogeneity within the group. SV may be used in addition to size to determine a more definite homogeneous group to predict SP more precisely