Ruptured Anterior Communicating Artery Aneurysm Causing Bilateral Oculomotor Nerve Palsy : A Case Report

A rare case of bilateral third cranial nerve palsy due to a ruptured anterior communicating artery aneurysm is presented. A 68-yr-old woman was semicomatose with bilaterally fixed dilated pupil, abducted eyes, and ptosis. A computed tomography demonstrated extensive hemorrhage spreading around the both Sylvian and interhemisheric fissure without focal mass effect. Intracranial pressure via extraventricular drainage before surgery was 15-50 mmHg. Three months later, brain MRI showed infarction of left posterior cerebral artery territory and lacuna infarction of the pons. Eleven months after aneurysm repair, nerve palsy improved slowly and recovered partially. The patient communicated well with simple words. The author reviewed and discussed the possible mechanism of this rare neuro-ophthalmological manifestation in view of a false localizing sign

Textiloma: a case of foreign body mimicking a spinal mass

Items such as cotton or gauze pads can be mistakenly left behind during operations. Such foreign materials (called textilomas or gossypibomas) cause foreign body reaction in the surrounding tissue. The complications caused by these foreign bodies are well known, but cases are rarely published because of medico-legal implications. Some textilomas cause infection or abscess formation in the early stage, whereas others remain clinically silent for many years. Here, we describe a case of textiloma in which the patient presented with low-back pain 4 years after lumbar discectomy. Imaging revealed an abcess-like mass in the lumbar epidural space

Unilateral congenital elongation of the cervical part of the internal carotid artery with kinking and looping: two case reports and review of the literature

Unilateral and bilateral variation in the course and elongation of the cervical (extracranial) part of the internal carotid artery (ICA) leading to its tortuosity, kinking and coiling or looping is not a rare condition, which could be caused by both embryological and acquired factors. Patients with such variations may be asymptomatic in some cases; in others, they can develop cerebrovascular symptoms due to carotid stenosis affecting cerebral circulation. The risk of transient ischemic attacks in patients with carotid stenosis is high and its surgical correction is indicated for the prevention of ischemic stroke. Detection of developmental variations of the ICA and evaluation of its stenotic areas is very important for surgical interventions and involves specific diagnostic imaging techniques for vascular lesions including contrast arteriography, duplex ultrasonography and magnetic resonance angiography. Examination of obtained images in cases of unusual and complicated variations of vascular pattern of the ICA may lead to confusion in interpretation of data. Awareness about details and topographic anatomy of variations of the ICA may serve as a useful guide for both radiologists and vascular surgeons. It may help to prevent diagnostic errors, influence surgical tactics and interventional procedures and avoid complications during the head and neck surgery. Our present study was conducted with a purpose of updating data about developmental variations of the ICA. Dissections of the main neurovascular bundle of the head and neck were performed on a total 14 human adult cadavers (10 – Africans: 7 males & 3 females and 4 – East Indians: all males). Two cases of unilateral congenital elongation of the cervical part of the ICA with kinking and looping and carotid stenoses were found only in African males. Here we present their detailed case reports with review of the literature

Factors influencing overall survival rates for patients with pineocytoma

Given its rarity, appropriate treatment for pineocytoma remains variable. As the literature primarily contains case reports or studies involving a small series of patients, prognostic factors following treatment of pineocytoma remain unclear. We therefore compiled a systematic review of the literature concerning post-treatment outcomes for pineocytoma to better determine factors associated with overall survival among patients with pineocytoma. We performed a comprehensive search of the published English language literature to identify studies containing outcome data for patients undergoing treatment for pineocytoma. Kaplan–Meier analysis was utilized to determine overall survival rates. Our systematic review identified 168 total patients reported in 64 articles. Among these patients, 21% underwent biopsy, 38% underwent subtotal resection, 42% underwent gross total resection, and 29% underwent radiation therapy, either as mono- or adjuvant therapy. The 1 and 5 year overall survival rates for patients receiving gross total resection versus subtotal resection plus radiotherapy were 91 versus 88%, and 84 versus 17%, respectively. When compared to subtotal resection alone, subtotal resection plus radiation therapy did not offer a significant improvement in overall survival. Gross total resection is the most appropriate treatment for pineocytoma. The potential benefit of conventional radiotherapy for the treatment of these lesions is unproven, and little evidence supports its use at present

The marine pollution issue in international relations:The Mediterranean Action Plan

The focus of this study is the regional regime established by the Mediterranean states for the protection of the marine environment. As a case study on the current practice of states related to environmental protection, the character of the environmental issue in international relations, the definition of the problem in the Mediterranean Region, the identification of convergent and divergent state interests, and the structure and attributes of the regional regime are analysed. The problem of state compliance is dealt with along with the effects of other institutions of dealing with the issue of marine pollution on the development of the rules of the MAP. The compliance of coastal states with the regime are explored as indicators of regime effectiveness, growth and durability

Mikronöroşirürjide Laboratuvardan Pratiğe

Laboratuvar mikrocerrahi çalışmaları gerek mikrocerrahi ile uğraşan tıp branşlarında çalışacak hekimlerin el becerilerini geliştirmelerine ve ana­tomiyi öğrenmelerine olanak sağlayan, gerekse farklı disiplinler için ge­rekli deneysel çalışmaları yaparak bilimsel yeni veriler elde edilebilme­sine imkan veren son derece önemli bir eğitim ve öğretim konseptidir. Laboratuvarda çalışmaya başlamadan önce nasıl çalışacağını bilmek ve bir program dahilinde çalışmak başarılı bir sonuç elde etmek için şarttır. Tecrübeli bir eğitmenin gerek teorik gerekse pratik yönde yapacağı kat­kı laboratuvarda çalışan kişiye olumlu anlamda önemli destek verecektir. Bu kitabın oluşturulmasındaki amaç öncelikle tıp fakültesi öğrencilerini laboratuvar çalışmalarına teşvik etmek ve mikrocerrahi yöntemleri kul­lanacak nöroşirürji ve diğer cerrahi branş asistanlarının temel laboratu­var pratiğini hızlı ve görsel bir anlatımla öğrenmelerini sağlamaktır. Ay­rıca, bu kitap içerisinde, mikrocerrahi ile uğraşan her hekimin her dö­nem hatırlamasında ve gözden geçirmesinde yararlı olabilecek bilgiler bulunduğunu düşünmekteyiz. Kitabın hazırlanması esnasında, özellikle şekillerin çizimi ve tasarımı­nın oluşturulması konusunda bizlere destek veren Sayın Yük. Mim. Dr. Gökçe Önal'a, kitabın birinci bölümüne katkılarından dolayı Sayın Vet. Dr. İlyas Onbaşılara teşekkür ederiz. Yine, kitabın basılması için bizle­re desteğini esirgemeyen Hacettepe Üniversitesi Rektörü Sayın Prof. Dr. Uğur Erdener'e ve teknik destek ve basım aşamasındaki katkı ve yardım­larından dolayı Hacettepe Hastaneleri Basım Yayın ve Tanıtım Koordi­natörü Sayın Uğur Korkmaz, Sayın İkbal Başarısoy, Sayın Özge Rojda Yorulmaz Benzil ve tüm ekibe ayrıca teşekkür eder, kitabın okuyucuya beklenilen katkıyı vermesini dileriz