Aim. To investigate the effect of magnesium administered to the operative region muscle and administered systemically on postoperative analgesia consumption after lumbar disc surgery. Material and Method. The study included a total of 75 ASA I-II patients aged 18–65 years. The patients were randomly allocated into 1 of 3 groups of 25: the Intravenous (IV) Group, the Intramuscular (IM) Group, and the Control (C) Group. At the stage of suturing the surgical incision site, the IV Group received 50 mg/kg MgSO4 intravenously in 150 mL saline within 30 mins. In the IM Group, 50 mg/kg MgSO4 in 30 mL saline was injected intramuscularly into the paraspinal muscles. In Group C, 30 mL saline was injected intramuscularly into the paraspinal muscles. After operation patients in all 3 groups were given 100 mg tramadol and 10 mg metoclopramide and tramadol solution was started intravenously through a patient-controlled analgesia device. Hemodynamic changes, demographic data, duration of anesthesia and surgery, pain scores (NRS), the Ramsay sedation score (RSS), the amount of analgesia consumed, nausea- vomiting, and potential side effects were recorded. Results. No difference was observed between the groups. Nausea and vomiting side effects occurred at a rate of 36% in Group C, which was a significantly higher rate compared to the other groups (p < 0.05). Tramadol consumption in the IM Group was found to be significantly lower than in the other groups (p < 0.05). Conclusion. Magnesium applied to the operative region was found to be more effective on postoperative analgesia than systemically administered magnesium.

ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.

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AIm: Acromegaly is a chronic disorder characterized by enhanced growth hormone (GH) secretion and elevated insulin-like growth factor-I (IGF-I) levels, usually caused by pituitary adenomas. In this retrospective study, we reviewed our experience with endoscopic endonasal transsphenoidal surgery (EETS) with in remission rates using the 2010 consensus criteria, predictors of remission and associated complications. mATERIAl and mEThods:The authors retrospectively analyzed data from 56 acromegalic patients who underwent pure EETS. Tumors were classified according to size and suprasellar/parasellar extension. The criteria of remission were GH levels < 1 ng/mL randomly, < 0.4 ng/mL after oral glucose tolerance test and normal IGF-I levels for age and sex within the first 3 and 6 months after surgery. REsulTs:Biochemical remission was achieved in 4 of 5 microadenomas (80%) and in 33 of 51 macroadenomas (64.7%). The total remission rate was 66.1% (37 of 56 adenomas). Age, gender and suprasellar extension did not affect the remission rate. However, cavernous sinus invasion, sphenoid sinus invasion and history of prior surgery were associated with lower rates of disease control.CoNClusIoN: EETS represents an effective and safe option for the treatment of patients with acromegaly. High disease control rates and a small number of complications are some of the most important points related to the technique.KEywoRds: Acromegaly, Endoscopic transsphenoidal surgery, Remission, Predictive factors ÖZ AmAÇ: Akromegali genellikle hipofiz adenomuna bağlı gelişen büyüme hormonu (GH) aşırı salınımı ve yükselmiş insülin benzeri büyüme faktörü-1 (IGF-I) ile karakterize kronik bir hastalıktır. Bu retrospektif çalışmada, 2010 remisyon kriterleri kullanılarak endoskopik endonazal transsfenoidal cerrahi (EETC) ile tedavi edilen akromegali hastalarında remisyon oranı, remisyonu etkileyen faktörler ve ilgili komplikasyonlar sunuldu. yÖNTEm ve GEREÇlER: Pür EETC ile tedavi edilmiş 56 GH salgılayan hipofiz adenomu tanılı hastalar retrospektif olarak incelendi. Adenomlar boyutlarına göre mikro/makroadenom olarak ve suprasellar/parasellar yönelimlerine göre sınıflandırıldı. Hastalığın remisyon kriterleri olarak, rastgele bakılan GH düzeyi < 1 ng/mL, oral glukoz tolerans testi sonrası GH düzeyi < 0,4 ng/mL ve cerrahi sonrası ilk 3-6 ay arasında bakılan IGF-I düzeyinin yaşa ve cinsiyete gore normal olması kabul edildi.BulGulAR: 5 mikroadenomun 4'ünde (%80), 51 makroadenomun 33 (%64,7) ünde remisyon sağlandı. Hastaların tümü incelendiğinde, remisyon oranı 56 hastada 37 (%66,1) olarak bulundu. Yaşın, cinsiyetin ve suprasellar büyümenin remisyon oranlarına etkisinin olmadığı görüldü. Ancak daha önce cerrahi geçirmiş olmak, kavernöz sinüs ve sfenoid sinüs invazyonunun remisyon oranlarını azalttığı saptandı. soNuÇ: EETC, akromegalinin tedavisinde etkili ve güvenli bir yöntemdir. Bu teknikle yüksek başarı ve düşük komplikasyon oranlarına ulaşmak mümkündür.

This study shows that Catechin and its derivatives have a protective effect on peripheral nerve injury.

AIm: To assess the incidence, hormonal activity and postoperative follow up of the cases that are histopathologically diagnosed as atypical pituitary adenoma (APA) in our series. results:In histological studies, 133 cases were diagnosed as typical pituitary adenoma (91.1%) and 13 cases were APAs (8.9%) of which 10 were male (76.9%) and 3 were female (23.1%), ranged between 27 and 80 (mean 52.7) ages. Histopathological distribution of APAs was 9 nonsecretory adenomas (69.3%), 3 prolactinomas (23.1%) and 1 somatostatinoma (7.6%). Asymptomatic pituitary apoplexy was diagnosed in 4 cases (30.7%). Eleven cases of typical pituitary adenomas (8.2%) and 5 cases of the atypical pituitary adenomas (38.4%) were re-operated due to tumor recurrences.COnClusIOn: Accurate histopathological examination shows that atypical pituitary adenoma is not a rare disease. Although it is not the only determinant, APAs are more prone to recurrence than typical adenomas. In our opinion, if total resection is not possible for the patients with APA, close postoperative follow up and additional curative therapy modalities are needed.

A 47-year-old woman was admitted with complaints of progressive weakness in the lower extremities and pain in the back and left leg. Thoracic magnetic resonance imaging (MRI) revealed a spinal intramedullary tumor between the T9 and L1 levels, which were iso- to hypointense on T2 and slightly hyperintense on T1-weighted images. The tumor was resected as total, and the diagnosis was malignant melanoma confirmed with histopathology. Neurological findings improved at the postoperative period and no residual or recurrence was noted on postoperative MRI at the 9-month follow-up. Primary melanoma of the spinal cord, particularly intramedullar localization, is seldomly reported in the literature. We report a primary malignant melanoma of the spinal cord and emphasize the diagnostic and prognostic challenges.

Pseudotumor cerebri (idiopathic intracranial hypertension) is a syndrome characterized by intracranial pressure elevation and associated signs and symptoms in the absence of a space-occupying intracranial lesion. The most common symptoms are visual loss and headache. Sometimes, surgical therapy is needed in patients who have no apparent response to medical therapy and exhibit a progressive course. Optic nerve decompression is an effective and recommended treatment approach for patients with pseudotumor cerebri in whom visual loss predominates. With the growing experience with endoscopic skull base approaches, this method has begun to be used as an alternative and effective treatment modality. In this study, we aimed to present the outcome of endoscopic endonasal optic nerve decompression and to review the literature on this treatment modality in 2 patients diagnosed with pseudotumor cerebri that was unresponsive to medical therapy and associated with progressive visual loss.