This study aimed to report the authors' single-center clinical experience about craniopharyngiomas and discuss surgical outcomes of these patients according to the type of surgical approach (endoscopic endonasal or open microscopic transcranial approach).Twenty-four patients diagnosed with craniopharyngiomas between May 2013 and April 2017 were considered for inclusion. The patients were divided into 2 groups according to the surgical approach (open transcranial microscopic approach [group A] and endoscopic endonasal approach [group B]). These groups were compared in terms of postoperative surgical outcome scores (extent of tumor removal, visual deficit, hydrocephalus, metabolic disorders, and Glasgow coma scale) and hospitalization interval.There was no patient of mortality in both groups. In this study, 4 of the 13 patients in group A and 9 of the 11 patients in group B underwent gross total resection. However, 1 patient in group B underwent repair because of cerebrospinal fluid leakage postoperatively. In addition, 1 patient in group A had a wound healing problem postoperatively. The postoperative outcome scores were 9.5 in group A and 11.5 in group B. The hospitalization interval in group A (range, 7-9 days) was longer than that in group B (range, 5-7 days).The endoscopic endonasal approach should be considered the first-line surgical treatment modality in patients with a preliminary diagnosis of craniopharyngioma in terms of low complication risk, minimal invasiveness, and better outcome scores. Open microscopic transcranial procedures may be combined with this approach in a single session for challenging cases.
We outline the key for management of a rare intracranial air entrapment case after an endoscopic odontoidectomy surgery in a pediatric patient and the measures taken to prevent its occurrence in the future.
Öz DRESS Sendromu ateş, cilt döküntüsü, iç organ tutulumu ve hematolojik anormalliklerle karakterize akut başlangıçlı, hayatı tehdit eden, nadir görülen, ilaca bağlı bir aşırı duyarlılık reaksiyonudur. En sık nedeni aromatik antikonvülzan kullanma sonrası görülmektedir. Bu olguda fenitoin kullanımı sonrasında ikinci haftada ateş yüksekliği ve cilt döküntüleri başlayan kırk dört yaşında bir erkek hasta sunulmuştur. Olgu, fenitoin tedavisinin kesilmesi sonrasında sistemik kortikosteroid ve destek tedavisi ile başarılı bir şekilde tedavi edilebilmiştir. Birinci basamakta aile hekimi, hastalarının akut ve kronik sağlık sorunlarını aynı anda yönetebilmelidir. Olgumuzda olduğu gibi akut başlangıçlı ateşe yaklaşımda bir aile hekimi hastasını iyi yönetebilmeli ve beraberinde cilt döküntüleri de gördüğünde kullandığı ilaçları da sorgulayarak DRESS Sendromunu akla getirmelidir. Anahtar Kelimeler: DRESS sendromu, fenitoin, cilt döküntüsü Abstract DRESS syndrome is a life threatening, rare hypersensitivity reaction to drugs with an acute onset that is characterized by fever, skin rash, visceral involvement, and hematological abnormalities. It is often seen after the use of aromatic anticonvulsants. In this article, a forty-four year old male patient with fever and skin rash after two weeks of phenytoin administration is discussed. He has been treated successfully with systemic corticosteroids and supportive therapy after the discontinuation of phenytoin therapy. In first step health-care, the primary physician should be able to administer his patients' acute and chronic health problems concurrently. As in our case, a family physician should administer his patient well in the presence of fever with acute onset and he should question about the drugs used in the presence of accompanying skin rash.
Hans Chiari was the first who defined the term Chiari malformation (CM) in 1891, specifying the malformation of varying degrees of the descent of the brain stem and cerebellum below the foramen magnum (FM). 1 The most common form of CM is type I, the elongation of the tonsils of the cerebellum into the upper cervical canal. The most common form of CM is type I, the elongation of the tonsils of the cerebellum into the upper cervical canal. The most common symptoms reported by CM-I patients are suboccipital headaches, dizziness and cervical pain may also guide the practitioner to such a diagnosis. 2 The prevalent belief is that CM-I could result from an intrinsically smaller overcrowded posterior fossa that predisposes the upper cervical spine to eventual herniation of the cerebellar tonsils, resulting
Üst ekstremitede en sık görülen periferik sinir tuzaklanması el bilek bölgesinde median sinir tuzaklanmasıdır ve karpal tünel sendromu (KTS) olarak adlandırılır. Tanı; anamnez, fizik muayene, Boston skala (fonksiyonel ve duyusal skorlama) ve EMG ile konmaktadır. Cerrahi tedavi kararı verilmesinde; ameliyat öncesi ve sonrasının klinik ve/veya semptomların karşılaştırılmasında skorlama sistemi önemlidir. Çalışmamızda KTS tanısı alan hastaların ameliyat öncesi provakatif testler (Falen ve Tinel testi) ve Boston skalası ile ameliyat sonrası Boston skalasının etkinliği tartışılmıştır. GEREÇ VE YÖNTEM:İnönü Üniversitesi Beyin Cerrahisi kliniğinde 01.01.2016 -01.05.2020 tarihleri arasında KTS tanısı alan toplam 152 hastadan TOS (torasik outlet sendromu), travma ,servikal disk hernisi olmayan 41 hasta dahil edildi. Mini open cerrahi uygulandı. Hastalar; yaş, cinsiyet, taraf bulgusu, EMG, provakatif testler, Boston skalası ve eşlik eden ek hastalıklar açısından değerlendirildi. İstatistiksel olarak Shapiro-Wilk testi, Mann-Whitney U testi, Bağımsız örneklerde t testi, ki-kare testi, Kruskal Wallis testi, Tek Yönlü Varyans analizi kullanıldı. (p<0,05) değeri istatistiksel olarak anlamlı kabul edildi. Analizlerde IBM SPSS Statistics 25.0 programı kullanıldı.BULGULAR: Çalışmaya dahil edilen 41 hastanın, 6'sı (14.6%) erkek, 35'i (85.4%) kadındı. EMG'de orta şiddet 23 hasta (%56,1), ağır KTS 15 hasta (36,6) ve çok ağır 3 hasta (%7,3) tespit edildi. Hastaların ameliyat öncesi ve ameliyat sonrası ortalama Semptom Şiddet Skalası, Fonksiyonel Kapasitesi sırası ile 34±3, 12±2, ve 28±5, 11±3 'dür Tinel testi 25 (%61) hastada pozitif, Falen Testi 22 (%53,7) hastada pozitifti. Ameliyat öncesi Provakif testler, Boston skalası ile ameliyat sonrası Boston skalası arasında istatistiksel olarak anlamlı ilişki saptandı ( p<0,05). SONUÇ: KTS 'de tanı ve / veya tedavide gecikme kas atrofilerine ve fonksiyon kayıplarına neden olmaktadır. Bu hastalık grubunda provakatif testler, boston skalasının iyi tanımlanması cerrahi karar vermede gecikmeyi önleyeceği ve ameliyat sonrası boston skalasının takiplerde yararlı olacağı düşüncesindeyiz.
Objective: Bone mineral density decreases after liver transplantation, and the incidence of vertebral fracture concerning this increase. Vertebral fractures due to bone mineral density increase mortality due to pain, spinal deformity, neurological deficit, and immobility. This study discussed the patients with a vertebral fracture who underwent liver transplantation and received kyphoplasty and conservative treatments to reference clinical treatments.Methods: Among the 2200 patients who underwent liver transplantation between 2002-2020, 65 of the 110 patients underwent spinal Magnetic Resonance Imaging (MRI), and computed tomography (CT) due to back and low back pain had vertebral fractures. Of these 65 patients, 48 were unstable, and 17 were stable vertebral fractures. Patients with stable vertebral fractures were grouped as conservative (n=9) and balloon kyphoplasty (n=8), as these groups compared the following parameters: age, sex, bone densitometry, laboratory findings (Ca, P), vertebral fracture levels, cigarette, high blood pressure, alcohol use, pre-operation, and post-operation 20th-day Visual Analogue Scale scores.Results: While there were no significant differences between the VAS score and the VAS score after 20 days in the patients who received conservative treatment, a significant difference was found between the VAS score and the VAS score after 20 days in the patients who received kyphoplasty.Conclusion: It disrupts patient compliance in treating the primary disease due to pain and immobilization in patients who received organ transplantation, and increases the complications due to immobilization. Therefore, performing kyphoplasty is recommended in symptomatic vertebral fractures that do not require stabilization after organ transplantation regardless of the VAS score.
Background: The known primary radiological diagnosis of Chiari Malformation-I (CM-I) is based on the degree of tonsillar herniation ( TH) below the Foramen Magnum (FM). However, recent data also shows the association of such malformation with smaller posterior cranial fossa (PCF) volume and the anatomical issues regarding the Odontoid. This study presents the achieved result regarding some detected potential radiological findings that may aid CM-I diagnosis using several machine learning (ML) algorithms. Materials and Methods: Between 2011 and 2020, radiological examinations of 100 clinically/radiologically proved symptomatic CM-I cases and 100 control were evaluated by matching age and gender. A team of Neuroradiologists had reviewed the MR images of the study population. A total of 11 different radiological parameters were assessed for CM-I diagnosis. The parameters were defined and examined in 5 designed different ML algorithms. Statistical analysis was conducted for data analysis. Results: The mean age of patients was 29.92 ± 15.03 years. The primary presenting symptoms were headaches (62%). Syringomyelia and retrocurved-odontoid were detected in 34% and 8% of patients, respectively. All of the morphometric measures were significantly different between the groups, except for the distance from the dens axis to the posterior margin of FM. The Radom Forest model is found to have the best 1.0 (14 of 14) ratio of accuracy in regard to 14 different combinations of morphometric features. Conclusion: This study indicates the potential usefulness of ML-guided PCF measurements, other than TH, that may be used to predict and diagnose CM-I accurately. Our results support the view of TH as a single radiological parameter may fail during the diagnosis of CM-I. Combining two or three preferable osseous structure-based parameters may increase the accuracy of radiological diagnosis of CM-I.
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