Objective: To evaluate the quality and reliability of carpal tunnel syndrome surgery videos on YouTube. Methods: A keyword set of "carpal tunnel syndrome surgery" was searched on YouTube. The DISCERN scoring system, Journal of the American Medical Association (JAMA) scoring system, and Health on the Net (HON) ranking systems were used to evaluate the quality and reliability of the first 50 videos appeared in the search results. The characteristics of each video, such as the number of likes, dislikes and views, upload days, video length, and the uploader, were collected retrospectively. The relationships between the video quality and these factors were investigated statistically. Results: All of the featured videos sorted were found to be of poor content (mean DISCERN score [n = 1.71 of 5], mean JAMA score [n = 1.76 of 4], mean HON score [n = 5.65 of 16]). Yet, DISCERN scores of the videos uploaded by medical centers were higher than that of the others (p = 0.022). No relationship was detected between the other variables and video quality. Conclusion:Healthcare professionals and organizations should be more cautious when recording and uploading a video to the online platforms. As those videos could reach a wide audience, their content should provide more information about possible complications of a treatment and other treatment modalities.
Objective:Arteriovenous malformation (AVM) is the most common form of intracranial vascular malformations in adults. Intracranial pediatric AVMs are rare. AVM located in the vicinity of the brain stem in children are even more rare.Case report:This study reports a rare case of acute obstructive hydrocephalus following aqueductal stenosis caused by an unruptured grade IV perimesencephalic arteriovenous malformation. An 11-year-old boy admitted to the hospital with progressive headache, nausea and vomiting throughout a month. A Computerized Tomography (CT) showed an obstructive hydrocephaly. A Magnetic Resonance (MR) imaging revealed a mesencephalic AVM compressing the aqueduct. The patient deteriorated in hours and an emergency ventriculoperitoneal shunting was performed. He did well in the early postoperative period. AVM examined with Digital Subtraction Angiography (DSA) in detail for maintaining the definitive treatment by means of endovascular embolization, microsurgery and stereotactic radiosurgery; but the patient was lost to follow up.Conclusion:A Pubmed search revealed 34 cases of hydrocephalus caused by an unruptured AVM in the literature, and only four cases were less than 18 years old with unruptured AVM locating in brain stem or posterior fossa. Although focal neurologic deficit, seizure and headache are the most common symptoms, acute neurologic deterioration due to hydrocephalus may be the presenting symptom in these cases. The decrease in intracranial pressure by changing the flow of cerebrospinal fluid (CSF) via an emergency ventriculoperitoneal (VP) shunting or Endoscopic Third Ventriculostomy (ETV) can be a lifesaving procedure that gives a chance for further treatment modalities.
BACKGROUND Hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of death and long-term neurological impairment in the pediatric population. Despite a limited number of treatments to cure HIE, stem cell therapies appear to be a potential treatment option for brain injury resulting from HIE. AIM To investigate the efficacy and safety of stem cell-based therapies in pediatric patients with HIE. METHODS The study inclusion criteria were determined as the presence of substantial deficit and disability caused by HIE. Wharton’s jelly-derived mesenchymal stem cells (WJ-MSCs) were intrathecally (IT), intramuscularly (IM), and intravenously administered to participants at a dose of 1 × 10 6 /kg for each administration route twice monthly for 2 mo. In different follow-up durations, the effect of WJ-MSCs administration on HIE, the quality of life, prognosis of patients, and side effects were investigated, and patients were evaluated for neurological, cognitive functions, and spasticity using the Wee Functional Independence Measure (Wee FIM) Scale and Modified Ashworth (MA) Scale. RESULTS For all participants ( n = 6), the mean duration of exposure to hypoxia was 39.17 + 18.82 min, the mean time interval after HIE was 21.83 ± 26.60 mo, the mean baseline Wee FIM scale score was 13.5 ± 0.55, and the mean baseline MA scale score was 35 ± 9.08. Three patients developed only early complications such as low-grade fever, mild headache associated with IT injection, and muscle pain associated with IM injection, all of which were transient and disappeared within 24 h. The treatment was evaluated to be safe and effective as demonstrated by magnetic resonance imaging examinations, electroencephalographies, laboratory tests, and neurological and functional scores of patients. Patients exhibited significant improvements in all neurological functions through a 12-mo follow-up. The mean Wee FIM scale score of participants increased from 13.5 ± 0.55 to 15.17 ± 1.6 points (mean ± SD) at 1 mo (z = - 1.826, P = 0.068) and to 23.5 ± 3.39 points at 12 mo (z = -2.207, P = 0.027) post-treatment. The percentage of patients who achieved an excellent functional improvement (Wee FIM scale total score = 126) increased from 10.71% (at baseline) to 12.03% at 1 mo and to 18.65% at 12 mo post-treatment. CONCLUSION Both the triple-route and multiple WJ-MSC implantations were safe and effective in pediatric patients with HIE with significant neurological and functional improvements. The results of this study support conducting further randomized, placebo-controlled studies on this treatment in the pediatric population.
AIM: To examine the morphological structure of anterior lumbar spinal region. MATERIAL and METHODS: Fifteen fresh human cadavers were studied in our forensic medicine institution. Within the first 24 hours after death, cadavers were subject to a routine autopsy, by which the intestines were removed and the structures adjacent to the lumbar arteries (LAs) were examined. The following characteristics of the LA were examined and recorded: diameter, number of LA, intervertebral disc, and vertebral corpus relationship, and LA anatomical variations. RESULTS: In 14 of the 15 cadavers (93.3%), the first four LAs originated from the abdominal aorta. In one (6.7%) cadaver, the fourth LA originated from the right aortic trunk together with the median sacral artery (MSA), and this was observed only in the right side. In one cadaver, the first LAs emerged as a common trunk. Twelve cadavers did not have a fifth LA. In one cadaver (6.7%), the fifth LAs emerged as in a pair, distally from the origin of the MSA. Two cadavers (13.3%) had fifth LAs that emerged from the common trunk with the MSA and this occurred only on the right side. LAs which emerged from the right side of the abdominal aorta passed under the inferior vena cava. Of the first four LA, the third LA had the largest vessel diameter, and the first LA had the narrowest vessel diameter. Fifth LAs had one of the narrowest vessel diameters of all LAs. CONCLUSION: We consider that anatomical study of LAs using fresh cadavers can be useful to ensure safer anterior lumbar spinal surgeries.
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