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Objective: To emphasize the importance of the mechanism and surgical approach to trigeminocardiac reflex (TCR) developing 48 h after orbital trauma due to a foreign body. Case Report: After gunshot injury of a 17-year-old male patient, computerized tomography evaluation revealed a right globe perforation and an intraorbital metallic foreign body in the right orbita adjacent to the lateral wall. The ocular perforation was repaired, but the foreign body was not removed. Constant bradycardia (45/min) developed 48 h after the operation. Since there were no cardiological findings, a temporary cardiac pacemaker was inserted and on the 6th postoperative day, the foreign body was removed through orbitolateral approach. After the removal of the foreign body, bradycardia completely recovered. Conclusion: In the presence of an intraorbital foreign body accompanied by globe perforation, TCR may develop 48 h after the trauma and insertion of a temporary pacemaker may be required to control the cardiac rhythm. In this paper, the delayed TCR complication presented an indication for the removal of the intraorbital foreign body.

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IntroductionLipomyelomeningocele is a form of the spina bifida occulta, which show differentiation from spina bifida aperta by pathogenesis. Laterally located thoracal lipomyelomeningocele is very rare congenital spinal pathology. The clinical presentation may be soft tissue mass, sensorial-motor loss and/or bladder dysfunction.Case presentationHere we presented a 10-month-old girl patient harboring lipomyelomeningocele in left lateral side of the lower thoracal region.ConclusionsWe have not found the entity of lateral lower thoracal lipomyelomeningocele and especially as large as this size mass at ages of our patient in the literature. We operated our patient for the possible emerging complications and purposed prevention of these complications with this intervention.

Objective: In this study, the correlation between the level of nerve growth factor (NGF) in cerebrospinal fluid (CSF) and transcranial Doppler (TCD) results has been investigated during preoperative and postoperative periods of hydrocephalic infants. Methods: In the study, 27 patients (11 males and 16 females, aged 0–6 months) with congenital hydrocephalus were studied. CSF levels were obtained from the patients preoperatively and on postoperative days 3 and 30, and TCD was applied. The level of NGF was investigated in CSF by the ELISA method. The pulsatility index (PI) and resistive index (RI) were examined in the right middle cerebral artery by TCD. Results: The mean NGF level (0.27 ± 0.48 ng/ml) on the 3rd (NGF3) postoperative day was observed to be higher than the preoperative mean NGF level (NGF0; 0.15 ± 0.16 ng/ml; p < 0.05). The mean NGF level on postoperative day 30 (NGF30; 0.13 ± 0.13 ng/ml) was lower than the mean NGF3 level (p < 0.05). While the mean PI value on postoperative day 30 (PI30; 1.06 ± 0.068) was observed to decrease compared to the preoperative PI (PI0; 1.26 ± 0.83) and the PI on postoperative day 3 (PI3; 1.09 ± 0.063), the mean PI3 value exhibited a drop compared to the PI0 value (p < 0.05). Whereas the mean RI value on postoperative day 30 (RI30; 0.63 ± 0.023) showed a decrease compared to both preoperative mean RI (RI0; 0.70 ± 0.025) and RI on postoperative day 3 (RI3; 0.65 ± 0.021), RI3 displayed a drop compared to RI0 (p < 0.05). Conclusion: In this study, no correlation was determined between preoperative and postoperative NGF levels and preoperative and postoperative RI and PI values obtained from TCD examination. However, a positive correlation was found between the following results: preoperative PI and preoperative RI (r = 0.848); PI on postoperative day 3 and RI on postoperative day 3 (r = 0.690), and PI on postoperative day 30 and RI on postoperative day 30 (r = 0.707).

Objective: In the present study, our aim was to designate standards for Doppler USG images correlating with dysfunctions in each segment of the ventriculoperitoneal (VP) shunt. Materials and Methods: For this mechanical study, a platform was formed with pools filled with SF on both sides. Low-, intermediate- and high-pressure shunt mechanisms were placed on this platform. For each shunt system, flow wave pattern was evaluated. Doppler USG was performed when the shunt functioned normally, the peritoneal, ventricular ends and the exit of the valve were obstructed. The results were recorded. Results: When the distal end of the peritoneal catheter was obstructed, no flow wave pattern was observed in Doppler USG. When the exit of the valve was obstructed, no flow pattern was taken from the peritoneal end, either. When the valve was pressed on the ventricular catheter, a second wave pattern with lower amplitude and a wider base was observed, in addition to the wave pattern that was observed when the pressure on the valve was removed. Conclusion: Doppler USG is an effective method for the diagnosis of shunt obstruction. The evaluation of flow wave patterns using this method instead of measuring flow rates creates a different standard for each situation.

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