This article aims to describe an extraordinary complication of a ventriculoperitoneal shunt system that formed a knot spontaneously and lead to a shunt malfunction. A 3-year-old male patient was operated due to posttraumatic hydrocephalus. After an uneventful follow-up period of 34 months, he presented with shunt malfunction. During the shunt revision surgery, the peritoneal catheter was found to form a loop over itself. There are various complications of ventriculoperitoneal shunt systems. Migration to body cavities is among the most interesting ones. This is the fifth report describing this rare complication. Hydrocephalic patients should be closely followed up after shunt surgery for various extraordinary complications. KeywOrds: V/P Shunt, Shunt Complication, Shunt Malfunction ÖZBu makale, kendi üzerine katlanarak bir düğüm oluşturup şant malfonksiyonuna neden olan ventriküloperitoneal şant sisteminin yol açtığı bu sıradışı bir komplikasyonu incelemektedir. Travma sonrasında gelişen hidrosefali nedeni ile opere edilen 3 yaşındaki erkek hasta 34 aylık sorunsuz bir takip süresi ardından şant malfonksiyonu ile başvurdu. Şant revizyonu sırasında peritoneal kateterin kendi üzerine katlanarak bir düğüm oluşturduğu gözlendi. Ventriküloperitoneal şant sistemlerine ait birçok farklı komplikasyon bildirilmiştir. Vücut boşluklarına migrasyon bu komplikasyonlardan en ilginç olanlar arasındadır. Bu makalede, sunulan vaka literatürdeki beşinci vakadır. Hidrosefalili hastalar şant cerrahisi sonrasında bu komplikasyonlar için yakın takipte tutulmalıdırlar.

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This preliminary report the on effects of QUE in a chronic constriction injury model proved significant effects of the agent, which should be supplemented with different studies using different dose regimens.

AIm:To investigate the effects of hyperbaric oxygen treatment on epidural fibrosis formation in an experimental laminectomy model. mAteRIAl and methods: Twenty-four Wistar rats underwent L5-L6 total laminectomy and divided into three groups. Animals in the control group received no further treatment while animals in short and long term groups received 2,5 ATM ABS of hyperbaric oxygen for 3 and 7 days, respectively. The amount of epidural fibrosis was analyzed histologically at the end of 42 days of follow up. Results:The ratio of severe fibrosis was 57% in the control, 29% in the short HBOT, and 14% in the long HBOT groups. Although there was a clear trend towards having less fibrosis in the HBOT groups, the difference did not reach to the level of statistical significance (p=0.242), probably due to small number of animals used in this preliminary study. ConClusIon:Our findings suggest that hyperbaric oxygen treatment may have favorable effects on epidural fibrosis. Further studies with larger cohorts are required to prove our results KeywoRds:Epidural fibrosis, Failed back syndrome, Hyperbaric oxygen, Laminectomy, Peridural fibrosis ÖZ AmAÇ: Bu çalışmada, deneysel laminektomi modeli kullanılarak ratlarda oluşturulan epidural fibrosis ve buna bağlı olarak gözlenen ağrı cevabı üzerine hiperbarik oksijen tedavisinin etkilerinin incelenmesi amaçlanmıştır. yÖntem ve GeReÇleR: Yirmi dört wistar cinsi rata L5 L6 seviyelerinden total laminektomi yapılıp ratlar rastgele bir şekilde 3 gruba ayrılmıştır. Kontrol grubundaki hayvanlar her hangi bir ek tedavi almazken kısa ve uzun süreli tedavi gruplarındaki hayvanlara sırası ile 3 ve 7 gün boyunca 2.5 ATM ABS hiperbarik oksijen tedavisi uygulanmıştır. Kırkiki günlük takip süresi sonunda laminektomi sahasındaki epidural fibrosis miktarı histolojik olarak değerlendirmiştir.BulGulAR: Grade 3 fibrozis kontrol grubunda %57 oranında gözlenirken kısa HBOT grubunda %29; uzun HBOT grubunda ise %14 oranında gözlenmiştir. Her ne kadar HBOT alan gruplarda daha az fibrozis gözlenmiş olsa da gruplar arasındaki farklar istatistiksel olarak anlamlı bulunmamıştır (p=0.242). Bunun nedeninin, bu öncü çalışmada kullanılan hayvan sayısının azlığı olarak düşünülmüştür. sonuÇ: Çalışma bulguları hiperbarik oksijen tedavisinin epidural fibrozis üzerine olumlu etkileri olabileceğini göstermektedir. Daha çok deneğin katıldığı farklı dizaynda çalışmalara ihtiyaç duyulmaktadır.

Pituitary apoplexy (PA) may very rarely present with hiccups. A 32-year-old man with classical acromegaloid features was admitted with headache, nausea, vomiting and stubborn hiccups. Pituitary magnetic resonance imaging (MRI) demonstrated apoplexy of a macroadenoma with suprasellar extension abutting the optic chiasm. Plasma growth hormone (GH) levels exhibited suppression (below <1 ng/mL) at all time points during GH suppression test with 75 g oral glucose. After treatment with corticosteroid agents, he underwent transsphenoidal pituitary surgery and hiccups disappeared postoperatively. The GH secretion potential of the tumor was clearly demonstrated immunohistochemically. We conclude that stubborn hiccups in a patient with a pituitary macroadenoma may be a sign of massive apoplexy that may result in hormonal remission.Learning points:Patients with pituitary apoplexy may rarely present with hiccups.Stubborn hiccupping may be a sign of generalized infarction of a large tumor irritating the midbrain.Infarction can be so massive that it may cause cessation of hormonal overproduction and result in remission.

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ObjectiveTumor necrosis factor alpha (TNF-α) have proven effects in pathogenesis of neuroinflammation after spinal cord injury (SCI). Current study is designed to evaluate the effects of an anti-TNF-α agent, adalimumab, on spinal cord clip compression injury in rats.MethodsThirty two male adult Wistar rats were divided into four groups (sham, trauma, infliximab, and adalimumab groups) and SCI was introduced using an aneurysm clip. Animals in treatment groups received 5 mg/kg subcutaneous adalimumab and infliximab right after the trauma. Malondialdehyde (MDA) levels were studied in traumatized spinal cord tissues 72 hours after the injury as a marker of lipid peroxidation.ResultsAnimals that received anti-TNF-α agents are found to have significantly decreased MDA levels. MDA levels were significantly different between the trauma and infliximab groups (p<0.01) and trauma and adalimumab groups (p=0.022). There was no significant difference in neurological evaluation of the rats using Tarlov scale.ConclusionThese results suggest that, like infliximab, adalimumab has favorable effects on lipid peroxidation induced by spinal cord trauma in rats.

This study has been presented in the 31 th Scientific Congress of Turkish Neurosurgical Society.