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Öğe Brucellar lumbar epidural abscess - case report and review(Lippincott Williams & Wilkins, 2006) İş, Merih; Gezen, FerruhBrucellosis is an infectious disease characterized by an acute febrile stage with few or no localizing signs and a chronic stage with relapses of fever, weakness, sweats, and vague symptoms. Brucellosis is one of the major causes of spondylitis in the Mediterranean area. We present a 46-year-old woman who had pain in the low back and both legs for 2 months. The diagnosis was performed on clinical presentation, laboratory findings (Rose Bengal and Wright agglutination tests), and magnetic resonance imaging. Magnetic resonance imaging revealed an extradural mass compressing the thecal sac at the L5-S1 level. The mass was isointense to hypointense compared with the spinal cord on T1WI and heterogenic hyperintense on T2WI. With contrast material, heterogeneous enhancement was seen. The patient was treated with surgery and 3 antibiotics. In an endemic area, brucellosis should be included in the differential diagnosis of any patient complaining of back or leg pain.Öğe Cerebrospinal fluid and serum levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in patients with severe head injury(Turkish Assoc Trauma Emergency Surgery, 2007) Sanus, Galip Zihni; Tanrıverdi, Taner; Coşkun, Abdurrahman; Hanımoğlu, Hakan; İş, MerihBACKGROUND The aim of this study is to present time course of insulin like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in both cerebrospinal fluid (CSF) and serum of patients after severe head injury (SHI) and to compare with controls. METHODS Our trauma and control groups included 11 consecutive patients with isolated SHI and 9 patients with hydrocephalus (one with normotensive and eight with hydrocephalus due to aqueduct stenosis), respectively. Both serum and cerebrospinal fluid levels of IGF-1 and IGFBP-3 were measured during post-traumatic days and we compared the levels with controls. RESULTS Patients and controls showed undetectable levels of both IGF-1 and IGFBP-3 in their CSF. When considering serum levels, patients with SHI had always lower levels of both molecules than that of controls. CONCLUSION Administration of IGF-1 during acute, as well as chronic phase of severe head trauma may provide beneficial effects and may decrease both mortality and morbidity in humans with SHI.Öğe Çocukluk ve erişkin dönemi "Büyüyen kafa kırıkları" (sessiz bir komplikasyondan komplike patolojik süreçe uzanan yol)(2000) Ziyal, İbrahim M.; Döşoğlu, Murat; İş, Merih; Yıldız, Hakan; Yücel, Engin; Gezen, FerruhBüyüyen Kafa Kırıkları (BKK) çocukluk dönemi kafa travmalarının nadir bir komplikasyonudur. Erişkin döneminde tanı konan olgular daha da nadirdir ve başlıca neden yeterli tedavinin uygulanmamış olması ya da gecikmiş tanıdır. Bu çalışmada, beşi erişkin döneminde olmak üzere onbeş BKK olgusu sunulmaktadır. On olguda leptomeningeal kist ile birlikte ya da olmaksızın kafa kırığında genişleme tesbit edildi. Bu gruptaki (Grup I) olguların 7si erkek, üçü bayan ve olguların ortalama yaşı 14.9 ay idi. Yırtılmış olan duraya bağlı olarak kırık kemik kenarları birbirinden ayrılmış ve beyin omurilik sıvısı ile dolu araknoid boşluk bir leptomeningeal kiste dönüşmüş idi. Dokuz olgu kafada şişlik ve şekil bozukluğu, bir olgu ise nöbet şikayeti ile başvurdu. Tanı konmamış ya da tanı konmakta gecikilmiş olgularda kist genişlemekte, ensefalomalazi ve parankim dokusu kaybı oluşmakta ve kist ventrikül ile birleşmektedir. Böylece bir porensefalik kist ortaya çıkmaktadır. Erişkin döneminde tanı konan beş olgumuz ise bu patolojik ilerlemeyi göstermekte idi (Grup II). Bu olguların 4ü erkek, biri bayan ve ortalama yaşları 14.6yıl idi. Sadece nöbet dört olguda, sol hemiparezi ile birlikte nöbet ise bir olguda tesbit edildi. Grup l olgular kranyotomi ve duraplasti ile tedavi edildiler. Kemik büyümesi tamamlandıktan sonra iki olguya kranyoplasti uygulandı. Grup II olgular kranyotomi, duraplasti ve kranyoplasti ile tedavi edildiler. Bu grubun iki olgusu daha sonra şant uygulamasını gerektirdi. Olguların tedavi sonrası ortalama takip süresi 37 ay olarak tesbit edildi. Erişkin olgularda tedavi sonuçları yetersiz kaldı ve beş olgudan sadece birinde nöbetler önlenebildi. Sonuç olarak, BKKda erken tanı, uygun tedavinin seçimi, yeterli iyileşme ve geç başarısız sonuçların önlenmesi için kafa travması sonrası oluşan lineer kırıkların en az iki sene düzgün aralıklar ile takibi esas olmalıdır.Öğe Epidural extension of a lumbar vertebral haemangioma(Elsevier Sci Ltd, 2006) İş, Merih; Gezen, Ferruh; Alper, Murat; Yıldız, Hakan Kartal; Akyüz, FevzullahVertebral haemangiomas are relatively common, but those extending into the epidural space are rare. A 59-year-old man with severe lower back and right leg pain that did not resolve with conservative treatment was seen in an outpatient clinic. Magnetic resonance imaging of the lumbar spine identified an L3 vertebral corpus lesion with epidural extension. The diagnosis was unclear, so the patient underwent surgery. The pathologic diagnosis was capillary haemangioma, so angiography-guided embolization was performed postoperatively. Vertebral haemangioma must be considered when there is evidence of a vertebral corpus lesion with epidural extension on magnetic resonance imaging.Öğe Expression and cellular distribution of multidrug resistance-related proteins in patients with focal cortical dysplasia(W B Saunders Co Ltd, 2007) Ak, Hatil; Ay, Bahadır; Tanrıverdi, Taner; Sanus, Galip Zihni; İş, Merih; Öz, BügeRecent arouse of interest indicated that drug resistant proteins are markedly over-expressed in the epileptogenic tissue and they may be responsible for the one-third of the epileptic patients who were refractory to anti-epileptic drugs (AEDs). Since several AEDs may act as substrates for these drug resistant proteins, the enhanced function of such proteins may increase drug extrusion, resulting in inadequate response to drug therapy in patients with epilepsy. We studied expression of the muttidrug resistance protein 1 (MDR1) and muttidrug resistance-associated protein 1 (MRP1) in the epileptic tissues resected surgically in 28 patients with focal cortical dyspLasia (FCD) by immunohistochemistry. The results were compared with 10 normal necropsy brain tissues. Normal brain showed no MDR1 expression in neurons and astrocytes, while MRP1 expression was very weak, which were encountered in a few samples. MDR1 expression was mainly localized on the vascular endothelial cells. In contrast to normal brain, we found intense MDR1 and MRP1 expression in both neurons and reactive astrocytes in the vast majority of dysplastic tissues. The majority of the dysplastic neurons demonstrated moderate to strong MRP1 immunoreactivity. Endothelial cells showed both MDR1 and MRP1 expression in the majority of the specimens studied. Muttidrug transporters are over-expressed in the epiteptogenic zone in patients with FCD. These results are concordant with previous studies, in which over-expression of multidrug proteins were shown in epiteptogenic brain tissue in patients with FCD, that the over-expression of drug transport proteins in tissue from patients with refractory epilepsy may explain one possible mechanism for drug resistant in these pathologies. (c) 2007 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.Öğe High-sensitivity C-reactive protein levels in cerebrospinal fluid and serum in severe head injury: relationship to tumor necrosis factor-alpha and interleukin-6(Churchill Livingstone, 2007) İş, Merih; Coşkun, Abdurrahman; Sanus, Galip Zihni; Tanrıverdi, Taner; Kafadar, Ali Metin; Hanımoğlu, Hakan; Gezen, FerruhRecent studies have demonstrated the role of high-sensitivity C-reactive protein (hsCRP) in inflammatory diseases; however, it is unclear whether this molecule has a role after severe head injury (SHI). Our aim was to evaluate the levels of hsCRP in both cerebrospinal fluid (CSF) and serum from patients after SHI. The study focused on 11 patients with SHI and evaluated CSF and serum levels of hsCRP, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in a 10-day period following the head trauma. The values were compared with those from nine control patients, who had normal pressure hydrocephalus. In the CSF and serum of the patients after SHI HsCRP was found to be significantly higher, at all times, than in the controls; TNF-alpha and IL-6 levels were also higher in these patients. However, hsCRP levels did not correlate with either TNF-alpha or IL-6. TNF-alpha and IL-6 increased during the period immediately following the SHI and intrathecal levels were always higher than those of the serum. This study demonstrates for the first time that hsCRP reaches high levels in both CSF and serum in patients with SHI, and it may therefore be used as an inflammatory index. This finding suggests a need for further studies in this area, which are larger in scope than the present study.Öğe Intraventricular albumin: An optional agent in experimental post-traumatic brain edema(2005) İş, Merih; Uzan, Mustafa; Ünal, Faruk; Kırış, Talat; Tanrıverdi, TanerHypothesis: Human albumin may be effective in the treatment of posttraumatic brain edema due to its hyperoncotic features. Therefore, the aim of the experimental study presented in this paper has two points: the first is to evaluate the efficacy of intraventricular hyperoncotic human albumin on post-traumatic brain edema and the second is to try to show the appropriate post-traumatic time window for albumin administration. Method: Traumatic brain injury and subsequent edema was formed by a model of impact acceleration injury in rats. Human albumin was administered via intraventricular route by using a stereotactic head holder. All animals in each group were decapitated 24 hours after the procedure and the effect of albumin was evaluated by measurement of tissue specific gravity. Results: Tissue specific gravity decreased in edematous tissue (trauma indicator), increased after albumin administration at the 12th (p<0.001), and both at the 1st and 12th hour of the trauma (edema treatment; p<0.001). On the other hand, albumin administered at the 12th, and at both the 1st and 12th hours in the rats without trauma has caused the formation of the brain edema. Conclusion: We conclude that human albumin is effective in cytotoxic, but not in vasogenic edema and exerts its best anti-edematous effect at the 12th hour of severe head trauma and this study may help future studies that will try to show the effects of albumin with different time modalities after severe head injury.Öğe MRI determination of conus medullaris level in an adult population in Turkey(Centauro SRL, 2006) Sevinç, Özdemir; İş, Merih; Barut, Çağatay; Eryörük, Nesrin; Kıran, Sibel; Arifoğlu, YasinThe level of the conus medullaris (CM) in adults has been described in many studies with cadavers and living people. T1-weighted sagittal spin-echo MR images of the lumbar spine were reviewed in 364 consecutive patients (207 women, 157 men) with a mean age of 45 years (range 18-80). The most common level of CM was the L1-L2 intervertebral disc level in females and the T12-L1 intervertebral disc level in males. The distribution of CM location in a large adult population was shown to range from the T11-T12 intervertebral disc level to L2-L3 intervertebral disc level.Öğe Nightmare of lumbar disc surgery: iliac artery injury(Elsevier Science Bv, 2006) Döşoğlu, Murat; İş, Merih; Pehlivan, Mevlüt; Yıldız, K. HakanIntra-operative injuries of pelvic vessels are quite infrequent but serious complications of lumbar disc surgery. Injury may cause laceration of the vessel with acute life threatening retropentoneal haemorrhage, formation of pseudoaneurysms or arteriovenous fistulae in the late phase. It is important for surgeons to be aware of these potentially fatal complications. Authors reported a case of major vascular injury recognised intra-operatively during posterior lumbar discectomy and repaired immediately.Öğe Opere edilmeyen dev serebellar hematom: Olgu sunumu(2005) Gezen, Ferruh; İş, Merih; Yıldız, Hakan K.; Döşoğlu, Murat; Tuncer, CengizSpontan intraserebellar hematomlu (SİH) hastaların tedavisi halen tartışmalıdır. Bilgisayarlı tomografi (BT) SİH'un erken ve doğru tanısını sağlar, SİH'un boyut ve lokalizasyonu kesin bir şekilde tanımlanabilir. Sonucu etkileyen temel prognostik faktörler hastanın başvuru sırasındaki klinik durumu, hematomun boyut ve lokalizasyonu, beyin sapı basısı, intraventriküler kanama ve hidrosefali varlığıdır. Bu çalışmada altmış iki yaşında tıbbi tedavi yapılan dev serebellar hematomlu bayan hasta sunulmuştur.Öğe Prolonged elevation of magnesium in the cerebrospinal fluid of patients with severe head injury(Taylor & Francis Ltd, 2007) Kafadar, Ali Metin; Sanus, Galip Zihni; İş, Merih; Coşkun, Abdurrahman; Tanrıverdi, Taner; Hanımoğlu, Hakan; Uzan, MustafaObjectives: Several works have investigated the role of serum magnesium (Mg) concentrations in traumatic brain injury. However, there is restricted information about cerebrospinal fluid (CSF) levels of Mg in patients with severe head injury (SHI). We assessed the changes of Mg concentrations in CSF and serum in patients with SHI during the first 10 days after the trauma. Methods: Eleven patients with SHI were studied prospectively on days 1-3, 5 and 10 with analysis of CSF and serum levels of Mg and Ca. The control group consisted of nine patients with hydrocephalus. Results: CSF levels of Mg were significantly higher in patients than controls in the corresponding time points except on days 5 and 10 of trauma. The CSF Mg levels tended to decrease and the highest level was found on day 1 after trauma (2.81 +/- 0.65 mg/dl). In the control group, the CSF level of Mg was 1.95 +/- 0.66 mg/dl. No significant difference can be detected between controls and patients regarding serum Mg and Ca levels. In addition, significantly higher values of Ca in the CSF were observed in all time points after trauma in patients with SHI than in the controls. There was no correlation between the CSF and serum levels of Mg and Ca levels. Discussion: Our study demonstrates that in patients with SHI, CSF levels of Mg and Ca are elevated during the whole observation period. Further works should be designed in order to show the role and importance of CSF levels of ionized Mg in outcome of patients with SHI.Öğe Soft tissue closure and plastic surgical aspects of large dorsal myelomeningocele defects (review of techniques)(Springer, 2005) Özçelik, Derya; Yıldız, Kartal Hakan; İş, Merih; Döşoğlu, MuratThe large myelomeningocele defects that cannot be closed reliably by simple skin undermining require a close cooperation between the neurosurgeon and the plastic surgeon. In this study, a 3-year review was undertaken of nine consecutive patients with a myelomeningocele defect treated in our hospital. The aim of the study was to analyze the size, location of myelomeningocele defects, features of the surrounding tissue, and type and results of the reconstruction method for skin closure. Of the nine patients, five were repaired within the first 48 h of life, two within the 1st month of life, and two were repaired within the 1st year of life. Of the nine patients, seven (78%) underwent repair with direct skin approximation by the Neurosurgical Service. For three patients (33%) with large lumbosacral meningomyelocele defects, including one patient who had failed direct skin approximation, the Plastic Surgery Service achieved the skin closure by bilateral paralumbar fasciocutaneous rotational flaps. Minimal area in the patients referred to the Plastic Surgery Service was 24 cm(2) ( range 24 - 48 cm(2)); patients having 18 cm2 or less skin defect were not referred for closure. In conclusion, fasciocutaneous rotational flaps provided tension-free, durable, innervated and well-vascularized skin coverage over the dural repair in all three referred patients, without using skin graft. Since myelomeningocele defects vary in size, shape, and location, no single procedure applies to all. Therefore, other reconstruction methods involving skin grafts, fasciocutaneous flaps, and musculocutaneous flaps are reviewed in this report.Öğe Transanal protrusion of a ventriculoperitoneal shunt catheter(Coll Physicians & Surgeons Pakistan, 2012) Öztürk, Hülya; İş, Merih; Öztürk, Hayrettin; Küçük, Adem; Döşoğlu, MuratA two years old boy presented with a transanal protrusion of the ventriculoperitoneal (VP) shunt catheter. A VP shunt was inserted when the boy was six-month-old for congenital hydrocephalus. He was active and neurologically normal, with no signs of meningitis and peritoneal irritation. During laparotomy, the tube was seen entering the sigmoid colon, so the tube was cut at the point where it entered the sigmoid colon. The distal end of the protruding tube was pulled out from the anus. The sigmoid colon was repaired, and a delayed shunt revision was completed. The patient was discharged without abdominal and neurological deterioration.Öğe The use of methylprednisolone, vitamin E and their combination in acute spinal cord injury: An experimental study(Turkish Neurosurgical Society, 2006) İş, Merih; Ulu, Mustafa Onur; Tanriverdi, Taner; Yıldız, Hakan; Akyüz, Fevzullah; Aksoy, Aylin; Gezen, FerruhObjective: The effects of methyprednisolone (MP) and Vitamin E (Vit E) combination treatment was investigated in an experimental spinal cord injury model in rats. Method: Thirty-one rats were randomly divided into the five following groups: control group, MP group, Vit E group, MP+Vit E group and sham operated group. A spinal cord injury was produced in the rats by using a compression injury model at the T8 vertebra level for 10 minutes. MP was injected as a 30 mg/kg IV bolus, 1 hour after the injury, followed by an infusion of 5.4mg/kg for 23 hours. Vit E was administered as a 30 mg/kg IV bolus at the posttraumatic 1st, 7th, 13th and 19th hours. The sham group underwent laminectomy without spinal cord compression and did not receive medication. The animals were sacrificed at the posttraumatic 48th hour and histopathological examination was performed in a blinded fashion for the following criteria: hemorrhage, necrosis, edema, microcyst, microglia proliferation and PMNL infiltration. Results: The pathology evaluation of the groups revealed that the MP+Vit E combination treatment impeded the progress of edema/microcyst formation, microglia proliferation, and necrosis. Conclusion: Vit E, when combined with MP for spinal cord injury treatment, augments the effect of MP probably due to its antioxidant effects.Öğe Variation in the formation of the median nerve involving a communicating branch from the musculocutaneous nerve(2007) Sevinç, Özdemir; Arifoğlu, Yasin; Barut, Çağatay; İş, Merih; Dıramalı, MuratBackground: The brachial plexus has a complex anatomical structure from its origin in the neck, through its course in the axillary region. It is formed by the union of the ventral rami of the spinal nerves from C5 to T1. Anomalies in the formation of the cords of brachial plexus and the communications between its branches are common. Case Report: Anomalies of the brachial plexus in terms of the formation of the median nerve were observed during routine dissection of the right upper limb of the cadaver of a 55-year-old male. The branches of the lateral and medial cords of the brachial plexus were dissected carefully and the variation from the usual pattern was noted. The lateral root of the median nerve arose from the lateral cord and bifurcated after 2 cm. The upper part united with the medial root of the median nerve and the lower part united with the median nerve approximately 0.5 cm past the aforementioned unification. There was also a communicating branch originating from the musculocutaneous nerve that arose 6 cm distal to the origin of the lateral root. This communicating branch coursed medially and united with the median nerve. Conclusions: It is important to be aware of these variations when planning surgery and regional anesthesia of the axilla or upper extremity. In addition, the presence of anatomic variations of the peripheral nervous system is often used to explain unexpected clinical signs and symptoms.Öğe Yings and yangs of acute ethanol intoxication in experimental traumatic brain injury(Lippincott Williams & Wilkins, 2005) İş, Merih; Tanrıverdi, Taner; Akyüz, Fevzullah; Ulu, Mustafa Onur; Üstündağ, Nil; Gezen, Ferruh; Yavuz, ÖzlemAlthough the deleterious effects of acute alcohol intoxication on traumatic brain injury (TBI) are well known, neuroprotective features of lower doses of ethanol (EtOH) before head trauma have been reported during recent years. Inhibition of N-methyl-D-aspartate receptor (NMDA)-mediated excitotoxicity by lower doses of EtOH has been believed to be responsible for this protection. The aim of this study was to show the neuroprotective effects of low and moderate doses of EtOH and to compare their efficacy in each group. Acute EtOH intoxication at low and moderate doses was induced 40 minutes before trauma. Severe TBI was administered in Sprague-Dawley rats using an impact acceleration model. At 24 hours after trauma, all the rats were decapitated and hippocampi were evaluated under light microscopy. According to our results, red neuron formation and vacuolar degeneration in the CA1 and CA3 sectors of the hippocampi were less prominent in the lowdose and moderate-dose EtOH plus trauma groups than in the trauma only group. In addition, edema formation was less prominent in the EtOH plus trauma group. When comparing the low-dose EtOH Plus trauma and moderate-dose EtOH Plus trauma groups, an almost normal appearance of the hippocampus was noted in the moderate-dose EtOH plus trauma group. EtOH may have a neuroprotective effect when administered at a lower dose, particularly a moderate dose, and this protection may be a result of the inhibition of NMDA receptor-mediated excitotoxicity.
