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Biomedical subjects

M Zileli

Publications and source records attributed to M Zileli.

At least 19 recordsLinked to original sources
PubMed2002

Diagnostic value of electrical stimulation of lumbosacral roots in lumbar spinal stenosis.

OBJECTIVES: This paper compares the diagnostic sensitivity of two tests in lumbar spinal stenosis (LSS): lumbosacral root stimulation with needle electrodes and needle electromyograph (EMG). MATERIAL AND METHODS: Twenty patients with LSS were assigned to two groups: Patients with 'neurogenic intermittent claudication' (NIC) only (n=11), and patients with 'neurological signs' (n=9). Ten normal subjects were also examined. The effects of direct stimulation of the lumbosacral roots and conventional EMG recorded from important muscles [rectus femoris (RF): L4, tibialis anterior (TA): L5, soleus muscle (SOL): S1], were compared with each other and correlated with their respective clinical findings and radiological images. RESULTS: Needle EMG and nerve conduction study revealed pathology in 15/20 patients, and electrical stimulation of the roots in 17/20 patients. Agreement in radiological findings with electrical stimulation of the roots and EMG was found in 12 patients. The other patients were harmonic with radiological findings either in EMG or in electrical stimulation of the roots. CONCLUSIONS: Electrical root stimulation revealed more abnormalities in patients with LSS in comparison with needle EMG. However, both methods seemed to complement each other to show additional pathology in a given patient.

Adult↗
PubMed2001

Hemangioblastoma causing cervical neural foraminal widening.

We present the MRI findings in a case of a 24-year-old woman with spinal hemangioblastoma, causing neural foraminal widening by producing a dumbbell mass in the lower cervical region. Hemangioblastomas can very rarely present as an intradural extramedullary lesions and this case is another exceptional pathology which should be considered among the differential diagnosis of enlarged intervertebral foramen due to neoplastic processes.

Adult↗
PubMed2000

Transsacral usage of a pure island TRAM flap for a large sacral defect: a case report.

A pedicled transverse rectus abdominis musculocutaneous (TRAM) flap was used to reconstruct a large sacral defect retroperitoneally. Muscle and superiorly located skin were elevated on the deep inferior epigastric pedicle. The flap was transposed retroperitoneally from the abdominal wall to the sacral region of the patient. The selection criteria for this particular flap are discussed and compared with other reconstructive choices.

Abdomen↗
PubMed1999

Unilateral pallidal stimulation in cervical dystonia.

Cervical dystonia (spasmodic torticollis) is a focal dystonia of the cervical region. Various treatment modalities have been performed with variable success rates. We present a 42-year-old woman complaining of involuntary head rotation for the last 3 years. Different medical treatments had been used for 3 years. Botulinum toxin injections resulted in temporary and moderate improvement for periods of 3-4 months. Pallidal stimulation was performed using a quadripolar electrode and a battery-operated programmable pulse generator. We conclude that a unilateral pallidal lesion or stimulation is an effective method of treatment in focal dystonia. The target must be the pallidum contralateral to the contracted sternocloidomastoid muscle. Deep brain stimulation is superior to lesioning because of the capability of manipulating the stimulation parameters which can modify the pallidotomy effect.

Adult↗
PubMed1998

Intradural spinal hydatid cysts.

Spinal hydatid cysts are very rare and comprise only 1% of all bony involvement. Intradural hydatid cysts are extremely rare compared to other types of spinal hydatid cysts. We report the case of a 19-year-old man with lumbar intradural hydatid cysts. He complained of paraparesis and urinary hesitancy. Myelography revealed a block of the contrast medium at the L4 level and multiple round radiolucent lesions rostrally. At surgery, multiple hydatid intradural cysts were extirpated. The patient's neurologic deficits improved postoperatively, but recurred 6 weeks later. Reoperation led to partial improvement of deficits. Primary intradural hydatid cysts are extremely rare. It is difficult to explain an isolated intradural location of multiple cysts. In our patient, the cysts were multiple and the patient's cerebral CT scan was normal; he had undergone no previous lumbar puncture. So we can hypothesize that intradural spinal cysts may be primarily multiple.

Adult↗
PubMed1998

Spinal hydatid disease.

Vertebral hydatid cysts are rare and found in less than 1% of all the cases of hydatidosis. Neural compression is common in vertebral hydatidosis. The prognosis is generally regarded as very poor. This paper examines the natural history and complications which may arise during the treatment of vertebral hydatid cyst, and discusses their treatment. Thirteen cases of hydatid disease affecting the vertebrae are presented. The patients were admitted with symptoms of spinal cord compression. Twelve were treated by laminectomy and one by costotransversectomy. Low back pain radiating to the legs and lower extremity weakness were the predominant symptoms. Different degrees of pareses were present in 12 patients. Nine patients had impaired sensation in lower extremities. In 13 patients, 27 operations were performed. The major complication of surgery was the death of one patient due to the formaline irrigation. The surgical goal should be an extensive removal of the cysts and affected bone. The surgical area needs to be irrigated with hypertonic saline. Mebendazole or albendazole therapy seems to retard the recurrences and control the disease.

Adolescent↗
PubMed1997

Chondrosarcoma causing cervical neural foramen widening.

Various neoplastic, vascular, and developmental causes may lead to spinal neural foraminal widening, the most common causes of spinal dumbbell lesions being schwannomas and neurofibromas. Occasionally, some other slow-growing tumors may cause neural foraminal widening. We report an exceptional case of a low-grade spinal chondrosarcoma which apparently developed from a pre-existing osteochondroma in the neural arcus of C6. The lesion passed through the C5-C6 foramen, producing a dumbbell mass.

Adolescent↗
PubMed1996

Surgery of intramedullary spinal cord tumors.

The diagnosis and management of intramedullary spinal cord tumors have been significantly influenced by new diagnostic and surgical tools such as MRI, ultrasonic aspiration, intraoperative ultrasound, and evoked potential monitoring. In this study we compared the surgical results of our earlier cases using conventional methods with more recent cases using these new methods. We report our experience based on 44 adult cases. Histologic diagnosis revealed ependymoma (20 cases), astrocytoma (15 cases), glioblastoma multiforme (1 case), and other histologic diagnoses (8 cases). We performed 20 gross total resections, 19 partial resections, and 5 biopsies. The mean follow-up period was 25.8 months (3 months-10 years). Surgical results were improvement in 11 patients (25%), stabilization in 24 (54%), and deterioration in 9 (20%). The first 28 cases (group A) were diagnosed using conventional myelography and CT myelography. The more recent 16 cases (group B) were diagnosed with MRI and operated on using techniques such as ultrasonic aspiration, intraoperative monitoring and ultrasound imaging. Radical surgery (total excision) was performed in 36% (n = 10) of group A, while it was possible in 62% (n = 10) of group B. Deterioration after operation was noted in 28% (n = 8) of group A, but only 6.2% (n = 1) of group B. These results stress the importance of a preoperative MRI scan and the positive effects of intraoperative ultrasound imaging, ultrasonic aspiration, and evoked potential monitoring on surgical results. With the help of these tools, most intramedullary spinal cord tumors may be diagnosed and treated surgically with significantly decreased risk. Radical surgery was possible in as many as 62% of our more recent patients. Partial resection with radiotherapy should be confined to patients with high-grade astrocytomas.

Adult↗
PubMed1996

Tuberculous radiculomyelitis as a complication of spondilodiscitis: MR demonstration.

We present the MRI features and follow-up results in a case of acute tuberculous (TB) radiculomyelitis adjacent to spondilodiscitis in the thoracic spine. Medullary involvement by tuberculosis originating by different mechanisms have been demonstrated in the recent literature. However, this rare complication accompanying TB spondilodiscitis has not been reported.

Adult↗
PubMed1995

Electrophysiological monitoring during CT-guided percutaneous cordotomy.

During percutaneous cordotomy, impedance monitoring and electric stimulation have been widely used to enable a precise localization of the lesion electrode. The purpose of this study was to examine the possibility that the usage of additional electrophysiological techniques could help in improving the precision of the placement of the lesion electrode. Fourteen patients were monitored with 4 different techniques during CT-guided percutaneous cordotomy: 1) Median nerve somatosensory evoked potentials (mSEP): median nerve stimulation with recording from the scalp. 2) Spinal cord evoked potentials (SCEP): median nerve stimulation with recording via the cordotomy electrode. 3) Spinothalamic evoked potentials (SthEP): stimulation via the cordotomy electrode and recording from the scalp. Ipsilateral and contralateral mSEPs and SCEPs did not change after the lesion. SthEPs showed a significant decrease in 10 of 12 patients provided the stimulus intensity was kept below that producing a motor response (approx 0.5-1 mA). There was no obvious relationship between changes of the evoked potentials and the clinical outcome of the cordotomy. Our results suggest that there may be a relationship between the extent of the lesion and the decrease of the spinothalamic evoked potentials.

Adult↗
PubMed1991

Motor versus somatosensory evoked potential changes after acute experimental spinal cord injury in rats.

In this study, averaged cortical somatosensory evoked potentials (SEP) after sciatic nerve stimulation, and lower extremity muscle responses after motor cortex stimulation (MEP) were compared in rats. 10 animals served as light (25 g-cm) and 10 animals as severe (80 g-cm) acute spinal cord injury group after weight dropping trauma. After the initial loss of components, both SEP and MEP recovered in most cases in the light injury group. In the severe injury group, however, no recovery was observed in cortical SEPs, while the muscle MEP recovered in some animals. Light spinal cord injury had little effect on muscle MEPs and caused a paradoxical amplitude increase in some MEP recordings. Latency values of muscle MEPs did not show great changes after either kind of injury, while cortical SEP latency was considerably delayed. In this model cortical SEPs were more sensitive to light spinal cord injury than muscle MEPs after single electrical cortical stimuli. Severe spinal cord injury caused amplitude changes or loss of waves from both SEP and MEP.

Animals↗
PubMed1989

Vestibulospinal evoked potential versus motor evoked potential monitoring in experimental spinal cord injuries of cats.

Changes in vestibulospinal evoked potentials (VsEP) and motor evoked potentials (MEP) were examined in 10 cats before and after two different weight-dropping spinal cord injuries. In six animals somatosensory evoked potentials (SEP) were also monitored. The recordings were done from epidural spinal cord electrodes. Before and after severe and light weight-dropping spinal cord injuries all 3 modalities were recorded at the same time intervals till the end of 4th hour postinjury. According to a scoring system, evoked potential changes below and above the level of injury were monitored, and compared with each other. This study showed that the different motor stimulation methods use different descending spinal tracts, and both can be useful as a monitoring tool. Both descending tracts carrying VsEP and MEP had similarly remarkable changes after severe spinal cord injury. These consisted of major deformation, development of an evoked injury potential and complete potential loss. During the 4 hour monitoring period, no case showed EP recovery in the severe injury group. Light spinal cord injury caused somewhat more deterioration in MEPs than VsEP. The higher numbers of severe potential alterations in the lightly injured animals suggest that MEP is a more sensitive method for spinal cord monitoring compared to VsEP and also to SEP. On the other hand, this sensitivity might be a disadvantage during intraoperative monitoring, if MEP alone were used.

Action Potentials↗
PubMed1989

A prospective study on acute spinal injuries.

This work examines demographic and clinical characteristics of 163 consecutive cases of acute spinal injuries in a small area of Western Turkey, since 1982. These include all spinal injuries with or without neurological symptoms. Combined conservative and surgical methods were used for treatment. Age, sex, etiology, site of injury, radiologic findings, neurological status, and outcome are compared with the other studies. The results have been found to be parallel to those of the other studies except for some regional differences like an excess of tractor accidents.

Adolescent↗
PubMed1989

[Spinal and muscular evoked response following single stimulation of the motor cortex of the rat].

The general characteristics of motor evoked potentials recorded from muscle and spinal cord in response to single electrical stimulation of motor cortex were examined in 30 rats. 5 other rats were additionally examined before and after full muscle relaxation, to differentiate the volume-conducted muscle response from spinal cord responses. The first positivity (P1) recorded from the lower thoracic cord following anodal stimulation was 1.1 +/- 0.1 ms and the second positivity (P2) was 2.1 +/- 0.2 ms. P1 was present in 11 animals and P2 in 20. The later components after 2.3 ms latency recorded from the epidural spinal electrode were lost with full muscular relaxation and seem to originate from volume conducted muscular activity. A relatively stable early MEP muscle response (6.1 +/- 0.9 ms) was observed in contralateral lower extremity muscles of all animals. Following this early response, a late MEP muscle response (16.0 +/- 1.9 ms) has been recorded in 43% of all animals. This relatively inconstant and multiphasic late muscle response disappeared during vibration of same extremity tendons and has similar characteristics as Hoffmann's reflex response. Additionally, with increasing stimulus intensities, the amplitude ratio of early to late response was similar to M response/H reflex amplitude ratio. The results suggest that the late MEP muscle response is probably the result of a reflex response caused by the first/early descending volley and traveled back to the spinal cord possibly through the Ia afferents similar to that in the H-reflex.

Animals↗
PubMed1988

Effects of methyl prednisolone, dimethyl sulphoxide and naloxone in experimental spinal cord injuries in rats.

The effects of methyl prednisolone (MPD), dimethyl sulphoxide (DMSO), and naloxone were examined in 38 albino rats after making an impact spinal cord injury on the midthoracic segments with a modified Allen's weight dropping trauma method. Somatosensorial evoked potentials (SEPs) were recorded before and 12 h and 14 d after the injury from epidurally inserted electrodes on the parietal cortex with sciatic nerve stimulations. Lower extremity motor functions of the animals were also examined. It may be concluded that in this study model, DMSO has a moderate effect which can be demonstrated clinically and through SEPs. Naloxone has no effect on the clinical outcome but causes reasonable improvement electrophysiologically.

Action Potentials↗
PubMed1988

A comparative study of brain-stem auditory evoked potentials and blink reflexes in posterior fossa tumor patients.

Brain-stem auditory evoked potentials (BAEP's) and blink reflexes (BR's) were recorded from 40 patients with clinical and radiological evidence of posterior fossa tumors. They were examined in three groups according to the anatomical location of the lesion: Group A included 15 patients with midline tumors; Group B included 14 patients with cerebellar hemispheric tumors; and Group C included 11 patients with cerebellopontine angle (CPA) tumors. More of the 40 patients had BAEP abnormalities (32) than BR abnormalities (24). All of the 11 patients with CPA tumors had some kind of BAEP and BR abnormalities. The 14 patients with cerebellar tumors showed the next most frequent abnormalities: 12 related to the BAEP's and seven to the BR's. The 15 patients with midline tumors showed the least number of abnormalities: nine related to BAEP's and six to the BR's. In the analysis of BAEP wave latencies and interpeak latencies, a wave III latency delay occurred in all groups; latencies of waves IV and V were more significantly delayed in patients with CPA and cerebellar hemispheric tumors, and the interpeak latencies of waves III-V and I-V were markedly prolonged only in patients with CPA tumors (p less than 0.01). In all tumor groups, early response (R1) of BR's was significantly delayed in comparison to a healthy volunteer control group (p less than 0.01), but R1 was more pronounced in cases of CPA tumors when compared with the other tumor groups. Although significant delays in direct and consensual late reflex components (R2) of BR's were noted in comparison to the control group, this delay could not differentiate one tumor group from another. In can be concluded that, while these tests reflect the functions of different cranial nerves and brain-stem tracts, BAEP monitoring is more sensitive than BR testing for the detection of brain-stem involvement in posterior fossa tumors. Cerebellopontine angle tumors almost always cause severe abnormalities in both tests. Cerebellar hemispheric tumors and midline tumors cause fewer changes in both BAEP's and BR's.

Adolescent↗
PubMed1983

Unusual spinal cord injury by a speargun.

Penetrating injury of the upper cervical spinal cord is usually caused by missiles. An unusual case of injury to the upper cervical spinal cord by a speargun is reported. Surgical treatment was uneventful, and the patient made good neurological progress within 2 days after the operation. On the fifth day he became confused and had a temperature of 40 degrees C. A diagnosis of Branhamella catarhalis meningitis was made. The patient's condition continued to deteriorate despite parenteral broad-spectrum antibiotic therapy, and he died 15 days after the injury.

Adult↗