Biomedical subjects

Murat Kalayci

Publications and source records attributed to Murat Kalayci.

15 recordsLinked to original sources

PubMed2007

Migration of a bullet in the spinal canal.

Migration of a bullet within the spinal canal after gunshot injury is rare. We report here the case of a penetrating gunshot injury of the lumbar spine at L3 with migration of the bullet within the spinal canal S2. The patient had marked paraparesis (proximal 1/5, distal 0/5 muscle strength) and anaesthesia at L3 and below, and had a hypocompliant, hyper-reflexive bladder with decreased capacity, and absent anal tonus. We removed osseous fragments in the canal with an L3 laminectomy and extracted the bullet by S2 laminectomy. After surgery, we observed an improvement in paraparesis, an increase in bladder capacity and urinary compliance, and improvement in anal tonus. The appropriate course of action in this type of injury remains unclear, because the number of cases described in the literature is not sufficient to provide a basis on which to make a definitive therapeutic decision. We herein review the literature describing cases in which a bullet in the spinal canal has migrated; we describe the treatment used and the outcomes in these cases.

Adult↗

PubMed2006

Giant unruptured anterior communicating artery aneurysm presenting with seizure.

Giant aneurysms of the anterior communicating artery (AComA) are rare. The clinical presentation of giant AComA aneurysms is usually associated with the mass effect of the space-occupying lesion or with subarachnoid haemorrhage. A giant AComA aneurysm presenting with a seizure has only been reported twice previously. We report a 70-year-old female patient, in whom a single seizure was the only symptom of a giant AcomA aneurysm, with no neurological deficit. The diagnosis of unruptured giant AComA aneurysm was made with cranial CT, MRI and angiography. The patient refused surgical intervention, was treated with anti-epileptic therapy and has been asymptomatic for 7 months. We suggest that elderly patients presenting with a first seizure need detailed evaluation and giant aneurysms, which may be confused with other intracranial space-occupying lesions, need to be considered in the differential diagnosis.

Aged↗

PubMed2005

Dispersion of cerebral temperature, cerebral perfusion and intracranial pressure in rabbits placed with epidural balloons.

This study examines the intracranial pressure and temperature dispersion in a rabbit model after epidural balloon compression. Right and left supratentorial, intraventricular and infratentorial pressures and temperatures of the rabbits have been measured before epidural balloon was placed. Afterwards, the epidural balloon was placed in right parietal epidural area. The intracranial pressure and temperature dispersion values were recorded after inflation with 0.3 and 0.6 ml, respectively. The control values of intracranial pressure measurements of four different brain regions were found to be similar. When the balloon was inflated to 0.3 ml, the intracranial pressure distribution was found to be equal in all the fields. After the balloon was inflated up to 0.6 ml, right and left supratentorial intracranial pressure values were found to be equal. However, infratentorial pressure values were lower and intraventricular pressure values were higher when compared with the right hemisphere. Before the inflation and at two different inflation volumes, perfusion pressure and temperature dispersion were found to be similar between right hemisphere and other compartments. We conclude that, the effective mechanism in cerebral temperature regulation may be related to preserved cerebral perfusion pressure and cerebral blood flow.

Animals↗

PubMed2005

Primary spinal extranodal Hodgkin's disease at two levels.

About 90% of Hodgkin's disease cases originate from lymph nodes whereas 10% from extranodal regions. Patients rarely present with spinal cord compression due to epidural Hodgkin's disease. Primary spinal extradural Hodgkin's disease which does not have any other organ involvement in the body is even rarer. A 39-year-old male patient who complained of lumbar pain had normal findings upon neurological examination. Radiological examination revealed a mass on the epidural space at level L3 and the involvement of the vertebral corpus accompanied by the involvement of C6 vertebral body. Primary focus could not be identified despite further investigation. The patient underwent L3 laminectomy and posterior decompression and biopsy was obtained from the lesion extending to epidural space. The pathological result was reported as lymphocyte dominant type Hodgkin's disease. Flow cytometry was performed to the lesion, also. The patient was evaluated as Stage 4A according to Ann Arbor classification. Postoperative radiotherapy was applied to lumbar and cervical region. In the literature we have not come across any case of primary spinal extranodal Hodgkin's disease with involvement at two levels. In conclusion, although it might be extremely rare, primary spinal extranodal Hodgkin's disease with involvement at two levels might be observed.

Adult↗

PubMed2005

Neuroprotective effects of ebselen on experimental spinal cord injury in rats.

Spinal cord injury (SCI) results in rapid and significant oxidative stress. This study was aimed to investigate the possible beneficial effects of Ebselen in comparison with Methylprednisolone in experimental SCI. Thirty six Wistar albino rats (200-250 g) were divided in to six groups; A (control), B (only laminectomy), C (Trauma; laminectomy + spinal trauma), D (Placebo group; laminectomy + spinal trauma + serum physiologic), E (Methylprednisolone group; laminectomy + spinal trauma + Methylprednisolone treated), F (Ebselen group; laminectomy + spinal trauma + Ebselen treated), containing 6 rats each. Spinal cord injury (SCI) was performed by placement of an aneurysm clip, extradurally at the level of T11-12. After this application, group A, B and C were not treated with any drug. Group D received 1 ml serum physiologic. Group E received 30 mg/kg Methylprednisolone and, Group F received 10 mg/kg Ebselen intraperitoneally (i.p.). Rats were neurologically examined 24 h after trauma and spinal cord tissue samples had been harvested for both biochemical and histopathological evaluation. All rats were paraplegic after SCI except the ones in group A and B. Neurological scores were not different in traumatized rats than that of non-traumatized ones. SCI significantly increased spinal cord tissue malondialdehyde (MDA) and protein carbonyl (PC) levels and also decreased superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) enzyme activities compared to control. Methylprednisolone and Ebselen treatment decreased tissue MDA and PC levels and prevented inhibition of the enzymes SOD, GSH-Px and CAT in the tissues. However, the best results were obtained with Ebselen. In groups C and D, the neurons of the spinal cord tissue became extensively dark and degenerated with picnotic nuclei. The morphology of neurons in groups E and F were very well protected, but not as good as the control group. The number of neurons in the spinal cord tissues of the groups C and D were significantly less than the groups A, B, E and F. We concluded that the use of Ebselen treatment might have potential benefits in spinal cord tissue damage on clinical grounds.

Animals↗

PubMed2005

A training model for lumbar discectomy.

Training models are becoming increasingly important for gaining surgical skills. We present an easy to prepare and cheap model using cadaver sheep spine appropriate to learn and practice various discectomy procedures.

Diskectomy↗

PubMed2005

Dose-dependent neuroprotective effects of melatonin on experimental spinal cord injury in rats.

BACKGROUND: This report examines the dose-dependent effects of melatonin on early lipid peroxidation levels, ultrastructural changes, and neurological function in experimental spinal cord injury (SCI) by comparing them with therapeutic levels of methylprednisone in rats. METHODS: SCI was performed by an aneurysm clip placed extradurally at the level of T10. Rats were randomly divided into six groups of 10 rats each. Group 1 (sham) received only laminectomy; group 2 (control) received SCI; group 3 (placebo) received SCI and physiological saline; group 4 received methylprednisone (30 mg/kg); groups 5 and 6 received melatonin at doses of 50 or 100 mg/kg, respectively, after SCI. Rats were neurologically tested 24 hours after trauma. Spinal cord samples were harvested for both lipid peroxidation levels and ultrastructural histopathological evaluation. RESULTS: Neurological scores of rats were not different in SCI groups. Lipid peroxidation levels are significantly restricted only in methylprednisone group at 24 hours. Melatonin-treated groups showed more ultrastructural improvement on electron microscope studies when compared with methylprednisone group. However, the therapeutic effects of melatonin were mainly observed on white matter of spinal cord in ultrastructural investigation. There was significant difference between melatonin dose groups increasing with dose. CONCLUSIONS: Results showed that melatonin has no significant dose-dependent effects on early lipid peroxidation bur rather some neuroprotective effects on both axons and myelin sheaths of white matter in ultrastructural observations when compared with methylprednisone. These effects significantly augmented with dose increase.

Animals↗

PubMed2005

Ventral cervicomedullary junction compression secondary to condylus occipitalis (median occipital condyle), a rare entity.

OBJECTIVE: Condylus occipitalis is presented in postmortem anatomic studies. There is no clinical study in the literature. Myelopathy due to anomalies of the craniovertebral junction is rare in neurosurgical practices. To our knowledge, myelopathy due to condylus occipitalis has not been reported before. Deaths of two cases were previously reported, but these were not live cases. METHODS: We describe the case of a 40-year-old woman presenting with progressive myelopathy related to condylus occipitalis located in the anterior foramen magnum region. RESULTS: Magnetic resonance imaging and computed tomography showed the condylus occipitalis, marked stenosis of the spinal canal at the level of the atlas, with cord compression and evidence of myelopathy. We performed posterior decompression without fusion and duraplasty. Because the cervicomedullary compression syndrome was not resolved, a transoral decompression could not be done owing to pulmonary insufficiency. CONCLUSIONS: This unique clinical article (a live case), not anatomic, presents a very rare abnormality of the craniovertebral junction. Myelopathy is a very important complication of this congenital craniovertebral junction abnormality. Posterior decompression seems not to be effective for myelopathy due to condylus occipitalis. In our opinion, anterior decompression is needed in this condition. A larger series will be needed to better define its role in the management of this anomaly.

Adult↗

PubMed2005

Does hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane interfere with the healing of intestinal suture lines and abdominal incisions?

Although hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane has the advantage of preventing intraabdominal adhesions, it has theoretical risk of negative effects on the healing of intestinal suture lines by forming a barrier between the suture lines and neighboring serosal surfaces. This study evaluated the effect of HA-CMC on bowel anastomoses, scar healing, and intraabdominal adhesion formation. Two groups of 10 male Sprague-Dawley rats were examined. In the first group, laparotomy was performed with a median incision. Colotomy on the cecum and a single-layer repair of the bowel wall was performed. HA-CMC membrane was placed on the cecal suture line and under the laparotomy incision before abdominal closure. The second group had the same procedure but no HA-CMC membrane was placed. The animals were killed on postoperative day 14. Intraabdominal adhesions, laparotomy suture line endurance, bursting pressure of the repaired cecal wall, and tissue hydroxyproline levels were determined. The repaired cecal wall was also examined histopathologically. The statistical analyses revealed that HA-CMC prevented intraabdominal adhesions significantly. No negative effects of this material on the healing of the bowel and laparotomy suture lines were observed. HA-CMC appears to be a safe material to prevent intraabdominal adhesions, without negative effects on the healing of abdominal incisions and bowel suture lines.

Abdomen↗

PubMed2005

Spinal granulocytic sarcoma (chloroma) presenting as acute cord compression in a nonleukemic patient.

The case of a previously healthy 24-year-old man diagnosed with extradural thoracic granulocytic sarcoma with no evidence of bone marrow or other hematological involvement is described. The tumor was removed totally by microsurgery. The histopathological examination was consistent with granulocytic sarcoma. Granulocytic sarcomas are most commonly found in the context of an acute myelogenous leukemia or in chronic myelogenous leukemia. They rarely have been reported in otherwise healthy patients without any evidence of systemic disease. A review of the literature revealed only 14 more nonleukaemic cases with granulocytic sarcoma causing thoracic spinal cord compression.

Adult↗

PubMed2004

[High resolution MR neurography in patients with cervical radiculopathy].

PURPOSE: To image the cervical spinal nerves directly in patients with clinical and radiographic evidence of cervical radiculopathy via high resolution MR neurography by means of a qualitative and quantitative analysis. MATERIALS AND METHODS: Twenty symptomatic patients with cervical radiculopathy and five asymptomatic volunteers were examined. A phased-array coil system was used to obtain high-resolution coronal T1-weighted spin echo and coronal/axial short tau inversion recovery (STIR) images of the cervical spine and spinal nerves. On the axial STIR images, nerve/muscle signal intensity ratio of the cervical spinal nerves were measured on both sides and compared with paired samples t test. P values below 0.05 were considered statistically significant (p<0.05). RESULTS: A markedly increased signal in the distal portion of the affected spinal nerves was found. Nerve/muscle signal intensity ratio measurements of the affected spinal nerves showed a significantly increased intensity compared with the noninvolved spinal nerves (p<0.05). In controls, nerve/muscle signal intensity rate was nearly identical on both sides (p>0.05). CONCLUSION: Magnetic resonance neurography performed with phased-array coils can detect signal abnormalities within compressed cervical spinal nerves in patients with corresponding radicular symptoms and findings. This technique may be helpful especially in evaluating patients with multi-level disc disease of the cervical spine.

Adult↗

PubMed2004

[The role of three dimensional MR myelography in lumbar discogenic disease].

PURPOSE: To evaluate the role of the three dimensional (3D) MR myelography (MRM) in the diagnosis of the lumbar discogenic disease compared with conventional MR imaging. MATERIALS AND METHODS: Fifty consecutive patients with clinical symptoms of lumbar disc herniation were enrolled for the study. Conventional MR imaging and coronal 3D MRM were performed on a 1.5 T MR system. At each disc space level, the presence and the location of disc herniation and nerve root compression were evaluated. Note was also made if MRM had additional contribution to the determination of most significant level in the cases of multilevel disc disease and lumbar spinal stenosis. RESULTS: Disc herniation was found in 60 disc space levels on conventional MR imaging and in 54 disc space levels on 3D-MRM imaging. As regards to disc herniation, the sensitivity, specificity, and accuracy of 3D-MRM was 90%, 100%, and 96%, respectively. Nerve root compression was seen in 91 levels on conventional MR images, as opposed to 98 on 3D-MRM. Regarding nerve root compression, the sensitivity, specificity, and accuracy of 3D-MRM was 100%, 97%, and 98%, respectively. In all of 13 patients with multilevel disc disease and lumbar spinal stenosis, 3D-MRM had additional contribution. CONCLUSION: Scan time of 3D-MRM is short. It can be easily added to routine lumbar MR imaging. It may be a valuable modality in the diagnosis of the lumbar discogenic disease. The presence of false-negative and false-positive examinations necessitates caution in interpreting 3D-MRM images. 3D MRM technique may be useful in selected cases such as patients with multilevel disc abnormalities or lumbar spinal stenosis where it allows a rapid and easy appreciation of the level most likely to account for the pathology.

False Positive Reactions↗

PubMed2004

[Endovascular coil embolization with balloon remodelling technique after partially clipped ica aneurysm (case report)].

The presence of aneurysm remnant after incomplete or unsuccessful surgical clipping is associated with persistent risk of regrowth and rupture, and additional treatment is generally recommended. Advances in aneurysm coiling techniques and technology have allowed for more remnants to be treated safely. We present a 47-year-old woman with residual internal carotid artery aneurysm after surgical clipping with coils and balloon remodeling technique.

Aneurysm↗

PubMed2003

A prospective randomized study comparing perioperative outcome variables after epidural or general anesthesia for lumbar disc surgery.

General and regional anesthesia (spinal and epidural) can be performed successfully for lumbar disc surgery. The aim of this study was to assess the superiority of general anesthesia or epidural anesthesia techniques in lumbar laminectomy and discectomy. Sixty patients undergoing lumbar partial hemilaminectomy and discectomy were randomly divided into two groups receiving standardized general anesthesia (GA) or epidural anesthesia (EA). Demographically, both groups were similar. Surgical onset time (36.72 +/- 5.47 vs. 25.40 +/- 7.83 minutes) was longer in the EA group, but total anesthesia time (154.32 +/- 35.73 vs. 162.40 +/- 26.79 minutes) did not differ between the two groups. Surgical time (118.80 +/- 35.42 vs. 139.60 +/- 26.80 minutes) was longer in the GA group. The heart rate and mean arterial pressure values of the EA group measured 15, 20, and 25 minutes after local anesthetic administration to the epidural catheter were found to be lower than in the GA group measured after induction of general anesthesia. The frequency of bradycardia (EA vs. GA, 3 vs. 2), tachycardia (3 vs. 7), and hypotension (6 vs. 4) during anesthesia did not differ between the groups, but the occurrence of hypertension (1 vs. 7) was higher in the GA group. Blood loss was less in the EA group than in the GA group (180.40 +/- 70.38 vs. 288.60 +/- 112.51 mL). Postanesthesia care unit (PACU) heart rate and mean arterial pressure were higher in the GA group. Peak pain scores in PACU and postoperative 24 hours were higher in the GA group when compared with the EA group. Nausea was more common in the GA group both in PACU and 24 hours after surgery. There was no difference between the hospitalization duration of the groups. In conclusion, this study suggests that EA is an important alternative to GA during lumbar disc surgery.

Adult↗

PubMedDate not supplied

Effect of cerebrospinal fluid leakage on wound healing in flap surgery: histological evaluation.

The aim of this study was to find out the effect of CSF leakage on wound healing after flap surgery. Sixteen male Wistar rats were used. The superiorly based rectangular dorsal skin flap 3 x 3 cm was elevated at the interscapular region. Through this opening, paraspinal muscle dissection and three-level bilateral laminectomy were done. Finally, a dura defect with a diameter of 3-4 mm was created. In the control group, laminectomy was performed as in the study group but the dura was left intact. Persistent CSF leakage was confirmed using isotope cisternography. At the end of 2-week study period, there was no necrosis, infection, or dehiscence of the flap in either group. On necroscopy, cyst formation over the dura defect was detected in 4 animals of the study group. Another gross finding in this group was intensive vascularization of the undersurface of the flap and wound bed. With HE staining, the tissue sections from the study group revealed new vessel formation with small diameter, increase in the reactional mesenchymal tissue, granulation tissue, degeneration of the striated muscle fibers, dystrophic calcifications, fat necrosis, and coagulation necrosis (ischemic necrosis). In the control group, there was only minimal lymphocytic invasion of the subdermal plane. In this study, we have shown that CSF leakage itself has effects on wound healing in the absence of known causative factors.

Animals↗