Biomedical subjects

Nur Altinors

Publications and source records attributed to Nur Altinors.

At least 19 recordsLinked to original sources

PubMed2006

Primary amyloidoma of the thoracic spine.

Amyloidoma is a nodular mass of amyloid with no evidence of generalized amyloidosis. Primary amyloidoma of the spine is very rare and has a predilection for the thoracic region. The tumor-like appearance and behavior make it difficult to diagnose on imaging studies. Despite its rarity and nonspecific radiologic findings, primary spinal amyloidoma should be included in the differential diagnosis of an osteolytic and calcified mass of the spine. We report the case of a 38-year-old woman with amyloidoma involving the thoracic spine and describe the main characteristics of this condition.

Adult↗

PubMed2006

Augmentation of a loosened sacral pedicle screw with percutaneous polymethylmethacrylate injection.

STUDY DESIGN: Case report describing augmentation of a loosened sacral screw with percutaneous injection of polymethylmethacrylate. OBJECTIVE: To highlight the advantages of percutaneous injection of polymethylmethacrylate in treatment of loosened pedicle screws. SETTING: Turkey. SUMMARY OF BACKGROUND DATA: Lumbosacral instrumentation with pedicle screws is a commonly used procedure for correcting deformity and stabilizing the spine until bony fusion occurs. Loosening of the screws is a complication of this procedure and is seen more frequently in multilevel instrumentation, particularly in those instrumentations using sacral screws. METHOD: We present the case of a woman who had had L3-L4-L5-S1 instrumentation with pedicle screws who developed severe low back pain radiating to the left hip 2 months after the operation. Radiologic and clinical examination revealed that the left pedicle screw of the sacrum had loosened, and revision surgery was planned. The left sacral screw was augmented with percutaneous injection of polymethylmethacrylate. RESULTS: The patient was free of pain after the operation. CONCLUSIONS: We suggest that percutaneous polymethylmethacrylate injection around a loosened screw may be an alternative to major open revision surgery in cases of sacral screw failure in multisegmental instrumentation.

Bone Screws↗

PubMed2006

Systemic administration of phosphodiesterase V inhibitor, sildenafil citrate, for attenuation of cerebral vasospasm after experimental subarachnoid hemorrhage.

OBJECTIVE: One of the phosphodiesterase isoenzymes, Type V (PDE V), specifically hydrolyzes cyclic guanosine monophosphate to cause vasoconstriction. This study analyses the effect of PDE V inhibition with sildenafil citrate (SC) on cerebral vasospasm and its effect on apoptotic changes of the vascular endothelium. METHODS: Twenty-four rabbits were divided into four groups. The first group was composed of sham-surgery animals. The second group was the subarachnoid hemorrhage (SAH) group, in which cerebral vasospasm was induced. In the third group, sham-surgery rabbits were treated with SC. In the fourth group, animals were treated with SC after SAH. SC was administered for 48 hours, 0.7 mg/kg, three times per day in Groups 3 and 4. Basilar artery lumen circumferences were measured in all groups by computerized image analysis. The terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling (TUNEL) method was used to evaluate the rate of apoptosis between SAH and SC-treated SAH groups. Results were compared by analysis of variance and paired t tests, and P values less than 0.05 were considered significant. RESULTS: Basilar artery circumferences between groups were significantly different (P < 0.001). SC (0.7 mg/kg, three times per d) significantly dilated the basilar arteries in both the sham-surgery group (2370 +/- 233 microm; P = 0.039) and the SAH group (2142 +/- 195 microm; P = 0.006) after 48 hours of treatment. The TUNEL method for apoptosis revealed that actual numbers of the apoptotic endothelial cells per cross section after SAH in the control (no treatment) (73 +/- 2) and SC-treated (0.7 mg/kg) groups(76 +/- 3) were not significantly different (P > 0.05). CONCLUSION: The vasodilatory effect of SC was observed to be significant on normal cerebral vessels and after SAH-induced vasospasm. SC did not prevent apoptosis of the endothelium in our study, which suggests that prevention of apoptosis is not necessary in the treatment of cerebral vasospasm.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2005

Unusual case of skull metastasis secondary to pancreatic adenocarcinoma.

Skull metastasis must be kept in mind when considering the differential diagnosis of a skull tumor. Skull metastases cause local swelling that is usually painless, and rarely they lead to neurologic dysfunction. Despite the fact that hematogenous skull metastases can be caused by nearly all types of tumors (lung, prostate, thyroid carcinoma, malignant melanoma), breast cancer is associated with the highest rate of metastatic skull lesions. We report an extremely rare case of skull metastasis from a pancreatic adenocarcinoma, in a 65-year-old woman, presented with painless frontoparietal scalp swelling which developed within three months. To the best of our knowledge, this is the second case involving the skull secondary to a pancreatic adenocarcinoma, and the first case when skull metastasis was the first evidence of a pancreatic adenocarcinoma.

Adenocarcinoma↗

PubMed2005

Can E-selectin be a reliable marker of inflammation in lumbar disc disease?

The cause of sciatica and low back pain associating with lumbar disc herniation has not been clearly identified until now. Inflammation has been shown to occur via immunohistochemical and biochemical methods in herniated disc tissues. The important prognostic role of E-selectin has recently been substantiated by other studies in early rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). The important role of adhesion molecules in the initiation and progression of the inflammatory response is well known for infectious diseases and autoimmune disorders. In our study, we aimed to show the role of E-selectin as an inflammatory marker and the correlation of inflammation with straight-leg raise (SLR) test findings and subtype of disc herniation. We found that the cases with positive SLR test had higher rates of immunostaining with E-selectin. This led us to think that E-selectin might play an important role in the activity status of the disease, meaning patients with more limited movement capacity might benefit from E-selectin antagonist therapy. Among the many studies performed to identify the relationship between the inflammation markers and activity of lumbar disc herniation, this is the first investigation held with E-selectin.

Adult↗

PubMed2005

Multiple myeloma of the thoracic spine developed at the previous trauma site: case report.

The precise nature of the underlying plasma cell dyscrasias is not well understood. Even today, no causative factor has been found for this disease. It has been suggested that, several factors may act together in the development of this disease. This is a report of a 62-year-old man who initially had a T7 compression fracture and developed a multiple myeloma two years later at that site and at the adjacent vertebral level (T7-T8), respectively. Although the notion that trauma would initiate such a malignancy is speculative, the preceding trauma may be a causative factor in plasma cell dyscrasias.

Humans↗

PubMed2005

Silent pituitary macroadenoma co-secreting growth hormone and thyroid stimulating hormone.

Silent pituitary adenomas are a group of tumors showing heterogenous morphological features with no hormonal function observed clinically. To date no explanation has been provided as to why these tumors remain "silent". We report a case of a silent macroadenoma with both growth hormone (GH) and thyroid stimulating hormone (TSH) staining and secretion but with no clinical manifestations, in particular, the absence of features of acromegaly or hyperthyroidism. The relevant literature is reviewed.

Adenoma↗

PubMed2005

Kyphoplasty: 2 years of experience in a neurosurgery department.

BACKGROUND: Kyphoplasty is a new technique to treat collapsed vertebral body (VB) fractures. The technique is very effective for achieving rapid pain relief, restoring bone height,and consequent vertebral realignment,and thus stabilization of the vertebra. METHODS: We reviewed 57 patients with vertebral compression fractures. All patients were neurologically intact and presented with severe low back pain or localized pain over the thoracolumbar region. Indications for kyphoplasty were osteoporotic and traumatic compression fractures, osteolytic tumor metastases, and aggressive hemangiomas without spinal canal compression. RESULTS: In 57 patients, 77 levels were treated. Follow-up was 6.5 months. Patients were evaluated with a visual analog scale (VAS) preoperatively and postoperatively. The mean preoperative VAS score was 91.08 for pain, whereas the mean postoperative VAS score was 11.22. Percentage of mean pain relief was 87.9% during the first 6 months of follow-up. We achieved a 43.6% improvement in the height of the compressed VB and 6.3 degrees of improvement in the kyphotic angle. No serious complications occurred. Mean hospital stay was 24 hours. CONCLUSIONS: Kyphoplasty carries significantly less morbidity than vertebroplasty or open surgery. Risk for embolization is low. Normal kyphotic angle can be restored or improved by this technique. In the hands of experienced surgeons, kyphoplasty is a safe and a minimally invasive technique for patients with neoplastic, traumatic, or osteoporotic lesions of the vertebra or sacrum.

Aged↗

PubMed2005

Management of fronto-orbital sphenoidal and facial osteosarcoma: a case with uncommon localization.

Osteogenic sarcomas of the head and neck are rarely seen; approximately 6% to 13% these tumors occur in the head and neck, and less than 2% occur in the cranium. Not only eradication of the tumor but reconstruction to achieve satisfactory esthetic and functional results are the main issues regarding these tumors. In this report, a case of osteogenic sarcoma that invaded the infratemporal area, fronto-orbital region, and sphenoid wing is presented. The surgical results of eradication and reconstruction are also presented.

Adult↗

PubMed2005

Fronto-orbital leptomeningeal cyst manifested with exophthalmus.

A 41-year-old female patient with fronto-orbital leptomeningeal cyst is presented. After decompression of the cyst, repair of bone and dura defects were achieved with autogenous bone grafts and pericranial flap. Our case was very interesting in several aspects: a head trauma at 3 years of age and manifestation of clinical symptoms (headaches and exophthalmia) after almost 4 decades that had been progressive for 6 months and a rare location (fronto-orbital region) that required a special management. A thorough history is crucial in such cases because clinical symptoms might appear after decades. An old fracture that is surrounded by thin calvarial tissue in conjunction with intracranial cystic formation should make one take a leptomeningeal cyst into consideration in differential diagnosis. Extensive dissection and adequate access osteotomies followed by repair with autologous and vascular tissues are the key factors for a successful outcome in the management of fronto-orbital pathologies.

Adult↗

PubMed2005

The relation between serum levels of osteoprotegerin and postoperative epidural fibrosis in patients who underwent surgery for lumbar disc herniation.

OBJECTIVES: Epidural fibrosis (EF) is a part of the normal physiological tissue response to laminectomy and it is an important cause of failed back surgery syndrome (FBSS). Osteoprotegerin (OPG) is a soluble member of the tumor necrosis factor receptor family, and is expressed in high concentrations by a variety of tissues and cell types. The objective of this study was to evaluate the relationship between serum OPG levels, and the existence of postoperative EF in patients with lumbar disc herniation. It has been suggested that cytokines and growth factors, which play a role in the wound healing, may enhance the expression of OPG. METHODS: Forty women who underwent surgery for lumbar disc herniation were included in this study. Postoperative MRI was performed to assess EF in all patients. RESULTS: The serum OPG levels of subjects with postoperative EF were significantly higher than those of subjects without postoperative EF (4.72 +/- 0.27 versus 3.25 +/-0.41 pmol/l; p=0.005) DISCUSSION: Although the role of OPG in the development of EF is poorly understood, our results suggest that elevated levels of serum OPG are associated with and may play a role in the pathogenesis of fibrotic process.

Absorptiometry, Photon↗

PubMed2005

Effect of melatonin on cerebral vasospasm following experimental subarachnoid hemorrhage.

OBJECT: The current study was undertaken to determine whether melatonin therapy reverses vasospasm and prevents apoptosis by inhibiting lipid peroxidation in an experimental subarachnoid hemorrhage (SAH) model. MATERIALS AND METHODS: The rabbits were divided into four groups as follows: Group 1, SAH + melatonin (5 mg/kg/i.p. BID) simultaneously with SAH (n = 6); Group 2, SAH + melatonin (5 mg/kg/i.p. BID) treated 2 hours after SAH (n = 6); Group 3, control group (n = 4); Group 4, SAH only (n = 6). Light microscopic examinations of the basilar arteries were performed to demonstrate the pathophysiological changes of the arterial wall with hematoxylin- eosin. Apoptosis: Immunohistology using the ApopTag Peroxidase In Situ Apoptosis Detection Kit was used to demonstrate apoptosis in a cross section of basilary arteries. Apoptotic index was calculated as the number of the immunoreactive nuclei per total number of endothelial cells, and expressed as a percentage. RESULTS: The results of measurements of diameters of the vessels between groups were significantly different (p = 0.028). While basilar arteries of the SAH only group showed 57% constriction, Groups 1 and 2 were calculated as 33 and 26% constriction, respectively, compared with the control group (p < 0.05). And also Groups 1 and 2 showed significant protection of apoptosis compared with Group 4. The difference between the four groups was tested by Kruskal-Wallis test and the significance between the two groups was tested by Mann- Whitney U-test. CONCLUSION: Melatonin with its strong antioxidant effect can prevent SAH-induced vasospasm and apoptosis of endothelial cells of vessels.

Animals↗

PubMed2005

Analysis and prevalence of inflammatory cells in subtypes of lumbar disc herniations under cyclooxygenase-2 inhibitor therapy.

OBJECTIVE: The aim of the present study was to analyse inflammatory cells in lumbar disc tissue under cyclooxygenase-2 (COX-2) inhibitor therapy, to detect their prevalence in different subtypes of lumbar disc herniations and to assess the influence of inflammatory reactions in herniated disc tissue on postoperative outcome. METHODS: In this prospective study, intervertebral disc specimens were obtained from 50 patients. All the patients were given COX-2 inhibitor therapy (Rofecoxib) 25 mg/day for 10 days before surgery. The herniated disc specimens were routinely fixed in a 10% buffered formaline solution and paraffin-embedded; 5 microm thin sections were stained with monoclonal antibodies CD-68 for macrophages, CD-45 RO for T cells and CD-20 for B cells. The specimens were microscopically examined and classified by two independent examiners in a blinded manner. RESULTS: CD-68 macrophages were evident in herniated lumbar disc tissue in 40% of the cases, but abundant inflammation was observed in only 18% of the cases. Macrophages were significantly common in sequesters with a prevalence of 80%, and no macrophages were observed in the protrusions. We obtained the best outcome scores in the patients with a sequestrated lumbar disc herniation. CONCLUSION: Although most of the specimens from all the patients showed no significant inflammatory reaction, maybe due to COX-2 inhibitor therapy, they all needed surgery with no relief of the symptoms despite conservative therapy. Nerve root compression still seems to be the leading pathomechanism.

Adult↗

PubMed2004

The role of closed-suction drainage in preventing epidural fibrosis and its correlation with a new grading system of epidural fibrosis on the basis of MRI.

In this study we aimed to evaluate the role of closed-suction drainage on the extent of epidural fibrosis (EF) after lumbar disc surgery and to define a new grading system of epidural fibrosis in these patients, based on magnetic resonance imaging. Seventy-nine patients (34 women, 45 men) with a unilateral, single-level lumbar disc herniation were included in this study. Forty-one patients in whom closed-suction drainage was implanted were compared with 38 patients in whom the drain was not implanted. We have used a new grading system for the extent of epidural fibrosis, on the basis of follow-up magnetic resonance imaging findings. Pain intensity was evaluated by visual analog scale (VAS), and the patients' function and working ability were measured according to the Prolo functional-economic scale. We conclude that, in patients operated on for unilateral, single-level lumbar disc hernias, implantation of closed-suction drainage into the operation site results in less formation of EF radiologically and yields better clinical outcome.

Adult↗

PubMed2004

Lumbar meningeal hamartoma and epidermoid cyst associated with spinal dysraphism in an elderly patient.

Meningeal hamartoma associated with spinal dysraphism in an elderly patient is an extremely rare clinical presentation. A 62-year-old woman who progressively developed gait disturbance and urinary retention was admitted to our hospital. Magnetic resonance imaging (MRI) revealed a large cystic mass associated with a dermal sinus at the L4-L5 level. MRI was useful in the diagnosis and determination of this lesion. However, preoperative differential diagnosis of the tumor was not possible based on neuroimaging evidence. The diagnosis of meningeal hamartoma was based on the histological and immunohistological findings of the specimen obtained from the tumor. Meningeal hamartoma associated with spinal dysraphism should be kept in mind, even in adult cases. In this article, we also discuss the radiological and pathological appearance of this rare clinical entity.

Epidermal Cyst↗

PubMed2004

Primary primitive neuroectodermal tumor within the spinal epidural space: report of a case and review of the literature.

Primary intraspinal primitive neuroectodermal tumors (PNETs) are rare tumors and a have poor prognosis. In reviews of the literature, it is seen that primary intraspinal PNETs may arise at all levels of the spine and may be intramedullary, intradural-extramedullary, or epidural. Spinal epidural location of PNET is extremely rare and out of 22 cases of primary spinal PNETs reported to date, only two were epidural. Tumors within the epidural space of the spinal canal are most often metastatic neoplasms from different primary sites. Here we report a case of primary extradural PNET located in the thoracic spine in a 16-year-old boy and review the relevant literature.

Adolescent↗

PubMed2004

Intima-media thickness of the carotid arteries is related to serum osteoprotegerin levels in healthy postmenopausal women.

Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and also plays a role in vascular calcification. The objective of this study was to evaluate the relationship between serum OPG levels, and carotid artery intima-media thickness (IMT) and carotid plaque formation in healthy postmenopausal women. We recruited 68 healthy postmenopausal women for the study. Carotid plaque presence and IMT were evaluated by high resolution B-mode ultrasound. IMT was positively correlated with presence of plaque, age, menopause age and OPG, and inversely correlated with Apolipoprotein A1 (Apo A1). Serum OPG level was positively correlated with IMT (r = 0.366; p < 0.003) and age (r = 0.324; p < 0.008), and negatively correlated with Apo A1 (r = -0.481; p < 0.0001). We did not observe any significant relation between plaque occurrence and levels of serum OPG. In regression analysis OPG (p < 0.02) and menopause age (p < 0.05) were independent risk factors for IMT, and age (p < 0.05) and IMT (p < 0.05) were independent risk factors for plaque formation. Although the role of OPG in the vascular biology is poorly understood, our results suggest that elevated levels of serum OPG is associated with IMT and may play a role in the pathogenesis of atherosclerotic disease.

Carotid Arteries↗

PubMed2003

Rapidly calcifying and ossifying epidural hematoma.

Conservative treatment of an epidural hematoma is not always effective in children. We describe an 8-year-old boy who had been followed up conservatively for 10 days at a local hospital due to acute epidural hematoma. A new CT revealed an expansion of the former hematoma accompanied by a thick hyperdense layer. Because the patient presented with symptoms of elevated intracranial pressure, an immediate craniotomy was performed to evacuate the hematoma. The ossified layer, which was densely adhered to the dura mater, was also completely removed. Rapid ossification and/or calcification of an epidural hematoma appearing 10 days after a head injury have not been reported previously. Possible mechanisms of rapid ossification are also discussed in relation to the present report, and the relevant literature is reviewed.

Calcinosis↗