Biomedical subjects

Orhan Sen

Publications and source records attributed to Orhan Sen.

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

Atypical traumatic craniocervical junction focal spinal subdural hematoma.

Spinal subdural hematoma (SSDH) is a rare entity and post-traumatic cervical SSDH is very rare. Review of the literature revealed 8 reported cases of traumatic SSDH and only 2 were cervical. The exact mechanism and pathogenesis of SSDHs are unclear. There are still controversies about the source of bleeding and mechanisms of formation of a hematoma. Here we report a case of a unique traumatic craniocervical junction focal subdural hematoma in an 8-year-old boy and discuss the possible mechanisms of SSDHs in trauma cases.

Cervical Vertebrae↗

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

Giant cell tumour of the sixth cervical vertebrae with close relationship to the vertebral artery.

Giant cell tumours of the vertebral column are rare and cervical vertebrae involvement is even less common. As these lesions may be closely related to the vertebral artery, therapeutic decision-making may be complex. Reviewing the literature, we found that there was no consensus on treatment or outcome assessment for these rare and difficult lesions. We present a case of a giant cell tumour of the sixth cervical vertebrae involving the posterior elements, neural foramina and transverse foramina and closely related to the vertebral artery. Radiological evaluation and therapeutic solutions are also discussed.

Adult↗

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

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↗

PubMed2003

Hemispheric cerebrovascular venous thrombosis due to closed head injury.

CASE REPORT: We present the case of an 8-month-old infant who was admitted to our Neurosurgery Department with venous infarction related to sagittal sinus thrombosis. The infarction was radiologically detected 5 days after the baby had undergone surgery for acute subdural hematoma due to a closed head injury. RESULTS AND CONCLUSIONS: Cerebrovascular venous thrombosis is a rare clinical entity that has multiple causes and variable presenting symptoms. There is no consensus on overall strategy concerning surgical, radiosurgical, or medical therapy (anti-coagulation, thrombolytic, and anti-edema treatment), and exactly how, when, or in which cases these should be applied. The treatment planning should be based on clinical findings, and should be modified according to the clinical course. In this case, the clinical and radiological findings regressed with symptomatic treatment alone.

Brain Edema↗

PubMed2003

Roles of periosteum, dura, and adjacent bone on healing of cranial osteonecrosis.

It has been reported that large cranial osteonecrotic areas can heal. It was hypothesized that optimal healing is possible by the synchronized contribution of the osteogenic structures (periosteum, dura, and adjacent bone) that envelop the necrotic cranium. This hypothesis was tested by preserving or isolating the contribution of these osteogenic tissues. A total of 37 4-old-month rats were included in the study. Twelve animals were killed immediately, and cranial bone samples were taken and processed for examination (from 6 animals as fresh samples [Group A] and from the rest as autoclaved samples [Group B]). Group B was created to test if the bone was completely nonviable. In Group C (n = 25), cranial bone disks 8 mm in diameter were taken from 4-month-old rats, autoclaved, and put back onto the defect area. This group was further divided into the four Subgroups C1 through C4 (n = 7 in C3; n = 6 in C1, C2, and C4). Dura mater was isolated from the overlying bone disk with a polytetrafluoroethylene sheet in Subgroups C1 and C2, whereas the bone contacted the dura in the rest. The bone samples were covered with healthy periosteum in Subgroups C1 and C3 and with skin in Subgroups C3 and C4. These animals were killed after a healing period of 12 weeks, and the relevant bone disks were obtained. Surrounding healthy bone was also harvested from the same animals after they were killed to create Group D. The data of Group A and D were compared with those of the experimental group to comment on the degree of bone healing in the latter group. Quantitative and qualitative assessment was performed by mammography, bone densitometry, computed tomography, and histological examinations to find out the density and cellular content (osteocytes and vessels) of the samples. Examination of Group B samples showed nonviable tissue with a preserved microstructure. Analysis of other samples showed that both the periosteum and, mainly, the dura play an important role in cranial bone healing. The periosteal reaction was observed to be more evident when the dura was not separated. Cellular repopulation was more evident when both structures contributed to the healing process. Newly formed bone progressed centripetally; however, adjacent bone without the support of the dura and periosteum was capable of producing limited neovascularization and bone formation.

Animals↗

PubMed2003

Prefabricated galeal flap based on superficial temporal and posterior auricular vessels.

Scalp layers are widely used in reconstructive procedures. The authors used prefabricated galeal flaps based on the superficial temporal or postauricular vessels for ear, cheek, mandible, and cranium reconstructions in three cases. In case 1, synchronous beard and ear reconstructions were accomplished by using the temporoparietal and retroauricular flaps. In case 2, a buccomandibular defect was reconstructed by transposing the supra-auricular and retroauricular galea with prefabricated bone and skin. In case 3, an epidural hematoma in the left frontoparietal area was evacuated after a circular craniectomy. The harvested bone was not put back on the defect area but buried between the periosteal and galeal layers because of brain edema. These layers were raised as an osteogaleoperiosteal flap and transposed onto the defect area after 7 weeks. When used with a prefabrication method, scalp layers offer versatile options for repairing composite defects of the head region. A galeal flap based on the posterior auricular vessels is practical and reliable in reconstructive procedures. The authors suggest that this flap is an option in cases in which the temporoparietal fascia artery or the superficial temporal artery is not available. Prefabrication of the harvested cranial bone inside the adjacent tissues offers several advantages in that a viable bone is provided at the end of the procedure, intervention at a distant area is avoided, the graft is placed on osteogenic tissue (periosteum) that is also transposed onto the defect, and sophisticated procedures such as microsurgical techniques are not needed.

Adult↗

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↗