Myxofibrosarcoma involving the sciatic nerve: From ultrasonography to histopathology.

Myxofibrosarcoma (MFS) is a unique soft tissue (fibroblastic) sarcoma, characterized by malignant with a locally infiltrative behavior. In this case image, we aimed to report an uncommon/challenging scenario of MFS involving the scatic nerve in which the potential contribution of ultrasound examination has been touched upon.

Sciatic neurotmesis and periostitis ossificans progressiva due to a traumatic/unexpected glass injury: a case report.

Peripheral nerves may be affected or injured for several reasons. Peripheral nerve damage can result from trauma, surgery, anatomical abnormalities, entrapment, systemic diseases, or iatrogenic injuries. Trauma and iatrogenic injuries are the most common causes. The ulnar, median, and radial nerves are the most injured nerves in the upper extremities, while the sciatic and peroneal nerves are the most injured nerves in the lower extremities. The clinical symptoms of peripheral nerve damage include pain, weakness, numbness/tingling, and paresthesia. Therefore, early diagnosis and appropriate treatment of peripheral nerve injuries are crucial. If a peripheral nerve injury is left untreated, it can lead to severe complications and significant morbidity. The sciatic nerve is one of the most affected nerves. This nerve is generally injured by trauma and iatrogenic causes. Children are more susceptible to trauma than adults. Therefore, sciatic nerve injuries are observed in pediatric patients. When the sciatic nerve is damaged, pain, weakness, sensory loss, and gait disturbances can occur. Therefore, the diagnosis and treatment of sciatic nerve injuries are important to avoid unexpected consequences. Ultrasound can play an important role in the diagnosis of peripheral nerve injury and the follow-up of patients. The aim of this case report is twofold. First, we aimed to emphasize the critical role of ultrasonographic evaluation in the diagnosis of peripheral nerve injuries and pathologies. Second, we aimed to present this case, which has distinguishing features, such as the existence of periostitis ossificans progressiva with sciatic neurotmesis due to a traumatic glass injury.

Spontaneous Idiopathic Cerebrospinal Fluid Rhinorrhea.

Cerebrospinal fluid rhinorrhea is described as cerebrospinal fluid flow through the nose due to the abnormal connection of the subarachnoid space and sinonasal cavity. Spontaneous idiopathic rhinorrhea is a rarely seen disease. Besides the patient's clinical presentation detailed radiological evaluation and other invasive procedures must be carried out to confirm the diagnosis. Its treatment is compelling due to high recurrence rates. In the treatment algorithm when conservative treatment modalities had been proven inadequate, surgical repair must follow in order. In this paper the authors present the details of 2 cases of spontaneous rhinorrhoea patients.

Synthesis of 1,2,4-triazole-5-on derivatives and determination of carbonic anhydrase II isoenzyme inhibition effects.

Carbonic anhydrase (CA) II plays major roles in pH regulation of body, protection of electrolyte balance, transportation of water and some metabolic pathways. Therefore, CA II inhibitors are very important molecules for drug design and have many pharmacological applications. CA II as a target molecule is also important for eliminating some pathological conditions such as glaucoma, cancer, epilepsy, ulcer and obesity. In this study, some 1,2,4-triazole derivatives were synthesized and CA II inhibition potentials of these molecules were examined. It has been found that molecule 7c was the most potent inhibitor with the lowest IC50 value at micromolar level among the examined molecules. The inhibition in the range of 18.41-64.97% was seen in the presence of newly synthesized molecules at their reachable maximum concentration in the reaction mixtures. Kinetic studies showed that the inhibition mechanism of compound 7c on carbonic anhydrase activity was reversible and uncompetitive. Molecular docking studies also indicated that compound 7c could bind to the active site of the enzyme by weakly interacting with especially Gln102, Leu240, Ala241 and Trp243. ADME properties of these newly synthesized (3a-e, 6, 7a-e) were also studied and showed good oral drug candidate like properties.

A new multipartite plate system for anterior cervical spine surgery; finite element analysis.

BACKGROUND: There are numerous available plates, almost all of which are compact one-piece plates. During the placement of relatively long plates in the treatment of multi-level cervical pathologies, instrument related complications might appear. In order to overcome this potential problem, a novel 'articulated plate system' is designed. We aimed to delineate finite element analysis and mechanical evaluations. MATERIAL AND METHODS: A new plate system consisting of multi partite structure for anterior cervical stabilization was designed. Segmental plates were designed for application onto the ventral surface of the vertebral body. Plates differed from 9 to13 mm in length. There are rods at one end and hooks at the other end. Terminal points consisted of either hooks or rods at one end but the other ends are blind. Finite element and mechanical tests of the construct were performed applying bending, axial loading, and distraction forces. RESULTS: Finite element and mechanical testing results yielded the cut off values for functional failure and breakage of the system. CONCLUSIONS: The articulated system proved to be mechanically safe and it lets extension of the system on either side as needed. Ease of application needs further verification via a cadaveric study.

Atretic cephaloceles: a comprehensive analysis of historical cohort.

PURPOSE: This study aims to analyze the historical cohort of patients with atretic cephaloceles (ACs) comprehensively, since the literature regarding ACs is limited by small case series or case reports and to report a new venous anomaly concomitant with a parietal AC in our exemplary case. METHODS: After a PubMed/Medline search with "atretic cephalocele" in April 2016, we retrieved 42 articles, 41 of which were relevant with the topic. Full texts of accessible articles and abstracts of inaccessible articles were read comprehensively. References of retrieved articles were manually searched. Additional 29 articles reporting the cases of atretic, rudimentary, occult, or sequestered cephaloceles were accessed, since these terms have been used interchangeably in the literature. RESULTS: Median age and mean age of the patients were 1 and 6.69 years, respectively. Female/male ratio was 1.03:1. Atretic cephaloceles were located in different regions, in decreasing order of frequency: parietal (55 %; n = 105), occipital (37 %; n = 71), parieto-occipital (n = 8), frontal (n = 4), asterion (n = 1), and sincipital (n = 1). Concomitant central nervous system (CNS) anomalies were present in 73.3 % of patients with parietal atretic cephaloceles and in 32.4 % of patients with occipital atretic cephaloceles (p < 0.0001). We realized that all patients with worse outcomes had concomitant CNS anomalies (100 %), whereas only 48 % of those with good clinical outcomes had concomitant anomalies (p = 0.0248). CONCLUSIONS: Atretic cephaloceles present as nodular extrusions on the parietal and occipital regions. Concomitant CNS anomalies, which impair the clinical outcomes, are more common in patients with parietal ACs. Observation-only approach is enough in patients with asymptomatic ACs. However, life-long follow-ups are required, because of recurrence after the surgery.

Demographical Aspects of Central Large Lumbar Disc Herniation.

AIM: The purpose of this study was to investigate the risk factors for the development of the central large disc herniations and to compare the demographic data between central mass prolapse and broad-based central disc herniation. MATERIAL AND METHODS: Between 2002 and 2007, 1630 patients underwent surgery and a large disc herniation was the main problem in 59 patients (3.6%). We performed a retrospective analysis of the demographic data of these patients. Magnetic resonance (MR) images were evaluated according to the disc type and level. Variables were evaluated both at baseline and follow-up, with special emphasis on physical job characteristics, sports activities, and MR - based morphologic findings. RESULTS: Central large disc herniation was diagnosed in 59 patients consisting of 41 males and 18 females. The average age was 34.7 years. 36 patients had a central mass prolapse that occupied more than 50% of the spinal canal. Intraoperative observations confirmed that 29 out of 36 central disc prolapse patients (80.5%) had intact posterior longitudinal ligaments. Interestingly, the condition in these 29 patients was found to have a direct relation with age and occupation or other body training sports activities. CONCLUSION: The size of the large central disc herniation, physical activity, age and gender are major factors in the development of disc herniation.

Is back pain a diagnostic problem in clinical practices? A rare case report.

Multiple thoracic disc herniations are rare, and few reports exist in the literature. Diagnosis of these herniations is often missed because of their lack of specific clinical presentation. They may be treated conservatively or surgically. We presented a 35-year-old woman with five contiguous level thoracic disc herniations. She was admitted with upper back pain. Magnetic resonance imaging showed disc herniations at levels T6-7, T7-8, T8-9, T9-10 and T10-11. All were left sided and on the same line in the sagittal plane. The patient underwent conservative treatment. This report presented an unusual case and discussed its mechanisms.

Ganglioglioma mimicking the cerebral abscess in advanced age: a case report.

Ganglioglioma is one of the rare mixed neuronal glial tumors of the central nerve system. It is responsible for 0.4 - 2% of the intracranial tumors observed in infants and young matures. Its most common localization is the supratentorial region. Typically, the first symptom is epilepsy. Due to the glial structure, that rare tumor can exhibit a malign transformation. Growing slowly through several months or years, it forms neurological dysfunction. The standard treatment of that supratentorial tumor is usually total resection. If an anaplastic quality is observed, the patient undergoes radiotherapy after the surgical intervention. In this article, we presented a 53-year-old patient who presented with headache and dysphasia. The patient was operated for the cystic mass in the left parietal lobe reported as an abscess. The pathology was reported as ganglioglioma and we discussed the case according to the literature.

Further modified Taylor retractor for spinal surgery.

New techniques have minimized the incision length and thus required modifications of surgical instruments. The Taylor retractor is one of these instruments. We therefore designed several modifications of the classical Taylor retractor. The following structural modifications were made on the classical Taylor retractor: First, we provided detachable blades with three different lengths (60, 70, 80 mm). Second, we breached a slit wide enough to let the intervertebral disc rongeurs to nestle down in it. Third, instead of a single sharp tip at the end of the blade, an arched blade that had two smooth tips was designed. Adjustable blades allowed placing the retractor just on the skin without any space between the retractor and skin by sliding the retractor over its blade downwards, thus providing a low-profile surgical retraction. The slit facilitated reaching the other side of the disc by leaning against the retractor. Pressing slightly and lowering the retractor subsided the skin and the paravertebral muscle, consequently facilitated motion of rongeurs and provided better exposure owing to low profile retraction. The arched blade with two tips served better placement with less traumatization at the facet joint. The relevant modifications facilitated the surgical procedure. We believe one retractor with adjustable blades is enough for more comfortable surgery at any depth.

Concomitant tubercular and fungal cerebellar abscess in an immunocompromised girl.

Concomitant tubercular and fungal cerebellar abscess is rare and we report the first concomitant recurrent multi-lobulated tubercular and fungal cerebellar abscess in an immunocompromised girl with Histiocytosis-X. She presented with cerebellar abscess history diagnosed during the ongoing treatment for tuberculous meningitis. The abscess was drained. Upon the detection of cerebellar abscess recurrence and pulmonary infection, she was referred to our clinic five weeks after the first surgical intervention. Patient was conscious, co-operating but confused. She had severe cachexia, stiff neck and fever. Fundus examination showed bilateral papilledema. Cranial MR images revealed multiple lobulated lesions. Suboccipital craniectomy was performed and abscess was evacuated in toto. Lesion was multi-lobulated. Thick, yellow-gray purulent material was drained. Histopathological examinations yielded Langhans giant cells,budding and branching fungal structures. Fungal infection was identified. We emphasize that posterior decompression and total resection should be considered first in the management of lesions with mass effect in the posterior fossa. Also the presence of concomitant fatal fungal abscess highlights that although the clinic and former diagnoses of the patient may direct the clinician to a certain pathogen, unusual resistant organisms should not be.

Surgical results of degenerative spondylolisthesis patients over 70 years old: a single-center experience and clinical outcomes.

AIM: The aim of this study is to evaluate results of surgery in Degenerative Spondylolisthesis (DS) patients over 70 years old. MATERIAL AND METHODS: This is a non-randomized retrospective analysis of the clinical outcome of 34 patients older than 70 years who underwent surgery. At the end of two-year follow-up period, preoperative and postoperative courses were assessed by Oswestry Disability Index (ODI) and Visual Analog Scales (VAS). RESULTS: The mean age was 75 years (range 70-86 years). The mean duration of symptoms was 13.5 years (range 2-30 years). All patients underwent physiotherapy and also 15 (11 female, 4 male) patients used brace. L4-L5 was the most commonly affected level (n=26), Preoperative ODI and VAS scores were mean 71,63 (range 34-100) and 6,77 (range 2-9) (p < 0,05). Postoperative ODI and VAS scores were mean 22,73 (range 0-100) and 2,13 (range 0-10) (p < 0,05). Patients were asked if they had known the outcome, would they accept surgical treatment or not. 86.6% (n=26) of the patients answered the question positively. CONCLUSION: A conventional decompressive laminectomy with foraminotomy and posterolateral fusion in situ with transpedicular instrumentation is necessary and reduces pain and recovers functional disability in elderly patients over 70 years old with DS.

The effects of Diesel exhaust particles on neural tube development in the early stage chicken embryo.

AIM: Particulate matter is an important air-pollutant and its toxicity has been reported. Diesel exhaust particles (DEP) constitute a large portion of particulate matter. Therefore, we established our study to investigate the effects of DEP on neural tissue in early stage chicken embryos. MATERIAL and METHODS: Four study groups and one control group, each of which included 24 objects were designed. Eggs were incubated for 30 hours. Solutions of DEP containing 10, 50, 100, and 200 µg/0.1 ml were prepared with serum saline. At the end of thirty hours diesel exhaust particle solutions were administered under the embryonic discs. After 72nd hour of the incubation, embryos were excised and evaluated macroscopically and histopathologically. RESULTS: The difference between the embryos that were defined as poorly and well developed, was found statistically significant (p < 0.05). Neural tube defects were detected in 16 of 104 embryos. Statistically significant association between the administration of DEP and development of neural tube defect was identified (p=0.037). CONCLUSION: Thus, the direct neurotoxic effects of DEP, which the whole population encounters inevitably, have been shown in the early stages of embryonic development. Further studies are needed to identify the effects of these particles in the later stages of embryonic development.

Correlation between leptin and pro-inflammatory cytokines in cortical contusion injury model.

BACKGROUND: The present study aimed to investigate time-dependent changes in leptin concentrations in brain tissue following experimental traumatic brain injury and to examine the relationship with cytokines. METHODS: After circular craniectomy, 33 male Wistar-albino rats were positioned on a stereotaxic frame and subjected to cortical contusion injury and then divided into 3 groups based on the depth of deformation as: 0 mm (sham controls, n=3), 1.5 mm (moderate injury, n=15) and 2.7 mm (severe injury, n=15). Animals were sacrificed on the 1st, 3rd and 5th days post-injury. RESULTS: One day after moderate injury, interleukin-1 beta (IL-1ß), IL-6, tumor necrosis factor-alpha (TNF-?), and leptin levels were found to be markedly increased in the brain tissue. On the 3rd and 5th days, the levels returned to the shamcontrol levels. Following severe injury, IL-1ß, IL-6 and TNF-? levels increased in correlation after the 1st day and reached the sham-control levels on the same days. However, leptin tissue levels decreased on the 1st and 3rd days and normalized to the sham-control levels on the 5th day. CONCLUSION: Our results showed that the release of leptin is decreased in the early stage of severe injury. Thus, leptin replacement may play an important role in therapy in cases with severe traumatic brain injury.

Anterior tarsal tunnel syndrome secondary to missed talus fracture: a case report.

The anterior tarsal tunnel syndrome (ATTS) has first been described by Kopell and Thompson in 1963. The anterior tarsal tunnel is formed by the fascia lining the inferior extensor retinaculum and talus as well as the navicular bone. Many ATTS cases with various etiologies have been reported since the first description. We report here an ATSS case resulting from a fibro-osseous structure that occurred after a missed talus fracture. The ATTS diagnosis can be made with a comprehensive clinical neurological examination and electrophysiological study. The treatment is based on the underlying etiology, while surgery is the most common treatment providing successful outcomes in the long term.

Capillary hemangioma of the cervical intervertebral disc.

An anterior cervical decompression and fusion operation was complicated by extensive bleeding from the disc space. Histopathological evaluation of the resected specimen revealed the diagnosis as the very first reported case of capillary hemangioma in intervertebral disc space. Retrospective review of the preoperative MRI demonstrated supporting findings of a capillary hemangioma within the cervical intervertebral disc.

DNA binding, antioxidant and antimicrobial activities of homo- and heteronuclear copper(II) and nickel(II) complexes with new oxime-type ligands.

Some homo- and heteronuclear Cu(II) and Ni(II) complexes of new oxime-type ligands were tested against several pathogenic microorganisms to assess their antimicrobial potentials. The antimicrobial activities of complexes were evaluated in terms of minimum inhibitory concentration (MIC; µg/µL) and it was observed that the complexes possess moderate antimicrobial properties. The binding of the complexes with DNA were also investigated by using UV-Vis spectroscopy. It was seen that three of the complexes could bind to DNA through an intercalative mode while the other complexes could have other mechanisms. Furthermore, the antioxidant efficiencies of the metal complexes were determined by 2,2-diphenyl-1-picrylhydrazyl (DPPH) and superoxide radical scavening activities. Due to the observed IC(50) values, they are potential drugs to eliminate the radicals.