Dextrose injections for failed back surgery syndrome: a consecutive case series.

PURPOSE: Patients with chronic low back pain, who do not respond to conservative treatment methods, generally undergo surgical revision operations, and sometimes an undesirable condition called failed back surgery syndrome (FBSS) may be inevitable. Hereby, dextrose is one of the regenerative methods that has gained popularity in the treatment of many musculoskeletal problems, and we aimed to present and evaluate the outcomes of 5% dextrose for the treatment of FBSS. METHODS: It has been designed as a consecutive case series. A total of 79 patients with FBSS, who had minimum 6 months of symptoms and did not respond to 3 months of conservative methods between May 2014 and March 2016, participated in the study. Prolotherapy injections were applied in posterior and lateral approaches. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for the pre- and post-treatment evaluations. Patient satisfaction was assessed with using a 5-point Likert scale by phone contacting. RESULTS: There was statistically significant difference between repeated VAS and ODI measurements. CONCLUSIONS: These results may be the first step giving a lead to an undiscovered field. This treatment method should be kept in mind for FBSS patients before giving a decision of revision surgery. These slides can be retrieved under Electronic Supplementary Material.

The evaluation of the effects of steroid treatment on the tumor and peritumoral edema by DWI and MR spectroscopy in brain tumors.

OBJECTIVE: To investigate the effects of dexamethasone on brain tumor and peritumoral edema by different sequences of magnetic resonance imaging (MRI). MATERIALS AND METHODS: MRI was performed in 28 patients with brain tumor. Patients were divided into the 3 groups based on the histological diagnosis; Group I: high-grade glial tumor, Group II: low-grade glial tumor, and Group III: brain metastasis. The measurements of peritumoral edema volume and apparent diffusion coefficient (ADC) values were performed while the peak areas of cerebral metabolites were measured by spectroscopy in groups I and II. The changes in edema volumes, ADC values and cholin/creatine peak areas were compared. RESULTS: The volume of peritumoral edema was decreased in groups I and II, but increased in group III after dexamethasone treatment. These changes were not statistically significant for 3 groups. ADC value was decreased in group I and increased in groups II and III. Changes in ADC values were statistically significant. Cholin/creatine peak areas were decreased after dexamethasone in groups I and II, but these changes were also not significant. CONCLUSION: Dexamethasone has no significant effect on the volume of peritumoral edema in glial tumor and metastasis. Moreover, dexamethasone increases the fluid movements in low grade gliomas and metastases, decreases in high grade gliomas. However, more comprehensive clinical studies are needed to show the effects of dexamethasone on brain tumors and peritumoral edema.

Factors Associated with Treatment Success After Interlaminar Epidural Steroid Injection for Cervical Radicular Pain.

AIM: To investigate the demographic, clinical and radiological findings associated with treatment success after interlaminar epidural steroid injection (ILESI) in radicular pain induced by cervical disc herniation. MATERIAL AND METHODS: In this retrospective study, the data of patients who received cervical ILESI between January 2017 and June 2021 were screened. Of 223 patients, 92 with unilateral radicular neck pain due to cervical disc herniation were included. Demographic data, symptom duration, and numerical rating scale scores at baseline, at three weeks, three months, and six months after treatment were collected from the medical records of the patients. Disc herniation level, cervical axis, disc height, presence and degree of spinal canal and neural foraminal stenosis, vertebral endplate signal change, and definitive presence of uncovertebral and facet osteoarthritis were evaluated using cervical spine magnetic resonance imaging. Treatment success was determined as ?50% reduction in pain scores at six months compared to baseline. RESULTS: Data of 92 patients (27 men, 65 women) were included. The mean age was 50.82 ± 10.22 years, and the median symptom duration was 12 (4.25 to 20) months. At six months after ILESI, treatment was successful in 58 (58.7%) patients and unsuccessful in 34 (41.3%) patients. Multivariable logistic regression analysis was performed to identify the factors associated with treatment success at six months post-injection. In the final model, neural foraminal stenosis (non-severe vs. severe) and spinal canal stenosis (non-severe vs. severe) were significantly associated with the treatment success (OR=3.02, 95% CI=1.40?10.95, p=0.009; OR=5.31, 95% CI=1.77?15.85, p=0.003). CONCLUSION: Treatment success of cervical ILESI at six months is favorable. However, the presence of severe neural foraminal and spinal canal stenosis is associated with a reduced likelihood of treatment success.

Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study.

OBJECTIVE: A 1-day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 am, and March 12, 2022, 08.00 am, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 ± 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation-II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground-glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.

Modified prolotherapy by 5% dextrose: Two years experiences of a traditional and complementary medicine practice center in Turkey.

BACKGROUND: Prolotherapy (PrT) is an increasingly popular regenerative injection treatment for the management of musculoskeletal injuries. The diagnostic injection is a method for selecting suitable patients to apply PrT using subcutaneous 5% dextrose solution. OBJECTIVE: The study aims to assess the PrT usage and modifications in the treatment of chronic low back pain and lumbar disc herniation and to define diagnostic injection procedure for PrT. METHOD: Two thousand three hundred and eighty-two patients with low back pain or lumbar disc herniation were evaluated at the Traditional and Complementary Medicine Practice Center in Ankara, Turkey. Six hundred fifty-four patients were included in the study. Diagnostic injections were performed on all patients who were thought to be eligible candidates for PrT indications. A 4-or-6 week interval was allowed between treatment sessions. RESULTS: Xix hundred and fifty-four patient treatments were completed. The Visual Analogue Scale (VAS) scores decreased to 5.1 ± 1.4 while 7.2 ± 1.1 before the diagnostic injection (p< 000.1). The VAS scores decreased from 7.2 ± 1.1 before the treatment to 0.9 ± 0.9 after 52 weeks of the treatment (p< 000.1). Thirty-four patients' treatments resulted in poor clinical results (5.2%), and 620 of the patients' pain improved (94.8%). CONCLUSION: PrT can be regarded as a safe way of providing a meaningful improvement in pain and musculoskeletal function compared to the initial status. Diagnostic injection is an easy way to eliminate patients and may become a favorite treatment modality. 5% dextrose is a more simple and painless solution for PrT and also has a high success.

Comparison of nimodipine delivery routes in cerebral vasospasm after subarachnoid hemorrhage: an experimental study in rabbits.

BACKGROUND: nimodipine is the most widely preferred and administered calcium channel blocker in cerebral vasospasm prevention and treatment. There is no experimental or clinical study investigating the comparative effects of routine treatment modalities. METHOD: 35 male New Zealand White rabbits were assigned randomly to one of seven groups: Control, only SAH, SAH/oral nimodipine, SAH/IV nimodipine, SAH/IT nimodipine, SAH/IA nimodipine, SAH/angiography. FINDINGS: basilar artery vessel diameters are measured by angiography. Basilar artery vessel diameters and luminal sectional areas are measured in pathology slides. Basilar artery thicknesses were significantly higher in group 2 and 7 than the others (p < 0.05). Luminal sectional areas in group 5 and 6 were significantly higher than other groups (p < 0.05). We found no significant difference in group 1, 5 and 6 (p > 0.05). Basilar section areas in group 3 and 4 were significantly higher than group 2 but lower than group 1. CONCLUSION: this is the first study to show the most effective drug delivery route in CVS after SAH. Nimodipine treatment in cerebral vasospasm is useful. This study showed that selective IA nimodipine treatment and IT nimodipine treatment must be preferred to IV and oral treatments of chronic vasospasm following SAH.

Comparison of intrathecal dotarizine and nimodipine treatments in cerebral vasospasm after subarachnoid hemorrhage: an experimental study in rabbits.

BACKGROUND: cerebral vasospasm (CVS) is one of the most considerable complications of subarachnoid hemorrhage (SAH). The aim of this study was to assess and to compare the ability of intrathecal dotarizine and nimodipine to prevent and treat vasospasm in a rabbit model of subarachnoid hemorrhage. METHOD: thirty male New Zealand white rabbits weighing 2,500-3,000 g were allocated into five groups randomly. The treatment groups were as follows: Control, only SAH, SAH/Dotarizine, SAH/Nimodipine, SAH/Vehicle. Forty-eight hours after SAH injection, all animals underwent femoral artery catheterization procedure by open surgery under anesthesia and angiography performed for each animal in the fifth day just before sacrifice. FINDINGS: basilar artery vessel diameters are measured by angiography. Basilar artery vessel diameters and luminal sectional areas are measured in pathology slides. There was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). CONCLUSIONS: these findings demonstrate that calcium channel blocker dotarizine has marked vasodilatory effect in an experimental model of SAH in rabbits. Nimodipine is an effect-proven agent in CVS, but dotarizine may take place of it.

Comparison of intrathecal flunarizine and nimodipine treatments in cerebral vasospasm after experimental subarachnoid hemorrhage in rabbits.

BACKGROUND: the aim of this study was to assess and to compare the ability of intrathecal flunarizine and nimodipine to prevent vasospasm in a rabbit model of subarachnoid hemorrhage (SAH). METHOD: forty male New Zealand white rabbits were allocated into 5 groups randomly. The treatment groups were as follows: (1) control (no SAH [n = 8]), (2) SAH only (n = 8), (3) SAH plus vehicle (n = 8), (4) SAH plus nimodipine (n = 8), and (5) SAH plus flunarizine (n = 8). Before sacrifice, all animals underwent femoral artery catheterization procedure by open surgery under anesthesia and angiography performed for each animal. FINDINGS: there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). Basilar artery vessel diameter and luminal section areas in group 4 were significantly higher than in group 2 (p < 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 2 (p < 0.05).Basilar artery vessel diameter and basilar artery luminal section areas in group 5 were significantly higher than in group 4 (p < 0.05). CONCLUSIONS: these findings demonstrate that flunarizine has marked vasodilatatory effect in an experimental model of SAH in rabbits.

The effects of intrathecal nicergoline and nimodipine in cerebral vasospasm: an experimental study in rabbits.

BACKGROUND: the aim of this study was to assess and to compare the ability of intrathecal nicergoline and nimodipine in prevention of cerebral vasospasm in a rabbit model of subarachnoid hemorrhage (SAH). METHOD: twenty male New Zealand white rabbits were allocated into four groups randomly. Subarachnoid hemorrhage was induced by injecting autologous blood into the cisterna magna. The treatment groups were as follows: (1) control [no SAH (n = 5)], (2) SAH only (n = 5), (3) SAH plus nimodipine (n = 5), and (4) SAH plus nicergoline (n = 5). FINDINGS: there was a statistically significant difference between the mean basilar artery cross-sectional areas and the mean arterial wall thickness measurements of the control and SAH-only groups (p < 0.05). Basilar artery vessel diameter and luminal section areas in group 3 were significantly higher than in group 2 (p < 0.05). Basilar artery vessel diameter and basilar artery luminal section areas in group 4 were significantly higher than in group 2 (p < 0.05). There was no significant difference between basilar artery vessel diameter and basilar artery luminal section areas in group 3 and group 4. CONCLUSIONS: these findings demonstrate that intrathecal nicergoline has a vasodilatatory effect in an experimental model of SAH in rabbits but not more than that of nimodipine.

A comparative study of histopathological analysis of filum terminale in patients with tethered cord syndrome and in normal human fetuses.

BACKGROUND: The structural changes in filum terminale (FT) may be responsible for tethered cord syndrome (TCS) in children. Although the histological changes in FT related to TCS are well-known, there is no comparative study of the changes which occur in TCS and normal fetal FT samples. The aims of this study are to compare the histological changes which occurred in FT samples of TCS and in fetuses, and to point out these changes. METHODS: During the last 2 years, 14 cases of TCS were operated on, the FT was cut and the spinal cord was released. Among them, 6 samples of FT were obtained for histopathological examination. Moreover, 1 FT from an adult cadaver and 4 samples from fetal FT were obtained for the same examination. RESULTS: While adipose tissue, fibrosis, hyalinization, and meningothelial proliferation were observed in FT samples of TCS, none of these findings were observed in fetal samples. Elastic fibers were present in all TCS specimens and the adult cadaver, but were not observed in fetuses. Peripheral nerves, ganglion cells and ependymal cells were observed in fetal FT samples. CONCLUSION: These changes probably begin at birth.

Subdural hematomas and emergency management in infancy and childhood: a single institution's experience.

OBJECTIVE: We aimed to identify the incidence, clinical features, management, and outcome of subdural hematomas (SHs) in infancy and childhood. METHODS: Twenty-one children younger than 11 years with SH were analyzed. Clinical features and possible child abuse were considered in each case. RESULTS: Eight children experienced minor injuries due to hitting of solid items on their head. Five of these children also had coagulation disorders. Three of the children suffered from child abuse, only one of the children had head trauma due to car accident. Nine of the patients experienced SH due to fall down. Nine patients have acute SH, 7 had subacute SH, 4 had chronic SH, and 1 had acute and subacute SH together. Clinical presentation varied greatly. Most of them presented with vomiting and seizure. The outcome patterns were different among the patients. Deep coma on admission was associated with an unfavorable outcome. CONCLUSIONS: Subdural hematoma is common in infancy and childhood and carries a poor prognosis. Most of the cases are due to head trauma, coagulation disorders, and child abuse. We believe that clinical investigation of such children should be carried out in a multidisciplinary approach with the collaboration of pediatricians, social workers, and neurosurgeons.

Management outcome of peroneal nerve injury at knee level: experience of a single military institution.

BACKGROUND AND PURPOSE: We investigated the management outcome of common peroneal nerve decompression at the knee level between the years 2005 and 2009. MATERIAL AND METHODS: Thirty consecutive patients with knee-level peroneal nerve injury who underwent decompression surgery and external neurolysis at our institution were evaluated preoperatively and postoperatively by electrophysiological studies and motor examination (Medical Research Council grading). RESULTS: Twenty-eight of the cases were male and 2 were female. Mean age was 31.1 for males and 57.5 for females. Physical activity during military training (overstretch/contusion) was the cause of nerve lesion in the majority of the patients (n = 28, 93%). Mean time interval between the diagnosis and the surgery was 5 months. Follow-up time ranged from 3 to 48 months (mean: 14 months). Twenty-nine of 30 (97%) patients recovered totally or near totally in foot/toe dorsiflexion. CONCLUSIONS: Early decompression and neurolysis of the common peroneal nerve (CPN) at knee level after strenuous physical activity offers excellent functional recovery. Additionally, for knee-level CPN injuries, in order to minimize the postoperative scar, pain and delay in wound healing, we strictly advocate short 'lazy S-shaped incision' around the fibular head in supine position unlike the classical extensive opening up to the superior border of the popliteal fossa in prone position.

The complications of cerebral hydatid cyst surgery in children.

PURPOSE: Complications related to cerebral hydatid cyst surgery are not uncommon but require prompt diagnosis and treatment. The aim of this study is to demonstrate the radiological findings that would indicate complications after cerebral hydatid cyst surgery in children and to report our results. METHOD: The data of 25 pediatric patients who underwent surgery for cerebral hydatid cysts over a 16-year period were analyzed retrospectively. The complications related to surgical technique and cyst location were recorded. Postoperative radiological findings of the patients were documented. RESULTS: Intraoperative cyst rupture occured in three patients. Subdural effusion developed in five patients, porencephalic cyst in four, subdural effusion associated with porencephalic cyst in two, hemorrhage in two, epidural hematoma in one, and pneumocephalus in three patients. Subdural-peritoneal shunt was placed in two patients. Recurrence of cerebral hydatid cyst was observed in only one patient who experienced intraoperative cyst rupture. There was no surgery-related death. CONCLUSIONS: The complications following cerebral hydatid cyst surgery in children are various and usually not fatal. When appropriate surgical procedures are planned and carefully applied, the results will be excellent with no mortality.

Intramedullary lumbar lesion mimicking spinal cord tumor: a case of non-neoplastic intramedullary spinal cord lesion.

Non-neoplastic intramedullary spinal lesion cases are rarely seen in the literature. We would like to present this case for differential diagnosis of intramedullary spinal tumors. The aim of this case report is to attract attention on the MRI findings with lack of contrast enhancement and long syrinx formation which differs these types of lesions from the intramedullary spinal tumors. Intraoperative, pathological and immunohistochemical findings of non-neoplastic intramedullary spinal lesion were discussed.

Analysis of proximal radial nerve injury in the arm.

BACKGROUND: Radial nerve is the most frequently injured major nerve in the upper extremity. Proximal part of the radial nerve involvement can result from a humerus fracture, direct nerve trauma, compression and rarely from tumors. OBJECTIVES: The aim of the study is to determine the clinical characteristics and electrodiagnostic findings in patients with proximal radial nerve injuries, and also the outcome of surgical treatment. MATERIALS AND METHODS: The study subjects included 46 patients with radial nerve injuries seen between June 2000 and June 2008 at our hospital. The analysis included demographics, clinical features, etiology, pre-and postoperative EMNG (Electromyoneurography) findings. RESULTS: Surgical decompression resulted in neurological improvement in patients with radial entrapment neuropathies. Good neurological recovery was observed from decompression of callus of old humeral fracture. The worst results were observed in the direct missile injuries of the radial nerve. CONCLUSIONS: A detailed clinical and electrodiagnostic evaluation is of importance in patients with radial nerve injury to ensure an appropriate treatment. The choice of treatment, conservative or surgical, depends on the clinical presentation and the type of injury.

The surgical anatomy of the brachial plexus.

AIM: The brachial plexus (BP) has a complex structure and risky relations with its neighborhoods. This study was designed to investigate and overcome the morphometric features of the BP and the difficulties regarding surgery of BP lesions. MATERIAL AND METHOD: Twelve BP of six adult cadavers were dissected and neural structures, branches, and variations were evaluated. Morphometric measurements were done and surgical approaches were discussed. RESULTS: The length of anterior (ventral) rami of C5-T1 are in decreasing order such as C5 > C6 > C7 > C8 > T1 and the width of them is in decreasing order such as C7 > C8 > C6 > T1 > C5. The length of upper trunk (UT) , middle trunk (MT) and lower trunk (LT) are approximately similar (UT approximately MT approximately LT) , but the width is in decreasing order as LT > UT > MT. The length of the cords are in decreasing order as posterior cord (PC) > lateral cord (LC) > medial cord (MC), whereas their widths are PC > LC > MC . CONCLUSION: From the ventral rami to the cords, BP has a complex and variable anatomic structure. The selection of surgical procedure to the BP needs to be mastered by having the best knowledge of the relevant anatomy.

Diffuse cerebral arteriovenous malformation.

Diffuse cerebral arteriovenous malformation (AVM) is a rare disorder of the brain and defined as diffuse infiltration of brain by complex vascular structures. It is usually associated with hereditary syndromes and presented with hemorrhage or seizure. We report a 20-year-old male patient who presented with drooping of the left eyelid. He had no skin lesion. The ophthalmological examination was within normal limits except periorbital bruit on oscultation. Radiological examination revealed a diffuse AVM comprising multiple arteriovenous shunts, draining bihemispherically through numerous dilated veins but without a typical arteriovenous malformation nidus. No hereditary disorder was detected. No treatment was performed and the patient is still under follow-up.

A new method of patient's head positioning in suboccipital retrosigmoid approach.

BACKGROUND: The retrosigmoid approach is a common route to the cerebellopontine angle and lateral clivus. Patient's head positioning just before the operation is crucial to perform the procedure effectively and safely. AIM: The aim of the study is to determine the positional angle of the head on preoperative axial sequences of the cranial magnetic resonance imaging (MRI). MATERIALS AND METHODS: The angle between the line drawn along the petrous bone ventral to the internal auditory canal and the line drawn parallel to the dorsal face of the clivus on the axial view of MRI sequences was measured. RESULTS: This method of patient positioning has resulted in minimal cerebellar retraction, less time in the preoperative preparation period and less postoperative headache and neck pain. CONCLUSIONS: This method can provide quick and better exposure of the cerebellopontine angle. Preoperative measurement of positional angle on axial MRI sequences is a very simple and sufficient way to determine the angle of the head that is turned to the contralateral side.

Traumatic brain injury due to gunshot wounds: a single institution's experience with 442 consecutive patients.

AIM: Traumatic brain injury (TBI) caused by a gunshot wound is a complex injury with a broad spectrum of symptoms and high rates of mortality and morbidity. This study presents an evaluation of TBI caused by gunshot wounds presenting at a single institution and discusses possible predictive factors for the outcome of surgical intervention. MATERIAL AND METHODS: The study sample consisted of 442 patients who underwent surgery for TBI over a 16-year period. All injuries were caused by gunshot wounds, such as bullets and shrapnel. All patients underwent surgical intervention. RESULTS: Almost all patients (99.3%) were male, and the mean patient age was 22.3 years. Wounds were caused by shrapnel in 68 percent of patients. The Glasgow Coma Scale (GCS) score at admission was below 8 in 116 patients (26.2%) and above 8 in 326 patients (73.8%). In total, 47 patients (10.6%) died despite surgical management, with diffuse brain injury the most common cause of death. CONCLUSION: Low GCS scores, ventricular injuries and bihemispheric injuries are correlated with poor prognosis. Early and less invasive surgery in conjunction with short transportation time to the hospital could decrease mortality rates.

Tumors of the lateral ventricle: the factors that affected the preference of the surgical approach in 46 patiens.

AIM: Optimal surgical pathway for lateral ventricle tumors is still controversial. The purpose of this study is to discuss the factors that affected the preference of the surgical techniques for removing lateral ventricle tumors. MATERIAL AND METHODS: 46 consecutive patients underwent operation for lateral ventricle tumors. The mean age was 36 years. Preoperative magnetic resonance imaging (MRI) images were examined to determine the location, expansion and size of each tumor. The transcallosal approach was used in 25 patients, and the transcortical approach was used in 21 patients. We performed MRI to determine the tumor size and recurrence or increased size of the residual tumor. RESULTS: Total resection was performed in 31 patients. Only one patient, with glioblastoma, died due to hepatic encephalopathy and intraventricular hemorrhage after the operation. Additional neurological deficits were seen 4 patients, and postoperative seizure occurred in one patient. The mean duration of follow-up was 38,37 months. CONCLUSION: Lateral ventricle tumors can be treated best by careful selection of the surgical approach according to localization of the tumor within the ventricle, the expansion side of the tumor, the size of the tumor, the origin of the vascular feeding branches, the venous drainage, and the relationship of the structures, and the histopathological features.