Spontaneous Resolution of an Orbital Mass After Delivery: A Diagnostic Challenge.

The authors report a 35-year-old woman who presented 1 month after delivery with the complaint of pain behind her left eye which started during her pregnancy. The patient described increased fullness with dependent head position and pain on left gaze but she had no proptosis and her ocular examination was normal. Magnetic resonance imaging (MRI) revealed an intraconal mass with inhomogeneous contrast enhancement. As the authors did not suspect malignity and her ocular examination was normal without any signs of inflammation, the authors followed the patient closely. Repeat MRI obtained 6 months after delivery revealed complete resolution of the mass. Upon disappearance of the lesion, the authors reviewed the case thoroughly and decided that orbital venous anomaly with intralesional hemorrhage/thrombosis was the most probable diagnosis. As hemorrhage or thrombosis occurring in orbital vascular anomalies may be a diagnostic challenge because of the localized lesion and distinct borders, careful interpretation of clinical characteristics and MRI findings and close follow-up is important in interpretation of orbital mass lesions, especially in pregnant or puerperal women.

Clinical Outcomes of Patients over 75 Years of Age with Degenerative Spondylolisthesis Following Bilateral Decompression via Unilateral Approach.

AIM: To investigate the clinical outcomes of bilateral decompression via unilateral approach (BDUA) on degenerative spondylolisthesis with spinal stenosis in patients over 75 years of age. MATERIAL AND METHODS: Elderly patients (n=41; average age=79.3±2.5 years) who underwent BDUA under spinal anaesthesia between April 2011 and May 2014 were enrolled. Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) values of the patients were evaluated preoperatively and at the last visit postoperatively (Mean follow-up period=27 month). All parameters were analysed using Student paired-sample t test with p < 0.05 considered statistically significant. RESULTS: All 41 patients experienced significant postoperative improvement in VAS leg (p < 0.01) and back pain (p < 0.05) scores. Average ODIs were 52±4.1% preoperatively and 39±3.5% postoperatively. All changes were statistically significant. CONCLUSION: BDUA is a safe and very effective treatment in elderly patients with degenerative spondylolisthesis with spinal stenosis. This procedure has a very low complication rate and can be performed successfully under spinal anaesthesia.

Mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation.

OBJECTIVE: We investigated the prevalence of mood and anxiety disorders in patients with chronic low back and neck pain caused by disc herniation and the relationships between pain and mood, and anxiety disorders. METHODS: In total, 149 patients with disc herniation and 60 healthy subjects were included. Disc herniation was diagnosed based on a physical examination and magnetic resonance imaging. Mood and anxiety disorders were diagnosed using the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition/Clinical Version. RESULTS: The mean age of the study subjects (n = 209) was 45.96 ± 11.45 years. Seventy (46.6%) patients with disc herniation met the criteria for at least one mood or anxiety disorder. The prevalence rates of mood and anxiety disorders were 16.6% and 35.8%, respectively. The most common specific diagnoses were major depression (n = 25, 16.9%) and generalised anxiety disorder (n = 19, 12.8%). CONCLUSIONS: Mood and anxiety disorders were more commonly seen in patients with lumbar or cervical disc herniation than in those without herniation. No relationship was detected between pain severity and mood or anxiety disorders. However, mood and anxiety disorders were associated with neurological deficits.

An unusual ventriculoperitoneal shunt complication: spontaneous knot formation.

This article aims to describe an extraordinary complication of a ventriculoperitoneal shunt system that formed a knot spontaneously and lead to a shunt malfunction. A 3-year-old male patient was operated due to posttraumatic hydrocephalus. After an uneventful follow-up period of 34 months, he presented with shunt malfunction. During the shunt revision surgery, the peritoneal catheter was found to form a loop over itself. There are various complications of ventriculoperitoneal shunt systems. Migration to body cavities is among the most interesting ones. This is the fifth report describing this rare complication. Hydrocephalic patients should be closely followed up after shunt surgery for various extraordinary complications.