Use of an epidermal growth factor-infused foam dressing in a complicated case of Adams-Oliver syndrome.

Adams-Oliver syndrome is a rare disorder with varying degrees of scalp and cranial bone defects as well as limb anomalies, which can range from mild to more pronounced manifestations. In mild cases, closure of these defects can be achieved with a conservative approach. However, surgical closure is recommended in cases where the defect is extensive and includes cranial involvement. Several complicated cases of Adams-Oliver syndrome have been reported, in which flap failures were encountered and other alternatives had to be used to close critical scalp defects. Here, the case of a 4-year-old child with Adams-Oliver syndrome and a complex cranial defect with exposed titanium mesh is described. The patient was successfully treated with epidermal growth factor (EGF) infused foam dressings and subsequent split-thickness skin grafting. The EGF has been highlighted for its essential role in dermal wound repair through the stimulation of the proliferation and migration of keratinocytes, and showed accelerated wound healing when used in partial or full-thickness skin wounds.

Haematoma-like primary intracranial malignant fibrous histiocytoma in a 5-year-old girl.

We present CT and MRI of an intracranial malignant fibrous histiocytoma in a 5-year-old girl with headache and vomiting. This case is unusual particular by virtue of its radiological appearances and the young age of the patient.

A new coated bipolar coagulator: technical note.

BACKGROUND: Sometimes charring or popping occurs and the bipolar blades get stuck to the vessel. METHODS: The tips of one of the many commercially available bipolar forceps were coated in a striped manner with Teflon--50 micro in thickness. RESULTS: The new bipolar coagulator coated with Teflon reduced the incidence of tissue sticking. CONCLUSIONS: Experience with this instrument was still quite limited, but preliminary results were promising.

Antiischemic effect of ZK-118.182 in rabbits: a comparative study with iloprost.

The effects of ZK-118.182, a stable analogue of PGD2, were evaluated in an endothelin-1-induced cerebral ischemia rabbit model. Ischemia was induced by endothelin-1 injection (0.25 ng bolus) into subcavian artery and ischemic changes were assessed histologically by the number of ischemic neurons in the brain stem. ZK-118.182 (2 micrograms/kg, bolus into subclavian artery) reduced the number of ischemic neurons when injected 20 min after endothelin-1 injection, Iloprost, a stable analogue of PGI2, was also effective in reducing the number of ischemic neurons in a dose of 0.5 microgram/kg (bolus into subclavian artery). The results suggested that ZK-118.182 has a potent antiischemic effect which is comparable to that of iloprost in rabbits.

Clinical significance of acute traumatic intracranial pneumocephalus.

Among 1142 patients with head injuries hospitalized in the Neurosurgery Department of Gazi University Medical School during the period between 1979 and 1992, 583 had initial CT scans. A retrospective analysis of these initial CT images revealed intracranial air on admission in only 21 cases. These were classified as acute traumatic intracranial pneumocephalus: a potentially serious complication of head injury. CT scans were re-evaluated so as to reveal whether air was situated in the epidural, subdural, or subarachnoid spaces or intracerebrally; whether associated space-occupying lesions were present and whether the air bubbles were single or multiple. Clinical data such as the presence of persistent rhinorrhea and/or otorrhea, tension pneumocephalus, severity and type of trauma, and outcome were were also assessed to determine the significance of this rare finding.

Early phase alterations in endothelium dependent vasorelaxation responses due to aneurysm clip application and related manipulations.

Mechanically induced vasoconstriction observed throughout surgery and in the immediate postoperative period was investigated to assess the effects of various microsurgical manipulations. Factors such as the type of aneurysm clip, duration of temporary clipping and peri-adventitial tissue stripping were the variables in this study. Microsurgical clips were applied on guinea pig "cervical carotid arteries" in which peri-adventitia had been removed microsurgically. Arterial rings were removed immediately after surgery. Endothelium dependent relaxations were measured and morphological investigations were performed using light microscopy. It was observed that as the clip application period increased, relaxation responses decreased. Peri-adventitial tissue stripping caused a marked decrease in the relaxation responses in all types of the clips. Microvascular clips, in spite of their lower closing forces, had the greatest deleterious effect on relaxation responses of the vessel, in both normal and peri-adventitial tissue stripped. When the peri-adventitial tissue of the vessel had been stripped, convolutions of the lamina elastica interna were found to be lost in parallel with the decreased tonus of the artery. In the vessels subjected to clipping endothelial denudation and cracking took place. As a conclusion it can be stated that both peri-adventitial tissue stripping and microvascular clip application have deleterious effects in the early postoperative period. While choosing clips from minimal occlusion force tables, care must be taken to choose clips with less width; and while performing microvascular anastomosis, temporary clips with a lesser width must be used in place of microvascular clips. Adventitial stripping must not be unnecessarily generous during microvascular anastomosis.

Pharmacological and pathophysiological effects of periadventitial stripping on immediate and subacute postoperative vasoconstriction in guinea pigs.

Mechanically induced vasospasm observed in the immediate post-operative period was investigated, and the effect of factors such as temporary clip applications and post-operative intervals were studied. Guinea pig "cervical internal carotid arteries" were used and temporary clips, chosen according to the diameter of the artery and systolic pressure, were applied for a standard period. The same procedure was applied on arteries in which periadventitial tissue had been removed using appropriate microsurgical techniques. On postoperative days 1, 5, and 10, arterial rings were removed while the animals were still alive and Endothelium Dependent Relaxations were measured using a bioassay system. Morphological investigations were also performed using light microscopy on the same arterial preparations. We observed no difference between perioperative and first day postoperative results. The relaxations were minimum. The most striking pathological changes were observed on postoperative day 5, and the relaxation responses began to rise on day 10 together with morphological improvement. It was also found that periadventitial tissue stripping could be used to prevent subacute post-operative vasoconstriction, since its effect was marked on postoperative day 5 and began to resolve on day 10.

Neurocranial morphology as determined by asymmetries of the skull base.

The goal of the current study was to provide an easy to use criterion to diagnose neurocranial asymmetries. An anatomical survey of the external aspect of the skull base was planned to correlate with radiological studies. In a sample of 239 skulls, variations of the angular relationship between the structures seen on a basilar view of the cranium were analysed. An anterior and a posterior transverse line were plotted with respect to the midline. Departures from 90 degrees to the midline for either of the transverse lines were less than 5 degrees in normal skulls, between 5 degrees and 7 degrees in skulls classed by independent inspection as asymmetric, and more than 7 degrees in obviously malformed skulls.

Sella turcica fractures in a trauma series and their clinical significance.

BACKGROUND: Fractures in the region of the sella turcica (ST) are usually associated with severe blunt head trauma and may produce many complications. The true incidence is difficult to assess since there have been only about 30 cases reported in the literature. METHODS: A total of 470 computed tomography (CT) sections--with optimum bone window images of skull bone--of 1600 head trauma patients who were admitted between 1979 and 1992, inclusive, to the Neurosurgery Department of Gazi University Medical School were analyzed retrospectively. RESULTS: There were a total of 17 patients with a fracture of the ST, constituting an incidence of 3.6%, and there was a preponderance of children. CONCLUSIONS: Computed tomography was very helpful in assessing the extent of ST fractures. In our cases, these fractures were not associated with a high complication or death rate, although a cerebrospinal fluid fistula was present in 53%.

Moderate head injuries in children as compared to other age groups, including the cases who had talked and deteriorated.

Patients defined as having a moderate head injury on the basis of Glasgow Coma Scale scores within the ranges of 9 to 13 after acute nonsurgical procedures were selected. Almost 1600 cases were hospitalized in the Neurosurgery Department. The cases were admitted through the Emergency Unit of Gaz University Medical School, Ankara, Turkey during the period between 1979 and 1992. The group studied consisted of 231 selected patients assessed separately in paediatric, adult and elderly age groups. Possible risk factors such as: GCS score, anisocoria, unilateral or bilateral fixed pupils, impaired oculocephalic reflexes, presence of multiple systemic injuries, aetiology of head trauma, presence of linear or depressed skull fractures, space occupying mass on CT or operation was also assessed. Subarachnoid haemorrhage turned out to be the only independent significant risk factor in predicting mortality. The data about the patients who have "talked and deteriorated" were also reported so as to assisst physicians charged with the care of trauma victims.

Autogenous bone grafts in cervical vertebrectomy and fusion practice for injuries.

Among the patients with a cervical injury admitted to our clinic between 1980 and 1988, 18 cases underwent a ventral fusion operation (Cloward) and 8 of them needed additional vertebrectomy. The injury in all of these cases was due to falls and presented with major compression fractures. In each case the vertebral body was resected and replaced by a "T" shaped iliac bone graft. The graft was fixated by a screw or wire when necessary, than the patients were immobilized by a bed rest for 2 weeks duration. During the follow-up period, cervical alignment was found to be stable in all patients. The radiological characteristics of the lesions, intraoperative surgical modifications for specific aspects of the lesion, other technical availabilities and the results are discussed.

Index for optimum ventricular catheter length. Technical note.

The optimum length of a ventricular catheter to be placed in a particular patient may be difficult to determine when either intraoperative ultrasound is not available or considerable time has elapsed between the diagnostic computerized tomography scan and the operation. An index for estimating ventricular length based on the head circumference of the individual is described. This method was tested clinically and proved to be successful.

Spinal cord compression due to Brucella granuloma.

Central Nervous System (CNS) involvement during the course of Brucella infection is a rare clinical condition. In this article, a patient with a progressive paraparesis syndrome with spasticity, who was treated by medical methods and surgical intervention is analysed. This patient suffered from spinal cord compression in the thoracal region caused by a Brucella granuloma. The patient had no evidence of systemic Brucella infection.

Observation of 95 patients with extradural hematoma and review of the literature.

The authors review the cases of 95 patients with extradural hematoma managed at Gazi Hospital in the last 4 years. The common factors in craniocerebral traumas, the time interval between admittance and trauma, the interval between admittance and operation, and the location of hematomas are determined. The arterial origins demonstrated at operation in extradural hematomas are described. The interactions between all these factors and mortality are discussed. Availability of computed tomography scanning accounts for the present mortality rate of 9.4% when compared with the mortality rate of 33% for conventional diagnostic facilities.