The feasibility of anthropometric measurements for evaluation of abdominal obesity in patients with autosomal dominant polycystic kidney disease: a cross-sectional study / La viabilidad de las mediciones antropométricas para la evaluación de la obesidad abdominal en pacientes con enfermedad renal poliquística autosómica dominante: un estudio transversal

Introduction: total kidney volume (TKV) increases in patients with autosomal dominant polycystic kidney disease (ADPKD), which perturbs anthropometric measurements. Objectives: the primary objectives were to investigate the accuracy of waist circumference (WC) and waist-to-hip ratio (WHR) for determining abdominal obesity in patients with ADPKD by comparison with magnetic resonance images. The secondary objectives were to investigate the associations of energy/macronutrient intake with WC and WHR. Methods: sixty patients with ADPKD were recruited from a nephrology outpatient clinic in this cross-sectional study. Main outcome measures were: TKV, total subcutaneous fat (TSF), total intraperitoneal fat (TIF), WC, WHR, body mass index (BMI), skinfold thickness (SFT), and energy/macronutrient intake. Results: mean age was 48.6 ± 11.3 years, 38 of 60 were women, median TKV was 1486 (IQR, 981-2847) mL. The patients classed as obese by the BMI had higher WC, TSF, TIF, and SFT than did non-obese; however, WHR was similar in obese and non-obese men. In the all-patients group, the WHR of obese and non-obese patients were also similar. TKV was positively correlated with WC and WHR in women, but not in men. In the multivariate analysis, TKV was an independent factor affecting WC and WHR in women. Dietary fat intake was similar in groups with and without abdominal obesity according to WC and WHR. Conclusions: in women with ADPKD, WC and WHR may not be accurate anthropometric measurements for evaluation of abdominal obesity; however, they may be associated with TKV (AU)

Introducción: el volumen total del riñón (TKV) crece en los pacientes con enfermedad poliquística autosómica dominante del riñón (ADPKD), la cual perturba las mediciones antropométricas. Objetivos: los principales objetivos eran investigar la precisión de la circunferencia de la cintura (WC) y del cociente cintura-cadera (WHR) para determinar la obesidad abdominal en pacientes con ADPKD en comparación con imágenes de resonancia magnética. Los objetivos secundarios eran investigar las asociaciones entre consumo de energia/macronutrientes y WC y WHR. Métodos: sesenta pacientes con ADPKD fueron reclutados por una clínica ambulatoria de nefrología en este estudio transversal. Las medidas resultantes principales fueron: TKV, grasa subcutánea total (TSF), grasa intraperitoneal total (TIF), WC, WHR, índice de masa corporal (BMI), espesor del pliegue cutáneo (SFT) y consumo de energía/macronutrientes. Resultados: la edad media era de 48,6 ± 11,3 años, 38 de 60 eran mujeres, la media de TKV era 1486 (IQR: 981-2847) mL. Los pacientes clasificados como obesos por el BMI tenían niveles más altos de WC, TSF, TIF and SFT que los no obesos; sin embargo, el WHR era similar en los hombres obesos y no obesos. En el grupo de todos los pacientes, el WHR de obesos y no obesos era también similar. El TKV se correlacionó positivamente con la WC y el WHR en las mujeres pero no en los hombres. En el análisis multivariado, el TKV era un factor independiente que afectaba a la WC y el WHR en las mujeres. La ingesta de grasas en la dieta era similar en los grupos con y sin obesidad abdominal de acuerdo con la WC y el WHR. Conclusiones: en las mujeres con ADPKD, la WC y el WHR quizá no son las medidas antropométricas más apropiadas para evaluar la obesidad abdominal; sin embargo, quizá esté relacionada con el TKV (AU)

The feasibility of anthropometric measurements for evaluation of abdominal obesity in patients with autosomal dominant polycystic kidney disease: A cross-sectional study.

Introduction: Introduction: total kidney volume (TKV) increases in patients with autosomal dominant polycystic kidney disease (ADPKD), which perturbs anthropometric measurements. Objectives: the primary objectives were to investigate the accuracy of waist circumference (WC) and waist-to-hip ratio (WHR) for determining abdominal obesity in patients with ADPKD by comparison with magnetic resonance images. The secondary objectives were to investigate the associations of energy/macronutrient intake with WC and WHR. Methods: sixty patients with ADPKD were recruited from a nephrology outpatient clinic in this cross-sectional study. Main outcome measures were: TKV, total subcutaneous fat (TSF), total intraperitoneal fat (TIF), WC, WHR, body mass index (BMI), skinfold thickness (SFT), and energy/macronutrient intake. Results: mean age was 48.6 ± 11.3 years, 38 of 60 were women, median TKV was 1486 (IQR, 981-2847) mL. The patients classed as obese by the BMI had higher WC, TSF, TIF, and SFT than did non-obese; however, WHR was similar in obese and non-obese men. In the all-patients group, the WHR of obese and non-obese patients were also similar. TKV was positively correlated with WC and WHR in women, but not in men. In the multivariate analysis, TKV was an independent factor affecting WC and WHR in women. Dietary fat intake was similar in groups with and without abdominal obesity according to WC and WHR. Conclusions: in women with ADPKD, WC and WHR may not be accurate anthropometric measurements for evaluation of abdominal obesity; however, they may be associated with TKV.

Introducción: Introducción: el volumen total del riñón (TKV) crece en los pacientes con enfermedad poliquística autosómica dominante del riñón (ADPKD), la cual perturba las mediciones antropométricas. Objetivos: los principales objetivos eran investigar la precisión de la circunferencia de la cintura (WC) y del cociente cintura-cadera (WHR) para determinar la obesidad abdominal en pacientes con ADPKD en comparación con imágenes de resonancia magnética. Los objetivos secundarios eran investigar las asociaciones entre consumo de energia/macronutrientes y WC y WHR. Métodos: sesenta pacientes con ADPKD fueron reclutados por una clínica ambulatoria de nefrología en este estudio transversal. Las medidas resultantes principales fueron: TKV, grasa subcutánea total (TSF), grasa intraperitoneal total (TIF), WC, WHR, índice de masa corporal (BMI), espesor del pliegue cutáneo (SFT) y consumo de energía/macronutrientes. Resultados: la edad media era de 48,6 ± 11,3 años, 38 de 60 eran mujeres, la media de TKV era 1486 (IQR: 981-2847) mL. Los pacientes clasificados como obesos por el BMI tenían niveles más altos de WC, TSF, TIF and SFT que los no obesos; sin embargo, el WHR era similar en los hombres obesos y no obesos. En el grupo de todos los pacientes, el WHR de obesos y no obesos era también similar. El TKV se correlacionó positivamente con la WC y el WHR en las mujeres pero no en los hombres. En el análisis multivariado, el TKV era un factor independiente que afectaba a la WC y el WHR en las mujeres. La ingesta de grasas en la dieta era similar en los grupos con y sin obesidad abdominal de acuerdo con la WC y el WHR. Conclusiones: en las mujeres con ADPKD, la WC y el WHR quizá no son las medidas antropométricas más apropiadas para evaluar la obesidad abdominal; sin embargo, quizá esté relacionada con el TKV.

Prediabetes and Type 2 Diabetes are Independent Risk Factors for Computed Tomography-Estimated Nonalcoholic Fatty Pancreas Disease.

OBJECTIVES: Nonalcoholic fatty pancreas disease (NAFPD) is characterized by excessive fat deposition in the pancreas in the absence of alcohol consumption. In this study, we aimed to detect a possible relationship between adipose tissue accumulation, prediabetes and diabetes. METHODS: This cross-sectional and retrospective study included 110 patients. Three groups were classified as controls, patients with prediabetes and patients with type 2 diabetes. The abdominal computed tomography (CT) attenuation measurement results of the pancreas were evaluated independently by two experienced radiologists. CT measurements and biochemical parameters were compared between study groups. The relationship between continuous variables was assessed by using one-way ANOVA. To determine the changes in the dependent variable for the effects on study groups, the independent variable was adjusted using ANCOVA. A p-value less than 0.05 was considered statistically significant. RESULTS: The presence of prediabetes and type 2 diabetes was correlated with a decrease in the mean Hounsfield Unit (HU) value of the pancreas (p=0.002). Age was determined to be an independent risk factor and was correlated with NAFPD (p=0.0001). When compared to the controls (p=0.041), 71% of patients with prediabetes and 67% of patients with type 2 diabetes were observed to have an increased incidence of NAFPD. Decreased serum amylase was found to be correlated with the mean HU value of the pancreas (p=0.043). CONCLUSION: NAFPD was independently correlated with both prediabetes and type 2 diabetes adjusted for age (p=0.0001) in this study. Additionally, age was determined to be an independent risk factor and was correlated with NAFPD.

Prediabetes and type 2 diabetes are independent risk factors for computed tomography-estimated nonalcoholic fatty pancreas disease

OBJECTIVES: Nonalcoholic fatty pancreas disease (NAFPD) is characterized by excessive fat deposition in the pancreas in the absence of alcohol consumption. In this study, we aimed to detect a possible relationship between adipose tissue accumulation, prediabetes and diabetes. METHODS: This cross-sectional and retrospective study included 110 patients. Three groups were classified as controls, patients with prediabetes and patients with type 2 diabetes. The abdominal computed tomography (CT) attenuation measurement results of the pancreas were evaluated independently by two experienced radiologists. CT measurements and biochemical parameters were compared between study groups. The relationship between continuous variables was assessed by using one-way ANOVA. To determine the changes in the dependent variable for the effects on study groups, the independent variable was adjusted using ANCOVA. A p-value less than 0.05 was considered statistically significant. RESULTS: The presence of prediabetes and type 2 diabetes was correlated with a decrease in the mean Hounsfield Unit (HU) value of the pancreas (p=0.002). Age was determined to be an independent risk factor and was correlated with NAFPD (p=0.0001). When compared to the controls (p=0.041), 71% of patients with prediabetes and 67% of patients with type 2 diabetes were observed to have an increased incidence of NAFPD. Decreased serum amylase was found to be correlated with the mean HU value of the pancreas (p=0.043). CONCLUSION: NAFPD was independently correlated with both prediabetes and type 2 diabetes adjusted for age (p=0.0001) in this study. Additionally, age was determined to be an independent risk factor and was correlated with NAFPD.

The Relation between Sarcopenia and Mortality in Patients at Intensive Care Unit.

BACKGROUND AND AIM: Psoas muscle area (PMA) can reflect the status of skeletal muscle in the whole body. It has been also reported that decreased PMA was associated with postoperative mortality or morbidity after several surgical procedures. In this study, we aimed to investigate the relation between PMA and mortality in all age groups in intensive care unit (UNIT). MATERIALS AND METHOD: The study consists of 362 consecutive patients. The demographic characteristics of patients, indications for ICU hospitalization, laboratory parameters, and clinical parameters consist of mortality and length of stay, and surgery history was obtained from intensive care archive records. RESULTS: The mean age was 61.2 ± 18.2 years, and the percentage of female was 33.3%. The mean duration of stay was 10.3 ± 24.4 days. Exitus ratio, partial healing, and healing were 25%, 70%, and 5%, respectively. The mean right, left, and total PMA were 8.7 ± 3.6, 8.9 ± 3.4, and 17.6 ± 6.9, respectively. The left and total PMA averages of the nonoperation patients were statistically significantly lower (p = 0.021 p = 0.043). The mean PMA between the ex and recovered patients were statistically significantly lower (p = 0.001, p = 0.001, p < 0.001). Dyspnoea, renal insufficiency, COPD, transfusion rate, operation rate, ventilator needy, and mean duration of hospitalization were statistically significant higher in patients with exitus. There is a significant difference in operation types, anesthesia type, and clinic rates. CONCLUSION: Our data suggest that sarcopenia can be used to risk stratification in ICU patients. Future studies may use this technique to individualize postoperative interventions that may reduce the risk for an adverse discharge disposition related to critical illness, such as early mobilization, optimized nutritional support, and reduction of sedation and opioid dose.

Imaging Findings of the Unusual Presentations, Associations and Clinical Mimics of Acute Appendicitis.

There are many kinds of unusual presentations or associations and clinical mimics of acute appendicitis, and definitive diagnosis requires knowledge of the imaging findings in some cases. The unusual presentations and associations of acute appendicitis included in this study are perforated appendicitis, acute appendicitis occurring in hernias, acute appendicitis with cystic endosalpingiosis, intussusception of appendix, and acute appendicitis with pregnancy. We also present uncommon gastrointestinal, urinary and gynecologic clinical mimics of acute appendicitis including anomalous congenital band, duplication cysts, giant Meckel's diverticulitis, inflammatory fibroid polyp, renal artery thrombosis, spontaneous urinary extravasation and OHVIRA syndrome. Familiarity with these entities may improve diagnostic accuracy and enable the quickest and most appropriate clinical management.

Effectiveness of Using Dual-source CT and the Upshot it creates on Both Heart Rate and Image Quality.

BACKGROUND: Early detection of coronary artery disease (CAD) is important because of the high morbidity and mortality rates. As invasive coronary angiography (ICA) is an invasive procedure, an alternative diagnostic method; coronary computed tomography angiography (CTA), has become more widely used by the improvements in detector technology. AIMS: In this study, we aimed to examine the accuracy and image quality of high-pitch 128-slice dual-source CTA taking the ICA as reference technique. We also aimed to compare the accuracy and image quality between different heart rate groups of >70 beates per minute (bpm) and ≤70 bpm. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Among 450 patients who underwent coronary CTA with the FLASH spiral technique, performed with a second generation dual-source computed tomography device with a pitch value of 3.2, 102 patients without stent and/or bypass surgery history and clinically suspected coronary artery disease who underwent ICA within 15 days were enrolled. Image quality was assessed by two independent radiologists using a 4-point scale (1=absence of any artifacts- 4=non-evaluable). A stenosis >50% was considered significant on a per-segment, per-vessel, and per-patient basis and ICA was considered the reference method. Radiation doses were determined using dose length product (DLP) values detected by the computed tomography (CT) device. In addition, patients were classified into two groups according to their heart rates as ≤70 bpm (73 patients) and >70 bpm (29 patients). The relation between the diagnostic accuracy and heart rate groups were evaluated. RESULTS: Overall, 1495 (98%) coronary segments were diagnostic in 102 patients (32 male, 70 female, mean heart rate: 65 bpm). There was a significant correlation between image quality and mean heart rate in the right coronary artery (RCA) segments. The effective radiation dose was 0.98±0.09 mili Sievert (mSv). On a per-patient basis, sensitivity, specificity, and positive and negative predictive values were 93.8%, 88.8%, 93.8% and 88.8%, respectively. These values were also similar in per-vessel and per-segment basis. Two different groups categorized by mean heart rate had almost similar results in terms of the diagnostic power of dual-source CTA. CONCLUSION: CTA with a high pitch value is a reliable, non-invasive diagnostic method that can CAD with low radiation doses not only in patients with a heart rate below 70 bpm, but also in patients with higher heart rates.

Novel hematologic inflammatory parameters to predict acute mesenteric ischemia.

Acute mesenteric ischaemia (AMI) is an emergency condition that requires urgent diagnosis. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding AMI are lacking. The study population included patients with AMI (n = 46) versus age and sex-matched healthy controls (n = 46). Computed multidetector tomographic angiography was performed to diagnose AMI. NLR and PLR were calculated using complete blood count. C-reactive protein (CRP) levels were also analyzed. Neutrophil levels and lymphocytes were significantly higher in patients with AMI than in the control individuals (P < 0.001 and P = 0.43, respectively). NLR levels were significantly higher in patients with AMI compared with that in the control individuals (P < 0.001). Platelet levels did not reach statistical significance between the groups (P = 0.709). However, patients with AMI had significantly higher PLR levels than the control group (P = 0.039). CRP levels on admission were higher in patients with AMI in comparison with control individuals. There was also a positive correlation between NLR and CRP (r = 0.548, P < 0.001), and between PLR and CRP (r = 0.528, P < 0.001). NLR level greater than 4.5, measured on admission, yielded an area under the curve value of 0.790 (95% confidence interval 0.681-0.799, sensitivity 77%, specificity 72%), and PLR level of greater than 157 yielded an area under the curve value of 0.604 (95% confidence interval 0.486-0.722, sensitivity 59%, specificity 65%). Patients with AMI had increased NLR, PLR, and CRP levels compared with controls. Increased NLR and PLR was an independent predictor of AMI.

The role of ultrasonography in the imaging of body packers comparison with CT: a prospective study.

PURPOSE: This study investigated the sonographic properties of drug packets containing narcotic drugs and the diagnostic role of ultrasonography in detecting body packing in comparison with CT. METHODS: Forty-five suspects admitted to our hospital for diagnosis and management were routinely evaluated by non-contrast CT for the presence of drug packets. A single radiologist blind to CT data independently performed the abdominal ultrasonographic scans. RESULTS: Thirty-five of 45 suspects were carrying packets. In positive cases, two types of packets with different properties were noted. Twenty-eight cases had type 1 packets (solid form drug) and 7 had type 2 packets (liquid form cocaine). The sensitivity, specificity, positive, and negative predictive values of ultrasonography for detecting drug packets were 91%, 70%, 91%, and 70%, respectively. Ultrasonography accurately determined the presence or absence of packs in 39 of 45 suspects. CONCLUSION: Ultrasonography was found to have a high sensitivity but a low specificity in suspected cases. A negative ultrasonography cannot rule out the diagnosis of body packing. However, it may be preferred as the initial imaging method or for follow-up of suspected cases as a radiation-free, easy-to-use, and inexpensive technique.

Clinical and radiologic outcomes of TLIF applications with or without pedicle screw: a double center prospective pilot comparative study.

STUDY DESIGN: Prospective cohort data by merging data from comparative studies. OBJECTIVE: This study aimed to compare clinical and radiologic outcomes of the transforaminal lumbar interbody fusion (TLIF) procedure with or without pedicle screw support in stable patients with a degenerative disease. SUMMARY OF BACKGROUND DATA: The unilateral lumbar interbody fusion technique has gained popularity in the management of many lumbar degenerative conditions requiring fusion. TLIF is routinely performed with the support of pedicle screws. The use of the TLIF procedure without pedicle screw support has not yet been reported. METHODS: Between February 2006 and May 2009, surgical decompression and fusion was performed in patients with lumbar degenerative conditions using the TLIF technique either with (n=30, group A) or without pedicle screw support (n=30, group B). The 2 groups had similar age, sex distribution, pain level, and pain history. In this prospective study, patients were followed for a mean period of 31 months (range, 22 to 38 mo). The mean age was 45.5 years (range, 29 to 78 y), and all patients had a disease involving a single intervertebral space. RESULTS: The female to male ratio was 19:11 and 18:12 in groups A and B, respectively. Pain and function were evaluated by the Oswestry disability index and visual analog scale. Pseudoarthrosis developed in 2 patients from group A and in 3 patients from group B. Although these 5 patients had insufficient fusion, they did show a clinical improvement. The mean duration of the operation was 110 and 73 minutes in groups A and B, respectively. The mean total amount of bleeding was 410 and 220 mL in groups A and B, respectively. Cage loosening did not occur in group A, but 1 patient in group B developed asymptomatic cage loosening limited to the endplates. Four patients in group A suffered sciatic pain because of the malposition of the screw, and 1 patient in group B had contralateral sciatic pain lasting for 2 months. The visual analog scale and Oswestry disability index scores were higher in group A than in group B 1 month after the operation (P<0.005), but the groups did not significantly differ at 3 months (P<0.89). The cost of the procedure was 3-fold higher in group A compared with group B. CONCLUSIONS: This study showed that the TLIF procedure without pedicle screw support would be sufficient in the management of preoperatively stable patients with lumbar degenerative spinal disease requiring fusion after single-level decompression. This technique is minimally invasive, requires only unilateral intervention, allows magnetic resonance imaging during the postoperative period and is associated with less costs and complications when compared with pedicle screwing. This study represents the first prospective comparative report on this technique showing several of its advantages.

Anastomoses of the vestibular, cochlear, and facial nerves.

The internal auditory canal (IAC) is 10 to 17 mm in length, and the facial nerve and vestibulocochlear nerve, which consist of the cochlear nerve, the superior vestibular nerve, and the inferior vestibular nerve, run together in the IAC packaged in dura mater. Oort first described the vestibulocochlear anastomoses in 1918, which is important for the understanding of the pathogenesis and pathophysiology of otologic disorders. The current study documents the existence of vestibulofacial and vestibulocochlear neural connections and topographical relationship of the nerves as part of a radiologic evaluation of 73 human temporal bones from brainstem to the lateral portion of IAC.

Neurovascular complications of cervical pedicle screw fixation.

We rarely use the cervical transpedicular fixation (CPF) technique in the neurosurgery departments of the authors' institutions because the pedicle is thin and there is a risk of neurovascular damage. In this study we investigated postoperative neurovascular injury caused by the transpedicular screws of 210 pedicles in 45 patients on whom we performed CPF for various cervical pathologies. Fixation was performed between C3 and C7, and the iliac crest and lamina were used as autografts for fusion. In 205 of 210 pedicles (97.6%), the screws were in the correct position, while a non-critical lateral orientation was detected in three pedicles (1.4%). Two screws (one in each of two patients) were positioned inappropriately (0.9%, Grade 3), unilaterally and directly in the vertebral foramen, as shown on postoperative CT scans; blood circulation was normal on angiography. The fusion rate was 100%. The average screw length used for C3 to C7 was 32 mm. The patients were followed up for an average of 35.7 months (range: 17-60 months). There was no morbidity or mortality in our study. We concluded that CPF provides very strong cervical spine fixation but also carries a risk of pedicle perforation without neurovascular injury. However, a free-hand technique performed by an experienced surgeon is acceptable for CPF for various cervical pathologies.

A Radiological Study on the Topographical Relationships between the Vestibular, Cochlear and Facial Nerves.

OBJECTIVE: The purpose of our study was to investigate the topographical relationship between these nerves along their course from the brainstem through the internal acoustic canal IAC in the living human brain using MR imaging. MATERIALS AND METHODS: We performed three-dimensional gradient echo balanced Fast Field Echo (3D bFFE) sequence oblique parasagittal MR imaging in 73 healthy subjects. The IACs were analyzed from the brainstem end of the IAC to the fundus in contiguous sections. At five levels, the topographical relationships between the facial and vestibulocochlear nerves (VCN) were recorded. In the lateral portions of the IACs where they separated from each other, the relative sizes of the individual nerves were examined. RESULTS: In general, the facial nerve (FN), which is a round structure, is located anteriorly and superiorly to the vestibulocochlear nerve throughout its course. The vestibulocochlear nerve is usually rectangular; however, it was found to be round and at times triangular in shape near the brainstem, before it became crescent-shaped at the porus in 89% of the cases. The superior vestibular nerve kept its posterosuperior position in the canal, and the inferior vestibular nerve (IVN) and the cochlear nerve (CN) travelled inferior to it. The superior and inferior vestibular nerves were divided by the falciform crest in 53% of the cases. The inferior vestibular nerve was the smallest nerve in 52% of the cases, and the cochlear nerve was the largest in 36% of the cases. CONCLUSION: To the best of our knowledge, this study is the largest in vivo MR study, and most of our findings differ from previous cadaver studies. Determination of these topographical relationships may facilitate our understanding of the complicated physiological relationships between the 7(th) and 8(th) nerve complexes during surgery in this region.

Cervical transpedicular fixation aided by biplanar flouroscopy.

UNLABELLED: PURPOSE; To evaluate the accuracy of fluoroscopyassisted cervical transpedicular fixation in different pathologies. METHODS: 28 men and 17 women aged 34 to 65 (mean, 41) years underwent 210 one-stage cervical transpedicular fixations. The indications were trauma (n=35), degenerative disease leading to cervical spondylotic myelopathy (n=4), tumours (n=4), and Pott's disease (n=2). Regarding the 35 trauma patients, fractures were at C5-C6 (n=22), C4-C5 (n=8), and C3-C5 (n=5); 16 of them had dislocated vertebrae, of whom 13 had cervical disc herniation. Two of the patients with degenerative disease underwent additional laminectomy. Both anterior and posterior surgeries were performed for the 2 of the patients with tumours; all other patients underwent posterior surgery only. The length, diameters, and frontal, sagittal, and longitudinal angles of all pedicle screws were calculated. The dominant vertebral artery was detected using Doppler ultrasonography. Biplanar fluoroscopy was also used. Postoperatively, patients were allowed to mobilise at day 1; a collar was not used. The position of the pedicle screws was graded. RESULTS: The mean operating time was 105 (range, 90-155) minutes. The mean follow-up period was 26 (range, 17-34) months. Of the 210 pedicles fixed, 192 (91%) were at the correct screw position (grade I), 16 (8%) were at an acceptable position (grade II), and 2 (1%) were completely perforated but without morbidity (grade III). The overall perforation rate was 9%. There were no neurovascular injuries or instrumentation-associated complications (failure of implant components, screw loosening, or lucent zone formation around the pedicle screws). The fusion rate was 100%. CONCLUSION: Cervical transpedicular fixation provides strong stabilisation. With the aid of biplanar fluoroscopy, the risk of pedicle perforation was about 8%, but no neurovascular injury was ensued.

Medical treatment of primary extradural solitary lumbar hydatid disease.

Hydatid disease of the spine is rare and has a poor prognosis, presenting both diagnostic and therapeutic challenges. Paraplegia is the most serious complication of the disease and is caused by compression of the spinal cord by the cysts. We report a 30-year-old woman with an isolated primary hydatid cyst that responded to treatment with albendazole. She presented with back and right leg pain. MRI of the lumbar spine showed a solitary cyst measuring 2.2 x 2.7 cm, with an intraspinal extension at L4-L5. Physical examination did not reveal any focal deficit and the patient was treated with albendazole drug therapy (400mg daily). After 7 months' treatment, she had improved both clinically and radiologically. Albendazole drug therapy appears to be effective for conservative treatment of patients with primary solitary hydatid disease in the lumbar spine.

Frontal sinus obliteration by a composite multifractured osteoperiosteal flap: a pilot study.

The objective result is to obliterate the frontal sinus by a neo-osteogenic tissue, which develops behind the composite multifractured osteoperiosteal flap (CMOF) tailored from the anterior wall's bone cortex of the frontal sinus in the New Zealand rabbit model. In this study, as surgical objects 4 New Zealand rabbits were used. First, in each animal, the CMOF was formed from the anterior wall's bone cortex of the frontal sinus. After obtaining the CMOF, the remainder of the cortical bone of the anterior wall was removed by a drill. This procedure provided an anteriorly opened frontal sinus cavity, which has been filled firstly with absorbable gelatin sponge and finally covered with the CMOF. To investigate any possible neo-osteogenic activity behind the CMOF, CT scans of the paranasal sinuses were obtained on the first day and on the third month after surgery. Besides those, to histologically verify the developments, biopsies were obtained from behind the flap at the end of the third month. Evaluation of the CT images of the paranasal sinuses, confirms that more than half of the volume has been filled in frontal sinuses. Likewise, histologically, clear evidence of osteoblastic activity has been detected in each biopsy material. In this rabbit model, we have shown that more than half of the frontal sinus' cavity can be filled by the neo-osteogenic tissue forming behind the CMOF.

Delamination technique together with longitudinal incisions for treatment of Chiari I/syringomyelia complex: a prospective clinical study.

BACKGROUND: Treatment modalities in Chiari malformation type 1(CMI) accompanied by syringomyelia have not yet been standardized. Pathologies such as a small posterior fossa and thickened dura mater have been discussed previously. Various techniques have been explored to enlarge the foramen magnum and to expand the dura. The aim of this clinical study was to explore a new technique of excision of the external dura accompanied by widening the cisterna magna and making longitudinal incisions in the internal dura, without disturbing the arachnoid. METHODS: Ten patients with CMI and syringomyelia, operated between 2004 and 2006, formed this prospective series. All cases underwent foramen magnum decompression of 3 x 3 cm area with C1-C2 (partial) laminectomy, resection of foramen magnum fibrous band, excision of external dura, delamination and widening of internal dura with longitudinal incisions. RESULTS: Patients were aged between 25 and 58 years and occipital headache was the most common complaint. The mean duration of preoperative symptoms was 4 years and the follow-up time was 25 months. Clinical progression was halted for all patients; eight patients completely recovered and two reported no change. In one patient, there was a transient cerebrospinal fluid (CSF) fistula that was treated with tissue adhesive. While syringomyelia persisted radiologically with radiological stability in five patients; for three patients the syringomyelic cavity decreased in size, and for the remaining two it regressed completely. CONCLUSION: Removal of the fibrous band and the outer dural layer, at level of foramen magnum, together with the incision of inner dural layer appears to be good technique in adult CMI patients. The advantages are short operation time, no need for duraplasty, sufficient posterior fossa decompression, absence of CSF fistulas as a result of extra arachnoidal surgery, and short duration of hospitalization. Hence this surgical technique has advantages compared to other techniques.