Epidural hemostasis by autologous fat graft in minimally invasive surgery for lumbar spinal stenosis: In vivo experimental study.

BACKGROUND: Epidural hemostasis needs to use small, adapted material in minimally invasive surgery, including bilateral decompression via a unilateral approach for lumbar spinal stenosis. Most surgeons avoid external material for hemostasis because of possible neural tissue damage or complications. We compared epidural hemostasis in minimally invasive surgery by fat graft versus gelatin sponge. METHODS: The design was a prospective randomized controlled in-vivo human experimental study. The 24 levels operated on for lumbar spinal stenosis were evaluated in two groups: Group A (control group: gelatin sponge) and Group B (experimental group: fat graft). International Normalized Ratio and Prothrombin Time were assessed preoperatively. Number of cotton hemostats and systolic and diastolic blood pressure were assessed intraoperatively. Epidural hemorrhage area, spinal cord size and ratio of epidural hemorrhage area to spinal cord size were evaluated on early postoperative lumbar MRI. RESULTS: Mean epidural hemorrhage area in groups A and B was respectively 1.3±0.5 and 1.2±0.6cm2, and mean spinal cord size 1.2±0.6 and 1.8±0.6cm2 on early postoperative axial lumbar MRI. The two groups did not significantly differ in ratio of epidural hemorrhage/spinal cord size or number of intraoperative hemostats (P=0.36, and P=0.71). CONCLUSIONS: The autologous fat graft ensured sufficient and safe epidural hemostasis without serious adverse events in minimally invasive spinal surgery, and is preferable as autologous tissue is easily and quickly harvested. The surgeon feels safe with this technique and does not need external hemostatic agents.

Surgical treatment and outcomes of intramedullary tumors by minimally invasive approach.

Intramedullary tumors are uncommon neoplasms which, without treatment, can cause neurologic morbidity or mortality. The goal of the treatment is complete surgical resection with a minimally invasive approach while preserving neurological status and also spinal stability. Out of 1972 patients with tumors of the spinal canal treated between 1994 and 2017, 168 intramedullary tumors of 417 intradural tumors have been presented. All patients had undergone one surgical resection. The mean age is 43 ± 12 years (range 11-67 years). Tumors were subdivided into 4 groups: cervically located-tumors (n = 43), cervicothoracic-region-tumors (n = 32), thoracic-region-tumors (n = 57), and lumbosacral-region-tumors (n = 36). The mean follow-up time was 37 ± 29 months. Gross-total resection rate was higher in cervical located intramedullary tumors compared to the thoracic intramedullary tumors. Cervical intramedullary tumors showed better postoperative functional outcome than the thoracic intramedullary lesions. In intramedullary tumors, extending more than 3 spinal segments, postoperative worsening was significantly increased. A minimally invasive approach (the bilateral decompression via unilateral hemilaminectomy) was used to remove the tumor while preserving spinal stability. Perioperative permanent morbidity was very low. Intramedullary tumors should be surgically treated as soon as neurological symptoms appear. Patients with thoracic intramedullary tumors and tumor extension of more than three segments were at a higher risk for permanent morbidity. The minimally invasive approach allowed complete removal of the intramedullary tumors, and adequate preservation of vertebral stability while providing a good postoperative course.

Successful treatment of multidrug-resistant Acinetobacter baumannii ventriculitis with intravenous and intraventricular colistin.

Management of multidrug-resistant Acinetobacter baumannii (MDRAB) meningitis/ventriculitis is a difficult therapeutic problem owing to the limited penetration of antibiotics into cerebrospinal fluid (CSF). A 2-month-old girl with ventriculitis caused by MDRAB is reported. Despite therapy with intravenous (IV) colistin ventricular fluid, cultures remained positive for MDRAB. Institution of combination therapy with IV and intraventricular colistin resulted in a successful clinical and microbiological outcome. Intraventricular/intrathecal and IV colistin might be the best therapeutic option in the treatment of central nervous system infection caused by MDRAB. Further studies are required to evaluate pharmacokinetic and pharmacodynamic parameters of combined IV and intraventricular/intrathecal colistin administration, especially in children.

Analysis of clinical characteristics and surgical results of upper lumbar disc herniations.

BACKGROUND: Upper lumbar disc herniation (ULDH) is described mostly in levels L1-2, L2-3 and L3-4 of the lumbar spine in the literature and accounts for less than 10% of all disc herniations. The aim of our study was to evaluate the clinical characteristics and surgical results of ULDH. METHODS: In all, 367 patients treated for upper lumbar disc herniation and 2137 treated for lower lumbar disc herniation (LLDH) between January 2008 and January 2017 were included. They were followed up postoperatively at 12 months by radiological investigations, back and leg pain Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). Preoperative data comprised age group (20-40, 40-60, 60-80 years), gender (male, female), lumbar level (L1-2, L2-3, L3-4), side of disc herniation (left, right) and symptom duration (0-3, 3-6, 6-9 months). RESULTS: ODI and VAS scores improved significantly postoperatively for all patients. Of the 367 ULDH patients, 169 were female (54%) and 198 male (46%), with a mean age of 55.8±10.1 years (range, 35-71). In 174 (47.4%) patients symptom duration was 3 months, in 99 (27.0%) 3-6 months, and in 94 (25.6%) 6-9 months. At 12 months, ODI, back and leg pain VAS scores showed a significant difference in improvement according to ULDH symptom duration<3 months and to LLDH symptom duration<6 months. CONCLUSION: Microdiscectomy in ULDH provided sufficient and safe decompression of neural structures, with significant reduction in symptoms and disability. We suggest that early surgical treatment is an important factor for good outcome in ULDH.

The serum levels of soluble interleukin-2 receptor levels in patients with obstructive jaundice.

BACKGROUND/AIMS: Increased susceptibility to infection in patients with obstructive jaundice is well recognized. Depression of reticuloendothlial system phagocytic function and suppression of cellular immunity suggested by in vivo studies have been postulated as the cause. It has been shown that increased serum soluble interleukin-2 receptor (sIL-2R) levels are the marker of immune system activation, especially T cell activation. The purpose of this study was to evaluate cellular immune system activation by measuring serum sIL-2R levels in 18 patients with obstructive jaundice (11 with choledocholithiasis, 7 with malignant obstructive jaundice), 10 patients with liver cirrhosis and 10 healthy subjects. MATERIAL AND METHODS: Serum sIL-2R levels were measured by using ELISA (Boehringer Manheim). Lymphocyte subgroups were determined by flowcytometry. Serum immungolubulins (IgG, IgA, IgM) and autoantibodies such as antinuclear antibody, rheumatoid factor, anti-thyroglobulin and anti-microsomal antibody were measured. RESULTS: The levels of serum sIL-2R were found to be 47.1-121.2 (mean 77.3, SD +/- 20.1) pmol/l in healthy subjects, 82.8-199.2 (mean 150.9 +/- 32.2) pmol/L in patients with liver cirrhosis and 32.6-172.5 (mean 121.7 +/- 40.6) pmol/L in patients with obstructive jaundice. Serum sIL-2R levels were significantly higher in patients with liver cirrhosis or obstructive jaundice than in healthy subjects (p < 0.01 and p < 0.05 respectively). There is a significant difference in levels between patients with choledocholithiasis and with malignant obstructive jaundice (p < 0.01). Serum sIL-2R levels were measured higher in patients with liver cirrhosis than those in patients with obstructive jaundice (p < 0.059). CONCLUSIONS: In patients with obstructive jaundice, and to a lesser extent in those with liver cirrhosis, in vivo activation of immune system may be considered possible.

Problems related to the diagnosis and treatment of adolescents with leukemia.

This descriptive study investigated the problems related to the diagnosis and treatment of adolescents diagnosed with leukemia. Subjects were 8 females and 22 males diagnosed with leukemia for at least one year and who received outpatient treatment. The study found that the information needs of the adolescents related more to the treatment and the prognosis of the disease than to the etiology. All subjects reported that they experienced physical problems relevant to the disease and the treatment, and 50% reported that they experienced social problems. Also, their social problems decreased as the time period after the diagnosis increased and subjects were in the remission stage. Adolescents also have fears and concerns related to the side effects of treatment and prognosis. Especially in the recurrence stage, their fears and concerns about death are increased. Friends and family relationships of the adolescents changed, and their future life plans were disrupted after the disease.

Self-esteem in adolescence: a comparison of adolescents with diabetes mellitus and leukemia.

This descriptive study examined the self-esteem of adolescents with diabetes mellitus and leukemia. Participants included 22 adolescents with diabetes mellitus and 33 with leukemia. No significant difference was found between the self-esteem of males and females in either group. After the initial diagnosis, over time a decrease in self-esteem in the leukemia group and an increase in self-esteem in the diabetes mellitus group were observed. The adolescents with leukemia who experienced a relapse had moderate self-esteem. Most of the adolescents with leukemia could not attend school because of their illness. The mean scores of self-esteem were high in the diabetes mellitus group and moderate in the leukemia group. In both groups, the mean scores of self-esteem were compared to depressive affect, daydreaming, psychosomatic symptoms, intensity of discussion, and parental interest (subscales in the Rosenberg self-esteem scale). No significant difference was found between the two disease groups. There was a strong and significant correlation between self-esteem and depressive affect in both groups.

Depression in children with cancer.

In this study, children with cancer and healthy students between the ages of 9 and 13 were investigated in terms of depression status. A demographic data form and the Children's Depression Inventory were given to both groups. The research group consisted of 50 children with cancer who were followed up in pediatric hematology and oncology outpatient clinics at Ankara University. The control group was comprised of 50 healthy students who attended Türközü Timur Primary School. It was found that there were significant differences between depression scores of children with cancer and children that are healthy. Children with cancer have higher depression scores than healthy students.