Search PubMed⌕ Search

Biomedical subjects

R Tuncer

Publications and source records attributed to R Tuncer.

At least 19 recordsLinked to original sources
PubMed2006

The effects of fenestration of the interpeduncular cistern membrane arousted to the opening of lamina terminalis in patients with ruptured ACoA aneurysms: a prospective, comparative study.

BACKGROUND: The incidence of chronic hydrocephalus requiring shunt placement is a well-known and common complication of aneurysmal subarachnoid hemorrhage (aSAH). It was suggested that fenestration of the lamina terminalis (LT) during microsurgery for aSAH may be associated with a reduced rate of shunt-dependent chronic hydrocephalus (SDCH). We analyzed that, fenestrations of the LT and Liliequist membrane (LM) would reduce rate of SDCH and improve rate of favorable outcome. METHODS: 145 patients who were analyzed in the study were treated in our department with ruptured anterior communicating artery (ACoA) aneurysms. We compared the rate of shunting and clinical outcome in patients in whom only fenestration of the LT (Group 1) was performed with that in patients in whom fenestrations of both the LT and LM (Group 2) were performed. RESULTS: Chronic hydrocephalus requiring shunting amounted to 9.8% (7 patients) in Group 1 and 4% (3 patients) in Group 2 (p=0.203). Also, there were no differences in the rate of shunt dependent hydrocephalus between the two groups in patients with Fisher's CT grades 3 (p=0.343) and 4 (p=0.667), and HH grades 4 (p=0.306) and 5 (p=0.361). Favorable clinical outcomes were observed with rates of 74.6% in Group 1 and 79.7% in Group 2 (p=0.693). Also there were no differences in the rates of favorable clinical outcome between the two groups in patients with Fisher's CT grades 3-4, HH grades 4-5. CONCLUSIONS: Our study shows that fenestration of the LM coupled with the opening of the LT reduced-relatively-the incidence of SDCH; this however was not significant. This positive effect was particularly noticeable in patients in whom a cisternal "overflow" was observed at surgery when opening the LM. This corresponded to cases with ventricular dilatation and a IVth ventricle with clots.

Adult↗
PubMed2005

Effect of temporary clipping on frontal lobe functions in patients with ruptured aneurysm of the anterior communicating artery.

BACKGROUND: After surgery for ruptured anterior communicating artery (ACoA) aneurysm, several patients who have achieved a favorable neurological outcome yet have been observed to suffer from a poor cognitive outcome. The aim of this study was to explore the possible effects of temporary clip applications on frontal lobe functions in the patients with ruptured ACoA aneurysm. METHODS: Forty patients were chosen among a series of cases who underwent an early surgery (within 96 h) after ACoA aneurysm bleeding. All of them were in Hunt-Hess grade 1 or grade 2. Of the 40 patients, temporary clipping was used in 22 patients (group A), whereas it was not used in 18 patients (group B). These two groups were compared with 20 volunteers (group C) without neurologic or psychiatric disorders. RESULTS: The mean duration of temporary vessel occlusion for both A1 was 8.2 +/- 2.9 min (4-15) in group A. Neither clinical nor radiographic strokes were detected. An improvement in frontal lobe function occurred at long term in group B patients. Whereas, cognitive deficits were persisting at long-term follow-up in group A, especially in patients who had temporary clipping duration longer than 9 min. CONCLUSIONS: The results emphasize that the negative effects of temporary vessel occlusion on cognitive changes occur before ischemic damage. Thus, such negative effects of temporary clipping on cognitive functions should not be neglected by surgeons during surgery.

Adolescent↗
PubMed2004

Primary primitive neuro-ectodermal tumor of cauda equina with intracranial seeding.

Primitive neuro-ectodermal tumor (PNET) of the cauda equina is a rare entity. 18 cases have been reported in the literature so far, including 4 cases with intracranial seeding. Moreover parenchymal involvement of brain has never been reported as a form of intracranial seeding from PNET of the cauda equina. A 31 year-old female patient, with PNET of cauda equina showing intracranial seeding 6 months after surgery, is presented in this report. To our knowledge, this is the first adult case of spinal cord PNET with parenchymal involvement of brain. The histopathological, clinical and radiological findings as well as treatment of the patient were evaluated.

Adult↗
PubMed2004

Angiographic follow-up after surgical treatment of intracranial aneurysms.

This study was undertaken to evaluate the long-term angiographic outcome of surgically treated aneurysms. In addition, the incidence of recurrent aneurysms, the fate of residual aneurysms and the de novo formation of aneurysms were evaluated. Moreover, morphological conditions such as dilatation, stenosis or irregularity in temporarily clipped vascular segments were analyzed.166 aneurysms were operated on in 136 patients and these 166 aneurysms subsequently underwent late follow-up angiography. Late angiographic follow-up review was obtained at a mean of 46.6+/-11.5 months postsurgery (range 36-85 months). Out of the 7 aneurysms with known residua, 5 residual aneurysms were determined as unchanged, 1 residual aneurysm as spontaneous thrombosis and 1 residual aneurysm as enlarged. No recurrent aneurysm was found, however two de novo aneurysms were found. During the surgery of 85 aneurysms, 137 vascular segments clipped temporarily were evaluated in terms of morphological changes in postoperative and long-term angiograms. No morphological changes were determined in any vascular segments. These anatomical long-term results confirm the long-term efficacy of aneurysm clipping, when perfect. Small residual aneurysms can be followed with periodically performed angiography.

Adolescent↗
PubMed2002

Effects of the temporary clipping in aneurysm surgery on the remnant.

The residual aneurysm rate is reported between 3,8% and 21% in the cases followed after intracranial aneurysm surgery. In the formation of the residual aneurysm, the risk factors include such structural characteristics as the size and lobulation of the aneurysm, posterior circulation, para-ophthalmic localisation and intra-operative rupture. The rates and causes of postoperative residual aneurysms were analyzed in 186 intracranial aneurysm of 160 patients, including the possible effects of temporary clipping on the residual rates. The entire series demonstrated a residual rate of 7%. It was found higher in the large lobulating aneurysms and intra-operative rupture. The residual rate considerably decreased to 4,2% in the aneurysms with temporary clipping. The determination of residual aneurysms, identification of any risk factors and elimination of recoverable factors would allow improvement of surgical results in the treatment of the intracranial aneurysms in the future. Moreover we believe that these will be useful in development of the indications for alternative treatment methods.

Adolescent↗
PubMed2002

Complications of closed continuous lumbar drainage of cerebrospinal fluid.

Sixty three patients who had a lumbar subarachnoid catheter placed for closed continuous cerebrospinal fluid drainage and the complications are presented. The drain was successful in achieving the desired goal in 59 patients (93,6%). The complications are mainly divided into 3 groups; A - complications related to alterations in CSF drainage rate, B - complications due to mechanical failure of the catheter, C - infection. The overall complication rate is found to be 44,4%. Overdrainage, pneumocephalus and meningitis are found to be the most severe complications, but most of these complications are reversible with early recognition. Unfortunately one patient died following meningitis and hepatic failure. Lumbar subarachnoid drainage is a safe method unless the development of any neurological findings should prompt rapid discontinuation of lumbar drainage and immediate radiographic evaluation.

Catheterization↗
PubMed2002

Risk factors and infant outcomes associated with umbilical cord prolapse.

OBJECTIVES: Our goal was to identify risk factors associated with umbilical cord prolapse and to review the perinatal outcome of cases of cord prolapse. METHODS: During the study years 77 cases were identified retrospectively. Associations between cord prolapse and potential risk factors were evaluated by means of the odds ratio. RESULTS: Of the 77 fetuses with umbilical cord prolapse 9.1% had a fetal weight of < 2500 gas compared with 9.4% for fetuses in control group (P > 0.05). The umbilical cord prolapse occurred in association with vertex presentation 66 times (85.7%), breech presentation nine times (11.7%) and transverse presentation two times (2.6%). The occurrence of breech presentation among the control cases was 2.6%, and that of transverse lie was 1.7% (P < 0.01). Case mothers were 1.6 times more likely to be multiparas compared with the control group (P < 0.01). The perinatal mortality rate was 39/1000. CONCLUSIONS: Our study showed that abnormal fetal presentation and multiparity are associated with an increased risk of umbilical cord prolapse. The association of risk of cord prolapse with low birth weight was statistically insignificant (P > 0.05). We suggest that the cesarean delivery decreased the risk of perinatal mortality among cases of cord prolapse.

Adolescent↗
PubMed2001

Inevitable hysterectomy despite conservative surgical management in advanced cervical pregnancy: a case report.

A 35-year-old woman was diagnosed to have cervical pregnancy of 10.2 weeks duration. Methotrexate therapy was not chosen due to the presence of active tuberculosis. Since the patient had gradually increasing vaginal hemorrhage, she was taken to the operating room. A dilatation and curettage could not control the hemorrhage. A laparotomy was performed and the uterine arteries were ligated. A cervical hysterotomy was also performed to evacuate the products of conception. There was active bleeding in the cervix although no products of conception were observed. Two purse string sutures were placed, but the persistence of profuse bleeding despite these measures necessitated total hysterectomy.

Adult↗
PubMed2001

Pregnancy complicated by Evan's syndrome.

Evan's syndrome was initially diagnosed in a 26-year-old pregnant patient. Following the introduction of high dose steroid therapy, the patient developed possible disseminated gonococcal infection which was followed by preterm labor and abruptio placentae. A cesarean delivery was performed at the 34th week of pregnancy following platelet infusion. While the infant survived, the mother had delayed postpartum hemorrhage.

Abruptio Placentae↗
PubMed2000

Anatomical evaluation of the groove for the vertebral artery in the axis vertebrae for atlanto-axial transarticular screw fixation technique.

Anatomical measurements were studied on 40 dry axis vertebrae to determine the suitability of the groove for the vertebral artery for atlanto-axial transarticular screw fixation technique. We measured 13 parameters including three angular and 10 linear dimensions related to the groove of the vertebral artery, pedicle, and pars interarticularis and evaluated 80 measurements for each parameter. All measurements were done after placing a Kischner guide wire through the pedicle. We found that differences between measurements on the left and right sides of each vertebra were nonsignificant. In spite of the variability in measurements such as height, width, and median angle of the pedicle, the decline angle for instrumentation, the depth of the groove for the vertebral artery, and the internal height of the pars interarticularis, all of these had good symmetry. However, there were statistically significant differences between the sides in measurements for both the width (P=0.05) and the angle (P<0.02) of the pedicle allowing instrumentation and they did not show good symmetry. The risk of vertebral artery injury was found to be 22.5% per specimen, or 16.25% per screw inserted because the internal height of the pars interarticularis at point of fixation was </= 2.1 mm. In addition, we found that the pedicle width allowing instrumentation was not suitable in 12.5% of screws inserted because their values were </= 6 mm. When the width of the pedicle for instrumentation and the internal height of the pars interarticularis were both evaluated together, we also found that this technique would be extremely dangerous in 7.5% of specimens. In conclusion, the internal height of the pars interarticularis and the width of the pedicle for instrumentation should be evaluated together in thin CT sections preoperatively, because of the risk of vertebral artery injury in patients upon which atlanto-axial transarticular screw fixation is to be performed.

Atlanto-Axial Joint↗
PubMed2000

Proof of the patent subcutaneous fibrous tract in children with V-P shunt malfunction.

A connective tissue sheath that forms around the peritoneal catheter of silicone ventriculo-peritoneal (V-P) shunt tubing is quite often observed in children with V-P shunts. However, proof of the passage of cerebrospinal fluid (CSF) through these sheaths has been reported in only one published study to date. We present four cases associated with chronic malfunction of the V-P shunt peritoneal catheter. In these cases, CSF passage through the subcutaneous fibrous tract, which had a pericatheter connective tissue sheath, was demonstrated around the V-P shunt peritoneal catheter. In the first case the patient suffered intermittent headache attacks over a long period of time; abdominal migration of the peritoneal catheter was detected. The second patient, who had been asymptomatic in the follow-up period with an outgrown peritoneal catheter, was admitted with acute hydrocephalus symptoms. A peritoneal catheter disconnection was detected in another patient, who had had multiple shunt revisions previously. In the last case, an obstruction of the peritoneal catheter was detected. The existence of the subcutaneous fibrous tract and its function were demonstrated by radio-opaque shuntogram in two cases and radionuclide shuntogram in the other two cases. In all four cases V-P shunt revision was performed. Within this study, the possible passage of CSF through a fibrous tract in cases of migration, outgrowth, disconnection or obstruction of the peritoneal shunt catheter was demonstrated. In conclusion, patients with shunt malfunction with a well-grown pericatheter fibrous sheath who are either asymptomatic or minimally symptomatic and show no evidence of active ventricular dilatation on their cranial CT scan should not be regarded as having arrested hydrocephalus until radio-opaque or radionuclide shuntogram studies have been done.

Adolescent↗
PubMed2000

Spinal canal stenosis at the level of axis.

We describe a rare case of marked segmental stenosis of the axis secondary to developmental hypertrophy of the posterior neural arch causing severe neck pain and headache in the occipital region. The patient made a remarkable recovery following decompressive laminectomy and foraminal decompression.

Axis, Cervical Vertebra↗
PubMed2000

Recombinant human interleukin-11 prevents mucosal atrophy and bowel shortening in the defunctionalized intestine.

BACKGROUND: Mucosal atrophy and bowel shortening are the hallmark of proximal intestinal diversion for extensive necrotizing enterocolitis (NEC) or Thiry-Vella fistulas (TVF), in which the ends of a defunctionalized loop of intestine are exteriorized as stomas. Recombinant human interleukin-11 (rhIL-11) is a pleiotropic cytokine that promotes epithelial regeneration and enhances adaptation after bowel resection. The authors hypothesized that rhIL-11 may prevent mucosal atrophy and bowel shortening in rats with TVF METHODS: After creation of ileal TVF, Sprague-Dawley rats were selected randomly to receive either rhIL-11 or equal volume of 0.1% bovine serum albumin (BSA) subcutaneously daily. On day 14, the TVF were excised and examined morphologically. Enterocyte apoptosis was measured using the TUNEL assay. Mucosal DNA and protein content were measured. RESULTS: Administration of rhIL-11 resulted in a significantly greater weight gain and less shortening of TVF than BSA treatment. TVF from the rhIL-11-treated group showed evidence of hyperplasia and hypertrophy and increased crypt to villus ratio. The BSA group had substantial mucosal atrophy. There was a qualitative decrease in the incidence of apoptosis in the rhIL-11 group. CONCLUSIONS: Recombinant human IL-11 prevents mucosal atrophy and shortening of defunctionalized intestinal loops. It may help reduce the incidence of short gut syndrome in infants with extensive NEC.

Animals↗
PubMed2000

Bilateral cerebellopontine angle arachnoid cysts: case report.

OBJECTIVE AND IMPORTANCE: A rare case of bilateral cerebellopontine angle (CPA) arachnoid cysts (ACs), accompanied by cerebellar tonsillar displacement toward the foramen magnum, is presented. CLINICAL PRESENTATION: A 45-year-old woman presented with progressive dysphagia, vertigo, and truncal ataxia. Magnetic resonance imaging revealed bilateral CPA ACs and cerebellar tonsillar displacement. INTERVENTION: The right CPA AC was excised via a suboccipital approach. Decompression of the foramen magnum and duraplasty were also performed. CONCLUSION: The case reported here is the first case of bilateral CPA ACs. Decompression of the foramen magnum and excision of the cyst resulted in complete relief of symptoms.

Arachnoid Cysts↗
PubMed1999

Percutaneous anterior odontoid screw fixation technique. A new instrument and a cadaveric study.

We describe a new instrument and a percutaneous technique for closed anterior fixation of odontoid fracture. The instrument which we developed consists of a telescopic tube system. This new instrument and closed fixation technique was used in six cadavers with type II odontoid fractures and to two cadavers with an intact odontoid process. Each cadaver underwent satisfactory placement of the screw to the odontoid with this technique under biplanar scopy control. After this procedure, no serious injury was found in the parapharyngeal and neurovascular areas of the necks of the cadavers, in which anatomical dissection along the track of this instrument was performed. The instrumentation and the technique as a whole is seen as reliably applicable for odontoid fracture fixation. Also, we expect to reduce operating time and hospital costs because this system is simple, easily applicable and minimally invasive.

Bone Screws↗
PubMed1999

The effect of mild hypothermia, mannitol and insulin-induced hypoglycaemia on ischaemic infarct volume in the early period after permanent middle cerebral artery occlusion in the rat.

We investigated the effect of mild hypothermia (32-34 degrees C), mannitol and insulin - induced hypoglycaemia on the ischaemic infarct volume on permanent middle cerebral artery occlusion with bilateral carotid artery ligation in rats. Temporalis muscle temperature as an indicator of brain temperature was monitored throughout the experiment in all rats, which were randomly divided into seven groups. During ischaemia, control rats received intravenous saline in a normothermic condition; treated rats had hypothermia and intravenous saline, hypothermia and mannitol, normothermia and mannitol, normothermia and insulin, normothermia, insulin and glucose, and hypothermia and insulin applied. After the experiment, the animals were killed, and brain sections were stained with haematoxylin and eosin. Images of infarct areas were determined using a camera attached to the microscope, and analysed by image analysis software. The total volume of infarcted tissue, right hemispheric volume, and the percentage of infarction were determined at the end of the image analysis investigation. The infarct volume on the control group was found to be 128.16+/-6.67 mm(3). Infarct volumes in hypothermic groups were significantly smaller than those of the control group (p<0.05). There were no significant differences between infarct volumes in the hypothermic groups. However, we found that hypothermia plus mannitol have the greatest neuro-protective effect. In normothermic rats, the infarct volume decreased proportionally but not statistically (p>0.05) whether mannitol or insulin was given. Our results also demonstrate that pre-, and post-ischaemic serum glucose concentrations influence the volume of infarction. Rats that had had pre-ischaemic high serum glucose concentrations had a higher volume of infarct than the hypothermic rats (p<0.05), while rats with post-ischaemic low serum glucose concentrations had a lower volume of infarct than the control rats.

Animals↗