The Evaluation of 13 Patients with Intrathoracic Extrapulmonary Hydatidosis

Cases of intrathoracic extrapulmonary hydatid cysts are very rare. We identified 13 patients with intrathoracic extra-pulmonary hydatid cysts in our clinic over 12 years. Four patients had extra-pulmonary cysts only; nine patients had both intrapulmonary and extrapulmonary cysts. Cysts were identified in the pleural space, extrapleural region, diaphragm and chest wall. Thoracotomy was used in all patients, and extrapulmonary lesions were removed by cyst extirpation from surrounding tissue or by pericystectomy. In one patient with chest wall involvement, partial rib resections were performed because of rib destruction. In two patients with liver cysts passing through the diaphragm to the thorax, the diaphragm was cut, cysts on the liver roof were removed and then the diaphragm was repaired. There was no mortality, morbidity, or disease recurrence during the post-operative period in any of the 13 patients. We conclude that these rare cases give a new insight into hydatid cyst pathophysiology.

Is T3 and T6 sympathetic clipping more effective in primary palmoplantar hyperhydrosis?

OBJECTIVE

Our aim was to establish a standardized approach for patients with palmoplantar and axillary hyperhidrosis and to compare patient satisfaction and complication rates for two different operations.

MATERIALS AND METHODS

Between 2008 and 2010, 30 patients underwent conventional T3/4 clipping (group A), and 30 underwent only T3 and T6 clipping (group B). Both groups were compared with regard to compensatory sweating (CS), complications, patient satisfaction and recovery of plantar hyperhidrosis.

RESULTS

The CS rate was 60 % in group A and 47 % in group B. CS was significantly less in group B compared to group A ( P ≤ 0.001). The plantar hyperhidrosis recovery rate was higher in group B (n = 19) compared to group A (n = 13), but the difference was not statistically significant ( P ≥ 0.299). Patient satisfaction rate was 93.3 % in group A and 96.6 % in group B.

CONCLUSIONS

Our study showed that T3/6 clipping was as effective as T3/4 clipping for palmar and axillary hyperhidrosis. Our results revealed that this technique is more effective than T3/4 sympathectomy to treat plantar hyperhidrosis.

Intraradicular lumbar disc herniation: report of two cases

STUDY DESIGN

A case report.

OBJECTIVES

To report two cases of intra-radicular disc herniation.

SETTING

Kocatepe University Faculty of Medicine, Department of Neurosurgery, Afyon, Turkey, Vakif Gureba Training Hospital, Department of Neurosurgery, Istanbul, Turkey and Yeditepe University Faculty of Medicine, Department of Neurosurgery, Istanbul, Turkey.

METHODS

Two cases with intra-radicular disc herniation at L2-3 level in one, and at L5-S1 level in the other were presented. Both patients were admitted with complaints of severe leg pain and motor weakness. In both cases, intra-radicular disc herniation was diagnosed during surgery.

RESULTS

The patients had uneventful recovery. They had no complaints or neurological deficits 6 and 3 months after surgery, respectively.

CONCLUSIONS

The possibility of an intradural disc herniation should be kept in mind for the success of the management of lumbar disc herniation. In some patients who did not benefit from surgery, intra-radicular or intradural disc herniations may be the cause of failure.

Spinal extradural arachnoid cyst

The case of 16-year-old boy with a spinal extradural arachnoid cyst is presented. An extradural arachnoid diverticulum extending from T10 to L1 was excised totally with hemilaminectomy. Surgery caused prompt improvement of the neurological deficit. The pertinent literature is reviewed.

Surgical management of craniocerebral gunshot wounds

Thirty-nine cases operated on because of gunshot wounds in our clinics the years 1976-1986 have been investigated. Factors contributing to mortality and outcome were evaluated. All the principles of emergency medical care and of surgical treatment of penetrating wounds should be applied to those patients with craniocerebral gunshot wounds in whom surgery is indicated.

Primary Ewing's sarcoma of the skull: follow-up with bone scanning

The authors report and discuss an extremely rare case of primary Ewing's sarcoma originating in the flat bones of the skull. The case was followed up by serial bone scanning during the postoperative period. A subclinical recurrence was detected as a focus at the original site 2.5 years after the first operation. Following a second operation and adjuvant chemotherapy the patient is still asymptomatic.

A case of Foster Kennedy syndrome without frontal lobe or anterior cranial fossa involvement

Foster Kennedy syndrome is a very rare syndrome which includes ipsilateral optic atrophy and central scotoma, anosmia, contralateral papilledema, and, occasionally, ipsilateral proptosis. A large frontal lobe, olfactory groove, or medial third sphenoidal wing tumor, usually a meningioma, creates this syndrome. In this report, the author presents a case of metastatic cerebral tumor with Foster Kennedy syndrome but without frontal lobe or anterior cranial fossa involvement.

Clinical analysis and results of operative treatment of 41 brain abscesses

In this study, 41 cases of cerebral abscess operated on in our clinics between 1977 and 1986 were investigated retrospectively. The surgical strategy and the factors affecting the mortality rate were discussed. It was confirmed that the most important factor affecting the mortality rate was the consciousness level of patients in the preoperative period. The importance of computed tomography (CT) for early diagnosis and management of brain abscess is stressed.

Intradural disc herniations pathogenesis, clinical picture, diagnosis and treatment

The relatively rare occurrence and uncertainty about pathogenesis of intradurally displaced disc herniations stimulated an anatomico-pathological study into intradural disc herniations. The relation between the ventral dura and posterior longitudinal ligament in the cervical, thoracic, lumbar and sacral regions were examined macroscopically and microscopically, and ventral and dorsal dural thickness was compared in 20 adult autopsies on patients who died from various causes; in addition, 20 late abortions and newborn cadavers were investigated in the same way. In this study, a total of 40 autopsies has shown that the ventral dura is most frequently and firmly attached to the posterior longitudinal ligament at the L4-L5 level and these adhesions may be congenital. In the adult cadavers dorsal dura was found to be thicker than the ventral dura in the lumbar and lower cervical interspaces. Three personal clinical cases of intradurally herniated disc prolapse are shortly described and the diagnosis and management of this pathology discussed.

Effect of dexamethasone on various stages of experimental brain abscess

Rats were inoculated with staphylococcus aureus to produce cerebral abscesses and treated with either antibiotic or dexamethasone and with antibiotic plus dexamethasone at sequential stages of abscess formation. Antibiotic alone shortened the cerebritis stage, accelerated the encapsulation and affected the bacterial clearance in the abscess centre when it was started early in the course of cerebritis. Dexamethasone impaired the lymphocytic and fibroblastic responses and delayed the collagen deposition as well as suppressed the efficacy of antibiotic. However, it did not halt entirely the encapsulation and did reduce the associated cerebral oedema.

Treatment of experimental brain abscess. 2. Effects of combinations of hyaluronidase with antibiotics and dexamethasone

Brain abscess formation was studied experimentally in rats to determine the most appropriate nonsurgical treatment method by applying different combinations of hyaluronidase, dexamethasone and antibiotic sensitive to the inoculated bacteria in various stages of classical abscess development. The results showed that combined therapy with antibiotic and hyaluronidase started the day before inoculation averted the formation of brain abscess and the same therapy started after encapsulation, effectively eliminated the organisms and resolved the infection leaving a glial scar. But the same therapy, only started at the cerebritis stages, caused an increase of cerebritis. The addition of dexamethasone reduced the oedema but enhanced the cerebritis and delayed encapsulation. Though neurosurgical intervention continues to be the definitive method for eradicating the infection and preventing the pressure-related complications of brain abscess, our concept of management with hyaluronidase and appropriate antibiotic might be a new effective chemotherapeutic method of encapsulated brain abscesses in selected high-risk patients.

Cervical spinal intramedullary myxoma in childhood. Case report

A unique case is reported of a cervical intramedullary myxoma in an 18-month-old boy who presented with torticollis and monoparesis. Radical removal of the tumor by a planned two-stage procedure was curative.