Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 5 de 5
Filter
Add more filters










Database
Language
Publication year range
1.
World Neurosurg ; 181: e911-e917, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37949297

ABSTRACT

BACKGROUND: Cascading of referrals to health institutions aims to increase the balanced distribution and quality of health services provided. Although health institutions in Turkey are divided into steps in terms of scope, there is no mandatory referral system for patient application. METHODS: Patients admitted to the neurosurgery outpatient clinic of 3 different hospitals in the first week of September 2023 were analyzed. The patients' complaints, reasons for referral to the outpatient clinic, by whom or by which system, the department to which they should have applied, and the necessity of the operation were examined to evaluate. RESULTS: There were 671 applications made to the neurosurgery outpatient clinic in 3 different health institutions. The average examination time per patient was 6 minutes. Surgical treatment was planned for only 14.8% of the patients. Most patients were referred to physical therapy and neurology departments from neurosurgery. Only 59% of the patients came to the examination by making an appointment, while 41% were examined without an appointment. The ratio of inappropriate admissions to total admissions in these 3 health institutions was 85.1%. CONCLUSIONS: Only a minority of patients admitted to the neurosurgery outpatient clinic at a public health institution in Turkey were found to require surgery, while the majority were referred to other outpatient clinics. This study underscores the significance of the referral chain in delivering high-quality health care services, particularly in the field of neurosurgery.


Subject(s)
Neurosurgery , Humans , Tertiary Care Centers , Retrospective Studies , Turkey , Ambulatory Care , Referral and Consultation
2.
J Craniofac Surg ; 30(7): 2171-2173, 2019 Oct.
Article in English | MEDLINE | ID: mdl-31574785

ABSTRACT

OBJECTIVE: Choroid plexus cysts are the most common neuro-epithelial cysts. METHODS: The authors describe 2 cases. The first case is a 1-year-old child presenting with hydrocephalus and cyst of the choroid plexus. The child was treated with endoscopic fenestration of the cysts. RESULTS: The histological examination of the cyst wall was consistent with choroid epithelium and water-filled vesicles. The second case is a 63 year old male with a highly vascularized tumor extending to choroid plexus. A quaductus Silvius was obstructed by the tumor. The histopathologic examination of choroid plexus showed a low number, water-vesicles. CONCLUSIONS: According to our knowledge, there are no previous reports of water-filled vesicles with choroid plexus cyst causing hydrocephalus. The first case is a good example of over secretion of cerebrospinal fluid (CSF) with the water-filled vesicle. The second case with low number of water filled vesicle shows that the cause of hydrocephalus is not over production of CSF, it is blockage of the CSF pathway in Aquaductus Silvius by the tumor itself. These 2 cases are illustrative and more importantly highlight the need to study for water-filled vesicles in these kind of cases.


Subject(s)
Choroid Plexus Neoplasms/pathology , Central Nervous System Cysts/diagnostic imaging , Choroid Plexus Neoplasms/complications , Choroid Plexus Neoplasms/diagnostic imaging , Choroid Plexus Neoplasms/surgery , Humans , Hydrocephalus/etiology , Infant , Male , Middle Aged , Neuroendoscopy
3.
Turk Neurosurg ; 29(3): 434-439, 2019.
Article in English | MEDLINE | ID: mdl-30984987

ABSTRACT

AIM: To examine ischemic neurodegeneration of the ciliospinal center on permanent miosis following subarachnoid hemorrhage (SAH). MATERIAL AND METHODS: Nineteen rabbits were examined in this study. The animals were divided into three groups, as control (GI, n=5), sham (GII, n=5) and study group (GIII, n=9). Pupil diameters were measured after giving 0.5 mL physiological saline for sham and autologous arterial blood for the study group into the cervico-thoracic subarachnoid space. After three weeks of follow up, the cervico-thoracic cord and bilateral superior cervical sympathetic ganglia were removed. The pupil diameter values were compared with degenerated neuron volumes of sympathetic ganglia and degenerated neuron densities of thoracic sympathetic nuclei which were studied by stereological methods. RESULTS: The mean pupil diameter was 5180 ± 370 µm and the mean degenerated neuron density of the ciliospinal center was 4 ± 1/mm3 in animals of the control group (GI). These values were 9850 ± 610 εm, 10 ± 3/mm3 in sham (GII), and 7.010 ± 440 εm and 98 ± 21/mm3 in the study (GIII) groups. There was an inverse relationship between degenerated neuron density of the ciliospinal nuclei and pupil diameters. CONCLUSION: We showed and reported for the first time that ciliospinal sympathetic center ischemia-induced neurodegeneration may have been responsible for permanent miosis following SAH.


Subject(s)
Ischemia/diagnosis , Miosis/diagnosis , Subarachnoid Hemorrhage/diagnosis , Superior Cervical Ganglion/pathology , Animals , Disease Models, Animal , Ischemia/complications , Ischemia/physiopathology , Male , Miosis/etiology , Miosis/physiopathology , Nerve Degeneration/diagnosis , Nerve Degeneration/etiology , Nerve Degeneration/physiopathology , Pupil/physiology , Rabbits , Random Allocation , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/physiopathology , Superior Cervical Ganglion/physiopathology
4.
World Neurosurg ; 126: e779-e785, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30853517

ABSTRACT

BACKGROUND: Spinal surgery is a procedure that causes intense and severe pain in the postoperative period. Erector spinae plane (ESP) block can target the dorsal-ventral rami of thoracolumbar nerves, but its effect on lumbar surgery is unclear. The aim of this study was to investigate the effect of the ESP block on postoperative opioid consumption and pain scores in patients undergoing spinal surgery. METHODS: Sixty patients undergoing open lumbar decompression surgery were randomly assigned to 2 groups. The ESP Group (n = 30) received ultrasound-guided bilateral ESP block with 0.25% bupivacaine 20 mL. In the Control Group (n = 30), no intervention was performed. Postoperative analgesia was performed intravenously twice a day with 400 mg ibuprofen and patient-controlled analgesia with tramadol. Postoperative visual analogue scale scores, opioid consumption, rescue analgesia, and opioid-related side effects were evaluated. RESULTS: Compared with the Control Group, the visual analogue scale scores were statistically lower in the ESP Group during all measurements of time, both at rest and active movement (P < 0.05). Tramadol consumption was lower in the ESP Group compared with the Control Group at all time periods (P < 0.05). Twenty-four hour tramadol consumption in the Control Group was significantly higher compared with the ESP Group (370.33 ± 73.27 mg and 268.33 ± 71.44 mg; P < 0.001, respectively) and the difference was 28%, and time to first analgesic requirement was significantly longer in the ESP Group than in the Control Group. CONCLUSIONS: ESP block can be used in multimodal analgesia practice to reduce opioid consumption and relieve acute postoperative pain in patients undergoing open lumbar decompression surgery.


Subject(s)
Anesthetics, Local/therapeutic use , Bupivacaine/therapeutic use , Decompression, Surgical/methods , Lumbosacral Region/surgery , Nerve Block/methods , Pain, Postoperative/drug therapy , Adult , Decompression, Surgical/adverse effects , Female , Humans , Male , Middle Aged , Pain Management/methods , Pain, Postoperative/etiology , Treatment Outcome
5.
J Craniofac Surg ; 29(3): 778-782, 2018 May.
Article in English | MEDLINE | ID: mdl-29381627

ABSTRACT

OBJECTIVES: In hydatid disease, the central nervous system is affected approximately in 2% to 3% of patients. Surgical management in these patients is important. To develop a surgical technique to avoid the formation of great volume of cavity after hydatid cyst removal and prevent complications associated with brain collapse and cortical convolution. PATIENTS AND METHODS: In 2 patients, hydatid cysts were delivered by this new technique. A balloon filled with 150 cc of sterile air/distilled water was placed in the cavity until the balloon filled the entire cavity. Air/distilled water evacuation was continued at a rate of 20 cc/d and, after a week, eventually, the balloons were removed RESULTS:: All cysts were delivered without rupture. Neurologic outcomes were good. No complications were observed related to usage of the system such as balloon rupture, evacuation problems, and infection. CONCLUSION: The authors believe that the balloon insertion technique may be a useful method to prevent brain collapse, cortical convolution, and complications associated with this condition. Further technical refinements of the system are needed for better results.


Subject(s)
Brain Diseases/surgery , Echinococcosis/surgery , Neurosurgical Procedures/methods , Brain Diseases/pathology , Child , Echinococcosis/pathology , Female , Humans , Male , Neurosurgical Procedures/instrumentation , Postoperative Complications/prevention & control , Treatment Outcome , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL
...