Evaluation of the Relationship Between Preoperative and Postoperative Platelet Values and Amount of Blood Transfusion in Cases with Craniosinocytosis.

AIM: To demonstrate that decreased platelet count in patients with craniosynostosis increases the requirement for blood replacement, thus providing guidance to clinicians by revealing the time at which the platelet count decreases. Additionally, the relationship between the amount of blood transfusion and preoperative and postoperative platelet counts was evaluated. MATERIAL AND METHODS: This study included 38 patients with craniosynostosis who underwent surgery between July 2017 and March 2019. The patients exhibited no cranial pathologies except craniosynostosis. All surgeries were performed by a single surgeon. The demographic data, anesthesia and surgical durations, preoperative complete blood count and bleeding time, intraoperative blood transfusion amount, and postoperative complete blood count and total blood transfusion amount of the patients were recorded. RESULTS: The preoperative and postoperative changes and the timing of changes in hemoglobin and platelet counts, amount and timing of postoperative blood transfusion, and relationship between the amount and timing of blood replacement and preoperative and postoperative platelet counts were evaluated. The postoperative platelet counts tended to decrease after 12, 18, 24, and 36 hours (h), and began increasing after 48 h. Although decreased platelet count did not lead to platelet replacement, it influenced the erythrocyte replacement requirement in the postoperative period. CONCLUSION: Platelet count was associated with the amount of blood replacement. The platelet counts decreased within the first 48 h following surgery and tended to elevate thereafter; thus, clinicians should closely monitor these platelet counts within 48 h after surgery.

A new supportive approach in the diagnosis of Chiari malformation type 1 in pediatric patients.

PURPOSE: Chiari malformation type 1 (CM-1) is a posterior fossa anomaly characterized by herniation of the cerebellar tonsils from the foramen magnum (FM). This study compares FM, medulla spinalis (MS), and herniated cerebellar tonsils ratios by making area measurements from axial plane MRI in CM-1 patients and the control group. METHODS: Our study evaluated 30 pediatric patients with CM-1 and 30 people in the control group. The lengths of the McRae line, twining line, and clivus line were measured on the posterior cranial fossa evaluation. The areas of FM (AFM), MS (AMS), and herniated cerebellar tonsils (ATONSILS) were measured by axial images. RESULTS: As a result of area measurements obtained from axial cross-sectional MRI, a statistically significant difference was found between CM-1 patients and the control group. According to the results of the ROC analysis, if an individual's AMS/AFM value is above 17.9% or the ATONSILS/AFM value is above 18.4%, it can be interpreted as a CM-1 patient. CONCLUSION: It will be easier to diagnose the patient with the new approach we obtained from axial MR images in addition to sagittal MR images. This method can be a guide in some cases when the surgeons are undecided.

Less Use of the Bipolar Cautery can Prevent Postlaminectomy Epidural Fibrosis: An Experimental Study in Rats.

AIM: To investigate the role of bipolar electrocautery in the occurrence of epidural fibrosis following lumbar spine laminectomy in a rat model. MATERIAL AND METHODS: Fourteen male Sprague-Dawley rats (age: 4-6 months, weight: 250-300 g) were randomly divided into two groups, a bipolar group (Group I) and a control group (Group II). Laminectomy was performed between the L1 and L3 levels. In Group I (n=7), a laminectomy was carried out and soft tissue around the spinal cord was coagulated by using a bipolar electrocautery. In the control group (n=7), only laminectomy was performed. The animals were sacrificed 4 weeks after surgery, and post-laminectomy epidural fibrosis (PLEF) was evaluated. Macropathological, qualitative and quantitative histological evaluations as well as immunohistochemical staining including transforming growth factor-ß (TGF-ß), collagen I and collagen III were performed. RESULTS: The numbers of TGF-ß positive cells staining (PCS) were 3.00 ± 0.46 for Group I and 1.00 ± 0.52 for Group II. The numbers of collagen I PCS were 2.00 ± 0.93 for Group I and 1.25 ± 0.46 for Group II. The numbers of collagen III PCS were 2.25 ± 0.76 for Group I, 1.25 ± 0.46 for Group II, and TGF-ß PCS than Group II (p≤0.05). Compared with the control group, Group I's formation of epidural fibrosis was significantly increased. CONCLUSION: Our study clearly demonstrated that the use of bipolar cauterisation is associated with increased PLEF in the experimental animal model. Thus, limiting the use of bipolar cauterisation may be effective in reducing this complication.

Assessment of markers expressed in human hair follicles according to different skin regions.

BACKGROUND: Body region-dependent hair follicle (HF) characteristics are concerned with follicular size and distribution, and have been demonstrated to have characteristics for each region of the body. OBJECTIVES: The aim of the present study was to investigate the expression patterns of the markers called cytokeratin 15 (K15), cytokeratin 6 (K6) and monoclonal antibody Ki-67, and also apoptosis in HFs, which can be observed in different parts of the human body. MATERIAL AND METHODS: In this study, healthy human HFs were taken by biopsy from 5 various donor sites of the human body: the scalp, the leg, the abdomen, the back and waist. HF-containing skin specimens taken using cryosection were stained with hematoxylin & eosin (H&E) and K15, K6, Ki-67 and terminal deoxynucleotidyl transferase-mediated digoxigenin-dNTP nick end-labelling (TUNEL) immunofluorescence staining protocol was performed. RESULTS: Different skin regions from the human body were examined histologically. While the HFs of scalp tissue showed anatomically obvious hair layers, some hair sections from other regions, like the leg, the abdomen, back and waist, were not as distinct as in the scalp region. According to our findings, K15 expression was highest in the scalp. In addition, the immunoreactivity (IR) intensity of K15 was significantly decreased in the HFs on the waist and abdominal regions, compared to the scalp and back regions (p < 0.001). However, the IR intensity of K6 in the scalp region was statistically significantly higher than the IR intensity of K6 in the abdomen region (p < 0.05). Moreover, we showed intraepithelial apoptosis and proliferation of keratinocytes in the bulge of HF. In the study, Ki-67-positive and TUNEL-positive cell numbers were not statistically significant (p > 0.05). CONCLUSIONS: Our findings are important for further investigation of molecular aspects of the human hair follicle stem cells compartments in health and disease, which might be a promising model for comparative studies with different human diseases.

The Management of Blood Loss in Non-Syndromic Craniosynostosis Patients Undergoing Barrel Stave Osteotomy.

AIM: Barrel stave osteotomy is a widely used procedure in neurosurgery for the majority of craniosynostosis patients. Both in the intraoperative and postoperative periods, there is inevitable leakage type bleeding from the bones undergoing osteotomy. A number of studies have been performed in order to prevent this complication but a concise procedure is still lacking. MATERIAL AND METHODS: Synostectomy and parietotemporal barrel stave osteotomy were applied to 143 patients who were operated on with a diagnosis of craniosynostosis between the years 2005-2013. At the beginning to osteotomy, 5 ml/kg erythrocyte suspension (ES) was given for probable blood loss. Whole blood count was performed at the postoperative 1st and 6th hours and cases with hemoglobin levels below 10 or with hematocrit levels which had decreased more than 5% between the 1st and 6th hours were administered erythrocyte transfusion. RESULTS: Of the patients, 100 were boys and 43 were girls. Of these, 98 had metopic, 30 had sagittal, 9 had metopic+sagittal, 4 had unilateral, 2 had bilateral and 6 had coronal synostosis. All the cases were administered intraoperative erythrocyte suspension. The preoperative amount of administered mean erythrocyte was 8.61 ml/kg. In the postoperative period, 92 patients were administered erythrocyte suspension. The postoperative amount of administered mean erythrocyte suspension was 7.98 ml/kg. CONCLUSION: For an operated infant with craniosynostosis who is operated on in the first year of life, undergoing osteotomy and inevitable bone-borne blood losses are very important and these have to be replaced immediately.

Physician exposure to violence: a study performed in Turkey.

Recently, in Turkey, there has been an increase in the number of violent acts against healthcare workers, towards doctors in particular. This study aimed to investigate the extent of violence, the causes of violence and to evaluate proposed solutions to violence. Out of 597 physicians, 86.4% indicated that they were exposed to at least one type of violence (physical, verbal, sexual) throughout their careers. Among the physicians participating in the study, 27.5% suffered physical threats and 68.6% suffered verbal violence in the past year. Only 40.4% reported the physical violence to their institution. Physicians indicated that the top three causes of violent behavior were excessive demands of patients, the expectation that the issue will be solved immediately and blaming physicians for their problems. To stop violence against themselves, physicians need to raise their voices, along with those of their personal or professional organizations, and should report and follow up incidents.

Laminoplasty with miniplates for posterior approach in thoracic and lumbar intraspinal surgery.

OBJECTIVE: A prospective clinical follow-up study of patients who underwent thoracolumbar intraspinal surgery with replacement of the posterior spinal arch and supporting elements is reported. PATIENTS AND METHODS: The surgical procedures of 45 patients who underwent intraspinal surgery with osteotomy and replacement of 122 spinal laminae using an air drill and mini-plates with repair of the supraspinous ligaments were analyzed. Data of a complete clinical and radiological follow-up examination were evaluated in 45 patients. Plain radiographs and computed tomography scans were analyzed for bony healing of the laminae and spinal alignment. RESULTS: No complications due to the technique were observed. None of the patients had kyphosis and/or instability on static or dynamic plain x-ray films. There was no scar tissue invasion in the spinal canal based on MRI findings. CONCLUSIONS: No patient required additional surgery because of progressive spinal instability. This technique is safe and well-suited to serve as a standard posterior approach to intraspinal pathologies and offers distinct advantages over laminectomy and repeat surgery.

Atypical intracerebral schwannoma mimicking glial tumor: case report.

A rare case of a solitary schwannoma arising within parenchyma of the brain is reported. A 37-year old right-handed man presented with a 3- month history of progressive headaches, lethargy and vomiting. The initial diagnosis being considered was primary intracranial tumor, including high-grade astrocytoma, metastasis or lymphoma Histopathological examination revealed schwannoma. Cysts, calcification and mild to moderate peritumoral edema are common in intracerebral schwannomas. However, our case is atypical and has no cystic component, calcification or vascularization. The pathogenesis and neuroradiological findings of intraparenchymal schwannomas are discussed and we review the related literature.

When should ventriculoperitoneal shunt placement be performed in cases with myelomeningocele and hydrocephalus?

AIM: The shunt infection rates vary from 2 to 39% among complications related to shunts used for hydrocephalus treatment. Shunt infections are reported to be more common than any other etiologies in newborn babies with myelomeningocele. MATERIAL AND METHODS: In this study, we performed a retrospective evaluation of 94 MM and HS cases that were treated in our clinics between 1994 and 2005. Comparisons of shunt infection rates of cases that had surgical placement of VPS either at a different session (group A) or in the same session (Group B) with repair of MM sac were made. RESULTS: Sixty three patients were grouped in group A and 31 cases in group B. MM sac operation site wound infection was seen in 7 versus 5 cases, CSF fistula in 5 versus 3 cases and VPS infection in 9 versus 6 cases in group A and B respectively. 6 patients had meningitis in both groups. CONCLUSION: These data indicate that ventriculoperitoneal shunt placement in the same session of MM sac repair in patients with HS is not an acceptable practice. We therefore believe in VPS placement in a separate session by confirming absence of infection after MM sac repair surgery.