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Öğe An Alternative Method for Restoring Opposition After Median Nerve Injury: An Anatomical Feasibility Study for the Use of Neurotisation(CAMBRIDGE UNIV PRESS, 2001) Üstün, Mehmet Erkan; Öğün, Tunç Cevat; Karabulut, A. Kağan; Büyükmumcu, MustafaOpposition, one of the most important functions of the hand, is lost or impaired after median nerve injury. Complete recovery does not always occur after treatment, and various techniques of opponensplasty are used for restoring opposition. This study was performed in order to develop an alternative method for selective restoration of thenar muscle function. Ten arms from 5 cadavers were used. The median nerve with its thenar motor branch (Tb) and the anterior interosseous nerve with its motor branch to pronator quadratus (PQb) were prepared in the distal forearm. The mean widths and the number of myelinated fibres of these nerves were: PQb 1.3 +/- 0.10 mm, Tb 1.4 +/- 0.12 mm and PQb 912 +/- 88 mm, Tb 1020 +/- 93 mm. The minimum necessary distance from the distal flexor crease of the wrist for neurotisation of the Tb by the PQb was 60 +/- 5.41 mm. It was concluded that PQb-Tb neurotisation would be possible anatomically. The advantages are that motor function is reestablished with a motor nerve, the diameters and the number of myelinated fibres of both nerves are similar, the loss of function after denervation of the pronator quadratus is slight and opponensplasty still remains as a final option.Öğe Beyin Tümörlerinin Cerrahi Eksizyonu Sırasında Elektrokortikografinin Kullanımı(2003) Üstün, Mehmet Erkan; Güney, Önder; Genç, Bülent Oğuz; İlhan, Nurhan; Özkal, ErtuğAmaç: Beyin tümörlü hastalarda elektroensefalografi (EEG) ve elektrokortikografinin (ECoG), preoperatif nöbetlerin insidansı ile ilişkisini araştırmayı amaçladık. Yöntem: Bu çalışmamızda glial tümör görünümü olan 11 olguda operasyon öncesi ve sonrası EEG ve operasyon esnasında eksizyon öncesi ve sonrası kraniotomi alanından ECoG kayıtları alındı. Bulgular: Operasyon öncesi epileptik nöbet anamnezi olmayanların aksine epileptik nöbet anamnezi olan hastaların % 80'inin pre- ve postoperatif EEG'lerinde epileptik aktivite (EA) mevcuttu ve ECoG'lerinde de sadece tümöre yakın değil, uzak alanlarda da EA vardı. Sonuç: Bulgularımız daha önceki yayınların aksine tümörün çıkarılmasının EEG ve ECoG'deki EA'yi ortadan kaldırmadığını ve epileptik atak öyküsü olan hastaların EEG ve EcoG'lerinin epileptik nöbet hikayesi olmayanlardan farklı olduğunu göstermiştir.Öğe Congenital morphological abnormalities of the distal vertebral arteries (CMADVA) and their relationship with vertigo and dizziness(INT SCIENTIFIC INFORMATION, INC, 2004) Paksoy, Yahya; Vatansev, Hüsamettin; Şeker, Muzaffer; Üstün, Mehmet Erkan; Büyükmumcu, Mustafa; Akpınar, ZehraBackround: The aim of our study was to identify congenital morphological abnormalities of distal vertebral arteries (CMADVA) and their association with cerebral hypoperfusion leading to vertigo, and the role of MR and MRA in the diagnosis of vertebrobasilar (VB) abnormalities. Materials/Methods: 768 patients who complained of dizziness and/or vertigo were included in the study and evaluated by MR and MRA. CMADVAs were determined in 88 of the cases with no other explanation for vertigo and dizziness. 150 patients without dizziness or vertigo were used as a control group. The 3D TOF (Time-of-flight) MR angiographic technique was used. Results: CMADVAs were detected in 88 of 768 patients (11.5%) with vertigo and/or dizziness. We also detected CMADVAs in 4 (2.7%) of 150 persons in the control group. The patients with abnormal vertebral artery findings were classified into ten categories. Lacunar infarcts in the brain stem were found in 8 patients after long-duration vertigo attacks. There was significant correlation between the control and vertigo groups in terms of CMADVA (p=0.0001). After excluding the control group, there was a significant relationship between CMADVA and vertigo and/or dizziness symptoms (P=0.0001). Conclusions: We believe that vertigo and dizziness associated with CMADVA is a real entity that deserves greater attention. For this reason, the vertebrobasilar system in these patients should be examined for CMADVA with MRA. This would enable us to take preventive measures against brainstem ischemia or at least elucidate the etiology of vertigo in these patients.Öğe Correlation Between Tissue Lactate Levels and Electroencephalogram In Evaluating the Severity of Experimental Head Trauma(Lippincott Williams & Wilkins, 2002) Öğün, Cemile Öztin; Üstün, Mehmet Erkan; Duman, Ateş; Gürbilek, Mehmet; Genç, Bülent OğuzObjective: The objective of this study was to develop an electroencephalographic grading scale for evaluating the severity of head trauma and assessing the correlation of this scale with brain tissue lactate concentrations. Design: Animal experiment. Setting: Animal research laboratory in a university hospital. Subjects: Thirty New Zealand rabbits were divided into three groups. Interventions: Rabbits were anesthetized, and bilateral frontoparietal craniectomy was performed. An electroencephalogram was recorded over the dura from both sides. After electroencephalographic recording, unilateral trauma was produced by using the weight drop method with a calculated force of 401) g(.)cm(-1) and 800 g(.)cm(-1) in group 2 (n = 10) and group 3 (n = 10), whereas in group I (n = 10) only craniectomy was performed. Electroencephalographic recording was repeated 60 mins after trauma or craniectomy, and cortical tissue samples were resected from both sides to evaluate tissue lactate concentrations in all three groups. Measurements and Main Results: Electroencephalographic recordings from both sides of the brain were evaluated together by using a 6-point scale (1 = best to 6 = worst) that was based on the presence or absence of electroencephalographic activity and the decrease in amplitude or frequency band of the electroencephalogram. Lactate was measured in resected tissue by using spectrophotometric enzymatic methods. One-way analysis of variance for repeated measures, Bonferroni-adjusted paired Student's t-test, Kruskal Wallis analysis of variance, Bonferroni-adjusted Mann-Whitney-U, and Spearman's correlation tests were used as appropriate for statistical analysis. We considered p < .05 to be significant. The difference in lactate concentrations was significant between the three groups (p < .05). Electroencephalographic grades were significantly different between the pretraumatic and posttraumatic recordings (p < .05) and between the three groups after craniectomy or trauma (p < .001). There was a positive high correlation between lactate concentrations and electroencephalographic grades. Conclusions. Tissue lactate concentrations and electroencephalograhic grades change with the severity of the trauma, and there is a strong positive correlation between tissue lactate concentrations and electroencephalographic grades.Öğe Detection of monosomy 22 in interphase nuclei by fluorescence in situ hybridization(KARGER, 1997) Acar, H.; Acar, Osman; Acar, A.; Üstün, Mehmet Erkan[Abstract not Available]Öğe Dev Vertebrobaziler Bileşke Anevrizmasının Endovasküler Koil ile Embolizasyonunda Radyolojik Takip(2007) Cengiz, Şahika Liva; Karaköse, Serdar; Üstün, Mehmet ErkanAmaç: Bu yazıda endovasküler koil ile tedavi edilmiş dev, geniş boyunlu vertebrobaziler anevrizmanın embolizasyon sonrası uzun dönem takibinin önemini belirttik. Olgu sunumu: 52 yaşında erkek hasta, 2 yıldır baş ağrısı, 2 haftadır sağ tarafında ilerleyici kuvvet kaybı ile kliniğimize başvurdu. Serebral anjiografide, vertebrobaziler bileşkede parsiyel, tromboze olmuş, dev bir anevrizma tespit edildi. Anevrizma, hidrojel kaplı koil ile başarıyla embolize edildi. Embolizasyonun ertesi günü hastanın baş ağrısı yakınması geçti.16 ay yakınması olmayan hasta tekrar baş ağrısı şikayeti ile kliniğimize başvurdu. Vertebrobaziler anjiografide eski anevrizma boyun bölgesinin hemen yakınında yeni küçük bir anevrizma tespit edildi. Sonuç: Her ne kadar ilk yapılan işlemde dev vertebrobaziler anevrizma başarılı olarak dolaşım dışında bırakılmış gibi görünse de, koil embolizasyon takibinin en az 1.5-2 yıl yapılması gerekir.Öğe Distal Superficial Temporal Artery to Proximal Posterior Cerebral Artery Bypass by Posterior Oblique Transzygomatic Subtemporal Approach(THIEME MEDICAL PUBL INC, 2010) Ülkü, Çağatay Han; Üstün, Mehmet Erkan; Büyükmumcu, MustafaThis article investigates the possibility for the distal superficial temporal artery (STA) to proximal posterior cerebral artery (PCA) direct bypass by subtemporal oblique posterior transzygomatic approach. Five adult cadaveric specimens were dissected. Cadeveric dissection protocol was approved by the Research Ethics Committee. A preauricular vertical skin incision was made, the trunk of STA was identified, and bifurcation, frontal, and parietal branches of the STA were followed distally. Posterior zygomatic arch osteotomy and microcraniotomy were then performed, and the dura was opened. The temporal lobe was retracted, interpeduncular and ambient cisterns were opened, and the P2 segment of the PCA was exposed. Parietal branch of STA and P2 segment of the PCA was anastomosed. The average length of the transected STA from the bifurcation and the zygomatic arch were 47.3 +/- 2.1 mm and 71.4 +/- 2.3 mm, respectively. The mean calibers of the parietal and frontal branch of the STA at this distance were 1.6 +/- 0.1 and 1.4 +/- 0.2, respectively. The mean diameter of the P2 was 2.1 +/- 0.2 mm. Because of the calibers of the parietal branch of the STA and proximal PCA are over 1.5 mm and 2.0 mm, respectively, this direct end-to-side bypass technique may be a reasonable alternative in suitable cases.Öğe Effects of Deferoxamine on Tissue Superoxide Dismutase and Glutathione Peroxidase Levels in Experimental Head Trauma(LIPPINCOTT WILLIAMS & WILKINS, 2001) Üstün, Mehmet Erkan; Duman, Ateş; Öğün, Cemile Öztin; Sümer, Fatih; Gürbilek, MehmetBackground: This study aims to evaluate the effects of deferoxamine on tissue superoxide dismutase (SOD) and glutathione peroxidase (GPx) brain levels after head trauma. Methods: Thirty rabbits were divided equally into three groups: group 1 was the sham-operated group, group 2 suffered head trauma (no treatment was given), and group 3 received deferoxamine 50 mg/kg after the trauma. Head trauma was applied unilaterally. One hour after trauma, brain cortices were resected and SOD and GPx levels were determined. One-way analysis of variance and Tukey-HSD tests were used for analysis. Significance was defined asp < 0.05. Results: Baseline SOD levels are preserved in the traumatized side of the deferoxamine-treated group. Although GPx level of the traumatized side of the deferoxamine-treated group decreased significantly, the decrease was significantly less than the nontreated group. Conclusion: Trauma leads to a decrease in brain tissue SOD and GPx levels, Deferoxamine suppresses this decrease completely in SOD level and partially in GPx level when given after trauma.Öğe Effects of Magnesium Sulfate on Tissue Lactate and Malondialdehyde Levels in Experimental Head Trauma(SPRINGER-VERLAG, 2001) Üstün, Mehmet Erkan; Gürbilek, Mehmet; Ak, Ahmet; Vatansev, Hüsamettin; Duman, AteşObjective: To determine the effects of magnesium sulfate (MgSO4) on tissue lactate and malondialdehyde (MDA) levels in rabbit brain after experimental head trauma. Design: Prospective, randomized trial. Subjects: Thirty New Zealand rabbits. Interventions: Group 1 (n = 10) was the sham operated group. Group 2 (n = 10) (untreated group) and group 3 (n = 10) received head trauma with the weight drop method. MgSO4 was administered 100 mg/kg (15%) i.v. immediately after the head trauma to group 3. Trauma was applied to one side. The non-contused side was named as "a" and the contused side as "b". Measurements: One hour after trauma, brain cortices were resected and the concentrations of lactate and MDA were determined using the spectrophotometric enzymatic and thiobarbituric acid methods. One-way ANOVA and Tukey's HSD tests were used for the evaluation of the results. P < 0.05 was considered as significant. Pearson's correlation test was used between lactate and MDA levels (P < 0.001). Results: There were significant differences between MDA and lactate levels of group 1 and all other groups; non-contused (a) and contused (b) sides of groups 2 and 3; groups 2b-3a, 2b-3b (P < 0.05). The difference in MDA levels was significant between groups 2a-3b (P < 0.05). Correlation between lactate and MDA was very good in group 1, and excellent in groups 2a, 2b, 3a, and 3b. Conclusions: These results demonstrate that head trauma leads to an increase in brain tissue lactate and MDA levels, and MgSO4 suppresses the rise in contused tissue when given after head trauma.Öğe Effects of Nimodipine and Magnesium Sulfate on Endogenous Antioxidant Levels in Brain Tissue After Experimental Head Trauma(LIPPINCOTT WILLIAMS & WILKINS, 2001) Üstün, Mehmet Erkan; Duman, Ateş; Öğün, Cemile Öztin; Vatansev, Hüsamettin; Ak, AhmetTo examine the effects of calcium antagonists nimodipine and magnesium sulfate (MgSO4) on tissue endogenous antioxidant levels, the authors studied superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels in rabbit brain 1 hour after experimental head trauma. Forty New Zealand rabbits were anesthetized and randomly divided into four groups. Group 1 (n = 10) was the sham operated group. Group 2 (n = 10), the control group, received head trauma and no treatment. Group 3 (n = 10) received head trauma and intravenous (IV) 2 mu gr/kg nimodipine. Group 4 (n = 10) received head trauma and IV 100 mg/kg MgSO4. Head trauma was delivered by performing a craniectomy over the right hemisphere and dropping a weight of 20 g from a height of 40 cm. In the right (traumatized) hemisphere, SOD and GPx decreased by 57.60% +/- 9.60% and 72.93% +/- 5.51% respectively from sham values. Magnesium sulfate, but not nimodipine, reduced the magnitude of decrease of SOD and GPx to 19.43% +/- 7.15% and 39.01% +/- 7.92% respectively from sham values. In the left (nontraumatized) hemisphere, MgSO4 increased SOD to 42.43% +/- 24.76% above sham values. The authors conclude that MgSO4 treatment inhibited the decrease in SOD and GPx levels in experimental brain injury.Öğe I?ntraoperatif Periferik Sinir Motor ve Duyu Lif Ayırımında Elektrofizyolojik Yöntem(2003) Üstün, Mehmet Erkan; Güney, Önder; Eser, Olcay; Öğün, Tunç CevatAmaç: Periferik sinir tamiri ve seçici nörotizasyon uygulamalarında motor ve duyu liflerin ayırımı başarıyı önemli derecede artırır. Bu amaçla çeşitli histokimyasal metodlar geliştirilmiş, ancak pratik olmadıklarından yaygınlık kazanamamışlardır. Bu çalışmanın amacı, periferik sinirde duyu ve motor liflerinin elektrofizyolojik olarak ayırt edilebilirliğini deneysel olarak araştırmaktır. Yöntem: Çalışmada, 6 adet tavşanın 12 femoral siniri, motor ve duyu dalları ile birlikte ortaya kondu. Motor ve duyu dalları birbirinden ayrı uyarılarak quadriceps femoris kasından birleşik kas aksiyon potansiyelleri (BKAP) elde edildi. Bulgular: BKAP, motor dalın düşük şiddette uyarımı ile elde edilebilirken, duyu dalının ancak çok yüksek şiddette uyarımları ile oluşturulabildi. Yüksek şiddette uyarının antidromik yolla spinal korda ve oradan ön boynuz motor nöronlarına geçerek BKAP'ni ortaya çıkardığı düşünüldü. Sonuç: Sonuç olarak, BKAP'ni kullanarak motor ve duyu lif ayırımı yapmak mümkündür. Bu yöntem ucuz, kolay ve çok hızlı olması nedeniyle, sinir transferi ve primer sinir tamiri olgularında diğer zaman aNcı tekniklerin yerine veya onlara yardımcı olarak kullanılabilir.Öğe Konjenital Dev Nevüs ile Karışan Bir Patoloji: Diastematomyeli(2005) Tosun, Zekeriya; Karaçor, Zeynep; Aydoğdu Kıreşi, Demet; Üstün, Mehmet Erkan; Avunduk, Mustafa Cihat; Savacı, NedimDiastematomyeli nadir görülen konjenital bir spinal cord anomalisidir. Bu hastalar nörolojik ve/veya cilde ait bulgular nedeniyle başvururlar ve sıklıkla konjenital kıllı dev nevüs ile karıştırılırlar Bu çalışmada kliniğimize lumbosakral bölgede kıllı cilt şikayeti ile başvuran, konjenital dev nevüs ile karışan ve diastematomyeli tanısı konmuş 2 kız ve bir erkek hasta sunulmuştur. Beyin cerrahisi kliniği ile beraber takip edilen hastaların radyografik incelemelerinde vertebrada diastema tespit edildi. Hastaların hiç birinde nörolojik patoloji mevcut değildi. Tüm hastalarda kıllı cilt alanları eksize edildi. Post operatif dönemde komplikasyon gözlenmedi. Lumbo sakral bölgede cilt lezyonu ile başvuran hastalar özenle incelenmeli ve ilave patolojiler konusunda dikkatli olunmalıdır.Öğe A Modified Technique for Bypass of the External Carotid Artery to the Proximal Posterior Cerebral Artery: An Anatomical and Technical Study(Taylor & Francis as, 2006) Öztürk, Kayhan; Uysal, İlknur İsmihan; Arbag, Hamdi; Büyükmumcu, Mustafa; Üstün, Mehmet Erkan; Salbacak, AhmetConclusions. Our results support the proposition that bypass between the external carotid artery (ECA) and proximal posterior cerebral artery (PCA) can be achieved by using a short saphenous venous graft. The diameters of the ECA and vein graft may provide an increased blood flow with a straighter course. This technique may be helpful for management of patients with vertebrobasilar insufficiency or those requiring a high volume blood flow to the posterior circulation. Objectives. We aimed to describe a modified technique using a short saphenous vein graft for bypass between the ECA and the PCA in order to use a small length of graft material and increase the patency of the anastomosis. Materials and methods. Ten sides of five cadavers were dissected bilaterally. After a frontotemporal craniotomy and zygomatic arch osteotomy, the middle cranial fossa was exposed. A hole located approximately 2 - 3 cm posterolateral to the foramen rotundum was created extradurally. The sylvian fissure and the interpedincular and ambient cisterns were opened. The proximal P2 segment of the PCA was identified. The ECA was found through a cervical incision. A short interposition saphenous vein graft was conducted to pass just behind the ramus mandible to the infratemporal fossa. The bypass between the ECA and P2 segment of the PCA was performed by using a short saphenous vein graft. The diameters of the ECA, P2 segment of PCA and both ends of the saphenous vein graft and its length were measured using an electronic micrometer. Results. The mean cross-clamping time of the PCA was 10.4 +/- 1.8 min. The mean diameters of the P2 segment of the PCA and ECA were 2.2 +/- 0.15 mm and 3.83 +/- 0.28 mm, respectively. The mean length of the saphenous vein graft was 88.8 +/- 3.8 mm.Öğe Neurotization as an Alternative for Restoring Finger and Wrist Extension(AMER ASSOC NEUROLOGICAL SURGEONS, 2001) Üstün, Mehmet Erkan; Ogun, T. C.; Büyükmumcu, MustafaObject. In cases of irreparable injuries to the radial nerve or in cases in which nerves are repaired with little anticipation of restoration of function, tendon transfers are widely used. In this study, the authors searched for a more natural alternative for selectively restoring function, with the aid of a motor nerve transfer. Methods. Ten arms from five cadavers were used in the study. The posterior interosseous nerve and the median nerve together with their motor branches were exposed in the proximal forearm. The possibility of posterior inter osseous nerve neurotization via the median nerve through its motor branches leading to the pronator teres, flexor pollicis longus, flexor digitorum profundus, and pronator quadratus muscles was investigated. The lengths of the nerves from points of divergence and their widths were measured using calipers, and the means with standard deviations of all nerves were calculated. Motor branches to the pronator teres, flexor pollicis longus, and pronator quadratus muscles were found to be suitable for neurotization of the posterior interosseous nerve at different levels and in various combinations. The motor nerve extending to the flexor digitorum profundus muscle was too short to use for transfer. Conclusions. These results offer a suitable alternative to tendon transfer for restoring finger and wrist extension in cases of irreversible radial palsy. The second step would be clinical verification in appropriate cases.Öğe The Penetration of Cefoperazone and Sulbactam Into the Lumbar Intervertebral Discs(LIPPINCOTT WILLIAMS & WILKINS, 2001) Köroğlu, Adnan; Acar, Osman; Üstün, Mehmet Erkan; Tıraş, Bünyamin; Eser, OlcaySix patients received I and six other patients received 2 of cefoperazone and sulbactam 15 minutes before lumbar disc surgery. Liquid chromatographic analysis of disc tissue revealed that only patients receiving the 2-g dose had mean tissue levels above the minimum inhibitory concentration for Staphylococcus aureus and epidermidis.Öğe The possibility of deep peroneal nerve neurotisation by the superficial peroneal nerve: an anatomical approach(CAMBRIDGE UNIV PRESS, 1999) Büyükmumcu, Mustafa; Üstün, Mehmet Erkan; Şeker, M.; Kocaoğullar, Yalçın; Sağmanlıgil, AyhanNeurotisation involves transfer of nerves for the restoration of function following injury. A number of nerves have been used in different part of the peripheral nervous system. This study was undertaken to develop a practical and relatively safe surgical approach to the treatment of L4 root lesion's. We examined the effectiveness and safety of neurotisation of the deep peroneal nerve and its branches by the superficial peroneal nerve. Twelve legs of dissected cadavers provided for teaching purposes in the anatomy laboratory were used to display the common peroneal nerve and its branches. Each branch was measured using calipers and analysed to investigate the possibility of neurotisation of the deep peroneal nerve by the superficial peroneal nerve and its branches. It was found that of the measured branches, transposition was possible between those to peroneus longus and tibialis anterior on the basis of their diameter and length. In recent decades, advances in microsurgical reconstruction and understanding of the microanatomy have played major roles in improving the results of surgical treatment of nerve injuries. There is a need for further experimental studies on the feasibility of this surgical approach.Öğe Saphenous Vein Graft for Bypass of the Maxillary to Supraclinoid Internal Carotid Artery: An Anatomical Short Study(SPRINGER-VERLAG, 2001) Karabulut, Ahmet Kağan; Üstün, Mehmet Erkan; Uysal, İsmihan İlknur; Salbacak, AhmetThe use of a saphenous vein graft for bypass of the maxillary artery (MA) to the supraclinoid internal carotid artery (ICA) in internal! carotid: occlusions is investigated. Five adult cadaver sides were used. Dissection required zygpmatic arch osteotomy and a pterional craniotomy with extensive removal of the floor of the middle cranial, fossa. The MA was found easily media[ to infratemporal crest. The clinoidal segment of the ICA was exposed with the removal of the anterior clinoid process intradurally. The bypass graft was 4 to 5 cm long and was sutured end-to-end to the MA and end-to-side to: the supraclinoid ICA. When high blood flow is needed in cases with ICA occlusion, such a bypass may be an alternative to superficial temporal (STA)-to-middle cerebral artery (MCA) bypass as well as to common carotid-to-MCA or-ICA bypass, which needs a long vein graft. This type of bypass will provide the opportunity to clip the ICA proximal to the origin of ophthalmic artery, which may inhibit distal embolization.Öğe Selective Restoration of Motor Function in the Ulnar Nerve by Transfer of the Anterior Interosseous Nerve - An Anatomical Feasibility Study(JOURNAL BONE JOINT SURGERY INC, 2001) Üstün, Mehmet Erkan; Öğün, Tunç Cevat; Büyükmumcu, Mustafa; Salbacak, AhmetBackground: Proximal ulnar-nerve lesions have an unfavorable prognosis. The goal of the present study was to evaluate the feasibility of selective restoration of motor function of the ulnar nerve by the transfer of the anterior interosseous nerve or one of its branches to the motor branch of the ulnar nerve. Methods: Ten cadaveric arms were used in the present study. The ulnar nerve and its motor and sensory branches as well as the anterior interosseous nerve and its branches were dissected. The widths of the motor branch of the ulnar nerve and the anterior interosseous nerve and its motor branches as well as the relevant distances from the points of divergence were measured. The axons were counted, and the distances from the end of the main anterior interosseous nerve, its motor branches, and the motor branch of the ulnar nerve to the level of the dorsal sensory branch of the ulnar nerve were measured. Results: Our results indicate that the length, width, and number of axons of the branch of the anterior interosseous nerve to the pronator quadratus make it suitable for transfer to the motor branch of the ulnar nerve. The use of the main anterior interosseous nerve or its motor branches to the flexor pollicis longus and the flexor digitorum profundus is less feasible because of the need to graft a long segment and the longer distance from the level of transfer to the motor end points. Conclusions: The findings of the present study confirm the feasibility of motor-nerve transfer for reconstruction after an injury of the ulnar nerve. Nerve-grafting would be needed for injuries distal to the level of the dorsal sensory branch of the ulnar nerve.Öğe Selective Restoration of Motor Function in the Ulnar Nerve by Transfer of the Anterior Interosseous Nerve: An Anatomical Feasibility Study(Journal of Bone and Joint Surgery Inc., 2001) Üstün, Mehmet Erkan; Öğün, Tunç Cevat; Büyükmumcu, Mustafa; Salbacak, AhmetBackground: Proximal ulnar-nerve lesions have an unfavorable prognosis. The goal of the present study was to evaluate the feasibility of selective restoration of motor function of the ulnar nerve by the transfer of the anterior interosseous nerve or one of its branches to the motor branch of the ulnar nerve. Methods: Ten cadaveric arms were used in the present study. The ulnar nerve and its motor and sensory branches as well as the anterior interosseous nerve and its branches were dissected. The widths of the motor branch of the ulnar nerve and the anterior interosseous nerve and its motor branches as well as the relevant distances from the points of divergence were measured. The axons were counted, and the distances from the end of the main anterior interosseous nerve, its motor branches, and the motor branch of the ulnar nerve to the level of the dorsal sensory branch of the ulnar nerve were measured. Results: Our results indicate that the length, width, and number of axons of the branch of the anterior interosseous nerve to the pronator quadratus make it suitable for transfer to the motor branch of the ulnar nerve. The use of the main anterior interosseous nerve or its motor branches to the flexor pollicis longus and the flexor digitorum profundus is less feasible because of the need to graft a long segment and the longer distance from the level of transfer to the motor end points. Conclusions: The findings of the present study confirm the feasibility of motor-nerve transfer for reconstruction after an injury of the ulnar nerve. Nerve-grafting would be needed for injuries distal to the level of the dorsal sensory branch of the ulnar nerve.Öğe Spect'in İskemik Tipte Stroktaki Prognostik Değeri(2002) Üstün, Mehmet Erkan; Yürüten, Betigül; Taştekin, Güngür; Atcı, Arzu; Eser, OlcayAmaç: SPECT'in (single photon emission computed tomography) iskemik stroktaki prognostik değerini tayin etmek amacı ile 1998-2000 yılları arasında geçirilmiş strok nedeniyle motor defisiti olan 42 hastada strok'tan 72 saat sonra BT (Bilgisayarlı Tomografi) ve/veya MRG (magnetik rezonans görüntüleme) yanısıra SPECT incelemesi yapıldı. Gereç ve Yöntem: Hastalardan 34'ünün 4 ay ile 24 ay arasında değişen sürelerde (ortalama 10 ay) kontrol motor muayeneleri yapıldı. SPECT bulgularının hem nörolojik tablo, hem BT ve/veya MRG bulguları ile hem de takibi yapılan hastalarda prognoz ile olan ilişkisine bakıldı. Bulgular: SPECT'te ileri hipoperfüzyon (%60'ın üzerinde perfüzyon kaybı) gözlenen vakaların %87.5'inde ileri motor defisit olduğu ve bu defisitin hastaların %78.9'unda düzelmediği, buna karşı hafif-orta hipoperfüzyon (%60 ve altında perfüzyon kaybı) varsa hastaların %88.9'unda orta veya hafif motor defisiti olduğu ve hastaların %80'inin fonksiyonel olarak düzeldiği görüldü. SPECT'de ileri hipoperfüzyonu olan hastaların hepsinde BT ve/veya MRG'de infarkt görülürken, hafif-orta hipoperfüzyonu olan hastalarda bu oran %73.7'ye düşmekteydi. Sonuç: SPECT bulguları ile nörolojik tablonun korelasyon gösterdiği, radyolojik görüntüleme yöntemleriyle saptanamayan lezyonların SPECT ile gösterilebileceği ve SPECT'in prognozu belirlemede önemli bir tanı yöntemi olduğu kanaatine varıldı.
