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Öğe Ağrılı lomber vertebra çökme kırığı ve lumbosakral spondilolistezisi olan bir vakada tedavi(2006) Torun, Fuat; Kalkan, Erdal; Çiçek, Onur; Erdi, FatihAmaç: Bu yazıda aynı seansta balon kifoplasti ve lumbosakral stabilizasyon işlemi yapılan hastanın kliniği ve uygulanan cerrahi prosedür tartışılmıştır. Olgu sunumu: Yirmi dört yaşında erkek hasta, kliniğimize sırt, bel ve her iki bacakta ağrı, uyuşukluk yakınması ile başvurdu. Klinik ve radyolojik incelemelerinde, L1 lomber vertebra çökme kırığı ve instabil lumbosakral listezis saptandı. Hastaya aynı seansta L1 balon kifoplasti, L5-S1 transpediküler vida-rod sistemi ile stabilizasyon ve internal fiksasyon uygulandı. Sonuç: Balon kifoplasti ve lumbasakral stabilizasyon işleminin aynı seansta uygulanması göreceli olarak postoperatif dönemde gelişebilecek komplikasyonların değerlendirilmesinde zorluk yaratabilir. Ancak cerrahi deneyim ve uygun endikasyon ile gelişebilecek komplikasyonlar minimalize edilebilir.Öğe Apoptosis and Cerebral Ischemic Reperfusion Injury Developed After Haemorrhagic Shock: Experimental Study(2006) Kalkan, Erdal; Eser, Olcay; Avunduk, Mustafa Cihat; Coşar, Murat; Fidan, Hüseyin; Kalkan, SerpilBACKGROUND: Apoptosis is a process of programmed cell death that plays a role in some normal and pathological conditions. In this study, we investigated the apoptosis during cerebral ischemic reperfusion injury in response to haemorrhagic shock in a rat model. METHODS: Thirty-six adult Sprague-Dawley rats were divided into six groups: control, haemorrhagic shock (HS), ischemic reperfusion (IR), 1st hour IR, 3rd hour IR, 6th hour IR and 24th hour IR. Rats were sacrificed by taking blood from intracardiac area after finishing the experiment. The tissues were fixed using neutral buffered 10% formaldehyde solution for histopathological examination. Tissues were stained immunohistochemically with APO 2.7 and positive expression apoptotic cells were counted using a Clemex Vision Lite 3.5 vision analysis system. RESULTS: There were 2-3 apoptotic cells in the control group (group 1) and this number increased to 8-11 in the haemorrhagic shock group (group 2) (p<0.05). Secondary or more serious injury occurs during ischemic reperfusion injury. The number of apoptotic cells increased to 11-14 at the 1st hour (group 3) and it was significant as compared to group 2 (p<0.05). The number of apoptotic cells significantly increased to 15-17 by the 3rd hour (group 4) as compared to group 3 (p<0.05). While there was no additional increase by the end of the 6th hour (group 5) as compared to group 4, the number of apoptotic cells significantly increased to 18-24 by the end of 24th hour (group 6) as compared to group 5 (p<0.05). CONCLUSION: The majority of injuries to the brain following haemorrhagic shock occur during ischemic reperfusion. We observed that apoptosis increases step by step on the 1st, 3rd and 24th hours after ischemic reperfusion injury.Öğe Association of the Polymorphisms of Vitamin D Receptor and Aggrecan Genes With Degenerative Disc Disease(Mary Ann Liebert Inc, 2010) Eser, Betül; Cora, Tülin; Eser, Olcay; Kalkan, Erdal; Haktanır, Alpay; Erdoğan, Müjgan O.; Solak, MustafaThe aim of this study was to investigate the association between the polymorphisms of the vitamin D receptor (VDR) and aggrecan genes and degenerative disc disease in young Turkish patients. Aggrecan and VDR proteins are the main components of bone and cartilage. In our study, the polymorphisms of the VDR and aggrecan genes were investigated in a total of 300 individuals regarding disc degeneration and herniation. An association was found in the patients having VDR gene TT, Tt, FF, and Ff genotypes with the protrusion type of disc herniation, whereas the patients having tt and ff genotypes were associated with extrusion/sequestration types of the disease. Also, an association was observed between TT and FF genotypes of the VDR gene and mild forms of disc degeneration; and tt, ff, and Ff genotypes and severe forms of the disease. There was also an association between shorter, normal, and longer alleles of the aggrecan gene and a protrusion type of disc herniation. An association was found between short alleles and multilevel and severe disc degeneration, as well as normal and long alleles and mild disc degeneration. This study revealed that the polymorphisms of the VDR and aggrecan genes are associated with disc degeneration and herniation.Öğe Bir çocukta serebellumun disembriyoplastik nöroepiteliyal tümörü(2014) Köse, Doğan; Kalkan, Erdal; Paksoy, Yahya; Toy, Hatice; Ergün, Nurcan Üçüncü; Köksal, YavuzDisembriyoplastik nöroepitelyial tümörler (DNT) tipik olarak supratentorial yerleşen benign neoplazmalardır. Bilinç ve postural tonus kaybı şikayetleri ile bir lokal hastaneye başvuran 12 yaşındaki erkek hasta saptanan serebellar kitlesi nedeniyle hastanemize refere edildi. Hikayesinden benzer şikayetlerinin 3 ve 10 yaşlarında da tekrar ettiği ancak o dönemde pediatric kardiyolog ve pediatric nörolog tarafından yapılan incelemelerde herhangi bir anomaliye rastlanmadığı öğrenildi. Hastanın fizik muayenesi ve rutin laboratuvar tetkikleri normaldi. Serebellumda saptanan kitle total olarak çıkarıldı. Alınan dokunun histopatolojik değerlendirmesi ile hastaya DNT tanısı konuldu. Hasta halen, 5 yıldır, herhangi bir nüks belirtisi olmadan ayaktan takip edilmektedir. Bu yazıda serebellum yerleşimli DNT'ye sahip bir çocuk vakanın literatürle paylaşılması amaçlanmıştır.Öğe Brain tissue biochemical parameters in cerebral ischemic reperfusion injury after hemorrhagic shock: An experimental study(UNIVERSITATSVERLAG ULM GMBH, 2007) Cosar, Murat; Eser, Olcay; Fidan, Hueseyin; Kalkan, Erdal; Buyukbas, Sadik; Ozen, O. A.Objective: In this study, we showed the tissue biochemical parameters in cerebral ischemic reperfusion injury that developed after hemorrhagic shock in a rat model. Materials and Methods: Hemorrhagic shock models were established in 36 adult Sprague-Dawley rats and divided into six groups: control (group A), hemorrhagic shock (HS) (group B), first hour ischemic reperfusion (IR+1h) (group Q, 311 hour IR (IR+3h) (group D), 61(th) hour IR (IR+6h) (group E) and 2411 hour IR (IR+24h) (group F). The rats were sacrificed by bleeding from the intracardiac area after finishing the experiment. The brains were removed from the skull immediately. Bilateral hemispheres were dissected for biochemical analyses, and activities of superoxide dismutase (SOD) and myeloperoxidase (MPO), and the levels of malondialdehyde (MDA) were evaluated. Results: The study revealed that the SOD activities decreased stepwise from group A (control) to group F (IR+24h) (P<0.05). In addition, MDA levels and MPO activities increased stepwise from group A (control) to group F (IR+24h). Conclusion: We think that the level of cell injury increases stepwise in the first, 3(rd), 6(th) and 24(th) hours after ischemia reperfusion injury.Öğe A case report of firearm bullet settling into the thoracic spinal canal without causing neurological deficit or vertebral bone destruction(SPRINGER, 2007) Kalkan, Erdal; Keskin, Fatih; Cengiz, Sahika Liva; Baysefer, AlperObjective The main objective of this study was to present a case of gunshot injury in which a bullet particle settled into the inferior-thoracic epidural canal, which was neurologically intact, without causing any vertebral bone destruction. Summary and background data There has been no previous report in the literature regarding a foreign body settling into the vertebral canal following gunshot injury without causing any bony destruction. Case report A 40-year-old male patient was hospitalized in emergency service with the complaints of severe pain in his back and both legs secondary to a gunshot wound. The entrance wound of the traversing projectile was located at the level of the tenth costa at the inferior of the right scapula. Neurological examination revealed no motor deficit. His lung X-ray was normal at radiological examination. Direct radiograph determined a bullet nucleus on the medium line at thoracolumbar level T-12. Intracanalicular bullet nucleus was found at posterior epidural at the T-12 level on thoracic CT, myelography and CT myelography. No vertebral bone destruction was seen in the direct radiograph studies and serial CT. T12 total laminectomy was performed and epidural foreign body removed. The patient, whose pains ameliorated during the postoperative process, was discharged without any neurological deficit. Conclusion We prefer removal of firearm particles settling into the spinal canal in view of possible later complications such as infection and the toxic effect of the metallic particles, unless there appears any risk of neurological detriment to the patient.Öğe Cerebral venous sinus thrombosis in an adolescent with Ewing sarcoma(SPRINGER, 2008) Unal, Ekrem; Yazar, Abdullah; Koksal, Yavuz; Caliskan, Umran; Paksoy, Yahya; Kalkan, ErdalBackground Although thromboembolic complications are common in adult patients with malignant diseases, cerebral venous sinus thrombosis has been rarely described in cancer afflicted pediatric and adolescent population. Case history A 16-year-old adolescent girl referred for complaints of pain and swelling on her left leg. On physical examination, a solid tibial mass was discovered. After the diagnosis of Ewing sarcoma with a tru-cut biopsy, chemotherapy protocol consisting of cisplatin, ifosfamide, adriamycine, and vincristine was started. During the first course of the treatment, the patient expressed headache, diplopia, and ptosis. Contrast-enhanced magnetic resonance (MR) images and MR angiography showed superior sagittal and transverse sinus thromboses. After anticoagulant therapy, the thromboses disappeared within 1.5 months. She received her chemotherapy protocol with the anticoagulant prophylaxis. After a follow-up period of 12 months, she is still in a good neurological recovery without any sequel. Conclusion Children and adolescents with cancer should be monitored closely for thrombotic complications. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment of intracranial thrombosis in childhood cancer, and we review the relevant literature.Öğe Congenital Cranial and Spinal Dermal Sinuses: A Report of 3 Cases(Health Communications Inc, 2006) Kalkan, Erdal; Karabağlı, Pınar; Karabağlı, Hakan; Baysefer, AlperThree cases of congenital dermal sinus are presented-2 female and I male. Frontal, thoracic, and lumbosacral congenital dermal sinuses were explored. All patients presented with skin findings, but no neurologic deficits. The case with frontal localization was associated with a corpus callosum lipoma and dermoid tumor, and the patient presented with recurrent meningitis. The case with sacral localization was associated with an epidermoid tumor. Morphogenetic, clinical, and radiologic aspects of these cases are discussed. The midline should be carefully examined whenever a child suffers from meningitis. Dermal sinus tracts should be excised prophylactically.Öğe Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: Imaging features(ELSEVIER IRELAND LTD, 2009) Kivrak, Ali Sami; Koc, Osman; Emlik, Dilek; Kiresi, Demet; Odev, Kemal; Kalkan, ErdalComputed tomography (CT) and magnetic resonance imaging (MRI) reliably demonstrate typical features of schwannomas or neurofibromas in the vast majority of dumbbell lesions responsible for neural foraminal widening. However, a large variety of unusual lesions which are causes of neural foraminal widening can also be encountered in the spinal neural foramen. Radiologic findings can be helpful in differential diagnosis of lesions of spinal neural foramen including neoplastic lesions such as benign/malign peripheral nerve sheath tumors (PNSTs), solitary bone plasmacytoma (SBP), chondroid chordoma, superior sulcus tumor, metastasis and non-neoplastic lesions such as infectious process (tuberculosis, hydatid cyst), aneurysmal bone cyst (ABC), synovial cyst, traumatic pseudomeningocele, arachnoid cyst, vertebral artery tortuosity. In this article, we discuss CT and MRI findings of dumbbell lesions which are causes of neural foraminal widening. (C) 2008 Elsevier Ireland Ltd. All rights reserved.Öğe The effect of aprotinin on brain ischemic-reperfusion injury after hemorrhagic shock in rats: An experimental study(LIPPINCOTT WILLIAMS & WILKINS, 2007) Eser, Cay; Kalkan, Erdal; Cosar, Murat; Buyukbas, Sadik; Avunduk, Mustafa Cihat; Aslan, Adem; Kocabas, VolkanBackground. We aimed to demonstrate the positive effects of the serine protease inhibitor aprotinin on neural ischemia-reperfusion injury and apoptosis in a rat model. Methods: There were 18 rats divided into 3 groups: group A (sham, n = 6), group B (ischemia-reperfusion, n = 6), and group C (ischemia-reperfusion + aprotinin, n = 6). The systolic blood pressure of the group B and C rats was decreased to 40% to 50% of the normal level by taking blood from the femoral vein to develop hemorrhagic shock. The blood was retained and given to the remaining group B and C rats for reperfusion 20 minutes after the procedure. In group B, isotonic solution and, in group C, aprotinin was administered to the rats 5 minutes before reperfusion. After the rats were killed, the brain tissue samples were fixed for histopathologic examination. Brain tissue superoxide dismutase, malondialdehyde, and tissue myeloperoxidase level and apoptotic cell analyses were performed in all groups. Results: Superoxide dismutase level decreased from group A to group B and increased from group B to group C (p < 0.05). Malondialdehyde and myeloperoxidase levels and apoptotic cells increased from group A to group B and decreased from group B to group C (p < 0.05). Conclusions: The results suggest that the systemic use of aprotinin in ischemic neural tissue prevents reperfusion injury and also protects the morphologic, functional, and biochemical integrity of the neural tissue.Öğe The effect of meperidine-impregnated autogenous free fat grafts on postoperative pain management in lumbar disc surgery(LIPPINCOTT WILLIAMS & WILKINS, 2008) Kalkan, Erdal; Torun, Fuat; Tavlan, Aybars; Cengiz, Sahika Liva; Kaya, BuelentStudy Design: Prospective, randomized, double-blind clinical study. Objective: To examine the effect of meperidine-impregnated autogenous free fat grafts (AFFGs) on postoperative pain management after 1-level, first-time lumbar disc surgery. Summary of Background Data: Uncontrolled postoperative pain impedes patient recovery. Insuffidient control of postoperative pain makes it difficult to convince new patients to undergo the lumbar disc surgery. Methods: Twenty-seven patients scheduled to undergo lumbar microdiscectomy for the first time were divided into 2 groups by a randomized double-blind method. Group 1 patients received a meperidine-impregnated AFFG in the epidural area. Group 2 received the graft without meperidine impregnation. Both groups were asked to use a Patient Controlled Analgesia device to deliver tramadol, and at 1, 4, 12, and 24 hours postoperatively, the amounts of tramadol used and pain severity on the 10-cm Visual Analog Scale (VAS) were recorded. Results: The VAS scores and total tramadol use were both lower in group 1 compared with the control group (P < 0.05). The first hour of VAS scores were significantly lower in group 1 than in the control group (P < 0.05). Conclusions: In this study, we helped patients, who underwent I-level, first-time lumbar microdiscectomy have a postoperative pain-free and comfortable period by using epidural meperidine-impregnated AFFGs.Öğe Emergency Operation Indications in Emergency Medicine Clinic (Model of Emergency Medicine in Turkey)(Health Communications Inc, 2006) Cander, Başar; Kalkan, Erdal; Girişgin, Sadık; Gül, Mehmet; Coşkun, FigenAlthough patients who present for emergency medical care have a broad spectrum of symptoms, such events can generally be categorized as internal medicine, surgical, and pediatric emergency cases. Indications for emergency surgery are estimated to be infrequent compared with the overall number of patients admitted for emergency care. This study investigated the indications for emergency surgery in patients (612 of 8422 patients who sought emergency care) admitted to the surgical division of the emergency department at Konya City Hospital between January and July of 2002. This retrospective study, which investigated reasons for surgical procedures and relevant branch distribution, comprised 405 men (65%) and 207 women (35%). Ages of enrolled patients ranged from 6 months to 70 years. Most of the patients (n=280, 46%) who underwent surgery at the emergency clinic were treated for acute abdomen. Emergency indications for neurosurgery (n=71, 12%) were the second most common reason for emergency procedures. Epidural hematoma and depressed fracture were the most apparent indications for neurosurgery. Surgery of the thorax was the third most common emergency surgery performed (n=44,7%). Patients who had emergency surgery indications and who underwent surgery account for approximately 7% of the total number of patients who presented for emergency care. Acute abdomen and trauma were the most frequently reported precipitating events.Öğe Enfekte Lumbosakral Spinal Dermoid Kist(2010) Kalkan, Erdal; Erdi, Fatih; Keskin, Fatih; Kaya, Bülent; İlik, Kemal; Karataş, YaşarAmaç: Bu olgu sunumun amacı nadir görülen ve tanıda karışıklığa sebep olabilecek intradural yerleşimli enfekte olmuş bir dermoid kist olgusu sunmaktır. Olgu sunumu: Beş aylık kız bebek, belinde hassasiyet ve kızarıklık oluşturan şişlik ve iltihabi akıntı şikayetleri ile başvurdu. Lumbosakral bölgede eritemli, ısı artışı olan şişlik mevcut olup, şişliğin ortasındaki cilt lezyonundan iltihabi akıntı oluşmakta idi. Manyetik rezonans görüntülemesinde L3- S1 arasında uzanım gösteren; hiperintens, heterojen, intradural yerleşimli, spinal kordda ekspansiyona yol açan kitle lezyonu tespit edildi. Hasta opere edilerek L3-4 total laminektomi ile abse drenajı, traktus ve subtotal kitle eksizyonu uygulandı. Eksize edilen tümöral dokunun histopatolojik incelemesinde kistik dermoid tümör tanısına ulaşıldı. Abseye yönelik antibiyotik tedavisi düzenlenen hasta tedavisi tamamlandıktan sonra önerilerle taburcu edildi. Sonuç: Dermoid tümörler nadir görülen spinal tümörlerdir. Genellikle yavaş ve asemptomatik seyrederlerken araya giren enfeksiyon ya da tümöral kistin rüptürü gibi nedenlerle akut ve bazen geri dönüşümsüz tehlikeli sonuçlara neden olabilirler. Bu olgu sunumu ile özellikle pediatrik çağda görülen spinal kitlelerin ayırıcı tanısında dermoid tümörlerin akılda tutulması ve bunlarda görülebilen enfeksiyon ve rüptür riski göz önüne alınarak uygun zamanda cerrahi tedavi planlanması gerekliliği hatırlatılmak istenmektedir.Öğe The evaluation of protective effects of FK-506 on neural ischemic-reperfusion injury: an experimental study(SPRINGER HEIDELBERG, 2007) Eser, Olcay; Kalkan, Erdal; Cosar, Murat; Yaman, Mehmet; Buyukbas, Sadik; Avunduk, Mustafa Cihat; Fidan, HueseyinObjective: In this study, we aimed to delineate the mode of neuroprotective action of FK-506, and demonstrated that FK-506 could decrease oxidative stress and apoptotic cell death in an in vivo rat model of neural ischemia-reperfusion after hemorrhagic shock. Methods: Thirty rats were used as experimental subjects and divided into five equal groups. Group A rats (sham group, n = 6) were anesthetized and craniotomies were performed for collecting brain tissue samples. In group B ischemia-reperfusion (I/R + 1 h, n = 6), group C (I/R + 24 h, n = 6), group D (I/R + 1 h FK-506, n = 6) and group E (I/R + 24 h FK-506, n = 6), systolic blood pressure of the rats decreased to 40-50% of the normal level via bleeding from the femoral vein. Thus, a hemorrhagic shock and ischemic neural tissue model was formed. The blood was retained and given to the remaining animals in groups B, C, D and E via femoral vein for reperfusion 20 min after the procedure. In group D and E, 1 mg/kg FK-506 in 0.5 ml isotonic solution was administered to the rats 5 min before reperfusion. Group B and D rats were sacrificed after 1 hand group C and E rats were sacrificed 24 h after reperfusion; the rats were sacrificed via bleeding associated with intracardiac puncture. Craniotomy was also performed in groups B, C, D and E and brain tissue samples were fixed using neutral buffered 10% formaldehyde solution for immunohistopathological examination as in group A. Brain tissue superoxide dismutase (SOD) activities, malondialdehyde (MDA) levels, tissue myeloperoxydase (MPO) activities and apoptotic cell analyses with APO 2.7 immunohistochemically were also performed in all groups. Results: The result of the study revealed that the SOD activities were lower for groups B (I/R + 1 h) and C (I/ R + 24 h) than for group A (sham group) (p < 0.05). In addition, SOD activities were higher in groups D (I/ R + 1 h FK-506) and E (I/R + 24 h FK-506) than in groups B (I/R + 1 h) and C (I/R + 24 h) (p < 0.05). MDA levels, MPO activities and the number of apoptotic cells were lower in group A (sham group) than in groups B (I/R + 1 h) and C (I/R + 24 h) (p < 0.05). In addition to these MDA levels, MPO activities and the number of apoptotic cells were higher in groups B (I/R + 1 h) and C (I/R + 24 h) as compared to groups D (I/R + 1 h FK-506) and E (I/R + 24 h FK-506) (p < 0.05). Conclusion: The results suggest that the prophylactic use of FK-506 in an in situ ischemic neural tissue may prevent reperfusion injury.Öğe Fibrinolytic markers and neurologic outcome in traumatic brain injury(NEUROL SOC INDIA, 2006) Bayir, Aysegul; Kalkan, Erdal; Kocak, Sedat; Ak, Ahmet; Cander, Basar; Bodur, SaidAims: To determine the usefulness of fibrinolytic markers as early prognostic indicators in patients with isolated head trauma. Materials and Methods: Sixty-two consecutive patients (26 women and 36 men; mean age 61 years, range 2-76 years) with isolated head trauma seen within the first three hours of the trauma were included in the study. The Glasgow Coma score (GCS), platelet counts (Plt), prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP) and D-dimer levels were measured. Head computerized tomography (CT) findings were categorized as brain edema, linear fracture, depressed fracture, contusion and bleeding. Plt counts, PT, PTT, fibrinogen, FDP, D-dimer levels and CT findings were compared with both GCS and mortality in the first week. Statistical significance was accepted at P <= 0.05. Results: A marked negative relationship was found between GCS and PT, PTT, FDP and D-climer levels (P < 0.001). Plt levels did not correlate with GCS. Mortality was most strongly related to GCS, PT, FDP and D-dimer levels (P < 0.001, P < 0.001, P < 0.001 and P < 0.001, respectively). We found no relationship between mortality and CT findings, nor was there any significant relationship between Plt, PTT and fibrinogen levels. Conclusion: GCS and fibrinolytic markers measured within the first three hours were useful in determining the prognosis of patients with isolated head trauma.Öğe Gibboziteye Neden Olan ve Tedavi Altında Farklı Seviyede Reaktivasyon Gösteren Pott Hastalığı(2010) Kalkan, Erdal; Erdi, Fatih; Keskin, Fatih; İlik, Kemal; Karataş, YaşarAmaç: Pott Hastalığı; Mycobacterium tuberculosis'in neden olduğu vertebral osteomyelit olarak tanımlanmaktadır. Bu yazıda gibboziteye neden olan ve tedavi altında farklı seviyede reaktive olan Pott Hastalığı bulunan bir olgu sunulmaktadır. Olgu sunumu: Otuz iki yaşında bayan hasta sırt ağrısı şikayeti ile kliniğimize başvurdu. Hastanın torakal manyetik rezonans görüntülemesinde (MRG) Th 6-7 vertebra osteomyeliti tespit edildi. Hasta opere edildi. Sol anterolateral yaklaşımla Th5-6 abse drenajı, korpektomi ve anterior stabilizasyonfüzyon uygulandı. Hastanın ameliyat sonrasında sırt ağrısı şikayeti düzeldi. Histopatolojik ve mikrobiyolojik inceleme sonuçları tüberküloz olarak rapor edildi. Anti tüberküloz tedavisi başlandı. İlk ameliyattan 3 ay sonra hasta bel ağrısı ve yürümede güçlük şikayetleri ile tekrar kliniğimize başvurdu. Hastanın bu sürede önerilen anti tüberküloz ilaçlarını düzenli bir şekilde aldığı öğrenildi. Çekilen MRG’de lomber vertebra osteomyeliti tespit edildi. Hasta tekrar opere edilerek anterior yaklaşımla L2 vertebral abse drenajı, korpektomi, diskektomi uygulanıp anterior stabilizasyon ve füzyon uygulandı. Sonuç: Son yıllarda tüm dünyada ve ülkemizde tüberküloz olgularında artış kaydedilmektedir. Omurga tüberkülozu iskelet sistemi tüberkülozları içerisinde en sık görülen tip olup hastalık günlük nöroşirurji pratiğinde tekrar gündeme gelmeye başlamıştır.Öğe Intradural Intramedullary Conus Medullaris Metastasis of Colorectal Adenocarcinoma: A Case Report(Ege University Press, 2012) Keskin, Fatih; Kalkan, Erdal; Erdi, Mehmet Fatih; Esen, HasanSpinal cord metastasis is rarely seen. Intramedullary spinal metastasis has been defined between the rates of 0,9 -2,1% in the autopsies performed on the cancerous cases. And also intramedullary spinal metastases are defined at a rate of 8,5% in the cases which have metastasis at central nervous system. The male patient, who was at the age of 62, was admitted to our clinic with the complaints of serious back and left leg pain and weakness at the left leg which had begun 15 days before. Low anterior resection + total mesorectal excision + ileostomy were applied to the patient five years ago due to colorectal adenocarcinoma. The carcinoma was reported as adenocarcinoma grade II. Chemotherapy and radiotherapy were applied after postoperative period. Left SLR was positive and 3/5 monoparesis at left leg was determined in the patients neurological examination. Conus medullaris located tumor was determined in the magnetic resonance imaging of the patient. Intradural intramedullary tumor which was infiltrated to the conus medullaris was totally removed with microneurosurgical technique via Th12-L1-2 total laminectomy. Th11-L3 posterior instrumentation and fusion were added because of expansive laminectomy and L1 corpus involvement of the tumor. The histopathological examination was reported as colorectal adenocarcinoma metastasis. In this manuscript we report a colorectal adenocarcinoma metastasis to the conus medullaris for the first time in the literature.Öğe Intradural Intramedullary Conus Medullaris Metastasis of Colorectal Adenocarcinoma: A Case Report(2012) Keskın, Fatıh; Kalkan, Erdal; Erdi, Mehmet Fatih; Esen, HasanOmurilik metastazları nadiren görülür. Kanserli olgularda yapılan otopsilerde %0.9 ile %2.1 arasında intramedüller spinal metastaz tanımlanmıştır ve de santral sinir sistemi metastazı olan olgularda %8.5 oranında intramedüller omurilik metastazı görülür. 62 yaşında erkek hasta 15 gün önce başlayan şiddetli bel ve sol bacak ağrısı, sol bacakta kuvvetsizlik şikayeti ile kliniğimize yatırıldı. Hastaya beş yıl önce alt anterior rezeksiyon, total mezorektal eksizyon, ileostomi uygulanmıştı. Patolojisi kolorektal adenokarsinom grade II idi. Nörolojik muayenesinde sol SLR (), solda 3/5 monoparezi tespit edildi. Hastanın manyetik rezonans görüntülemesinde konus medullarisde tümoral kitle tespit edildi. Th12-L1-L2 total laminektomi ile mikroskopik olarak konus medullarise infiltre olan kitle total çıkarıldı. L1 korpus tutulumu ve geniş laminektomi uygulandığı için Th11-L3 arası posterior enstrumantasyon ve füzyon uygulandı. Histopatolojisi kolorektal adenokarsinom metastazı olarak değerlendirildi. Konus medullarise metastaz yapmış kolorektal adenokarsinom olgusunu literatürde ilk kez rapor etmekteyiz.Öğe İntraventriküler oligodendrogliomalar(2005) Kalkan, Erdal; Torun, M. Fuat; Cengiz, Şahika L.; Erdi, M. Fatih; Baysefer, AlperAmaç: Oligodendrogliomalar nöroepitelyal tümörlerden olup, tüm intrakranial tümörlerin %1-4’nü, tüm glial tümörlerin ise %4-8’ini oluştururlar. Primer intraventriküler oligodendrogliomalar ise nisbeten daha nadir bildirilmektedir. Bu yazıda kliniğimizde opere edilen iki primer intraventriküler oligodendroglioma olgusu sunularak klinik özellikleri tartışılmıştır. Olgu sunumu: Klinik ve radyolojik olarak primer intraventriküler yerleşimli iki oligodendroglioma olgusu opere edildi. Olgu 1 elektif şartlarda opere edilerek nörolojik defisitsiz taburcu edilirken; olgu 2 Glaskow Koma Skoru 5 olarak acil şartlarda opere edilmiş ve postoperative 5.gün eksitus olmuştur. Sonuç: İntraventriküler lezyonlara yaklaşımda primer oligodendrogliomalar akla getirilerek total cerrahi rezeksiyon amaçlanmalıdır.Öğe Kronik Böbrek Yetmezlikli Hastada Çökme Kırığına Neden Olan Torakal Vertebra Osteomyeliti(2010) Kalkan, Erdal; Erdi, Fatih; Kaya, Bülent; İlik, KemalAmaç: Kronik böbrek yetmezlikli bir hastada gelişen ve çökme kırığına sebep olan torakal vertebra osteomyeliti olgusunu sunmak. Olgu Sunumu: Altmış bir yaşında kadın hasta sırt ağrısı şikayeti ile başvurusu sonucu yatırıldı. Hastada polikistik böbrek hastalığına bağlı gelişen, diyalize bağımlı kronik böbrek yetmezliği mevcuttu. Nörolojik muayenesinde Th 5-6 altında hipoestezi tespit edildi. Torakal manyetik rezonans görüntülemesinde Th 5-6 vertebra seviyesinde spondilodiskitis, Th 6 vertebrasında patolojik çökme kırığı, bu seviyede spinal kordda anteriordan basıya neden olan spinal abse tespit edildi. Perkutan biyopsi ve vertebral abse drenajı uygulandı. Biyopsi materyalinde Metisilin’e dirençli Staph Epidermidis üredi. Hasta 23 gün süre ile antibiyotik tedavisi aldı. Mevcut abse boyutlarında bir küçülme olmaması ve hastanın şikayetlerinin de düzelmemesi neticesinde hasta operasyona alınarak; anterolateral yaklaşımla Th 5-6 vertebral abse drenajı, Th 6 korpektomi, distrakte edilebilir cage yerleştirilmesi ve anterior rod-vida sistemi ile stabilizasyonfüzyon uygulandı. Ameliyat sonrası dönemi sakin geçen hastanın sırt ağrısı ve bacaklarda uyuşma şikayetlerinde belirgin düzelme kaydedildi. Ek nörolojik defisiti olmadı. Sonuç: İmmun yetmezlikli hastalarda sıklıkla görülebilen vertebra osteomyelitinin tanı ve tedavisi, geri dönüşümsüz nörolojik hasarların engellenmesi için hızla ve etkili bir şekilde yapılmalıdır.
