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Öğe Comparison of glutathion-s-transferase A-4 expression values between lumbar spinal canal stenosis and lumbar discal hernia patients(2019) Cakir, Tayfun; Yucetas, Seyho CemAim: To compare the glutathione s-transferase α-4 (GSTA4) isoenzymes expression values in patients with lumbar spinal canal stenosis (LSCS) due to ligamentum flavum (LF) hypertrophy with patients no evidence of LF hypertrophy.Material and Methods: 27 LF specimens were obtained from patients with LSCS and 27 LF specimens were obtained from patients with lumbar discal hernia (LDH). Firstly these LF samples were analyzed histologically to identify the fibrosis and elastin degradation values. Then GSTA4 isoenzyme values were measured and compared.Results: The mean LF thickness was significantly higher in the LSCS group than in the LDH group (6.72±0.86 and 3.1±0.7 mm, respectively, p 0.005). Average elastin degradation degree was significantly higher in the LSCS group than LDH group (4.4 ±0.50 vs. 0.18±0.1, respectively, p 0.001). And avarage fibrosis degree was significantly higher in the LSCS group than LDH group (4.41±0.17 vs. 0.96±0.11, respectively, p 0.001). And significantly higherexpression of GSTA4 izoenzyme was observed in the LF samples obtained from patients with LSCS compared with controls (144.1±11.16 vs 51.75±21.53, respectively, p=0.009). Conclusion: Our findings in this study suggest that there is a relationship between LF hypertrophy and GSTA4 isoenzyme expression.Öğe Comparison of surgery techniques for recurrent lumbar disc herniation: Total and parsiyel laminectomy(2020) Cakir, Tayfun; Yucetas, Seyho CemAim: The purpose of this study was to compare different surgical methods; hemi-laminectomy versus facet protective total laminectomy in recurrence lumbar discal hernia(rLDH) patients. Materials and Methods: The patients were categorized into 2 groups:34 patients underwent total laminectomy formed the group 1, and 31 patients underwent hemi-laminectomy formed group 2. Patients were compared in terms of age, sex, body mass index(BMI), duration of surgery, length of hospital stay and complications. After 3 years, visual analogue scale for leg and back pain(VASlp,bp), oswestry disability index(ODI) scores and presence of spinal instability were evaluated. Results: There was no significiantly differences about age, sex, BMI, operation segment, mean operative time and length of hospital stay. Significant improvement was observed in both groups in terms of VAS and ODI values. Dural tear was occurred in 8 patients in group 1 and 1 patient in group 2. Superficial wound infection was seen in 1 patient in group 2. Postop spinal instability was observed in 1 patient in group 2. Conclusion: Total laminectomy increased the duration of the operation, but significantly reduced the complication rates. In recurrent disc hernias facet protective total laminectomy may be used at especially in patients without evidence of spinal instability.Öğe Effects of epilepsy control following decompressive craniectomy on mortality and morbidity in epileptic patients with malignant MCA infarction(2020) Gezgin, Inan; Kafadar, Huseyin; Yucetas, Seyho Cem; Cakir, TayfunAim: The present study aims to investigate the effects of seizure or epilepsy formation on mortality and morbidity in epileptic patients after craniectomy.Material and Methods: The patients were divided into the following groups: Group 1, those who had no seizures, but were routinely treated with 3x100 mg of epanutin daily (n=6), Group 2, those who had at least one or multiple seizures and were initiated a second antiepileptic drug in addition to 3x100 mg of epanutin daily (n=13), and Group 3, those who had multiple seizures and who were sedated or narcotized in addition to being treated with 3x100 mg of epanutin daily (n=7). All patients underwent decompressive craniectomy within a maximum period of 48 hours and their characteristics such as age, gender, localization of infarct, hemiplegia, monoplegia, operation time, Glasgow coma and outcome scales were recorded. Results: According to the Glasgow Outcome Scale, 1 patient in Group 1, 8 patients in Group 2 and 6 patients in Group 3 died and there was a significant increase in patient losses in Group 2 and Group 3 compared to Group 1 (p0.05). 10 patients continued to live their lives with the support of home-care services and 2 patients with other forms of help. Conclusion: It was seen that there is a high incidence of seizure and epilepsy in MMCA infarcts after decompressive craniectomy and this significantly increased mortality or dysfunctional recovery if epilepsy could not be brought under control.Öğe Natural course of non-surgical acute traumatic subdural hematomas: Retrospective analysis of 92 patients(2019) Cakir, Tayfun; Turkoz, DursunAim: In the present study, we aimed todiscuss the natural course of acute subdural hematoma (ASDH) patients who were not operated according to the admisssion findings.Material and Methods: In this study patients who admittedwith a diagnosis of traumatic ASDH and underwent conservative treatment according to the admission findings at the neurosurgery clinic of Adıyaman University between 2013 and April 2019 were identified. Patients who had a diagnosis of ASDH less than 10 mm, a midline shift of less than 5 mm and had a repeat computed tomography (CT) scan were included in this study.Two groups were formed with and without increase in the hematoma size according to thecontrol CT. Age, gender, anticoagulation status, comorbidities of the patients, type of trauma, size of the hematoma, GCS scores and presence or absence of a “low-density band” on CT were evaluated. Results: We identified 92 patients who had coded as “traumatic ASDH” and managed nonoperatively according to the findings of the initial CT.32.6% of patients had hematoma growth according to the control CT and68.4% had either decreased or the same size.According to the statistical analysis results, anticoagulant drug use(p=0.001) and comorbidity status(p=0.03) were found to be related with the increase of the hematoma size. Also there was no statistically significant difference (p=0.07) between the two groups about the low density band but it was seen more differencein the non-increased group. Conclusion: Conservative treatment is one of the treatment methods of traumatic acute subdural hematomas. Patients who have under 10 mm hematoma size and 5mm midline shift can be followed up by non-surgical methods. But increased headache in these patients may be a sign that should be considered in terms of increased hematoma. Furthermore, the use of anti-coagulant drugs and the presence of comorbidity make patients more risky.Öğe What is the optimum time to decompressive surgery in the patients with malignant middle cerebral artery infarction?(2019) Yucetas, Seyho Cem; Ucler, Necati; Kafadar, Safiye; Cakir, Tayfun; Kilinc, SuleymanAim: In the patients with malignant middle cerebral artery (MCA) infarctions, the mortality was as high as 70% with conservative treatment. Decompressive craniectomy (DC) was shown to decrease mortality especially in 48 hours. We aimed to investigate both the effect of decompression time and the size of craniectomy on the mortality in this patient group. Material and Methods: 45 adult patients underwent to DC due to malignant MCA infarction were evaluated in this study. The demographic and clinical features were recorded retrospectively. The patients were splitted into three groups: Group 1, DC in the first 24 hours; group 2, in 24-48th hours; group3, in 48-96th hours of the admission. The size of craniectomy was the same as the infarct (standard), or it was two centimeters larger than the size of infarct (larger). Results: Of all patients, 53.3% (n=24) was female; and mean age of the sample was 67.38±4.76. 66.7% (n=30) of the patients died due to malign MCA infarction. The size of craniectomy was larger in 26.7% (n=12), and was standard in the others. Mean time to surgery was 43.07±29.87 hours. Mortality rate was minimum in group 2 (p=0.01). The patients undergoing to larger craniectomy survived longer than the others, but the difference was non-significant (p=0.06). Conclusion: We suggested that not the approach of “surgery as soon as possible” but the surgery between 24-48th hours of the admission would be the optimal approach. This issue is especially important, because earlier or later interventions not only have a less benefit on the outcome but also may lead several unnecessary complications.
