Browsing by Author "Kiymaz, N"

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Anal Protrusion of Ventriculo-Peritoneal Shunt Catheter in an Infant
(Elsevier Science Bv, 2003) Çaksen, H; Kiymaz, N; Odabas, D; Tuncer, O; Atas, B
Bilobed Fasciocutaneous Flap Closure of Large Meningomyeloceles
(Lippincott Williams & Wilkins, 2006) Atik, B; Tan, O; Kiymaz, N; Yilmaz, N; Tekes, L
Background: Closure of large meningomyelocele defects presents a challenging problem. In this paper, the procedure and outcome of bilobed fasciocutaneous flap closure of large meningomyeloceles have been discussed. Materials and Methods: Bilobed fasciocutaneous flap was used in 20 patients with large meningomyelocele defects, the largest of which was 77 cm(2). A fasciocutaneous dissection was performed and the defect area was covered by tension-free closure. Results: In the follow-up period of 6 weeks, partial flap loss in a patient and cerebrospinal fluid leak inferior to the flap in another 2 were observed. These patients recovered by dressing without flap loss. Conclusions: Utilization of bilobed flaps for closure of large meningomyelocele defects seems to be an effective and reliable procedure, with advantages of decreased operative time, minimal bleeding, the suture lines for dura and flap not superimposed, and low morbidity.
Brain Abscess Drainage by Use of Mr Fluoroscopic Guidance
(Amer Soc Neuroradiology, 2005) Ünal, O; Sakarya, ME; Kiymaz, N; Etlik, O; Kayan, M; Kati, I; Harman, M
We describe herein the use of MR fluoroscopic guidance in the drainage of abscess cavities. We percutaneously drained 12 brain abscesses in 11 patients. A 0.3T open MR imaging system was used. Sixteen drainages were performed in 12 abscesses. Repeat drainage was needed in three recurrences and one residual lesion. No serious complications were seen. MR fluoroscopy-guided percutaneous brain abscess drainage in an open MR imaging system is feasible.
Brainstem Lesions After Head Injury
(Amer Assoc Neurological Surgeons, 1999) Cirak, B; Unal, O; Isik, S; Kiymaz, N
Brucellar Spondylodiscitis -: Mri Diagnosis
(Elsevier Science inc, 2001) Harman, M; Unal, Ö; Onbasi, KT; Kiymaz, N; Arslan, H
Early diagnosis of bruccellar spondylodiscitis is often difficult because of the long latent period. Radiographs of the spine, bone scan, and computed tomography (CT) scan provide insufficient data. Among 25 patients with brucellar spondylodiscitis studied by magnetic resonance imaging (MRI), 9 were in the acute stage and 16 were in the chronic stage. MRI is the investigation method of choice in diagnosing brucellar spondylodiscitis. (C) 2001 Elsevier Science Inc. All rights reserved.
A Case of Metastatic Spinal Ewing's Sarcoma Misdiagnosed as Brucellosis and Transverse Myelitis
(Springer-verlag Italia Srl, 2004) Çaksen, H; Odabas, D; Demirtas, M; Kiymaz, N; Anlar, Ö; Ünal, Ö; Ugras, S
An 11-year-old girl was admitted with back pain for 2 months, inability to walk for 15 days, and enuresis and encopresis for 2 days. She had been hospitalized with the diagnosis of brucellosis in another hospital. At presentation, she had paraplegia, sphincter dysfunction, and bilateral sensory loss below the T6 level, and was initially diagnosed with transverse myelitis caused by brucellosis. On the third day of hospitalization, however, agglutination test for brucella was negative, but it was positive for Salmonella. Therefore, transverse myelitis was considered to be due to salmonellosis. Thoracic spine magnetic resonance imaging showed an extradural, paraspinal mass at the level of T6-T7. The mass was totally extracted, and histopathological examination revealed Ewing's sarcoma. During follow-up, no improvement in paraplegia was noted and an enlarged presacral decubital ulcer developed. Aside from supportive care, local radiotherapy was applied. Unfortunately, the patient died from probable infection 9 months after the diagnosis. We emphasize that metastatic spinal Ewing's sarcoma may mimic brucellosis and transverse myelitis in childhood.
Central Nervous System Lipomas
(Tohoku Univ Medical Press, 2002) Kiymaz, N; Cirak, B
The lipomas of the central nervous system are rare lesions of congenital origin and are located in the medial line and especially in corpus callosum. Intramedullary spinal lipomas can be seen in the life span of 30 years of age and most frequently coincide with initial puberty period. Magnetic resonance imaging and computerized tomography together with clinical trials are of crucial importance for diagnosis. The first case: A two-year-aged girl who had lipoma in quadrigeminal cistern and who suffered from encephalocraniocutaneous lipomatosis has been clinically studied. The fascial lipoma of the patient has been excised subtotally by the Plastic Surgeons; then the patient has underwent supracerebellar infratentorial operation where the intracranial lipoma has been excised by our team. The histopathology has been reported to be consisting of peripheric nerve tissue and calcification. The second case: A twenty-year-aged man with intramedullary lipoma localized between T1-T4 has been given our clinical trials. T1-T5 total laminectomy and subtotal excision were made for this patient. Due to the fact that the lipomas of central nervous system are rarely seen and are involved in nervous and calcific tissues except for fatty tissues they can be mistaken for hamartomatous masses. The total excision of the lipomas of central nervous system and especially the spinal intramedullary lipomas are quite difficult to be excised since they are tightly entangled with the neural tissue. So any attempt for total excision would be dangerous. Operation for decompression and biopsy is of primary concern.
Comparing Open Surgery With Endoscopic Releasing in the Treatment of Carpal Tunnel Syndrome
(Georg Thieme verlag Kg, 2002) Kiymaz, N; Cirak, B; Tuncay, I; Demir, Ö
Aim: The aim of this study is to retrospectively assess the complications and result of cases that underwent open surgery or endoscopic releasing for carpel tunnel syndrome. Method: A total of 50 cases of carpel tunnel syndrome, 30 of whom underwent endoscopic release using the biportal extra-bursal technique described by Chow, and the other 20 that underwent open surgery were included in the study. Average age of the cases was 41 (24-62),44 of them were females and 6 males. Results: Follow-up examinations of the patients at the first and third month after operation revealed no limitation of activity in 40 (80%) cases, minimal limitation in 4 (8%), moderate limitation in 5 (10%) and significant limitation in 1 (2%). Among the group that underwent endoscopic release, as a major complication, the median nerve was almost totally cut in a patient under-going endoscopic release. During the same operation setting perifascicular neurorrhaphy was done. Fourth and fifth digital nerve lesions occurred in three cases. Among the group that underwent open surgery fourth and fifth digital nerve injury occurred in one case, and in another case severe inflammation requiring reoperation occurred. Conclusion: Before intervention, cases of carpal tunnel syndrome should be examined well as regards which technique to use. Experience of the surgeon with the technique to be used should also be taken into consideration. Endoscopic carpal tunnel releasing, though a relatively easier procedure, leads to neurovascular injuries more frequently than open surgery; thus open surgery appears to be safer.
Effects of Dexamethasone on Trace Elements and Serum Protein Patterns Following Brain Trauma in Rats
(Humana Press inc, 2005) Ekin, S; Berber, I; Kiymaz, N
The effect of dexamethasone (Dxm) on trace elements and serum protein patterns was investigated in male Sprague-Dawley rats subjected to brain trauma. After 6- or 24 h of the traumatic incident, the level of serum copper was significantly higher in the Dxm-treated rats, compared to controls (p < 0.05). The corresponding levels of zinc and iron did not show significant differences. The zinc level returned to normal 24 h after trauma. After 6 and 24 h of trauma, the sodium dodecyl sulfate (SDS)-polyacrylamide gel patterns of serum proteins showed that a 41.6-kDa protein was significantly increased in the Dxm-treated animals. Two proteins weighing 26.6 kDa and 55.1 kDa did not show Dxm-induced changes. These results suggest that increases in the copper-zinc ratio and the changes of the 26.6-kDa, 41.6-kDa, and 55.1-kDa proteins might be a useful prognostic indicator for severe traumatic brain injury.
The Effects of Endothelin Antagonist Bq-610 on Cerebral Vascular Wall Following Experimental Subarachnoid Hemorrhage and Cerebral Vasospasm
(Springer Heidelberg, 2004) Cirak, B; Kiymaz, N; Ari, HH; Ugras, S
Endothelin, a potent vasoconstrictor, has been found to increase in the cerebrospinal fluid and serum of patients following subarachnoid hemorrhage (SAH) and to play a major role in the development of cerebral vasospasm. The aim of this study is to investigate the role of endothelin-A antagonist BQ-610 in the experimentally performed cerebral vasospasm following SAH. Thirty New Zealand rabbits were divided into three groups (each n=10): group A, control group; Group B, SAH group; Group C, treatment (endothelin antagonist BQ-610 treated) group. In the study, the rabbits developed vasospasm after injection of intracisternal autolog blood into the cisterna magna. After cerebral vasospasm development, in group C, endothelin antagonist BQ-610 was injected intracisternally. Morphometrically, basilar artery lumen was constricted 25% and 62% compared to the control group (group A) in the endothelin treated group (group C) and the endothelin untreated group (group B), respectively. Histopathological findings of the basilar artery wall confirmed the therapeutic effect of endothelin antagonist in vasospasm development. Endothelin-A receptor antagonist BQ-610 has a therapeutic effect in the cerebral vasospasm following experimentally performed subarachnoid hemorrhage when used intracisternally.
Is External Ventricular Drainage Useful in Primary Intraventricular Hemorrhages
(Springer, 2005) Kiymaz, N; Demir, Ö; Çirak, B
Nontraumatic primary intraventricular hemorrhage (PIVH) is characterized by direct bleeding into the neuroventricular system. A very rare condition, PIVH accounts for 3% of all spontaneous intracerebral hemorrhages. Hypertension is a major cause of PIVH. Reports about PIVH in the literature are infrequent and it appears to be a relatively benign condition. Between 1998 and 2001, 15 patients with PIVH were evaluated in the Departments of Neurosurgery of Yuzuncu Yil and Pamukkale Universities; their prognosis and results of treatment with external ventricular drainage (EVD) were recorded. The diagnosis was established easily and rapidly with computed tomography. Prognoses of the patients were made by the Glasgow Coma Score (GCS). Hypertension was the most common etiology (n=9, 60%); the prognosis for survivors (73.3%) was good (mortality, 26.6%). Elderly patients, who scored low on the GCS, and patients with coagulopathy had poor prognoses. All patients with PIVH underwent surgery with EVD within 24 hours of their hospital admission. Applying EVD had positive results and influenced the prognosis and early and late complications of PIVH accordingly.
Malignant Meningioma in a 3-Year Girl
(Lippincott Williams & Wilkins, 2006) Bayram, I; Kiymaz, N; Harman, M; Ugrath, S
Metastatic Germ Cell Testicular Tumor of the Eye and Brain
(Acta Medica Belgica, 2005) Kiymaz, N; Çirak, B; Yilmaz, N
The aim of this report is to contribute to the clinical understanding of this rare combined pathology. Intraocular metastatic tumors are rarely encountered pathologies. Mostly encountered primary sites are breast, prostate, kidney, lung and skin. Testis as a primary site for orbital metastases is rather rare. Metastasis to orbit usually occurs to periorbital structures, but to vitreus is relatively rare. Here we describe a case of intraocular metastatic tumor to the vitreus originating from testicular embryonal cell carcinoma. Patient with intraocular tumor had also intracranial metastasis. He was operated on for intracranial lesion, after an uneventfull postoperative period he was discharged. 2 months later when he died, postmortem examination of the intraocular lesion reported as metastatic embryonal cell carcinoma. As a conclusion testicular embryonal cell carcinoma, eventhough rare, must be considered to metastasize to the eye.
Penetrating Intracranial Stone
(Karger, 2005) Kiymaz, N; Yilmaz, N
Traumatic intracranial foreign objects may cause cranial hemorrhage and contusion at an early stage and epileptic seizures and infections at a later stage, leading to morbidity and mortality in children. In the present study we report a case of a traumatic intracranial stone, which is a rarely encountered foreign object in intracranial traumatic injuries. Copyright (c) 2005 S. Karger AG, Basel.
Spontaneous Cervical Paraspinal and Epidural Giant Abscess in a Child -: Case Report
(Japan Neurosurgical Soc, 2005) Kiymaz, N; Demir, Ö
A 10-year-old girl presented with a very rare paraspinal and spinal epidural abscess manifesting as fever, and neck pain and stiffness. Initially, she was treated under a diagnosis of meningitis for 3 weeks. However, she developed monoparesis of the right upper extremity, and was referred for neurosurgery. Magnetic resonance imaging revealed an epidural and paraspinal lesion intensely enhanced by gadolinium. The patient underwent urgent surgery for C2-3 laminectomy and abscess drainage, followed by broad spectrum antibiotic therapy. She was discharged and followed up in the outpatient clinic. Two months later, the paraspinal abscess recurred with great increase in size. A second operation was performed and 150 ml pus was drained. Streptococcus anginosus was grown in the culture. The patient fully recovered after long-term targeted antibiotic therapy. Such abscesses are very rare in children, especially in the cervical region. The correct diagnosis can be difficult to establish but early treatment is essential for a good prognosis.
Surgical Treatment Outcomes in Subdural Effusion: a Clinical Study
(Karger, 2006) Yilmaz, N; Kiymaz, N; Yilmaz, C; Bay, A
Objective: In this study, patients who underwent surgery due to subdural effusion were retrospectively analyzed. The location, depth and etiology of the subdural effusion, the surgical approach that was used and the recurrence rates were studied in these patients. Method: A total of 32 patients who were followed up and treated for subdural effusion at the Neurosurgery Clinic of the Yuzuncu Yil University School of Medicine were included in the study; 18 (56%) of the patients were male and 14 (44%) were female. The surgical techniques applied were surgical burr hole drainage, repeated subdural transaxial puncture and subduroperitoneal shunt approaches. The patients were evaluated by computerized tomography of the brain in week 1 and in the third month after surgery. Recurrences were evaluated based on radiological findings and the clinical condition of the patients. Result: The consciousness level of the patients was proportional to the mass effect of the subdural effusion. Lower recurrence rates were found in patients with a large midline shift resulting from the subdural effusion. In addition, recurrence rates were higher in patients with cerebral atrophy and lower protein content in the subdural effusion fluid. It was observed that these patients responded better to the subduroperitoneal shunt treatment. Copyright (c) 2006 S. Karger AG, Basel.