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Öğe Can facet joint infiltrative analgesia reduce postoperative pain in degenerative lumbar disc surgery?(Soc Espanola Neurocirugia, 2008) Bademci, G.; Basar, H.; Sahin, S.; Ozcakir, S.; Anbarci, H.; Evliyaoglu, C.; Keskil, S.Objective. Perioperative analgesia effects the postoperative course of pain. The purpose of this study was to evaluate its possible relation with the consumption of dolantine and analgesics and the facet-induced pain and postoperative pain score in degenerative disc surgery. Methods. We employed perioperative intra- and perifacet bupivacaine infiltration technique to reduce the postoperative pain after lumbar disc surgery. The study was randomized and observer blinded enrolling 40 American Society of Anesthesiologists physical status class I-II patients scheduled for elective degenerative lumbar disc surgery. The patients were divided into two groups of 20 of which Group 1 underwent injection of bupivacaine into the subcutaneous and muscular layers around the incision site, while Group 2 underwent additional intra- and perifacetal joint infiltration. Postoperatively, the patients were provided with a programmed patient-controlled pump which was only activated on demand to infuse dolantine for the next 24 hours. In the postanesthesia care unit the delay for analgesia and the dose of dolantine used were recorded. Results. There was no statistical significance between these two groups regarding postoperative visual analoque scale scores. The time before the first analgesic request was significantly longer in facet group (p = 0,006). The cumulative dolantine dose was also significantly lower in the facet group (p = 0,001). Conclusion. The results indicate that facet joint infiltrative analgesia may have an effect on the postoperative analgesic requirement and reduce the dolantine consumption.Öğe Diagnostic value of bed-side ultrasonographic evaluation by anterior approach in spine disorders? A preliminary report(Sociedad Luso-Espanola Neurocirugia, 2003) Evliyaoglu, C.; Ayberk, G.; Sargin, H.; Keskil, S.A preliminary investigation was planned so as to evaluate the effectiveness of ultrasonography for bedside evaluation of patients with suspected spinal pathology. Its application by anterior approach in 37 cases showed that herniated disc material, bone, epidural fat, scar tissue, tumoral masses and their relation to the interspace and dural sac could be visualized. A short description of the sonographic appearance of normal and pathological structures was also given in comparison to Computed Tomography or Magnetic Resonance images. Ultrasonographic examination was inadequate in five of the patients due to obesity, meteorism or diminution of the intervertebral disc space. Advantages of this technique are the availability almost in every hospital, the ease of obtaining images at various angles, avoiding the use of x-rays and the low price. The disadvantages are its relatively poor definition as compared to Computed Tomography or Magnetic Resonance Imaging and its inability to see through bone.Öğe Effects of trauma and pain on the acute anterior pituitary hormonal response(Elsevier, 2002) Gözil, R.; Evrenkaya, T.; Keskil, Z.; Çalgüner, E.; Keskil, S.The aim of this study was to compare the effects of trauma and pain on the pituitary gland so as to determine whether pain is a significant component in the general acute hormonal trauma response. Adenohypophysis of rabbits that have undergone either diffuse traumatic brain injury or pain were investigated using immunohistochemistry. The ACTH staining pattern of the pain-administered rabbits was not as strong as the head-trauma-administered group, whereas PRL staining pattern of the former group was not so weak as the later group. As a conclusion, since adrenocorticotrophic hormone and prolactin staining patterns were different in the trauma administered and pain induced groups; it may be postulated that pain alone may not be an important factor in the hormonal response to trauma. © 2002 Published by Elsevier Science Ltd.Öğe Effects of vasoconstriction on the acute anterior pituitary hormonal response to head injury(Churchill Livingstone, 2002) Keskil, Z.; Evrenkaya, T.; Gozil, R.; Calguner, E.; Keskil, S.Since cerebral vasoconstriction alone may impair the hypothalamic and pituitary circulation, we planned to investigate whether the hormonal response to the vasoconstriction that may be induced by the head injury is a significant component of the general acute hormonal response to head injury. Although diffuse adrenocorticotropic hormone immunohistochemical staining of the adenohypophysis of rabbits was observed in the head trauma administered group, only mild positive staining was present in the Endothelin-1 administered group. However, decreased prolactin staining was found in both of the groups. It is postulated that trauma induced vasoconstriction may not be an important manipulating factor in the corticotrophic hormone response to injury, while it may be responsible for the decreased prolactin response. (C) 2002 Elsevier Science Ltd. All rights reserved.Öğe Endoscopy in the 15th Century(Georg Thieme Verlag Kg, 2002) Keskil, S.; Sabuncuoglu, H.The aim of this study was to investigate the contributions of Serefeddin Sabuncuoglu (1385-1468?) - who was born and practiced in Amasya in northern part of central Anatolia - to the field of endoscopy. He was a humble, curious and intelligent surgeon, and also a calligrapher and a miniature artist. This remarkable pioneer used the classification of the Andalusian surgeon, Abdul-Kasim Kalaf Ibni Abbas El Zahravi, known as Albucasis of Cordoba (936-1013); but improved it by adding many important and major new observations and chapters. He described "a thin and hollow tube of almost 35 cm, which was made of silver" and used it to inspect the interior of the bladder.Öğe Ganglioglioma with lytic skull lesions: a case report(Sociedad Espanola Neurocirugia, 2007) Gürkanlar, D.; Koçak, H.; Yücel, E.; Acıduman, A.; Günaydın, A.; Ekinci, Oe.; Keskil, S.Gangliogliomas represent only 0.4% of central nervous system neoplasms and 1.3% of brain tumors. They are benign neoplasms with low morbidity and mortality and the patients usually present with seizures, but there has been no adult ganglioglioma with lytic skull lesion. A 49-year-old right handed woman suffering from generalized epileptic seizures was admitted to our hospital. She had also left hemiparesis with 4/5 motor strength. Magnetic resonance imaging and immunohistochemical studies revealed WHO Grade 11 ganglioglioma. Skull X-ray showed the lytic skull lesions. We have to consider gangliogliomas in the differential diagnosis of lytic skull lesions.Öğe Imaging problems and clinical findings in adolescent lumbar disc herniation: A retrospective study(Georg Thieme Verlag Kg, 2002) Keskil, S.; Seçkin, Z.; Ayberk, G.; Tosun, H.; Tokyay, M.; Kiliç, C.Objectives: Disc degeneration probably begins in childhood although low back pain and radicular leg pain is not as common a complaint as in adults. However as yet no explanation exists for the appearance of advanced degenerative changes seen occasionally in patients in their twenties. Patients and methods: We report 12 adolescents between the ages of 15 and 20 among a total of 1068 cases with radiologically demonstrated lumbar disc herniations treated between March 1991 and March 1996. Results: Most of their findings were in good agreement with earlier and more recent reports. The only different findings worth commenting upon were the common presence of multiple level disc herniations, and the occasional presence of a so called "fractured epiphysial plate". Conclusion: Depending on magnetic resonance imaging findings coupled with computed tomographic images: we suppose that the so called "fractured bone fragments of the vertebral epiphysial rim impinging on the spinal canal at multiple levels" and "wedges of bone attached to the disc end plate and associated bony defects in the margins of the posterior vertebral bodies" reported to be demonstrated on computed tomographic (CT) images may in fact be false images. Inappropriately angled CT scan slices may cut partly through the epiphysial ring which has totally been distracted backwards together with the firmly attached avulsed disc annuli, designated as an "epiphysial avulsion"; giving rise to the mistaken interpretation as a "fractured epiphysial ring" appearance. Such a mechanism may also involve the posterior longitudinal ligament, which is firmly attached to the neighboring annuli, accounting for the common multilevel involvement.Öğe The precise human bioclock, possibly imported(Churchill Livingstone, 2002) Keskil, Z.A.; Keskil, S.Contrary to what has long been suggested, the biological clock is not a poor timekeeper. In fact, it has been working in precision for millions of years as a genetically set clock, independent of environmental periodicity. However, as the Earth's rotation has gradually slowed, this internal clock has gone through a relative phase shift. Extrapolating of changes backwards through time shows that the clock was set when mammals first appeared on the planet. Interestingly, primates are the only beings that have a free-running cycle longer than 24 hours. This bioclock may be set by lunar entrainment, or may be set extraterrestrially? (C) 2002 Elsevier Science Ltd. All rights reserved.Öğe Preliminary report on surgical mask induced deoxygenation during major surgery(Soc Espanola Neurocirugia, 2008) Beder, A.; Buyukkocak, U.; Sabuncuoglu, H.; Keskil, Z. A.; Keskil, S.Objectives. This study was undertaken to evaluate whether the surgeons' oxygen saturation of hemoglobin was affected by the surgical mask or not during major operations. Methods. Repeated measures, longitudinal and prospective observational study was performed on 53 surgeons using a pulse oximeter pre and postoperatively. Results. Our study revealed a decrease in the oxygen saturation of arterial pulsations (SpO(2)) and a slight increase in pulse rates compared to preoperative values in all surgeon groups. The decrease was more prominent in the surgeons aged over 35. Conclusions. Considering our findings, pulse rates of the surgeon's increase and SpO(2) decrease after the first hour. This early change in SpO(2) may be either due to the facial mask or the operational stress. Since a very small decrease in saturation at this level, reflects a large decrease in PaO(2), our findings may have a clinical value for the health workers and the surgeons.Öğe Redundant ventriculomegaly associated with brain abscess(Elsevier Doyma Sl, 2002) Keskil, S.; Ayberk, G.; Seçkin, Z.; Kizartici, T.; Kilic, C.Although brain abscess had a high mortality rate, improvements in radiologic imaging facilities, bacteriological techniques and antibiotics have resulted in a mortality of about 5%(16.11,31). Our aim was to emphasize the recently observed increase in the incidence of ventriculomegaly associated with brain abscess among the patients operated on in our hospital during five years. The causes and management of this well-known complication of brain abscesses was also discussed.Öğe Sinonasal ossifying fibroma with fluid-fluid levels on MR images(Amer Soc Neuroradiology, 2003) Kendi, A.T.K.; Kara, S.; Altinok, D.; Keskil, S.Ossifying fibroma is a rare benign neoplasm that usually affects mandibular and maxillary bones. In this report, we present a case of sinonasal ossifying fibroma with fluid-fluid levels and posterior extension toward the torus tubarius on MR images.Öğe Spontaneous resolution of "protruded" lumbar discs(Georg Thieme Verlag Kg, 2004) Keskil, S.; Ayberk, G.; Evliyaoglu, C; Kizartici, T.; Yucel, E.; Anbarci, H..Decreasing size of disc material that has herniated, whether "contained" or "protruded" has previously been described and sometimes this can be so complete that residual material is barely visible. In a retrospective clinical survey, from among almost 2180 consecutive patients admitted during 1994-2002 with low back pain; due to our low follow-up ratios and high price of the magnetic resonance imaging (MRI), only 42 patients with a lumbar disc protrusion could be found who had two MRI scans obtained at least five weeks apart. Among these, 4 patients were spotted with a totally resolved disc protrusion. T-2-weighted MRI images were suggesting shrinkage due to dehydration and regression within the annulus of protruded disc fragments that had not fully migrated. Our patients are further examples for total resolution of the large "protruded" disc without any treatment; and since concomitant disc protrusions at other levels persisted, the resolution of these discs is supposed to be spontaneous.Öğe Tracing the dural tail with image-guided surgery(Georg Thieme Verlag Kg, 2006) Keskil, S.; Bademci, G.; Göksel, M.Objective: The extent of dural resection is important for preventing recurrence in meningioma management. An image-guidance assisted technique is described to perform adequate dural resection. Methods: A universal instrument adapter system for image-guidance was used to track the dural extension of the meningioma accurately. Results: The universal instrument adapter offers the surgeon the possibility to image-guide nearly any rigid instrument via the computed calibration method. in this way a surgical marking pen was used to chase and adequately mark the "dural tail". Discussion: Image-guidance systems can be used to avoid incomplete resection of the affected dura that may be responsible for tumour recurrence.Öğe VACTERL-H associated with central hypothyroidism: A case report(Medecine Et Hygiene, 2007) Aliefendioğlu, Didem; Bademci, Gülşah; Keskil, S.; Somuncu, Salih; Mısırlıoğlu, E.; Çakmak, Ahmet MuratVACTERL-H associated with central hypothyroidism: A case report: The VACTERL-14 syndrome is a rare combination of vertebral anomalies, anal atresia, congenital heart defects, tracheo-esophageal fistula, abnormalities of kidneys and limb anomalies together with hydrocephalus. This condition is recognized as a hereditary entity with poor prognosis. We present a newborn weighing 3400 g, born by cesarean section to a 27 years old mother who had had an irregular antenatal follow-up. The patient had severe hydrocephalus, proximal esophageal atresia and distal tracheoesophageal fistula, gastric outlet obstruction, imperforated anus and recto-urethral fistula, patent ductus arterious, a bifid scrotum, a vertebral defect, sacral dimple and central hypothyroidism. The patient had no limb defects. The association of central hypothyroidism and VACTER-L-H has previously not been reported.
