Browsing by Author "Umur, S"

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    Genetical and Histological Investigation of Turkish Siblings With Spina Bifida Occulta Who Had Neurosurgical Intervention
    Altintas, N; Umur, S; Vatansever, S; Temiz, C; Selçuki, M; Selçuki, D; Örenay, S; Arslan, E
    Spina bifida is the one of the most frequently occurring birth defects. More children have spina bifida than muscular dystrophy, multiple sclerosis, and cystic fibrosis combined. Occulta present type is a mild very common form of spina bifida. The reported frequency of occurrence of spina bifida occulta (SBO) varies widely, depending largely on the age groups included in a particular study. The most accurate estimate of occurrence rate is 17% of examined spines. In present study we have examined and compared two Turkish siblings with spina bifida occulta who had neurosurgical intervention. Clinical, histopathological and cytogenetical analyses had been performed on mother and both siblings (brother and sister) diagnosed with spina bifida occulta. Hypertrichosis on their low-backs was diagnosed in both siblings. Magnetic resonance imaging (MRI) studies revealed low conus medullaris and thick filum terminale in brother and sister. The brother somatosensory evoked potential (SEP) results showed lumbar conduction blockade which was not found in sister. Despite the brothers's thick and fatty filum terminale sisters's seemed to be normal. Filum terminale sections from both siblings had normal appearance but atypical structure with increased amount of connective tissue and hyalinization areas. Sections from 9 years old boy were also prominent in glial cells. Genetical analysis revealed normal caryotype in 13 years old sister (46,XX), however deletions on chromosome 17 have been detected in 9 year-old brother [46,XY/46,XY,del(17)(q25)/47,+mar] and their mother [46,XX/46, XX,del(17)(q25)]. Our results show on strong correlation between the deletion of chromosome 17(q25) with genetical and histological results in both siblings with SBO. This is the first report of chromosome 17 (q25) deletion related to the SBO and its genetic connection with neural tube defects.
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    Cutting filum terminale is very important in split cord malformation cases to achieve total release
    Barutcuoglu, M; Selcuki, M; Selcuki, D; Umur, S; Mete, M; Gurgen, SG; Umur
    Split cord malformations (SCMs) are rare congenital anomalies of the vertebrae and the spinal cord. Tethered cord syndrome (TCS) is a clinical condition of various origins that arises from tension on the spinal cord. Radiographic findings may include and/or associate split cord malformations and the other neural tube defects. However, the spinal cord can even be tethered by a filum terminale with normal appearance and normal level conus medullaris in magnetic resonance imaging (MRI). The aim of our study is to show whether SMC patients with normal or abnormal MRI findings had all histological abnormal filum terminale and also to show that the standard SCM repairing operation without cutting filum will not achieve total release. We have reviewed 33 SCM patients between July 2005 and December 2013. They were operated by adding untethering procedure of filum terminale following standard surgical intervention, and a part of the filum was taken for histopathological examination even though MRI did not show the presence of abnormality of filum terminale. We found that abnormal filum terminale with a normal appearance may had dense collagen fibers, wide and numerous capillaries, and hyaline formation, while normal filum terminale is a mixture of collagen fibers and blood vessels. We did not obtain positive Verhoeff elastic fiber staining. The elastic fibers had disappeared in all fila terminalia, except control cadaver group. Our results showed that all fila of SCM patients had loss of elastic fibers and increased of hyalinization, which means loss of elasticity of filum terminale. Less severe traction may remain asymptomatic in childhood and present with neurological dysfunction later in life. For this reason, surgical procedure of SCM patients including releasing of filum terminale seems more beneficial for the patients and be better for long term.
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    High-velocity gunshot wounds to the head: Analysis of 135 patients
    Bakir, A; Temiz, U; Umur, S; Aydin, V; Torun, F
    Head injuries due to high-velocity missiles and shrapnel as a result of military conflicts have become a very important cause of death or severe neurological deficits. Military-type missiles have high velocities and transfer higher amounts of energy to neural tissue, compared to civil-type missiles. This physical phenomenon also causes greater neural tissue destruction. Shrapnel particles derive from blasts and cause less severe injury because of the irregular particle shape and low energy transmission. This study analyzed 135 patients with head trauma, 80 patients (59%) injured by missiles and 55 patients (41%) by shrapnel. Glasgow Coma Scale (GCS) scores at admission were 3 to 7 in 69 patients, 8 to 10 in 29 patients, and 11 to 15 in 37 patients. The most common anatomical localizations were the right frontoparietal region in 42 patients and the left frontoparietal region in 40 patients. one hundred patients (74%) were operated on immediately and 35 patients (26%) were treated conservatively in the intensive care unit. Ten of the 135 patients died (7.4%), seven from missile injury and three from shrapnel injury. In this study, we found that high mortality was associated with low GCS score at admission, presence of multilobar or skull base injuries, and involvement of ventricles. Early and aggressive surgical intervention decreased the mortality.