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Guclu B.,Dr Lutfi Kirdar Egitim ve Arastirma Hastanesi | KazancI B.,Ufuk University | KazancI A.,Ataturk Arastirma ve Egitim Hastanesi | TehlI O.,GATA Askeri Hastanesi
Journal of Neurological Sciences | Year: 2015

We report a 21-year-old man who was admitted to physical therapy clinic and had low back and left leg pain for 6 months. Magnetic resonance imaging (MRI) showed L5-S1 central disc herniation and the patient underwent physical therapy for 2 weeks. However patient's symptoms were worsened, and before surgical intervention, more radiologic investigations were planned. X-ray and computed tomography (CT) scan showed an L5 posterior endplate fracture. MRI is the standard modality for diagnosing lumbar disc herniation, but other diseases mimicking lumbar disc herniation may be overlooked in an MRI. As there are many different diseases that might be misdiagnosed as lumbar disc herniation, for accurate diagnosis, other diagnostic modalities besides MRI should be used to provide the appropriate surgical strategy. © 2015, Ege University Press. All rights reserved. Source

Koktekir E.,Selcuk University | Ceylan D.,Sakarya University | Tatarli N.,Dr Lutfi Kirdar Egitim ve Arastirma Hastanesi | Karabagli H.,Selcuk University | And 2 more authors.
Spine Journal | Year: 2014

Background context We retrospectively analyzed a total of 1,218 pedicle screws for accuracy, with postoperative computed tomography (CT), in 198 patients who were operated on between March 2004 and September 2012. Purpose To determine the incidence of screw misplacement in patients who received a transpedicular screw fixation, with intraoperative fluoroscopy in the lateral and lateral with anteroposterior (AP) positions. The results are compared between the two groups. Study design Retrospective comparative study of accuracy of pedicle screw placement in thoracic and lumbar spine. Patient sample The sample consists of 198 consecutive patients who underwent transpedicular screw fixation. Outcome measures Accuracy of screw placement was evaluated by postoperative CT scan. Misplacement was defined in cases where more than 25% of the screw size was residing outside the pedicle. Methods The indications for hardware placement, radiologic studies, patient demographics, and reoperation rates were recorded. Five hundred twenty-eight screws (Group A, n=81) were inserted into the vertebral body with the assistance of lateral fluoroscopy only, whereas 690 screws (Group B, n=117) were inserted with the assistance of lateral fluoroscopy, and the final positions of the screws were checked with AP fluoroscopy. Results A total of 1,218 screws were analyzed, with 962 screws placed at the lumbosacral region and 256 screws at the thoracic region. According to the postoperative CT scan, 27 screws (2.2%) were identified as breaching the pedicle. Nineteen of them (3.6%) were in Group A, whereas 8 (1.16%) were in Group B. The rate of pedicle breaches was significantly different between Group A and B (p=.0052). In Group A, the lateral violation of the pedicle was seen in 10 screws (1.9%), whereas medial violation was seen in 9 screws (1.7%). In Group B, the lateral violation of the pedicle was seen in six screws (0.87%), whereas medial violation was seen in two screws (0.29%). The medial and lateral penetration of screws were significantly different between Groups A and B (p<.05). A pedicle breach occurred in 21 patients, and 15 of them underwent a revision surgery to correct the misplaced screw. Of these patients, 11 (13.6%) were in Group A, and 4 (3.4%) were in Group B (p=.0335). Conclusions In this study, we evaluated and clarified the diagnostic value of intraoperative fluoroscopy in both the lateral and AP imaging that have not yet been evaluated in any comparative study. We concluded that the intraoperative use of fluoroscopy, especially in the AP position, significantly decreases the risk of screw misplacement and the results are comparable with other advanced techniques. © 2014 Elsevier Inc. All rights reserved. Source

Yucel N.,Dr Lutfi Kirdar Egitim ve Arastirma Hastanesi | Madenci O.C.,Dr Lutfi Kirdar Egitim ve Arastirma Hastanesi | Dagdelen L.,Dr Lutfi Kirdar Egitim ve Arastirma Hastanesi | Aksoy D.,Izmir Bozyaka Egitim Ve Arastirma Hastanesi | Kaptanagas A.O.,Dr Lutfi Kirdar Egitim ve Arastirma Hastanesi
Turkish Journal of Biochemistry | Year: 2013

Aim: It has been known for a long time that the presence of clinically silent hemoglobin (Hb) variants in blood samples could influence the measurement of glycohemoglobin (HbA1c) since these abnormal hemoglobins might interfere with some methodologies. In the present study we describe the first case of Hb Beckman in Turkey. Material and Methods: The variant was detected during the HbA1c measurement by cation exchange high performance chromatography (CE-HPLC) in a patient with diabetes mellitus. Since a HbA1c result could not be obtained by this method, the test was repeated by boronate afinity HPLC. Results: Fur ther investigation performed in order to identify the variant revealed heteroz ygote Hb Beckman 135 GCT-GAT (Ala --> Asp) which explained the inappropriate HbA1c result by CE-HPLC. Conclusion: This new case of Hb Beckman is thought to be a modest contribution to the subject of abnormal hemoglobins that interfere the HbA1c measurement. Source

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