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Decompression, spinal distraction and fusion in nerve root compression due to Paget's disease
No full textAğrı ve kas zaafına yol açan kök basısı bulunan Paget hastalıklı bir olgu sunularak manyetik rezonans görüntüleri ve tedavi yöntemleri üzerinde durulmuştur. Paget hastalığındaki kontrolsüz ve fazla kemikleşme, manyetik rezonans görüntülemede kortikal bölgede kalınlaşma olarak görülür. Omur cismi yayvanlaşmıştır. İlik dokusu azalmış ve bağ dokusuyla bölünmüştür. Muhtemelen artmış dolaşım ve venöz göllenmeye bağlı olarak kontrast madde tutar. Paget hastalıklı omur nöral dokuya bası yaparsa cerrahi serbestleştirme yapılabilir. Hastamızda hem tanıyı doğrulamak hem de kökü serbestleştirmek için hemilaminektomi ve foraminotomi yapıldı. Ayrıca pedikül vidası yardımıyla omurga gerilerek köklerin daha da rahatlaması sağlandı ve füzyon uygulandı. Omurganın gerilmesinin kanalı genişlettiği bilinmektedir. İç sabitleyiciyle germe ve arka elemanlara füzyon işlemi hastalıklı ön ve orta kolonlara binecek yükü azaltarak çökme ve yayvanlaşmanın önüne geçecektir. Paget hastalığında artmış osteoblastik aktiviteyle hiperostoz ile blok omurgaya eğilim vardır ve bu sayede füzyon oluşması da kolaydır. Bu girişimlerden yararlanan hastanın tedavisi kalsitonin ile sürdürüldü ve takip edildiği sürede yakınması olmadı.A case of Paget's disease causing radicular pain and reduced muscle power is presented. MR imaging and therapeutic features are discussed. Excessive and uncontrolled bone reformation is imaged as decreased signal intensity in enlarged cortical areas on MR. The vertebra is flattened. The marrow is reduced and divided by connective tissue and is enhanced probably because of increased circulation and venous pooling. Surgical decompression is considered if Paget's disease of the vertebral column causes neural compression. We performed hemilaminectomy and foraminotomy to decompress the nerve root and for histological confirmation. Further root decompression is obtained by vertebral distraction by pedicle screw system, and osseous fusion is added. It is known that distraction improves the stenotic canal and foramen; besides internal fixation and fusion of the posterior elements reduce the pressure on the affected anterior and medial columns. Diffuse idiopathic skeletal hyperostosis has been reported in Pagetic patients and this may facilitate vertebral fusion. The patient benefited from the surgical procedure and remained asymptomatic during the follow-up under calcitonin treatment
Bası yarası karsinomu: Bir olgu bildirisi
No full textObservation.- Pressure sore carcinomas are ra¬rely seen. They have a high recurrence rate with poor prognosis. Generally they require radical sur¬gical excision and elective lymph node dissection. A male patient suffering from paraplegia secon¬dary to a spinal cord injury, for 20 years is repor¬ted, The histopathological examination of the sac¬ral pressure sore which developed 15 years later revealed a well- differentiated squamous cell car¬cinoma. Here we present a review of the literature and the details of the surgical therapy instituted
Effect of epidermal growth factor receptor status on the outcomes of patients with metastatic gastric cancer: A pilot study
No full textİstanbul Bilim Üniversitesi, Tıp Fakültesi.The expression of epidermal growth factor receptor (EGFR) has been linked to clinical outcome in several solid tumors. However, the clinical significance of EGFR (c-erbB1) in gastric cancer remains unclear. The present study was designed to detect the clinical implications of EGFR in the Turkish population. Paraffin-embedded tissue microarrays containing gastric cancer tissue were obtained from 30 patients. EGFR expression was detected using immunohistochemistry. The correlation of this biomarker to the clinicopathological features and survival of patients with gastriccancer was studied. The overall positivity rate of EGFR was 63.3%. EGFR expression was significantly correlated with an improved progression-free survival (PFS) and overall survival (OS) rate (P=0.039 and 0.01, respectively). EGFR expression is a good prognostic marker for patients withgastric cancer