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    Abdominal aortic aneurysm surgery: retroperitoneal or transperitoneal approach?
    (Minerva Medica, 2006) Çınar, B.; Göksel, Onur; Kut, S.; Çetemen, Şebnem; Şahin, S.; Eren, Emin Ergen
    Aim. Mortality and morbidity of abdominal aortic aneurysm surgery have decreased significantly in time and transperitoneal approach (TPA) still preserves its popularity although retroperitoneal approach (RPA) is known to cause lower incidence and shortened duration of ileus, shorter intensive care unit (ICU) and hospital stay, earlier oral intake and less patient discomfort or pain. Methods. One hundred and fifty patients that underwent abdominal aortic aneurysm repair at our Cardiovascular Surgery Center between January, 1990 and March, 2000 were reviewed and analyzed based on the elective/emergent nature of the surgery and the type of the incision as either TPA or RPA. Results. Significantly shorter mechanical ventilation (15.2±3.8 vs 10.1±2.3 hours) and nasogastric decompression periods (40.6±10.7 vs 9.1±2.2 hours), less need for intravenous fluid supplementation and shorter ICU stay (29.5±14.8 vs 18.6±1.9 hours) were observed with the retroperitoneal approach (P<0.001). Need for allogeneic blood transfusion was, similar (1.3±1.4 vs0.9±0.4, P>0.05). Analysis of mortality and morbidity revealed bleeding as the major cause of mortality for ruptured aneurysm. A similar comparison between TPA and RPA groups, however, revealed no significant difference (P>0.05). Conclusion. Retroperitoneal approach is a reliable technique causing less fluid-electrolyte imbalance with rapid restoration of gastrointestinal physiology. It causes less discomfort to patients with reduced need for analgesia. A shorter weaning period from mechanical ventilation is among the benefits for patients with co-morbid states.
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    Alien hand syndrome
    (2006) Şahin, S.; Tan, D.; Karşida?, S.
    Alien hand syndrome (AHS) refers to the occurrence of apparently purposeful movements in the hand which are independent of volitional control. Two subtypes of AHS have been proposed: 'anterior-motor' subtype with grasp reflex and impulsive manipulation of tools by the dominant hand and 'posterior-sensorial' subtype with hemispheric neglection. Here in a case of Corticobasal Ganglionic degeneration (CBGD), we report, anteriortype AHS with symptoms of impulsive grasping and apraxia in his left hand. Cranial magnetic resonance imaging (MRI) showed diffuse atrophy of cortex and periventricular millimetric ischemic-gliotic lesions. Single - photon emission computed tomography (SPECT) analysis labelled with 99m technetium hexamethylpropyleneamineoxime (Tc-99m-HMPAO) demonstrated hypoperfusion in the left frontal lobe and the temporo-parietal areas dominantly in the left hemisphere. In this article, we aim to review the literature about AHS based on our case's findings.
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    Could apomorphine be an effective treatment option for refractory tremor in Parkinson's disease? A pilot study
    (2013) Çınar, N.; Şahin, S.; Karşida?, S.
    Objective: We aimed to evaluate the extent of the clinical efficacy of intermittent subcutaneous apomorphine in addition to oral treatment in patients with Idiopathic Parkinson's Disease experiencing serious, refractory tremor despite the use of optimal oral dopaminergic medication. Treatment response was assessed with the motor section of the Unified Parkinson's Disease rating scale (UPDRS). Tremor, rigidity and bradykinesia were scored by using specific items of the UPDRS. Material and Method: The study group included 13 consecutive patients with Parkinson's disease who have refractory tremor. Increasing doses of 1 mg, 2 mg, 4 mg subcutaneous apomorphine were used; peak improvement dose and UPDRS scores were determined after 30 minutes. The patients have used oral dopaminergic treatment plus subcutaneous apomorhine and they have been followed on weekly phone calls. The completion of the study was defined as the end of the 1st month. Finally, the UPDRS motor scores of the patients were compared to the basal scores. Results: Three patients dropped out due to side effects. The average reduction rate of total UPDRS, tremor, bradykinesia and rigidity scores were found as 20.6%, 38.5%, 30.1% and 16.6% respectively. At the end of the first month, tremor, bradykinesia and rigidity scores were statistically improved in comparison to those of the baseline. Conclusion: Subcutaneous apomorphine combined to oral dopaminergic medications may provide effective relief in serious and refractory rest tremor as well as bradykinesia and rigidity in selected Parkinson patients.
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    Is herpes zoster merely a simple neuralgia syndrome?
    (TIP ARASTIRMALARI DERNEGI, 2011) Çınar, N.; Şahin, S.; Okluo?lu, T.; Batum, K.; Karşida?, S.
    Aim: Although, herpes zoster usually presents with postherpetic neuralgia (PHN) localized at single dermatome, it may also manifest with different clinical presentations. To clarify of these rare conditions, we aimed to examine the cases of PHN followed by our clinic in more details. Method: Medical records of 26 patients in total monitored by the neurology outpatient clinic for PHN between 2008 and 2010 were reviewed. Result: The mean age of the patients was 61.9±16.4 years, with a female-male ratio of 15/11. Ten of the patients (38%) had a chronic illness history such as solid cancer, lymphoma, diabetes mellitus, cardiac valve prosthesis and Parkinson's disease. Eight of the patients had trigeminal nerve lesions (ophthalmic in 7 and mandibular in 1), 3 had spinal cervical lesions, 8 had spinal thoracic lesions and 7 had spinal lumbar dermatomic lesions. Three (11.5%) patients had motor involvement (C7 in one and L4-L5 innervated muscles in two). Four patients (15.3%; symmetric sides of the same dermatome in two and at different dermatomes in another two) had multiple dermatomal involvements. Conclusion: Immunosuppression and advanced ages are known to facilitate varicella reactivation. By reviewing patients with zona zoster monitored by our clinic for accompanying conditions, anatomical localizations and presence of multiple dermatomal involvements, the present study emphasizes that zona may also cause 'motor involvement' besides sensory involvement. Our findings demonstrate that zona is a complex syndrome which may manifest as varying clinical presentations.