Background/aim: Caudal epidural steroid injection (CESI) has been increasingly used for treating lower back pain. However, there is still significant controversy about the efficacy and safety of different imaging techniques used to guide CESI. In this context, the objective of this study is to compare the efficacies of fluoroscopy- and ultrasonography-guided CESI in patients with chronic lower back pain. Materials and methods: The population of this retrospective, observational study consisted of all consecutive patients who underwent CESI for lower back pain between 2018 and 2020. Of the 371 patients included in the study sample, 192 had undergone fluoroscopy- guided CESI (Group F) and 179 ultrasonography-guided CESI (Group U). Patients' pain and functional statuses were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) immediately before (baseline) and after the procedure (postintervention day 0-D0), during the second week (D15), the first month (D30), and the third month (D90) after the procedure. Results: The mean age of Group F was significantly higher than that of Group U (p < 0.001). The number of patients with lumbar disc hernia was significantly higher in Group U, whereas the number of patients with spinal stenosis and lumbar disc hernia + spinal/lumbar stenosis was significantly higher in Group F (p = 0.001). The baseline and D0 ODI scores were significantly lower in Group U than in Group F (p = 0.006 and p = 0.017, respectively). There was no significant difference between the groups in other VAS and ODI scores (p > 0.05). Intragroup analyses revealed significant reductions in VAS and ODI scores over the follow-up period till D30 compared to the baseline scores in each group (p < 0.001). The decrease recorded in the ODI score between the D15 and baseline measurements was significantly higher in Group F than in Group U (p = 0.006). Conclusion: The CESI was as effective as fluoroscopy-guided CESI in treating chronic lower back pain.

Objective: This study aimed to compare the clinical outcomes of navigation-assisted and conventional (freehand) ventriculoperitoneal (VP) shunt placement in pediatric hydrocephalus patients. Methods: A retrospective review was conducted of 164 patients under the age of 18 who underwent VP shunt placement for hydrocephalus between 2015 and 2023 and had a minimum postoperative follow-up of 12 months. The conventional technique was used in 116 patients. The navigation-assisted technique (intraoperative ultrasonography or frameless neuronavigation) was used in 48 patients. Demographic data, hydrocephalus etiology, catheter tip position (Yim classification), revision rates, infection, complications, and length of hospital stay were recorded. Catheter tip position was assessed on postoperative imaging by two independent investigators. Results: No significant differences were found between the groups in terms of age, sex, and hydrocephalus etiology. The optimal catheter placement rate was significantly higher in the navigation-assisted group compared to the conventional technique (81.25% vs. 60.34%, p = 0.017). The revision rate was significantly lower in the navigation-assisted group (16.67% vs. 38.79%, p = 0.010). The mean hospital stay was shorter in the navigation-assisted group (7.85 ± 3.97 days vs. 10.20 ± 3.70 days, p < 0.001). The groups were similar in terms of infection (2.08% vs. 9.48%, p = 0.183) and overall complication rates (14.58% vs. 16.38%, p = 0.959). Conclusions: Navigation-assisted VP shunt placement in pediatric hydrocephalus patients is associated with a high rate of optimal catheter position, a low revision rate, and a short hospital stay. These findings support the use of navigation technology in pediatric hydrocephalus surgery, but also reveal that infection and complications are unassociated with the surgical technique.

Aim: This study aimed to evaluate the diagnostic performance of the Delta Neutrophil Index (DNI) and Neutrophil-to-Lymphocyte Ratio (NLR) in distinguishing malignant from benign primary brain tumors during the preoperative period. Methods: This retrospective cohort study was conducted at a tertiary university hospital. A total of 140 participants were included 60 patients with malignant glial tumors, 50 patients with benign brain tumors, and 30 healthy controls without inflammatory, infectious, or hematologic disease. Preoperative complete blood count results obtained within seven days before surgery were analyzed. Results: Patients with malignant tumors were significantly older than those in the benign and control groups (p < 0.001). DNI, NLR, PLR, MLR, and SII values were all significantly elevated in the malignant group (p < 0.001, for all comparisons). ROC analysis revealed high diagnostic accuracy for DNI (AUC = 0.847) and NLR (AUC = 0.850), with optimal cut-off values of 3.50 and 3.95, respectively. In multivariable logistic regression adjusted for age, DNI > 3.5 (OR = 20.67; 95% CI: 3.35–127.64; p = 0.001), NLR > 3.95 (OR = 21.17; 95% CI: 3.28–136.50; p = 0.001), and CRP (OR = 1.52; 95% CI: 1.20–1.93; p = 0.001) remained independent predictors of malignancy. The combined model including DNI and NLR achieved the highest diagnostic accuracy (AUC = 0.937; age-adjusted AUC = 0.943), with a sensitivity of 88.3% and a specificity of 86.0% after age adjustment. Conclusions: Both DNI and NLR demonstrated significant value in differentiating malignant from benign primary brain tumors prior to surgery, with DNI emerging as the most powerful independent predictor. The combined use of DNI and NLR substantially improved diagnostic accuracy, suggesting that simple hematologic indices may serve as practical, noninvasive adjunctive tools in the preoperative assessment of brain tumor malignancy. These markers may assist in surgical prioritization, patient counseling, and clinical decision-making, particularly in resource-limited settings.

Effect of Thiocolchicoside on Midline Closure in Early Chicken Embryos - Cyprus Journal of Medical Sciences

Amaç: Bu çalışmada Kahramanmaraş ili sınırları içerisinde doğan bebeklerde nöral tüp defekti (NTD) sıklığının belirlenmesi, NTD’li bebeğe sahip ailelerin sosyo-demografik özelliklerinin, annelerin gebelikleri süresince özellikle ilk trimestrda teratojen etkenlere maruz kalıp kalmadığının araştırılmasıdır. Gereç ve Yöntemler: Ocak 2000-Aralık 2013 tarihleri arasında Kahramanmaraş ili sınırları içerisindeki canlı ve ölü doğum kayıtları retrospektif olarak değerlendirilmiş ve Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Hastanesi Nöroşirurji kliniği dahil Kahramanmaraş ilinde Nöroşirurji kliniği barındıran tüm hastanelerde NTD tanısı alan hastalar incelenmiştir. Sosyodemografik özellikler, gebeliğin ilk trimestrında karşılaşılan teratojen etkenler, anne ve babaların meslekleri, aylık maddi gelirleri ve akrabalık durumları, annelerin ateşli hastalık geçirme öyküsü, ilaç ve alkol kullanımları anket yöntemiyle değerlendirildi. Bulgular: Çalışmamızda 907 NTD’li hasta değerlendirildi. Hastaların 702’sinde (%77.4), spina bifida, 528’inde (%58.2) meningomyelosel,134’ünde (%14.8) meningosel, 40’ında (%4.4) dermal sinüs traktı, 107’sinde (%11.8) anensefali, 98’inde (%10.8) ensefalosel tanısı mevcuttu. Kahramanmaraş ilinde NTD sıklığı ‰3.83 olarak bulundu. Hastalardan 574’ü (%63.2) kadın, 333’ü (%36.8) erkek cinsiyetteydi. Olguların ebeveyn meslekleri değerlendirildiğinde işsizler veya ayda birkaç gün işçi olarak çalışanlar anlamlı oranda yüksekti. Ailenin gelir seviyesi ve annelerin eğitim seviyesi düşüktü. NTD’li bebeğe sahip annelerin gebelikleri sırasında folik asit preperatı kullanım oranının ise çok düşük olduğu görüldü (%11.4). Sonuç: Çalışmamızda Kahramanmaraş ilinde NTD görülme sıklığı ülkemizdeki benzer çalışmalar içinde göreceli olarak yüksek bulunmuştur. NDT’li bebeklerin ailelerinin düşük sosyoekonomik düzeyde olması ve annelerin yetersiz eğitim seviyeleri sonucu gebelik öncesi dönemde veya gebelik esnasında folik asit kullanımının ilimizde ciddi olarak düşük olması bu yüksek NTD sıklığının sebebi olabilir. Ayrıca NTD hastalarında doğumda veya sonradan ortaya çıkabilecek ek patolojiler olabileceği ve bu hastaların multidisipliner yaklaşımla, deneyimli kliniklerce takip ve tedavisinin yapılması gerektiği sonucuna ulaşılmıştır.