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    Percutaneous treatment of lumbar synovial cyst: A case report
    (Acta Medica Mediterranea, 2014) Erbas, Mesut; Ozdemir, Ugur; Toman, Huseyin; Sahin, Hasan; Savluk, Omer Faruk; Luleci, Nurettin
    Introduction and aims: Synovial cysts are benign cystic lesions that form when the joint capsule is worn during joint movement and synovial fluid leaks out. Intraspinal synovial cysts in the lumbar region are generally diagnosed when investigating patients who complaints of back pain or other symptoms which could be attributed to radiculopathy. The aim of this paper is to present the use of the percutaneous needle aspiration method with tomography guidance to treat an L4-L5 synovial cyst causing radicular symptoms. Case report: A 40-year old female, with a 5-year complaint of back pain, applied to our clinic with recent increase in existing complaints and the addition of left leg pain. Lumbar computed tomography and magnetic resonance imaging examinations showed at L4 vertebra corpus level in the spinal canal right posterolateral recess, neighboring the right L5 nerve root, a 9x7x4 mm T2 hyperintense, T1 hypointense nodular appearance. A percutaneous cyst aspiration was planned and after aseptic conditions were ensured, a 22 G spinal needle was used to aspire the fluid in the synovial cyst between L4-L5 guided by tomography images and 80 mg methyl prednisone with 6 ml 0.25% bupivacaine were injected into cyst and the procedure was completed. Discussion and conclusion: In symptomatic lumbar synovial cyst cases percutaneous cyst aspiration, steroid injection or surgical resection may be chosen. However as percutaneous cyst aspiration has a lower rate of complications such as infection, bleeding, nerve damage and dural puncture compared to surgical treatment, it should be first choice.
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    PERCUTANEOUS TREATMENT OF LUMBAR SYNOVIAL CYST: A CASE REPORT
    (Carbone Editore, 2014) Erbas, Mesut; Ozdemir, Ugur; Toman, Huseyin; Sahin, Hasan; Savluk, Omer Faruk; Luleci, Nurettin
    Introduction and aims: Synovial cysts are benign cystic lesions that form when the joint capsule is worn during joint movement and synovial fluid leaks out. Intraspinal synovial cysts in the lumbar region are generally diagnosed when investigating patients who complaints of back pain or other symptoms which could be attributed to radiculopathy. The aim of this paper is to present the use of the percutaneous needle aspiration method with tomography guidance to treat an L4-L5 synovial cyst causing radicular symptoms. Case report: A 40-year old female, with a 5-year complaint of back pain, applied to our clinic with recent increase in existing complaints and the addition of left leg pain. Lumbar computed tomography and magnetic resonance imaging examinations showed at L4 vertebra corpus level in the spinal canal right posterolateral recess, neighboring the right L5 nerve root, a 9x7x4 mm T2 hyperintense, T1 hypointense nodular appearance. A percutaneous cyst aspiration was planned and after aseptic conditions were ensured, a 22 G spinal needle was used to aspire the fluid in the synovial cyst between L4-L5 guided by tomography images and 80 mg methyl prednisone with 6 ml 0.25% bupivacaine were injected into cyst and the procedure was completed. Discussion and conclusion: In symptomatic lumbar synovial cyst cases percutaneous cyst aspiration, steroid injection or surgical resection may be chosen. However as percutaneous cyst aspiration has a lower rate of complications such as infection, bleeding, nerve damage and dural puncture compared to surgical treatment, it should be first choice.
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    Öğe
    Sedation for transesophageal echocardiography: Comparison of propofol, midazolam and midazolam-alfentanil combination
    (Medical Association of Zenica-Doboj Canton, 2016) Toman, Huseyin; Erkılınc, Atakan; Kocak, Tuncer; Guzelmeric, Fusun; Savluk, Omer Faruk; Dogukan, Mevlut; Acar, Goksel
    Aim The administration of trans esophageal echocardiography (TEE) may cause nausea, shortness of breath, agitation, emotional distress and pain in patients due to pharyngo-esophageal intubation, which may be partially relieved by sedoanalgesia. The aim of this study was to compare clinical effects of midazolam, midazolam-alfentanil combination and propofol sedation given for sedation and sedoanalgesia to patients with planned diagnostic TEE interventions. Methods This study was prospectively completed with 90 randomized adult patients in ASA risk groups I-II-III. Group M were given 2.5 mg midazolam, group MA were given 1 mg midazolam and 5 ?g/kg alfentanil and group P were given 0.5 mg/kg propofol intravenous bolus. If necessary, additional doses were administered. Patients administered with TEE were evaluated in terms of additional dose requirements, Ramsey Sedation Scale (RSS), modified Aldrete Scoring (MAS), recovery time and duration of stay in the hospital. Results In the group P additional dose requirements were greater (p<0.05), as well as the duration of stay in the recovery unit and hospital were shorter (p<0.05). On insertion of the TEE probe, the RSS in the group P was clearly higher than in other groups M and MA (p<0.05). Conclusion During the TEE intervention, the use of propofol, contrary to requirements for additional dose and observation of apnea, appears to be advantageous due to providing more rapid and effective sedation depth without a need of expensive antagonist agents, and allowing early discharge of patients. Additionally, it seems that the use of midazolam combined with alfentanil, is more advantageous comparing to midazolam alone. © 2016, Medical Association of Zenica-Doboj Canton. All rights reserved.