Adnan Tüfek

The complications of transforaminal lumbar epidural steroid injections.

Study Design. A prospective observational study. Objective. In this study, we aimed to investigate the major and minor complications of transforaminal lumbar epidural steroid injections guided by fluoroscopy and the incidence of vascular penetration encountered during this procedure. Summary of Background Data. Epidural steroid administration is one of the treatment options for lumbar disc hernia accompanied by radiculopathy. This method, initially applied by blind interlaminar technique, has generally been performed by fluoroscopically guided transforaminal method now. The complications of this method cause to a serious concern. The complications of this intervention have been reported by either mostly retrospective studies or case reports until now. Prospective studies with large patient series are needed to determine the types and incidences of the complications. Methods. In this study carried out for more than 5 years, major and minor complications of transforaminal lumbar epidural steroid injections were investigated prospectively. All of the interventions were performed under fluoroscopic guidance by the same physician using a standardized method. A follow-up was made once in the third week. The complications encountered during the procedure and in the third week were prospectively recorded. In addition, the incidence of vascular penetration that is potentially hazardous is included in the study. Results. A total of 562 patients were performed 1305 times transforaminal lumbar epidural steroid. The overall incidence of vascular penetration encountered was 7.4%. Although major complications were not seen, the total rate of all minor complications was 11.5%. Whereas all of the minor complications were transient, the most frequent minor complication was vasovagal reaction (8.7%). Conclusion. On the basis of the results of this study in which only minor complications were encountered, it can be said that the frequency of major complications is pretty rare in transforaminal lumbar epidural steroid injections in expert hands and in the conditions in which safety precautions are taken.

The protective effects of dexmedetomidine on the liver and remote organs against hepatic ischemia reperfusion injury in rats.

AIM To investigate the protective effects of dexmedetomidine against hepatic ischemia/reperfusion (IR) injury and hepatic IR induced remote organ injury. METHODS Forty Wistar albino rats were divided into the following four groups: sham, dexmedetomidine, IR, and IR + dexmedetomidine. Hepatic ischemia was created by the Pringle maneuver for 30 min followed by a 30 min reperfusion period in the IR and IR + dexmedetomidine groups. The dexmedetomidine and IR + dexmedetomidine groups were administered dexmedetomidine (100 μg/kg, single dose) intraperitoneally after the anesthesia insult. Blood samples and hepatic, renal, and lung tissue specimens were obtained to measure serum and tissue total oxidative activity (TOA), total antioxidant capacity (TAC), paraoxonase (PON-1), and oxidative stress index (OSI) after 60 min in all groups. RESULTS According to the biochemical analyses of the samples taken from the serum and the liver, lung, and kidney tissues, when comparing the sham group and the IR group, TOA and OSI values were higher in the IR group, while TAC and PON-1 values were lower (p < 0.05). It was observed that TOA and OSI values were significantly lower, while TAC and PON-1 values increased with dexmedetomidine treatment (p < 0.05). In addition, dexmedetomidine ameliorated hepatic histopathological changes inducing IR, but there were no significant histopathological changes in the remote organs. CONCLUSION This study demonstrated that dexmedetomidine markedly reduced the oxidative stress in serum, liver, and remote organs induced by hepatic IR injury, and ameliorated the histopathological damage in the liver.

The anti-oxidant and anti-apoptotic effects of nebivolol and zofenopril in a model of cerebral ischemia/reperfusion in rats.

The aim of this experiment was to investigate whether nebivolol and zofenopril have protective effects against oxidative damage and apoptosis induced by cerebral ischemia/reperfusion (I/R). There were seven groups of rats, with each containing eight rats. The groups were: the control group, I/R group, I/R plus zofenopril, I/R plus nebivolol, I/R plus nebivolol and zofenopril, zofenopril only and nebivolol only. Cerebral I/R was induced by clamping the bilateral common carotid artery and through hypotension. The rats were sacrificed 1h after ischemia, and histopathological and biochemical analyses were carried out on their brains. The total antioxidant capacity was evaluated by using an automated and colorimetric measurement method developed by Erel. I/R produced a significant increase in the levels of total oxidant status and malondialdehyde levels, the number of caspase-3 immunopositive cells and activities of prolidase and paraoxonase in brain when compared with the control group (p<0.05). A significant decrease in brain total antioxidant capacity and nitric oxide levels were found in I/R group when compared with the control group (p<0.05). Both nebivolol and zofenopril treatment prevented decreasing of the total antioxidant capacity and nitric oxide levels, produced by I/R in the brain (p<0.05). Both nebivolol and zofenopril treatment prevented the total oxidant status, malondialdehyde levels, activities of paraoxonase and prolidase from increasing in brains of rats exposed to I/R (p<0.05). In conclusion, both nebivolol and zofenopril protected rats from ischemia-induced brain injury. The protection may be due to the indirect prevention of oxidative stress and apoptosis.

Cooled radiofrequency application for treatment of sacroiliac joint pain

BackgroundThe unavailability of an effective and long-lasting treatment for sacroiliac-based pain has led researchers to study the efficacy of radiofrequency in denervation. In this study, we aimed to investigate the efficacy and safety of novel cooled radiofrequency application for sacral lateral-branch denervation.MethodsPatients experiencing chronic sacroiliac pain were selected for our observational study. Fluoroscopy guidance cooled radiofrequency denervation was applied on the L5 dorsal ramus and the S1-3 lateral branches on patients who had twice undergone consecutive joint blockages to confirm the diagnosis and obtained at least 75% pain relief. At the 1st, 3rd and 6th month postoperatively, the patients’ pain was evaluated using a visual analog scale (VAS), and their physical function was evaluated with the Oswestry Disability Index (ODI).ResultsCooled radiofrequency was applied on a total of 15 patients. Prior to the procedures, the median VAS score (interquartile range) was 8 (7–9), but at the 1st, 3rd and 6th month, this had fallen to 3 (1–4), 2 (1–3) and 3 (2–4). The baseline median ODI score (interquartile range) was 36 (32–38), while at the 1st, 3rd and 6th month, it was 16 (8–20), 12 (9–18) and 14 (10–20), respectively. At the final control, while 80% of the patients reported at least a 50% decline in pain scores, 86.7% of those reported at least a ten-point reduction in ODI scores.ConclusionIt was seen that the cooled radiofrequency used for sacroiliac denervation was an effective and safe method in the short to intermediate term.

Intra-articularly applied pulsed radiofrequency can reduce chronic knee pain in patients with osteoarthritis.

Background: Osteoarthritis (OA) is the most widespread chronic joint disease worldwide. Symptomatic knee OA is observed in approximately 12% of individuals more than 60 years of age. Conservative treatments models may not be effective always, and that some of them have serious adverse effects that prompted the researchers to research different treatment methods. In this study, we investigated short‐ and mid‐term effectiveness of intra‐articular pulsed radiofrequency (PRF) applied in patients with chronic knee pain due to OA. Methods: This study was carried out in the pain management center of a university hospital between January 2009 and June 2009. The patient record files of 31 patients who received intra‐articular PRF were retrospectively reviewed. The antero‐lateral area of the knee, where the intervention would be applied, was anesthetized with 1% lidocaine. An introducer needle was placed intra‐articularly. PRF was started as 42°C at 2 Hz for 15 minutes. The pain of the patients was evaluated by 10 cm Visual Analog Scale (VAS). Furthermore, the ages, the gender, the symptom duration of the patients, the side of the knee on which the intervention was applied, and the complications were collected for statistical evaluation. Results: Although the mean initial VAS scores of the patients were 6.1 ± 0.9 cm, it was found, respectively, to be 3.9 ± 1.9 cm and 4.1 ± 1.9 cm at the first‐ and sixth‐month follow‐ups. In general, a decrease of 32.8% in mean in the VAS scores was achieved in the last follow‐up; whereas the rate of patients reporting a minimum decrease of 2 points in the VAS scores was 64.5% and the rate of patients reporting a decrease of ≥50% in their pain was calculated as 35.5%. Conclusion: PRF applied to the knee joint appears to be an effective and safe method.

Thymoquinone treatment against acetaminophen-induced hepatotoxicity in rats

AIM In this study, we aimed to examine the efficacy of thymoquinone (TQ) treatment in acetaminophen-induced liver toxicity in rats. METHODS Forty Wistar Albino rats were used for the study (four groups, with 10 rats for each group). Animals in the control group were not given any medication. In the thymoquinone (TQ) group, animals were given three times 5 mg/kg oral thymoquinone for every six hours, which equals to a total dose of 15 mg/kg. In the acetaminophen (APAP) group, animals were given APAP at a single dose of 500 mg/kg orally. In the APAP + TQ group, animals were given 500 mg/kg APAP orally followed by three doses of TQ at a 15 mg/kg total dose in an 18-h time interval. All animals were sacrificed at the 24th hour. Alanine amino transferase (ALT), aspartat amino transferase (AST), superoxide dismutase (SOD), oxidized glutathione (GSSG), glutathione peroxides (GSH-Px), and malondialdehyde (MDA) activities were measured in rat blood. Histopathological examination was also performed. RESULTS Serum ALT, AST levels, GSSG, and SOD activity as well as the serum and tissue MDA levels were found to be higher in the APAP group than in the control group (p ≤ 0.001). Likewise, serum GSH-Px activity was found to be lower in the APAP group (p ≤ 0.001). In contrast, in the APAP + TQ group, serum ALT, AST levels, GSSG, SOD activity and the serum and tissue MDA levels were found to be lower compared to that of the APAP group. This difference was statistically significant (p ≤ 0.001). In the APAP + TQ group, the GSH-Px activity was found to be significantly higher compared to the APAP group (p < 0.05). In contrast to this finding, the GSH-Px activity in the APAP + TQ group was found to be lower than that of the control group (p ≤ 0.001). Histopathological analysis revealed significant liver necrosis and toxicity with a high dose of APAP where TQ treatment was related with significantly lower liver injury scores. CONCLUSION TQ treatment may have an important therapeuthic effect via the upregulation of antioxidant systems in the APAP-induced liver hepatotoxicity in rats.

Radiation-free percutaneous nephrostomy performed on neonates, infants, and preschool-age children

AIM The aim of this study was to evaluate the effectiveness and safety of high-frequency linear probe ultrasonographic (US) guidance percutaneous nephrostomy (PN) in terms of diagnostic and therapeutic approach in preschool-age children with urological problems. MATERIALS AND METHODS PN was performed on 40 kidneys in 33 patients (13 girls, 20 boys) aged 3 days - 7 years (mean 4.1 years). All procedures were performed with US guidance utilizing a Shimadzu SDU 2200 Xplus 5-10 mHz probe. Complete blood count, urinalysis, bladder urine culture, blood urea, and creatinine values were obtained before PN placement on the same day. Urine cultures were obtained by nephrostomy tube and compared to bladder urine culture. RESULTS PN procedures were technically successful in 39 kidney units (97.5%). Two major complications were macroscopic hematuria requiring blood transfusions (1 case) and sepsis (1 case). Minor complications were displacement of the catheter (4), urinary tract infection (4), urine extravasation (1), early dislocation of the catheter (1). In three cases, the catheter was replaced. Analysis of bladder urine showed that 13 patients (39.4%) had positive cultures, but analysis of PN urine showed that 25 patients (78.1%) had positive cultures. CONCLUSIONS PN is an easy, safe and efficient diagnostic and therapeutic procedure with few complications even in preschool-age children. The antibiotic regimen should be revised in order to avoid sepsis and urinary tract infection.

The comparison of neuroprotective effects of intrathecal dexmedetomidine and metilprednisolone in spinal cord injury

BACKGROUND The purpose of this study is the investigation of the effects of intrathecally injected dexmedetomidine and methylprednisolone and their dominancy over one another in rats with generated Spinal Cord Injury (SCI). METHODS 40, female, adult Wistar Albino rats weighing 220-260 g were included in the study. The rats were fixed with Intrathecal catheter (IT) and divided into four groups. All subjects were applied T7-10 laminectomy after catheter. Group S (n:10) was injected with IT 10 μL isotonic saline; Group C (n:10) with IT 10 μL isotonic saline after SCI; Group D (n:10) with IT one doze 10 μL of dexmedetomidine after SCI; Group M (n:10) IT one dose 10 μL of methylprednisolone. The subjects were sacrificed 72 h after this operation. The damaged area was removed biochemically and histopathologically examined. RESULTS Antioxidant and inflammatory parameters searched for in all damages tissue were statistically different in all groups from group S. They were different in group M and group D than group C (p < 0.001). After the comparison of group D and group M, PON and IL6 values were higher in group D (p = 0.003, p = 0.035) while the other two biochemical parameters were similar in both groups (Table 1). After histopathologic trials, edemas, bleeding and necrosis were found less in group S while at the most in group C (p < 0.001). In group M and group D, however, they were higher than group S and lower than group C (p < 0.001). After the comparison of group D and group M, while there was no difference in terms of edema necrosis, the amount of bleeding was lower in group D (p < 0.001) (Table 2). CONCLUSIONS It has been discovered that intrathecal use of dexmedetomidine caused neuroprotective effects similar to methylprednisolone.

The Forgotten Ureteral Stent in Children: From Diagnosis to Treatment

PURPOSE We conducted a multicenter pediatric study of ureteral stents unintentionally left in situ. MATERIALS AND METHODS A total of 22 patients with encrusted Double-J® ureteral stents unintentionally left in situ were treated at 4 centers between January 2007 and March 2012. Stone burdens were estimated using plain radiography and computerized tomography. Treatment decision was made based on clinical and radiological findings or stone burden. RESULTS Nine girls and 13 boys with a mean age of 9.5 years (range 2 to 16) were analyzed. Mean indwelling time of ureteral stent was 21.7 months (range 6 to 60). Stents were inserted for the indication of urolithiasis (17 patients) and reconstructive urological intervention (5). In 2 patients stents had been placed bilaterally. Mean stent stone burden was 184 mm(2) on plain radiography and 247 mm(2) on computerized tomography, a difference that was statistically significant (p = 0.002). Shock wave lithotripsy was done in 6 cases. Endoscopic procedures were performed in all patients, including ureteroscopy in 8, simple stent removal in 7, endoscopic cystolithotripsy in 6, percutaneous nephrolithotomy in 5, retrograde intrarenal surgery in 3 and percutaneous cystolithotripsy in 2. Surgical removal of each stent required a mean of 1.5 interventions and a mean hospital stay of 4.4 days. CONCLUSIONS At experienced centers combined endourological techniques can achieve successful and safe management of forgotten stents even in the pediatric age group. Thus, routine preprocedural tomography is a must in children with forgotten ureteral stents.

Effectiveness of nucleoplasty applied for chronic radicular pain

Summary Background Over the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than 1 year. Material/Methods Patients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index. Results Mean VAS that was 8.7±1.1 before the procedure was determined to be 3.4±1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1±10.2 in the beginning, they went down to 33.9±14.9 at the end of 2 years. The percent of those stating “good” and “excellent” satisfaction was 66% (23 persons) on the last follow-up. Conclusions While it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.