Ahmet Sukru Umur

The effects of meloxicam on neural tube development in the early stage of chick embryos.

AIM The aim of this study is to demonstrate the effect of meloxicam in early stage chick embryos on neural tube development. MATERIAL AND METHODS One hundred specific pathogen-free (SPF) chicken eggs were used to investigate the neurulation. SPF eggs were invastigated in four groups (n:25). All of the groups were incubated at 37.2 +/- 0.1 degrees C and 60 +/- 5 % relative humidity for 30 hours, and an embryological development in the ninth stage as classified by Hamburger and Hamilton was obtained. In the end of the 30th hour, group A(control group) was administered 0.1 ml of saline (0.9% NaCl) in ovo and the other groups were administered meloxicam in increasing doses. At the end of 72 hours, all of the embryos were extracted from eggs and they underwent pathological examination with hematoxylin eosine and immunohistopathological examinations with CD138 and tubulin beta II. RESULTS While the groups Aand B showed no neural tube defects, totally eight defective embryos were detected in the groups C and D (three in group C and five in group D. CONCLUSION Our results suggested that meloxicam, a nonselective COX inhibitor, caused neural tube closure defects when injected at supratherapeutic doses. However, further studies with larger numbers of subjects are needed for its use in lower doses.

Congenital dermal sinus tract of the spine: experience of 16 patients.

Congenital dermal sinus tract is a rare entity which lined by epithelial cells and can end anywhere between subcutaneous planes to thecal sac. These tracts may be accompanied with other pathologies such as lipomyelomeningocele, myelomeningocele, split cord malformation, tethered cord, filum abnormality and inclusion tumors and treatment includes resection of tract with intradural exploration. The authors review their experience with 16 cases. Clinical, radiological appearance and treatment of these lesions discussed with literature review.

Adult tethered cord syndrome mimicking lumbar disc disease

ObjectThis paper reports four tethered cord cases who initially applied with lumbar disk disease symptoms.Materials and methodsAll of them were investigated by magnetic resonance imaging (MRI) and somatosensory evoked potential (SSPE). In two patients, MRI revealed thick and fatty filum terminale, while in remaining two, the filum terminale appeared as normal in thickness. SSEP revealed pathological conduction values in all, and it was the main indicator for surgical sectioning in patients especially with normal MRI investigations. All patients had benefit from the surgical sectioning of the fila terminalia with either thick and fatty or normal appearance.ConclusionA particular patient with lumbar disc disease symptoms having normal MRI should also be investigated for tight filum terminale. If there is no pathological appearance in MRI investigation (both in regard to disc herniation and thick and fatty filum terminale), SSEP investigation should be done to check whether a conduction block or delay is present, indicating cord tethering.

Tethered Cord Syndrome in Adults: Experience of 56 Patients.

AIM The aim of this study was to describe the results of surgery performed in a group of adult patients with tethered cord syndrome with their outcomes. MATERIAL AND METHODS This retrospective study included 56 patients. There were 38 females and 18 males. All patients were older than 18 years. RESULTS The mean age at referral was 36 years and 1 month. The mean follow-up period was 10 months 27 days. 95% of all patients with back and leg pains improved and 5% remained the same. Three patients with motor deficits remained the same in the postoperative period. Of the 16 patients with urological complaints, 10 improved, 5 unchanged and 1 patient died in the postoperative first day due to pulmonary embolism. CONCLUSION The syndrome of tethered cord may be a situation to be treated even in the elderly in case of normal level conus medullaris and filum terminale with a normal appearance as well as a low-lying conus and thick filum. To prevent overlooking the diagnosis of tethered cord and/or unnecessary spinal surgeries, the tethered cord syndrome should be remembered in the differential diagnosis list in the presence of back and leg pains, neurological deficits or urological complaints.

Evaluation of the effects of mobile phones on the neural tube development of chick embryos.

AIM The objective of this study is to examine the effects of radiation of mobile phones on developing neural tissue of chick embryos. MATERIAL AND METHODS There were 4 study groups. All Groups were placed in equal distance, from the mobile phones. Serial sections were taken from each Group to study the neural tube segments. RESULTS The TUNEL results were statistically significant (p < 0.001) at 30 and 48 hours in the third Group. We found low Bcl-2 levels partly in Group 4 and increased activity in Group 3. Caspase-3 was negative in the 48 and 72 hours in the Control Group, had moderate activity in the third Group 3, weak activity in the 48 hour, and was negative in the 72 hour in other groups. Caspase-9 immunoreactivity was weak in Group 1, 2 and 3 at 30 hours and was negative in Group 1 and 4 at 48 and 72 hours. Caspase-9 activity in the third Group was weak in all three stages. CONCLUSION Electromagnetic radiation emitted by mobile phones caused developmental delay in chick embryos in early period. This finding suggests that the use of mobile phones by pregnant women may pose risks.

Scoliosis may be the first symptom of the tethered spinal cord.

Background: Tethered cord syndrome (TCS) is a progressive clinical entity that arises from abnormal spinal cord tension. Scoliosis may be a unique symptom in TCS. The aim of this study is to investigate prognosis after releasing the filum terminale in scoliosis due to TCS with/without findings in magnetic resonance imaging (MRI) and to draw attention to the importance of somatosensorial evoked potentials (SSEP) on the differential diagnosis of idiopathic scoliosis versus scoliosis due to TCS with normal appearance of filum terminale and conus medullaris. Materials and Methods: Eleven female and seven male patients with progressive scoliosis were included in the study. They were evaluated radiologically, SSEP and urodynamical studies. Preoperative and postoperative anteroposterior full spine X-rays were obtained for measuring the Cobbs angle. MRI was performed in all cases for probable additional spinal abnormalities. All patients underwent filum terminale sectioning through a L5 hemilaminectomy. The resected filum terminale were subjected to histopathological examination. Results: The mean Cobb angle was 31.6° (range 18°–45°). Eight patients (44.45%) had a normal appearance of filum terminale and normal level conus medullaris in MRI, but conduction delay and/or block was seen on SSEP. In the histopathological examination of filum terminale dense collagen fibers, hyaline degeneration and loss of elastic fibers were observed. Postoperatively none of the patients showed worsening of the Cobb angle. Three patients showed improvement of scoliosis. Conclusion: In TCS presented with scoliosis, untethering must be performed prior to the corrective spinal surgery. Absence of MRI findings does not definitely exclude TCS. SSEP is an important additional guidance in the diagnosis of TCS. After untethering, a followup period of 6 months is essential to show it untethering helps in stopping the progress of the scoliotic curve. In spite of non progression (curve stopped lesser than 45°) or even improvement of scoliosis, there may be no need for major orthopedic surgical intervention.

Double Split Cord Malformations in a Child: Types I and II at 2 Different Levels in the Same Route

Spinal split cord malformations (SSCMs) are thought to be originated from an error that causes splitting of the notochord during gastrulation period, in which the formation of an accessory neurenteric canal between the yolk sac and amnion cavity takes place. Herein, we reported a 1-month-old boy who had both type II SSCM with meningocele at Th2-4 level and type I SSCM at Th10-12 level. Between those 2 malformations there was a normally developed spinal cord. Lesions were surgically corrected with good cosmetic and neurological outcome. There have been divergent suggestions on these pathologies. Although the multisite closure model of the neural tube may be used for explanation of these multiple neural tube defects, this theory alone cannot explain the nature and mechanism of development of such developmental defects of the neural tube. The aim of this study is to understand the embryological changes that cause the formation of a composite split spinal cord malformation. The idea of temporally different unexpected events that may cause developmental defects at different levels while other segments continue to neurulate normally seems appropriate to explain the multiple midline closure defects.

Primary Intraorbital Hydatid Cyst in a Child

Intraorbital hydatid disease is quite rare and its incidence has been reported to range from 0.3% to 1.0% among patients with Echinococcosis. The authors report a 4-year-old boy with primary intraorbital hydatid cyst who had presented with proptosis of the left eye. Because of high risk for cyst rupturing, the cyst was aspirated-injected simultaneously and reaspirated and then removed totally.

Unusual Presentation of Congenital Dermal Sinus: Tethered Cord With Paramedian Cutaneous Ostia

Congenital dermal sinus tract is a rare dysraphism with an incidence of 1/2500-3000 ratio. The sinus ostium located in the midline of the posterior of the body from the occiput to the lumbosacral region. Paramedian congenital dermal sinus tract with paramedian ostium are rare. Here, we describe a 2-year-old boy who presented with paramedian pigmented lesion with an ostium on the left lumbosacral region. During surgery we noted that sinus tract attached to thick lipomatous filum terminale.

Preoperative and postoperative evaluation of somatosensorial evoked potentials of upper extremities in cervical intervertebral disc herniation.

This study aims to determine the dysfunction caused by existing pathological condition in structures involved in the transfer of sensory functions of the neural system in cervical disc herniation, and to establish whether or not the level and degree of this anatomical damage can be anticipated by SEP (Somatosensorial Evoked Potentials). We compared the obtained SEP values for statistical significance using the Friedman Variation Analysis. In parameters with statistical significance, the Wilcoxon Signed Rank test was used to identify when significant improvements occurred. The study found that the statistical data of the latency of the N14 wave originating from the dorsal column nuclei of the medulla spinalis and dorsal column gray matter improved (p < 0.05) in the postoperative period compared with the preoperative values. Using the Wilcoxon Signed Rank test, we studied postoperative months separately in regard to the difference in the latency of the N14 wave, and found the statistically significant improvement to be marked particularly in months 3 and 6 postoperatively (p < 0.05). In conclusion, we suggest that SEP is a useful tool to check the functional condition of the dorsal spinal column. The benefit of the SEP utilization is the ability to determine the severity of the pathological condition preoperatively and follow the patients functional postoperative improvement.