Burhan Oral Güdü

Activity of mannitol and hypertonic saline therapy on the oxidant and antioxidant system during the acute term after traumatic brain injury in the rats.

In this study, our objective is to investigate the effects of mannitol and 7.5% hypertonic saline (HS) therapy on the levels of malondialdehyde (MDA), catalase and glutathione peroxidase (GSH-Px) in the early stages of experimental head traumas in rats. Rats included in the study were divided into four groups: Group I Control, Group II Trauma, Group III Mannitol, and Group IV 7.5% Hypertonic Saline. Rats in Group II were subject to head trauma only. Mannitol was injected intraperitoneally to rats in Group III after head trauma and 7.5% HS was injected intraperitoneally to rats in Group IV after head trauma. Rats were sacrificed 4 h after administration of mannitol or 7.5% HS, and the levels of MDA catalase and GSH-Px in brain tissues extracted from rats were determined. MDA levels in the trauma group were significantly increased compared with the control group (p<0.01), whereas there was a reduction in catalase and GSH-Px levels, although these differences were not significant. By contrast, in the mannitol group, MDA, catalase and GSH-Px levels were lower than the levels in the trauma group, and these reductions were statistically significant (p<0.05). The MDA, catalase and GSH-Px levels of the 7.5% HS group were lower than those of the trauma group; however, this reduction was not statistically significant. It was concluded that mannitol and 7.5% HS therapies that are used to reduce intracranial pressure and to increase the use of catalase, an antioxidant enzyme, and GSH-Px, are likely to reduce cellular damage by reducing the formation of MDA, the levels of which are known to be indicative of cellular level oxidant damage.

Transorbital orbitocranial penetrating injury caused by a metal bar

Transorbital intracranial injury is uncommon, representing 0.04% of penetrating head trauma with a high mortality rate. Orbital penetrating injuries may cause severe brain injury if the cranium is entered, typically via the orbital roof, the superior orbital fissure, or the optic canal. A 13-year-old male sustained a severe brain injury due to penetration of the right orbit with an iron bar. The bar entered the inferiomedial aspect of the orbit and emerged from the left occipital bone. Neurological examination revealed deep coma (GCS: E1M2V1) with fixed, dilated, and non-reactive pupils. The bar followed an intracranial trajectory, through the third ventricle and suprasellar cistern. The patient underwent an immediate exploration with removal of the bar. Unfortunately, he died 10 days postoperatively due to severe diencephalic injury with brainstem herniation. In this case report, we discuss the radiologic diagnosis and surgical management of transorbital orbitocranial injury by foreign body penetration.

Cervical Spinal Dysraphism

Objective: Cervical spinal dysraphism is a rare congenital spinal pathology. The results obtained from our series are compared with the results obtained from other series of studies in the literature. Methods: Seven patients with cervical myelomeningocele and meningocele who underwent surgery between January 1996 and March 2009 at the YYU Faculty of Medicine in the Department of Neurosurgery were retrospectively studied. Results: The referral ages of the patients (6 females and 1 male) varied between 4 days and 4 months (median 1 month). A stalk lesion covered with a dysplastic skin formed as a sac and located at the cervical midline was demonstrated in all of the patients. Cervical myelomeningocele was present in 4 patients, while cervical meningocele was present in 3 patients; however, Chiari type II malformation and hydrocephaly were present in 3 patients with myelomeningoceles. Diastematomyelia and a filum terminal lipoma were present in 1 of the patients. Conclusion: In this series, in contrast to the literature, we noted that the number of girls with spinal dysraphism with a cervical myelomeningocele and meningocele was greater than the number of boys. Chiari type II malformation, hydrocephaly and motor weakness in patients with cervical spinal dysraphism are less frequent when compared to patients with caudal spinal dysraphism. The structure of the sac is also more durable and, accordingly, a cerebrospinal fluid leakage is uncommon.

Relationship of antioxidant enzyme activities with myelomeningocele.

AIM To investigate the role of erythrocyte free radical scavenging enzyme activities (FRSE), carbonic anhydrase (CA) activity and malondialdehyde (MDA) in infants with myelomeningocele (MM). MATERIAL AND METHODS We compared antioxidant enzyme activities and MDA level in 40 individuals (10 infants with MM, 10 healthy infants; and mothers of these two groups) with age-matched subjects. Erythrocyte FRSE included catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPX) and glutathione-S- transferase (GST). RESULTS CA, CAT, SOD, GPX and GST concentrations were lower in all of the infants with MM compared to healthy infants. The mothers of infants with MM also had lower CA, CAT, SOD, GPX and GST activities than healthy mothers. It was also found out that the MDA level as a marker of oxidative damage was higher in infants with MM and their mothers than in healthy infants and their mothers. CONCLUSION Lower FRSE activities indicate an increased frequency of MM. Free radicals (FRs) such as MDA may play a significant role in the etiology of MM.

Spontaneous migration of a retained bullet within the brain: a case report.

Gunshot injury to the head is usually mortal, and spontaneous migration of a retained bullet is rare. We report the case of a 23-year-old man with a spontaneously migrated bullet within the brain. Cranial computerized tomography (CT) indicated that the bullet was lodged deeply in the left parietal region. The patient was conscious and had right homonymous hemianopsia. The bullet was close to the vital structures and deep-seated; therefore, surgical intervention was not considered. Two months after the injury, repeat CT revealed that the bullet had migrated posteriorly and caudally due to gravitational factors. Management of the retained bullet was controversial. Removal of a deep-seated bullet may cause additional neurological deficit, but migration of a retained bullet may cause damage to vital structures, producing significant neurological damage. We proposed that the bullet in the brain should be removed if it could be reasonably accessed without causing additional neurological damage.

Bowel Perforatıon at The Delayed Stage After Shunt Surgery: Case Report

DOI: 10.4328/JCAM.421 Received: 25.09.2010 Accepted: 05.10.2010 Printed: 01.01.2012 J Clin Anal Med 2012;3(1):109-11 Corresponding Author: Mehmet Arslan, Yüzüncü Yıl Üniversitesi Tıp Fakültesi Beyin Cerrahisi Kliniği, Van, Türkiye. T.: +904322150470-6315 / 905055079892 F.: +904322167519 E-Mail: arslan2002@hotmail.com Özet Ventriküloperitoneal şant cerrahisi hidrosefalusun tedavisinde yaygın kullanılan işlemdir. Bu invaziv işlem geç dönemde birkaç abdominal komplikasyonla birliktedir. Peritoneal kateter ile spontan barsak perforasyonu nadirdir, ama önemli bir komplikasyondur. Eğer erken tanı konulmazsa, kateter yoluyla taşınan gastrointestinal floradan dolayı şiddetli ventrikülit ve en sonunda sepsis gelişebilir. Hidrosefalili 7.5 yaşında bayan hasta, tekrarlayan menenjit nedeniyle bizim kliniğimize kabül edildi. Bilgisayarlı abdomen tomografisi sigmoid kolonu perfore eden peritoneal kateteri ortaya çıkardı. Eğer şantlı hastalarda peritoneal kateterin rektal çıkımı olmaksızın tekrarlayan menenjit atakları varsa barsak perforasyonu kesinlikle düşünülmelidir.

A craniocervical teratoma with an encephalocele-like appearance.

Teratomas are rare congenital tumors. Teratomas frequently occur in adult ovaries, but can be located primarily in the sacrococcygeal zone and intracranial compartment in newborns. Teratomas are rare in the head and neck region. Teratomas arise following a sequence of cells derived from more than one germ layer at different regions of the body due to a change in location of germ cells, and contain ectodermic, endodermic, and mesodermic tissues. Herein we detail the follow-up and treatment of a newborn with a mass that was located at the back of the head and was referred to our Neurosurgery Clinic with a pathologic diagnosis of a grade II-III immature teratoma resembling an encephalocele.