Emre Cemal Gokce

Neuroprotective effects of thymoquinone against spinal cord ischemia-reperfusion injury by attenuation of inflammation, oxidative stress, and apoptosis

OBJECTIVE Ischemia-reperfusion (I/R) injury of the spinal cord following thoracoabdominal aortic surgery remains the most devastating complication, with a life-changing impact on the patient. Thymoquinone (TQ), the main constituent of the volatile oil from Nigella sativa seeds, is reported to possess strong antioxidant, antiinflammatory, and antiapoptotic properties. This study investigated the effects of TQ administration following I/R injury to the spinal cord. METHODS Thirty-two rats were randomly allocated into 4 groups. Group 1 underwent only laparotomy. For Group 2, aortic clip occlusion was introduced to produce I/R injury. Group 3 was given 30 mg/kg of methylprednisolone intraperitoneally immediately after the I/R injury. Group 4 was given 10 mg/kg of TQ intraperitoneally for 7 days before induction of spinal cord I/R injury, and administration was continued until the animal was euthanized. Locomotor function (Basso, Beattie, and Bresnahan scale and inclined plane test) was assessed at 24 hours postischemia. Spinal cord tissue samples were harvested to analyze tissue concentrations of malondialdehyde, nitric oxide, tumor necrosis factor-α, interleukin-1, superoxide dismutase, glutathione-peroxidase, catalase, and caspase-3. In addition, histological and ultrastructural evaluations were performed. RESULTS Thymoquinone treatment improved neurological outcome, which was supported by decreased levels of oxidative products (malondialdehyde and nitric oxide) and proinflammatory cytokines (tumor necrosis factor-α and interleukin-1), increased activities of antioxidant enzymes (superoxide dismutase, glutathione-peroxidase, and catalase), as well as reduction of motor neuron apoptosis. Light microscopy and electron microscopy results also showed preservation of tissue structure in the treatment group. CONCLUSIONS As shown by functional, biochemical, histological, and ultrastructural analysis, TQ exhibits an important protective effect against I/R injury of the spinal cord.

Aged Garlic Extract Attenuates Neuronal Injury in a Rat Model of Spinal Cord Ischemia/Reperfusion Injury

Garlic has been used as a food as well as a component of traditional medicine. Aged garlic extract (AGE) is claimed to promote human health through antioxidant/anti-inflammatory activities with neuroprotective effects. We evaluated the possible beneficial effect of AGE neurologically, pathologically, ultrastructurally, and biochemically in a spinal cord ischemia-reperfusion (I/R) model of rats. Twenty-four Sprague-Dawley rats were divided into three groups: sham (no I/R), I/R, and AGE (I/R+AGE); each group consisted of eight animals. Animals were evaluated neurologically with the Basso, Beattie, and Bresnahan (BBB) scoring system. The spinal cord tissue samples were harvested for pathological and ultrastructural examinations. Oxidative products (Malondialdehyde, nitric oxide), antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase), inflammatory cytokines (tissue tumor necrosis factor alpha, interleukin-1), and caspase-3 activity were analyzed. The AGE group had significantly higher BBB scores than the I/R group. Pathologically, AGE group revealed reduced degree of ischemia and spinal cord edema. Ultrastructural results also showed preservation of tissue structure in the AGE group. Oxidative product levels of the I/R group were significantly higher than both the other groups, and antioxidant enzyme levels of AGE group were significantly higher than the I/R group. There was also significant difference between the sham and AGE groups in terms of total antioxidant enzyme levels. Furthermore, AGE treatment significantly reduced the inflammatory cytokines and caspase-3 activity than the I/R group. This study demonstrates the considerable neuroprotective effect of AGE on the neurological, pathological, ultrastructural, and biochemical status of rats with I/R-induced spinal cord injury.

Effects of the aged garlic extract in spinal cord injury in the rat

BACKGROUND Aged garlic extract (AGE) is a potent antioxidant agent with an established neuroprotective effect in cerebral ischemia. However, the potential protective effect of AGE in spinal cord injury (SCI) is still unknown. METHODS Spinal cord trauma was applied to 19 adult male Wistar rats using the clip compression method. Animals were divided into three groups. Animals in the AGE group were administered 250 mg/kg per day of AGE diluted in tap water orally by gavage for 15 days prior to trauma. After spinal cord trauma, malondialdehyde (MDA) and superoxide dismutase (SOD) levels of the AGE group were compared with the animals in the control and SCI groups. The animals were examined by inclined plane 24 hours (h) after the trauma. At the end of the experiment, spinal cord tissue samples were harvested for pathological evaluation. RESULTS Regarding tissue MDA and SOD levels after trauma, animals in the AGE group demonstrated decreased MDA levels and increased SOD levels when compared with the SCI group. However, these results were no better than in the control group. The AGE group demonstrated better pathological findings than the SCI group. The result regarding the functional finding was similar. CONCLUSION AGE demonstrated neuroprotective effects in SCI. Further studies with different experimental settings are required to achieve conclusive results.

Intramedullary spinal cord involvement from metastatic gastric carcinoma: a case report.

Intramedullary spinal cord metastasis (ISCM) is a rarely seen complication of cancer. We report a case of ISCM from gastric cancer. A 42-year-old male presented with a rare intramedullary spinal cord metastasis from gastric carcinoma manifesting as rapidly worsening motor and sphincter disturbances. The primary tumor had been treated 2 years previously. Magnetic resonance imaging (MRI) revealed the tumor localized in the thoracic spinal cord. The tumor was totally removed. The histological diagnosis was gastric adenocarcinoma. He has been stable postoperatively. Surgical treatment may be considered for cases with even rapid-growing tumors such as gastric carcinoma with no evidence of multi-organ dissemination, especially when presenting with progressive neurological deterioration.

A rare case of intracerebral hemorrhage due to arteriovenous malformation located at petrous portion of the temporal bone.

Primary intraosseous arteriovenous malformations (AVM) are not infrequently encountered. We report a case of intraosseous arteriovenous malformation arising in the left temporal bone. A 51-year-old male patient presented with loss of conscious. Computerized tomography displayed hematoma measuring 4 cm in diameter in the left temporal lobe. Digital subtraction angiography (DSA) showed that a temporal bone AVM supplied by all the branches of the external carotid artery and vertebral artery. Many treatment modalities can be considered for preoperative steps and/or for definitive treatment. We preferred embolisation for this vascular pathology. To the best of our knowledge this represents the first case of an intraosseous arteriovenous malformation located in the temporal bone.

Neuroprotective Effects of Pregabalin Against Spinal Cord Ischemia-Reperfusion Injury in Rats.

AIM To evaluate the effect of pregabalin pre-treatment on spinal cord ischemia-reperfusion (I/R) injury and compare with methylprednisolone (MP). MATERIAL AND METHODS Thirty-two rats were randomly divided into four groups as follow: Group 1 (sham)(n=8), group 2 (ischemia only)(n=8), group 3 (30 mg/kg pregabalin)(n=8), and group 4 (30 mg/kg methylprednisolone)(n=8). Laparotomy was performed without aortic clamp in the sham group. All animals were sacrificed 24 hours after surgery. The spinal cord tissue samples were harvested and caspase-3 activity, tumor necrosis factor-alpha (TNF-α) and Interleukin-1 Beta (IL-1β) levels, catalase (CAT) activity, glutathione peroxidase (GPx) activity, superoxide dismutase (SOD) levels malondialdehyde (MDA) levels and nitric oxide (NO) levels were analyzed to investigate the effects of different excitatory and inflammatory pathways in mechanism of I/R injury. Ultrastructural and histopathological examinations were carried out. Neurological recovery was measured by Basso, Beattie, Bresnahan (BBB) test and Inclined Plane Test. RESULTS Decresead caspase-3 activity and decreased inflammatory markers like TNF-α, IL-1β, and decresaed excitotatory pathways like CAT, GPx, MDA, NO and SOD were observed in both pregabalin pre-treatment and MP treatment groups. Pregabalin pre-treatment produced better ultrastructural results compared to MP treatment, as with histopathological examination. Pregabalin group showed better recovery compared to MP treament group according to BBB scoring system. CONCLUSION Pregabalin pre-treatmet and MP treatment both has neuroprotective effect on I/R injury by decreasing caspase dependant apoptosis, and inflammatory and oxidative stress markers. In addition, pregabalin pre-treatment had better clinical effects compared to MP treatment.

Neuroprotective Effects of Rosuvastatin in Spinal Cord Ischemia-Reperfusion Injury in Rabbits

Background:This experimental study was performed to investigate the neuroprotective effects of rosuvastatin in a rabbit model of spinal cord ischemia-reperfusion injury. Materials and Methods:Rabbits were randomized into 3 groups of 6 animals each: group 1 (control), group 2 (ischemia), and group 3 (rosuvastatin 5 mg/kg/d). Spinal cord ischemia was produced in rabbits by a 30-minute occlusion of the aorta by clamping with aneurysm clips; just caudal to renal artery divison and above the aortic bifurcation. Rosuvastatin was administered intraperitoneally before onset of occlusion, for 3 days. At 48 hours after ischemia, neurological evaluation was performed using the Basso, Beattie, and Bresnahan locomotor rating scale before they were killed. Levels of malondialdehyde (MDA), glutathione, advanced oxidation protein products (AOPP), superoxide dismutase, catalase, nitrite/nitrate, and tumor necrosis factor-&agr; were measured in the spinal cord tissue and plasma. Histopatologic evaluation of the tissues and activation of caspase 3 were also studied. Results:Basso, Beattie, and Bresnahan scores for rosuvastatin group were significantly higher. MDA, AOPP, and nitrite/nitrate levels in the ischemia group were significantly higher than those for control and rosuvastatin groups (P<0.05). There were no significant differences in MDA, AOPP, and nitrite/nitrate levels between rosuvastatin and control groups. In rosuvastatin group, spinal cord tissue and plasma superoxide dismutase, glutathione, and catalase levels were significantly increased compared with the ischemia group. The gross histopathologic examination demonstrated decrease in axonal damage, neuronal degeneration, and glial cell infiltration after rosuvastatin treatment. Conclusions:Rosuvastatin may protect the spinal cord tissue against ischemic damage, by its anti-inflammation and antiapoptotic effect. Although further studies including different dose regimens and time intervals are required, this drug may therefore be a good candidate for clinical use during surgical procedures on the thoracoabdominal aorta.

An Unusual Case of Extradural Primary Ewing Sarcoma of Lumbar Spine in an Adult

Ewing sarcoma (ES) is a malignant neoplasm of bones with mesenchymal origin that rarely occurs in extraosseous sites, most frequently presents in the pediatric population and is extremely rare in the adult population, with only 30 extradural spine cases reported in the literature. We present a case of an extraskeletal ES that belongs to the primitive neuroectodermal tumor/ES family occurring in the lumbar epidural space. A 46-year-old woman was admitted to neurosurgery department with the complaint of 1 month of worsening leg pain. Lumbosacral magnetic resonance imaging revealed the presence of a large, enhancing, extradural mass lesion at the level of L4 without any bony involvement. The patient underwent laminectomy and total tumor resection. ES diagnosis arising in the lumbar epidural space was confirmed by histopathologic examination. The patient received both chemotherapy and radiotherapy after the operation. Hereby, we report an extremely rare case of primary ES in adult patient with regard to tumor resection, prevention of recurrence, and metastasis.

Ping pong fracture in the newborn: illustration of a case

A 3,240-g infant was born at 38 weeks’ gestation to a 31-year old gravida 3 para 2 mother who received regular prenatal care. The pregnancy was uneventful except for right sided hip pain in the late third trimester, although the ultrasound scans were unremarkable. The infant was delivered by normal spontaneous vaginal delivery. Upon delivery, the infant was noted to have a depression measuring 5 9 4 cm in the right frontal region (Fig. 1a). The rest of the examination was normal. A cranial CT was obtained upon neurosurgical consultation, which revealed a ping pong fracture of the right frontal bone (Fig. 1b). The three-dimensional reconstruction image showed a 5 9 4 cm depression with no underlying cerebral pathology (Fig. 1c). Surgical elevation was performed and the infant was discharged after a few days without any further complication. The cosmetic result was excellent at the 1st month follow-up (Fig. 1d). Spontaneous ping pong fractures are extremely rare in the neonatal period. Birth trauma is primarily responsible; however, it is likely that the fracture in our case is a congenital process since there was no cephalopelvic disproportion, instrumentation, or extrinsic trauma. Although seldom observed, cerebral edema and intracranial hemorrhage can occur as a complication [1]. Several methods have been used to treat this condition. Mild forms have been reported to resolve spontaneously, whereas use of a breast milk extractor or an obstetrical vacuum extractor may be an alternative. Surgical approach is reserved for severe cases [2, 3]. A ping pong fracture is an exceedingly rare condition following an uncomplicated vaginal delivery, and there is insufficient evidence to support a particular treatment option and timing of correction [1, 2].