Ergun Karavelioglu

Anti-inflammatory and Antiapoptotic Effect of Interleukine-18 Binding Protein on the Spinal Cord Ischemia-Reperfusion Injury

We investigated the anti-inflammatory and antiapoptotic effects of interleukin-18 binding protein (IL-18BP) on spinal cord ischemia/reperfusion (I/R) injury in rats. Twenty-one adult male rats were divided into three groups: sham, I/R, and I/R+IL-18BP. Proinflammatory cytokines were determined in rat blood samples by using ELISA, while apoptosis was immunohistochemically evaluated in spinal cord tissue using caspase 3. Both IL-18 and TNF-α were significantly decreased in the IL-18BP group compared to that in the sham group. The highest caspase 3 levels were observed in the I/R group, while the lowest levels were found in the sham group. The mean Tarlov score of the I/R group was significantly lower than that of the sham group. However, the mean Tarlov score of the IL-18BP group was significantly higher than that of the I/R group. The results of the current study demonstrate that IL-18BP plays both anti-inflammatory and antiapoptotic roles in spinal cord I/R injury.

Pneumocephalus and pneumorrhachis after spinal surgery: case report and review of the literature.

Trauma is a common cause of pneumocephalus, or air in the cranial cavity, and of pneumorrhachis, or the presence of intraspinal air. After spinal surgery, occurrence of pneumocephalus, especially with pneumorrhachis, is extremely rare. We report the case of a patient who developed pneumocephalus and pneumorrhachis after lumbar disc surgery and pedicle screw fixation. There was no cerebrospinal fluid leakage during surgery. On postoperative day 1, the patient complained of headache, nausea, and dizziness. Brain and lumbar computed tomography scans revealed pneumocephalus and pneumorrhachis. With conservative treatment, the patients complaints resolved within 10 days.

The antioxidant and antiapoptotic effects of crocin pretreatment on global cerebral ischemia reperfusion injury induced by four vessels occlusion in rats

AIMS Cerebral ischemia reperfusion (IR) injury is a process in which oxidative and apoptotic mechanisms play a part. Neuroprotective agents to be found could work out well for the efficient and safe minimization of cerebral IR injury. Crocin is a strong antioxidant agent; however the influence of this agent on the experimental cerebral ischemia model has not been studied extensively and thus it is not well-known. The objective of our study was to investigate the antioxidant, antiapoptotic and protective effects of crocin on the global cerebral IR induced by four-vessel occlusion. MAIN METHODS A total of 30 adult female Sprague-Dawley rats were equally and randomly separated into three groups as follows: sham, IR and IR+crocin (40mg/kg/day orally for 10days). 24h after electrocauterization of bilateral vertebral arteries, bilateral common carotid arteries were occluded for 30min and reperfused for 30min. Oxidative stress parameters (TAS, TOS, OSI), haematoxylin and eosin staining, caspase-3 and hypoxia-inducible factor-1 alpha (HIF-1α) expressions and TUNEL methods were investigated. KEY FINDINGS There was a significant difference between the IR and sham groups by means of OSI level, histopathological scoring, caspase-3, HIF-1α and TUNEL-positive cell parameters. We have also observed that pre-treatment with crocin reduced these parameter levels back to the baseline. SIGNIFICANCE The data obtained from the present study suggest that crocin may exert antiapoptotic, antioxidant and protective effects in IR-mediated brain injury induced by four-vessel occlusion. To the best of our knowledge, this would be the first study to be conducted in this field.

Neuroprotective effect of alpha-lipoic acid and methylprednisolone on the spinal cord ischemia/reperfusion injury in rabbits

Abstract Objective. The aim of this study is to investigate the putative neuroprotective effect of alpha-lipoic acid (LA) on spinal ischemia/reperfusion (I/R) injury in rabbits. Methods. Thirty-five adult female New Zeland rabbits, weighing 2,000–3,500 g (mean: 2,800), were divided randomly into five groups of seven rabbits each (n: 7) as Group 1: sham, only laparotomy; Group 2 (İ/R): I/R; Group 3 (LA): I/R and 100 mg/kg of LA; Group 4 (MP): I/R and 30 mg/kg of methylprednisolone (MP); and Group 5 (LA + MP): I/R and 100 mg/kg of LA plus 30 mg/kg of MP. Results. A statically significant effect of LA, MP, and LA plus MP on lowering malondialdehyde levels both in the blood and in the cerebrospinal fluid (CSF) has been observed. Nitric oxide is significantly decreased in the blood and spinal cord tissues, and also in the CSF but it is not significant. Superoxide dismutase, catalase, and glutathione levels were increased by LA administration. Conclusion. LA exhibits antioxidant efficacy in spinal cord I/R injury, but it cannot decrease the oxidative stress. The histopathological result of the present study also demonstrated that LA has neuroprotective effect in spinal cord injury.

Selenium protects cerebral cells by cisplatin induced neurotoxicity

PURPOSE To evaluate the central nervous system toxicity of cisplatin and neuroprotective effect of selenium. METHODS Twenty-one male Wistar albino rats were divided into three groups: control (C), cisplatin (CS), cisplatin and selenium (CSE, n=7 in each group). Cisplatin (12 mg/kg/day, i.p.) was administered to CS and CSE groups for three days. Furthermore, CSE group received 3mg/kg/day (twice-a-day as 1.5 mg/kg) selenium via oral gavage five days before cisplatin injection and continued for 11 consecutive days. The same volumes of saline were administered to C group intraperitoneally and orally at same time. RESULTS Heterochromatic and vacuolated neurons and dilated capillary vessels in the brain were observed in the histochemical examinations of cisplatin treated group. Rats that were given a dose of 3mg/kg/day selenium decreased the cisplatin induced histopathological changes in the brain, indicating a protective effect. In addition, cytoplasmic staining of the cell for bcl-2, both cytoplasmic and nuclear staining for bax were determined to be positive in the all groups. Bax positive cells were increased in the CS group compared to C group, in contrast to decreased bcl-2 positivity. CONCLUSION Selenium limited apototic activity and histological changes due to the cisplatin related central neurotoxicity.

Cabazitaxel causes a dose-dependent central nervous system toxicity in rats

BACKGROUND Chemotherapeutic agents may lead to serious neurological side effects, which in turn can deteriorate the quality of life and cause dose limiting. Direct toxic effect or metabolic derangement of chemotherapeutic agents may cause these complications. Cabazitaxel is a next generation semi-synthetic taxane derivative, which is effective in both preclinical models of human tumors sensitive or resistant to chemotherapy and in patients with progressive prostate cancer despite docetaxel treatment. AIM The primary aim of this study was to investigate the central nervous system toxicity of Cabazitaxel. Secondary aim was to investigate the safety dose of Cabazitaxel for the central nervous system. METHODS A total of 24 adult male Wistar-Albino rats were equally and randomly divided into four groups as follows: group 1 (Controls), group 2 (Cabazitaxel 0.5mg/kg), group 3 (Cabazitaxel 1.0mg/kg) and group 4 (Cabazitaxel 1.5mg/kg). Cabazitaxel (Jevtana, Sanofi-Aventis USA) was intraperitoneally administered to groups 2, 3 and 4 at 0.5, 1.0 and 1.5mg/kg (body-weight/week) doses, respectively for four consecutive weeks. Beside this, group 1 received only i.p. saline at the same volume and time. At the end of the study, animals were sacrificed and bilateral brain hemispheres were removed for biochemical, histopathological and immunohistochemical examinations. RESULTS Intraperitoneal administration of Cabazitaxel has exerted neurotoxic effect on rat brain. We have observed that biochemical and immunohistochemical results became worse in a dose dependent manner. CONCLUSION Our findings have suggested that Cabazitaxel may be a neurotoxic agent and can trigger apoptosis in neuron cells especially at high doses.

Diffuse Idiopathic Sceletal Hyperosteosis and Central Cord Syndrome After Minor Trauma: A Case Report

Diffuse idiopathic skeletal hyperostosis (DISH) is characterized by anterior and lateral ossification of the vertebral body. We present a case report of central cord syndrome in a patient with DISH after minor trauma. The patient was treated surgically. We also discuss symptomatology and the common mechanism of cord injury in DISH.

Acute Paraplegia due to Thoracic Hematomyelia.

Spontaneous intraspinal intramedullary hemorrhage is a rare entity with the acute onset of neurologic symptoms. The etiology of idiopathic spontaneous hematomyelia (ISH) is unknown, and there are few published case reports. Hematomyelia is mostly associated with trauma, but the other nontraumatic etiologies are vascular malformations, tumors, bleeding disorders, syphilis, syrinx, and myelitis. MRI is a good choice for early diagnosis. Hematomyelia usually causes acute spinal cord syndrome due to the compression and destruction of the spinal cord. A high-dose steroid treatment and surgical decompression and evacuation of hematoma are the urgent solution methods. We present idiopathic spontaneous hematomyelia of a previously healthy 80-year-old male with a sudden onset of back pain and paraplegia.

Anesthetic management in a newborn with a giant occipital encephalocele: a case report

To the Editor: Cephalocele is a congenital abnormality that occurs when the ectoderm fails to transform into the neuroectoderm during the early embryonic stages of life. This anomaly results in bone structure defects. If hernia develops only in the meninges, a meningocele occurs; if hernia develops both in the meninges and in the neural tissues, an encephalocele occurs [1]. In some patients, the encephalocele can be accompanied by other anomalies. These patients are often operated on during the neonatal period to prevent bacterial contamination and sepsis and to avoid neurological complications [2]. Airway complications and the accompanying anomalies might present a problem for anesthesiologists. In this report, we discuss the case of a patient who underwent surgery for an encephalocele, a 3,300-g baby girl who was delivered via a cesarean section at 39 weeks of gestation by a 26-year-old mother. The baby underwent surgery on the fourth day after birth. Apart from the encephalocele (10 9 5 cm), her physical examination was unremarkable (Fig. 1). Induction of anesthesia with inhalational agents has the side effect of causing cardiac depression; however, it has the advantage of allowing intubation while maintaining spontaneous breathing. In this case, we chose to induce inhalation anesthesia with 6 % sevoflurane in oxygen, which was performed after preoxygenation. During spontaneous respiration, the patient’s thyroid cartilage was gently pressed by an assistant in the lateral decubitus position. The patient was intubated with a 3.0-mm endotracheal tube at the first attempt. For better fixation, a flexible spiral tube was used. After the intubation, a muscle relaxant (cisatracurium) was provided, and preoperative pain was managed by fentanyl administration. Anesthesia was maintained with 2–3 % sevoflurane in 50 % oxygen/air. The patient was positioned prone, with a silicone pad placed under the forehead. The operation lasted for 3 h 45 min. During the surgery, peripheral oxygen saturation, electrocardiography, noninvasive blood pressure measurement, and body heat monitoring were performed, and 30 ml blood was transfused. Body temperature was maintained by wrapping the infant in warm blankets and administering heated intravenous fluids. With the establishment of spontaneous respiration with open eyes and crying, with resistance to the tube, the patient was extubated and then transferred to the inpatient clinic. In inducing anesthesia in patients undergoing surgery for encephalocele, surgeons should be aware of possible airway complications, blood loss, and wrong positioning of the patient. Further, the body temperature of the patient should be monitored [3]. Intubation can be applied in either the supine or the lateral decubitus position [4]. In this study, the patient was successfully intubated in the lateral decubitus position. In patients with encephaloceles, the pontomedullary respiratory center might have structural defects in the afferent and efferent pathways, which can cause inadequate spontaneous respiration. It can also result in poor sucking reflex, absence of the gag reflex, a lack of pharyngeal coordination, and aspiration [2]. During S. Kokulu (&) Kocatepe University, Department of Anesthesiology and Reanimation, İzmir Yolu 8. km, Afyonkarahisar, Turkey e-mail: serdarkokulu@yahoo.com

Intraradicular lumbar disc herniation in a rare localization: Case report

Intradural disc herniations, which comprise between 0.1% and .1% of all disc herniations, are very rare [1]. Intraradicular disc erniation was first described in 1984 and only 21 cases have een reported since then [1–6]. This is a rare condition that canot be diagnosed preoperatively and can cause failed back surgery. ntraradicular lumbar disc herniation is generally diagnosed during urgery. In this report, we present the case of a 43-year-old female atient who had severe lower back and left leg pain. Lumbar magetic resonance imaging (MRI) showed an extruded disc fragment ompromising the dural sac at the L1–L2 level. This is the first case f intraradicular lumbar disc herniation at the L1–L2 level to be escribed in the literature.