Hakan Ak

Indications of brain computed tomography scan in children younger than 3 years of age with minor head trauma

Objective. To investigate the indications to receive brain computed tomography (CT) scan and to define the pathological findings in children younger than three years of age with minor head trauma in emergency departments. Methods. In this study, hospital case notes of 1350 children attending the emergency department of Bitlis State Hospital between January 2011 and June 2013 were retrospectively reviewed. 508 children under 3 years of age with minor head trauma were included in this study. We also asked 37 physicians about the indications for requiring CT in these children. Results. This study included 508 children, 233 (45,9%) of whom were female and 275 were male. In 476 (93,7%) children, the brain CT was completely normal. 89,2% of physicians asked in the emergency department during that time interval reported that they requested CT scan to protect themselves against malpractice litigation. Conclusion. In infants and children with minor head trauma, most CT scans were unnecessary and the fear of malpractice litigation of physicians was the most common reason for requesting a CT.

Neuroprotective Effects of Thymoquinone on the Hippocampus in a Rat Model of Traumatic Brain Injury.

BACKGROUND Traumatic brain injury is a leading cause of morbidity and mortality worldwide. We evaluated the neuroprotective effects of thymoquinone (TQ) in a rat model of traumatic brain injury by using biochemical and histopathologic methods for the first time. MATERIALS AND METHODS Twenty-four rats were divided into sham (n = 8), trauma (n = 8), and TQ-treated (n = 8) groups. A moderate degree of head trauma was induced with the use of Feeneys falling weight technique, and TQ (5 mg/kg/day) was administered to the TQ-treated group for 7 days. All animals were killed after cardiac perfusion. Brain tissues were extracted immediately after perfusion without damaging the tissues. Biochemical procedures were performed with the serum, and a histopathologic evaluation was performed on the brain tissues. Biochemical experiments included malondialdehyde (MDA), reduced and oxidized coenzyme Q10 analysis, DNA isolation and hydroylazation, and glutathione peroxidase, and superoxide dismutase analyses. RESULTS Neuron density in contralateral hippocampal regions (CA1, CA2-3, and CA4) 7 days after the trauma decreased significantly in the trauma and TQ-treated groups, compared with that in the control group. Neuron densities in contralateral hippocampal regions (CA1, CA2-3, and CA4) were greater in the TQ-treated group than in the trauma group. TQ did not increase superoxide dismutase or glutathione peroxidase antioxidant levels. However, TQ decreased the MDA levels. CONCLUSIONS These results indicate that TQ has a healing effect on neural cells after head injury and this effect is mediated by decreasing MDA levels in the nuclei and mitochondrial membrane of neurons.

Does the removal of spinal implants reduce back pain

Background The importance of the removal of spinal implants is known in the presence of infection. However, the benefits and/or risks of the removal of spinal implant for the management of back pain are not clear. Methods In this retrospective study, we aimed to evaluate the beneficial effects of the removal of spinal implants for back pain. Study included 25 patients with thoracolumbar instrumentation. Results Seventeen (68%) of them were male. Indications for spinal instrumentation were vertebra fracture (n = 9), iatrogenic instability due to multiple segment laminectomy (n = 12), and instrumentation after recurrent disk herniations (n = 4). Mean visual analog score (VAS) before the removal was 8.08. Mean VAS was 3.36 after the removal. Spinal instruments were removed after the observance of the presence of fusion. All patients were prescribed analgesics and muscle relaxants for 3 weeks before removal. Back pain did not decrease in five (20%) patients in total. Four of them had been instrumented due to recurrent lumbar disk herniation. None of the patients reported the complete relief of pain. Conclusion In conclusion, patients should be cautioned that their back pain might not decrease after a successful removal of their instruments.

Resveratrol treatment prevents hippocamal neurodegeneration in a rodent model of traumatic brain injury

AIM Traumatic brain injury (TBI) is a complex process. Increasing evidence has demonstrated that reactive oxygen species contribute to brain injury. Resveratrol (RVT) which exhibits significant antioxidant properties, is neuroprotective against excitotoxicity, ischemia, and hypoxia. The aim of this study was to evaluate the neuroprotective effects of RVT on the hippocampus of a rat model of TBI. MATERIAL AND METHODS Twenty eight rats were divided into four groups. A moderate degree of head trauma was induced using Feeneys falling weight technique. Group 1 (control) underwent no intervention or treatment. Head trauma was induced in Group 2 (trauma) and no drug was administered. Head trauma was induced in Group 3 and low-dose RVT (50 mg/kg per day) was injected. In Group 4, high-dose RVT (100 mg/kg per day) was used after head trauma. Brain tissues were extracted immediately after perfusion without damaging the tissues. Histopathological and biochemistry parameters were studied. RESULTS Brain tissue malondialdehyde (MDA) levels in the trauma group were significantly higher than those in the control, lowdose RVT-treated, and high-dose-RVT-treated groups. The superoxide dismutase (SOD) levels in the control group were significantly higher than those in the trauma, low-dose RVT-treated, and high-dose RVT-treated groups. Glutathione peroxidase (GSH-Px) levels in the control group were significantly higher than those in the trauma and low-dose RVT-treated groups. The level of oxidative deoxyribonucleic acid (DNA) damage (8-OHdG/106 dG) in the trauma group was higher than that in the control group, low-dose RVT-treated, and high-dose RVT-treated groups. CONCLUSION Resveratrol has a healing effect on neurons after TBI.

Prognostic Factors in Oligodendrogliomas: a Clinical Study of Twenty-Five Consecutive Patients

BACKGROUND The purpose of this study was to evaluate the prognostic significance of Ki-67 and subjective microvascular density (SMVD) indexes together with other factors in patients with oligodendroglioma. MATERIALS AND METHODS In this retrospective study, oligodendroglioma specimens obtained from twenty-five consecutive patients were evaluated for Ki-67 and SMVD indices to help determine histological grading and investigate the fidelity of these markers in clinical prognosis. Other potentially prognostic factors were Karnofsky performance scale, tumor histological grade, and adjuvant radiotherapy. RESULTS The Ki-67 proliferation index appeared to have a strong correlation with the grade of the tumor and the survival. Age, gender, adjuvant radiotherapy, surgical resection type (complete versus incomplete) did not have any influence on recurrence. The SMVD index correlated significantly with the 3 to 5-year survival. CONCLUSIONS Ki-67 and MVD indexes are important and useful markers in estimating the prognosis of oligodendrogliomas.

Recurrent gliosarcoma in pregnancy.

Gliosarcoma is a rare tumor of the central nervous system and it constitutes about 1 to 8% of all malignant gliomas. In this report we are presenting a recurrent gliosarcoma case during a pregnancy in a 30-year-old woman. This is the first report presenting gliosarcoma in the pregnancy.

Bilgisayarlı tomografide akut epidural hematomu taklit eden iyatrojenik subdural hematom

Computed tomography images of the subdural and epidural hematoma are well defined, crescent and lentiform shapes, respectively. However, it has been reported that both of them might mimic each other in rare instances. Literature reveals seven reports subdural hematoma mimicking epidural. We are reporting a new case of subdural hematoma mimicking epidural hematoma radiologically, which occurred after evacuation of chronic subdural hematoma with burr-hole in a 75 years old man. J Clin Exp Invest 2013; 4 (3): 367-369

Tuberculous Tenosynovitis With “Rice Bodies” in the Forearm and Wrist

Rice body formation is a rare disorder which may be seen in various systemic disorders including tuberculosis (TB). Musculoskeletal TB compromises 1-3% of TB patients and only 2% of them is seen on the wrist which can include either tenosynovium (most commonly), carpal synovium or bone. In this report, we describe rice body formation due to tuberculous infection in a 28-year-old patient presented with an enlarging mass on right forearm with the signs and symptoms of carpal tunnel syndrome. Tenosynovectomy and removal of all rice bodies were performed. Patient diagnosed as extrapulmonary TB. Although general frequency of TB declines around world, it should be kept in the mind in the differential diagnosis of patients presenting with an enlarging mass in the forearm. Moreover, if there is neurological deficits prompt surgical approach must be performed for the definite diagnosis and treatment.

Atipik şikayetlerle prezente olan akut travmatik interhemisferik subdural hematom

OZET Akut interhemisferik subdural hematom akut subdural hematomun nadir gorulen bir tipi olup genellikle kafa travmasindan sonra ortaya cikmaktadir. Bu hematomda gorulen klinik belirti ve bulgular arasinda bas agrisi, bulanti kusma, nobet, demans, gorme bozuklugu, monoparezi, ve hemiparezi bildirilmistir. Bu yazida anksiyete ve terleme hissi gibi atipik sikayetlerle basvuran 54 yasindaki bir erkek hastada saptanan interhemisferik subdural hematom olgusunu sunulmaktadir. Hasta klinik gozlem ile takip edilmis olup 10 gun sonra hematomun tamamiyla rezorbe oldugu gorulmustur. Sonuc olarak, interhemisferik subdural hematomda vital bulgularin ve norolojik durumun stabil seyretmesi durumunda sadece izlem yeterli olabilmektedir. Anahtar Sozcukler: Kafa travmasi; Interhemisferik subdural hematom; Terleme ABSTRACT Acute interhemispheric subdural hematoma is a rare type of acute subdural hematoma and it usually develops after head trauma. Headache, nausea, vomiting, seizures, dementia, visual impairment, monoparesis and hemiparesis have been reported among clinical signs and symptoms for this hematoma. In this report, we present a case of interhemispheric subdural hematoma in a 54-year-old male patient with atypical complaints as anxiety and sweating. The patient was followed by clinical observation and the hematoma was completely resorbed after 10 days. In conclusion, if the vital signs and neurological status of the patient are stable in interhemispheric subdural hematoma, only follow-up is sufficient. Keywords: Head trauma; Interhemispheric subdural hematoma; Sweating

The acute effects of thymoquinone on acute peripheral nerve injury: an experimental study

BACKGROUND The purpose of this study was to evaluate the acute effects of thymoquinone (TQ) on acute nerve injury. METHODS A rat model of crush injury of the sciatic nerve was used. Animals were divided into 3 groups: control, trauma, and TQ treatment groups (n=6 per group). Seven days after injury, sciatic nerve specimens were obtained from the site of the injury and analyzed histologically and stereologically. Axon diameter, myelin thickness, and axon density were measured. RESULTS There were no significant differences in axon diameter, myelin thickness, or axon density among groups. CONCLUSION TQ has no acute therapeutic effect on acute nerve injury.