Hakan Simsek

Combined hyperbaric oxygen and hypothermia treatment on oxidative stress parameters after spinal cord injury: an experimental study.

BACKGROUND AND AIMS We undertook this study to investigate the possible beneficial effects of combined hypothermia and hyperbaric oxygen (HBO) treatment in comparison with methylprednisolone in experimental spinal cord injury (SCI). METHODS Forty eight male Wistar albino rats (200-250 g) were randomized into six groups; A (normothermic control group; only laminectomy), B (normothermic trauma group; laminectomy + spinal trauma), C (normothermic methylprednisolone group; laminectomy + spinal trauma + methylprednisolone treated), D (hypothermia group; laminectomy + spinal trauma + hypothermia treated); E (HBO group; laminectomy + spinal trauma + HBO therapy), F (hypothermia and HBO group; laminectomy + spinal trauma + hypothermia and HBO treated) each containing eight rats. Neurological assessments were performed 24 h after trauma and spinal cord tissue samples had been harvested for both biochemical and histopathological evaluation. RESULTS After SCI, tissue malondialdehyde (MDA) level of the control group was measured increased, and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) enzyme activities were measured decreased. In group F, it was also shown that MDA level elevation had been prevented, and group F has increased the antioxidant enzyme activities than the other experimental groups C, D, E (p <0.05). CONCLUSIONS We concluded that the use of combined hypothermia and HBO treatment might have potential benefits in spinal cord tissue on secondary damage.

Lumbar epidural capillary hemangioma presenting as lumbar disc herniation disease: case report.

Study Design. A case of lumbar spinal epidural hemangioma is presented. Objective. To present the first reported lumbar spinal epidural hemangioma patient clinically mimicking the lumbar disc herniation disease. Summary of Background Data. Capillary hemangiomas are benign endothelial cell neoplasms that are believed to be hamartomatous proliferations of vascular endothelial cells. The occurrence of spinal epidural capillary hemangiomas is exceedingly rare. There are only 3 reported epidurally located cases of capillary hemangiomas in the spinal channel in literature. Lumbar spinal epidural capillary hemangioma in a patient has not been previously reported. Methods. Radiologic features, pathology, and clinical course were documented. Results. L4 hypoesthesia and back pain of the patient was caused by an epidurally located capillary hemangioma. The neurologic symptoms of the patient were markedly improved after surgery. Conclusion. We have reported for the first lumbar epidural capillary hemangioma patient in literature. These lesions are benign and surgical treatment is curative.

Is there any relationship between proinflammatory mediator levels in disc material and myelopathy with cervical disc herniation and spondylosis? A non-randomized, prospective clinical study

The proinflammatory mediator (PIM) levels were assessed in surgically removed samples of herniated cervical intervertebral discs. The objective of this study was to investigate if there is a correlation between the levels of PIMs in disc material and myelopathy associated with cervical intervertebral disc herniation and spondylosis. The role of proinflammatory mediators in the degeneration of intervertebral disc and the inflammatory effects of disc herniations on radicular pain has been previously published. However, the possible relationship between PIMs and myelopathy related to cervical disc herniation and spondylosis has not been investigated before. Thirty-two patients undergoing surgery for cervical disc herniation and spondylosis were investigated. Surgically obtained disc materials, stored at 70°C, were classified into two groups: cervical disc herniation alone or with myelopathy. Biochemical preparation and solid phase enzyme amplified sensitivity immunoassay (ELISIA) analysis of the samples were performed to assess the concentration of mediators in the samples. Very similar values of interleukin-6 were found in both groups whereas the concentrations of mediators were significantly higher in myelopathy group. This study has demonstrated that PIMs are involved in cervical intervertebral disc degeneration with higher concentrations in the samples associated with myelopathy.

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.

The effects of Diesel exhaust particles on neural tube development in the early stage chicken embryo.

AIM Particulate matter is an important air-pollutant and its toxicity has been reported. Diesel exhaust particles (DEP) constitute a large portion of particulate matter. Therefore, we established our study to investigate the effects of DEP on neural tissue in early stage chicken embryos. MATERIAL and METHODS Four study groups and one control group, each of which included 24 objects were designed. Eggs were incubated for 30 hours. Solutions of DEP containing 10, 50, 100, and 200 μg/0.1 ml were prepared with serum saline. At the end of thirty hours diesel exhaust particle solutions were administered under the embryonic discs. After 72nd hour of the incubation, embryos were excised and evaluated macroscopically and histopathologically. RESULTS The difference between the embryos that were defined as poorly and well developed, was found statistically significant (p < 0.05). Neural tube defects were detected in 16 of 104 embryos. Statistically significant association between the administration of DEP and development of neural tube defect was identified (p=0.037). CONCLUSION Thus, the direct neurotoxic effects of DEP, which the whole population encounters inevitably, have been shown in the early stages of embryonic development. Further studies are needed to identify the effects of these particles in the later stages of embryonic development.

Balloon compression technique in the management of persistent intraoperative intratumoral hemorrhage resulting from stereotactic biopsy: technical note.

BACKGROUND Despite its proven safety, intraoperative intratumoral hemorrhage is an uncommon but serious complication of stereotactic brain biopsy. OBJECTIVE We describe the “balloon compression technique” that was used in the management of persistent intraoperative bleeding that could not be arrested by conventional methods of hemostasis. METHODS Between January 2001 and March 2009, of 184 image-guided stereotactic brain biopsy procedures, intraoperative intratumoral bleeding occurred in 12 cases (6.5%). In 3 of these 12 cases (1.6%), intraoperative hemorrhage was persistent. In these cases, after adjustment of the optimum length, a balloon catheter (Fogarty) was inserted through the cannula and inflated with a contrast agent. We observed the patient for 10 minutes by checking the position of the balloon with regular intervals, using a frozen C-arm fluoroscope to determine any significant changes in its initial position due to possible enlargement of the hematoma. The patient was also closely observed during this time. RESULTS Hemostasis was obtained immediately after the inflation of the balloon in all 3 cases. The patients tolerated the procedure well. During and after the procedure no complications related to the technique were observed. None of the cases required craniotomy for evacuation of the hematoma and to secure hemostasis. CONCLUSION Our preliminary results indicate that the balloon compression technique seems to be a safe, rapid, and effective stereotactic practice in the management of the persistent intraoperative intratumoral bleeding that could not be arrested by standard, conventional hemostatic methods.

Surgical results of degenerative spondylolisthesis patients over 70 years old: a single-center experience and clinical outcomes.

AIM The aim of this study is to evaluate results of surgery in Degenerative Spondylolisthesis (DS) patients over 70 years old. MATERIAL AND METHODS This is a non-randomized retrospective analysis of the clinical outcome of 34 patients older than 70 years who underwent surgery. At the end of two-year follow-up period, preoperative and postoperative courses were assessed by Oswestry Disability Index (ODI) and Visual Analog Scales (VAS). RESULTS The mean age was 75 years (range 70-86 years). The mean duration of symptoms was 13.5 years (range 2-30 years). All patients underwent physiotherapy and also 15 (11 female, 4 male) patients used brace. L4-L5 was the most commonly affected level (n=26), Preoperative ODI and VAS scores were mean 71,63 (range 34-100) and 6,77 (range 2-9) (p < 0,05). Postoperative ODI and VAS scores were mean 22,73 (range 0-100) and 2,13 (range 0-10) (p < 0,05). Patients were asked if they had known the outcome, would they accept surgical treatment or not. 86.6% (n=26) of the patients answered the question positively. CONCLUSION A conventional decompressive laminectomy with foraminotomy and posterolateral fusion in situ with transpedicular instrumentation is necessary and reduces pain and recovers functional disability in elderly patients over 70 years old with DS.

Demographical Aspects of Central Large Lumbar Disc Herniation.

AIM The purpose of this study was to investigate the risk factors for the development of the central large disc herniations and to compare the demographic data between central mass prolapse and broad-based central disc herniation. MATERIAL AND METHODS Between 2002 and 2007, 1630 patients underwent surgery and a large disc herniation was the main problem in 59 patients (3.6%). We performed a retrospective analysis of the demographic data of these patients. Magnetic resonance (MR) images were evaluated according to the disc type and level. Variables were evaluated both at baseline and follow-up, with special emphasis on physical job characteristics, sports activities, and MR - based morphologic findings. RESULTS Central large disc herniation was diagnosed in 59 patients consisting of 41 males and 18 females. The average age was 34.7 years. 36 patients had a central mass prolapse that occupied more than 50% of the spinal canal. Intraoperative observations confirmed that 29 out of 36 central disc prolapse patients (80.5%) had intact posterior longitudinal ligaments. Interestingly, the condition in these 29 patients was found to have a direct relation with age and occupation or other body training sports activities. CONCLUSION The size of the large central disc herniation, physical activity, age and gender are major factors in the development of disc herniation.

Basal cell adenocarcinoma of the parotid gland with rare scalp metastasis: a case report.

Salivary gland tumors constitute 3% of tumors in the body. Salivary gland tumors constitute 4% to 10.80% of all tumors in the head and neck tumors and most of them originate from the parotid gland. Most salivary gland tumors are benign. Basal cell adenocarcinoma is a rare salivary gland tumour. Most appear to be benign clinically. Metastases have occurred in less than 10% of patients. A 58-year-old female patient was admitted with the complaint of a growing mass at the top of her head. She was operated for parotid adenocarcinoma two years ago. Computed Tomography (CT) was performed to clarify the relationship between the mass with the calvarium and intracranial region. There is a risk of malignancy in scalp and calvarium lesions. Patients must be subjected to preoperative radiological evaluations.

Concomitant tubercular and fungal cerebellar abscess in an immunocompromised girl.

Concomitant tubercular and fungal cerebellar abscess is rare and we report the first concomitant recurrent multi-lobulated tubercular and fungal cerebellar abscess in an immunocompromised girl with Histiocytosis-X. She presented with cerebellar abscess history diagnosed during the ongoing treatment for tuberculous meningitis. The abscess was drained. Upon the detection of cerebellar abscess recurrence and pulmonary infection, she was referred to our clinic five weeks after the first surgical intervention. Patient was conscious, co-operating but confused. She had severe cachexia, stiff neck and fever. Fundus examination showed bilateral papilledema. Cranial MR images revealed multiple lobulated lesions. Suboccipital craniectomy was performed and abscess was evacuated in toto. Lesion was multi-lobulated. Thick, yellow-gray purulent material was drained. Histopathological examinations yielded Langhans giant cells,budding and branching fungal structures. Fungal infection was identified. We emphasize that posterior decompression and total resection should be considered first in the management of lesions with mass effect in the posterior fossa. Also the presence of concomitant fatal fungal abscess highlights that although the clinic and former diagnoses of the patient may direct the clinician to a certain pathogen, unusual resistant organisms should not be.