Kivanc Topuz

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.

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.

Comparison of deferoxamine and methylprednisolone: protective effect of pharmacological agents on lipid peroxidation in spinal cord injury in rats.

Study Design. Experimental study. Objective. To investigate the protective effect of deferoxamine (DFO) administration in comparison with methylprednisolone (MP) on lipid peroxidation and antioxidants after spinal cord injury (SCI) in rats. Summary of Background Data. DFO is used for treating an iron-chelating agent, which is also used in the treatment of iron poisoning and thalassaemia. The neuroprotective effect of DFO was evaulated as a therapeutic agent for SCI. Methods. Forty Wistar rats were randomly divided into 5 groups as sham laminectomy (n = 8), laminectomy with SCI (n = 8), laminectomy with SCI and 0.9% saline intraperitoneal (i.p.) (n = 8), laminectomy with SCI and 30 mg/kg MP i.p. (n = 8), and laminectomy with SCI and 30 mg/kg DFO i.p. (n = 8). Neurological deficits were examined 24 hours after trauma, and all rats were killed. Spinal cord segments were harvested for both biochemical and histopathological evaluation. Results. At 24 hours post-SCI, whereas malondialdehyde levels were increased, superoxide dismutase, catalase, and glutathione peroxidase levels were decreased in groups I, II, and III. MP and DFO treatment decreased MDA levels and increased superoxide dismutase CAT, and glutathione peroxidase levels in control and study groups. There was no statistically significant difference between treatment with MP and DFO (P> 0.05). All rats were paraplegic after SCI, except in the sham group. Histopathological improvement was observed in control and study groups. Conclusion. This study indicates that beneficial effects may be provided and further studies need to investigate the dose-dependent beneficial and side effects of DFO in SCI. Level of Evidence: N/A

Effect of hyperbaric oxygen therapy on the duration of treatment of spinal tuberculosis.

The aim of this retrospective study was to investigate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment and rate of radiological improvement in the management of spinal tuberculosis. We reviewed a total of 51 patients with tuberculous spondylitis of the spine who were treated by percutaneous abscess drainage or radical surgical debridement with chemotherapy, and of whom 16 randomly selected patients also received adjuvant HBO therapy and 35 did not. Serological markers were monitored in the course of treatment. Percutaneous needle biopsy was performed on each patient before treatment. Spine and chest radiographs, CT scans and MRI were performed. Infection control was achieved in all patients and no recurrence occured. To our knowledge this is the first reported series of patients with spinal tuberculosis treated with HBO therapy as an adjunct to antituberculous chemotherapy. This combination provided earlier clinical and radiologic improvement than chemotherapy alone.

Cramp finding: can it be used as a new diagnostic and prognostic factor in lumbar disc surgery?

Abstract. In this prospective study, the validity and the importance of a new finding (cramp finding) in the diagnosis and outcome after lumbar disc surgery were tested. The test is performed with the person in prone position. Against a forceful knee flexion, the examiner holds the leg with one hand and applies a force to overcome the knee flexion. The finding is positive if the examined person feels a disturbing cramp in the leg or thigh. The study was performed between October 1997 and December 1999. Besides the cramp finding, the classical disc herniation examination, including mechanical and neurological findings, magnetic resonance (MR) imaging tests, and laboratory findings were checked pre- and postoperatively. The positive cramp finding in the operated group was 72% (n=133) preoperatively and straight leg raising (SLR) test was positive in all of them. Cramp finding was positive in 70%, 52%, 34%, and 8% of patients postoperatively in the first, 3rd, 12th and 24th months, respectively. The presented finding appears to be as valuable as the SLR, and especially contralateral SLR, tests in lumbar disc surgery. Cramp finding is also important in outcome evaluation.

Anterior tarsal tunnel syndrome secondary to missed talus fracture: a case report.

The anterior tarsal tunnel syndrome (ATTS) has first been described by Kopell and Thompson in 1963. The anterior tarsal tunnel is formed by the fascia lining the inferior extensor retinaculum and talus as well as the navicular bone. Many ATTS cases with various etiologies have been reported since the first description. We report here an ATSS case resulting from a fibro-osseous structure that occurred after a missed talus fracture. The ATTS diagnosis can be made with a comprehensive clinical neurological examination and electrophysiological study. The treatment is based on the underlying etiology, while surgery is the most common treatment providing successful outcomes in the long term.

Existence of two separate facet joints on the same side: case of a congenital anomaly.

We present a case that had two separate facet joints on the same side causing an intervertebral instability. The embryological pathogenesis of the congenital existence of two separate facet joints on the same side of the vertebra is not conclusively known. A 68-year-old woman presented with lower back pain and severe left leg pain. Neuroradiological evaluation including dynamic plain radiography, computed tomography, and magnetic resonance imaging of the lumbar spine revealed the existence of two separate facet joints on the same side of the first sacral vertebra, severe degenerative changes of both right and left L5-S1 facet joints, and Grade II L5-S1 spondylolisthesis. Subsequently, she underwent surgery. Intraoperatively, two separate facet joints on the same side of the first sacral vertebra were confirmed. The patients symptoms were resolved after decompression and fusion surgery. This is a unique case of the congenital existence of two separate facet joints on the same side of the first sacral vertebra.

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.

Capillary hemangioma of the cervical intervertebral disc

An anterior cervical decompression and fusion operation was complicated by extensive bleeding from the disc space. Histopathological evaluation of the resected specimen revealed the diagnosis as the very first reported case of capillary hemangioma in intervertebral disc space. Retrospective review of the preoperative MRI demonstrated supporting findings of a capillary hemangioma within the cervical intervertebral disc.