Mehmet Gazi Boyaci

Spondylodiscitis: evaluation of patients in a tertiary hospital.

INTRODUCTION Spondylodiscitis (SD) is an uncommon but important infection. The aim of this work was to study the risk factors, bacteriological features, clinical, laboratory and radiological findings of SD, and to shed light on the initial treatment. METHODOLOGY A total of 107 patients who underwent treatment for SD were evaluated. The diagnosis of SD was defined by clinical findings, complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum tube agglutination (STA) test, Ziehl-Neelsen staining, culture, histopathology, and radiological methods such as magnetic resonance imaging (MRI) and computed tomography (CT) scans. RESULTS Of the 107 cases, ranging between 17 to 83 years of age, 64 (59.8%) were male. Twenty-seven (25.2%) patients had diabetes mellitus. Laboratory investigations revealed elevated CRP in 70 (65%) patients, elevated ESR in 65 (61%) patients, and elevated white blood cell (WBC) counts in 41 (38.3%) patients. Thirty-six (33.6%) patients were identified as having brucellar SD, and 5 (4.7%) patients were identified as having tuberculous SD. A total of 66 (61.6%) patients were determined to have pyogenic SD. The most frequently isolated microorganism was Staphylococcus aureus. Antibiotic therapy was given intravenously to all pyogenic SD patients. CONCLUSIONS The incidence of SD has increased as a result of the higher life expectancy of older patients with chronic debilitating diseases and the increase of spinal surgical procedures. In patients with low back pain, SD should be considered as a diagnosis. For effective treatment, it is important to determine the etiology of the disease.

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.

Prognostic value of perihematomal edema area at the initial ED presentation in patients with intracranial hematoma.

OBJECTIVE Intracerebral hemorrhage (ICH) is a potentially life-threatening condition. Interventions and treatments should be managed on time to reduce mortality. It has been put forth that perihematomal edema absolute volume (PHEAV) is related to mortality, however the effect of perihematomal edema absolute area (PHEAA) on mortality is unknown. The objective of this study was to evaluate the effect of PHEAA on 30-day mortality in patients with ICH. METHODS Patients were screened with ICD-9, retrospectively. 106 patients were included in the study. Clinical data were obtained from the patient files. Computed tomography (CT) was acquired from the hospital imaging database. PHEAV and PHEAA were measured via CT by two clinicians blinded to the study protocol. The predictors of 30- day mortality were examined. RESULTS Forty-three (40.6%) patients died within 30days. Older age, lack of trauma, low Glasgow coma scale and high blood glucose were associated with high mortality (P≤.001). PHEAV and PHEAA values were higher in nonsurvivors (P<.001). PHEAA was detected as an independent predictor of 30-day mortality. The cutoff value of PHEAA for mortality was 33.41cm(2) (sensitivity: 84.4%, specificity: 59.0%). There was no difference between receiver operating characteristic curves of PHEAA and PHEAV (P=.55). CONCLUSION In contrast to PHEAV, PHEAA is a simple value which can be measured without the requirement of any additional techniques or extra costs which can be quickly applied and which is an independent indicator of 30-day mortality. PHEAA can accelerate physician interventions for patients with ICH within several hours of ED admission.

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.

Spinal Epidural Hematoma Due To Tyre-Blast Injury: A Case Report.

Study Design. A retrospective case report. Objective. The objective of this article is to report a spinal epidural hematoma (SEH) due to shock wave. Summary of Background Data. SEH is an infrequent condition. Most of SEHs are spontaneous. We have reported an SEH traumatic case without bone lesions due to exploding truck tire. A different category of blast injuries is the one related with exploding tyres. Shock waves are the main mechanism that is responsible for blast injuries. We are presenting the first report of acute SEH due to shock wave. Methods. A 33-year-old man was brought to the emergency department with complaints of weakness and numbness of the upper extremities. There was an epidural high-signal density without osseous lesion in computerized tomography from the level of C2 to C5, and there was a T2-weighted hyperintense lesion in magnetic resonance imaging from the level of C2 to C5 with compression of the spinal cord the anterior and posterior which proved to be an SEH. Results. The patient was discharged from the hospital with complete neurologic recovery. Conclusion. SEH should be considered possible in the blast injury. SEH condition carries a significant risk of morbidity and mortality without early recognition and rapid management. Level of Evidence: 5

A Rare Cause of Calcified Subdural Empyema and Ventriculitis in a Pediatric Patient: Achromobacter Denitrificans

Intracranial infections in the pediatric age group are still important causes of morbidity in developing countries. A 2-year-old male patient presented with acute onset of seizures and loss of consciousness to our emergency department with a past history of being followed for hypogammaglobulinemia. Unenhanced computerized tomography scan of the brain revealed a right frontoparietal peripherally calcified extraaxial collection, brain edema and a left sided shift. Contrast enhanced magnetic resonance imaging revealed a subdural empyema associated with the brain parenchyma and the ventricular system. In spite of a decompression procedure and subsequent medical therapy, the patient succumbed on the 9. postoperative day. This is the first case report of a pediatric patient with subdural empyema and ventriculitis due to Achromobacter denitrificans.

Ligamentum flavum thickening at lumbar spine is associated with facet joint degeneration: An MRI study

OBJECTIVE Degenerative changes in posterior elements of the spine such as thickening or hypertrophy of the ligamentum flavum (LF) may result in spinal stenosis. In the present study, we aimed to investigate the potential factors including age, intervertebral disc degeneration (IDD), facet joint degeneration (FJD), end plate degeneration (EPD), which may affect LF thickening and to reveal the relationship among those factors at each level of lumbar spine by evaluating the magnetic resonance images (MRI). METHODS A total of 200 individuals with low back and/or leg pain complaints who had undergone lumbar MRI were included in this study. The thickness of LF, FJD, IDD and EPD were assessed at all lumbar levels. RESULTS Totally 1000 end plates, 1000 intervertebral discs and 2000 facet joints were evaluated and the thicknesses of 2000 LFs were measured from MRI images of 200 patients (100 males and 100 females). The mean age was 46.87 ± 12.47 years. LF thickness was strongly associated with FJD especially on the ipsilateral side. Age and IDD were correlated at whole vertebral levels. The age related changes (LF thickness, FJD, IDD and EPD) were more prominent at L4-L5 vertebral level. However, gender had no effect on LF thickness. CONCLUSION The results of this study suggest that LF thickening may occur independently or could be associated with FJD especially on the ipsilateral side and this relationship is due to the vertebral level. The degree of disc degeneration increases with age and age related changes may be predominantly observed at L4-L5 vertebral level.

Ankylosing spondylitis: A cause of death after minor trauma

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 16 mars 2016