Nebi Yilmaz

Protective effects of tadalafil on experimental spinal cord injury in rats

Tadalafil is a selective inhibitor of cyclic guanosine monophosphate (cGMP)-specific phosphodiesterase type 5 (PDE5). Nitric oxide (NO) functions as a retrograde neurotransmitter in the spinal cord, and postsynaptic structures respond to NO by producing cGMP. The concentrations of cGMP in the spinal cord are controlled by the actions of PDE. The aim of the study was to evaluate and compare the effects of the use of both methylprednisolone and tadalafil on serum and tissue concentrations of NO, malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, and tissue glutathione peroxidase (GSH-Px) activity in rats with spinal cord injury (SCI). SCI was induced in Wistar albino rats by dropping a 10 g rod from a 5.0 cm height at T8-10. The 28 rats were randomly divided into four equal groups: tadalafil, methylprednisolone, non-treatment and sham groups. Rats were neurologically tested at 24 hours after trauma. At the end of the experiment, blood samples were collected and spinal cord tissue samples were harvested for biochemical evaluation. The tissue level of NO was increased in the tadalafil group compared with the non-treatment and methylprednisolone groups (p<0.05). The tissue levels of SOD and GSH-Px did not differ between the groups. Serum levels of NO were higher in the tadalafil group than in the non-treatment group (p<0.05). The increase in serum SOD levels was greater in the tadalafil group than the methylprednisolone group. Serum MDA levels in the tadalafil and methylprednisolone groups tended to be lower than in the non-treatment group (p>0.05). Tissue MDA levels in the tadalafil and methylprednisolone groups tended to be lower than in the non-treatment group and sham groups (p>0.05). Although there was no difference in neurological outcome scores between the tadalafil, methylprednisolone and non-treatment groups (p>0.05), the animals in the tadalafil and methylprednisolone groups tended to have better scores than the non-treatment group. Thus, tadalafil appears to be beneficial in reducing the effects of injury to the spinal cord by increasing tissue levels of NO and serum activity of SOD.

Being a neighbor to Syria: A retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war

OBJECTIVEnToward the end of 2010, the Arab spring, the waves of revolutionary demonstrations and protests influenced also Syria, where violent clashes turned into a civil war. Hundreds of thousands of people became refugees. The use of excessive force unfortunately culminated in numerous deaths and injuries in many cities. Being the closest city to Aleppo, Damascus and Homs, the biggest cities of Syria, Antioch/Hatay has been the city where initial emergency treatments were performed. For this reason, we examined and retrospectively analyzed the medical records of the patients treated in the clinics of our hospital due to cranial gunshot wounds during the war.nnnMATERIAL AND METHODSnThe medical records of 186 patients who were injured in the Syrian War and brought to, followed up and treated in the Neurosurgery Clinic of Mustafa Kemal University, Faculty of Medicine in Hatay, a Turkish city on the Syrian border, between April 2011 and June 2013.nnnRESULTSnA total of 186 patients were evaluated in a period of more than 2 years. Of all 91.4% of the patients were adults (male/female: 152/18) and 8.6% of them were pediatric patients (male/female: 14/2). The average age of the patients was 31 years, with an age range of between 2 months and 67 years. According to Glasgow coma score (GCS) of the patients at the time of admission, GCS was 3 in 32 patients (17.2%), between 4 and 7 in 70 patients (37.6%), and between 8 and 15 in 84 patients (45.1%). We observed that the patients with GCS of 4-7 had a significantly lower mortality among the 56 patients treated surgically compared with the 14 patients treated medically.nnnDISCUSSIONnCranial gunshot wounds are responsible for high mortality and morbidity. A multiplicity of factors plays a role on morbidity and mortality. These are the duration of transport, the injury pattern, the velocities of the weapons used, and the Glasgow Coma Scales of the patients at the time of admission.nnnCONCLUSIONnThe authors recommend that the patients with cranial gunshot wounds who has GCS of 4-7 should be aggressively treated including surgery as well. We do not recommend surgical treatment for patients with GCS of 3. All our experiences show that treatment of gunshot wounds will continue to be a matter of debate, about which there is more to learn. The data presented in this study will once again demonstrate the seriousness of the event, and will, perhaps, contribute to the peace negotiations to end the war.

INTRACRANIAL HEMORRHAGE DUE TO VITAMIN K DEFICIENCY IN INFANTS: A CLINICAL STUDY

The hospital records of 30 infants with a diagnosis of intracranial hemorrhage (ICH) due to late onset of vitamin K deficiency, seen during a 5-year period (2001–2005) were retrospectively evaluated. Signs and symptoms of the patients were convulsions (80%), poor sucking (50%), irritability (40%), vomiting (47%), acute diarrhea (33%), and fever (40%). On physical examination there were bulging or full fontanel in 19 patients (63%), collapsed fontanel in one (3%), diminished or absent neonatal reflexes in 11 (37%), pallor in 14 (47%), and cyanosis in one (3%) patient. Gastrointestinal disorder, skin hemorrhagic findings, and epistaxis each were noted in two (7%) patients. All the infants had prolonged prothrombin time (PT) and seven had prolonged activated partial thromboplastin time (APTT), both of which were corrected by the administration of vitamin K. All the infants had ICH, with the most common being intraparenchymal hemorrhage, followed by multiple type ICH (27%). Neurosurgical intervention was performed in five patients (17%). The overall case fatality rate was 33%. In conclusion, we would like to stress that ICH due to vitamin K deficiency in infants is still an important health problem in Turkey resulting in high mortality rate.

Protective effects of minocycline on experimental spinal cord injury in rats.

BACKGROUNDnThe effects of minocycline on neuronal injury after spinal cord injury (SCI) are limited and controversial. Therefore we aimed to investigate the protective effects of minocycline on tissue and on serum concentrations of malondialdehyde (MDA) levels, superoxide dismutase (SOD) activity, glutathione peroxidase (GSH-Px) activity, tissue total antioxidant and oxidant status (TAS and TOS, respectively), and AST and LDH levels in rats with SCI.nnnMETHODSnThis study was performed on 7-8 weeks 38 male Wistar albino rats. The animals were randomly divided into five groups: group 1, Sham (n=8); group 2, SCI (spinal cord injury)/control (n=8); group 3, SCI+minocycline3 (n=7); group 4, SCI+minocycline30 (n=8) and group 5 SCI+minocycline90 (n=7). Blood and tissue samples were analysed for MDA, SOD, GSH-Px, TAS, TOS, AST and LDH levels.nnnRESULTSnThe MDA levels were significantly higher in SCI group compared to sham group (p<0.001), and MDA levels were also significantly higher in SCI group compared to SCI+M3, SCI+M30, SCI+M90 (p<0.05). SOD levels were significantly higher in SCI+M30 when compared to SCI and SCI+M3 groups (p<0.05). GSH-Px levels decreased significantly in SCI and SCI+M3 groups compared to sham (p<0.05). SCI+M3 group showed significantly decreased levels of TAS and TOS compared to SCI group (p<0.05). TAS and TOS levels significantly increased in SCI+M90 group compared to SCI+M3 and SCI+M30 groups (p<0.05).nnnCONCLUSIONSnThe present study demonstrates the dose-dependent antioxidant activity of minocycline against spinal cord injury in rats. Minocycline administration increased antioxidant enzyme levels and improved total antioxidant status.

Effects of tadalafil on ischemia/reperfusion injury in rat brain

Cerebral ischemia–reperfusion (I/R) injury is caused by lack of blood supply to the brain. The accumulation of toxic products such as reactive oxygen species (ROS) occurs on reperfusion, when the occlusion is removed. The resulting oxidative stress results in the initiation of pathways leading to necrotic and apoptotic cell death. Tadalafil (TAD) prevents the accumulation of ROS and increases antioxidant cellular protective mechanisms. The aim of this study was to investigate the effect of TAD treatment against short-term global brain I/R injury in rats. The study was carried out on 30 Wistar-albino rats, which were divided into three groups including a control group (nxa0=xa010), an I/R group (nxa0=xa010) and an I/Rxa0+xa0TAD group (nxa0=xa010) (2xa0mg/kg/day for 4xa0days before ischemia). At the end of the experiment, tissue samples were collected for both biochemical and histopathological analyses. Malondialdehyde was significantly lower in the TAD-administered group (9.06xa0±xa00.15) than in the I/R group (pxa0<xa00.05). However, no significant difference was observed in nitric oxide levels in the TAD-administered group compared to the I/R group. The mean superoxide dismutase level was significantly higher in the I/R–TAD group than the I/R group. There was no statistically significant difference in glutathione peroxidase levels in I/Rxa0+xa0TAD group compared to I/R group. Histopathologically, TAD-administered group provided significant morphological improvement compared to the I/R group. We concluded that TAD prevented I/R-induced neurotoxicity as shown by obtained biochemical and histopathological findings.

Effects of ceftriaxone on ischemia/reperfusion injury in rat brain.

The aim of this study was to investigate the effect of ceftriaxone treatment against short-term global brain ischemia/reperfusion (I/R) injury in rats. The study was carried out on 30 Wistar-albino rats that were divided into three groups: control group (n=10), I/R group (n=10) and I/R-ceftriaxone group (n=10). Malondialdehyde (MDA) levels were significantly increased in the I/R group in comparison with the control group (p<0.001). MDA was significantly lower in the I/R-ceftriaxone group than in the I/R group (p<0.05). Superoxide dismutase activity was significantly decreased in the I/R group and increased in the I/R-ceftriaxone group as compared with the control group. Glutathione peroxidase activity was significantly decreased in the I/R group and increased in the I/R-ceftriaxone group as compared with the I/R group and the control. Histopathologically, ceftriaxone provided morphological improvement compared with the I/R group. We concluded that ceftriaxone has neuron-protective effects due to its antioxidant properties as shown by a decrease in MDA overproduction and histological improvement in brain tissue.

The Dowling-Orlando technique in a giant primary cerebral hydatid cyst: a case report

Hydatid cyst disease is a parasitic illness that is rarely located in the brain. We present a case of a 26-year-old female who complained of headache, nausea, and vomiting. The diagnosis was intracranial hydatid cyst disease and was confirmed with radiological and serological tests. Neurological examination revealed papilloedema and left-sided pyramidal signs. She was operated on using the Dowling-Orlando technique. The cyst was removed without rupture, and therapy was completed with albendazole for a period of four weeks. In this article, we discuss the application of the Dowling-Orlando technique, microsurgery, the Valsalva manoeuvre and the positioning of the patient such that gravity could facilitate surgical removal of a giant cerebral hydatid cyst.

Evaluation of Lymphocyte Subgroups in Children with Subacute Sclerosing Panencephalitis

The aetiology of subacute sclerosing panencephalitis (SSPE) remains to be fully elucidated, although it follows infection with a hypermutant defective M-protein measles virus. This study analysed peripheral blood lymphocyte subgroups to determine their role in the pathophysiology of SSPE. It included 22 children with SSPE aged 2-15 years (patient group) and 22 age- and gender-matched healthy children (control group). In children < 6 years old, there were no statistically significant differences between the two groups in the proportions of lymphocytes expressing the surface markers CD3, CD8, CD19 or CD16/56, or in CD4/CD8 ratio. The proportion of CD4+ lymphocytes in SSPE patients < 6 years of age was significantly lower compared with the control group. In children ≥ 6 years old, there were no significant differences in the lymphocyte subgroups. In conclusion, these findings suggest that a low CD4+ lymphocyte count might be responsible for SSPE in younger children.

Electrophysiological and Clinical Assessment of Response to Surgery in Carpal Tunnel

ABSTRACT The objective of this study was to assess the clinical and electrophysiological changes before and after surgery in 44 patients who underwent surgical intervention due to the diagnosis of carpal tunnel syndrome (CTS). Patients who were diagnosed with a slight, moderate, and severe idiopathic CTS were assessed clinically and by electrophysiological tests before (mean 2–4 weeks) and after surgery (at sixth month). Improvement in clinical parameters was achieved more significantly than electrophysiological recovery.

Kalsifiye kronik subdural hematom

Kalsifiye kronik subdural hematom nadir karsilasilan bir hastaliktir. Bu durum, gecirilmis travmalara veya yetersiz cerrahi girisimlere ikincil olarak gelisebilir. Etiyolojisi halen net olarak anlasilamadigindan tedavi sekli konusunda ihtilaflar mevcuttur. Bu makalede, kalsifiye kronik subdural hematomlu, 27 yasinda erkek hasta sunuldu. Hastanin 5 yil once trafik kazasi sonrasi baska bir merkezde ameliyat gecirme oykusu vardi. Nobet gecirme, bas agrisi ve bas donmesi sikâyeti ile basvurdu. Norolojik muayenede patoloji saptanmadi. Norogoruntulemede, sag frontotemporoparietal bolgede kalsifiye kronik subdural hematom tespit edildi. Antiepileptik ve analjezik ilac uygulamasi ile izleme alindi.Kalsifiye kronik subdural hematomlu olgularda, cerrahi tedavi karari dikkatli ve titiz bir degerlendirme sonrasinda verilmeli ve hastaya fayda saglamayacak cerrahi islemlerden kacinilmalidir. Klinik izlem goz onunde bulundurulmalidir. n nCalcified chronic subdural hematoma n nCalcified subdural hematoma is a rarely seen event. It may develop secondary to previous trauma or inappropriate surgical procedures. Due to the not well understood etiology, there are variations in the treatment choices. We present a 27-year old male patient with calcified chronic subdural hematoma. He was operated on following an motorcycle accident in another hospital 5 years ago. He was admitted to our hospital complaining about seizure, headache and dizziness. Neuroradiological examination revealed a calcified chronic subdural hematoma was detected on the right hemisphere. The patient was hospitalized and put on anti-epileptic and analgesic drugs. Any surgical treatment was not applied. In cases with calcified chronic subdural hematoma, the decision of surgical operation should be decided after a carefully and meticulously investigation. It should be avoided any profitless and likely harmful surgical procedures. The clinical observation may be appropriate in the determination of treatment approaches. n nJ. Exp. Clin. Med., 2012; 29:159-161