Zuhtu Ozbek

Use of Dural Graft to Prevent Cerebrospinal Fluid (CSF) Leakage and its Effects on Medulla Spinalis: An Experimental Study

Introduction: Dural injuries are encountered generally as trauma, spinal tumor excision or postop complications. It is a major problem leads to cerebrospinal fluid leakage meningitis. The method used often in repair is applying the watertight suture to the damaged area with appropriate measures of fascia and dural grafts. The used grafts can be ranged as bovine pericardium, synthetic collagen matrices, fibrin tissue adhesive, vicryl, and polydioxanone graft. In the studies, it is observed that there is still no significant difference between grafts and fascia. Material-Methods: In our study, 60 Spraque Dawley rats whose weights are ranging from 200-250 gr were used. The solution consists of the ketamine hydrochloride (60 mg/kg) and xylazine (12 mg/kg) was injected intraperitoneally to the subjects and the subjects were taken into anesthesia. The subjects were divided into 5 groups. In the first group no extra action was taken, in the second group, fibrin tissue adhesive was applied on the dural injury and in the third group collagen matrix was applied on the dural injury, in the fourth group bovine pericardium was applied on the dural injury, in the fifth group subcutaneous fascia (autogenetic graft) was applied on the dural injury. Surgical Operation: After providing the sterile conditions and operating the anesthesia agents, the experimental animals were laid down on the operating table in the prone position for surgical operation. Following the local area cleaning and environment isolation, subcutaneous incision was applied. Fascia was opened and paravertebral muscles were scarred subperiostally. After applying L1-4 laminectomy, approximately 2 cm linear incision was made with bistoury and cerebrospinal fluid leakage was observed from the dural injury. Analgesia was applied with 10 mg/kg paracetamol on the subjects which survived approximately 6 weeks after the operation. On the 7th day (early group) after the operation, 6 animals from each group and 6 animals from each group after 6 weeks from the operation were injected 100 mg/kg phenobarbital intraperitoneally and scarification operation was completed. Former incision was opened and spinal cord under the laminectomy area was removed with the dural graft as a block and histopathological findings was provided. Histopathological findings: The incisions from this area were stained with Hematoxylin Eosin and Masson Trichrome. In the examination, collagen, vascular diagenesis and necrosis from histopathological findings were examined in early period (first week) and late period (sixth) week. It was observed that in the groups.

Early decompressive surgery after combined intra-venous thrombolysis and endovascular stroke treatment.

BACKGROUND AND PURPOSE The prognosis of malignant middle cerebral artery infarctions (MCA) is poor. The poor prognosis is attributable to the severe cerebral edema that causes a brain herniation and death. Decompressive surgery reduces mortality and may further improve patient outcomes. However, the safety and effectiveness of decompressive surgery in patients who underwent combined intravenous (IV) thrombolysis and endovascular stroke treatment are not certain. Moreover, the evidence on the timing of decompressive surgery is lacking. METHODS The purpose of the open, prospective and non-randomized study was to compare the outcome and complication rates of patients with malignant MCA strokes who underwent early decompressive surgery after combined intravenous thrombolysis and endovascular treatment with those of decompressive surgery patients without prior recanalization treatment strategy. All patients underwent decompressive surgery within 24h of symptom onset. RESULTS Thirty patients were included in the study. Twelve of the 30 patients were treated with combined IV thrombolysis and endovascular approach and 18 patients received standard treatment. The proportion of patients with a modified Rankin score ≤3 at the sixth month follow-up was 33% in the standard group and 44% in the combined treatment group (p=0.712). Mortality, and major and minor complications including symptomatic intracerebral hemorrhage after decompressive surgery did not differ between the two groups (p>0.05). CONCLUSION Early decompressive surgery can be safely performed in patients who received combined IV thrombolysis and endovascular treatment and there was no difference in outcome of these patients compared with patients who did receive the standard medical treatment before early decompressive surgery.

Implant Migration in Cervical Disk Arthroplasty

OBJECTIVE The purpose of this study is to discuss the causes of implant migration after cervical arthroplasty with clinical cases. METHODS The patients who underwent cervical arthroplasty operations in our department between 2006 and 2015 because of cervical disk disease were retrospectively analyzed. The patients who were determined to be symptomatic of implant migration were evaluated. RESULTS Symptomatic implant migration was detected in 5 of 163 (0.3%) patients who underwent cervical disk arthroplasty, and these patients also underwent reoperation. In 4 patients who underwent reoperation, the prosthesis was removed, and an anterior fusion was made. The prosthesis was only removed in 1 patient. CONCLUSIONS The following situations should be considered in the prevention of dislocation and migration of the implant in cervical arthroplasty: protection of the structure of the end plate, selection of the appropriate implant size, and proper surgical construction. In the preoperative period, computed tomography scan may be useful for determining the implant size and details of the bone structure. Foreign body reactions or postoperative trauma may be a rare and unpreventable reason for prosthesis dislocation despite all of the preoperative and perioperative measures and well-made prosthesis designs.

Neuroprotective Effect of Genistein In Peripheral Nerve Injury.

AIM To investigate the effects of genistein in a rat model of sciatic nerve crush injury and complete sciatic nerve transection. The effects of genistein were compared with those of gabapentin, which is widely used in clinical practice for peripheral nerve injury. MATERIAL AND METHODS Forty-eight rats were randomly divided into six groups (8 rats in each group): group 1 (sham); group 2, sciatic nerve crush injury (control); group 3, sciatic nerve crush injury+genistein 20 mg/kg; group 4, sciatic nerve crush injury+gabapentin 90 mg/kg; group 5, sciatic nerve transection+genistein 20 mg/kg; group 6, sciatic nerve transection+gabapentin 90 mg/kg. The effects of genistein and gabapentin were assessed with immunohistochemical staining for growth associated protein-43 (GAP-43) and myelin basic protein (MBP). Interleukin-1β and tumor necrosis factor α levels in the injured nerve specimens were assessed as a measure of inflammatory response; walking track analysis and sciatic function index for neurological recovery and the paw mechanical withdrawal threshold were examined for neuropathic pain. RESULTS On histopathological examination, genistein use was associated with a greater immunoreactivity for GAP-43 and MBP compared with that associated with gabapentin. Genistein and gabapentin had similar effects on anti-inflammatory activity, functional recovery, and neuropathic pain. CONCLUSION Genistein and gabapentin exhibit positive effects on histopathology, inflammation, and clinical findings of peripheral nerve injury. When the systemic side effects of gabapentin are considered, genistein (a basic soy isoflavone that has no side effects) can be used as an alternative to medical treatment in peripheral nerve injury.

Application of Lumbar Drainage in Vasospasm After Spontaneous Subarachnoid Hemorrhage and Prevention of Late Cerebral Infarction

Cerebral vasospasm, especially delayed cerebral ischemia following subarachnoid hemorrhage (SAH) is the most important complication that effects mortality and morbidity of patients with intracranial aneurysms. The presence of cerebral vasospasm has been correlated with an increase in mortality in the first 2 weeks after SAH. Despite clinical studies and research, the etiopathogenesis of cerebral vasospasm is not understood exactly and there is not yet an effective therapy. The aim of our study was to investigate the effect of application of lumber drainage on vasospasm and delayed cerebral infarction following SAH and to examine the incidence of complications. Patient groups were determined by retrospective screening of 70 patients who underwent a surgical operation at the Osmangazi University Medical Faculty Department of Neurosurgery between 2009 and 2013 after a diagnosis of ruptured aneurysmal SAH. After the application of lumbar drainage, the complications and mortality after aneurysm surgery was significantly decreased and correlated with the amount of hemorrhagic cerebrospinal fluid drainage.

Histopathological Evaluation of the Effects of CAPE in Experimental Spinal Cord Injury

AIM < /B > Spinal cord injuries negatively affect the individuals and the life quality of their families due to neurological deficits caused by trauma. The prevalence of spinal cord injury is 15-45/1 million in the world. Caffeic acid phenethyl ester (CAPE) is the most active component of propolis and has neuroprotective, anti-oxidant and anti-apoptotic effects. Our aim was to determine the effects of CAPE on the prevention of secondary injury and to compare with methylprednisolone. MATERIAL AND METHODS Forty rats were divided into 4 groups. The control group did not undergo surgery (Group I), only trauma group (Group II), trauma+CAPE treatment group (Group III), and trauma+methylprednisolone treatment group (Group IV). Histopathological assessment was performed with two staining methods as hematoxylin-eosin (HE) and terminal deoxynucleotidyl Transferase Biotin - dUTP Nick End Labeling (TUNEL). The groups were statistically compared. RESULTS The apoptotic cells decreased in treatment groups compared with the trauma. CAPE has more anti-apoptotic effect than methylprednisolone. The histological difference between the Group II, and Groups III and IV was statistically significant. CONCLUSION CAPE has a positive effect on spinal cord injuries by preventing apoptosis.

Digoxin may provide protection against vasospasm in subarachnoid haemorrhage

BackgroundVasospasm is a significant reason for poor clinical outcome in subarachnoid haemorrhage (SAH). One of the possible causes of vasospasm is attributed to the inhibition of Na+/K+-ATPase and increased intracellular calcium. Although digoxin, a cardiac glycoside (CG), inhibits the Na+/K+-ATPase, diverse and contradictory biological actions of CGs have also been reported. This study aimed to investigate the effect of digoxin on an experimental vasospasm after subarachnoid haemorrhage (SAH) in rats.MethodsThe rats used in the study were divided into normal, saline, SAH, and drug groups. A double-haemorrhage method was applied for the SAH groups. Normal saline or blood samples were injected into the cisterna magna. No surgical procedures were performed on the normal group. For the drug groups, daily digoxin was administered intraperitoneally after saline or blood injections. On days 3 and 7 after injections, the brains and basilar artery sections of all the groups were prepared for light-microscopic examination. The wall thickness and luminal area of the basilar artery were calculated by using medical imaging software.ResultsIncreased wall thickness and reduced vessel luminal area were conspicuously significant in the SAH groups which did not receive digoxin. In SAH groups after digoxin administration, the vessel wall thickness decreased, and no significant change was found in vessel wall thickness when compared with the normal and saline groups. The vessel luminal area was not reduced in SAH after digoxin administration.ConclusionsThese results suggest that digoxin administration in experimental SAH may have a beneficial effect on the protection against vasospasm. If further investigations support our results, the present study may offer a new insight into the treatment of SAH.

Calvarial-orbital metastasis of prostate carcinoma which was diagnosed with sixth cranial nerve palsy

Sixth nerve palsy is frequently due to infectious orbital lesions, trauma, elevated intracranial pressure, brainstem lesions, and vasculopathies. Here, we describe a rare cause of sixth cranial nerve (CN) palsy secondary to calvarial and orbital metastasis of prostate carcinoma. The diagnosis of the prostate carcinoma with sixth CN palsy is a very rare condition. A 66-year-old male patient presented with complaints of blurred vision, double vision, and inability to move outward in the right eye for 3 weeks. Magnetic resonance imaging revealed a right orbitocalvarial mass and the mass surgically removed completely. Pathologic findings were compatible with prostate adenocarcinoma metastasis. After surgical removal, significant improvement in sixth CN palsy was observed.

Deneysel spinal kord travmasında eritropoetin ve tadalafilin terapötik etkinliği

BACKGROUND This experimental study was an investigation of the efficacy of erythropoietin and tadalafil in rats with induced spinal cord injury (SCI). METHODS Thirty-five Sprague Dawley rats were distributed into 5 groups. First group was used for normal biochemical values. Spinal cord injury was induced in 4 remaining groups with clip compression technique after laminectomy process to T10 vertebra. Second group was designated solvent group and received 1 cc physiological serum after injury. Third group was medicated with intraperitoneal 2000 u/kg single dose erythropoietin after injury. Orogastric 2 mg/kg single dose tadalafil was administered to fourth group after injury. Fifth group did not receive any treatment and was used for biochemical values with injury. All subjects were sacrificed 48 hours after application. Malondialdehyde (MDA) and total antioxidant capacity (TAOC) values were evaluated using blood and tissue samples. RESULTS Lowest serum and tissue MDA values were found in group with erythropoietin intake. While highest serum TAOC values of all groups were seen in tadalafil group, highest tissue TAOC values were observed in group given erythropoietin. CONCLUSION It was concluded that by decreasing oxidative stress, tadalafil and erythropoietin can inhibit secondary damage in SCI.

Comparison of the effects and mechanism of the Curcumin with different acting drugs in Experimental Vasospasm after Subarachnoid Hemorrhage.

AIM Cerebral vasospasm following subarachnoid hemorrhage (SAH) is the most important complication that effects the mortality and morbidity of patients with intracranial aneurysm. Today, the mechanisms of vasospasm are not understood in spite of experimental and clinical researches. The aim of our study was to investigate the effects of curcumin on vasospasm following SAH. MATERIAL AND METHODS In this study, 64 rats (200-250 g weight) were divided into 7 groups. Group 1: having no treatment after SAH; Group 2: treatment with nimodipine after SAH; Group 3: treatment with nicorandil after SAH; Group 4: treatment with sildenafil citrate after SAH; Group 5: treatment with 150 mg/kg curcumin after SAH; Group 6: treatment with 300 mg/kg curcumin after SAH, Group 7: treatment with 600 mg/kg curcumin after SAH. The experimental SAH was induced by injection of autologous blood into the cisterna magna. After medical treatment, in the first hour, blood was taken for quantified the levels of TNF-α, IL-1β and IL-6. Then, cerebrum and cerebellum were removed for analysis. Basilar artery luminal diameter was measured and apoptotic cell count was performed with tissue samples. RESULTS Histopathological findings showed that, in sufficient dose, curcumin dilated the basilar artery beside anti-oxidant effect. CONCLUSION Curcumin can be used for the treatment of vasospasm as a new medical drug.