Punica granatum L. Juice Attenuates Experimental Cerebral Vasospasm in the Rabbit Subarachnoid Hemorrhage Model: A Basilar Artery Morphometric Study and Apoptosis

Background This study investigated the effect of Punica granatum L. (pomegranate) juice on the rabbit basilar artery in an experimental subarachnoid hemorrhage (SAH) model. Methods Eighteen adult male New Zealand white rabbits were randomly divided into three groups: a control group (n = 6), SAH group (n = 6), and SAH + treatment group (n = 6). Basilar artery diameter was measured with magnetic resonance angiography (MRA) in all groups at the beginning of the study. Experimental SAH was created by injecting autologous arterial blood into the cisterna magna. In the treatment group, the subjects were administered a daily dose of 30 ml/kg pomegranate juice via gastric gavage for 4 days after the SAH. The SAH group and SAH + treatment group underwent cerebral MRA after 72 hours. After a neurologic score assessment, all the animals were killed. The wall thickness and lumen area of the basilar artery were measured histometrically in all groups, and the apoptotic cell percentage in the artery was identified. The mean diameter of the basilar artery during MRA was measured. Results Pomegranate improved neurologic functions compared with the SAH group (p < 0.01). The mean basilar artery diameter on MRA in the SAH + treatment group was larger than in the SAH group and smaller than in the control group (p < 0.01 and p < 0.05, respectively). The mean vessel wall thickness value in the SAH + treatment group was lower than in the SAH group (p < 0.01), whereas there was no difference between the control and the SAH + treatment group (p > 0.05). The apoptotic cell rate in the SAH + treatment group was significantly lower than in the SAH group (p < 0.001). Evaluation of the basilar artery luminal area showed no difference between the three groups (p > 0.05). Discussion Pomegranate was shown to have a vasospasm- attenuating effect on the basilar artery in the rabbit SAH model for the first time in our study.

Neuroprotective effect of magnesium sulfate and dexamethasone on intrauterine ischemia in the fetal rat brain: ultrastructural evaluation

AIM

The aim of this study was to investigate the neuroprotective effect of magnesium sulfate and dexamethasone on oxidative damage in intrauterine ischemia.

MATERIAL AND METHODS

In this study, 19-day pregnant rats were divided into five groups. Fetal brain ischemia was achieved in the ischemia/ reperfusion (I/R) group by bilaterally closing the utero-ovarian artery with aneurysm clips for 30 min and subsequently removing the aneurysm clips for 60 min for reperfusion. Mg (600 mg/kg) and dexamethasone (0.25 mg/kg) were administered 20 min before the I/R insult. The lipid peroxidation in the brain tissue was determined by the concentration of thiobarbituric acid reactive substances (TBARS). The mitochondrial score was calculated after an evaluation with electron microscopy.

RESULTS

Both the electron microscope and TBARS data showed a significant difference between the control and I/R groups. The Mg and dexamethasone treatment groups exhibited significantly lower TBARS values compared to the IR group. Similarly, the mitochondrial scores in the Mg and dexamethasone treatment groups were significantly lower than those in the I/R group.

CONCLUSION

Result showed that magnesium sulfate and dexamethasone prevent lipid peroxidation and reduce mitochondrial injury thus suggests neuroprotective effects in fetal rat brain in intrauterine ischemia-reperfusion (I/R) injury.

The therapeutic effects of melatonin and nimodipine in rats after cerebral cortical injury

AIM

Secondary brain injury starts after the initial traumatic impact and marked by an increase in the intracellular calcium concentrations.This cascadeeventually results in membrane lipid peroxidation and neuronal cell death.

MATERIAL AND METHODS

We investigated the neuro-protective effects of nimodipine and melatonin in 38 rats after 6 hours of head trauma using the cortical impact injury model of Marmarou.

RESULTS

Brain water in the melatonin-given group decreased significantly comparing to that of control group the brain water in the nimodipine given group increased significantly comparing to that of trauma group. Histopathologically, brain edema was significantly low in melatonin-administered group comparing to that of control group while there were no changes in brain edema in the nimodipine given group and in the group that both nimodipine and melatonin were administered in combination. MDA levels in the brain tissues were significantly lower in the melatonin and nimodipine groups comparing to those of trauma and control group however this difference was by far significant in melatonin group comparing to nimodipine group.

CONCLUSION

Melatonin appears to have neuro-protective effects on the secondary brain damage while nimodipine and nimodipine plus melatonin combination did not show such neuro-protective effects on the secondary brain injury.

Neuroprotective effects of propofol, thiopental, etomidate, and midazolam in fetal rat brain in ischemia-reperfusion model

PURPOSE

The aim of this study was to investigate the neuroprotective effects of propofol, thiopental, etomidate, and midazolam as anesthetic drugs in fetal rat brain in the ischemia-reperfusion (IR) model.

METHODS

Pregnant rats of day 19 were randomly allocated into eight groups. Fetal brain ischemia was induced by clamping the utero-ovarian artery bilaterally for 30 min and reperfusion was achieved by removing the clamps for 60 min. In the control group, fetal rat brains were obtained immediately after laparotomy. In the sham group, fetal rat brains were obtained 90 min after laparotomy. In the IR group, IR procedure was performed. No treatment was given in the IR group. One milliliter intralipid solution, 40 mg/kg propofol, 3 mg/kg thiopental, 0.1 mg/kg etomidate, and 3 mg/kg midazolam was administered intraperitoneally in the vehicle group, propofol group, thiopental group, etomidate group, and midazolam group, respectively, 20 min before IR procedure. At the end of the reperfusion period, the whole brains of the fetal rats were removed for evaluation of thiobarbituric acid reactive substances and for examination by electron microscopy.

RESULTS

According to lipid peroxidation data, all the anesthetic drugs provide neuroprotection; however, ultrastructural findings and mitochondrial scoring confirms that only propofol and midazolam provides a strong neuroprotective effect.

CONCLUSIONS

Propofol and midazolam may be used to protect fetal brain in case of acute fetal distress and hypoxic injury as a first choice anesthetic drug in cesarean delivery.

Faun Tail Nevus and Spinal Dysraphism: Cosmetic Improvement with Alexandrite Laser Epilation

Faun-tail presents as an abnormal lumbosacral hypertrischosis and may be associated with spinal dysrasphism. In addition to the problems due to spinal anomalies, patient's physico-social life may also be affected. Here, we report a case of 13 years old female patient with Faun-tail in association with sypinal dysraphism, in which cosmetic improvement was achieved with the help of Alexandrite laser. Alexandrite laser can be the method of choice for permanent hair removal method due to its safe, effective and easy to apply properties.

Cranial ossifying fibroma causing visual disorder

Fibrous lesions of the head and the maxillofacial region are generally slow-developing benign tumors that may aggressively take course in clinical terms. These locally destructive lesions show a high recurrence rates unless they are removed gross totally. Sarcomatoid degeneration is also reported to develop in recurring lesions. Difficulties in the diagnosis, classification, and treatment make this entity complex for several years. These tumors are frequently seen among children and young adults. The maxilla and the mandibula are the 2 most common sites that the tumor originates. In our article, we discuss a 59-year-old man whose condition was diagnosed as an ossified fibroma revealing craniofacial extension. Accompanied by literature findings, it has been underlined that, as well as with the pathologic criteria, clinical features and radiologic images should be evaluated together for a specific diagnosis in fibrous lesions.

An attempt to treat patients who have injured spinal cords with intralesional implantation of concentrated autologous bone marrow cells

BACKGROUND AIMS

Spinal cord injury is common among young subjects involved in motor vehicle accidents. Mechanisms and attempts to reverse post-traumatic pathophysiologic consequences are still being investigated. Unfortunately no effective and well-established treatment modality has been developed so far. The regeneration capability of the human nervous system following an injury is highly limited.

METHODS

The study involved four patients (two male, two female) who had suffered spinal cord injury as a result of various types of trauma. On neurologic examination, all the patients were determined to be in American Spinal Injury Association (ASIA) grade A. All patients were treated with decompression, stabilization and fusion for vertebral trauma anteriorly, as well as intralesional implantation of cellular bone marrow concentrates using a posterior approach 1 month after the first operation. The patients were then treated and followed-up in the physical rehabilitation clinic.

RESULTS

At the end of the post-operative 1-year follow-up, two of the patients were classified as ASIA C while one was classified as ASIA B. One patient showed no neurologic change; none of the patients suffered from any complications or adverse effects as a result of intralesional application of bone marrow cells.

CONCLUSIONS

The results of this experimental study show the potential contribution of intralesional implantation of bone marrow to neuronal regeneration in the injured spinal cord, with neuronal changes. In light of the results of this experimental study, the potential for regenerative treatment in injuries of the human spinal cord is no longer a speculation but an observation.

Use of pimecrolimus to prevent epidural fibrosis in a postlaminectomy rat model

OBJECT

Epidural fibrosis is the scar tissue formed over the dura mater after a laminectomy. Extensive epidural fibrosis may be an important underlying cause of failed back syndrome. Pimecrolimus, an ascomycin derivative, is one of the new classes of immunomodulating macrolactams and was specifically developed for the treatment of inflammatory diseases. This study examined the preventive effects of the local application of pimecrolimus in minimizing spinal epidural fibrosis in a rat laminectomy model.

METHODS

Thirty Wistar rats were divided into 3 equal groups: control, mitomycin C (MMC), and pimecrolimus groups. Each rat underwent a laminectomy at the L-3 lumbar level. In the experimental groups, a cotton pad soaked with MMC (0.5 mg/ml) or 5 mg pimecrolimus was placed on the exposed dura mater. No treatment was performed in the control group rats. Thirty days after surgery, the rats were killed and the dura mater thickness, epidural fibrosis, and arachnoidal involvement were quantified.

RESULTS

The mean dura thickness was measured at 9.28 +/- 3.39 microm in the MMC group and at 8.69 +/- 2.32 microm in the pimecrolimus group, compared with 14.70 +/- 4.14 microm in the control group. In addition, the epidural fibrosis and arachnoidal involvement were reduced significantly in the treatment groups compared with the control group.

CONCLUSIONS

In this animal model, it was shown that locally applied pimecrolimus effectively reduces epidural fibrosis and dural adherence in rats that underwent lumbar laminectomy. Mitomycin C was equally effective as pimecrolimus in reducing epidural fibrosis and dural adherence in this study.

Morphometric characteristics of the inner and outer diameter of lumbar pedicles on computed tomography

BACKGROUND AND PURPOSE

The inner pedicle diameter is very important in pedicle screw placement in order to achieve safe and strong posterior stabilization. The optimal pull-out strength can be achieved by a screw which fits into the pedicle medulla. The aim of the present study was to compare the inner and outer pedicle diameters of lumbar pedicles, to determine the inner/outer pedicle diameter ratios, and to develop a simple measure for estimating optimal pedicular screw size.

MATERIAL AND METHODS

178 lumbar pedicles of 20 patients were evaluated. Inner and outer pedicle diameters of lumbar vertebrae were measured in computed tomography (CT). A simple linear regression analysis was performed to assess the relationship between the inner and outer pedicle diameters.

RESULTS

The widest pedicle outer diameter was seen at L5, with a mean of 16.538 +/- 1.899 mm. The narrowest pedicle outer diameter was seen at L1, with a mean of 8.310 +/- 1.870 mm. The maximum inner pedicle diameter was at the L5 level, with a mean of 11.416 +/- 2.664 mm, whereas the minimum was at the L1 level, with a mean of 5.510 +/- 1.887 mm. The regression coefficient between the inner and outer pedicle diameter was 0.68 for all pedicles combined.

CONCLUSIONS

We have demonstrated the relation of the inner and outer pedicle diameter of lumbar pedicles and described an easy and reliable method to estimate the inner pedicle diameter from the outer diameter on CT.

Glioblastoma multiforme mimicking arteriovenous malformation

Glioblastoma multiforme is the most common intracranial neoplasm of all primary central nervous system tumors. Glial tumors can present in different forms. Intracranial hemorrhage may occur in all central nervous system tumors to a varying degree and extent and may even be massive. A 58-year-old man presented with intraparenchymal hemorrhage manifesting as severe headache and vomiting. Cranial computed tomographic scans revealed a right posterior temporoparietal intraparenchymal hemorrhage. Cerebral angiography revealed a 3 x 2 cm right inferior parietal arteriovenous malformation. The patient underwent surgical treatment with a diagnosis of arteriovenous malformation. Postoperatively, the histological diagnosis was glioblastoma. Glioblastoma may mimic an arteriovenous malformation. Close follow-up of such patients is essential.

The importance of vertebral artery proximity to the odontoid process during anterior odontoid approaches

The proximity of the vertebral artery (VA) to the odontoid process makes it vulnerable to injury during surgery. Knowledge of the quantitative anatomy of the VA groove is therefore necessary. In this study we assessed the spatial relationship between the VA and the odontoid process on cadavers by direct measurement and in patients by CT angiography. Our goal was to measure the distances from the VA and vertebrobasilar junction to the odontoid tip. The VA and odontoid process of 10 craniocervical cadavers ("cadavers") and of 20 patients were evaluated and average measurements obtained. The measured parameters were: (i) distance from the right VA to the odontoid tip (right VA-odontoid tip); (ii) distance from the left VA to the odontoid tip (left VA-odontoid tip), and (iii) distance from the vertebrobasilar junction to the odontoid tip (vertebrobasilar-odontoid tip). On the cadavers, the right VA-odontoid tip distance was 11.55mm, the left VA-odontoid tip was 11.02mm, and the vertebrobasilar junction-odontoid tip distance was 24.55mm. In patients, using CT angiography, the right VA-odontoid tip distance was 11.47mm and the left VA-odontoid tip distance was 11.50mm. The VA-odontoid tip distance is important in anterior odontoid approaches. Since the odontoid process may be in close contact with the VA, the relationship between them should be evaluated preoperatively in all candidates for odontoid surgery using three-dimensional CT angiography.

A neurosurgical view of anatomical evaluation of anterior C1-C2 for safer transoral odontoidectomy

An anatomical study for evaluation of anterior C1-C2. To provide essential anatomic data for safer transoral odontoidectomy. The surface dimensions of the atlas vertebra and the transoral approach for odontoidectomy have been described in detail. Anterior arcus of C1 must be drilled out to reach odontoid process for transoral odontoidectomy. The thickness of anterior ring of C1 has not been studied before. Sixty, dried adult atlas and 60 axis vertebrae and ten cadaveric craniocervical specimens were measured for the following: (1) bony drilling depth (BDD), the distance from the anterior wall of anterior ring of C1 to anterior wall of odontoid; (2) minimum drilling diameter (MDD), distance of minimum C1 anterior ring removal for odontoid resection on horizontal plane; (3) maximum bony drilling diameter (MBDD), distance of maximum C1 anterior ring removal for odontoid resection on horizontal plane. Lateral border of this diameter is limited by medial borders of the lateral mass; (4) the widest odontoid diameters (WOD) on coronal sections were measured. On 60 atlas and axis vertebrae, the BDD was 7.0 +/- 1.2 mm on dry bones, the distance between the medial borders of the lateral mass (MBDD) was 16.1 +/- 1.5 mm, and the WOD on coronal sections (WOD) was 9.8 +/- 0.8 mm. On cadavers, the distance between the two edges of C1 anterior ring removal for odontoid resection (MDD) was 10.8 +/- 1.1 mm and the WOD on coronal sections (WOD) was 10.1 +/- 1.4 mm. An odontoid surgery through transoral approach is safe and feasible. A quantitative understanding of the anterior anatomy of C-1 and C-2 is necessary when considering transoral odontoid resection. In this study the authors define safe zones for anterior atlas and axis.

Relapsing polychondritis with involvement of posterior inferior cerebellar artery causing acute lateral medullary syndrome

We present a patient with relapsing polychondritis who presented with findings of lateral medullary syndrome, known as the syndrome of Wallenberg, produced by infarction of a wedge of lateral medulla lying posterior to the inferior olivary nucleus. Angiographic examination showed complete occlusion of the right posterior inferior cerebellar artery and segmental narrowings in the basilar artery. We believe that the angiographic findings were based on an underlying vasculitis because of his relapsing polychondritis. This is the first case of relapsing polychondritis with angiographically demonstrated posterior inferior cerebellar artery involvement. Although this syndrome is usually a result of atherosclerosis, our case suggests that vasculitis must also be considered because it may respond to treatment with corticosteroids.

The evaluation of the role of beta-hydroxy fatty acids on chronic inflammation and insulin resistance

β-hydroxy fatty acids are a major component of lipid A moiety of lipopolysaccaride. We aimed to investigate the role of free β-hydroxy fatty acids on inflammation, as well as to evaluate their effects on cytokine release from human blood cells, and whether they exist in plasma of patients with chronic inflammatory diseases with/without insulin resistance. Peripheral venous blood was incubated with β-hydroxy lauric and β-hydroxy myristic acids (each 100 ng, 1 μg, 10 μg/mL) up to 24 hours. Cytokines were measured from culture media and plasma. Free fatty acids and biochemical parameters were also measured from patients' plasma. Only β-hydroxy lauric acid significantly stimulated interleukin-6 production at 10 μg/mL compared to control (533.9 ± 218.1 versus 438.3 ± 219.6 pg/mL, P < .05). However, free β-hydroxy lauric and myristic acids were not found in patients' plasma. Therefore, free β-hydroxy lauric and myristic acids do not seem to have a role on sterile inflammation in chronic inflammatory diseases associated with insulin resistance.

Spinal drop metastasis of choroid plexus papilloma

A rare case of choroid plexus papilloma (CPP) with spinal drop metastasis is presented. A 51-year-old woman was operated on for a tumor of the fourth ventricle with histopathological diagnosis of CPP. Seven years later, she was re-admitted with low back pain. MRI showed multilobulated tumor at the lumbosacral subarachnoidal space with histopathological diagnosis of CPP. Thus, CPP can spread via the cerebrospinal fluid pathways and cause drop metastasis.

Metoprolol treatment decreases tissue myeloperoxidase activity after spinal cord injury in rats

Neutrophil infiltration has been reported to play an important role in spinal cord injury (SCI). In addition to their cardioprotective effects, beta-blockers have been found to have neuroprotective effects on the central nervous system, but their effect on SCI has not yet been studied. In the current study, we investigated the effect of metoprolol on myeloperoxidase (MPO) activity, a marker of neutrophil activation, in the spinal cord after experimental SCI in rats. Rats were divided into six groups: controls received only laminectomy and spinal cord samples were taken immediately; the sham operated group received laminectomy, and spinal cord samples were taken 4h after laminectomy; the trauma only group underwent a 50g/cm contusion injury but received no medication; and three other groups underwent trauma as for the trauma group, and received 30mg/kg methylprednisolone, 1mg/kg metoprolol, or 1mL saline, respectively. All the medications were given intraperitoneally as single doses, immediately after trauma. Spinal cord samples were taken 4h after trauma and studied for MPO activity. The results showed that tissue MPO activity increased after injury. Both metoprolol and methylprednisolone treatments decreased MPO activity, indicating a reduction in neutrophil infiltration in damaged tissue. The effect of metoprolol on MPO activity was found to be similar to methylprednisolone. In view of these data, we conclude that metoprolol may be effective in protecting rat spinal cord from secondary injury.

Intracranial sewing needle

A 45-year-old patient was found to have an intracranial sewing needle, located in the left frontal lobe. The needle was detected incidentally after minor head trauma. The clinical and radiological findings suggested that it might have entered the brain through the anterior fontanelle.

Ameloblastic carcinoma arising from anterior skull base

Ameloblastic carcinoma (AC) is an aggressive malignant epithelial odontogenic tumor. It may appear de novo or originate from a pre-existing ameloblastoma or odontogenic cyst. To our knowledge, an AC that originates from the anterior skull base has not been reported before in the English literature. We report a case of an AC that originated from the anterior skull base and invaded the dura of the anterior fossa and discuss its clinical course and treatment.

Intracranial metastasis of lung adenocarcinoma mimicking colloid cyst of the third ventricle

A patient with intracranial lung adenocarcinoma metastasis mimicking a colloid cyst of the third ventricle is reported. These tumours may be associated with excessive bleeding and may infiltrate into surrounding structures. Open microsurgery rather than endoscopic surgery should be considered for these cases, particularly a transcortical-transventricular or transcallosal approach, in order to avoid serious complications.

Increased xanthine oxidase activity after traumatic brain injury in rats

Oxidative stress may contribute to many of the pathophysiologic changes that occur after traumatic brain injury (TBI). There are a number of potential sources and mechanisms for oxygen free radical (OFR) production and lipid peroxidation after TBI. In this study, we investigate the time-dependent changes in xanthine oxidase (XO) activity and lipid peroxidation using a focal TBI animal model. We demonstrate that there is an immediate increase in lipid peroxidation by-products and in XO enzyme activity after TBI.

Magnesium sulfate treatment decreases caspase-3 activity after experimental spinal cord injury in rats

BACKGROUND

Apoptosis has increasingly been considered as an important factor in secondary injury after spinal cord injury (SCI). Manifestation of apoptotic cell death process involves activation of the caspase-3 apoptotic cascade. The aim of the study was to demonstrate the effect of magnesium sulfate on caspase-3 activity and to compare its effectiveness with methylprednisolone after acute SCI.

METHODS

The rats were randomly and blindly allocated into 5 groups of 8 rats each. Spinal cord contusion injury was produced by the weight drop method. The control group consisted of non-injured rats. In the trauma group, no treatment was given, whereas 1 mL saline, 600 mg/kg magnesium sulfate, and 30 mg/kg methylprednisolone sodium succinate (MPSS) were administered in the vehicle and both treatment groups immediately after injury. Twenty-four hours after trauma, spinal cord samples were obtained, and tissue caspase-3 activity levels were examined. A 1-way analysis of variance and the post hoc test were used for statistical analysis.

RESULTS

The results showed that caspase-3 activity increased to statistically significantly higher levels in spinal cord after contusion injury than in the control group. Caspase-3 enzyme activity levels were significantly reduced in animals treated either with magnesium sulfate or MPSS.

CONCLUSIONS

We have shown that magnesium sulfate decreases caspase-3 activity in rat spinal cord subjected to contusion injury. Magnesium sulfate may have potential therapeutic benefits by reducing apoptotic tissue damage after SCI.

Electron microscopic study of the progeny of ependymal stem cells in the normal and injured spinal cord

BACKGROUND

Spinal cord injury (SCI) is a common and often irreversible lesion that can incapacitate patients. Precursor cells in the spinal cord proliferate in response to trauma, and this proliferation can be enhanced by exogenous stimuli such as specific growth factors. In the present study, we examined electron microscopic detection of the proliferation, distribution, and phenotypic fate of these precursor cells in the injured adult rat spinal cord.

METHODS

Adult female Sprague-Dawley rats weighing 250 to 300 g were divided into 3 groups. The first group consisted of spinal cord-injured animals with application of a 2.4-g clip extradurally around the spinal cord at the T1 level. A 26-g clip was applied in the second group. The third group included normal uninjured animals. Rats were sacrificed at 3 days, 3 weeks, and 6 weeks after injury. A segment of the spinal cord, 0.4 cm in length, encompassing the injury site was removed and was prepared for electron microscopy.

RESULTS

Three days after mild injury (2.4-g clip), ependymal cells had begun to proliferate and had migrated from the central canal. They had a tendency to surround perivascular spaces close to the axons. The central canal rostral to the lesion site was widely dilated at 6 weeks postoperative in the moderately injured groups (26-g clip). The layer of ependymal cells lining the dilated canal showed reduction in cell height. Traumatic syringomyelic cavities were observed in all of the animals. There was an active proliferative response of the ependymal cells to injury. Large clusters of displaced ependymal cells associated with the dilated central canal were observed. Rests of ependymal cells were observed remote from the central canal with a tendency to form rosettes and accessory lumina 6 weeks after trauma. Fascicles of 3 to 8 fibers enclosed within an ependymal cell were a common finding among the ependymal clusters. There were also debris and some ependymal cells in the lumen.

CONCLUSION

Trauma induces active proliferation of precursor cells in the ependymal region. These cells may replace neural tissue lost to SCI and may assist in axonal regeneration.

Protective effect of erythropoietin on type II pneumocyte cells after traumatic brain injury in rats

BACKGROUND

The main objective was to evaluate the protective effect of erythropoietin on lung ultrastructure against damage in rats after traumatic brain injury.

METHODS

We used forty Wistar-Albino female rats weighing 170-200 gr. The rats were allocated into five groups. The first group was the control and the second was the craniotomy without trauma. The third group was the trauma group. The fourth and fifth groups were erythropoietin (1000 IU/kg) and vehicle (0.4 mL/rat) groups, respectively. A weight-drop method was used for achieving head trauma. Samples were obtained from pulmonary lobes 24-hour post injury. Lipid peroxidation levels were determined and electron microscopic scoring model was used to reveal the ultrastructural changes.

RESULTS

Ultrastructural evaluation revealed pathologic changes in the trauma group compared with the control group (p < 0.05). Lipid peroxidation levels were found to be higher in the trauma group (p < 0.05). Erythropoietin significantly reduced both the ultrastructural pathologic changes and the lipid peroxidation levels in the treatment group (p < 0.05).

CONCLUSIONS

Erythropoietin protects the ultrastructure of pneumocyte type II cells against damage after traumatic brain injury.

Mexiletine treatment—induced inhibition of caspase-3 activation and improvement of behavioral recovery after spinal cord injury

Object. It has been demonstrated in several experimental studies that apoptosis contributes to cellular damage after spinal cord injury (SCI). During apoptosis dying cells secrete additional mediators of apoptosis such as cytokines and free radicals which have additional toxic effects and exacerbate neuronal death. The aim of this laboratory study was to investigate the effects of mexiletine on caspase-3 activation and functional recovery and compare its post-SCI effectiveness with methylprednisolone.

Methods. The rats were divided into five groups. Animals in the trauma group underwent traumatic interventions after laminectomy. Spinal cord contusion injury was produced using the weight-drop method. Animals in treatment groups received a single dose of methylprednisolone sodium succinate (Group C), single dose of mexiletine (Group D), or vehicle solution (saline; Group E) intraperitoneally immediately after injury. Hind-limb functions were assessed using the inclined plane technique and caspase-3 activity in tissue samples was measured 24 hours after SCI. Traumatic injury was found to increase tissue caspase-3 activity. In both treatment groups the drug prevented an increase in caspase-3 activity. Mexiletine treatment improved early behavioral recovery after SCI.

Conclusions. The results obtained in this study demonstrated that mexiletine treatment inhibits caspase-3 activation and preserve/restore better neuronal function compared with methylprednisolone after experimental SCI.

Blockade of sodium channels by phenytoin protects ultrastructure and attenuates lipid peroxidation in experimental spinal cord injury

Spinal cord injury (SCI) involves a series of pathological events. Abnormal sodium influx has been implicated as one of the key events in the pathophysiology of the SCI. Pharmacological blockade of sodium channels can reduce secondary injury and increase recovery from trauma. The aim of the present study was to show the neuroprotective effect of phenytoin, a sodium channel blocker, after experimental SCI. Control and laminectomy-only groups were not injured. 50 g-cm weight drop injury was produced in the trauma group. In the treatment groups, methylprednisolone (30 mg/kg) and phenytoin (1 mg/kg, 10 mg/kg, or 30 mg/kg) were given intraperitoneally immediately after injury. Malondialdehyde (MDA) levels in the spinal cord samples were examined for lipid peroxidation. Spinal cord ultrastructure was evaluated and grading system was used for quantitative evaluation. Trauma increased tissue MDA levels. Treatment with methylprednisolone and phenytoin decreased MDA levels compared to trauma in all doses. Significant ultrastructural neuroprotection was observed with 30 mg/kg of phenytoin treatment according to general neural score. This ultrastructural neuroprotection of phenytoin was not different from methylprednisolone. Phenytoin appears to protect spinal cord against injury by decreasing lipid peroxidation and lessening neuronal damage associated with SCI in rats.

Ultrastructural changes in tracheobronchial epithelia following experimental traumatic brain injury in rats: protective effect of erythropoietin

BACKGROUND

We aimed to demonstrate the time dependent ultrastructural changes in tracheobronchial epithelia after traumatic brain injury. And also, protective effect of erythropoietin was demonstrated.

METHODS

We used 56 Wistar-Albino female rats weighing 170 to 200 g. The rats were allocated into 7 groups. First group was the control. The second underwent craniotomy without trauma. The third, fourth, and fifth groups were respectively 2-, 8-, and 24-hour trauma groups. The sixth and seventh groups were respectively treatment (erythropoietin, 1,000 IU/kg) and vehicle (0, 4 ml/rat) groups. Weight-drop method was used for achieving head trauma. Samples were obtained from both trachea and main bronchi. Modified electron microscopic scoring model was used to reveal the ultrastructural changes in both trauma and treatment groups.

RESULTS

There was no statistical difference between control and sham groups (p >0.05). Scores of all trauma groups were significantly different from the controls (p <0.05). Trauma produced obvious gradual damage on ultrastructure of the tracheobronchial epithelia. Erythropoietin decreased tracheobronchial scores after traumatic brain injury in significant levels. Erythropoietin attenuated ultrastructural scores for each organelle in significant levels (p <0.05 for each organelle).

CONCLUSIONS

The data suggested that ultrastructural damage is obvious at 2 hours deteriorating with time. Erythropoietin protects epithelia against damage after traumatic brain injury. Pharmaceutical lung preservation may help gaining efficacious donor lungs in brain death. But, further time dependent experiments are needed to determine the liability of the donor lung after traumatic brain injury. This fact is to be known for achieving higher graft survival rates.

Correlation of injury severity and tissue Evans blue content, lipid peroxidation and clinical evaluation in acute spinal cord injury in rats

OBJECTIVE

To demonstrate the changes in microvascular permeability occurring in association with graded acute spinal cord injury and to determine whether tissue Evans blue content is a useful indicator of the severity of spinal cord injury. The study also aimed to test the ability of the Evans blue method to demonstrate secondary injury after spinal cord contusion.

METHODS

In step one of the study, spinal cord lipid peroxidation levels and spinal cord Evans blue content were evaluated at 2 h post-injury in five groups of rats: a control group, a laminectomy-only group and three trauma groups (10, 50, and 100 gcm). In step two, these rats were used for Evans blue assessment following clinical examination at 24 h post-injury.

RESULTS

The laminectomy-only group showed no difference from the control group with regard to spinal cord lipid peroxidation levels, tissue Evans blue content, and clinical findings. Increase in spinal cord tissue Evans blue content and lipid peroxidation was correlated with increasing intensity of trauma. There was a negative correlation between trauma intensity and clinical findings, and there was an increase in spinal cord tissue Evans blue content at 24 h compared with that at 2 h.

CONCLUSIONS

Determination of spinal cord tissue Evans blue content is a reliable, rapid, simple and inexpensive method that can be used in experimental spinal cord injury to assess the severity of injury and to evaluate neuroprotection studies. The present study is the first to show that the Evans blue technique is a useful method to demonstrate secondary injury of spinal cord tissue and vasculature.

The possible effect of clinical recovery on regional cerebral blood flow deficits in fibromyalgia: a prospective study with semiquantitative SPECT

OBJECTIVES

Regional deficits in cerebral blood flow have been reported in a few studies of fibromyalgia; however, there is no information on the effects of treatment and clinical recovery on these abnormalities. We evaluated the effects of amitriptyline treatment and consequent clinical recovery on cerebral blood flow changes in fibromyalgia.

METHODS

We assessed cerebral blood flow with a semiquantitative functional brain mapping technique of single-photon emission computed tomography in 14 patients with primary fibromyalgia before and after 3 months of amitriptyline treatment. Patients were followed by visual analog scale, tender point count, and Beck Depression Inventory for clinical improvement.

RESULTS

There was statistically significant improvement in visual analog scale and tender point count after treatment. Beck Depression Inventory did not change significantly. Statistically significant blood flow increase in bilateral hemithalami and basal ganglia and decrease in bilateral temporal, left temporo-occipital, and right occipital lobes were observed on single-photon emission computed tomography after treatment.

CONCLUSIONS

We speculate that these findings could indicate that deficits in cerebral blood flow in fibromyalgia improve parallel to clinical recovery.

The prevalence of diffuse idiopathic skeletal hyperostosis in patients with diabetes mellitus

OBJECTIVE

The relation of diffuse idiopathic skeletal hyperostosis (DISH) and diabetes mellitus (DM) has been frequently reported. However, there is little knowledge about its prevalence in DM. The purpose of this study was to determine that prevalence and whether it differs from that of controls.

METHODS

The prevalence of DISH was investigated in 133 patients with DM and 133 nondiabetic controls matched for sex, age, and weight. Radiologic criteria were used for diagnosis. Erythrocyte sedimentation rate, fasting blood glucose levels, glycolized hemoglobin, triglyceride, very low-density lipoprotein, low-density lipoprotein, high-density lipoprotein, calcium, uric acid, alkaline phosphatase, phosphorus, insulin, and insulin-like growth factor-1 (IGF1) levels of both groups were compared.

RESULTS

The prevalence of DISH (12%) was higher in patients with DM than the control group (6.8%), but there was no statistically significant difference. The average age of the patients diagnosed with DISH (63.36 +/- 9.27) was significantly higher than that of the others (54.21 +/- 12.12) (P < 0.05). There was no significant difference between the DISH patients and the others in other parameters examined.

CONCLUSION

We found no statistically significant difference in the prevalence of DISH between patients with DM and controls. We suggest that the factors thought to be responsible for the etiopathogenesis of DISH such as DM, insulin, and insulin-like growth factor-1 be investigated further.

Determination of the length of anteromedial screw trajectory by measuring interforaminal distance in the first sacral vertebra

STUDY DESIGN

Measurements of the length of pediculocorporeal screw trajectory were performed on bony sacra. Outer interforaminal distances of the first sacral vertebra were measured on bony sacra and anteroposterior sacral radiographs.

OBJECTIVES

To demonstrate the correlation of the length of pediculocorporeal screw trajectory of the first sacral vertebra on bony specimens with outer interforaminal distances on their anteroposterior radiographs.

SUMMARY OF BACKGROUND DATA

Posterior fixation of the lumbosacral vertebra has been used in the treatment of unstable lumbar spine disorders. To achieve the strongest biomechanical stability and to avoid injury to anterior sacral structures for anteromedial insertion of the posterior transpedicular screw to the first sacral vertebra (S1), it is crucial to determine the optimum screw length for both unicortical and bicortical screw placement.

METHODS

Fifty-one dry bony adult sacra were measured and correlated with anteroposterior lumbosacral radiographs. The length of S1 screw trajectory, which was accepted as between inferolateral border of superior articular facet of S1 and sacral promontory, and the outer interforaminal distances of anterior S1 foramens were measured on bony specimens. The outer interforaminal distances of anterior S1 foramens were also measured on anteroposterior sacral radiographs.

RESULTS

The outer interforaminal distances were not statistically different from the length of the S1 screw trajectory on bony specimens. Radiographs of the S1 vertebra have also shown that outer interforaminal distances were not statistically different from the length of the S1 screw trajectory.

CONCLUSION

In this study, we described an easy and a reliable method to determine the length of anteromedial screw by measuring outer interforaminal distance of S1 vertebra on anteroposterior radiograph of the sacrum.

Maternal Treatment with Propofol Attenuates Lipid Peroxidation after Transient Intrauterine Ischemia in the Neonatal Rat Brain

The purpose of this study was to investigate whether propofol has a neuroprotective effect on the fetal brain after intrauterine ischemia-reperfusion (I/R) injury in the rat fetus. Fetal brain ischemia was induced by clamping the utero-ovarian artery bilaterally for 30 min and reperfusion was achieved by removing the clamps for 2 h. A 40-mg/kg single dose of propofol was administered intraperitoneally 15 min before I/R injury. Lipid peroxidation in the brain tissue was determined as the concentration of thiobarbituric acid reactive substances (TBARS) for each fetal rat. Results showed that lipid peroxidation byproducts increased after I/R injury. Maternal treatment with propofol reduced TBARS compared to the I/R group. Propofol has been shown to have neuroprotective effects in intrauterine I/R-induced fetal brain damage in rats.

Erythropoietin exerts neuroprotection after acute spinal cord injury in rats: effect on lipid peroxidation and early ultrastructural findings

Lipid peroxidation has been reported to play an important role in spinal cord injury (SCI). Erythropoietin (EPO) is a hematopoietic growth factor that stimulates proliferation and differentiation of erythroid precursor cells and is also known to exert neurotrophic activity in the central nervous system. The purpose of this study was to investigate the effectiveness of recombinant human EPO in attenuating the severity of experimental SCI. Rats were divided into seven groups. Controls (1) received only laminectomy. The trauma-only group (2) underwent 50-g/cm contusion injury and had no medication. In group 3, 30 mg/kg of methylprednisolone was introduced. The vehicle group (4) received vehicle solution containing human serum albumin, which is a solvent of EPO. Groups 5, 6, and 7 received 100 IU/kg, 1,000 IU/kg, and 5,000 IU/kg of EPO, respectively. All treatments were given as single doses, intraperitoneally, immediately after injury. Thiobarbituric acid-reactive substances were estimated to demonstrate lipid peroxidation, and ultrastructure was evaluated by electron microscopy. The results showed that lipid peroxidation by-products increased after injury. Administration of EPO and methylprednisolone sodium succinate (MPSS) reduced thiobarbituric acid-reactive substances after trauma. The best biochemical results were obtained with 5,000 IU/kg of EPO. Electron microscopic findings showed that EPO protected the spinal cord from injury. Although 1,000 IU/kg and 5,000 IU/kg of EPO inhibited lipid peroxidation better than MPSS, ultrastructural neuroprotection was similar.

Ultrastructural changes in pneumocyte type II cells following traumatic brain injury in rats

OBJECTIVE

We aimed to demonstrate the time-dependent ultrastructural changes in pneumocyte type II cells following brain injury, and to propose an electron microscopic scoring model for the damage.

METHODS

Forty Wistar-Albino female rats weighing 170-200 g were used. The rats were allocated into five groups. The first group was the control and the second was the craniotomy without trauma. The others were trauma groups. Weight-drop method was used for achieving head trauma. Samples were obtained from the right and left pulmonary lobes at 2-, 8-, and 24-h intervals after transcardiac perfusion. An electron microscopic scoring model was used to reveal the changes.

RESULTS

There were no ultrastructural pathological findings pointing to lung injury in any rat of the control groups. There was intense intracellular oedema in type II pneumocyte and interstitial oedema in the adjacent tissue in trauma groups. Oedema in mitochondria and dilatation in both smooth endoplasmic reticulum and Golgi apparatus was more evident in the 8- and 24-h trauma groups. The chromatin dispersion was disintegrated in the nucleus in all trauma groups. Scores of all trauma groups were significantly different from the controls (P<0.05). All trauma groups were different from each other at significant levels (P<0.05 for each trauma groups).

CONCLUSIONS

The data suggested that ultrastructural damage is obvious at 2 h and deteriorates with time. The electron microscopic scoring model worked well in depicting the traumatic changes, which were supported by lipid peroxidation. Further experiments are needed to determine the exact outcome after brain death model.

Solitary extra-axial posterior fossa abscess due to neurobrucellosis

Neurobrucellosis is a rare manifestation of systemic brucellosis. The incidence of nervous system involvement in chronic Brucellosis is approximately 5%. In this case report a solitary, extra-axial posterior fossa abscess due to neurobrucellosis is presented. The clinical manifestations, diagnosis, and treatment of this unusual condition are discussed.

Transcortical-transventricular approach in colloid cysts of the third ventricle: surgical experience with 26 cases

Colloid cysts of the third ventricle account for 0.5-2% of all intracranial tumors. The treatment of these benign tumors remains controversial, and the best surgical option has not yet been determined. Between 1995 and 2002, 27 patients with colloid cysts of the third ventricle presented at our clinic. Twenty-six underwent transcortical-transventricular approaches. One refused surgical treatment. There was no surgical mortality. The main morbidity was epileptic seizures in two patients. Overall outcome was good in all patients. The mean follow-up period was 3.4 years. There were no tumor recurrences. The transcortical-transventricular approach can be used safely to excise third ventricle colloid cysts with low risk of mortality and morbidity.

Prevalence of atopy in rheumatoid arthritis in Sivas, Turkey. A prospective clinical study

Assumed mutual antagonism of T-helper cell (Th)1 and Th2 diseases suggests that the prevalence of atopy should be decreased in rheumatoid arthritis (RA). We tried to determine that prevalence. Sixty-two patients with RA and 61 with osteoarthritis (control group) were included in the study. A questionnaire was used concerning mainly the symptoms of atopy. Skin prick tests, pulmonary function tests, chest X-rays, immunoglobulin E levels, and eosinophil counts were obtained. The prevalences of asthma, hay fever, and eczema in the RA group were 3.2%, 14.5%, and 1.6%, respectively. In the control group, they were 6.5%, 22%, and 6.5%, respectively. There was no significant difference between groups. There was also no significant difference between immunoglobulin E levels. Eosinophil counts were higher in the control group, however these values were within the normal range. Skin prick tests were obtained in seven RA patients, and eight controls revealed increased positivity. The prevalence of atopy in rheumatoid arthritis was not different from that in the general population. Our study results cannot support the concept of Th1/Th2 mutual antagonism.

Magnesium sulfate treatment in experimental spinal cord injury: emphasis on vascular changes and early clinical results

Injury to the spinal cord results in disruption of neurons, cell membranes, axons, myelin, and endothelial cells. The aim of this study was to demonstrate the protective effect of magnesium sulfate on the blood-spinal cord barrier after acute spinal cord injury (SCI). This experiment was conducted in two parts. In the first, rats were injected intravenously with Evans blue 2 h after SCI. The laminectomy-only group had no trauma. Contusion injury (50 g-cm) was applied to the trauma and treatment groups. Magnesium sulfate (600 mg/kg) was given to the treatment group immediately after injury. For the second part, clinical evaluations were performed 24 h post surgery. Then, following Evans blue injection, spinal cord samples were obtained from the laminectomy-only, trauma, and treatment groups. For the control group, nontraumatized spinal cord samples were taken after Evans blue injection following clinical examination. Laminectomy did not affect the spinal cord Evans blue content in 2-h and 24-h groups. The trauma increased tissue Evans blue content, and 24-h samples showed more remarkable tissue Evans blue content, suggesting secondary injury. Application of 600 mg/kg of magnesium resulted in lower Evans blue content in the spinal cord than with injury. Remarkable clinical neuroprotection was observed in the treatment groups. Magnesium sulfate showed vaso- and neuroprotective properties after contusion injury to the rat spinal cord. The authors also demonstrated secondary injury of the blood-spinal cord barrier with the Evans blue clearance technique for the first time.

Closed posterior superior iliac spine impeding pediculocorporeal S-1 screw insertion

OBJECT

Placement of pedicle screws into S-1 is difficult. In cases in which there is a closed posterior superior iliac spine (PSIS), its medial situation prevents lateral oblique placement of the screw inserter sleeve and directing the screw to the anteromedial aspect of S-1. In the present study, the authors discuss anatomical variations of the PSIS and sacrum, and they describe a safe and effective S-1 screw insertion technique.

METHODS

The relation of 50 PSISs obtained from 25 dry pelvises (15 male and 10 female cadavers) was examined. The distance from the inferolateral aspect of the S-1 superior articular facet to its promontory was estimated. The relation between the point of anterior penetration of the "screw line" and "safe zone" was analyzed. Penetration of screw lines into the S-1 body was also measured. (An illustrative case of closed PSIS is presented with pre- and postoperative computerized tomography [CT] scan findings.) The authors found that that PSIS was situated in 28% of the specimens. When screws were directed anteromedially, the screw lines failed to penetrate the S-1 body in 24% of the male and in 15% of female specimens. The screw lines deviated from the safe zone anteriorly in 34% of the male and in 20% of the female specimens. When the PSIS was medial to the line that connects the inferolateral aspect of the S-1 superior articular facet to the promontory, a classification of closed PSIS was assigned.

CONCLUSIONS

The accuracy of the placement of the screws and their pullout strength are increased when using the present technique. Preoperative CT scanning should be performed to determine the presence of a closed PSIS; in cases in which a closed PSIS is found, the ilium should be resected to enable a greater anteromedial trajectory for placement of S-1 pedicle screws.

Pott's disease after heart transplantation: a case report

The incidence of tuberculosis among patients undergoing antirejection therapy is considerably higher than in the general population. Heart transplant recipients have been found to carry the highest risk of tuberculosis. There are no reported data about Pott's disease in heart transplant recipients. The authors present a case of Pott's disease seen after heart transplantation (HTx).

Effect of magnesium sulphate in experimental spinal cord injury: evaluation with ultrastructural findings and early clinical results

Excitotoxic mechanisms have been implicated in the pathophysiology of spinal cord injury (SCI). The authors have studied the protection against secondary damage to rat spinal cord with magnesium sulphate, a well-known N-methyl-D-aspartate antagonist. Rats were randomly allocated into 5 groups. Group 1 rats were controls and normal spinal cord samples were obtained after clinical examination. 50 g-cm contusion injury was introduced to Group 2. Group 3 was vehicle, 1 cc of physiologic saline was injected post-trauma. Group 4 and 5 were treatment groups and 100 mg/kg and 600 mg/kg of Magnesium sulphate was given immediately after trauma, intraperitoneally. Animals were evaluated with inclined plane, Tarlov motor scale and Basso-Beattie-Bresnahan scale 24h after SCI. Spinal cord samples for ultrastructural evaluations were obtained following clinical examinations. Magnesium treatment improved neurological outcome. Electron microscopic results showed obvious neuroprotection in the treatment groups. Application of 600 mg/kg of magnesium revealed better ultrastructural findings and clinical results than 100 mg/kg. These findings demonstrated that magnesium sulphate possesses neuroprotection on spinal cord ultrastructure and on functional scores after acute contusion injury to the rat spinal cord.

Erythropoietin prevents ischemia-reperfusion from inducing oxidative damage in fetal rat brain

OBJECTIVE

The aim of this study was to show the effect of erythropoietin on ischemia-reperfusion-induced oxidative damage in fetal rat brain.

METHODS

Fetal brain ischemia was induced by clamping the utero-ovarian artery bilaterally for 20 min, and reperfusion was achieved by removing the clamps for 30 min. The control group was made up of non-injured rats that were 19 days pregnant. In the ischemia-reperfusion group no treatment was given, while 0.4 ml of human serum albumin solution and 5,000 U/kg recombinant human erythropoietin (r-Hu-EPO) were administered in the vehicle and treatment groups 30 min before ischemia-reperfusion injury. Lipid peroxidation in the brain tissue was determined as the concentration of thiobarbituric acid-reactive substances (TBARS) for each fetal rat. A one-way analysis of variance and the post-hoc test were used for statistical analysis.

RESULTS

TBARS increased to statistically significantly higher levels in fetal rat brain after ischemia-reperfusion injury than were found in the control group. Recombinant human erythropoietin prevented the increase in TBARS after ischemia-reperfusion injury.

CONCLUSION

Recombinant human erythropoietin has been shown to have neuroprotective effect in intrauterine ischemia-reperfusion-induced fetal brain damage in rats.

Different responsiveness of central nervous system tissues to oxidative conditions and to the antioxidant effect of melatonin

Melatonin, a product of the pineal gland, is an effective free-radical scavenger both in vitro and in vivo. Free-radical-mediated lipid peroxidation has been increasingly considered as an important factor in post-traumatic neuronal degeneration. The aim of the present study was (i). to examine the responses of different regions of central nervous system (CNS) to free-radical generation induced in vitro and (ii). to test the efficacy of melatonin in reducing oxidative damage in different regions of the CNS. Rat brain, total spinal cord, spinal cord white matter and optic nerves were dissected with the rats under general anesthesia and immediately frozen at -20 degrees C. Thiobarbituric acid reactive substances were measured as an index of lipid peroxidation. Peroxidation was induced with ferrous iron (0.02 mm), ascorbate (1 mm), and hydrogen peroxide (H2O2) (0.5 mm). All tissue samples showed increased lipid peroxidation levels after treatment with free-radical generating agents. The highest amount of damage was observed in the presence of ferrous iron, ascorbate, and H2O2. Melatonin showed antioxidant effects in the brain, total spinal cord, optic nerve, and spinal cord white matter. The results show that melatonin has differential protective effects on CNS tissues in vitro and the most potent effect is observed in the spinal cord white matter.

Extra-axial cavernomas of the cerebellopontine angle involving the seventh-eighth nerve complex

Extra-axial cavernous malformations (cavernomas) of the central nervous system are rare. Although occasional cases located in different parts of the central nervous system have been reported, only five cases of extra-axial cavernous malformation in the cerebellopontine angle are to be found. We describe here two additional cases of cavernomas in the cerebellopontine angle causing hearing loss and tinnitus presenting as vestibular schwannoma.