Primary tubercular chorioretinitis

The aim of this report is to emphasize that corticosteroids should not be prescribed when the etiological factors remain unidentified. A 34-year-old male visited our ophthalmology clinic suffering from blurred vision. Behçet's disease had been diagnosed 5 years prior, and the patient was taking an oral immunosuppressant and a systemic corticosteroid. Vitreous cell count and foci of chorioretinitis (apparently confined to the ocular fundus) were evident. A vitreous sample was subjected to polymerase chain reaction, which resulted in the identification of and Mycobacterium tuberculosis. Treatment with a combination of four anti-tuberculosis drugs was commenced. During the follow-up, the vitritis disappeared, and the foci of active chorioretinitis improved. Systemic and Sub-Tenon corticosteroid treatment should not be prescribed until vitreous and anterior chamber fluid samples have been evaluated in patients with uveitis. Some microbes are not detected on routine examination.

Is intralipid fat emulsion a promising therapeutic strategy on neurotoxicity induced by malathion in rats?

AIM

Malathion is one of the most widely used organophosphate pesticides and herbicides. It has given rise to major clinical problems by its poisoning in all over the world. Malathion also a highly lipophilic agent, and tends to accumulate within lipid-rich tissue like a brain in the body, causing toxicity. Therefore, the study was aimed to investigate if there is a possible beneficial effect of using intralipid fat emulsion (IFE) on the neurotoxicity, and to detect it time-dependently at the beginning, 6th and 12th hours of M intoxication.

MATERIALS AND METHODS

Forty-eight rats were randomly divided into six groups including: control (C), Lipid (L) group (18.6 mL/kg oral IFE), Malathion (M) group (10 mg/kg oral M), M0L group (IFE treated after immediate from M), M6L group (IFE treated after 6 hours from M), M12L group (IFE treated after 12 hours from M).

RESULTS

M group in comparison with all others group, there was an increase in the total oxidant status (TOS) level. M group in comparison with C, L, M0L groups, it was seen significantly decrease in the total antioxidant capacity (TAC) level. Interestingly, M group in comparison with M6L and M12L groups, there was no significant difference among these groups in terms of the TAC levels. Although there was no significant difference among C, L and M0L groups in terms of both TAC and TOS levels, but was significant difference C, L groups in comparison with M6L, M12L groups in terms of TAC levels. C group in comparison with L, M0L, M6L, M12L groups in terms of TOS levels, there was no significant difference. These findings have indicated that IFE seriously reduced TOS levels in all the groups depending on time. Also, M0L group in comparison with M6L and M12L groups, there was significantly increase of the TAC levels. There was no statistically significant difference between M6L and M12L groups. These biochemical results were confirmed with immunohistochemical results.

CONCLUSIONS

The study has had some certain evidence that IFE is a promising safe therapy for acutely intoxicated cases by organophosphate. It is much more effective if used at the beginning of organophosphate poisoning. As such, there is no need to avoid using IFE in clinical practice.

The effect of bevacizumab and 5-Fluorouracil combination on epidural fibrosis in a rat laminectomy model

OBJECTIVE

An animal model of laminectomy in rats was used to study scar tissue formation around the spinal cord. Bevacizumab (BV) [a recombinant, humanized, monoclonal antibody targeting vascular endothelial growth factor], 5-Fluorouracil (5-FU) and BV+5-FU was tested in this system for its ability to decrease fibrous tissue formation.

MATERIALS AND METHODS

Twenty-eight Sprague Dawley rats were used in this sudy. Rats were divided into four groups; a control group, a BV group, a 5-FU group and a BV+5-FU group. L1-2 laminectomies were performed on the rats. The medicated groups were treated with topical drug administration. After 6 weeks, the rats were sacrified and histologic sections prepared from the spines were examined and graded by a pathologist. Epidural fibrosis and fibroblast density were evaluated under light microscope.

RESULTS

BV (Avastin: Genentech, San Francisco, CA, USA) significantly reduced the density of the scar tissue undermining the laminas (p < 0.005). Monotherapy with 5-FU did not change the scar formation in the back (p = 0.317). Combination of 5-FU and BV was more effective on reducing the epidural fibrosis after laminectomy on rats (p < 0.001).

CONCLUSIONS

Bevacizumab reduced the spinal epidural fibrosis significantly that developed in rats after laminectomy and 5-Fluorouracil combination had a synergic effect. Further investigations under the light of these findings may help to reduce epidural fibrosis formation after laminectomy.

Histopathologic Changes in Oculomotor Nerve and Ciliary Ganglion in Aneurysmatic Compression Injuries of Oculomotor Nerve

BACKGROUND

Bilateral common carotid artery ligation (BCCAL) increases vertebrobasilar blood flow and leads to increased luminal pressure, luminal enlargement, wall thinning, convolutions and sometimes aneurysm formation in posterior circulation arteries, especially the posterior communicating arteries (PcomA). PcomA aneurysms compress the oculomotor nerves. The principal aim of this investigation is to examine the histopathologic results of the compressive effect of PcomA aneurysms on the oculomotor nerves (OMN) and on ciliary ganglions (CG).

METHODS

When we observed the effects of BCCAL on the posterior circulation arteries of the brain in fifteen ligated rabbits after sacrifice, we noticed aneurysm formation on these arteries in three rabbits. These aneurysms developed on the PcomAs compressed the oculomotor nerves. These compressed nerves and normal oculomotor nerves together with their ciliary ganglions were examined histopathologically.

RESULTS

A PComA aneurysm developed in three rabbits from 15 ligated animals and these aneurysms compressed the oculomotor nerves on the same side. Partial peripheral necrosis and axonal loss were seen on the compressed oculomotor nerves. Concomitantly, cellular loss and necrosis were also observed on their ganglions.

CONCLUSION

Bilateral common carotid artery ligation may lead to PcomAs and these aneurysms could compress the oculomotor nerves. Compression injuries of oculomotor nerve may cause cellular injury and necrosis on both oculomotor nerves and ciliary ganglions.

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats

STUDY DESIGN

A randomized-controlled experimental study was conducted to investigate the effectiveness of recombinant tissue plasminogen activator (rt-PA) on postlaminectomy epidural fibrosis in rats.

SETTING

Diyarbakir, Turkey.

METHODS

In a rat model, allowing objective histopathological quantification, the postoperative epidural scar formation was investigated and the potential of local rt-PA in preventing the production of epidural fibrosis was assessed. Rats were randomly allocated to local rt-PA (12 rats) or control (12 rats).

RESULTS

Findings suggest a beneficial effect of rt-PA in decreasing the epidural fibrosis following laminectomy when compared with control groups for all investigated parameters such as intermuscular scar (P=0.04), middle scar (P=0.001), deep scar (P=0.001) and dural adhesion (P=0.01) except new bone formation. The presence of arachnoiditis was less in treatment group (P=0.01).

CONCLUSION

In rats, the topical thrombolysis with rt-PA is safe and efficacious in preventing postlaminectomy epidural fibrosis. This Thrombolytic therapy with rt-PA after spine surgery may come to play an important role in the prevention of epidural fibrosis and arachnoiditis.

Widespread post-traumatic acute spinal subdural haematoma: case report and review of the literature

STUDY DESIGN

A case report of acute post-traumatic spinal subdural haematoma (ASSH).

OBJECTIVE

To report a rare post-traumatic problem.

SETTING

Dicle University Hospital, Diyarbakir, Turkey.

METHOD

A 3-year-old boy was admitted to our clinic with paraplegia 24 h after falling from a height of about 5 meters. Investigation revealed an acute spinal subdural haematoma.

RESULTS

Following surgery there was marked improvement. The rehabilitation of the patient continues.

CONCLUSION

MRI is the most valuable diagnostic method. In each case diagnosed as ASSH, prompt evacuation should be performed before irreversible neurological damage occurs.

Protective effect of posterior cerebral circulation on carotid body ischemia

BACKGROUND AND PURPOSE

Carotid Bodies (CB) are fed mainly by External Carotid Artery (ECA) and rarely by Internal Carotid Artery (ICA). We aimed to investigate the effect of Bilateral Common Carotid Artery ligation and BCCAL plus bilateral external carotid artery ligation on CB.

METHODS

This study has been conducted on 30 hybrid male rabbits. Normal CB analyses were made in six of these animals and others divided into two groups. BCCAL has been applied to the 1st group, and the 2nd group has undergone bilateral ECA ligation in addition to BCCAL. After sacrificing the animals, both sides CB were histopathologically observed. Normal and ischemic cells were counted.

FINDINGS

Bilateral Common Carotid Artery ligation did not cause total atrophy in CB. Partial reversible atrophy of CB was seen in group I, but that atrophy was found to be irreversible and all animals died within one week after ligation in group II.

INTERPRETATION

Retrograde blood flow mechanisms and collateral circulation impede the oligemic CB atrophy after BCCAL. But bilateral ECA ligation, in addition to BCCAL, causes both sides irreversible CB atrophy and death of animals within one week of ligation.

ABSTRACT

The CB are parasympathetic paraganglia. They are chemoreceptors and located at the bifurcation zone of common carotid arteries. They are fed mainly by ECA or by its branches and rarely by ICA. As a consequence of this, BCCAL and/or ligation of external branches of common carotid artery may lead to an ischemic impairment of CB. In order to analyse the effect of carotid stenosis on CB, CB were directly examined in 6 of 30 hybrid rabbits. BCCAL was applied to twelve rabbits (group I) with ligation of both ECA in addition to BCCAL were made to the others (group II). Animals were followed up four months in group I; but all of the animals in group II died within one week. From both sides the CB were taken including the carotid bifurcation and histopathological changes were evaluated. As a result, it has been observed that incomplete ischemic lesions have developed in the CB because of retrograde blood flow from posterior circulation to the ECA providing blood for the CB. But in the second group these changes were irreversible and on both sides CB complete atrophy developed in those whose ECA were also ligated bilaterally.

Growth rate of cerebral hydatid cyst, with a review of the literature

This extremely rare case was one of secondary solitary cerebral echinococcosis associated with possible cerebral thromboembolism. A 7-year-old girl living in a rural area was admitted to our hospital with a history of headache, right-sided hemiparesis, and dysphasia. She had been treated 6 months previously for a cerebral infarct, diagnosed from sudden altered consciousness and a myoclonic generalised convulsion. The growth rate determined for the cerebral hydatid cyst was about 4.5 cm during the 6-month period. In children a parasitic cyst can be the source of a cerebral embolus, particularly in areas where hydatid disease resulting from cardiac echinococcosis is endemic.

Gigantic intracranial mass of hydatid cyst

A child (8 years old) with a gigantic mass of intracranial hydatid cysts (95x90x75 mm) is presented. The first manifestation was difficulty in walking, which was followed by symptoms of raised intracranial pressure. A craniotomy was performed, and more than 25 hydatid cysts were removed. The literature is reviewed and the incidence of gigantic mass of cerebral hydatid cyst is compared in the published reports.

CT of the brain in tuberculous meningitis. A review of 289 patients

PURPOSE

In this retrospective study, CT findings of 289 patients with tuberculous meningitis (TBM) are presented and diagnostic criteria are discussed.

MATERIAL AND METHODS

The medical records of patients who were diagnosed as having central nervous system tuberculosis were investigated. Cranial CT investigations of 289 patients with TBM were reviewed. Of these 289 patients, 214 were children and 75 adults; 157 patients were male and 132 were female. CT images were obtained with and without i.v. contrast administration.

RESULTS

CT findings were normal in 35 patients and abnormal in 254. The abnormalities were hydrocephalus (172 children, 32 adults), parenchymal enhancement (56 children, 6 adults), contrast enhancement of basal cisterns (32 children, 17 adults), cerebral infarct and focal or diffuse brain edema (29 children, 10 adults), and tuberculoma (9 children, 5 adults).

CONCLUSION

CT is pathologic in the great majority of patients with TBM and is helpful in assessing the complications associated with the disease.

Spinal subdural tuberculous abscess

OBJECTIVES

Spinal subdural abscess is rare and only 48 cases have been described to date. In this report, we present an additional spinal subdural tuberculous abscess.

METHOD

Tuberculous meningitis was diagnosed with clinical and laboratory findings in a 45-year-old man. A spinal subdural abscess was demonstrated using MRI. Presence of the abscess was revealed by surgical intervention. The diagnosis was confirmed by pathological examination.

RESULTS

The patient had been treated for tuberculous meningitis 2 years previously. The disease recurred when anti-tuberculous therapy was prematurely discontinued. During the second treatment, the patient also underwent a ventriculo-peritoneal shunt operation for hydrocephalus. Dizziness and weakness of both legs developed after the postoperative period. Spinal MRI showed a spinal subdural abscess as a iso-intense mass with spinal cord in the T1 and T2 weighted images, ring like enhancement and compression on the spinal cord at T3-T4 level. The patient underwent surgery and the abscess was drained.

CONCLUSION

Tuberculosis may cause a spinal subdural abscess and although it is a rare disorder, when encountered MRI is very useful in the diagnosis.

Corrosive injuries of the esophagus in newborns

To evaluate the morbidity and mortality of corrosive esophageal injuries (CEI) in the neonatal period, the records of 184 children hospitalized following caustic ingestion over a 10-year period from January 1987 to November 1997 were reviewed. Eight (4.3%) were newborns (5 boys and 3 girls). The mean age of the newborns was 12 days (range 1-28). The ingested caustic materials were benzalkonium chloride in six patients and trichloroacetic acid in two. Oropharyngeal examination and esophagoscopy were performed for diagnosis. Hyperemia and fibrin plaques were present in the oropharynx in all patients. The management consisted of endotracheal intubation, antibiotics, corticosteroids, and total parenteral nutrition. Pneumonia and sepsis developed in three patients and one died of sepsis. Stenosis developed in two patients, who were treated three times with antegrade dilatations. The morbidity was 62.5% (five patients) and the mortality was 12.5% (one) in newborns with CEI. These results indicate that ingestion of a caustic substance results in high morbidity and mortality in newborns. Parents and nurses should be warned about this risk.

Lumbar epidural brucellar abscess causing nerve root compression

OBJECTIVES

To evaluate the usefulness of MR sequences for the differential diagnosis of spinal brucellar abscesses which mimic lumbar disc herniation.

METHODS

We analyzed six patients with brucellar abscesses who had symptoms mimicking lumbar disc herniation. The study group consisted of three women and three men who were 15-67 (mean = 37) years old. Patients were imaged in the axial and sagittal planes with a I.0-T MR scanner using a spine coil.

RESULTS

The level of abscesses were accurate in 100% (six of six) of patients with MR imaging. MRI examinations revealed an extradural soft tissue mass which were iso- to hypointense compared to spinal cord on T1WI and hyperintense on T2-weighted images. By contrast study, diffuse homogeneous or slightly heterogeneous enhancements were seen.

CONCLUSION

Lumbar extradural brucellar abscess can have lumbar disc disease symptoms. MRI may non-invasively and rapidly reveal the presence of spinal abscess and degree of extension to the spinal canal. Extradural brucellar abscess should be included in the differential diagnosis of radicular symptoms caused by disc herniation.

Comparison of microsuturing to the use of tissue adhesives in anastomosing sciatic nerve cuts in rats

The purpose of this study was to investigate and to compare the effects of microsuturing to that of tissue adhesives (Tisseel) on the healing of anastomosing peripheral nerve incisions. Forty-five Wistar-Albino rats were placed in special cages and separated into three groups (n = 15). In the control group, biliteral sciatic nerves were explored but no incision was made. In the first experimental group, bilateral sciatic nerves were incised and end-to-end anastomosing was performed by microsuturing the epineurium. In the second experimental group, tissue adhesive (Tisseel) was used alone in anastomosing the sciatic nerve cuts. Assessments of the healing processes were demonstrated by 1.electromyography (EMG), 2. measuring the electrical responses of the anastomosed nerves after electrical stimuli, 3. histopathological examination. Statistical analysis of the EMG findings showed that the Tisseel group was the closest in the healing process to the control group. After applying electrical stimuli to the dissected nerves, the resistance value of the Tisseel group was nearest to those of the control group. The histopathological examinations showed highly degenerative nerve bundles and prominent foreign body granuloma at the anastomosed sites of the microsutured group. The granulomatous inflammation was observed to be much less in the Tisseel group. We conclude that the healing effect of Tisseel was found to be superior to that of microsuturing as demonstrated by the findings of EMG, electrical responses of the anastomosed nerves, and histopathological examination.

Complications of 1303 central venous cannulations

Central venous catheterization (CVC), now a common procedure, has several major complications. We assessed their incidence in a prospective study of 1303 cannulations done in the intensive care unit or operating theatre. Chest radiographs were obtained to verify proper catheter placement and to detect pneumothorax. Complications were arterial puncture in 68 (5.2%) patients, arrhythmias in 21 (1.6%), cardiopulmonary arrest in 1 (0.1%), and pneumothorax in 5 (0.5%). The tip of the CVC was incorrectly located in 149 (11.2%). The chest radiograph was a valuable method for detecting complications of central venous catheterization.

Treatment of subdural empyema by burr hole

Subdural empyema, a collection of pus in the space between the dura and arachnoid, is a rare type of intracranial infection. We report on 23 patients, aged 8 months to 70 years, with subdural empyema who were treated in our clinic between 1989 and 1994. The sources of subdural empyemas were meningitis in five patients, middle ear in five, trauma in four, paranasal sinus in three, complications of surgery and subdural tap in four, and unknown in two patients. The common presentations were headache, focal neurologic deficit, fever, vomiting, seizures, and neck stiffness. Diagnosis was achieved by computerized tomography and neurologic examinations in all cases. Treatment was effected by burr hole or small craniotomy with catheter drainage, and antibiotics were administered to all patients. The mortality rate was 8.7%; the remaining patients made a good recovery without sequelae. We therefore recommend burr hole with catheter drainage plus antibiotics as a method of treating subdural empyema.

Experimental Shwartzman phenomenon in the heart muscle

Intravenous injection of E. coli culture caused a sudden death in rabbits which were injected Streptococcus culture into the myocardium 24 h before the experiment. Pretreatment of animals with Trasylol-R, before injection of E. coli culture, caused an increase of survival time. In isolated Langendorff perfused heart from myocardially Streptococcus culture injected animals, E. coli culture filtrate caused a transitory increase and then a continuous decrease in coronary perfusion pressure together with an increase in heart rate. These findings are shown to be prevented by previous addition of Trasylol to the perfusion medium. According to these results it is speculated that a Shwartzman-like phenomenon can also occur in the heart muscle. The possible role of the activation of tissue kallikrein system in the production of this phenomenon is discussed.