Effect of humic acid on oxidative stress and neuroprotection in traumatic spinal cord injury: an experimental study.

Background/aim: Traumatic spinal cord injury (TSCI) is an important health problem, especially in developing countries with additional socioeconomic loss. Humic acid (HA) usually has antioxidant, antiinflammatory, blood circulating, and antiviral effects. Hence, it was aimed herein to show the effect of HA on neuroprotection in a TSCI model. Materials and method: A TSCI model was used, in which 24 Wistar albino rats were divided into 4 groups: control group: subjected to only laminectomy; sham group: subjected to laminectomy + TSCI; HA 5 mg/kg group: subjected to laminectomy + TSCI + intraperitoneal (IP) injection of 5 mg/kg of HA; and HA 10 mg/kg group: subjected to laminectomy + TSCI + IP injection of 10 mg/kg of HA. Intracardiac blood samples were obtained preoperatively (preop), and at 1 and 24 h postoperatively (postop). The total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) levels were evaluated in the serum. The motor functions were evaluated using the Modified Tarlov Score at 24 h postop. Results: There were no significant changes in the TAS values between the sham and HA 5 mg/kg and HA 10 mg/kg groups (p = 0.77/0.21). However there was a significant decrease in the TOS values at 24 h postop when comparing the sham and HA 5 mg/kg groups (p = 0.02). The pathological evaluation showed a significant decrease in the severity of edema, hemorrhage, polymorphonuclear leucocyte (PNL) infiltration, and mononuclear leucocyte (MNL)/macrophage/microglia infiltration when compared with the control group (p < 0.05). There was a significant recovery at the paraplegia level when the HA 5 mg/kg and HA 10 mg/kg groups were compared with the control group (p < 0.001). Conclusion: The effects of HA in the early stages of TSCI on oxidative stress, histopathological changes, and neurological improvement were investigated herein. It is thought to be a potential therapeutic agent in acute TSCI but needs to be further evaluated to determine the extent of its effect on other neuroprotective pathways in larger series.

Postnatal surgery for myelomeningocele in neonates: neurodevelopmental outcomes.

BACKGROUND: The study aims to evaluate the neurodevelopmental outcomes of neonates with myelomeningocele (MMC) operated in the postnatal period. METHODS: This is a prospective follow-up study in a tertiary neonatal intensive care unit. Neurodevelopmental outcomes of term neonates operated for MMC and healthy term newborns were compared with the Bayley Scales of Infant and Toddler Development -Third Edition (BSID III) at 12-18 months. RESULTS: A total of 57 cases were included in the study (patient group = 27; control group = 30). Demographic data between the groups were similar. Cognitive, linguistic, and motor composite scores of the patient group were lower than those of the control group (p < 0.001). In the patient group, those who underwent ventriculoperitoneal shunt had lower cognitive, language and motor scores than those without shunt (p < 0.05). The cognitive, linguistic, and motor composite scores in the patient group who underwent surgery before 72 h were better than those who underwent surgery after 72 h. DISCUSSION: In our study, it was found that the neurodevelopmental prognosis of MMC cases requiring ventriculoperitoneal shunt in the postnatal period was significantly worse than those without shunt. It is the first study in which the neurodevelopment of patients with MMC who were operated in the postnatal period was evaluated with BSID III evaluated and delays in all areas were shown in cases with MMC compared to normal cases. Better neurodevelopmental outcomes in patients operated in the first 72 h suggest that early surgery will improve neurodevelopmental outcomes in patients with MMC.

Effect of humic acid on oxidative stress and neuroprotection in hypoxic-ischemic brain injury: part 1.

BACKGROUND: Aimed to investigate in an animal model the efficacy of humic acid by showing its antioxidant and anti-apoptotic effect comparing with the histopathological and neurological outcomes for the hypoxic-ischemic brain injury. METHODS: 28 Wistar-Albino rats who were on the 7th postnatal day and weighting between 9 and 19 g randomly divided into four groups with developed HIE model under the gas anesthesia. 20 mg/kg and 10 mg/kg intraperitoneal HA were given to Group I and II respectively. Saline was given to Group III and the sham group was Group IV. The brain tissues were stained with cresyl-violet histochemistry for grading neuronal cell injury and caspase immunohistochemistry. RESULTS: The neuronal cell injury was statistically lower in all neuroanatomical lands in HA treatment groups. The degree of ischemia was significantly smaller in HA groups. Caspase-3 immunoreactivity was decreased in the HA groups compared with the saline group. When the groups were compared, there were no serious neuronal injury in Group I. CONCLUSIONS: This is the first study which investigates the role of HA in HIE model. HA reduces apoptosis and neuronal injury in cerebral tissue of the rats. This findings suggest that HA may be viable protective agent against HIE.

Effect of Humic Acid on Oxidative Stress and Neuroprotection in Traumatic Spinal Cord Injury: An Experimental Study.

OBJECTIVE: Traumatic spinal cord injury (TSCI) is an important health problem especially in developing countries with additional socio-economic loss. Humic acids (HA) usually have anti-oxidant, anti-inflammatory, blood-circulating and antiviral effects. We aimed to show effect of HA on neuroprotection in TSCI model. METHODS: We performed TSCI model in Twenty-four Wistar-Albino rats in four groups. Control group underwent only laminectomy. Sham group underwent laminectomy followed by TSCI. Low dose HA (5mg/kg) and high dose HA (10mg/kg) groups underwent laminectomy and TSCI followed by peritoneal administration of HA. Preoperative, postoperative 1st hour and postoperative 24th hour cardiac blood samples were obtained. Total Antioxidant Status (TAS), Total Oxidant Status (TOS) and Oxidative Index (OI) levels were evaluated in serum. The 24th hour motor functions were evaluated by Modified Tarlov Score. RESULTS: There were no significant changes in TAS values between sham- low dose and high dose humic acid groups (p:0.77/0.21). However there were a significant decrease of TOS levels in the 24th hour post operative blood samples comparing the sham group with low dose humic acid group (p=0.02). Pathological evaluation showed a significant decrease in the severity of edema, hemorrhage, Polymorphonuclear leucocytes (PNL) and Mononuclearleucocytes (MNL) /macrophage/microglia when we compare with the control group (p<0.05). There is a significant recovery in paraplegia level as we compared the HA groups with control groups (p<0.001). CONCLUSION: In this study, we showed the effects of HA in the early stages of TSCI on oxidative stress, histopathological changes and neurological improvement. It is thought to be a potential therapeutic agent in acute TSCI but needs to be further evaluated by showing proper effect on other neuroprotective pathways in larger series.

Kyphectomy in neonates with meningomyelocele.

PURPOSE: Kyphosis is the most severe spinal deformity associated with meningomyelocele (MMC) and is seen in approximately 15% of neonates. Our purpose is to present our clinical experience, to discuss the technique and deformity correction in kyphectomy in neonates with MMC, and to assess its long-term outcomes. METHOD: In this prospective study, the authors reviewed eight cases submitted to surgery between 2013 and 2015. We evaluated clinical characteristics that were analyzed, as were the operative technique employed, and angle range of the kyphosis deformity postcorrection follow-up. RESULTS: Neonatal kyphectomy was performed of six females and two males. The mean birth weight was 2780 g, and the mean age at the time of surgery was 5.6 days. There were S-shaped type deformity in lumbar region in all neonates. In the correction of the kyphotic deformity, a total vertebrae were removed from four patient, whereas a partial vertebrectomy was done in four. The mean operative time was 116 min. No patients did not require the blood transfusion. There were no serious complications, and wound closure was successful in all patients. The mean follow-up period was 4 years and 3 months (range 36-61 months), except one patient who died 1 week after discharge. The mean preoperative kyphosis of 75.6° (range, 50°-90°) improved at last follow-up to 35° (range 15°-55°). All patients had surgical procedures for hydrocephalus. Three patients had surgery for Chiari type II malformation. The mean hospital stay was 27.7 days. CONCLUSION: Kyphectomy performed at the time of dural sac closure in the neonate is a safe procedure with excellent correction.

Can Right-Handed Surgeons Insert Upper Thoracic Pedicle Screws in much Comfortable Position? Right-Handedness Problem on the Left Side.

OBJECTIVE: Thoracic pedicles have special and specific properties. In particular, upper thoracic pedicles are positioned in craniocaudal plane. Therefore, manipulation of thoracic pedicle screws on the left side is difficult for right-handed surgeons. We recommend a new position to insert thoracic pedicle screw that will be much comfortable for spine surgeons. METHODS: We retrospectively reviewed 33 patients who underwent upper thoracic pedicle screw instrumentation. In 15 patients, a total of 110 thoracic pedicle screws were inserted to the upper thoracic spine (T1-6) with classical position (anesthesiologist and monitor were placed near to patient's head. Surgeons were standing classically near to patient's body while patients were lying in prone position). In 18 patients, a total of 88 thoracic pedicle screws were inserted to the upper thoracic spine with the new standing position-surgeons stand by the head of the patient and the anesthesia monitor laterally and under patient's belt level. All the operations performed by the same senior spine surgeons with the help of C-arm. Postoperative computed tomography scans were obtained to assess the screw placement. The screw malposition and pedicle wall violations were divided and evaluated separately. Cortical penetration were measured and graded at either : 1-2 mm penetration, 2-4 mm penetration and >4 mm penetration. RESULTS: Total 198 screws were inserted with two different standing positions. Of 198 screws 110 were in the classical positioning group and 88 were in the new positioning group. Incorrect screw placement was found in 33 screws (16.6%). The difference between total screw malposition by both standing positions were found to be statistically significant (p=0.011). The difference between total pedicle wall violations by both standing positions were found to be statistically significant (p=0.003). CONCLUSION: Right-handedness is a problem during the upper thoracic pedicle screw placement on the left side. Changing the surgeon's position standing near to patient's head could provide a much comfortable position to orient the craniocaudal plane of the thoracic pedicles.

Primary Sacral Hydatid Cyst Causing Cutaneous Fistula.

Echinococcus granulosus and Echinococcus multilocularis are the causes of hydatid disease and the main characteristic is endemic. Generally, it affects the liver and lungs. Spinal hydatidosis accounts for less than 1% of the cases. Vertebral hydatidosis is usually silent and a slowly progressive disease with a long latent period. Another rare form is the primary sacral hydatid cyst. Generally, patients suffer from back pain and neural compression symptoms. A 43-year woman was admitted with left leg pain and a fluid leakage from a cutaneous fistula on the left hip. It was diagnosed on MRI as a bilateral cystic lesion which eroded the first sacral wing, extending to the paravertebral region and left intervertebral for a men. We present a case with fluid leakage from cutaneous fistula.

A Retrospective Study of 39 Patients Treated With Anterior Approach of Thoracic and Lumbar Spondylodiscitis: Clinical Manifestations, Anterior Surgical Treatment, and Outcome.

The aim of this study is to report our 39 patients treated with anterior debridement and autologous iliac bone grafting with or without anterior instrumentation, which is the presumed treatment of choice for thoracic or lumbar spondylodiscitis.Our patients underwent surgical treatment of spondylodiscitis using anterior debridement and autologous iliac bone grafting with or without anterior instrumentation and were analyzed with a mean follow-up of 8 years (range, 2-11 years). Kaneda 2-rod system instrumentation was used in 12 patients, in total. Clinical outcomes were assessed by the Frankel grade. Radiographic fusion was characterized based on 3-dimensional computed tomography.Of the whole group, 20 patients suffered from tuberculous spondylodiscitis and 19 suffered from hematogenous spondylodiscitis. Pathogens responsible for pyogenic infection included Staphylococcus aureus (4 patients), Pseudomonas aeruginosa (3 patients), and Brucella melitensis (1 patient). Fifteen patients had thoracic involvement, 20 had lumbar involvement, and 4 had thoracolumbar junction involvement. Preoperative neurological deficits were noted in 13 of the 39 patients. In terms of Frankel grade, 8 patients have improved, 4 have remained the same, and 1 patient has worsened during the follow-up period. Imaging-documented fusion was achieved in 23 of 27 patients in the graft group (85% fusion rate) and 11 of 12 patients in the graft + Kaneda instrumentation group (91% fusion rate).There was no instrumentation failure, loosening, or graft-related complication such as slippage or fracture of the graft. This approach demonstrated a good recovery rate of neurological functions and a high fusion rate.

Bilateral Internal Carotid Artery Occlusion as a Cause of Intraventricular Hemorrhage due to Pial Collateral Vessels.

In patients with high-grade atherosclerotic stenosis or occlusion of the extracranial cerebral arteries, subarachnoid hemorrhage (SAH) may occur, potentially due to rupture of fragile dilated pial collateral vessels. This association has been well described in Moyamoya disease. There are only few cases in the literature that reported SAH due to bilateral carotid artery stenosis but intraventricular hemorrhage caused by dilated pial collateral has not been reported yet. We present a case of bilateral carotid artery occlusion presented with intraventricular hemorrhage. Based on the findings in the present case, carotid artery stenosis or occlusion may present with intraventricular hemorrhage due to rupture of the dilated, fragile collateral vessels.