The effect of flurbiprofen on the development of anencephaly in early stage chicken embryos.

OBJECTIVE: The study investigated the effect of flurbiprofen on the development of anencephaly in early stage chicken embryos. MATERIAL AND METHODS: We looked at four groups with a total of 36 embryos. There was a control group, a normal saline group, a normal-dose group and a high-dose group with ten, ten, eight and eight eggs with embryo respectively. RESULTS: Two embryos in the control group, studied with light microscopy at 48 h, were consistent with 28-29 hours' incubation in the Hamburger-Hamilton System. They had open neural tubes. The other embryos in this group were considered normal. One embryo in the normal saline group was on the occlusion stage at 48 h. One embryo showed an open neural tube. They were compatible with 28-29 hours' incubation in the Hamburger-Hamilton system. The remaining eight embryos showed normal development. In the normal dose group, one embryo showed underdevelopment of the embryonic disc and the embryo was dead. In four embryos, the neural tubes were open. One cranial malformation was found that was complicated with anencephaly in one embryo. In two embryos the neural tubes were closed, as they showed normal development, and they reached their expected stages according to the Hamburger-Hamilton classification. There was no malformation or growth retardation. Four experimental embryos were anencephalic in the high dose group, and three embryos had open neural tubes. One embryo exhibited both anencephaly and a neural tube closure defect. None of the embryos in this group showed normal development. CONCLUSIONS: Even the usual therapeutic doses of flurbiprofen increased the risk of neural tube defect. Flurbiprofen was found to significantly increase the risk of anencephaly. The provision of improved technical materials and studies with larger sample sizes will reveal the stage of morphological disruption during the development of embryos.

Aneurysms of the distal anterior cerebral artery: a clinical series.

BACKGROUND AND PURPOSE: Distal anterior cerebral artery (DACA) aneurysms, also called pericallosal or A2 aneurysms, are rare and comprise about 1.5 to 9% of all intracranial aneurysms. In this study, a series of 10 patients with DACA aneurysms who were surgically treated in our clinic is presented and discussed, focusing on their clinical features and sur-gical outcomes. MATERIAL AND METHODS: A total of 344 patients with cerebral aneurysms were operated on in our clinic and 10 patients (2.9%) with DACA aneurysms were studied retrospectively. All patients underwent a computed tomography (CT) scan followed by four-vessel digital subtraction angiography (DSA). RESULTS: Initial CT revealed intracerebral haematoma (ICH) in 7 patients (70%) and in 2 of them the haematoma was over 3 cm in diameter. The pericallosal-callosomarginal bifurcation was the most common location in 9 patients (90%). Four cases (40%) showed multiple aneurysms. The mean waiting time for the operation was 4.8 days. Surgical clipping was performed in all the cases. Multiple aneurysms required two different craniotomies in the same session. The patients with ICH over 3 cm in diameter, in addition to poor preoperative grade, are likely to have a poor outcome, and so clinical grade is the definite factor affecting the surgical outcome of patients. CONCLUSIONS: DACA aneurysms are usually small and bleeding occurs irrespective of their size because of the lack of resistant arachnoid membranes at the level of the pericallosal cisterns. All DACA aneurysms, even if very small in size or discovered incidentally, should be aggressively treated because of the high tendency to rupture.

Cervical epidural abscess in haemodialysis patients by catheter related infection: report of two cases.

Despite advances in neuroimaging and neurosurgical treatment modalities, spinal epidural abscess remains a challenging problem. Early diagnosis is often difficult and treatment is always delayed. Spinal epidural abscess usually develops in patients with predisposing factors such as IV drug abuse, senillity, diabetes mellitus, spinal attempts, alcoholism, immunosuppression, liver diseases and catheterizations. It is rarely seen in cervical region. A successful treatment is only possible with early diagnosis and accurate surgical and medical treatment. Optimal management is unclear and morbidity and mortality are significant. We present two adult haemodialysis patients with end-stage renal insufficiency who developed cervical epidural abscess following central venous catheter placement. Early surgical intervention is mandatory in cases those have progressive neurological deficit and spinal deformity, and this is also increases the success rate of medical therapy.

Spontaneous regression of a huge subligamentous extruded disc herniation: short report of an illustrative case.

Herniated nucleus pulposus (HNP) is a common cause of radicular and low-back pain. Although some patients need surgical intervention because of prolonged intolerable leg pain, the majority heal with conservative treatment. Recently, with the advent of imaging diagnostic methods, there is an increasing interest in the phenomenon of spontaneous resorption of the HNP. We presented a case of lumbar HNP at the L4-L5 level in which clinical improvement was associated with a significant decrease in size of a huge subligamentous extruded disc herniation, documented on serial magnetic resonance imaging (MRI) scans.

Serum leptin levels following acute experimental spinal cord injury.

BACKGROUND/OBJECTIVE: Spinal cord injury influences many hormones that are known to be involved in the modulation of neurotrophic, neurogenic, and neuroprotective events. Recent studies showed that leptin could be neuroprotective, enhancing neuronal survival in vitro and in vivo. The objective of this study was to evaluate the pattern of the serum leptin levels in rats during acute traumatic SCI. METHODS: Forty male Sprague-Dawley rats were divided randomly into 4 groups. In the control group, neither laminectomy nor SCI was performed; only laminectomy was performed without SCI in the sham group. In the cervical and thoracic spinal trauma groups, laminectomies were performed following the same trauma procedure. Blood samples were drawn 2, 6, 12, and 24 hours after the procedures and assayed immediately. RESULTS: In the first 2 hours, levels of leptin were similar in control and sham-operated groups and higher in neurotrauma groups (P < 0.05). At the sixth hour, leptin levels increased in the sham-operated group, decreased in the neurotrauma groups (P < 0.05), and did not change in the control group (P > 0.05). At the 12th hour, the levels of leptin increased in all groups (P > 0.05). At the 24th hour, they decreased in the control, sham-operated, and cervical groups (P < 0.05); levels did not change in the thoracic group (P > 0.05). The decrease was higher in the control group than in the other groups (P < 0.05). CONCLUSIONS: Activation of endogenous leptin secretion started immediately after the SCI. The level of neurologic lesion (either cervical or thoracic regions) affected the levels of serum leptin differently, but with the exception of the first 12-hour period, this difference did not reach a statistically significant level.

The effect of ethyl cyanoacrylate on experimental posterior lateral spinal fusion in a rat model.

BACKGROUND AND PURPOSE: Cyanoacrylates (CAs) are a type of tissue adhesives which are currently the most commonly used for cutaneous closings. The use of CAs was reported in other clinical procedures such as odontology, neurological surgery, maxillary surgery, orthopaedics, plastic surgery, etc. In this experimental study the authors carried out posterolateral spinal fusion in a rat model to test the usefulness of ethyl-cyanoacrylate (ECA) in fixation of allograft/autograft fusions. MATERIAL AND METHODS: 25 Sprague-Dawley rats were randomized into two study groups. Bilateral posterolateral lumbar intertransverse process spinal fusion was performed with both autograft and allograft in both groups. ECA gel was dropped in the fusion area in a rat model in group II. RESULTS: The fusion rates as determined by manual palpation were 75% in controls and 46% in the ECA group (p = 0.322). According to radiographic score, the spinal segment was considered to be fused radiographically in 66% of controls and in 46% of animals in the ECA group (p = 0.43). The mean histological scores were 5.58 +/- 0.14 and 4.53 +/- 0.18 for the control and treatment group, respectively (p = 0.001). The mean bone density of the fusion masses was 101.3 +/- 2.5 in the control group and 92.0 +/- 3.3 in the ECA treatment group (p = 0.044). CONCLUSIONS: Ethyl-cyanoacrylate appeared to retard the osteogenic fusion but was well tolerated and did not induce necrosis, allergic reaction, infection, necrosis or neurological deficit in a rat model of posterolateral spinal fusion.

Serum cortisol levels following acute experimental spinal cord injury.

BACKGROUND AND PURPOSE: Cortisol has neuroprotective effects. We monitored the serum cortisol levels after cervical and thoracic spinal cord injury (SCI) in four groups of rats. MATERIAL AND METHODS: Forty male Sprague-Dawley rats were randomized to four groups. The control group received neither laminectomy nor SCI. The sham group received laminectomy without SCI. The cervical spinal trauma group received a C5-C6 laminectomy and spinal trauma at this level. The thoracic spinal trauma group received a T6-T7 laminectomy and spinal trauma. Blood samples were drawn 2, 6, 12 and 24 hours after surgeries and assayed immediately. RESULTS: The level of cortisol in the cervical spinal trauma group was highest at the second hour of the experiment and the lowest in control and sham-operated groups at the same time. At the sixth hour, cortisol levels increased in control and sham-operated groups, decreased in the cervical group and did not change in the thoracic group. At the 12th hour, cortisol levels in control and sham-operated groups decreased, but increased in thoracic and cervical groups. At the 24th hour, serum cortisol levels in thoracic and cervical groups decreased but did not change significantly in control and shamoperated animals. CONCLUSIONS: Activation of endogen cortisol secretion of the organism starts immediately after the SCI injury and throughout the experiment the serum cortisol levels in neurotrauma groups remained high compared with the control and sham-operated groups. At the beginning, the level of neurological lesion (cervical or thoracic) affected differently the level of serum cortisol at a statistically significant level but this difference disappeared at the 6th hour.

Intradiscal electrothermal treatment for chronic discogenic low back pain: a prospective outcome study of 39 patients with the Oswestry disability index at 18 month follow-up.

OBJECTIVE: The authors evaluate the efficacy of intradiscal electrothermal therapy (IDET) for discogenic pain on outcome of patients using the Oswestry disability index (ODI) after 18 month follow-up. METHODS: Thirty-nine patients with chronic discogenic low back pain who failed to improve following conservative treatment were considered for this study. Inclusion criteria included the presence of one- or two-level symptomatic disk degeneration without evidence of nerve root compression. Patients were excluded if there was severe disk degeneration together with loss of more than 50% disk height. We measured the outcome scores at minimum of 18 month period with the Turkish version of the ODI and compared them with pre-treatment scores. RESULTS: All procedures were considered technically successful and there were no device-related complications. Mean ODI scores of 39 patients pre-operatively and post-operatively 6, 12 and 18 months were 45.7436 +/- 11.6545, 24.7692 +/- 10.7861, 23.0256 +/- 10.6412 and 21.4872 +/- 10.0286, respectively. The effect of treatment was calculated as the difference between the scores before and after treatment. They were 20.9744 +/- 12.5394, 22.7179 +/- 12.5697 and 24.2564 +/- 12.5922 after the same follow-up periods. There was a significant difference (p<0.01) between all the mean scores after treatment (6, 12 and 18 months) compared with the pre-IDET mean ODI. DISCUSSION: Although various alterations in outcome scores have been reported in previous works, we found nearly four in five patients (79.48%) who clearly benefited from this therapy. This procedure may become a middle step for carefully selected group of patients who failed non-operative treatment before surgical intervention.

Hydrothorax: transdiaphragmatic migration of a ventriculoperitoneal shunt catheter.

Symptomatic hydrothorax following ventriculoperitoneal shunt insertion is a very rare complication. The patient was a 5-month-old child known to have had shunted congenital hydrocephalus two months before. He presented to the emergency room in respiratory distress. Chest X-ray and computerized tomography images confirmed left hydrothorax and showed transdiaphragmatic migration of the tip of the peritoneal catheter to the thoracic cavity. After the catheter had been shortened and replaced to the peritoneal cavity, the patient's symptoms abated.

Giant ossifying fibroma complicated by mucocele of sphenoid sinus--case report.

Ossifying fibroma is a benign tumour that rarely involves the skull. It is most commonly seen in the facial bones with a particular predilection for the mandible. It shares many pathological features with fibrous dysplasia. Ossifying fibroma is an expansive lesion and shows larger non-ossified areas of fibrous tissues. When the tumour is located deeply, encasing the optic-carotid complex, surgical removal becomes difficult because of its ossifying nature. Following surgical resection, the recurrence rate is very low. In the present study, a rare case of giant ossifying fibroma of sphenoid bone which had an intracranial extension with a coexistent mucocele is reported.

Angiographically occult vascular malformation of the third ventricle.

Angiographically occult vascular malformations (AOVM) are cerebrovascular malformations that are not demonstrable on cerebral angiography. The majority of AOVMs located in the third ventricle are cavernous malformations. To the best of our knowledge an angiographically occult arteriovenous malformation (AOAVM) of the third ventricle has not been previously reported. We report an unusual vascular malformation of the third ventricle presenting with hydrocephalus due to mass effect, verified histopathologically as an AOAVM.

Early changes in the cervical foraminal area after anterior interbody fusion with polyetheretherketone (PEEK) cage containing synthetic bone particulate: a prospective study of 20 cases.

OBJECTIVES: Although the use of intervertebral fusion after anterior cervical microdiscectomy remains controversial, a new surgical device is proposed for use in intervertebral fusion instead of bone graft. The authors evaluate the effects of implantation of polyetheretherketone (PEEK) cage containing synthetic bone particulate on the height and cross-sectional area of the foramen, the intervertebral disk height and the degree of lordosis. METHODS: Twenty consecutive patients with radiculopathy owing to cervical disk herniation were scheduled. They underwent multislice computed tomographic scanning pre-operatively and 1 day post-operatively. RESULTS: Pre-operatively, the mean height of the right foramina was 8.807 +/- 1.120 mm, the left foramina was 9.500 +/- 1.529 mm. Post-operatively, the mean foraminal height of the right side was 11.080 +/- 1.121 mm and 10.020 +/- 1.453 mm on the left. This difference reached statistical significance on the right foraminal height (p=0.000) but not on the left side (p=0.078). The mean area of the right foramina was 46.82 +/- 14.54 mm(2) and 52.71 +/- 15.62 mm(2) on the left side pre-operatively. Post-operatively, the values were 60.87 +/- 15.91 mm(2) and 55.83 +/- 13.88 mm(2) respectively. In terms of pre-operative value, the 1 day post-operative measurement reached again statistical significance (p=0.002) on the right side. The mean value of disk height was 3.653 +/- 0.596 mm pre-operatively and 6.387 +/- 0.533 mm at 1 day post-operatively. This difference is statistically significant (p=0.000). DISCUSSION: Implantation of a PEEK cage containing synthetic bone particulate in the treatment of cervical disk disease offers good immediate stabilization by easier implantation technique and avoids donor site morbidity. It provides an increase in height and cross-sectional area of the neural foramina. These preliminary results suggest that interbody fusion cages appear to be safe and effective.

[Traumatic subarachnoid hemorrhage: a prospective study of 58 cases]. / Travmatik subaraknoid kanamalar: 58 olguluk prospektif çalisma.

BACKGROUND: We evaluated the prognostic factors in traumatic subarachnoid hemorrhage (tSAH). METHODS: This study was conducted with 58 patients (44 males, 14 females; mean age 39.2; range 17 to 79 years) with tSAH, between 2001 and 2003. The patients who were admitted to the hospital within in the first 6 hours of head injury were included, whereas patients with gun shot wounds, multiple injured patients and postoperative patients were excluded. Fifty-eight patients with tSAH were prospectively followed. The neurological status of the patients and the outcomes were evaluated using Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS), respectively and computed tomography (CT) examinations were done according to the grading criteria by Hijdra and Fisher. RESULTS: The etiology of tSAH included traffic accidents (73%), falls (20%) and others (7%). The GCS scores of patients at admission were mild (9%), moderate (39%) and severe (52%). In the CT scans, the amount and distribution of bleeding was grade 1 (small SAH) in 21 patients, grade 2 (moderate SAH) in 17 patients, and grade 3 (extensive SAH) in 20 patients according to Hijdra grading system and according to Fisher's criteria. The thickness of blood layer was grade 1 (no blood) in 6 patients, grade 2 (bleeding layer less than 1 mm) in 21 patients, grade 3 (bleeding layer more than 1 mm) in 15 patients and grade 4 (ventricular bleeding) in 16 patients. Neurological outcomes of patients were favorable (good recovery or moderate disability) in 59%, and unfavorable (severe disability, persistent vegetative state or death) in 41% according to GOS. CONCLUSION: We have found in our series that the prognosis was poor in patients with poor admission scores of GCS, cysternal or fissural hemorrhage, tSAH with cerebral contusion or acute subdural hematoma, higher than 13 points according to Hidjra's classification and patients of grade 3 or 4 in Fisher's criteria.

Prognostic value of interleukin-1 beta levels after acute brain injury.

Traumatic injury to central nervous system results in the production of inflammatory cytokines via intrinsic mechanisms by neurons, astrocytes and microglia, and extrinsic mechanisms by infiltrating macrophages, lymphocytes and other leukocytes. Interleukin-1 beta is the key mediator of the acute inflammatory host response. While this response is necessary for resolution of the pathologic event, the toxic nature of many of its products can cause significant tissue damage. We analyzed serum interleukin-1 beta levels by enzyme-linked immunosorbent assay in 48 patients with solitary head injury who were transported to our clinic immediately after trauma. We categorized the patients according to their initial Glasgow coma scores in three groups, and compared their serum interleukin-1 beta values both with their Glasgow coma initial and outcome scores. This study helped to provide quantitative data to estimate clinical impressions and prognosis after head injury.

The effect of risedronate on posterior lateral spinal fusion in a rat model.

OBJECTIVE: To evaluate the potential effects of risedronate (RIS) which shows a higher anti-resorptive effect among bisphosphonates, after a posterolateral lumbar intertransverse process spinal fusion using both autograft and allograft in a rat model. METHODS: A totoal of 28 Sprague-Dawley rats were randomized into 2 study groups. A posterolateral lumbar intertransverse process spinal fusion was peformed using both autograft and allograft in a rat model. Group I (control) received 0.1 mL of steril saline (placebo) and Group II (treatment) received risedronate, equivalent to human dose (10 microg/kg/week) for 10-weeks period. RESULTS: The fusion rates as determined by manual palpation were 69% in the group I and 46% in the group II (p = 0.251). According to radiographic score, the spinal segment was considered to be fused radiographically in 7 (53%) of the 13 controls and 9 (69%) of the 13 rats treated with RIS (p = 0.851). The mean histological scores were 5.69 +/- 0.13 and 3.84 +/- 0.43 for the control and treatment groups, respectively. There was a significant difference between the both groups (p = 0.001). The mean bone density of the fusion masses was 86.9 +/- 2.34 in the control group and 106.0 +/- 3.54 in the RIS treatment group. There was a statistical difference in mean bone densities of the fusion masses comparing the two groups (p = 0.001). CONCLUSION: In this study, risedronate appears to delay bone fusion in a rat model. This occurs as a result of uncoupling the balanced osteoclastic and osteoblastic activity inherent to bone healing. These findings suggest that a discontinuation of risedronate postoperatively during acute fusion period may be warranted.

Neuroprotective effects of propofol following global cerebral ischemia in rats.

Propofol has cerebral vascular and metabolic effects similar to those of barbiturates, and it is used to maintain neurosurgical anesthesia because it reduces cerebral metabolic rate, cerebral blood flow, and intracranial pressure. Although the use of propofol as a cerebral protectant during certain neurosurgical procedures has been advocated, consensus has not been reached as to a protective effect of propofol on cerebral ischemia. In this study we observed the neuroprotective effects of propofol during global cerebral ischemia-reperfusion injury by the use of four-vessel occlusion method in a rat model. We measured the levels of malondialdehyde as a marker of lipid peroxidation in ischemic tissue, and the results indicate that propofol plays a role in the inhibition of neuronal death induced by brain ischemia.