Comparison of histopathologic findings of initial and recurrent lumbar disc herniation.

OBJECTIVE: Recurrent lumbar disc hernia (RLDH) is a common and challenging complication after an initial discectomy. This study aimed to investigate the relationship between the histopathologic outcomes of the initial and recurrent disc tissues. METHODS: This study investigated 70 patients who underwent a microdiscectomy and subsequently developed same-level same-side lumbar disc herniation (LDH) recurrence. The clinic, western blot, and immunohistochemical evaluations of patients with initial LDH and RLDH were conducted and statistically analyzed. RESULTS: The effect of inflammation and apoptosis in the degenerative changes of intervertebral disc hernia and increased histopathologic findings in RLDH was demonstrated. The degeneration of the hernia disc tissue is a major pathological process, which is characterized by cellular apoptosis, inflammation, and reduced synthesis of extracellular matrix. Currently, there is no clinical therapy targeting the reversal of disc degeneration. CONCLUSIONS: This, therefore, stay away from factors that increase inflammation in the intervention of intervertebral disc hernia, applying to reduce inflammation the medicines, could allow reducing disc collagen degeneration, and more successful outcomes. These findings might shed some new lights on the mechanism of disc degeneration and provide new strategies for the treatments of initial and recurrent LDH.

Evaluation of the association between biochemical and immunohistochemical score of caspase-9 and TNFα, and the grading of lumbar disc herniation.

OBJECTIVE: The aim of our study is to investigate the influence of caspase-9 and tumour necrosis factor alpha (TNFα) in the grade of lumbar disc herniation. We determined the strength of different predictors such as age, gender, disc grading, caspase-9 and TNFα. METHODS: We retrospectively reviewed 84 patients who had discectomies. Histological and biochemical evaluations of disc specimens were performed. All patients were scanned by the magnetic resonance imaging (MRI) scanner before the operation. Masson's trichrome stain, biochemical analysis and immunohistochemical staining were performed to measure the expression levels of caspase-9 and TNFα. The results were evaluated statistically. RESULTS: This study included 84 patients (mean age: 41.59 ± 12.21 years; range: 19-76): 60 men (age 40.47 ± 12.63 years) and 24 women (44.42 ± 10.81 years). No statistically significant age difference was found between the genders (p = 0.182). MRI scans showed 16 patients had protrusion, 44 had extrusion and 24 had sequestration of discs. There was a statistically significant negative correlation between the grading of lumbar disc herniations and age (p < 0.001, r = -0.509). Histological and biochemical analyses of disc materials were done. Inflammation, collagen fibre deterioration, apoptotic process, TNFα and caspase-9 were seen to increase with increasing disc grading (p < 0.01). CONCLUSIONS: Biochemical and immunohistochemical score of caspase-9 and TNFα indicate the grading of lumbar disc herniation. As the grading of disc herniation increases, inflammation of cells and collagen fibre disruption increase and accelerate the apoptotic process. Apoptosis in disc nucleus pulposus cells may reduce disc herniation.

Bilateral spontaneous atraumatic rupture of the Achilles tendon in an athlete.

We report a case of spontaneous, bilateral Achilles rupture in a 33-year-old man with no specific risk factors. The rupture occurred after a heavy impact during a sports activity, and although the rupture was painful, he was able to mobilize slowly. After a clinical examination confirmed the diagnosis, ultrasonography and magnetic resonance imaging evaluation of the Achilles tendons revealed bilateral ruptures. The patient underwent bilateral conservative treatment and subsequently embarked on a comprehensive rehabilitation program with a good functional outcome at follow-up. The patient's return to premorbid work and social life was uneventful. A spontaneous rupture in a patient without any predisposing risk factors is uncommon, and for it to occur bilaterally is notably rare.

Exogenous Ceramide Treatment Induce Death and Cytotoxicity in Glioma Cells.

AIM: To evaluate the cytotoxic and proapoptotic effects of C6 ceramide on the C6 rat glioma cell line. MATERIAL AND METHODS: The C6 rat glioma cell line was evaluated. Using a confocal microscope and the appropriate software, the cytotoxic effects of C6 ceramide were identified using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H tetrazolium bromide (MTT) colorimetric experiments. Transmission electron microscopy (TEM) was utilized to examine the ultrastructural changes following treatment with IC50 concentrations of C6 ceramide. RESULTS: Condensation and fragmentation of nuclei and DNA laddering was observed, indicating apoptotic cell death. C6 ceramide induced apoptosis and effectively caused cytotoxicity in the C6 glioblastoma cells. MTT assay demonstrated > 90% cell death after short-term application of C6 ceramide, confirming its apoptosis-triggering effect. Apoptosis was also confirmed via confocal microscopy and TEM. CONCLUSION: Glioblastoma cells undergo apoptosis when exposed to C6 ceramide, which makes it a potential chemotherapeutic agent for the treatment of this aggressive brain cancer.

Effect of MCI-186 on Lipid Peroxidation in Experimental Traumatic Brain Damage in Rats.

Objective: Brain damage occurs in many clinical conditions, including trauma, ischemia, and hypertension. Reactive oxygen products and lipid peroxidation are responsible for the brain damage that occurs in these clinical conditions. We investigated whether MCI-186 (3-methyl-1-phenyl-2-pyrazoline-5-one), a free radical binding agent on lipid peroxidation, affects malondialdehyde (MDA), glutathione (GSH), and glutathione peroxidase (GPx) levels in traumatic brain damage. Methods: The traumatic brain damage model, modified by Feeney, was performed on 28 male Wistar rats separated into 4 groups. The MDA, GSH, and GPx levels in the brain tissues of each group were studied. Results: MDA levels in the traumatized group were significantly higher than those in the sham and MCI-186 groups (p<0.05), while GSH levels were significantly higher in the sham group than in the trauma and solvent groups (p<0.05). No significant difference was observed between the sham and MCI-186 groups (p>0.05). Although the average GPx level was higher in the sham and MCI-186 groups, no significant difference was found between groups. Conclusion: Reactive oxidation products significantly decreased in the MCI-186 group. Thus, MCI-186 can be used as a free radical-binding agent in traumatic brain damage.

Cytotoxic Impact of N-Oleoylethanolamine on Bone Cancer Cells.

BACKGROUND: Cancer is a complex disease that derives from the uncontrolled proliferation of cells. Bone cancer is a type of prevalent cancer that occurs both in young and adults. Bone cancer is most common in the long bones of the pelvis, arms and legs. Statistically, more than 200 cases of osteosarcoma have been reported annually in our country. Classical treatment with chemotherapeutics remains ineffective in the cure of this cancer type. Recent studies have shown that ceramide induces apoptosis at its increased levels in the cells. Thus, many studies have been conducted to cause the accumulation of ceramide molecules in the cell by different ways to induce apoptosis. NOE (Noleoylethanolamine) is a specific inhibitor of ceramidase enzymes that hydrolyze intracellular ceramides and prevent apoptosis. OBJECTIVE: This study investigates the cytotoxic and apoptosis-inducing activities of NOE on human osteosarcoma Saos-2 cells. METHODS: Cytotoxic effects were investigated by MTT colorimetric assay. For the detection of morphological and ultrastructural indicators of apoptosis, confocal and TEM techniques were used. RESULTS: Our finding indicated that NOE is effective in the inhibition of the growth of Saos-2 cells. Confocal and TEM findings showed morphological and ultrastructural changes as chromatin condensation, fragmentation of nuclei and mitochondria as well as damaged cytoskeleton and cell shrinkage. CONCLUSION: The results revealed that NOE exerts its cytotoxicity on Saos-2 cells through changing the ultrastructure and morphology of cells with clear apoptotic sparks.

Spontaneously resorbed idiopathic syringomyelia: a case report.

A 28-year-old female patient presented with severe neck and back pain in 2003. No abnormality was observed at neurological examination. Syringomyelia in the cervical region was determined at MRI. MRI examination of the cranial, thoracal and lumbosacral regions was normal. The patient refused surgery and was followed up. A control cervical MRI 17 months later showed that the syringomyelia had disappeared. This spontaneously resorbed case of idiopathic syringomyelia, presenting solely due to neck and back pain and with a normal neurological examination, was evaluated in the light of syringomyelia pathogenesis as only three similar cases have been identified in the literature.

Multi-Level Cervical Disc Degeneration and Vertigo / Degeneração do disco cervical em múltiplos níveis e vertigem

Objective While complaints of pain, loss of strength, and numbness radiating to the neck and arm are common in patients due to cervical disc degeneration, vertigo is a rare symptom. The articles previously published on the subject focus on single-level disk degeneration and its correlation with vertigo. However, in the case of multilevel cervical discopathy, its effect on the severity of vertigo and its response to surgical treatment has not been clarified. Therefore, the objective of the present study is to shed light on the topic. Methods Patients with vertigo complaints in whom all known etiological causes of vertigo had been excluded, but with cervical disc degeneration, were included in the study. The scores on the Visual Analog Scale (VAS) and Cervical Vertigo Evaluation Scale (CVES) were analyzed in terms of numbers of discopathy, spine levels, and differences regarding the preoperative and postoperative status. Results A total of 24 patients (14 with single-level and 10 with multi-level disc degeneration) underwent anterior cervical discectomy. The preoperative CVES score was significantly decreased after surgery. Multi-level disc degeneration causes fewer vertigo symptoms than the single-level kind. No significant correlation between the severity of pain and vertigo was observed. Conclusion Multi-level disc degeneration causes fewer vertigo symptoms. These symptoms decreased after anterior cervical discectomy in cases of single-level disk herniation at upper segments. The surgical intervention could be a favorable choice of treatment. However, the mechanism and treatment approach to cervical vertigo is still a controversial issue.

Objetivo Embora as queixas de dor, perda de força e dormência com irradiação para o pescoço e braço sejam comuns em pacientes devido à degeneração do disco cervical, a vertigem é um sintoma raro. Os artigos publicados anteriormente se concentram na degeneração do disco de nível único e na sua correlação com a vertigem. No entanto, no caso da discopatia cervical em múltiplos níveis, seu efeito sobre a gravidade da vertigem e sua resposta ao tratamento cirúrgico não foi esclarecido. Portanto, o objetivo do presente estudo foi lançar luz sobre essa questão. Métodos Foram incluídos no estudo pacientes com queixa de vertigem nos quais foram excluídas todas as causas etiológicas conhecidas de vertigem, mas que apresentavam degeneração discal cervical. As pontuações na Escala Visual Analógica (EVA) e na Escala de Avaliação da Vertigem Cervical (Cervical Vertigo Evaluation Scale, CVES, em inglês) foram analisadas em termos dos números de discopatia, dos níveis da coluna, e das diferenças entre o estado pré e pós-operatório. Resultados A todo, 24 pacientes (14 com degeneração discal de nível único e 10 com degeneração em múltiplos níveis) foram submetidos a discectomia cervical anterior. A pontuação pré-operatória no CVES sofreu redução significativa após a cirurgia. A degeneração do disco em múltiplos níveis provoca menos sintomas de vertigem do que a de nível único. Não se observou correlação significativa entre a gravidade da dor e a vertigem. Conclusão A degeneração discal em múltiplos níveis provoca menos sintomas de vertigem. Os sintomas de vertigem diminuíram após a de discectomia cervical anterior em hérnia de disco de nível único nos segmentos superiores. A intervenção cirúrgica pode ser uma escolha favorável no tratamento. No entanto, o mecanismo e a abordagem do tratamento da vertigem cervical ainda é uma questão controversa.

The Changed Route of Anterior Tibial Artery due to Healed Fracture.

We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia).