Which is more effective for pain relief during fractionated carbon dioxide laser treatment: EMLA cream or forced cold air anesthesia?

BACKGROUND AND AIM: The aim of this study was to compare the effectiveness of a eutectic mixture of local anesthetic (EMLA) cream and forced cold air anesthesia (FCAA) on pain control during ablative fractionated carbon dioxide (CO2) laser treatment. METHODS: Fifteen volunteers participated in this prospective, controlled, split-face clinical study. EMLA cream was applied 60 minutes before the laser procedure on half of the face, and FCAA was performed on each subunit of the other half of the face. The laser procedure was performed on each half of the face. Patients rated their pain during the procedure using a pain scale scored from 0-10. Both doctor and nurse rated patient discomfort during the procedure using a scale scored from 0-10. The pain scores associated with both EMLA and FCAA sides of the face were compared statistically. RESULTS: Patient pain scores and discomfort scores detected by doctor and nurse were not statistically different between EMLA and FCAA. There was no statistically significant difference between males and females. CONCLUSION: Instead of using EMLA, FCAA-which can be applied in a shorter time-may be a cost-effective, simple, and safe local anesthesia method used in the ablative fractionated CO2 laser procedure.

Estimated beginning time of local anesthesia effectiveness in forced cold air application: A preliminary study.

BACKGROUND: The literature has reported that forced cold air anesthesia decreases the discomfort effect of various laser therapies. The aim of this preliminary study was to determine the average beginning time of the local anesthetic effect of the forced cold air application when it is applied to all body surfaces except the face. MATERIALS AND METHODS: A total of 52 participants (26 females and 26 males) were included in this study. During application of the forced cold air, the beginning time of local anesthesia effectiveness for each volunteer was determined by giving painful stimuli. The results were then analyzed statistically. RESULTS: The mean beginning time value of the local anesthesia was 52.88 (ranging between 30 and 60) seconds in the female group and 56.34 (ranging between 30 and 60) seconds in the male group. The mean beginning time value of the local anesthesia was 54.61 (ranging between 30 and 60) seconds in both genders. There was no statistical difference between the two groups (Z = - 0.834, p = 0.404). CONCLUSION: Forced cold air anesthesia-which is a quick, safe, cost-effective, and practical local anesthesia method-seems to be useful and effective when used alone in laser treatment.

Effectiveness of Dimethylsulfoxide on the Survival and Volume Preservation of Autologous Fat Graft Tissue: A Preliminary Study.

BACKGROUND: The survival of autologous fat graft tissue is dependent on various factors, such as vascularization and inflammation. OBJECTIVE: This study aims to evaluate the possible beneficial effects of dimethylsulfoxide (DMSO) on fat graft volume and survival. METHODS: Eighteen male Wistar albino rats were divided randomly into three groups. An autologous fat graft obtained from the inguinal region of each rat was transferred to its back. DMSO was administered intraperitoneally (IP) in the DMSO-IP group and cutaneously (C) in the DMSO-C group once daily for 15 days after the surgical procedure. The control group underwent surgery but was not administered with DMSO. Two months after surgery, the grafted fatty tissues were harvested for histopathological and biochemical analyses. RESULTS: The results showed that 2 months postoperatively, fat grafts of the DMSO-C and DMSO-IP groups weighed significantly more than the grafts of the control group. Moreover, the vascularity of the grafts was higher in the DMSO-C group than in the control group, and no significant difference was found between the two DMSO groups. The mean lipid peroxidation levels were the same in the three groups, but myeloperoxidation was significantly lower in the DMSO-C group than in the other two groups. CONCLUSIONS: The study results showed that cutaneous rather than intraperitoneal DMSO administration could preserve the quality and volume of transplanted fat tissue in rats by enhancing vascularity and decreasing inflammation.

Evaluation of dimethyl sulfoxide and dexamethasone on pulmonary contusion in experimental blunt thoracic trauma.

BACKGROUND: A thoracic trauma model was designed to evaluate the effect of dimethyl sulfoxide (DMSO) and dexamethasone (DX) on histopathologic and oxidative changes in lung parenchyma seen after pulmonary contusion. METHODS: Twenty-four Wistar albino rats were included in the study. They were allocated into control (CG, n=6), sham (SG, n=6), DX (DXG, n=6), and DMSO (DMG, n=6) groups. Only a lung biopsy was performed in CG. In the experimental groups, blunt thoracic trauma was induced by dropping a cylindrical metal weight (0.5 kg) through a stainless steel tube onto the right hemithorax from a height of 0.4 m (E=1.96 J). In the SG, 1 mL of physiologic saline was injected intraperitoneally, in the DXG 10 mg/kg of DX was injected intraperitoneally, and in the DMG 1.2 g/mL of DMSO was injected intraperitoneally 15 minutes after trauma. After 6 hours, lung biopsy was performed for histopathologic and oxidative injury markers. RESULTS: Histopathologically, congestion, hemorrhage, neutrophil infiltration, endothelial-nitric oxide synthase (E-NoS), and total pathologic score were significantly higher in SG, DXG, and DMG when compared with CG (p<0.05). Neutrophil infiltration, total pathologic score, and E-NoS were significantly decreased in DMG when compared with SG and DXG (p<0.05). Biochemically, superoxide dismutase (SOD) level was significantly higher in SG, DXG, and DMG than in CG. SOD level was significantly lower in DXG and DMG than in SG (p<0.05). CONCLUSION: DMSO prevents further injury by decreasing neutrophil infiltration and endothelial injury in lung contusions. DX may have a role in the progression of inflammation but not in preventing the pathologic disruption of pulmonary parenchyma.

Effects of low-dose methotrexate in spinal cord injury in rats.

BACKGROUND: This study was designed to evaluate the possible protective effects of low-dose methotrexate in the spinal cord injury (SCI) in rats. METHODS: Thirty-seven Wistar albino rats were used in the present study. Except for the animals of the Sham group, all animals were divided into two main groups, which were used in acute and subacute stage investigations. Then, thoracal laminectomy was performed, and except for the Sham group, SCI was induced using a temporary aneurysm clip. After clip compression, the experimental material (methotrexate or methylprednisolone) was administered intraperitoneally, except in the Sham and Control groups. Then, the spinal cords were removed to evaluate the SCI histopathologically and biochemically at the scheduled date. RESULTS: Neither experimental material was shown to reduce the histopathological grade in either stage of SCI. Low-dose methotrexate was shown to decrease lipid peroxidation levels only in the subacute stage of SCI. However, methylprednisolone and low-dose methotrexate could not decrease or block myeloperoxidase enzyme activation in either stage of SCI. CONCLUSION: Low-dose methotrexate was effective in reducing the lipid peroxidation levels in the subacute stage of SCI, although histopathological evaluation results and myeloperoxidase levels of all groups did not support this finding at either stage.

Investigation of therapeutic effects of calcium dobesilate in cerebral hypoxia/ reperfusion injury in rats.

OBJECTIVES: Cerebral stroke is a serious clinical condition in which oxidative stress, inflammation, necrosis, apoptosis, and autophagy play important roles in its pathogenesis. This study investigated the neuroprotective and healing effects of calcium dobesilate (CD) on cerebral hypoxia/reperfusion injury in rats. METHODS: Forty Wistar albino male rats, each weighing 300-350 g, were separated into the Control group (no surgery and no pharmacological agent was administered); Sham-A group (only surgery was performed); DBL-A group (surgery was performed and CD 100 mg/kg/day was administered intraperitoneally for 3 days); Sham-C group (only surgery was performed); and DBL-C group (surgery was performed and 100 mg/kg/day CD was administered intraperitoneally for 10 days). Under sedation anesthesia, the bilateral common carotid arteries of all rats except the Control group were clipped for 30 min. After 4 h, the CD was given to the relevant groups, and then, all subjects were euthanized at scheduled times. The brain of each animal was removed for histopathological (hematoxylin and eosin staining), immunohistochemical (beclin-1, anti-MHC class II and anti-CD-68 staining), and biochemical (TNF, IL-1ß, IL-6, caspase-3, GSH/GSSG, malondialdehyde, protein carbonyl, LC3II/LC3I, and beclin-1 levels) evaluations. RESULTS: It was observed that CD could reduce necrosis and mitigate polarization of microglia to the M1 phenotype, autophagy, free oxygen radicals, protein carbonylation, lipid peroxidation, IL-1ß, IL6, TNF, caspase-3, beclin-1, and LC3II/LC3I levels in acute and chronic periods of hypoxia/reperfusion injury. CONCLUSION: From these results, it was observed that CD treatment could reduce neuronal necrosis and create anti-inflammatory, anti-edema, anti-oxidant, anti-apoptotic, and anti-autophagic effects in hypoxia/reperfusion injury in rats.

Evaluation of the effectiveness of oxytocin and enalapril in the prevention of epidural fibrosis developed after laminectomy in rats.

INTRODUCTION: Except for methylprednisolone, there is no current low-cost and low-side-effect drug/barrier method to prevent epidural fibrosis after spine surgery. However, the use of methylprednisolone has led to substantial controversy because of its serious side effects on wound healing. This study aimed to evaluate the effects of enalapril and oxytocin on preventing the development of epidural fibrosis in a rat laminectomy model. MATERIALS: Under sedation anesthesia, T9, T10, and T11 laminectomy was performed on 24 Wistar Albino male rats. The animals were then separated into four groups; Sham group (only laminectomy was performed; n = 6), MP group (laminectomy was performed and 10 mg/kg/day methylprednisolone was administered intraperitoneally (ip) for 14 days; n = 6), ELP group (laminectomy was performed and 0.75 mg/kg/day enalapril was administered ip for 14 days; n = 6), OXT group (laminectomy was performed and 160 µg/kg/day oxytocin was administered ip for 14 days; n = 6). Four weeks after the laminectomy, all the rats were euthanised, and the spines were removed for histopathological, immunohistochemical, and biochemical examinations. RESULTS: Histopathological examinations revealed that the degree of epidural fibrosis (X2=14.316, p = 0.003), collagen density (X2=16.050, p = 0.001), and fibroblast density (X2=17.500, p = 0.001) was higher in the Sham group and lower in the MP, ELP, and OXT groups. Immunohistochemical examinations showed that collagen type 1 immunoreactivity was higher in the Sham group and lower in the MP, ELP, and OXT groups (F = 54.950, p < 0.001). The highest level of α-smooth muscle actin immunoreactivity was seen in the Sham and OXT groups, and the lowest was in the MP and ELP groups (F = 33.357, p < 0.001). Biochemical analysis revealed that tissue levels of TNF-α, TGF-ß, IL-6, CTGF, caspase-3, p-AMPK, pmTOR, and mTOR/pmTOR were higher in the Sham group and lower in MP, ELP, and OXT groups (p < 0.05). The GSH/GSSG levels were lower in the Sham group and higher in the other three groups (X2=21.600, p < 0.001). CONCLUSION: The study results showed that enalapril and oxytocin, which are known to have anti-inflammatory, antioxidant, anti-apoptotic, and autophagy-related regenerative properties, could reduce the development of epidural fibrosis after laminectomy in rats.

Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study.

OBJECTIVE: Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the "bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)" technique in CSM patients. METHODS: The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images. RESULTS: Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50 ± 3.42, kyphosis angles were -13.34 ± 13.69° and spinal canal areas were 87.11 ± 28.30 mm2. In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94 ± 3.09, kyphosis angles were -15.07 ± 12.78° and spinal canal areas were 149.65 ± 42.57 mm2. A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (P < 0.001). Kyphosis angles were not different (P = 0.198), and no instability was observed in any patient in long-term follow-up. CONCLUSIONS: The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.

Analysis of radiological measurement parameters that can predict the type of treatment to be applied in odontoid fractures: Clinical research.

Introduction: Although various conservative and surgical treatment methods have been proposed, treatment options for patients with odontoid fractures remain controversial. This study was conducted to determine some demographic and radiological measurement parameters that can predict treatment options in patients with odontoid fractures. Materials and Methods: The patients were separated into the surgery (-) group (n = 9) and the surgery (+) group (n = 10). Patient data were recorded of age, gender, type of odontoid fracture, morphological measurement results obtained from computed tomography images, treatment regimens, duration of stay in the hospital, and mortality rate. In the operating room, a halo-vest corset or Philadelphia-type cervical collar was applied to the surgery (-) patients after the reduction of the fracture under fluoroscopy. Anterior odontoid lag screw fixation was performed on surgery (+) patients. Results: The amount of displacement of the fractured odontoid, the distance between the C1 vertebra and the odontoid process, the angle between the posterior wall of the odontoid process and the posterior wall of the clivus, the slip angle, and the anterior to posterior width of the spinal canal were not different between the groups. No difference was determined between the groups in respect of the amount of lateral displacement of the odontoid process in the spinal canal in the axial plane and the angle of the fractured odontoid process with the C2 vertebral body. Conclusion: This preliminary study showed that the demographic data and radiological measurement parameters analyzed in the present study could not be used as predictive markers either in decision-making for treatment modality or mortality risk.

Possible predictive clinical and radiological markers in decision making for surgical intervention in patients with Chiari Malformation type 1.

BACKGROUND: The first aim of this study was to compare the clinical data and posterior fossa morphometry obtained during the admission to the hospital between control group individuals (who had not Chiari Malformation (CM) type 1) and CM type 1 patients treated surgically or not. The second aim was to create a valid and reliable scale that can predict the decision-making for surgical intervention simply and easily in these patients. MATERIALS: Medical data and radiological images of 70 CM type 1 patients during their admission to the hospital were compared with the data of 69 control group individuals. RESULTS: Conservative treatment and/or follow-up was applied to 58 (82.9%) patients, and 12 (17.1%) patients underwent surgery. ROC analysis showed that the presence of myelopathy, tonsillar herniation >8 mm, Chamberlain line >84 mm, McRae line >44.50 mm, and odontoid process-McRae line angle <10.50 degrees could be used as predictive markers in decision-making for surgical intervention (p < 0.05). Logistic Regression analysis revealed that symptoms severity, and McRae line value would be the 'best parameters' in decision-making for surgical intervention (p < 0.05). A scale named the CHIASURG scale developed using this study's parameters showed that the parameters of 'depth of tonsillar herniation', 'Chamberlain line', and 'McRae line' could predict the surgical intervention risk. CONCLUSION: It was found that symptoms severity and McRae line value could be used as predictive markers in decision-making for surgical intervention. Additionally, it was concluded that a new scale called CHIASURG could predict surgical intervention risk validly and reliably.

Predictive Markers in Decision-Making for Screwing the Fractured Thoracolumbar Vertebra in the Short-Segment Instrumentation.

Introduction: In this study, it is aimed to compare the long-term results of patients with short-segment instrumentation where screws were inserted into the fractured vertebra with those of patients with long-segment instrumentation applied by skipping the fractured vertebra and reveal the predictive markers in decision-making for screwing fractured vertebra. Methods: Patients were separated into two groups, namely, Group A (patients in which the fractured vertebra and vertebrae above and below the fractured vertebra were screwed (short-segment instrumentation, n=22) and Group B (patients in whom the fractured vertebra was not screwed, whereas two vertebrae above and below the fractured vertebra were screwed (long-segment instrumentation, n=27). Results: The presence of pedicle fracture, AOSpine Classification Scale score, the height of the fractured vertebra, vertebra height below the fractured vertebra, spinal canal diameter, and duration of stay in hospital were different between the groups, preoperatively (p<0.05). Fractured vertebra height, vertebra height below the fractured vertebra, and Karnofsky Performance Scale score were different between the groups in long-term follow-up (p<0.05). The preoperative measurement values were similar to each group's postoperative long-term follow-up results. Logistic regression analysis revealed that the presence of pedicle fracture, AOSpine Classification Scale score, vertebra height below the fractured vertebra, and spinal canal diameter could be the best parameters in decision-making for screwing fractured vertebra (p<0.05). Conclusions: Both instrumentation procedures were observed to have similar effectiveness in preventing a collapse in fractured vertebra during long-term follow-up. It was thought that the AOSpine Classification Scale score, presence of pedicle fracture, vertebra height below the fractured vertebra, and spinal canal diameter could be used as predictive markers in decision-making for screwing fractured vertebrae. Consequently, it was concluded that patients with pedicle fractures, more height loss in the vertebra below the fractured vertebra, and narrow spinal canal would not be suitable for screwing the fractured vertebra.

Evaluation of the therapeutic effects of calcium dobesilate in sciatic nerve crush injury in rats.

INTRODUCTION: Proinflammatory cytokines released from nerve endings and surrounding injured tissue after nerve damage can prolong the inflammation process, delay nerve healing or result in poor quality nerve healing. In this case, due to the loss of function in the muscles innervated by the damaged nerve, the patient may have neurological and functional difficulties which may reduce the patient's quality of life and create an economic burden. Although the attempts of many pharmacological agents to heal crush injury of peripheral nerves have been recorded in literature, a drug that can provide adequate recovery of the crushed nerve and can be applied in daily life has not been defined as yet. This study aimed to assess the effects of calcium dobesilate on sciatic nerve crush injury in a rat model. METHODS: A total of 26 male Wistar albino rats were separated into four groups as follows: CONTROL group (healthy subjects, n=6); SHAM group (crush injury was created, n=6); MP group (after created crush injury, methylprednisolone was administered, n=7); and CAD group (after created crush injury, calcium dobesilate was administered, n=7). A crush injury was created, then the electrophysiological findings and sciatic nerve functional index (SFI) were recorded before euthanasia. After the euthanasia of all the rats, samples of the crushed nerve and gastrocnemius muscle were evaluated histopathologically, immunohistochemically, and biochemically. RESULTS: Both pharmacological agents were histopathologically effective in axon regeneration and repair. Calcium dobesilate did not preserve total muscle mass but was seen to prevent atrophy microscopically. Immunohistochemistry and biochemistry results showed that calcium dobesilate and methylprednisolone had anti-inflammatory, anti-oxidant, anti-apoptotic, and anti-autophagic activity in the crushed sciatic nerve. Neither calcium dobesilate nor methylprednisolone improved the nerve conductance level. SFI values obtained on day 30 from the CAD group were numerically closer to the values of the healthy animals but not at a statistically significant level. CONCLUSION: The study results demonstrated that calcium dobesilate could suppress inflammatory processes and provide histopathological and functional improvements in the injured nerve in rats. Therefore, further clinical studies are recommended to investigate in detail the therapeutic effects of calcium dobesilate on peripheral nerve crush injury.

Pheochromocytoma presented with vertebral artery dissection.

BACKGROUND: Pheochromocytoma may rarely cause arterial dissection. Here the authors report a patient with pheochromocytoma complicated with vertebral artery dissection (VAD) and stroke. CASE HISTORY: A 48-year-old man presented with probable diagnosis of myocardial infarction. Following premedication with methylprednisolone for coronary artery angiography, he had unstable hypertension. Three days later, he had right cerebellar and left occipital lobe infarction in association with VAD. Urinary cathecolamines and MR scan of the abdomen suggested a diagnosis of phaeochromocytoma, which was later histopathologically confirmed. CONCLUSION: This case is interesting in that there is no previous report of the combination of pheochromocytoma, VAD, and stroke. Awareness of the atypical clinical presentations of this tumor is important for definitive treatment.

Predictive diagnostic and/or prognostic biomarkers obtained from routine blood biochemistry in patients with solitary intracranial tumor.

BACKGROUND: Radiological and/or laboratory tests may be sometimes inadequate distinguishing glioblastoma from metastatic brain tumors. The aim of this study was to find possible predictive biomarkers produced from routine blood biochemistry analysis results evaluated preoperatively in each patient with solitary brain tumor in distinguishing glioblastoma from metastatic brain tumors as well as revealing short-term prognosis. METHODS: Patients admitted to neurosurgery clinic between January 2015 and September 2018 were included in this study and they were divided into GLIOMA (n=12) and METASTASIS (n=17) groups. Patients' data consisted of age, gender, Glasgow Coma Scale scores, duration of stay in hospital, Glasgow Outcome Scale (GOS) scores and histopathological examination reports, hemoglobin level, leukocyte, neutrophil, lymphocyte, monocyte, eosinophil, basophil and platelet count results, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio values, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were evaluated preoperatively. RESULTS: The CRP levels of METASTASIS group (143.10 mg/L) were higher than those of GLIOMA group (23.90 mg/L); and it was 82% sensitive and 75% specific in distinguishing metastatic brain tumor from glioblastoma if CRP value was >55.00 mg/L. A positive correlation was determined between GOS score and hemoglobin level and between ESR and CRP values. However, GOS scores were negatively correlated with the ESR level and duration of stay in hospital. CONCLUSIONS: Study results demonstrated that CRP values could be predictive biomarker in distinguishing metastatic brain tumor from glioblastoma. In addition, ESR, CRP, hemoglobin levels and duration of stay in hospital could be prognostic biomarkers in predicting short-term prognosis of patients with solitary brain tumor.

Using of the Synthetic Dural Graft as Described in Bogota Bag Technique to Decrease the Adhesions in Decompressive Craniectomy.

AIM: To create an alternative synthetic dural graft using a parenteral solution bag made of polyvinyl chloride/polypropylene (PVC/ PP). MATERIAL AND METHODS: Twenty-two albino rats were divided into the Sham, DC and BAG groups. Except for the Sham group animals, the right parietal bone of the rats was totally drilled in a diameter of 1.0 x 0.5 mm. Then, the PVC/PP BAG was layered over the craniectomized bone of the BAG group animals. Thirty days later, all animals were sacrificed, and inflammatory processes consisting of polymorphonuclear cell infiltration, inflammation, edema, hyperemia, lymphocytosis, histiocytosis, vascular proliferation, and fibrosis were graded at the craniectomy site. RESULTS: The grade values of inflammation, edema, histiocytosis, and fibrosis were found different among the groups (p < 0.017). It was observed that placing a synthetic graft to the surgical site undergoing craniectomy could prevent fibrotic adhesions that might occur between the brain tissue and scalp in the chronic period. Furthermore, it was considered that this synthetic material did not increase inflammatory processes secondary to surgery at the surgical site and did not produce a foreign body reaction, toxicity, or infection. CONCLUSION: As a result of this study, it was argued that the synthetic material used in this study could be compatible with dermal and neural tissues and reduce adhesions at the craniectomy field. Therefore, it was considered that this material could be used as an alternative synthetic dural graft in decompressive craniectomy in human subjects after detailed toxicity studies.

In spontaneous intracerebral hematoma patients, prediction of the hematoma expansion risk and mortality risk using radiological and clinical markers and a newly developed scale.

Objective: In patients with spontaneous intracerebral hematoma (ICH), early-stage hematoma expansion has been associated with poor prognosis in literature. This study aimed to develop predictive parameter(s) as well as a new scale to define hematoma expansion and short-term prognosis in patients with ICH.Methods: In 46 patients with ICH, Glasgow Coma Scale (GCS) scores, non-contrast CT (NCCT) markers (hematoma volume on admission and follow-up, hypodensity, intraventricular hemorrhage, blend and island sign, BAT score), and modified Rankin Scale scores were evaluated for predicting the hematoma expansion risk and mortality risk. Furthermore, a newly developed scale called the 'HEMRICH scale' was constituted using the GCS score, hematoma volumes, and some NCCT markers.Results: Roc-Curve and Logistic Regression test results revealed that GCS score, initial hematoma volume value, hypodensity, intraventricular haemorrhage, BAT score, and HEMRICH scale score could be the best markers in predicting hematoma expansion risk whereas GCS score, intraventricular haemorrhage, BAT score, hematoma expansion, and HEMRICH scale score could be the best markers in predicting mortality risk (p = 0.01). Moreover, Factor analysis and Reliability test results showed that HEMRICH scale score could predict both hematoma expansion and mortality risks validly (Kaiser-Meyer-Olkin test value = 0.729) and reliably (Cronbach's alpha = 0.564).Conclusion: It was concluded that the GCS score, intraventricular haemorrhage, and BAT score could predict both hematoma expansion risk and mortality risk in the early stage in patients with ICH. Furthermore, it was suggested that the newly produced HEMRICH scale could be a valid and reliable scale for predicting both hematoma expansion and mortality risk.

The Healing Effects of Thymoquinone and Dexpanthenol in Sciatic Nerve Compression Injury in Rats.

INTRODUCTION: Functional healing of peripheral nerve injuries is still difficult. In this study, potential healing effects of thymoquinone and dexpanthenol in sciatic nerve compression injury (SCI) were investigated. Method: Twenty-four male Wistar albino rats which were applied compression injury to their sciatic nerves were randomly separated into four groups as following: "control" group contained six rats administered no pharmacological agent; "TMK" group consisted of six rats administered 10 mg/kg intraperitoneal thymoquinone once a day for one week; "DXP" group contained six rats administered 50 mg/kg intraperitoneal dexpanthenol once a day for one week; and "TMK-DXP" group consisted of six rats administered separately 10 mg/kg intraperitoneal thymoquinone and 50 mg/kg intraperitoneal dexpenthanol once a day for one week. Four weeks later from SCI, sciatic nerve function index (SFI) was applied before sacrifice of all rats, and then their crushed sciatic nerves were histopathologically examined, in terms of "Schwann cell count", "axon and myelin degeneration", "axon shape/size differences", "fibrosis", and "neovascularisation". Results: "Schwann cell count" (p = 0.011), "axon and myelin degeneration" (p = 0.001), "axon shape/size differences" (p = 0.011), and "fibrosis and neovascularisation" (p = 0.026) scores were different between the control and TMK-DXP groups. SFI scores were different between the control and TMK groups (p = 0.002), between the control and TMK-DXP groups (p < 0.001), and between the DXP and TMK-DXP groups (p = 0.029). Conclusions: This study results revealed that these pharmacological agents used alone had no histopathological healing effect in rats with SCI, but thymoquinone could improve walking function. However, thymoquinone and dexpanthenol used together had a significant histopathological and functional healing effect.

Evaluation of the toxicity of onyx compared with n-butyl 2-cyanoacrylate in the subarachnoid space of a rabbit model: an experimental research.

INTRODUCTION: The toxic effects of onyx, its solvent dimethyl sulphoxide (DMSO), and n-butyl 2-cyanoacrylate (NBCA) were evaluated after infusion into the subaracnoid space of a rabbit model. METHODS: Each of the two various concentrations of onyx, pure DMSO, NBCA, and normal saline solution were percutaneously infused into the pontocerebellar cisternae of 39 domestic male albino rabbits, after which, the brain stems and medial cerebellar tissues were harvested for biochemical and histopathological studies. RESULTS: The specimens infused in various concentration of onyx, DMSO, and NBCA showed neural tissue necrosis and edema with inflammatory cell infitration in the acute stage. Although the mean values of the lipid peroxidase in the control, saline, and NBCA groups were found to be almost similar, they were found to be low in the onyx and DMSO groups. CONCLUSION: This experimental study suggests that NBCA, and various concentrations of onyx and DMSO have toxic effects on the neural tissues of rabbits when infused into the subarachnoid space.

[Venous sinus thrombosis after closed head injury: case report]. / Kapali kafa travmasi sonrasi venöz sinüs trombozu: Olgu sunumu.

Dural sinus thrombosis after closed head injury is seen very rarely and its pathophysiological mechanisms are not yet understood. An 18-year-old man who had been crushed in an automobile had closed head injury with Glasgow Coma Score 4. Computerized tomography showed diffuse cerebral edema and right occipital linear fracture extending to the internal jugular foramen. Because of high- level intracranial pressure, he underwent bilateral frontotemporoparietal craniectomy. After surgery, magnetic resonance scan with venography showed that the right internal jugular vein was obliterated from the torcular Herophili and the left internal jugular vein was very thin in calibration. He was discharged home with Karnofsky performance score of 30/90. Dural sinus thrombosis with dominant side can carry high morbidity and mortality if not treated immediately.

Research on the Effects of Levetiracetam in Spinal Cord Injury Model in Rats: An Experimental Study.

Purpose: Despite advances in spinal biomechanic research, surgical techniques, and rehabilitation processes, no significant improvement has been identified in the treatment of spinal cord injury (SCI) and neurological recovery. Aim of the Study: This study was designed to investigate the potential therapeutic effects of methylprednisolone and levetiracetam on SCI. Materials and Methods: In this study, 42 male Wistar Albino rats, each weighing 300-350 g, were separated into three main groups: control group, acute and subacute stage groups. With the exception of the control group, a T7-8 dorsal laminectomy was performed on the spinal column of the rats. A temporary vascular aneurysm clip was then applied to the spinal cord for 1 min to create SCI and methylprednisolone or levetiracetam was administered intraperitoneally to all except the control and SHAM control groups. The damaged spinal cord was removed for histopathological and biochemical examinations. Results: Both pharmacological agents were determined to have improved the histopathological architecture in damaged neural tissues during the acute period of SCI, but could not sustain this activity in the subacute period. Neither pharmacological agent affected the biochemical data in the acute nor subacute stages. Conclusions: Both pharmacological agents showed histopathological healing effects in injured tissues during the acute phase of SCI in this rat model but these effects could not be sustained in the subacute period. No effect on biochemical data was seen in either the acute or subacute period. There is a need for further advanced studies to determine the effects of levetiracetam on the healing processes in SCI.