Increased expression of ubiquitin C-terminal hydrolase L1 in astrocytomas of ascending grades.

BACKGROUND: The ubiquitin-proteasome pathway controls the monitoring and degradation of important proteins and is involved in several cellular processes, such as development, differentiation, and transcriptional regulation. Recent evidence has shown that ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), a member of the deubiquitinating enzyme family that removes ubiquitin from protein substrates, is overexpressed in many types of cancer. AIM: This study thus examined the expression of UCH-L1 in human astrocytoma tissues. MATERIAL AND METHODS: Formalin-fixed, paraffin-embedded astrocytoma samples were obtained from 40 patients, after which histopathological examination, typing, and grading were performed. The study group included 10 histologically normal brain tissues, which served as the control group, and 10 WHO grade II, 10 WHO grade III, and 10 WHO grade IV (glioblastoma) samples. Normal brain tissue samples were obtained from the histologically normal, non-tumoral portion of the pathology specimens. UCH-L1 expression was evaluated using quantitative reverse transcription-polymerase chain reaction and immunohistochemistry. RESULTS: Astrocytoma tissues exhibited higher UCH-L1 expression compared to the control group. UCH-L1 overexpression increased significantly together with the increase in astrocytoma grades (from II to IV). CONCLUSION: UCH-L1 could be a good diagnostic and therapeutic marker for determining astrocytoma development and progression.

CSF hydrothorax after ventriculoperitoneal shunt without catheter migration: a case report.

Ventriculoperitoneal (VP) shunting is the most common procedure performed for the management of hydrocephalus. VP shunt related complications remain a persistent problem in current clinical practice. Five-year-old female patient was admitted to our hospital with persistent dyspnea complaint. The patient was operated at the age of 3 months and a VP shunt established in a different clinic due to hydrocephalus associated with Dandy-Walker malformation. The patient's chest X-ray revealed right sided pleural effusion. Thorasentesis was performed and the effusion was drained with a chest tube. The discharged liquid was consistent with CSF. Scintigraphic radionuclide shunt analyses were performed and CSF passage from abdomen to chest and lower mediastinal region was determined in the late static images. The patient was operated and the incorporated ventriculoperitoneal shunt was removed. Hydrothorax was completely resolved after early postoperative stage. CSF hydrothorax especially without catheter migration is an unusual but potentially serious-clinical complication.

Neuroprotective Effects of Milrinone on Experimental Acute Spinal Cord Injury: Rat Model.

OBJECTIVE: Spinal cord injury (SCI) disrupts nerve axons with devastating neurological consequences, but there is no effective clinical treatment. The secondary damage mechanism is a mainstay process, and it starts within a few minutes after trauma. We aim to investigate the neuroprotective effects of milrinone on the SCI model. MATERIALS AND METHODS: A total of 36 Wistar albino rats, each weighing 300-400 g, were randomly split into 4 groups that received different treatments: in group 1 (sham) (n = 9) control, only a laminectomy was performed; in group 2 (SCI) (n = 9), SCI was imitated after laminectomy; in group 3 (SCI + saline) (n = 9), physiological saline solution was injected intraperitoneally immediately after the SCI; and in group 4 (SCI + milrinone), milrinone was administered intraperitoneally on lateral decubitus position immediately after the SCI. Spinal cord contusion was established by the weight-drop technique after laminectomy. Neurological examination scores were recorded, and rats were killed 72 hours later. Serum and spinal cord tissue glutathione peroxidase, total antioxidant status, total oxidant status, 8-hydroxiguanosine, interleukin-6 and interleukin-10 levels, histopathological spinal cord damage score, and apoptotic index were examined and compared between groups. RESULTS: Neurological examination scores were significantly better in the milrinone-treated group compared with groups 2 and 3. SCI significantly increased serum and spinal cord tissue glutathione peroxidase, total oxidant status, 8-hydroxiguanosine, and interleukin-6 levels that were successfully reduced with milrinone treatment. Interleukin-10 and total antioxidant status levels decreased as a result of SCI increased with milrinone treatment. Increased histopathological spinal cord damage score and apoptotic index in groups 2 and 3 significantly decreased in group 4. CONCLUSIONS: Milrinone could reduce apoptosis and increase anti-inflammatory and antioxidative mediators, thus playing a protective role in secondary nerve injury after SCI in rats.

Transzygomatic-Subtemporal Approach for Middle Meningeal-to-P2 Segment of the Posterior Cerebral Artery Bypass: An Anatomical and Technical Study.

We evaluated the use of a bypass between the middle meningeal artery (MMA) and P2 segment of the posterior cerebral artery (PCA) as an alternative to an external carotid artery (ECA-to-PCA) anastomosis. Five adult cadaveric heads (10 sides) were used. After a temporal craniotomy and zygomatic arch osteotomy were performed, the dura of the floor of the middle cranial fossa was separated and elevated. The MMA was dissected away from the dura until the foramen spinosum was reached. Intradurally, the carotid and sylvian cisterns were opened. After the temporal lobe was retracted, the interpeduncular and ambient cisterns were opened and the P2 segment of the PCA was exposed. The MMA trunk was transsected just before the bifurcation of its anterior and posterior branches where it passes inside the dura and over the foramen spinosum. It was anastomosed end to side with the P2 segment of the PCA. The mean caliber of the MMA trunk before its bifurcation was 2.1 +/- 0.25 mm, and the mean caliber of the P2 was 2.2 +/- 0.2 mm. The mean length of the MMA used to perform the bypass was 32 +/- 4.1 mm, and the mean length of the MMA trunk was 39.5 +/- 4.4 mm. This bypass procedure is simpler to perform than an ECA-to-P2 revascularization using long grafts. The caliber and length of the MMA trunk are suitable to provide sufficient blood flow. Furthermore, the course of the bypass is straight.

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up. Case report.

The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft-assisted fusion to achieve long-term stabilization.

Submandibular and intracranial hydatid cyst in an adolescent.

OBJECTIVES: An unusual case of hydatid disease is reported. Review of the pertinent literature did not reveal any hydatid disease located simultaneously in both the intracranial and submandibular glands. This is the first case with hydatid disease occurring in both locations at the same time. STUDY DESIGN: The case of an 18-year-old is presented; the symptoms, findings, methods of diagnosis, and our approach for treatment are discussed; and the literature is reviewed. RESULTS: The intracranial lesion was completely excised by left-sided frontoparietal craniotomy, and the mass in the right side of the submandibular gland was removed through a submandibular approach at the same session. The intact cyst was completely excised. Histological examination of both lesions confirmed the diagnosis of hydatid cyst by. Postoperative recovery was uneventful, and the patient was discharged on the seventh day. CONCLUSIONS: Hydatid cyst should be suspected during the evaluation of cervical masses, particularly in endemic regions. Hydatid disease infestations are best treated with complete excision of the intact cyst.

Arachnoid cyst within the fourth ventricle: a case report.

The authors report a case of fourth ventricular arachnoid cyst that presented clinically with the criteria of normal pressure hydrocephalus. Only a few cases of intraventricular arachnoid cyst have been recorded in the literature. In our case, a posterior approach was used via a midline suboccipital craniectomy and the cyst was excised.

Effects of gamma-hydroxybutyrate on cerebrospinal fluid lactate and glucose levels after spinal cord trauma.

This study aims to evaluate the effects of gamma-hydroxybutyrate (GHB) after spinal cord trauma (SCT). Twenty rabbits were divided equally into four groups: group I was the sham-operated group, group II suffered from SCT but received no treatment, group III was given a dose of 400 mg/kg of GHB intravenously before SCT and group IV received the same dose after SCT. Cerebrospinal fluid (CSF) samples were obtained 30 min before SCT (T(0)), at 60 (T(1)) and 120 min (T(2)) after SCT. There was a threefold increase in lactate levels from baseline value at T(2) in group II, while statistically significant elevation of the lactate levels were not observed in groups III and IV. Glucose levels at T(1) and T(2) were significantly lower in groups III and IV compared with the control group. The findings of this study demonstrate that GHB can control the increase of CSF lactate and glucose levels following SCT and that this metabolic effect may be associated with neuroprotective physiological changes.

The effects of alpha lipoic acid on cerebral vasospasm following experimental subarachnoid hemorrhage in the rabbit.

AIM: The aim of this study is to determine the effects of a strong dithiol antioxidant, alpha lipoic acid (ALA) on cerebral vasospasm following subarachnoid hemorrhage in a rabbit model. MATERIAL AND METHODS: Twenty-one New Zealand white rabbits were assigned to one of three groups: group 1 (control), group 2 (SAH only), group 3 (SAH+ALA). ALA was administered (100 mg/kg/day, single dose, intraperitoneally). The rabbits were sacrificed 72 hours after SAH. The basilar artery lumen areas, arterial wall thickness and endothelial apoptosis in a cross section of basilar artery were measured in all groups. The tissue MDA, SOD, GSH-Px levels were also determined. RESULTS: The elevated tissue MDA levels after SAH were significantly reduced by ALA treatment. The reduced tissue SOD and GSH-Px levels after SAH were also elevated by ALA treatment. In the treatment group the average wall thickness and the mean percentages of apoptotic cells (apoptotic index) were reduced and the average cross-sectional areas of the basilar artery were increased statistically significantly. CONCLUSION: ALA treatment attenuates the severity of cerebral vasospasm by its strong antioxidant, antivasospastic and antiapoptotic properties. ALA may potentially serve as agents in the prevention of cerebral vasospasm after SAH.

N-acetylcysteine prevents vasospasm after subarachnoid hemorrhage.

BACKGROUND: This study investigated the ability of NAC to prevent cerebral vasospasm in a rabbit model of SAH. METHODS: Twenty-one, male New Zealand white rabbits were randomly divided into 3 groups of 7 rabbits each: group 1 (control), group 2 (SAH only), group 3 (SAH + NAC treatment). NAC (150 mg/kg, single dose, IP) was administered just before SAH and continued until 72 hours after SAH in group 3. Animals were killed 72 hours after SAH. Tissue MDA levels, SOD, and GSH-Px activities were measured, and basilar artery cross-sectional areas, arterial wall thickness, and endothelial apoptosis in a cross section of basillary artery were determined in all groups. RESULTS: Intraperitoneal administration of NAC was found to be markedly effective against developing a cerebral vasospasm following a SAH in rabbits. It could significantly reduce elevated lipid peroxidation and increase the level of tissue GSH-Px and SOD enzymatic activities. Also, NAC treatment was found to be effective in increasing the luminal area and reducing wall thickness of the basilar artery. The morphology of arteries in the NAC treatment group was well protected. NAC markedly reduced apoptotic index and protects the endothelial integrity. CONCLUSIONS: This study demonstrates, for the first time, that NAC treatment attenuates cerebral vasospasm in a rabbit SAH model. NAC treatment has significant neuroprotective effect and markedly prevents cerebral vasospasm after SAH. In conclusion, the NAC treatment might be beneficial in preventing cerebral vasospasm after SAH, thus showing potential for clinical implications.

Preventive effects of intraperitoneal selenium on cerebral vasospasm in experimental subarachnoid hemorrhage.

Vasospasm is an important cause of morbidity and mortality with subarachnoid hemorrhage (SAH). The effect of intraperitoneal administration of selenium, which is an antioxidant on cerebral vasospasm was investigated in an experimental model. By means of intracisternal blood injection model, SAH was induced in 24 rabbits, which were randomly divided into 3 groups (group 1= control group, group 2=SAH alone group, and group 3=SAH plus selenium group). Basilar artery angiography was performed on day 0 and day 3 as described. Intraperitoneal selenium (0.05 mg/kg) treatment was started after the induction of SAH and administered once a day. Three days later, the animals were killed and the basilar artery was examined histologically for the luminal diameter and thickness of the arterial muscular wall. The mean values for the measurements of angiographic luminal diameter, pathologic luminal area, muscular wall thickness derived from the blind observer were analyzed statistically. There was no statistically significant difference in basal angiographic luminal diameter evaluation between groups 1-2-3 (P>0.005). But in third day angiography; comparison of group 2 and group 1-3 showed statistically significant differences (P<0.001). In pathologic investigation; there was statistically significant difference in luminal area and muscular wall thickness of the basilar artery between groups 1, 2, and 3 (P<0.005). Intraperitoneal selenium treatment was found effective by increasing the angiographic diameter; pathologic luminal area and reducing muscular wall thickness measurements. This is the first study to show that intraperitoneal administration of selenium is effective in preventing vasospasm after SAH in rabbits.

Electrophysiology of papillary muscle in SAH: changes and N-acetylcysteine protection.

BACKGROUND: Although subarachnoid hemorrhage (SAH) serves as a good model to study heart-brain interactions, neither the changes on the single ventricular action potential (SVAP) and contraction nor the effects of possible cardioprotective agents have been investigated. MATERIALS AND METHODS: A total of 18 male rabbits were used for the three experimental groups. SAH was induced by replacing the cerebrospinal fluid (CSF) with fresh autologous blood at the ratio of 1 mL to the 1-kg body mass (N = 6). In the control (CON; N = 6) group, the CSF was replaced with serum physiologic at the same ratio. The treated SAH group (SAH+NAC) received daily intraperitoneal N-acetylcysteine (NAC; 150 mg/kg for 3 days) starting from just before SAH was induced by CSF replacement. On the fourth day, animals were examined for the single action potential and contraction recordings from the left ventricular papillary muscle. RESULTS: At the end of 3 days, the overshoot decreased together with increased time to reach the peak potential. Additionally, the resting membrane potential was depressed and repolarization was slowed during SVAPs. On the other hand, peak tension depressed and time to peak increased. NAC treatment, which protects infarction in the brain, prevented these pathological changes in the cardiac muscle. CONCLUSION: SAH-induced cardiac changes can be attributed to adenosine triphosphate depletion through mitochondrial dysfunction. Pretreatment of NAC to SAH on the other hand had a positive effect on these cardiac changes. But the exact mechanism by which NAC treatment protects the cardiac muscle needs further investigation.

Does Botox effect neural tube development in early chick embryos?

Botulinum toxin (BTX) is a potent neurotoxin produced by Clostridium botulinum and has wide usage in different areas. The current study aimed to analyze the effects of C. botulinum toxin on the central nerve system in chick embryos. Forty fertile Hubbard Broil eggs, all at Stage 8 of development, were divided into four equal groups: Group 1 embryos (n=10), the control group, were explanted and grown for 18 h in a nutrient medium (thin albumin). Group 2 embryos (n=10) were grown in medium containing 5 U BTX, Group 3 embryos (n=10) in a medium containing 10 U BTX and Group 4 embryos (n=10) in medium containing 20 U BTX. After the incubation period, 80% of Group 1 and 2 embryos and 90% of Group 3 and 4 embryos had intact neural tubes (P>0.05). The results of this study suggest that BTX had no additional effect on neural tube development in early chick embryos.

Epidural thoracal teratoma in a 7-month-old girl.

CASE REPORT: We report a rare case of epidural thoracal teratoma in a 7-month-old girl. A total laminectomy was performed via T6-T8 and the lesion was totally excised. RESULTS AND DISCUSSION: We describe the radiological, surgical and pathological findings in this patient and review the findings in other reported cases.

The effects of folic acid in the prevention of neural tube development defects caused by phenytoin in early chick embryos.

STUDY DESIGN: The effects of phenytoin and folic acid on the development of neural tube defects in early chick embryos were studies. OBJECTIVE: To investigate the effects of folic acid in the prevention of neural tube development defects. SUMMARY OF BACKGROUND DATA: Several studies have shown that phenytoin selectively inhibits neural tube closure. Folic acid supplementation has been reported to decrease the occurrence of neural tube defects. METHODS: This study shows the effects of folic acid in preventing neural tube development defects caused by phenytoin in chicks based on light microscopy, transmission electron microscopy, and histopathological examination. Forty-five fertile Hubbard Broil eggs, all at Stage 8 (four somite) of development, were divided into three equal groups: Group 1 embryos (n = 15), the control group, were explanted and grown for 18 hours in a nutrient medium (thin albumin). Group 2 embryos (n = 15) were explanted and grown for 18 hours in a nutrient medium containing 500 microg/mL of phenytoin. Group 3 embryos (n = 15) were explanted and grown for 18 hours in a nutrient medium containing 500 microg/mL of phenytoin and 0.4 microg/mL of folic acid. RESULTS: After the incubation period, 86.6% of the control embryos (Group 1) had intact neural tubes; 80% of Group 2 and 46.6% of Group 3 embryos showed neural tube defects. CONCLUSIONS: The results of this study suggest that phenytoin causes neural tube defects, whereas folic acid decreases the incidence of neural tube development defects caused by phenytoin in early chick embryos.

Proximal superficial temporal artery to proximal middle cerebral artery bypass using a radial artery graft: an anatomic approach.

We present the use of radial artery graft for bypass of the proximal superficial temporal artery to the proximal middle cerebral artery. Six adult cadaver sites were used bilaterally. After apterional incision, 2x2-cm minicraniectomy was performed which began 2 cm behind the zygomatic process of the frontal bone. The superficial temporal artery was transsected before exposing the zygomatico-orbital artery branch. The proximal side of the radial artery graft was anastomosed end-to-end to the proximal superficial temporal artery and the distal side end-to-side to the proximal middle cerebral artery. The mean calibers of the proximal superficial temporal artery and largest trunk of the middle cerebral artery were 2.25+/-0.35 mm and 2.3+/-0.3 mm, respectively. The average graft length was 85+/-5.5 mm. We conclude that such bypasses are simpler than proximal middle cerebral artery revascularization using long vein grafts. This method proves that the caliber of the proximal superficial temporal artery is more suited to providing sufficient flow than the distal superficial temporal artery, and the graft is short. Such bypasses to the middle cerebral artery may be an alternative to those from the distal superficial temporal artery or extracranial carotid artery.