Extracorporeal Shock Wave Therapy with Low-Energy Flux Density Treatment Applied to Hemiplegia Patients on Somatosensory Functions and Spatiotemporal Parameters.

We aimed to investigate the efect of Extracorporeal Shock Wave Therapy (ESWT) applied to patients with hemiplegia on somatosensory data, spatiotemporal parameters, posture, and muscle tone. This was a double-blind, randomised, controlled trial. Patients were randomised within pairs to either the experimental (ESWT) group (n=20) or the control group (n=20). All patients participated in the same conventional stroke rehabilitation program for 60 minutes of treatment a day, 5 times a week for 6 weeks (30 sessions). Patients assigned to the ESWT group received additional ESWT over the plantar fascia 3 days/week for 6 weeks. Timed Up and Go (TUG) test, Modified Ashworth Scale (MAS) score, Posture Assessment Scale for Stroke Patients (PASS), spatiotemporal parameters, Semmes-Weinstein monofilament (SWM) test, and vibration sensation test (VST) were performed in all participant before and after treatment. In the ESWT and control groups, statistically, significant diferences were obtained in the posttreatment analysis than pre-treatment. Significant diferences were found in foot angle, step cycle duration, swing phase, cadence, gait cycle distance, and VST values after ESWT treatment (P < .01). When combined with a neurological rehabilitation program, it was determined that ESWT applied to the plantar face of the foot in individuals with hemiplegia increased somatosensory functions and was more successful in developing postural control and balance.

Assessment of deltamethrin-induced DNA damage, neurotoxic and neuroimmune effects in the brain tissue of brown trout (Salmo trutta fario).

This study investigated the impact of deltamethrin (DM) toxicity on brown trout (Salmo trutta fario), examining its effects on the immune system, including the white blood cell (WBC), lymphocyte (Lym), total immunoglobulin (T. Ig), and lysozyme levels, as well as its neurotoxic consequences on the brain tissue. The neurotoxic effects encompassed oxidative stress, the activity of the antioxidant enzymes, such as the superoxide dismutase (SOD) and catalase (CAT), acetylcholinesterase (AChE) activity, and DNA damage using 8-hydroxy-2-deoxyguanosine (8-OHdG). The DM exposure led to elevated levels of malondialdehyde (MDA), and 8-OHdG, while concurrently causing a reduction in the AChE activity, protein and lipid content, WBC count, Lym, lysozyme activity, T. Ig levels, as well as the SOD and CAT levels in the brain tissues of groups 2 and 3 when compared to those in group 1. In summary, the findings of this study strongly indicate that DM induces DNA damage, immunotoxicity, and neurotoxicity in the brain tissue of brown trout, primarily due to the excessive production of reactive oxygen species (ROS). Moreover, the observed dose-dependent responses of DM to the environmental concentrations on all the investigated parameters suggest its potential utility in aquaculture risk assessment.

Deep brain stimulation for the abernethy malformation related tremor.

Deep brain stimulation (DBS) is introduced for the surgical treatment of movement disorders such as Parkinson's disease, tremor, dystonia, and tics. Electrostimulation of the ventral thalamus or subthalamic area has been found effective in different types of tremors that have different etiologies. Abernethy malformation is a rare congenital abnormality characterized by the presence of a congenital extrahepatic portosystemic shunt between the portal vein and systemic circulation. In this report, we present as a case of Abernethy malformation that caused hyperammonemia congenitally and presented as action and resting tremor in the hands and, treated with DBS.

Describing a New Mechanism of Retinal Detachment Secondary to Ophthalmic Artery Vasospasm Following Subarachnoid Hemorrhage: An Experimental Study.

BACKGROUND: The pterygopalatine ganglion (PPG) and ophthalmic arteries (OpAs) have important roles in ocular autoregulation and retinal and visual functions. The relationship between PPG neuron density, OpA vasospasm, and retinal detachment in subarachnoid hemorrhage (SAH) has never been studied. METHODS: This study was conducted on 25 rabbits. Five animals were in the control group (GI; n = 5), five in the sham group (GII; n = 5), and 15 in the study group (GIII; n = 15). After injection of 1 cc serum saline into the cisterna magna in the sham group, and autologous blood in the SAH group, the animals were followed for 3 weeks. All animals underwent a retinal examination five times a week for 3 weeks before and after the experiment. After the experiment, the neuron density of PPGs of the facial nerves, vasospasm index (VSI) of OpAs, and total basal surface values of the detached retinal parts (DRPs) were calculated. RESULTS: In the funduscopic examination, intravitreous hemorrhage ( Terson's syndrome) was detected in four animals in the SAH group. In the control groups, neuron density was 12,000 ± 1,240/mm3, VSI = 0.345 ± 0.076, and DRP = 0 to 1.5 mm2. Mean neuron density was 9,450 ± 940/mm3, VSI = 1.645 ± 0.940, and DRP = 6.23 ± 1.61 mm2 in the sham group (p < 0.05). Neuron density was 6,890 ± 932/mm3, VSI = 2.92 ± 0.97, and DRP = 9.43 ± 2.54 mm2 in SAH group. CONCLUSION: Mean neuron density, VSI of OpAs, and DRP values differed statistically significant between the SAH group and other groups (p < 0.005). There is an inverse relationship between PPG neurons and DRP. However, a direct relationship was observed between the mean VSI and DRP values.

Histopathological Investigation of the Effectiveness of Collagen Matrix in the Repair of Experimental Spinal Dura Mater Defects.

OBJECTIVE: This study investigated the suitability of the collagen matrix as a dural graft in the repair of experimental spinal dura mater defects. MATERIALS AND METHODS: In the study, 30 New Zealand white rabbits were used. The rabbits were divided into a study and control group. In both groups, following exact laminectomy (Th 10 and 11) in rabbits under the isoflorane anesthesia, a spinal dural defect 1×0.5 cm in size was formed. In the study group, the dura mater defect was covered with collagen matrix; in the control group, the excised dura was sutured back to its original position. At the end of the follow-up period, the rabbits were sacrificed. In all subjects, the vertebral colon was excised completely, and it was fixed in 10% formaldehyde solution. Sections 3 pm thick were taken from the specimens, stained with hematoxylin and eosin, and examined under a light microscope. The stained sections were evaluated under light microscopy with regard to the cellular inflammatory response, fibroblastic proliferation, foreign body reaction, and capsule formation. RESULTS: The collagen matrix was completely absorbed, and it was easy to use since it did not require sutures. Foreign body reactions were minimal in the early period and were resolved entirely in the end. Inflammatory response against the collagen matrix was no greater than in the control group in which the dura was sutured primarily and then closed, eventually disappearing entirely, and no adhesion formation resulted. Collagen permits successful regeneration by combining with the dura mater. No capsule formation was observed in either group. CONCLUSION: This study shows that collagen is suitable for duraplastic procedures and that it may be a useful agent in patients in whom the dura cannot be closed primarily due to retraction, constriction, or excision.

New determinants for casual peripheral mechanism of neurogenic lung edema in subarachnoid hemorrhage due to ischemic degeneration of vagal nerve, kidney and lung circuitry. Experimental study1.

PURPOSE: To evaluate whether there is a relationship between renal artery vasospasm related low glomerular density or degeneration and neurogenic lung edema (NLE) following subarachnoid hemorrhage. METHODS: This study was conducted on 26 rabbits. A control group was formed of five animals, a SHAM group of 5 to which saline and a study group (n=16) injected with homologous blood into the sylvian cisterna. Numbers of degenerated axons of renal branches of vagal nerves, atrophic glomerulus numbers and NLE scores were recorded. RESULTS: Important vagal degeneration, severe renal artery vasospasm, intrarenal hemorrhage and glomerular atrophy observed in high score NLE detected animals. The mean degenerated axon density of vagal nerves (n/mm2), atrophic glomerulus density (n/mm3) and NLE scores of control, SHAM and study groups were estimated as 2.40±1.82, 2.20±1.30, 1.80±1.10, 8.00±2.24, 8.80±2.39, 4.40±1.14 and 154.38±13.61, 34.69±2.68 and 12.19±1.97 consecutively. Degenerated vagal axon, atrophic glomerulus and NLE scores are higher in study group than other groups and the differences are statistically meaningful (p<0.001). CONCLUSION: Vagal complex degeneration based glomerular atrophy have important roles on NLE following SAH which has not been extensively mentioned in the literature.

"Reverse J Shaped " Skin Flap and Cranial Bone Groove for Shunt Hardware: A New Technique for Patients with Fragile Skin.

Shunt systems are not perfect devices and can cause severe complications. Complications may originate from problems related to the valve, the patient, or the surgery and are more common in neonates, infants, especially preterm, by reason of the special characteristics of these patients. We, therefore, have successfully developed a useful and viable surgical technique in order to provide helpful aspects to the surgical issues mentioned above. This technique includes a "reverse J shaped" skin incision nonintersecting the shunt's hardware and distal catheter to reduce wound problems to a minimum by opening a "bone groove". We believe that the above technique described by us will both reduce issues such as scalp ulceration, wound dehiscence, and shunt exposure in premature and pediatric hydrocephalus cases with a friable scalp, and eliminate a cosmetic problem in hydrocephalic patients of all ages.

New determinants for casual peripheral mechanism of neurogenic lung edema in subarachnoid hemorrhage due to ischemic degeneration of vagal nerve, kidney and lung circuitry. Experimental study

Abstract Purpose: To evaluate whether there is a relationship between renal artery vasospasm related low glomerular density or degeneration and neurogenic lung edema (NLE) following subarachnoid hemorrhage. Methods: This study was conducted on 26 rabbits. A control group was formed of five animals, a SHAM group of 5 to which saline and a study group (n=16) injected with homologous blood into the sylvian cisterna. Numbers of degenerated axons of renal branches of vagal nerves, atrophic glomerulus numbers and NLE scores were recorded. Results: Important vagal degeneration, severe renal artery vasospasm, intrarenal hemorrhage and glomerular atrophy observed in high score NLE detected animals. The mean degenerated axon density of vagal nerves (n/mm2), atrophic glomerulus density (n/mm3) and NLE scores of control, SHAM and study groups were estimated as 2.40±1.82, 2.20±1.30, 1.80±1.10, 8.00±2.24, 8.80±2.39, 4.40±1.14 and 154.38±13.61, 34.69±2.68 and 12.19±1.97 consecutively. Degenerated vagal axon, atrophic glomerulus and NLE scores are higher in study group than other groups and the differences are statistically meaningful (p<0.001). Conclusion: Vagal complex degeneration based glomerular atrophy have important roles on NLE following SAH which has not been extensively mentioned in the literature.

Single level discectomy with and without disc prosthesis: A comparative study of 114 patients.

BACKGROUND: Low back and leg pain due to lumbar discal hernia (LDH) is an important health issue. Current evidences support surgery in carefully selected patients who have failed conservative treatment and do not exhibit any psychosocial overlay. However, as known, sometimes it may be still very difficult to normalize the life qualities of patients for long times. Now different surgical methods for LDH are in use with new technological materials. One of them is lumbar disc prosthesis. In this study, the radiological and clinical effects of using lumbar disc prosthesis were evaluated with comparing patients underwent simple lumbar microdsicectomy. The purpose of this study is to reveal whether inserting the disc prosthesis into the intervertebral distance after lumbar microdiscectomy is beneficial or not both radiologically and clinically. METHODS: A total of 114 patients were analyzed; the first cohort consisted of 57 patients who received a lumbar discectomy at a single level along with the implantation of a disc prosthesis and the second consisted of 57 patients only received a lumbar discectomy at a single level. These 2 groups were studied by comparing the disc space on the level of carried out operations with pain scales, foramen diameters of coming about related roots preoperatively and postoperatively at 3 years. RESULTS: One of the significant results of the implementation of the disc prosthesis is fulfilment of a healthy disc height again after microdiscectomy due to LDH. We concluded that fulfilment of a healthy disc height with lumbar disc prosthesis was clinically beneficial for patients underwent microdiscectomy. CONCLUSIONS: Based on the results obtained in this study, it can be concluded that the implantation of a disc prosthesis in appropriate patients is more favorable regarding pain and spinal physiology when compared to simple microdiscectomy.

Open Discectomy vs. Microdiscectomy: Results from 519 Patients Operated for Lumbar Disc Herniation.

OBJECTIVE: The aim of this study was to evaluate the outcomes of patients with lumbar disk hernia operated between 2012 January and 2017 August and to compare the differences between open discectomy (OD) and microdiscectomy (MD). MATERIALS AND METHODS: Files of 519 patients who presented at our neurosurgical department with lumbar disk herniation were retrospectively reviewed and recorded. Preoperatively, all patients routinely underwent spinal lumbar magnetic resonance imaging (MRI) and anteroposterior as well as lateral lumbar vertebrae X-rays. During the early postoperative period, there was no need for imaging. Surgical interventions were performed using the two currently accepted OD and MD methods. RESULTS: We reviewed 519 patients with lumbar disk herniation who were operated in our clinic between 2012 and 2017. The mean age of 276 patients who underwent OD was 44.85±9.92 y, and that of the remaining 243 patients who underwent MD was 47.69±12.87 y. There was no difference in the demographic distributions of patients; levels of lumbar disk herniations; postoperative clinical outcomes; and long-term reoperation rates due to root injury, wound infection, dural tear, or the recurrence of lumbar disk herniation (p>0.05). The duration of operation was significantly shorter for OD (37.82±7.15 vs. 49.07±6.88 min; t=-18.184, p<0.001). CONCLUSION: The long-term results of patients who underwent OD and MD for lumbar disk herniation were similar. We believe that both methods can be safely used under appropriate conditions and surgical experience and that surgical experience has an impact on their outcomes.

Percutaneous Kyphoplasty: Is Bilateral Approach Necessary?

STUDY DESIGN: A multicenter retrospective study of patients who underwent unilateral and bilateral balloon kyphoplasty. OBJECTIVE: The aim of this study was to compare the radiographic and clinical results of unilateral and bilateral balloon kyphoplasty to treat osteoporotic vertebral compression fractures. SUMMARY OF BACKGROUND DATA: Percutaneous kyphoplasty has long been used as a successful method in the treatment of osteoporotic vertebral compression fractures. Although the bilateral approach is considered to be the mainstay application of percutaneous kyphoplasty, the unilateral approach has also been shown to be sufficient and even more effective in some cases. METHODS: A total of 87 patients who underwent percutaneous kyphoplasty due to osteoporotic vertebral compression fractures between 2009 and 2016 were retrospectively evaluated and divided into two groups as patients who underwent unilateral or bilateral percutaneous kyphoplasty. Unilateral percutaneous kyphoplasty was performed in 36 and bilateral percutaneous kyphoplasty in 51 patients. The groups were compared in terms of clinical outcomes, radiological findings, and complications. Clinical outcomes were evaluated using Visual Analogue Scale and Oswestry Disability Index and the radiological findings were evaluated by comparing the preoperative and postoperative day 1 and year 1 values of anterior, middle, and posterior vertebral heights and kyphosis angle. RESULTS: Clinical improvement occurred in both groups but no significant difference was observed. In radiological workup, no significant difference was found between the groups in terms of improvements in vertebral heights and kyphosis angle. Operative time and the amount of cement used for the surgery were significantly lower in the patients that underwent unilateral kyphoplasty. CONCLUSION: Unilateral percutaneous kyphoplasty is as effective as bilateral percutaneous kyphoplasty both radiologically and clinically. Operative time and the amount of cement used for the surgery are significantly lower in unilateral kyphoplasty, which may play a role in decreasing complication rates. LEVEL OF EVIDENCE: 3.

Use of programmable versus nonprogrammable shunts in the management of normal pressure hydrocephalus: A multicenter retrospective study with cost-benefit analysis in Turkey.

Ventriculoperitoneal shunt systems that are used in the treatment of normal pressure hydrocephalus are often associated with drainage problems. Adjustable shunt systems can prevent or treat these problems, but they may be expensive. The aim of our study is to compare the complications and total cost of several shunt systems.Patients with normal pressure hydrocephalus who underwent ventriculoperitoneal shunting between 2011 and 2016 were included in the study. The study involves patient consent and the informed consent was given. Complications and the average cost per person were compared between patients with adjustable and nonadjustable shunts. Shunt prices, surgical complications, and revision costs were taken into account to calculate the average cost.Of the 110 patients who were evaluated, 80 had a nonadjustable shunt and 30 had an adjustable shunt. In the group with adjustable shunts, the rates of subdural effusion and hematoma were 19.73% and 3.29%, respectively. In the group with nonadjustable shunts, these rates were 22.75% and 13.75%, respectively. One patient in the adjustable group underwent surgery for subdural hematoma, while 8 patients in the nonadjustable group underwent the same surgery. Ten patients required surgical intervention for subdural effusion and existing shunt systems in these patients were replaced by an adjustable shunt system. When these additional costs were factored into the analysis, the difference in cost between the shunt systems was reduced from 600 United States dollars (USD) to 111 USD.When the complications and additional costs that arise during surgical treatment of normal pressure hydrocephalus were considered, the price difference between adjustable and nonadjustable shunt systems was estimated to be much lower.

A Rare Complication of Subdural-peritoneal Shunt: Migration of Catheter Components through the Pelvic Inlet into the Subdural Space.

Subdural-peritoneal (SP) shunting is a simple procedure to treat subdural hygromas; however, several rare complications such as shunt migration exist. A 15-year-old boy presented with headache, nausea, and vomiting, and underwent SP shunting for left frontoparietal chronic subdural effusion. Six weeks later, radiographic examinations revealed total migration of the shunt through the pelvic inlet. The migrated shunt was replaced with a new SP shunt. Four weeks later, radiographic examinations revealed shunt migration into the subdural space. The shunt catheter was removed and the subdural effusion was evacuated. Shunt migration may result from pressure differences between the abdomen and the cranium or from head movement, and insufficient fixation and/or large burr holes can facilitate shunt migration. Double firm anchoring and small-sized burr holes can prevent this complication. SP shunt is a simple procedure, and its assumed complications can be prevented through precaution.

Should we use the serum vaspin level for the diagnosis and/or prognosis of subarachnoid hemorrhage?

BACKGROUND: We aimed to investigate whether vaspin, a member of the serine protease family, could be used as a marker for the severity and prognosis of subarachnoid hemorrhage (SAH). METHODS: Fifty-two consecutive patients (mean age, 51.46±3.2 years; 61.5% male) admitted to the emergency service of our hospital and hospitalized at our clinic with the diagnosis of aneurysmal SAH between 2012 and 2014 were included in the study and followed up for six months for outcome. The control group consisted of 52 healthy individuals of similar age and gender. RESULTS: During the 6-month follow-up, 8 of 52 patients died, and 18 (34.6%) patients had poor the Glasgow Outcome Score (GOS) scores. In 20 (38.46%) patients, acute hydrocephalus developed, and external ventricular drainage was performed. In the study group, the mean vaspin level was significantly higher than control group (157.88±33.6 pg/mL and 109.59±45.68 pg/mL, respectively; P<0.01). The mean vaspin level was 215.18±12.36 pg/mL in the non-survival group and 147.47±24.43 pg/mL in the survival group. Furthermore, it was 195.99±21.10 pg/mL in patients with poor outcome in terms of GOS, and 137.71±17.61 pg/mL in those with good outcome. The vaspin levels significantly increased with worsening of GOS, the World Federation of Neurological Surgeons (WFNS) grading system, and Fisher scores and increasing plasma C-reactive protein levels (P<0.01 for all). CONCLUSIONS: In conclusion, vaspin can play a role as a new marker in the diagnosis, severity assessment, and prognosis of SAH.

Serum nesfatin-1 levels: a potential new biomarker in patients with subarachnoid hemorrhage.

BACKGROUND: Acute subarachnoid hemorrhage (SAH) is a neurological emergency with significant potential for long-term morbidity and mortality. Nesfatin-1 is a polypeptide which is found in various regions of the brain that play role in the feeding and metabolic regulation. OBJECTIVE: So this study aimed to investigate if nesfatin-1 levels in patients with SAH, could be used as a marker for the severity and prognosis. METHOD: Forty-eight consecutive patients (except those excluded) admitted to the emergency service of our hospital and hospitalized at our clinic with the diagnosis of aneurysmal SAH between 2011 and 2013 were included in the study and followed up for six months for outcome. The control group consisted of 48 healthy individuals of similar age and gender. RESULTS: During the 6-month follow-up, 7 of 48 patients died and 16 (33.3%) patients had poor Glasgow Outcome Score (GOS) scores. In the study group, the mean nesfatin-1 level was significantly higher than the control group (7.36 ± 2.5 pg/ml and 4.29 ± 2.02 pg/ml, respectively; p < 0.01). The mean nesfatin-1 level was 11.58 ± 0.87 pg/ml in the non-survival group and 6.64 ± 1.89 pg/ml in the survival group. Furthermore, it was 10.22 ± 1.42 pg/ml in patients with poor outcome in terms of GOS and 5.93 ± 1.46 pg/ml in those with good outcome. The nesfatin-1 levels significantly increased with worsening of GOS, the World Federation of Neurological Surgeons grading system, and Fisher scores and increasing plasma C-reactive protein levels (p < 0.01 for all). CONCLUSION: The present study is the first that shows the mortality/poor outcome of the SAH with assessing serum nesfatin-1 levels. So levels of nesfatin-1 might be useful in SAH management.

A Very Rare Complication of Cerebral Hydatid Cyst Surgery: Cortical Collapse.

Hydatid diseases are still endemic pathologies in developing countries which generally needs surgical treatment. The main aim of the treatment is total cyst evacuation without rupture. Dowling technique is preferable for this aim. There are various complications of hydatid disease surgery which include cortical collapse which is very serious and can be mortal. Our case was a 6-year-old boy diagnosed with a solitary isointense cystic mass in the left parietal region. There was no surrounding edema. The cyst was completely evacuated with Dowling technique without rupture. In about 10 min after evacuation, hemispheric cortical collapse occurred, and the patient developed cardiac arrest. Although cortical collapse is a rare complication, it can cause perioperative mortality. Special care and efforts should be taken as not to form large defects after cyst evacuation to prevent cortical collapse and related mortality.

Once the Light Touch to the Brain: Cytotoxic Effects of Low-Dose Gamma-Ray, Laser Light, and Visible Light on Rat Neuronal Cell Culture.

OBJECTIVE: We aimed to evaluate the effects of gamma-ray, laser light, and visible light, which neurons are commonly exposed to during treatment of various cranial diseases, on the viability of neurons. MATERIALS AND METHODS: Neuronal cell culture was prepared from the frontal cortex of 9 newborn rats. Cultured cells were irradiated with gamma-ray for 1-10 min by (152)Eu, (241)Am, and (132)Ba isotopes, visible light for 1-160 min, and laser light for 0.2-2 seconds. The MTT tetrazolium reduction assay was used to assess the number of viable cells in the neuronal cell cultures. Wavelength dispersive X-ray fluorescence spectrometer was used to determine Na, K, and Ca levels in cellular fluid obtained from neuronal cell culture plaques. RESULTS: Under low-dose radiation with (152)Eu, (241)Am, and (132)Ba isotopes, cell viability insignificantly decreased with time (p>0.05). On the other hand, exposure to visible light produced statistically significant decrease in cell viability at both short- (1-10 min) and long-term (20-160 min). Cell viability did not change with 2 seconds of laser exposure. Na, K, and Ca levels significantly decreased with gamma-ray and visible light. The level of oxidative stress markers significantly changed with gamma-ray. CONCLUSION: In conclusion, while low dose gamma-ray has slight to moderate apoptotic effect in neuronal cell cultures by oxidative stress, long-term visible light induces remarkable apoptosis and cell death. Laser light has no significant effect on neurons. Further genetic studies are needed to clarify the chronic effect of visible light on neuronal development and functions.