The effect of bevacizumab and 5-Fluorouracil combination on epidural fibrosis in a rat laminectomy model.

OBJECTIVE: An animal model of laminectomy in rats was used to study scar tissue formation around the spinal cord. Bevacizumab (BV) [a recombinant, humanized, monoclonal antibody targeting vascular endothelial growth factor], 5-Fluorouracil (5-FU) and BV+5-FU was tested in this system for its ability to decrease fibrous tissue formation. MATERIALS AND METHODS: Twenty-eight Sprague Dawley rats were used in this sudy. Rats were divided into four groups; a control group, a BV group, a 5-FU group and a BV+5-FU group. L1-2 laminectomies were performed on the rats. The medicated groups were treated with topical drug administration. After 6 weeks, the rats were sacrified and histologic sections prepared from the spines were examined and graded by a pathologist. Epidural fibrosis and fibroblast density were evaluated under light microscope. RESULTS: BV (Avastin: Genentech, San Francisco, CA, USA) significantly reduced the density of the scar tissue undermining the laminas (p < 0.005). Monotherapy with 5-FU did not change the scar formation in the back (p = 0.317). Combination of 5-FU and BV was more effective on reducing the epidural fibrosis after laminectomy on rats (p < 0.001). CONCLUSIONS: Bevacizumab reduced the spinal epidural fibrosis significantly that developed in rats after laminectomy and 5-Fluorouracil combination had a synergic effect. Further investigations under the light of these findings may help to reduce epidural fibrosis formation after laminectomy.

Portable stimulator design aimed at differentiating facial nerves from normal tissues.

Facial nerves are very prone to risk of being cut away in the facial surgeries. In order to differentiate the normal tissues from the nerves during the surgeries, facial stimulator is very essential. These stimulators are particularly useful in triggering action potentials in the facial muscle tissue. In the case of any damage to these nerves, paralysis is unavoidable. Second use of the stimulator would be to diagnose how severe the facial problems are. Third use, which is a noninvasive application, is the employment of facial stimulator to treat and diagnose facial problems that arose from temperature differences, cuts or strain. The stimulation is achieved through DC voltage pulses that conform to user-specified amplitude, pulse duration and pulse intervals. These variables are set according to the age, sex, and physiological conditions of the patient. Peripheral Interface Controller is used to derive different pulse patterns. The current specifications of our stimulator are a range of 0.1-20 V pulse amplitude, 0.1-2 msec pulse duration, and 0.05-1 sec pulse interval. The main benefits of our stimulator are its graphic display that shows the form of pulse, its compact size, and operation on a battery power supply and adaptability to convert to other stimulation applications.

Prevention of spinal epidural fibrosis by recombinant tissue plasminogen activator in rats.

STUDY DESIGN: A randomized-controlled experimental study was conducted to investigate the effectiveness of recombinant tissue plasminogen activator (rt-PA) on postlaminectomy epidural fibrosis in rats. SETTING: Diyarbakir, Turkey. METHODS: In a rat model, allowing objective histopathological quantification, the postoperative epidural scar formation was investigated and the potential of local rt-PA in preventing the production of epidural fibrosis was assessed. Rats were randomly allocated to local rt-PA (12 rats) or control (12 rats). RESULTS: Findings suggest a beneficial effect of rt-PA in decreasing the epidural fibrosis following laminectomy when compared with control groups for all investigated parameters such as intermuscular scar (P=0.04), middle scar (P=0.001), deep scar (P=0.001) and dural adhesion (P=0.01) except new bone formation. The presence of arachnoiditis was less in treatment group (P=0.01). CONCLUSION: In rats, the topical thrombolysis with rt-PA is safe and efficacious in preventing postlaminectomy epidural fibrosis. This Thrombolytic therapy with rt-PA after spine surgery may come to play an important role in the prevention of epidural fibrosis and arachnoiditis.

Intramedullary tuberculoma of the conus medullaris: case report and review of the literature.

OBJECTIVE: To illustrate the dilemmas in the diagnosis and management of intramedullary tuberculomas of the spinal cord. METHODS: Case report of a 32 year-old man with tuberculous meningitis. The presence of unexplained urinary retention and progressive weakness in the legs led to the discovery of an additional tuberculoma of the conus medullaris. SETTING: Dicle University Diyarbakir, Turkey. RESULTS: The patient was on a 1-year course of isoniazid, pyrazinamide and rifampicin, and responded well to conservative treatment. Our patient's unique features were represented by the worsening of neurological symptoms while being treated with adequate anti-tuberculous medication. CONCLUSION: We present a case of intramedullary tuberculoma of the conus medullaris to illustrate the dilemmas in the diagnosis and management of this curable disease, and review of the literature to date.

Synovial cyst at the intervertebral foramina causing lumbar radiculopathy.

OBJECTIVE: To determine the presence of intraforaminal synovial cysts resulting in nerve root compression. METHODS: A 26 year old man presenting with left leg pain was admitted. He had no motor, sensory, or reflex changes. Magnetic resonance imaging (MRI) and MRI-myelography showed an intra and extra foraminal, extradural, cystic lesion at L4 vertebra on the left side. RESULTS: At surgery there was a cystic mass pressing on the nerve root, and no connection or communication with the dural structures could be found. CONCLUSION: Synovial cysts are uncommon extradural degenerative lesions. Intraspinal synovial cysts occur most often at the L4-5 level, but they have been reported in all areas of the spine except the intraforaminal region and the sacrum.

Growth rate of cerebral hydatid cyst, with a review of the literature.

This extremely rare case was one of secondary solitary cerebral echinococcosis associated with possible cerebral thromboembolism. A 7-year-old girl living in a rural area was admitted to our hospital with a history of headache, right-sided hemiparesis, and dysphasia. She had been treated 6 months previously for a cerebral infarct, diagnosed from sudden altered consciousness and a myoclonic generalised convulsion. The growth rate determined for the cerebral hydatid cyst was about 4.5 cm during the 6-month period. In children a parasitic cyst can be the source of a cerebral embolus, particularly in areas where hydatid disease resulting from cardiac echinococcosis is endemic.

Spinal subdural tuberculous abscess.

OBJECTIVES: Spinal subdural abscess is rare and only 48 cases have been described to date. In this report, we present an additional spinal subdural tuberculous abscess. METHOD: Tuberculous meningitis was diagnosed with clinical and laboratory findings in a 45-year-old man. A spinal subdural abscess was demonstrated using MRI. Presence of the abscess was revealed by surgical intervention. The diagnosis was confirmed by pathological examination. RESULTS: The patient had been treated for tuberculous meningitis 2 years previously. The disease recurred when anti-tuberculous therapy was prematurely discontinued. During the second treatment, the patient also underwent a ventriculo-peritoneal shunt operation for hydrocephalus. Dizziness and weakness of both legs developed after the postoperative period. Spinal MRI showed a spinal subdural abscess as a iso-intense mass with spinal cord in the T1 and T2 weighted images, ring like enhancement and compression on the spinal cord at T3-T4 level. The patient underwent surgery and the abscess was drained. CONCLUSION: Tuberculosis may cause a spinal subdural abscess and although it is a rare disorder, when encountered MRI is very useful in the diagnosis.

CT of the brain in tuberculous meningitis. A review of 289 patients.

PURPOSE: In this retrospective study, CT findings of 289 patients with tuberculous meningitis (TBM) are presented and diagnostic criteria are discussed. MATERIAL AND METHODS: The medical records of patients who were diagnosed as having central nervous system tuberculosis were investigated. Cranial CT investigations of 289 patients with TBM were reviewed. Of these 289 patients, 214 were children and 75 adults; 157 patients were male and 132 were female. CT images were obtained with and without i.v. contrast administration. RESULTS: CT findings were normal in 35 patients and abnormal in 254. The abnormalities were hydrocephalus (172 children, 32 adults), parenchymal enhancement (56 children, 6 adults), contrast enhancement of basal cisterns (32 children, 17 adults), cerebral infarct and focal or diffuse brain edema (29 children, 10 adults), and tuberculoma (9 children, 5 adults). CONCLUSION: CT is pathologic in the great majority of patients with TBM and is helpful in assessing the complications associated with the disease.