The relationship between health locus of control and quality of life in patients with chronic low back pain.

AIM: To investigate the relationship between health locus of control and quality of life in patients with chronic low back pain. MATERIAL AND METHODS: Pain intensity by visual analog scale, quality of life related to health by the World Health Organization Quality of Life (WHOQOL) assessment and disability level by Turkish version of Oswestry Disability Index (ODI) were evaluated. Multidimensional Health Locus of Control (MHLC) for the perception to responsibility and control of the individual over his/her own health was used. RESULTS: Patients were separated into two groups according to the scores of ODI as group with Low Disability [0-40 minimal/moderate disability; n=53] and group with High Disability [40-100 severe disability /crippled/bedbound/ exaggerating; n=60]. Scores of chance health locus of control (CHLC) in the subscale of MHLC were significantly higher in the patients who had high disability (p < 0.05). Negative correlation between CHLC scores and all domains of WHOQOL, positive correlation between CHLC scores and disability level and pain severity was found (p < 0.05). CONCLUSION: Quality of life was negatively influenced in the patients with low back pain who had chance health locus of control. LOC is an important parameter in evaluation and treatment of patients with LBP.

Evaluation of patients with spinal operation according to functional mobility.

OBJECTIVE: The aim of our study is to determine the effect of age, BMI (Body Mass Index: kg/m(2)), gender, level of lumbar disc operation and standardized physiotherapy of the patients during hospitalization on the Physiotherapy Functional Mobility Profile (PFMP). DESIGN: A retrospective study. PATIENTS: Eighty three patients who had undergone surgery with lumbar disc hernia were included in the study. Data were separately interpreted considering such parameters as age, BMI, gender, and level of operation which we believe might have affected the associated consequences. METHODS: PFMP was used in the assessment of the patients. Evaluations were made on the days when they were referred and discharged. RESULTS AND CONCLUSION: Increases were observed in totals and subheadings of PFMP scores during the early period of the inpatients exposed to lumbar disc operations to whom we applied standardized physiotherapy programs, with increases in subheadings involving ambulation being found significant. It follows from the conclusions of grouping our patients that functionality was positively influenced by 4th decade muscularity and by one-level operation in the early period.

Simulation of cerebrovascular circulation in the human cadaver for surgical neuroanatomy training.

OBJECTIVE: The current progress in diagnostic and screening methods and surgical equipment technologies facilitates the accessibility to numerous anatomic structures through various interventional approaches. Consequently, the exact knowledge of the anatomic locations of neurovascular structures and their interactions may ensure that the surgical intervention is planned in the most appropriate way and the structures are accessed with the least complication risk during the intervention. MATERIAL AND METHODS: A decapitated and formalin fixated whole-head of a male human cadaver kept for educational and research purposes in the Dokuz Eylul University Department of Anatomy was used in this study. Two separate reservoirs (for the arterial and the venous system) were connected to the Truno System 3 labeled perfusion pump. The reservoirs were filled with blue and red warm tap water. Colored tap water pumped on the right was emptied from the left. Continuous flow of the water in the closed-circuit arterial and venous systems was achieved. As the circulation was continuing, pterional craniotomy was performed and the dura mater was accessed and lifted under the Zeiss dissecting microscope. CONCLUSION: We believe that this model may contribute to neuroanatomy education and provide experience for the safe and ethical performance of surgical interventions during the intraoperative period.

Morphometric analysis of human occipital condyle.

OBJECTIVE: The human occipital condyle is the unique bony structure connecting the cranium and the vertebral column. The progress in neuroimaging techniques has increased interest for aggressive craniovertebral surgery. Such surgery requires the knowledge regarding anatomical aspects of the craniovertebral junction. The aim of the present study is to analyze the occipital condyle morphometrically. MATERIAL AND METHODS: 404 occipital condyles of 202 dry skulls were used for this study. Twenty-seven parameters were measured, including length, width and height of occipital condyle, the distances between the occipital condyle and hypoglossal canal, as well as some important condyle-related angles. RESULTS: The length, width and the height of the occipital condyle were found to be 23.4, 10.6, and 9.2 mm, respectively. The anterior and posterior intercondylar distances are 21.0 and 41.6 mm, respectively. Sagittal intercondylar angle was 59.3 degrees. The intracranial orifice of the hypoglossal canal was found in the junction of the second and third quarter on the condyle in more than 55% of specimens. The shape of occipital condyles was classified into eight types as follows--type 1: oval-like condyle; type 2: kidney-like condyle; type 3: S-like condyle; type 4: eight-like condyle; type 5: triangle condyle; type 6: ring-like condyle; type 7: two-portioned condyle and type 8: deformed condyle. The most common type was type 1 (50%), whereas the most unusual type was type 7 (0.8%). CONCLUSION: It is concluded that the occipital condyle may present various shapes, length, width, and orientation, requiring a careful radiological analysis before craniovertebral junction surgery.

Metastatic pheochromocytoma of the thoracic spinal extradural space. Case report and review of the literature.

In this case report, a thoracic extradural metastatic pheochromocytoma without bony invasion, is presented. The disease which has been identified with its symptoms, bio-chemical features, radiological appearance, histological diagnosis has been discussed in comparison with malignant pheochromocytoma metastases in the literature. The origin of this tumor is the adrenal glands. Our review of the literature shows that tumor has primary metastasis in bony structures of the spine and then demonstrates secondary intraspinal invasion. This is the first case report of an epidural metastasis from malignant pheochromocytoma without a bony invasion.

Functional anatomy of the spine by Avicenna in his eleventh century treatise Al-Qanun fi al-Tibb (The Canons of Medicine).

The history of spinal surgery is an important part of the spine-related sciences. The development of treatment strategies for spine-related disorders is acquired from the Western literature. In this article, an Eastern physician, Ibn Sina, who is known as Avicenna in the West, and his treatise, Al-Qanun fi al-Tibb (the Canons of Medicine), are presented. Eight chapters of this book regarding the functional neuroanatomy of the spine were reviewed and are presented to give insight into the development of the understanding of spinal anatomy and biomechanics.

History of spinal disorders and Cerrahiyetül Haniye (Imperial Surgery): a review of a Turkish treatise written by Serefeddin Sabuncuoglu in the 15th century. Historical vignette.

The history of spinal surgery represents an important aspect of spine-related sciences. The development of the treatment strategies of spine-related disorders has predominantly been recorded in the Western literature. In this paper, a Turkish physician, Serefeddin Sabuncuoglu (1385-1468), and his treatise, Cerrahiyetül Haniye (Imperial Surgery), are presented. Three sections of this book regarding spinal disorders (spinal dislocations, sciatica, and back pain) are reviewed. The techniques described were used by Sabuncuoglu in the 1400s. In conclusion, the language and illustrations of this treatise are unique. Compared with current approaches, there are no major differences in the principles of treating spinal traumas despite the passage of almost 500 years.

Factors affecting reduction in low-grade lumbosacral spondylolisthesis.

OBJECT: Lumbosacral spondylolisthesis (LSS) is a common disorder that often requires a stabilization and fusion procedure. The aim of this study was to determine the early neuroimaging-detected results of instrumentation-assisted (in situ) fusion with no attempt at surgical reduction of the deformity in patients with low-grade LSS. The neuroimaging results were evaluated to determine the extent of reduction and its correlation with different parameters. METHODS: Thirty patients with low-grade LSS underwent short-segment transpedicular screw fixation; surgical reduction was not attempted. All patients underwent plain anteroposterior and lateral lumbar radiography, flexion-extension lateral lumbar radiography, and computerized tomography and magnetic resonance imaging of the lumbar spine before and after surgery. Postoperative measurements were determined on the late (9 to 12-month) postoperative radiographs. The findings were recorded and grouped. Correlation analysis was performed among the radiological findings, body mass index, age, and sex. Paired-sample t-tests were performed for each paired group to determine statistically significant differences. There was no significant difference in extent of deformity reduction in patients with different lordotic angles, sagittal-plane rotation angles, and intervertebral disc heights. The extent of reduction was statistically significant at the L4-5 level (p < 0.05), in patients younger than 50 years of age (p < 0.05), and in those in whom the facet joint angle was increased (p < 0.05). CONCLUSIONS: The authors found that in cases of low-grade LSS, short-segment posterior stabilization (in situ fusion and fixation) does not require surgical reduction and in fact is associated with a measurable reduction when used as the sole treatment.

Anatomical and computed tomographic analysis of C1 vertebra.

Craniovertebral junction surgery requires knowledge regarding the anatomy of this region, particularly the C1 vertebra. Both C1 laminectomy and C1-2 instrumentation necessitate preoperative information about bony landmarks and the vertebral artery. This study compares the results obtained from anatomic and computed tomographic measurements of C1 bony landmarks. 31 C1 cervical vertebrae were measured; the C1 AP diameter, and C1 transverse diameter, the facet diameter, the distance between the anterior tubercle and the anterior aspect of the C1 lateral mass on a lateral view, the distance between the midline and the vertebral artery groove on the outer cortex of the posterior arch of C1 anatomically and computed tomographically. Anatomic measurements were performed by an anatomist using a Vernier caliper accurate to 0.1 mm, whereas the computed tomographic measurements were performed by a radiologist on bone window computed tomography (CT). The mean values and the differences between two measurement modalities were analysed using a paired t-test. There was no statistical difference between the results obtained by anatomical and radiological measurements for six parameters. There was, however, a statistically significant difference between two modalities regarding the distance between the midline and vertebral artery groove on the outer cortex of posterior arch of C1, while slightly different, the difference is within 1 mm and, therefore, not clinically significant. It is concluded that CT reflects most anatomical details of bony landmarks of C1.

Assessment of physical activity in patients with chronic low back or neck pain.

AIM: To investigate physical activity level in patients with chronic low back and neck pain. MATERIAL AND METHODS: 32 preoperative patients, 32 outpatients with low back or neck pain and 32 healthy controls were included in study. The physical activity level of the participants was evaluated with the International Physical Activity Questionnaire. The Oswestry Disability Index and Neck Pain Disability Index, Short Form-36, Pittsburgh Sleep Quality Index and Beck Depression Inventory were used for assessment of disability, quality of life, sleep quality and depression. RESULTS: Statistical significant differences was found in disability, sleep quality, depression, physical activity level and quality of life scores between three groups (p < 0.05). All scores of preoperative patients were significantly lower than outpatients except sleep parameter (p < 0.05). Sleep quality, disability and depression scores of patients with chronic neck pain were significantly lower and physical activity level and quality of life scores were significantly higher than patients' with chronic low back pain (p < 0.05). CONCLUSION: Physical activity modification was found in patients with chronic low back and neck pain. Physical activity level, disability, sleep, depression and quality of life scores of preoperative patients with low back pain more affected than neck patients.

Combined treatment with progesterone and magnesium sulfate positively affects traumatic brain injury in immature rats.

AIM: It is well known that head trauma results in damage in hippocampal and cortical areas of the brain and impairs cognitive functions. The aim of this study is to explore the neuroprotective effect of combination therapy with magnesium sulphate (MgSO4) and progesterone in the 7-days-old rat pups subjected to contusion injury. MATERIAL AND METHODS: Progesterone (8 mg/kg) and MgSO4 (150 mg/kg) were injected intraperitoneally immediately after induction of traumatic brain injury. Half of groups were evaluated 24 hours later, the remaining animals 3 weeks after trauma or sham surgery. Anxiety levels were assessed with open field activity and elevated plus maze; learning and memory performance were evaluated with Morris Water maze in postnatal 27 days. RESULTS: Combined therapy with progesterone and magnesium sulfate significantly attenuated trauma-induced neuronal death, increased brain VEGF levels and improved spatial memory deficits that appear later in life. Brain VEGF levels were higher in rats that received combined therapy compared to rats that received either medication alone. Moreover, rats that received combined therapy had reduced hipocampus and prefrontal cortex apoptosis in the acute period. CONCLUSION: These results demonstrate that combination of drugs with different mechanisms of action may be preferred in the treatment of head trauma.

Relationship between circulating IGF-1 levels and traumatic brain injury-induced hippocampal damage and cognitive dysfunction in immature rats.

It is well known that traumatic brain injury (TBI) induces the cognitive dysfunction resulting from hippocampal damage. In the present study, we aimed to assess whether the circulating IGF-I levels are associated with cognition and hippocampal damage in 7-day-old rat pups subjected to contusion injury. Hippocampal damage was examined by cresyl violet staining and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay. Spatial memory performance was assessed in the Morris water maze. Serum IGF-1 levels decreased in both early and late period of TBI. Decreased levels of serum IGF-1 were correlated with hippocampal neuron loss and spatial memory deficits. Circulating IGF-1 levels may be predictive of cognitive dysfunction resulted from hippocampal damage following traumatic injury in developing brain. Therapy strategies that increase circulating IGF-1 may be highly promising for preventing the unfavorable outcomes of traumatic damage in young children.

Herophilus of Chalcedon: a pioneer in neuroscience.

A review of the history of ancient medicine reveals that most of the knowledge is concentrated in the studies of a few scientists. The best-known names include Hippocrates, Rufus of Ephesus, Celsus, and Galen. The survival of their works throughout the ages has been the most important factor contributing to their popularity. However, there are other scientists who made great contributions to science, but whose writings have been lost or destroyed over the course of time. As a result, their names are not as well known as those of others and the value of their contributions is not appreciated. With the improvement of communication technology in the past 50 years, links between the studies of ancient science can be made more effectively and scientists who have remained hidden under the shade of time have begun, after thousands of years, to receive the appreciation they deserve. In the field of neuroscience, the historical record focuses on Galen of Pergamon. But, when his marvelous works are carefully studied, it is interesting to note two names he frequently referenced: Herophilus (335-280 BC) and Erasistratus (310-250 BC). These two scientists were the first to place scientific value on the dissection of the human body. Herophilus is considered the father of scientific anatomy, and Erasistratus was the first experimental physiologist. Attracted by the prospect of material advancement and eminent students, both migrated from their homes in Asia Minor to Alexandria. The works of Herophilus and Erasistratus have been lost entirely, but some details of their teachings may be recovered from the writings of Galen. In this study, we focus on Herophilus, a master of ancient medicine, whose important discoveries about the human body formed the basis for positive science and the foundation for neuroscience.