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    Cerebral ischaemia/reperfusion injury could be managed by using tramadol
    (Taylor & Francis Ltd, 2018) Akkurt, Ibrahim; Cetin, Cansel; Erdogan, Ahmet Melih; Dincel, Gungor Cagdas; Ceylan, Asli Fahriye; Kisa, Ucler; Bakar, Bulent
    Objectives: No valid treatment modality that will repair stroke damage and provide neurological recovery has yet been identified in literature. Studies demonstrated that adequate quality of life could be provided if post-stroke pain could be treated sufficiently and timely. Besides its pain relief effects, tramadol has oedema-reducing and anti-inflammatory properties. With these in mind, this study investigated the influence of tramadol in acute and/or chronic ischaemia/reperfusion (I/R) injury. Methods: Putting aside the Control group, 23 Wistar albino rats were distributed to four groups to investigate the acute (Sham-A, TR-A) and chronic (Sham-C, TR-C) periods of I/R injury, and temporary aneurysm clips were applied to their internal carotid arteries for 30 min. Four hours after clippage, tramadol was administered to animals of TR-A and TR-C groups intraperitoneally. After sacrificing all animals, pyknotic and necrotic neuronal cells in hippocampal cornu ammonis (CA)1, CA2, CA3 and parietal cortical regions were counted, and perivascular oedema, intercellular organization disorder (IOD) and inflammatory cell infiltration were scaled histopathologically. Additionally, tissue interleukin (IL)-1 beta, IL-10, malondialdehyde, nitric oxide, tumour necrosis factor-alpha, caspase-3, beclin-1, Atg12, LC3II/LC3I levels were measured biochemically. Results: Tramadol could minimize perivascular oedema, IOD, parietal and hippocampal neuronal necrosis, inflammatory cell infiltration in both periods of I/R injury histopathologically. Apart from inhibiting apoptosis and enhancing autophagy, tramadol had no influence on any other biochemical result. Discussion: Tramadol can ameliorate the histopathological structure of ischaemic tissue in both periods of I/R injury in rat. We suggest further research investigating various dosages with different administration methods of tramadol in stroke should be conducted by adopting different explorative techniques.
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    Current Ablation Type Surgical Treatment Modalities in Treatment-Resistant Major Depression: Review of The Recent Major Surgical Series
    (Aves Press Ltd, 2019) Bakar, Bulent; Cetin, Cansel; Oppong, Jonathan; Erdogan, Ahmet Melih
    Purpose: Major depression is currently a disease with high morbidity and mortality rates. About 20% of patients have treatment-resistant major depression (TRMD). This article which consisted of a recent large clinical case series reported in medical literature is constituted to screen ablative surgical treatment methods and their safety and efficacy in patients with TRMD. Methods: Four types of ablative surgical modality (i.e. anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy, limbic leucotomy) in TRMD patients were evaluated and patients' data which was used to describe the basis of radiologic and operative procedures and findings, and outcome was obtained from PubMed/Medline database between years 2000-2018. Results: In literature, studies showed that about 40-60% of patients had complete remission and 35% of patients showed partial remission following anterior cingulotomy. It was reported that approximately 50% of patients were responsive and 40% of patients were remission following anterior capsulotomy. Studies demonstrated that about 55-75% of patients were responsive to treatment after performing subcaudate tractotomy. Long term clinical recovery was seen 36-76% of patients applied limbic leucotomy in literature. Conclusion: In conclusion, the long term therapeutic effects and mechanism of action of these surgical techniques that were used last two decades in the management of patients with TRMD are still under investigation and the need for research on the long-term benefits of these surgical modalities should be considered.
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    Effects of Sulphasalazine in Cerebral Ischemia Reperfusion Injury in Rat
    (Elsevier Science Inc, 2017) Cetin, Cansel; Erdogan, Ahmet Melih; Dincel, Gungor Cagdas; Bakar, Bulent; Kisa, Ucler
    Background. Management of cerebral ischemia/reperfusion (I/R) injury is still difficult process today. Aims of the Study. Aim of present study was to investigate therapeutic properties of sulfasalazine in cerebral transient I/R injury in rat. Methods. Except Control group (n = 5), 20 Wistar albino rats were allocated for acute and chronic stage investigation of I/R injury, and temporary aneurysm clips were attempted to both internal carotid arteries for thirty min. Four hours later, 40 mg/kg once a day sulfasalazine was administered to animals of SL-A and SL-C groups, orally. Animals were decapitated, following which pyknotic and necrotic neuronal cells, perivascular edema, irregularities of intercellular organization (IIO) of hippocampal regions, and cortical necrotic neurons of parietal lobe were counted or scaled histopathologically. Tissue malonyldialdehyde (MDA), myeloperoxidation (MPO), total nitrite/nitrate (NO), interleukin 1-beta (IL-1 beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) level values were evaluated biochemically. Results. Sulfasalazine could reduce perivascular edema, 110, cortical and hippocampal neuronal cell death in both stages. It could decrease MDA in acute stage, but not reduce IL-1 beta, IL-6, MPO, NO, and TNF alpha levels. It could increase IL-1 beta levels in chronic stage but not affect to IL-6, MPO, MDA, NO, TNF-alpha levels. Conclusion. Sulfasalazine could improve histopathological architecture of hypoxic tissue in both stages of FR injury in rat. It could inhibit lipid peroxidation cascades just in acute stage. These results suggested that therapeutic mechanisms of sulfasalazine in cerebral I/R injury should be investigated by using more specific laboratory methods in future studies. (C) 2017 IMSS. Published by Elsevier Inc.
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    Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study
    (Elsevier Science Inc, 2023) Ogden, Mustafa; Karagedik, Mustafa Ilker; Ozdemir, Alemiddin; Bulut, Ibrahim Umud; Erdogan, Ahmet Melih; Bakar, Bulent
    OBJECTIVE: Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or lam-inoplasty. 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 u nderwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, n umber 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(degrees) and spinal canal areas were 87.11 +/- 28.30 mm(2). In post-operative 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(degrees) and spinal canal areas were 149.65 +/- 42.57 mm(2). A statistically significant difference was determined between the preoperative and the post-operative 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-u p.CONCLUSIONS: The UHBOLD technique performed in multilevel CSM patients did not cause any change in cer-vical 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.