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Servikal Miyelopatili Hastalarda Unilateral Yaklaşım İle Bilateral Dekompresyonun Klinik Sonuçları
(2018) Öğden, Mustafa; Akkaya, Süleyman; Yüksel, Ulaş; Daglı, Ahmet Turan; Bakar, Bülent; Özveren, Mehmet Faik
Amaç: Servikal omurgadaki kemik ve ligamentöz yapıların dejeneratif değişiklikleri spinal kanal darlığına ve spinal kord basısına yol açmaktadır. Posterior destek sağlayan kas, ligament gibi yapıların korunarak, unilateral yaklaşım ile bilateral dekompresyon (UYBD) giderek yaygın olarak uygulanmaktadır. Bu çalışmada, unilateral yaklaşım ile bilateral dekompresyon cerrahi tekniği kullanılarak tedavi edilen servikal spondilotik myelopatili (SSM) hastalarda, bu yöntemin etkinliğini değerlendirmeyi amaçladık. Gereç ve Yöntem: SSM tanısıyla unilateral yaklaşım ile bilateral dekompresyon tekniği ile opere edilen hastaların verileri retrospektif olarak incelendi. Hastaların yaş, cinsiyet, operasyon öncesi ve 1 yıl sonrası ağrı şiddetini gösteren vizüel analog skala (VAS) değerleri ile OSWESTRY Disabilite İndeksi (ODİ) değerleri kayıt edildi. Bulgular: Çalışmamıza yaşları 41 ile 77 arasında değişen (ortalama 60.23±9.5 yıl) toplam 13 hasta dahil edildi. Hastaların %76.9’u erkek idi. Tedavi sonrası VAS ve ODİ değerleri karşılaştırıldığında tedavi sonrası değerlerde istatistiksel olarak anlamlı bir iyileşme görüldü (p=0.001). Sonuç: Çalışmamızda SSM’li hastalarda unilateral yaklaşım ile bilateral dekompresyon cerrahisiyle başarılı sonuçlar elde edilmiştir. SSM’li hastalarda henüz az sayıda çalışmada unilateral yaklaşım ile bilateral dekompresyon tekniği ile tedavinin etkinliği değerlendirilmiş olduğu dikkate alındığında, bu çalışmada elde ettiğimiz sonuçlar bundan sonraki çalışmalara ışık tutacaktır.
Yaşlılarda ağrılı osteoporotik vertebra çökme kırıklarının tedavisinde kifoplasti-vertebroplasti etkinliğinin değerlendirilmesi
(2005) Bademci, Gülşah; Aydın, Zafer; Batay, Funda; Attar, Ayhan; Çağlar, Yusuf Şükrü
Amaç: Konservatif tedaviden fayda görmeyen ağrılı osteoporotik vertebra çökme kırıklı yaşlı hastaların vertebroplasti ve kifoplasti ile tedavi edilerek, beklenen morbidite ve mortaliteden korunmaları ve yaşam kalitelerinin arttırılması amaçlanmıştır. Gereç ve Yöntem: Ankara Üniversitesi Tıp Fakültesi Nöroşirürji Anabilim Dalında 2003-2004 yılları arasında, ağrılı osteoporotik vertebra çökme kırığı olan dokuz yaşlı hastaya (iki erkek, yedi kadın, 60 yaş üzeri) kifoplasti ve vertebroplasti uygulanmıştır. Yöntemlerin etkinliği, klinik ve radyografik olarak değerlendirilmiştir. Sonuçlar: Osteoporotik vertebra kırıkları, serimizde kadınlarda daha yüksek oranda bulunmuştur. Tüm hastalar osteopenik veya osteoporotiktir ve dirençli ağrı en belirgin semptomdur. İlaç tedavisine ve fizik tedaviye yanıt vermemişlerdir. Torakolomber vertebroplasti ve kifoplasti uygulanan dokuz hastadan sadece birinde klinik olarak önemsiz epidural kaçak gelişmiştir. Tüm hastaların şikayetlerinde akut düzelme izlenmiş, radyografik olarak da %88.8’inde postoperatif vertebra elevasyonu sağlanmıştır. Seride mortalite ve morbidite yoktur. Tüm hastalar aynı gün mobilize edilmiş ve ilk üç gün içinde taburcu edilmişlerdir. Tartışma: Osteoporotik vertebra kompresyon kırıkları, yaşlılarda önemli bozukluklara ve mortaliteye yol açar. Bu kırıkların cerrahi tedavisinde, hastanın ağrısını en aza indirmek, kifozu önlemek ve daha iyi yaşam koşullarını minimal invaziv bir yolla gerçekleştirmek hedeflenmelidir.
Decompressive craniectomy for intractable intracranial hypertension
(2012) Bakar, Bülent; Sümer, Mehmet Murat; Tekkök, İsmail Hakkı
Amaç: Bu retrospektif klinik çalışmada çeşitli sebeplerle ortaya çıkmış olan intrakranial hipertansiyon tedavisinde dekompresif kraniektominin yeri ve etkileri incelenmiştir. Gereç ve Yöntem: 18 ile 75 yaş arası 9 hasta çalışmaya alınmıştır. Dört hasta travmatik beyin yaralanması, iki hasta subaraknoid kanama ve üç hasta ise malign orta serebral arter tıkanıklığı ile takip ve tedavi edilmiştir. Bulgular: Dokuz hastaya dekompresif kraniektomi tedavisi uygulanmıştır. Bu hastaların ilk başvurularındaki intrakranial basınç (ICP) değerleri ortalaması 22.6 ± 6.7 mmHg; ortalama ameliyat öncesi ICP değeri 40.8 ± 16.3 mmHg ve cerrahi tedavi sonrası ICP ortalama değeri 9.3± 3.6 mmHg olarak ölçülmüştür. İki hastaya bilateral ve kalan yedi hastaya unilateral frontotemporoparietal kraniektomi uygulanmıştır. Kraniektomi kemik flebinin tekrar yerine konması için ortalama 25.75±10.0 gün beklenmiştir. Subaraknoid kanama ile takip edilen bir hasta cerrahi tedavi sonrası ölmüştür (mortalite oranı %11.1). Otuz altı aylık takip sonrası hastaların ortalama Glasgow iyileşme skala puanı yaklaşık 4 olarak hesaplanmıştır. Sonuç: Eğer zamanında ve dikkatli bir şekilde uygulanabilirse bu cerrahi teknik akut ya da gecikmiş dirençli intrakranial hipertansiyon tedavisinde başarılı sonuçlar verir.
Effects of the Glutamine on the Neuronal Cell Death in rat Ischemia-reperfusion Model
(2014) Kasımcan, Mustafa Ömür; Bakar, Bülent; Köse, Arzu; Atilla, Pergin; Kılınç, Kamer; Müftüoğlu, Sevda
Amaç: Bu çalışmada glutamin adlı maddenin ratlardaki deneysel serebral hipoksi/reperfüzyon hasarlanması üzerine etkileri araştırılmaya çalışıldı. Yöntem ve Gereç: Yirmi dört adet Wistar albino ratın sağ ana karotis arterleri geçici anevrizma klibi kullanılarak 30 dakika süre ile kapatıldı. İki saat sonra CONTROL grubundaki hayvanlar hariç glutamin adlı materyal GLIV grubundaki ratlara femoral venden; GLIS grubundakilere ise sisterna magnadan enjekte edildi. SFIS grubundaki ratlara sisterna magnadan serum fizyolojik verildi. Yedi gün sonra tüm hayvanların beyinleri çıkarılıp santral sulkustan ikiye bölündü; sağ hemisfere “hipoksi/reperfüzyon tarafı (HRS)”; karşı hemisfere “toksisite tarafı (TS)” ismi verildi ve dokular histopatolojik ve biyokimyasal analize tabi tutuldu. Bulgular: TS ve HRS için GLIV grubunun dejenere nöron sayım sonuçları diğer gruplara göre yüksek bulundu. Her bir grup için TS sayım sonuçları ile HRS sonuçları karşılaştırıldı ve toksisite tarafı SFIS ile GLIS gruplarının sayım sonuçlarının hipoksi/reperfüzyon tarafı gruplarınkine göre anlamlı derecede düşük olduğu görüldü, ancak her iki tarafın GLIV gruplarının sonuçları arasında anlamlı fark saptanmadı. Her iki taraf doku lipid peroksidasyon (LPO) düzeyi sonuçları arasında istatistiksel anlamlı fark yoktu. Sonuç: Bu çalışma sonunda glutamin adlı maddenin ratlarda oluşturulan hipoksi/reperfüzyon yaralanması üzerinde yararlı etkilerinin bulunmadığı sonucuna ulaşıldı.
The Effects of Microdecompression on Patients with Lumbar Degenerative Spinal Stenosis with or without Degenerative Spondylolisthesis
(2019) Öğden, Mustafa; Yüksel, Ulaş; Akkaya, Süleyman; Kamaşak, Kağan; Daglı, Ahmet Turan; Bakar, Bülent
AIM: To investigate the mid-term efficacy of bilateral decompression with a unilateral approach (BDUA) on symptoms and quality of life of in patients with lumbar spinal stenosis (LSS), with low grade (with percentage slip <25%) degenerative spondylolisthesis or without spondylolisthesis. MATERIAL and METHODS: The study included patients who underwent BDUA due to one or two-level LSS related to degenerative spondylosis and/ or degenerative spondylolisthesis. Pre- and postoperative data of the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and walking distance were compared. RESULTS: Evaluation was made up of a total of 53 patients, comprising 32 males and 21 females with a mean age of 60.6 ± 9.0 years. Compared with the preoperative data, VAS, ODI and walking distance improved significantly in all patients at the 3-year follow-up examination. Furthermore, a significant improvement was determined in the clinical parameters of patients with degenerative spondylolisthesis, with no worsening of slip and no requirement for instrumentation. Moreover, when patients were separated into two groups according to age, as elderly (>60 years) and adult (<60 years), similar improvements were seen in both groups. CONCLUSION: BDUA could be quite effective in reducing pain, improving quality of life and walking distance with no worsening of the grade or degree of slipping.
Evaluation of the systemic antiinflammatory effects of levosimendan in an experimental blunt thoracic trauma model
(2017) Ateş, Gökay; Yaman, Ferda; Bakar, Bülent; Kısa, Üçler; Büyükkoçak, Ünase; Atasoy, Pınar
BACKGROUND: Blunt thoracic injury often leads to pulmonary contusion and the development of acute respiratory distress syndrome, which carries a high risk of morbidity and mortality, originating from the local and systemic inflammatory states. This study aimed to investigate the local and systemic antiinflammatory effects of levosimendan in rat models of blunt chest trauma.METHODS: A total of 32 Wistar albino rats were randomly assigned to one of the following four groups: control, sham, low-dose levosimendan (LDL) (5 µg/kg loading dose for 10 min and 0.05 µg/kg/min intravenous infusion), and high-dose levosimendan (HDL) (10 µg/kg loading dose for 10 min and 0.1 µg/kg/min intravenous infusion). Blunt chest trauma was induced, and after 6 h, the contused pulmonary tissues were histopathologically and immunohistopathologically evaluated, serum TNF-?, IL-1?, IL-6, and NO levels were biochemically evaluated.RESULTS: The mean arterial pressure was low throughout the experiment in the LDL and HDL groups, with no statistically difference between the groups. Levosimendan reduced the alveolar congestion and hemorrhage, which developed after inducing trauma. Neutrophil infiltration to the damaged pulmonary tissue was also reduced in both the LDL and HDL groups. In rats in which pulmonary contusion (PC) was observed, increased activation of nuclear factor kappa B was observed in the pulmonary tissue, and levosimendan did not reduce this activation. Both high and low doses of levosimendan reduced serum IL-1? levels, and high doses of levosimendan reduced IL-6 and NO levels. TNF-? levels were not reduced.CONCLUSION: In conclusion, the results showed that in a rat model of PC, the experimental agent levosimendan could reduce neutrophil cell infiltration to damaged pulmonary tissues and the systemic expressions of some cytokines (IL-1?, IL-6, and NO), thereby partially reducing and/or correcting pulmonary damage. Systemic inflammatory response that occurs after trauma could also be reduced
Comparison of Thalamus Volume on Magnetic Resonance and Cadaveric Section Images
(TURKISH NEUROSURGICAL SOC, 2020) Kayaci, Selim; Bas, Orhan; Beyazal Celiker, Fatma; Ucuncu, Yilmaz; Arslan, Yusuf Kemal; Ozveren, Mehmet Faik; Aykol, Sukru
AIM: To measure and to compare the volume of thalamus using magnetic resonance imaging (MRI) and the anatomical sections. MATERIAL and METHODS: In this study, 13 brain specimens were used. First, the images were taken in 3 mm sections on MRI, the thickness of the thalamus was measured. Subsequently, 4 mm coronal sections were prepared using amicrotome. The thalamic volumes calculated from cadaveric specimens were compared with the measurements obtained using MRI. RESULTS: On MRI, the mean thalamic volumes on the right and left hemispheres were found to be 5843.4. 361.6 mm(3) and 5377.0 +/- 666.2 mm(3) respectively. The mean volumes of the cadaveric sections were 5610.8 +/- 401.3 mm(3) on the right side and 5618.5 +/- 604.1 mm(3) on the left hemisphere. No statistically significant difference was found between the volume calculated from MRI and that obtained from the cadaveric section (p<0.05). CONCLUSION: This study shows a correlation between measurement of thalamus volume based on MRI and those calculated from anatomical sections. Our findings support the reliability of DBS procedures using MRI and stereotactic method.
Oxidative and histopathological effects of the application of electrosurgical devices to the penile tissue of rats
(ELSEVIER SCI LTD, 2020) Günal, Yasemin Dere; Boybeyi, Özlem; Atasoy, Pınar; Kısa, Üçler; Aslan, Mustafa Kemal; Bakar, Bülent; Soyer, Tutku
Introduction This study was performed to evaluate the oxidative and histopathological changes that occur following the application of electrosurgical devices (monopolar or bipolar cautery) to penile tissue. Material and methods Eighteen Wistar albino male rats were randomly distributed into three groups. In the control group (CG, n = 6), all penile tissues were sampled without any additional process following the administration of anesthesia. In the monopolar cautery group (MPG, n = 6), a 15-W cauterization process lasting 5 s was performed on an approximately 2 mm(2) area of the ventral side of the penile shaft, 0.5 cm proximal to the edge of the glans in the midline. Bipolar cautery was practiced in the third group (BPG, n = 6) using the same techniques outlined in the previous statement. Penile tissues consisted of the cautery application area, the edge of the glans, and dorsal side of the penis and were sampled after 90 min; then, histopathological evaluation and biochemical examination involving malondialdehyde (MDA), nitric oxide (NO), and superoxide dismutase (SOD) measurements were performed. Results and discussion Histopathologically, the MPG and BPG demonstrated increased inflammation, fibrosis, and epithelial loss in the urethra in the areas to which cautery was applied as compared to the CG (P < 0.05). The vascular structures of the corpus cavernosa were significantly decreased in the cautery application area of both the MPG and the BPG as compared to the CG (P < 0.05). In the Masson's trichrome stained samples, significant collagen deposition was observed in the cautery application area both in the MPG and the BPG as compared to the CG (P < 0.05). However, S-100 staining was decreased in these groups as compared to the CG (P < 0.05). S-100 staining was also decreased in the MPG as compared to the BPG on the edge of the glans (P < 0.05). Biochemically, MDA values were significantly increased in the MPG as compared to the CG and the BPG (P < 0.05). Conclusion Monopolar and bipolar cautery both did cause oxidative changes and triggered inflammatory, vascular, and peripheral nerve alterations in the cautery application area while bipolar cautery did not cause any distant effects.
Research on the Effects of Levetiracetam in Spinal Cord Injury Model in Rats: An Experimental Study
(TAYLOR & FRANCIS INC, 2020) Nursoy, Egemen; Ogden, Mustafa; Bakar, Bulent; Dincel, Gungor Cagdas; Kisa, Ucler; Ozveren, Mehmet Faik
Purpose: Despite advances in spinal biomechanic research, surgical techniques, and rehabilitation processes, no significant improvement has been identified in the treatment of spinal cord injury (SCI) and neurological recovery. Aim of the Study: This study was designed to investigate the potential therapeutic effects of methylprednisolone and levetiracetam on SCI. Materials and Methods: In this study, 42 male Wistar Albino rats, each weighing 300-350 g, were separated into three main groups: control group, acute and subacute stage groups. With the exception of the control group, a T7-8 dorsal laminectomy was performed on the spinal column of the rats. A temporary vascular aneurysm clip was then applied to the spinal cord for 1 min to create SCI and methylprednisolone or levetiracetam was administered intraperitoneally to all except the control and SHAM control groups. The damaged spinal cord was removed for histopathological and biochemical examinations. Results: Both pharmacological agents were determined to have improved the histopathological architecture in damaged neural tissues during the acute period of SCI, but could not sustain this activity in the subacute period. Neither pharmacological agent affected the biochemical data in the acute nor subacute stages. Conclusions: Both pharmacological agents showed histopathological healing effects in injured tissues during the acute phase of SCI in this rat model but these effects could not be sustained in the subacute period. No effect on biochemical data was seen in either the acute or subacute period. There is a need for further advanced studies to determine the effects of levetiracetam on the healing processes in SCI.
Assessment of the optic nerve using strain and shear-wave elastography in patients with pseudotumour cerebri
(W B SAUNDERS CO LTD, 2020) Asal, N.; Inal, M.; Sahan, M. H.; Say, B.
AIM: To evaluate the optic nerve using strain elastography (SE) and shear-wave elastography (SWE) in idiopathic intracranial hypertension (IIH) patients in comparison to participants in the control group. MATERIALS AND METHODS: Eighty eyes were evaluated in 40 cases consisting of 20 IIH patients and 20 participants in the control group. This study was conducted using SE and SWE in addition optic nerve sonography measurements of participants in the IIH patient group and the control group. SE patterns were categorised using three main types and two subtypes. Quantitative measurements of optic nerve stiffness with SWE were expressed in kilopascals. RESULTS: In the IIH patient group, type 2 and type 1 elasticity patterns were primarily observed, followed by type 3 patterns. In the control group, type 3 elasticity patterns were most often observed, while type 2 elasticity patterns were seen less frequently. Statistically significance differences in the types of elasticity strain patterns were observed between the groups (p<0.01). Quantitative analysis was also performed, and the SWE moduli were obtained for the control group (10.1 +/- 0.28 kPa) and the IIH patient group (26.97 +/- 1 kPa). A statistically significant difference in the SWE modulus was found between the groups (p<0.01). CONCLUSION: Biomechanical changes may have occurred in the optic nerve secondary to increased intracranial pressure in IIH patients. Strain and shear elastography may have potential as assistive diagnostic techniques for the detection and follow-up of these changes. (C) 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
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.
Analysis of biochemical laboratory values to determine etiology and prognosis in patients with subarachnoid hemorrhage: a clinical study
(Taylor & Francis Ltd, 2019) Ogden, Mustafa; Bakar, Bulent; Karagedik, Mustafa Ilker; Bulut, Ibrahim Umud; Cetin, Cansel; Aydin, Gulcin; Ozveren, Mehmet Faik
Objectives: The aim of this study was to establish prognostic and predictive markers in patients with subarachnoid hemorrhage (SAH) using simple laboratory methods. Methods: A retrospective examination was made of patients with SAH diagnosed secondary to isolated head trauma, isolated anterior communicating artery aneurysm rupture, and angiography-negative SAH. Age, gender, Glasgow Coma Scale (GCS) scores, and Fisher's grade scores, Glasgow Outcome Scale (GOS) scores, leukocyte count, neutrophil count, lymphocyte count, platelet count, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio results (PLR) were evaluated. Results: NLR and PLR values, which were similar in patients with spontaneous SAH, were significantly high in patients with traumatic SAH. NLR and PLR values could be 80% sensitive and 75% specific for distinguishing traumatic SAH from spontaneous SAH. Eosinophil count was lower in patients with angiography-negative SAH and patients with aneurysmal SAH than in patients with traumatic SAH. Initially measured GCS score, Fisher's grade score, eosinophil, neutrophil and lymphocyte counts could be prognostic in all patients with SAH. Moreover, it was concluded that the initially measured number of eosinophils might be directly related to patient prognosis. The eosinophil count was generally found to be high in traumatic SAM patients and it was observed that this parameter could be predictive for these patients. Lymphocyte count and NLR values could be prognostic markers in patients with angiography-negative SAH. Conclusion: NLR, PLR and eosinophil count values could be predictive for etiological factors (traumatic SAH or spontaneous SAH) of patients who were admitted unconscious to the emergency room with SAH detected on radiological imaging.
Effectiveness of the Biophysical Barriers to the Peridural Fibrosis in Rat Laminectomy Model
(Taylor & Francis Inc, 2019) Akkurt, Ibrahim; Bakar, Bulent; Dincel, Gungor Cagdas; Yildiran, Fatma Azize Budak; Ogden, Mustafa; Nursoy, Egemen; Sari, Elif
Purpose: Peridural fibrosis which could occur after the spinal surgery could adhere neural tissue closely and may cause to neural entrapment symptoms and require surgical reintervention. Aim of the study: Present study was designed to reduce occurrence of peridural fibrosis in rat laminectomy model by using biophysical barriers called hyaluronic acid (HAS) dural barrier, activated polyethylene glycol and polyethylene imine (PEG) dural barrier, and platelet-rich plasma (PRP). Materials and methods: In this study, 2 of 26 male Wistar albino rats (325-350 g body weight), which were not included into study groups were sacrificed by removing their total blood and their blood was used for preparation of PRP, and remaining rats were randomly delivered into four groups called SHAM, HAS, PEG, and PRP groups. Then L3-4-5 laminectomy was performed to all animals and experimental agents were administered to the selected groups mentioned above. Spinal colons of all animals were removed gross total after 6-week period and investigated histopathologically. Additionally, real-time-polymerase chain reaction was used to obtain collagen type I and type III, transforming growth factor-1 beta, and tumor necrosis factor-alpha gene expressions. Results: All results demonstrated that polyethylene glycol and polyethylene imine dural barrier and PRP could decrease peridural fibrosis formation efficiently in rat. Conclusion: Present study results suggested that to reduce or block formation of peridural fibrosis, either polyethylene glycol and polyethylene imine dural barrier or PRP could be used effectively in human subjects after they will be closely investigated in future studies.
A comparison of lateral ventricle volume estimation on magnetic resonance and cadaveric section images using the planimetry method
(Elsevier Sci Ltd, 2019) Bas, Orhan; Kayaci, Selim; Celiker, Fatma Beyazal; Ucuncu, Yilmaz; Ozveren, Mehmet Faik; Yilmaz, Ali; Sahin, Bunyamin
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The Investigation of the Cox-2 Selective Inhibitor Parecoxib Effects in Spinal Cord Injury in Rat
(Taylor & Francis Inc, 2019) Yuksel, Ulas; Bakar, Bulent; Dincel, Gungor Cagdas; Yildiran, Fatma Azize Budak; Ogden, Mustafa; Kisa, Ucler
Aim: Today, spinal cord injury (SCI) can be rehabilitated but cannot be treated adequately. This experimental study was conducted to investigate possible beneficial effects of methylprednisolone and parecoxib in treatment of SCI. Materials and methods: Forty-eight male Wistar albino rats were assigned into CONTROL, acute (MP-A, PX-A, and PXMP-A), and subacute (MP-S, PX-S, and PXMP-S) stage groups. Then, to induce SCI, a temporary aneurysm clip was applied to the spinal cord following T7-8 laminectomy, except in the CONTROL group. Four hours later parecoxib, methylprednisolone, or their combination was administered to rats intraperitoneally except CONTROL, SHAM-A, and SHAM-S groups. Rats in the acute stage group were sacrificed 72 h later, and whereas rats in the subacute stage were sacrificed 7 days later for histopathological and biochemical investigation and for gene-expression analyses. Results: Parecoxib and methylprednisolone and their combination could not improve histopathological grades in any stage. They also could not decrease malondialdehyde or caspase-3, myeloperoxidase levels in any stage. Parecoxib and methylprednisolone could decrease the TNF-alpha gene expression in subacute stage. Methylprednisolone could increase TGF-1 beta gene-expression level in acute stage. Conclusion: Neither of the experimental drugs, either alone or in combination, did not show any beneficial effects in SCI model in rats.
The Healing Effects of Thymoquinone and Dexpanthenol in Sciatic Nerve Compression Injury in Rats
(Taylor & Francis Inc, 2019) Ogden, Mustafa; Karaca, Sahika Burcu; Aydin, Gulcin; Yuksel, Ulas; Dagli, Ahmet Turan; Akkaya, Suleyman; Bakar, Bulent
Introduction: Functional healing of peripheral nerve injuries is still difficult. In this study, potential healing effects of thymoquinone and dexpanthenol in sciatic nerve compression injury (SCI) were investigated. Method: Twenty-four male Wistar albino rats which were applied compression injury to their sciatic nerves were randomly separated into four groups as following: "control" group contained six rats administered no pharmacological agent; "TMK" group consisted of six rats administered 10 mg/kg intraperitoneal thymoquinone once a day for one week; "DXP" group contained six rats administered 50 mg/kg intraperitoneal dexpanthenol once a day for one week; and "TMK-DXP" group consisted of six rats administered separately 10 mg/kg intraperitoneal thymoquinone and 50 mg/kg intraperitoneal dexpenthanol once a day for one week. Four weeks later from SCI, sciatic nerve function index (SFI) was applied before sacrifice of all rats, and then their crushed sciatic nerves were histopathologically examined, in terms of "Schwann cell count", "axon and myelin degeneration", "axon shape/size differences", "fibrosis", and "neovascularisation". Results: "Schwann cell count" (p = 0.011), "axon and myelin degeneration" (p = 0.001), "axon shape/size differences" (p = 0.011), and "fibrosis and neovascularisation" (p = 0.026) scores were different between the control and TMK-DXP groups. SFI scores were different between the control and TMK groups (p = 0.002), between the control and TMK-DXP groups (p < 0.001), and between the DXP and TMK-DXP groups (p = 0.029). Conclusions: This study results revealed that these pharmacological agents used alone had no histopathological healing effect in rats with SCI, but thymoquinone could improve walking function. However, thymoquinone and dexpanthenol used together had a significant histopathological and functional healing effect.
Which is more effective for pain relief during fractionated carbon dioxide laser treatment: EMLA cream or forced cold air anesthesia?
(Taylor & Francis Inc, 2018) Sari, Elif; Bakar, Bulent
Background and aim: The aim of this study was to compare the effectiveness of a eutectic mixture of local anesthetic (EMLA) cream and forced cold air anesthesia (FCAA) on pain control during ablative fractionated carbon dioxide (CO2) laser treatment. Methods: Fifteen volunteers participated in this prospective, controlled, split-face clinical study. EMLA cream was applied 60minutes before the laser procedure on half of the face, and FCAA was performed on each subunit of the other half of the face. The laser procedure was performed on each half of the face. Patients rated their pain during the procedure using a pain scale scored from 0-10. Both doctor and nurse rated patient discomfort during the procedure using a scale scored from 0-10. The pain scores associated with both EMLA and FCAA sides of the face were compared statistically. Results: Patient pain scores and discomfort scores detected by doctor and nurse were not statistically different between EMLA and FCAA. There was no statistically significant difference between males and females. Conclusion: Instead of using EMLA, FCAAwhich can be applied in a shorter timemay be a cost-effective, simple, and safe local anesthesia method used in the ablative fractionated CO2 laser procedure.
Biochemical markers in the prognosis of intracranial hemorrhages
(Cukurova Univ, Fac Medicine, 2018) Yuksel, Ulas; Ogden, Mustafa; Akkurt, Ibrahim; Bakar, Bulent; Kisa, Ucler; Ozveren, Mehmet Faik
Purpose: The aim of this study was to determine prognosis of patients with intracranial hemorrhage by examining routine laboratory findings. Materials and Methods: Patients were divided into three groups according to hemorrhage type (subarachnoid hemorrhage, spontaneous intracerebral hematoma, subdural hematoma). Then serum sodium, potassium, C-reactive protein, blood leukocyte count and neutrophil percentage values were measured pre- and postoperatively. Results: Twenty-eight patients (10 female, 18 male) were included in study. There was no difference among groups in terms of all parameters. However, postoperative leukocyte counts were higher than preoperative values in intracerebral hematoma group; and postoperative sodium levels were higher than preoperative values in subarachnoid hemorrhage group. There was found negative correlation between Glasgow Outcome Scale scores and preoperative neutrophil, preoperative and postoperative sodium values in subarachnoid hemorrhage group. A negative correlation was found between Glasgow Outcome Scale scores and preoperative C-reactive protein values in subdural hematoma group. Conclusion: Study results suggested that pre-and postoperative serum sodium values in subarachnoid hemorrhage; age, Glasgow Coma Scale score, pre-and post-operative C-reactive protein values in spontaneous intracerebral hematoma; and preoperative C-reactive protein values in subdural hematoma were considered to be predictors of patient prognosis.
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.
An Evaluation of the Quality of Sleep Before and After Surgical Treatment of Patients with Cervical Disc Herniation
(Korean Neurosurgical Soc, 2018) Ogden, Mustafa; Akgul, Mehmet Huseyin; Yuksel, Ulas; Bakar, Bulent; Kamasak, Kagan; Ozveren, Mehmet Faik
Objective : It has been reported in recent studies that 50-80% of patients with cervical disc hernia have concomitant sleep disorders. The aim of this study was to evaluate the quality of sleep before and after surgical treatment in patients with cervical disc hernia and to assess the effects on treatment. Methods : The study included 32 patients performed discectomy and fusion with an intervertebral cage through the right anterior cervical approach. Oswestry Disability Index (ODI), Visual Analog Scale (VAS) and Pittsburgh Sleep Quality Index (PSQI) were applied to all patients preoperatively and at one month postoperatively. Results : The postoperative PSQI total points and all the PSQI subscale points, the ODI and VAS scores were significantly reduced compared to the preoperative values. A positive correlation was determined between the preoperative ODI points and the PSQI total points and sleep duration, sleep latency and daytime functional loss subscale points. A positive correlation was also found between preoperative ODI points and VAS points. A positive correlation was determined between the preoperative VAS points and and the PSQI total points and sleep duration, and sleep latency subscale points. A negative correlation was determined between the postoperative ODI and the daytime functional loss subscale points. Conclusion : The results of the study showed that in patients with cervical disc hernia, sleep quality and daytime functionality were negatively affected by severity of pain that limited daily activities. Bringing the pain under control with surgical treatment was observed to increase sleep quality. It can be concluded that when planning treatment for these patients, it should be taken into consideration that there could be a sleep disorder in addition to the complaints and symptoms such as pain, hypoestesia and loss of strength.

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