Evaluation of cholinergic enzymes and selected biochemical parameters in the serum of patients with a diagnosis of acute subarachnoid hemorrhage.

Background: Spontaneous subarachnoid hemorrhage (SAH) is the most severe form of hemorrhagic stroke and accounts for 5-7% of all strokes. Several chemical enzymes and cytokines are thought to cause reactions that may affect the mortality and morbidity of SAH patients. This study aimed to examine the possible relationships between these parameters and the occurrence of SAH and the clinical-radiological parameters in patients with acute SAH. Methods: This study evaluated 44 patients, including 20 with SAH and 24 controls. We obtained blood from the patients and control groups, which was stored in heparinized tubes and used in determining tumor necrosis factor alpha (TNF-α), brain-derived neurotrophic factor (BDNF), acetylcholinesterase (AChE), caspase-3, and butyrylcholinesterase (BChE) enzymes. Results: TNF-α, BDNF, AChE, and BChE enzyme levels were not related to the Glasgow Coma scale (GCS) score in the patient group (p > 0.05), whereas higher enzyme levels of caspase-3 were associated with lower GCS scores (p < 0.05). The difference between the control and patient groups in terms of mean TNF-α levels was statistically significant (p < 0.01). The BDNF levels were statistically insignificant in the patient groups (p > 0.05). Caspase-3, AChE, and BChE levels were significantly different between the control and patient groups (p < 0.01). Conclusions: Our results may be valuable for predicting the prognosis, diagnosis, and follow-up of patients with SAH. However, further studies are required to elucidate the relationship between the clinical and radiological results in patients with SAH and certain enzymes, cytokines, and growth factors.

Investigation of the Neuro-Regenerative Effects of Bioresonance and Magnetotherapy in Sciatic Nerve Damage-Induced Rats / Investigación de los Efectos Neurorregenerativos de Biorresonancia y Magnetoterapia en Ratas Inducidas por Daño del Nervio Ciático

SUMMARY: Peripheral nerve damage is a significant clinical problem that can lead to severe complications in patients. Regarding the regeneration of peripheral nerves, it is crucial to use experimental animals' nerves and use different evaluation methods. Epineural or perineural suturing is the gold standard in treating sciatic nerve injury, but nerve repair is often unsuccessful. This study aimed to investigate the neuroregenerative effects of magnetotherapy and bioresonance in experimental animals with sciatic nerve damage. In this study, 24 female Wistar rats were divided into 7 groups (n=6) as follows: Group 1 (Control), Group 2 (Axonotmesis control), Group 3 (Anastomosis control), Group 4 (Axonotmesis + magnetotherapy), Group 5 (Anastomosis + magnetotherapy), Group 6 (Axonotmesis + bioresonance), Group 7 (Anastomosis + bioresonance). Magnetotherapy and bioresonance treatments were applied for 12 weeks. Behavioural tests and EMG tests were performed at the end of the 12th week. Then the rats were sacrificed, and a histopathological evaluation was made. The statistical significance level was taken as 5 % in the calculations, and the SPSS (IBM SPSS for Windows, ver.21) statistical package program was used for the calculations. Statistically significant results were obtained in animal behaviour tests, EMG, and pathology groups treated with magnetotherapy. There was no statistically significant difference in the groups treated with bioresonance treatment compared to the control groups. Muscle activity and nerve repair occurred in experimental animals with acute peripheral nerve damage due to 12 weeks of magnetotherapy, and further studies should support these results.

El daño a los nervios periféricos es un problema clínico importante que puede conducir a complicaciones graves en los pacientes. En cuanto a la regeneración de los nervios periféricos, es crucial utilizar los nervios de los animales de experimentación y diferentes métodos de evaluación. La sutura epineural o perineural es el gold estándar en el tratamiento de lesiones del nervio ciático, pero la reparación del nervio a menudo no tiene éxito. Este estudio tuvo como objetivo investigar los efectos neuroregenerativos de la magnetoterapia y la biorresonancia en animales de experimentación con daño del nervio ciático. En el estudio, 24 ratas hembras Wistar se dividieron en 7 grupos (n=6) de la siguiente manera: Grupo 1 (Control), Grupo 2 (Control de axonotmesis), Grupo 3 (Control de anastomosis), Grupo 4 (Axonotmesis + magnetoterapia), Grupo 5 (Anastomosis + magnetoterapia), Grupo 6 (Axonotmesis + biorresonancia), Grupo 7 (Anastomosis + biorresonancia). Se aplicaron durante 12 semanas tratamientos de magnetoterapia y biorresonancia. Las pruebas de comportamiento y las pruebas de EMG se realizaron al final de la semana 12. Luego se sacrificaron las ratas y se realizó una evaluación histopatológica. El nivel de significación estadística se tomó como 5 % en los cálculos, y se utilizó el programa de paquete estadístico SPSS (IBM SPSS para Windows, ver.21). Se obtuvieron resultados estadísticamente significativos en pruebas de comportamiento animal, EMG y grupos de patología tratados con magnetoterapia. No hubo diferencia estadísticamente significativa en los grupos con tratamiento de biorresonancia en comparación con los grupos controles. La actividad muscular y la reparación nerviosa, se produjeron en animales de experimentación con daño nervioso periférico agudo, debido a 12 semanas de magnetoterapia.Estudios adicionales deberían respaldar estos resultados.

A New Approach in the Treatment of Traumatic Brain Injury: The Effects of Levosimendan on Necrosis, Apoptosis, and Oxidative Stress.

OBJECTIVE: Traumatic brain injury (TBI) is an essential and common health problem worldwide. Levosimendan is an inotropic and vasodilator drug used to treat heart failure. Moreover, it exerts pleiotropic effects and, thus, protective effects on many organs. The present study aimed to investigate the effect of levosimendan on necrosis, apoptosis, and reactive oxygen species in rats with TBI. METHODS: The study included 28 female Wistar-Albino rats weighing 200-250 g. The rats were divided into 4 groups with 7 rats each as follows: Group 1: No trauma group (Control), Group 2: Traumatized, untreated group (T), Group 3: Levosimendan was administered at a dose of 12 µg/kg intraperitoneally 1 hour after the trauma (L1), Group 4: Levosimendan was administered at a dose of 12 µg/kg intraperitoneally 2 hours after the concussion (L2). After the experiment, the rats were decapitated, and the brain tissue was removed. Necrosis was assessed with Cresyl violet staining, apoptosis was assessed with immunohistochemical analysis, superoxide dismutase and catalase levels were measured with the spectrophotometric method, and malondialdehyde (MDA) levels were assessed by High-Performance Liquid Chromatography. RESULTS: The number of necrotic cells in the L1 and L2 groups was significantly lower than in the K and T groups (P = 0.015 and P = 0.03, respectively). Although the active caspase-3 level was signified considerably in the T, L1, and L2 groups compared to the K group, no significant difference was found among these 3 groups (P > 0.05). The results of superoxide dismutase levels were similar to those of active caspase-3. catalase level was significantly higher in the K group than in the T and L2 groups (P = 0.045). Malondialdehyde activity was considerably higher in the L1 and L2 groups compared to the K group (P = 0.023). CONCLUSIONS: Our results indicated that levosimendan may exert a neuroprotective effect by reducing necrosis in TBI and that levosimendan does not affect apoptosis and antioxidant levels in TBI. Comprehensive studies are needed to elucidate the effect of levosimendan on TBI fully.

Embolization after internal carotid artery injury secondary to transsphenoidal pituitary surgery and delayed intranasal coil protrusion: illustrative case.

BACKGROUND: The authors presented a case of spontaneous nasopharyngeal coil migration that occurred 3 years after a patient had undergone transsphenoidal resection due to pituitary macroadenoma and was treated with coil application because of internal carotid artery injury secondary to transsphenoidal resection of the pituitary macroadenoma. OBSERVATIONS: In the literature, eight cases of coil migration that occurred between 2 and 120 months after coil application have been reported, most of which were treated with surgical removal of the coil in a same-day surgery setting. LESSONS: The case presented emphasized that coil protrusion and migration may lead to destruction in the skull base, thereby leading to serious consequences if left untreated, even in the absence of history of trauma. To the authors' knowledge, this is the first case in the literature that required additional invasive procedures due to recurrent bleeding that occurred several months after surgical removal of coils. Also, this report underlined the need for careful and long-term follow-up of coil materials used for the treatment of pseudoaneurysms caused by vascular injuries secondary to skull base injury during surgery.

The role of microsurgery for poor-grade aneurysmal subarachnoid hemorrhages in the endovascular era.

BACKGROUND: Poor-grade aneurysmal subarachnoid hemorrhage (PGASAH) is associated with high mortality and morbidity regardless of treatment. Herein, we re-evaluate the safety and efficacy of microsurgical treatment for managing PGASAH patients in the current endovascular era. METHODS: We retrospectively reviewed 141 consecutive patient records in a single institution who underwent microsurgical (n = 80) or endovascular (n = 61) treatment for PGASAH. RESULTS: Baseline characteristics were similar, except for more intracerebral hematomas (46.3% vs 24.6%, p = 0.009), fewer intraventricular hemorrhages (26.3% vs 59%, p < 0.001), and fewer posterior circulation aneurysms (5.1% vs 44.3%, p < 0.001) in the microsurgery group. Decompressive craniectomy (58.5% vs 24.6%, p < 0.001) and shunt-dependent hydrocephalus (63.7% vs 41%, p = 0.01) were more common for microsurgery, while procedural ischemic complications were less common (5% vs 24.6%, p = 0.001). Both early (12.5% vs 32.8%, p = 0.006) and late mortality rates (22.5% vs 39.3%, p = 0.041) were lower for microsurgery, and favorable 12-month outcomes (modified Rankin scale = 0-2) were better (62.5% vs 42.6%, p = 0.026). Multivariate analysis revealed that advanced age, neurological grade, modified Fisher grade, larger aneurysm size, rebleeding, and cerebral infarctions were independent predictors of poor outcome. Microsurgery fared marginally better than endovascular treatment (OR: 2.630, 95% CI: [0.991-6.981], p = 0.052). CONCLUSIONS: Timely and efficient treatment, either via open microsurgery or endovascular surgery, provided favorable outcomes for over half of PGASAH patients in this series. Therefore, early treatment should be offered to all PGASAH patients regardless of clinical and/or radiological factors. Microsurgery remains an effective treatment modality for selected PGASAH patients in the endovascular era.

Efficiency of topical rifampin on infection in open neural tube defects: a randomized controlled trial.

OBJECTIVES: Neural tube defects are the second most common congenital malformation in humans. Despite significant decreases in neural tube defects and related mortality and morbidity with recent developments, infections remain an important problem. Research on the role of topical therapy for managing neural tube defects and associated infections in the neonatal period has been limited. This randomized controlled trial aimed to investigate the efficiency of topical Rifampin on infection control in paraplegic newborns with open neural tube defects. METHODS: Thirty-seven patients who underwent an operation for neural tube defects were included. Topical Rifampin and cefotaxime were administered to 19 patients constituting the case group and local saline and cefotaxime were administered to a control group. Patients were examined for ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, and sepsis. RESULTS: None of the patients using topical rifampin had ventriculoperitoneal shunt infection/dysfunction, surgical site infection, urinary tract infection, or sepsis. In the control group, ventriculoperitoneal shunt infection/dysfunction was found in 4 (22.2%) cases, surgical site infection in 3 (27.7%), urinary tract infection in 3 (27.7%), and sepsis in 5 (27.7%), with statistically significant differences between the groups (p = 0.01, p = 0.032, p = 0.032, and p = 0.002, respectively). No local or systemic side effect was observed regarding rifampin use. CONCLUSION: Topical Rifampin is effective in minimizing complications like sepsis, surgical site infection, urinary tract infection, and ventriculoperitoneal shunt infection due to neural tube defect operations. Further research with larger numbers of cases is needed to implement this practice routinely.

From Ibni Sina (Avicenna) to Present, History of International Fellowship and Observership: University of Wisconsin-Madison Experience.

Since the inception of the International Fellowship (IF) Program in the Department of Neurological Surgery at the University of Wisconsin-Madison in 2006, training has been provided to 219 residents, neurosurgeons, and medical students from 18 countries and five continents. These IFs took a long academic and geographic journey to improve their skills in patient care. The advanced training, they received lead to 14 of these IF neurosurgeons to return to their hometowns with higher academic appointments, including two chairmen, seven professors, two associate professors, two assistant professors, and one consultant neurosurgeon. An additional measure of success for the IF Program is that fellows continue to communicate with their mentors and with their prior fellow international colleagues long after their fellowship ends.

A rare case: sclerosing osteomyelitis of the frontal bone.

The patient presented in this study had a form of chronic sclerosing osteomyelitis (CSO) that is rarely reported in calvarial bones and has never been reported in the frontal bone in the literature. We aimed to contribute to the literature with this case study. In this study, we report a 14-year-old girl who presented with swelling and pain in the frontal bone and underwent treatment due to CSO. The patient had no history of trauma and chronic infection. We conclude that CSO should be considered in the differential diagnosis of the patients presenting with cranial swelling whose diagnosis cannot be established based on the radiological findings.

Determination of trace element levels in patients with burst fractures.

BACKGROUND: This study aimed to determine trace element levels (Zn, Fe, Mn, Mg, Cu, Cd, Co, and Pb) in patients with burst fractures in Van Province, Turkey. METHODS: The study included a total of 44 participants with no additional pathologies, including 22 patients with burst fractures aged over 18 years who were admitted to the neurosurgery departments at two hospitals between June 15, 2015 and January 20, 2016 and 22 healthy volunteers. Serum samples were obtained from all participants to measure the serum levels of trace and heavy elements, including Mn, Cd, Cu, Pb, Fe, Co and Zn, using atomic absorbance spectrophotometry. RESULTS: The trace element levels of Zn, Mn, Cu, Co, and Mg were significantly lower (p<0.001), whereas those of Fe, Cd, and Pb were significantly higher in the patient group than in the control group. In addition, the levels of Zn, Mn, Cu, Co, and Mg were lower and the levels of Fe, Cd, and Pb were higher in the patient group than in the control group. CONCLUSION: The probability of burst fracture and its causes leading to any injury may be considered as an indicator balance for the concentration of trace elements between the patient group and control group and may also be a risk factor associated with the bone exposed to burst fracture Significant changes in serum levels of Zn, Cd, Mn, Mg, Pb, Fe, Cu and Zn elements can be observed in patients with burst fractures.

Primary Spinal Lymphoma Masquerading as Meningioma: Preoperative and Postoperative Magnetic Resonance Imaging Findings.

A 55-year-old male who complained of frequent back pain accompanied by increasing weakness in the lower extremities was admitted to our hospital's Neurosurgery Department. No additional disease was in his history. Magnetic resonance imaging of the thoracic area, anterior epidural space, and paravertebral area revealed an approximately 55 × 9 mm lymphoma pressuring the spinal cord from the anterior. It was fusiformed with a dural tail, hypointense on sagittal T1-weighted imaging series, and hypointense on sagittal T2-weighted imaging series compared with the spinal cord, showing contrast enhancement. After gadolinium application, an extra-axial mass lesion was detected. The lesion was surgically removed from the patient, whom we thought had meningioma on the basis of radiology. However, histopathology resulted in the diagnosis of diffuse large B-cell non-Hodgkin lymphoma.

Evaluation of Oxidative Stress Levels and Antioxidant Enzyme Activities in Burst Fractures.

BACKGROUND Spinal burst fractures are pathologies that occur in spinal injuries and cause significant mortality and morbidity as a result. Burst fractures in spinal cord injuries can result in rapid and significant oxidative stress. In addition to the primary injury in severe spinal cord injuries, subsequent secondary lesions are mainly due to inflammatory cascade activation and excessive production of free radicals. This study evaluated oxidative stress and antioxidant enzyme levels in burst fractures. MATERIAL AND METHODS Twenty patients with burst fractures were diagnosed and underwent surgery and 20 healthy control subjects were included in the study. Neurological status was evaluated using the American Spine Injury Association Impairment Scale (ASIA) before and after surgery. Neurological function was scored as ASIA A: complete deficits, ASIA B-D: incomplete deficits, and ASIA E: neurologically intact. Spectrophotometry was performed to measure malondialdehyde (MDA) and low glutathione (GSH), glutathione peroxidase (GPx) levels, which represent lipid peroxide content. Evaluations were performed within 2 days after injury in the patients. RESULTS MDA levels were higher in the burst fracture group (p<0.001), whereas GSH and SOD activities were higher in the control group (both p<0.001). There was no statistically significant difference in GPx levels between the groups (p=0.482). CONCLUSIONS Oxidative stress appears to be related to burst fractures. Considering the importance of burst fractures in spinal cord injuries, a better understanding of these mechanisms may help in defining the role of oxidative stress after burst fractures. Prospective, randomized, controlled trials may reveal new therapeutic approaches that include antioxidants for explosive fractures focusing on oxidative stress.

The efficiency of acoustic radiation force impulse (ARFI) elastography in the diagnosis and staging of carpal tunnel syndrome.

OBJECTIVES: The aim of the present study was to quantify the stiffness of the median nerve (MN) at the carpal tunnel inlet by acoustic radiation force impulse (ARFI) elastography and to evaluate whether ARFI can be used in diagnosis and staging of carpal tunnel syndrome (CTS). METHODS: Sonographic examinations of 96 wrists in 50 patients were included in the study. The cross-sectional area and stiffness of the MN were quantitatively measured by B-mode ultrasonography (USG) and ARFI. The findings of CTS were assigned to four groups: (I) normal (n = 21), (II) mild (n = 39), (III) moderate (n = 38), and (IV) severe (n = 19). The differences between CTS patients and controls and the differences in electrodiagnostic tests among subgroups were statistically compared. ROC analysis was performed to determine the cut-off values between subgroups. RESULTS: Bilateral CTS was present in 46 patients (92 wrists) and unilateral CTS in four patients. Of the 96 nerves in the 50 symptomatic "idiopathic CTS" patients (48 women, 2 men; mean age 45.9 years, range 23-73 years), 39 (40.4%) were mild, 38 (39.8%) were moderate, and 19 (19.8%) were severely affected. When compared to controls, MN stiffness was significantly higher in the CTS group (P < 0.001); furthermore, it was higher in the severe or extreme severity group than the mild or moderate severity group (P < 0.001). A 3.250 m/s cut-off value on ARFI revealed sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81, 82, 95.1, 50, and 82%, respectively. CONCLUSION: The MN stiffness measured by ARFI elastography is significantly higher in patients with CTS then in controls. ARFI elastography appears to be a highly efficient imaging modality for the diagnosis and staging of these patients.

Relationship between hydrocephalus etiology and ventriculoperitoneal shunt infection in children and review of literature.

OBJECTIVE: The purpose of this retrospective study was to clarify the relationship of shunt infection to childhood hydrocephalus etiology. METHODS: We analyzed 1021 patients with childhood hydrocephalus who underwent V-P shunting over a period of approximately 15 years. The etiology of 1021 patients include myelomeningocele (794 patient), congenital (165 patient) and intraventricular haemorrhage (62 patient). RESULTS: Of the 1021 patients who underwent V-P shunting, 19.32% exhibited shunt infection. Shunt infection developed in 180 (22.67%) of 794 patients with myelomeningocele, 9 (5.45%) of 165 patients with congenital obstructive hydrocephalus, and 9 (14.51%) of 62 patients with intraventricular haemorrhage. Recurrent shunt infection was detected in 54 (27.27%) of 198 patients with a previous shunt infection. CONCLUSIONS: Patients with previous shunt infection as well as those with shunts associated with myelomeningocele were observed to be at a greater risk for shunt infection. Results indicated that patients with congenital obstructive hydrocephalus may be less prone to shunt infections.

Posttraumatic Oculorrhea From the Eyelid.

We report a 21-month-old boy with a sutured laceration of the left upper eyelid with drainage of cerebrospinal fluid. Careful evaluation, including computerized tomography, revealed a penetrating injury of the left orbital wall and a linear bone fracture. The wound was resutured carefully. There was no cerebrospinal fluid leakage in the postoperative follow-up period.

Spinal Metastasis of Unknown Primary Accompanied by Neurologic Deficit or Vertebral Instability.

BACKGROUND AND OBJECTIVE: Spinal bone metastases are common. They are mostly localized to the lumbar, thoracic, and cervical spine. The most common primaries to result in spinal metastases include lung, breast, and prostate carcinomas in adults as opposed to leukemia, Ewing sarcoma, rhabdomyosarcoma, and neuroblastoma in children. In patients diagnosed with cancer, bone metastases are found in 40% and spinal metastases in 10%. In this study, we reviewed 25 patients diagnosed with a spinal metastasis of unknown primary who presented with low back pain or acute-onset neurologic deficits and underwent operative treatment. METHODS: The retrospective study included 25 patients with a spinal metastasis of unknown primary who presented to our clinic with acute-onset vertebral fracture or neurologic deficit. Statistical descriptions were obtained for each patient. Survival analysis was performed using the Kaplan-Meier method. RESULTS: The 25 patients included 17 men (68%) and 8 women (32%), with a mean age of 55 years (range, 14-81 years). Eleven patients (44%) presented with varying degrees of motor deficits ranging from flaccid paralysis to paraplegia. Motor deficits were completely reversed in 4 patients postoperatively. The tumors were localized to the upper thoracic spine (T1-4) in 2 patients, in the midthoracic spine (T5-8) in 2 patients, in the lower thoracic spine (T9-12) in 8 patients, in the cervical 7 in 1 patient, and in the lumbar spine in 12 patients. In 10 patients, the tumor affected multiple spinal regions. Nonosseous tumors were not present in 10 patients. Ten patients had an extradural tumor. Costal involvement was detected in 2 patients. The tumors were pathologically identified as lung cancer (n = 3), lymphoma (n = 5), breast cancer (n = 3), gastric cancer (n = 2), liver cancer (n = 2), prostate cancer (n = 2), renal cell carcinoma (n = 2), malignant melanoma (n = 1), plasmacytoma (n = 1), bladder cancer (n = 1), paraganglioma (n = 1), Ewing sarcoma (n = 1), and yolk sac carcinoma (n = 1). Posterior instrumentation was performed in patients with instability. In addition, decompression was performed in patients with neurologic deficit. CONCLUSIONS: Considering that 10% of patients with cancer are diagnosed by vertebral metastasis, presence of malignancy should be suspected and a detailed examination should be performed in patients presenting with vertebral fractures caused by no or minor trauma. Moreover, in patients presenting with neurologic deficit, soft tissue metastases leading to spinal cord compression should be kept in mind and further examinations should be promptly administered.

Posterior reversible encephalopathy syndrome in IgA vasculitis: Neuroimaging of a 14-year-old child.

IgA vasculitis (IgAV) is a leukocytoclastic vasculitis and characterized by involvement of small vessels in skin, gastrointestinal system, joints, kidneys, and less frequently other organs. It is the commonest vasculitis in childhood and etiology is not completely known. Neurological manifestations of IgAV are very rare and usually seen in patients with severe hypertension or as an uncommon feature such as peripheral neuropathy. Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiologic entity characterized with temporary vasogenic edema developing typically in posterior circulation of the brain and has been reported as a rare manifestation of IgAV. In this paper, a PRES case of 14-year-old male with IgAV is reported and etiopathogenesis was discussed with literature. Diagnosis was made by magnetic resonance imaging because of the existence of neurological symptoms (headache and visual loss) during the course of disease. His radiological findings have resolved with therapy. Although neurological involvement is a rare manifestation in IgAV, we recommend magnetic resonance imaging in such patients for diagnosis and evaluation of complications.

Rapidly Progressive Spontaneous Spinal Epidural Abscess.

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

Effects of Low-Intensity Treadmill Exercise on Sciatic Nerve in Experimental Diabetic Neuropathy.

OBJECTIVE: To investigate the potential beneficial effects of low-intensity exercise on histopathological changes of sciatic nerves in streptozotocin (STZ)-induced diabetic rats. STUDY DESIGN: The rats were allotted randomly into 3 experimental groups: A (control), B (diabetic untreated), and C (diabetic treated with low-intensity exercise); each group contained 8 animals. Groups B and C received STZ. Diabetes was induced in 2 groups by a single intraperitoneal injection of STZ (40 mg/kg, freshly dissolved in 0.1 M citrate buffer, pH 4.2). Two days after STZ treatment, diabetes in 2 experimental groups was confirmed by measuring blood glucose levels. Rats with blood glucose levels ≥ 250 mg/dL were considered to be diabetic. Animals in the exercise group were made to run the treadmill once a day for 4 consecutive weeks. Exercise started 3 days prior to STZ administration. RESULTS: The treatment of low-intensity exercise caused a sharp decrease in the elevated serum glucose and an increase in the lowered serum insulin concentrations in STZ-induced diabetic rats. STZ induced a significant decrease in the area of insulin-immunoreactive ß cells. Low-intensity exercise treatment resulted in increased area of insulin-immunoreactive ß cells signficantly. Myelin breakdown decreased significantly after treatment with low intensity exercise. The ultrastructural features of degenerated axons also showed remarkable improvement. CONCLUSION: We believe that further preclinical research into low-intensity exercise may indicate its usefulness as a potential treatment for peripheral neuropathy in STZ-induced diabetic rats.

Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma.

A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS). The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI) showed an image of a mass compressing the medulla.