The effects of Garcinia kola and curcumin on the dorsal root ganglion of the diabetic rat after peripheral nerve transection injury.

OBJECTIVE: To test the protective effects of Garcinia kola and curcumin on the ganglion tissues of diabetic rats following the use of autologous vein graft in peripheral nerve transection injury. METHODS: The sciatic nerve on the right side was transected, and anastomosis was performed between the proximal and distal ends using an autologous vein graft. Curcumin and Garcinia kola seed extract were administered daily by oral gavage. The ganglion tissues were harvested after a 90-day waiting period. Sensory neurons in the dorsal root ganglion at the L4 and L5 levels were used for stereological evaluations. Mean sensory neuron numbers were analyzed using a stereological technique. The size of the light and dark neurons was also estimated, and ultrastructural and immunohistochemical evaluations were performed. RESULTS: A statistically significant difference in sensory neuron numbers was observed between the groups with and without Garcinia kola and curcumin applications. The immunohistochemical results showed that the s-100 protein is expressed selectively between cell types. CONCLUSION: The results of this study show that curcumin and Garicinia kola prevented sensory neuron loss in diabetic rats following transection injury to the sciatic nerve.

Bilateral Frontoparietotemporal Craniectomy for Traumatic Brain Injury: A Case Report.

There is no conclusive agreement on the optimal approach to managing severe traumatic brain injury. This article details the methodology and outcomes of bilateral frontoparietotemporal decompression surgery performed on a three-year-old patient with severe traumatic brain injury. As the patient had fixed dilated pupils, GCS (Glasgow coma scale) 4, and marked edema in the frontal and parietal regions, the Kjellberg approach was modified, and decompression including part of the parietal bone was performed. The patient was intubated and sedated in the intensive care unit for one week postoperatively. After extubation, the patient had reactive pupils and a GCS of 13. The patient underwent a cranioplasty two months after the trauma, combining the bone grafts placed in the abdomen. The patient was followed for three days after cranioplasty and discharged with a GCS:15 and intact motor examination.

The effect of dietary sesame oil and ginger oil as antioxidants in the adult rat dorsal root ganglia after peripheral nerve crush injury.

AIM: The purpose of this study was to investigate the effect of dietary sesame oil and ginger oil supplements on the dorsal root ganglia following a sciatic nerve crush model in male Wistar albino rats. MATERIALS AND METHODS: Crush injury models have been done by means of graded forceps (50 Newton). The animals were given a daily sesame oil (4 ml/kg/day) and ginger oil (400 mg/kg/day) via oral gavage for a period of 28 days. Dorsal root ganglia from the L5 levels were harvested. Processing of tissues was done for electron microscopy and light microscopy. Immunohistochemical staining with active caspase-3 antibody and qualitative ultrastructural analyses of tissues were made by a light and a transmission electron microscope, respectively. RESULTS: The results showed that crush injury leads to remarkable ultrastructural changes in sensory neurons, such as swollen mitochondria, disruption of cristae structure, glial cell proliferation and, consequently, phagocytosis of the damaged neuron. These ultrastructural changes were less evident in the treated groups, and both natural compounds reduced the expression of activated caspase-3, which may also affect ultrastructural changes. CONCLUSION: The application of the natural products sesame oil and ginger oil may represent a supportive approach to the protection of sensory neurons against the destructive effects of peripheral nerve crush injury.

Histopathological evaluation of mesenchymal stem cells in the healing of anastomosed carotid arteries.

The objective of this study was to evaluate the influence of mesenchymal stem cells on the healing of experimental carotid artery anastomoses histopathologically. Twenty-four female Sprague-Dawley rats were used in this study. After random separation of the subjects into two groups, in both groups carotid arteries were transected and anastomosed in end-to-end fashion. Anastomoses were locally treated with 1 ml 0.09% NaCl, and 1 ml mesenchymal stem cell suspension (1×106 cells) in control and trial groups, respectively. Anastomoses were wrapped with an 8 mm sheet of surgicel and soaked with BioGlue in order to sequestrate the stem cells. After patencies were confirmed via Doppler USG, surgical site was closed with 2/0 silk sutures. Histopathological evaluation was carried out after 4 weeks. In respect to endothelial continuity, vessel patency (along with presence or absence of restenosis), integrities of internal and external elastic laminae, muscularis and adventitia; no statistically significant differences were present between the trial and control groups. In Trial and Control Groups, luminal thrombus was present in 8 (66.6%) and 3 (25%) of the 12 subjects, respectively. The difference was statistically significant (P < 0.05). Recanalization was present in 6 subjects in trial group; 1 subjects in Control Group, respectively. Our results suggest that local administration of mesenchyme stem cell does not have a positive influence on success of an anastomosis.

Reconsideration of Neurogenic Pulmonary Edema as Source of Metastatic Cerebral Abscess Following Subarachnoid Hemorrhages: A Preliminary Study.

BACKGROUND: Subarachnoid hemorrhage (SAH) may be a cause of neurogenic pulmonary edema (NPE). It is well known that lymphatic fluid draining by thoracic duct to lungs consists of many dangerous metabolites, degraded tissue particles, and microbiologic pathogens. However, not enough studies have investigated whether NPE causes septicemia or not. In this study, we retrospectively examined our experimental materials to determine whether there is a meaningful relationship between NPE and cerebral abscess formation. METHODS: Forty-two rabbits were divided into 3 groups: Control (n = 5), SHAM (n = 7), and SAH (n = 30) with severe neurogenic lung edema detected in rabbits. The SHAM and SAH groups received 1 mL saline and 1 mL autologous arterial blood into the Sylvian cisterna, respectively. Weight, heartbeat, respiration rate, and blood pressure were recorded by routinely using monitoring devices. All multilevel lungs and brain tissue microsections were examined by stereologic and Cavalier methods. For statistical analysis, NPE criteria and the numbers of abscess or abscess resembling cores in the brains were estimated in all groups and compared. The Mann Whitney-U test was used to analyze the results statistically. RESULTS: All rabbits were around 4 years old; body weight was between 3.94 and 4.5 kg; normal heart rhythm rate was found between 251 ± 39/minutes and 281 ± 30/minutes; and respiration rate was between 24 ± 5/minutes and 36 ± 7/minutes. Histopathologic examinations showed that abscess formations frequently spread in middle cerebral arterial territories of all animals in the NPE-detected rabbits. While average abscess numbers were estimated as 3 ± 1 in 7 animals (n = 7; P < 0.005) in severe NPE-detected rabbits, only 1 ± 1 abscess core was detected in a less severe NPE that developed in 3 (n = 3; P < 0.05) animals. The vasospasm index values of pulmonary arteries (PAs) of all animals were 1.233 ± 0.065 in the control group; 1.567 ± 0.0430 in the SHAM group, and 2.890 ± 0.0453 in the SAH group (P < 0.05). CONCLUSIONS: This experimental study showed that NPE is a relatively common pathology following experimental SAH in rabbits. The NPE is frequently complicated with brain abscess as shown in this study. The pathophysiologic mechanism was concluded, as NPE may be responsible for cerebral abscess development via bacteria/cytotoxic particles conveyed by thoracic duct to lungs and transferred from the ruptured alveoli-capillary membrane to the brain by way of systemic circulation.

Proconvulsant Effect of Papaverine on Penicillin-Induced Epileptiform Activity in Rats.

AIM: Papaverine is a vasodilator agent that is an opium alkaloid. It exhibits its effects by inhibiting the phosphodiesterase enzyme. Papaverine administration is widely used to avoid symptomatic vasospasm after subarachnoid hemorrhage. We aimed, in this research, to study the effects of papaverine on the epileptic discharges stimulated by penicillin. MATERIAL AND METHODS: Adult female Wistar rats (220±30 g) were included in this research (n=30). Rats were anesthetized with urethane (1.25 g/kg) and then the left cerebral cortex was reached by opening a burr hole with a drill. Penicillin G sodium salt (500 IU)(200 IU/1 µl) was injected into the left lateral ventricle to produce epileptiform activity. Thirty minutes before penicillin G sodium injection, papaverine was administered at doses of 5, 10, 20 or 40 mg/kg intraperitoneally. RESULTS: There was no significant difference in spike frequency between the control group and the groups given 5 mg/kg, 10 mg/ kg or 40 mg/kg papaverine, while 20 mg/kg papaverine significantly increased the spike frequency (p < 0.05). CONCLUSION: Papaverine augments the epileptiform activity produced by penicillin injection. It is important to remember that papaverine might induce convulsions in patients who have epilepsy. More research is required to understand the mechanisms of the proconvulsant influence of papaverine in epilepsy.

The histopathological and stereological assessment of the effect of topically administered leptin on cerebral vasospasm in an experimental subarachnoid hemorrhage model

Background/aim: Cerebral vasospasm is a term that refers to prolonged, slowly progressing but reversible pathological narrowing of cerebral arteries occurring several days after subarachnoid hemorrhage (SAH), usually accompanied by a decrease in perfusion distal to the affected artery. Leptin is an endogenous polypeptide hormone that can be carried freely and bound to protein in the blood. Materials and methods: We investigated the superiority of topical application of leptin that may make a contribution to the development of new treatment modalities for unconscious patients in brain injury intensive care units and its preventive effect, which is considered to have multifactorial pathogenesis on cerebral vasospasm occurring after SAH via stereological studies of the basilar artery. Results: When mean serum leptin levels of the groups were compared, statistically significant differences were observed between the control and topical leptin-treated groups in favor of the treated groups with respect to serum leptin levels (P < 0.05). In the topical leptin-applied group, a significant difference in favor of vasodilatation was observed in the measurements of the basilar artery luminal area (P < 0.05). Conclusion: In accordance with the results, the topical administration of leptin can be used in the prevention of vasospasm, especially in unconscious patients with subarachnoid hemorrhage.

Postlaminectomy Bone and Scar Formations in Presence of Ankaferd Blood Stopper and Bitter Melon (Momordica Charantia): An Experimental Study.

AIM: A quantitative model of postlaminectomy was designed in rats. The effects of Momordica Charantia (MC) and Ankaferd blood stopper (ABS) on the bone and scar formation after laminectomy were concurrently evaluated. MATERIAL AND METHODS: Eighteen adult Wistar albino rats underwent lumbar laminectomy at L2-L3 vertebral levels, and were randomly assigned to one of three groups of six rats each. The Treatment group received MC and ABS treatment and the Control group was left untreated. Rats were sacrificed 4 weeks after treatment. Then; the lumbar spine was excised en-block, fixed and decalcified. Sections were stained with hematoxylin and eosin (H&E) and Masson"s trichrome, and evaluated for peridural fibrosis (PF), new bone formation, and vascular proliferation. RESULTS: Total volume of new bone in the MC group was significantly increased in comparison to the Control group (p < 0.05). Also; there was highly significant increase in terms of the total volume of fibrous tissue in the MC and ABS groups when compared with the Control group (p < 0.01). Besides; there was a highly significant difference between the MC and the Control groups (p < 0.01) in point of total volume of vessel. CONCLUSION: Both MC and ABS are not convenient to prevent the PF formation and MC may promote new bone formation and angiogenesis after lumbar laminectomy in rats.

Three Dimensional Microanatomy of the Ophthalmic Artery: Spontaneous Intracranial-Extracranial Anastomosis Site within the Orbital Cavity.

AIM: The aim was to evaluate three-dimensional structure of the ophthalmic artery (OphA). MATERIAL AND METHODS: The raw data of the Three-dimensional Computerized Tomography Angiography (3D-CTA) were transferred to computer and recorded in a software program. RESULTS: The study group consisted of 45 (24 female and 21 male) patients. The mean age of the patients was 56 ± 9.5 years. It was found that the entry point of the OphA to the orbital cavity was inferior to the optic foramen in 29 (64.44%) of the cases. The length of the postcanalicular-prelacrimal was 0.54 ± 0.13 centimeters at the right side and 0.51 ± 0.13 centimeters at the left side. The distance of the postlacrimal-presupraorbital segment was 0.43 ± 0.11 centimeters at the right and left sides. The location of the anastomosing site was 0.97 ± 0.42 centimeters from the supraorbital notch. CONCLUSION: The results of this study showed us that this technique could be used in the evaluation of the three-dimensional microsurgical anatomy of the OphA and its critical extracranial-intracranial anastomosing site.

Three-Dimensional Microsurgical Anatomy of the Choroid Plexus Using the Volume Rendering Technique.

AIM: The choroid plexus (CP) is a specific anatomical structure producing cerebrospinal fluid into the ventricular space. The three-dimensional anatomical structure of the choroid plexus located within the lateral ventricle may be evaluated by using the three dimensional volume rendering technique (3D-VRT) from acquired two-dimensional contrast enhanced computerized tomographic images. MATERIAL AND METHODS: The raw data of Three-dimensional Computerized Tomography Angiography (3D-CTA) were transferred into the computer and recorded in a software program. These images were evaluated in terms of anatomical shape, borders, extensions length and dimensions. RESULTS: The patient group consisted of 57 (27 female and 30 male) patients. The mean age of the patients was 55±9 years. In male individuals, the distance of the superior tip from Frazier's point was 7.96±0.71 centimeters at the right side. In males, the distance of the inferior tip of the CP was estimated as 1.93±0.26 centimeters posterior-lateral from the anterior clinoid process, 1.64±0.23 centimeters posterior-lateral from the bifurcation of internal carotid artery, and 2.86±0.23 centimeters posterior-medial from the bifurcation of middle cerebral artery on the right side. CONCLSION: The results of this study showed us that this technique could be used in the three-dimensional evaluation of some anatomical structures such as the choroid plexus.

Fusiform Enlargement of the Superficial Temporal Artery in the Cases with Intracranial Aneurysm.

AIM: The superficial temporal artery is one of the main terminal branches of the external carotid artery. This artery ascends through the lateralposterior margin of the zygomatic arch to reach the temporal region of the scalp. The superficial temporal artery divides its frontal and parietal branches around the zygomatic arch. MATERIAL AND METHODS: The raw data of the Three-dimensional Computerized Tomography Angiography (3D-CTA) were transferred to computer and recorded in a software program. This software program created the three-dimensional images of the superficial temporal artery using these transferred raw data with volume rendering technique. RESULTS: Fifteen cases (5 female and 10 male, mean age 54.26 ± 12.35 years) with intracranial aneurysm were evaluated in terms of the type, location and dimensions of the fusiform enlargements. Fusiform enlargement was bilateral in eleven of the cases. Remaining four cases have unilateral fusiform enlargement of the superficial temporal artery. CONCLUSION: Fusiform enlargement of the superficial temporal artery may be seen in the cases with intracranial aneurysms. 3D-CTA should be carefully evaluated in the demonstration of extracranial-intracranial vascular pathologies.

The Contribution of Three-Dimensional Computerized Tomographic Angiography in the Head Positioning of the Patients with Middle Cerebral Artery Aneurysms.

Surgical intervention is a gold standard technique for ruptured and unruptured middle cerebral artery bifurcation aneurysm. Before surgical intervention it is necessary to know the three-dimensional shape, surgical position, projection and position of the aneurysm and the course of the parent artery. In a demonstrative case with middle cerebral artery aneurysm, using the OsiriX MD image processing software for DICOM images, it was demonstrated the position of the aneurysm neck, the projection of the aneurysm and the course of the M1 segment in relation with dynamic rotation and extension of the head. These dynamic videographic neuroradiological images may enhance the surgical anatomic perspective of the surgeon before the surgical intervention.

Electrophysiological and histopathological effects of mesenchymal stem cells in treatment of experimental rat model of sciatic nerve injury.

AIM: The aim of this study was to evaluate electrophysiological and histopathological effects of mesenchymal stem cells in treatment of sciatic nerve injury. MATERIAL AND METHODS: Thirty-two female Spraque-Dawley rat were used in this study. Eight rats were used as a reference group in electrophysiological analysis for evaluation of non-injured nerve recordings (Control Group). Twenty-four rats were used for experimental evaluation. Twelve rats were anastomosed without treatment with mesenchymal stem cells (Sham Group) and twelve other rats were anastomosed and treated with mesenchymal stem cells (Stem Cell Group). Surgicel and bioglue were used in anastomosed line in both Groups. Eight weeks after the surgery, electrophysiological evaluation of rats was performed and, then, rats were decapitated under anesthesia and specimens including sciatic nerves and anastomosed line were taken for histopathological evaluation. Electromyography and nerve conduction velocity testing and histopathological scoring including rate of Wallerian degeneration, and neuroma and scar formation were evaluated for both Groups. RESULTS: There were no statistically significant differences between Sham and Stem Cell Groups with respect to histopathological evaluation. However, nerve conduction velocity showed significant difference between groups (P = 0.001). Nerve conduction velocity was significantly improved in Stem Cell Group when compared to Sham Group. CONCLUSION: In this study, based on nerve conduction velocity data, it was concluded that treatment with mesenchymal stem cells during end-to-end anastomosis improves functional regeneration.

The evaluation of three-dimensional anatomy of the superficial temporal artery using the volume rendering technique.

AIM: The superficial temporal artery (STA) is the one of the terminal branches of the external carotid artery. Three-dimensional anatomical structure of the STA can be evaluated by using three dimensional volume rendering technique (3D-VRT) from acquired two-dimensional contrast-enhanced computerized tomographic images. MATERIAL AND METHODS: The raw data of the Three-dimensional Computerized Tomography Angiography (3D-CTA) was transferred to computer and recorded in a software program. This software program created the three-dimensional images of STA using these transferred raw data with the volume rendering technique. These images were evaluated in terms of the location of the STA bifurcation, the distance from the some anatomical landmarks, the inner diameter of the artery, and the type of the variations. RESULTS: The total number of patients consists of 53 (27 female and 26 male) patients. The mean age of the patients was estimated as 57.9 ± 9.7 years. It was found that the location of the STA bifurcation was over the posterior third of the zygomatic arch in 58% of the cases. In 40% of the cases the location of the bifurcation was above the zygomatic arch. The location of the bifurcation was below the zygomatic arch in the remaining part of the cases (2%). CONCLUSION: The STA images created using the volume rendering technique were evaluated in terms of the bifurcation point of the artery, the length of the bifurcation from some anatomical structures, the inner diameter of the artery and arterial variations. The results of this study showed that this technique might be helpful for the three-dimensional microsurgical anatomy of the STA in daily neurosurgical practice.

Application of three-dimentional computerized tomographic angiography in the planning of pterional scalp incision to preserve the superficial temporal artery.

A standard pterional scalp incision is commonly used in the surgical treatment of lesions located at the cranial base. There is a close relationship between the superficial temporal artery and a pterional scalp incision. Standard pterional scalp incision is widely used in the aneurysm surgery of the basal cerebral arteries. Three-dimensional computerized tomographic angiography (3D CT Angiography) using the three-dimensional (3D) volume rendering technique is commonly used in the neuroradiological diagnosis of intracranial aneurysms. 3D CT Angiography produced for the mentioned purpose may concomitantly be used without any additional investigation for the imagination of superficial temporal artery. Virtual skin incision may be done in the computer software under the illumination of data obtained from the 3D CT Angiography. In this study, we investigated the applicability of this technique using 3D CT Angiography. In conclusion, using this technique in cases undergoing surgery with standard pterional scalp incision may preserve the superficial temporal artery leading to the prevention of the skin problems originating from insufficient blood supply, and allowing the use of the preserved superficial temporal artery for cranial anastomosis surgery in the future.

Shoulder traction device for enhanced conventional fluoroscopy during cervical spine operations.

Conventional biplanar fluoroscopic imaging of the cervical spine is commonly used during cervical spinal surgery. We designed an intraoperative traction device to prevent shoulder superimposition on the cervical fluoroscopic imaging. During surgery at the stage of fluoroscopic examination, an operator can apply traction via the traction band of the device. This device is safe and easy to use, and can be preoperatively fitted to patients. Fluoroscopic images obtained with the new traction device were definitely superior compared with images obtained without the traction device. This device may be useful in cases with difficult fluoroscopic imagination of the lower cervical spine.

The interactions of nitric oxide and acetylcholine on penicillin-induced epilepsy in rats.

The aim of this study was to investigate the interaction between nitric oxide (NO) and acetylcholine (ACh) in penicillin-induced experimental epilepsy. Adult male Wistar rats weighing 220 ± 35 g were used in the experiments. The epileptiform activity was induced by microinjection of penicillin (200 IU/1 µl) into the left sensorymotor cortex. Electrocorticogram was recorded by using Ag/AgCl ball electrodes. Sodium nitroprusside (SNP), a NO donor, given intracortically 30 min after penicillin significantly reduced the spike frequency whereas ACh increased the epileptiform activity for 5 min. Atropine, an antagonist for muscarinic receptors, was given intracortically 30 min after penicillin and did not significantly affect epileptiform activity for 30 min. SNP given after atropine significantly suppressed the epileptiform activity. ACh given 10 min after Nω-nitro-L: -arginine methyl ester (L-NAME), a nonspecific nitric oxide synthase inhibitor, did not have a significant effect on spike frequency. When ACh and SNP were administered together, penicillin induced epileptiform activity and spike frequency were significantly suppressed from the 10th minute onwards. It can be concluded that ACh increases the penicillin-induced epileptiform activity while co-administration of ACh and SNP produces a potent anticonvulsant effect as compared to SNP alone.

The interactions of nitric oxide and adenosine on penicillin-induced epileptiform activity in rats.

In this study, the influence of nitric oxide (NO) and adenosine systems on penicillin-induced epileptiform activity was examined in rats. NO donor, sodium nitroprusside (SNP, 50 micrograms per rat, i.c.v.) reduced the frequency but not the amplitude of epileptiform discharges. Non-selective NOS inhibitor, N-omega-nitro-L-arginine methyl ester (L-NAME, 100 micrograms per rat, i.c.v.) practically did not exert any effect on the spike frequency and amplitude. Adenosine (100 micrograms per rat, i.c.) reduced spike frequency but not the amplitude, whereas theophylline (100 micrograms per rat, i.c.v.) increased the mean spike frequency and amplitude of penicillin-induced epileptiform discharges. Co-injection of theophylline and L-NAME did not cause a further increase in the epileptiform activity compared with theophylline. When NO production was blocked with L-NAME, the inhibitory effects of adenosine were lost. The obtained results suggest that NO and adenosine may decrease penicillin-induced epileptiform activity in rats and that NO, at least in part, may mediate the anticonvulsant effect of adenosine.