Preventative effect of diclofenac sodium and/or diltiazem in rats with epidural fibrosis.

OBJECTIVE: Spinal epidural fibrosis is commonly seen after laminectomy. There is not yet proven any agent preventing fibrosis in clinical usage. We used diclofenac sodium and diltiazem, which are fibrosis inhibitors. METHODS AND MATERIALS: 40 rats were divided into four groups of equal numbers: control, diclofenac sodium, diltiazem, and diclofenac sodium + diltiazem. Laminectomies were performed at L5 and L6. After a 4 week period, the rats were decapitated and the vertebral column blocks were removed for histopathologic examination. Fibrosis percentage, spread of fibrous regions, and fibroblast numbers were evaluated in each group and compared between the groups. RESULTS: The distribution of epidural fibrosis density, percentage of fibrosis, and distribution of fibroblasts in the diclofenac sodium + diltiazem group were significantly lower than in the other groups. The fibroblast numbers of the diltiazem, and diclofenac sodium + diltiazem groups were significantly lower than in the other groups. CONCLUSION: Diclofenac sodium + diltiazem used together provided better outcomes because each of them prevented fibrosis via different ways, probably through synergistic action (Tab. 5, Fig. 3, Ref. 43).

Civilian gunshot wounds to the head.

BACKGROUND AND PURPOSE: Civilian Gunshot Wounds (GSWs) to the head are important causes of mortality. The severity of GSWs is related to several factors. Patients with GSWs tend to do very well or very poor depending on these factors. METHODS: We retrospectively reviewed 47 patients with GSWs to the head during the last 5 years. Clinical and radiological findings of cases are described. Statistical analysis was used to find the effects of all independent variables with mortality and the prognostic factors. RESULTS: Glasgow Outcome Scale results showed that 38% of patients died, 13% were moderately disabled and 49% had good recovery at discharge. Patients with respiratory depression, hypovolemia, bilateral pupil dilatation, Glasgow Coma Scale (GCS) scores of 3 to 5, central bihemispheric and transventricular injury experienced 100% mortality. The mortality rate was 58% in patients with intracerebral or subdural hematoma, 78% in multilobar injury, 14% in unilobar injury and 57% in self-inflicted wounds. The postoperative mortality was 27%. CONCLUSION: The manuscript describes the clinical experience of penetrating missile injuries in a Turkish civilian practice. Mortality and/or poor outcome are relatively high in spite of the cases wounded by low-velocity weapons. We should emphasize that following stabilization of vital signs, all patients with GCS scores of 3 to 5 should be evaluated immediately with CT and treated conservatively. If it is appropriate the patients with a GCS score higher than 8 should undergo surgery. Patients with GCS scores of 6 to 8 should be followed closely and treated with surgery when necessary even if they have poor prognosis.