Potential neuroprotective effect of Anakinra in spinal cord injury in an in vivo experimental animal model.

OBJECTIVE: To evaluate the therapeutic effects of inhibiting interleukin-1 beta (IL-1 beta) in vivo using Anakinra in an experimental model of spinal cord injury (SCI). METHODS: All experimental procedures were performed in the animal laboratory of Ankara Education and Research Hospital, Ankara, Turkey between August 2012 and May 2014. The SCI was induced by applying vascular clips to the dura via a 4-level T5-T8 laminectomy. Fifty-four rats were randomized into the following groups: controls (n = 18), SCI + saline (n = 18), and SCI + Anakinra (n = 18). Spinal cord samples were obtained from animals in both SCI groups at one, 6, and 24 hours after surgery (n = 6 for each time point). Spinal cord tissue and serum were extracted, and the levels of IL-1 beta, malondialdehyde, glutathione peroxidase, superoxide dismutase, and catalase were analyzed. Furthermore, histopathological evaluation of the tissues was performed. RESULTS: The SCI in rats caused severe injury characterized by edema, neutrophil infiltration, and cytokine production followed by recruitment of other inflammatory cells, lipid peroxidation, and increased oxidative stress. After SCI, tissue and serum IL-1 beta levels were significantly increased, but were significantly decreased by Anakinra administration. Following trauma, glutathione peroxidase, superoxide dismutase, and catalase levels were decreased; however, Anakinra increased the activity of these antioxidant enzymes. Malondialdehyde levels were increased after trauma, but were unaffected by Anakinra. Histopathological analysis showed that Anakinra effectively protected the spinal cord tissue from injury. CONCLUSION: Treatment with Anakinra reduces inflammation and other tissue injury events associated with SCI.

Gabapentin versus pregabalin in relieving early post-surgical neuropathic pain in patients after lumbar disc herniation surgery: a prospective clinical trial.

OBJECTIVES: The roles of gabapentin and pregabalin are well established in the management of chronic neuropathic pain. Here, we investigated the effectiveness of pregabalin and gabapentin for treating acute neuropathic pain following lumbar discectomy. METHODS: This prospective, non-randomized, and observational study included 54 patients who experienced acute neuropathic pain after lumbar discectomy. The assessments included the Leeds assessment of neuropathic symptoms and signs scale (LANSS), the Oswestry disability index (ODI), and the visual analog scale (VAS) pre-operatively and at 3 days, 6 months, and 1 year after surgery. The LANSS scores ≧12 suggest the presence of neuropathic pain. Those patients who reported neuropathic pain were randomly treated with gabapentin or pregabalin. RESULTS: In the gabapentin group, the LANSS scores increased to 14 at 3 days after surgery. The patients improved neurologically and on the LANSS, which decreased to 10 points 6 months after surgery and to 4 points at 1 year (P < 0.001). In the pregabalin group, the LANSS scores increased from 12 to 16 points on post-operative day 3 and then decreased to 12 and 5 at the 6-month and 1-year follow-ups, respectively (both P < 0.001). The ODI and VAS scores significantly improved in both groups (P < 0.001). DISCUSSION: Many patients may suffer from neuropathic pain in the early post-surgical period after lumbar discectomy. Gabapentin and pregabalin are anticonvulsant agents that may decrease perioperative central sensitization and early post-surgical neuropathic pain. Gabapentin and pregabalin effectively relieved neuropathic pain and prevented the conversion of acute pain to chronic pain at the 1-year follow-up after lumbar discectomy.

The surgical outcome of traumatic extra-axial hematomas causing brain herniation in children.

AIM: The aim of this study was to assess the surgical outcome and prognostic importance of clinical and radiological data from children operated on under emergency conditions due to an extra-axial hematoma causing brain herniation. METHODS: This retrospective study included 25 children operated on due to herniated traumatic extra-axial hematomas from January 2000 to December 2010. RESULTS: Of those 25 children, 17 (68%) were diagnosed with subdural hematoma (SDH), 7 (28%) with epidural hematoma (EDH) and only 1 patient (4%) suffered from both SDH and EDH. Overall mortality from a herniated extra-axial hematoma was 44%. The mortality rate for herniated SDH patients was 52.9%, and only 1 patient died from a herniated EDH (14.2%). Low Glasgow coma scale scores at admission, high postoperative intracranial pressure (ICP) values, longer intervals from trauma to surgery, longer durations of brain herniation, the presence of intraoperative brain swelling, larger and thicker hematomas and more displacement of the midline structures and obliteration of the basal cisterns were all correlated with mortality and an unfavorable outcome. CONCLUSIONS: Brain herniation is a serious consequence of traumatic extra-axial hematomas in children, and approximately one third of these patients have the potential for a favorable outcome. We recommend postoperative ICP monitoring to predict outcome and early decompressive surgery when possible for promising results.

Sensorial quality and bone strength of female and male broiler chickens are influenced by weight and growth rate.

1. An experiment was conducted with 98 male and 98 female broiler chickens (Ross 308) to study the effect of growth rate, induced by different dietary means, sex and live weight (1500 g and 2000 g) at slaughter on production parameters, bone strength and sensorial characteristics of the breast meat. 2. The birds were divided into four groups and individually fed a standard commercial diet, a high energy diet or low energy diet from d 11 to slaughter at between d 28 and 39. Three groups were fed ad libitum and a further group was fed a restricted amount of the high energy feed. Half of the birds in each group were slaughtered at approximately 1500 g and the other half at 2000 g live weight. 3. The diets resulted in different growth rates. The chickens fed the high energy and the commercial diet had the highest growth rate at both live weights at slaughter. The restricted fed chickens had lower bone strength than the chickens fed the low energy diet. 4. Breast meat from male broilers was juicer, more tender and less hard than breast meat from females. Chickens slaughtered at 2000 g live weight were juicer than those slaughtered at 1500 g. Chickens given the high energy feed ad libitum and restricted had different growth rates, but the sensory parameter related to texture showed no difference. 5. It was concluded that an increased slaughter weight might improve meat quality due to improved juiciness.

Rapamycin prevents interstitial fibrosis in renal allografts through decreasing angiogenesis and inflammation.

Rapamycin (RPM) has antiangiogenic and antiproliferative effects on cells. The aim of this study was to evaluate the mechanism of RPM as a novel antifibrotic agent by assessing its effect on interstitial fibrosis (IF). Among 60 renal transplant recipients, group 1 patients (n=20) were treated with RPM and group 2 (n=40), with cyclosporine. The proportions of infiltrating macrophages and lymphocytes in the interstitium were evaluated in 1-year biopsies. The microvessels were highlightened with CD34. After an initial biopsy, the development of diffuse IF over 18 months was evaluated by follow-up biopsies. The mean microvessel density (MVD) was significantly lower among group 1 (69.3±16) versus group 2 (96.5±30; P<.001). The proportions of macrophages and lymphocytes were lower in group 1 compared to group 2 biopsies (P<.001 for both). Fourteen (35%) group 2 and only 2 (10%) group 1 cases developed IF over 18 months (P<.05). The mean MVD in the initial biopsy was 75.6±18 in cases that did not versus 120±28 among those who did develop IF (P<.001). The amount of interstitial inflammation was greater among patients who did compared with cases who did not develop IF (P<.01). The overall 1-, 3-, and 5-year graft survival rates for group 1 were 95%, 95%, and 89% versus 95%, 65%, and 45% for group 2 patients, respectively (P<.001). RPM-treated patients showed a lower incidence of diffuse IF, which can be explained by antiproliferative and antiangiogenic effects of RPM. In conclusion, RPM therapy displayed an independently positive impact on long-term graft survival.

Neuroprotective effect of mesna (2-mercaptoethane sulfonate) against spinal cord ischemia/reperfusion injury in rabbits.

Although the precise mechanism by which ischemia/reperfusion injury occurs in the spinal cord remains unclear, it is evident that free oxygen radicals and apoptosis play major roles in the destruction of membrane lipids, damage to DNA and cell death. The apoptotic process involves activation of the caspase-3 cascade. Although it is widely used as a protective agent against cell injury, it is unknown whether mesna (2-mercaptoethane sulfonate) ameliorates neuronal ischemic injury. The aim of this study was to determine the effect of mesna on caspase-3 activity in a rabbit model. Adult rabbits underwent spinal cord ischemic injury via occlusion of the abdominal aorta for 20 min. Twenty-four hours after ischemia, spinal cord samples were obtained and tissue caspase-3 activity was measured. Rabbits that had been given a single dose of 150 mg/kg mesna had decreased caspase-3 activity in the spinal cord following ischemia/reperfusion injury, indicating a protective effect. However, caspase-3 activity was lower in rabbits given methylprednisolone than in those given mesna, indicating that methylprednisolone has the stronger protective effect of the two agents.

Chiari Type I malformation presenting with bilateral hearing loss.

Chiari Type I malformations can present with several clinical signs and symptoms. We describe a 44-year-old female patient presenting with bilateral hearing loss with hydrocephalus coexisting with Chiari Type I malformation and a unilateral arachnoid cyst. Thus, sensorineural hearing loss may be caused by hydrocephalus with Chiari Type I malformation. The placement of a ventriculoperitoneal shunt without a posterior fossa decompression is an effective treatment.

Solitary fibrous tumour of the ethmoid sinuses and anterior fossa.

A 68-year-old woman presented with a 2 month history of progressive headache, left extremity weakness, and cognitive difficulties. Neuroimaging results demonstrated a macrocystic tumour attached to ethmoid sinuses and disclosed atypical findings. The tumour was totally removed. All the symptoms and signs ameliorated after surgery. Histological and immunohistochemical examinations led to a diagnosis of solitary fibrous tumour. A solitary fibrous tumour could be seen in various intracranial areas but ethmoid sinuses and anterior fossa are not an exceptional site. They appear as extra-axial tumours with a characteristic pattern on magnetic resonance imaging (MRI), but the cystic component is very unusual. Intracranial location and MRI features of this rare entity are presented and discussed along with various dura based tumours.

Aneurysmal bone cyst of the temporal bone: case report.

BACKGROUND: Aneurysmal bone cysts (ABCs) are uncommon lesions of the temporal bone and their occurrence in the calvarium is rare. CASE DESCRIPTION: A case of a right temporal ABC is reported in a 14-year-old boy who presented swelling of the right temporal region. Magnetic resonance imaging showed a destructive and expansile bone lesion on the right anterior temporal and orbital bone. The lesion was removed in total by the right temporal craniotomy and orbitozygomatic osteotomy. ABC was diagnosed in the pathologic examination. The patient had good recovery during the postoperative course. CONCLUSIONS: This report presents the diagnosis and imaging of an ABC in the temporal bone. This localization is very rare for ABC. Total excision, if feasible, is the ideal treatment.

Osteoporosis after renal transplantation: single center experience.

BACKGROUND: Osteoporosis is a major source of morbidity after renal transplantation. The aim of this retrospective study was to determine the independent influences of different parameters on bone mineral density (BMD) in various parts of the body after renal transplantation. METHODS: BMD was measured in 130 of 954 renal allograft recipients who underwent surgery between 1985 and 1999. RESULTS: Time since transplantation and cumulative prednisolone doses were significantly higher in patients who had osteoporosis of the lumbar vertebrae (P=0.06 and 0.034, respectively). Logistic regression analysis revealed that cumulative prednisolone dose was the only significant predictor of low vertebral BMD (P=0.02, r=0.33). For the neck of the femur, high blood urea nitrogen and low Mg levels were found to be the predictors of low bone density (P=0.002 and 0.04, respectively). Although parathyroid hormone levels were higher in femoral osteoporosis patients than in those not affected at this site, the difference was not statistically significant (P=0.294). Time since transplantation, cumulative prednisolone dose, and cyclosporine A dose were all found to have a major negative impact on BMD in the radius region (P=0.001, 0.000, 0.001, respectively). Regression analysis showed that cumulative prednisolone dose (P=0.0008, r=0.34), time since transplantation (P=0.005, r=0.27), body mass index (P=0.01, r=-0.21), male gender (P=0.02, r=-0.21), and age (P=0.04, r=0.16) all had major effects on radius BMD. In conclusion, the radius seems to be one of the major parts of the skeleton affected by factors introduced after renal transplantation.