Abstract: Aim: The aim of this study is to compare the usage of synthetic and autologous dura mater in terms of complication risk in 0-1-year-old children who were operated for meningocele and myelomeningocele. Material and Methods: This cross-sectional observational study was conducted with 44 children aged 0-1 years who were operated for meningocele and myelomeningocele in a university hospital neurosurgery clinic between November 2010 and December 2016. Patient data were extracted retrospectively from hospital records. The demographics and gestational and clinical features of the mothers and babies, and the need for secondary surgery and the presence of postoperative infection, necrosis, wound dehiscence, and/or neurological deficit were compared between the cases who synthetic dura mater was used in their surgery and those autologous dura was used in their surgery. Results: In total, 86.4% of the 44 infants were preterm, and the predominant neurological problem was plegia in the vast majority. While the defect was located in the lumbar region in more than half of them, myelomeningocele was detected in 77.3% of all cases. The median defect size detected in the patients was 20.0 cm2, primary closure was performed in 30 patients, Limberg flap procedure in 14 patients, however, autologous dura mater and synthetic dura mater were used equally in the patients. The defect size was larger in patients using synthetic dura, furthermore hydrocephalus was found more frequently in these patients. While primary closure was applied in all patients using autologous dura and in one third of the patients using synthetic dura, Limberg flap procedure was applied in two thirds of synthetic dura group. The need for secondary surgery developed more frequently in synthetic dura group, and all postoperative complications were observed more frequently in these patients. In addition, the need for secondary surgery and postoperative necrosis, wound dehiscence, and neurologic deficit are more frequent in patients who underwent Limber flap compared to primary closure. However, the need for secondary surgery and the risk of postoperative complications were similar between primary closure and Limberg flap procedures in synthetic dura group. Conclusion: Although the synthetic dura mater was used in more severe patients, it had a higher need for secondary surgery and a higher risk of complications compared to autologous dura. In patients using synthetic dura, on the other hand, primary closure and Limberg flap had similar efficacy and safety.
Spine fractures are most commonly observed among older people due to weak bones and irregular postures. These fractures of 10 lead to coccygodynia. Women are 5 times more prone to developing coccygodynia as compared to men. Initially, different painkillers, physiotherapy, and other non-surgical treatments are recommended to reduce the pain. However, in case of the failure of these treatments, a surgical procedure (named coccygectomy) is considered to remove the tailbone to achieve effective outcomes. The main aim of this study is to determine the effectiveness of coccygectomy in treating coccygodynia (after the failure of different non-surgical treatments) in the context of patients who were treated at Konya City Hospital neurosurgery department, Turkey. In this study, a total of 14 cases of coccygodynia treated with coccygectomy at Konya City Hospital were selected from the period of August 2020 and January 2022. These patients were given different treatments for 6 to 7 months before the operation. Therefore, due to the lack of positive outcomes, a coccygectomy was performed by a senior surgeon. Visual analogue scale was used to assess the pain of the patients after the surgery. Statistical Package for the Social Sciences was used for statistical analysis. The level of significance was set at P < .05. The results of this study showed that more women suffered from coccygodynia as compared to men. Most of the patients had Type I (35.7%) and Type IV (35.7%) coccyx. The visual analogue scale was reduced after the surgery (P < .0011), showing positive outcomes. Ten (71.4%) cases showed excellent outcomes, whereas only one (7.1%) case showed poor outcomes after the surgery, and wound infections were observed in two (14.2%) cases post-operatively. The results obtained from this study concluded that in case of failure of conservative non-surgical treatments for coccygodynia, coccygectomy has emerged as an effective surgical method which is recommended by various surgeons to reduce the pain by removing the tailbone. Additionally, only a few complications such as infection as a relevant concern after this type of surgery were observed, and most of the patients were satisfied with the outcomes and also recommended it to others.
Aim: This study aimed to evaluate the effects of tocilizumab (TCZ), a recombinant humanized, anti-human monoclonal antibody of the immunoglobulin G1k subclass, on vascular morphological changes, endothelial apoptosis, and the levels of pro-inflammatory and apoptotic cytokines, such as IL-6, tumor necrosis factor-alpha (TNF-α), caspase-3, Bcl-2 associated X-protein (BAX), and vascular endothelial growth factor (VEGF) in a rat SAH model. Material and Method: The rats were randomly assigned (animal study) to 4 groups KONÜDAM Experimental Animal Research Center, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey; 15/03/2019): (1) normal control (without SAH); (2) SAH (without treatment); (3) SAH treated with saline (SAH + Sal.); and (4) SAH treated with TCZ (SAH + Toc.). The tissues were measured using enzyme-linked immunosorbent assay (ELISA) kits. A series of brain and basilar artery sections were categorized into several subgroups for hematoxylin and eosin (H&E) staining, immunohistochemistry, and Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. Results: The levels of caspase, BAX, and IL-6 in the SAH + TOC group were significantly lower than in other groups. TCZ treatment significantly increased the lumen of the basilar artery compared with that in the SAH and SAH + SAL groups without treatment (p=0.002 and p=0.004 respectively). SAH increased the apoptotic index in the endothelium compared with TCZ treatment (p=0.027) groups. Conclusion: It can be concluded that TCZ is safe and effective for treating experimental SAH. The results reveal clearly experimental evidence for the potential clinical application of TCZ in SAH patients.
Background: The ubiquitin-proteasome pathway controls the monitoring and degradation of important proteins and is involved in several cellular processes, such as development, differentiation, and transcriptional regulation. Recent evidence has shown that ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1), a member of the deubiquitinating enzyme family that removes ubiquitin from protein substrates, is overexpressed in many types of cancer. Aim: This study thus examined the expression of UCH-L1 in human astrocytoma tissues. Material and methods: Formalin-fixed, paraffin-embedded astrocytoma samples were obtained from 40 patients, after which histopathological examination, typing, and grading were performed. The study group included 10 histologically normal brain tissues, which served as the control group, and 10 WHO grade II, 10 WHO grade III, and 10 WHO grade IV (glioblastoma) samples. Normal brain tissue samples were obtained from the histologically normal, non-tumoral portion of the pathology specimens. UCH-L1 expression was evaluated using quantitative reverse transcription-polymerase chain reaction and immunohistochemistry. Results: Astrocytoma tissues exhibited higher UCH-L1 expression compared to the control group. UCH-L1 overexpression increased significantly together with the increase in astrocytoma grades (from II to IV). Conclusion: UCH-L1 could be a good diagnostic and therapeutic marker for determining astrocytoma development and progression.
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