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Öğe Bilateral epidural hematoma(Walter De Gruyter & Co, 2000) Görgülü, A; Çobanoglu, S; Armagan, S; Karabagli, H; Tevrüz, MBilateral epidural hematomas are very rare and are associated with high mortality. The purpose of this study is to identify the clinical features, mechanisms, and outcomes of bilateral epidural hematomas. This report considers 19 cases of bilateral epidural hematoma hospitalized between 1987 and 1997. All of the cases, with the exception of three, were diagnosed within the first 6 h. The neurologic evaluations on admission and during hospital stay were based on the Glasgow Coma Scale. Hematomas were determined by CT scans in all cases. The patients were evaluated using the Glasgow Outcome Scale after 6 months. In 13 patients, the bilateral epidural hematoma was in the midline. In six patients, hematomas were at different locations on either side. Surgical approach was chosen as the primary treatment modality in 18 patients. One was treated conservatively. The mortality rate was 15.7% in this series. With the widespread use of CT scan, diagnosis before deterioration of the neurological status affects the results of surgery and prognosis or even presents the possibility of a conservative treatment.Öğe The effect of aprotinin on extraneural scarring in peripheral nerve surgery(Springer-Verlag Wien, 1998) Görgülü, A; Imer, M; Simsek, O; Sencer, A; Kutlu, K; Cobanoglu, SExtraneural scarring is one of the factors negatively influencing the result of peripheral nerve surgery. Many organic materials have been used to prevent fibrosis. The effect of aprotinin on peripheral nerve scarring in rats was investigated in this study. Three types of surgical intervention were carried out; namely external neurolysis (I), abrasive injury (II), and anastomosis (III). The coded samples which consisted of pure collagen fibers soaked with aprotinin or phosphate-buffered saline were applied around the left sciatic nerves of rats whereas only sham operations were performed on the right sciatic nerves. Animals were sacrificed after 4 or 6 weeks. Neurological examination, gross evaluation of extraneural fibrosis, and histological study were undertaken. The results have demonstrated that aprotinin is a promising agent in the prevention of extraneural scarring.Öğe The effect of epidural free fat graft on the outcome of lumbar disc surgery(Springer, 2004) Görgülü, A; Simsek, O; Çobanoglu, S; Imer, M; Parsak, TNumerous materials have been used to prevent epidural scar tissue after lumbar disc surgery. Free fat grafts are common both experimentally and clinically, but there is some doubt about their protection against fibrosis, and some complications have been reported. In this prospective study, the usefulness of free fat grafts during lumbar disc surgery was evaluated. Ninety-nine patients who had undergone operation due to lumbar disc herniation were divided in two groups: those with implantation of free fat grafts (group A) and those without (group B). Outcome was evaluated at a mean of 2.6 years postoperatively according to the following criteria: visual analog scale for back and leg pain, Hannover Questionnaire on activities of daily living, reflex findings, sensory and motor deficits, consumption of analgesics, walking distance, straight leg raising test, and clinical examination. The outcome variables showed no significant differences between the two groups (P>0.05). This study suggests that the use of free fat grafts during lumbar disc surgery was clinically ineffective.Öğe The effect of low-dose external beam radiation on extraneural scarring after peripheral nerve surgery in rats(Lippincott Williams & Wilkins, 2003) Görgülü, A; Uzal, C; Doganay, L; Imer, M; Eliuz, K; Çobanoglu, SOBJECTIVE: Scar tissue is an inevitable result of peripheral nerve surgery. A variety of substances have been used to prevent epineurial scarring. In this study, the effect of low-dose radiation therapy on epineurial scarring was investigated. METHODS: Seventy-eight male Sprague-Dawley rats were studied. A total of 60 rats were subjected to one of three types of surgical procedure on the sciatic nerve, as follows: Procedure 1, external neurolysis (n = 20); Procedure 2, abrasive injury (n = 20); and Procedure 3, anastomosis (n = 20). On the left sciatic nerves, 700 cGy external beam radiation was administered 24 hours after surgery, and the right sciatic nerves served as a control group (surgery only). Eighteen animals without surgical intervention were used to establish the fibrotic effect of radiotherapy on normal nerves. A neurological examination was performed weekly. Six weeks after surgery, the extent of extraneural scarring was examined by gross microdissection by means of a numerical grading scheme and histological analysis. Cellular density and surface measurements of scar tissue were also evaluated. RESULTS: The dissection around the nerve was easier in rats treated with low-dose radiation compared with the control group. Furthermore, grading scores in both nerve adherence and nerve separability were significantly lower in treated nerves than in the control group (P less than or equal to 0.05). Low-dose radiotherapy decreased the scores of cellular density and surface measurement of scar tissue (P less than or equal to 0.05). In normal nerves, radio? therapy did not produce any fibrotic effects and the density of fibroblasts/fibrocytes was also very low. CONCLUSION: In the case of surgery or local trauma to peripheral nerve, the use of low-dose radiation therapy may be a safe method of limiting postoperative epineurial scar formation.Öğe The effects of memantine on lipid peroxidation following closed-head trauma in rats(Springer, 2005) Özsüer, H; Görgülü, A; Kiris, T; Çobanoglu, SMemantine is an uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist. Unlike other NMDA antagonists, it has been used clinically for years for the treatment of Parkinson's disease, spasticity, and dementia without serious side effects. We aimed to investigate the therapeutic efficacy of memantine on a closed head trauma model. A total of 132 adult male Sprague-Dawley rats were randomly divided into four groups: sham-operated, control (closed head trauma), sham-vehicle (closed head trauma + saline), treatment (closed head trauma + memantine, 10 mg/kg, i.p.). A cranial impact was delivered to the skull, just in front of the coronal suture, over the left hemisphere, from the height of 7 cm. Saline or memantine were applied 15 min after trauma. Rats were euthanased 0.5, 1, 2, 6, 24, 48 h after trauma. Brain tissue samples were taken 5 mm away from the left frontal pole and also from the corresponding point of the contralateral hemispheres. Malondialdehyde activity (MDA) was considered to reflect the degree of lipid peroxidation. The MDA levels continued to increase for the first 2 h after the injury, then started to decrease gradually. Memantine treatment significantly reduced lipid peroxidation levels in the treatment group compared with other groups (P < 0.01). The findings of the present study indicate that memantine provides beneficial effects after closed head trauma in rats.Öğe Immunoglobulin concentration in human intervertebral disc herniations(Springer Wien, 1999) Görgülü, A; Yalniz, E; Demir, M; Çobanoglu, SThe pathogenesis of low back pain and sciatica is poorly understood. In this prospective study, we determined local production of IgM and IgG in nucleus pulposus, serum and cerebrospinal fluid by rate nephelometry in patients with herniated lumbar disc (n = 20). Patients operated for anterior stabilizations because of fresh fracture in the lumbar or thoracolumbar spine and scoliosis constituted the control group (n = 10). In the patients with lumbar disc herniation, the ratio IgM(NP)/IgM(S) x 10(3), IgG(CSF)/IgG(S) x 10(3), and IgM(CSF)/IgM, x 103 was significantly increased when compared with control group values (p < 0.001). We found a close relationship of the ratio IgM(NP)/IgM(S) x 10(3) between low SLR (<40 degrees) (p = 0.02) and the duration of sciatric pain less than 2 months (p = 0.002). The results indicate a connection between the clinical findings and IgM production in nucleus pulposus. This fact may contribute in some way to the inflammatory origin of sciatica.Öğe Protective effect of the N-methyl-D-aspartate receptor antagonists, MK-801 and CPP on cold-induced brain oedema(Springer Wien, 1999) Görgülü, A; Kiris, T; Ünal, F; Türkoglu, Ü; Küçük, M; Çobanoglu, SCold injury model in rat was used to determine the effect of treatment with the competitive NMDA antagonists CPP and the noncompetitive NMDA antagonist MK-801 in cerebral oedema. MK-801 was applied in doses of 1 mg/kg and CPP of 10 mg/kg, 15 min. after injury. Control animals received 1 mi saline at the same time interval after injury. Tissue samples from the core and periphery of the lesion of the injured hemisphere and from the symmetrical location of the undamaged contralateral hemisphere were removed 24 hours after injury. Blood brain barrier permeability, brain water content and tissue specific gravity values were determined. MK-801 was found beneficial for reducing the oedema and restore the blood brain barrier permeability at the penumbral zone of the lesion, whereas both MK-801 and CPP were found ineffective for prevention of oedema accumulation at the core of the lesion.Öğe Reduction of edema and infarction by memantine and MK-801 after focal cerebral ischaemia and reperfusion in rat(Springer-Verlag Wien, 2000) Görgülü, A; Kins, T; Çobanoglu, S; Ünal, F; Izgi, N; Yanik, B; Küçük, MN-methyl-D-aspartate (NMDA) receptor antagonists have been found to be protective after cerebral ischemia. However most of these drugs have limited value as neuroprotectives in clinical therapy because of their side effects. Memantine is a noncompetitive NMDA receptor antagonist and it has been used for the treatment of various cerebral disorders with relatively few side effects. We investigated the beneficial effects of Memantine and compared its effect with MK-801 in a temporary focal cerebral ischemia model. As cerebral ischemia model three hours middle cerebral artery occlusion (MCAO) with intraluminal thread and three hours reperfusion was used. 78 male Sprague-Dawley rats were divided into three groups as follows: Control (Saline), treatment 1 (MK-801), and treatment 2 (Memantine) groups. In the treated groups, 15 minutes after MCAO, MK-801 and Memantine were administered in amounts of 1 mg/kg and 10 mg/kg intraperitoneally respectively. After a 3 hour period of reperfusion, the animals were examined for neurological deficits and then killed. The following values were measured; cerebral water content, blood brain barrier (BBB) permeability at the core and periphery of the ischemic hemisphere and contralateral hemisphere and infarct volumes. The severity of neurological deficit (p < 0.001) and infarct volume (p < 0.001) was reduced in both Memantine and MK-801 treated groups compared with saline treated groups. Memantine attenuated brain edema formation and BBB permeability at the periphery (p < 0.01), MK-801 both at the core (p < 0.05) and the periphery (p < 0.01) of the ischemia. These results demonstrated that the NMDA receptor antagonists Memantine and MK-801 were neuroprotective when given 15 min after MCAO in temporary focal cerebral ischemia.Öğe Superoxide dismutase activity and the effect of N-methly-D-aspartate antagonists on lipid peroxidation in the early phase of cold injury(Springer, 1999) Kiris, T; Görgülü, A; Ünal, F; Türkoglu, Ü; Çobanoglu, S; Ekuklu, GFree radicals, lipid peroxidation and excitatory amino acids have been implicated in the secondary mechanisms of traumatic brain injury. We used the cold injury model in rats to assess the endogenous activity of the protective enzyme superoxide dismutase (SOD) and the lipid peroxidation level in the contused tissue at an early phase of injury. Furthermore, we treated the rats with two different N-methyl-D-aspartate receptor antagonists, namely MK-801 and CPP, and evaluated their effect on lipid peroxidation in the contused tissue. Rats were divided into four groups: sham, control, treatment 1 and treatment 2 groups (n = 16 for each group). Thirty and 60 min after craniectomy or injury, tissue samples were removed. SOD activity didn't change in this period. However, lipid peroxidation in terms of malondialdehyde (MDA) amount showed a significant increase at 60 min. Fifteen minutes after injury, MK-801 (1 mg/kg), CPP (10 mg/kg) or saline (1 ml) were applied intraperitoneally in treatment 1, treatment 2 and the control groups, Treatment with MK-801 attenuated MDA levels, whereas treatment with CPP did not. The protective effect of MK-801 achieved statistical significance. These results demonstrate that SOD activity does not change in the Parry period of cold injury. Moreover, these results show that lipid peroxidation increases after 60 min of cold injury, and treatment with MK-801 15 min after injury can prevent this elevation.Öğe Superoxide dismutase activity and the effects of NBQX and CPP on lipid peroxidation in experimental spinal cord injury(Springer Verlag, 2000) Görgülü, A; Kiris, T; Ünal, F; Turkoglu, Ü; Küçük, M; Çobanoglu, SThe endogenous activity of the neuroprotective enzyme superoxide dismutase (SOD) and the amount of lipid peroxidation in the early phase of experimental spinal cord injury, together with the effects of N-methyl-D-aspartate (NMDA) antagonist CPP and non-NMDA antagonist NBQX on lipid peroxidation were evaluated. The clip compression model was used for the production of a standardized spinal cord trauma. SOD activity and malondialdehyde (MDA) levels - as an indicator of lipid peroxidation - were determined in the injured segment of the spinal cord 30 and 60 min after injury. SOD activity did not change in this period, whereas MDA levels at 30 and 60 min after trauma were significantly elevated. Intrathecal administration of CPP or NBQX 15 min after injury produced statistically significant reductions in MDA elevation 60 min after injury. NBQX was found to be more effective than CPP. These results demonstrated that intrathecal local application of excitatory amino acid receptor antagonists can protect the spinal cord from secondary damage caused by the generation of lipid peroxides in experimental spinal cord injury.
