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Öğe Could red cell distribution width and mean platelet volume be a predictor for lumbar disc hernias?(Literatura Medica, 2016) Dağıstan, Yaşar; Dağıstan, Emine; Gezici, Ali Rıza; Halıcıoğlu, Sıdıka; Akar, Semih; Özkan, Nezih; Aktaş, GülaliBackground Lumbar disc herniation (LDH) causes major disabilities worldwide. Several studies in the literature had reported the correlation between radiculopathy and inflammatory markers. Mean platelet volume (MPV), red cell distribution width (RDW) and neutrophil to lymphocyte (N/L) ratio are parameters of hemogram which have been found to be associated with inflammatory conditions. Purpose - Since inflammation has an important role in lumbar disc hernias, and RDW, MPV and N/L ratio are also known to be in correlation with inflammation, we have investigated these parameters of the patients with lumbar disc hernias and compared them with the results of the healthy subjects. Methods - Our study group was composed of patients with lumbar disc hernia, whereas the control group was consisted of healthy volunteers whom visited our outpatient clinics for a routine check-up. Patient characteristics and hemogram parameters of the study cohort were obtained from computerized database system of our institution. SPSS software (SPSS 15.0 for Windows, Chicago, IL, USA) was used for the analysis. Results - There was no significant difference between study and control groups in terms of WBC, neutrophil count, lymphocyte count, neu\lym ratio, Hb, Htc, MCV, and PLT levels (all p>0.05). RDW was significantly increased in study group [15.6 (12.3-22.5)] when compared to control group [14.5(11.9-16.3)] (p=0.004). And MPV in the study group [9.25 (6.38-14.5)] was also significantly increased in comparison to the control subjects [8.8 (6-10.1)] (p=0.013). Discussion In this retrospective study, we found that, RDW and MPV values in hemograms were increased in patients with lumbar disc herniation when compared to the control group. Conclusions - We suggest that, elevated RDW and MPV may help physicians in decision taking to order radiological imagings in patients with symptoms which can be associated with possible LDH diagnosis. However, for the sake of precision, prospective studies with larger populations are needed.Öğe Deneysel rat omuriliği yaralanma modelinde methotrexat-etanercept kombinasyonunun tedavi edici ve koruyucu etkilerinin değerlendirilmesi(Bolu Abant İzzet Baysal Üniversitesi, 2014) Akar, Semih; Gezici, Ali RızaGiriş: Travmatik omurilik yaralanması (TOY) ani ve beklenmedik şekilde oluşan; son derece yıkıcı, sakatlayıcı; kişisel ve toplumsal açıdan yüksek maliyetlere; psikolojik ve sosyolojik sorunlara neden olan bir olay olarak tanımlanabilir. Gelişen tıbbi bakım, morbidite ve mortaliteyi iyileştirmiş olmasına rağmen, nöronal hasarın sınırlanması ve rejenerasyonun uyarılması amacıyla yapılan farmakoterapideki gelişmeler ise hala sınırlıdır. Preklinik çalışmalarda başarılı tedavi modalitelerinin çoğunun, klinik çalışmalarda sınırlı başarı elde etme nedenlerinden birisi, primer mekanik yaralanmanın tetiklediği sekonder dejeneratif yanıtın karmaşıklığıdır. Çünkü birçok monoterapi sekonder yaralanma mekanizmasının yalnızca bir aşamasını etkilemektedir. Oysa başarılı tedavi bu mekanizmanın birçok aşamasında etkili olmalıdır. Bu nedenle kombine tedavi uygulamaları klinik ve deneysel bazda daha öncelikli düşünülmeye başlanmıştır. Bu çalışma SKY'ında Etanersept+Methorexat(MTX) kombinasyonunun eş zamanlı kullanımının sinerjik bir etki yaratıp yaratmadığını anlamak için gerçekleştirilmiştir. Methot: Bu çalışmada klip kompresyon yöntemi kullanılarak oluşturulan omurilik yaralanmaları histolojik(Luxol fast hematoxilen-eozin ve TUNEL boyama yöntemleri) ve nörolojik muayene yöntemleri ( Eğik düzlem ve motor skorlama) kullanılarak Etanercept, methotrexat ve etanercept+methotrexat kombinasyonlarının ikincil hasar üzerindeki koruyucu ve tedavi edici etkinlikleri araştırıldı. Çalışmada 30 adet sprague Dawley cinsi dişi erişkin rat kullanıldı. Anesteziyi takiben T7-9 (torakal) mesafesinden yapılan cilt insizyonu ve paravertebral adaleler sıyrıldı. Grup 1(kontrol), grup 2 (laminektomi+kord basısı),grup 3 (laminektomi+kord basısı+etanercept), grup 4 (laminektomi+kord basısı+methotrexat), grup 5 (laminektomi+kord basısı+etanercept+methotrexat) verilen 6'şar rattan oluşan toplam 5 grup oluşturuldu. Deneklerin 1, 3, 5 ve 10. günlerde eğik düzlem ve motor skorları değerlendirildi. Histopatolojik değerlendirme için 10. gün sakrifiye edildiler. Bulgular: Her iki monoterapi grubunun travma grubuna göre klinik bulgularda istatistiksel anlamda belirgin düzelme ve buna uyumlu şekilde histolojik bulgularda istatistiksel anlamda nekroz ve apoptozis oranlarında belirgin baskılanma sağlanmıştır. Her iki monoterapi grubunun karşılaştırmalarında klinik ve histolojik bulgulara göre aralarında istatistiksel anlamda farklılığın olmadığı, ancak etanercept lehine kısmi bir farklılığın olduğu görülmüştür. Kombine terapi grubunun travma grubu ile karşılaştırılmasında klinik bulgular ve apoptozis açısından istatistiksel anlamda kombine tedavi lehine; mono terapiler ile karşılaştırılmasında ise kombine tedavinin histolojik (nekroz ve apoptozisin baskılanması) olarak istatistiksel anlamda monoterapi gruplarına üstünlük sağlamasına karşın klinik anlamda bu farklılığın görülmediği ortaya konmuştur. Sonuç: Gerek çalışmamızdaki denek sayısının; gerekse literatürde yapılan çalışma sayısının çok sınırlı olması methotrexat+etanercept kombinasyonunun etkilerinin net olarak ortaya konmasına engel olmaktadır. Bu nedenle daha fazla sayıda deneysel ve klinik çalışmanın yapılması gereklidir.Öğe The therapeutic effects of etanercept-methotrexate combination on experimental spinal cord injury(Scientific Publishers of India, 2017) Gezici, Ali Riza; Akar, Semih; Firat, Tulin; Dagistan, Yasar; Cancan, Seckin Emre; Kukner, Aysel; Ozkan, NezihBackground: Experimental studies have demonstrated that neurons keep dying in an unrecoverable and non-regenerative pattern in following hours after primary mechanical injury to spinal cord. The cascade of events which is called secondary injury is composed of vascular impairment, oedema, ischemia, inflammation, exotoxicity, electrolyte imbalance, lipid peroxidation, free radicals, necrosis and apoptotic cell death. Aims: With clinical and histopathological tests, this study investigated the therapeutic effects of etanercept-methotrexate combination which is an option in mono-therapy resistant rheumatological diseases; but this combination has not been used on recovery processes in clip compression Spinal Cord Injury (SCI) model yet. Study design: Forty Spraque-Dawley rats were divided into five groups: group 1 (Sham-control), group 2 (SCI+2 ml saline intramuscular), group 3 (SCI+1.25 mg/kg etanercept), group 4 (SCI+0.5 mg/kg methotrexate) and group 5 (SCI+1.25 mg/kg etanercept+0.5 mg/kg methotrexate). Methods: Rats were evaluated 1st, 3rd, 5th and 10th days after SCI, clinically by Drummond and Moore scale, under light microscopy and by Tunel test; after sacrification on 10th day. Results: Clinical and histopathological results of all treatment groups were found significantly better than the results of the trauma group; also no superiority in the monotherapy groups, over each other, was noted. Conclusion: Combined-treatment group had a statistically significant better outcome in preventing apoptosis, but there was no difference according to the clinical results. © 2017, Scientific Publishers of India. All rights reserved.Öğe The therapeutic effects of etanercept-methotrexate combination on experimental spinal cord injury.(Allied Acad, 2017) Gezici, Ali Rıza; Akar, Semih; Fırat, Tülin; Dağıstan, Yaşar; Cancan, Seçkin EmreBackground: Experimental studies have demonstrated that neurons keep dying in an unrecoverable and non-regenerative pattern in following hours after primary mechanical injury to spinal cord. The cascade of events which is called secondary injury is composed of vascular impairment, oedema, ischemia, inflammation, exotoxicity, electrolyte imbalance, lipid peroxidation, free radicals, necrosis and apoptotic cell death. Aims: With clinical and histopathological tests, this study investigated the therapeutic effects of etanercept-methotrexate combination which is an option in mono-therapy resistant rheumatological diseases; but this combination has not been used on recovery processes in clip compression Spinal Cord Injury (SCI) model yet. Study design: Forty Spraque-Dawley rats were divided into five groups: group 1 (Sham-control), group 2 (SCI+2 ml saline intramuscular), group 3 (SCI+1.25 mg/kg etanercept), group 4 (SCI+0.5 mg/kg methotrexate) and group 5 (SCI+1.25 mg/kg etanercept+0.5 mg/kg methotrexate). Methods: Rats were evaluated 1st, 3rd, 5th and 10th days after SCI, clinically by Drummond and Moore scale, under light microscopy and by Tunel test; after sacrification on 10th day. Results: Clinical and histopathological results of all treatment groups were found significantly better than the results of the trauma group; also no superiority in the monotherapy groups, over each other, was noted. Conclusion: Combined-treatment group had a statistically significant better outcome in preventing apoptosis, but there was no difference according to the clinical results.Öğe Upper cervical spinal injuries in elderly patients: Age-specific treatment(Scientific Publishers of India, 2017) Gezici, Ali Rıza; Dagistan, Yasar; Cancan, Seçkin Emre; Sarı, Kutlu; Kaya, Necdet Selim; Kılıç, Güven; Akar, SemihIncidence of upper cervical vertebra injuries in elder population augments in accordance with the increase in mean life expectancy of the general population. These injuries can be easily misdiagnosed since they can be caused by low-accelerated traumas due to the osteo-degenerative changes in elderly patients, and with generally no neurological findings. Odontoid fractures are the most common among these injuries. Treatment algorithms of odontoid fractures are not still well established because of preexisted co-morbidities and high rates of morbidity and mortality in older individuals. We have retrospectively evaluated 16 cases admitted to our clinic in last 3 years, which were older than 65 years of age and which have been diagnosed with C2 fractures. In 13 of these cases (81.3%) odontoid fractures (10 cases with type II and 3 cases with type III), in 2 cases (12.5%) lateral mass fractures and 1 pars interarticularis fracture were identified. 14 of the patients (87.5%) were treated with medical corsets (7 Halo vests, 7 Minerva braces) and 2 patients (12.5%) had undergone surgery. All patients who had rigid cervical immobilization (RCI) were discharged in cured conditions whereas 2 patients, who were treated with surgical intervention, had died in early post-operative period. In patients with RCI bone fusion rate was 63.6% and recovery with stable fibrosis rate was 36.4% for odontoid fractures. At the end of the medical corset application period, all patients were checked with dynamic X-ray imaging and in an unrelated manner to the bone fusion rates no instability, greater than 1 mm, was determined. In the mean follow-up period of 30 months, no complications were seen after the medical corset application for stabilizations. Therefore, we have the conclusion that in patients from the older population, with no certain indications for surgery, a suitable RCI should be tried at first, and recovery with a stable fibrosis can be adequate for this patient group. © 2017, Scientific Publishers of India. All rights reserved.
