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Öğe Deneysel hafif kafa travması sonrasında juvenil ratlarda nöromotor fonksiyon, kognitif fonksiyon ve iyileşme süreci üzerine vortıoxetıne'in etkilerinin araştırılması(Bolu Abant İzzet Baysal Üniversitesi, 2020) Cancan, Seçkin Emre; Gezici, Ali RızaKafa travması önemli sağlık sorunlarından birisidir. Literatürde kafa travmasına bağlı başvurular incelendiğinde vakaların %75-90'ını hafif kafa travmalarının oluşturduğu bildirilmektedir. Özellikle genç nüfus içinde kafa travmaları önemli bir engellilik ve ölüm nedenidir; tüm ölümlerin neredeyse %30'undan sorumludur. Hafif kafa travması sonrası ortaya çıkabilecek sekeller içinde baş ağrısı, uyku bozuklukları, kognitif fonksiyon bozuklukları, anksiete ve duygu-durum değişiklikleri sayılabilir. Kafa travması hafif ve bulgular geçici olsa bile travmanın yarattığı hasar jüvenil bireylerde kognitif fonksiyonları uzun dönemde de etkileyebilecek sorunlara neden olabilir. Çalışmamızda vortioxetine etken maddesinin; jüvenil ratların hipokampus ve frontal kortekslerindeki serotonin ve beyin kaynaklı nörotropik faktör seviyelerine etkisi, apoptoz miktarları, hücresel rejenerasyon ve nörogenez üzerine etkileri araştırılmıştır; eş zamanlı olarak klinik yansımaları incelemek için motor ve kognitif beceriler değerlendirilmiştir. Çalışmamız jüvenil 36 ratla, 3 grupla (kontrol, sham, deney), oluşturulan hafif kafa travması modeli sonrasında Barnes Maze, Tapered Beam Walking verileri ve sakrifikasyon sonrasında elde edilen beyin dokusu örneklerinde ELISA, immünhistokimyasal boyamalar ve histolojik değerlendirmelerin neticeleri üzerinden yapılmıştır. Deney grubu ratlara uygun dozda vortioxetine, sham grubuna salin uygulanmıştır, kontrol grubuna herhangi bir girişim yapılmamıştır. Vortioxetine'in deney grubunda hipokampal beyin kaynaklı nörotropik faktörü artırdığı (p=0.014); hipokampus ve kortekste apoptozu azalttığı (p=0.002; p=0.014); ödem, kanama ve enflamasyonu azalttığı (p<0.001; p<0.001; p=0.025); erken dönemde ve çalışma boyunca deney grubundaki arka ayaklarda kayma sayısını azalttığı (p=0.047; p=0.016); süre (p=0.010), erken dönem ortalama hız (p=0.021), geçilen kadran sayısı (p=0.045), yol verimliliği (p=0.024) gibi parametrelerde olumlu sonuçları olduğu görülmüştür. Vortioxetine hafif kafa travması sonrasında jüvenil ratlarda motor koordinasyon ve fonksiyonun daha hızlı geri kazanımında, kognitif becerilerin korunmasında etkili bulunmuştur.Öğe Effects of minimally invasive decompression surgery on quality of life in older patients with spinal stenosis(Elsevier, 2015) Dağıstan, Yaşar; Dağıstan, Emine; Gezici, Ali Riza; Cancan, Seçkin Emre; Bilgi, Murat; Çakır, UğurObjectives: Lumbar spinal stenosis (LSS) in the elderly may result in a progressive narrowing of the spinal canal leading to compression of nerve roots in some individuals. The aim of this study was to evaluate the quality of life changes after minimally invasive decompression surgery without instrumentation in geriatric patients with lumbar spinal stenosis. Patients and methods: This prospective clinical study included 37 patients with American Society of Anes-thesiologists (ASA) II-III scores between the ages of 65 and 86 years, who were planned to undergo surgical intervention due to LSS. All patients had neurogenic claudication and pain in the hips, thighs, and legs. Measurements of the osseous spinal canal were evaluated by magnetic resonance imaging. Before the surgical intervention, patient demographics and clinical characteristics were recorded. The Short-Form-36 test, the Oswestry Disability Index, and the Visual Analog Scale were applied to all patients preoperatively and two years postoperatively. Results: In the study population, 11 patients had single level of spinal stenosis, 20 patients had two levels of spinal stenosis, and six patients had three levels of spinal stenosis. There were significant differences between the preoperative and postoperative ODI and VAS scores. There was a statistically significant difference in all subscales of the SF-36 test with the exception of general health scores. Three patients who had dural damage during the operation were treated with bio glue. Also, no patients were recorded to have any neurological deficits and root injuries postoperatively. Conclusion: Minimally invasive decompression surgery, without instrumentation, for lumbar spinal stenosis in geriatric patients significantly improves the patients' quality of life. (C) 2015 Elsevier B.V. All rights reserved.Öğe Role of the optic nerve sheath diameter in the assessment of the effectiveness of decompressive surgery after malignant middle cerebral artery infarction(Assoc Arquivos Neuro- Psiquiatria, 2022) Şenol, Özgür; Coşgun, Zeliha; Dağıstan, Emine; Demiryürek, Bekir Enes; Cancan, Seçkin EmreBackground After a case of stroke, intracranial pressure (ICP) must be measured and monitored, and the gold standard method for that is through an invasive technique using an intraventricular or intraparenchymal device. However, The ICP can also be assessed through a non-invasive method, comprised of the measurement of the optic nerve sheath diameter (ONSD) through ultrasound (US). Objective To evaluate the ICP of patients who underwent wide decompressive craniectomy after middle cerebral artery (MCA) infarction via preoperative and postoperative ONSD measurements. Methods A total of 17 patients, aged between 34 and 70 years, diagnosed with malignant MCA infarction with radiological edema and mid-line shift, who underwent decompressive surgery, were eligible. From the records, we collected data on age, sex, preoperative and postoperative Glasgow Coma Scale (GCS) scores, National Institutes of Health Stroke Scale (NIHSS) score, the degree of disability in the preoperative period and three months postoperatively through the scores on the Modified Rankin Scale (MRS), and the preoperative and postoperative midline shift measured by computed tomography (CT) scans of the brain. Results Preoperatively, the mean GCS score was of 8 (range: 7.7-9.2), whereas it was found to be of 12 (range 10-14) on the first postoperative day ( p = 0.001). The mean preoperative NIHSS score was of 21.36 +/- 2.70 and, on the first postoperative day, it was of 5.30 +/- 0.75 ( p < 0.001). As for the midline shift, the mean preoperative value was of 1.33 +/- 0.75 cm, and, on the first postoperative day, 0.36 +/- 0.40 cm ( p < 0.001). And, regarding the ONSD, the mean preoperative measurement was of 5.5 +/- 0.1 mm, and, on the first postoperative day, it was of 5 +/- 0.9 mm ( p < 0.001). Conclusion The ocular US measurement of the ONSD for the preoperative and postoperative monitoring of the ICP seems to be a practical and useful method.Öğe The therapeutic effects of cyclosporin-A on experimental spinal cord injury.(Scientific Publishers India, 2017) Gezici, Ali Rıza; Kılıç, Güven; Fırat, Tülin; Cancan, Seçkin Emre; Kükner, AyselBackground: According to the experiments, neutrophils and microglial cells are the first to attend the early phase of events in inflammatory response to SCI. Those pilot cells are seen in the first 12-24 hours and disappear about 3-5 days. The neutrophil accumulation and activation are steered by many cytokines such as TNF-alpha, IL-1 and IL-6. Neutrophils do accompany to the modulation of secondary injury mechanisms via neutrophil proteases and reactive oxygen molecules. When those processes are taken into account, depletion of neutrophils or depression of their functions may derive neuro-protection and neurological healing. Purpose: To investigate the therapeutic and neuroprotective effects of Cyclosporin-A (CSA) on recovery processes using clinical and histopathological tests, which has not been used very frequently in clip compression spinal cord injury (SCI) models. Material and methods: Twenty-four Spraque-Dawley rats were divided into three groups: group 1 [Sham-control, n=8], group 2 [SCI+2 mL saline intramuscular (i.m.), n=8], group 3 [SCI+5 mg/kg CSA (i.p.) 1 h after SCI and for the following three days, n=8]. Rats were evaluated 1st, 3rd, 5th and 10th days after SCI, clinically by Drummond and Moore scale and under light microscopy and by TUNEL test; after scarification on 10th day. Results: Clinical and histopathological results of treatment group were found significantly better than the results of the trauma group. Conclusion: CSA can depress apoptosis and necrosis rates in a statistically significant manner and carry out the statistical difference in clinical results.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.Öğe Upper cervical spinal injuries in elderly patients: age-specific treatment.(Allied Acad, 2017) Gezici, Ali Rıza; Dağıstan, Yaşar; Cancan, Seçkin Emre; Sarı, Kutlu; Kaya, Necdet SelimIncidence 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.
