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    Cerebrospinal fluid and serum levels of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 in patients with severe head injury
    (Turkish Assoc Trauma Emergency Surgery, 2007) Sanus, Galip Zihni; Tanrıverdi, Taner; Coşkun, Abdurrahman; Hanımoğlu, Hakan; İş, Merih
    BACKGROUND The aim of this study is to present time course of insulin like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels in both cerebrospinal fluid (CSF) and serum of patients after severe head injury (SHI) and to compare with controls. METHODS Our trauma and control groups included 11 consecutive patients with isolated SHI and 9 patients with hydrocephalus (one with normotensive and eight with hydrocephalus due to aqueduct stenosis), respectively. Both serum and cerebrospinal fluid levels of IGF-1 and IGFBP-3 were measured during post-traumatic days and we compared the levels with controls. RESULTS Patients and controls showed undetectable levels of both IGF-1 and IGFBP-3 in their CSF. When considering serum levels, patients with SHI had always lower levels of both molecules than that of controls. CONCLUSION Administration of IGF-1 during acute, as well as chronic phase of severe head trauma may provide beneficial effects and may decrease both mortality and morbidity in humans with SHI.
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    Expression and cellular distribution of multidrug resistance-related proteins in patients with focal cortical dysplasia
    (W B Saunders Co Ltd, 2007) Ak, Hatil; Ay, Bahadır; Tanrıverdi, Taner; Sanus, Galip Zihni; İş, Merih; Öz, Büge
    Recent arouse of interest indicated that drug resistant proteins are markedly over-expressed in the epileptogenic tissue and they may be responsible for the one-third of the epileptic patients who were refractory to anti-epileptic drugs (AEDs). Since several AEDs may act as substrates for these drug resistant proteins, the enhanced function of such proteins may increase drug extrusion, resulting in inadequate response to drug therapy in patients with epilepsy. We studied expression of the muttidrug resistance protein 1 (MDR1) and muttidrug resistance-associated protein 1 (MRP1) in the epileptic tissues resected surgically in 28 patients with focal cortical dyspLasia (FCD) by immunohistochemistry. The results were compared with 10 normal necropsy brain tissues. Normal brain showed no MDR1 expression in neurons and astrocytes, while MRP1 expression was very weak, which were encountered in a few samples. MDR1 expression was mainly localized on the vascular endothelial cells. In contrast to normal brain, we found intense MDR1 and MRP1 expression in both neurons and reactive astrocytes in the vast majority of dysplastic tissues. The majority of the dysplastic neurons demonstrated moderate to strong MRP1 immunoreactivity. Endothelial cells showed both MDR1 and MRP1 expression in the majority of the specimens studied. Muttidrug transporters are over-expressed in the epiteptogenic zone in patients with FCD. These results are concordant with previous studies, in which over-expression of multidrug proteins were shown in epiteptogenic brain tissue in patients with FCD, that the over-expression of drug transport proteins in tissue from patients with refractory epilepsy may explain one possible mechanism for drug resistant in these pathologies. (c) 2007 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
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    High-sensitivity C-reactive protein levels in cerebrospinal fluid and serum in severe head injury: relationship to tumor necrosis factor-alpha and interleukin-6
    (Churchill Livingstone, 2007) İş, Merih; Coşkun, Abdurrahman; Sanus, Galip Zihni; Tanrıverdi, Taner; Kafadar, Ali Metin; Hanımoğlu, Hakan; Gezen, Ferruh
    Recent studies have demonstrated the role of high-sensitivity C-reactive protein (hsCRP) in inflammatory diseases; however, it is unclear whether this molecule has a role after severe head injury (SHI). Our aim was to evaluate the levels of hsCRP in both cerebrospinal fluid (CSF) and serum from patients after SHI. The study focused on 11 patients with SHI and evaluated CSF and serum levels of hsCRP, tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in a 10-day period following the head trauma. The values were compared with those from nine control patients, who had normal pressure hydrocephalus. In the CSF and serum of the patients after SHI HsCRP was found to be significantly higher, at all times, than in the controls; TNF-alpha and IL-6 levels were also higher in these patients. However, hsCRP levels did not correlate with either TNF-alpha or IL-6. TNF-alpha and IL-6 increased during the period immediately following the SHI and intrathecal levels were always higher than those of the serum. This study demonstrates for the first time that hsCRP reaches high levels in both CSF and serum in patients with SHI, and it may therefore be used as an inflammatory index. This finding suggests a need for further studies in this area, which are larger in scope than the present study.
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    Lack of association between the IL1A gene (-889) polymorphism and outcome after head injury
    (2006) Tanrıverdi, Taner; Uzan, Mustafa; Sanus, Galip Zihni; Baykara, Onur; iş, Merih
    Background: Interleukin (IL) 1 is a proinflammatory cytokine that has been identified as an important mediator of neurodegeneration induced by ischemia or traumatic brain injury. Accumulating evidence to date has suggested that the major cytokine contributing to neurodegeneration after head injury is IL-1? rather than IL-1?; however, there is no sufficient data regarding IL-1? in literature, and there may be an association between IL1A gene polymorphism and outcome after head injury. Methods: We performed a prospective clinical study and included a recruited series of 71 patients who had head injury and were admitted to our neurosurgical unit. Severity of initial injury was assessed by the Glasgow Coma Scale. Outcome at 6 months after injury was assessed by means of the Glasgow Outcome Score. Interleukin 1? genotypes were determined from blood samples by standard methods. Results: Of 40 patients with IL1A*2, 18 (45%) had an unfavorable outcome (dead, vegetative state, or severe disability) compared with 7 (22.5%) of 31 without IL1A*2 (P = .08). Conclusion: Our findings show that there is no genetic association between IL1A gene polymorphism and outcome after head injury. Further clinical studies should be designed to confirm and further evaluate these findings. © 2006 Elsevier Inc. All rights reserved.
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    Prolonged elevation of magnesium in the cerebrospinal fluid of patients with severe head injury
    (Taylor & Francis Ltd, 2007) Kafadar, Ali Metin; Sanus, Galip Zihni; İş, Merih; Coşkun, Abdurrahman; Tanrıverdi, Taner; Hanımoğlu, Hakan; Uzan, Mustafa
    Objectives: Several works have investigated the role of serum magnesium (Mg) concentrations in traumatic brain injury. However, there is restricted information about cerebrospinal fluid (CSF) levels of Mg in patients with severe head injury (SHI). We assessed the changes of Mg concentrations in CSF and serum in patients with SHI during the first 10 days after the trauma. Methods: Eleven patients with SHI were studied prospectively on days 1-3, 5 and 10 with analysis of CSF and serum levels of Mg and Ca. The control group consisted of nine patients with hydrocephalus. Results: CSF levels of Mg were significantly higher in patients than controls in the corresponding time points except on days 5 and 10 of trauma. The CSF Mg levels tended to decrease and the highest level was found on day 1 after trauma (2.81 +/- 0.65 mg/dl). In the control group, the CSF level of Mg was 1.95 +/- 0.66 mg/dl. No significant difference can be detected between controls and patients regarding serum Mg and Ca levels. In addition, significantly higher values of Ca in the CSF were observed in all time points after trauma in patients with SHI than in the controls. There was no correlation between the CSF and serum levels of Mg and Ca levels. Discussion: Our study demonstrates that in patients with SHI, CSF levels of Mg and Ca are elevated during the whole observation period. Further works should be designed in order to show the role and importance of CSF levels of ionized Mg in outcome of patients with SHI.