Spinal cord stimulation in failed back surgery

Objective: Spinal cord stimulation is used for treating failed back surgery syndrome, chronic arachnoiditis, peripheral neuropathies, postamputation phantom pain, complex regional pain syndrome and pain secondary to spinal cord injury. In this study we present 7 cases with intractable neuropathic radicular pain which developed following spine surgery. Material and Methods: Spinal cord stimulation was applied to 7 (3male/4 female) patients who had failed back surgery syndrome and pain resistant to medical and invasive methods, with the council decision, which included neurosurgery, neurology, and psychiatry. One week stimulation trial was applied to all cases. Results:The mean age of the patients was 54.85±7.64 years. The mean of pain intensity in Visual Analog Scale was 8.71±0.74 at preoperative status and post operative pain intensity was 2.27±0.67 at 6 months. Pain intensity significantly decreases after spinal cord stimulation (p=0.000). One of the three cases who had unsuccessful trial period received morphine pump implantation, and percutaneous lumbar sympathectomy was applied to another one. One case who received permanent implantation was replaced to another location due to skin erosion. There was no morbidity. Conclusion: Spinal cord stimulation is an effective tool in reducing pain, in patients who have unsuccessful lower back surgery with the correct indications

Definition of the Ethical Values and Ethics Codes for Turkish Midwifery: A Focused Group Study in Kocaeli

Background: The independent roles of midwives have not been properly defined, and midwifery ethical values and moral codes proper to Turkish culture have not been developed. The absence of legal regulations concerning midwifery has negatively affected midwifery in the process of professionalization. Objectives: The purpose of this study was to identify the professional values of midwifery in Turkey. Materials and Methods: A focus group was created with the participation of nine midwives working at two state hospitals and a university hospital that provide birth service for women in Kocaeli, which is the most important industrial city in Turkey. The opinions of the midwives on the characteristics that a good midwife should possess and the professional values that a good midwife should observe were collected via in-depth interviews. The interviews were recorded. A total of three meetings were held with the participants. Finally, the notes taken by the reporter during these interviews were rearranged, and the recordings were transcribed by the researchers. Results: The characteristics suggested by the participants were classified into three categories: professional, personal, and interpersonal. Professional competence, capacity to properly inform interested parties, trustworthiness, respect for individuals and human dignity, and empathy were the most commonly named characteristics. As for the professional values of midwifery, professional competence, trustworthiness, responsibility, maximum benefit, and protection of privacy were the most often identified. Midwives also reported that most of the difficulties they faced in the exercise of daily tasks concerned protecting the privacy of their patients as well as the integrity and prestige of the profession, achieving the maximum benefit and least harm for patients, and providing a just and equal service. Conclusions: The professional values were mentioned by participant midwives were similar to the values proposed by international professional organizations. But there were some differences perhaps due to cultural differences

Some quality traits and neurotoxin β-N-oxalyl-L-α,β- diaminopropionic acid (β-ODAP) contents of Lathyrus sp. cultivated in Turkey

In this study, 52 landraces accessions belonging to the species of Lathyrus sativus and Lathyrus clymenum collected from different regions of Turkey and one released variety of Lathyrus sativus were evaluated for some quality traits like seed coat color, 1000 seed weight, crude protein and neurotoxin β- N-oxalyl-L-α,β-diaminopropionic acid (β-ODAP) content. Among the investigated landraces, high variation was determined for all the investigated traits, which was attributed to both genetic as well as environmental factors. Protein content was as between 24.07 to 30.90% and β-ODAP content was as 1.35 to 3.86 mg g-1 for seed. Many landraces with low β-ODAP content (< 2.00 mg g-1) and high protein content seem to be promising material for Lathyrus breeding. Furthermore, many investigated landraces showed lower β-ODAP and higher protein contents compared with the released variety. Also, the local consumption of L. sativus landraces as a food or feed was determined during the collection process.Key words: Lathyrus, landrace, protein, β-ODAP, Turkey

Seed yield and agronomic parameters of cowpea (Vigna unguiculata L.) genotypes grown in the Black Sea region of Turkey

Nine cowpea (Vigna unguiculata L.) genotypes (two released cultivars and seven lines) were evaluated for grain yield and agronomic parameters at two locations within the Middle Black Sea region of Turkey for two years (2005 to 2006). Genotypes were evaluated for plant height, first pod height from ground, branches number per plant, main branch diameter, pod length, seed number per pod, thousand seed weight and seed yield. Results indicate that the effect of genotype, year and location were significant (P<0.05) for many of the traits studied. Line G1 had the highest plant height (122.4 cm). Seed number per pod was higher in line G1 (9.9) than in other genotypes. Thousand seed weight ranged between 138.7 and 233.2 g. Seed yield ranged from 1,010 to 1,420 kg ha-1. The highest seed yield (1,420 kg ha-1) was obtained in cultivar Karagoz. Among locations, average values for most variables studied were higher in Samsun than in Kavak.Key words: Vigna unguiculata, seed yield, thousand seed weight, Black Se

The effects of sheep manure application time and rates on yield and botanical composition of secondary succession rangeland

This experimental study was conducted in Samsun/Turkey on a secondary succession rangeland during 2006 - 2008. Botanical composition of the experimental area consists of 28% legumes, 64% grasses, and 8% of other species. Target rates of sheep manure were 0, 25.0, 50.0, 75.0, and 100 kg total N ha–1, based on the manure analyses results (according to N rates in sheep manure). The sheep manure was applied at two different times. Means of 3 years of experimental period and total dry matteryield was obtained from the manure treatment of 75.0 kg N ha-1 and 50 + 50 kg N ha-1 (4153 kg ha-1, and 3813 kg ha-1, respectively). With respect to the three-year average, ratios of legumes, grasses, and otherplants ranged from 20.8 to 40.7%, 41.6 to 66.9%, and 10.7 to 20.7%, respectively. Although ratios of legumes, and other plants increased in the all of the treatments, grass ratios decreased. The crude protein content of obtained rangeland hay ranged between 107.0 and 143.0 g kg-1 in 2006, 93.0 and 123.4 g kg-1 in 2007, 116.3 and 166.4 g kg-1 in 2008. The maximum benefit was provided from the application of 75.0 kg N ha-1 with a sum of 971.2 ha-1

Diagnosing early onset dementia and then what? A frustrating system of aftercare resources

Recent studies indicate that the prevalence of early onset dementia (EOD) is more common than it was once presumed. As such, and considering the substantial challenges EOD presents to the patient, caregivers, and health care providers, this study sought to investigate the mechanism of care delivered to these patients. A medical record chart review was conducted for 85 patients attending a memory disorder unit who initially presented to rule out EOD as a working diagnosis. The results suggest that while the majority of these patients received an extensive work-up and were heavily medicated, they remained at home, where they lacked adequate age-related services and could not be placed, despite the crippling caregiver burden. This manuscript is a platform to discuss our current system limitations in the care of these patients with an eye on new opportunities for this challenging group

Coeliac trunk and common hepatic artery variations in children: an analysis with computed tomography angiography

Background: Understanding the coeliac trunk (CeT) and hepatic artery anatomy is important not only in preventing iatrogenic injuries but also in planning surgical procedures in children. Therefore, the aim of this study is to analyse the prevalence of CeT and common hepatic artery (CHA) variations in the paediatric population.   Materials and methods: One hundred and seventy-four children who underwent abdominal multidetector computed tomography (MDCT) angiography, either because of trauma or liver transplantation, were analysed retrospectively. The patterns of CeT, CHA and their variant branches were revealed and compared with previous studies involving adults.   Results: A total of 157 (90.2%) of the 174 patients had normal CeT anatomy, whereas 17 (9.8%) had variations. Five types of CeT variations were identified according to Song’s classification in which ‘hepatosplenic trunk + left gastric artery + superior mesenteric artery’ was the most prevalent. One hundred-twelve (64.4%) of the 174 patients had normal CHA anatomy; however, 62 (35.6%) had variations. Six types of CHA variations were identified according to Michel’s and Hiatt’s classification. The most common was ‘replaced left hepatic artery originating from left gastric artery’.   Conclusions: The prevalences of CeT and hepatic artery variations are high in children, as they are in older patients. Awareness of these variations is important in terms of avoiding iatrogenic injury and in promoting surgical procedure planning for liver transplantation or abdominal tumour surgery

Effects of the hippocampal deep brain stimulation on cortical epileptic discharges in penicillin - induced epilepsy model in rats

Aim: Experimental and clinical studies have revealed that hippocampal DBS can control epileptic activity, but the mechanism of action is obscure and optimal stimulation parameters are not clearly defined. The aim was to evaluate the effects of high frequency hippocampal stimulation on cortical epileptic activity in penicillin-induced epilepsy model. Material and Methods: Twenty-five Sprague-Dawley rats were implanted DBS electrodes. In group-1 (n=10) hippocampal DBS was off and in the group-2 (n=10) hippocampal DBS was on (185 Hz, 0.5V, 1V, 2V, and 5V for 60 sec) following penicillin G injection intracortically. In the control group hippocampal DBS was on following 8μl saline injection intracortically. EEG recordings were obtained before and 15 minutes following penicillin-G injection, and at 10th minutes following each stimulus for analysis in terms of frequency, amplitude, and power spectrum. Results: High frequency hippocampal DBS suppressed the acute penicillin-induced cortical epileptic activity independent from stimulus intensity. In the control group, hippocampal stimulation alone lead only to diffuse slowing of cerebral bioelectrical activity at 5V stimulation. Conclusion: Our results revealed that continuous high frequency stimulation of the hippocampus suppressed acute cortical epileptic activity effectively without causing secondary epileptic discharges. These results are important in terms of defining the optimal parameters of hippocampal DBS in patients with epilepsy