Morphometric analysis of dose-dependent effect of progesterone on experimental vasospasm-induced rat femoral arteries

Objective: Our aim of this study was to determine effective doses of progesterone which has a vasodilatory effect during the early stage of vasospasm. Cerebral vasospasm (CV) is a predominant cause of morbidity and mortality which develops following subarachnoidal hemorrhage (SAH). Etiopathogenesis of CV is multifactorial. Despite many previously performed studies on this issue, the mechanism by which blood and blood products in the subarachnoidal space induce CV has not been clarified yet.Materials and methods: In our study, we used "Rat Femoral Artery Vasospasm Model" introduced by Okada et al. Thanks to easy procurement and maintenance of rats. Rats were divided into four groups as: Group 1 (n = 8; control group), Group 2 (n = 8; vasospasm group), Group 3 (n = 8; vasospasm + 3 mg/kg progesterone group), and Group 4 (n = 8; vasospasm +15 mg/kg progesterone group). Progesterone which is an endogenously synthesized natural steroid was preferred in our study. Progesterone increases the production of vasodilatory epoxyeicosatrienoic acid by acting on its binding sites termed as pregnane X receptor. It decreases the intracellular influx of Ca2+ by blocking the functioning of L-type channels in smooth muscle cells. It manifests another vasodilatory effect by decreasing expression of TxA2 receptor. In our study, at the end of the 7th day, where the most intense vasospasm is seen, 1 cm pieces were excised from the femoral arteries and histopathologically examined under light microscope.Results: Vascular walls of three vasospasm-induced groups were relatively thicker when compared with the control group. Drug-treated groups were not different from each other. Vascular walls of the groups treated with lower and higher doses of the drug were thinner when compared with the vasospasm group without any statistically significant difference between groups (P > 0.05). Luminal cross-sectional areas of the drug-treated groups did not differ from each other. Mean luminal cross-sectional areas of the control and the drug-treated groups were larger than that of the vasospasm group without any statistically significant intergroup difference (P > 0.05).Conclusion: Based on the results of our study, progesterone did not exert protective effects on vascular wall thickness, while histopathological examination of luminal cross-sectional areas revealed its vasodilatory effects without any statistically significant difference between groups. Starting from the study results obtained, we think that its potential use as a preventive agent against the development of post-SAH CV requires conduction of multicentered, placebo-controlled, randomized, and double-blind studies

Myelomeningosel Onarımı Sırasında Kök ve Plakodun İntraoperatif Direkt Elektrik Stimülasyon Sonuçları

INTRODUCTION: The safety of transcranial high current stimulation is controversial in newborns. However, intraoperative direct stimulation techniques are safe and useful methods even for newborns to determine the functional neural tissue and to provide a safer surgery. We routinely use direct nerve stimulation techniques during myelomeningocele closure in our institution unless patient has total paraplegia. In this paper, we analyzed and presented the results of intraoperative direct stimulation of nerves and neural placode in 20 infants with myelomeningocele. METHODS: Intraoperative direct stimulation was performed and electromyography was followed from lower extremity muscles both for triggered and spontaneous activity during myelomeningocele repair. RESULTS: The compound muscle action potentials were correlated with motor examination of lower extremities. While, the level of conduction block in motor pathways involved nerve roots in some cases, most of the stimulated roots were functional which indicates the motor conduction block was upper in spinal cord. In one case dysmorphic appearing rootlet was found functional and preserved throughout the surgery. DISCUSSION and CONCLUSION: In our practice, intraoperative direct stimulation is a useful and reliable method to check the functional neural tissue and spare it to preserve during releasing and closure of neural tube in myelomeningocele operations.GİRİŞ ve AMAÇ: Transkraniyal yüksek akım elektriksel uyarımın güvenliği yenidoğanlarda tartışmalıdır. Ancak, intraoperatif direkt stimülasyon teknikleri yenidoğanlarda da fonksiyonel sinir dokusunu belirlemek ve daha güvenli bir cerrahi sağlamak için güvenli ve faydalı yöntemlerdendir. Hastanın total paraplejisi olmadıkça, enstitümüzde myelomeningosel onarım operasyonlarında direkt sinir stimülasyon yöntemini rutin olarak kullanmaktayız. Bu yazıda, myelomeningoseli olan 20 bebekte sinir ve nöral plakodun intraoperatif direkt stimülasyonunun sonuçlarını analiz ettik ve sunduk. YÖNTEM ve GEREÇLER: İntraoperatif direkt stimülasyon uygulanan 20 myelomeningoselli hastanın sonuçları incelendi. Hastaların alt ekstremite kaslarındaki elektromiyografi aktivitesi hem tetiklenmiş hem de spontan aktivite açısından takip edildi. BULGULAR: Elde edilen bileşik kas aksiyon potansiyeli yanıtları alt ekstremitelerin preoperatif motor fonksiyonu ile ilişkilidir. Motor yollardaki iletim bloğu seviyesi bazı durumlarda sinir köklerini içerse de, stimüle edilen köklerin çoğunun işlevsel olması motor iletim bloğunun spinal kordun üst seviyelerinde olduğunu göstermiştir. Bir olguda, dismorfik görünen ince kökler fonksiyonel bulunmuş ve ameliyat boyunca korunmuştur. TARTIŞMA ve SONUÇ: İntraoperatif direkt stimülasyon, myelomeningosel operasyonlarında nöral tüpün diseksiyonu ve onarımı sırasında fonksiyonel sinir dokusunun tespit edilip korunması için yararlı ve güvenilir bir yöntemdir

Three level spinal dysraphism: multiple composite Type 1 and Type 2 split cord malformation

İstanbul Bilim Üniversitesi, Tıp Fakültesi.It has reported an uncommon case a 3 year-old girl a composite split cord malformation (SCM) with two different levels of SCM type1 and one level SCM type2, tight filum and sacral dermal sinus. The patient was admitted with a hypertrichosis and hyperpigmented patch. MRI of whole spine and brain was done. SCM type1 at T 7 and L2 levels and SCM typ2 at T11 level were removed then tight filum was cut and dermal sinus was excised at different sites during the same surgery

Effects of metformin on lipopolysaccharide induced inflammation by activating fibroblast growth factor 21

Lipopolysaccharide (LPS) is a component of the cell wall of Gram-negative bacteria that produces endotoxemia, which may cause septic shock. Metformin (MET) is a widely used hypoglycemic drug that exhibits anti-inflammatory properties. Fibroblast growth factor 21 (FGF21) is an endocrine polypeptide that affects glucose and lipid metabolism, and also possesses anti-inflammatory properties. We investigated the effects of MET and FGF21 on inflammation due to LPS induced endotoxemia in male rats. Animals were divided into five groups: control, LPS, pre-MET LPS, LPS + 1 h MET and LPS + 3 h MET. Serum levels of alanine aminotransferase, aspartate aminotransferase, FGF2, interleukin-10 and tumor necrosis factor alpha were measured. Malondialdehyde, myeloperoxidase and FGF21 levels were measured in liver tissue samples. Histopathology of all groups was assessed using hematoxylin and eosin stained sections. LPS caused severe inflammatory liver damage. MET exhibited a partially protective effect and reduced inflammation significantly. FGF21 is produced in the liver following inflammation and MET may increase its production