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Taha Toros Arşivi, Dosya No: 80-KenterlerUnutma İstanbul projesi İstanbul Kalkınma Ajansı'nın 2016 yılı "Yenilikçi ve Yaratıcı İstanbul Mali Destek Programı" kapsamında desteklenmiştir. Proje No: TR10/16/YNY/010

Improvement of Spatial Learning and Memory Impairments by Fetal Neural Tissue Transplantation in Experimental Rat Model of Alzheimer’s Disease

Objective:It is known that the acetylcholinergic afferents of the neocortex from subcortical areas participate in learning and memory. Autopsy studies in cases of Alzheimer’s disease (AD) have shown that most of the neurons of nucleus basalis magnocellularis (NBM) are atrophic or decreased in number. In this study, we searched for whether or not it was possible to improve the impaired learning and memory functions with foetal neural tissue transplantation in an experimental model of AD.Method:A total of thirty seven young adult male Wistar albino rats were served as experimental subjects. NBM on the right side was destroyed by the injection of kainic acid stereotactically so as to make a model of AD. The grafts were obtained from 14-16 day foetuses of the same genus. After the tissue with cholinergic neurons dissected from ventral forebrain and tissue with non-cholinergic neurons dissected from telencephalic vesicle, cell suspensions were prepared and injected stereotactically to the ipsilateral frontal cortex. Spatial learning and memory functions were tested by Morris’ water maze tasks.Results:Spatial learning and memory functions in rats were impaired by unilateral lesions of nucleus basalis magnocellularis. The impairment observed during the early period partially improved by the time. It was observed that this amelioration was accelerated with both cholinergic and non-cholinergic foetal neural tissue implantation.Conclusion:In our study, improvement of spatial learning and memory impairment with both cholinergic and non-cholinergic foetal neural tissue implantation can be explained by re-establishment of impaired connections via proliferation of limited number of surviving cholinergic neurons creating new synapses, as a result of upregulation of endogenous neural stem cells and activation of trophic mechanisms by implantation, rather than creation of functional synapses between the graft and the recipient tissue

Feeding tube displacement (case report)

Beslenme sondası takıldıktan sonra doğru yerleştirildiğini objektif olarak göstermek gereklidir. Beslenme tüpünün yerinin onayı için çekilen kontrol grafisinin önemini vurgulamak amacıyla, iki olgumuzda karşılaştığımız sorunları sunmayı amaçladık.This paper is aimed to express the importance of control x-ray following insertion of a feeding tube, regarding two cases with tube displacement

A technique to facilitate the cannulation of the foramen ovale for balloon compression

Backgroun

Unilateral ablative lesions of the subthalamic nucleus in moderate-to-advanced parkinson’s disease

Amaç: Orta-ileri evre Parkinson hastalığı (PH) tedavisinde, subtalamik nükleusa (STN) yönelik derin beyin stimülasyonu (DBS) ameliyatlarının tüm parkinsonyan motor semptomlara ve motor komplikasyonlara karşı yarar sağladığı bilinmektedir. Bu çalışmada unilateral STN lezyonlarının orta-ileri PH’daki etkileri araştı rılmıştır. Yöntemler: Orta-ileri evre PH olan 11 hasta (8 erkek, 3 kad›n) çalışmaya alındı. Cerrahi öncesinde hastaların tamamında motor komplikasyonlardan biri veya birkaçı (doz sonu kötüleşmesi, “açık-kapalı” dönemler, diskinezi) vardı. Hastaların tamamı “kapalı” dönemlerinde Hoehn-Yahr ölçeğine göre 3 veya 4 evresindeydiler ve Birleşik Parkinson Hastalığı Değerlendirme Ölçeği (BPHDÖ)’ne göre değerlendirildiler. Hastaların izlenme süreleri 12 ile 20 ay (ortalama: 14±2.94) arasında değişiyordu. Subtalamik nükleusun saptanmasında bilgisayarlı tomografi ve manyetik rezonans incelemeleri kullanıldı. Subtalamik nükleus lezyonları tek taraflı olarak termokoagülasyon kullanılarak yapıldı. Bulgular: Subtalamotomi kontralateral, ipsilateral ve aksiyel motor bulgularda belirgin düzelme sağladı. Ortalama “açık” dönemdeki toplam BPHDÖ skoru 61.7±19.2’den 31.6±15.7’ye (p=0.001) ve BPHDÖ motor bölüm skoru 26.1±11.1’den 15±11.1’e (p=0.02) düştü. Toplam "açık" zamanı 8 hastada %50 oranında arttı, ancak diğer 3 hastada belirgin değişiklik olmadı. Maluliyet verici diskinezileri olan 9 hastanın 6’sında belirgin iyileşme hali görüldü (BPHDÖ-bölüm IV ortalama %40). Cerrahi öncesi ve sonrası levodopa-eşdeğer dozları karşılaştırıldığında 8 hastanınki azaldı, 1 hastanın arttı ve geri kalan 2’sinde değişmedi. Onbir hastanın sadece 1’inde hemiballismus gelişti. Hemiballistik hareketler ablasyondan hemen sonra ortaya çıktı ve tedavi ile iki hafta içinde tamamen düzeldi.Sonuç: Sonuç olarak subtalamotomi orta-ileri PH’da güvenilir ve etkili bir yöntemdir.Derin beyin stimülasyonunun mümkün olmadığı vakalarda subtalamatomi alternatif bir yöntem olarak düşünülebilir.Objective: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been reported to be effective in alleviating all parkinsonian motor symptoms and motor complications in moderate-to-advanced Parkinson’s disease (PD). We have studied the effects of unilateral STN lesions on moderate-to-advanced PD. Methods: Eleven patients (eight male, three female) with moderate-to-advanced PD were studied. Before surgery, all patients suffered from one or more motor complications (wearing-off and on-off phenomena, dyskinesias). All patients had Hoehn and Yahr stage 3 or 4 in off-drug condition and were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS). The follow-up time ranged between 12 and 20 months (mean: 14±2.94 months). STN was identified through CT and MRI scans. STN lesions were performed unilaterally using thermocoagulation. Results: Subthalamotomy induced a marked motor improvement contralaterally, ipsilaterally and axially. Mean “on” time total UPDRS and motor scores decreased from 61.7±19.2 to 31.6±15.7 (p=0.001) and from 26.1±11.1 to 15±11.1 (p=0.02), respectively. Total ‘on’ time period increased by 50% in eight patients but did not change in the remaining three. Nine patients had disabling dyskinesia and six of these patients improved significantly (mean 40%, UPDRS part IV). Compared to presurgical doses, the levodopa-equivalent dose was reduced in eight patients,increased in one and left unchanged in the remaining two patients during the postoperative phase. Notably, only one out of eleven patients developed hemiballismus. Hemiballistic movements emerged immediately after the ablation and were ameliorated under treatment within two weeks after surgery.Conclusion: We conclude that subthalamotomy is a safe and effective treatment for moderate-to-advanced PD. In cases in which DBS is not feasible, subthalamotomy may be considered as an alternative procedure

Unilateral Ablative Lesions of the Subthalamic Nucleus in Moderate-to-Advanced Parkinson's Disease

Objective: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been reported to be effective in alleviating all parkinsonian motor symptoms and motor complications in moderate-to-advanced Parkinson's disease (PD). We have studied the effects of unilateral STN lesions on moderate-to-advanced PD

Treatment of syringomyelia with ventriculoperitoneal shunt: A case report

Komünikan sirengomiyeli saptanan olgularda, ventriküler sisteminde genişlemiş olduğu görülür ise ventrikiiloperitoneal şant sistemi ilk tedavi seçeneği olarak uygulanabilir. Bu çalışmada ventriküloperitoneal şant takılarak tedavi edilen komünikan sirengomiyelili bir olgu sunulmaktadır. Sağ elinde daha belirgin olmak üzere tüm ekstremitelerinde güçsüzlük ve ses kısıklığı yakınması ile başvuran 41 yaşındaki olgunun yapılan manyetik rezonans görüntüleme tetkikinde serebellum tonsillerinin 5mm. fıtıklanmasına ek olarak sirengomiyeli ve beyin venüiküllerinde genişleme saptandı. Tedavi için ventriküloperitoneal şant uygulandı. Ameliyat sonrası klinik ve radyolojik tüm bulgular düzeldi. İlk girişimden 7 yıl sonra yapılan kontrol muayenesinde iyilik halinin devam ettiği görüldü. Sirengomiyelinin doğru tedavisi, beyin omurilik sıvısı dinamiğinin anlaşılmasına ve buna yönelik uygun girişimin seçilmesine bağlıdır. Uygun olgularda ventriküloperitoneal şant tatkibi seçkin tedavi yöntemi olarak görülmektedir.SUMARY Treatment of syringomyelia with ventriculoperitoneal shunt: Case report. The ventriculoperitoneal shunting procedure may be first choice of treatment in patients harboring communicating syringomyelia associated with enlarged cerebral ventricles. In this report, a patient with communicating syringomyelia who was treated by inserting a ventriculoperitoneal shunt is presented. A 41-yeard-old man was admitted to our clinic with the complaints of hoarseness and weakness in all four extremities. Magnetic resonance imaging of the head and cervical spine revealed the presence of a type I Chiari malformation and syringomyelia associated with enlarged cerebral ventricles. Neurological symptoms improved dramatically after operation. Six months later, a control magnetic resonance imaging was performed to find out that the syrinx and the tonsillar hernation as well had disapperared completely. The patient was still in good neurological condition when he was lost to follow-up 7 years after operation. The accurate treatment of syringomyelia relies upon the understanding of dynamics of cérébro-spinal fluid and choosing the appropriate surgical procedures. Ventriculoperitoneal shunting should be considered as the initial treatment modality in the case of cervical syringomyelia associated with enlarged ventricles