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    The anti-oxidant and anti-apoptotic effects of nebivolol and zofenopril in a model of cerebral ischemia/reperfusion in rats
    (Pergamon-Elsevier Science Ltd, 2012) Uzar, Ertugrul; Acar, Abdullah; Evliyaoglu, Osman; Firat, Ugur; Kamasak, Kagan; Gocmez, Cuneyt; Alp, Harun
    The aim of this experiment was to investigate whether nebivolol and zofenopril have protective effects against oxidative damage and apoptosis induced by cerebral ischemia/reperfusion (I/R). There were seven groups of rats, with each containing eight rats. The groups were: the control group, I/R group, I/R plus zofenopril, I/R plus nebivolol, I/R plus nebivolol and zofenopril. zofenopril only and nebivolol only. Cerebral I/R was induced by clamping the bilateral common carotid artery and through hypotension. The rats were sacrificed 1 h after ischemia, and histopathological and biochemical analyses were carried out on their brains. The total antioxidant capacity was evaluated by using an automated and colorimetric measurement method developed by Erel. I/R produced a significant increase in the levels of total oxidant status and malondialdehyde levels, the number of caspase-3 immunopositive cells and activities of prolidase and paraoxonase in brain when compared with the control group (p<0.05). A significant decrease in brain total antioxidant capacity and nitric oxide levels were found in I/R group when compared with the control group (p<0.05). Both nebivolol and zofenopril treatment prevented decreasing of the total antioxidant capacity and nitric oxide levels, produced by I/R in the brain (p<0.05). Both nebivolol and zofenopril treatment prevented the total oxidant status, malondialdehyde levels, activities of paraoxonase and prolidase from increasing in brains of rats exposed to I/R (p<0.05). In conclusion, both nebivolol and zofenopril protected rats from ischemia-induced brain injury. The protection may be due to the indirect prevention of oxidative stress and apoptosis. (C) 2011 Elsevier Inc. All rights reserved.
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    Assessment of Cases With Intracranial Hydatid Cyst: A 23-Year Experience
    (Journal Neurological Sciences, 2014) Turan, Yahya; Yilmaz, Tevfik; Gocmez, Cuneyt; Kamasak, Kagan; Kemaloglu, Serdar; Tekin, Recep; Hattapoglu, Salih
    Objective: Brain is involved in 1-2% of hydatid cyst infections. A cranial location is rare. In this study, we aimed to assess clinical findings, radiological investigations, and treatment modalities of cases with intracranial hydatid cyst. Materials and Method: The present study included 26 patients operated for cerebral hydatid cyst disease between January 1990 and October 2012. Results: Seventeen patients were male and 9 were female. The mean age of the study population was 20.3 years (range 7-50 years). Headache and nausea were the most common clinical symptoms. The lesions were demonstrated by computed tomography (CT) and magnetic resonance imaging (MRI) as large, smooth, thin walled, spherical-shaped, cystic homogenous lesions with the same density as cerebro spinal fluid, which showed no edema or contrast uptake. Two patients were complicated or infected cysts with perifocal edema and contrast uptake. In 20 patients, the cysts were removed completely with Dowlings technique, by rectifying cysts without rupturing. Eleven patients with ruptured cysts during operation, recurrent or systemic hydatid cyst were treated medically. Conclusion: Medical therapy appears effective in hydatid cyst disease. Cerebral hydatid cysts should be excised totally without rupturing them. Preoperative imaging techniques are central to surgical planning. Intracranial hydatid cyst should be remembered when CT or MRI shows a cystic lesion, especially in countries where hydatid cyst is endemic.
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    Association Between Neuropathic Pain, Pregabalin Treatment, and Erectile Dysfunction
    (Wiley-Blackwell, 2014) Bozkurt, Mehtap; Gocmez, Cuneyt; Soylemez, Haluk; Daggulli, Mansur; Em, Serda; Yildiz, Mehmet; Atar, Murat
    Introduction. The pathophysiology of erectile dysfunction (ED) may be vasculogenic, hormonal, anatomical, neurogenic, drug-induced and/or psychogenic in origin. Neuropathic pain (NP) may facilitate ED, because it is frequently associated with anxiety, depression, and its drug, pregabalin, may also contribute ED. Aim. The objective of this study was to determine whether pregabalin treatment for patients with neuropathic pain promotes erectile dysfunction. Methods. The study sample consisted of a total of 102 male subjects that were subdivided into three groups. Group 1 patients (n = 31) had a pre-existing diagnosis of NP and was treated with 300 mg/day of pregabalin for at least 3 months. Group 2 patients (n = 34) were diagnosed with NP for at least 3 months; however, neither were they treated with pregabalin nor did they received physical therapy throughout the study. Lastly, healthy age-matched control subjects comprised group 3 (n = 37). Main Outcome Measures. Patients in all groups completed the International Index for Erectile Function (IIEF) questionnaire. Results. Mean age and mean body mass index did not differ significantly between each of the three groups. The cause of NP and the mean duration of having a diagnosis of NP did not differ significantly in groups 1 and 2. However, IIEF scores were significantly lower for group 1 when compared to group 2 in terms of erectile function, orgasmic function, overall satisfaction and total score. Yet groups 1 and 2 did not diverge significantly in the intercourse satisfaction and sexual desire scores. Overall IIEF scores for group 3 were significantly higher than those of group 2 except for mean erectile function scores. Conclusion. Taking pregabalin for the treatment of neuropathic pain poses an increased risk for developing ED in male patients. Thus, clinicians prescribing pregabalin to patients diagnosed with neuropathic pain should assess for ED before and during treatment with this medication.
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    The comparison of neuroprotective effects of intrathecal dexmedetomidine and metilprednisolone in spinal cord injury
    (Elsevier Science Bv, 2013) Celik, Feyzi; Gocmez, Cuneyt; Kamasak, Kagan; Tufek, Adnan; Guzel, Abdulmenap; Tokgoz, Orhan; Firat, Ugur
    Background: The purpose of this study is the investigation of the effects of intrathecally injected dexmedetomidine and methylprednisolone and their dominancy over one another in rats with generated Spinal Cord Injury (SCI). Methods: 40, female, adult Wistar Albino rats weighing 220-260 g were included in the study. The rats were fixed with Intrathecal catheter (IT) and divided into four groups. All subjects were applied T7-10 laminectomy after catheter. Group S (n:10) was injected with IT 10 mu L isotonic saline; Group C (n: 10) with IT 10 mu L isotonic saline after SCI; Group D (n:10) with IT one doze 10 mu L of dexmedetomidine after SCI; Group M (n:10) IT one dose 10 mu L of methylprednisolone. The subjects were sacrificed 72 h after this operation. The damaged area was removed biochemically and histopathologically examined. Results: Antioxidant and inflammatory parameters searched for in all damages tissue were statistically different in all groups from group S. They were different in group M and group D than group C (p < 0.001). After the comparison of group D and group M, PON and IL6 values were higher in group D (p = 0.003, p = 0.035) while the other two biochemical parameters were similar in both groups (Table 1). After histopathologic trials, edemas, bleeding and necrosis were found less in group S while at the most in group C (p < 0.001). In group M and group D, however, they were higher than group S and lower than group C (p < 0.001). After the comparison of group D and group M, while there was no difference in terms of edema necrosis, the amount of bleeding was lower in group D (p < 0.001) (Table 2). Conclusions: It has been discovered that intrathecal use of dexmedetomidine caused neuroprotective effects similar to methylprednisolone. (C) 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
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    Effect of Caffeic Acid Phenethyl Ester on Cerebellar Tissue Damage Secondary to Methanol Intoxication: Experimental Study
    (Turkish Neurological Soc, 2013) Arikanoglu, Adalet; Yuksel, Hatice; Gocmez, Cuneyt; Uzar, Ertugrul; Acar, Abdullah; Aluclu, Mehmet Ufuk
    Objective: Previous studies have shown the role of oxidative stress in methanol neurotoxicity. CAPE is known to have an antioxidant property that is shown in many experimental studies. In this study, we aimed to investigate whether CAPE has a protective effect against oxidative stress observed in the cerebellar tissue in methanol intoxication. Material and Method: In this study, a total of 40 rats were split into 5 groups: control group (n=8), MTX-alone group (n=8), MTX+methanol group (n=8), MTX+methanol+ethanol group (ethanol group) (n=8), and MTX+metanol+CAPE group (CAPE group) (n=8). All the rats except the control group were delivered methotrexate (MTX) therapy (0.3 mg/kg/day, via i. p. route) for 7 days in order to induce methanol toxicity. The control group received no drug therapy. Seven days later, 3 g/kg (i.p.) methanol was delivered in the ethanol and CAPE groups. Four hours after the delivery of methanol, ethanol group received 0.5 g/kg ethanol (i.p.) and CAPE group received 10 mu mol/kg CAPE (i.p.), while the other groups were delivered only saline (i.p.). The rats were decapitated after 8 hours and the cerebellar tissues were removed. PON-1, TAS, and MDA levels were measured in the tissues. Results: MTX-alone group demonstrated decreased TAS and PON-1 levels (p=0.001 and p=0.004, respectively) and increased MDA level (p=0.001), as compared to the control group. When MTX+methanol group was compared with the MTX-alone group, MTX+methanol group was found to have decreased TAS and PON-1 activities (p=0.037 and p=0.046, respectively) and increased MDA level (p=0.022). The ethanol group was found to show a significant decrease in MDA level (p=0.001), as compared with the MTX+methanol group. The CAPE group exhibited increased TAS and PON-1 levels (p=0.001 and p=0.001, respectively) and decreased MDA levels, as compared with the MTX+methanol group. Discussion: Cerebellum demonstrates oxidative stress secondary to methanol intoxication. CAPE therapy is more effective against cerebellar oxidative stress than ethanol therapy.
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    The effects of erythropoietin, dextran and saline on brain edema and lipid peroxidation in experimental head trauma
    (Turkish Assoc Trauma Emergency Surgery, 2015) Basarslan, Seyit Kagan; Gocmez, Cuneyt; Kamasak, Kagan; Ekici, Mehmet Ali; Ulutabanca, Halil; Dogu, Yurdaer; Menku, Ahmet
    BACKGROUND: The aim of this study was to investigate the protective effects of erythropoietin, dextran/saline and erythropoietin in combination with dextran/saline on brain edema and lipid peroxidation following traumatic brain injury in rats. METHODS: In the study, 40 male 3-month-old albino Wistar rats, weighing 250-340 g, were divided into four groups, each consisting of ten rats. Traumatic brain injury was induced in all rats by the weight drop method, and erythropoietin (5,000 U/kg) and/or dextran and saline (8 ml/kg) solutions were injected intraperitoneally ten minutes after trauma. Control animals received an equal volume of serum physiologic. All rats were sacrificed 24 hours later. Glutathione peroxidase activity and malondialdehyde levels were measured in the left hemisphere, and edema was quantitated by the wet dry method. RESULTS: Brain edema and the levels of malondialdehyde, the last product of lipid peroxidation in tissues, were decreased variably, and the activity of glutathione peroxidase, an antioxidant enzyme, was increased in others compared with the control group. CONCLUSION: In this study, it was concluded that the brain edema that developed in rats on which head trauma was induced and the secondary brain damage caused by oxidative stress could be deceased using a combination of erythropoietin, dextran, and saline.
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    Effects of Intrathecal Caffeic Acid Phenethyl Ester and Methylprednisolone on Oxidant/Antioxidant Status in Traumatic Spinal Cord Injuries
    (Thieme Medical Publ Inc, 2015) Gocmez, Cuneyt; Celik, Feyzi; Kamasak, Kagan; Kaplan, Metin; Uzar, Ertugrul; Arikanoglu, Adalet; Evliyaoglu, Osman
    PurposeTo examine the effect of intrathecally given caffeic acid phenethyl ester (CAPE) on peroxidation and total oxidant and antioxidant systems, and the effect of intrathecally given methylprednisolone (MP) in spinal cord injury (SCI) models. Materials and MethodsFour groups of 10 rats were formed: (1) Laminectomy, intrathecal saline injection, no SCI (sham: S); (2) Laminectomy, intrathecal saline injection, SCI (control: SCI); (3) Laminectomy, intrathecally given single dose of 3 mg/kg MP, SCISCI (SCI+MP). 4) Laminectomy, intrathecally given single dose of 1 mu g/kg CAPE, SCI (SCI+CAPE). Malondialdehyde (MDA), total oxidant activity (TOA), total antioxidant capacity (TAC), superoxide dismutase (SOD), and glutathione peroxidase (GPx) values in the spinal cord tissue were evaluated. ResultsWhen group S and group SCI were compared, MDA, TOA, and SOD parameters increased post-SCI (p<0.01). When compared with group SCI, it was observed that CAPE and MP decreased the MDA, TOA, and SOD levels (p<0.01). This decrease was more pronounced in the SCI+CAPE group. When group S and group SCI were compared, a statistically substantial decrease was observed in the post-SCI TAC levels. When compared with group SCI, it was shown that CAPE and MP treatment substantially increased TAC levels (p<0.001). ConclusionIntrathecal injection of both CAPE and MP inhibits lipid peroxidation and increase of oxidants in SCIs.
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    Evaluation of risk factors affecting hospital-acquired infections in the neurosurgery intensive care unit
    (Informa Healthcare, 2014) Gocmez, Cuneyt; Celik, Feyzi; Tekin, Recep; Kamasak, Kagan; Turan, Yahya; Palanci, Yilmaz; Bozkurt, Fatma
    The aim of the present study was to identify nosocomial infections (NIs), and their associated risk factors, in patients treated in the neurosurgery intensive care unit (NICU) of our hospital. Patients determined to have NIs between January 2008 and December 2012 were included in the study. Each patient's age, gender, microbiological culture results, underlying conditions, type of NIs, device utilization, total parenteral nutrition, reason for hospitalization, Glasgow score, and treatment were recorded and evaluated using statistical analysis. Risk factors for NIs were analyzed with a logistic regression model. During the five-year period, 60 NI episodes were detected in 56 out of 1643 patients. The mean age of the patient population was 33.3 (1-79) years. Of the patients, 22 were female and 34 were male. The overall incidence rate (NIs/100) and incidence density (NIs /1000 days of stay) of NIs were 3.65% and 6.5/1000 patient days, respectively. Regardless of the year of surveillance, the three most commonly detected NIs were bloodstream infection, shunt infection, and ventilator-associated pneumonia. No statistically significant difference was detected between infected and uninfected patients in terms of sex, age, blood transfusions, or mannitol and steroid use (p >= 0.05). In the present study, Glasgow scores, the frequency of prior usage of broad-spectrum antibiotics, and NICU stay durations were significantly higher among patients with infections (p < 0.001). Univariate analysis demonstrated that a low Glasgow score, re-operation, and use of mechanical ventilation were risk factors for NIs. We identified low Glasgow coma scores, long hospital stay duration, use of wide spectrum antibiotics, mechanical ventilation, total parenteral nutrition, and re-operation as risk factors for NIs.
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    Imaging features of cerebral and spinal cystic echinococcosis
    (Springer-Verlag Italia Srl, 2015) Teke, Memik; Gocmez, Cuneyt; Hamidi, Cihad; Gunduz, Ercan; Goya, Cemil; Cetincakmak, Mehmet Guli; Hattapoglu, Salih
    The main objective of this study was to describe the characteristic imaging features of cerebral and spinal hydatid disease (HD) in magnetic resonance imaging (MRI) and computed tomography (CT) in order to provide more effective differential diagnoses in endemic regions. We also aimed to use MRI and CT to evaluate whether the World Health Organization's (WHO) new classification of hepatic cystic echinococcosis (CE) could be used in the classification of cerebral HD. We retrospectively reviewed the CT and MR images of 30 patients who were diagnosed with cerebral and spinal HD between 1990 and 2014. The imaging findings were noted. All hydatid cysts were classified according to the WHO classification of hepatic CE, consisting of six types. The study group consisted of 49 CEs in 27 patients with cerebral HD and 12 CEs in three patients with spinal HD. Of the cysts, 14 were type CL (cystic lesion), 29 were type CE1, 11 were type CE2 and seven were type CE3. In other words, 54 cysts were in the active group and seven were in the transition group. Most of the cysts were type CL and CE1. Even though characteristic imaging features could be used in the differential diagnosis of HD, sometimes the differentiation of HD from other cystic lesions may be difficult. The use of WHO classification will provide standardisation of uniform treatment modality, as the treatment of HD, according to the stage of the disease, may be surgical or medical.
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    Is the Elapsed Time following the Placement of a Ventriculoperitoneal Shunt Catheter an Individual Risk Factor for Shunt Fractures?
    (Karger, 2012) Kaplan, Metin; Cakin, Hakan; Ozdemir, Niyazi; Gocmez, Cuneyt; Ozturk, Sait; Erol, Fatih S.
    In this study, we examined whether the resistance of peritoneal catheters against the retraction force changed over time following shunt placement, and the role of this resistance in shunt fracture is discussed. We investigated peritoneal catheters removed from patients treated with a ventriculoperitoneal shunt because of hydrocephalus; previously, patients underwent shunt revision. The maximum tension, maximum elongation and elongation percentages of the peritoneal catheters were measured. The mean and maximum tension values of the revised peritoneal catheters were increased compared to the unused catheters. The maximum elongation and elongation rates were significantly decreased. The changes in the maximum elongation, elongation rate and tension values were unrelated to the time elapsed after catheter insertion. This finding indicates that the time elapsed following peritoneal catheter placement was not an individual factor based on the strength of the response of the organism to the foreign body and the mechanical trauma exposed in shunt fractures. Copyright (C) 2013 S. Karger AG, Basel
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    Malign Transformation in the Low Grade Astrocytomas and Related Factors
    (Turkish Neurosurgical Soc, 2012) Kamasak, Kaan; Ekici, Mehmet Ali; Gocmez, Cuneyt; Tucer, Bulent; Basarslan, Seyit Kaan; Kurtsoy, Ali
    AIM: Retrospective investigation of prognostic factors in low-grade astrocytomas. MATERIAL and METHODS: In the study, prognostic factors were prospectively identified and assumed to be effective on prognosis, which were reviewed in 67 cases diagnosed as low-grade astrocytoma with craniotomy between May 1998 to December 2005 at Erciyes University Neurosurgery Department. Assessment of demographic, neurologic, radiological, surgical and clinical features of cases and adjuvant therapies and their relationship with prognosis were evaluated. Post-operative cumulative survival of the cases was estimated by using the Kaplan-Meier method. The Log Rank test was used to compare the survival curve of the sub-groups. Multivariate analysis of survival was analyzed by using the Cox regression method. RESULTS: It was seen that malign transformation occurred in 9 patients of subtotal resection group. The difference was statistically significant (p < 0.01). malign transformation was detected in one female (3.2%) and 8 male patients (22.2%). Difference in favor of men was statistically significant (p < 0.05). Malignant transformation was detected in 7 of the patients given post-operative radiotherapy, only 2 patients displayed malign transformation in the group which received no radiotherapy. Comparison of groups revealed a significant difference (p=0.01). CONCLUSION: Detection of higher malign transformation rate in cases underwent radiotherapy than those did not and the statistical significance in this meaning mandates to revise treatment plan regarding radiotherapy.
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    Predictors of surgical approaches for the repair of anterior cranial base encephaloceles
    (Springer, 2013) Gun, Ramazan; Tosun, Fuat; Durmaz, Abdullah; Yorgancilar, Ediz; Bakir, Salih; Kamasak, Kaan; Gocmez, Cuneyt
    Surgical approaches to the anterior cranial base have changed considerably with the introduction of endonasal endoscopic surgery. This study aims to define the factors which help in selecting the optimal surgical approach for the treatment of anterior cranial base encephaloceles. Patients who received treatment for anterior cranial base encephaloceles at our department between 1996 and 2011 were included in the study. Patients' charts were reviewed retrospectively to collect the necessary data. Treatment periods were classified as before 2000, between 2000 and 2005, and after 2005. The relationship between the treatment period, localization of encephalocele, symptoms related with the lesion, size of skull base defect, and selected treatment modality were investigated. Twenty-five patients, aged between 1 and 61 years with anterior encephaloceles were included in the study. Patients with small asymptomatic frontonasal and trans-ethmoidal encephaloceles (n = 5) were followed without surgery. An external approach with or without subfrontal craniotomy was mainly preferred for resection of sincipital encephaloceles (n = 10), especially with facial deformity. A subfrontal craniotomy approach was used for resection of basal encephaloceles in two cases before 2000. Two cases with sincipital encephaloceles and six cases with basal encephaloceles underwent pure endonasal endoscopic surgery after 2000. Cranial base defects of every size could be repaired using the endoscopic approach. Hydrocephalus and meningitis were the two complications seen after craniotomy in a follow-up period of 13-26 (mean 14.5) months. An external approach with or without craniotomy is needed for encephaloceles with external mass and facial deformity. Otherwise, sincipital and basal encephaloceles can be repaired successfully using the endonasal endoscopic approach.
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    Three-Dimensional Analysis of Foramen Magnum and its Adjacent Structures
    (Lippincott Williams & Wilkins, 2014) Gocmez, Cuneyt; Goya, Cemil; Hamidi, Cihad; Kamasak, Kagan; Yilmaz, Tevfik; Turan, Yahya; Uzar, Ertugrul
    The goal of this effort is to evaluate the anatomy of the foramen magnum (FM) using 3-dimensional computed tomography (3D CT), and determine whether or not the anatomical features of vascular structures and condylar foramen (CF) affect the types of FM. The CT angiography records of 101 patients (44 men and 57 women) were retrospectively examined in this study. Details of the FM, CF, and the vertebral and basilar arteries were examined using maximum intensity projection and 3D rendering images. The average age of the 101 patients was 45.28 +/- 16.3 years. The 8 types of FM, in order of their frequency of occurrence, are as follows: round (19 cases; 18.8%), 2 semicircles (18; 17.8%), egg-shaped (15; 14.9%), hexagonal (14; 13.9%), tetragonal (11; 10.9%), oval (11; 10.9%), pentagonal (9; 8.9%), and irregular (4; 4%). There was no statistically significant relationship between the anatomical features of the vertebral and basilar arteries and the CF with the different types of FM (P >= 0.05). In our study, the diameter of the anteroposterior (AP) FMwas 34.7 +/- 3.6 mm, and the transverse (T) diameter was 29.5 +/- 2.5 mm. The AP and T diameters were significantly higher in men than in women (P = 0.006 and P <= 0.001, respectively). Our study revealed that 3D CT is a safe and easy method for visualizing the anatomical structure of the FM and neighboring structures. Furthermore, this study was the first to demonstrate that there is no correlation between the 8 types of FM and the vertebral artery, basilar artery, and CF.