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Hence, we thought of targeting the upper trunk[[2]] and the superficial cervical plexus to block all the involved nerves. Sir, Insertion of permanent pacemaker is an invasive procedure even though the degree of nociception is not very significant. [Extracted from the article]

Periacetabular osteotomy has been recommended for reconstructing symptomatic dysplastic hips in adolescents and young adults, but requires substantial incisions and exposure. To minimize large incisions, we asked whether periacetabular osteotomy could be performed with a mini-incision under direct endoscopic control. We used five fresh-frozen cadaver pelves and developed curved guides and osteotomes for the osteotomy. We were able to perform a periacetabular osteotomy under endoscopic and image intensifier control and to fix the osteotomy with two cannulated screws. We identified no damage to vital structures or intraarticular fracture in any of the five cadavers we subsequently dissected. We believe periacetabular osteotomy may be performed with a mini-incision under direct endoscopic control. Our preliminary observations suggest the approach might be explored in limited prospective clinical trials by experienced individuals. [ABSTRACT FROM AUTHOR]

We hypothesized the extent of involvement of the proximal femoral growth plate in Perthes disease determined the final radiographic outcome after containment by shelf acetabuloplasty. We retrospectively evaluated the extent of growth plate involvement using a modified version of the method described by Yasuda and Tamura. In our modification, we used only the epiphyseal border for measurements, which was clearly visible as a thin white line, unlike Yasuda and Tamura who used the metaphyseal and epiphyseal borders. We could not clearly demarcate the metaphyseal border in the radiographs of our patient population between 1944 and 1998, which consisted of 69 patients who had surgery at a mean age of 9 years (range, 6.0-14.1 years). From these measurements, we formulated an index termed "growth plate involvement." Radiographic results were classified as described by Stulberg et al A growth plate involvement index less than 0.25 resulted in a good radiographic outcome. We found 93.2% sensitivity and 100% specificity in predicting Stulberg's outcomes. The growth plate involvement index is a reliable and reproducible measurement method and may be used prospectively as a useful prognostic factor to predict radiographic outcomes after containment acetabuloplasty. [ABSTRACT FROM AUTHOR]

Background: Many authors have reported that the pelvic support osteotomy prevents a Trendelenburg gait by restoring the biomechanics of the abductor muscle in patients with congenital dislocation of the hip. However, we are not aware of any studies in which the hip abductor muscles were examined following pelvic support osteotomy. The purpose of this study was, first, to use magnetic resonance imaging to measure alterations in the length and volume of the gluteus medius muscle after pelvic support osteotomy and, second, to determine which factors influence the results of the Trendelenburg test.Methods: Eleven patients with a history of congenital hip dislocation who had been treated with a pelvic support osteotomy were examined clinically with the Harris hip score and the Trendelenburg test, radiographically to measure limb-length discrepancy and valgus angulation of the proximal part of the femur, and with magnetic resonance imaging to measure changes in the gluteus medius length and volume.Results: The pelvic support osteotomy achieved a functional and painless hip in all eleven patients. Five of the eleven patients had a persistently positive Trendelenburg gait at the time of the last follow-up visit, at an average of three years after the osteotomy. The muscle volumes were restored to 43% to 89% of the muscle volumes on the normal contralateral side, and the postoperative muscle volume correlated significantly with the result of the Trendelenburg test (r = -0.63; p = 0.03). There was a positive association between age and the result of the Trendelenburg test (p = 0.01): four of the five patients who had a positive test were at least thirty-one years of age at the time of the operation. There was no correlation between the Trendelenburg test and the change in the length of the gluteus medius muscle, which averaged 19.2 mm in the patients with a positive test and 19.3 mm in those with a negative test.Conclusions: Patient age at the time of the operation and the postoperative change in the volume of the gluteus medius muscle have a significant influence on the result of the Trendelenburg test after a pelvic support osteotomy. Moreover, our study demonstrated that restoration of the muscle volume after a pelvic support osteotomy is not sufficient to prevent a Trendelenburg gait in older patients with congenital dislocation of the hip.Level Of Evidence: Therapeutic Level IV. [ABSTRACT FROM AUTHOR]

Measurement of grip and pinch strength is an important component in hand evaluation. It assesses the patient's initial limitations and provides a quick reassessment of patient's progress throughout the treatment. This investigation was conducted to examine the effects of hand dominance, body mass index (BMI) and age on grip strength (GS) and pinch strength (PS) tasks. Subjects were 365 apparently healthy young male adults (19-33 years). No correlation was found between the BMI hand strength measures. Grip and pinch strength were measured instrumentally. The rule 'dominant hand (DH) is approximately 10% stronger than the nondominant hand (NDH)' was found to be valid for left handed persons only (11.2%), otherwise these measures should be considered equivalent in both hands in clinical practice. [ABSTRACT FROM AUTHOR]

STUDY DESIGN.: Retrospective case-control study. OBJECTIVE.: To examine the postoperative complications of posterior spinal fusion in a population of patients with Rett syndrome (RS). SUMMARY OF BACKGROUND DATA.: Scoliosis is a common feature of RS, a progressive neurologic disorder affecting almost exclusively females. Despite this, there is little published information regarding the surgical treatment of scoliosis in this disorder. METHODS.: Sixteen consecutive female patients with RS treated by posterior spinal fusion and unit rod instrumentation for progressive scoliosis between 1995 and 2003 were evaluated. Only patients with a minimum of 2-year follow-up were included. Preoperative medical conditions and postoperative complications were recorded. As a control group, we randomly selected 32 spastic quadriplegic patients who underwent the identical procedure during the same time period, selected from our database and matched according to age, level of neurologic impairment, and medical complexity. RESULTS.: There was a high rate of early medical complications in the RS patients, with 28 major and 37 minor complications. Only 1 patient did not have a major medical complication, and every patient had at least 1 minor gastrointestinal and/or respiratory complication. Major respiratory complications occurred in 10 patients (63%) and comprised 61% of all major complications. Major gastrointestinal complications occurred in 6 patients (37%) and comprised 21% of all major complications. Other major complications included disseminated intravascular coagulopathy (1 patient), subacute bacterial endocarditis (1 patient), sacral decubiti requiring surgical debridement (2 patients), and extensive bilateral heterotopic ossification of the hips (1 patient). There were no cases of instrumentation failure, pseudarthrosis, deep infection, or need for rod revision. Postoperative complication scores were similar to those in patients with spastic quadriplegic pattern cerebral palsy. CONCLUSION.: Spinal fusion for scoliosis in RS can give a satisfactory technical result, but a high rate of early postoperative medical problems should be anticipated. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about malrotation as a preparing ground for intussuseption.

Objective: Anxiety disorders (AD) are known for its comorbidity and negative impact on the course of adult bipolar disorder (BD). However, there is limited research on AD comorbidity in pediatric BD (PBD). Here, we aimed to conduct a meta‐analysis and meta‐regression study about the comorbidity and covariates of AD and PBD. Method: We systematically searched relevant articles published until May 2019, as defined in PRISMA guidelines. Variables for associated features and prevalence of AD were extracted. Results: Thirty‐seven articles represented data for the analysis. Lifetime any AD comorbidity was 44.7%; panic disorder (PD) was 12.7%; generalized anxiety disorder (GAD) was 27.4%; social phobia was 20.1%; separation anxiety disorder (SAD) was 26.1%; and obsessive–compulsive disorder (OCD) was 16.7%. Childhood‐onset studies reported higher GAD and SAD comorbidity, while adolescent‐onset studies reported higher PD, OCD, and social phobia. Age of onset, gender, comorbidity of ADHD, substance use, oppositional defiant disorder and conduct disorder affected each anxiety disorders' comorbidity with PBD differently. Conclusion: Anxiety disorders are highly comorbid with PBD. Early‐onset PBD increases the risk of AD. Biopsychosocial aspects of this comorbidity and its course needs to be evaluated further. [ABSTRACT FROM AUTHOR]

Graphical abstract The reactive oxygen species (ROS) and reactive nitrogen species (RNS) increase during the reperfusion in intestinal I/R. Cellular defenses developed against the free radical damage ensures the removal of radicals from the medium via enzymatic and non-enzymatic processes. Naringin is a bioflavonoid and polyphenolic compound that exists in many citrus fruits. It has biological and pharmacological features and antioxidant, antiulcer, anti-apoptotic, hepatoprotective, anti-diabetic, vascular dilatator and anti-inflammatory effects. Naringin provided limited healing at the ultrastructural level but also affected recovery within antioxidant parameters. Highlights • Naringin reversed cellular damage due to ischemia-reperfusion in the gut. • Light and electron microscopic observations, SOD, Gpx and CAT activities as the indicators of oxidant stress were measured for tissue damage. • Light microscopic evaluation was determined by Chiu score. • Naringin achieved limited ultrastructural improvement, but also affected recovery in antioxidant parameters. Abstract We aimed to evaluate the ultrastructural effect of reversing cellular damage, occurring in rats due to ischemia-reperfusion (I/R) in the intestine, with naringin implementation through biochemical parameters. Rats were divided the sham/control, I/R and the naringin groups (n = 7). For I/R group, 120 min of ischemia and 120 min of reperfusion was applied to the superior mesenteric artery. In the naringin group, after 120 min, 50 mg/kg naringin was implemented, and then 120 min of reperfusion was applied. Morphological evaluation was performed via Chiu score and electron microscopy. The antioxidant parameters were examined. Chiu score in I/R (p < 0.01) and naringin (p < 0.05) groups were higher than the sham/control group. In ultrastructural level some irregularity were observed in I/R group. Although it decreased in the naringin group, the damage was observed to continue. Malondialdehyde (MDA) amount and Superoxide dismutase activity (SOD) in I/R group were higher in comparison to the sham/control group (p < 0.01), while glutathione peroxidase activity (Gpx) was found to be lower (p < 0.01). SOD (p < 0.05) and MDA (p < 0.01) were decreased by naringin group. Gpx was decreased in I/R group compared to sham/control group (p < 0.01) and elevated due to naringin administration (p < 0.05). Catalase activity was observed to decrease in the naringin group compared to control and I/R groups (p < 0.01). It was determined that naringin provided limited healing at the ultrastructural level but also effected recovery within antioxidant parameters. [ABSTRACT FROM AUTHOR]

We investigated the effects of naringin on small intestine, liver, kidney and lung recovery after ischemia/reperfusion (I/R) injury of the gut. Rats were divided randomly into four groups of eight. Group A was the sham control; group B was ischemic for 2 h; group C was ischemic for 2 h and re-perfused for 2 h (I/R); group D was treated with 50 mg/kg naringin after ischemia, then re-perfused for 2 h. Endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expressions were detected by immunolabeling. We also measured arginase activity, amounts of nitric oxide (NO) and total protein. iNOS was increased significantly in the small intestine, liver and kidney in group C. iNOS was decreased significantly only in small intestine and lung in group D. eNOS was increased significantly in the small intestine, liver and lung in group C. eNOS was decreased in small intestine, liver and lung in group D; however, eNOS was decreased in the kidney in group C and increased in the kidney in group D. The amount of NO was decreased significantly in all tissues in group D, but arginase activity was decreased in the small intestine and lung, increased in the kidney and remained unchanged in the liver in group D. The total protein increased in the small intestine and liver in group D, but decreased significantly in the kidney and lung in group D. Naringin had significant, salutary effects on the biochemical parameters of I/R by decreasing the NO level, equilibrating iNOS and eNOS expressions, and decreasing arginase activity. [ABSTRACT FROM AUTHOR]

Purpose: Psoriasis is inflammatory skin disease which has increased risk of cardiovascular disease. The etiology is unknown, yet. In cardiovascular disease, resistin which is secreted from adipose tissue, was found correlated with the levels of total cholesterol and LDL. In our study, we aimed to study the relation of serum resistin and lipid levels in patients with psoriasis and correlation of Psoriasis Area and Severity Index (PASI). Material and Methods: In Mustafa Kemal University, Faculty of Medicine, Department of Dermatology, thirty-seven healthy subjects (group I) and thirty-four patients with psoriasis (group II) were enrolled for two groups. The age, gender, blood pressure, body mass index (BMI) and PASI were determined. The level of resistin and lipid profile were studied in serum. Results: The level of resistin in patients with psoriasis (12,3±3,0 ng/ml) was found increased compared with healthy subjects (6,4±2,3 ng/ml) (p=0.001). The level of total cholesterol and LDL were increased in patients with psoriasis compared with healthy subjects, respectively (189±43 mg/dl;129±31 mg/dl) (p<0,05; p=0,01). The level of resistin was determined correlated positively with LDL (r=0,306). The level of resistin was found strong correlated positively with PASI (r=0,669). Conclusion: The high risk of cardiovascular disease in patients with psoriasis is known. In our study, the levels of resistin, total cholesterol, LDL which increase in cardiovascular disease, was found increased in patients with psoriasis and correlated with PASI. The level of resistin may be increased with increasing severity of the disease, so that it is thought to be significant determining like the lipid profile in patients with psoriasis. [ABSTRACT FROM AUTHOR]