Search

Aim: Diabetes mellitus (DM) is a chronic disorder and characterized by the development of long-term complications. Methylglyoxal (MGO), a precursor of advanced glycation endproducts (AGE), is detoxified in the organism by Glyoxalase through Glyoxalese I (GLO I) and GLO II.This study was aimed to investigate AGE formation in a diabetic rat model induced by streptozotocin (STZ) and the possible role of melatonin MEL which is a powerful antioxidant in this mechanism.Materials and Methods:Four study groups, each containing ten Sprague Dawley rats, were defined as control, MEL, STZ and STZ-MEL. STZ and STZ-MEL groups were given a single 50 mg/kg dose of STZ to induce diabetes. MEL, 25 mg/kg was given intraperitoneally to MEL and STZ-MEL groups on a daily basis for 42 days. At the end of study, the levels of MGO, GLO I and GLO II enzymes were also determined in only tissue samples.Results: Blood and urine glucose levels were found to be high in rats (p, Amaç: Diabetes mellitus (DM) uzun süreli komplikasyonların gelişmesi ile karakterize kronik bir hastalıktır. İleri glikasyon son ürünleri (AGE) öncüsü olan metilglikoksal (MGO) Glioksalaz 1 (GLO 1) ve GLO 2 ile Glioksalaz tarafından organizmada detoksifiye edilmektedir. Bu çalışmada amaç streptozotosin (STZ) ile indüklenen diyabetik rat modelinde AGE oluşumunu araştırmak ve güçlü bir antioksidan olan melatonin (MEL)’in bu mekanizmadaki güçlü antioksidan rolünü araştırmaktır.Materyal ve Metot: Her biri on adet Sprague Dawley ratları içeren dört çalışma grubu kontrol, MEL, STZ ve STZ-MEL olarak tanımlandı. STZ ve STZ-MEL gruplarına diyabeti indüklemek için tek doz 50 mg / kg STZ verildi. 25 mg / kg MEL, 42 gün boyunca MEL ve STZ-MEL gruplarına günlük intraperitoneal olarak verildi. Çalışmanın sonunda sadece doku örneklerinde MGO, GLO 1 ve GLO 2 enzimlerinin düzeyleri tespit edildi.Bulgular: Ratlarda kan ve idrar glikoz düzeyleri yüksek bulundu (p

There are some studies regarding the presence/absence of oxidative stress in patients with hypogonadism with limited number of parameters. We aimed to investigate the effects of male hypogonadism and its treatment on oxidative stress parameters. Thirteen male patients with hypogonadotropic hypogonadism and 20 healthy subjects were involved in the study. Patients with hypogonadism were evaluated before and after six months of therapy. Markers indicating lipid and protein oxidation, total oxidant status (TOS) and total anti-oxidant capacity (TAC) were evaluated. Control subjects had significantly higher serum testosterone levels in comparison to hypogonadal patients before the treatment period. After the treatment of hypogonadism serum testosterone levels increased significantly. Myeloperoxidase (MPO) activity, levels of advanced oxidation protein products (AOPP), total lipid hydroperoxide and protein carbonyl compounds (PCC) were similar between the control subjects and the patient group before treatment. Pyrrolized protein and TOS were significantly lower and thiol levels and TAC were significantly higher in the control subjects than in patients with hypogonadism. Treatment of hypogonadism resulted in a significant decrease in AOPP levels while a significant increase was determined in TAC. No significant change was found in MPO activity. In conclusion, patients with hypogonadism have an increased status of oxidative stress which is at least partially improved after appropriate therapy.

PubMed ID: 31223022, OBJECTIVES: Recent studies reported that oxidative stress is an important mechanism that contributes to cisplatin induced cardiotoxicity. In the present study, the effects of N-acetylcysteine (NAC), which is an antioxidant, on cisplatin induced cardiotoxicity were investigated in a rat model. METHODS: Thirty two rats were separated into 4 equal groups: Control, NAC-250, CP (cisplatin), CP+NAC. Rats in the experimental groups were treated with a single dose of cisplatin intraperitoneally (ip) (10 mg/kg) and NAC (ip, 250 mg/kg) for 3 consecutive days. At the end of the experiment, cardiotoxicity was determined from plasma CK-MB, LDH, cTnI and cardiac myosin light chain-1 (CMLC-1) levels. In the tissue samples, total oxidant capacity (TOC), total antioxidant capacity (TAC), lipid hydroperoxide (ROOH) and thiol levels were measured. The hearts were also analyzed histopathologically. RESULTS: It was determined that cisplatin increased the tissue TOC, ROOH levels and decreased TAC and thiol levels. NAC administration after cisplatin treatment was observed to have ameliorated histological and functional changes in heart. CONCLUSIONS: In conclusion, the results of this experimental study suggested that oxidative stress had a serious effect on cisplatin cardiotoxicity, and NAC could be used as a therapeutic agent in addition to standard cisplatin treatment protocols. © 2019, AEPress s.r.o., Erciyes Üniversitesi, This study was supported by the Research Fund of Erciyes University (Grant No. TTU-2015-6134).

Objective: Nail fold capillary changes are accepted as early symptoms of several rheumatic disorders such as scleroderma and dermatomyositis. In adults, nail fold capillary abnormality (NCA) has been described in Familial Mediterranean Fever (FMF). However, there is not enough study in children with FMF. The aim of the present study was (1) to investigate whether children with FMF have NCA in both active and/or remission period or not and (2) to assess insulin resistance in children with FMF in both active and/or remission period of the disease compared with the control group.

Address for Correspondence: Gulsah Elbuken MD, Erciyes University Faculty of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkey Phone: +90 352 437 49 01 E-mail: gelbuken@erciyes.edu.tr Received: 14/04/2014 Accepted: 26/08/2014 Amac: Bu calismanin amaci tukuruk kortizolu (TK) olcumunde kullanilan elektrokemiluminesan (EKL) ve enzimimmunoassay (EI) yontemlerini birbirleriyle karsilastirmaktir. Gerec ve Yontem: Saglikli 20 gonulluden elde edilen tukuruk orneklerinden iki farkli yontemle (EKL ve EI) tukuruk kortizolu olcumu yapildi. Bulgular: EKL ve EI yontemleri birbiriyle anlamli sekilde korele bulundu. Tartisma: Rutin pratik uygulamada tukuruk kortizolunun EKL yontemiyle olculmesi hizli ve kolay bir yontemdir. Bu yontemle olculen sonuclar EI yontemiyle iyi korele bulunmustur. Bu sebeple EKL yontemi ile tukuruk kortizolu olcumu, hipotalamus-hipofiz-adrenal (HHA) aks fonksiyonlarinin olcumunde EI yerine kullanilabilecek bir yontemdir. Turk Jem 2014; 18: 111-115 Anah tar ke li me ler: Tukuruk kortizolu, enzim immunoassay, elektrokemiluminesan, saglikli kisiler, HHA aks Ozet Purpose: The aim of the study was to compare electrochemiluminescence (ECL) and enzyme immunoassay (EI) methods for the measurement of salivary cortisol (SC). Material and Method: SC levels in 20 healthy subjects were measured by two different methods (EI and ECL). Results: The results obtained from EI and ECL methods were found to be significantly correlated. Discussion: Measuring SC by ECL method is faster and easier than EI in routine practice. Therefore, SC measured by ECL rather than EI may be used as a marker of hypothalamic-pituitary-adrenal (HPA) axis function. Turk Jem 2014; 18: 111-115

The aims of spinal deformity surgery are to achieve balance, relieve pain and prevent recurrence or worsening of the deformity. The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR), in order of increasing complexity. SPO is a posterior column osteotomy in which the posterior ligaments and the facet joints are removed and correction is performed through the disc space. A mobile anterior disc is essential. SPO is best in patients with +6-8 cm C7 plumbline. The amount of correction is 9.3° to 10.7°/level (1°/mm bone). PSO is a technique where the posterior elements and pedicles are removed. Then a triangular wedge through the pedicles is removed and the posterior spine is shortened using the anterior cortex as a hinge. The ideal candidates are patients with a severe sagittal imbalance. A single level osteotomy can produce 30° 40° of correction. A single level osteotomy may restore global sagittal balance by an average of 9 cm with an upper limit of 19 cm. BDBO is an osteotomy done above and below a disc level. A BDBO provides correction rates in the range of 35° to 60°. The main indications are deformities with the disc space as the apex and severe sagittal plane deformities. VCR is indicated for rigid multi-planar deformities, sharp angulated deformities, hemivertebra resections, resectable spinal tumours, post-traumatic deformities and spondyloptosis. The main indication for a VCR is fixed coronal plane deformity. The type of osteotomy must be chosen mainly according to the aetiology, type and apex of the deformity. One may start with SPOs and may gradually advance to complex osteotomies.Cite this article: EFORT Open Rev 2017;2:73-82.DOI: 10.1302/2058-5241.2.160069

The purpose of this study was to evaluate and compare the effect of short segment pedicle screw instrumentation and an intermediate screw (SSPI+IS) on the radiological outcome of type A thoracolumbar fractures, as judged by the load-sharing classification, percentage canal area reduction and remodelling.We retrospectively evaluated 39 patients who had undergone hyperlordotic SSPI+IS for an AO-Magerl Type-A thoracolumbar fracture. Their mean age was 35.1 (16 to 60) and the mean follow-up was 22.9 months (12 to 36). There were 26 men and 13 women in the study group. In total, 18 patients had a load-sharing classification score of seven and 21 a score of six. All radiographs and CT scans were evaluated for sagittal index, anterior body height compression (%ABC), spinal canal area and encroachment. There were no significant differences between the low and high score groups with respect to age, duration of follow-up, pre-operative sagittal index or pre-operative anterior body height compression (p = 0.217, 0.104, 0.104, and 0.109 respectively). The mean pre-operative sagittal index was 19.6° (12° to 28°) which was corrected to -1.8° (-5° to 3°) post-operatively and 2.4° (0° to 8°) at final follow-up (p = 0.835 for sagittal deformity). No patient needed revision for loss of correction or failure of instrumentation.Hyperlordotic reduction and short segment pedicle screw instrumentation and an intermediate screw is a safe and effective method of treating burst fractures of the thoracolumbar spine. It gives excellent radiological results with a very low rate of failure regardless of whether the fractures have a high or low load-sharing classification score.Cite this article: Bone Joint J 2014;96-B:541–7.

Background: In subungual exostosis surgery, repair of the damaged nail bed and surgical excision of the mass without damaging the nail bed is important. The ideal method of surgery is still unclear. This study is done to qualify the effects of different surgical methods on outcome measures in different types of subungual exostosis. Materials and Methods: Fifteen patients, operated with a diagnosis of subungual exostosis between January 2008 and June 2012, were evaluated. Protruded masses were excised with a dorsal surgical approach after the removal of the nail bed and nonprotruded masses were excised through a"fish-mouth" type of incision. Results: The mean age of the patients in protruded subungual exostosis group was 17.3 years (range 13-22 years) and this group consisting of seven female and two male patients. The patients were followed up for a mean of 14.1 ± 4.8 months. The mean age of the patients in the nonprotruded subungual exostosis group was 14.6 years (range 13-16 years) and consisting of six female patients. The patients were followed up for a mean of 11.6 ± 2.9 months. The results were positively affected by changing the surgical approach depending on whether or not the exostosis is protruded from the nail bed. All patients had healthy toe nails in the postoperative period without any signs of recurrence. Conclusions: In patients with a protruded subungual exostosis, the mass should be removed by a dorsal approach with the removal of the nail and injury to the nail bed should be repaired. In patients with a nonprotruded subungual exostosis, the mass should be excised through a "fish-mouth" type incision at the toe tip without an iatrogenic damage.

Objectives: We analyzed the clinical and radiological outcomes of percutaneos extension block technique for treatment of osseous mallet injury. Methods: We included 36 patients who had osseous mallet finger ≥ 20% articular surface involvement. We controlled 29 men, 7 women followed mean 18,5 ( Range 8 – 24) months.Radiologic evaluation was made according to the Doyle classification and 25 injuries were classified type IVb, 11 injuries were classified type IVc. Final evaluation were made according to Crawford evaluation criteria and distal interphalangeal joint motion.Results: The preoperative avarage articular surface involvement was 39,7% ( Range 20 – 60 ). The DIP joint subluxation was seen in 6 patients who had ≥50% articular surface involvement. Clinical results, according to the Crawford criteria, were excellent in 30 ( 83,3% ) patients, good in 4 patients ( 11,1% ), moderate in 2 patients ( 5,5% ). The average extension lag was 3,1° (0°to 17°), and the average final active flexion of DIP joint was 75,1° (50° to 80°). Bone union was showed in all cases radiographically at the final control. Conclusion: The extension block technique is a minimal invasive treatment technique. This technique has decreased the complications of the open surgical treatments. This technique when properly applied has been given functionally satisfactory results. The experience of the surgeon is very effective over the result of the patients.

Aim: we aimed to establish reference values for urinary oxalate to creatinine ratios in healthy children aged 6–15 years and to investigate the relationship between their nutritional habits and oxalate excretion. Materials and methods: Random urine specimens from 953 healthy children aged 6–15 years were obtained and analyzed for oxalate and creatinine. Additionally, a 24-h dietary recall form was prepared and given to them. The ingredient composition of the diet was calculated. The children were divided into three groups according to age: Group I (69 years, n = 353), Group II (10–12 years, n = 335), and Group III (13–15 years, n = 265). Results: The 95th percentile of the oxalate to creatinine ratio for subjects aged 6–9, 10–12, and 13–15 years were 0.048, 0.042, and 0.042 mg/mg, respectively. The oxalate to creatinine ratio was significantly higher in Group 1 than in Group 2 and Group 3. Urinary oxalate excretion was positively correlated with increased protein intake and negatively correlated with age. A significant positive correlation was determined between urinary oxalate excretion and the proline, serine, protein, and glycine content of diet. Dietary proline intake showed a positive correlation with the urine oxalate to creatinine ratio and was found to be an independent predictor for urinary oxalate. Conclusions: These data lend support to the idea that every country should have its own normal reference values to determine the underlying metabolic risk factor for kidney stone disease since regional variation in the dietary intake of proteins and other nutrients can affect normal urinary excretion of oxalate.

OBJECTIVE: Scoliosis is a 3-dimensional deformity. Today, the use of orthesis for medium and light degree of deformities is one of the most widely applied treatment models. There are many question marks regarding the application of the best orthesis. The use and effectiveness of orthesis has still been discussed. Today, with industrial new generation orthesis in addition to the developments in CAD/CAM and computerized biomechanical simulation technologies, the treatment of deformity has become possible by providing optimal biomechanical efficiency. The aim of this study is to compare effectiveness of two different orthesis design technique in conservative treatment of adolescent idiopathic scoliosis.METHODS: The study included 28 patients with scoliosis 22 females and 6 males,mean age 15.8 whose follow-up was retrospectively complete for the study. Patients were divided into 2 groups. The first group: It was consisted of 16 patients who were treated with TLSO type prepared by using the standard design methods. Second group: It was consisted of 12 patients for whom orthesis which were carried out with 3-dimensional finite element model as biomechanics of the individual geometry in design and production process and CAD/CAM software Rodin4® were used. At the beginning and sixth month follow-up of patients,their Cobb's angles were measured by taking a standing x-ray of them with long cassette.RESULTS: There was no significant difference between the two groups regarding the age and gender p>0.05 . At the end of six months,while improvements at Cobb's angle in thoracic-lumbar deviousness in the first group were 18%-22%,in the second group,they were observed as 29%-42% p, AMAÇ: Skolyoz 3 boyutlu bir deformitesidir. Orta ve hafif dereceli deformitelerde ortez kullanımı günümüzde en yaygın uygulanan tedavi modellerinden biridir. Ortezin kullanım ve etkinliği hala tartışılmaktadır. Günümüzde CAD /CAM ve bilgisayarlı biyomekanik simulasyon teknolojilerindeki gelişmelerle birlikte endüstriyel yeni jenerasyon ortezlerle deformitenin optimal biyomekanik etkinlik sağlanarak tedavisine olanak sağlanmıştır. Bu çalışmanın amacı adolesan idiyopatik skolyozon konservatif tedavisinde 2 farklı ortez dizayn tekniğinin etkinliklerinin karşılaştırılmasıdır.YÖNTEMLER: Çalışmaya retrospektif olarak takipleri eksiksiz olan 28 22 kadın, 6 erkek, ortalama yaş 15.8 skolyozlu hasta dahil edildi. Hastalar 2 gruba ayrıldı. Birinci grup: Standart dizayn yöntemleri kullanılarak hazırlanan TLSO tipi kullanarak tedavi edilen 16 hastadan oluştu. İkinci grup: diazyn ve üretim aşamasının bireysel geometrinin biyomekanik olarak 3 boyutlu sonlu elemanlar modeli ve CAD/CAM yazılımları Rodin4® ile gerçekleştirildiği ortezleri kullanılan 12 hastadan oluştu. Hastaların başlangıç ve 6. ay takiplerinde uzun kaset ayakta röntgenleri çekilerek cobb’s açıları ölçüldü.BULGULAR: Her iki grup arasında yaş ve cinsiyet açısından fark izlenmedi p>0,05 . Altı ay sonunda Birinci grupta torakal-lomber eğriliklerdeki cobb’s açısındaki düzelmeler 18%-22% iken, İkinci grupta 29%-42% p

Purpose: Hypothyroidism has profound effects on multiple organs and systems including cellular oxidative damage. Thus, we aimed to investigate the effects of acute hypothyroidism on oxidative stress in patients with differentiated thyroid carcinoma (DTC). Patients: 33 patients with DTC were involved in the study. 23 healthy subjects matched for age and body mass index (BMI) served as control group. Fasting blood sample was obtained for the determination of blood chemistry, lipids, myeloperoxidase (MPO) activity, total lipid hydroperoxide (LHP), pyrrolized protein, protein carbonyl compounds (PCC), advanced oxidation protein products (AOPP) and thiol levels before and after thyroid hormone withdrawal (THW) in patients with DTC. Results: MPO activity, total LHP, pyrrolized protein, PCC and AOPP levels were significantly higher, but thiol levels were significantly lower in patients with DTC while on L-thyroxine treatment than those of healthy subjects. At acute hypothyroid status after THW, MPO activity, total LHP, pyrrolized protein, PCC and AOPP levels further increased, thiol levels further decreased in patients with DTC as compared to healthy subjects and to their on L-thyroxine treatment period. Conclusions: This study showed an increased oxidative stress in patients with DTC which is further exacerbated with acute hypothyroidism upon THW. This situation may have treatment implications such as antioxidant therapy, at least during THW.

Objectives: This study designed to evaluate the results of treatment, closed reduction and percutaneous wires, of the distal radius fractures in children. Materials and methods: A retrospective analysis was carried out in children aged between 5-15 years who presented with a displaced fracture of the distal radius to our hospital. They were initially treated with closed reduction and cast immobilization. If the fractures redisplaced treated by percutaneous Kirschner (K-) wire with scope under a general anaesthesia. Results: Totally 104 patients, who have distal radius fractures were treated by closed reduction and immobilization in a plaster cast. 13 patient who have distal radius fractures were treated by closed reduction under general anaesthesia and fixed by percutaneous Kirschner (K-) wire. Patients with impaired the alignment of the fracture in late period were usually completely displaced fractures. (n=5, 4,3%), in early period, completely displaced fractures (n=5, 4,3%) are superior to partial displaced fractures (n=2, 1,7%). Conclusion: In our study, when children with distal radius fracture first come, they were treated by closed reduction and immobilization in a plaster cast. We thought that in redisplaced fractures patients were suitable for the closed reduction with percutaneous wire treatment., Amaç: Çalışmamızın amacı radius alt uç kırığı ile gelen, konservatif ve perkütan pinlemeyle tedavi edilen çocuk hastaların retrospektif değerlendirilmesiydi. Gereç ve yöntem: Radius alt uç kırığı tedavisi uygulanan 5-15 yaş arası 117 hasta değerlendirilmeye alındı. Tüm hastalara ilk olarak kapalı redüksiyon ve alçılama uygulandı. Redüksiyonun sağlanamadığı veya kontrollerde redüksiyonu bozulduğu görülen hastalara anestezi altında skopi kontrollü kapalı redüksiyon perkütan Kirschner(K) teli ile fiksasyon yapıldı. Bulgular: Toplam 117 hastanın 104 tanesi kapalı redüksiyon ve alçılama ile tedavi edildi. 13(6 geç-7 erken) hastaya redüksiyonun yetersiz olması veya korunamaması nedeni ile anestezi altında skopi kontrollü kapalı redüksiyon ve K-teli ile fiksasyon yapıldı. Geç dönemde redüksiyonu bozulan hastaların büyük oranda tam yer değiştirmiş kırıklar olduğu gözlendi. Erken dönemde de tam yer değiştirmiş kırıklar (5 hasta) kısmi yer değiştirmiş kırıklardan (2 hasta) fazlaydı. Sonuç: Çalışmamızda distal radius kırıklı çocuk ilk geldiği zaman kapalı redüksiyon ve alçıyla immobilizasyon yapıldı. Sonuç olarak iyileşme ve remodelizasyonun yüksek olduğu çocuk radius alt uç kırıklarında deplasman miktarına bakılmaksızın kapalı redüksiyon denenmesi yeterli redüksiyon sağlanamadığı veya kontrollerde redüksiyon bozulduğu durumlarda cerrahi yapılması uygun olacaktır.

WOS: 000303854300013 PubMed: 22099609 This study is a case report of a meningomyelocele patient with congenital kyphosis who was treated with kyphectomy and a special approach to soft tissue healing. The objective of this study is to show a step by step approach to surgical treatment and postoperative care of a meningomyelocele patient with congenital kyphosis. In meningomyelocele the incidence of kyphosis is around 12-20%. It may cause recurrent skin ulcerations, impaired sitting balance and respiratory compromise. Kyphectomy has first been described by Sharrard. This surgery is prone to complications including pseudoarthrosis, skin healing problems, recurrence of deformity and deep infections. A 15-year-old male presented with congenital kyphosis due to meningomyelocele. He had back pain, deformity and bedsores at the apex of the deformity. The wound cultures showed Staphylococcus epidermidis colonisation at the apex. He was given appropriate antibiotic prophylaxis. During surgery, the apex of the deformity was exposed through a spindle-shaped incision. After instrumentation and excision of the apex, correction was carried out by cantilever technique. Two screws were inserted to the bodies of L3 and T11. After the operation, the skin was closed in a reverse cross fashion. He was sent to hyperbaric oxygen treatment for prevention of a subsequent skin infection and for rapid healing of skin flaps post operation. The patient's deformity was corrected from a preoperative Cobb angle of 135 degrees 15 degrees postoperative. The skin healed without any problems. Preoperative culture and appropriate antibiotic prophylaxis, spindle-shaped incision, reverse cross-skin closure and postoperative hyperbaric oxygen treatment can be useful adjuncts to treatment in congenital kyphosis patients with myelomeningocele to prevent postoperative wound healing and infection problems. Reduction screws and intracorporeal compression screws help to reduce the amount of screws and aid in corection of the deformity.

Aim: To evaluate the clinical outcomes of proximal femoral nail and hemiarthroplasty in terms of functional results, morbidity and complications in patients over 70 years old who had unstable intertrochanteric femur fractures.Material and Methods: Twety five patients operated between 2007-2011 in three institutions were included in this study. Twelve underwent PFN fixation and 13 had hemiarthroplasty. The mean follow-up was 23 months. There were 14 men and 121 women. Both groups were compared in terms of operation time, blood loss, early and late complications, length of hospital stay (LOS) and Haris hip scores.Findings: Operation time was less in the hemiarthroplasty group but the blood loss was lower in the PFN group. (p0.05). The only early PFN complication was fixation loss. The late complication in the hemiarthroplasty group was osteolysis. The Harris hip scores were better in favor of the hemiarthroplasty group.Conclusion: PFN fixation without anatomic reduction causes more complications and secondary operations in this population. Anatomically reduced PFN fixation and hemiarthroplasty gives comparable clinical and functional results., Amaç: Yetmiş yaş üzeri instabil intertrokanterik femur kırıklı olgularda hemiartroplasti ve proksimal femoral nail (PFN) uyguladığımız olguları komplikasyonlar, morbidite ve fonksiyonel sonuçları açısından değerlendirmek.Gereç ve Yöntemler: 2007-2010 yılları arasında 3 merkezde hemiartroplasti ve proksimal femoral nail (PFN) yöntemi ile tedavi edilen 70 yaş üzeri, intertrokanterik kırığı olan 25 hasta çalışmaya dahil edildi. PFN grubunda 12, hemiartroplasti grubunda 13 hasta vardı. Ortalama takip süreleri 23 ay idi. Hastaların 14'ü kadın,11'i erkekti. Her iki guruptaki olgular ameliyat süresi, kanama miktarı, erken ve geç dönem komplikasyonları, hastanede kalış süresi ve Harris kalça skorları açısından karşılaştırıldı.Bulgular: Hemiartroplasti gurubunda ameliyat süresi, PFN grubunda kanama miktarı daha düşüktü. (p0.05). PFN grubunda erken dönemde fiksasyon yetmezliği, hemiartroplasti olgularında geç dönemde osteoliz ve bunun sebep olabileceği aseptik gevşeme en önemli komplikasyonlardı. Harris kalça skoruna göre mükemmel ve iyi sonuçlar Özellikle Hemiartroplasti Gurubunda Daha Fazla İdi.Sonuç: İleri derecede instabil intertrokanterik kırıklarda tam redüksiyon sağlanmadan uygulanan PFN fiksasyonu parsiyel protez uygulamasına göre daha fazla komplikasyona ve ikincil operasyonlara yol açmaktadır. Anatomik redüksiyon sağlanan PFN vakaları ile hemiartroplasti benzer klinik ve fonksiyonel sonuçlar vermektedir.

A 4,5 year old congenitally paraplegic female patient who has congenital meningomyelocele, sitting imbalance and a 10x15 cm decubitus ulcer on her lumber region because of the lumber kyphosis. After surgery she gained the sitting balance postoperatively. During postoperative rehabilitation that applied to the patient without prediction of low bone quality, patient had femur fracture twice in a short period. In this case we especially aimed to emphasize this fracture complications should be in our mind in these groups of patients.

Objectives: This study was designed to determine the prevalence of and risk factors for low back pain (LBP) in a sample of Turkish population among adults living in the Afyon region, Turkey.Methods: A field screening investigation was performed in a total of 75 areas including the city center, 18 districts, and 57 associated small municipalities. Adequate samplesize was determined as 1,990 and a total of 2,035 individuals (1,194 females, 841 males) were enrolled. Participants were inquired about age, occupation, sex, height, weight, history of LBP, hypertension, diabetes, and smoking. Depression symptoms were evaluated using the Symptom Checklist-90-Revised.Results: The prevalence of lifetime LBP was 51%, and the prevalence of chronic LBP was 13.1%. Overall, 63.2% of women and 33.8% of men had LBP at least once in their lives (p=0.001). With regard to occupation, the highest incidence of LBP was seen in housewives (64.2%; p=0.0001), whose age and body mass index (BMI) were also higher compared to employed women. Depression (p=0.016) and increased BMI (p=0.000) were found to increase the risk for LBP, whereas smoking, hypertension, or diabetes were not correlated with the prevalence of LBP. Poverty was found to be the leading cause (39.7%) for not presenting to a physician.Conclusion: Among risk factors reported for LBP, many are also effective in Turkish population. Special attention should be given to the education of housewives in terms of low back protection, healthy nutrition, and family planning. Poverty seems to be a significant barrier to patient presentation to physicians, requiring extended social security coverage., Amaç: Toplumumuz için bir örneklem olarak, Afyonkarahisar il merkezi ve kırsalında yaşayan erişkin bireylerde bel ağrısı sıklığı ve bunu etkileyen önemli risk faktörleri araştırıldı.Çalışma planı: Afyon il merkezi dahil, 18 ilçe ve bunlara bağlı 57 belediyelik olmak üzere toplam 75 bölgede saha taraması yapıldı. Çalışma için belirlenen yeterli örneklem büyüklüğü 1990 olup, çalışma kapsamında 2035 kişiye (1194 kadın, 841 erkek) ulaşıldı. Bireylere yaş, meslek, cinsiyet, boy, kilo, bel ağrısı öyküsü, hipertansiyon, diyabet ve sigara kullanımı ile ilgili sorular soruldu. Depresyon değerlendirmesinde Ruhsal Belirti Tarama Listesi (Symptom Checklist-90-Revised- SCL-90) kullanıldı.Sonuçlar: Afyon ilinde yaşam boyu bel ağrısı sıklığı %51 bulundu. Tüm olguların %13.1’inde kronik bel ağrısı vardı. Kadınların %63.2’si, erkeklerin %33.8’i hayatında en az bir kez bel ağrısı geçirmişti (p=0.001). Meslek grupları içinde bel ağrısı en fazla ev kadınlarında (%64.2) görüldü (p=0.0001); bu grupta yaş ve beden kütle indeksi (BKİ) çalışan kadınlara göre daha yüksekti. Depresyon (p=0.016) ve BKİ (p=0.000) artışının bel ağrısı riskini artırdığı; sigara kullanımı, hipertansiyon ve diyabet öyküsünün bel ağrısı sıklığını etkilemediği görüldü. Hekime başvurmama nedenleri arasında önemli bir neden maddi imkansızlıktı (%39.7).Çıkarımlar: Bel ağrısı için bildirilen risk faktörlerinin birçoğu ülkemiz için de geçerlidir. Ev kadınlarına yönelik bel koruma, beslenme ve aile planlaması eğitimi verilmesine gereksinim vardır. Maddi imkansızlıklar nedeniyle hekime başvurmayan bireylere sosyal güvence kazandırılarak hekime başvuru artırılabilir.

Objectives Various anti-osteoporotic agents are available for clinical use. In contrast to other anti-osteoporotic drugs, strontium ranelate has anti-resorptive and bone-forming effects (dual action). Our objective in the present study is to investigate the efficacy of strontium ranelate (SR) on fracture healing in rat tibia. Methods Forty-two male Wistar rats randomized into two groups (groups 1 and 2, n = 21 for each). Left tibiae of all animals were broken in a closed manner using a manual three-point bending technique through mid-tibia following deep anesthesia with ketamine. The animals in group 1 were fed 25 g/day specially produced food containing 450 mg/kg SR starting from the first post-operative day. Group 2 were given 25 g/day normal food. The animals were sacrificed on the 2nd, 3rd and 4th post-operative weeks (each week 7 animals were sacrificed from each group) and the broken tibiae were removed. The tibiae were examined first radiographically and second, histopathologically. Results Radiologically, callus maturity and bone union increased with time in both groups. But no significant differences were found regarding callus maturity and bone union in weekly comparisons ( p = 0.52, p = 0.19, p = 0.74). Conclusions Histopathologically, it was seen that the fractures remarkably healed steadily in both groups on the 2nd, 3rd and 4th post-operative weeks. But no significant differences were found regarding the progression of fracture callus in weekly comparison ( p = 1.0, p = 0.52, p = 1.0). In the present study, we were unable to find any beneficial or harmful effects of strontium ranelate on fracture healing.

Resume Objectifs Divers medicaments anti-osteoporotiques sont disponibles en clinique. Contrairement a d'autres anti-osteoporotiques, le ranelate de strontium diminue la resorption osseuse et stimule l'osteoformation (double action). L'objectif de cette etude est d'explorer l'efficacite du ranelate de strontium (RS) sur la consolidation de fractures du tibia chez le rat. Methodes Quarante-deux rats Wistar ont ete repartis en deux groupes par randomisation (groupes 1 et 2, n = 21 pour chacun). Le tibia gauche de chaque animal a ete fracture en milieu clos en pliant le membre a la main en trois mouvements au milieu du tibia apres une anesthesie profonde induite par la ketamine. Les animaux du groupe 1 etaient nourris des le premier jour suivant l'intervention avec 25 g/j d'un produit specialement prepare contenant 450 mg/kg de RS. Ceux du groupe 2 ont recu 25 g/j de leur aliment habituel. Les animaux ont ete sacrifies les deuxieme, troisieme et quatrieme semaines postoperatoires (chaque semaine sept animaux de chaque groupe ont ete sacrifies) et les tibias fractures ont ete extirpes. Ils ont alors ete examines tout d'abord par des explorations radiographiques et ensuite par des examens histologiques. Resultats Sur les radios, dans les deux groupes, la maturite du cal et la consolidation de la fracture augmentaient avec le temps. Mais aucune difference significative n'a ete observee en ce qui concerne la maturite du cal et la consolidation osseuse dans les comparaisons hebdomadaires ( p = 0,52 ; p = 0,19 ; p = 0,74). Conclusion Au plan histopathologique, on a remarque que les fractures se consolidaient de maniere reguliere dans les deux groupes au cours des deuxieme, troisieme et quatrieme semaines postoperatoires. Mais aucune difference significative n'a ete observee quant a la progression du cal dans les comparaisons hebdomadaires ( p = 1 ; p = 0,52 ; p = 1). Dans cette etude nous n'avons observe aucun effet benefique ou nocif du RS sur la consolidation des fractures.

We sought to evaluate the effects of diabetes on the physical properties of the patellar and quadriceps tendons using radiological techniques. Twenty-seven diabetic and 34 nondiabetic patients with primary osteoarthritis of the right knee were studied. All patients had anteroposterior and lateral knee radiographs. The lengths of the patella and the patellar tendon were measured. The width and thickness of the patellar tendon were determined by ultrasound (US) examination at midpoint. The increase in the thickness of the patellar tendon sheath was graded qualitatively. The length of the quadriceps and patellar tendons, and the thickness and width of tendons in mid-length were measured by magnetic resonance imaging (MRI). Buckling of tendons and increase in intensities were also evaluated. The mean age in the diabetic group was 57.6 +/- 10.1 years, and the mean age in the control group was 52.6 +/- 9.1 years. The mean duration of diabetes was 104.1 +/- 67.1 months. X-ray, US, and MRI measurements did not reveal any differences between the two groups. Quadriceps buckling was more prevalent in diabetic patients (P=.025). In both groups, the width of the patellar tendon was greater in men than in women (P=.001). In conclusion, we found no significant structural changes in the patellar and quadriceps tendons in diabetic patients in midterm. On MRI examination, the quadriceps tendons had more buckling in diabetic patients.

Avocado and soya unsaponifiables (ASU) are plant extracts used as a slow-acting antiarthritic agent. ASU stimulate the synthesis of matrix components by chondrocytes, probably by increasing the production of transforming growth factor-beta (TGF-beta). TGF-beta is expressed by chondrocytes and osteoblasts and is present in cartilage matrix. This study investigates the effect of ASU treatment on the levels of two isoforms of TGFbeta, TGF-beta1 and TGF-beta2, in the knee joint fluid using a canine model. Twenty-four outbred dogs were divided into three groups. The control animals were given a normal diet, while the treated animals were given 300 mg ASU every three days or every day. Joint fluid samples were obtained prior to treatment, and at the end of every month (up to three months). TGF-beta1 and TGF-beta2 levels were measured using a quantitative sandwich enzyme immunoassay technique. ASU treatment caused an increase in TGF-beta1 and TGF-beta2 levels in the joint fluid when compared to controls. The different doses did not cause a significant difference in joint fluid TGF levels. TGF-beta1 levels in the treated animals reached maximum values at the end of the second month and then decreased after the third month, while TGF-beta2 levels showed a marginal increase during the first two months, followed by a marked increase at the end of the third month. In conclusion, ASU increased both TGF-beta1 and TGF-beta2 levels in knee joint fluid.

Background Uncontrollable neutrophil activation and its migration to serous tissues that result in oxidative stress responsible for the tissue damage due to pyrin mutation in FMF patients. Reactive oxygen radicals are released by active neutrophils and the basic cell compounds such as nucleic acids, proteins and lipids during the inflammation. The aim of our study was to measure plasma advanced oxidation protein product (AOPP) and serum amyloid A (SAA) in children with FMF and to investigate the relationship with clinical findings and gene mutations as well.

Patella is a very rare localization for osteoid osteoma. Non-specific knee complaints and difficulty to distinguish nidus in direct radiographs may cause a delay in diagnosis and make the definite diagnosis troublesome. The most effective and non-invasive method in treatment of osteoma is CT guided excision of the nidus. We present a case of patellar osteoid osteoma diagnosed by MRI scans. After being marked under CT guidance, the lesion was completely excised with a skin punch. We propose that, this method is both minimal invasive and effective in the management of patellar osteoid osteoma.

Background: A 36-year-old woman was suffering from a right forearm ulna-radius diaphysis displaced fracture and a non-displaced fracture of the radius neck. Open reduction and internal fixation with screws and a plate for the ulna and radius diaphysis fractures and a long-arm plaster splint treatment was performed.Findings: Four months later, the patient presented with pain, swelling, and restricted mobility on the antecubital side of the right forearm. Radiography showed that the screw which was used for ulna fixation caused enthesopathy of the neighboring bicipital tuberosity of the radius. Removal of the screw improved the symptoms and angular degree of pronation-supination movements from 20° to 70°. Two years after screw removal, radiography showed resolution of enthesopathy of the radius bicipital tuberosity.Conclusions: When inserting a screw for ulna and radius diaphysis fractures, maximum care must be taken to avoid screw irritation of the bicipital tendon enthesis. When this complication ...

There is a considerable inconsistency in terms of the association between alcoholism and alterations in monoamine oxidase (MAO) activity. The main objectives of this study were to investigate the changes in platelet MAO-B activity throughout the alc ohol withdrawal period and whether or not MAO-B activity differed between patients with high- and low-aggression tendency. We assaye d platelet MAO-B levels spectrophotometrically in 22 male inpatients with alcohol dependence in their first and fourth weeks of w ith- drawal and in 20 healthy controls. Patients were divided into two high- and low-aggression subgroups according to scores obtain ed in a Brown-Goodwin Assessment for Life History of Aggression. Our data revealed that the significantly lower platelet MAO-B activity observed during the first week of alcohol withdrawal in patients, compared to controls, did not continue in the fourth week, an d that there was no relationship between aggressiveness and MAO activity. These results suggest that low platelet MAO activity may be a state marker of alcohol withdrawal period or a result of high alcohol consumption rather than a trait marker of alcoholism.

Objective There is growing evidence supporting the reactive oxygen species (ROS) in the pathogenesis of psoriasis. Propylthiouracil(PTU), an antithyroid drug, has been shown to have beneficial effects on psoriasis. The aim of this study was to investigate both disturbances in oxidant/antioxidant system in psoriasis and whether PTU, shown to have immunomodulatory effects and antioxidant potential, has effects on oxidant/antioxidant system and clinical improvement in psoriatics. Design and methods Malondialdehyde (MDA), end product of lipid peroxidation, superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and antioxidant enzymes were measured in plasma, erythrocytes and skin biopsies of psoriatics who were resistant to conventional therapy before and after 8 weeks of oral treatment with PTU (300 mg/day) or PTU/thyroxine (25 microg/day- to prevent possible hypothyroidism). The same parameters were also studied in healthy controls. Psoriasis Area and Severity Index (PASI) scores were used to evaluate the severity of the disease, and routine analyses and thyroid function tests were measured during the study. Results Increased baseline MDA in all samples were found to be lower. In addition baseline SOD and GSH-Px in skin and erythrocytes were also lower. The increased plasma SOD levels in skin and erythrocytes of the study groups was found to be higher and lower,respectively in all patients after the treatment. No tissue parameters or erythrocyte GSH-Px were different from control levels at the end of the study. Significant clinical improvement and decreased PASI scores were observed in all patients. Post treatment TSH levels were higher in all patients, but these levels were within the reference range and none had clinical hypothyroidism. Conclusion These findings may provide some evidence for a potential role of increased lipid peroxidation and decreased antioxidant activity in psoriasis. PTU may be considered as treatment model in psoriasis, in particular for resistant cases, because of its antioxidant potential, and also antiproliferative and immunomodulatory effects.

In spite of unknown etiology, it is now accepted that reactive oxygen species (ROS) produced by neutrophils may be related to the pathogenesis of Behcet's Disease (BD). The objective was to investigate whether increased production of ROS may affect erythrocyte oxidant/antioxidant system in patients with BD. The levels of malondialdehyde (MDA), one of the end products of lipid peroxidation, in plasma and erythrocyte, and the activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), antioxidant enzymes, in erythrocyte, also C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured in 22 patients in active stage of the disease and also in 30 healthy controls. Increased CRP, ESR, and MDA levels in plasma and erythrocyte and. increased SOD but decreased GSH-Px activities in erythrocytes were observed in the patients, when compared to the controls. In addition, significantly positive correlations between plasma and erythrocyte MDA levels, and erythrocyte MDA-CRP, MDA-ESR, MDA-SOD, SOD-ESR and SOD-CRP levels, but negative correlation between plasma MDA and erythrocyte GSH-Px, were found in BD patients. It may be suggested that increased production of ROS in BD, as reflected by higher plasma and erythrocyte MDA levels, may impair erythrocyte membrane integrity and also may lead to the alterations in the erythrocyte antioxidant defense system, as reflected by higher SOD and lower GSH-Px activities in erythrocytes. - Behget's disease; lipid peroxidation; glutathione peroxidase; superoxide dismutase; acute phase reactant (C) 2002 Tohoku University Medical Press.

Oxidative stress may play a pivotal role in the pathogenesis of psoriasis, an inflammatory/hyperproliferative skin disease characterized by the cutaneous accumulation of neutrophils releasing reactive oxygen species, as revealed in a number of studies. This study was performed to demonstrate the presence of oxidative stress in psoriasis, as measured by protein oxidation markers. Twenty-nine psoriasis patients were selected based on disease severity assessment using body surface area as well as the psoriasis area severity index (PASI), and were grouped as mild (PASI a parts per thousand currency sign 10) and moderate-to-severe (PASI > 10). The measured parameters in psoriatic patients and fourteen healthy volunteers were as follows: erythrocyte sedimentation rate (ESR), high sensitive C-reactive protein (CRP), myeloperoxidase (MPO) activity, neopterin, total lipid hydroperoxides (LHP), pyrrolized protein (PP), protein carbonyl compounds (PCC), advanced oxidation protein products (AOPP), thiol levels, along with complete blood count. Except lower thiols, all parameters were found to be higher in total patients as well as in subgroups, compared to controls. There was no significant difference among the subgroups. In conclusion, protein oxidation in psoriatics, not only in moderate-to-severe, but also in mild patients, may be explained by the findings of inflammation, phagocytic cell oxidation, and MPO-hypochlorous acid-oxidation reactions; as reflected by increased total/differential leucocytes counts, CRP, ESR as well as MPO, neopterin, AOPP, PCC, PP, LHP, and decreased thiol levels. Demonstrating the AOPP and PP formation for the first time, oxidants from active neutrophils/monocytes may play an important role in the pathogenesis of psoriasis, leading to oxidative stress, especially by protein oxidation.

WOS: 000294278700010 PubMed: 21765233 Objective: We aimed to determine and compare the effects of intraoperative bleeding control and two hours postoperative drain clamping method on postoperative wound drainage and the need for donor blood transfusion following total knee arthroplasty (TKA). Methods: Seventy-one patients who underwent TKA were randomly assigned into two groups. Fourty-four knees of 32 patients comprised Group A and 51 knees of 39 patients comprised Group B. In Group A, no bleeding control was done and postoperatively, the drain was clamped for 2 hours. Then it was unclamped to begin aspiration after the 2nd hour. In Group B, the bleeding was controlled intraoperatively, and the drain was not clamped after the surgery. Drains were removed 48 hours after the surgery in both groups. Bilateral and unilateral arthroplasty patients were evaluated separately. The groups were compared for their preoperative and postoperative 3-day haemoglobin (Hb) levels, total drainage amount and total number of blood transfusions. Results: The haemoglobin levels were similar in both groups preoperatively and at the 1st, 2nd and 3rd postoperative days. In Group A, the wound drainage was 696.1 +/- 235.4 ml in unilateral TKA patients and was 1010.8 +/- 535.5 ml in bilateral arthroplasty patients. In Group B, the wound drainage was 710.1 +/- 380.1 ml in unilateral TKA patients and was 878.3 +/- 489.6 ml in bilateral arthroplasty patients. The mean number of transfusions was 1.41 units with no significant differences between the groups. Conclusion: The two hour drain clamping method without intraoperative bleeding control does not seem to affect the amount of blood loss and the need for transfusion when compared to intraoperative bleeding control in total knee arthroplasty patients. Hovewer, it is a simple and feasible method and can be used to decrease the operation time.

STUDY DESIGN A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of the cervical spine in patients with muscular dystrophy presenting clinically with debilitating hyperlordosis is described, and 3 cases are reported. OBJECTIVE To describe a new surgical technique with emphasis on the clinical results and the effect of osteotomy on sagittal balance, gaze angle, and spinopelvic parameters. SUMMARY OF BACKGROUND DATA Previous reports of cervical osteotomy essentially have described opening wedge (extension osteotomy) for correction of severe flexion deformities. To the authors' knowledge, C7-T1 closing wedge osteotomy to correct hyperextension deformity due to muscular dystrophy in the cervical spine has not been described previously. METHODS Three male patients aged 16, 16, and 21 years presented with cervical hyperlordosis due to Becker muscular dystrophy. There was upward deviation of forward gaze in all patients. Anterior closing wedge (bone-disc-bone) osteotomy of C7-T1 was performed followed with a posterior release correction and instrumented stabilization. The chin-brow angle was visualized with the aid of fluoroscopy during the operation. After closure and posterior fixation, patient was turned supine again and the osteotomy site was grafted and fixed with a plate to further strengthen the construct and to prevent any translation. RESULTS The gaze angles and both sitting and standing postures of the patients markedly improved. There was documented fusion at the osteotomy sites. The patients were free of complaints at the last follow-up. CONCLUSION Bone-disc-bone closing wedge osteotomy done at C7-T1 level is a technically demanding procedure but results in significant acute clinical and radiological improvement in patients with hyperextension deformity of the cervical spine. LEVEL OF EVIDENCE 4.

Background context Adolescent idiopathic scoliosis (AIS) is a complex three-dimensional (3D) deformity of the spine involving deviations in the frontal plane, modifications of the sagittal profile, and rotations in the transverse plane. Although Lenke classification system is based on 2D radiographs and includes sagittal thoracic and coronal lumbar modifiers, Lenke et al. suggested inclusion of axial thoracic and lumbar modifiers in the analysis. Purpose To analyze axial plane of Lenke 1A curves to identify curve characteristics. Study design Retrospective study. Patient sample Seventy patients (49 women, 21 men) with Lenke Type 1A idiopathic scoliosis were analyzed. Outcome measures Coronal, sagittal, and axial parameters were measured from plain radiographs that were obtained at initial medical examination of the patients. Methods Coronal and sagittal plane and whole spine segmental vertebra rotations from thoracic 1 to lumbar 5 were evaluated in 70 AIS patients with Lenke 1A curves by using Drerup method. Three different subgroups were identified according to magnitude and direction of lower end vertebra (LEV) rotation. Results In Group 1 (Lenke 1A1), the direction of LEV rotation was same with other vertebrae in the main curve and the magnitude of the LEV rotation was less than −0.5°. In Group 2 (Lenke 1A2), the rotation of LEV was between −0.5° and 0.5° and so was accepted as neutral. In Group 3 (Lenke 1A3), the rotation of LEV had opposite direction with vertebrae in the main curve and the magnitude of LEV rotation was more than 0.5°. The mean thoracic Cobb angle of patients with Lenke 1A idiopathic scoliosis was 51.1° (range 37°–80°), whereas the mean lumbar Cobb angle was 16.4° (range 0°–32°). The mean angle of trunk rotation of the patients was 5.7° (range 1°–16°). In terms of maximum thoracic vertebra rotation, the mean rotation angle of Lenke 1A idiopathic curves was −18.9° (range −(9.8°–44.7°)). The mean maximum lumbar vertebra rotation was 4.5° (range −7.2° to 15.1°). Conclusions Addition of axial plane analysis to conventional coronal and sagittal evaluations in patients with Lenke 1A curves may reveal inherent structural differences that are not apparent in single planar radiographic assessments and may necessitate a different surgical strategy.

The number of fusion surgeries increase each year which also increase the need for implant removal. In some cases, it can be extremely hard to remove a pedicle screw especially when there is a mismatch of the screw and the screwdriver. Also the screwdrivers can be contaminated during the operation, and this will cause a delay till the instruments are re-sterilized. There is a need for the removal of screws without special instruments. We describe a method for removing tulip-head polyaxial pedicle screws without special instruments. The screws are removed using an Allen key, a rod bender and a “U” shaped rod. We successfully removed 76 screws in 11 recent cases without any complications. The “U” rod technique is a simple and useful technique for the removal of tulip-head polyaxial screws.

Multiple fractures of the long bones can be seen in the intrauterine period as a result of disorders such as skeletal dysplasias or maternal trauma, but isolated intrauterine femoral fracture is an extremely rare condition. Congenital short femur should be kept in mind, especially during the intrauterine period in the differential diagnosis. We report a case diagnosed as isolated femoral fracture in the 34th gestational week with post-partum confirmation of the diagnosis by X-rays and physical examination.

The authors reported a case of a secondary chondrosarcoma of the proximal phalanx of the fourth toe. This is a rare lesion in which radiological and histological findings are presented. A radical excison is the right way to minimize the risk of local recurrence.

This study aimed to evaluate the influence of type II diabetes mellitus (DM) on the postoperative outcomes of mini-open carpal tunnel syndrome (CTS) surgery. A total of 99 hands in 74 patients were included in the study. Of these, 36 patients (54 hands) had type II DM (Group A), and 38 patients (45 hands) had idiopathic CTS (Group B). Mini-open carpal tunnel release surgery was performed on all the hands. The night pain, weakness, paraesthesia, numbness complaints were significantly improved in both groups after surgery. However, thenar atrophy was improved significantly only in group A. Night pain, weakness, paraesthesia, numbness, and pillar pain were significantly worse in Group A than in Group B on postoperative examination. Postoperatively, Tinnel and Phalen tests were positive in 32 hands in Group A and 6 hands in Group B. Persistence of symptoms in diabetic patients was found to be more prevalent compared to non-diabetic controls after mini-open carpal tunnel release.

STUDY DESIGN: Retrospective study. OBJECTIVE: To demonstrate that intralaminar screws (ILS) can be used as supplements in spinal deformity surgery in the thoracic and lumbar levels in pediatric and adult patients. SUMMARY OF BACKGROUND DATA: Rigid posterior fixation of the spine is generally accomplished using pedicle screws, hooks, or wires. ILSs are useful tools when other spinal fixation techniques have failed or the bony anatomy precludes hook or screw placement. MATERIALS AND METHODS: All spinal deformity patients (primary/revision) operated between 2007 and 2011 were retrospectively reviewed. The patients with ILS were included in the study. The anteroposterior and lateral standing x-rays were evaluated in terms of preoperative and postoperative coronal and sagittal deformities. The number and level of ILS, intraoperative complications, and postoperative complications were noted. RESULTS: There were 20 patients (12 male and 8 female). The mean age was 21.75 years. The mean follow-up period was 17.4 months. Fifty-seven ILS were inserted. Seventeen screws were used in the uppermost to lowermost levels. Forty screws were used in the middle. There was 1 lamina fracture and screw pull out (1.75%). There were 3 canal violations (corrected intraoperative) and 2 instrument prominences which required implant removal. The mean preoperative/postoperative cobb angles were 78.5 degrees/27.8 degrees and the mean preoperative/postoperative kyphosis angles were 57.2 degrees/32.5 degrees, respectively. The loss of correction was 1.2 degrees. There were no neurological deficits and no instrument failures. CONCLUSIONS: ILS are safe and effective when used in deformity correction. However, biomechanical studies and randomized controlled trials are needed to conclude whether ILS will be considered a first-line technique, or will remain a technique for salvage situations.

Study Design:A case series depicting the results of a novel surgical technique.Objective:To prove that a minimally invasive surgical technique can effectively control and even correct congenital scoliosis caused by a fully segmented hemivertebra.Summary of Background Data:Congenital hemivertebrae have been treated by anterior and posterior growth arrest with/without fusion, anterior and posterior hemivertebrectomy, transpedicular hemivertebra excision, and transpedicular hemiepiphysiodesis. These approaches are complex and require experience. There is a need for a simple treatment method to treat these deformities.Methods:Twelve patients under 5 years of age with Putti type1 hemivertebrae were treated by posterior convex short segment instrumentation, partial chevron osteotomies, and fusion. Scoliosis, segmental scoliosis, kyphosis, segmental kyphosis, trunk shift were measured both preoperatively and postoperatively.Results:The mean correction of the segmental curve was 6 degrees (21%) which was maintained at the latest follow-up. The average final correction of the main curve was 23%. The trunk shift was 1.8 cm (range, 1-3 cm) preoperative and 1.4 cm (range, 0-2.5 cm) at the latest follow-up. The segmental angle of kyphosis averaged 11 degrees (range, -12 to 20 degrees) preoperative, and 14 degrees (range, 0-29 degrees) at the latest follow-up assessment. The values of the total thoracic kyphosis (T2-T12) were 29.5 degrees (range, 10-46 degrees) preoperative, 31 degrees (range, 10-44 degrees) postoperative, and 32 degrees (range, 16-45 degrees) at the last follow-up resulting in a mean improvement of 2 degrees. This improvement continued at the latest follow-up with a mean increase of 3 degrees.Conclusions:Transpedicular instrumentation is ideal for early correction in young children. The new posterior approach is much less invasive than the combined approaches or other posterior vertebrectomies and is well tolerated even in very young patients. The fusion segment is kept short. The deformities seem to stop progressing and this can avoid development of severe local deformities and secondary curves.

©2013 Turkish League Against Rheumatism. All rights reserved. Tipik olarak tekrarlayan akut ataklardan sonra gelisen gut tofusu, tum gut olgularinin %10’unda gorulur. Gut oncelikle erkek hastaligi olarak bilinmesine ragmen, hastalarin %5’inde kadinlari etkiler ve bunlarin buyuk cogunlugu ilk atak sirasinda postmenopozal donemdedir. Gut tofusu, kadinlarda siklikla poliartikulerdir. Inflamatuar eklem hastaligi olmaksizin yumusak doku kitlesi olarak gorulen soliter tofus, neoplastik durumlarla karistirilabilir. Bu yazida, hiperurisemi veya akut enflamatuvar gut atagi olmaksizin atipik yerlesimli gut tofusu olan 30 yasinda bir kadin olgu sunuldu.

The antioxidant potential of Ginkgo biloba extract (EGb 761) on healthy human erythrocyte membranes was investigated. Lipoperoxidation was induced in erythrocyte suspensions using hydrogen peroxide, in the presence of EGb 761 at 37 °C; malondialdehyde production was determined as the indicator of lipoperoxidation during the incubation period. The results for EGb 761 at concentrations of 0, 25, 50, 125, 250 and 500 μg/ml suggest that the antioxidant potential of EGb 761 in erythrocyte membranes increases with dose. Similarly, using different incubation periods (0, 15, 30, 45 or 60 min) indicated that the antioxidant effect of EGb 761 increased by the incubation time.

Plasma myeloperoxidase (MPO) and glutathione peroxidase (GSH-Px) activities, and malondialdehyde (MDA), ceruloplasmin (Cp), transferrin (TF), thiol (SH), selenium (Se) and copper (Cu) levels were determined in patients with Behçet's disease (BD), in order to investigate whether the plasma antioxidant defense system is impaired in BD. When compared to controls, plasma MDA, Cp, Cu levels and also plasma MPO activity were significantly higher in patients, whereas plasma TF, SH and Se levels, and also plasma GSH-Px activity were lower in BD patients than those in controls. In addition, there were significant and positive correlations between MDA-Cp, MDA-Cu, MDA-MPO, MPO-Cp, GSH-Px-Se, Cp-Cu, and TF-SH parameters, but negative correlations between MPO-TF and Cp-TF parameters in BD patients. Based on these findings, it is concluded that plasma antioxidant defense system is insufficient and impaired in BD.

To compare only partial matrixectomy and combination techniques (partial matrixectomy + phenol application) in the treatment of patients with an ingrown toenail in terms of recurrence, residual pain level and time of return to daily activities.The study included 118 patients with moderately ingrown toenails who were unresponsive to conservative treatment together with severely ingrown toenail patients. Of these patients, 76 cases were treated with a partial matrixectomy technique and 42 patients received combination treatment. Patients having nail infection received preoperative oral antibiotics.Of 118 patients, 87 were males and 31 were females. The disease relapsed in seven (9.2%) of the patients treated with the partial matrixectomy technique, and in two (4.8%) patients from the combination treatment group (p=0.5). No statistically significant difference was found between the groups in terms of return time to daily activities (p=0.5) nor in terms of residual pain (p=0.7).Treatment costs and operation times of patients who underwent phenol application in addition to partial matrixectomy were found to be higher compared to only partial matrixectomy, however combined therapy was not found to be superior to only partial matrixectomy in terms of recurrence, post-op pain and return to daily activities.

This study was performed to investigate the antioxidant mechanisms of polymorphonuclear leucocytes (PMN) in active stage of Behcet's Disease. PMN activities of myeloperoxidase (p < 0.02), superoxide dismutase (p < 0.001), catalase (p < 0.005), and glutathione peroxidase (p < 0.005) were significantly lower in the patients: the NADPH oxidase activity was significantly higher (p < 0.001) than those in controls. The plasma levels of ceruloplasmin (Cp), fibrinogen, and copper (Cu) were also significantly higher in the patients group (p < 0.001). Significant and positive correlations were found between the glutathione peroxidase and catalase activities (p < 0.001) and also between the plasma Cp and Cu levels (p < 0.001) in the patients group. However, no correlation was observed among the other enzyme activities. In the control group, a significantly positive correlation was present only between the plasma ceruloplasmin and Cu levels (p < 0.001). It was concluded that (impaired PMN functions) decreased enzyme activities in the antioxidant system and increased levels of oxygen free radicals may play a role in tissue damage in Behcet's disease.

Tissue fibrosis is a known complication of intramuscular injections, which is especially seen in children due to vaccinations and injections. Herein we report a case of post injection gluteal fibrosis that had undergone two unsuccessful lumbar discectomies to treat the symptoms of this disease. A 45 years old male patient was consulted to our clinic from the department of neurochirurgy with complaints of bilateral hip pain. The patient was operated on for lumbar disc herniation in L4-5 level twice but his complaints had not resolved. A third operation including L4-5 instrumentation and fusion was planned. His examination revealed nodules in his both hips. His x-rays, MRI and blood tests were normal. He underwent bilateral gluteal fascia excision and his complaints resolved totally. The clinical diagnosis of post-injection fibrosis is problematic, due to the difficulty of determining the etiology. In many patients the diagnosis comes from a history of injection. Pain in the gluteal region is not a frequently described clinical feature of this condition. Many reports in the literature emphasize a contracture rather than pain. Post-injection fibrosis in the gluteal region may mimic lumbar disc herniation and a detailed physical examination is the key for correct differential diagnosis. In refractory cases not responding to conservative treatment, surgical excision of the nodules may lead to a complete clinical recovery of the patient.

Objectives It has been proposed that major depression is associated with a dysfunction of the gamma-aminobutyric acid (GABA) system. This study was planned to investigate whether there are any alterations in GABAergic activities in major depressive patients and, if there are, whether electroconvulsive therapy (ECT) has any effect on these changes. Methods Twenty-five depressed inpatients who responded to a course of ECT and 23 healthy subjects were included in the study. Serum GABA levels were measured 2 days before and 10 minutes after the first ECT and 3 days after the last ECT, and a baclofen challenge test was performed 2 days before the first ECT and 3 days after the last ECT in the patients. The same tests were carried out only once in the control group. Results Depressive patients had lower serum GABA levels compared with healthy individuals, and ECT caused a significant increase in these levels. The acute effect of the one-ECT procedure was a huge increase in the baseline GABA levels. Although there was no difference in the maximum alteration in growth hormone with baclofen between the patients and controls before the therapeutic ECT course, it became significantly higher in the depressive patients than in the controls after the treatment. Conclusions The findings of this study support the GABA deficit hypothesis of major depression because major depressive patients have lower levels of serum GABA that are increased by a completed ECT course. ECT seems to increase brain GABA levels as well as GABAB activity, and these effects may contribute to its mechanism of therapeutic effect.

Background: Lesions of the talar dome or tumors within the talar body may require an open approach with medial or lateral malleolar osteotomies. The aim of this study was to evaluate the possibility and feasibility of a new minimally invasive approach without osteotomy, using the talonavicular joint (TJ) as the entry portal for lesions of the talar body. Materials and Methods: Nine cadaveric feet were used for this study. Using the TJ and a 5-mm skin incision we aimed to reach the superolateral, superomedial, inferolateral and inferomedial corners of the talar body under fluoroscopy. A 2-mm Kirshner wire and a 4-mm cannulated drill bit were used to reach the desired target area and an angled curette was used for curettage after reaching the target. The proximity of vascular structures to the entry portal was noted. The talar and navicular joint surfaces were checked for any damage. The articular areas of the talar heads and the defect areas were measured. Results: All 4 targets and even the posterior talus could be reached by this approach. The nearest neurovascular structures were the saphenous vein and the saphenous nerve. The navicular cartilage was not damaged in any specimen. The talar defect area corresponded to only 3.3% of the talar head cartilaginous area. Conclusion: The TJ approach can be used to reach lesions in all regions of the talar body without the need for an osteotomy. A mini-incision may be used to retract the saphenous nerve and vein. Damage to the talar head cartilage is minimal with this approach which requires no special equipments. Clinical Relevance: This study shows that talar dome lesions can be reached with a minimally invasive method.

This study was conducted to compare the results of anterior transposition methods and to determine the time needed to attain subjective well-being in patients with cubital tunnel syndrome. A total of 49 cases were retrospectively evaluated. Patients were called for follow-up, completed a questionnaire, and were reexamined. They were assigned to one of 3 groups: subcutaneous transposition (SCT), submuscular transposition (SMT), or intramuscular transposition (IMT). The McGowan classification and Wilson-Krout criteria were used for classification and outcomes assessments. Categorical variables were analyzed with the chi2 test, and metric variables by analysis of variance or through Kruskal-Wallis variance analysis. Improvement of at least 1 McGowan grade was observed in 87.63% of patients. The least responsive group was assigned a McGowan grade of III. The most effective procedure for resolving clawing was SMT. Clinical results were excellent in 26 patients (53.06%), good in 12 (24.48%), fair in 4 (8.16%), and poor in 7 (14.28%). At the latest follow-up, overall grip and pinch strength had improved by 23% and 34%, respectively, compared with the contralateral side. Thirty-six patients exhibited an improvement in grip power and 38 in fine dexterity. Complete resolution of numbness was observed in 32 patients, and complete resolution of pain was noted in 30 patients. The preoperative mean visual analog scale score of 6.82 improved to 3.36 postoperatively. Clawing improved in 4 patients and atrophy in 7. The mean time to subjective improvement was shortest in the SMT group and longest in the IMT group. The greatest pain relief was reported in the IMT group and the least in the SMT group. One case with IMT required reoperation because of recompression of the nerve. The most frequent complication in the SMT and IMT groups was muscular tenderness. In conclusion, SCT offers an alternative to other anterior transposition methods because of its simplicity and quicker recovery time, especially in mild to moderate cases.