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In this study, the protective effects of Ruta chalepensis L . extracts on the extent of tissue damage in gentamicin-induced nephrotoxicity have been investigated. Ruta chalepensis L . extracts were prepared by subcritical water and ultrasound-assisted organic solvent extraction methods. Protective activity of Ruta chalepensis L . extracts on Gentamicin-induced nephrotoxicity is investigated by apoptotic, DNA damage, oxidative stress markers and evaluating histopathological in kidney tissue of mice. Gentamicin significantly increased Caspase-3 and -8 activities, NO levels, serum creatinine and BUN, while 8-OHdG and MDA levels were significantly decreased with Ruta chalepensis L. extract treatment. In addition, Ruta chalepensis L . extracts treatment significantly increased CAT and SOD activities. Histopathological alterations in Gentamicin group were significantly diminished by application of Ruta chalepensis L . extracts. These results suggest that treatment with Ruta chalepensis L . extracts may ameliorate renal dysfunction and structural damage through the reduction of oxidative stress and apoptosis in the kidney.

Objective: The main objective of this study is to evaluate the availability of lateral antebrachial cutaneous nerve (LACN) autograft for acute or delayed repair of segmented digital nerve injuries., Patients and Methods: 13 digital nerve defects of 11 patients; treated with interposition of LACN graft that harvested from ipsilateral extremity were included in the study. Mean follow up period was 35, 7 months. The mean time from injury to grafting is 53, 3 days. The results of the mean 2PDT and SWMT values of injured /uninjured finger at the end of follow up period were evaluated with Paired T test. The correlation between the defect length and the difference of 2PDT, SWMT values between the uninjured and injured finger at the end of follow up period; were evaluated with Pearson - correlation analysis., Results: The mean value of our 2PDT and SWMT results are ~5,923, ~3, 52, respectively in which can be interpreted between the normal and diminished light touch. The defect length and difference percentage of SWMT values is positively and significantly correlated statistically. Mean length of interposed nerve grafts was 18.5 mm. The age of the patient and the mean values of 2PDT and SWMT with the difference % of 2PDT and % of SWMT are not statistically correlated., Conclusion: Based on results regarding sensory regaining at recipient side and negligible sensory deficit at harvesting side, we suggest that lateral antebrachial cutaneous nerve might be a valuable graft option for digital nerve defects.

Background: Prior studies revealed the presence of superior labrum anterior-to-posterior (SLAP) injury together with Bankart lesions in some patients. The purpose of the study is to compare the clinical results of isolated Bankart repairs with the clinical results of Bankart repairs when performed with concomitant SLAP repairs., Methods: The patients who underwent arthroscopic surgery for treatment of anterior glenohumeral instability were evaluated retrospectively. Group 1 consisted of 19 patients who had arthroscopic SLAP repair together with Bankart repair. The mean age of the patients was 23. Group 2 consisted of 38 patients who underwent isolated Bankart repair. The mean age was 24. Knotless anchors were used in both groups., Results: The mean follow-up was 34 months (range: 26-72). In group 1, the mean preoperative Constant score was 84 (range: 74-90, standard deviation (SD): 5.91) and Rowe score was 64.1 (range: 40-70, SD: 8.14). In group 2, the preoperative Constant score was 84.4 (range: 70-96, SD: 5.88) and Rowe score was 60 (range: 45-70, SD: 7.95). In group 1, the postoperative mean Constant score raised to 96.8 (range: 88-100, SD: 2.91) and the mean Rowe score raised to 92.3 (range: 85-100, SD: 5.17). In group 2, the postoperative mean Constant score was 94.9 (range: 88-100, SD: 3.70) and the mean Rowe score was 94.2 (range: 80-100, SD: 4.71). The difference between the scores of two groups was insignificant ( p > 0.05). When the numbers of redislocations and range of motion were compared, no significant difference was found ( p > 0.05)., Conclusion: Accompanying SLAP repair in surgical treatment with Bankart repair for shoulder instability does not affect the results negatively. Properly repaired labral tears extending from anterior inferior to the posterior superior of the glenoid in instability treatment have the same outcome in overall results as repaired isolated Bankart lesions.

Background Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system. Methods The surgical technique consists of a Kirschner wire that is passed percutaneously and perpendicular to the fracture line, and a cerclage wire that is passed in a semi-circular fashion over the ends of the Kirschner wire on the lateral side of the bone, leaving loops on each side to allow bilateral compression while twisting both wires. We retrospectively evaluated patients treated with this technique, with or without additional fractures. Follow-up of <24 months and bilateral ankle fractures were the exclusion criteria. Fractures were examined clinically and radiologically in comparison to the uninjured side and were rated according to the criteria reported by McLennon and Ungersma. Olerud and Molander ankle score was used to evaluate functional outcome. Results At the final follow-up, 15 out of 21 patients (9 women and 6 men; mean age, 48.2 years [range, 19-78 years]) were evaluated. The mean follow-up was 5.16 years (28-129 months). Five patients had an isolated lateral malleolar fracture; eight had lateral and medial malleolar fractures; and two had trimalleolar fractures. At the final follow-up, 11 patients were rated good functionally and four were fair, and all patients were rated good radiographically according to the criteria by McLennon and Ungersma. Mean Olerud and Molander ankle score was 93.3 (range, 80-100). Conclusions The compression cerclage system provides good functional and radiological outcomes in patients with lateral malleolus fractures. This method is useful, safe, and efficient with minimum hardware. It can be applied through limited soft-tissue stripping, which is especially important in patients with a high risk for wound complications.

Introduction: Osteoid osteoma is a benign osteoid-forming tumor generally localized to the long bones, is rarely localized in the hand and the major symptom is intermittent pain. This study aims to present two patients who were operated on for metacarpal osteoid osteomas., Case Outline: A 16-year-old female patient and an 18-year-old male patient were operated on for metacarpal osteoid osteomas. The major symptom was intermittent pain for both patients. After surgical excision of the niduses, the complaints resolved in both cases., Conclusion: In the case of high suspicion for osteoid osteoma, computed tomography or magnetic resonance imaging should be performed due to the risk of negative radiographic findings. Surgical excision is curative and a safe method of treatment.

The coracoid base is a very rare location for tumors. It is difficult to diagnose and approach, but easy to dismiss. In this case, the tumor (eosinophilic granuloma of the scapula) was located at the base of the coracoid, and the posterior cortex was eroded by the tumor. Accessing this lesion through the deltopectoral approach with coracoid osteotomy without penetrating the supposed tumor extending posterior soft tissue will be discussed. This approach gives a wider and safer access to the surgeon than the posterior approach. This report presents a customized solution with the deltopectoral approach, and the chevron-type osteotomy to access the coracoid base and tension band wiring to fix the osteotomy side.

A 34-year-old male sustained a crush injury resulting in bone and soft tissue loss along the medial longitudinal arch of his left foot. Specifically, the injury resulted in loss of first metatarsal without injury to the medial cuneiform or proximal phalanx, fracture of the third metatarsal, and a 5-cm × 9-cm soft tissue defect overlying the dorsomedial aspect of the right foot. After debridement and daily wound care, the defect was subsequently reconstructed using a free osteocutaneous fibular graft. Approximately 6 months after reconstructive surgery, the patient returned to his job without pain, and his pedogram showed almost equal weightbearing distribution on both feet., (Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)

We would like to highlight unusual sequelae of healed distal third diaphyseal tibia fracture that was treated conservatively 36 years ago, in which we incidentally detected peripheral CT angiography. The anterior tibial artery was enveloped three-quarterly by the healing callus of the bone (distal tibia).

Gustilo type IIIC open fractures of the tibia are high-energy injuries necessitating long treatment periods and usually multiple surgical procedures and eventually resulting in high morbidity rates and even amputations. We present here a case involving a type IIIC open tibial fracture with massive loss of the entire tibial diaphysis, which we treated by performing acute tibialization of the fibula after revascularization of the posterior tibial artery in a single-stage emergency operation.

Although trigger finger occurs mostly due to a problem at the A1 pulley various other causes have also been reported. We present three patients with different tumors at the carpal tunnel as a cause of triggering. All patients were treated with local excision.

This study presents the surgical and functional outcomes of below-knee total leg amputation and Gustilo type III C open fracture cases that were considered appropriate for salvage treatment according to a more proactive approach, despite being candidates for amputation according to the current scoring systems. Nineteen patients (21 legs) underwent replantation-revascularization surgery. At least Chen Grade II functional level was the aim. A limb salvage operation was performed in 21 legs in 19 patients (18 male, 1 female). The mean age was 28.5 years (range: 11 to 42 years). Six legs in four patients presented with total amputation, and 15 legs in 15 patients had Gustilo Type III C open fractures. A successful replantation/revascularization was performed in 20 legs, with a Chen Grade I and Grade II functional outcome in 3 and 17 legs, respectively. None of these patients were eligible for salvage operation according to currently used scoring systems. Limb-preserving surgery performed upon the assessment of local and general conditions of the patients with traumatic below-knee amputations or Gustilo Type III C open fractures seems to be a viable therapeutic option that can serve to achieve Chen Grade II functional level in most patients., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Background: Advancement of pressurized air through subcutaneous tissue after barotraumas involving skin laceration has been documented in the literature. The type and anatomic location of injury, amount of pressure, and time elapsed all play a role in determining the destination of the air advancing through tissues., Objectives: To report a case demonstrating the vascular system as the anatomic pathway for subcutaneous pressurized air resulting from an industrial accident., Case Report: We present the case of a 28-year-old laborer wounded by an air valve blast. An enormous accumulation of air was released through a subtotal fingertip amputation. The clinical appearance of massive subcutaneous emphysema around the upper extremity, neck, and chest suggested chest trauma to the clinicians, despite the absence of signs of respiratory distress. X-ray studies revealed pneumomediastinum. After confirmation that the respiratory system was undamaged, microsurgical repair of the injured finger was performed. Resolution of subcutaneous emphysema and pneumomediastinum was complete at the end of follow-up., Conclusion: Compressed air injuries constitute a well-known form of industrial accident. Although most result in localized subcutaneous emphysema, the risk of pneumomediastinum should not be overlooked due to the anatomic structure of the vascular system. The clinician should consider the pressure of compressed air, and must be alert for potential complications., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Reconstruction of foot soft tissue is challenging particularly in the presence of a large defect involving both dorsal and plantar surfaces. In large defects, use of a latissimus dorsi muscle (LDM) flap is the preferred coverage method, yet LDM flaps are bulky. Despite undergoing multiple debulking procedures, patients whose feet are repaired with LDM flaps must wear oversized custom-made shoes. We developed an approach to allow patients to wear regular shoes. In six patients, we used a debulking procedure that was based on tangential trimming of the flap to the level of thickness required for normal foot contour. All patients underwent debulking 3 months after initial LDM flap coverage. The mean duration of follow-up care was 21 months (range, 8 to 32 months). All flaps survived a secondary debulking procedure. One patient developed an ulcer at the weight-bearing area of a sole. All six patients were able to wear regular shoes without difficulty., (© Thieme Medical Publishers.)

Purpose: The purpose of this study was to determine whether the continuous horizontal mattress suture technique can replace the continuous simple suture technique and to compare the results with other microvascular suture procedures., Methods: Sixty-four femoral arteries of 32 Sprague-Dawley rats were used in this study. The animals were divided equally into 4 groups with 16 anastomoses in each group. The arteries (0.8-1.0 mm diameter) were anastomosed by using the continuous horizontal mattress suture technique in group I, interrupted horizontal mattress suture technique in group II, simple interrupted suture technique in group III, and simple continuous suture technique in group IV. At the end of the anastomosis time, leakage, and patency were assessed and graded in all groups. On the 14th day after surgery the rats were killed and 5 patent specimens from each group were examined under light microscopy for histology. One specimen from each group was prepared for scanning of the endothelial surface under electron scanning microscopy., Results: Group I anastomoses were performed the most quickly. Groups I and III anastomoses had 100% patency rates. Under light microscopy the edge eversion was apparent consistently and under electron microscopy all endothelial surfaces were intact and no suture material was seen in groups I and II. In group III some suture material was covered by endothelial cells and lumen surfaces were torn; endothelization also was rough compared with groups I and II. In group IV suture material was seen in the lumen because of a loose suture knot. The endothelium also was not regular., Conclusions: The horizontal mattress suturing technique is the only technique in which the suture material never contacts the lumen. Continuous horizontal mattress suture technique is superior to the other microvascular procedures and is the safest and fastest procedure for microvascular anastomosis in rats.

The influence of percent egg yolk during cooling from 37 to 5 C on ability of sperm to withstand subsequent freezing was studied with semen from each of eight bulls. Treatments were arranged factorially and included .5, 1, 2, 4, 8, 16, and 32% egg yolk, cooling times of .5, 1, 2, and 4 h, and freezing in ampules and straws. Percent egg yolk did not influence motility or percent intact acrosomes when semen was frozen in ampules. For sperm in straws, both post-thaw percentages of motile sperm and intact acrosomes were similar for sperm cooled with .5, 1, 2, 4, or 8% egg yolk and greater than with 16 or 32% egg yolk. Optimal egg yolk during cooling was not dependent upon rate of cooling, regardless of how semen was packaged for freezing. The influence of percent egg yolk during freezing was investigated in a second study. Treatments included eight bulls; 1, 2, 4, 8, 16, and 32% egg yolk; freezing times from +5 to -130 C of 3.5, 20, and 40 min; and freezing in ampules or straws. Optimal egg yolk during freezing in either ampules or straws was independent of the rate of freezing. For sperm frozen in ampules, differences in motility or the percent intact acrosomes due to egg yolk were small. However, the use of only 1 or 2% egg yolk depressed motility whereas 16 or 32% egg yolk decreased the percentage of intact acrosomes. Thus, extremely high or low egg yolk should be avoided. For sperm in straws, survival was optimal when the extended semen contained 4 to 32% egg yolk during freezing.

Five heifers and five lactating dairy cows were locked in adjacent stanchions and monitored continuously by human observation for 18 consecutive nights from 7:00 p.m. to 4:00 a.m. Total standing and lying time, number of position changes, and prevalence of bellowing was recorded. The animals were housed in stanchions for 20 hours each day and in outside lots for four hours each day. Estrus was synchronized by giving prostaglandins on Days 1 and 11. There were 16 documented estrous periods, and an increase (P < 0.05) in standing time occurred in two of 16. Similarly, an increase (P < 0.05) in number of position changes occurred in two of 16 estrous periods. Mean +/- SE standing time (during the nine-hour nightly observation period) for heifers and cows was 148 +/- 6.8 and 278 +/- 9.6 (P < 0.01) minutes, respectively. The prevalence of bellowing was very low and not always associated with estrus. These results indicate that standing time, number of position changes, and bellowing are rather weak indicators of estrus.