Coexistence of klippel feil syndrome, Poland syndrome and mirror movements: A genetic case study Klippel feil sendromu, Poland sendromu ve ayna hareketlerinin birlikteliği: Bir genetik olgu çalışması

© 2018, Logos Medical Publishing. All rights reserved.Coexistence of Klippel Feil syndrome, Poland syndrome and mirror movements have not been reported before. We aimed to report a patient with such coexistence and examined whether there is a possible genetic background of this association. A 19-year-old male patient presented with the absence of right thumb and deformity at the elbow. Right pectoral muscle mass was markedly smaller than left. There was a high scapula on the right side. Mirror movements were observed in neurological evaluation. Right radial head was dislocated. On magnetic resonance images, a syrinx was observed at the level of C6-C7 fusion. A high-resolution chromosome microarray (CMA) testing was performed. Small segmental de novo variations were detected. The largest gene spanning variation did not exceed 287 kb and none of the detected variations was known to be disease-associated or candidate to explain the phenotypic features according to The International Standard Cytogenomic Array (ISCA) criteria. Since our case is sporadic with multiple congenital abnormalities, we performed high-resolution chromosome microarray analysis to rule out genomic imbalance and did not find any significant deletion or duplication that could be associated with phenotypic characteristics

Results of endoscopically-assisted cubital tunnel release without using any specific instrument

Background: We aimed to report the clinical and electrophysiological results of patients who were treated with an endoscopically assisted in situ release technique for cubital tunnel syndrome and to show safety and efficacy of this procedure. Materials and methods: Twenty nine patients were included into the study. 13 patients (44.8%) were female, 16 patients (55.2%) were male. The mean age was 44.4 years (range; 22–66 years). Mean follow up period was 16.0 months (range; 7–42 months). We used Dellon classification for preoperative staging, and modified Bishop rating system for the evaluation of postoperative clinical results. Dynamometric and electromyographic measurements were obtained preoperatively and at final control. Results: Preoperative Dellon's classification revealed 3 patients grade 1, 14 grade 2, and 12 grade 3. Modified Bishop score was very good for 21 patients (72.4%), good for 4 patients (13.8%), fair for 3 patient (10.3%), and poor for 1 patient (3.4%). At final control; the mean proportion of grip power and pinch strength of the affected hand to the contralateral normal hand was improved, and also nerve conduction velocity were improved in all patients. As complication, hematoma formation developed in two cases. Conclusion: Our study showed that endoscopically assisted decompression technique without using any special instruments can be performed successfully with a low complication rate. It is a safe and effective method in the treatment of cubital tunnel syndrome. Level of evidence: Level IV, Therapeutic study Keywords: Cubital tunnel syndrome, Ulnar nerve, Endoscopic decompression, Minimal invasiv

Hip fractures treated with hemiarthroplasty: indicators of mortality in patients older than 85 years

AMAÇ: Bu çalışmada ortopedik cerrahlar açısından zorlayıcı bir popülasyon olan 85 yaş üstündeki hastalardaki kalça kırığı olgularında, mortalite riskinin tespiti için preoperatif risk faktörlerinin belirlenmesi amaçlanmıştır. GEREÇ VE YÖNTEM: Kalça kırığı tanısıyla servisimize yatırılarak tedavi ve takip edilen 85 yaş üstündeki hastaların bilgileri hastane kayıtlarından retrospektif olarak toplandı. Hastaların sağkalım durumları ve hayatını kaybetmişse ölüm tarihleri tespit edildi. Seçilmiş hastalardan hayatını kaybeden 46 hasta grup 1 olarak adlandırılırken; sağ kalan 83 hasta grup 2 olarak adlandırıldı. Her iki grup yaş, cinsiyet, ameliyat süresi, ameliyat olana kadar geçen süre, hastanede toplam yatış süresi, American Society of Anesthesiologists skoru, kardiyak ejeksiyon fraksiyonu (EF), kırık tipi, protezin çimentolu / çimentosuz olarak uygulanması ve komorbid faktör varlığı ile sayıları açısından karşılaştırıldı. BULGULAR: Grup 1’deki hastaların yaş ortalaması daha yüksekti ve istatistiksel olarak anlamlı idi (p=0.011). Erkeklerdeki ölüm oranı daha yüksekti ve istatistiksel olarak anlamlı idi (p=0.047). Çimentolu hemiartroplasti uygulanmış olanlarda ölüm oranı daha yüksekti ve istatistiksel olarak anlamlı idi (p=0,038). İki grup arasında ASA skoru ortalamaları (p=0.352), toplam yatış süresi (p=0.120), yatıştan ameliyat olana kadar geçen süre (p=0.531), ejeksiyon fraksiyonları (p=0.484) açısından anlamlı fark yoktu. SONUÇ: Yaşlı, erkek ve çimentolu protez kullanılmış olan 85 yaş üstü kalça kırıklı hastalarda ölüm oranları daha yüksektir ve bu hastalarda takip ve tedavide daha dikkatli olunmalı, tek modifiye edilebilir değişken olan protez kullanımında mümkünse çimentosuz sistemler tercih edilmelidir.OBJECTIVE: The aim of this study was to determine the preoperative risk factors of all-cause mortality in the small but very challenging group of hip fracture patients aged over 85 years. MATERIALS AND METHODS: Data was gathered retrospectively on patients aged over 85 years with a diagnosis of hip fracture. Subsequent survival was determined. The date of death was recorded (If present). The selected patients were separated into 2 groups: Group1 who had died within 1 year (n=46) and group2 who had survived (n=83).The two groups were compared in respect of age, gender, operating time, the time from initial trauma to surgery, total hospitalization duration, American Society of Anesthesiologists score, cardiac ejection fraction, type of fracture, application of cemented or uncemented prosthesis and number of comorbid diseases. RESULTS: The mean age of the patients in Group 1 was determined to be significantly higher (p=0.011). The rate of male mortality was significantly higher (p=0.047). The rate of mortality of patients with cemented hemiarthroplasty was significantly higher (p=0.038). No difference was determined between the groups in respect of mean ASA scores (p=0.352), total hospitalization duration (p=0.120),the time from trauma to surgery (p=0.531) or ejection fraction (p=0.484). No significance was determined between the groups in respect of the presence and number of comorbid diseases. CONCLUSIONS: The mortality rate of older male patients aged over 85 years with cemented prosthesis applied for hip fracture was higher. As the only parameter, which can be modified, uncemented systems, should be selected, if possible for the prosthesis to be used

Synovial Chondromatosis Of The Sub�Scapular Bursa

A 42-year-old housewife was admitted to our clinic because of shoulder pain. At X-ray and CT, multiple calcifications and ossification were seen in the subscapular bursa and glenohumeral joint. MR1 findings were consistent with synovial chondromatosis. Surgical treatment was planned but the patient refused. Thus conservative treatment was initiated for pain relief. The shoulder joint is a rare localization in this disorder. Although our patient′s symptoms resolved with conservative treatment, we think that it would be better to perform surgical treatment because of the increased size and number of loose bodies and minimal or moderate chondral damage

Hip fractures treated with hemiarthroplasty: indicators of mortality in patients older than 85 years

AMAÇ: Bu çalışmada ortopedik cerrahlar açısından zorlayıcı bir popülasyon olan 85 yaş üstündeki hastalardaki kalça kırığı olgularında, mortalite riskinin tespiti için preoperatif risk faktörlerinin belirlenmesi amaçlanmıştır. GEREÇ VE YÖNTEM: Kalça kırığı tanısıyla servisimize yatırılarak tedavi ve takip edilen 85 yaş üstündeki hastaların bilgileri hastane kayıtlarından retrospektif olarak toplandı. Hastaların sağkalım durumları ve hayatını kaybetmişse ölüm tarihleri tespit edildi. Seçilmiş hastalardan hayatını kaybeden 46 hasta grup 1 olarak adlandırılırken; sağ kalan 83 hasta grup 2 olarak adlandırıldı. Her iki grup yaş, cinsiyet, ameliyat süresi, ameliyat olana kadar geçen süre, hastanede toplam yatış süresi, American Society of Anesthesiologists skoru, kardiyak ejeksiyon fraksiyonu (EF), kırık tipi, protezin çimentolu / çimentosuz olarak uygulanması ve komorbid faktör varlığı ile sayıları açısından karşılaştırıldı. BULGULAR: Grup 1’deki hastaların yaş ortalaması daha yüksekti ve istatistiksel olarak anlamlı idi (p=0.011). Erkeklerdeki ölüm oranı daha yüksekti ve istatistiksel olarak anlamlı idi (p=0.047). Çimentolu hemiartroplasti uygulanmış olanlarda ölüm oranı daha yüksekti ve istatistiksel olarak anlamlı idi (p=0,038). İki grup arasında ASA skoru ortalamaları (p=0.352), toplam yatış süresi (p=0.120), yatıştan ameliyat olana kadar geçen süre (p=0.531), ejeksiyon fraksiyonları (p=0.484) açısından anlamlı fark yoktu. SONUÇ: Yaşlı, erkek ve çimentolu protez kullanılmış olan 85 yaş üstü kalça kırıklı hastalarda ölüm oranları daha yüksektir ve bu hastalarda takip ve tedavide daha dikkatli olunmalı, tek modifiye edilebilir değişken olan protez kullanımında mümkünse çimentosuz sistemler tercih edilmelidir.OBJECTIVE: The aim of this study was to determine the preoperative risk factors of all-cause mortality in the small but very challenging group of hip fracture patients aged over 85 years. MATERIALS AND METHODS: Data was gathered retrospectively on patients aged over 85 years with a diagnosis of hip fracture. Subsequent survival was determined. The date of death was recorded (If present). The selected patients were separated into 2 groups: Group1 who had died within 1 year (n=46) and group2 who had survived (n=83).The two groups were compared in respect of age, gender, operating time, the time from initial trauma to surgery, total hospitalization duration, American Society of Anesthesiologists score, cardiac ejection fraction, type of fracture, application of cemented or uncemented prosthesis and number of comorbid diseases. RESULTS: The mean age of the patients in Group 1 was determined to be significantly higher (p=0.011). The rate of male mortality was significantly higher (p=0.047). The rate of mortality of patients with cemented hemiarthroplasty was significantly higher (p=0.038). No difference was determined between the groups in respect of mean ASA scores (p=0.352), total hospitalization duration (p=0.120),the time from trauma to surgery (p=0.531) or ejection fraction (p=0.484). No significance was determined between the groups in respect of the presence and number of comorbid diseases. CONCLUSIONS: The mortality rate of older male patients aged over 85 years with cemented prosthesis applied for hip fracture was higher. As the only parameter, which can be modified, uncemented systems, should be selected, if possible for the prosthesis to be used

Comparison of various surgical methods in the treatment of implant-related infection

The treatment of implant-related infections is troublesome. This study was conducted to compare the effectiveness of three different surgical modalities in the treatment of implant-related infection. A total of 32 Wistar albino rats were randomised into four groups after the establishment of implant-related infection: no treatment, surgical débridement, antibiotic-loaded bone cement and antibiotic-loaded autogenous bone. Microbiological colony counts were made at the sixth week in order to evaluate the effectiveness of of the treatments. The antibiotic-loaded bone cement group revealed superior results compared with the other groups in terms of reduction of microbiological colonies. Three animals in the bone cement group revealed extensive infection. Although antibiotic-loaded bone cement showed superiority over other treatment modalities, it should be employed after an unsuccessful trial of débridement because of the risk of extensive infection