Maternal hypoglycaemia on the 50 g oral glucose challenge test — evaluation of obstetric and neonatal outcomes

  Objectives: To discuss obstetric and neonatal outcomes of maternal hypoglycaemia observed after the 50 g oral glucose challenge test. Material and methods: A retrospective evaluation was made of the results of patients at 24–28 weeks gestation of a live singleton pregnancy who underwent a 50 g OGCT at the Health Sciences University Gazi Yaşargil Training and Research Hos­pital, between September 2016 and August 2017. In the 50 g OGCT, 1-hour blood glucose results were divided into Low OGCT (< 90 mg/dL) and Normal OGCT (90–139 mg/dL). The groups were compared in respect of obstetrics and neonatal outcomes. Results: Of 2623 pregnant patients applied with the 50 g OGCT, blood glucose was < 140 mg/dL in 77.16% (n = 2024), with 11.9% (n = 312) in the Low OGCT group, and the remaining 65.26% (n = 1712) in the Normal OGCT group. Based on the comparison of the groups, the SGA rate was 7% in the Low OGCT group and 4% in the Normal OGCT group; the 5th minute APGAR score was < 7 in 2% of the Low OGCT group and in 1% of the Normal OGCT group, while caesarean section rates were 25% and 32% respectively (p < 0.05). Conclusions: The results of the study showed a significant association between maternal hypoglycaemia and increased SGA rate, decreased 5-minute APGAR scores and reduced caesarean section rates, and this relationship should be confirmed with further comprehensive studies

Total diz protezi uygulaması sonrası arter kan basıncı kontrolü kan kaybını azaltır mı?

Objective: Blood loss from bone and soft tissues after total knee arthroplasty (TKA) can be significant. Many patients undergoing TKA need blood transfusions postoperatively to increase their hemoglobin levels. Due to the small but real risks associated with blood transfusions, every effort should be made to prevent excessive blood loss in such patients. We hypothesized that blood loss post-TKA may be correlated with postoperative arterial blood pressure (ABP). Materials and methods: In order to investigate the relationship between postoperative ABP and blood loss, we retrospectively evaluated the post-operative status of 27 knees from the charts of 24 patients [20 female, 4 male; mean age 69.8 (57–83) years] who underwent TKA. The relationship between post-operative ABP (uncontrolled: ≥140/90 mmHg or controlled: <140/90 mmHg) and postoperative blood loss via suction drains was analyzed using the Mann-Whitney U test. Results: The average blood loss (610 mL, range 325- 1440 mL) in patients with an ABP ≥140/90 mmHg was not significantly different than that (491 mL, range 250- 775 mL; M-W U=66.0, p═0.44) in patients with an ABP <140/90 mmHg. Discussion: The lack of association between postoperative ABP and blood loss should be further validated in a prospective study to determine if efforts should be made to carefully control ABP post-TKA for the purpose of decreasing post-operative hemorrhage.Amaç: Total diz protezi (TDP) uygulaması sonrasında kemik ve yumuşak doku kaynaklı belirgin kanama oluşabilir. TDP uygulanan çoğu hastanın ameliyat sonrası dönemde düşük hemoglobin seviyesi nedeniyle kan transfüzyon ihtiyacı vardır. Kan transfüzyonu belirli riskler taşıdığı için bu hastaların ameliyat sonrası dönemde kan kayıplarının mümkün olduğunca azaltılması gerekir. TDP uygulamasını takiben ameliyat sonrası dönemde arter kan basıncının (AKB) kontrolü kan kaybını azaltabilir. Gereç ve Yöntem: Ameliyat sonrası AKB ve kan kaybı arasındaki ilişkiyi araştırmak için TDP uygulanmış olan 24 hastanın [20 kadın, 4 erkek; ortalama yaş 69,8 (57–83 yaş)] 27 dizinin ameliyat sonrası durumu değerlendirildi. Ameliyat sonrası AKB (kontrolsüz: ≥140/90mmHg veya kontrollü: <140/90mmHg) ve cerrahi yara dreninden kan kaybı arasındaki ilişki Mann-Whitney U testi kullanılarak analiz edildi. Bulgular: AKB ≥140/90mmHg olan hastaların ortalama kan kaybı (610mL; 325-1440mL arasında) AKB <140/90mmHg olan hastalarınkinden (491mL; 250- 775mL arasında; M-W U=66,0, p═0,44) farklı değildi. Tartışma: TDP ameliyatı sonrası AKB ve kan kaybı arasında anlamlı ilişki tespit edilmedi. TDP ameliyatı sonrası AKB kontrolünün ameliyat sonrası kan kaybının önlenmesinde önemli olduğu varsayımı ret edilmeden önce daha fazla prospektif çalışma yapılmalıdır

Medial approach without opening the joint capsule for developmental dislocation of the hip

Seventy-one developmentally dislocated hips in 47 children with an average age of 11 months (range 4-16 months) were treated by the medial approach without opening the capsule followed by 6 months of hip spica-cast immobilization. At the latest follow-up 63 hips were rated excellent and good, and 8 hips showed subluxation. No avascular necrosis had occurred. It is concluded that this approach is safe and effective for treating developmental dislocation of the hip. Moreover, opening the capsule is not only an unnecessary task in this age group but also should be avoided to prevent avascular necrosis

Diabetic Extremity Infections: Our Clinical Experiences

Between April’93 & March’96, we follewed 93 patients (68 men & 33 women) who have 101 extremity infections in Internal Medicine Section, Infectious Diseases Unit. Among them one patient three times and six patients two times was followed. 93 infections diagnosed in lower extremities and 8 in upper. 39 (38.6%) of them was osteomyelitis and 62 (61.4%) wus soft tissue infection. Amputation was done in 17 (16.8%) patients because of late admission and gangrene 28 (27.7%) bacterial growth detected in aspiration cultures. The most frequent isolate was S.aureus (35.6%)

Does severe osteoarthritis in knees with varus deformity alter the adductor ratio?

Objective: In our retrospective study, we aimed to investigate the differences between the adductor ratio (AR) in knees with and without osteoarthritis, and its validity in determining the articular level. Methods: Data from 80 knees of 80 patients were retrospectively evaluated. Anteroposterior weight bearing knee radiographs of the patients with and without osteoarthritis (40 knees in each group) were obtained. The adductor ratio was determined using the following formula: ATJL/FW (adductor tubercle-joint line distance/femoral width). All radiographs were evaluated at the baseline and at one-month intervals afterwards. Intraobserver reliability of the two measurements was assessed using interclass correlations (ICC). Pearson's correlation test was used to evaluate the correlation between the ATJL and the FW. The differences between the adductor ratios of the two groups were evaluated by the independent samples two-tailed t-test. Results: Most of the ICC values were well above 0.95, indicating a very high intraobserver reliability. The adductor ratio was significantly greater in Group 2 in comparison to Group 1 (Mean AR in Group 2: 0.522 +/- 0.031 and Mean AR in Group 1: 0.502 +/- 0.032; p = 0.005). There was a significant correlation between the ATJL and FW in the groups when assessed both separately and combined. Conclusion: In conclusion, we can assert that if the AR is used to determine the articular level in revision arthroplasty cases, it may be sensible to measure the FW intraoperatively rather than measuring it on primary or contralateral radiographs of arthritic patients. (c) 2017 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V