Unicameral bone cyst of the lunate in an adult: case report

We report a case of a symptomatic unicameral (simple) bone cyst of the lunate in a 42-year- old woman. The lesion was treated with curettage and cancellous autogenous iliac bone grafting. At five years of follow-up the wrist was pain free, there were no limitations of motion, and the radiographs showed complete obliteration of the cavity. To the best of our knowledge, no other unicameral bone cyst of the lunate has been reported in an adult. Cysts with significant cavities at the carpal bones in an adult should be approached cautiously, as they may require early curettage and bone grafting for healing, before collapse and degenerative changes occur

Incidence of coronary bifurcation lesion as a culprit lesion in patients with acute myocardial infarction: impact of treatment strategy on short- and long-term outcomes

Background: Although, there are several studies comparing single and two-stent techniques in patients with bifurcation lesions, evidence in patients presenting with myocardial infarction (MI) is still insufficient.1-3 We aimed to assess the short- and long-term outcomes of provisional and two-stent techniques of bifurcation lesions in patients with acute coronary syndromes (ACS). Patients and Methods: 2992 patients with MI who underwent percutaneous coronary intervention (PCI) were enrolled in the present study. Of 2992 patients, 385 patients with MI had bifurcation lesions. The Synergy between PCI with TAXUS™ and Cardiac Surgery (SYNTAX) score, pre-PCI Thrombolysis in Myocardial Infarction (TIMI) flow, post-PCI TIMI flow, duration of procedure, angiographic features, post-PCI side branch loss, 1- and 12-month mortality rates were noted. Results: 169 (43.9%) patients had ST-segment elevation MI, whereas 216 (56.1%) patients had non-STsegment elevation MI. 355 (92.2%) patients underwent provisional stenting and 30 (7.8%) patients underwent two-stent technique. Side branch loss was observed in 40 patients (11.2%) in the provisional group and 1 patient (3.3%) in the two-stent group (p=0.2). Compared to provisional group, durations of angiography and revascularization in two-stent group were significantly longer (p<0.001 and p<0.001). Both 1-month and 12-month mortality rates were similar in provisional and two-stent groups (4.2% vs. 3.3%, p=0.8 and 11.5% and 13.3%, p=0.7; respectively). Conclusion: In patients presenting with ACS and bifurcation lesions, procedural success, side branch loss, as well as short- and long-term mortality were similar in both provisional and two-stent techniques

Apical instrumentation alters the rotational correction in adolescent idiopathic scoliosis

The aim of this study was to retrospectively evaluate the effect of apical vertebral instrumentation in the axial plane in the surgical treatment of idiopathic scoliosis. Seventy-six consecutive patients with King type 11 idiopathic scoliosis, treated with posterior spinal instrumentation, were included in the study. The mean age of the patients was 14.5 years (range 10-18 years), and the mean follow-up was 49 (range 28-74) months. Preoperative radiological evaluation was performed with postero-anterior, lateral, traction and side-bending radiographs. Vertebral rotation was measured with a Perdriolle torsion meter. Patients were retrospectively divided into two groups according to the presence of apical vertebra instrumentation. Group 1 consisted of 43 patients in whom the upper and lower neutral and intermediate vertebrae of thoracic curves had been instrumented on the concave side. Group 2 consisted of 33 patients who had received instrumentation of the apical vertebra on the concave side in addition to the instrumentation configuration of group 1. Posterior fusion was added in all patients. Cobb and Perdriolle measurements were compared between the two groups preoperatively and at the last follow-up. Preoperative age and gender distribution, Cobb angle and rotational measurements, and correction ratios on side-bending films were similar in the two groups. Although the differences between the two groups in preoperative mean values of both Cobb angle and apical rotation were not statistically significant (P>0.05), mean values of apical rotation were significantly different postoperatively (P<0.05). At the same time, apical derotation ratios differed significantly between the two groups (P=0.000). We conclude that instrumentation of the apical vertebra provides better derotation at the apex

Bilateral trochanteric fractures of the femur in a patient with chronic renal failure

We report a spontaneous intertrochanteric fracture with bilateral avulsion of the greater trochanter in a patient with chronic renal failure

The pharmacists' ability to use pressurized metered-dose inhalers with a spacer device and factors affecting it

Objective: The aim of this study is to evaluate the pharmacists' ability to use pMDIs with a spacer device and the factors that affect this ability. Method: Face to face interviews were conducted with the pharmacists. A nine item questionnaire was completed and the checklist for how to use pMDIs with a spacer device was filled out. Results: A total of 307 pharmacists voluntarily participated in this study. Fifty-six (18.2%) of the pharmacists stated that they did not know how to use pMDIs with a spacer device. These pharmacists were excluded and remaining 251 pharmacists included in the study. Only 100 (39.8%) pharmacists demonstrated all of the inhaler spacer device usage steps correctly. The step in which pharmacists made the most mistakes was "take 5-6 deep and slow breaths, hold for 10 s and slow breaths." Those pharmacists who were more likely to correctly use pMDIs with a spacer device were younger (p = 0.023), had dispensed more asthma medications per day (p < 0.001), had dispensed more asthma medications per day for patients younger than six years of age (p = 0.016), and sold inhaler spacer devices at their pharmacy (p = 0.042). Conclusion: Approximately one third of the pharmacists in the current study were able to correctly demonstrate all of the steps for proper usage of pMDIs with a spacer device, which indicates that pharmacists should be included in the training program and be provided continuous training on the use of pMDIs with a spacer device

A new method for detecting pedicular wall perforation during pedicle screw insertion.

Study Design. Sensitivity, specificity, and predictive value analyses of a method that can be used to detect pedicular wall perforation during pedicle screw insertion were assessed