ZOLEDRONIC ACID ADMINISTRATION ENHANCES FRACTURE HEALING IN THE OSTEOPOROTIC FRACTURES IN OVARIECTOMIZED RABBITS

Objectives: To evaluate the radiological, histological and mechanical effects on osteoporotic fracture healing of single-dose zoledronic acid (ZA) applied to an animal model with an experimentally created osteoporotic bone fracture. Methods: A total of 14 adult, female New Zealand rabbits, aged 5-6 months were used in the study. Bone mineral density (BMD) values were calculated from bone densitometry measurements and recorded. Bilateral ovariectomy was then applied to all the rabbits. At 10 weeks after ovariectomy, bone densitometry was again performed on all the animals and the BMD values were compared. Osteoporosis was accepted as having developed in animals determined with a reduction of 28% in BMD values. After the placement of a K-wire intramedullarly in the femurs of the rabbits, a closed fracture was created with the standard method. The animals were then randomly separated into 2 groups as the zoledronic acid group (ZAG) and the control group (CG). An infusion of 0.1mg/kg ZA was administered to the ZAG animals from the ear vein. With visualisation of bone union rabbits were sacrificed by decapitation. Radiological, mechanical and histological assesments were then applied. Results: In the histological evaluation, the mean histological score was determined as 5.00 in the ZAG and 3.00 in the CG. The difference between the groups was found to be statistically significant (p<0.001). In the radiological evaluation, the mean score was 7.00 in the ZAG and 6.25 in the CG. Even though higher points were obtained by the ZAG in the inter-observer evaluations, the difference between the groups was not statistically significant (p=0.073). In the mechanical evaluation, the elasticity collapse in negative proportion to rigidity was measured as 2.91 mm in the ZAG and 3.96mm in the CG (p=0.686). The rigidity data of the ZAG were higher in the mechanical tests but the difference between the groups was not statistically significant (p=0.086). Conclusion: As the results of the study showed that the ZAG had higher values than those of the CG in all the histological, mechanical and radiological evaluations, the application of a single dose of ZA can be considered to increase the healing of osteoporotic fractures

Massive Primary Intraventricular Hemorrhage Due to Idiopathic Lateral Posterior Choroidal Artery Aneurysm: Case Illustration

Peripheral aneurysms of the lateral posterior choroidal artery are rare and mostly in association with vascular and occlusive pathologies such as moyamoya disease. To the best of our knowledge, pure lateral posterior choroidal artery aneurysms without association of any other vascular diseases are unique and only 3 cases have been reported in the literature

Penile curvature after Peyronie's disease surgery: What are the risk factors?

Surgery is the golden standard for the treatment of patients with Peyronie's disease in chronic phase (12-18 months). Learning risk factors for post-surgical curvature (>20 degrees) would aid both surgeon and patient in their decision-making process. The aim of this study was to investigate the risk factors for residual/recurrent curvatures. The clinical data of the patients, who underwent reconstructive surgery for PD between 1997 and 2016, were retrospectively reviewed. Follow-ups were performed via physical examination, surveys and phone calls. For shortening surgery (Nesbit/plication), initial bi-planar curvature was proved to be a predictor of post-operative curvature (p = .05). Lateral and ventral curvatures were associated with higher recurrence rates in patients who underwent grafting surgery (p = .01). In terms of baseline comorbidities, only diabetes mellitus had an association with curvature nonrecurrence for both shortening and lengthening surgeries (p < .05). Grafting surgery may be suggested to patients who had bi-planar curvatures instead of Nesbit surgery. Nesbit plication surgery may be preferred for patients with lateral and ventral curvatures instead of grafting surgery. Higher cavernosal blood pressures and more nocturnal erections of nondiabetic young patients might impede plication sutures and grafts and therefore increase penile curvature recurrence

The Management of Acute Cholecystitis in Chronic Hemodialysis Patients: Percutaneous Cholecystostomy Versus Cholecystectomy

Treatment of acute cholecystitis in chronic hemodialysis (HD) patients still remains controversial. Because of underlying disease that can influence surgical results, less invasive alternative managements have been tried over the last decades. The goal of this study was to analyze the results of cholecystectomy versus percutaneous cholecystostomy for acute cholecystitis (AC) in chronic HD patients.Treatment of acute cholecystitis in chronic hemodialysis (HD) patients still remains controversial. Because of underlying disease that can influence surgical results, less invasive alternative managements have been tried over the last decades. The goal of this study was to analyze the results of cholecystectomy versus percutaneous cholecystostomy for acute cholecystitis (AC) in chronic HD patients.METHODS:All patients with end-stage renal disease who were treated for AC were identified retrospectively from our medical records. Between July 2007 and September 2011, 47 patients were treated for AC while they were on chronic HD. The records of these patients were reviewed for documented AC and its treatment.RESULTS:Of the 47 HD patients, 26 (55.3&nbsp;%) underwent cholecystectomy (CC), while 21 (44. 7&nbsp;%) had a percutaneous cholecystostomy (PC) for AC as an initial treatment. The mean length of follow-up was 20.4&thinsp;&plusmn;&thinsp;16&nbsp;months in PC and 18&thinsp;&plusmn;&thinsp;15&nbsp;months in CC patients. The success rate was higher in CC patients compared to PC patients (92. 3 versus 66.7&nbsp;%, p&thinsp;=&thinsp;0.0698). Eleven (52. 4&nbsp;%) patients who had PC subsequently underwent CC; six open CC and five delayed laparoscopic CC were performed. Of the 26 patients who underwent CC, 18 were performed emergently due to the persistence of AC-related symptoms and gangrenous and perforated gallbladders. Eight were initially treated conservatively and then underwent elective cholecystectomy at an interval of 32&thinsp;&plusmn;&thinsp;24 (range&thinsp;=&thinsp;14-59) days following initial treatment. In emergent CC, 10 (55.6&nbsp;%) were completed laparoscopically, three were open, and five (33.3&nbsp;%) had conversions. In elective CC patients, two were conversions, but the remainder (75&nbsp;%) had laparoscopic CC. Readmission rates were higher in the PC group (33.3 versus 12.5&nbsp;%, p&thinsp;=&thinsp;0.1732). Although AC-related mortality was higher in PC patients, there was no statistically significant difference in the patient survival rate between the two groups (Kaplan-Meier analysis, Fig. 1, 19 versus 7.7&nbsp;%; p&thinsp;=&thinsp;0.4035), and the overall mortality rate was higher in the PC group (33.7 versus 15.7&nbsp;%, p&thinsp;=&thinsp;0.2737).CONCLUSION:This study confirms that the safety and effectiveness of CC has a higher success rate and lower morbidity and mortality rate compared with percutaneous cholecystostomy for acute cholecystitis in chronic HD patients.</p

Hypergonadotropic Hypogonadism: Management of Infertility

Background: Medical treatments are used either alone or in combination with assisted reproductive techniques for the treatment of infertile patients with hypergonadotropic hypogonadism. A wide range of treatment options such as gonadotropins, aromatase inhibitors (AIs), selective estrogen receptor modulators (SERMs) and their combination are available as options. Objective: The aim of this review was to evaluate treatment options for infertile men with hypergonadotropic hypogonadism. Methods: A literature search of MEDLINE (1980-2019) was conducted using the terms 'hypogonadism', 'male infertility', 'gonadotropins', 'SERMs' and 'AIs'. Pathologies leading to hypergonadotropic hypogonadism and treatment modalities such as gonadotropins, SERMs, AIs and surgical treatment were discussed. Results: FSH increases spontaneous pregnancy rates but the level of evidence was proven to be low for live birth rates. AIs are valid treatment options for patients with low T/E2 ratio as they significantly increase sperm concentrations. SERMs are recommended for infertile males with a sperm concentration between 10-20 million. Varicocele was reported to increase testosterone levels of hypogonadic infertile males. Conclusion: Medical treatment modalities such as gonadotropins, SERMs, AIs and a combination of these therapies has been showed to have some effect in improvement of fertility but is not mainstream of the treatment

Validation Of Pre-Adolescent Decision-Making Competence In Turkish Students

The objective of this study was to adapt the Pre-Adolescent Decision-Making Competence Test to Turkish, which was originally developed in English by Weller, Levin, Rose and Bossard (2012) for assessing decision-making competence of children between the ages of 9 and 14. For this purpose; a) the test and instructions were translated into Turkish, b) the Turkish test was administered to a group of 398 students as a pilot, c) retest was administered to a group of 97 students, and finally, d) a group of 382 students was subject to a norm study. The Confirmatory Factor Analysis model created by the data of the pilot administration was well adapted, and one-factor model was verified for construct validity. As the construct of the test was altered, a Confirmatory Factor Analysis was performed on the data obtained from the norm study. A construct similar to that acquired from the data of the first test administration and the results obtained have even relatively better fit indices. Although the reliability values were less than what was expected, Cronbach's Alpha coefficient of internal consistency was similar to the results obtained from the original test.Wo

Safe surgical approach to extrahepatic pseudocyst, a rare shunt complication: 2 case reports

Abstract Background Hepatic pseudocysts are not a common complication and “extrahepatic” pseudocysts are rarer complications but may occur in every ventriculo-peritoneal shunt patient. Case presentation We present two patients with ventriculo peritoneal shunt induced extrahepatic pseudocysts, who underwent shunt surgery for different etiologies. Etiology, treatment strategies and our choice of treatment have been discussed. Conclusions When a ventriculoperitoneal shunt patient is presented with non-specific abdominal symptoms, the possibility of this complication should always be considered. In the treatment of this complication, it is shown that repositioning the catheter is sufficient for cyst regression

Analysis of Denver Neurodevelopmental Screening Test Results of Myelomeningocele, Hydrocephalus, and Microcephaly Patients

WOS: 000433244300005PubMed ID: 29899768Context: Spina bifida, hydrocephalus, and similar congenital central nervous system (CNS) anomalies take origin from embryologic stages weeks before birth, but assessment and follow-up of these patients are important to figure and predict the effects of these anomalies on child's neurodevelopment. Aims: To evaluate of multiple groups of congenital CNS anomalies in the neurodevelopment level. Settings and Design: The study was conducted at a research and treatment center for spina bifida patients. Materials and Methods: The study group included 348 patients with a mean age of 15.4 (+/- 15.1) months, who had spina bifida aperta, hydrocephalus, and microcephaly. Patients with other known intracranial conditions were excluded. The subjects were evaluated into five groups: Group 1, 88 patients with congenital hydrocephalus; Group 2, 48 patients with congenital hydrocephalus and ventriculoperitoneal shunt; Group 3, 148 patients with microcephaly; Group 4, 30 patients who were operated for spina bifida aperta; and Group 5, 39 patients who were operated for spina bifida aperta and also had ventriculoperitoneal shunt implantation. Denver Developmental Screening Test II was used to assess patients' neurodevelopment levels. Statistical Analysis Used: Pearson's chi-square and Fisher's exact tests were used for data analysis. Group comparisons were also made in pairs with chi-square test according to Bonferroni corrections. Frequency of abnormal findings was significantly correlated with age (P = 0.014). Results: Total score differences of five groups appeared to be statistically significant according to Pearson's chi-square test (P = 0.000). When we compared groups in pairs, abnormal results were significantly frequent in shunted groups (P < 0.01). Conclusions: Our results suggested that shunt-dependent hydrocephalus caused serious neurodevelopmental impairments in patients