Is Peer Assessment Reliable in Objectively Structured Clinical Examination?

Objective:The study was designed to evaluate the reliability of the peer assessment in the objectively structured clinical examination (OSCE) for the summative assessment of 4th grade students at the end of general surgery clerkship.Method:The study was planned prospectively with the permission of the Dean of Medicine Faculty and approval of the ethics committee. The 6th grade students who were in the surgery rotation participated in the study as peer assessors (PA). Both peers and department of general surgery assessed the students. Pass/fail point was accepted as 60. The scores of OSCE and performance evaluation given by peers and faculty were compared statistically.Results:Twenty-three students completed general surgery clerkship. Ten students (43.5%) were female. According to performance scores given by the faculty, 15 (65.2%) of the 23 students were successful, while all students were considered successful (having a grade of 60 or more) based on the scores of peer evaluation. There was a significant difference between the faculty members and PA with regard to the performance evaluation (p=0.008). The faculty members found five students (27.8%) successful in the OSCE (having a grade of 60 or more). However, ten students (43.5%) received a score of at least six from peer evaluation. Although there was a difference, it was not significant (p=0.063). Gender did not affect scoring in performance evaluation and OSCE application.Conclusion:Although there was a difference between faculty members and peer evaluators in the performance evaluation, no difference was observed in OSCE. In conclusion, OSCE assessment by peer evaluators is reliable

A novel biomaterial-carbon nanotube/ hydroxyapatite tricalcium phosphate composite for posterolateral fusion: Rat model

Giriş: Posterolateral spinal füzyon uygulamalarında greftleme standart olarak uygulanan prosedürlerden biridir. Otojen greftler ideal greft özelliklerine sahip olmalarına rağmen ortaya çıkardıkları komorbiditeler nedeniyle çok çeşitli greft materyalleri üzerinde çalışmalar sürdürülmektedir. Günümüzde seramik bazlı sentetik greftlerin spinal füzyon operasyonlarında kullanımları yaygın olmakla birlikte etkinliklerini artırmak için çeşitli materyallerle birlikte kombine edilerek spinal füzyona olan etkileri incelenmektedir. Karbon nanotüplerin (KNT) hidroksiapatit (HA) gibi seramiklerle kullanımı yeni olup kemik doku mühendisliğinde olumlu gelişmelere neden olmuştur. Çalışmamızda daha önce spinal füzyonda greft materyali olarak kullanılmayan KNT destekli HA- trikalsiyum fosfat (TCP) materyalinin spinal füzyon üzerine etkileri incelenmiştir. Gereç ve Yöntem: Çalışmamızda 20 adet Spraque- Dawley cinsi rat kullanılarak lomber 4-5 (L4-L5) vertebralar arasına posterolateral füzyon modeli oluşturulmuştur. Denekler 5' erli dört gruba ayrılmıştır. Tüm deneklerin L4-L5 posterior arklarına dekortikasyon uygulanmış, birinci gruba herhangi bir greft materyali uygulanmamış, ikinci gruba sadece KNT, üçüncü gruba HA-TCP sentetik seramik ve dördüncü gruba ise KNT/ HA-TCP kompoziti uygulanmıştır. Sekiz hafta sonunda tüm hayvanlar sakrifiye edilmiş ve elde edilen lomber füzyon segmenti manuel palpasyon, radyolojik, biyomekanik (her gruptan 2' şer hayvana), mikro bilgisayarlı tomografi (mikro-BT) cihazı ile ve histolojik olarak değerlendirilmiştir. Bulgular: Sadece dekortikasyon yapılan grupta tüm değerlendirmelerde füzyona rastlanmadı. Grup 2' de grup 1' e göre manuel palpasyon, histolojik ve mikro-CT değerlendirmeleri ile anlamlı fark olmasına (p<0.01) rağmen solid füzyon oluşmadığı görüldü. Grup 3 ve Grup 4 de ise manuel palpasyonla sırasıyla %60 ve %100, radyolojik olarak sırasıyla %60 ve %92, histolojik olarak %42 ve %68.5 füzyon oranı saptandı. Mikro- BT incelemeleri ile sırasıyla %18.7 ve %33.1 kemikleşme oranları (kemik hacmi/ füzyon kitlesi) saptandı. Bu veriler ile grup 3 ve 4 arasında füzyon açısından anlamlı fark saptandı (p<0,01). Sonuç: KNT' ler tek başlarına kullanıldığında spinal füzyon oluşturmada yetersiz kalsa da özellikle yüksek biyouyumlulukları ve kemik dokusuyla uyumlu eşşiz biyomekanik özellikleri nedeniyle özellikle seramik bazlı sentetik greftlerle birlikte füzyon oranlarını anlamlı olarak yükseltmektedirler.Introduction: Bone grafting is essential in posterolateral spinal fusion surgery. Although autogenous grafts have ideal graft properties, their use is limited due to the donor site comorbidities. For this reason, a variety of graft materials have been researched. The use of carbon nanotubes (CNTs) with ceramics such as hydroxyapatite (HA) has recently been used and has led to positive effects in bone tissue engineering. In this study, the effects of CNT-assisted HA-tricalcium phosphate (TCP) material on spinal fusion, which were not previously used as graft material in spinal fusion, have been investigated. Material and methods: We operated 20 Sprague-Dawley rats to create a posterolateral fusion model between the lumbar 4-5 (L4-L5) vertebrae. Subjects were divided into four groups of five. The L4-L5 posterior arches of all the subjects were decorticated. No graft material was applied to the first group (Group 1). In the second group, we used only CNTs (Group 2),in the third group HA-TCP synthetic ceramics (Group 3) and the fourth group CNT / HA-TCP composite (Group 4). After eight weeks, all subjects were sacrificed and the obtained lomber fusion segments were assessed by manual palpation, radiological images, biomechanical tests (2 'sham animals from each group), histological evaluation and micro computerized tomography (micro-CT) device. Findings: There was no fusion in the Group 1 where only decortication was done. In Group 2 (CNTs), there was no solid fusion, although there was a significant difference (p <0.01) between manual palpation, histological and micro-CT scans according to Group 1. In Group 3 (HA-TCP) and Group 4 (CNT/HA-TCP), 60% and 100% fusion was detected with manual palpation, respectively. Radiologically, fusion rates were 60% and 92%, histologically 42% and 68.5%, respectively. Micro-CT scans revealed ossification rates (bone volume / fusion mass) of 18.7% and 33.1%, respectively. Significant differences were found between groups 3 and 4 in all the evaluations (p <0,01). Conclusion: Although CNTs are incapable to form spinal fusion when used alone; they significantly increase fusion rates, especially with ceramic-based synthetic grafts, due to their high biocompatibility and unique biomechanical properties compatible with bone tissue

Strategies of management of deep spinal infection: from irrigation and debridement to vacuum-assisted closure treatment

Postoperative surgical site problems (PSSPs) following spinal surgery may lead to patient mortality, increased treatment costs and possible recurrent medical interventions. Despite efforts to reduce spinal surgery-related infection rates, complications are common and significantly increased by patient comorbidities. Since PSSPs occur regardless of deterrent measures, it is essential to distinguish the related risk factors. Different treatment conventions for PSSPs, for example, antibiotic treatment, debridement, soft tissue care and removal of implants have been prescribed with blended outcomes. The utilization of the wound vacuum-assisted closure (VAC) system has gained increasing popularity in the management of deep wound infections after deformity surgery

[Salter innominate osteotomy for the treatment of developmental dysplasia of the hip: 37 years of follow-up].

In this article, we report the radiological and clinical status at postoperative 37th year of a 39-year-old male patient who was treated with bilateral Salter innominate osteotomy due to bilateral developmental dysplasia of the hip when he was two years old. The patient expressed that he had no complaint including pain or limitation in range of motion in both hip joints for 37 years. Pain started six months ago in right hip joint. Patient used cortisone for 12 months with a diagnosis of Henoch-Schönlein purpura five years ago. Radiologic imaging revealed findings of bilateral Salter innominate osteotomy and avascular osteonecrosis on the right femoral head. Kirschner wires which were used during operations 37 years ago remained buried in pelvic bone. Bilateral development of acetabulum and femoral head was very good. Anteroposterior and lateral radiographs of right hip joint revealed degenerative osteoarthritis secondary to avascular osteonecrosis on the right femoral head. Except for the last six months, patient has been living without pain or limitation in range of motion for postoperative 37 years

The Efficacy of Hemoglobin, Albumin, Lymphocytes, and Platelets as a Prognostic Marker for Survival in Octogenarians and Nonagenarians Undergoing Colorectal Cancer Surgery

Objectives: With the aging population worldwide, the octogenarians are becoming a substantial group and since cancer incidence increases by age, this group of patients is becoming more affected. However, no distinct treatment algorithm has been established for the elderly patients with cancer. The present study aimed to determine the prognostic value of several inflammatory parameters by comparing octogenarian patients treated surgically for colorectal cancer with their younger counterparts, as well as to predict and prevent age-related complications in this frail group of patients

Salter innominate osteotomy for the treatment of developmental dysplasia of the hip: 37 years of follow-up

In this article, we report the radiological and clinical status at postoperative 37th year of a 39-year-old male patient who was treated with bilateral Salter innominate osteotomy due to bilateral developmental dysplasia of the hip when he was two years old. The patient expressed that he had no complaint including pain or limitation in range of motion in both hip joints for 37 years. Pain started six months ago in right hip joint. Patient used cortisone for 12 months with a diagnosis of Henoch-Schonlein purpura five years ago. Radiologic imaging revealed findings of bilateral Salter innominate osteotomy and avascular osteonecrosis on the right femoral head. Kirschner wires which were used during operations 37 years ago remained buried in pelvic bone. Bilateral development of acetabulum and femoral head was very good. Anteroposterior and lateral radiographs of right hip joint revealed degenerative osteoarthritis secondary to avascular osteonecrosis on the right femoral head. Except for the last six months, patient has been living without pain or limitation in range of motion for postoperative 37 years

3D printing and spine surgery

Rapid prototyping (RP), also known as three-dimensional printing (3DP), allows the rapid conversion of anatomical images into physical components by the use of special printers. This novel technology has also become a promising innovation for spine surgery. As a result of the developments in 3DP technology, production speeds have increased, and costs have decreased. This technological development can be used extensively in different parts of spine surgery such as preoperative planning, surgical simulations, patient-clinician communication, education, intraoperative guidance, and even implantable devices. However, similar to other emerging technologies, the usage of RP in spine surgery has various drawbacks that are needed to be addressed through further studies

Solitary osteochondroma of pubic ramus

[Cukurova Med J 2016; 41(0.100): 108-110

The implant density does not change the correction rate of the main and the accompanying curves: A comparison between consecutive and intermittent pedicle screw constructs

Objective: The aim of this study was to evaluate the clinical outcomes and the coronal correction rate of the main and accompanying curves of adolescent idiopathic scoliosis (AIS) corrected with pedicle screws inserted consecutively or intermittently. Methods: The prospectively collected data of 60 patients (8 men and 52 women; mean age: 14.6±2.5 years) who underwent corrective surgery for AIS between January 2010 and December 2015 were reviewed retrospectively. Two groups were constituted according to the pedicle screw construct type: consecutive pedicle screw construct (CPSC) and intermittent pedicle screw construct (IPSC) groups. The preoperative, early postoperative, and 24-month follow-up radiographs and the Scoliosis Research Society-22 (SRS-22) scores were reevaluated. The Cobb angle of the main and accompanying curves, the correction rate, and the flexibility of the curves were calculated. Results: The mean preoperative Cobb angles were 57.03° and 57.46°, the mean postoperative Cobb angles were 14.93° and 14.4°, and the mean correction rates were 76.22% and 75.31% in IPSC and CPSC groups, respectively (p>0.05). The preoperative and postoperative accompanying curve magnitudes and correction rates were similar (p>0.05). These radiographic outcomes were also consistent with the SRS-22 scores. Conclusion: Both the pedicle screw constructs had satisfactory outcomes following the surgery, which were confirmed by both the SRS-22 scores and radiographs taken perioperatively and at follow-ups. The IPSC and CPSC groups did not demonstrate a significant change in the correction rate of the main and minor or major accompanying structural and nonstructural curves, and also in the SRS-22 scores. Level of Evidence: Level III, Retrospective comparative study