GİZEMLİ TABLO

Sabahattin Ali’nin “Kürk Mantolu Madonna” adlı yapıtında kadın-erkek ilişkilerinin varoluşsal boyutları nasıl işlenmektedir

Short-Term Outcome of Combined Corticosteriod and Local Anaestetic Therapy with Home-Based Exercıse Programme in Painful Shoulder Conditions

Purpose: The aim of this study was to evaluate the efficacy of combined local corticosteroid and anaestethic therapy with home exercise programme in the treatment of painful shoulder conditions. Methods: 40 mg Depomedrol® (methylprednisolone acetate) + 120 mg Citanest® (procaine hydrochloride) were parenterally administered into the subacromial region of 28 patients (17 female, mean age: 48 years; 11 male, mean age: 52 years) from a group of patients who have been suffering from shoulder pain for a period of at least two months and had received no benefit from previous treatments. Simultaneously, they were placed on a home-based shoulder exercise programme. The patients were seen two months later and questioned about their conditions. The data were evaluated together with clinical findings based on the range of motion (ROM) of the shoulder. Results: Twenty of 28 patients (71.42%) reported complete relief from pain, 5 patients or 17.85% stated that they had only partial relief of pain, and 3 patients (10.71%) said that the level of pain remained essentially the same. Nineteen of 28 patients (67.85%) had good to excellent ROM while 3 (10.71%) still manifested poor ROM. Conclusion: Local corticosteroid plus local anaestethic therapy together with home exercise programme was found to be an economic, effective and safe short-term treatment in the management of painful shoulder conditions arising from certain disorders. Keywords: Painful shoulder, Local corticosteroid, Local anaesthetic, Home exercise programe, Range of motion.Tropical Journal of Pharmaceutical Research Vol. 7(4) 2008: pp. 1123-112

GİZEMLİ TABLO

Sabahattin Ali’nin “Kürk Mantolu Madonna” adlı yapıtında kadın-erkek ilişkilerinin varoluşsal boyutları nasıl işlenmektedir

Erken başlangıçlı skolyozda nöral aks deformiteleri

Erken başlangıçlı skolyoz infantil idiopatik skolyoz, juvenil idi- opatik skolyoz ve konjenital skolyozu kapsar. Nöromusküler skolyoz, sendromik skolyoz ve torasik yetersizlik sendromu da erken başlangıçlı skolyoz tipleridir. Büyüyen bir omurgada spinal deformiteler sıklıkla nöral aks anomalileri olmakla be- raber diğer organ anomalileri ile birliktelik gösterebilirler. MR görüntülemenin intraspinal anomali değerlendirmesinde altın standart olmasına rağmen, skolyoz tedavisi ile ilgilenen bir he- kimin asemptomatik nöral aks anomalileri belirtileri hakkında bilgi sahibi olması gerekir.Infantile idiopathic scoliosis, juvenile idiopathic scoliosis and congenital scoliosis are included within early onset scoliosis. Neuromuscular scoliosis, syndromic scoliosis and thoracic in- sufficiency syndrome are also the types of early onset scolio- sis. Spinal deformities in the growing spine may be observed with abnormalities of other organ systems, with neural axis abnormalities being one of the most common. Also the gol- den standard in the diagnosis of intraspinal abnormalities is MR evaluation, doctors dealing with scoliosis treatment sho- uld be cautious about the signs of asymptomatic neural axis abnormalities

Bilateral intertrochanteric and femoral diaphyseal fractures with unilateral proximal tibial fracture: A case report and review of the literature

INTRODUCTION Bilateral intertrochanteric femur fractures are relatively rare injuries. This study aims to present a case of a patient with simultaneous bilateral intertrochanteric femur fractures and femoral diaphyseal fractures and proximal tibial fracture with his twelve years follow-up. PRESENTATION OF CASE A 44-year-old man presented to emergency department after a motor vehicle accident. Bilateral intertrochanteric femur fractures (OTA classification - 31A.1.2) and bilateral femoral diaphyseal fractures (OTA classification - 32A.2) and nondisplaced right proximal tibial fracture (OTA classification - 41B.1) were determined in radiographs. Following closed reduction, fractures were fixed with intramedullary nails bilaterally. Proximal tibial fracture was fixed with cannulated screws following open reduction. At twelfth year follow-up he was able to do his daily activities with minimal limitation. DISCUSSION High energy traumas, stress fractures, systemic disorders (osteomalacia, chronic renal failure), steroid treatments, seizures and electric injuries are possible causes for bilateral hip factures. However bilateral femoral diaphyseal fractures are mostly due to high energy traumas. Long-term biphosphonate use may also cause bilateral fractures. Single-stage surgery should be performed in order to avoid secondary damages of surgical interventions. All fractures of our patient were fixed in a single session. This prevented further deterioration of patient's status and made rehabilitation easy. CONCLUSION Careful evaluation of all systems should be performed in multi-trauma patients to find out concomitant injuries. Single staged surgical treatment may decrease morbidities

The treatment method and results of percutaneous pinning and dynamic external fixator application for unstable distal radius fractures

WOS: 000454997800004Amaç: Çalışmamızda instabil radius distal uç kırığı nedeniyle kapalı redüksiyon ve K teli ile tespit sonrası erken el bileği hareketine izin veren Pennig tipi dinamik eksternal fiksatör (Orthofix, Srl, Italya) uygulanan hastaların sonuçlarının değerlendirilmesi amaçlanmıştır. Yöntem: Kapalı redüksiyon ve perkütan K teli ile tespiti takiben dinamik el bileği eksternal fiksatörü uygulanan instabil radius distal uç kırıklı 25 olgu (15 erkek [%60], 10 kadın [%40], yaş ortalaması 47.32 [20-76yaş]) değerlendirildi. Travma sonrası ortalama 8.52 (1-23) günde ameliyat edilen hastalara, ilk gün aktif omuz, dirsek ve parmak egzersizleri başlanarak normal günlük aktivitelerine geri dönmeleri sağlandı. Bulgular: Radyolojik-anatomik sonuçlar Lidström’ün geliştirdiği Sarmiento tarafından modifiye edilen radyolojik kriterlerlere göre yapıldı. Oniki olguda (%46.15) mükemmel, onbir olguda (%42.30) iyi, üç olguda (%11.55) ise orta sonuç elde edildi. Kötü sonuç alınan hasta bulunmamaktaydı. Fonksiyonel sonuçlar Sarmiento tarafından modifiye edilen Gartland-Werley’in geliştirdiği skorlama sistemi ile değerlendirildi. Hastaların ondördünde (%56) mükemmel, sekizinde (%32) iyi, üçünde de (%12) orta sonuç alındığı saptandı. Sonuç: Stabil olmayan radius distal uç kırıklarının tedavisinde Pennig tipi dinamik el bileği eksternal fiksatörü; kolay uygulanması, minimal cerrahi travma yaratması, erken dönemde rehabilitasyona izin vererek hastaların normal günlük aktivitelerine kısa sürede geri dönmelerini sağlaması ile birlikte başarılı anatomik ve fonksiyonel sonuçlara ulaşılması açılarından tercih edilebilir bir tedavi yöntemidir.Objective: The aim of the present study was to present the results of patients with unstable distal radius fracture treated withclosed reduction and percutaneous fixation followed by application of the Pennig dynamic wrist fixator to allow early wrist motion.Methods: Twenty-five patients diagnosed with distal radius fracture and treated with closed reduction and percutaneous fixationfollowed by application of a dynamic wrist fixator were included in the study. There were 15 (60%) male and 10 (40%) femalepatients. The mean age of the patients was 47.32 (20–76) years. The mean period between initial trauma and operation was 8.52(1–23) days. All patients were allowed active shoulder, elbow, and finger exercises immediately after surgery.Results: Radiological evaluation was performed according to the criteria described by Sarmiento and modified by Lidström. Results were excellent in 12 (46.15%), good in 11 (42.30%), and fair in 3 (11.55%) patients. No patient had poor result. Functionalscores were assessed according to the Gartland–Werley classification and modified by Sarmiento. Results were excellent in 14(56%), good in 8 (32%), and moderate in 3 (12%) patients.Conclusion: Use of the Pennig dynamic wrist fixator in the treatment of unstable distal radius fractures has advantages, suchas ease of use, minimal surgical trauma, allowing early rehabilitation, and early return to daily activities as well as increasedanatomical and functional results

Mini External Fixator Assisted Metacarpal Lengthening With The Distraction Method

Phalangeal brachydactyly, which is caused by the abnormal development of the metacarpal, is characterized by shortness that can be seen in a single finger or in all fingers of the hands. Although brachydactyly is usually thought of as congenital, it can occur due to metabolic disorders or trauma. A twelve-year-old girl was admitted to our clinic with complaints of shortness in the fourth finger of the left hand. Osteotomy was applied with the drilling-osteotomy technique. The screws holding the upper and lower segments were adapted to the external fixator. Lengthening began one week after the osteotomy. The lengthening rate was organized as 0.25×2 mm/day. The amount of elongation was planned not to exceed 40% of the original bone length. Distraction was terminated after the planned elongation amount was reached, and the bone was allowed to heal. In patients under twenty years of age, the results from progressive distraction without bone grafting are close to perfect. Although the technique of successfully lengthening metacarpal fractures in children is simple, strict rules should not be ignored. Primarily, the external fixator and the distraction system should be sufficiently stable, lightweight, and should be appropriate for the size of a child’s hand