Osteosarkom Tedavisinde Modüler Tümör Rezeksiyon Protezi

Amaç: Osteosarkom nedeniyle tümör rezeksiyon protezi uygulanan olguların değerlendirilmesi amaçlandı. Gereç ve Yöntem: Kliniğimizde 2000 ile 2012 yılları arasında Osteosarkom nedeniyle tümör rezeksiyon protezi uygulanan ve yeterli takipleri olan 14 olgu değerlendirildi. Olgular cinsiyet, yaş, yön, tümör yerleşimi, takip süresi, tedavi başarısı, komplikasyon, nüks ve sağkalım açısından incelendi. Elde edilen veriler SPSS 15.0 programına aktarılarak analiz edildi. Verilerin normal dağılıma uygunluğu Shapiro-Wilk testi ile değerlendirildi. Bulgular: 14 olgunun 8'i erkek, 6'sı kadın ve ortalama yaş 21.9±7.02 idi. Osteosarkom 9 (%64.3) hastada femur distalinde, 5 (%35.7) hastada tibia proksimalinde, 5 hastada sağ ve 9 hastada sol alt ekstremitede idi. Ortalama takip süresi 33 ay idi. Ortalama MSTS skoru 81.9 hesaplandı, 11 hastada (%78.6) mükemmel, 3 hastada (%21.4) yetersiz sonuç elde edildi. Komplikasyon olarak 3 olguda aseptik gevşeme, 2 olguda peroneal sinir felci, 2 olguda cilt nekrozu, 2 olguda periprostatik kırık, 1 olguda protez enfeksiyonu ve 1 olguda lokal nüks gözlendi. Peroneal sinir felci olan 2 olgu dısında komplikasyonlar sorunsuz iyileşti. Lokal nüks gelişen hasta akciğer metastazı nedeniyle kaybedildi. Tartışma: Osteosarkomun tümör rezeksiyon protezi ile tedavisi, uzun dönemde protezin sağkalımını etkileyecek olan olası komplikasyonlar nedeniyle kullanımında soru işareti yaratmaktadır. Ancak stabilite, erken yük verme ve osteosentez kaygısından uzak olması nedeniyle avantajlı ve amputasyona kıyasla psikolojik olarak yüz güldürücüdür.Aim: The aim of the study is to evaluate the cases who underwent tumor resection prosthesis due to osteosarcoma. Material and Method: 14 cases who underwent tumor resection prosthesis due to osteosarcoma in our clinic between 2000 and 2012 and who had sufficient follow-ups were evaluated. The cases were examined in terms of gender, age, direction, tumor location, follow-up time, success of the treatment, complication, recurrence, and survival. The data obtained were transferred to the SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with the ShapiroWilk test. Results: 8 of the 14 cases were male, 6 were female, and the average age of the cases was 21.9±7.02. Osteosarcoma was in the distal femur in 9 (64.3%) of the patients, in the proximal tibia in 5 (35.7%) of the patients, in the right lower extremity in 5 of the patients, and in the left lower extremity in 9 of the patients. Average follow-up time was 33 months (3-144 months range). Average MSTS score was found as 81.9 (53-96 range), perfect results were taken in 11 (78.6%) patients while insufficient results were taken in 3 (21.4%) patients. As for complications, aseptic softening was observed in 3 cases, peroneal nerve paralysis was observed in 2 cases, skin necrosis was observed in 2 cases, periprostatic fracture was observed in 2 cases, prosthesis infection was observed in 1 case, and local recurrence was observed in 1 case. Except for the two cases with peroneal nerve paralysis, cases with complications recovered without any problems. The patient who developed local recurrence was lost due to lung metastasis. Discussion: Treatment of osteosarcoma through tumor resection prosthesis raises question marks due to possible complications that can affect the survival of the prosthesis in the long term. However, this treatment method is favorable in terms of stability, early load efficiency, and causing less anxiety than osteosynthesis; it is also psychologically more pleasing than amputation

Modular Tumor Resection Prosthesis in Osteosarcoma Treatment

WOS: 000376567100026Aim: The aim of the study is to evaluate the cases who underwent tumor resection prosthesis due to osteosarcoma. Material and Method: 14 cases who underwent tumor resection prosthesis due to osteosarcoma in our clinic between 2000 and 2012 and who had sufficient follow-ups were evaluated. The cases were examined in terms of gender, age, direction, tumor location, follow-up time, success of the treatment, complication, recurrence, and survival. The data obtained were transferred to the SPSS 15.0 program and analyzed. Normality distributions of the data were analyzed with the Shapiro-Wilk test. Results: 8 of the 14 cases were male, 6 were female, and the average age of the cases was 21.9 +/- 7.02. Osteosarcoma was in the distal femur in 9 (64.3%) of the patients, in the proximal tibia in 5 (35.7%) of the patients, in the right lower extremity in 5 of the patients, and in the left lower extremity in 9 of the patients. Average follow-up time was 33 months (3-144 months range). Average MSTS score was found as 81.9 (53-96 range), perfect results were taken in 11 (78.6%) patients while insufficient results were taken in 3 (21.4%) patients. As for complications, aseptic softening was observed in 3 cases, peroneal nerve paralysis was observed in 2 cases, skin necrosis was observed in 2 cases, periprostatic fracture was observed in 2 cases, prosthesis infection was observed in 1 case, and local recurrence was observed in 1 case. Except for the two cases with peroneal nerve paralysis, cases with complications recovered without any problems. The patient who developed local recurrence was lost due to lung metastasis. Discussion: Treatment of osteosarcoma through tumor resection prosthesis raises question marks due to possible complications that can affect the survival of the prosthesis in the long term. However, this treatment method is favorable in terms of stability, early load efficiency, and causing less anxiety than osteosynthesis; it is also psychologically more pleasing than amputation

Comparison of Open and Arthroscopic Bankart Repair Results in Traumatic Anterior Shoulder Instability

Amaç: Travmatik anterior omuz instabilitesi cerrahi tedavisinde açık ve artroskopik Bankart tamirinin klinik sonuçlarının karşılaştırılması amaçlandı.Materyal ve Metod: Ocak 2005 ile Ocak 2013 yılları arasında tekrarlayan anterior omuz instabilitesi nedeniyle cerrahi tedavi uygulanan 23 hastadan son kontrolleri yapılan 20 hasta (17 erkek, 3 kadın) çalışmaya dahil edildi. Hastaların 10'una açık Bankart tamiri, 10'una artroskopik Bankart tamiri uygulandı. Ağrı değerlendirmesi vizüel analog skalasına (VAS) göre yapılırken klinik sonuçlar Rowe skalası kullanılarak değerlendirildi. Ameliyat sonrası ortalama takip süresi açık tamir grubunda 37.4±27.1 ay iken, artroskopik tamir grubunda 23±6.9 ay idi. İstatistiksel değerlendirmede Shapiro-Wilk testi ile Mann-Whitney U testi kullanıldı. Bulgular: VAS skoru açık tamir grubunda 5.7±2.5, artroskopik tamir grubunda 4.1±1.9, Rowe skoru açık tamir grubunda 97.5 , artroskopik tamir grubunda 95 olarak bulundu. Klinik sonuçlar açık tamir grubunda 9 hastada (%90) mükemmel, bir hastada (10%) iyi iken, artroskopik tamir grubunda 8 hastada (80%) mükemmel, bir hastada (10%) iyi, bir hastada (10%) kötü olarak bulundu. Açık grupta 2 hastada, artroskopik grupta ise 5 hastada dış rotasyon kısıtlılığı gözlendi. İki grup arasında VAS skoru, Rowe skoru ve eklem hareket açıklığı bakımından istatistiksel olarak anlamlı fark görülmedi (p>0.05). Sonuç: Çalışmamızda artroskopik tamir ile açık tamir sonuçları, son yıllardaki çalışmalarla paralel olarak eşdeğer bulundu. Ancak artroskopik tamirin cerrahi tecrübe ve tamir yöntemlerinin gelişmesiyle, postoperatif hasta konforu ve rehabilitasyon kolaylığı nedeniyle avantajlı olduğu kanısındayız.Objective: The purpose of the study was to compare the clinical results of open and arthroscopic bankart repair in the surgical treatment of traumatic anterior shoulder instability. Material and Methods: Out of 23 patients who had surgical treatment due to recurrent anterior shoulder instability between January 2005 and January 2013, 20 patients (17 men, 3 women) whose last controls were made were included in the study. Open Bankart repair was applied on 10 (average age 30, ranging between 17 and 43) patients and arthroscopic Bankart repair was applied on 10 (average age 21, ranging between 18 and 49) patients. While pain was assessed according to visual analog scale (VAS), clinical results were assessed by using Rowe scale. Average postoperation follow-up time was 37.4±27.1 months in the open repair group, while it was 23±6.9 months in the arthroscopic repair group. ShapiroWilk test and Mann-Whitney U test were used for statistical analysis. Results: VAS score was 5.7±2.5 in the open surgery group, while it was 4.1±1.9 in the arthroscopic group and Rowe score was 97.5 (ranging between 80 and 100), while it was 95 (ranging between 50 and 100) in the arthroscopic repair group. Clinical results were perfect in 9 (90%) patients in the open surgery group, while they were good in 1 (10%) patient. In the arthroscopic repair group, clinical results were perfect in 8 (80%) patients, good in 1 (10%) patient and bad in 1 (10%) patient. Limitation of external rotation was seen in 2 patients in the open group and in 5 patients in the arthroscopic group. No statistical difference was found between the two groups in terms of VAS score, Rowe score and range of motion (p>0.05).Conclusion: The results of arthroscopic repair and open repair in our study were found to be in parallel with the results of recent studies. However, with the developments in repair methods and surgical experiences, we are of the opinion that arthroscopic repair is more advantageous due to postoperative patient comfort and ease of rehabilitation

Primer Total Diz Artroplastisi İçin Traneksamik Asid Kullanımında Gizli Kan Kaybı, Enfeksiyon ve Fiyat-Fayda Oranı

Objective: The purpose was to evaluate the effect of combined administration of TXA on total blood loss, hidden blood loss, drain output, costeffectiveness and periprosthetic infection rate in patients undergoing unilateral primary knee arthroplasty.Sakarya Med J, 2018, 8(2):423-431 )Materials andMethodsWe enrolled fi fty-eight patients with primary gonarthrosis undergoing unilateral primary knee arthroplasty between May 2014 andDecember 2014. We compared 29 cases performed without the application of TXA to 29 cases performed with the application of TXA.Our TXA protocol consisted of three stages.Results Postoperative hemoglobin and hematocrit levels were found to be signifi cantly lower in the non-TXA group. Estimated blood loss, hiddenblood loss, and drain output were found to be higher in the non-TXA group. Transfusion rate was lower in TXA group. The blood bankcosts were found to be higher in the non-TXA group. The total direct cost was also higher in the non-TXA group. This was average 29.9$savings per case in the TXA group. No complication such as infection or thromboemboli was detected among the study groups.Conclusion Combined topical and continuous up to 24 hours intravenous administration of TXA reduced the total blood loss and decreased drainagevolume, as well as reducing hidden blood loss.Level of evidence III.Amaç Tek tarafl ı primer total diz artroplastisi uygulanan hastalarda kombine traneksamik asid (TXA) kullanımının total kan kaybı, gizli kan kaybı, drenaj miktarı, kost efektivite ve periprostetik enfeksiyon oranı üzerine etkisini değerlendirmektir. ( Sakarya Tıp Dergisi, 2018, 8(2):423-431 ). Gereç ve Yöntem 2014 yılı Mayıs ve Aralık ayları arasında primer gonartroz tanısı ile tek tarafl ı primer total diz artroplastisi uygulanmış olan 58 hasta çalışmaya dahil edilmiştir. TXA uygulanmamış 29 hasta ile TXA uygulanmış olan 29 hasta karşılaştırılmıştır. Söz konusu TXA protokolü 3 aşamadan oluşmaktadır. Bulgular Ameliyat sonrası hemoglobin ve hematokrit seviyeleri non-TXA grubunda anlamlı olarak düşük bulundu. Gene tahmini kan kaybı, gizli kan kaybı ve drenden olan kayıp miktarı non-TXA grubunda daha yüksek bulundu. Transfüzyon oranı TXA grubunda daha düşüktü. Kan bankası masrafl arı non-TXA grubunda daha yüksek bulundu. Total masrafl ar da gene non-TXA grubunda daha yüksek idi. TXA grubunda vaka başına 29,9 USD daha az masraf söz konusu idi. Çalışma gruplarında enfeksiyon veya tromboemboli gibi komplikasyonlara rastlanmadı. Sonuç Topikal ve 24 saat sürekli intravenöz TXA’in kombine kullanımı total kan kaybı, drenaj hacminin yanı sıra gizli kan kaybı miktarını da azaltır. Kanıt düzeyi II

Effects of circulating endothelial progenitor cells, serum vascular endothelial growth factor and hypogammaglobulinemia in Perthes disease

Objective: The aim of this study was to investigate Legg-Calvé-Perthes disease (PD) pathogenesis by comparing absolute circulating endothelial progenitor cell (EPC) counts, serum levels of vascular endothelial growth factor-A (VEGF-A) and immunoglobulins between PD patients and controls. Methods: The study included 28 PD cases (mean age: 8±3.8) and 25 healthy age-matched control subjects. EPC, serum VEGF-A and immunoglobulin levels were measured in peripheral blood samples. Comparisons and correlation analysis were performed. Results: In the PD group, 17 subjects were in the fragmentation stage and 11 in the healing stage. Four patients had bilateral disease and 14 had hypogammaglobulinemia. Median EPC count of the PD group was 80 and was significantly higher than those of the control group (p=0.011). No significant difference was determined in serum VEGF-A levels (p=0.354). EPC count were inversely correlated with serum IgG levels of the PD group (r=0.403, p=0.03). Absolute EPC count was also significantly higher in the fragmentation stage than in the healing stage and were also greater in bilaterally affected than in unilaterally affected patients. Circulating EPC count was correlated to the serum VEGF-A levels in patients with fragmentation stage of PD (r=0.605, p=0.01) and in those with hypogammaglobulinemia (r=0.599, p=0.001). Conclusion: High EPC count at the fragmentation stage of PD and relatively higher counts in bilateral disease suggest that EPC may be a valuable marker in the diagnosis and follow-up of PD. Additional studies are needed to explain the strong correlation between EPC and serum VEGF-A level in the fragmentation stage and in the presence of hypogammaglobulinemia.Objective: The aim of this study was to investigate Legg-Calvé-Perthes disease (PD) pathogenesis by comparing absolute circulating endothelial progenitor cell (EPC) counts, serum levels of vascular endothelial growth factor-A (VEGF-A) and immunoglobulins between PD patients and controls. Methods: The study included 28 PD cases (mean age: 8±3.8) and 25 healthy age-matched control subjects. EPC, serum VEGF-A and immunoglobulin levels were measured in peripheral blood samples. Comparisons and correlation analysis were performed. Results: In the PD group, 17 subjects were in the fragmentation stage and 11 in the healing stage. Four patients had bilateral disease and 14 had hypogammaglobulinemia. Median EPC count of the PD group was 80 and was significantly higher than those of the control group (p=0.011). No significant difference was determined in serum VEGF-A levels (p=0.354). EPC count were inversely correlated with serum IgG levels of the PD group (r=0.403, p=0.03). Absolute EPC count was also significantly higher in the fragmentation stage than in the healing stage and were also greater in bilaterally affected than in unilaterally affected patients. Circulating EPC count was correlated to the serum VEGF-A levels in patients with fragmentation stage of PD (r=0.605, p=0.01) and in those with hypogammaglobulinemia (r=0.599, p=0.001). Conclusion: High EPC count at the fragmentation stage of PD and relatively higher counts in bilateral disease suggest that EPC may be a valuable marker in the diagnosis and follow-up of PD. Additional studies are needed to explain the strong correlation between EPC and serum VEGF-A level in the fragmentation stage and in the presence of hypogammaglobulinemia

Determination of Biodex Balance System Cutoff Scores in Older People With Nonspecific Back Pain: A Cross-sectional Study.

AbstractObjectiveThe purpose of this study was to determine cutoff scores for the Biodex Balance System (BBS) and verify if they could be used to discriminate older people with nonspecific low back pain (NSLBP) with poor postural performance from those with good postural performance.MethodsThis cross-sectional study included 52 participants with NSLBP older than 65 years. One level of stability (level 5; intraclass correlation ≥0.70) and 2 conditions (eyes open and eyes closed) were selected for the testing procedure. Anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and overall stability index (OSI) scores were calculated. The participants were classified into 2 groups: high risk of falling and low risk of falling. Both the receiver operating characteristic and the area under the curve were used to determine the best BBS cutoff values. Binary logistic regression analysis was used to investigate the ability of BBS scores to predict risk of falling.ResultsBBS cutoff scores in the eyes-open condition (APSI = 2.60, MLSI = 1.95, OSI = 2.95) and eyes-closed condition (APSI = 3.05, MLSI = 2.17, OSI = 3.25) were found to be sensitive and specific in determining postural performance. Participants with index values lower than the cutoff scores had, respectively, 6.42, 4.20, and 3.72 times lower risk of falling in the eyes-open condition and 3.33, 5.50, and 3.00 times lower risk of falling in the eyes-closed condition. The predictive characteristics of the models for risk analysis were excellent and good to excellent.ConclusionOur study shows that BBS cutoff scores are sensitive and specific in distinguishing between poor and good postural performance in older people with NSLBP.</div