Patients who developed osteonecrosis during the treatment of acute lymphoblastic leukemia

Osteonekroz; çocuklarda akut lenfoblastik lösemi tedavisi sırasında veya sonrasında nadir görülen fakat ciddi sorunlara yol açabilen bir komplikasyondur. Yapılan çalışmalarda ALL tedavisi alan çocuklarda semptomatik osteonekroz insidansı %1,6-9,3 olarak bulunmuştur. Yüksek doz steroid tedavisi en önemli risk faktörüdür. Osteonekrozis fizyopatolojisi tam olarak açıklanamamıştır. Kortikosteroidlerin, sinüzoidal venlerdeki tromboembolilere bağlı mekanik tıkanmaya neden oldukları bunun sonucunda kan akımının azalmasıyla birlikte hipoksiye bağlı olarak osteoblast aktivitesinin azalıp, osteoklast aktivitesinin artmasıyla oluştuğu düşünülmektedir. Osteonekroz tanısında manyetik rezonans görüntüleme erken dönemde en duyarlı tanı yöntemidir. Burada ALL tanısıyla takip edilirken idame tedavisi sırasında osteonekroz gelişen 15 ve 14 yaşlarında 2 kız hasta sunulmuştur.Osteonecrosis is a rare and serious complication that can be developed during or after treatment for acute lymphoblastic leukemia (ALL). The incidence of symptomatic osteonecrosis related to ALL treatment is 1.6-9.3%. High-dose steroid therapy is the major risk factor for osteonecrosis. The pathophysiology is unclear. It is thought that osteonecrosis occurs due to steroid use causing thromboembolism in sinusoidal veins leading to hypoxia resulting in decreased osteoblast activity and increased osteoclast activity. Magnetic resonance imaging is the most sensitive diagnostic method in early period. We present two girls, 15 and 14-year-old, in whom osteonecrosis developed during ALL maintenance therapy

Congenital arterial thrombosis in newborn: A case report

Neonatal thrombosis is a serious event that can cause mortality or severe morbidity. Although catheters are the most common cause of neonatal thrombosis, spontaneous events can also occur. Arterial thrombosis is very rare and accounts for approximately half of all thrombotic events in neonates. Genetic prothrombotic risk factors may affect the occurence of neonatal thrombosis. In this report, a case of left brachial, radial, and ulnar arterial thrombosis associated with methylene-tetrahydrofolate reductase (MTHFR) gene C677T and A1298C polymorphism heterozygosity is presented. Plasma homocysteine level and other prothrombotic components were normal. Standard heparin, aspirin, vitamin B12, B6 and folic acid were initiated for treatment. However, the left arm of the patient was amputated at the shoulder because its capillary stream could not be observed. We suggest that MTHFR gene C677T and A1298C polymorphism heterozygosity might be investigated in neonates with congenital arterial thrombosis in spite of normal serum homocysteine levels. © Trakya University Faculty of Medicine

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Serebral palsili çocuklarda kalça subluksasyonu ve dislokasyonunun cerrahi rekonstrüksiyonu

WOS: 000427282300003PubMed ID: 29526153Objectives: This study aims to review the efficacy of femoral varus derotation osteotomy (VDRO) and Dega transiliac osteotomy in the treatment of hip subluxation and dislocation of cerebral palsy (CP) patients. Patients and methods: This retrospective study included 25 hips of 22 CP patients (9 males, 13 females; mean age 8.7 years; range, 4 to 18 years) who were operated due to hip subluxation and dislocation between July 2010 and December 2015. The mean follow-up period was 36.1 +/- 10.4 months (range, 20 to 65.6 months). Femoral VDRO and Dega transiliac osteotomy were performed in all cases. None of the patients were administered cast immobilization postoperatively. Patients were evaluated clinically with gross motor function classification system preoperatively and at the follow-up period. Acetabular index (AI), migration percentage (MP), and neck-shaft angle (NSA) were measured and documented by pelvic radiographs taken pre-and postoperatively and at the follow-up period. Intra- and postoperative complications were recorded. Results: Gross motor function classification system scores improved in 16 patients. Mean AI was 33.2 degrees preoperatively and 20.4 degrees postoperatively. In preoperative period, MP and NSA were 72.7% and 160 degrees, respectively, which improved to 24.3% and 130 degrees, respectively, postoperatively. The postoperative improvement in AI, NSA and MP were statistically significant (p<0.001). We performed revision surgery due to implant failure in two patients and detected hip subluxation due to increased pelvic obliquity in one patient who had thoracolumbar scoliosis. Conclusion: In CP patients, reconstruction of hip subluxation and dislocation with femoral VDRO and Dega transiliac osteotomy establish femoroacetabular congruency. Without any cast immobilization, early physical therapy is encouraged for immediate recovery.Amaç: Bu çalışmada serebral palsi (SP) hastalarındakalça subluksasyonu ve dislokasyonunun tedavisinde femurvarus derotasyon osteotomisi (VDRO) ve Dega transiliyakosteotomisinin etkinliği incelendi.Hastalar ve yöntemler: Geriye dönük bu çalışmaya Temmuz2010 - Aralık 2015 tarihleri arasında kalça subluksasyonu vedislokasyonu nedeniyle ameliyat edilen 22 SP hastasının (9 erkek,13 kadın; ort. yaş 8.7 yıl; dağılım 4-18 yıl) 25 kalçası dahiledildi. Ortalama takip süresi 36.1±10.4 ay (dağılım 20-65.6 ay)idi. Tüm olgularda femur VDRO ve Dega transiliyak osteotomisiuygulandı. Ameliyat sonrasında hastaların hiçbirine alçı ileimmobilizasyon uygulanmadı. Hastalar ameliyat öncesinde vetakip süresinde kaba motor fonksiyon sınıflandırma sistemi ileklinik olarak değerlendirildi. Asetabular indeks (Aİ), migrasyonyüzdesi (MY) ve boyun-cisim açısı (BCA) ameliyat öncesinde,sonrasında ve takip süresinde çekilen pelvis grafileri ileölçülüp belgelendi. Ameliyat sırası ve sonrası komplikasyonlarkaydedildi.Bulgular: Kaba motor fonksiyon sınıflandırma sistemi skorları16 hastada iyileşti. Ameliyat öncesi ortalama AI 33.2°, ameliyatsonrası 20.4° idi. Ameliyat öncesi sırasıyla %72.7 ve 160° olanMY ve BCA, ameliyat sonrası sırasıyla %24.3 ve 130°’ye iyileşti.Aİ, BCA ve MY’deki ameliyat sonrası iyileşme istatistiksel olarakanlamlı idi (p<0.001). İki hastada implant yetmezliği nedeniylerevizyon cerrahisi uygulandı ve torakolomber skolyozu olanbir hastada artmış pelvik oblisiteye bağlı kalça subluksasyonusaptandı.Sonuç: Serebral palsi hastalarında kalça subluksasyonu vedislokasyonunun femur VDRO ve Dega transiliyak osteotomisiile rekonstrüksiyonu femoroasetabular uyum sağlar. Hızlı düzelmeiçin alçı ile immobilizasyon olmaksızın erken fizyoterapi teşvikedilir

Utěsnění femorálního kanálu autologním kostním štěpem snižuje krevní ztrátu

PURPOSE OF THE STUDY Total knee arthroplasty is commonly used procedure with advanced stage arthritis which causes extensive blood loss intraoperatively and postoperatively. Purpose of this study is to show the effectiveness of sealing of femoral tunnel with bone grafting in preventing blood loss. MATERIAL AND METHODS 288 patients with primary bicompartmental knee arthroplasty who were operated in between April 2012 and June 2015 are retrospectively studied. Two groups are formed according to sealing of femoral tunnel with autologous bone graft or not. Group 1 was the plugged group with 192 patients and group 2 was the unplugged group with 96 patients. Operation time, arthrotomy method, anticoagulant therapy, postoperative care were similar in between two groups.‘Independent sample t-test’ is used to compare two groups as statistical method. RESULTS Postoperative lowest hemoglobin levels are higher in plugged group (p < 0.001). Drain outputs are much less than unplugged group (p < 0.001). There is no statistically significant difference between amount of given erythrocyte suspensions. DISCUSSION In the literature there are many attempts to reduce blood loss and allogenic blood transfusion. Some systemic or local usage of medical therapies, mechanical interventions such as cold application or intraoperative fibrin sealers are some of them. There are a few studies favoring usage of plugs and a few do not. Our findings showed less blood loss with usage of autologous bone grafting but did not significantly affect the blood transfusion amount. CONCLUSION Autologous bone grafting is a free to use, non-time consuming and an effective method to reduce blood loss

Ocular Adnexal Lymphoma: Epidemiology and Clinical Characteristics

The aim of the study is to emphasize the frequency, clinical presentation, histopathologic features and TNM staging for each type of ocular adnexal lymphoma (OAL), and investigating treatment results and prognosis in our region. A retrospective review of 54 patients treated for primary and secondary OAL between Jan 2012 and Jan 2019 was made. Epidemiologic data, clinical characteristics of the tumor and recurrence free survival rates were evaluated. Patients with ocular adnexal lymphoma included 27 (50%) women and 27 (50%) men, with a mean age of 60.38 +/- 15.36 (range: 18-93) years at the time of presentation. Mean follow-up time was 40.88 +/- 20.75 (range 1-84) months. Histopathological diagnosis was extranodal marginal zone lymphoma in 75.9%, diffuse large B-cell lymphoma in 14.8%, chronic lymphocytic leukemia/small lymphocytic lymphoma in 5.6%, mantle cell lymphoma in 1.9% and follicular cell lymphoma in 1.9% of patients. Among 54 patients with OAL 66.7% had orbital, 22.2% had conjunctival, 5.6% had orbital plus conjunctival, 3.7% had orbital plus conjunctival and choroidal, 1.9% had conjunctival plus choroidal involvement. No recurrences were observed in 87.1% of patients during their follow-up. Our data indicates patient epidemiologic data, TNM staging, most common clinical presentation and location of primary and secondary OALs from a single center

Spontaneous regeneration of the large femoral defect in patient with diffuse osteomyelitis after intramedullary nailing

Infection of the long bones after intramedullary nailing is a troublesome condition and management of the infection remains challenging to orthopedic surgeons Associated infection can be more problematic and more diffuse in intramedullary bone fixation since it may spread along the nail Surgical treatment choices are also difficult especially in cases with large bone defects after debridement In this article, we present a 75-year-old woman that had been treated only with in-situ external fixation, antibiotic therapy and observation Despite diffuse femoral osteomyelitis, a 10 cm femoral defect healed with unexpected bone regeneration which couldn't be explained reasonabl

Ultrasonographic evaluation of the risser sign

Study Design: A prospective study of ultrasonographic evaluation (UE) results of the Risser sign (RS) in adolescents. Objective: This study aims to assess the efficiency of UE of RS, compare it with radiographic evaluation, and investigate the intraexaminer and interexaminer reliability of UE. Summary of Background Data: The use of ultrasound in orthopedic practice has a growing popularity. As a noninvasive radiological method, the evaluation of RS seems to be a promising alternative in patients suffering from scoliosis who require a long-term follow-up. Methods: This study consists of 142 patients (70 female and 72 male cases) aged between 10 and 17 years, with a mean age of 13.8 ± 1.7 years. Menarche experience, body mass index, and skinfold thickness of the patients were recorded. Forty-five patients were found to have scoliosis. All ultrasonographic and radiographic evaluations were made by 2 blinded orthopedists. X-ray was considered as the gold standard. Results: Percentage accuracy of UE was found to be 77.7% (κ = 0.698) for the first examiner and 64.30% (κ = 0.542) for the second examiner. Intraexaminer and interexaminer agreement were 0.971 and 0.924 for the UE, respectively. Moreover, interexaminer agreement for radiographic evaluation was 0.689. No significant difference was observed between the values of scoliosis and nonscoliosis patients. When the patients with a skinfold thickness of 16 mm or less and more than 16 mm were examined, the percentage accuracy of the UE was 80.43% (κ = 0.727) for the first group, whereas it was 72.91% (κ = 0.637) in the other group. Conclusion: We found the intraexaminer and interexaminer agreement for the UE of RS to be reliable. In radiographic evaluation of RS, the intraexaminer and interexaminer agreement were lower. These findings were also consistent with data from the literature. In conclusion, UE of RS is a reliable method; however, the results may vary when x-ray is considered as the gold standard. Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited