Ocular findings of patients with "Crush syndrome" following the eartquake

17.08.1999 tarihinde Marmara Bölgesinde meydana gelen depremde hastanemize başvuranlar arasında akut böbrek yetmezliği gelişen ve "Crush sendromu" (Ezilme sendromu) tanısı konulan 20 depremzedenin göz bulgularını değerlendirildi. Hastaların yaşları 9 ile 56 arasında değişiyordu (ortalama: 35.4±12.2). Göçük altında kalma süreleri 3-22 saat arasında değişiyordu. Hastalar yatağında değerlendirildi. Görme keskinlikleri ölçüldü, ışık kaynağı ile ön segment bulguları değerlendirildi, dilate edilerek fundus bulguları değerlendirildi. Dört (%20) hastada periorbital ekimoz mevcuttu, 3 (%15) hastada subkonjonktival hemoraji, 1 (%5) hastada retinal venlerde dilatasyon izlendi, 1 (%5) hastada kortikal iskemiye bağlı görme kaybı gelişti. 11 (%55) hastada göz bulguları normaldi. Ezilme sendromuna bağlı gelişen hipertansiyon ile birlikte subkonjunktival hemoraji, kortikal vasopazm oluşabilir. Göze direkt travma olmasa da periorbital ekimoz görülebilir.20 patients, who had spent considerable time under the rubble following the major earthquake in August 1999, were admitted to Başkent University Hospital with acute renal failure and -Crush syndrome-. None of these patients had ophthalmologic problems before the earthquake. The mean age of the group was 35.4 years (SD+12.2; range 9-56), and they had stayed under fallen masonry from 3 to 22 hours. All the patients were evaluated at the bedside. Visual acuity, anterior segment and fundus examinations were completed in all of the cases. Four (20%) patients had periorbital ecchimosis, 3 (15%) had subconjunctival hemorrhage and 1 (5%) had dilated retinal veins. One (5%) patient had visual loss due to cortical ischemia. Ophthalmologic findings were normal in 11 (55%) patients. Hypertension due to -Crush syndrome- may cause subconjunctival hemorrhage and cortical vasospasm and even in the absence of direct trauma to the eye, periorbital ecchymoses may develop

A case of juvenil ocular rosacea

AMAÇ: Juvenil oküler rozasea tanısı koyduğumuz bir olguda tedavi yaklaşımımızı sunmak. OLGU: İki yıldır her iki gözünde ışıktan rahatsız olma, sulanma ve kızarıklığı olan 9 yaşındaki kız hasta, son bir aydır şikayetlerinde artış ve gözlerini rahat açamama nedeniyle kliniğimize başvurdu. BULGULAR: Hastanın yapılan oftalmolojik muayenesinde sağ göz kornea parasantralinde vaskülarize lökom, konjonktivada kızarıklık mevcuttu. Sol gözde ön kamara dardı ve periferik korneada saat 3 hizasında irisin tıkadığı perforasyon tespit edildi. Hastanın sol gözüne tenon içeren konjonktival yama konularak perforasyon kapatıldı. Sistemik eritromisin tedavisi ile her iki göze topikal suni gözyaşı ve steroid damla başlandı. Hastanın takiplerinde şikayetleri kayboldu ve görme keskinliği arttı. SONUÇ: Juvenil oküler rozasea deri tutulumu olmadan çeşitli göz bulguları ile karşımıza çıkabilen çocukluk döneminin nadir hastalıklarından biridir. Topikal tedavinin yanında sistemik antibiyotik ve gerekli olgularda cerrahi ile başarılı sonuçlar alınabilmektedir.PURPOSE: To report our treatment in a case with juvenil ocular rosacea. CASE: A 9 -year- old girl admitted to our clinic, with the complaint of difficulty while openning her eyes which was deteriorated in last month and also she had photophobia, lacrimation, and hyperemia in her both eyes for last two years. RESULTS: Ophtalmological examination revealed paracentral vascularized leucoma with conjunctival hyperemia in right eye. The anterior chamber was narrow and a perforation blocked by iris was detected in peripheral cornea at 3 o'clock position in left eye. Perforation was managed by conjunctival patch with tenon in her left eye. Artificial eye drops and steroids were started bilateraly with systemic erythromycin treatment. During follow-up periods, her complaint has disappeared and visual acuity has increased. CONCLUSION: Juvenil ocular rosacea is a rare disease of childhood with variable eye manifestations without skin involvement. Systemic antibiotic besides topical treatment and surgery in selected cases could give successful results

Cartilage repair strategies in the knee: A survey of Turkish surgeons

Objectives: The purpose of this study was to analyze the trends in cartilage repair strategies among Turkish orthopedic surgeons for isolated focal (osteo)chondral lesions of the knee joint. Materials and methods: A web-based survey of 21 questions consisting of surgical indications, techniques and time to return to sports was developed to investigate the preferences of members of the TOTBID and the TUSYAD. Results: A total of 147 surgeons answered the questionnaire.70% of the respondents were TUSYAD members. 82% of respondents had at least five years experience in arthroscopy. Half of the surgeons indicated that patient age of 50 was the upper limit for cartilage repair. Irrespective of activity level, microfracture (60–67%) was the most frequently used technique for lesions smaller 2.5 cm2. In lesions larger than 4 cm2, MACI was the most commonly advocated procedure (67%). In patients with high activity levels, mosaicplasty was the first choice (69%) for lesions between 2.5 and 4 cm2 in size, followed by MACI (27%). Conclusion: Patient age, activity level, BMI and lesion size were important determinants for the choice of treatment of isolated chondral lesions in the knee. These results reflect the choices of experienced knee surgeons in the country. Although not widely performed in Turkey and has limited reimbursement by the health care system, the first choice for defects over 4 cm2 was second generation ACI. Third party payers & health reimbursement authorities should take into account that large defects require methods which are relatively expensive and need high technology. Cross-sectional survey, Level II. Keywords: Cartilage, Survey, Turkey, Cartilage repair, Knee, Osteochondral lesion, Web-based-survey, Microfracture, Mosaicplasty, Autologous chondrocyte implantatio

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TT-TG distance decreases after open wedge distal femoral varization osteotomy in patients with genu valgum & patellar instability. A pilot 3D computed tomography simulation study

Abstract Background Genu valgum is considered to be a risk factor for patellar instability. Correction of valgus alone or combined with a tibial tuberosity medialization has been described. However, changes occurring in the tibial tuberosity-trochlear groove (TT-TG) distance after a lateral distal femoral opening wedge osteotomy (LDF-OWO) are not known. Purpose This study aimed to define changes in TT-TG distance with increasing amounts of valgus correction after LDF-OWO. Methods Three-Dimensional Computed Tomography (3D-CT) scans of six patients (two females and four males) aged between 19 and 35 years with genu valgum and patellar instability were analyzed. 3D models of femoral, tibial, and patellar bones were created with the advanced segment option of Mimics 21® software. An oblique lateral opening wedge osteotomy of the distal femur was simulated in 2-degree increments up to 12 degrees of varus opening. Change in TT-TG distance was measured in mm on 3D models of the knee. Results Compared to baseline without osteotomy, the TT-TG distance decreased significantly (p < 0.05) for all corrections from 2 to 12 degrees in 2° steps. The TT-TG distance decreased by an average of 1.7 mm for every 2 degrees of varus opening. Conclusion Lateral opening wedge distal femoral osteotomy causes a decrease in TT-TG distance. The surgeon should be aware of the magnitude of this change (1.7 mm decrease for every 2° increment of valgus opening)