Heel Pain

Topuk ağrısı, toplumda yaygın olarak görülen ve klinisyenlerle hasta popülasyonunu sıkça karşı karşıya getiren klinik bir durumdur. Topuk ağrısının lokal ve sistemik etkenler başlığı altında bir çok nedeni olabilir. Yumuşak doku kökenli lokal ağrı nedenleri arasında başta plantar fasiit, topuk yağ yastığı atrofisi olmak üzere tendinopatiler, tuzak nöropatiler ve bursit sayılabilir. Lokal kemik doku nedenleri arasında ise öncelikle haglund deformitesi, apofizit ve kalkaneus stres kırıkları sayılabilir. Sistemik nedenler etiyolojide çok fazla yer almazlarHeel pain is a frequent problem confronted by clinicians. Various local or systemic irregularities can cause heel pain. Local causes arising from soft tissue are mainly plantar fasciitis, heel fat pad atrophy tendinopathies trap neuropathies and bursitis.Local tissue irregularities causing heel pain are mainly heglund deformity apophysitis and calcaneus stress fractures . Systemic causes are not frequent in the etiology of heel pai

Evaluation of oxidative stress in degenerative rotator cuff tears

Background: Oxidative stress occurs as a result of the disruption of the balance between the formations of reactive oxygen species and antioxidant defense mechanisms during the conversion of nutrients into energy. Increased body oxidative stress has been reported to be involved in the etiology of several degenerative and chronic diseases. We hypothesized that the body oxidative stress level is higher in patients with atraumatic degenerative rotator cuff tear than that in healthy individuals. Methods: The patients who underwent arthroscopic repair for atraumatic, degenerative rotator cuff tear were prospectively evaluated. A total of 30 patients (group 1, 19 females and 11 males; mean age: 57.33 ± 6.96 years; range: 50-77 years) and 30 healthy individuals (group 2, 18 females and 12 males; mean age: 56.77 ± 6 years; range: 51-72 years) were included in the study. The Constant and American Shoulder and Elbow Surgeons scoring systems were used to evaluate the clinical outcomes. Serum oxidative stress parameters of the patients and the control group were biochemically evaluated. Accordingly, thiol/disulfide (DS) balance (DS/native thiol [NT], DS/total thiol [TT]), Total Oxidant Status (TOS), oxidative stress index, and nuclear factor erythroid-2–associated factor-2 values were used as the biochemical parameters indicating an increase in the serum oxidative stress level. Total antioxidant status and NT/TT values served as the biochemical parameters indicating a decrease in the serum oxidative stress level. Results: The study follow-up duration was 12 months. A statistically significant increase was observed in American Shoulder and Elbow Surgeons and Constant scores of patients who underwent arthroscopic rotator cuff repair relative to that during the preoperative period (P = .01). The values of biochemical parameters (DS/NT, DS/TT, TOS, oxidative stress index, and nuclear factor erythroid-2–associated factor-2), which indicated an increase in the serum oxidative stress, were significantly higher in preoperative patients than those in postoperative patients, albeit the control group values were significantly lower than those of the postoperative patients. The biochemical parameters (NT/TT and total antioxidant status) indicating a decrease in the serum oxidative stress levels were significantly higher in the postoperative patients than those in the preoperative patients and significantly lower than those in the control group. Conclusion: High levels of markers indicating an increase in the serum oxidative stress in patients with degenerative rotator cuff rupture suggested that TOS may be involved in the etiopathogenesis of rotator cuff degeneration. Although the oxidative load decreases during the postoperative period, the fact that it is still higher than that in healthy individuals supports this claim. © 2022 Journal of Shoulder and Elbow Surgery Board of Trustee

Successful Treatment of Mushroom Poisoning with Silybin: A Case Report

Although up to 100 of them known to be toxic, there are more than 5,000 mushroom species in the world. Of these, the most poisonous species belong to Amanita and Gallerina species. Alpha- and beta-amanita toxins which are associated with serious liver, kidney and central nervous system damage is produced by Amanita phalloides which is responsible for 90% of fatal mushroom poisoning in Turkey. Two cases that we aimed to present are two male patients aged 55 and 42 who collected and consumed mushrooms in the forest. The patients were admitted to the county state hospital with complaints of nausea, vomiting, diarrhea and fatigue after 18 and 24 hours. Patients with increased liver function tests were referred to our hospital for further examination and treatment, and they were discharged after successful treatment in our intensive care unit

Biomechanical Evaluation of a Novel Apatite-Wollastonite Ceramic Cage Design for Lumbar Interbody Fusion: A Finite Element Model Study

Objectives. Cage design and material properties play a crucial role in the long-term results, since interbody fusions using intervertebral cages have become one of the basic procedures in spinal surgery. Our aim is to design a novel Apatite-Wollastonite interbody fusion cage and evaluate its biomechanical behavior in silico in a segmental spinal model. Materials and Methods. Mechanical properties for the Apatite-Wollastonite bioceramic cages were obtained by fitting finite element results to the experimental compression behavior of a cage prototype. The prototype was made from hydroxyapatite, pseudowollastonite, and frit by sintering. The elastic modulus of the material was found to be 32 GPa. Three intact lumbar vertebral segments were modelled with the ANSYS 12.0.1 software and this model was modified to simulate a Posterior Lumbar Interbody Fusion. Four cage designs in different geometries were analyzed in silico under axial loading, flexion, extension, and lateral bending. Results. The K2 design had the best overall biomechanical performance for the loads considered. Maximum cage stress recorded was 36.7 MPa in compression after a flexion load, which was within the biomechanical limits of the cage. Conclusion. Biomechanical analyses suggest that K2 bioceramic cage is an optimal design and reveals essential material properties for a stable interbody fusion

Çimentosuz total kalça artroplastisi uygulamalarımızda kısa dönem sonuçlarımız

Amaç: Çalışmamızda, değişik etiyolojik nedenlerle çimentosuz total kalça artroplasti uygulanan hastaların kısa dönem klinik ve radyolojik sonuçları değerlendirildi. Gereç ve Yöntem: Kasım 2003 ve Şubat 2010 tarihleri arasında Gazi Üniversitesi Tıp fakültesi Ortopedi ve Travmatoloji Ana Bilim Dalı’nda, değişik etiyolojik nedenlerle 92 hastanın 102 kalçasına ( 10 hasta bilateral) uygulanan, çimentosuz, dikdörtgen kesitli, proksimal üçte biri plazma püskürtme üzerine hidroksiapatit kaplamalı, distali plazma püskürtmeli Zweymuller femoral komponentin (Zweymuller® SL-Plus) ve poroz kaplama üzerine hidroksiapatit kaplı asetabuler komponentin (EPF Plus® ,asetabular komponent) kullanıldığı total kalça artroplastisi (TKA) sonuçları değerlendirildi. Hastalar, klinik olarak ameliyat öncesi ve son kontrollerdeki Harris Kalça Skorlarına göre; radyolojik olarak ise ameliyattan hemen sonra ve son kontrollerde çekilen ön arka kalça ve ön arka pelvis grafilerinde, Callaghan ve Engh’in belirlediği asetabulum ve femurdaki radyolojik kriterlere göre değerlendirildi. Heterotopik Ossifikasyon’un değerlendirilmesi Brooker sınıflamasına göre yapıldı. Tüm hastalara doğrudan lateral girişim uygulandı. Bulgular: Ameliyat tarihindeki yaş dağılımı, 55,66 (22-80) olarak tespit edildi. 92 hastanın, 68’inin (%74), kadın 24’ünün (%26) erkek olduğu görüldü. Ortalama takip süresi 34.9 (10-84) ay olarak belirlendi. Ameliyat öncesi, ortalama Haris Kalça Skoru 45,87 (30-67) iken, ameliyat sonrası ortalama Harris Kalça Skoru 92,49 (68-100) olarak tespit edildi. Engh ve Callaghan’ın kriterlerine göre bütün femoral komponentler stabil olarak değerlendirildi. Femur Gruen zone 1’de 66 kalçada (%67,32), zone 7’de 59 kalçada (%60,18), zone 2’de 2 kalçada (%2.04), zone 3’de 1 kalçada (%1.02), zone 6’da 2 kalçada (%2.04), radyolusensi gözlendi.. Asetabuler komponent çevresinde, 34 kalçada (%34,68) zone 2’de, 21 kalçada (%21.42) zone 3’te, 18 (%18,36) kalçada ise zone 1’de radyolusensi saptandı. Asetabular komponent açısı ortalama 47,25 (28-70) olarak saptandı Ameliyat edilen kalçaların 10’unda (%10,2) Heterotopik Ossifikasyon, 4’ünde (%4,08) nöropraksi (2 siyatik, 2 femoral sinir), 1’inde (%1,02) anterior uyluk ağrısı saptandı. Toplam 4 kalçada (%4,08) femurda çatlak, 1 kalçada (%1,02) femoral osteotomi hattında kaynamama, 1 kalçada (%1,02) asetabular çatı olarak yerleştirilen femur başı otogreftinde kaynamama ve 1 kalçada ise (%1,02) polietilen ‘‘insert’’te aşınmaya bağlı kırık görüldü. Sadece polietilen aşınması olan kalçaya revizyon cerrahisi uygulandı. Sonuç: Usulüne uygun teknikle uygulanan, Zweymuller femoral stem ve hidroksiapatit kaplı ‘‘pres-fit’’ asetabular komponentlerin kullanıldığı çimentosuz total kalça artroplastisinde kısa dönemde mükemmel sonuçlar elde edilebilmektedir.Purpose: Aim of this study is to investigate the short term clinical and radiographic outcomes of cementless total hip arthroplasty in different etiological causes. Materials and Methods: The clinical and radiographic outcomes of 92 patients (102 hips) with consecutive cementless total hip arthroplasties were evaluated. The patients admitted to Gazi University Faculty of Medicine, Department of Orthopaedics and Traumatology between November 2003 and December 2010. The study group consisted of hydroxyapatite coated flattened press-fit EPF-PLUS cup and the tapered cementless with a rectangular cross-section and hydroxyapatite coated Zweymuller SL-PLUS stem. Clinical outcome was measured by comparing Harris Hip Scores pre-operatively and at last clinic visit. Radiolucencies and osteolysis with respect to the stem and acetabulum were classified according to the system of Callaghan and Engh on anteroposterior radiographs of the hip and pelvis. Direct lateral approach has been performed to the all patients. Heterotopic ossification (HO) formation was also graded by the criteria indicated in Brooker et al. Results. In total 24 (%26) of the 92 patients were men and 68 (%74) were women. The age ranges of the all patients varied between 22 and 80 years old and the average age for the whole patients was 55,66 years during the time of surgery. The average follow-up time was 34.9 (10-84) months. The average preoperative Harris Hip Score was 45,87 (30-67) points. At the time of the most recent follow-up visit, the average Harris Hip Score was found as 92,49 (68-100) points. According to the criteria of Engh et al., all femoral implants were graded as stable bone-ingrown. Radiolucent lines were mostly observed in Gruen zones 1 and zone 7 of the femur [zone 1 %67.32, zone 7 % 60.18 zone 2 %2.04, zone 3 %1.02, zone 6,2.04]. Radiolucent area occured in 42 (%42,84) cups [zone 2 %34.68, zone 3 (%21.42), zone 1 %18.36]. The inclination angle of the acetabular component was 47,25 (28-70). Postoperative neuropraxy were identified in four (%4.68) cases (siatic neuropraxy of in two cases, both of them recovered, and femoral neuropraxy in two cases, one of them recovered). The prevalence of thigh pain at the time of the latest follow-up was %1.02 (one case). One acetabular component needed revision surgery due to polyethylene insert wear. None of the femoral stems and acetabular components was changed as a result osteolysis. HO was observed in 10 hips (% 10,2). Heterotopic bone was graded as class I in 5 hips, class II in 3 hips, class 2 in 2 hips. Intraoperative femoral fissur was developed in 4 (%4.8) hips. One of the 6 subtrochanteric osteotomies and one of the 12 femoral head autograft were followed by nonunion. Conclusions: The results show that arthroplasty with Zweymuller femoral stem which is combined with a flattened, hydroxyapatite coated press-fit acetabular cup which was inserted without cement. These outcomes were found excellent in short term follow-up result

METASTATİK MESANE KİTLESİNDE NADİR GÖRÜLEN BİR ORİJİN; PRİMER MEME KANSERİNİN MESANEYE METASTAZI

OLGU SUNUMUPrimeri bilinmeyen metastatik mide andiferansiye karsinomu nedeniyle tetkik edilen 66 yaş kadın hasta, yapılan FDG-PET görüntülemesinde kemik, mide, ve memede FDG tutulumunun yanı sıra mesane sağ lateral duvarda artmış FDG tutulumunun eşlik ettiği kalınlık artışı ve sağ hidroüreteronefroz varlığı nedeniyle tarafımıza yönlendirildi. Öykü ve fizik muayenesinde hematüri, dizüri semptomları olmayan hastanın iki yıldır devam eden urgency, hesitancy, mikst tip inkontinans ve yeni başlayan sağ yan ağrısı şikayeti mevcuttu. İdrar incelemesinde mikroskopik hematüri gözlenmedi ancak mikroskopik proteinüri mevcuttu. Yapılan sistoskopisinde mesane sağ lateral duvarda üreter orifisini içine alan alanda dıştan bası ile uyumlu görünüm ve papiller olmayan ödematöz değişiklikler gözlendi. Tanımlanan alana transüretral rezeksiyon yapıldı ve hastaya sağ üreteral stent takıldı. Patoloji sonucu primer meme tümörü metastazı ile uyumlu andiferansiye adenokarsinom (GCDFP ile diffüz boyanma PR ile fokal boyanma, %95 üzerinde ER ile (+++ ) boyanma) olarak sonuçlandı. Yapılan fizik muayenesinde sol memede 4 cm çapında kitlesel lezyon saptanan hastanın meme MR görüntülemesinde BI-RADS 5 lezyon saptanması üzerine hastaya tru-cut biyopsi yapıldı. Biyopsi patolojisi derece 2 invaziv lobüler karsinom olarak sonuçlandı.&nbsp; Hastaya doksorubisin, 5 floro-urasil ve siklofosfamid kemoterapisi başlandı. Hastanın üreteral kateteri çıkartıldı ve hastanın takip ve tedavisi devam ediyor.TARTIŞMAMeme kanseri kadınlarda en yüksek insidans (2.2 milyon/yıl) ve mortalite (yaklaşık 700 bin / yıl) hızına sahip kanserdir (1). Meme kanseri en sık metastazını akciğer, karaciğer ve kemiklere yapar ancak diğer birçok organ metastazı da bildirilmiştir (2). Başvuru anında meme kanserinin %3-10 kadarı metastatiktir. Ancak mesane metastazı son derece nadir görülen bir durum olup literatürde otopsi verileri dahil 65 vaka bildirilmiştir (3,4). Mesane metastazı genellikle tek metastaz alanı değildir ancak soliter mesane metastazı bildirilen vakalar da mevcuttur (5). Mesane metastazının soliter metastatik odak olmadığı durumlarda beklenen sağkalım 1 ay ile 2 yıl arasındadır (4). Olgumuzda olduğu gibi tanı anında mesane metastazı mevcut olabileceği gibi primer kansere yönelik tedaviden 30 yıl sonra mesaneye metastaz bildirilmiştir (3). Memenin mesaneye metastazı durumunda en sık gözlenen semptom hematüridir, bunun yanında stress veya urge inkontinans, frequency, noktüri ve yan ağrısı da görülebilir (4). Ancak semptom başlangıcı için genellikle metastatik lezyonun mukozal yüzeyi aşmış olması gerekmektedir ve bu durum metastazın geç bulgu vermesine yol açar (4).Memede en sık invaziv duktal adenokarsinom görülse de mesane metastazını daha sık invaziv lobüler adenokarsinom yapar (3). Son derece nadir görülen bir durum olduğu için akla gelmediği takdirde patolojik olarak mesanenin primer adenokarsinomundan ayrımı güçtür. Hormon pozitifliği ayırıcı tanıda değerlidir ve ER, PR, GATA-3 and GCDFP-15’den oluşan bir panelin boyamada kullanılması ayırıcı tanıda yardımcı olacaktır (6).SONUÇMemenin mesaneye metastazı son derece nadir görülen bir durumdur. Hematüri, işeme semptomları ve obstrüksiyona sekonder yan ağrısı ile kendisini gösterebilir. Patolojik örneğinin detaylı incelenmesi tanının konulması için önemlidir.</p

İzole Tip 2 Slap Lezyonu Nedeniyle Artroskopik Tamir Uygulanan Hastaların Kısa Dönem Klinik Sonuçlarının Değerlendirilmesi

Objective: The purpose of this study was to assess the clinical outcomes of isolated type IIsuperior labrum anteriorposterior (SLAP) lesions which were repaired arthroscopically Methods: The patientswho wereunderwent arthroscopic stabilization for isolated type IISLAP lesions werereviewed retrospectively. Shoulder function was evaluated according to the Constant-Murley score and visual analog scale (VAS) .Ranges of motion of the shoulders were evaluated both preoperatively and at the final follow-up. Results: A total of19 patients were evaluated. Of the patients; 15 were male and 4 were female and 31.5(23-45) was determined to be the mean age. Mean follow-up duration was 16.8 months (8-26). Preoperative mean Constant-Murley score was57 (40-71), whereas it was determined to be a mean of 81 (66- 98) at the final follow-up. VAS was determined to be 7(6-9) preoperatively, whereas it was determined to be 2 (0-5) at the final follow-up. Statistically significant differences were determined for both scoring systems at the final follow-up compared with the preoperative period(p<0.001). Conclusion: Arthroscopic repair ofisolated type II SLAP lesionsappeared as a reliable and effective procedure with respect to short-time clinical outcomes

Combined spinal-epidural anesthesia or local anesthesia + Sedoanalgesia in abdominal aortic Aneurism Repair?

Objective: Anesthesia for the repair of abdominal aortic aneurism can be performed with different modalities of anesthesia or their combinations. The risk level for the morbidity and mortality of the patients, is increased in geriatric patients with the existence of accompanying pathology. To compare two different anesthesia methods (local anesthesia and sedation vs combined spinal and epidural anesthesia) for the repair of endovascular aneurism in a geriatric patient. Material and Methods: 16 high risk geriatric patients were included in the study. The parameters of 16 high risk patients who underwent elective or emergency treatment for endovascular aneurism were included. Group-I (n:8) was given local anesthesia and sedation, Group-II (n:8) was given combined spinal and epidural anesthesia. Intraoperative and postoperative hemodynamic parameters were reviewed and analyzed. The demographic data of the two groups ressembled each other. Results: The complication rate was calculated at an average of 6.25%, which was considered insignifcant (p>0.05). There was no signifcant difference between the duration of hospital and intensive care unit stay for the two groups (p>0.05). Conclusion: Combined spinal and epidural anesthesia requires much more experience, but it is safer than local anesthesia and sedation for endovascular aneurism patients