Use of autologous fascia in midurethral sling surgeries; comparison of transobtrator and retropubic ways

Objectives: To compare autologous transobturator-tape (A-TOT) and autologous transvaginal tape (A-TVT) surgeries in terms of effectivity and complications. Material and methods: Preoperative data, duration of the operation, complications and postoperative visual analogue scores were noted. Patients were assessed 12 months after surgery. An objective cure was defined as a negative CST and no need for reoperation due to SUI. Subjective cure was defined as a PGI-I score ≤ 2. Symptom severity and QoL were measured using the total score and the total QoL score of the ICIQ-FLUTS. Results: Retrospectively 44 patients (A-TOT:29, A-TVT:15) were enrolled in this study. Mean follow-18 months. Preoperative parameters were similar. The VAS score at the 8th hour postoperatively was higher in the A-TOT group and similar at the 24th h (p = 0.007 and p = 0.587, respectively). Grade 3 complications according to clavien dindo were only observed in the A-TOT group. At 12 month the objective cure rates according to CST were 96.5% and 100 the subjective cure rates according to PGI-I veew 96.5% and 100%. A positive CST finding was recorded in one patient (3.3%) in the A-TOT group. Total score and total quality of life (QoL) scores on the ICIQ-FLUTS were found to be significantly improved in both groups (p = 0.001 and p = 0.001, respectively) (Tab. 4). Similar improvements were found in both groups in the overall and quality of life subscores of the ICIQ-FLUTS filling and voiding sections (p = 0.476, p = 0.315, p = 0.520, and p = 0.448, respectively). Conclusions: The A-TOT technique has objective, subjective cure, and overall complication rates comparable to those of the A-TVT technique. The use of autologous fascia provides an opportunity to avoid mesh-related complications

Crouzonodermoskeletal Syndrome with Hypoplasia of Corpus Callosum and Inferior Vermis

hypoplasia of corpus callosum and inferior vermis. This association may be coincidental. These patients should be investigated for other possible cranial MRI findingshypoplasia of corpus callosum and inferior vermis. This association may be coincidental. These patients should be investigated for other possible cranial MRI finding

Pseudohypoparathyroidism: A case report

Psödohipoparatiroidi parathormona end organ direnci nedeniyle gelişen hipokalsemi, hiperfosfatemi ve parathormon yüksekliği ile karakterize bir durum olup şimdiye kadar üç tipi tanımlanmıştır. Tip-Ia’da hastalarda dismorfik özellikler mevcut iken tip-1b ve tip-II’deki hastalar normal görünüme sahiptir. Kliniğimize jeneralize tonik-klonik konvulsiyon ve hipokalsemi nedeniyle refere edilen 11 yaşındaki kız hastaya psödohipoparatiroidi tip-Ib tanısı konuldu. Hastamızda psödohipoparatiroidiye ek olarak hipotiroidi de saptandı. Psödohipoparatiroidide hipotiroidi daha çok tip- Ia ve tip-1c’de görülmektedir. Tip-I ve tip-II’de beklenen bir bulgu değildir. Olgu, hem hipokalsemik konvulsiyon nedeniyle başvuran ve tedaviye cevap vermeyen hastalarda psödohipoparatiroidizmin tanı seçenekleri arasında düşünülmesi gerektiğini vurgulamak amacıyla hem de beraberinde hipotiroidi de saptandığı için ilginç bulunarak sunuldu.Pseudohypoparathyroidism is characterized by hypocalcemia, hyperphosphatemia and parathormone elevation resulting from end organ resistance against parathormone and three types of it have been defined till now. While type-Ia patients have dysmorphic characteristics, type-Ib and type-II patients have normal appearances. Here we present a 11 year-old girl who was referred to our clinic because of generalized yonic-clonic convulsion and hypocalcemia, and diagnosed as pseudohypoparathyroidism type-Ib. We also detected hypothroism in this patient. Hypothyroidism is frequent in type-Ia and type-Ic pseudohypoparathyroidism, although is very rare in type Ib and type-II pseudohypoparathyroidism. This case was reported in order to remind pseudohypoparathyroidism in patients with hypocalcemic convulsions. Additionally hypothyroidism is the interesting feature of this case

The efficiency of pamidronate treatment on children with osteogenesis imperfecta

Osteogenezis imperfekta düşük kemik kitlesi ve artmış kemik frajilitesi ile karakterize ektraselüler matriksin genetik bir hastalığıdır. Sodyum bifosfonat tedavisi ile osteogenezis imperfektalı hastaların çoğunda kemik dansitesinde hızlı bir artış, kronik kemik ağrılarında ve kırık sayısında azalma ile mobilitede iyileşme sağlanmaktadır. Bu çalışmaya siklik bifosfonat tedavisi alan 16’sı kız toplam 31 osteogenezis imperfektalı çocuk alındı. Hastaların ortalama yaşları 8.80±5.04 yıl olup dokuzu tip 1, 11’i tip 3 ve 11’i tip 4 olarak değerlendirildi. Hastalar ortalama 3.43±1.91 yıl süreyle (9 ay - 6 yıl), ortalama 12,2 mg/kg/yıl dozunda ve 2-4 aylık dönemler halinde bifosfonat tedavisi aldılar. Tedavi öncesi hastaların sekizinde 15 ve üstü sayıda kırık oluşmuştu. Tedavi öncesi kırık sayıları yıllık ortalama 7.45±5.33 iken tedavi ile bu sayı 1.70±1.90/ yıl’a geriledi. Tip 1 ve Tip 4 olarak değerlendirilen hastalardan 10’unda tedavi sonrası hiç kırık gözlenmezken iki hastanın tedavi ile kırık sayılarında herhangi azalma olmadı. Pamidronat tedavisi ile kemik mineral yoğunluğu Z skorlarında ilk 3 yıl artış gözlenirken sonraki yıllarda bu artışın durduğu ve yıllar içinde bir miktar azaldığı saptandı. Pamidronat tedavisi ile kas gücünde artış, yürüme fonksiyonunda düzelme gözlenirken boy SDS’lerinde herhangi bir değişiklik izlenmedi. Sonuç olarak osteogenezis imperfektalı çocuklarda pamidronat tedavisi ile kemik mineral yoğunluğunda artış, kırık sayısında ve ağrıda belirgin azalma ve mobilitede artış sağlanması ile yaşam kalitesinde belirgin düzelme elde edildiği gözlendi.Osteogenesis imperfecta is a genetic disorder of extracellular matrix, characterized with decreased bone mass, and increased bone fragility. Sodium bisphosphonate treatment leads to a quick increase in bone mineral density with resultant reduced bone pain, fracture rate, and immobility in osteogenesis imperfecta. In this study we evaluated the data of 31 children, of 16 female, aged 8.80±5.04 years, with osteogenesis imperfecta who were treated with cyclic bisphosphonates. Nine patients were diagnosed as type I, eleven were type III, and eleven were type IV. All patients received bisphosphonate at a mean dose of 12.2 mg/kg/year, once every two-four months. Mean duration of this treatment is 3.43±1.91 years (9 months-6 years). Before treatment number of fracture were minimum 15 in eight patients. The number of fracture were decreased to 1.70±1.90 from 7.45±5.33 with bisphosphonate treatment. Although ten patients with osteogenesis imperfecta type I and IV had no fracture after treatment, we did not observe a decrease in the number of fractures in two patients. Bone mineral density Z-scores increased in the first three years of bisphosphonates treatment, however this increment was stopped and decreased slow rate in the following years. Ambulation scores and muscle were decreased in all patients. We did not observe any beneficial effects of bisphosphonates on the height SDS. In conclusions our data demonstrated that bisphosphonates have dramatically beneficial effect on bone mineral density, rate of fracture, bone pain, and mobility, which leads a higher quality of life in children with osteogenesis imperfecta

Osteogenezis İmperfekta Olan Çocuklarda İki Farklı Pamidronat Protokolünün Değerlendirilmesi

Amaç: Osteogenezis imperfekta bağ dokusunun kalıtsal bir hastalığıdır. Bu durumdaki çocuklar tekrarlayan kırıklar, deformiteler, osteoporosis ve ağrıdan yakınırlar. Son yıllarda pamidronat standart tedavi tercihi olmuştur. Ancak, optimal doz ve aralık henüz tam olarak belirlenmemiştir. Bu çalışmada amaç, iki farklı pamidronat tedavi rejiminin karşılaştırılmasıdır. Materyal ve Metod: Yaşları 42.3 ± 37.4 ay arasında değişen toplam 12 hastada yapıldı. Başlangıçta her iki ayda bir defa 1.5 mg/kg/gün dozunda 23.5 ± 9.0 ay pamidromat infüzyonu uygulandı (ilk protokol), daha sonra üçer aylık aralarla 3 gün üstüste 1 mg/kg/gün 18.5 ± 5.1 ay dozuna geçildi (ikinci protokol). Kemik mineral dansitesi z-skoru yıllık değerlendirildi. Bulgular: Yıllık kırık oranı ilk protokolde 6.3 ± 5.5'den 1.1 ± 1.3'e (p=0.001), ikinci protokolde 1.1 ± 1.3'den 0.0 ± 0.0'a (p<0.001) düştü. Kemik mineral dansitesi z-skoru ilk protokolde -3.9 ± -1.4'den -2.5 ± -1.3'e (p<0.05), ikinci protokolde 2.5 ± -1.3 ±'den -1.2 ± -1.1'e (p<0.05) yükseldi. Tartışma: Çalışmamızda pamidronatın 3 gün üst üste yıllık yüksek doz uygulamasının herhangi bir ek yarar sağlamadığı gösterilmiştir. Ayrıca, yüksek doz tedavi, uzun süre hastanede yatışa, okul saatlerinde ve ebevenylerin zaman kaybına ve böylece fazla maliyete neden olmaktadır.Purpose: Osteogenesis imperfecta is an inherited disorder of connective tissue. Children with this condition suffer from recurrent fractures, deformities, osteoporosis and pain. Over the recent years, pamidronate became the standard treatment choice. However the optimal dose and interval have not been defined yet. The main of this study was to compare of two different pamidronate regime. Materials and Methods: 12 patients aged 42.3 ± 37.4 months were studied. At the beginning patients had received pamidronate infusion at a dose of 1.5 mg/kg/day once, every two months with duration of 23.5 ± 9.0 months (first protocol), than switched to a dose of 1mg/kg/day for three consecutive days, every three months with duration of 18.5 ± 5.1 months (second protocol). The bone mineral density Z-score was evaluated yearly. Results: Annual fracture rate decreased from 6.3 ± 5.5 to 1.1 ± 1.3 (p=0.001) in the first and from 1.1 ± 1.3 to 0.0 ± 0.0 (<0.001) in the second protocol. Bone mineral density Z-scores increased from -3.9 ± -1.4 to -2.5 ± -1.3 (<0.05) in the first, and from -2.5 ± -1.3 ± -1.2 ± -1.1 (<0.05) in the second protocol. Conclusion: Our study demonstrated that higher yearly doses in 3 consecutive day administration of pamidronate did not provide any additional beneficial effects. Furthermore, higher doses of treatment and longer duration of hospitalization led to the loss of school hours and work hours of parents and was more costly