Bilateral Avascular Necrosis of Femoral Heads Associated with Pregnancy: A Case Report and Review of Literature

Avascular necrosis (AVN) is a pathological process that results in death of bone marrow cells and osteocytes after the disturbance of normal blood flow of the affected bone. AVN of the femoral head is a progressive disease that generally seen in the fourth through fifth decades of life. If it is not diagnosed and treated in the early period, it can lead to complete deterioration in the hip joint. It is estimated that 20.000 new cases have been diagnosed in the USA each year. The list of common causes for AVN includes alcohol consumption, gout, Caisson disease, Gaucher disease, renal osteodystrophy, hypercoagulable states, sickle cell anemia, systemic steroid use, and trauma. Hip AVN that occurs during or immediately after pregnancy is a quite rare condition and a limited number of cases have been reported in the literature until present time. Little is known about pregnancy as an etiological factor for femoral head AVN with a few cases in the literature. In this study, a 24-year-old female patient who developed AVN in her bilateral femoral head at the last trimester of pregnancy is presented

Effect of Bone Mineral Density on Functional and Radiological Results in Conservatively Treated Distal Radius Fractures

Objective: This study was designed to evaluate the effect of bone mineral density on functional and radiographic results of distal radius fractures, which were treated with closed reduction and casting. Materials and Methods: Fifty-two patients [21 males, 31 females, 31 right, 21 left-wrist mean age: 63.4 years (range, 50-84)] who were treated with closed reduction and short arm casting due to fracture of distal radius were included in this study. Patients were divided into groups according to bone mineral density (BMD) measurement results as low (group 1, n=31) and normal (group 2, n=21). Groups were compared according to healing times, radiographic parameters of the last controls and Gartland-Werley functional scores. Results: The fracture type, dominant side, gender distribution and mean age were homogeneous in both group (p=0.18; p=0.96, p=0.38 and p=0.42). There were no significant differences in terms of loss of radial inclination (p=0.17), the volar tilt loss (p=0.24) and the amount of radial shortening (p=0.14) between two groups. There was also no significant difference between the groups in terms of time to union (p=0.87). Functional scores were significantly lower in group with low BMD (p=0.03) and a significant positive correlation was found between BMD and functional results (r=0.29, p=0.04). There was no significant correlation between functional scores and amount of shortening, loss of radial inclination and volar tilt (p=0.53, p=0.38 and p=0.57). Conclusion: This study showed that, lower BMD scores have no significant effect on healing time and loss of reduction of conservatively treated distal radius fractures, however affect adversely the functional results. (Turkish Journal of Osteoporosis 2015;21: 40-5

Oncological Approach With Wide Resection and Antihelminthic Chemotherapy In Treatment of Musculoskeletal Hydatidosis

We aimed to prevent recurrence in patients with hydatid disease of skeletal muscle and bone who were treated with wide surgical resection and antihelminthic chemotherapy.Between 2004 and 2012 we treated ten (4M/6F) patients with hydatid disease of the muscle (eight) and bone (two). The mean age was 42.5 (11-66) years and the mean follow-up was 64 months (28-120 months). All lesions were excised with wide surgical margins. Chemotherapy with albendazole was used preoperatively and postoperatively with a duration of 3-6 months.Complete clinical recovery was achieved in seven patients with lower extremity involvement within 3-6 months. One patient with upper extremity involvement had mildly limited shoulder motion throughout follow-up. Following pelvic resections nearly full activity with mild limping was regained in one year. Clinical and radiological follow-up did not reveal any recurrence. Two complications including deep infection and hematoma formation required additional surgery.An oncological approach consisting of wide resection and adjuvant antihelminthic chemotherapy provides satisfactory results by preventing recurrence in the management of musculoskeletal hydatidosis

Generalized epileptic seizure in an adolescent idiopathic scoliosis (AIS) patient with syringomyelia after deformity correction surgery

AbstractINTRODUCTIONAdolescent idiopathic scoliosis and epilepsy are pathologies rarely seen together. In this study we report an AIS case we operated in which epilepsy was seen post operatively. We want to emphasize the items one should pay attention in such cases.PRESENTATION OF CASEIn a 14-year-old girl with AIS and concomitant syringomyelia and spondylolisthesis, posterior deformity correction and fusion were performed. After stabilization the patient was discharged on the 10th day of discharge epileptic seizure appeared.DISCUSSIONIn scoliosis surgery, the mechanic stress and bleeding caused by the operation itself can cause neurological problems due to primary nervous system injury. The operation and bleeding during and after the operation, pulmonary and cardiac functional instability, metabolic imbalance can be the causes of epileptic seizures.CONCLUSIONEpilepsy seen after a major surgery like scoliosis surgery, can be either as a result of central nervous system origined vascular and hypoxic problems or metabolic. In our case we concluded that massive hemorrhage must have induced epilepsy. In neurologic consultations the case was considered as an incidental epileptic picture

Izmir mental health survey for gene-environment interaction in psychoses (TürkSch): objectives and methodology

Amaç: İzmir büyükşehir bölgesi hanelerinde yaşayan 15-64 yaş arası bireylerden oluşan bir örneklemde psikotik bozukluklar ve belirtiler başta olmak üzere akıl sağlığı sorunlarının yaygınlığını, risk etkenlerini değerlendiren çok aşamalı bir araştırmanın amaçlarını ve yöntemini tanımlamak. Yöntem: Araştırma üç aşama içermektedir. Yöntemi bu makalenin ana konusu olan ilk aşamada, temel tarama aracı olarak birçok DSM-IV bozukluğunun yaşam boyu ve son bir yıl yaygınlığını değerlendiren Uluslararası Bileşik Tanı Görüşmesi 2.1 kullanılmıştır. İkinci olarak, aynı yerleşim birimlerinde mahallelerin sosyal sermayesini değerlendiren paralel bir araştırma yürütülmüştür. Üçüncü olarak, genetik ve çevresel risk etkenlerini araştırmak için kesitsel araştırmanın içine yerleştirilmiş bir olgu-kontrol çalışması gerçekleştirilmiştir. Bulgular: Toplam 4011 erkek ve kadından oluşan, 9 ilçede ve 302 idari mahallede yer alan haneleri temsil eden çok katmanlı kümeli bir örneklem ile görüşülmüştür. İlk aşamanın katılım oranı, görüşme yapılabilecek 5242 hanede %76,5’dir ve katılımcılarla 2008 yılında evlerinde görüşme yapılmıştır. Duygudurum bozuklukları (son 1 yıl), şizofreni ve diğer psikotik bozukluklar (yaşam boyu) ve psikoaktif madde kullanımı ve bağımlılığı (yaşam boyu) taranmıştır. Sonuç: Kesitsel olmasına rağmen TürkSch’ın araştırma deseni özgündür ve yüksek kaliteli bir verinin elde edilmesini sağlamıştır. Bu da araştırmanın, akıl sağlığı hastalıklarının Türkiye nüfusundaki yaygınlığını, risklerini ve daha üst seviyedeki etkileşim özelliklerini psikoza odaklı olarak incelenmesine olanak vermiştir.Objective: To describe the objectives and design of a multistage study on the prevalence and risk factors of mental health problems, in particular psychotic disorders and psychotic symptoms, by assessing a probabilistic sample of household residents in the Izmir Metropolitan Area, aged 15-64 years. Method: The study included three different observation frames. In the first stage, of which methodology is in the focus of this paper, the primary screening instrument was the Composite International Diagnostic Interview 2.1, which assesses lifetime and/or last one year occurrence of several DSM-IV disorders. Second, a parallel survey of social capital of administrative wards was conducted in the same neighbourhoods. Third, a nested-case control study was performed to study effects of genetic and environmental risk factors on wide psychosis phenotype. Results: A total of 4011 males and females were contacted through a multistage clustered area probability sample of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods. The response rate for the first stage was 76.5% in 5242 eligible households. Respondents were interviewed at home in 2008 for the screening of included mental health problems. The screened disorders were mood disorders (last 1 year), schizophrenia and other non-affective psychotic disorders (lifetime), and dependence and abuse of psychoactive substances (lifetime). Conclusion: Although cross-sectional in nature, the TürkSch has a unique study design and yields data of high quality. This enables study of the prevalence, risk and higher-order interactions underlying illhealth in the Turkish population, with a specific focus on psychosis

Does computerized tomography change the treatment decision in pediatric medial epicondyle fractures?

The amount of displacement in medial epicondylar fracture is one of the most important criteria for treatment decision. The displacement of medial epicondyle fractures of the humerus may be underestimated by standard AP and lateral views of elbow. The aim of the current study is to show the clinical relavance of computerized tomography (CT) for medial epicondyle fractures.A retrospective analysis; on patients with medial epicondyle fracture; was performed.Measurement was made from 9 reviewer, for 12 case,on both radiographs and CT. The difference between measurement of AP Xray and frontal and axial CT scans was found statistically significant for both 1st and 2nd assessments(p=0.001). Treatment decision for operative treatment was found statistically higher after evaluation with CT for both first and second assessment.(p=0,0001). CT had great relavance on treatment decision for pediatric medial epicondylar fractures. There is also much better interobserver agreement for axial CT scans for treatment decision.