Preoperative Radiological Assessment of The Total Knee Arthroplasty

Total knee arthroplasty (TKA) is a surgery method that can reduce symptoms and restore joint functions. Long-term success of this operation depends on the correct anatomical and mechanical planning before the prosthetic material implantation. Accurate implant alignment together with anatomical balance provides more successful clinical outcomes and longer duration of the prosthetic material. Improper preoperative planning may cause implant loosening and increased load on the knee joint. Conventional radiographs are the most frequently used imaging methods for this purpose. Computed tomography and magnetic resonance imaging may be used in required cases. In addition, computer-aided systems have come into use and successful results have been reported. Early radiographic evaluation is unnecessary after an uncomplicated TKA. Preoperative imaging has several aims such as to assess the severity of the disease, to analyze the reserve bone tissue, to review the relevant anatomy, and to decide which implant and surgical approach will be applied. In this article, we aimed to present the necessary and also auxiliary radiological evaluations made before TKA in order to achieve better clinical results

European Union's security and defense structure and Turkey

Avrupa Birliği, ekonomik ve mali gelişimini tamamlamasının ardından bu alanda elde ettiği gücü uluslararası alandaki siyasi gelişmelere yön vermek amacıyla kullanmak istemiştir. Bunda amaç, uluslarası alanda bütün Avrupa Birliği'ni temsil edecek Ortak Dış ve Güvenlik Politikası(ODGP) oluşturmaktır. NATO'nun Avrupa'nın güvenliğine katkı ile ilgili geçmişten gelen rolü AB üye ülkeleri arasında yeni bir güvenlik ve savunma mekanizmasının gerekliliği konusunda derin tereddütler oluşturdu. Avrupa'nın özerk siyasal bir yapıya kavuşmasını isteyenler ve NATO ve ABD'nin Avrupa'daki güvenlik ve savunma ağırlığının azalmasını istemeyen gruplar arasında tartışmalar olmaktadır. Bazı Avrupa Birliği üye ülkeleri savunma bütçelerine ilave yük getirmek istememektedirler. Türkiye, AB üyesi olmadığı halde birçok fırsatta Avrupa güvenliğine ilişkin faaliyetlerin içinde bulunmuştur. Ancak, AB üyesi olmaması, Avrupa Güvenlik Savunma Politikası (AGSP) planlamaları ve icraatlarında bir takım zafiyetler yol açmıştır. Bu zafiyet bir takım anlaşmalarla kısmen çözülmüştür. AB, NATO ve ABD ile, görevlerle ilgili olarak koordinasyon yapmıştır. Berlin-artı, her iki kurum arasındaki detaylı görevleri göstermektedir. Bu koordinasyon sürecinin amacı kurumlar arasındaki tekrarlamaları önlemektedir. Türkiye'nin üyelikle ilgli tutumu ve AB'nin olumsuz tepkisi Türkiye'nin AGSP'deki belirsiz pozisyonunu devam ettirmekte ve mevcut durumu daha da karmaşık hale getirmektedir. Anahtar kelimeler: Avrupa Birliği, Avrupa Güvenlik Stratejisi, Avrupa Güvenlik ve Savunma Politikası, Ortak Dış ve Güvenlik Politikası, AGSP OperasyonlarıAfter finishing his economical and financial development, European Union(EU) wanted to use the power of itself on purpose of directing international political issues. The aim is to establish a Common Foreign and Security Policy (CFSP) which will represent the whole European Union in international affairs. The role of NATO?s contribution to Europe?s security that comes from past, rises deep doubts among EU member states about the requirement of a new security and defence structure. Between groups which want a sovereign political Europe and those that don?t want to loose US and NATO?s forces in Europe still discuss it. Some European Union member states don?t want an additional burden on their defence budgets. Although Turkey is not a EU member state, it has many times found itself in implementations concerning Europe?s security matters. But being not a member to EU has some shortcomings as not taking place in planning and command process. These shortcomings have been tolerated with some agreements lately. EU has coordinated it?s role and mission with NATO and USA. Berlin-plus shows detailed missions of both structures. The aim of this coordination process is to prevent duplication of the assets. Turkey?s steps to join EU and EU?s pessimistic reaction to Turkey, seems to last it?s uncertain position in European Security and Defense Policy (ESDP) and makes the current situation more complicated. Keywords: European Union, European Security Strategy, European Security and Defense Policy, Common Foreign and Security Policy, European Security and Defense Policy Operation

An adenocarcinonna developed in tuberculosis cavity

WOS: 000287543100031PubMed: 20570163

Air Quality of the Black Sea Region: Local and Long Range Transported Pollutants

Catalysis has manifested its role as a fundamental tool in pollution prevention. While catalysis has long been utilized in increasing efficiency, yield, and selectivity, it is now also recognized as accomplishing a wide range of green chemistry goals. Air pollutants produced by industrial and man-made emissions possesses a unique property that it could affect regional and global receptors. Measuring and defining the levels of pollutants and its sources whether it is local, regional or global should precede the precautions and measures that should be taken to reduce the levels of a particular pollutant. In this article the air quality at the Black Sea region of Turkey is being discussed. Moreover, it endeavors to locate the possible sources of the different pollutants at local, regional and long range transported scales. About 196 rainwater samples were collected over the Black Sea region of Amasra between 1995-1999 and analyzed for major and trace ions. Although statistical tools do provide information on the type of sources and processes affecting the site, they do not provide information on where these sources are located. A back trajectory has to be included in the evaluation to incorporate geographical information in analytical results. To compute the PSCF for each ion the back trajectories were computed using ECMWF model, which is an isentropic 3-D model. Then number of 1 hour-long segment of the 3.5 daylong trajectories in each defined sub-region is determined. This study shows that, the Black Sea region receives different amounts and types of anthropogenic pollutants via long-range transport according to trajectory models. The highest PSCF values for H+ are calculated for central Europe and Russia have fairly high contribution to observed free acidity in our samples. The main source areas for SO4 2- were found to be central Europe and Northwestern Turkey (Marmara region or Istanbul–Kocaeli industrial area)

Fixator-assisted tibial lengthening over a plate in a patient with sequelae of poliomyelitis

WOS: 000388566200051PubMed: 27858886There are many techniques for limb lengthening. Lengthening over a plate is an alternative choice of fixation in children or when nailing is difficult. We present a new technique for tibial lengthening with using a monolateral external fixator over a lengthening plate. Lengthening over an intramedullary nail is a commonly used method in patients with short stature or limb-length discrepancy. However, in patients with a narrow and excessively sclerotic intramedullary cavity in the pediatric age group where the skeletal system has not yet fully developed, difficulties have been observed in lengthening methods with nailing. Therefore, in these cases, the use of lengthening techniques over a plate is an alternative treatment option. Nevertheless, in lengthening techniques over a plate, if one side of the osteotomy area cannot be fixed, associated mechanical axis problems have been reported. We applied tibia lengthening with external fixator assistance over a custom-made lengthening plate in a patient with sequelae of poliomyelitis. This new lengthening technique applied over a plate could be the solution to the problems observed in other lengthening techniques over a plate

Learning Curve for Surgical Treatment of Acetabular Fractures: A Retrospective Clinical Study of a Practical and Theoretical Training Course

WOS: 000414707200001PubMed: 29093436Background: Surgical treatment of acetabular fracture and the anatomic reconstruction of the hip joint are difficult to achieve due to the complex pelvic anatomy, and surgical training requires a prolonged and steep learning curve. The aim of this study was to evaluate the effects of an applied training course, including cadaveric dissection, for the surgical treatment of acetabular fractures. Material/Methods: This retrospective study included 35 patients who underwent surgical treatment for acetabulum fractures between 2012-2016. Patients were divided into three groups during two training courses, for the first two years and second two years. The surgical treatment was performed through single or combined standard approaches, according to the fracture pattern. The radiological outcome was evaluated using Matta's criteria to grade postoperative reduction and final radiological outcome and the restoration of the hip joint center (HJC). The clinical outcome was evaluated using the modified the Merle d'Aubigne-Postel (DAP) hip score. Results: Both post-course groups had statistically better functional and radiological outcomes compared with the precourse group. Depending on the learning curve, the mean duration of surgery decreased from 153 minutes to 82.3 minutes. Although there was no statistical difference between groups in the vertical shift of the HJC, there was a statistically significant in the amount of horizontal shift of the HJC in the second two years of training, compared with the other groups. Conclusions: Functional and radiological outcome of surgical treatment of acetabular fracture may be improved with increased training, depending on the learning curve

Unicameral (simple) and aneurysmal bone cysts: the effect of insufficient curettage on recurrence

Gurger, Murat/0000-0002-7510-7203WOS: 000391829400001PubMed: 28154666Introduction: Curettage of the cyst and bone grafting are the most common methods used in the treatment of unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC). Recurrence of these cysts is often associated with insufficient curettage of the cyst during surgery. In this study, we aimed to evaluate the effect of insufficient curettage on recurrence in patients with UBC and ABC. Methods: The retrospective study included 18 patients with UBC and 14 patients with ABC that were surgically treated by curettage and bone grafting in our clinic between 2006-2013. Mean age was 19.80 (range, 4-50) years in the patients with UBC and 21.76 (range, 4-56) in the patients with ABC. The diagnosis of the cysts was established both clinically and radiologically. Mean follow-up period was 36 (range, 6-60) months both in the patients with UBC and ABC. The patients with recurrence underwent a second curettage and grafting procedure. Healing and recurrence were evaluated according to modified Neer's scale. Results: Recurrence occurred in 8 patients. Of these, 5 patients underwent a second curettage and grafting procedure and 3 patients were lost to follow-up. Complete healing occurred in all the patients that underwent a second curettage and grafting procedure. Conclusion: The achievement of complete healing in the patients that underwent a second curettage and grafting procedure indicates that the recurrence of UBC and ABC is associated with insufficient curettage.

Tibial Lengthening Using a Fixator-Assisted Lengthening Plate: A New Technique

WOS: 000389064100010PubMed: 28184364Background: There are many techniques that are used for limb lengthening. Lengthening a limb over a plate is an alternative choice used in children or when using an intramedullary nail is difficult. Objectives: In this study, we presented a new technique for tibial lengthening using a monolateral external fixator over a lengthening plate. Materials and Methods: For tibial lengthening, a monolateral external fixator was attached to the composite bone model medially. After a corticotomy was performed, the lengthening plate was placed laterally. Three locking screws were inserted proximally, and two cortical screws were inserted into a lengthening hole that was 1 cm below the osteotomy site. We avoided contact between the screws of the lengthening plate and the pins of the external fixator. During bone lengthening with the monolateral external fixator, the screws at the lengthening hole were able to slide distally with the distal segment of the tibia to allow for tibial elongation. Two locking screws were fixed at the distal locking holes of the plate when the bone elongation was complete. The external fixator was then removed. Results: The fixator-assisted lengthening plate allowed bone lengthening without malalignment. There were no mechanical problems associated with the external fixator during the lengthening process. Plate osteosynthesis was stable after the fixator was removed. There was no contact between the screws of plate and the Schanz pins of the external fixator under C-arm fluoroscopy. Conclusions: The fixator-assisted lengthening plate technique helps to maintain the stability and alignment at both sides of an osteotomy during tibial elongation. It allows the early removal of the external fixator immediately after lengthening is completed. This technique can be applied in children with open physes and in patients with a narrow medullary canal who are unsuitable for limb lengthening over an intramedullary nail