Anatomical Versus Nonanatomical Resection of Colorectal Liver Metastases: Is There a Difference in Surgical and Oncological Outcome?

Background: The increased use of neoadjuvant chemotherapy and minimally invasive therapies for recurrence in patients with colorectal liver metastases (CLM) makes a surgical strategy

Management of colorectal cancer presenting with synchronous liver metastases

Up to a fifth of patients with colorectal cancer (CRC) present with synchronous hepatic metastases. In patients with CRC who present without intestinal obstruction or perforation and in whom comprehensive whole-body imaging confirms the absence of extrahepatic disease, evidence indicates a state of equipoise between several different management pathways, none of which has demonstrated superiority. Neoadjuvant systemic chemotherapy is advocated by current guidelines, but must be integrated with surgical management in order to remove the primary tumour and liver metastatic burden. Surgery for CRC with synchronous liver metastases can take a number of forms: the 'classic' approach, involving initial colorectal resection, interval chemotherapy and liver resection as the final step; simultaneous removal of the liver and bowel tumours with neoadjuvant or adjuvant chemotherapy; or a 'liver-first' approach (before or after systemic chemotherapy) with removal of the colorectal tumour as the final procedure. In patients with rectal primary tumours, the liver-first approach can potentially avoid rectal surgery in patients with a complete response to chemoradiotherapy. We overview the importance of precise nomenclature, the influence of clinical presentation on treatment options, and the need for accurate, up-to-date surgical terminology, staging tests and contemporary management options in CRC and synchronous hepatic metastatic disease, with an emphasis on multidisciplinary care

The effects of exercise on articular cartilage [Egzersizin eklem kikirdagina etkileri.]

PubMedID: 18180579The effect of exercise on articular cartilage has been assessed on animal models and on humans using various imaging techniques. Joint cartilage, whose water content decreases itself thanks to its unique permeable medium, maintains load distribution and joint function together with the synovial fluid under physiologic conditions and sports activities. The adaptive capacity of joint cartilage is limited under various conditions such as excessive load bearing or prolonged immobilization; however, when these factors are reversed deformed cartilage returns to its former state under normal conditions. Due to its adverse effect on joint cartilage, immobilization period following cartilage damage or operation should be as short as possible for wound healing. It is reported that exercise contributes to cartilage healing and reduces risk for injury, and that moderate exercise can even decrease the number of cases requiring arthroplasty. Conversely, excessive (harsh) exercise may be associated with increased cartilage damage or degenerative changes. Despite the presence of osteophytic changes in joint cartilage of athletes performing mild sports activities, these may not result in osteoarthritis due to the adaptive feature of joint cartilage. In contrast, the risk for osteoarthritis is increased in professional sportsmen exposed to acute repetitive impact and torsional loading. This article reviews the influence of controlled, passive-active exercise on healing, and on the development of osteoarthritis and the short- and long-term changes in articular cartilage associated with exercise and participation in sports of different duration and intensity

Bilateral dislocation of the knee with rupture of both patellar tendons. A case report

PubMedID: 16806939Knee dislocations are rare injuries caused by violent trauma. Damage to soft tissues and ligament lesions almost always accompany the injury. Vascular compromise further complicates the situation. We report a case of bilateral posterior knee dislocation with traumatic rupture of both patellar tendons. Treatment consisted of external fixation of both knees. Vascular compromise resolved with reduction and traction pins were placed on both patellae which were connected to the external fixators on following days. Primary repair of patellar tendon was undertaken after gradual distal repositioning of patella. The result is successful with full range of motion. Rupture of patellar tendon should be considered with posterior dislocation of the knee. External fixators provide quick stabilization in case of vascular compromise and can be modified to provide a traction system for distal repositioning of patella which allows primary repair of the patellar tendon. © 2006 Elsevier B.V. All rights reserved

Clinical analysis of the trigger thumb of childhood

PubMedID: 14696802Trigger thumb of childhood, termed congenital trigger thumb, is a pathology of the flexor pollicis longus tendon with an unknown etiology. In this study, treatment outcomes of 47 trigger thumbs of 36 children were evaluated. There were 18 males and 18 females with a mean age of 34 months (9 months-13 years). Average age of recognition of pathology by the family was 20.5 months (0-8 years). In seven of 11 bilateral cases pathology was recognized simultaneously while in the other four, diagnosis was made at different times. We used conservative treatment for all patients under three years of age, which was unsuccessful. Thus, surgical relase was performed in all cases. In the mean follow-up of seven years (range 5-15), contracture and palpable nodules disappeared. In conclusion, we believe trigger thumb in childhood should be treated surgically and that the term "congenital trigger thumb" should be changed to "developmental trigger thumb"

Central acetabular fracture-dislocation following electroconvulsive therapy: Report of two similar cases

PubMedID: 8760548Acetabular fracture-dislocations usually occur as a result of high velocity trauma. Such fractures following electroconvulsive therapy are extremely rare. In this report, two similar cases of acetabular fractures and central fracture-dislocations following ECT are presented. This rare complication could be eliminated easily by using short-acting anaesthetic agents and muscle relaxants

Psoriasis induced by tumor necrosis factor-alpha antagonist therapy: Case series and literature overview [Tümör nekrosis faktor-alfa i·nhibitörü kullanımına baglı olarak gelişen psöriazis: Olgu serisi ve literatürün gözden geçirilmesi]

Although tumor necrosis factor-alpha (TNF-?) antagonists are shown to be effective in the treatment of psoriasis, induction of psoriatic skin lesions have been seen in patients with different rheumatic conditions who were treated with TNF-? antagonists. In this case series, we report four cases that developed psoriatic lesions; in one of the cases, psoriasis was associated with two different TNF-? antagonists. Case 1: A 31-year-old man with ankylosing spondylitis developed erythematous and squamous lesions on his extremities in the 2nd week of infliximab treatment. Two months later he began to receive etanercept, and psoriatic skin lesions developed on the entire trunk and extremities, and predominantly on the scalp after one month. Case 2: A 53-year-old female with rheumatoid arthritis developed psoriatic skin lesions in the ankle region after two months' treatment with etanercept. Case 3: A 34-year-old female with ankylosing spondylitis developed psoriatic lesions on her palms after 10 months' treatment with infliximab. Case 4: A 40-year-old female with ankylosing spondylitis developed pustular lesions on her palms and soles after two years' treatment with infliximab. The patients had no personal or family history of psoriasis. The diagnosis of psoriasis was confirmed by skin biopsy in three of the cases. Psoriatic skin lesions can be induced as a result of treatment with TNF-? antagonists in patients with rheumatoid arthritis, ankylosing spondylitis and other spondyloarthropathies. The most common form is plaque or pustular pattern with palmoplantar distribution

Subungual exostosis: Report of 7 cases

A subungual exostosis is a benign bone tumor found on the distal phalanx of a adjacent or beneath to the nail. This tumor is relatively uncommon. From 1981 through 1992 seven patients with subungual exostoses were seen in Cukurova University Orthopaedic clinic. Tumors were localized on great foe of six patients and fourth foe of one patient. All patients were treated by local excision and no patient had local recurrence

Comparison of mechanical performance among different frame configurations of the Ilizarov external fixator: Experimental study

PubMedID: 15761350The circular frame of the Ilizarov fixator can be modified to reflect anatomic variations and treatment aims. However, these modifications in the frame system cannot always achieve the mechanical performance of the standard frame system. A standard system has two rings in each bone fragment connected by four longitudinal bars on each side of the ring. In this study, the mechanical performances of one standard and eight modified frame systems were compared. Each system was loaded on a material testing machine, with calculation of axial compression, four-point bending, and torsion. As a result, systems that were modified with drop wires and Schanz screws 45° oblique to the wires on the proximal ring provided a mechanical performance closer to the standard system than systems with other modifications. Copyright © 2005 by Lippincott Williams & Wilkins, Inc

Arthroscopy of the knee in pre-adolescent children

PubMedID: 16830144Introduction: Arthroscopic operations performed in the pediatric age group constitute less than 5% of all arthroscopies. Diagnostic accuracy is reported to be lower than the procedures in adult patients. The incidence of pathologies also varies in the literature. We aimed at assessing the diagnostic accuracy of arthroscopy and review the incidence of pathologies in pre-adolescent patients. Materials and methods: In the period April 1990-January 2002, 50 pre-adolescent patients underwent knee arthroscopy after clinical and radiological assessment. Average age was 10.24 (1-13) with a male-to-female ratio of 34:16. Results: Discoid lateral meniscus was found to be the most common pathology encountered in 17 cases followed by infection and synovitis in 8 cases each. Diagnostic accuracy of arthroscopy correlated with preoperative clinical and radiologic evaluation was 90%. Arthroscopy findings were negative in two cases. Two cases of plica syndrome and one case of chondral injury were mistaken for medial meniscal tear. Final diagnosis was familial Mediterranean fever in one case of synovitis and knee fusion was performed at follow-up due to progressive degenerative changes. No other patient required reoperation. Conclusion: Arthroscopyis a safe procedure with minor morbidity allowing treatment of various intraarticular knee disorders. Diagnostic accuracy of the procedure may increase with careful preoperative work-up. © Springer-Verlag 2006