THE EFFICACY OF 1,2- INTERCOMPARTMENTAL SUPRARETINACULAR ARTERY PEDICLED VASCULARISED BONE GRAFT FOR SCAPHOID PROXIMAL END NON-UNION AND AVASCULAR NECROSIS

  Purpose:To show the efficacy of 1,2-intercompartmental supraretinacular artery pedicled vascularised bone graft in treatment of scaphoid non-union with concomitant proximal end avascular necrosis retrospectively. Methods:Twentytwo cases of scaphoid nonunion with concomitant proximal end avascular necrosis were evaluated. Radiographic evaluation was made with radiographs, computed tomography, and magnetic resonance imaging. Clinical evaluation was made according to the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Mayo wrist score, and the Short Form-36. Results:Union was achieved in 18 81.8%. The mean age was 31.13±5.29 years and the mean follow-up was 34.95±16.87 months. The median wrist flexion-extension range was 123.5° (100°-144°) preoperatively and 128° (82°-146°) postoperatively. The median radial-ulnar deviation was measured as 41.5° (24°-55°) preoperatively and 42° (24°-58°) postoperatively. The dominant hand was measured as 92% (p=0.061) grip strength compared to the healthy side and the non-dominant side as 74% (p=0.012). Improvement was observed in all patients in SF-36,DASH,Mayo score and in patients with union (p<0.001).Conclusion:The radiological and clinical results of this study showed that 1,2- intercompartmental supraretinacular artery pedicled vascularised bone graft is an effective method in the treatment of scaphoid nonunion with concomitant proximal end avascular necrosis. 

Ebola epidemiyolojisi, klinik özellikleri ve hemşirelik bakımı

Ebola, Afrika’da uzun bir süreden beri sporadik düzeyde görülürken, 2014 yılı Mart ayında yeniden pandemi düzeyinde ortaya çıkmıştır. Son salgında Zaire Ebolavirüs sorumludur ve öldürücülük hızı %74’e ulaşmıştır. Hastalık, etkenleri taşıyan şempanze, goril, meyve yarasaları, antilop gibi hayvanların ya da hasta/hastalıktan yaşamını yitiren insanların kan, vücut sıvıları ya derisine doğrudan temas ile bulaşmaktadır. Korunma açısından sağlık sistemlerinin uygun bir biçimde yapılandırılması yanında, formal ya da informal bakım vericilerin temas önlemlerine uyması gerekmektedir. Hemşirelerin Ebola tanısı almış bireylere bakım verirken temas önlemlerine bağlı kalarak semptomları nasıl yöneteceklerini bilmeleri, hem bulaştırıcılığı önlemek hem de hastaların yaşama tutunma olasılığını artırmak açısından önemlidir. Dolayısıyla bu makalenin hemşirelere eboladan korunma ve semptom yönetimi açısından katkı sunması beklenmektedir

Tranexamic acid in total knee replacement Which protocol? Which application form? :A prospective randomised study

The aim of this study was to prospectively compare different doses and application forms of TXA for the reduction of blood loss in patients with TKR and evaluate the results. This study included patients who were unresponsive to conservative management and 168 patients met the inclusion criteria. They were divided into 5 groups randomly as, Control (1), Local (2), Systemic+short infusion (3), Systemic+long infusion (4) and Systemic+oral (5). When compared with the Control group, blood loss was significantly reduced in Groups 2, 3 and 4 (p=0.001,0.001,0.003) but when the TXA protocols were compared, no statistically significant difference was observed. It was determined that in comparison with the control group, all the protocols for the use of TXA reduced blood loss and the need for transfusion without any increase in the complication rate. TXA is considered to be more effective and reliable than systemic use

Two-stage Reimplantation in Infected Total Knee Arthroplasty by Using Resterilized Femoral and Tibial Components with a New Polyethylene Insert: Report of 4 Cases with at Least 15 Years’ Follow-up

Background. This study evaluates 15 years’ results of the implantation of autoclaved femoral and tibial prosthesis components together with a new same brand polyethylene insert which were used as a temporary articulating spacer in patients with periprosthetic infection of total knee arthroplasty (TKA) in a two-stage reimplantation procedure in 6 patients.  Material and methods. The femoral and tibial prostheses of 6 patients with deep chronic periprosthetic infection of TKA who underwent elective two-stage exchange arthroplasty were autoclaved and reinserted with a new polyethylene insert of the same brand and bone cement mixed with tecoplanin in 2004. Results. Four patients were followed for 15 years. They were all female and between 47-70 years old. The infectious agent was meticillin-resistant Staphylococcus aureus (MRSA) in 3 and coagulase negative Staphylococcus in one patient. Patients were invited for second stage reimplantation, but they refused to undergo the second stage. Three of them had their second stage reimplantation after 15, 13 and 10 years while one patient was reinfected after 5 years, in 2009, and arthrodesis was performed. They were all happy with the result and infection free at last follow-up.  Conclusions. 1. Regarding the results of our patients, reinsertion of autoclaved femoral and tibial prostheses together with a new same brand polyethylene insert with teicoplanin loaded bone cement can be used cautiously in the management of periprosthetic deep infection of TKA. 2. That is because patients might not want the second stage reimplantation. 3. We believe that the refusal of patients to undergo the surgery shows that the single-stage treatment is effective

Factors affecting survival in retroperitoneal sarcomas treated with upfront surgery: A real-world study by Turkish Oncology Group

Retroperitoneal sarcomas (RPS) account for approximately 15% of all soft tissue sarcomas (STS) and encompass a heterogeneous group of tumors with limited multimodality treatment options. Surgical resection with negative margins remains the standard primary treatment for patients with localized RPS. In this multicenter study, we aimed to demonstrate the real-world data on factors affecting survival in RPS treated with upfront surgery. We included a total of 197 patients who underwent curative-intent resection of a primary non-metastatic RPS between 2000-2020 at ten experienced medical oncology departments in Turkey. The median follow-up was 33 months. The median age of patients was 53 years, 57.4% of patients were female. Univariate analysis revealed that; tumor size, grade, necrosis, resection margin status, were factors affecting recurrence-free survival (RFS) (p= 0.002, p= 0.044, p= 0,024, p= 0.003 respectively). Age, tumor size, stage, resection margin status were factors affecting overall survival (OS) (p= 0.038, p= 0.001, p= 0.032, p< 0.001, respectively). In multivariate analysis, tumor size and resection margin status were independent factors affecting RFS and OS (all p-values < 0.05). Our study demonstrated that tumor size, and resection margin status were the main factors affecting survival in resected RFS. In comparison, adjuvant chemotherapy (CT), radiotherapy (RT), or multimodality treatment did not show OS and RFS advantages. We believe that advances in the molecular characterization of these tumors might help clinicians to detect the best candidates for adjuvant therapies in RPS