Long-Term Results Of Three Different Techniques in Ankle Arthrodesis

Amaç: Bu çalışmada, ayak bileği artrozu tanısı ile üç farklı yaklaşımla opere edilen hastaların uzun dönem klinik fonksiyonel sonuçlarınıdeğerlendirmeyi amaçladık.Yöntem: 2002-2013 tarihleri arasında opere edilen 49 olgu retrospektif olarak değerlendirildi. İlizarov tekniği ile artrodez yapılan hastalar İABA grubu(n:8) olarak isimlendirildi. Vida ile artrodez yapılan hastalar VABA grubu (n:25) olarak isimlendirildi. Kalkaneotalotibial çivi ile artrodez yapılanhastalar ise KABA grubu (n:16) olarak isimlendirildi. Gruplar; hastane yatış süresi, cerrahi süre, komplikasyon oranı, preoperatif ve postoperatif görselanalog ölçeği (Visual Analogue Scale; VAS) ve postoperatif Maryland ayak skoru açısından değerlendirildi.Bulgular: Gruplara göre preoperatif VAS değerlendirilmesinde anlamlı bir farklılık gözlemlenmedi (p=0,452). İABA grubunda VAS diğer iki grubagöre anlamlı düzeyde düşük olarak gözlemlendi (p=0,01). Gruplara göre Maryland ayak skoru değerlendirmesinde anlamlı bir farklılık gözlemlenmedi(p=0,145). İABA grubunda diğer iki gruba göre daha fazla komplikasyon gözlemlenmiştir. KABA grubunda diğer iki gruba göre daha az komplikasyongözlemlendi (p=0,004).Sonuç: İABA grubunda, diğer gruplara göre VAS daha az olarak bulundu fakat daha yüksek komplikasyon oranı gözlemlendi. KABA grubunda diğeriki gruplara göre daha az komplikasyon oranı gözlemlendi. Postoperatif Maryland ayak skoru açısından; göre gruplar arasında farklılık gözlemlenmedi.Aim: In this study, we aimed to evaluate the long-term clinical functional results of patients who were operated with the diagnosis of ankle arthrosis with three different techniques. Methods: 49 cases who were operated between 2002 and 2013 were evaluated retrospectively. The patients who underwent arthrodesis with Ilizarov technique were evaluated as IABA group (n: 8). The patients who underwent arthrodesis with screws were evaluated as VABA group (n: 25). The patients who underwent arthrodesis with the calcaneotalotibial nail were evaluated as KABA group (n: 16). Duration of hospitalization, duration of surgery, complication rates, preoperative and postoperative visual analog scales (VAS), and postoperative Maryland foot scores were evaluated. Results: No significant difference was observed in the preoperative evaluation of VAS according to the groups (p= 0.452). It was observed that the VAS of the IABA group was significantly lower than the other two groups (p= 0.01). No significant difference was observed in Maryland foot score evaluation according to the groups (p= 0.145). More complication rates were observed in the IABA group compared to the other two groups. Less complication rates were observed in the KABA group compared to the other two groups (p= 0.004). Conclusion: It was observed that VAS was less in the IABA group compared to other groups, but the IABA group had higher complication rates. A lower complication rate was observed in the KABA group compared to the other other groups. There was no difference between the groups according to the Maryland foot score

Brucellar prosthetic infection after total knee arthroplasty: A case with retained prosthesis by arthroscopic and medical treatment

Enfeksiyon, total diz protezi uygulamalarının önemli bir komplikasyonudur ve ciddi bir morbiditeye sahiptir. Çalışmamızda çimentolu total diz protezi uygulanmasından dört yıl sonra ortaya çıkan brusella enfeksiyonu olgusu tanımladık. Literatürde, öncesinde eksizyonel artroplasti uygulanan yada uygulanmayan durumlar için antimikrobiyal kemoterapi stratejileri belirtilmiştir. Biz ise sunulan olguda artroskopi ve debridman ile sinoviektomi sonrası eksizyonel artroplasti yapmaksızın doksisiklin ve rifampisin kombinasyonu ile tedaviye başladık. Bu tedavi planı ile hastanın yaşam kalitesini etkileyecek majör bir cerrahi uygulamadan tedavi alternatifi oluşturulabilir.Infection after total knee arthroplasty is a severe complication and is associated with high morbidity. We describe a case of a brucellosis infection of the knee joint, four years after cemented total knee prosthesis application. Treatment strategies of antimicrobial chemotherapy with or without initial excisional arthroplasty are recommended in the literature. After diagnostic arthroscopy and wash-out with synovectomy, we initiated doxycycline and rifampicin combination therapy without an initial excisional arthroplasty, in this case. This treatment strategy can be another option before performing a major surgery which may affect the patient's quality of life

Kalça kırıklı yaşlı Türk hasta grubunda bir ve iki yıllık mortaliteyi etkileyen faktörler

Amaç: Kalça kırıkları ileri yaşların fonksiyon kaybı ve ölüm ile sonuçlanabilen ciddi sağlık sorunlarındandır. Bu çalışmada amaç kalça kırığı sonrası yaşlı Türk hastalarda değişik risk faktörlerinin mortalite üzerine etkisini ortaya koymaktır. Hastalar ve Yöntemler: 2001-2006 yılları arasında kalça kırığı nedeniyle ameliyat edilmiş, 60 yaş ve üzeri, en az iki yıllık takibi olan 240 hastanın (ort. yaş 76.0±8.2) demografik verileri, ameliyat öncesi süreleri, anestezi ve ASA fiziksel durumu, başvuru albumin düzeyi ile ek morbiditeleri incelendi. Bulgular: Geliş albumin seviyesi 3.45±0.62 g/dl olarak bulundu. Yüz sekiz hastada (%45) albumin düşüklüğü vardı. Albumin düzeyine göre bir ve iki yıl mortalite oranı anlamlı değildi. Ameliyat öncesi yatış süreleri incelendiğinde; birinci yıl mortalitesi erkek hastalarda istatistiksel anlamlı yüksek bulunurken (p=0.015), ikinci yıl mortalitesi bulunmadı. ASA fiziksel skorları yüksek olan hastaların birinci yıl mortaliteleri ile korelasyonunun istatistiksel olarak anlamlı olduğu (p=0.002), ikinci yılda ise olmadığı (p=0.169) saptandı. Cinsiyet incelendiğinde, birinci yıl mortalitesi erkekler için yüksek bulundu (p=0.001). Sonuç: Yüksek ASA skorlarına ek morbiditeler nedeniyle yaşlı hastalarda sık karşılaşılmaktadır. Preoperatif hazırlık sürecinin ASA skoru yüksek olan hastalarda uzun olması nedeniyle ameliyat öncesi süre uzayabilmektedir. Kalça kırığı olan hastaların bir ve iki yıllık mortalite öngörüsünde ASA fiziksel durumu ve ameliyat öncesi gecikmenin önemli belirteçler olduğu görüşündeyiz.Objectives: Hip fractures are one of the most serious causes of impairment and death in the elderly. The aim of this study is to identify the effects of different risk factors on mortality after a hip fracture in elderly Turkish patients. Patients and Methods: Two-hundred forty patients (>60 years; mean age 76.0±8.2 years) who were operated for fracture of the hip from 2001 to 2006 were investigated. Demographic data, preoperative length of hospital stay, anesthesia type and ASA physical status, albumin level at admission and comorbidities were recorded. Results: Mean albumin level was 3.45±0.62 g/dl. Onehundred eight (45%) had hypoalbuminemia. The difference between mortality rates of normo- and hypoalbuminemic patients were not significant at one and two-year. According to preoperative length of stay; one-year mortality was significantly higher in male patients (p=0.015) while two-year mortality was not. One-year mortality was related with high ASA physical status scores (p=0.002) while two-year mortality was not (p=0.169). According to gender; one-year mortality was found higher in men (p=0.001). Conclusion: Due to comorbidities, high ASA scores are common in elderly patients. Since the preoperative evaluation in high ASA physical status is longer, this may prolong the preoperative hospital stay. Delay after admission and high ASA physical status are important predictors of mortality for elderly hip fracture patients

Comparison of the efficacy of SAPS II and MPM II scoring systems in ıntensive care unit mortality

Amaç: Yoğun bakım ünitesi (YBÜ) hastalarında mortalite oranı öngörüsünün belirlenmesinde Simplified Acute Physiology Score (SAPS) II ile Mortality Probability Model (MPM) II0 ve MPM II24 skorlama sistemlerinin etkinliğini araştırmayı amaçladık. Hastalar ve Yöntemler: Üniversite hastanemiz YBÜ'süne kabul edilen ardışık 100 hastanın verileri geriye dönük olarak incelendi, 92 hasta çalışmaya alındı. Hastaların SAPS II ve MPM başlangıç verilerinin değerlendirilmesi ve mortalite öngörü oranlarının hesaplanması yardımcı yazılım ile yapıldı. Hastaların YBÜ'ye geldiği yer, YBÜ ve hastanede kalış süresi ve mekanik ventilasyon süreleri hesaplandı. Bulgular: Yoğun bakım ünitesine en çok hasta, hastanemiz acil servisinden (%53) kabul edilmişti. Yirmi yedi hasta başka bir servise devir, 15 hasta ise taburcu edildi. Ölen hastaların sayısı 50, mortalite oranı ise %54 olarak saptandı. Yoğun bakım ünitesinde kalış ve mekanik ventilasyon süreleri ölen hastalarda istatistiksel olarak anlamlı bulundu (sırasıyla p=0.007, p=<0.0001). Sonuç: SAPS II, MPM II0 ve MPM II24 analizlerinin tümünün mortalite ile ilişkisi olmakla beraber lojistik regresyon analizinden bağımsız olarak mortaliteyi öngörmede etkileri yoktur. Öngörülmüş ölüm oranları lojistik regresyon analizi ile gözlenen ölüm oranlarıyla ilişkili bulunmuştur. Mekanik ventilasyon ve YBÜ'de kalış süreleri ile 24 saatten uzun süren mekanik ventilasyon süresi öngörülen mortaliteyi bağımsız olarak etkilemektedir.Objectives: We aimed to investigate the predicting performances of Simplified Acute Physiology Score (SAPS) II and Mortality Probability Model (MPM) II0 and MPM II24 on determining the mortality rates of intensive care unit (ICU) patients. Patients and Methods: Consecutive 100 patients admitted to the ICU were investigated retrospectively, and 92 of them were included in the study. Initial SAPS and MPM analysis and calculations for mortality prediction percentages were performed with auxiliary software package. Transfer data, total ICU and hospital stay and duration of mechanical ventilation were calculated. Results: Most of the patients (53%) were transferred to the ICU from the emergency department. Twenty two patients were transferred to another department and 15 patients were discharged. The number of patients died were 50, the mortality rate was determined as 54%. The ICU stay and duration of mechanical ventilation of patients who died were found as statistically significant (p=0.007, p=&lt;0.0001, respectively). Conclusion: Although SAPS II, MPM II0 and MPM II24 analysis are related to mortality, they have no effect on predicting the mortality independent from logistic regression analysis. The predicted mortality rates were found related with those determined by logistic regression analysis. Duration of mechanical ventilation and ICU stay and mechanical ventilation duration above 24 hours affect the predicted mortality, independently

Sultan Bayezid II Külliyesi: One of the Earliest Medical Schools—Founded in 1488

During the 8th to 13th centuries, Islamic medicine went through a golden age which influenced medical education and practice in the Ottomans, who conserved fundamental features of Islamic civilization. A külliye is an Ottoman architectural concept that designates a complex with a central mosque and a series of ancillary buildings surrounding it. Sultan Bayezid II Külliyesi of Edirne, Turkey is an early characteristic example with its sections, and in particular, with the medical school and hospital. The other constructed units were built to complete the hospital service in social, cultural, religious and financial aspects. This foundation (vakıf, waqf in Arabic) of health was a trust with deeds that contain notable information regarding hospital management, and the duties, responsibilities, qualities, and proficiency standards requisite for physicians. The Külliye, established in the 15th century, provided substantial contributions to medical and scientific history, and patient care. Together with the history of the Külliye, I will focus on the medical books of the period, in particular works of Şerefeddin Sabuncuoğlu who used the Turkish language instead of Arabic and color illustrations and his two books which were the main medical books of the period combining knowledge of Greek, Roman, Arabic, and Turkish acquirements

Distal oblique metatarsal osteotomy for hallux valgus deformity: A clinical analysis

WOS: 000400884400015PubMed ID: 28258948We compared the outcomes of the distal oblique metatarsal (DOM) osteotomy, which is parallel to the articulation surface of the proximal phalanx, with those of the chevron osteotomy and evaluated whether displacement and shortening of the first metatarsal have any effect on the incidence of metatarsalgia and patient satisfaction. Patients treated with the DOM osteotomy (n = 30) or distal chevron osteotomy (n = 31) were evaluated retrospectively. The chevron and DOM osteotomies both provided significant improvement in the first intermetatarsal angle (p <.001), hallux valgus angle (p <.001), distal metatarsal articular angle (p <.001), range of first metatarsophalangeal joint motion (p <.001), American Orthopaedic Foot and Ankle Society score (p <.001), and sesamoid position (p <.001), without any significant differences between the 2 groups. Patient satisfaction and metatarsalgia also were not different between the study groups. The DOM osteotomy group had higher plantar displacement (0.1 +/- 0.1 mm versus 1.0 +/- 0.1 mm; p <.001) and absolute shortening of the first metatarsal (1.0 +/- 0.4 mm versus 6.8 +/- 1.0 mm; p <.001). In conclusion, the DOM osteotomy is an alternative treatment method for mild and moderate hallux valgus

Tendons and ligaments

Tendons and ligaments are complex structures and have different anatomical and dynamic properties. Injury of tendons and ligaments remodel with scar formation with differences in themselves. Although scarring depends on the quality and quantity of the injured tissues, it can be qualified with appropriate rehabilitation. In normal conditions, scar formation prevents returning of normal tendon function because of its structural and biological limitations. It has been shown that reconstruction of injured tendons and ligaments with allografts and autografts in different clinical and experimental studies. Despite of these developments, healing process of both biological and biomechanics of the tendons and ligaments is still have to be investigated