Ahmet Ege

Regional bone density changes in anterior cruciate ligament deficient knees: A DEXA study

Bone mineral density (BMD) loss is one of the secondary problems occurring in knee joint after injury of anterior cruciate ligament (ACL). The effect of this injury on BMDs of specific regions is not clear. The aim of this study was to investigate BMD changes in unreconstructed ACL-deficient knees with subregion analysis of dual energy X-ray absorptiometry (DEXA). Precision and reliability studies of DEXA revealed that two region of interests (ROI) in medial condyle, two ROIs in lateral femoral condyle (LFC) and one ROI in medial tibial plateau (MTP) in anteroposterior (AP) DXA view and one ROI for each of distal femur, proximal tibia and patella in lateral view had high reproducibility and reliability. Thirty-two patients with complete ACL ruptures were collected for the study and uninjured sides served as the control. All the patients were male with a mean age of 30 years. Mean duration of ACL rupture was 24 months. There were significant BMD losses in both ROIs of LFC and ROI of MTP in AP view and all three ROIs of lateral view. Greatest BMD losses in AP and lateral views were at MTP and patella respectively. There was a significant association between patellar BMD loss and duration after trauma. Bone bruises in lateral condyle might be the cause of selective involvement of LFC. Periarticular bone mineral loss in ACL-deficient knees has a predilection for the specified region of interest rather than uniform periarticular loss. This may be important for graft fixation or a factor in tunnel enlargement.

The effect of watching live arthroscopic views on postoperative anxiety of patients

Surgery is a stressful experience. Many minor interventions have been shown to cause considerable anxiety in patients, but whether arthroscopy leads to such anxiety is not well-known. Methods for lowering perioperative anxiety have been sought and listening to music or watching a movie have been recommended. The method of permitting patients to watch their own endoscopy has been studied infrequently. Our aim in this study was to find out the effect of watching simultaneous arthroscopic views on postoperative anxiety. A total of 63 patients were randomly divided into two groups: those watching their own arthroscopy formed group W, while patients that were only verbally informed formed group NW. The mean age of patients in both groups were 33 and 34, respectively. Meniscal surgery was the most commonly performed procedure (49/63 patients). The patients filled in state scale of State-trait anxiety inventory (STAI) forms and the study questionnaire (SQ) prepared for this study, just before and after the arthroscopy. Group W had significantly lower postoperative scores of STAI-S, whole questionnaire (Q-score) and all but one of individual statements in SQ. Having a previous operation history did not affect STAI scores. Age and level of education was not correlated with any of the studied parameters either. The ratio of patients that were pleased with the arthroscopy experience in group W and NW were 94 and 63%, respectively. Watching live arthroscopic views has led to a significant decrease in postoperative anxiety and worries about the surgery and the postoperative period, while increasing overall understanding and satisfaction of the patient.

Elephantiasis nostras verrucosa complicated with chronic tibial osteomyelitis

Elephantiasis nostras verrucosa represents an infrequent clinical entity with cutaneous changes characterized by dermal fibrosis, hyperkeratotic verrucous and papillamotous lesions resulting from chronic non-filarial lymphedema secondary to infections, surgeries, tumor obstruction, radiation, congestive heart failure, and obesity. Although recurrent streptococcal lymphangitis is believed to play a critical role in the origin of elephantiasis nostras verrucosa, the exact pathogenesis of the disorder is not yet clear. Therapeutic efforts should aim to reduce lymph stasis, which will also lead to improvement of the cutaneous changes but unfortunately there is no specific treatment for advanced cases. In this report, we present a patient who was treated by below knee amputation as a result of elephantiasis nostras verrucosa complicated with chronic tibial osteomyelitis.

In which period of skeletal muscle ischemia-reperfusion injury is local hypothermia more effective?

OBJECTIVES We investigated the potential beneficial effects of local hypothermia applied during different periods of ischemia-reperfusion injury in a rat model. METHODS An isolated gracilis muscle model of ischemia-reperfusion injury was used consisting of four groups, each with six rats. Ischemic injury was induced by clamping the femoral artery for six hours. Local hypothermia at 10 degrees C was applied during only ischemia (IH), during reperfusion (RH) for four hours, and during both ischemia and reperfusion (IRH). The control group remained untreated. After 24 hours of perfusion, the rats were sacrificed and the gracilis muscles were removed to determine muscle edema (wet-to-dry weight ratio), polymorphonuclear leukocytes (PMNL), and the percentage of necrosis. RESULTS Compared to the control group (193.7 +/-38.9), the PMNL count was significantly lower in the IH, RH, and IRH groups (111.5+/-36.2, p<0.004; 82+/-18.6, p<0.002; 54.5+/-21.8, p<0.002, respectively). The only significant difference in the PMNL count was between the IH and IRH groups (p<0.004). In all the hypothermia groups, the percentage of necrosis was found significantly less than that of the control group (22.5+/-5.2% vs 11.7+/-5.2% in IH, p<0.004; 10.8+/-3.8% in RH, p<0.004; 6.7+/-2.6% in IRH, p<0.002).Similarly, muscle edema was significantly decreased in the study groups (control, 2.89+/-0.46 vs 2.01+/-0.26 in IH, p<0.001; 1.98+/-0.34 in RH, p<0.001; 1.97+/-043 in IRH, p<0.001). There were no significant differences between the three hypothermia groups with respect to the percentage of necrosis and muscle edema. CONCLUSION Our results show that local hypothermia applied during ischemic and reperfusion periods is significantly effective in reducing ischemia-reperfusion injury.

Axillary artery entrapment following proximal humeral fracture: a case report and review of literature

Injury to the axillary artery following proximal humerus fracture is a very rare occurrence. The most common mechanism of axillary artery injury is fracture dislocation, resulting with intimal tears, arterial lacerations or avulsions. The most common lesion is the subtotal transaction of the vessel. In this report, we aim to define entrapment of axillary artery by tethering of anterior circumflex humeral artery, which is an unreported mechanism of injury that occurred after a proximal humerus fracture. Diminution of pulse with abduction of arm was the only finding at initial examination, and diagnosis was confirmed with angiography. Treatment was accomplished through ligation and release of anterior circumflex artery with reduction and fixation of fracture fragments, resulting with full recovery. We also have reviewed current literature about axillary artery injuries following proximal humeral fracture.