Burak Kaymaz

Preventive effects of coenzyme Q10 (CoQ10) on steroid-induced osteonecrosis in rats.

OBJECTIVE The aim of this study was to examine the role of coenzyme Q10 (CoQ10) in the prevention of steroid-induced osteonecrosis of the femoral head (ONFH) in rats. METHODS The study included 20 Sprague-Dawley rats injected once with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle to induce osteonecrosis. Animals were divided into two equal groups; Group 1 received no prophylaxis (control group) and the Group 2 received CoQ10. Hematological examinations were performed before steroid injection (0 weeks) and at 4 weeks after steroid injection. Femoral heads were examined histologically to evaluate osteonecrosis. RESULTS Changes in blood glutathione (GSH) and malondialdehyde (MDA) concentrations were less significant in the CoQ10 group. The incidence of histologic changes consistent with early osteonecrosis was lower in the CoQ10 group (2 of 10; 20%) than the control group (7 of 10; 70%). CONCLUSION Coenzyme Q10 may be useful as a preventing agent in steroid-induced ONFH. Inhibited oxidative stress is a possible mechanism for this effect.

Effects of Aloe Vera on Spinal Cord Ischemia–Reperfusion Injury of Rats

ABSTRACT Aim: The purpose of this study was to evaluate the possible protective/therapeutic effects of aloe vera (AV) on ischemia–reperfusion injury (I/R) of spinal cord in rats. Materials and Methods: A total of 28 Wistar Albino rats were divided into four random groups of equal number (n = 7). Group I (control) had no medication or surgery; Group II underwent spinal cord ischemia and was given no medication; Group III was administered AV by gastric gavage for 30 days as pre-treatment; Group IV was administered single dose intraperitoneal methylprednisolone (MP) after the ischemia. Nuclear respiratory factor-1 (NRF1), malondialdehyde (MDA) and superoxide dismutase (SOD) levels were evaluated. Tissue samples were examined histopathologically and neuronal nitric oxide synthase (nNOS) and nuclear factor-kappa B (NF-κB) protein expressions were assessed by immunohistochemical staining. Results: NRF1 and SOD levels of ischemia group were found to be lower compared to the other groups. MDA levels significantly increased after I/R. Treatment with AV and MP resulted in reduced MDA levels and also alleviated hemorrhage, edema, inflammatory cell migration and neurons were partially protected from ischemic injury. When AV treatment was compared with MP, there was no statistical difference between them in terms of reduction of neuronal damage. I/R injury increased NF-κB and nNOS expressions. AV and MP treatments decreased NF-κB and nNOS expressions.Conclusions: It was observed that aloe vera attenuated neuronal damage histopathologically and biochemically as pretreatment. Further studies may provide more evidence to determine the additional role of aloe vera in spinal cord ischemia reperfusion injury.

Popliteal schwannoma mimicking baker cyst: an unusual case

Schwannoma, also known as neurilemoma, is the most common tumour of peripheral nerves. Although it is the most common tumour of peripheral nerves, it is seldom seen in adult population. We present a very rare case of schwannoma in an unusual localization. The presented case concerns a 58-year-old patient with a slowly growing popliteal mass and neuralgia for 6 months. A mass originating from a nerve or compressing a nerve was thought in the differential diagnosis. Ultrasonographic and magnetic resonance imaging revealed a heterogenous, well-defined solid mass that seems to originate from tibial nerve. Surgical excision and histopathological examination confirmed the diagnosis of schwannoma. Diagnosis of the neurilemmoma originating from lower extremity peripheral nerves may be delayed because the mass can be misdiagnosed as baker cyst or the symptoms of the patient can be thought as a result of lumber disc herniation.

Consultation of traditional bone setters instead of doctors: is it a sociocultural and educational or social insurance problem?

Background Patients consulting bone setters is common in the eastern and south-eastern regions of Turkey. The reasons for consulting bone setters instead of qualified doctors remains unclear. We investigated the characteristics of such patients who consult traditional bone setters after trauma prior to admission to hospital. Methods In the study, 3,422 of 14,080 patients were investigated admitted to hospital between January 2012 and February 2013 with trauma or sequelae of such who were previously treated by bone setters. The characteristics of these patients and the main reasons for consultation of bone setters instead of doctors were recorded. Results Most of the patients consulting bone setters were found to be young adults or children. Generally speaking, the poorly educated prefer bone setters despite having social insurance. The most common reason (29.3%) was a general preference and secondarily (27.1%) the fear of being disabled after medical treatment. However, the most common cause of patients’ consultation at hospital subsequently was due to complications of treatment (46.8%); indeed the complication rate after bone setters’ intervention was found to be 54.8%. Conclusion Although improvements have occurred in the access to and utilisation of healthcare services, consultation by patients of bone setters seems to be a sociocultural and educational issue rather than a problem of lack of medical insurance.

Treatment of juvenile hallux valgus interphalangeus with a double compression headless bone screw.

A 14-year-old girl presented with idiopathic valgus deformity of her left great toe at the interphalangeal joint (IPJ). The deformity, which had been present but asymptomatic for the past 4 years, began to enlarge and cause discomfort. The measured IPJ angle on anteroposterior standing X-ray was 26°. We treated the toe by medial closing wedge osteotomy and fixation with a double compression headless bone screw (DCHBS). Postoperative hallux valgus interphalangeus (HVI) angle was 14°.

Comment on the article 'The biomechanics of guided growth: does screw size, plate size, or screw configuration matter?' by Schoenleber et al.

The authors carried out a study to determine the optimal combination of plate size, screw size, and screw configuration for the guided growth with the eight-plate and concluded that parallel screws tended to be superior to divergent screws, and the plate sizes and screw sizes were negligible and did not affect the correction significantly. We believe that this is an important topic for study, but question some of the study design methodology and statistical analysis.

An uncommon cause of anterior knee pain: patellar chondroma.

A 16-year-old boy presented with a patellar mass and anterior knee pain without any trauma. On physical and radiologic assessment, a mass at the superolateral edge of the patella and a hyperintense lesion on T2 sequences of magnetic resonance imaging was detected. Excisional biopsy revealed a chondroma of patella. Primary bone tumors of the patella are extremely rare and occurence of chondroma in this localization is very uncommon. Although anterior knee pain is a very frequent and usually harmless, it is essential to consider the more severe disorders such as bone tumors.

Neutrophil to lymphocyte ratio may be a predictive marker of poor prognosis in Legg-Calvé-Perthes disease

Background Legg-Calvé-Perthes disease (LCPD) is the idiopathic avascular necrosis of the femoral head in childhood. The pathologic changes seen in the femoral head are likely a result of vascular factors. Blood neutrophil to lymphocyte (N/L) ratio is a simple marker of subclinical inflammation. This study aims to to analyse the predictive ability of N/L ratio for the prognosis in LCPD patients. Methods Patients who had been diagnosed as LCPD from 2008 to 2014 were investigated retrospectively and 40 LCPD patients (33 male and 7 female) and 25 healthy age and sex-matched children (controls) were included in the study. LCPD patients were divided into 2 groups according to expected prognosis (good prognosis expected Herring A and B patients as Group I and poor prognosis expected Herring B-C and C patients as Group II) and healthy children (control) were included in Group III. All the patients’ hematological markers were analysed. Results Mean age was 7.1 ± 2.0 years in group I (4.9-12 years), 8.3 ± 2.2 years (4-12.5 years) in group II and 7.8 ± 1.3 years (6-12 years) in group III. Mean values for Groups I, II and III for neutrophil to lymphocyte (N/L) ratio were 1.13 ± 0.65, 1.75 ± 0.95, 1.08 ± 0.37, respectively. The mean neutrophil to lymphocyte (N/L) ratio of Group II was higher than the other 2 groups (p = 0.003). Conclusions N/L ratio may give us information about the natural course of LCPD and may be used as independent predictor of prognosis in patients with LCPD.

The inevitable outcome of chronic recurring actinomyces osteomyelitis of the hand.

A 50 year-old patient presented with pain, swelling, purulent discharge, multiple nodules, and deformity of his right hand (Figure 1). His symptoms had begun with pain and swelling without trauma 16 years ago. He had been diagnosed with chronic actinomyces osteomyelitis and underwent medical therapy and surgical debridement in four different incidents. He had been on antibiotics irregularly for 12 years. Deformity was evident, there was no active wrist movement; supination and pronation were severely restricted. Erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were elevated (Sed: 120 mm/h (0–20), CRP: 4.7 mg/dL (0–0.5)), but there was no leukocytosis. Chronic osteomyelitis of the distal forearm and hand on radiological examination. Anaerobic cultures of the pus were negative, whereas aerobic cultures yielded Staphylococcus aureus. Biopsy specimens from the nodules confirmed the previous diagnoses of chronic Actinomyces israelii. No additional diagnostic tests were necessary, and the patient underwent above elbow limb amputation. There were no complications following the surgery. A twelve month course of ampicillin/sulbactam was initiated. FIG. 1. Preoperative image Involvement of the upper extremities is very rare, and only case reports are present in the literature. So far, only 15 cases with actinomyces osteomyelitis of the hand are reported. Of these, 13 have involved metacarpals and phalanxes, and 2 have involved the carpal bones. (1–4) Our case is distinct from the literature as it is the only case with all of the bones distal to the mid-forearm involved. Typical presentation and radiographic examination may resemble tuberculosis, fungal infections or malignancies. Anaerobic culture and biopsy are necessary for definitive diagnosis (1, 2). It is not always possible to isolate the microorganism. Identification of yellow sulphur granules in histological specimens is pathognomic (1–4). Mah et al. have reported Actinomyces meyeri osteomyelitis in a 40 year-old patient in the fifth proximal phalanx. (2) Other cases in the literature are caused by Actinomyces israelii. In three of these cases, anaerobic cultures were negative (1–4). In our case, prolonged disease, poor patient compliance and failure to eradicate the pathogen resulted in a much worse clinical scenario. Carpal and metacarpal bones were completely destructed; the radius, ulna and phalanxes were severely affected by the ongoing infection. Anaerobic cultures were negative, whereas Staphylococcus aureus was isolated in aerobic cultures. Pulverer et al. reported that Staphyloccoci are usual concomitant pathogens of actinomyces. (5) Histological findings were similar to other cases in the literature and the causative agent was Actinomyces israelii. The treatment of actinomyces osteomyelitis incudes surgical debridement combined with a 6–12 month course of large doses of penicillin, ampicillin and sulphonamides (1–4). All of the cases but two in the literature have been successfully cured with this treatment (1–4). Amputation is indicated for recurring cases, despite adequate treatment. Kundu et al. amputated the hand of a 33 year-old patient at the wrist (4). We performed above-elbow amputation in our case, which did not cure the problem, despite 4 antibiotic therapies. A 12 month course of oral ampicillin/sulbactam therapy was initiated. Radical surgical intervention is inevitable in cases with recurring chronic actinomyces osteomyelitis. This paper presents the case with longest history of disease, largest soft tissue involvement and most radical surgical treatment.

Boyun Ağrısı ve Disabilite: Etkileyen Bir Etmen Olarak Göz Damlasını Kullanma Tekniği

©2014 Turkish League Against Rheumatism. All rights reserved. Objectives: This study aims to investigate a possible relationship between long standing eye drop usage and neck pain and to determine the optimal neck position while instilling the eye drop. Patients and methods: Sixty-seven patients who admitted to the ophthalmology outpatient clinic with the diagnosis of glaucoma and using eye drops for at least one year were included in the study as group 1 (n=31). The ages of the patients were between 18 to 80 years. A control group (group 2, n=36) was selected from age-matched individuals who did not use eye drops. The neck disability index form and a study form which included demographic data and the method of eye drop usage of patients were filled. Results: The mean age of the patients were 55.7±11.5 and 53.5±17.1 years for group 1 and group 2, respectively. There was no significant difference in the age and sex between the groups (p=0.526 and p=0.396, respectively). Compared to the controls, the chronic eye drop usage and its application method produced significant difference in neck disability index (p<0.001). Also, there was a positive correlation between neck disability index and number of eye drop usage per a day and period of eye drop usage (p=0.003 and p=0.004, respectively). Conclusion: Neck posture which is not placed in hyperextension position during administration of eye drop may reduce postural neck malpositionrelated neck disability. Patients who are on eye drop for a long time should be informed about postural disorders and instructed to correct the administration of eye drop technique to avoid neck pain.