Erbil Oguz

A new classification and guide for surgical treatment of spinal tuberculosis

So far, there is no widely accepted classification system based on objective findings that can serve as a guide in selecting the treatment method for spinal tuberculosis. This retrospective study evaluates patients with spinal tuberculosis (Pott’s disease) treated with different surgical procedures. Our aim was to outline a new classification of spinal tuberculosis. A retrospective review of 76 cases (55 male and 25 female patients) of spinal tuberculosis was conducted. Five of the patients were treated medically, and the others who were treated surgically were classified into three types (I, II and III) according to the new classification system for spinal tuberculosis. All 76 patients were classifiable by this new system. The most common complication observed was local kyphosis (maximum 8 degrees) in type-II patients, but none of the patients needed correction. No neurological deterioration was observed in any of the cases. This new classification system helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis. We believe that this new classification system can be used as a practical guide in the treatment of Pott’s disease.RésuméIl n’y a pas de système permettant de classer de façon objective les méthodes de traitement de la tuberculose osseuse. Cette étude rétrospective évalue les patients présentant une maladie de Pott, traités avec différentes techniques dans le but avoué de mettre en évidence une nouvelle classification de cette pathologie. Une étude rétrospective de 76 cas (55 hommes et 25 femmes) de tuberculose osseuse a été réalisée. Cinq patients ont été traités médicalement, les autres chirurgicalement en les classant en trois types A, B et C, selon la nouvelle classification. Les 76 patients ont été classés avec ce nouveau système. La complication la plus habituelle observée a été la cyphose locale (max. 8°) dans les types II. Mais il n’a pas été nécessaire chez ces patients de réaliser une correction chirurgicale. Nous n’avons observé aucune détérioration sur le plan neurologique. Cette nouvelle classification permet de différencier les différentes manifestations de la tuberculose osseuse et permet de faire une corrélation avec le traitement chirurgical. Nous espérons qu’elle pourra être utilisée et réaliser ainsi un guide pratique du traitement du mal de Pott.

The role of preconditioning and N-acetylcysteine on oxidative stress resulting from tourniquet-induced ischemia-reperfusion in arthroscopic knee surgery.

BACKGROUND The aim of this study was to investigate the effects of ischemic preconditioning (IPC) and N-acetylcysteine (NAC) on oxidative stress resulting from tourniquet-induced ischemia-reperfusion (IR) period in arthroscopic knee surgery. METHODS Forty-five patients who had arthroscopic knee surgery for meniscal and chondral lesions and for pathologic medial plica were included in this study. They were assigned to the following treatment groups: control (group C; n=15), IPC (group P; n=15), and NAC (group N; n=15). Subjects in the control group underwent routine surgical procedures. Subjects in the preconditioning group were subjected to temporary ischemia, with tourniquet performed by three compression cycles of 5 minutes followed by 5 minutes of reperfusion just before the application of tourniquet inflation. Subjects in the NAC group received 10 mg/kg NAC dissolved in 100 mL 0.9% normal saline intravenously 30 minutes before tourniquet inflation. An hour before the tourniquet was applied (preischemia) and 2 hours after tourniquet was removed (reperfusion), blood samples (to test for metabolites) were obtained. Levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), total antioxidant capacity (TAC), and total oxidant status (TOS) were measured in all serum samples. Results were compared between preischemia and reperfusion in three groups. RESULTS MDA in the control group was found to be increased significantly compared with preischemia, whereas MDA in IPC and NAC groups did not change insignificantly. SOD and GSH activities in the control group were found to be increased significantly, whereas SOD and GSH activities in IPC and NAC groups did not change significantly after reperfusion. TAC in the control group was found to be decreased and TOS was found to be increased significantly, but TAC and TOS in IPC and NAC groups were not significantly different after reperfusion. Mean serum MDA, TOS, SOD, and GSH-Px levels were lower in group P than group C at reperfusion period (p<0.05). Mean serum SOD levels were lower in group P than group N at reperfusion period (p<0.05). CONCLUSIONS Tourniquet-induced IR period in routine arthroscopic knee surgery resulted in oxidative stress by increasing MDA, SOD, GSH-Px, TOS and decreasing TAC. NAC and IPC had protective effect on occurrence of oxidative stress resulting from IR period by preventing MDA, SOD, GSH-Px, TAC, and TOS changes in routine arthroscopic knee surgery.

Coccygectomy with or without periosteal resection

The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent coccygectomy. Resection of all mobile coccygeal segments including the periosteum was performed in 11 patients (group 1) and resection was performed subperiostally sparing the periosteum in the remaining 14 patients (group 2). A visual analogue scale was used for pain assessment before and after the surgery both in sitting and standing positions. A questionnaire to evaluate subjective patient satisfaction was also used. The two groups were statistically similar in terms of age, sex, aetiology, duration of symptoms before surgery and follow-up time. Both surgical techniques resulted in a statistically similar clinical outcome. Overall, 84% of patients who underwent coccygectomy benefited from surgery. We observed four wound infections (two superficial and two deep) that caused delayed wound healing in group 1. The rate of infection in group 1 was statistically higher than in group 2. The results of this study suggest that periosteal preservation and closure are related to low risk of infection.

Effect of Preconditioned Hyperbaric Oxygen and Ozone on Ischemia-Reperfusion Induced Tourniquet in Skeletal Bone of Rats

BACKGROUND The aim of the study was to investigate effect of I/R injury on bone tissue and protective role of hyperbaric oxygen precondition (HBO-PC) and ozone precondition (O(3)-PC) on I/R injury by using biochemical analysis. MATERIALS AND METHODS Thirty-two rats were included in study. The animals were divided into four equal groups: sham operation, I/R, I/R+HBO and I/R+O(3). One session of 60 min, 3 ATA, 3-4 L/min, 100% oxygenation was defined as one dose of HBO. First dose of HBO was administrated 72 h before ischemia. Subsequent, one-dose of HBO administrated per 12 hours until ischemia time (total seven doses); 0.7 mg/kg ozone/oxygen mixture intraperitoneally was defined as one dose of ozone. First dose of O(3) was administered 72 h before ischemia (total four doses). I/R model was induced in anesthetized rats by unilateral (right) femoral artery clipping for 2 h followed by 22 h of reperfusion. The right tibia and were harvested. Tissue was assayed for levels of malondialdehyde (MDA) and protein carbonyl (PCO), activities of superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). RESULTS MDA and PCO levels were increased in I/R group. SOD activity was increased; GSH-Px activity was decreased in I/R group. MDA and PCO levels were decreased, SOD and GSH-Px activities were increased in both HBO+I/R and O(3)+I/R groups. CONCLUSION It has been shown that levels of MDA and PCO in bone were increased followed by 2 h of ischemia and 22 h of reperfusion period. Ozone-PC and HBO-PC has protective effect against skeletal bone I/R injury by decreasing levels of MDA and PCO, increasing activities of SOD and GSH-Px in rats.

Ankle swelling in a 6-year-old boy with unusual presentation: Report of a rare case☆☆☆★★★♢♢♢♦

A 6-year-old boy with a history of pain and swelling in the right ankle was referred to our medical center. A cascading algorithm helped us to better evaluate this case of an osteochondroma of talus. The diagnosis was based on clinical and radiologic findings and on histopathologic analysis of the excised tissue. Although osteochondroma, or osteocartilaginous exostosis, is a common skeletal neoplasm, it is rarely seen in the foot. The rare location, a young age group, and an inexperienced surgeon may make the diagnosis confusing. We presented a case that shows the importance of an orderly evaluation of a musculoskeletal neoplasm. This may be helpful for the physician to better understand the clinical implications of any case before attempting a surgical intervention.

Evaluation and Comparison of the Effects of Hyperbaric Oxygen and Ozonized Oxygen as Adjuvant Treatments in an Experimental Osteomyelitis Model

BACKGROUND We evaluated and compared the efficacy of ozone (O(3)) and hyperbaric oxygen (HBO) therapies in an experimental rat model of osteomyelitis. MATERIALS AND METHODS Forty-eight male Sprague-Dawley rats were divided into sham, osteomyelitis (control), vancomycin (V), vancomycin + HBO (VHB), vancomycin + O(3) (VO), and vancomycin + HBO + O(3) (VOHB) groups. Osteomyelitis was induced by a bone injection of 10(8) CFU/mL methicillin-resistant Staphylococcus aureus. HBO was administered daily at 2.8-atm pressure for 90 min; O(3) therapy was provided as intraperitoneal injections of 0.7 mg/kg O(3)/O(2) gas mixture once daily. Treatments were continued from d 7 to 21 after induction of osteomyelitis. Bone tissues and blood samples were harvested for biochemical, histopathologic, and microbiologic analyses. RESULTS Rats in the sham, VO, and VOHB groups gained weight but those in the control, V, and VHB groups did not. Levels of malondialdehyde, superoxide dismutase, and glutathione peroxidase were lower in the VHB, VO, and VOHB groups than in V and control groups. Levels of interleukin-10 and -1β and tumor necrosis factor-α were decreased in the VHB, VO, and VOHB groups; transforming growth factor-β was increased in these groups compared with V and control groups (P ≤ 0.001). Bacteria counts in VOHB were significantly lower than those in group of V (P = 0.012). Histopathologic scores in group VO were significantly lower than those in group V (P = 0.046). CONCLUSIONS O(3) was as effective as HBO in decreasing oxidative parameters and inflammatory cytokines. Rats in the VO and VOHB groups gained more weight than did the other groups. Bacteria counts were significantly decreased in group VOHB compared with the other groups. Histopathologic scores in group VO were significantly decreased compared with the other groups.

Does false aneurysm behave like a sarcoma? Distal femoral arterial false aneurysm simulated a malign mesenchymal tumor

We report a case of a pseudo-aneurysm of the distal femoral artery presenting as a malignant mesenchymal tumor with insidious onset, progressive symptoms, large volume mass, and atypical radiological findings.

Benign fibrous histiocytoma of the lumbar vertebrae

Benign fibrous histiocytoma is an extremely rare spinal tumor with ten reported cases in the literature. Benign fibrous histiocytoma constitutes a diagnostic challenge because it shares common clinical symptoms, radiological characteristics, and histological features with other benign lesions involving the spine. We present a case of benign fibrous histiocytoma of the lumbar spine and discuss its differential diagnosis and management.

Anterosuperior calcaneal process fracture or OS calcaneus secundarius

A 36-yr-old woman was admitted to our emergency department after having sustained an inversion injury of her right ankle. On physical examination, there was diffuse swelling and ecchymosis on the dorsolateral aspect of her foot. The ankle joint movements were in normal range without laxity. The anteroposterior and lateral x-rays of the right foot were considered to be normal by the emergency physician. The patient was diagnosed with simple ankle sprain and was treated accordingly with classical RICE protocol and a nonsteroidal antiinflammatory drug. Four weeks after the initial trauma, the patient presented to our orthopedic outpatient clinic with persistent complaint of right foot pain on weight bearing. On physical examination, severe pain on the dorsal part of the calcaneocuboid joint was present. The initial anteroposterior and lateral x-rays were reevaluated, and a fracture was suspected at the anterior calcaneal process (Fig. 1A). Medial oblique foot x-ray revealed a bony fragment located between the anterosuperior calcaneal process and the cuboid (Fig. 1B). In the differential diagnosis, anterosuperior calcaneal process fracture and OS calcaneus secundarius were considered. Further computed tomography imaging delineated the anatomy of the fragment better, while the ovoid shape, well corticated margins, regular interface, and blunt edges of the fragment supported the diagnosis of OS calcaneus secundarius, wide proximal base and considerably large size favored the anterosuperior calcaneal process fracture. Magnetic resonance imaging was eventually performed and, with the presence of bone marrow edema adjacent to the fracture line, an anterosuperior calcaneal process fracture rather than an OS calcaneus secundarius was confirmed at diagnosis (Fig. 2). She was treated with a medial longitudinal arc support, and after 1 mo, she was free of pain during mobilization. OS calcaneus secundarius and anterosuperior calcaneal process fractures are two similar clinical syndromes, both of which present with anterior ankle pain. The differentiation of these two entities may be quite challenging only with physical examination or classical x-rays. Herewith, we imply that the distinction may be possible when oblique x-rays or, even better, magnetic resonance imaging is performed. This is important because the treatment of each syndrome is different.

Fluoroscopy for transpedicular screw placement in scoliosis: to what extent can radiation exposure be reduced by the freehand technique?

AIM In spinal surgery, high doses of radiation are delivered during surgical procedures that require fluoroscopic control. The aim of this study was to determine the amount of radiation delivered from the fluoroscopic unit and also the factors to reduce the amount of radiation during the surgery of adolescent idiopathic scoliosis patients. MATERIAL AND METHODS In this retrospective study 21 patients with adolescent idiopathic scoliosis treated by transpedicular screws between 2009 and 2012 were enrolled the study. Dose Area Product (DAP) values , number of views obtained during screw placement and other data were retrieved from the medical records of the patients. RESULTS The mean number of transpedicular screws used was 18. An average of 10,1 vertebrae were instrumented. The mean number of images obtained was 7.76. Mean fluoroscopy time was 7.95 seconds. The total mean DAP was 64.6 cGy.cm < sup > 2 < /sup > . CONCLUSION The amount of ionizing radiation transmitted to the patient and the surgical team can be reduced by freehand insertion, confirmation of screw position by AP and lateral fluoroscopic views including more than one segment, the use of K-wires as a guide in spinal segments with abnormal pedicular anatomy and neuromonitorization of the patient during the surgical correction of adolescent idiopathic scoliosis.