Erdem Aktaş

Serum and knee synovial fluid matrixmetalloproteinase-13 and tumor necrosis factor-alpha levels in patients with late stage osteoarthritis

Objective To compare the levels of MMP-13 and TNF-α in late stage osteoarthritis, define their predominant pathways and investigate their correlation with McMaster Universities Arthritis Index scores. Patients and methods A total of 42 patients (mean age 64 ± 8.8) with grade 3 and grade 4 knee osteoarthritis according to Kellegren- Lawrence criteria and who were scheduled for total knee arthroplasty were enrolled in the study. TNF-alpha and MMP-13 levels were measured preoperatively from venous blood samples and intraoperatively from knee synovial fluid via ELISA. Preoperative and 1 month postoperative knee functions were assessed by McMaster Universities Arthritis Index. Results Grade 4 synovial fluid MMP-13 (4.76 ± 5.82) was elevated compared to grade 3 (3.95 ± 4.45) (p = 0.438), whereas grade 3 serum MMP-13 (1.128 ± 0.308) was found elevated compared to grade 4 (1.038 ± 0.204) (p = 0.430). Grade 4 serum TNF-α (0.253 ± 0.277) was elevated compared to grade 3 (0.206 ± 0.219) whereas grade 3 synovial fluid TNF-α (0.129 ± 0.052) was elevated compared to grade 4 (0.118 ± 0.014). Positive correlation was observed between synovial fluid MMP-13 levels and postoperative WOMAC scores. Mean serum TNF-α level (0.226 ± 0.246 pg/ml) was found higher compared to synovial level (0.124 ± 1.59), synovial MMP-13 level (4.31 ± 1.24) was found higher compared to serum level (1.089 ± 1.519). Conclusion Despite the systemic increase in TNF-α levels concordant with osteoarthritis grade, MMP-13 levels are elevated via local manner with a significant correlation with WOMAC scores. Level of evidence Level IV, Diagnostic study.

Brucellosis Suspicion is the Most Important Criterion for Diagnosis Particularly in Endemic Regions.

Introduction: Brucellosis is a zoonotic infectious disease that remains endemic in developing countries. The purpose of this study is to emphasize the need for considering brucellosis as a diagnosis, since this disease has a high risk of complications among young patients when not treated appropriately. Methodology: A total of 88 brucellosis cases with blood cultures that were positive for the pathogen were evaluated retrospectively in this study. Results: The patients included 33 males (37.5%) and 55 females (62.5%) with a median age of 8.9 years (range: 5-14 years). A total of 43.1% (n=38) of the cases included occupational exposure to animals as a possible infection source. The consumption of raw milk products, especially cheese, was present in 52.2% (n=46) of the cases. Clinically, 55 of the cases were acute (62.5%), 23 of the cases were subacute (26.2%) and 10 of the cases were chronic (11.3%). The distribution of the joint pain complaints was as follows: 62.5% (n=55) of patients reported hip pain, 22.7% (n=20) of patients reported knee pain, 11.4% (n=10) of patients reported lumbar-back pain and 3.4% (n=3) of patients reported pain in other joints. A total of 59.1% (n=52) of the cases had been examined by another doctor at least once and mistreated. Conclusion: Complication rates and the rate of chronic infection increase with delayed diagnosis, and clinical doubt is the most important criterion for diagnosis, particularly in endemic regions.

Comparison of multimodal intraoperative neurophysiological monitoring efficacy in early childhood and school aged children undergoing spinal surgery

Objective The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age. Methods 43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded and evaluated at specific time points for each patient. Results Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There was no false-negative whereas 9 false positive recordings due to physiological conditions that all recovered intraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosis component. The tcMEPs fully recovered by the end of the operation except for the patient with post-tuberculosis kyphosis. There was no statistically significant difference in the mean threshold values with regard to transcranial stimulus intensity for the tcMEPs between the two groups. Conclusion Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM is effective for early childhood patients undergoing spinal surgery. Level of evidence Level III, Diagnostic Study.

Spinal Cord and Intervertebral Disc

The spinal cord is a part of the central nervous system (CNS) that extends longitudinally with its surrounding meninges within the vertebral canal down to the space between the first and second lumbar vertebrae. Its morphology is a tubular cord made up of nervous tissue and support cells. Cord includes 31 segments (12 thoracic segments, 5 lumbar segments, 5 sacral segments, and 1 coccygeal segment), which gives 31 pair of spinal nerves to the trunk and limb. It controls the voluntary muscles of the limbs and trunk, receives sensory information from these regions, and controls the viscera and blood vessels of the thorax, abdomen, and pelvis.

Konjenital El Deformitelerinden; Sindaktilide Güncel Sınıflamalar ve Bir Olgu Sunumu

Sindaktili; 2000 canli dogumda bir gorulme orani ile konjential el deformiteleri icerisinde en sik rastlanilan ve literaturde tanimlanma zamani eski Yunan hekimlerine kadar uzanan, ancak klinik prezentasyon olarak pek cok farkli sekli bulunmasi nedeniyle siniflamalarda uzlasma saglanamamis bir deformitedir.Farkli klinik prezentasyonlar ve eslik eden diger durumlar nedeni ile 2012 yilinda sendromik olmayan sindaktili tipleri fenotipik ozellikleri de goz onunde bulundurularak 9 farkli tip ve subtipler olarak yeni bir siniflama ile literature dahil edilmistir.Vaka sunumumuzdaki 48 yasindaki ailesel sindaktili oykusu bulunmayan kadin hastamiz, tipik olan 4. parmak hipoplazisi bulunmamasi ve 5. parmak orta falanks ve distal falanks uzerinde 2 adet canli tirnak bulunmasi ile literaturde nadir gorulen bir prezentasyon ile cikmistir.Vaka planlamasi icin yapilan dijital anjiografide tum vaskuler yapilar dogal olarak izlenmistir. Distalde yeterince veb dokusu bulunan olgumuzda; Yao ve arklarinin tanimladigi yontemle subkutan pedikul uzerinde, V insizyonla cilt kaldirilarak komisur olusturuldu. Cerrahi sonrasi, yara yeri ve dolasim problemi gorulmeyen hastanin; 1 yillik takibinde ek sorun gozlenmedi.