Gürdal Nusran

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.

Effect of systemic carnitine therapy on serum fibronectin level in diabetic rats

BACKGROUND L-carnitine has been shown to enhance wound healing. There has, however, not been sufficient research on the effect carnitine has on diabetic wound healing. We investigated the relationship between the viability of full thickness skin grafts (FTSGs) and fibronectin (FN) serum levels in diabetic rats that were administered carnitine. MATERIALS AND METHODS A total of 40 rats were divided into four groups of 10 rats each and operated on. The FTSG model was 10 × 3 cm, with the dorsal flap extending from the tip of the scapula to the hip joint. After surgery, group 1 (nondiabetic control, n = 10) and group 2 (diabetic control, n = 10) were given a sterile saline solution at 0.9% with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. Group 3 (diabetic sham, n = 10) contained diabetic rats and did not receive any agent after the surgery. The diabetic rats in group 4 (carnitine study diabetic, n = 10) were given carnitine with a dose of 100 mg/kg/d intraperitoneally for 7 d after the surgery. RESULTS The percentages of viable areas in groups 1-4 were 70.38 ± 6.10%, 62.66 ± 1.55%, 62.59 ± 2.94%, and 73.48 ± 4.43%, respectively. The mean levels of FN, measured in milligram per deciliter, in groups-4 were 23.57 ± 3.27 mg/dL, 21.58 ± 2.35 mg/dL, 22.04 ± 2.71 mg/dL, and 27.11 ± 2.79 mg/dL, respectively. Furthermore, we found that there was a strong positive correlation (R = 0.509; P = 0.001) between FN and the viability of the FTSG. CONCLUSIONS We demonstrated that administering carnitine leads to an increase in diabetic wound healing. Further increasing the levels of the FN serum might have a role in this process.

The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor.

PURPOSE To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. METHODS Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness from 3 locations and meniscus injury were assessed by two specialist radiologists. RESULTS Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P = 0.033). CONCLUSIONS An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process.

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.

The Effect of Intraoperative Sounds of Saw and Hammer on Psychological Condition in Patients with Total Knee Arthroplasty: Prospective Randomized Study

Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures. Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patients mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed.

Relationship between serum fibronectin levels and carnitine administration: an experimental study in rats

We aimed to investigate the relationship between dorsal flap viability and serum fibronectin levels in carnitine‐administered rats. A total of 24 rats were equally divided into three groups and operated on. Group 1 (sham group n = 8): following surgery, no agent was given. Group 2 (control group, n = 8): following surgery, sterile saline solution at 0·9% with a dose of 100 mg/kg per day for 7 days was administered intraperitoneally. Group 3 (study group, n = 8): following surgery, carnitine with a dose of 100 mg/kg per day for 7 days was administered intraperitoneally. The flap model used was a 10 × 3 cm dorsal flap extending from the tip of the scapula to the hip joint. This was elevated, and then sutured back to its original site. At the end of postoperative day 8, the animals were anaesthetised and blood samples were collected from intracardiac space. Then, the animals were euthanised. Flap viability was then evaluated measuring the surviving area, using a transparent graph paper. Finally, excised tissue was examined histopathologically. The percentages of viable areas in groups 1, 2 and 3 were 64·68 ± 3·37%, 67·35 ± 5·82% and 75·15 ± 3·56%, respectively. The mean value of fibronectin levels in groups 1, 2 and 3 were 22·3 ± 3·5, 23·1 ± 3·5 and 31 ± 6·8 mg/dl, respectively. The results of this study demonstrated that 100 mg/kg carnitine administration led to an increase in flap viability, and increased serum fibronectin levels might have a role in this process.