Hüseyin Yorgancıgil

Paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE syndrome): a report of two cases and review of the literature

We report two cases of paraneoplastic remitting seronegative symmetrical synovitis with pitting edema (RS3PE) associated with prostatic adenocarcinoma. One of the patients was positive for Helicobacter pylori and the other had secondary bone metastases. In the latter, the clinical picture of RS3PE developed after surgical intervention for the primary lesion. On physical examination, while the hands and feet were swollen in the first patient, pitting edema was present only at the feet of the other. All joints of the affected hands and feet were painful. Serological tests including rheumatoid factor, antinuclear antibody, and human leukocyte antigen B27 were all negative. Response to low-dose corticosteroid treatment was delayed in the first patient, but the symptoms were relieved better in the second one.

Anterior cruciate ligament injuries: do affect surgical treatment with otograft and allograft options, clinical results ?

BACKGROUND We investigated the clinical outcome of anterior cruciate ligament (ACL) reconstructions with allograft or autograft. METHODS We retrospectively evaluated 82 patients who underwent arthroscopic ACL reconstruction with anterior tibial tendon (ATT) allograft (n = 52) or quadrupled hamstring tendon (QHT) autograft (n = 30). The patients were assessed using the IKDC (International Knee Documentation Committee) and Lysholm knee scores and functional (one leg hop) and laxity (pivot-shift, Lachman, anterior drawer) tests. RESULTS The two groups were similar with respect to age and sex distribution, operated side, preoperative period and associated injuries (p > 0.05). Results were satisfactory in both groups, but there was no statistically significant difference between the groups with respect to IKDC and Lysholm scores, functionality and ligament laxity (p > 0.05). However, effusions were more frequent in the QHT group compared to the ATT group. CONCLUSION Our results suggest that differences in graft options for ACL reconstruction have no effect on the clinical outcome. Allografts with to-be-developed solutions to immune response may be a good alternative in ACL reconstruction.

Kalça kırığı ve koksartrozda piyüri

Accompanying systemic pathologies and other risk factors can be found in the most elderly patients who treated for hip fracture or coxarthrosis. All of these can cause urinary tract infection and colonization of bacteria in the urinary tract. Pyuria and urinary tract infection could pose a risk after the orthopedic implant surgery and is a frightening complication of surgical site wound infection. In this study, we investigated that the relationship between preoperative pyuria and postoperative surgical site infections, affect the risk factors in patients who underwent hip implant surgery or hip arthroplasty because of hip fracture or coxarthrosis. The period between 1994-2008, 563 patients with at least one year follow-up records were reviewed retrospectively. Working group was comprised of 38 cases detected preoperative pyuria (urine microscopy >10 white blood cell/field), the 62 patients that were randomly selected among the rest of 525 patients constituted the control group. Groups of age, gender, etiology, fever, hemoglobin, sedimentation rate, Creactive protein, white blood cell, albumin, preoperative period of time, diabetes, co-morbidities, urine culture in terms of reproductive and post-operative surgical site infection were compared. In the study group, blood albumin level was lower than the control group. In addition, the preoperative period and postoperative surgical site infection, urine culture positivity were higher than the control group. There was statistical difference between groups (p0.05). The results of this study, preoperative length of time, culture positivity and low level of albumin show significant risk factors for postoperative surgical site infection. In addition to the preoperative symptomatic urinary tract infection seems associated with surgical wound infection after surgery. Orthopedic surgery can be delayed until the preoperative treatment of symptomatic urinary tract infection, however we think that there is no correlation between preoperative asymptomatic pyuria and postoperative surgical site infection. And it is not necessary to delay orthopedic surgery in patients with asymptomatic pyuria.

Is Scintigraphy a Guideline Method in Determining Amputation Levels in Diabetic Foot

BACKGROUND In this study, we aimed to evaluate the potential use of a 3-phase bone scintigraphy method to determine the level of amputation on treatment cost, morbidity and mortality, reamputation rates, and the duration of hospitalization in diabetic foot. METHODS Thirty patients who were admitted to our clinic between September 2008 and July 2009, with diabetic foot were included. All patients were evaluated according to age, gender, diabetes duration, 3-phase bone scintigraphy, Doppler ultrasound, amputation/reamputation levels, and hospitalization periods. Patients underwent 3-phase bone scintigraphy using technetium-99m methylene diphosphonate, and the most distal site of the region displaying perfusion during the perfusion and early blood flow phase was marked as the amputation level. Amputation level was determined by 3-phase bone scintigraphy, Doppler ultrasound, and inspection of the infection-free clear region during surgery. RESULTS The amputation levels of the patients were as follows: finger in six (20%), ray amputation in five (16.6%), transmetatarsal in one (3.3%), Lisfranc in two (6.6%), Chopart in seven (23.3%), Syme in one (3.3%), below-the-knee in six (20%), above the knee in one (3.3%), knee disarticulation in one (3.3%), and two patients underwent amputation at other centers. After primary amputation, reamputation was performed on seven patients, and one patient was treated with debridement for wound site problems. No mortality was encountered during study. CONCLUSIONS We conclude that 3-phase bone scintigraphy prior to surgery could be a useful method to determine the amputation level in a diabetic foot. We conclude that further, comparative, more comprehensive, long-term, and controlled studies are required.

The effect of different intraarticular drug applications to the antioxidation system and lipid peroxidation in gonarthrosis

Oksidatif stres ve lipid peroksidayonu diz osteartrinin (gonartroz) patogenizinde rol oynayabilir. Bu calismada, osteoartritli dizlerde lipid peroksidasyonu ve antioksidan savunma sisteminin hastalik mekanizmasindaki rolu ve farkli eklem ici tedavilerin lipid peroksiyonu ve antioksidan enzim aktivitesi uzerine etkilerini arastirdik. Amerikan Romatoloji Koleji olcutlerine gore gonartroz tanisi alan 75 hasta rastgele esit 5 gruba ayrildi. Birinci gruba sadece eklem ici serum fizyolojik verilerek kontrol grubu kabul edildi. Ikinci gruba yuksek molekul agirlikli hyaluronik asit (HA, hylan G-F 20) eklem ici haftada bir uc kez uygulandi. Ucuncu gruba metil prednizolon asetat bir kez eklem ici verildi. Dorduncu gruba dusuk molekul agirlikli HA, hyaluronan eklem ici haftada bir bes kez uygulandi. Besinci gruba tenoksikam bir kez eklem ici verildi. Eklem sivisi ve hemolizatta serbest radikallerin lipid peroksidasyon urunu malondialdehit (MDA) ve antioksidan enzimler; superoksit dismutaz (SOD), katalaz (CAT), glutatyon peroksidaz (GSH-Px) duzeyleri tedavi oncesi ve sonrasinda olculerek karsilastirildi. Farkli eklem ici uygulamalarla tedavi sonrasi her bir grupta sinovial sividaki MDA duzeylerinin kontrol grubuna gore anlamli duzeyde azaldigi tespit edildi. Hemolizat MDA, SOD, GSH-Px ve CAT seviyelerinde tedavi oncesine gore anlamli fark gozlenmedi. Sinoviyal sivida CAT aktivitesine rastlanmadi. Sinoviyal sividaki SOD ve GSH-Px aktivitelerinde tedavi oncesine gore artis goruldu fakat bu artis istatistiksel olarak anlamli degildi. Gonartroz tedavisinde farkli eklem ici uygulamalar sinoviyal sivida lipid peroksidasyonunu azaltabilir. Gelecekte, gonartrozda tedavinin etkinligini degerlendirmede klinik olcutlere ek olarak MDA gibi biyokimyasal olcumlerin de rutin olarak kullanilabilmesine yonelik daha ileri arastirmalar yapilabilir.

Kas İskelet Tümörleri Tanı ve Tedaviye Genel Bir Bakış

Suleyman Demirel Universitesi TIP FAKULTESI DERGISI: 1995 Mart; 2(1) Huseyin Yorgancigil Remzi Arif Ozerdemoglu Ozet