Ugur E. Isikan

Synovial fluid and plasma selenium, copper, zinc, and iron concentrations in patients with rheumatoid arthritis and osteoarthritis

In recent years, a great number of studies have investigated the possible role of trace elements in the etiology and pathogenesis of rheumatoid arthritis (RA) and osteoartritis (OA). We studied synovial fluid and plasma concentrations of selenium (Se), zinc (Zn), copper (Cu), and iron (Fe) in patients with RA and OA and compared them with sex- and age-matched healthy subjects. Plasma albumin levels were measured as an index of nutritional status. Plasma Se, Cu, and Zn concentrations were determined by atomic absorption spectrophotometry and Fe concentrations were determined by the colorimetric method. Although plasma and synovial fluid Se concentration were found to be significantly lower (p<0.05, and p<0.05, respectively), Cu concentrations were significantly higher in patients with RA than those of healthy subjects and OA (p<0.05 and p<0.05, respectively). There were no significant differences in plasma and synovial fluid Zn concentrations and albumin levels among three groups (p>0.05). On the other hand, synovial fluid Cu and Fe concentrations were significantly higher in patients with OA than those of healthy subjects (p<0.05). There was a significantly positive correlation between synovial fluid Se−Cu values and Zn−Fe values in patients with RA. Our results showed that synovial fluid and plasma trace element concentrations, excluding Zn, change in inflammatory RA, but not in OA. These alterations in trace element concentrations in inflammatory Ra might be a result on the changes of the immunoregulatory cytokines.

Free nerve endings and morphological features of the ligamentum capitis femoris in developmental dysplasia of the hip.

A conflict exists on whether the ligamentum capitis femoris has the neuro-morphological structures required for nociception or proprioception of the hip joint. Therefore, we investigated the morphological features and the presence of mechanoreceptors in 24 ligamentum capitis femoris biopsies obtained at open reduction in patients with developmental dysplasia of the hip. Of these 24 hips, 16 were completely dislocated and eight were subluxated. The mean age was 33.8 months (range 13–52 months) at the time of surgery. En bloc ligamentum capitis femoris and pulvinar were taken for biopsy specimen. Ligamentum capitis femoris was dissected and the weight of each ligament was determined using a highly sensitive balance. Specimens were stained with hematoxylin and eosin and Masson trichrome for routine histolopathological evaluation and examined immunohistochemically using monoclonal antibody against S-100 protein. All specimens were graded on a four-grade system according to the amount of coarse-thick collagen bundles and hyalinization. The mean number and type of mechanoreceptors of each specimen were recorded. When the mean age, the patients weight and the ligamentum capitis femoris weight of each group (completely dislocated vs. subluxated) were compared, there were no significant differences. In the ligamentum capitis femoris of the dislocated hips, the cells were irregularly distributed, had different shapes, and appeared to be in different stages of functional activity. The collagen fiber bundles were thicker than in the subluxated hips, distributed and of varied thickness. The elastic fibers of the dislocated hips were thicker and more numerous than those in the subluxated hips. We found a significant difference between the two groups with regard to the grade of collagen and hyalinization of ligamentum capitis femoris (P<0.004). We found type IVa, free nerve endings in 16 of 24 samples of ligamentum capitis femoris. The 66.6% presence of free nerve endings in the ligamentum capitis femoris suggests a role in nociception/proprioception of the hip in developmental dysplasia of the hip. Interestingly, the percentage and the mean numbers of free nerve endings containing ligamentum capitis femoris were similar in completely dislocated hip group and the subluxated group (62.5 vs. 75%, 12.13±9.07 vs. 9.37±9.24, respectively). We conclude that the morphological features of ligamentum capitis femoris are influenced by the severity of developmental dysplasia of the hip, whereas the distribution of free nerve endings are not influenced.

Patellar denervation in total knee arthroplasty without patellar resurfacing: A prospective, randomized controlled study

BACKGROUND Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years. HYPOTHESIS Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing. PATIENTS AND METHODS Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain. RESULTS Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group. DISCUSSION Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing. LEVEL OF EVIDENCE Level II: low-powered prospective randomized trial.

Anteversion of the acetabulum and femoral neck in early walking age patients with developmental dysplasia of the hip.

Computed tomography measurements were made to quantify the relationship between the anteversion of the acetabulum and femoral neck in 27 early walking age patients (age range; 18–48 months) with developmental dysplasia of the hip. The centre–edge angle and acetabular index were measured in standard pelvis radiographs, and anteversion of acetabulum and femoral neck were measured by use of two-dimensional computed tomography in 25 complete dislocated, 19 subluxated and 10 unaffected hips (a total of 54 hips). The diagnosis of dysplasia, subluxation and complete dislocation of developmental hip dysplasia were determined radiographically using Ishidas criteria. There were statistically significant differences between the three groups for the centre–edge angle, the acetabular index, and acetabulum anteversion. There was no statistically significant difference between the three groups for femoral neck anteversion. The acetabular anteversion was found to be 13.4±2.8° (mean±SD) in unaffected hips, 16.7±1.9° in subluxated hips and 19.8±2.5° in complete dislocated hips. There was statistically significant difference between the three groups, with a wide range of acetabular anteversion values noted in all groups (9–26°). The acetabular anteversion was increased on the dislocated side in each patient and we found no retroverted acetabulum. On the other hand there was no significant difference between the groups with regards to femoral neck anteversion. We conclude that confirming anteversion of the acetabulum and the femoral neck by two-dimensional computed tomography is needed in treatment planning of early walking age patients with developmental hip dysplasia.

Relationship between synovial fluid and plasma manganese, arginase, and nitric oxide in patients with rheumatoid arthritis.

Nitric oxide (NO) participates in the pathogenesis of inflammatory reactions in many autoimmune diseases such as rheumatoid arthritis (RA). There is a reciprocal pathway between arginase and nitric oxide synthese (NOS) for NO production, and Mn is required for arginase activity and stability. To investigate whether NO production related with the arginine-nitric oxide pathway in patients with RA, we measured synovial fluid and plasma nitrite (NOx) levels, arginase activities, and its cofactor manganese (Mn) concentrations in 21 RA patients and 13 healthy control subjects. Plasma albumin levels were measured as an index of nutritional status. NOx levels were determined after the reduction of nitrates to nitrites using the Griess reaction. Whereas, synovial fluid arginase activities and Mn levels were found to be significantly lower (p<0.001, p<0.001, respectively), plasma arginase activities and Mn levels were similar in patients with RA when compared to the control subjects. Plasma and synovial fluid NO levels were similar in patients with RA and in healthy subjects (p>0.05, p>0.05, respectively). There were significantly positive correlations between synovial fluid and plasma arginase activities vs Mn content (r=0.543, p=0.011; r=0.516, p=0.017, respectively) and significantly negative correlations between synovial fluid and plasma NO levels vs arginase activities (r=−0.497, p=0.022; r=−0.508, p=0.019 respectively) in the patients group. Our results indicate that the lower concentration of synovial fluid Mn could cause lower arginase activity and this could also upregulate NO production by increasing L-arginine content in patients with RA.

A radiological comparison of Salter and Pemberton osteotomies to improve acetabular deformations in developmental dysplasia of the hip.

We investigated whether the following acetabular scores influence operative outcomes in patients with developmental dysplasia of the hip who underwent Salter innominate osteotomy (SIO) or Pemberton osteotomy (PO): the acetabular depth ratio (ADR), the acetabular index, the center-edge (CE) angle of Wiberg, and the femoral head migration rate (Reimer’s index). A total of 47 hips were treated with SIO and 50 hips were treated with PO. Changes in ADR were greater in children who underwent PO compared with those who underwent SIO. However, the acetabular index, the center-edge angle, and Reimer’s index did not differ between the groups at final follow-up. Children who underwent PO achieved an improved radiological ADR compared with those who underwent SIO on an average follow-up of 5 years after innominate osteotomy.

De Quervain's disease treatment using partial resection of the extensor retinaculum: A short-term results survey

BACKGROUND Several operative methods have been described for de Quervains disease, but no definite consensus has emerged in the literature. Sometimes simple release of the extensor retinaculum can cause incomplete relief, whereas re-adhesion and excessive excision of the extensor retinaculum can cause volar subluxation of the abductor pollicis longus and extensor pollicis brevis tendons. In this prospective study, we evaluated the early results of operative treatment with one-quarter partial resection of the extensor retinaculum when conservative methods have failed. HYPOTHESIS We hypothesized that partial removal of the extensor retinaculum may be used as an alternative to solve problems such as incomplete release or re-adhesion and volar subluxation of the tendons. PATIENTS AND METHODS Thirty-four patients (36 hands; 30 females and four males; mean age: 48.2 years; range: 20 to 75 years) with de Quervains disease were surgically treated. The surgical procedure was performed under local infiltration anesthesia. One-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist was performed. During the clinical follow-up period, treatment results, a patient-based scoring system and visual analogue scale were used. The mean follow-up duration was 23.7 months (range: 12 to 71 months). RESULTS Two patients with wound infections were treated with adapted antibiotics. All patients were relieved of their symptoms; no triggering, recurrence or volar subluxation of the tendons of abductor pollicis longus or extensor pollicis brevis occurred. With this partial resection technique and according to a treatment scoring system described by Sawaizumi et al., 23 hands had excellent results, 11 hands had good results, and two hands had fair results; no hand exhibited a poor result. The mean visual analogue scale score was 1.8 (range: 0-6). DISCUSSION Our results showed that one-quarter partial resection of the extensor retinaculum on the dorsal side of the wrist can be safely used for the operative treatment of de Quervains disease with satisfactory short-term clinical results and no serious complications. LEVEL OF EVIDENCE Level IV: low-power prospective study.

Serum prolidase activity and oxidative-antioxidative status in Legg-Calve-Perthes disease.

We aimed to find out that whether collagen turnover is altered in the context of Legg–Calve–Perthes disease (LCPD) by evaluating serum prolidase activity. We also investigated the correlation between collagen turnover and oxidative–antioxidative status in LCPD. Plasma prolidase activity, total oxidant status (TOS), total antioxidant capacity, and oxidative stress index (OSI) were determined for 39 patients with LCPD and 40 healthy controls. Serum prolidase activity, TOS, and OSI were higher, but TAC was lower in patients with LCPD compared with controls. Prolidase activity was positively correlated with TOS and OSI levels. Serum prolidase activity is significantly associated with LCPD.

Effects of salmon calcitonin treatment on serum and synovial fluid bone formation and resorption markers in osteoporosis patients

OBJECTIVE This study aimed to evaluate the effects of salmon calcitonin, and calcium and vitamin D treatment on bone mineral density, serum and synovial fluid bone formation and resorption markers in patients with osteoporosis. METHODS The study was completed with twenty-five osteoporosis patients divided into two groups: The 15 patients comprising Group I (1 male and 14 females; mean age: 67.0±12.0) were administered calcitonin treatment in addition to calcium and vitamin D. The 10 patients in Group II (3 males and 7 females; mean age 68.0±16.0) were administered calcium and vitamin D only. Serum and synovial fluid calcium phosphorus, alkaline phosphatase, calcitonin, C-telopeptide (CTx), N-telopeptide (NTx) and sialoprotein levels, and bone densitometries were determined at the beginning and at the end of one year of treatment. RESULTS In the calcitonin and calcium and vitamin D treatment group (Group I), femoral neck density scores were decreased and vertebrae scores were increased after one-year treatment. Both scores were increased in the non-calcitonin group (Group II). In Group I, synovial fluid levels of calcitonin, sialoprotein and NTx were decreased, and synovial fluid CTx levels showed no change. The only decrease that was statistically significant was that in calcitonin levels. In Group II, synovial fluid calcitonin levels were decreased, synovial fluid CTx levels were increased and synovial fluid NTx and sialoprotein level were unchanged. These changes were not statistically significant. Serum changes in the parameters were not statistically significant in either group. CONCLUSION In osteoporosis, salmon calcitonin treatment affects synovial fluid bone formation and absorption marker levels. Advanced studies are needed to evaluate the mechanisms by which this takes place, and to explain the relationship between osteoporosis and articular cartilage metabolism.

A preliminary study pointing out the role of serum prolidase activity and oxidative-antioxidative status parameters during the treatment process of patients with idiopathic clubfoot

Abstract Background. We aimed to investigate serum prolidase activity and to find out its association with oxidative-antioxidative status in patients with idiopathic clubfoot and during the course of the disease. Material and methods. Oxidative status parameters, including total free sulfhydryl groups (−SH), total antioxidant capacity (TAC), total oxidant status (TOS), and oxidative stress index (OSI), as well as serum prolidase activity were assessed at the beginning of the treatment in patients with idiopathic clubfoot (n = 38), at the end of 3 months during the treatment of the disease and in healthy controls (n = 40). All patients were managed with the Ponseti method and severity of the foot deformity was evaluated according to the Pirani Severity Score. Results. Serum prolidase activity, TOS and OSI values of the patients at the beginning of the treatment were found to be significantly higher but –SH and TAC values were found to be significantly lower as compared to controls. In the treatment process, a significant decrease in serum prolidase activity, TOS and OSI values and Pirani Severity Score of the patients was observed, however a significant increase in –SH and TAC values of the patients was observed at the end of 3 months during the treatment of the disease as compared to the beginning of the treatment. Conclusion. Elevated levels of serum prolidase activity, TOS and OSI, and decreased levels of –SH and TAC may be associated with idiopathic clubfoot, and that these parameters may be useful adjunctive tools for follow-up in patients with idiopathic clubfoot.