Yilmaz Tomak

Subungual glomus tumours of the hand: diagnosis and treatment of 14 cases.

A glomus tumour is a rare tumour of the hand, which presents with a classic triad of symptoms of temperature sensitivity, pain, and localised tenderness. We report a series of 14 patients with glomus tumours in the subungual region. There were four men and 10 women, whose mean age was 46 years (range 28-65). All patients complained of pain and localised tenderness and six of temperature sensitivity. The bony lesion was seen on radiographs in four patients. We used a transungual approach in all cases. A detailed history and clinical findings are the best way of making the diagnosis. The treatment of glomus tumour consists of complete excision and repair of the nailbed. Inadequate excision of the tumour usually causes local recurrence.

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVES The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Extradigital glomus tumor of the triceps tendon as a cause of elbow pain: a case report

G lomus tumors are rare benign vascular tumors first described by Wood in 1812.5 Of all of the upper extremity tumors, they are the most interesting and worth investigating because of their clinical findings. Clinically, glomus tumors are characterized by a triad of temperature sensitivity, severe pain, and localized tenderness.2,3 Often these are unique positive diagnostic findings of a tumor, although several diagnostic methods have also been used. The lesion is usually located in the hand, especially the nail bed of the distal phalanx, but it may occur anywhere.1,2,4-7 We report a rare case of glomus tumor in the tendon of the triceps. It caused severe pain and limitation of the elbow joint.

Arthroplasty for the treatment of joint degeneration caused by ochronosis in two cases

Ochronosis is a rare metabolic disease caused by the deficiency of the homogentisic acid oxidase enzyme. With increasing age, accumulation of pigment deposits of homogentisic acid in the joint cartilage results in ochronotic osteoarthritis. We presented two female patients, with ages 55 and 60 years, who underwent staged bilateral uncemented total hip and bilateral cemented total knee arthroplasty, respectively, for osteoarthritis caused by ochronosis. Both patients had no significant complaints at final follow-up examinations made 12 months and 10 months after the second operation in the hip and knee, respectively. Plain radiographs did not show any abnormality in the components of the prostheses. Histopathologic examination of surgical specimens showed brown-black pigment deposits in the connective tissue and cartilage tissue.

Late detachment modular femoral component after primary total hip replacement

Abstract Three years after total hip replacement surgery, a patient’s modular femoral head separated from the stem portion of a primary total hip replacement while the patient was rising from a chair. The modular femoral head was in a polyethylene acetabular socket. Modular femoral and acetabular components now widely are used in hip replacement. The use of modular components greatly increases the flexibility during primary or revision total hip arthroplasty, but introduces the risks of component dissociation and intraoperative errors in matching. We report an unusually late dislocation of a primary modular total hip replacement.

Treatment of U-shaped Bone Ankylosis of the Knee with the Ilizarov Method: A Case Report

Osseous ankylosis following thermal burns is an uncommon but disabling problem1,2. There are two different types of bone ankylosis. The first type is due to extra-articular bridging heterotopic ossification with preservation of the underlying joint. This type typically responds to physical therapy and other treatment modalities, including surgical excision. The second type of bone ankylosis is intraarticular and occurs most commonly at the interphalangeal joints, resulting in serious functional and cosmetic problems2. There are several alternatives for treatment, including arthrodesis, osteotomy, arthroplasty, and amputation. However, treatment is always very difficult and the outcomes can be discouraging2,3. We present the case of a patient who had intra-articular bone ankylosis of the right knee joint in full flexion that was treated with the Ilizarov method4,5. To our knowledge, this is the first time that such a case, in terms of both the clinical presentation and the method with which it was treated, has been reported in the literature. Our patient was informed that data from the case would be submitted for publication. Aforty-seven-year-old woman presented with a 160° fixed flexion deformity of the right knee that was very disabling. She had sustained a third-degree thermal burn involving the right lower extremity when she was seven years old. There was circumferential scarring of the skin about the knee, and the right thigh appeared to be adhered to the leg. She required the use of crutches for mobility. A lateral radiograph showed that the right femur and tibia were almost parallel to each other and the knee was ankylosed (Fig. 1). We …

Subtrochanteric Derotation Osteotomy Using a Bent Dynamic Compression Plate in Children With Medial Femoral Torsion

Subtrochanteric osteotomy of the femur using a bent dynamic compression plate is a simple, safe, and stable technique for correction of severe medial femoral torsion.

Effects of cilostazol on fracture healing: an experimental study.

OBJECTIVE The aim of this experimental study was to examine the clinical, radiological and histological effects of cilostazol on fracture healing. METHODS A total of 60 Wistar albino male rats were divided into 2 groups: the study group (cilostazol) and the control group. Under general anesthesia, using a blunt-ended guillotine, standard closed shaft fractures were formed on the 3-point principle in the left femurs. Starting on the same day after the fracture was formed until sacrifice, the study group animals were administered with cilostazol (50 mg/kg/day, oral tablet). An equal number of rats from both control and study groups were sacrificed on the 7th, 14th, and 21st days after fracture formation, and the bone union tissue was examined clinically, radiologically and histologically. RESULTS The use of cilostazol was not determined to have any significant effect clinically or radiologically on fracture healing (p>0.05). According to the histological findings, at the end of the first week, the amount of union in the cilostazol group was observed to be significantly greater (p<0.05). At the end of the third week, no significant difference was determined between the control and study groups (p>0.05). CONCLUSION In the long term, cilostazol did not show any positive effect on fracture healing clinically, radiologically or histologically.

Mesh repair of a pelvic bone defect caused by a migrated acetabular cup

Abstract. Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intraoperative injury to iliac vessels. We present a case of a migrated acetabular cup, in which we used a combined preperitoneal and acetabular approach for its removal. With a bimanual approach, the procedure was safer and easier and allowed mesh repair of the pelvic bone defect. The preperitoneal mesh repair is a well-known method for inguinofemoral hernias. However, it has not been used before in the repair of an acetabular defect after removal of a migrated cup.

A giant subungual exostosis perforating through skin of the toe

Subungual exostosis is typically an uncommon, benign, bony tumor of cartilaginous bone that usually occurs as a solitary, solid lesion under the nail of the first toe or the fingernail. It may be difficult to diagnose subungual exostosis from a clinical presentation and it should be confirmed by radiographic examination. The treatment is surgical excision. It is essential to see normally cancellous bone under the area of excision to ensure that the tumor does not recur. In this article, our goal is to present a subungual exostosis case of the first toe, detailing diagnosis, pathologic findings and surgical management.