Zafer Orhan

Primary subcutaneous cyst hydatic disease in proximal thigh: an unusual localisation: a case report

BackgroundMusculoskeletal hydatidosis is very rare and represents 1% – 5.4% of all cases of echinococcosis. On clinical basis, infection mimics a soft-tissue tumor, and the preoperative radiological diagnosis is very important to avoid biopsy.Case PresentationWe report an unusual case of primary subcutaneous hydatidosis in proximity to vastus lateralis muscle. It was diagnosed according to the computed tomography appearance, clinical and pathological findings. A 43 year old female patient was admitted with a history of pain at proximal thigh for the last 30 days. On physical examination, a mass which was 4 × 5 cm in diameter, painful and erythamatous, was palpated over greater trochanter. Sedimentation rate was 40 mm in the first hour. CT (Computed Tomography) scan demonstrated, a soft tissue mass with central cystic component in the subcutaneous tissue near vastus lateralis muscle.Histopathological examination of the specimen revealed a pericystic structure, which consisted of connective tissue and scattered hyaline cells showing a necrotic basophilic structure that resembled a cuticular membrane. Treatment with high dose albendazole was conducted for 4 weeks.ConclusionsThis case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when they occur in areas where the disease is endemic.

The effect of extracorporeal shock waves on a rat model of injury to tendo Achillis: A HISTOLOGICAL AND BIOMECHANICAL STUDY

The effects of extracorporeal shock waves (ESWT) on tendon healing were assessed by observing histological and biomechanical parameters in a rat model of injury to the tendo Achillis. The injury was created by inserting an 18-G needle through tendo Achillis in 48 adult Wistar albino rats. The animals were divided into three groups. The first group received radiation only after the operation. The second received no shock waves and the third had 500 15 KV shocks on the second post-operative day. All the rats were killed on the 21st day after surgery. Histopathological analysis showed an increase in the number of capillaries and less formation of adhesions in the study group compared with the control group (p = 0.03). A significantly greater force was required to rupture the tendon in the study group (p = 0.028). Our findings suggest a basis for clinical trials using ESWT.

The preparation of ciprofloxacin hydrochloride-loaded chitosan and pectin microspheres: THEIR EVALUATION IN AN ANIMAL OSTEOMYELITIS MODEL

Ciprofloxacin hydrochloride-loaded microspheres were prepared by a spray-drying method using pectin and chitosan. The effects of different polymers and drug ratios were investigated. The most appropriate carriers were selected by in vitro testing. A rat methicillin-resistant Staphylococcus aureus osteomyelitis model was used to evaluate the effects of the loaded microspheres. The drug was released rapidly from the pectin carrier but this was more sustained in the chitosan formulation.Chitosan microspheres loaded with ciprofloxacin hydrochloride were more effective for the treatment of osteomyelitis than equivalent intramuscular antibiotics.

Sodium fusidate-poly(D,L-lactide-co-glycolide) microspheres: Preparation, characterisation and in vivo evaluation of their effectiveness in the treatment of chronic osteomyelitis

Purpose: The aim of this study was to prepare poly(D,L-lactide-co-glycolide) (PLGA) microspheres containing sodium fusidate (SF) using a double emulsion solvent evaporation method with varying polymer:drug ratios (1:1, 2.5:1, 5:1) and to evaluate its efficiency for the local treatment of chronic osteomyelitis. Methods: The particle size and distribution, morphological characteristics, thermal behaviour, drug content, encapsulation efficiency and in vitro release assessments of the formulations had been carried out. Sterilized SF-PLGA microspheres were implanted in the proximal tibia of rats with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis. After 3 weeks of treatment, bone samples were analysed with a microbiological assay. Results: PLGA microspheres between the size ranges of 2.16–4.12 µm were obtained. Production yield of all formulations was found to be higher than 79% and encapsulation efficiencies of 19.8–34.3% were obtained. DSC thermogram showed that the SF was in an amorphous state in the microspheres and the glass transition temperature (Tg) of PLGA was not influenced by the preparation procedure. In vitro drug release studies had indicated that these microspheres had significant burst release and their drug release rates were decreased upon increasing the polymer:drug ratio (p < 0.05). Based on the in vivo data, rats implanted with SF-PLGA microspheres and empty microspheres showed 1987 ± 1196 and 55526 ± 49086 colony forming unit of MRSA in 1 g bone samples (CFU/g), respectively (p < 0.01). Conclusion: The in vitro and in vivo studies had shown that the implanted SF loaded microspheres were found to be effective for the treatment of chronic osteomyelitis in an animal experimental model. Hence, these microspheres may be potentially useful in the clinical setting.

Cervical brucellosis mimicking cervical disc herniation

Brucellar spondylitis may be difficult to diagnose. Initial plain radiographs of the spine may show mild degenerative lesions. Although, magnetic resonance imaging of spine is mostly helpful to establish the disease, in some cases, it may lead to misdiagnosis. The aim of this report was to present a case of brucella infection involving the cervical spine that was falsely diagnosed and underwent to surgery for cervical disc herniation. Since the spinal form of brucellosis has no specific symptomatology, a patient has symptoms with mimicking the cervical hernia, with a history of disabling pain more severe than radicular pain, and especially who reside in countries where the disease is endemic, the brucella infection should be kept in mind in the differential diagnosis and specific diagnostic investigations such as brucella agglutination tests should be made before any treatment procedure.RésuméIl peut être difficile de diagnostiquer la spondylodiscite brucellienne. Les radiographies standard initiales du rachis peuvent montrer des lésions dégénératives seulement légères. Bien que l’IRM du rachis soit le plus souvent déterminante dans l’établissement du diagnostic, elle peut parfois aussi conduire à un diagnostic erroné. Le but de ce rapport est de présenter un cas de brucellose impliquant le rachis cervical qui a été faussement diagnostiquée et a été opérée avec un diagnostic de hernie discale cervicale. Etant donné que la forme vertébrale de la brucellose n’a aucune symptomatologie spécifique, un patient peut avoir les signes imitant ceux de la hernie cervicale, avec une histoire de douleur invalidante plus grave que la douleur radiculaire. En particulier pour des patients qui résident dans les pays où la maladie est endémique, l’on devrait toujours avoir à l’esprit la brucellose dans le diagnostic différentiel et des investigations diagnostiques spécifiques telles que les séro-tests d’agglutination devraient être faits avant toute décision thérapeutique.

Role of MR arthrography with arthroscopic correlation in the evaluation of knee articular disorders

Abstract In this study we assessed the role of MR arthrography for the diagnosis of knee disorders. We compared MR arthrographic results with standard MR imaging and with arthroscopy. We performed an MRI examination with a 0.5 tesla machine on 32 patients having various knee disorders. We obtained images before and after intra-articular gadolinium-DTPA injection for each patient. The main objective of this study was to evaluate hyaline cartilage in patients suffering from gonarthrosis. The thickness and surface of the hyaline cartilage was determined by arthroscopic examination the week following MR imaging. We concluded that MR arthrography, although an invasive method, is superior in demonstrating hyaline cartilage pathologies in patients with gonarthrosis.

Calcaneal stress fractures in amateur football players

Stress fractures resulting from physical exercise have been recognized since 1855, when Breithaupt reported foot pain and swelling in a group of Prussian soldiers feet (1,8). They typically occur in normal bones which are subjected to repeated cyclic force but the strength of the force applied on the bone should not be strong enough to result in an acute fracture. For this reason stress fractures are generally seen in military recruits, ballets, dancing students, athletic trainers who participate in repetitive travmatic sporting activites (1,5).In our country, football games among amateur players has become popular especially on small football areas covered by carpets, but the floor is concrete. In this paper a case of calcaneus stress fracture following a football game which was performed on small football area, is presented. Although repetitive physical exercise is the cause in most of the reported stress fractures cases our report demonstrate it is not essential and it seems that the hard concrete floor of the football area is the cause.RésuméLes fractures de fatigue ou de stress, qui surviennent sur un os sain soumis a’ des contraintes prolongées et répétitives, sont bien connues chez les jeunes recrues, les athlétes et les danseurs professionnels. Nous rapportons l’observation d’une fracture dela grosse tubérosité postérieure du calcaneus qui avait les signes cliniques et radiographiques d’une fracture de stress. Elle était apparue chez un sujet jeune et sédentaire, sans tares reconnues, qui pratiquait une partie de football sur un terrain miniature dont le sol était en béton recouvert d’un tapis. En l’absence de la notion classique d’activité physique longue et répétitive, nous pensons que la survenue de cette fracture était liée a’ la dureté du sol et aux dimensions réduites de ce type de terrain de football.