Comparison of High Hip Center versus Anatomical Reconstruction Technique in Crowe Types II and III Developmental Dysplasia of the Hip: a Retrospective Clinical Study.

PURPOSE OF THE STUDY The literature is conflicting as to whether the high hip center (HHC) reconstruction in total hip arthroplasty (THA) is an ideal option for patients with severe developmental dysplasia of the hip (DDH). This study aimed to compare the mid-term functional and radiographic outcomes of THA using HHC versus anatomical hip center (AHC) technique in Crowe types II and III DDH. Our hypothesis was that there may be no differences in terms of functional and radiographic outcomes between patients who underwent THA using HHC or AHC. MATERIAL AND METHODS Fifty-seven patients who underwent a primary THA due to Crowe type-II or type-III DDH were retrospectively reviewed and included. Patients were divided into two groups as per the hip center reconstruction: Group A (AHC technique) and group H (HHC technique). A cementless cup was inserted in 25 hips (19 female, 6 male; mean age = 51 years, age range = 28-67)) at near-AHC in group A and 32 hips (22 female, 10 male; mean age = 53 years, age range = 29-68) at HHC position in group H. To assess clinical status, the Harris Hip Score (HHS) was used at the final follow-up. In radiographical assessment, component loosening and osseointegration of the acetabular cup were examined on follow-up radiographs. Complications were also recorded. RESULTS The mean follow-up was 41 months (range, 25-84) in group A and 40 months (range, 24-86) in group H. The mean HHS was 83 (range, 74-91) in group A and 83.6 (range, 73-94) in group H (p = 0.741). Osteolysis was determined in three patients from each group. The other 51 cups demonstrated a minimum of one radiographic sign of osseointegration. Although the overall complication rate was higher in group A (64%) than in group H (46%), this difference reached no statistical significance (p = 0.11). CONCLUSIONS The HHC technique using cementless acetabular fixation seems to be a valuable alternative option to AHC technique in cases of Crowe types II and III DDH. Key words: High hip center; anatomical hip center; center of rotation; total hip arthroplasty; dysplastic hip; developmental dysplasia of the hip; Crowe type II; Crowe Type III.

Reliability of Bigliani's Classification using Magnetic Resonance Imaging for Determination of Acromial Morphology.

Introduction: Bigliani classification is used for determination of acromial morphology, but poor inter-observer reliability has been reported on conventional radiographs. This study aims to assess inter- and intra-observer reliability using magnetic resonance imaging (MRI). Materials and methods: Forty consecutive patients diagnosed with subacromial impingement syndrome were included to study. All subjects underwent standard shoulder MRI scan and acromial shape was evaluated by nine observers of different level of expertise (three attending surgeons, three senior orthopaedic residents and three radiologists). A second set of evaluation was performed in order to assess intra-observer reproducibility. Kappa (κ) coefficient analyses both for interobserver reliability and intra-observer reproducibility were then performed. Results: Overall inter-observer agreement among nine observers was fair (κ=0.323). κ values for all 4 individual types ranged from 0.234 to 0.720 with highest agreement for type 4 and lowest agreement for type 3. Second evaluation did not result with an increase of inter-observer agreement (κ=0.338, fair). The κ coefficients for intra-observer reproducibility of nine observers ranged from 0.496 to 0.867. Overall intra-observer reproducibility was substantial. Comparison of inter- and intra-observer reliability among three groups showed no significant difference (p=0.92 and 0.22, respectively). Conclusion: Results showed that MRI did not show superior reliability compared to conventional radiographs. Moreover, inter- and intra-observer agreement did not differ between observers of different level of expertise. Findings of present study suggest that despite a sophisticated imaging modality like MRI, Bigliani's classification apparently lacks accuracy and additional criteria, or different assessment methods are required to assess acromial morphology for clinical guidance.

Activity of resveratrol on the influence of aflatoxin B1 on the testes of Sprague dawley rats.

Twenty eight male Sprague Dawley rats (aged 3 months) were used in the study. The animals were given feed and water as ad libitum. Sprague dawley rats were randomly divided into 4 groups as 7 rats in each group. Except for the control one, aflatoxin B1 (7.5 µg / 200 g), resveratrol (60 mg / kg) was administered to rats of 3 other groups. At the end of the 16th day, blood, semen and tissue specimens were taken by decapitation under ether anesthesia. When we evaluate the spermatological parameters, it is understood that resveratrol has a statistically significant difference in terms of sperm motility and viability (membrane integrity) compared to the control group and aflatoxin B1 administration groups, indicating a protective effect on spermatological parameters. In terms of pathological parameters - histopathological examination - in the control and resveratrol groups, seminiferous tubules were observed to be in normal structure. In the group treated with aflatoxin, the regular structure of the spermatogenic cells deteriorated and the seminiferous tubules became necrotic and degenerative. In the group treated with Afb1 + res, the decreasing of necrotic and degenerative changes were determined compared with in the group treated with aflatoxin. As immunohistochemical examination, cleaved caspase 3 expression was found to be very low in the control and resveratrol groups. Cleaved caspase 3 expression was severely exacerbated in seminiferous tubules in aflatoxin group but cleaved caspase 3 expression level decreased in Afb1 + res. In the biochemical direction, resveratrol has been shown to inhibit the adverse effects of aflatoxin on antioxidant levels and to show a protective effect. For this purpose, the use of resveratrol with antioxidant activity was investigated in preventing or ameliorating damage to aflatoxin B1. It has been concluded that resveratrol effectively prevent the aflatoxin-induced testicular damage and lipid peroxidation. It has also been shown that resveratrol has protective effects on sperm motility and viability.

Effect of pomegranate (Punica granatum L.) juice on kidney, liver, heart and testis histopathological changes, and the tissues lipid peroxidation and antioxidant status in lead acetate-treated rats.

Pomegranate juice (PJ) contains relevant amounts of active biological compounds which alleviate the detrimental effects of chronic heavy metal exposure. This study investigated the protective potential of PJ against lead-induced oxidative stress. A total of forty adult male Sprague Dawley rats were divided into four experimental groups. The animals were fed a standard pellet diet and tap water ad libitum. The rats were divided into four groups (n=10 for each group): control, lead asetat (2000 ppm), low-treated PJ- a daily dose of 2.000 ppm lead plus 30µl pomegranate juice (included 1.050 µmol total polyphenols, gallic acid equivalent), and high-treated PJ- a daily dose of 2.000 ppm lead plus 60µl pomegranate juice (included 2.100 µmol total polyphenols, gallic acid equivalent). The treatments were delivered for 5 weeks. After the treatment period, the tissues samples (kidney, liver, heart and testis) were collected. Tissue lead (Pb) and mineral amounts (copper, zinc, and iron), tissues lipid peroxidation level and antioxidant status, and tissues histopathological changes were determined. The results showed that the highest rate lead loading was in the kidney and the testis. Pomegranate juice was decreased the lead levels of soft tissues examined; increased Zn amounts in tissues of which the lead accumulation was higher (kidney and the testis); decreased the copper, zinc and the iron levels of the liver and heart tissues, without creating a weakness in antioxidant capacity of these tissues, restricted the oxidative stress by decreasing lipid peroxidation, improved both of the activities of antioxidant enzymes such as superoxide dismutase (SOD) and catalaz (CAT), and the level of glutathione (GSH) in all the tissues examined in lead-treated groups. As histopathological findings, the cellular damage induced by lead in the tissues of the kidney, liver and the heart were observed to have been partially prevented by PJ treatment. The protective effect of PJ was more pronounced in the testis compared to those others.

Prevalence of vitamin D insufficiency in children with forearm fractures.

PURPOSE: This study aimed to determine whether children with distal radius impaction fractures have increased prevalence of 25-hydroxyvitamin D (25(OH) D) insufficiency compared with healthy controls. PATIENTS AND METHODS: This is a prospective controlled study. The 30 children who were diagnosed with forearm fracture at the orthopaedic emergency clinic were included in the study and 30 healthy children from the routine paediatric outpatient unit were included as the control group. Peripheric venous 25(OH) D, calcium (Ca), magnesium (Mg), phosphor (P), alkaline phosphatase (ALP) and parathyroid hormone (PTH) of both groups were recorded. The sample size was estimated based on the effect size for a type I error of 5% and power of 80%. RESULTS: Demographic characteristics of the two groups did not differ in terms of weekly physical activity levels and breast milk intake. The mean whole body BMI was similar in both groups of patients. History of previous fracture and 25(OH) D level were significantly lower in the patient group than the control group. CONCLUSION: In the present study, the prevalence of vitamin D insufficiency or deficiency was higher in patients with forearm impaction type fractures than healthy controls and the baseline levels reported in the literature. In addition, there were no significant differences in serum Ca, Mg, P, ALP and PTH levels between the healthy controls and the patient group.

Gustilo type IIIC open tibia fractures with vascular repair: minimum 2-year follow-up.

PURPOSE: Salvage or amputation for grade 3C open fracture of tibia is not well responded question universally because of surgical innovations, cultural believes, difficulties in estimate the outcome, coasts, and different results in the literature. The aim of this study was to evaluate the surgical outcomes of Gustilo grade 3C open tibia fractures with at least two years follow-up in non-military adults. METHODS: Twenty-two non-military patients with a mean age of 31.1 were operated with grade 3c open fractures at tibia level in last 10 years in our clinic. We evaluated them retrospectively and asked about their daily life, pain, and if present, about the wish for secondary amputation. We also asked if they would prefer a first day amputation rather than their present status. RESULTS: Mean operation time after the injury was 13 h. Seven patients had nerve injury. Mean operation number was 3.5. Eight patients (%36) (all due to circulatory problem) had to have amputation. All patients treated with temporary unilateral external fixation than converted to circular external fixators when soft tissue healing was completed. Two patients were reoperated because of deformity. Four patients needed revision surgery because of non-union. At long term follow, we had osteomyelitis in one patient. CONCLUSIONS: Scoring systems and the ischemic time are not the only predictors of amputation. The decision of the treatment mode should be made by the patient and the care team after discussing the options and outcomes rather than relying on a scoring system.

Comparison of simple arm sling and figure of eight clavicular bandage for midshaft clavicular fractures: a randomised controlled study.

Only a few randomised, controlled studies have compared different non-operative methods of treatment of mid-shaft fractures of the clavicle. In this prospective, randomised controlled study of 60 participants (mean age 31.6 years; 15 to 75) we compared the broad arm sling with the figure of eight bandage for the treatment of mid-shaft clavicle fractures. Our outcome measures were pain, Constant and American Shoulder and Elbow Surgeons scores and radiological union. The mean visual analogue scale (VAS) pain score on the first day after treatment was significantly higher (VAS 1 6.8; 4 to 9) in the figure of eight bandage group than the broad arm sling group (VAS 1 5.6; 3 to 8, p = 0.034). A mean shortening of 9 mm (3 to 17) was measured in the figure of eight bandage group, versus 7.5 mm (0 to 24) in the broad arm sling group (p = 0.30). The application of the figure of eight bandage is more difficult than of the broad arm sling, and patients experience more pain during the first day when treated with this option. We suggest the broad arm sling is preferable because of the reduction of early pain and ease of application.

Immunohistochemical detection of Mannheimia (Pasteurella) haemolytica antigens in goats with natural pneumonia.

Pneumonia is a leading cause of loss to ruminants throughout the world. Mannheimia (Pasteurella) haemolytica is one of the most important etiological agent of pneumonia in cattle, sheep, and goats. This study was carried out to determine the incidence of M.haemolytica antigens using immunohistochemistry labelling of formalin-fixed, paraffin-embedded tissues in pneumonic lungs of goats slaughtered at abattoir, and then to compare these immunohistochemistry results with the results of bacterial isolation. For these objectives, a total of 1505 goat lungs slaughtered in slaughterhouse were grossly examined and pneumonia was detected in 74 cases (4.91%). Of these, with the exception of verminous pneumonia observed in 32 cases, on 42 pneumonic lungs immunohistochemical examinations were performed. Formalin-fixed and paraffin-embedded lung tissue samples were immunohistochemically stained by the avidin-biotin-peroxidase complex (ABC) procedure using polyclonal antibodies to detect M.haemolytica antigens. Pneumonic lesions were more frequently encountered in cranioventral lobes than caudal lobes, and characterized by irregular lobular foci of atelectasis or lobar pneumonia. The presence of M.haemolytica antigens was detected in 19 (45%) out of 42 pneumonic lungs. Bacterial antigens were found most frequently in the cytoplasm of bronchial and bronchiolar epithelial cells, in the swirling degenerating leukocytes in the alveoli, and in the degenerating leukocytes in the area of coagulation necrosis, less frequently in the epithelial cells of bronchial glands, and lymphoid cells. Conclusionly, immunohistochemical detection of M.haemolytica antigens in pneumonic lungs appear to be more reliable compared to bacterial isolation.

De novo 18q deletion with mitral valve insufficiency.

We report an 18-year-old Turkish girl with an 18q- deletion and abnormalities of face, mental and growth retardation, mitral deficiency and hypothyroidism. Mitral deficiency has not been reported in 18q deletion syndrome cases previously. We performed cytogenetic and molecular cytogenetic analysis, and brain MRI. Her karyotype was 46,XX,del(18)(q21.2-->qter). This report compares the symptoms and features of the present patient with previously reported cases with 18q syndrome.

Embryo aneuploidy screening for repeated implantation failure and unexplained recurrent miscarriage.

Among other factors, chromosomal abnormalities that originate from gametogenesis and preimplantation embryonic development are thought to be one of the major contributing factors for early embryonic death and failure of pregnancy. However, so far, no non-invasive technique exists that allows the detection of the chromosomal complement of an oocyte or a developing embryo as a whole. Rather, by removing polar bodies/blastomeres, recent developments on preimplantation genetic diagnosis for aneuploidy screening (PGD-AS) have paved the way to detect and possibly eliminate the majority of chromosomally abnormal embryos, thereby increasing the chance of a healthy pregnancy. This article summarizes the origin and impact of chromosomal abnormalities on human reproduction in cases with repeated implantation failure (RIF) and unexplained recurrent miscarriage. It also discusses recent advances regarding the possible benefits of PGD-AS in such cases.

Preliminary FISH studies on spermatozoa and embryos in patients with variable degrees of teratozoospermia and a history of poor prognosis.

The aim of this study was to analyse to what extent sperm aneuploidy is associated with sperm morphology and subsequently with embryo aneuploidy. Fifty-nine men with variable degrees of teratozoospermia and previously poor assisted reproduction prognosis were included in the study. Samples from 10 normozoospermic men with proven fertility were used as controls. Individual spermatozoa were scored for chromosomes 13, 21 and for 18, X, Y separately. Compared with controls, 23 out of 59 cases (39.0%) were found to have increased sperm aneuploidy for at least one of the chromosomes analysed in a treatment cycle. Fifty-two patients underwent a treatment cycle and were documented according to the pregnancy and spermatozoa fluorescence in-situ hybridization results. A total of 121 previous unsuccessful assisted reproduction cycles of the cases were then retrospectively reviewed. In 23 of the latest cycles, preimplantation genetic diagnosis was applied to 106 cleavage stage embryos and 47 of 94 embryos analysed (50.0%) were found to be chromosomally abnormal. Furthermore, 16 of 47 (34.0%) embryos with chromosomal abnormality were carrying complex chromosomal defects. The results imply that increased aneuploidy is present in both spermatozoa and embryos in couples with severe male infertility with a history of repeated unsuccessful attempts. Therefore, proper genetic counselling should be considered in these cases.

Immunohistochemical detection of parainfluenza type 3 virus antigens in paraffin sections of pneumonic caprine lungs.

Pneumonia is a leading cause of loss to ruminants throughout the world. Parainfluenza type-3 virus (PI-3) is one of the most important respiratory pathogens of bovine and ovine. In this study, prevalence of PI-3 virus infection as causative agent of pneumonia in goats was investigated. For this purpose, a total of 1505 goat lungs slaughtered in Bitlis and Van slaughterhouses were grossly examined and pneumonia was detected in 74 cases (4.91%). Lesions were more frequently encountered in anteroventral lobes than caudal lobes. With the exception of verminous pneumonia observed in 32 cases, immunohistochemical examinations were performed on 42 pneumonic lungs. Formalin-fixed and paraffin-embedded lung tissue samples were immunohistochemically stained by the avidin-biotin-peroxidase complex procedure using polyclonal antibodies to detect PI-3 viral antigens. The presence of PI-3 viral antigens was detected in 28 (66.6%) of 42 pneumonic lungs. Viral antigens were found most frequently in the cytoplasm of bronchiolar epithelial cells, type II pneumocytes, and less frequently in the epithelial cells of bronchial glands, syncytial cells, alveolar macrophages, and lymphocytes and plasma cells. In conclusion, it was found that there was a close relationship between the pneumonia in goats and the presence of PI-3 viral antigens. Incidence of PI-3 virus in pneumonic lungs of goats was detected to be very high in the present study performed in the region of Bitlis and Van, Turkey.

Detection of rabies viral antigens in non-autolysed and autolysed tissues by using an immunoperoxidase technique.

The objectives of this study were to determine the potential of an immunoperoxidase technique involving the avidin-biotin complex (ABC) stain for the diagnosis of rabies in fresh tissues and compare it with other standard methods, including the fluorescent antibody test (FAT), haematoxylin and eosin and Seller's stain, and to investigate its capacity to detect rabies antigen in autolysed tissues. Samples of non-autolysed brain from 81 domestic and wild animals suspected of having rabies were examined. Rabies antigen was detected by FAT in 41 of these samples and Negri bodies were detected in 40 (97.6 per cent) of them by the immunoperoxidase technique, in 25 by haematoxylin and eosin and in 22 by Seller's stain. The sensitivity of the immunoperoxidase technique decreased as the tissues were left to autolyse; after two days it was 91.2 per cent, after four days 70.6 per cent, and after seven days 11.8 per cent.

Detection of leptospiral antigens in kidney and liver of cattle.

This study was designed to investigate the presence of leptospiral antigens in kidney and liver of naturally infected cattle using an immunoperoxidase (IP) staining and Levaditi's staining methods. A total of 39 cattle suspected from leptospirosis were examined histologically and immunohistochemically for the presence of leptospiral antigens. The leptospiral antigens were detected in 16 out of 39 cases (seven kidneys, three livers, and six kidneys and livers) when IP staining method was used, whereas leptospiral antigens were detected in 6 out of 39 cases (four kidneys and two livers) when Levaditi's staining method was used. This study ascertained that IP staining was more sensitive method than Levaditi's staining method for demonstrating the presence of leptospirosis in cattle.