The Relationship between the Shoulder Functional Score and the Change in Labral Morphology after Arthroscopic Bankart Repair.

PURPOSE OF THE STUDY: The aim of arthroscopic Bankart repair is restoration of the anterior block mechanism and regaining stability. There are few studies that have tested the adequacy of the angle made with the glenoid and the height from the glenoid level of the repaired labral tissue, but the correlation with the clinical results is not clear. The aim of this study was to defi ne the correlation of the height and slope of the repaired labral tissue in the glenoid anterior with the clinical results. MATERIAL AND METHODS This prospective study included 20 patients who underwent an arthroscopic Bankart repair. To evaluate the labrum anatomy of the affected shoulder, 4 measurement parameters were defi ned as axial height (Ah), axial slope (As), oblique coronal height (Ch), and oblique coronal slope (Cs) on non-contrast T2 MRI. The measurements were taken preoperatively of the affected shoulder and at 1 year postoperatively of both the affected shoulder and the contralateral asymptomatic shoulder. The measured values were compared with each other and with the contralateral shoulder. Correlations of the anatomic values with the Constant-Murley scores recorded at 1, 3, 6, and 12 months postoperatively were examined with the Wilcoxon test. RESULTS The mean preoperative Constant score of the patients was 57.7 (32-77) and postoperative scores at 1, 3, 6, and 12 months were 63.6 (44-79), 77.8 (61-90), 89.6 (77-100), and 95.2 (79-100), respectively (p=0.001). There was a statistically signifi cant difference in the preoperative MRI measurements of the axial and oblique coronal plane labral height and slope values compared to the postoperative values and those of the asymptomatic contralateral shoulder (p< 0.05 for all). There was no statistically signifi cant difference between the labral height and slope values of both planes postoperatively compared to the asymptomatic contralateral shoulder (p= 0.776, p= 0.910, p= 0.132, p= 0.589, respectively). These increases in the radiological data were not found to be statistically signifi cant in the correlation analysis with the increases in the Constant-Murley scores (Ah p=0.935, As p=0.587, Ch p=0.078, Cs p=0.105). CONCLUSIONS This prospective study was conducted using conventional T2 magnetic resonance imaging, which was suffi cient for the measurement of labral height and slope. This study results showed no signifi cant correlation between the radiological and clinical outcomes. KEY WORDS: Bankart repair, labrum height, labrum slope, functional result.

Poorly understood and often miscategorized congenital umbilical cord hernia: an alternative repair method.

PURPOSE: Umbilical cord hernia is poorly understood and often miscategorized as "omphalocele minor". Careless clamping of the cord leads to iatrogenic gut injury in the situation of umbilical cord hernia. This study aimed to determine the characteristics and outcomes of umbilical cord hernias. We also highlight an alternative repair method for umbilical cord hernias. METHODS: We recorded 15 cases of umbilical cord hernias over 10 years. The patients' data were retrospectively reviewed, and preoperative preparation of the newborn, gestational age, birth weight, other associated malformations, surgical technique used, enteral nutrition, and length of hospitalization were recorded. RESULTS: This study included 15 neonates with umbilical cord hernias. The mean gestational age at the time of referral was 38.2 ± 2.1

Does pregnancy-induced hypertension affect the electrophysiology of the heart?

Pregnancy-induced hypertension (PIHT) increases both maternal and neonatal mortality and morbidity in pregnant women. We sought to investigate the electrocardiographic findings in pregnant women with PIHT. Seventeen pregnant women (29.4 ± 5 years) with PIHT and 24 pregnant women (27.3 ± 6.1 years) with normal blood pressure (control group) were included in the study. A 12-lead surface electrocardiogram was used to evaluate the electrocardiographic parameters. Pregnant women with PIHT had higher blood pressure (p = 0.001). The Tp-e interval was longer in PIHT pregnant women at 83.5 ± 7.8 ms versus 75.8 ± 8.4 ms in the control group (p = 0.007). The Tp-e/QTc ratio was higher in pregnant women with PIHT than that in healthy controls (0.19 ± 0.02 vs. 0.18 ± 0.02, respectively). This study demonstrated that Pd, QTd and the P wave durations were similar in the PIHT pregnant women and control group, but the Tp-e and Tp-e/QTc ratio were higher in pregnant women with PIHT than in normotensive pregnant women.

Hypertrophic pyloric stenosis in twins; genetic or environmental factors.

The etiology of infantile hypertrophic pyloric stenosis (IHPS) remains obscure. Over 120 years after the condition has become a clinical entity the debate whether the cause of IHPS is genetic, environmental or both, has not yet reached a final conclusion. Herein, we present a pair of monozygotic male twins with IHPS together with a review of the literature. We aimed to support genetic pre-disposition in the epidemiology of IHPS, adding a twin data to the literature and to review the associated articles about the pathogenesis and inheritance patterns.

Epicardial adipose tissue thickness, flow-mediated dilatation of the brachial artery, and carotid intima-media thickness: Associations in rheumatoid arthritis patients.

AIM: The purpose of this work was to evaluate epicardial adipose tissue (EAT), carotid intima-media thickness (CIMT), and flow-mediated dilatation (FMD) of the brachial artery in rheumatoid arthritis (RA) patients using ultrasonographic methods. Interrelationships between these three parameters in RA patients were also investigated. METHODS: EAT thickness, CIMT, and FMD were measured by ultrasonography. We measured the disease activity score (DAS28), health assessment questionnaire (HAQ) score, and C-reactive protein (CRP) levels. Spearman or Pearson correlation analysis was used to evaluate the association between clinical findings, CIMT, FMD, and EAT. RESULTS: A total of 90 RA patients [19 men, mean age 54 years (range 21-76 years)] and 59 age- and gender-matched control subjects [17 men, mean age 54 years (range 26-80 years)] were included in the study. Patients with RA had a mean 4.34 DAS28 points (range 0-40 points) and the mean duration of the disease was 77.1 months (range 1-360 months). We found that RA patients had thicker EAT (7.7 ± 1.7 mm vs 6.2 ± 1.8 mm, p < 0.001), increased CIMT [0.9 (0.5-1.2) mm vs 0.6 (0.4-0.9) mm, p < 0.001], and decreased FMD values [5.7 % (- 23.5 to 20 %) vs. 8.5 % (- 4.7 to 22.2 %), p = 0.028] when compared to control subjects. CRP levels were significantly higher in the RA group [0.81 (range 0.1-13.5) vs 0.22 (range 0.05-12), p < 0.001]. EAT thickness was negatively correlated with FMD (r = - 0.26, p < 0.001) and positively correlated with CIMT values (r = 0.52, p < 0.001). CIMT also negatively correlated with FMD (r = - 0.29, p < 0.001). CONCLUSION: EAT can be simply measured by echocardiography and correlated with FMD and CIMT. It can be used as a first-line measurement for estimating burden of atherosclerosis in RA patients.

Effect of hypertension on echocardiographic parameters in rheumatoid arthritis.

OBJECTIVE: Hypertension (HTN) is common in rheumatoid arthritis (RA) patients. Both HTN and RA have a negative impact on echocardiographically determined parameters including wall thickness, chamber diameter, diastolic function, epicardial adipose tissue (EAT) and carotid intima media thickness (CIMT). We aimed to demonstrate the effect of HTN on these parameters in RA patients. METHODS: Patients were divided into two groups: one group comprised 39 RA patients with HTN (7 male, mean age 56.3 ± 8.4 years) and the second comprised 38 age- and gender-matched RA patients without HTN (10 male, mean age 55.3 ± 7.4 years). We retrospectively analyzed the RA patients without overt structural heart disease by determining the study parameters from echocardiograph recordings. The two groups were compared in terms of echocardiographic parameters and disease characteristics. RESULTS: RA characteristics, chamber sizes and wall thicknesses did not differ between the groups. CIMT was significantly increased in the RA with HTN group (median 0.9 mm, range 0.6-1.2 mm vs. median 0.8 mm, range 0.6-1.0 mm; p = 0.031). EAT was also significantly increased in the RA with HTN group (8.2 ± 1.8 mm vs. 7.4 ± 1.4 mm; p = 0.022). Septal early diastolic E' wave velocities were significantly decreased in the RA with HTN group (8.8 ± 2.4 cm/s vs. 10.2 ± 1.8 cm/s; p = 0.016). CONCLUSION: HTN has a further negative impact on diastolic functions, CIMT and EAT in RA patients.

Increased serum resistin levels in patients with coronary slow-flow phenomenon.

BACKGROUND: Slow coronary flow (SCF) is an angiographic finding characterized by delayed opacification of the epicardial coronary arteries without obstructive coronary disease. Resistin, an adipocytokine, plays a major role besides low-grade inflammation in atherosclerotic vascular processes and may be of importance in other coronary pathologies such as SCF. METHODS: The present study was cross-sectional and observational, consisting of 70 individuals who underwent coronary angiography and had angiographically normal coronary arteries of varying coronary flow rates. The study included 50 patients with isolated SCF and 20 control participants with normal coronary flow (NCF). RESULTS: There were no statistically significant differences between the SCF and NCF groups with respect to age, gender, presence of hypertension or diabetes mellitus, and smoking habit, except for increased creatinine levels (p = 0.014). The serum resistin level was significantly higher in the SCF group than in the NCF group (8.4 ± 7.2 vs. 5.4 ± 2.6 ng/ml, p = 0.014). Ln-transformed resistin levels correlated positively with left anterior descending (LAD) coronary artery TIMI frame count (TFC) (r = 0.408, p < 0.001) as well as with glucose (r = 0.340, p = 0.004), creatinine (r = 0.248, p = 0.044), and C-reactive protein (CRP; r = 0.283, p = 0.023) levels, and negatively with LAD coronary flow velocity (r = - 0.314, p = 0.009). When multivariate analyses were performed, in linear regression analysis, ln-resistin was associated with a longer TFC [beta (standardized regression coefficient): 0.404, p = 0.001] and lower coronary flow velocity (beta: - 0.280, p = 0.035); in logistic regression analysis, ln-resistin was an independent predictor of the presence of SCF (OR: 6.692, 65 %CI: 1.117-40.1, p = 0.037). CONCLUSION: We demonstrated, for the first time, a significant increase in serum resistin levels in patients with SCF compared to subjects with NCF. We believe that further studies are needed to clarify the role of resistin in patients with SCF.

Comparision of inflammatory biomarkers for detection of coronary stenosis in patients with stable coronary artery disease.

BACKGROUND: The objective of the current study was to evaluate the role of various inflammatory biomarkers in detection of coronary stenosis in patients with stable coronary artery disease (CAD) and healthy people. METHODS: A total of 111 patients with stable coronary artery disease, and 66 healthy subjects were enrolled in the study. Serum levels of lipoprotein-associated-phospholipase A2 (Lp-PLA2), high-sensitivity C-reactive protein (hs-CRP), and myeloperoxidase (MPO) were measured to compare patient and control groups. RESULTS: Baseline characteristics were similar between healthy and patient groups, with the exception of age. ANCOVA and log-transformed data of inflammatory biomarkers revealed that, Lp-PLA2 (p < 0.001) and hs-CRP (p < 0.05) levels in all patient groups were significantly higher than in the control group. Conversely, there was no significant difference in MPO levels among groups. CONCLUSIONS: In stable CAD patients, serum Lp-PLA2 levels are more compatible than hs-CRP and MPO levels in the detection of coronary stenosis.      

Polyarteritis nodosa: a case presenting with renal mass.

An adolescent girl was hospitalized due to fever and abdominal flank pain. A left renal haematoma was detected on magnetic resonance imaging. Renal angiography demonstrated multiple microaneurysms at both hepatic arteries, intrarenal segments of the bilateral renal arteries, and inferior lobar segment of the left pulmonary artery, which is consistent with the diagnosis of polyarteritis nodosa. Vasculitic syndromes should be considered in patients with visceral haemorrhage.

Virulence genes, antibiotic resistance and plasmid profiles of Enterococcus faecalis and Enterococcus faecium from naturally fermented Turkish foods.

AIM: To determine the virulence genes, antibiotic resistance and plasmid profiles of 16 Enterococcus faecium and 68 Enterococcus faecalis strains isolated from various naturally fermented foods. METHODS AND RESULTS: The presence of virulence genes (agg(2) , gelE, cylM, cylB, cylA, espfs, espfm, efaAfs, efaAfm, cpd, cop, ccf, cad) and also the genes vanA and vanB were investigated by polymerase chain reaction (PCR). Antibiotic resistance of the isolates was determined by disc diffusion method. Most of the tested isolates were positive for virulence genes and resistant to some antibiotics. One of the Ent. faecalis strains isolated from a cheese sample carried the vanA gene and was intermediately resistant to vancomycin. The strains usually contained large plasmids, which might harbour acquired antibiotic resistance. CONCLUSION: The study showed that Ent. faecium and Ent. faecalis strains isolated from naturally fermented Turkish foods may be potential risk factors for consumer health in terms of virulence genes and acquired antibiotic resistance. SIGNIFICANCE AND IMPACT OF THE STUDY: The results indicate the importance of enterococcal contamination in terms of the safety of some fermented Turkish foods.

A rare and frequently unrecognised pathology in children: femoral hernia.

A femoral hernia is the protrusion of the abdominal contents through the femoral canal. It accounts for less than 1% of all groin hernias in children and is often confused with inguinal hernia or other inguinal pathologies. Preoperative misdiagnosis has been reported to be between 40 and 75%. We believe that misdiagnosis and mistreatment usually occur due to insufficient physical examination, knowledge and experience about childhood femoral hernias. Here, we report and discuss the clinical appearance and treatment approach of three patients operated with the diagnosis of femoral hernias.

A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier.

In this experimental study, we aimed to examine the ability of absorbable oxidised regenerated cellulose (Interceed, TC-7, Johnson & Johnson, USA) to inhibit the formation of peritendinous fibrotic adhesions after tendon repair in rats. Both Achilles tendons of 23 female Wistar-Albino rats weighing between 350 and 450 grams were cut and repaired. On the right side, Interceed absorbable adhesion barriers were wrapped around the repaired tendon (group I). On the left, the same procedures were applied except for the Interceed wrapping and these were grouped as control (group II). Animals were sacrificed at postoperative day 28 and macroscopic and histological examination was performed. All the animals survived and no tendon rupture was observed. No wound dehiscence, wound infection or exposure of repaired tendons occurred. Macroscopically, there were three (13.1%) tendons without adhesion formation and 20 (86.9%) tendons with inferior adhesion formation in group I; on the other hand, there were 16 tendons (69.5%) with medium grade adhesion formation and seven tendons (30.5%) with severe peritendinous adhesion formation in group II (control group) (p<0.05). Histologically, adhesion formation was absent in 11 tendons (47.8%) and slight in 12 tendons (52.2%) in group I; while in group II, it was slight in two (8.6%), moderate in 15 (65.2%) and severe in six tendons (26.2%) (p<0.05). Sixteen (69.5%) of 23 tendons in group I and 11 (47.8%) of 23 tendons in group II showed no inflammatory reaction (p<0.05). Nineteen (82.6%) tendons in group I and only one tendon in group II showed excellent to good tendon healing (p=0.00). According to our results, we feel that Interceed may have an intraoperative role to play in the reduction of adhesions after surgical tendon repair. This study suggests that absorbable oxidised regenerated cellulose merits further evaluation as a potential treatment to inhibit the formation of peritendinous adhesions. Rigorous and extensive controlled trials should be undertaken on patients undergoing tendon repair with or without this barrier.

Evaluation of lateral mechanical tension in thin-film tissue constructs.

Fibroblast-populated collagen matrices provide a simplified tissue model for wound healing and development processes. A technology (CELLDRUM Technology) evaluating lateral mechanical tension in fibroblast-populated collagen matrices (tissue constructs) with a thickness of 1 mm was introduced. Defined mechanical boundary conditions together with the known number and orientation of the cells revealed precise data on the average tension exerted by a single cell. Circular cell-populated collagen gels were manufactured inside the CELLDRUM on top of a flexible membrane. The collagen matrix was then excited by a sound pulse. The resulting resonance oscillation was monitored by a laser-based deflection sensor and frequency and damping were analyzed giving information on mechanical properties of the tissue construct. Several evaluation experiments were performed. Calf serum enhanced contractile forces of fibroblasts dose dependently. After the gels were treated with cytochalasin D for 24 h, the cell forces were reduced by 42% of control. The remaining tension was attributed to the extracellular matrix remodeling occurring during cell growth and to other cytoskeletal structures like microtubules and intermediate filaments. We also found that only after a few hours of culture fibroblast-seeded collagen gels began developing significant mechanical tension. A mechanical tension profile of proliferating fibroblasts in collagen gels over culture time was obtained.

Leukocyte activation, oxidant stress and red blood cell properties after acute, exhausting exercise in rats.

Red blood cell (RBC) mechanical alterations and oxidative damage were investigated after an acute exhausting exercise in rats, together with the leukocyte activation. The groups formed as follows. Control (C) (n = 9), group I (n = 9) and group II (n = 7) from which blood samples were collected 15 minutes and 24 hours respectively, after acute exercise. The rats were subjected to running at a speed of 17 m/min until exhaustion. The leukocyte phagocytic activity (LPA), RBC lipid peroxidation and RBC deformability were measured. LPA increased significantly after the exhausting exercise and prolonged till 24 hours (p = 0.0168). RBC membrane lipid peroxidation was gradually increased till 24 hours (p = 0.0297) and there was a significant correlation between LPA and RBC lipid peroxidation (r = 0.63, p = 0.015). There was a slight but significant decrease in mean corpuscular volume (MCV) (p = 0.0467) and increase in mean corpuscular hemoglobin concentration (MCHC) (p = 0.0458) suggesting a cellular dehydration after 24 hours. No significant alteration was detected in RBC deformability, assessed by the Cell Transit Analyzer (CTA) and thought that decreased MCV might have masked to determine the alterations in membrane mechanical properties in CTA. As a conclusion the results imply that activated leukocytes might play role in the RBC damage observed after exhausting exercise encouraging oxidative stress.

The effect of skin transplantation on tumor growth in mice.

BACKGROUND: Skin allograft is an immunostimulant. Skin allograft activates effector arms of the immune system including the cytotoxic T lymphocytes, activated macrophages, and natural killer cells. These cells may be involved in the destruction of tumor cells. METHODS: Balb/c mice were divided into the study (n = 10) and control (n = 10) groups. Alloskin grafts 1 cm in diameter from the backs of Swiss albino mice were placed on the backs of balb/c mice (study group). The same size autoskin grafts from the backs of other balb/c mice were used for the control group. Fourteen days after grafting, we inoculated 1,000 Ehrlich ascites tumor cells intraperitoneally into both groups. Two days after tumor inoculation, we used secondary allografts and autografts (which were about 2 to 3 mm in diameter) for the same groups. We followed up graft survival and animal survival in both groups. RESULTS: All 10 of the autografted mice died between the 18th and 25th days owing to malignancy. In the allografted group, 2 mice died (1 on day 17 and the other on day 23). Allograft rejection had not occurred in these 2 mice at the time of their death. The other 8 mice in the same group rejected allograft, on average within 9 days (9+/-3, median 8). These 8 mice were alive and without apparent health problems during the 4 months of follow-up. CONCLUSION: Allo-skin graft rejection may help rejection of tumor cells and may be of use in immunotherapy of cancer.

Effect of superoxide anions on red blood cell rheologic properties.

The human red blood cell (RBC) is known to be susceptible to oxidant damage, with both structural and functional properties altered consequent to oxidant attack. Such oxidant-related alterations may lead to changes of RBC rheologic behavior (i.e., deformability, aggregability). Two different models of oxidant stress were used in this study to generate superoxide anions either internal or external to the RBC. Our results indicate that generation of superoxide within the RBC by phenazine methosulfate decreases RBC deformability without effects on cell aggregation. Conversely, superoxide generated externally by the xanthine oxidase-hypoxanthine system primarily affects RBC aggregability: the shear rate necessary to disaggregate RBC was markedly increased while the extent of aggregation decreased slightly. Increased disaggregation shear rate (i.e., greater aggregate strength) as a result of superoxide radical damage may adversely affect the dynamics of blood flow in low-shear portions of the circulation, and may also play a role in the no-reflow phenomena encountered after ischemia-reperfusion.

Erythrocyte deformability in high-tension and normal tension glaucoma.

The exact cause of primary open angle glaucoma is still unknown. Intraocular pressure is a major factor but it is impossible to explain the whole mechanism of glaucomatous optic nerve damage with only increased intraocular pressure. Other factors play important roles in the development of glaucoma. With this point of view, vascular factors have been implicated in the pathogenesis of glaucoma. We tried to determine the etiopathogenetic role of decreased erythrocyte deformability in normal tension glaucoma and high-tension glaucoma. The study group consisted of 16 patients with the diagnosis of normal tension glaucoma, 17 patients with the diagnosis of high-tension glaucoma, and 24 patients as controls. Independent t-tests were used to compare the three groups two by two for age, hematocrit, mean cell volume, plasma protein level, cardiovascular risk factors, and erythrocyte deformability. There was no statistically significant relationship (p>0.05) between the groups concerning the erythrocyte deformability. When we consider all of 57 patients, we found that both increasing age (>60 years) and greater mean cell volume (>84 fl) had a statistically significant relationship with decreased erythrocyte deformability (p<0.05). When we performed Pearson correlation analysis, we found that only mean cell volume and erythrocyte deformability had a statistically significant relationship (r = 0.31, p = 0.02). We conclude that decreased erythrocyte deformability is not a major factor in the ethiopathogenesis of normal tension glaucoma and high-tension glaucoma.

On-the-job training through follow-up visits to improve the quality of family planning services.

As part of a broader set of activities to strengthen family planning training and improve the quality of family planning services in Turkey, follow-up visits were performed at different family planning sites across the country in order to conduct on-the-job training. The objective of on-the-job training was to refresh and improve family planning counselling skills for all methods as well as to refresh and improve intrauterine device insertion/removal skills and also some determinants of quality care. It was also aimed at transferring up-to-date information to family planning practitioners, identifying frequently encountered problems and helping with solution approaches for problems both at the individual and programmatic levels. The results of the follow-up visits reflect issues about both the staff and the clinical facility itself in terms of conforming with the standards of the 'National Family Planning Guidelines' set forth by the Ministry of Health. The follow-up team consisted of nine members who were specially trained. They represented different sectors such as a non-governmental organization, a medical school and the Ministry of Health. The follow-up team performed 90 visits to 16 clinics in 11 provinces between 1995 and 1998. Methods used were structured observations via standard checklists, meetings with the clinic staff, self-assessment, role plays, demonstration, coaching and the provision of feedback. During this period, a total of 130 health professionals working in 16 clinics were trained on-the-job. A significant improvement was observed in the performance of the family planning practitioners and the quality of care provided in clinics. While none of the service providers were found to have a standard skill level in general counselling during the first visit, at the end of the fifth visit all were capable of providing counselling services according to the national standards. Intrauterine device insertion skills were high at the beginning of the visits, and 16 of the 17 observed service providers (94%) were assessed as conforming to the standards. At the fifth visit, all of the 42 service providers (100%) were found to be adequate. At the facility level, all 16 clinics established separate counselling rooms in the follow-up period. Additionally, the number of clinics conforming to infection prevention standards increased from two clinics in 15 at the first visit to all 16 clinics at the fifth visit. This study showed that the ultimate success of family planning programs depend on structured and well-supervised on-the-job training through follow-up visits to the sites.

Red blood cell aggregation in experimental sepsis.

Red blood cell (RBC) aggregation was investigated in a rat model of sepsis with special emphasis on RBC-related factors. Sepsis was produced by cecal ligation/puncture, whereas another group had only laparotomy (sham operation); blood samples also were obtained from control, unoperated-on animals. RBC aggregation was measured in autologous plasma and in 3% dextran 70, 18 hours after the operations, by using a Myrenne Aggregometer system and the zeta sedimentation ratio (ZSR) method. RBC aggregation in autologous plasma was found to be enhanced in both sham-operated and septic animals and was consistent with their increased plasma fibrinogen levels. However, RBC aggregation in dextran was significantly higher than control only in the sepsis group. RBCs from septic animals also aggregated more in septic plasma compared with RBCs from control animals. In the sepsis group, RBC deformability was significantly decreased, whereas RBC lipid peroxidation was significantly increased. Our results thus confirm the known increase of RBC aggregation in septicemia and, in addition, demonstrate marked alterations of intrinsic RBC properties that further enhance red cell aggregation.