Reconstruction of Coracoclavicular Ligaments with Semitendinosus Autograft and Temporary Kirschner Wires is a good option for Chronic Acromioclavicular Joint Instability.

Introduction: This study reports the results of surgical anatomic reconstruction of torn coracoclavicular ligaments with an autogenous semitendinosus graft and temporary Kirschner wires (K-wires) in chronic acromioclavicular (AC) joint dislocations. Materials and methods: Nineteen shoulders underwent surgical anatomic reconstruction of torn coracoclavicular (CC) ligaments with an autogenous semitendinosus tendon graft and temporary K-wires for Rockwood grade III, IV and V chronic AC joint dislocations. Pre-operative data included patients' demographic characteristics, injury characteristics and surgical histories. The primary outcome measures were the University of California Los Angeles (UCLA) shoulder rating scale and visual analogue pain scoring (VAS), and the complications were noted for each patient. Results: Surgical anatomic reconstruction of torn CC ligaments was performed in 19 patients with a mean age of 41.6±16 years (range 21-72 years). All of the patients were satisfied and felt better after CC ligament reconstruction. The average UCLA shoulder rating scale score was good/excellent: 29.4 (range 23-34) out of 35 points. The average pre-operative VAS score was 7.7 points out of 10 and improved to 1.1 points post-operatively (p<0.05). None of the patients experienced failure during the follow-up. One patient had a mild subluxation, but the patient was satisfied with the result. Conclusions: This technique is simple, reliable, and biologic without major complications. It is also a cost-effective procedure since it can be performed with Kirschner wires and autogenous grafts. It has a major advantage of leaving no implants inside the joint, which can lead to hardware complications, and it can be performed in basic operating room settings.

The effect of using iloprost on prognosis in COVID-19 patients with ARDS: a retrospective clinical study.

OBJECTIVE: Epithelial damage together with endothelitis and microvascular thrombi are responsible for COVID-19 associated acute respiratory distress syndrome (ARDS). Iloprost, improves endothelial damage and reduces thrombotic complications with its vasodilator, anti-platelet, anti-inflammatory, and anti-fibrotic effects. In our study, we aimed to determine the effect of iloprost on oxygenation, hemodynamics, weaning, and mortality in severe COVID-19 ARDS. PATIENTS AND METHODS: This was a retrospective study conducted in a pandemic hospital in the city of Istanbul, Turkey. Patients, with severe COVID-19 ARDS, who were receiving iloprost for seven days were included in the study. The demographic data, APACHE II, and SOFA (Sequential Organ Failure Assessment score) scores (at admission and discharge), pH, PaO2, PCO2, SatO2, lactate, PaO2/FiO2 (inspiratory fractionated oxygen), respiratory rate-oxygenation (ROX) index (peripheral oxygen saturation/fraction of inhaled oxygen), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressures (MAP), heart rate (HR) values were recorded before starting iloprost (T0), and on days of iloprost administration (2.0 nanograms/kg/minute/6 hours/day) (T1, T2, T3, T4, T5, T6, T7), and the day after last day of iloprost administration (Tfinal). Also, mortality was recorded in a retrospective manner. Two groups were formed according to mortality (Group M) and discharge (Group D). RESULTS: A total of 22 patients (16 men, 6 women) were evaluated. Age, APACHE II, SOFA scores were higher in Group M. The lactate value at T1-3-4-5-7 was lower than T0 in both groups. PaO2 value between T2-Tfinal was higher than T0. A statistically significant increase was found in PaO2/FiO2 levels in both groups. The PaO2/FiO2value between T5-Tfinal was significantly lower in Group M compared to Group D. ROX index was significantly higher between T4-Tfinal when compared with T0. CONCLUSIONS: Iloprost improves oxygenation but has no effect on mortality in COVID-19 ARDS.

The effect of post-auricular canal wall down mastoidectomy on the position of the auricle.

OBJECTIVE: This study aimed to investigate the effect of surgical incision on the auricle position in patients undergoing canal wall down mastoidectomy to treat chronic otitis media. METHODS: Thirty-four patients who had undergone canal wall down mastoidectomy with a post-auricular incision approach were included in the study. Patients who had a previous auricle deformity, who underwent limited mastoidectomy surgery or mastoid obliteration, or who were younger than 18 years of age were excluded. The distances of the upper and middle parts of the auricle to the mastoid were measured. RESULTS: Measurements in the first post-operative year were found to be 13.15 ± 3.59 mm in the upper region and 16.29 ± 5.00 mm in the middle region. It was observed that the auricle was approaching the mastoid area in both regions. CONCLUSION: In patients undergoing radical mastoidectomy, the distance between the auricle and the mastoid may decrease, leading to narrowing of the auriculo-cephalic angle.

Reconstruction of ear canal wall with superior pedicled composite multi-fractured osteoperiosteal flap: a new technique and preliminary outcomes.

OBJECTIVE: This study evaluated the functional results of the superior pedicled composite multi-fractured osteoperiosteal flap technique. This method is a novel technique for the reconstruction of the external auditory canal. The study also examined the effect of the superior pedicled composite multi-fractured osteoperiosteal flap technique on patients' disease-related quality of life. METHOD: A total of 37 patients who underwent the superior pedicled composite multi-fractured osteoperiosteal flap technique were enrolled in the study. Their functional hearing results and disease-related quality of life scores were evaluated. RESULTS: A significant improvement was observed in the patients' hearing scores at the post-operative sixth month relative to the pre-operative period, and the patients' disease-related quality of life increased significantly. CONCLUSION: The superior pedicled composite multi-fractured osteoperiosteal flap method can be safely used, especially in patients undergoing retrograde mastoidectomy because of limited cholesteatoma. This method contributes to improving patients' hearing levels and disease-related quality of life.

Osteoclastic activity in chronic otitis media with cholesteatoma-related bone destruction.

BACKGROUND: Cholesteatoma-related bone destruction is the cause of many complications due to chronic otitis media. This study aimed to evaluate osteoclastic activity in cholesteatoma-related bone destruction using tartrate-resistant acid phosphatase 5b, an enzyme specific to osteoclastic activity. METHOD: Seventy-two patients diagnosed with chronic otitis media were included in this study and were divided into two groups: with and without bone destruction. The blood serum and tissue tartrate-resistant acid phosphatase 5b levels from both groups were compared. RESULTS: There were no significant differences in the level of serum enzymes between both groups. However, in tissue samples, tartrate-resistant acid phosphatase 5b levels were significantly lower in the bone destruction group than the group without bone destruction. CONCLUSION: This study determined that the level of tartrate-resistant acid phosphatase 5b, a specific enzyme for osteoclastic activity in cholesteatoma-related bone destruction, is locally decreased. This data suggests that osteoclastic activity may decrease in cholesteatoma-related bone destruction. However, further experimental and clinical studies are required to clarify this highly complex mechanism.

The relationship between vitamin D and the severity of COVID-19.

AIM: Vitamin D, which has immunomodulatory effect, can reduce risk of infections and concentrations of pro-inflammatory cytokines. The aim of this study was to investigate the relationship between the levels of vitamin D and severity of COVID-19. METHODS: A total of 204 patients with COVID-19 disease were enrolled in the study. All patients had viral pneumonia, which was confirmed with chest computer tomography. All cases were divided in two groups- mild (outpatients); and serious (inpatients)- according to their clinical and laboratory data. Serum vitamin D levels were measured by chemiluminescence method. RESULTS: Vitamin D deficiency was found in 41.7 % (n = 85) of cases and insufficiency was found in 46.0 % (n = 94), while in 12.3 % (n = 25) of cases normal vitamin D levels were found. The odds of having a serious clinical outcome were increased for vitamin D insufficiency patients 5.604 times (%95 CI:0.633-49.584) and for vitamin D deficiency patients 38.095 times (%95 CI:2.965-489.50) for each standard deviation decrease in serum 25(OH)D. CONCLUSION: Adequate levels of vitamin D could suppress inflammation and reduce the severity of COVID-19. Vitamin D supplementation may have an important role in decreasing the impact of the pandemic (Tab. 5, Fig. 2, Ref. 27).

Can auditory cues improve visuo-spatial neglect? Results of two pilot studies.

Although neglect is known to be a multimodal deficit, current interventions often address the visual modality only. Experimental studies, however, found that neglect patients can partially overcome their spatial inattention temporarily when being exposed to auditory cues that move towards the neglected side of space. Two pilot studies investigated the impact of dynamic auditory cueing on egocentric neglect severity in a clinical-therapeutic setting. In both studies, the patient groups received 15 sessions of intervention. Study 1, designed as double-blinded trial with a historical control group, targeted severely impaired early-acute patients who listened to music or audio books which were presented as moving dynamically from right to left. Results showed a reduction in egocentric neglect severity that persisted after therapy termination in the intervention but not in the historical control group. In study 2, based on the comparison with reported effect sizes of previous studies, dynamic meaningful auditory cues and optokinetic stimulation were combined in a computer-based training. Both studies found a significant reduction of neglect severity. Results provide evidence for the reduction of egocentric neglect severity after repetitive auditory cueing therapy in both severely and moderately impaired patients. Our promising findings should be verified thoroughly in randomized-controlled trials.

Aneurysmal Bone Cyst after Femoral Derotational Osteotomy: A Case Report.

Aneurysmal bone cysts rather than local aggressive lesions of the bone which may arise in any part of the axial or appendicular skeleton. Although several theories are available in the literature, the pathogenesis is still conflicting. We report an exceptional case of an aneurysmal bone cyst in the distal femur of a female cerebral palsy patient who underwent bilateral distal femoral derotational osteotomy and plate-screw fixation operations when she was 11 years old. Twenty-four months after the operation, radiographs showed a cystic lesion in the distal portion of the right femur around the osteotomy site. The diagnosis of Aneurysmal Bone Cyst (ABC) was made and the lesion was treated by curettage with cement application. After 36 months of follow-up, there was no recurrence. This is the first case reported in literature which raises the possibility that an osteotomy could be a cause in the development of an aneurysmal bone cyst.

Three-dimensional modelling of the femur and humerus in adult male guinea pigs (guinea pig) with computed tomography and some biometric measurement values.

BACKGROUND: Guinea pig is a species belonging to the Caviidae family of the Rodentia order and is frequently used in experimental studies. Biomedical imaging methods are used in the diagnosis and treatment of many diseases in medicine. Among these methods, computed tomography (CT) is one of the most important imaging methods. In this study, it was aimed to perform the three-dimensional (3D) modelling of the CT images, obtained from the humerus and femur in the guinea pigs, via the MIMICS programme, and to make some biometric measurements regarding the bones over these models. MATERIALS AND METHODS: In the present study, 12 male adult guinea pigs were used. The soft tissue on the humerus and femur bones of the guinea pigs was removed. After this procedure, CT images at a 0.5 mm-thickness were obtained from the animals. The images were recorded in DICOM format. Then, the reconstruction process was performed from the images by using the 3D modeling programme MIMICS® 13.1. On the 3D model of the humerus and femur (right-left), volumes, surface areas and lengths as well as other biometric parameters were measured separately, and the values were recorded. In addition, measurements of the bones were made with the help of a digital calliper. RESULTS: Among the parameters obtained from 3D models, a statistical difference was observed between the right and left cortical thicknesses of the femur from the measurements of calliper and the right and left humerus volumes (p < 0.05); whereas, no statistical difference was found in other parameters of both measurements (p > 0.05). CONCLUSIONS: It can be stated that CT and 3D modelling can be used for the measurement of some parameters in the long bones of the guinea pigs.

Cortical disinhibition in diabetic patients with neuropathic pain.

OBJECTIVES: Motor cortex disinhibition has a role in the mechanism of neuropathic pain. The duration of the cortical silent period (CSP) is used as a measure of excitability in cortical inhibitory circuits. We investigated cortical disinhibition in diabetic patients with and without neuropathic pain. MATERIALS AND METHODS: We studied diabetic patients with (n = 20) and without (n = 50) neuropathic pain, and control subjects (n = 30). Transcranial magnetic stimulation (TMS) was performed on the right hemisphere at rest, and surface electromyography was recorded from the left first dorsal interosseous muscle for evaluation of motor evoked potential (MEP) latency and amplitude. CSP was recorded from the left FDI, and TMS was then delivered while the subject was performing a voluntary contraction. RESULTS: We showed a low resting motor threshold, a short CSP duration, and a low CSP duration/MEP amplitude ratio in patients with neuropathic pain (P < 0.0001, P < 0.0001, P < 0.0001). CONCLUSIONS: Our findings demonstrate that diabetic patients with neuropathic pain have a cortical disinhibition.

Multiple myeloma presenting as massive ascites.

Ascites is a rare complication of multiple myeloma and may occur either at presentation or more often during the disease course. Most reported cases have been associated with IgA type of myeloma. When it occurs, it is usually associated with extensive liver infiltration with plasma cells, infectious peritonitis or myelomatous peritoneal infiltration. Herein, we describe a case of IgG type multiple myeloma diagnosed by further examinations due to the presence of plasma cells in ascitic fluid.

Asymmetric dimethylarginine and nitric oxide levels in migraine during the interictal period.

Nitric oxide (NO), which modulates endothelial function, is thought to be pivotal in the pathophysiology of migraines. The connection between migraine and cardiovascular diseases has also drawn attention to the endothelial dysfunctions and NO pathway abnormalities seen in patients with migraine. Our goal was to assess the levels of NO and the endogenous NO synthase inhibitor, asymmetric dimethylarginine (ADMA), in people with migraine during the interictal period. A total of 49 patients with migraine and 22 control subjects were enrolled in the study. Their plasma NO metabolites (nitrite [NO2-] and nitrate [NO3-]) and ADMA levels were measured using the enzyme-linked immunosorbent assay method, and were then compared with their cardiovascular risk factors, anthropometric measurements, and headache frequency and severity. The plasma ADMA, NO2- and NO3- levels of the patients with migraine during the interictal period did not differ from the control group, and no relationship was found between cardiovascular risk factors and migraine attack severity and frequency. We conclude that, in patients with migraine, there is no dysfunction of baseline NO and ADMA metabolism during the interictal period.

Development of entrapment neuropathies in acute stroke patients.

BACKGROUND: Stroke is the third most common cause of mortality and is one of the most common causes of morbidity in the world. Polyneuropathies and entrapment neuropathies are known as the complications of stroke. AIMS OF THE STUDY: In this study we aimed to evaluate the development of entrapment neuropathies in severe stroke patients within the first month of the event. METHODS: Twenty first-ever stroke patients were included in the study. The nerve conduction studies were performed within the first 48 h and repeated 1 month later. RESULTS: At the end of the first month, seven of the 20 patients had median nerve entrapment at the wrist, five had ulnar nerve entrapment at the elbow and seven had peroneal nerve entrapment at the fibular head in the hemiparetic side. Three patients had median nerve entrapment at the wrist, one patient had ulnar nerve entrapment at the elbow, and none had peroneal nerve entrapment in the non-paretic side. CONCLUSION: Our results confirm that, in severe hemiparetic patients, the entrapment neuropathies may be commonly seen, especially in the paretic extremities. The early rehabilitation programs against the development of entrapment neuropathies may be beneficial in stroke patients.

Use of tunnelled catheters in haematological malignancy patients with neutropenia.

This prospective study analysed 83 patients (age 45 +/- 17 years) with haematological neoplasms, implanted with 93 tunnelled catheters, who were neutropenic or developed neutropenia during treatment. Catheters were implanted in the right (n = 82) or left (n = 11) jugular vein by the same surgical team using the same technique. They remained in place for 124 +/- 88 days: 29% were removed due to infection; 18% due to treatment termination and 2% due to mechanical problems. Seventeen patients died with catheters in place. At 30, 60, 90, 120 and 200 days mean catheter duration rates were 82%, 75%, 65%, 60% and 35%, respectively, and freedom from catheter removal due to infection was 92%, 88%, 80%, 77% and 67%, respectively. Patient diagnosis and history of previous catheter infection did not increase catheter infection risk, but patients undergoing stem cell transplantation had an increased infection risk. Tunnelled catheters can be used in high-risk patients with neutropenia. Systemic infections can be managed in most patients without catheter removal.

Dexmedetomidine-based versus fentanyl-based total intravenous anesthesia for lumbar laminectomy.

BACKGROUND: The present study was designed to show the effects of dexmedetomidine infusion with loading dosage on perioperative hemodynamics, propofol consumption, and postoperative recovery when used for general anesthesia in patients undergoing spinal laminectomy. METHODS: Fifty American Society of Anesthesiologists (ASA) I-II patients were randomised into two groups. Group D received dexmedetomidine 0.6 microg kg(-1) as bolus before induction and 0.2 microg kg(-1) h(-1) by infusion. Group F received fentanyl 1 microg kg(-1) as bolus before induction and 0.5 microg kg(-1) h(-1) by infusion. Signs of inadequate analgesia, defined as an increase in heart rate and mean arterial pressure (MAP) 20% above the baseline, were managed by increasing or decreasing the dosage of dexmedetomidine and fentanyl. Statistical analysis was performed with student t, chi-squared and Fisher's exact tests. RESULTS: The maintenance dosage was 0.64+/-0.06 microg kg(-1) h(-1) for fentanyl in Group F and 0.31+/-0.08 microg kg(-1) h(-1) for dexmedetomidine in Group D. MAP values in Group D were significantly higher than in Group F only after intubation. Before and after extubation, MAP values in Group F were significantly higher than those in Group D. There was no statistical difference in heart rate between the groups. Propofol dosages for induction (1.40+/-0.48 mgkg(-1)) and maintenance of anesthesia (2.03+/-0.41 mg kg(-1)) were lower with dexmedetomidine. Extubation time and postanesthesia care unit discharge time were similar in both groups. The fentanyl group patients required supplemental analgesia earlier than the dexmedetomidine group (34.8+/-1.35 min vs 60.4+/-1.04 min). Postoperative nausea and vomiting were significantly higher in Group F. CONCLUSION: In conclusion, propofol-dexmedetomidine is suitable for patients undergoing elective spinal laminectomy and provides stable perioperative hemodynamic responses. Propofol-fentanyl medication requires a higher dosage of postoperative analgesics and causes frequent postoperative nausea and vomiting compared with propofol-dexmedetomidine.

Changing cerebral blood flow velocity detected by transcranial Doppler ultrasound during head up tilt in patients with multiple sclerosis.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is a chronic inflammatory disease of central nervous system. We aimed to investigate the cerebral blood flow velocity (CBFV) changes in MS by transcranial Doppler. METHODS: Twenty patients with MS, 20 age-matched healthy controls were included in the study. In both groups, blood flow velocities (BFVs) of middle cerebral arteries (MCAs) were evaluated. The changes of blood pressure, heart rate along with the changes in BFV of MCA were recorded after the patients were raised to upright position. RESULTS: In both groups, upon raising the tilt table to the upright position, the mean CBFV values were found to be lower in comparison with the recorded baseline values (P values <0.05). The decline in the mean CBFV values was more significant in patients with MS (P = 0.01). CONCLUSION: Our study showed upon raise of the tilt table, the mean BFVs decreased more in MS patients than control group with a more prominent change in the subgroup of MS patients with expanded disability scale scores > or =2. By use of transcranial Doppler ultrasound, it may be possible to evaluate BFV changes in patients with MS.

Dysphagia as a primary manifestation of hyperthyroidism: a case report.

Myopathy effecting mainly skeletal muscles of the limbs are frequently seen in hyperthyroidism. Rarely bulbar muscles may also be involved, causing dysphagia, nasal speech, and aspiration. We report a 70-year-old woman with severe dysphagia and aspiration pneumonia. Clinical examination and laboratory tests showed an underlying Graves' disease. Her dysphagia improved dramatically by antithyroid therapy. Considering its excellent response to medical therapy, hyperthyroidism--being a very rare factor - is well-worth to remember for the unexplained dysphagia cases.

The correlation between the Richmond agitation-sedation scale and bispectral index during dexmedetomidine sedation.

BACKGROUND AND OBJECTIVES: The primary objective of sedation in the critically ill patient is to achieve security and comfort. The routine use of standardized and validated sedation scales and monitors are needed. The Richmond agitation sedation scale has been used but some patients cannot be evaluated with subjective assessment tools such as the Richmond agitation sedation scale because they lack motor responsiveness due to therapeutic paralysis or because they are receiving deep sedation. We aimed to assess the correlation of bispectral index with Richmond agitation sedation scale during dexmedetomidine sedation and evaluate the use of the bispectral index in monitoring the levels of sedation in intensive care patients. METHODS: This was a single centre, prospective, clinical study. Eleven mechanically-ventilated critically ill patients, aged 17-82 (50.09 +/- 17.76; mean +/- SD) yr, 3 males and 8 females, APACHE II score 12.63 +/- 3.90, SOFA score 3.27 +/- 1.73 were enrolled in the study. Patients received a dexmedetomidine infusion of 1 microg kg-1 over 10 min followed by a maintenance infusion of 0.5 microg kg-1 h-1 for 8 h. Sedation was assessed using the Richmond agitation sedation scale and bispectral index monitoring. Heart rate, blood pressure, respiratory rate and SPO2 were monitored. Wilcoxon signed rank sum test and Spearman's rank correlation analysis were used for statistical analysis. RESULTS: The variation of Richmond agitation sedation scale score was between 0.9 and -1.7 bispectral index varied from 65 to 75. Significant correlations between Richmond agitation sedation scale and bispectral index values were found in this study. (r = 0.900; P = 0.0001) CONCLUSIONS: Richmond agitation sedation scale levels significantly correlated with bispectral index values during dexmedetomidine sedation in critically ill patients requiring mechanical ventilation in the intensive care unit.