Quantitative microvascular alterations in butterfly-shaped pattern dystrophy and adult-onset foveomacular vitelliform dystrophy.

PURPOSE: To study retinal microvascular parameters in patients with butterfly-shaped pattern dystrophy (BPD) and adult foveomacular vitelliform dystrophy (AFVD). METHODS: This case-control study included BPD and AFVD patients in a tertiary university hospital. Eyes with known ocular disease and prior ocular surgery other than uncomplicated cataract surgery were excluded. Right eyes of healthy individuals without systemic or ocular disease were included as controls. En face 6×6mm angiograms were obtained with the RTVue XR Avanti (Optovue, USA). We used the Kruskal-Wallis test to compare vessel density (VD) values of the retina, optic disc and foveal avascular zone (FAZ) between groups. Dunn-Bonferroni correction was used for pairwise comparisons. RESULTS: Eighteen eyes of 10 BPD patients, 17 eyes of 9 AFVD patients, and 26 right eyes of 26 controls were included. Six patients in the BPD, 4 patients in the AFVD, and 16 patients in the control group were female. The groups did not differ by sex (P=0.650). AFVD patients were of higher mean age (64.3±7.8) than BPD patients (55.9±11.1) and controls (53.6±5.5) (P=0.008, p=0.009). In BPD (P=0.008, P=0.044) and AFVD (P=0.006, P=0.002), parafoveal and perifoveal vessel density (VD) of the superficial capillary plexus were lower than controls. Parafoveal VD of the deep capillary plexus in AFVD was lower than in controls (P=0.012). There was no difference in the foveal avascular area between groups (P=0.563). Optic discs parameters did not differ. CONCLUSION: A comparable loss in vascular density may indicate shared pathophysiology or represent a common sign of impairment in retinal homeostasis. Further research is needed to clarify underlying microvascular pathogenetic mechanisms in pattern dystrophies.

Post operative pain management in shoulder surgery: Suprascapular and axillary nerve block by arthroscope assisted catheter placement.

BACKGROUND: Postoperative pain management is the part of shoulder surgery to improve patient satisfaction, start rehabilitation process rapidly and decrease for hospital stay. Various treatment modalities have been used for pain management, but they have some limitations, side effects and risks. Throughout intraoperative and postoperative period, nerve blocks have been used more popularly than others because of efficacy. For the regional nerve block, local anesthetic should be infiltrated close to the nerve for maximum effect. Consequently, aim of this study was to evaluate analgesic efficacy when catheters are placed with assistance of arthroscope to block suprascapular and axillary nerves in patients undergoing arthroscopic repair of rotator cuff under general anesthesia. MATERIALS AND METHODS: 24 patients (5 males, 19 females; mean age: 54.3 years) who underwent arthroscopic repair of rotator cuff between June 2014 and September 2014 and were catheterized to block suprascapular and axillary nerves during shoulder arthroscopy were included in the study. Clinical outcomes were assessed using visual analog scale (VAS) scores preoperatively and at 0 h, 6 h, 12 h, 18 h, 24 h, and postoperative day 2. RESULTS: Preoperative and postoperative 0 h, 6 h, 12 h, 18 h, 24 h, and day 2 mean VAS scores were 6.38 ± 0.77, 0.44 ± 0.42, 0.58 ± 0.42, 0.63 ± 0.40, 0.60 ± 0.44, 0.52 ± 0.42, and 1.55 ± 0.46, respectively. No statistical difference was found among 0 h, 6 h, 12 h, 18 h, and 24 h time points; however, comparison of postoperative day 2 and postoperative 0 h, 6 h, 12 h, 18h and 24 h VAS scores showed statistically significant difference (P < 0.05). All patients were discharged at the end of 24 h with no complication. The mean time (in minutes) required for blocking suprascapular nerve and axillar nerve were 14.38 ± 3.21 and 3.75 ± 0.85, respectively. CONCLUSION: These results demonstrated that blocking two nerves with arthroscopic approach was an excellent pain management method in postoperative period. Accordingly, patients could recover rapidly and patients' satisfaction could be improved.

Treatment approaches and outcomes in childhood supracondylar humerus fractures.

BACKGROUND: Being one of the most frequent elbow fractures during childhood, supracondylar humerus fractures require rapid diagnosis and treatment, as they may be associated with significant neurovascular and functional problems. QUESTIONS AND PURPOSES: To evaluate demographic and clinical features, and treatment outcomes of the patients with supracondylar humerus fractures who underwent open reduction+minimal osteosynthesis or closed reduction+percutaneous wiring. PATIENTS AND METHODS: Forty patients (30 boys + 10 girls) between 2 and 13 years of age who were operated on with the diagnosis of supracondylar humerus fracture, between August 2003 and December 2006, were included. Open reduction+minimal osteosynthesis (n=34) and closed reduction+percutaneous wiring (n=6) were performed. The fractures were classified according to the Gartland classification and outcomes were assessed according to Flynn's criteria. RESULTS: All patients (mean age, 7.35 years; range, 2-13 years) had closed fractures (28 left and 12 right). Seven (17.5%) and 33 (82.5%) patients had Gartland type II and III fractures respectively. Three patients had flexion-type and 37 patients had extension-type fractures. Based on Flynn's criteria, cosmetic results were excellent in 37 (92.5%) patients and good in 3 (7.5%) patients, and functional results were excellent in 36 (90%) patients, good in 3 (7.5%) patients, and poor in 1 (2.5%) patient. A surgical success rate of 97.5% was noted. No significant difference was found between wire configurations (p > 0.05). CONCLUSIONS: Treatment of supracondylar humerus fractures in children should be patient-specific based on factors such as patient's age, soft tissue conditions and deformity status.

Carpal tunnel decompression: two different mini-incision techniques.

AIM: To compare two different mini-incision surgical techniques for carpal tunnel surgery. MATERIALS AND METHODS: A total of 45 patients in Group 1 underwent carpal tunnel release through a 2-cm longitudinal incision made distal to the flexor crease, whereas the 45 patients in Group 2 underwent carpal tunnel release through a 2-cm longitudinal incision made proximal to the flexor crease. The self-administered Boston Questionnaire was used to assess the severity of patients' symptoms and their functional status, both before and after the surgical intervention and at their final follow-up. Patients were also asked, during the final follow-up, about the pain level of their scar tissue. RESULTS: There was a significant decrease in the Boston Carpal Tunnel Questionnaire scores for the symptom severity scale and the functional status scale of patients in both groups, pre-operatively, post-operatively at one month and at final follow-up (p < 0.001 for both). The mean operative time for Group 2 was significantly shorter than for Group 1 (p < 0.001). At final follow-up, 11 patients in Group 1 stated they had scar tissue pain, compared to three patients in Group 2. The pain in scar tissue among Group 2 was significantly less than for Group 1 (p = 0.02). CONCLUSIONS: Due to shorter operative times, mini-incisions proximal to the flexor crease can be performed. The absence of relapse and good clinical results make both surgical techniques suitable. For this reason, we consider that the selection of the mini-surgical technique used should depend on the experience and skill of the surgeon.

Altered LKB1/CREB-regulated transcription co-activator (CRTC) signaling axis promotes esophageal cancer cell migration and invasion.

LKB1 is a tumor susceptibility gene for the Peutz-Jeghers cancer syndrome and is a target for mutational inactivation in sporadic human malignancies. LKB1 encodes a serine/threonine kinase that has critical roles in cell growth, polarity and metabolism. A novel and important function of LKB1 is its ability to regulate the phosphorylation of CREB-regulated transcription co-activators (CRTCs) whose aberrant activation is linked with oncogenic activities. However, the roles and mechanisms of LKB1 and CRTC in the pathogenesis of esophageal cancer have not been previously investigated. In this study, we observed altered LKB1-CRTC signaling in a subset of human esophageal cancer cell lines and patient samples. LKB1 negatively regulates esophageal cancer cell migration and invasion in vitro. Mechanistically, we determined that CRTC signaling becomes activated because of LKB1 loss, which results in the transcriptional activation of specific downstream targets including LYPD3, a critical mediator for LKB1 loss-of-function. Our data indicate that de-regulated LKB1-CRTC signaling might represent a crucial mechanism for esophageal cancer progression.

A new, objective radiographic classification system for the assessment of treatment results in developmental dysplasia of the hip.

The new, objective radiographic classification system for the assessment of treatment results in developmental dysplasia of the hip includes three quantitative parameters: centre-edge angle of Wiberg, acetabular angle of Sharp and the centre-trochanter distance. Each parameter is divided into three subgroups and assigned a point score (0, 1 and 2) according to their previously determined values. Besides this, three corrective items on the existence of middle/posterior acetabular deficiency, secondary operation and resubluxation/redislocation are added to the classification system and in the presence of any of these items, one point for each item is extracted from the total points. A total of five or six points represents a satisfactory outcome and less than five points, an unsatisfactory outcome. The new system was found to have adequate intraobserver and interobserver agreement levels. It was also observed that, the gold standard Severin system could lead the raters to obtain somewhat more optimistic results with respect to the new system before and after skeletal maturity. It was concluded that the present system could evaluate both the final radiographic status of the hip and the success or failure of the primary treatment and could be capable of leading orthopaedic surgeons to speak the same language while assessing radiographic results in developmental dysplasia of the hip.

Is concomitant bone surgery necessary at the time of open reduction in developmental dislocation of the hip in children 12-18 months old? Comparison of open reduction in patients younger than 12 months old and those 12-18 months old.

It is controversial to perform bone surgery at the time of open reduction in developmental dislocation of the hip in children 12-18 months old. The purpose of this study is to investigate whether concomitant bone surgery is necessary in patients treated with medial open reduction in this age range. Patients that were under 12 months of age at the time of open reduction were compared with patients that were 12-18 months old. Forty-four hips of 30 patients treated with open reduction through Ferguson's medial approach have been included in the study. Mean follow-up was 19.6 years (13-27.5). Age at the time of open reduction was less than 12 months in 21 hips (group A) and 12 months or more in 23 hips (group B). There was no significant difference between two groups concerning avascular necrosis or unsatisfactory radiological outcome (Severin's groups III and IV). A higher rate of secondary bone surgery was necessary in group B than in group A. Although secondary bone surgery is needed at a higher frequency in children 12-18 months old, the radiological outcome is not significantly different for patients younger than 12 months. Therefore, the recommendation of concomitant bone surgery on a routine basis during open reduction in developmental dislocation of the hip in children 12-18 months old is debatable.

Open reduction through a medial approach in developmental dislocation of the hip: a follow-up study to skeletal maturity.

Forty-four developmentally dislocated hips occurring in 30 patients with an average age at initial surgery of 10.7 (range 2-19) months underwent medial open reduction by Ferguson's approach. All patients were skeletally mature at most recent evaluation. Mean follow-up was 19.8 (range 13-27.5) years. No redislocation or sub-luxation occurred. Additional surgery was required in 11 hips (25%). Avascular necrosis was detected in nine hips (20%). The acetabular index was decreased and the center-edge angle was increased during follow-up. Excellent or good outcome (Severin group 1 or 2) was observed in 79% of the hips at skeletal maturity. At the most recent evaluation, all but two patients had the highest score on the Iowa Hip Rating. The authors conclude that open reduction through the medial approach is effective in developmental dislocation of the hip. Follow-up until skeletal maturity is necessary for an accurate assessment of treatment.

Treatment of developmental dysplasia of the hip with Pavlik harness: prospective study in Graf type IIc or more severe hips.

Successful treatment of developmental dysplasia of the hip (DDH) is associated with early diagnosis and appropriate treatment. In this prospective study, the results of the treatment with Pavlik harness followed by an abduction brace in patients with severe DDH were presented. Twenty-two hips of 18 patients with a mean age of 14.8+/-5.9 weeks (range, 6-26) when diagnosed were followed for an average of 24.2+/-10.8 months (range, 10-46). The hips were staged according to the classification of Graf with ultrasonography and Pavlik harness was instituted as the first line of treatment in all hips. If there was no improvement of ultrasonographic stage at the third week follow-up the harness treatment was discontinued. After the infant became too large for Pavlik harness an abduction brace was used. In all but one hip the treatment was successful (95.4%). In two hips type I avascular necrosis was noted. Of the dislocated hips 90% were reduced. The Pavlik harness is a safe and effective method of treatment of severe DDH in infancy if potential pitfalls are avoided.

Occult spinal dysraphism and its association with hip dysplasia in females.

We examined the pelvic radiographs of two groups of patients (more than 12 years of age) from six medical centres. Hip dysplasia was considered to be present if Shenton's line was broken and more than one third of the femoral head was revealed to be uncovered in an antero-posterior radiograph of the pelvis. Patients with hip dysplasia due to teratological or neurological causes were excluded. There were 291 patients with treated or untreated hip dysplasia in the dysplastic group. The control group of 415 individuals was collected from consecutive outpatients (with a pre-set standardised female/male ratio) for whom an antero-posterior radiograph of the pelvis had been made in one of two medical centres and which did not disclose any abnormality of the hip joints. The aim of the study was to assess the co-existence of hip dysplasia and occult spinal dysraphism. Radiographs of all patients were examined, and any partial or complete defect of the posterior vertebral arch was recorded. In the dysplastic group, a defect was recorded in 23% (67/291) radiographs and in the control group in 12% (48/415). In both groups, L5 and S1 were the most commonly recorded sites with a defect. In the dysplastic group, a defect was recorded in 56/190 females and in the control group in 30/302 females. In males, there was no significant difference between the recorded findings in the two groups. In females with hip dysplasia, occult spinal dysraphism seems to be fairly common.

Total knee arthroplasty complicated by Corynebacterium jeikeium infection.

Corynebacterium jeikeium is a slow-growing multiresistant micro-organism. It causes serious opportunistic infections in patients with long hospital stays who receive broad-spectrum antibiotics. It can be isolated from blood and other sites in neutropenic, immunosuppressed bone marrow recipients and in patients with indwelling catheters. Cases of infection related to bone and joint replacements are rare. This case is the first where Corynebacterium jeikeium has been isolated from an infected knee following total knee arthroplasty.

Unicameral bone cyst of the patella. A case report.

We present a case of a simple bone cyst in the patella in a women of 33 years. We were only able to find one similar case in the literature.

Circadian variation in circulating pyrogen: possible role in resistance to infection.

In the rat, body temperature (bt) is highest, and plasma iron (Fe) and zinc (Zn) concentrations are lowest at night while the rat is most active; the inverse is true during the day. Based on data implicating endogenous pyrogen (EP) as a mediator of the rise in body temperature and fall in plasma trace metal levels during infection we hypothesized that the circadian rise in body temperature and fall in plasma Fe and Zn levels may be attributed to a cyclic release of EP. To test this hypothesis: (1) Rats were injected ip with an antipyretic dose of sodium salicylate (300 mg/kg). The result was a reduction (P less than 0.05) in bt at night. (2) Rats were injected during the day with 1 ml each of plasma collected from rats during the night. As a control, rat plasma collected during the day was injected at this same time point. A rise (P less than 0.05) in bt was observed only in animals who had received plasma collected at night. These results support the hypothesis that a pyrogen, perhaps EP, is present in the plasma of rats at night. The release of EP during periods of greatest activity may have an adaptive role since rats are more likely to come into contact with pathogens during these times. If EP were released during periods of activity, the likelihood of severe infection occurring would be diminished. To test this hypothesis, two groups of rats were injected with Salmonella typhimurium, one group at midnight (A) and one group at noon (B). The mortality rate was 25% in group A and 60% in group B (P less than 0.025). These data support the hypothesis that the immune/host defense of rats to S. typhimurium is more effective at night, possibly due to an increased level of circulating pyrogen.

Chemical and biological characterization of an active substance of the human placenta.

Acetic acid extracts of human term placenta have been fractionated by pH and salt precipitations and by exclusion chromatography on a Sephadex G-75 column. A partially purified fraction (F-II) possessing uterotropic activity in immature and young mice was obtained. This active fraction was submitted to the action of protein denaturating agents (heat, 8 M urea) and of specific proteolytic enzymes (trypsin, alpha-chymotrypsin and pronase). These treatments completely destroy the uterotropic activity showing that the active substance is of protein nature. The administration of F-II to spayed mice did not produce any increase in their uterine weight suggesting that the uterotropic activity would be due to stimulation of the female gonad.