Scapholunate Ligament Partial Tears; Tear Localization, Extrinsic Ligament Injury Association and Conservative Treatment Responses Prior to Instability: Cross-Sectional Study.

PURPOSE OF THE STUDY Scapholunate interosseous ligament (SLIOL) tears with accompanying extrinsic ligament rupture have been associated with scapholunate (SL) instability. SLIOL partial tears were examined in terms of tear localization, grade and accompanying extrinsic ligament injury. Conservative treatment responses were scrutinized according to injury types. MATERIAL AND METHODS Patients with SLIOL tear without dissociation were evaluated retrospectively. Magnetic resonance (MR) images were reexamined in terms of tear localization (volar, dorsal or combined volar and dorsal tears), grade of injury (partial or complete) and extrinsic ligament injury accompaniment (RSC, LRL, STT, DRC, DIC). Injury associations were examined with MR imaging. All patients treated conservatively were recalled at their first year for re-evaluation. Conservative treatment responses were analyzed according to pre- and post-treatment first year visual analog scale for pain (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores. RESULTS In our cohort, 79% (n: 82/104) of patients had SLIOL tear and 44% (n: 36) of them had accompanying extrinsic ligament injury. The majority of SLIOL tears and all extrinsic ligament injuries were partial tears. In SLIOL injuries, volar SLIOL was most commonly damaged portion (45%, n: 37). DIC (n: 17) and LRL (n: 13) were most frequently torn ligaments, radiolunotriquetral (LRL) injury generally co-existed with volar tears and dorsal intercarpal ligament (DIC) with dorsal tears regardless of injury time. Extrinsic ligament injury accompaniment was associated with higher pre-treatment VAS, DASH and PRWE scores than isolated SLIOL tears. Injury grade, location and extrinsic ligament accompaniment had no significant effect on treatment responses. Test scores reversal was better in acute injuries. CONCLUSIONS On imaging SLIOL injuries, attention should be paid to the integrity of secondary stabilizers. In partial SLIOL injuries, pain reduction and functional recovery can be achieved with conservative treatment. Conservative approach can be the initial treatment option in partial injuries especially in acute cases regardless of tear localization and injury grade if secondary stabilizers are intact. Key words: scapholunate interosseous ligament, extrinsic wrist ligaments, carpal instability, MRI of wrist, wrist ligamentous injury, volar and dorsal scapholunate interosseous ligament.

Kefir alters craniomandibular bone development in rats fed excess dose of high fructose corn syrup.

INTRODUCTION: Dietary high fructose corn syrup (HFCS) is involved in the pathogenesis of oral diseases as well as metabolic diseases. The aim of this study was to investigate the effects of HFCS-feeding on the craniomandibular bone development at an early age and also the potential of milk kefir for preventive treatment. MATERIALS AND METHODS: In this study, Control, Kefir, HFCS, and HFCS plus Kefir groups were formed; kefir was given by gastric gavage, while HFCS (20% beverages) was given in drinking water; for 8 weeks. RESULTS: Based on morphological evaluations, immunohistochemical, and gene expression results, it was clearly determined that excess dose of HFCS consumption decreased osteoblastic activity in craniomandibular bones while increasing osteoclastic activity. However, it has been determined that the intake of kefir with the HFCS-feeding greatly suppresses the effects of HFCS on bone tissues. CONCLUSION: In conclusion, dietary the excess dose of HFCS at an early age has been observed to pose a risk for cranial and mandible bone development. The healing effects of kefir may be a new approach to the treatment via kefir consumption in young's.

Missed Sleeve Fracture of the Superior Pole of Patella.

Patellar sleeve fracture is a form of injury in which small osseous fragments avulsed with periosteum and cartilage. 15-year-old male patient, playing in school football team, apllied to our clinic with a history of previously missed patellar superior pole sleeve avulsion fracture. Care must be taken in order not to miss the patellar superior pole sleeve fractures, which are very rare in children. Extra care must be taken in patients, whose X-ray imaging is clean but there is a problem in the extensor mechanism of the knee. INTRODUCTION Since the patella has high mobility and large cartilage surfaces, it's fracture is very rare in children (9). Growing patella is more prone to osteochondral or avulsion fractures (8). Patellar sleeve fracture is a form of injury in which small osseous fragments fractured with periosteum and cartilage (5). Avulsion or sleeve fractures of patella can be seen in inferior and superior patellar poles. Fractures in superior pole is very rare and only a few cases have been described in the literature (2).

RELIABILITY OF THE CORTICOTROPIN RELEASING HORMONE STIMULATION TEST FOR DIFFERENTIATING BETWEEN ACTH DEPENDENT AND INDEPENDENT CUSHING SYNDROME.

CONTEXT: It is a challenge to determine the origin of Cushing syndrome (CS), especially in patients with low-normal adrenocorticotropic hormone (ACTH) concentrations. OBJECTIVE: To evaluate the reliability of the corticotropin-releasing hormone (CRH) stimulation test in patients with CS whose origin of disease was not clearly identified using ACTH values, the high-dose dexamethasone suppression test (HDDST), and imaging in a single tertiary referral center. DESIGN AND METHODS: Twenty-one patients with CS who were admitted to the endocrinology-metabolism clinic between 2004 and 2016 whose ACTH concentrations were 5-20 pg/mL and needed CRH stimulation test were retrospectively assessed. RESULTS: Nine out of 21 patients were diagnosed as having Cushing's disease (CD) and 12/21 had adrenal CS. The CRH stimulation test had a sensitivity and specificity of 100% and 8%, and positive and negative predictive values of 100% and 45% according to the current diagnostic criteria, respectively. An increase in ACTH ≥115% at 15 minutes and cortisol ≥86% at 60 minutes after CRH were associated with the highest likelihood ratio. The sensitivity and specificity of ACTH was 67% and 83% (AUC=0.75±0.12, 95% CI: [0.5-0.9]; p=0.03), and for cortisol it was 75% and 78% (AUC=0.71±0.15, 95% CI: [0.5-0.9]; p=0.03). Cortisol suppression of more than 64% from basal level in the HDDST suggested CD with the highest likelihood ratio. When these cut-off values were used together, both tests were negative in the patients with CD. CONCLUSION: The CRH stimulation test has low specificity to localize CS in patients with ACTH concentrations of 5-20 pg/mL according to the current diagnostic criteria. Different diagnostic criteria may be used in the CRH stimulation test and also in the HDDST in this group of patients.

Fatigue in systemic lupus erythematosus : Association with disease activity, quality of life and psychosocial factors.

OBJECTIVE: The aim of the study was to determine which disease-related factors and non-disease features can explain the presence of systemic lupus erythematosus (SLE)-related fatigue in Turkish patients. METHODS: This cross-sectional study was carried out with 99 SLE patients and 71 healthy controls. To assess fatigue and health-related quality of life (HRQoL) the participants were asked to complete two questionnaires: the short form-36 health survey (SF-36) and the multidimensional assessment of fatigue (MAF) scale. Anxiety and depression of participants were assessed by the hospital anxiety and depression scale (HADS). RESULTS: A total of 99 patients (female/male 95/4) and 71 controls (female/male 40/31) were studied. The mean age and standard deviation (±SD) of patients and controls were 43.3 ± 12.2 years and 43.2 ± 12.1 years, respectively. The mean (SD) disease duration was 7.8 ± 5.3 years and median SLE disease activity index (SLEDAI) score was 0 (range = 0-16). The level of fatigue was higher in patients compared to controls with mean MAF scores of 24.7 ± 12.2 and 12.8 ± 9.9 (p < 0.001), respectively. The HADS-D and HADS-A scores were also significantly higher in SLE patients (6.6 ± 4.3 vs. 3.6 ± 2.9, p < 0.001 and 7.2 ± 4 vs. 4.9 ± 4, p = 0.007, respectively). There were no significant associations between the MAF and SLEDAI scores (r = 0.05, p = 0.63) but MAF scores positively correlated with age, HADS-A and HADS-D scores and negatively correlated with physical component summary (PCS), mental component summary (MCS) and each domain of SF-36 except role emotional in SLE patients. CONCLUSION: Fatigue is an important factor influencing patient daily life independent from disease activity in our study. The SLE patients with severe fatigue should also be assessed for other possible underlying causes such as anxiety, depression and poor quality of life.

Computer-assisted assessment of ovarian echotexture parameters in mares following changes after ovulation determined by ultrasonography.

This study was carried out to determine the time-dependent changes in the ultrasonographic image of the ovary with computer-assisted analysis programs at certain intervals after ovulation and to determine whether computer-assisted analysis programs and ovulation programs can be managed in cases where the ovulation time is unknown. The study included 40 purebred Arab mares. The study was subdivided into 4 different time periods of 6 (Group 1), 12 (Group 2), 18 (Group 3) and 24 (Group 4) hours following ovulation. In addition, after ovulation and ultrasonographic examination, natural insemination was performed at 6, 12, 18 and 24 hours, and pregnancy examination and follow-up were performed at 15-30-45 days. In the echotexture analysis, mean grayness value (MGV) and contrast (CON) measurements were at different levels according to the time groups (p⟨0.001). Homogeneity (HOM) measurements were at different levels according to the time groups (p⟨0.001). A very strong, significant negative correlation was determined between MGV and pregnancy rates (r=-0.91, p=0.01, p⟨0.05). No significant relationship was observed between HOM values and pregnancy rates (r=0.19, p=0.23, p>0.05). A very strong, significant negative correlation was determined between CON and pregnancy rates (r=-0.92, p=0.01, p⟨0.05). It was concluded that the use of ultrasonographic echotexture in mares after ovulation provided very important information. In cases where the time of ovulation was not known, by looking at the values of echotexture parameters, it was seen that the highest pregnancy rates were at the 6th hour and the lowest pregnancy rates were at the 24th hour. As the echotexture parameters MGV and CON increased, it was determined that pregnancy rates decreased, but there was no relationship between them and the HOM value.

The frequency of fibromyalgia syndrome and quality of life in hospitalized cancer patients.

To explore the frequency of fibromyalgia syndrome (FMS) among hospitalized cancer patients and address the relationships between pain, fatigue and quality of life with regard to the extent of pain, a cross-sectional and descriptive study was carried out in the Oncology Supportive Care Unit on 122 hospitalized cancer patients. Pain, sleep, disease impact (Fibromyalgia Impact Questionnaire), fatigue (Brief Fatigue Inventory), quality of life (Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30) were gathered using standardized measures. Thirteen of the hospitalized cancer patients (10.7%) included in the study were diagnosed with FMS. There were no statistically significant differences among three pain groups with respect to demographic characteristics (P > 0.05). There were significant differences among groups with regard to the presence of metastasis, fatigue, sleep disorder, pain, Brief Fatigue Inventory, Fibromyalgia Impact Questionnaire, most of subscores of Short Form 36 and European Organization for Research on Treatment of Cancer questionnaires Quality of Life-C30 scores (P < 0.05). In the present study, we have calculated the frequency of FMS among patients admitted to the oncology hospital in addition to establishing the relationships between pain, fatigue and quality of life with regard to the extent of pain. We believe that the descriptive data presented in this study would be helpful in future studies and therapeutic approaches.

The level of satisfaction in cancer patients with completed treatments: a 7-year screening.

PURPOSE: Cancer patients encounter many problems in the post-diagnosis period and they want to establish a good contact with the treatment team in order to get better information about their condition. This study attempted to investigate in patients with completed treatment the level of satisfaction they derived from the treatment and the treatment team. METHODS: The archive of medical records of the Medical Oncology Department comprising 4622 patients was randomly screened between the years 2000 and 2006. Charts of 528 patients were reached via phone and analysed for clinical data. RESULTS: Approximately 78.8% of the patients had been informed about their malignant diseases. The rates of satisfaction from the treatment team, the treatment itself, and communication with the physician was higher among informed patients compared to uninformed ones (p<0.05). Of all the evaluated patients, 38.5% had been recommended to practise general exercises. CONCLUSION: The great majority of our patients were informed about their diseases and treatments, although without being given adequate importance, and the satisfaction rates were higher among informed patients. We believe that our study will provide new approaches in relation to the importance and methods of communicating with and informing patients.

In vitro effects of sodium fluoride and sodium dichromate on dynamic properties of human erythrocyte membrane.

Sodium fluoride (NaF) and sodium dichromate (Na2Cr2O7) are two different toxic compounds which are used as a dental caries prophylactic and as an oxidising agent in various industrial areas, respectively. However, accidental fluoride and chromate poisoning is not a rare occurrence, even death may result from cardiac or respiratory failure. In the present work, alterations produced by NaF, Na2Cr2O7 and temperature changes in the molecular dynamics of the human erythrocyte membrane were studied, in vitro, by the spin-labelling ESR technique. Human intact erythrocyte cells spin labelled with 5- and 16-doxyl stearic acids (5-DSA and 16-DSA) and treated with 40 microM NaF and 5 microM Na2Cr2O7 at 37 degrees C were used to quantify membrane fluidity. This was performed by measuring the changes in the order parameter (S), correlation time (tau) and phase transition temperature using recorded electron spin resonance (ESR) spectra. Experimental results show that 5 microM Na2Cr2O7 and 40 microM NaF do not produce any significant effects on the order parameter of 5-DSA spin label while they cause appreciable changes in the correlation time of the same label. As for 16-DSA, while Na2Cr2O7 does not produce any measurable effect on the order parameter of this label, NaF does in a certain extent. Although weak, the effects of both compounds on the correlation time of 16-DSA are found to be well above the experimental error limits. Change in temperature was observed to alter significantly S and tau parameters which show biphasic character in the temperature range of 5-50 degrees C. Activation energies of the hydrocarbon chains above and below transition temperatures were also determined for untreated and NaF or Na2Cr2O7 treated erythrocyte cells and the effect of NaF and Na2Cr2O7 on these energies and transition temperatures were discussed.

The effects of mitomycin-C and temperature on dynamical properties of human erythrocyte membrane.

Alterations produced by mitomycin-C (hereafter MC) and temperature changes in human erythrocyte membrane molecular dynamics were studied, in vitro, by spin-labeling ESR technique. Erythrocyte cells were spin-labeled with 5- and 16-doxyl-stearic acids, 5- and 16-DSA, respectively, and membrane fluidity was quantified by measuring the changes in the order parameter (S), correlation time (tau), phase transition temperature and activation energies. Erythrocyte cells were first labeled with 5-DSA and 16-DSA at 37 degrees C for 10 min, then they were treated with MC of three different concentrations (2.5; 5 and 10 microM) for various time (0-300 min) at the same temperature. Experimental results indicate that treatment time and applied MC concentrations do not produce any significant reproducible changes in the spectral parameters. However, change in temperature was observed to alter significantly S and tau parameters that show biphasic character in the temperature range of 5-50 degrees C. Activation energy values of hydrocarbon chains above and below transition temperatures for untreated and MC-treated erythrocyte cells were also determined, and the effect of MC on these energy values were discussed.

Intramedullary schwannoma of the spinal cord. A case report and review of the literature.

A 9-year-old boy presented with the numbness in both arms and hands, and neck stiffness. On examination, he had a slight quadriparesis and restricted neck movements. There were no signs of von Recklinghausen's disease. Magnetic resonance imaging (MRI) scan disclosed a gadolinium enhanced intramedullary tumor located at C6-T1 associated with syringomyelia. C6-T1 laminectomies were performed and the intramedullary tumor was totally removed by a microsurgical technique. Postoperative course was uneventful. The pathological examination revealed an intramedullary schwannoma. The occurrence of intramedullary schwannoma in a patient without signs of von Recklinghausen's disease is extremely rare. We have been able to find 57 cases of intramedullary schwannoma reported in the literature. Intramedullary schwannomas are usually seen in males. The ages of the patients ranged from 9 to 75 years (mean 40.44 years). Only 4 cases in the pediatric age group have been reported. The duration of symptoms ranged from 3 months to 20 years (mean 31.03 months). Symptoms and signs varied with the location of tumor. The vertebral levels of intramedullary schwannomas were usually cervical (61%). MRI has been the choice of diagnostic tool in the cases reported since 1986. The majority of the cases showed either a partial or complete recovery in the postoperative period.

Myelopathy due to hereditary multiple exostoses: CT and MR studies.

Substantiated myelopathy in hereditary multiple exostoses is very rare. A few cases have been reported previously. We report a case of a 17-year-old boy with two exostoses in the cervical spine, in one of which caused a high cervical cord compression.

In vitro effects of colchicine on human erythrocyte membranes: an ESR study.

Colchicine (CC) is an antimitotic and antitubular agent which is currently used in medicine as a drug to treat various diseases. In spite of its widespread use the interaction of this drug with membranes is not yet known clearly. To characterize alterations in membrane molecular dynamics produced by CC, human erythrocytes were spin-labeled with 5-doxylstearic acid (5-DSA) and 16-doxylstearic acid (16-DSA), and membrane fluidity was quantified by measuring the changes in the order parameter (S) which reflects the anisotropy due to restricted motional averaging, correlation time (tau c) representing the spin label tumbling rate in the sample and phase transitions derived from ESR measurements. CC induced significant changes in both order parameter and correlation time at the surface of 5-DSA labeled membrane, but this was not the case at the core of 16-DSA labeled membrane. Order parameter, S and rotational correlation time, tau c, showed a biphasic character in the temperature range of 5-50 degrees C. This fact was used to calculate phase transition temperatures and activation energies of untreated (control) and treated erythrocyte cells with CC.

Clinical evaluation of different applications of misoprostol and aglepristone for induction of abortion in bitches.

The aim of the present study was to compare the clinical and endocrinological effects of different applications of misoprostol (MIS) and aglepristone (AGL) for the induction of abortion in bitches. For this purpose, 28 healthy pregnant bitches from different breeds, ages, body weights (Body weigt, BWs, 10-40 kg), and between Days 25 to 35 of gestation were used. Bitches were randomly assigned to four groups. In group 1 (GI, n = 7), AGL (10 mg/kg BW, s.c. on 2 consecutive days); in group 2 (GII, n = 7), AGL (as in GI), intravaginal MIS (IVag, 200 µg for bitches with ≤20 kg BW, 400 µg for bitches with >20 kg BW, daily intravaginally until completion of abortion); in group 3 (GIII, n = 7), AGL (as in GI), ICVag (as in GII), per os MIS (400 µg for bitches with ≤20 kg BW, 800 µg for bitches with >20 kg BW, daily orally, until completion of abortion); in group 4 (GIV, n = 7), AGL (as in GI), per os MIS (as GIII) were used. Clinical, vaginal, and ultrasonographic examinations were performed daily until abortion was completed. For measurement of serum progesterone, blood samples were collected in all groups immediately after the first AGL administration and every other day until completion of abortion. No statistical differences were found between groups concerning the duration until completion of abortion after treatment (nonsignificant); however, in GII, one bitch completed abortion 2 days after the start of treatment.

Are intra-articular corticosteroid injections better than conventional TENS in treatment of rotator cuff tendinitis in the short run? A randomized study.

AIM: Rotator cuff problems are common causes of pain and restriction of movement in shoulder. The aim of this study to compare the effect of intra-articular injection of corticosteroid and conventional transcutaneous electrical nerve stimulator (TENS) treatment in treatment of rotator cuff tendinitis. METHODS: Subjects were randomly allocated into Group 1 (intra-articular injection of corticosteroid) and Group 2 (conventional transcutaneous electrical nerve stimulation-TENS). Outcome measurements were performed using the Visual Analogue Scale (VAS) for pain, range of motion (ROM), the Shoulder Disability Questionnaire (SDQ), the Short Form-36 (SF-36), and Beck Depression Scale (BDS) questionnaires and paracetamol consumption. RESULTS: In both groups, significant improvement was observed in all weeks in VAS, ROM and SDQ scores (P<0.05). Improvement was detected in most of the SF36 scores at the end of the treatment in both groups (P<0.05), while no significant change was observed in BDI score (P>0.05). In both treatment groups, paracetamol consumption decreased in time (P<0.05). When the groups were compared, a significant difference was found between the groups in favor of Group 1 in terms of VAS-at night and VAS-at rest in weeks 1, 4 and 12, and VAS-during movement in week 1 and 12 (P<0.05). The comparison of two groups revealed a significant difference in favor of Group 1 in weeks 1 in the passive abduction and the active and passive IR ROM measurements (P<0.05). There was also a significant difference in favor of Group 1 observed in weeks 1 in SDQ scores (P<0.05). CONCLUSION: Intra-articular injection of corticosteroid and conventional TENS are efficient in the treatment of rotator cuff tendinitis. When two treatments are compared, it may be concluded that intra-articular steroid injection was more effective especially in the first weeks regarding pain, ROM and disability. Otherwise, use of TENS allow to patients to increase activity level, improve function and quality of life like that in our study. TENS, as it is cheaper, non-invasive, more easily performed and efficient, may be preferable for the treatment of shoulder pain. Further studies are needed to include these results in the prospective treatment guidelines.