Serum lipoprotein (a) levels in patients with diabetic foot lesions.

Our aim was to see the levels of lipoprotein (a) (Lp (a)) in patients with gangrenous or non-gangrenous diabetic foot lesions. Twenty-two patients with gangrenous foot lesions, 11 with non-gangrenous foot lesions and 10 healthy subjects were included in the study. All the patients had similar glycemic control and duration of diabetes. The main outcome measure was serum Lp (a) levels in both group of patients with diabetes and healthy subjects. Diabetic patients with gangrenous foot lesions had significantly higher Lp (a) levels (83.8+/-8.3 mg/dl) than the patients with non-gangrenous foot lesions (38.3+/-5.8 mg/dl) and healthy subjects (35.6+/-4.2 mg/dl). Lp (a) levels were not significantly different in healthy subjects and in patients with non-gangrenous foot lesions. Lp (a) levels may have a pathogenetic role in the development of gangrenous foot lesions in patients with diabetes mellitus.

Role of insulin like growth factor-I in repair response in immature cartilage.

OBJECTIVE: The purpose of this study was to investigate the effects of exogenous local Insulin like growth factor-I (IGF-I) on the repair of full-thickness articular cartilage defects in immature rabbits. DESIGN: Thirty-six skeletally immature New Zealand rabbits between 6 and 8 weeks old were used. A single defect, 3.5-mm-wide by 4-mm-deep full-thickness articular cartilage defect in the medial femoral condyle, was created. The defect was either filled with a collagen sponge or with a collagen sponge impregnated with 5 mug of recombinant IGF-I. The animals were sacrificed at 4, 8 or 12 weeks, and the repair tissue was examined macroscopically and histologically. Repair tissue was also examined immunohistochemically for the presence of type-I collagen, type-II collagen and PCNA at all weeks. RESULTS: Newly formed tissue in all of the defects in the IGF-I group had the gross, histological and histochemical appearance of a smooth, intact hyaline articular cartilage. The average total scores on the histological grading scale were significantly better (p<0.05) for the defects treated with recombinant IGF-I at all time points. Immunostaining with an antibody against type-II collagen showed the diffuse presence of the repair cartilage in the IGF-I treated defects. The control groups demonstrated minimum staining with type-II collagen antibody. CONCLUSIONS: These findings suggest that repair of full-thickness immature cartilage defects can be enhanced by recombinant IGF-I.

Sodium hyaluronate regulating angiogenesis during Achilles tendon healing.

The aim of this study was to evaluate the effect of SH (sodium hyaluronate-NaHA) on vascular endothelial growth factor (VEGF) and type IV collagen expression during the Achilles-tendon healing process. Adult New Zealand white rabbits (n=32) aged 4 months and weighing 2.7-3.9 kg were used. The rabbits were randomly divided into two groups, and each group was divided into two subgroups and monitored for 6 and 12 weeks. Tendo calcanei were incised transversely and repaired. An injection of 0.5 ml NaHA (15 mg/ml) was administered between the tendon and paratenon of the right leg and repeated twice at one-week intervals. Equal numbers of animals were sacrificed at the 6th and 12th weeks, and the repaired tissue was examined macroscopically and histologically for the presence of VEGF and type IV collagen expression every week. The decrease in the amount of adhesion tissue and the acceleration of tendon healing in the NaHA group were significantly high when compared with control groups at 6 and 12 weeks (p<0.001, p<0.05). In the NaHA group, due to vascular proliferation VEGF immunostaining was strongly positive in the 6th week (p<0.05), and remained positive in the 12th week (p<0.05). Similar immunostaining findings were detected for type IV collagen in the 6th week. However, there was a significant decline in immunostaining rate in the 12th week (p<0.05). The increases in VEGF and type IV collagen expression following SH administration might be an indication that SH may partly be involved in regulation of angiogenesis.

Treatment of midclavicular nonunion: comparison of dynamic compression plating and low-contact dynamic compression plating techniques.

In this study a comparison of patients with midclavicular nonunion, treated by a combination of internal fixation with dynamic compression plate (DCP) or low-contact DCP (LC-DCP) and application of autogenous corticocancellous chips or sculptured graft on nonunion areas, was performed. Time to union in the patients treated with LC-DCP fixation was shorter than in those treated with DCP fixation (P <.001). Union was obtained in all patients treated with LC-DCP fixation and in 87.5% of those treated with DCP fixation. All of those treated with LC-DCP fixation returned to their original jobs, whereas two patients treated with DCP fixation had to change jobs. According to the Disabilities of the Arm, Shoulder, and Hand functional score, at the last follow-up visit, functional outcomes of the patients treated with LC-DCP fixation were more satisfactory (P <.001). The addition of internal fixation of the clavicle with DCP or LC-DCP to application of autogenous corticocancellous chips, or sculptured graft on nonunion areas in patients with midclavicular nonunion, shortens the time to union, increases union rates, and provides satisfactory functional outcomes.

Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases.

OBJECTIVES: To evaluate functional outcomes, morbidity and mortality rates, and psychological and psychosomatic status in patients treated for completely unstable pelvic injuries (Tile class C). DESIGN: Prospective clinical study. SETTING: University hospital. PATIENTS/PARTICIPANTS: Forty patients treated with anterior and posterior internal fixation for unstable pelvic ring fractures between January 1992 and August 1999. INTERVENTION: Open reduction and anterior and posterior internal fixation of the pelvic ring. MAIN OUTCOME MEASUREMENTS: The data were analyzed as follows: pelvic fracture classification, Tile classification; severity of trauma, Injury Severity Score (ISS); functional outcomes, the Majeed Outcome Scale; psychological and psychosomatic status, Hamilton Depression and Anxiety Rating Score (HDARS). RESULTS: Preoperatively the average ISS was 29.4 (range 12-66). There was a statistically significant positive correlation between anxiety and ISS (r = 0.536, P < 0.01). Two patients died during the early postoperative period. Two additional patients were lost to follow-up, leaving 36 patients followed for an average of 45 months (range 21-116 months). Deep infections developed in three patients with a posterior pelvic ring injury who had been treated with percutaneous fixation techniques. These were treated successfully with débridement. Nine patients complained of pain of pelvic origin. Nerve deficits recovered completely in four of the seven patients with preoperative neurologic deficiency. Moderate or major depression was diagnosed in sexually dysfunctional patients in the 12th postoperative month according to HDARS (r = -0.559, P < 0.001). At the last visit, there was an inverse correlation between ability to work and depression and anxiety (r = -0.551, r = -0.391). An inverse correlation was found between pain and ability to work (r = 0.597, P < 0.001). Of the 36 patients, 26 returned to their original jobs at the last follow-up visit. CONCLUSIONS: Morbidity and mortality rates are higher in patients with a completely unstable pelvic ring injury. Emergency department stabilization and reconstruction of the pelvic ring with optimal operative techniques in these patients can reduce morbidity and mortality rates. Anterior and posterior internal fixation results in satisfactory clinical and radiologic outcomes. The affective status of patients is an important aspect that should be considered during the entire care of the patient.

Bilateral obturator dislocation of the hip.

A case of a traumatic bilateral obturator dislocation of the hip and right side acetabular fracture in a 23-year-old man is presented. The patient was managed conservatively. After follow-up time of 24 months, the result was excellent. The importance of a pelvic radiograph and physical examination of the extremities after significant major trauma are emphasized.

Septic arthritis in patients followed-up in neonatal intensive care unit.

BACKGROUND: Septic arthritis is an uncommon, but serious disorder in neonates. Most patients survive with permanent handicaps. Due to the rarity of this condition in neonates and paucity of signs and symptoms, the diagnosis of septic arthritis in newborns is more difficult than in older children. METHODS: Septic arthritis or suppurative arthritis is an infection of the joint by a variety of microorganisms, including bacteria, viruses, mycobacteria and fungi. Purulent synovial fluid, positive culture and positive Gram stain were accepted as a gold standard for exact diagnosis. Fourteen neonates who were followed-up in a neonatal intensive care unit, with septic arthritis, were included in a study based on a review of medical reports and a long-term clinical and radiological follow-up. Clinical symptoms, bacteriology, risk factors and outcomes are discussed. RESULTS: Staphylococcus aureus was the predominant causative organism. Risk factors for septic arthritis were prematurity (4/14), umbilical catheterization or venous catheterization (3/14), sepsis (3/14), perinatal asphyxia (2/14) and difficult birth (1/14). All cases of septic arthritis in neonates were improved without squealae except in two patients. One patient died and one patient had severe squealae. In these two patients, the duration of disease from clinical onset to initiation of therapy was long. CONCLUSIONS: The most important prognostic factor in predicting a favorable outcome in neonatal septic arthritis is early diagnosis and therapy. When appropriate treatment is delayed, catastrophic sequelae are inevitable. Early diagnosis of the condition and rapid removal of pus are mandatory for the survival of the joint. Long-term follow-up may reveal effects of epiphyseal damage, early degenerative changes and limitation of the range of motion.

Experimental repair of segmental bone defects in rabbits by demineralized allograft covered by free autogenous periosteum.

Using an experimental model of segmental bone defect in the ulna of rabbits we investigated the effect on bone healing of fresh cancellous autograft (FCA), demineralized deep-frozen allograft (DDA), and demineralized deep-frozen allograft covered with free autogenous periosteum (DDAwP). Radiologically, it was found that the results of the FCA and DDAwP groups were superior to those of the DDA group. This superiority was statistically significant after the 3rd to the 9th week for the FCA group, and the 6th to the 9th week for the DDAwP group. However, bone formation and union in the DDA group reached the same level of those in the other groups after 12 weeks. When the all histological findings were compared at the 12th week, the FCA and DDAwP groups were statistically superior to the DDA group in terms of proximal union. On distal union, the FCA group was statistically superior to the DDA group. Biomechanically, the FCA and DDAwP groups were statistically superior to the DDA group in terms of maximum torque and energy absorption. The DDAwP group was superior to the DDA group in term of stiffness. We conclude that ossification could be more easily achieved if demineralized deep-frozen allograft is covered with periosteum when faced with the need for quicker and better quality bone integration.

Effects of epinephrine in local anesthetic mixtures on hemodynamics and view quality during knee arthroscopy.

We compared three different methods of anesthesia for outpatient knee arthroscopy in terms of perioperative surgical conditions, pain, and hemodynamics. In a prospective and double-blind study ( n=130) the patients were randomized into three groups. A 50-ml mixture composed of 20 ml 0.5% bupivacaine hydrochloride, 10 ml 2% lidocaine hydrochloride, and 20 ml 0.9% sodium chloride was prepared for local anesthesia. The knee joint was injected with 40 ml of the mixture. The portal sites were then injected with 10 ml of the mixture in group I. Using the same technique 250 micro g epinephrine was added to the same mixture in group II. In group III the knee joint was injected with 40 ml of the mixture, and only 50 micro g epinephrine was then added to 10 ml of the mixture left before the portal site injections. A tourniquet was not used. There were some statistically significant changes in hemodynamic data. Also the data on visual analogue scale scores, time of arthroscopy, and amount of liquid used for intra-articular flushing in group II and III were significantly lower than those in group I. According to our experience, bleeding in arthroscopy comes mostly from portal incision to intra-articular field, except when performing extensive synovial shaving, ligament reconstruction, and lateral retinacular release. Therefore, when hemostasis is obtained at portals, the arthroscopic view becomes clearer. We think that adding epinephrine to only portal site injections is sufficient to obtain a clear view and, furthermore, when carrying out arthroscopy in this manner, no significant changes are encountered in heart rate, mean arterial pressure, pain during arthroscopy, or time of arthroscopy.

[Comparison of the effects of NG-monomethyl-L-arginine and indomethacin on tuberculous arthritis: an experimental study in rats]. / Tuberküloz artritini engellemede NG-monometil-L-arginin ve indometazinin birlikte veya tek tek kullanimdaki etkinligi.

OBJECTIVES: We evaluated therapeutic effects of NG-monomethyl-L-arginine (NMMA), a nitric-oxide synthase inhibitor, and indomethacin in a rat model of tuberculous arthritis. METHODS: Eighty male Wistar albino rats were randomly divided into five equal groups. In the first group (controls) normal saline solution was injected into the right knee joints of the rats. In the remaining groups, tuberculous arthritis was induced in the right knee joints of the rats via injection of 0.1 ml of a solution prepared from Mycobacterium tuberculosis strains. No treatment was given to the second group. The third and forth groups were assigned to receive oral indomethacin and intraperitoneal NMMA, respectively, while the fifth group received a combination thereof. The occurrence of arthritis was evaluated in four rats in each group on the 3rd, 7th, 14th, and 21st days after induction of arthritis. The rats were then subjected to scintigraphic imaging with Tc99 and focal activity involvement was analysed. The ratio of joint to soft tissue was calculated quantitatively. Following sacrifice with ether anesthesia, nitrate/nitrite levels were measured via Griess reaction in the bone tissue adjoining the knee. The knee joints were histopathologically examined. RESULTS: The severity of arthritis in the NMMA group decreased by one point on the 14th day. On Day 21, arthritis score was zero in rats receiving a combination of indomethacin and NMMA. Scintigraphic examination revealed increased uptake activity on the 3rd and 7th days, whereas no uptake activity was seen on the 21st day in the group receiving both indomethacin and NMMA. Histopathologically, chronic inflammatory infiltration disappeared on Day 21 in rats receiving either NMMA alone or in combination with indomethacin. During the experiment, four rats in the second group and two rats in the third group died from sepsis. Nitrate measurements of the fifth group on Day 21 showed approximate values to those of the control group (p>0.05). CONCLUSION: The combined use of indomethacin and NMMA seems to be more efficacious in reducing negative effects of tuberculous arthritis on the joint.

[Results of conservative treatment of displaced mid-clavicular fractures in adults]. / Eriskinlerde deplase klavikula 1/3 orta cisim kiriklarinda konservatif tedavi sonuçlarimiz.

OBJECTIVES: We evaluated the mid-term results of conservative treatment of mid-clavicular fractures in adults. METHODS: Eighty-five patients (60 males, 25 females; mean age 36 years; range 19-61 years) with mid-clavicular fractures were treated conservatively with a figure-of-eight bandage method. Radiographically, 72 fractures were displaced and of two fragments, 13 were displaced and comminuted. Clinical and radiologic results were evaluated after a mean follow-up of 35 months (range 12 to 72 months). RESULTS: In 84 patients, union was achieved by conservative treatment. Only one patient required surgical treatment. Malunion occurred in seven patients. Clinically, the results were good in 68 (94.4%), moderate in three patients (4.1%), and poor in one patient (1.3%) in two-fragment fractures. Of comminuted fractures, the results were good in 10 (76.9%), and moderate in three patients (23.1%). No significant differences were found between the clinical results. CONCLUSION: Conservative treatment of displaced mid-clavicular fractures provide union, making surgical treatment indicated only in a small number of patients with unsatisfactory results.