Single coronary artery and coronary artery-pulmonary artery fistula in a variation of the Shone complex.

We aim to share the diagnostic methods and relevant findings of a rare case involving a 1-year-old girl with a variation of Shone syndrome, presenting with the coexistence of a single coronary artery and a fistula between the coronary artery and the right pulmonary artery. The patient had previously undergone aortic arch reconstruction surgery and during the preoperative evaluation, cardiac computed tomography angiography (CCTA) revealed the additional presence of a single coronary artery originating from the right, which fistulized into the right pulmonary artery distally. This finding was further confirmed by conventional angiography. This case report highlights the importance of CCTA in identifying and directing the treatment of additional anomalies that may accompany rare congenital abnormalities.

Comparing the efficacy of extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy in the treatment of proximal ureteral stones in children: A retrospective study.

OBJECTIVES: Ureteroscopic lithotripsy and extracorporeal shock wave lithotripsy methods are commonly used in the treatment of proximal ureteral stones. There are no adequate studies showing which method is more effective in children. In our study, we aimed to evaluate and compare the efficacy of two treatment methods, commonly used for proximal ureteral stones in children. METHODS: A total of 78 patients who underwent ureteroscopic lithotripsy (n = 38) and extracorporeal shock wave lithotripsy (n = 40) due to stones located in the proximal ureter between 2010 and 2021 were included in the study. Demographic data, clinical characteristics, and treatment outcomes were retrospectively analyzed. Kolmogorov-Smirnov, Chi-square, and Mann-Whitney U tests were used for statistical analysis. RESULTS: There was no statistical difference between the demographic characteristics of the groups, except for the mean age values (p = 0.008). A statistically significant difference was found in favor of the extracorporeal shock wave lithotripsy group in terms of stone-free rates after the first intervention, complication rates requiring intervention, re-intervention rates, and the average number of anesthesia sessions per patient until stone-free status (p = 0.043, p = 0.009, p = 0.017, and p < 0.001, respectively). CONCLUSIONS: The results of this retrospective study suggest that extracorporeal shock wave lithotripsy is the primary treatment option for single, non-complicated proximal ureteral stones.

Diffusion tensor imaging in anorectal malformations: a pilot study for the evaluation of lumbosacral plexus.

INTRODUCTION: Neurogenic bladder with anorectal malformations (ARM) is a well-known yet understudied topic. Diffusion tensor imaging (DTI) is a special usage of MRI that can evaluate peripheric nerves. The aim of this study is to evaluate the lumbosacral plexuses of patients with ARM using DTI. PATIENTS AND METHODS: Patients with ARM willing to participate were included. Patient files were reviewed, a questionnaire was made, and DTI was performed. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were computed for the right and left lumbosacral plexuses. RESULTS: There were 18 patients and 12 controls. Groups were similar in terms of sex (p = 0.232) and age (p = 0.853). There was a significant difference only for ADC of the left plexus. There was visible asymmetry in tractographies and DTI parameters of two patients with severely deformed pelvises (image 1) but also in another patient with a normal sacrum. In addition, despite asymmetry, FA and ADC were similar to controls also in these patients. CONCLUSION: This is the first study presenting quantitative data about the lumbosacral plexus in ARM. We think the most interesting finding of this study was observing the normal values even in the patients with severely malformed sacrum which is yet to be validated with further studies.

The Effect of Syndesmotic Screw Level on Postoperative Syndesmosis Malreduction.

Tibiofibular injury repair of ankle fractures may result in over-compression when performed via a partially threaded screw depending on its placed level. We aimed to examine the relationship between the screw level relative to the tibiotalar joint and syndesmosis malreduction in postoperative radiographs of ankle fractures treated with partially threaded screws. We retrospectively analyzed 129 patients who underwent surgery due to lateral malleolar fractures between 2011 and 2019. We measured the distance between the screw and the tibiotalar joint and stratified the patients per their screw level as either trans-syndesmotic or suprasyndesmotic. According to Lauge-Hansen, 83 cases were supination-external rotation type (64.3%), and the remaining were pronation-external rotation type (35.7%) injuries. We found postoperative syndesmosis malreduction in 20 cases (15.5%). Eight (6.2%) cases had medial clear space mismatch. As the distance of the screw to the joint increased, postoperative medial clear space values increased (rho: 0.190, p = .031). The relationship between postoperative syndesmosis mismatch and the level of the syndesmotic screw was statistically significant (p = .044). In syndesmosis repair with a partially threaded screw, as the distance of the screw from the joint increases, the over-compression caused by the screw may cause an increase in postoperative syndesmotic malreduction rates.

Distal metatarsal osteotomy and dorsal neutralization plate in the treatment of hallux valgus.

PURPOSE: Hallux valgus is a disease that can be treated with many different surgical procedures. In our study, we aimed to compare patients with and without dorsal neutralization plate after distal metatarsal osteotomy and fixation with compression screws. METHODS: The files of 59 patients with 89 feet operated with the diagnosis of moderate degree hallux valgus have been examined retrospectively. Hallux valgus angles, AOFAS, VAS and satisfaction scores, time to return to work of both groups were compared. The cases in which only screw fixation was performed were mobilized with the hallux valgus apparatus for 6 weeks postoperatively, while the cases in which dorsal neutralization plate was performed were immediately mobilized full weightbearing without using an additional apparatus. Patients with a minimum follow-up of 2 years were included in the study. RESULT: There was no statistically significant difference between the two groups in terms of being bilateral (p = 0.457), mean age (p = 0.105) and gender data (p = 0.105). There was no significant difference in the preop and postop second year hallux valgus angles, AOFAS, VAS and satisfaction scores of the patients. There was a significant difference in the time to return to work (p < 0.001) and the 6th week AOFAS (p < 0.001), VAS (p < 0.001) and postop satisfaction (p < 0.001) scores between the two groups. CONCLUSION: The dorsal neutralization plate performed in addition to the compression screw after distal metatarsal osteotomy can cause painless early postoperative results that do not require the use of an additional apparatus, and early good functional results.

Changing bulking agent may require change in injection volume for endoscopic treatment of vesicoureteral reflux.

INTRODUCTION: Various bulking agents were utilized for endoscopic correction of VUR. A study reviewing multi-institutional data showed that the amount of injection material has increased over time with the purpose of improving success rates, which also resulted in costs. We noticed an opposite trend in our center since we started using a new bulking agent. The aim of this study was to evaluate evolution of our practice with different bulking agents. PATIENTS AND METHODS: Records of VUR patients who underwent subureteric injection with polyacrylate polyalcohol copolymer (PPC) and dextronomere hyaluronic acide (DxHA) between 2005 and 2014 were reviewed. Variation of different parameters throughout the study period was evaluated along with the success rate. Success was defined as complete resolution of reflux. RESULTS: A total of 260 patients with 384 refluxing units were included. The success rate was higher in PPC group compared to DxHA group. There was no statistically significant difference between years regarding distribution of VUR grade, body weight, patient height, and age in PPC group. Despite significant reduction in injection volume, success rate did not decrease through the years with PPC. CONCLUSION: Different bulking agents may require different injection volumes to achieve the same success rate in endoscopic treatment of vesicoureteral reflux. Habits gained with previous experience using other materials should be revised while using a new agent.

More Successful Results with Less Energy in Endovenous Laser Ablation Treatment: Long-term Comparison of Bare-tip Fiber 980 nm Laser and Radial-tip Fiber 1470 nm Laser Application.

BACKGROUND: Varices and venous insufficiency are common and serious health problems in the general population which affect the quality of life. Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux, and the endovenous laser ablation (EVLA) method has been widely accepted all over the world. In this method, ablation is provided by a laser fiber inserted into the lumen of the vein. Initially, the fibers were 810 nm, but today the fibers are usually 940, 980, or 1470 nm. METHODS: The study included 400 patients (419 procedures) who were diagnosed with venous insufficiency and underwent 980 and 1470 nm EVLA. Patients were followed up for 48 months. A 980-nm bare-tip laser catheter in Group A and a 1470-nm radial-tip laser catheter in Group B were inserted until they were 2 cm below the saphenofemoral junction. An EVLA catheter was drawn slowly at the rate of 1-3 cm/sec (2.08 ± 0.6). The energy applied to the saphenous vein was 60-120 J/cm (84.65 ± 13.03) and 45-120 J/cm (76.95 ± 15.06) in Group A and Group B, respectively (P < 0.001), with 15 W in the continuous mode. Follow-up visits included a physical examination and Doppler ultrasonography performed at the following time points: day 1, week 1, and months 1, 6, 12, 24, 36, and 48. Saphenous vein occlusion rates and postprocedure saphenous vein diameters were evaluated at each follow-up visit. Pain levels were evaluated using the Wong-Baker FACES® pain scale (0-10). Postoperative complications were recorded. RESULTS: Group A (980 nm laser) consisted of 200 patients with a mean age of 37.84 ± 12.2 years. Group B (1470 nm laser) consisted of 200 patients with a mean age of 38.38 ± 12.1 years. The mean duration of the procedure was 32.2 ± 9.7 min in Group A and 31.7 ± 8.8 min in Group B, respectively (P = 0.47). Induration, ecchymosis, and paresthesia rates were significantly higher in the bare-tip laser group. The most important complication, deep vein thrombosis, was observed in 4 patients in Group A. Recanalization rates were found to be increased by prolonged follow-up periods. At the 48-month follow-up, this rate was 15.9% in Group A and 8.3% in Group B (P = 0.017). This rate showed that the 1470-nm wavelength laser treatment was more successful in Group B than in Group A over the long term. CONCLUSIONS: Both the 980 and 1470 nm wavelength laser-assisted EVLA procedures appear to be effective in treating saphenous vein insufficiency. The 1470-nm radial-tip fiber is preferred due to lower energy levels, lower complication rates, early return to daily life, and the successful long-term occlusion rate.

Lower numbers of mechanoreceptors in the posterior cruciate ligament and anterior capsule of the osteoarthritic knees.

PURPOSE: Impaired proprioception accuracy of the knee has been proposed as a local factor in the onset and progression of knee osteoarthritis. Patients with decreased numbers of mechanoreceptors could be more likely to develop arthrosis due to a loss in proprioception of the joint. We aimed to identify and quantify the mechanoreceptors of the posterior cruciate ligament (PCL), the anterior capsule (AC) and the medial meniscocapsular junction (MCJ) in knee arthrosis. METHODS: PCLs, ACs and MCJs were harvested from 30 patients with Kellgren and Lawrence grades 3 and 4 osteoarthritis (OA), and ten knees taken from five cadavers without OA were used as a control group. PCL degeneration was evaluated with haematoxylin & eosin, and the types and numbers of mechanoreceptors were evaluated using S100 immunostaining. RESULTS: The patient ages in the OA and control groups (n.s.) did not differ. PCL degeneration was more severe in the gonarthrosis group than in the control group (p = 0.04). The numbers of Golgi corpuscles, Ruffini corpuscles, free nerve endings, total nerve endings and small vessels of the PCL were low in the OA group, as were the numbers of Golgi corpuscles, free nerve endings and total nerve endings of the AC. No significant correlation was found regarding the mechanoreceptors of the MCJ between the two groups. CONCLUSION: The numbers of mechanoreceptors in patients with OA were low in the PCLs and ACs. A loss in proprioception could be a local risk factor in OA. The proprioceptive impact of preserving PCL while performing total knee arthroplasty may not be exaggerated as its thought. LEVEL OF EVIDENCE: Prognostic study, Level I.

Nonthermal, Nontumescent Endovenous Treatment of Varicose Veins.

BACKGROUND: Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux. A new technique for venous insufficiency is non-thermal ablation with vein sealing system which comprises the endovenous delivery of cyanoacrylate tissue adhesive to the vein causing fibrosis. METHODS: This is a single-center prospective study of treatment of great saphenous vein incompetence in 62 patients with vein sealing system (Biolas VariClose® FG Group, Turkey). All cases were implemented under local anesthesia. Tumescent anesthesia was not required. Patients were not given any nonsteroidal anti-inflammatory drug postoperatively; advised to wear elastic bandages for 1 day; and compression stockings were not offered. RESULTS: Treatment success was defined as complete occlusion of treated vein or recanalized segment shorter than 5 cm. Subtotal recanalization was defined as great saphenous vein flow containing 5-10 cm segment of treated vein. A recanalized great saphenous vein or treatment failure was defined as an open part of the treated vein segment more than 10 cm in length. At 1 week and 1 month control, duplex scans showed total occlusion for all patients (100%), total occlusion for 58 patients (93.5%), and subtotal occlusion for 4 patients (6.5%) at third month. At the end of 6 months, total occlusion 56 patients (90.3%) and subtotal occlusion for 2 patients (3.2%). For 4 (6.5%) patients, no occlusion was observed, and the diameter was >11 mm. Embolization of great saphenous vein with cyanoacrylate has been performed since the beginning of this decade. Combined chemical and physical mechanism of action results in permanent vein closure. In a recently published study, a 24-month occlusion rate of 92% was demonstrated. The most commonly reported complications of cyanoacrylate use for the treatment of varicose vein disease, so far, include ecchymosis and phlebitis. Almeida et al. reported that phlebitis is the most frequent side effect at a rate of 16%. In our study, phlebitis rate was not as high as reported. It may be caused due to shorter time of follow-up in the hospital. CONCLUSION: Endovenous ablation of incompetent great saphenous vein with cyanoacrylate-based glue is feasible. Operation time is short, and tumescent anesthesia is unnecessary as postprocedure compression stockings. Lack of significant side effects and an yearly success rate of 100% are benefits of the system.

Hydatid Cyst of the Posterior Cervical Region.

Hydatid cyst is an endemically seen parasitic disease and caused by the larval form of Echinococcus parasites. The disease is mostly seen in liver and lung, and the other involvement is rarely seen. Head and neck involvement is extremely rarely seen and its frequency in the literature is reported as less than 1%. It is usually asymptomatic and the symptoms are related to the compression to the adjacent structures. In this paper, the authors report a patient of hydatid cyst localized in the posterior cervical region.

Outcome of Type 3 Open Tibial Diaphyseal Fractures Managed with a Limb Reconstruction System: Analysis of a 49-Patient Cohort.

OBJECTIVE: To evaluate functional and radiological results following treatment with the single-plane external fixator limb reconstruction system (LRS) for open tibial diaphyseal fractures resulting from high-energy trauma. SUBJECTS AND METHODS: From a total of 62 patients who were operated on between 2011 and 2014 for open tibial diaphyseal fractures resulting from high-energy trauma, 50 tibias from 49 patients (males: 32, females: 17) were classified as type 3 according to the Gustilo-Anderson open fracture classification, and definitive treatment was applied with the LRS. The patients ranged in age from 20 to 36 years. Time to union, time of external fixator usage, complications and functional results according to the Johner-Wruhs criteria were recorded. RESULTS: The mean follow-up period was 23 ± 12 months (range: 11-44). Of the 50 tibias, full union was achieved with the LRS in 48 (96%). No shortness or deformity was observed in any patient. Knee and ankle range of movement were measured as full in all patients at the final follow-up examination after removal of the LRS. The mean time to union was 20.4 ± 4 weeks (range: 16-24). The mean time of external fixator use was 20 weeks (range: 16-24 weeks). CONCLUSION: In this study, for the definitive treatment of open tibia diaphyseal fractures, the LRS was an optimal and safe choice that offered single-stage surgery.

Anterograde Headless Cannulated Screw Fixation in the Treatment of Medial Malleolar Fractures: Evaluation of a New Technique and Its Outcomes.

OBJECTIVE: To evaluate the functional and radiological outcomes of anterograde headless cannulated screw fixation for medial malleolar fractures. SUBJECTS AND METHODS: This study included 12 patients (8 males, 4 females; age 27-55 years) with medial malleolar type B fractures according to the Herscovici fracture classification who had undergone anterograde headless cannulated screw fixation surgery between 2012 and 2014. Seven had an isolated medial malleolar fracture and 5 a bimalleolar fracture. All of the bimalleolar fractures were classified as 44-B2 based on the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification. Postoperatively, bone union was evaluated on direct radiographs at the final follow-up examination. The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used for clinical evaluation. RESULTS: The mean follow-up period was 17.2 ± 5.3 months (range 12-23). Full union was achieved in all fractures. The mean time to union was 3.4 ± 1.5 months (range 2-5). No instability, loss of reduction, non-union or infection was observed in any patient. The mean AOFAS score was 95.0 ± 5.4 (range 87-99). Based on the AOFAS score, 4 patients showed good results and 8 excellent results. The mean time to return to the previous level of activity was 4.0 ± 2.5 months (range 2-5). CONCLUSION: In this study, anterograde headless cannulated screw fixation yielded good clinical outcome in the surgical treatment of Herscovici type B fractures.

The role of simple elbow dislocations in cubitus valgus development in children.

PURPOSE: We investigated the functional and radiological outcomes of conservatively treated simple traumatic elbow dislocations and subsequent incidence of cubitus valgus development in children. METHODS: Eleven patients (one female, ten male; mean age 9.8 years, range seven to 12 years) who presented to our hospital with simple elbow dislocations and were conservatively treated between July 2008 and September 2010 were included in the study. All were posterolateral closed dislocations. None of the patients had accompanying elbow fractures. All patients had pre- and postoperative radiographic examinations. The carrying angle of the involved elbow was measured and compared to the contralateral non-injured elbow during follow-up. The incidence and severity of cubitus valgus development was assessed. The functional and clinical outcomes were evaluated using the Mayo Elbow Performance Scale. The mean monitoring period was 24.3 months (range 19-30 months). RESULTS: All patients had satisfactory good and excellent results (85-100 points; mean 96.8 points) according to the Mayo Elbow Performance Scale. The final average elbow flexion was 137° (range, 130-145°) and average extension was 8.6° (range 0-20°) with full supination and pronation in traumatic elbow. Four patients (36.4%) had an average increase (cubitus valgus) of 14.5° (10-20°) in carrying angle compared to the other elbow. CONCLUSIONS: While isolated traumatic dislocation of the elbow is uncommon among children, it can be successfully treated by urgent closed reduction, proper fixation of the elbow and appropriate timely rehabilitation. However, it should be considered that some patients may develop cubitus valgus deformity in a later period. Therefore, each patient with a simple traumatic elbow dislocation should be followed, and the parents should be informed of the potential for any deformity development.

Incorporation of hydrogen-producing magnesium into minced beef meat protects the quality attributes and safety of the product during cold storage.

The impact of hydrogen (H2) producing magnesium (Mg) incorporation into minced beef meat (MBM) on the quality and safety of the product was investigated. The H2-producing Mg (H2-P-Mg)-incorporated MBMs were vacuumed (VP) and stored at 4 °C for 12 days. Other MBMs were vacuumed and gassed with H2 or N2. At the end of storage, the lowest browning index values were for H2 and H2-P-Mg samples. H2- PMg and VP methods generally decreased the counts of mesophilic and psychrotrophic bacteria and yeast molds and restricted the formation of thiobarbituric acid reactive substances and biogenic amines. Heat mapping, PCA, and multivariate analysis methods confirmed chemical analysis results. The volatile compounds were at their highest levels in the control samples at the end of storage, followed by H2, N2, H2-P-Mg, and VP samples. Using the H2-P-Mg method in MBM preparation could protect the quality characteristics and safety of the product during cold storage.

Two-dimensional shear wave elastography can improve the diagnostic accuracy of ultrasonography in acute appendicitis.

AIM: We aimed to evaluate the effectiveness of combining 2-dimensional shear wave elastography (2D-SWE) with ultrasonography (US) in diagnosing acute appendicitis in patients with suspected acute appendicitis. METHODS: Clinical and laboratory findings, gray-scale US and 2D-SWE imaging features, operation information, and pathology results of 48 patients diagnosed with acute appendicitis who presented with right lower quadrant pain were prospectively evaluated. We compared the findings to the US and SWE imaging features of 79 asymptomatic patients. RESULTS: Mean Alvarado score and appendix diameter were statistically significantly higher for acute appendicitis (p < 0.001). In patients with acute appendicitis, mesenteric lymphadenopathy and fat stranding were also more frequent (p < 0.001). The mean velocity and kPa values for appendix and mesenteric fat were statistically significantly higher in acute appendicitis (p < 0.001). CONCLUSION: In the diagnosis of acute appendicitis, 2D-SWE increases the diagnostic performance of gray-scale US in the differentiation of inflamed and normal appendixes.

Evaluation of homemade fermented pickle juice as a marinade: Effects on the microstructure, microbiological, physicochemical, textural properties, and sensory attributes of beef strip loin steaks.

The current study aimed to characterize homemade fermented pickle juice and evaluate its efficacy as a marinade on physicochemical, microbiological, textural properties, microstructure, and sensory attributes of the strip loins. Organic acids, phenolics, flavonoids, volatiles, total phenolic content (TPC), and in-vitro antioxidant capacity (ABTS and FRAP) analyses were carried out. Furthermore, minimum inhibitory concentration (MIC), and the diameter of inhibition zones of the pickle juice were determined against Escherichia coli O157:H7, Salmonella Typhimurium, S. enteritidis, and Listeria monocytogenes. The strip loins were marinated with five different concentrations (10%, 25%, 50%, 75%, and 100%) of pickle juice at 4 °C for 24 h. A total of 4 organic acids, 23 phenolic and flavonoid compounds, and 69 volatiles were identified in the pickle juice. The TPC, ABTS, and FRAP values of the pickle juice were found to be 184.24 ± 33.28 GAE/L, 44.48 ± 0.41 mg TEAC/L, and 2.79 ± 0.01 mM FE/L, respectively. The MIC and inhibition zones were recorded between 7.81 and 12.50% and 8.25-13.80 mm against pathogenic bacteria, respectively. The textural properties of the strip loins marinated with 100% pickle were improved compared to the control (P < 0.05). Moreover, this concentration decreased the number of pathogens in strip loins, ranging between 1.07 and 2.77 log10 CFU/g (P < 0.05). Regarding sensory attributes, the strip loins marinated with 50% and 100% pickle juice had higher scores compared to the non-marinated samples. The results of this study indicated that pickle juice can be evaluated as a marinade to improve the microbiological quality and textural properties of strip loins.

Inhibitory effect of bioactive compounds derived from freeze-dried paraprobiotic of Pediococcus acidilactici against food-borne pathogens: In-vitro and food model studies.

It was aimed to assess the antimicrobial potential of lyophilized/freeze-dried paraprobiotic (LP) of P. acidilactici against some food-borne pathogens under in-vitro conditions and food model, and determination of bioactive compounds that contribute to the antimicrobial activity of LP. For this purpose, minimum inhibitory concentration (MIC), inhibition zones were determined against Listeria monocytogenes, Salmonella Typhimurium and Escherichia coli O157:H7. The MIC value was 6.25 mg/mL and a 20 µL LP displayed 8.78 to 10.0 mm inhibition zones against these pathogens. In the food matrice challenge, two concentrations of LP (3% and 6%) alone or in combination with EDTA (0.02 M) were added to pathogenic bacteria spiked meatballs, and antimicrobial activity of LP was also determined during refrigerated storage. 6% LP + 0.02 M EDTA treatment provided 1.32 to 3.11 log10 CFU/g reductions in the numbers of these pathogens (P < 0.05). Furthermore, this treatment provided significant reductions on psychrotrophs, TVC, LAB, mold-yeast, and Pseudomonas spp. over the storage (P < 0.05). Regarding characterization results, LP contained contained a wide variety of bioactive compounds, including 5 organic acids (2.15 to 30.64 g/100 g), 19 free amino acids (6.97 to 699.15 mg/100 g), free fatty acids (short-, medium-, and long-chain fatty acids), 15 polyphenols (0.03 to 383.78 mg/100 g), and some volatile compounds such as pyrazines, pyranone and pyrrole derivatives. These bioactive compounds are not only involved in antimicrobial activity but also contribute to the free radical scavenging activity according to the DPPH, ABTS and FRAP assays. In conclusion, the result revealed that the LP improved the chemical and microbiological quality of foods due to containing biologically-active metabolites involved in antimicrobial and antioxidant capacity.