Analysis of glenohumeral morphological factors for anterior shoulder instability and rotator cuff tear by magnetic resonance imaging.

OBJECTIVE: The aim of this study was to investigate whether there are glenohumeral morphological differences between normal population, glenohumeral instability, and rotator cuff pathology. METHOD: In this study, shoulder magnetic resonance (MR) images of 150 patients were evaluated. Patients included in the study were studied in three groups of 50 individuals: patients with anterior shoulder instability in group 1, patients with rotator cuff tear in group 2, and control subjects without shoulder pathology in group 3. RESULTS: There were statistically significant differences between groups in evaluations for glenoid version, glenoid coronal height, glenoid coronal diameter, humeral axial and coronal diameters, and coracohumeral interval distances. Significant differences were observed between groups 2 and 3 in glenoid axial diameter, glenoid coronal height, glenoid depth, humeral coronal diameter, and coracohumeral distances. CONCLUSION: The results obtained in this study suggest that glenoid version, glenoid coronal height and diameter, humeral diameter, and coracohumeral interval parameters in glenohumeral morphology-related parameters in patients with anterior instability are different from those of normal population and patients with rotator cuff pathology. In cases where there is a clinically difficult diagnosis, these radiological measurements will be helpful to clinicians in diagnosis and treatment planning, especially in cases of treatment-resistant cases.

Determination of IL-6, TNF-α and VEGF levels in the serums of patients with colorectal cancer.

Cytokines are multifunctional polypeptides synthesized by different body cells. They have clinical significance in terms of disease diagnosis, treatment and prevention. Cytokines TNF-α and IL-6 play an important role in the growth and differentiation of cells.Vascular Endothelial Growth Factor (VEGF) is excessively produced in epithelial, mesenchymal, and particularly in tumor cells. Studies have shown that the increased serum concentrations of IL-6, TNF-α, VEGF are strongly associated with colorectal cancer  and directly with the clinical stage of the disease. This can be used to diagnose cancer and to identify patients with a bad prognosis who can avail themselves of a more aggressive treatment. The present study investigated the role of cytokines in the development of cancer by comparing preoperative serum cytokine levels of patients suffering from colorectal cancer with those of the healthy control group. The prognostic significance of the data obtained has also been evaluated. For this purpose, IL-6, TNF-α and VEGF levels in 60 serums, 30 preoperatively taken from patients with colorectal cancer and 30 from a healthy control group at Çanakkale Onsekiz Mart University General Surgery Clinic, were determined by ELISA kits. The statistical analyses of the obtained data were evaluated on SPSS, a statistical package program. In this study, no significant difference was obtained between the mean scores concerning the IL-6 and VEGF serums of the colorectal cancer and healthy group (p>.05). But a statistically significant decrease was observed in the TNF-α serum level of the colorectal cancer group in comparison with the control group (p= .016; p < .05).

Outcome of Otologic Symptoms after Temporomandibular Joint Arthrocentesis.

The objectives of this study were to determine the prevalence of otologic complaints in patients with temporomandibular joint (TMJ) closed lock (CL), and to evaluate the efficacy of arthrocentesis in temporomandibular disorder (TMD) patients with otologic symptoms. Fifty-seven patients with TMJ CL were included in this study. The pre-treatment evaluations included assessment of the maximum mouth opening (MMO); pain level in palpation of the affected TMJ; pain level with function; and otologic complaints, including otalgia, tinnitus, vertigo, and hearing loss. Arthrocentesis treatment was performed for all the patients, and post-treatment data were recorded 1 month later. Before arthrocentesis and lavage, the mean MMO was 24.67 ± 4.61 mm; the mean tenderness score was 7.02 ± 1.09; and the mean score for pain in function was 6.86 ± 1.31. Following TMJ arthrocentesis and lavage, the mean MMO was 39.81 mm ± 4.56 mm; the mean tenderness score was 2.37 ± 0.65; and the mean score for pain in function was 2.45 ± 0.69. Seventeen (29.82%) patients reported at least 1 otologic complaint, 17 (29.82%) patients reported otalgia, and 8 (14.04%) patients reported tinnitus. Vertigo was noted in 5 (8.77%) patients. Complaints of hearing loss were not noted in any of the patients. After treatment, 14 patients no longer complained of otalgia, 5 patients no longer complained of tinnitus, and 2 patients no longer complained of vertigo. This represented a significant improvement in the patients' condition, especially in patients with otalgia (P < 0.0006). As evident from the results of this study, arthrocentesis procedures reduce both TMD symptoms and otologic complaints.

An improved method of supercharged transposed latissimus dorsi flap with the skin paddle for the management of a complicated lumbosacral defect.

OBJECTIVE: Treatment of non-healing wounds of lower back often poses a powerful challenge. We present one of the first report of treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle. CASE REPORT: We report a case of a 59 year-old man with myeloma of the sacral spine who underwent radiotherapy and chemotherapy and subsequently, laminectomies and placement of hardware for ongoing paresis and spine instability. Then, he developed an open wound and osteomyelitis of the spine with culture positive tuberculous granulomas. After multiple surgical debridement, he presented to our service and was treated with a single stage debridement followed by the performance of a latissimus dorsi musculocutaneous flap based on paraspinal perforators and supercharged. RESULTS: This solution, allowed for augmentation of blood flow to the muscle with the inferior gluteal artery, provided coverage of the defect resistant to the pressure, and simplified post-operative management of the patient. CONCLUSIONS: Alternative treatment options, including free tissue transfer, posed difficulties in finding suitable recipient vessels near the defect, in inserting the flap so as to restore its original length without compromising blood flow, and in postoperative care of the patient. Treatment of a lumbosacral defect with a supercharged latissimus dorsi flap with the skin paddle may represent a milestone procedure for complicated lower spine wounds.

Uterus retrieval in cadaver: technical aspects.

The authors describe uterus retrieval in cadavers. Uterine retrieval with its vasculature could be successfully achieved in four of the presented cases. Special attention was given to dissection of bilateral ureters and hypogastric vasculature. Uterine retrieval with its vasculature and supporting sacrouterine,vesicouterine peritoneal folds is an anatomically feasible procedure in preparation for uterus transplantation.

Modification of the Bascom cleft lift procedure for chronic pilonidal sinus: results in 141 patients.

AIM: There is no definitive consensus on the best treatment for pilonidal sinus. The Bascom cleft lift technique has been reported to produce successful results. This study presents the results of a modified cleft lift procedure in which the sinus tissue was excised and the lower end of the incision was kept outside the intergluteal sulcus by extending the lower end of the incision laterally. METHOD: Between August 2010 and January 2012, 141 consecutive patients who presented with primary or recurrent pilonidal sinus disease were included in the study, which was conducted at a single tertiary academic medical centre. Prospectively collected data were recorded, including complications, pain score, satisfaction level, primary healing rate, length of hospital stay and early recurrence. RESULTS: The mean operating time was 30 min and the mean length of hospital stay was 1.2 days. The most common surgical-site complication was a collection followed by partial wound dehiscence and superficial infection. The primary healing rate was 88%, the mean time for functional recovery was 13 days and the mean follow-up time was 14 months. No recurrence was observed within this follow-up period. CONCLUSION: The modified Bascom cleft lift technique is effective and reliable. It is applicable to all pilonidal sinus cases and has low complication rates, high satisfaction scores, rapid early recovery and low recurrence rates.

Erectile dysfunction and depression in patients with chronic lead poisoning.

In this retrospective study, we aimed to evaluate the relationship between erectile dysfunction (ED) and chronic lead intoxication (CLI) as well as the role of depression in this relationship. We compared the findings of 26 male patients with CLI and 24 male patients as the control group between November 2008 and January 2009. The blood lead levels and smoking index of patients were evaluated for both groups. The International Index of Erectile Dysfunction-erectile function domain (EFD) and Beck Depression Inventory (BDI) were obtained and reviewed in both groups. The mean blood lead levels of patients in the CLI and control groups were 42.1 and 3.2 µg dl(-1) respectively (P < 0.01). The mean interval of lead exposure of patients in CLI group was 71.5 (6-360) months. EFD scores of patients in CLI group were significantly lower, and number of patients with ED in CLI group was statistically higher (P < 0.05). BDI scores of patients in CLI group were significantly higher (P < 0.05). We detected a mildly negative and statistically significant relationship between the EFD scores and blood lead levels (r = -0.453 and P < 0.05). Our results showed that the increased frequency of ED is an independent factor in CLI group.

Salvage repair of anastomotic dehiscence following colon surgery using an expanded polytetrafluoroethylene graft.

Anastomotic dehiscence is a serious complication of colorectal surgery that causes death in up to 40% of cases in which it occurs. Edema and inflammation due to abdominal sepsis can prevent the use of standard management (i.e., colostomy, ileostomy or Hartmann's procedure), in which case alternative salvage repair methods are required. The present report describes the treatment of a 73-year-old female patient at high risk of mortality because of intraabdominal sepsis due to suture dehiscence following a right hemicolectomy and ileo-transversostomy. Several surgical repair procedures were tried, but all failed. We then used an expanded polytetrafluoroethylene (ePTFE) graft in salvage repair, and this approach proved successful. This is the first report to describe clinical, macroscopic and histopathological findings, following use of an ePTFE graft in colorectal repair in humans.

Outcome of kidney transplantation following end-stage renal disease due to reflux nephropathy.

BACKGROUND: Reflux nephropathy (RN) has an important place among the etiologies of end-stage renal disease (ESRD). In this retrospective study we sought to analyze posttransplantation complications among renal transplant recipients whose primary disease was RN. METHODS: Seven hundred forty-five patients who underwent transplantation in our institution between 1983 and 2006 were included in the study. The outcomes of patients with RN (Group 1) were compared with a control group (Group 2) that consisted of age-matched, nondiabetic patients whose primary disease was chronic glomerulonephritis or unknown etiologies. RESULTS: Group 1 consisted of 52 patients, including 20 males with a mean overall age of 25 years. Group 2 included 47 patients, including 21 males with a mean age of 27 years. There was no significant difference with regard to age, gender, donor type, donor age, modality of hemodialysis, or HLA match between the 2 groups. Group 1 graft survival rates in the first and fifth years were 95% and 90%, respectively, and in Group 2 they were 86% and 70%, respectively (P = .302 and P = .072, respectively). There was no significant difference with respect to follow-up duration, hospital stay, or incidence of biopsy-proven or clinically suspected acute rejection episodes between the groups. During the 6-year follow-up, the incidence of biopsy-proven chronic allograft nephropathy was the same in both groups. One patient in Group 1 and 2 in Group 2 died of cardiovascular issues; 1 Group 2 patient died of infection. The frequency of urinary tract infection in Group 1 was greater than that of Group 2 (40% vs, 23%; P = NS). CONCLUSION: Despite the higher incidence of urinary tract infections, there was no significant difference in posttransplantation complications or patient and graft survival rates between RN patients compared with the control group.

Parathyroid cyst: the forgotten diagnosis of a neck mass.

The differential diagnosis of cystic cervical masses includes cystic thyroid disease or some embryological diseases. Parathyroid cyst is one of the less common causes of the cervical masses. The Swedish anatomist Sandstrom reported the first description of parathyroid cyst in 1880. Up to date, only about 300 cases have been reported in the world literature. They may be functional or nonfunctional, depending on the presence or absence of the hyperparathyroidism and treatment options vary for both presentations. Particularly, nonfunctional cysts are often considered as thyroid cysts. Diagnosis is best made by monitoring serum calcium levels and sending cyst fluid for parathormone analysis. We herein report a patient diagnosed with a parathyroid cyst who had received the diagnosis of goitre at other institute; including a review of the literature.

A newly described scorpion species, Leiurus abdullahbayrami (Scorpion: Buthidae), and the lethal potency and in vivo effects of its venom

Currently, medically significant scorpion species belong to the Buthidae family and are represented by the genera Androctonus, Buthus, Mesobuthus, Hottentotta, Parabuthus, Tityus, Centruroides, Leiurus. Although Leiurus was originally considered a monotypic genus, four additional species have since been described. Leiurus abdullahbayrami (previously identified as L. quinquestriatus in Turkey) was classified as a new Leiurus species. This is the first report conducted on the lethality and biologic effects of L. abdullahbayrami scorpion venom in mice. In this study, the electrophoretic protein pattern of its venom was also determined. Two protein bands with molecular masses of 4 and 6 kDa were more strongly detected than other protein bands in the venom sample. Electrophoresis showed that L. abdullahbayrami scorpion venom possesses both short- and long-chain neurotoxins. The median lethal dose of this venom was found to be 0.19 mg/kg by subcutaneous (SC) injection in mice. Animals experimentally envenomed with L. abdullahbayrami venom exhibited hyperexcitability, agitation, aggressive behavior, squeaking and fighting, tachypnea, weakness, convulsions, and death due to cardiac and respiratory failure. In further studies, the potency of antivenom should be investigated in relation to the scorpion venom. Molecular and pharmacological studies are also required to identify and characterize L. abdullahbayrami scorpion venom.(AU)

Effect of local gentamicin application on healing and wound infection in patients with modified radical mastectomy: a prospective randomized study.

This study investigated the effects of Gentacoll implants on healing in patients (n = 44) undergoing modified radical mastectomy and axillary dissection. Group I, the Gentacoll group (n = 22), underwent surgery followed by insertion of 10 × 10 × 0.5 cm Gentacoll implants (280 mg collagen sponge plus 200 mg gentamicin sulphate) into the axillary area and under the flap area of the breast before wound closure. Group II, the control group (n = 22), underwent surgery without the application of Gentacoll. Neither group received oral or parenteral post-operative antibiotic therapy. Outcome measures included wound infection, seroma formation, total drainage volumes, drain removal time and duration of hospital stay. Post-operative infection rate, seroma formation, drainage volumes and duration of hospital stay were significantly reduced in the Gentacoll group compared with the control group. In conclusion, the application of Gentacoll significantly improved post-operative outcomes in patients undergoing modified radical mastectomy.

Effect of gentamicin-absorbed collagen in wound healing in pilonidal sinus surgery: a prospective randomized study.

Pilonidal sinus is a common disease that causes the loss of many working hours, but treatment is variable and problematic. The effect of gentamicin-absorbed collagen on healing, infection and recurrence, and length of hospital stay were examined after pilonidal sinus surgery. Patients undergoing surgical treatment for pilonidal sinus were randomly assigned into two groups each of 40 patients. Both groups were treated with excision and primary closure under local anaesthesia. Group 1 (control) received oral antibiotics for 7 days post-operatively. In group 2, prior to wound closure, gentamicin-absorbed collagen sponges were placed on the sacral fascia and these patients did not receive oral post-operative antibiotic therapy. Patients in group 2 had a significantly shorter mean wound healing time, significantly lower infection and recurrence rates, and a significantly shorter hospital stay than those in group 1. It is concluded that implantation of a gentamicin-containing collagen sponge on the wound area in pilonidal sinus decreased the rates of infection and recurrence, and shortened the hospital stay.

A study on the genetic diversity of Androctonus crassicauda (Olivier, 1807; Scorpiones: Buthidae) from Turkey

Mitochondrial DNA (mtDNA) has been widely employed in phylogeographic and phylogenetic studies. In the present study, the genetic identification of the scorpion Androctonus crassicauda (Olivier, 1807) was carried out by using the 16S mitochondrial gene, since this scorpion represents the most important species in Turkey regarding scorpionism and antivenom production. Two genetic groups were found according to the sequence analysis results, while five different loci at the nucleotide level presented genetic variation in the 16S region when compared to a known A. crassicauda sequence data (GenBank, AJ277598). Nucleotide variations found in the current work constitute the first descriptive report for A. crassicauda. Moreover, future studies may enlighten the genetic and venom composition variations for this scorpion species.(AU)

Snakebites in Turkey: epidemiological and clinical aspects between the years 1995 and 2004

The venom of poisonous snakes comprises a complex mixture of several proteins with other less significant constituents, resulting in principles capable of changing viable tissues. The hemotoxic factor is the main responsible for necrosis and tissue sloughing. Envenomations are common in rural areas of Turkey caused by snake species that present hepatotoxic venom, which causes local swelling, ecchymosis and alterations in blood profile. The epidemiological and clinical findings of snake envenomations in Turkey were evaluated based on data recorded by the National Poison Information Center (NPIC) between 1995 and 2004, in a total of 550 snakebite cases. The month of peak incidence was June (24.3 percent) while most incidents occurred in Marmara, Central Anatolia and Black Sea regions of Turkey. The victims were mainly adults (54.1 percent). Hospitalized patients displayed clinical signs of local (75.2 percent) and systemic effects (24.7 percent). Local clinical symptoms comprised edema, pain, hyperemia, numbness and ecchymosis, while systemic clinical symptoms included nausea, vomiting, hypotension, tachycardia, dyspnea, dry mouth, paresthesia, generalized edema, cyanosis and compartment syndrome. Occasionally, convulsions, confusion, loss of consciousness, hyperthermia, hepatic and circulation failure, hematoma, drowsiness, epistaxis, chest and abdominal pain, venous spasm, thrombocytopenia and bradycardia were recorded. Approximately one third (34.2 percent) of the patients were treated symptomatically, while 10.5 percent required antivenom therapy along with symptomatic treatments and 26.3 percent of all patients were exclusively treated with antivenom. Although a significant number of incidents were reported, no deaths occurred. These findings emphasize the presence of multiple medically important snake species in Turkey and that public awareness and therapeutic approaches appear sufficient to manage snakebite incidents.(AU)

Individual variation in the protein profile of the venom of Mesobuthus gibbosus (Brullé, 1832, Scorpiones: Buthidae) from Turkey

Mesobuthus gibbosus (Brullé, 1832) scorpions were collected from the Mugla province in the Aegean region of Turkey and housed in individual boxes. After extraction, the venom composition was analyzed using gel electrophoresis (SDS-PAGE). Interestingly, all scorpion venom samples contained only one protein band (~68 kDa) in common. Two protein bands (30 and 98 kDa) were common in six venom samples and were absent in the other venoms. Furthermore, two different protein bands (28 and 45 kDa) were detected in seven venom samples. This study proposes possible variations in the composition of individual scorpion venom samples collected from the same geographic region, based on the electrophoretic profile. Additional studies will be necessary in order to assess these variations further and to identify the proteins corresponding to the bands.(AU)

Evaluation of the neutralizing capacity of Androctonus crassicauda (Olivier, 1807) antivenom against Leiurus quinquestriatus (Ehrenberg, 1928) venom (Scorpiones: Buthidae)

The two most venomous species of the family Buthidae, Leiurus quinquestriatus and Androctonus crassicauda, are found in Africa and in the Middle East. Potency and paraspecific activities of A. crassicauda antivenom (RSHC anti-Ac) were tested against L. quinquestriatus venom. The sera produced by Refik Saydam Hygiene Center (RSHC) showed strong reactivity against the venoms of A. crassicauda and L. quinquestriatus in western blotting and dot-blot analysis. RSHC anti-Ac presents immunoactivity and neutralizing potential against Leiurus quinquestriatus venom. Neutralization capacity of antivenom was found to be 400 µL against 40 minimum lethal doses (MLD) of A. crassicauda scorpion venom and 10 MLD of L. quinquestriatus venom. This study indicates that the RSHC anti-Ac could be used for treating L. quinquestriatus stings.(AU)

Evaluation of scorpion sting incidence in turkey

Scorpion stings are common in Turkey due to its geographical location, climate and socioeconomic structure. Scorpion envenomation cases are a considerable public health problem in all regions of the country. Important health-threatening scorpions in Turkey are Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus and M. eupeus, all of which belong to the Buthidae family. They are described to be potentially dangerous to humans. So far, there is no study about scorpion sting incidence covering all geographical regions of Turkey; therefore, in this study, we analyzed the frequency of scorpion sting cases in the country. A total of 24,261 scorpion sting cases were reported during 2005. Most of which (about 80 percent) occurred in the Southeastern Anatolia (30.4 percent), Mediterranean Sea (24.9 percent) and Aegean regions (23.5 percent), where medically important scorpion species are found. The sting cases mostly occurred during the summer period. Our results suggest that scorpion stings are an important problem in Turkey. This simple descriptive study will help develop interventions to prevent scorpion stings, which should take local sting cases into consideration.(AU)

Effects of Androctonus crassicauda (Olivier, 1807) (Scorpiones: Buthidae) venom on rat metabolism

Scorpions are venomous arthropods of the Arachnida class and are considered relatives of spiders, ticks and mites. There is not any study about the biochemical effects of Androctonus crassicauda (Olivier, 1807) venom. Therefore, in the present study, we aimed at evaluating the toxicity of the venom from A. crassicauda, which is responsible for a number of deaths of infants, children and adults in tropical and subtropical countries. For this purpose, rats (n=35) were divided into seven groups of five animals each; venom solutions (250µg/kg) were subcutaneously injected into rats; blood samples were taken from each animal at various times; and serum biochemical parameters were measured (levels of total proteins, total bilirubin, albumin, globulin, urea, creatinine, uric acid, glucose, cholesterol, triglycerides, sodium, chlorine, potassium and calcium, and the activity of the enzymes alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, lactate dehydrogenase). Serum levels of glucose, cholesterol, aspartate aminotransferase, alanine aminotransferase and uric acid increased in envenomed animals, compared to controls. There was a statistically positive correlation between Na+ and Cl- ions.(AU)

Comparison of proteins, lethality and immunogenic compounds of Androctonus crassicauda (Olivier, 1807) (Scorpiones: Buthidae) venom obtained by different methods

Scorpions are venomous arthropods of the class Arachnida and are considered relatives of spiders, ticks and mites. There are approximately 1,500 species of scorpions worldwide, which are characterized by an elongated body and a segmented tail that ends in a venomous stinger. No specific treatment is available for scorpion envenomation, except for the use of antivenom. The current study aimed at comparing protein content and lethality of Androctonus crassicauda venom extracted by two different methods (electric stimulation and maceration of telsons). The LD50 calculated by probit analysis was 1.1mg/kg for venom obtained by electric stimulation and 39.19mg/kg for venom obtained by maceration of telsons. In the electrophoretic analysis, protein bands of the venom sample obtained by electric stimulation were between 12 and 53kDa (total: five bands), and those of venom extracted by maceration appeared as multiple protein bands, relative to the other venom sample. Low-molecular-weight proteins, revealed by western blotting, played an important immunogenic role in the production of antivenom. Lethality and protein levels varied according to the extraction method; venom obtained by the maceration technique showed lower toxicity than that obtained by electric stimulation.(AU)