Turkish community-based palliative care model: a unique design.

An organized palliative care system was lacking in Turkey before 2010. One of the pillars of Turkish Cancer Control Programme is palliative care. The Pallia-Turk project in this respect has been implemented by the Ministry since 2010. The project is unique since it is population based and organized at the primary level. This means, the whole population (>70 million) will have the quickest and easiest way for access to palliative care. This manuscript briefly summarizes the situation before the project and updates what has been done in last 2 years with the project.

Bilateral median nerve compression at the level of Struthers' ligament. Case report.

Struthers' ligament syndrome is a rare cause of median nerve entrapment. Bilateral compression of the median nerve is even more rare. It presents with pain, sensory disturbance, and/or motor function loss at the median nerve's dermatomal area. The authors present the case of a 21-year-old woman with bilateral median nerve compression caused by Struthers' ligament. She underwent surgical decompression of the nerve on both sides. To the authors' knowledge, this case is the first reported bilateral compression of the median nerve caused by Struthers' ligament. The presentation and symptomatology of Struthers' ligament syndrome must be differentiated from median nerve compression arising from other causes.

Effects of 2,4-dichlorophenoxy acetic acid dimethyl amine salt on dental hard tissue formation in rats.

2,4-Dichlorophenoxy acetic acid dimethyl amine salt (2,4-D DMA), as one of the phenoxy acids, is used as a herbicide mainly against broad-leaf weeds in cereal crops, sugar cane, and on turf, pasture, and non-crop land. Some formulations of 2,4-D may be contaminated with dioxins. Recently, it has been shown that chlorinated organic compounds, dioxins, and furans are present in mother's milk and may cause developmental defects in children's teeth. Therefore, we aimed to evaluate the effects of 2,4-D DMA on odontogenesis in rats. 2,4-D DMA was given orally combined with rat food to pregnant albino rats. Each group consisted of two pregnant rats and, 0 (control, group A), 25 ppm (group B), 50 ppm (group C), and 100 ppm (group D) 2,4-D DMA was given to each pregnant rat as daily intake. 2,4-D DMA affected young rat's dental development and dose-related findings were found in experimental groups. The odontoblast layer was irregular and globular dentin formation was present in Groups B, C, and D but not in the control group. Thickness of enamel decreased in Groups C and D. The results of the study have shown that 2,4-D DMA could disturb dental development in rats even in relatively low doses. It is concluded that environmental contaminants such as chlorinated organic pesticides may play an important role in infant's dental development when taken via mother's milk.

Severe peripheral polyneuropathy in a child with infective endocarditis caused by Staphylococcus aureus.

Although central nervous system complications such as stroke, encephalopathy and meningitis are commonly described in Staphylococcus aureus endocarditis, peripheral nervous system involvement is rarely reported in the literature. In this article we report on a 13-year-old boy with infective endocarditis caused by Staphylococcus aureus in whom severe polyneuropathy developed during hospitalization. To the best of our knowledge this is the first child case with infective endocarditis associated with peripheral polyneuropathy in the literature.

Effects of glutaraldehyde on synovial tissue.

This study investigated the effect of glutaraldehyde on the synovial tissue of rabbits. Four different concentrations of glutaraldehyde solution were injected into one knee and the contralateral glenohumeral joint of rabbits in group A to group D. The concentration levels used in group A and group B were 1000 ppm and 100 ppm, respectively. For group C and group D, samples of rinsing solutions obtained by rinsing arthroscopic equipment with 1 l or 2 l of isotonic saline, respectively, after immersion in 2% glutaraldehyde were used. The contralateral knee and ipsilateral glenohumeral joint of the same rabbits were injected with saline and used as control sites. Rabbits were sacrificed after 1 day, 7 days or 15 days and the histopathological changes in the synovial tissues were compared. The most dramatic inflammatory changes were observed in group A and group B. The histopathological changes were greater after 7 days than after 1 day or 15 days. Group C and group D showed no significant differences when compared with normal synovium. A correlation between the concentration of the glutaraldehyde solution and the number of inflamed joints was observed. Very few or no inflamed joints were seen when samples from rinsing solutions of 1 l or 2 l of saline, respectively, were used.

Anatomical characteristics of the tibial medullary canal and their implications for intramedullary fixation.

The use of intramedullary fixation methods in the tibia is limited by the anatomical characteristics of this bone. In this study, the shape and degree of axial lateral rotation of the medullary canal were determined in 45 human dry cadaver bones using X-ray and computed tomography examinations and direct measurement of rotation in inserted nails. Forty bones (88.8%) had slight and five bones (11.1%) had excessive anterior bowing along the tibial shaft. Six of the 45 bones (13.3%) had an extremely narrow medullary canal. Axial lateral rotation was demonstrated in the middle third of the medullary canal, being on average (+/- SD) 32.35 +/- 16.25 degrees (range 10-75 degrees). This study revealed that extreme narrowing of the medullary canal, axial lateral rotation of the medullary canal, and extreme anterior bowing of the tibial shaft are the anatomical characteristics most likely to cause difficulties when using intermedullary fixation in the tibia.

[Symptomatic triangular bone. A case report]. / Os triangulaire pathologique. A propos d'un cas.

Os triangulare is an accessory bone found in the triangular cartilage of the wrist just distal to the end of the ulna and is generally asymptomatic. A case report of symptomatic Os triangulare is reported. Treatment associated immobilization and anti-inflammatory medication.

Congenital true complete symphalangism of all proximal interphalangeal joints of hands with carpal anomalies: a case report.

Symphalangism is a rare condition which manifests in either PIP or DIP joint congenital fusion. Symphalangism may be with some other skeletal deformities. In our case, all PIP joints of both hands were fused with bilateral hypoplasia of carpal bones and Minaar type III lunatotriquetral coalition congenitally. No motion was detected in PIP joints with absence of cutaneous creases over all PIP joints. Radiologically, carpal hypoplasia and lunatotriquetral coalition were seen in all fingers with the absence of PIP joints. The patient's skeletal survey revealed no other pathology. He had no complaints related to his hands. So, regular follow-up was recommended. This pathology was presented as rarely observed although clinical problem is usually not so much.

Flexor tendon injuries of children in zone 2 (FDS repair or not).

Twenty flexor tendons in 13 children with a mean age of 7 years old (range from 9 months to 14 years) were treated by primary suture between 1994-1999. Both tendons were repaired in 12 (60%) digits and only FDP in 8 (40%) with excision of FDS. Mean follow-up was 19 months (from 6 to 55 months). In the 12 fingers with FDS repair, the results were excellent in 2, good in 4, fair in 3 and poor in 3. In the 8 fingers with FDS excision, 2 rated excellent, 5 good and 1 poor. In conclusion, repair of FDP alone with regional excision of FDS simplifies the operative procedure and reduces the number of tendon sutures inside the sheath.

Variations of abductor pollicis longus and extensor pollicis brevis muscles: surgical significance.

To investigate variations of the abductor pollicis longus and the extensor pollicis brevis muscles, an anatomic study was performed on 15 cadaver forearms. Some variations were observed as reported in previous studies. An unusual insertion of the abductor pollicis longus muscle and the extensor pollicis brevis muscle also was encountered during the dissection. Both tendons of these muscles were found to have inserted into the inferior side of the base of the first metcarpal bone together, instead of dorsal side. Our study suggested that the extensor pollicis brevis muscle and the abductor pollicis longus muscle differentiate from a common muscle.

Burkitt's lymphoma cell leukemia in a Turish boy.

Burkitt's lymphoma, associated with massive bone marrow and eyelid involvement that terminated with a manifested leukemic picture, was observed in a Turkish boy. Review of the world literature revealed the fact that Burkitt's lymphoma with a frankly leukemic picture is a rare condition, and usually has a very acute course with a poor prognosis.

Entrapment of the sensory branch of the radial nerve (Wartenberg's syndrome): an unusual cause.

Isolated neuropathy of the cutaneous branch of the radial nerve is a rarely recognized pathology. It was described in 1932 by Wartenberg, who suggested the name cheiralgia paraesthetica. The syndrome is described as known the entrapment of the superficial branch of the radial nerve. Many different etiologic factors for chronic nerve entrapment have been described, however our case has an unusual cause. A 52 year old man had pain and paresthesia in the area over the lateral aspect of the wrist, thumb and first web six months after Colles' fracture. The patient underwent bony spike resection after five months with ineffective conservative treatment. He has satisfied after this operation. The case was presented because of disappearing his preoperative complaints after the operation with respect to Wartenberg's syndrome constituted a rare cause of bone spike which has not been mentioned in the literature.

Mathematical relations between the lengths of the metacarpal bones and phalanges: surgical significance.

The mathematical relationship between the lengths of the metacarpals and phalanges is important in hand surgery because of its role in determining the lengthening of the tubular bone size or the length of a prosthesis. The purpose of the present study is to perform the measurements on the hand radiographs, and to determine possible mathematical relations between the lengths of the metacarpals and phalanges. The lengths and widths of metacarpals and phalanges were measured in millimeters on hand roentgenograms of 100 normal voluntary subjects (50 men, 50 women) and the results were evaluated with a descriptive analysis test. The relations between the lengths of the metacarpals and phalanges were mathematically investigated on several sets of data. Unchangeable proportions between the metacarpals and phalanges lengths were found and formulated. Because any defects or faults of the hand, especially shortness, can corrected with current improved surgical techniques, a knowledge of the morphometric relations between the lengths of metacarpals and phalanges may be useful for such surgical interventions.

Effect of intra-articular administration of hyaluronan and cortisone on secondary osteoarthritis of the infected rabbit's knee.

Hyaluronan is known to play an important role in the healing of degenerative osteoarthritis. But there is no clear consensus how it effects on osteoarthritis compare to cortisone. The purpose of the research was to determine the comparative effects of hyaluronan and cortisone on the healing of degenerative osteoarthritis. A rabbit model used in which a degenerative osteoarthritis were created in the articular cartilage by the inoculation of Staphylococcus Aureus (S. Aureus). The rabbits divided into two groups namely injected with hyaluronan (group A) and cortisone (group B) at days 20, 23 and 26. After hyaluronan and cortisone injections for treatment of osteoarthritis at day of 25 and 35 six rabbits (each of three injected with hyaluronan and cortisone) and at day 50 (six of injected with hyaluronan and five of cortisone) were sacrified. In biopsies obtained from these knees both articular cartilage degeneration and inflammation around the joint were examined by light microscopy. It was seen that the histopathologic findings were consistent with active chronic inflammation at day 10, followed by chronic inflammation. At day 5 of treatment the degeneration decreased (60%) in group A, and clinical findings disappeared after day 9 of treatment. At day 15 of hyaluronan treatment the degeneration degree regressed and at day 30 absolutely healed (all except one). In group B, at day 5 of treatment, the clinical findings disappeared and the healing rate was 72%. At day 15 of cortisone treatment, the degeneration slightly increased and at day 30 the degeneration degree increased more than that day of 15. The results showed that cortisone is effective in the treatment of cartilage degeneration and inflammation early in the course of the septic arthritis whereas the therapeutic effect of hyaluronan is higher late in the course of the disease. Further studies are required in order to understand the effectiveness of the combined or consecutive use of these drugs in degenerative osteoarthritis.