Pathogens in Pediatric Septic Arthritis: A Multi-Center Study in Turkiye (PEDSART Study).

OBJECTIVES: Septic arthritis (SA) is a serious bacterial infection that must be treated efficiently and timely. The large number of culture-negative cases makes local epidemiological data important. Accordingly, this study aimed to evaluate the etiology, clinical characteristics, and therapeutic approach of SA in children in Turkiye, emphasizing the role of real-time polymerase chain reaction (PCR) techniques in the diagnosis. METHODS: In this multi-center, prospective study, children hospitalized due to SA between February 2018 and July 2020 in 23 hospitals in 14 cities in Turkiye were included. Clinical, demographic, laboratory, and radiological findings were assessed, and real-time PCR was performed using synovial fluid samples. RESULTS: Seventy-five children aged between 3 and 204 months diagnosed with acute SA were enrolled. Joint pain was the main complaint at admission, and the most commonly involved joints were the knees in 58 patients (77.4%). The combination of synovial fluid culture and real-time PCR detected causative bacteria in 33 patients (44%). In 14 (18.7%) patients, the etiological agent was demonstrated using only PCR. The most commonly isolated etiologic agent was Staphylococcus aureus, which was detected in 22 (29.3%) patients, while Streptococcus pyogenes was found in 4 (5.3%) patients and Kingella kingae in 3 (4%) patients. Streptococcus pyogenes and Kingella kingae were detected using only PCR. Most patients (81.3%) received combination therapy with multiple agents, and the most commonly used combination was glycopeptides plus third-generation cephalosporin. CONCLUSIONS: Staphylococcus aureus is the main pathogen in pediatric SA, and with the use of advanced diagnostic approaches, such as real-time PCR, the chance of diagnosis increases, especially in cases due to Kingella kingae and Streptococcus pyogenes.

Benign Multicystic Peritoneal Mesothelioma: Two Rare Cases and Review of the Literature.

BACKGROUND: Benign multicystic peritoneal mesothelioma is a multiloculated cystic mass which originates from the peritoneum. This rare tumor is usually seen in women of childbearing age and has a high recurrence rate after surgery. CASE PRESENTATION: We present two benign multicystic peritoneal mesothelioma cases with different imaging modalities, which were also pathologically proven. CONCLUSION: The imaging features which may be diagnostic should be well known as there are very few reports regarding this entity.

Analysis of the factors affecting mortality after non-traumatic major lower extremity amputations.

OBJECTIVE: The aim of this study was to evaluate the prognostic factors affecting mortality after major lower extremity amputations in patients with diabetes mellitus and peripheral vascular disease. METHODS: For this retrospective study, 484 patients (345 male, 139 female) who were previously diagnosed with diabetes mellitus and peripheral vascular disease and underwent first-time nontraumatic major lower extremity amputations between January 2008 and January 2021 were included. The mean age of the patients was 64.2 ± 13.8 (20-114). In 32.4% of patients, peripheral vascular disease was the underlying cause, whereas diabetes mellitus was responsible for the etiology in 67.6% of patients. About 68.8% of patients had below-knee amputations, whereas 2.9% had bilateral below-knee amputations, 27.1% had above-knee amputations, and 1.2% had hip disarticulation performed. Gender, age, amputation level, amputation etiologies, Charlson comorbidity index, need for blood transfusion, and laboratory findings such as hemoglobin, platelet, albumin, erythrocyte sedimentation rate, C-reactive protein, sodium, potassium, and neutrophil to lymphocyte ratio levels were recorded preoperatively and at the time of discharge. Patients were grouped as died ≤1 month, ≤3 months, ≤6 months, and ≤12 months or alive. RESULTS: Advanced age, female gender, high Charlson comorbidity index, blood transfusion requirement, proximal amputation level, preoperative low platelet, preoperative low albumin, and parameters such as low hemoglobin, low erythrocyte sedimentation rate, high sodium, low platelet, low albumin, high C-reactive protein, and high neutrophil to lymphocyte ratio at time of discharge were seen to have a statistically significant effect on mortality at 1 month, 3 months, 6 months, and 12 months postoperatively. Preoperative high C-reactive protein had a statistically significant effect on mortality at 1 and 3 months postoperatively, whereas low C-reactive protein had a statisti cally significant effect on mortality at 6 months postoperatively. High potassium at the time of discharge was associated with mortality at 6 and 12 months postoperatively. CONCLUSION: This study has shown us that mortality rates are affected by modifiable parameters at the time of discharge such as hemoglo bin, sodium, potassium, platelet, and albumin, and normalization of these parameters before discharge could reduce the rates of mortality in the postoperative period. LEVEL OF EVIDENCE: Level IV, Prognostic Study.

Posterior fixation of thoracolumbar burst fractures: is it possible to protect one segment in the lumbar region?

BACKGROUND: The treatment for thoracolumbar burst fractures is controversial. The aim of this retrospective study was to compare intermediate-segment (IS) and long-segment (LS) instrumentation in the treatment for these fractures. METHODS: IS instrumentation was considered as pedicle fixation two levels above and one level below the fractured vertebra (infra-laminar hooks attached to lower vertebra with pedicle screws). LS instrumentation was done two levels above and two levels below the fractured vertebra. Among a total of 25 consecutive patients, Group 1 included ten patients treated by IS pedicle fixation, whereas Group 2 included fifteen patients treated by LS instrumentation. RESULTS: The measurements of local kyphosis (p = 0.955), sagittal index (p = 0.128), anterior vertebral height compression (p = 0.230) and canal diameter expansion (p = 0.839) demonstrated similar improvement at the final follow-up between the two groups. However, there was a significant difference (p < 0.05) between Group 1 and Group 2 regarding clinical outcome [Hannover scoring system, Oswestry disability questionnaire and the range of motion of the lumbar region compared to neutral (0°)]. CONCLUSIONS: The radiographic parameters were the same between the two groups. However, the clinical parameters demonstrated that IS instrumentation is a more effective management of thoracolumbar burst fractures.

Diabetic hand infections and hyperbaric oxygen therapy.

OBJECTIVE: The aim of this study was to discuss the clinical characteristics and results of hand infections in diabetic patients treated with hyperbaric oxygen therapy (HBOT). METHODS: This retrospective study included 10 patients with diabetes mellitus who underwent HBOT due to hand infections between January 2006 and February 2011. RESULTS: Amputation was performed at the level of the right hand index finger proximal interphalangeal joint in 1 patient and at the level of the distal phalanx of the left hand middle finger in 1 due to necrotizing soft tissue infection. Ulcers of 8 patients healed completely without amputation. CONCLUSION: The addition of HBOT to the standard treatment may contribute to the healing of hand ulcers in diabetics by increasing the tissue oxygenation and correcting the process of disturbed wound healing.

IGF-1 Increases with Hyperbaric Oxygen Therapy and Promotes Wound Healing in Diabetic Foot Ulcers.

Objectives. To investigate insulin-like growth factor I (IGF-1) levels in response to hyperbaric oxygen therapy (HBOT) for diabetic foot ulcers and to determine whether IGF-1 is a predictive indicator of wound healing in patients with diabetic foot ulcers. Design and Methods. We treated 48 consecutive patients with diabetic foot ulcers with HBOT. Alterations of IGF-1 levels in patients whose wound healed with HBOT were compared with those in patients who did not benefit from HBOT. Results. There was no significant difference in initial IGF-1 levels between the two groups (P = 0.399). The mean IGF-1 level increased with HBOT (P < 0.05). In the healed group, the mean IGF-1 increase and the final values were significantly higher (P < 0.05). In the nonhealed group, the mean IGF-1 increase was minus and the final values were not significantly different (P < 0.05). The increase in IGF-1 level with HBOT was significantly higher in the healed group (P < 0.001). Conclusions. IGF-1 increased significantly in the healed group. We believe that HBOT is effective in the treatment of diabetic foot ulcers, with an elevation of IGF-1. This alteration seems to be a predictive factor for wound healing in diabetic foot ulcers treated with HBOT.

Bilateral calcaneal stress fractures: a case report.

The majority of plantar heel pain is diagnosed as plantar fasciitis or heel spur syndrome. When history or physical findings are unusual or when routine treatment proves ineffective, one should consider an atypical cause of heel pain. Stress fractures of the calcaneus are a frequently unrecognized source of heel pain. In a normal population, the possibility of calcaneal stress fractures must be borne in mind with patients who have bilateral heel pain. When a stress fracture is considered, clinicans have different imaging options. First of all, x-rays must be used to evaluate for any visible osseous pathology. If plain films are inconclusive, the clinician can proceed with a bone scan or Magnetic Resonance Imaging. In the literature, calcaneal stress fractures are mostly reported in soldiers or athletes, but our case is one of a 44-year-old housewife with bilateral heel pain treated as Achilles tendinitis and plantar faciitis for a long time. Her final diagnosis was bilateral calcaneal fracture by Magnetic Resonance Imaging.

Long-term results of surgical treatment of pigmented villonodular synovitis of the knee.

OBJECTIVES: The aim of this study was to evaluate the long-term results of total synovectomy in pigmented villonodular synovitis of the knee (PVNS). METHODS: Open total synovectomy was performed for 19 patients (9 men, 10 women; mean age: 42.8 years) with PVNS. Of these patients, 15 had diffuse and 4 localized PVNS. The patients were followed for an average of 80.2 months and the average time between the onset of complaints and surgery was 23 months. In 4 patients, PVNS was identified during total knee replacement (TKR) performed due to gonarthrosis. Radiotherapy was performed as an adjuvant treatment in one patient with recurrence. Puncture was performed in 11 patients due to effusion and 8 to 70 cc of fluid was aspirated. Diagnosis was made during the exposure for TKR in 4 patients, by a biopsy in 2 and based on joint puncture and MRI findings in the rest. RESULTS: Recurrence occurred in 5 patients. A second total synovectomy was performed in 4 patients. Radiotherapy was used for the remaining one patient. Two patients were operated three times. During the follow-up, TKR was performed in 7 of the 19 patients. None of the patients developed infection and hemarthrosis requiring puncture nor required amputation or arthrodesis. Three patients had a postoperative knee joint stiffness of 10 to 25 degrees. The patients were evaluated according to the Knee Society Score and 8 (42.2%) had perfect, 9 (47.3%) good and 2 (10.5%) bad results. CONCLUSION: PVNS is a disease with a high risk of recurrence. No individual or combined treatment method can offer a definitive solution. Open or arthroscopic radical synovectomy is still considered as the gold standard. If necessary, adjuvant intraarticular or extraarticular radiotherapy can be added to the treatment.

Intra-articular lipoma of the knee joint in a girl.

Intra-articular lipoma is a rare benign mass that commonly occurs in the knee joint. We present the case of a 15-year-old girl with a slowly growing mass in her right knee. There was no history of trauma. The patient had no catching, locking, or giving way of the knee. On magnetic resonance imaging, multiple fibrous septa within a hyperintense mass was determined. After the arthroscopic examination, complete resection by open surgery was performed. There was no tumor recurrence at the end of the 1-year follow-up period. True intra-articular lipoma should be distinguished from lipoma arborescens, which is a similar but more common condition.

[Pseudarthrosis of a calcaneus fracture: a case report]. / Kalkaneus kiriginda psödoartroz: olgu sunumu.

Nonunion after a calcaneus fracture is rare. A forty-two-year-old man presented with complaints of extreme left heel pain on weight-bearing, that required him to use crutches. Clinical and radiological studies yielded a diagnosis of calcaneal nonunion. He had a history of an open calcaneal fracture that occurred in a traffic accident eight months before, for which he received cast treatment. He underwent surgical treatment (curettage, bone graft, and internal fixation) for the nonunion of the calcaneus. Eight months after the operation, no problem was observed at the union site, and the patient returned to his normal activity levels. He had a slight heel pain appearing only after walking long distances, which was attributed to the subtalar joint.

[Diffuse synovial hemangioma of the knee: a case report]. / Dizde yaygin sinovyal hemanjiyom: Olgu sunumu.

Synovial hemangioma is a rare benign tumor of joint cavities. It may be a cause of pain and recurrent joint swelling in children and young adults. Diffuse synovial hemangioma was diagnosed in a 25-year-old male patient with complaints of right knee pain and swelling of a 10-year history. Direct radiography, venography, magnetic resonance imaging, and diagnostic arthroscopy enabled the diagnosis. Surgical excision was not considered because of diffuse involvement and many pigmented areas in the skin; instead, the patient was monitored conservatively. At the end of a year, the severity of complaints and the size of the lesion did not increase. Since there is a high risk for recurrence following open synovectomy for diffuse synovial hemangiomas, conservative treatment may be an alternative approach in selected cases.

[Early results of treatment for developmental dysplasia of the hip in children between the ages of one and four years]. / Yürüme çagindaki (1-4 yas) gelisimsel kalça displazili olgularda erken dönem tedavi sonuçlarimiz.

OBJECTIVES: We evaluated the early results of treatment for developmental dysplasia of the hip in children between the ages of one and four years. METHODS: Twenty-four patients were retrospectively divided into two groups according to whether they were below or above two years of age at the time of the initial treatment. Group I consisted of 13 patients (20 hips; mean age 19.1 months; range 14 to 24 months); 11 patients (15 hips; mean age 32.6 months; range 26 to 50 months) comprised group II. Initially, patients in group I were treated with closed or open reduction (12 hips) and open reduction with femoral and/or pelvic osteotomies (8 hips). Group II patients underwent open reduction with femoral and/or pelvic osteotomies. Clinical results were evaluated according to the modified McKay criteria, and radiographic results to the Severin classification. The mean follow-up periods were 29.1 months (range 12 to 60 months) and 37.3 months (range 12 to 66 months), respectively. RESULTS: Subsequent operations were performed in nine hips in group I, and in two hips in group II (p<0.05). Avascular necrosis of the femoral head was noted in six hips (30%) in group I and in none of the hips in group II (p<0.05). Excellent or good radiographic results accounted for 85% and 86%, and clinical results for 90% and 100% in groups I and II, respectively. CONCLUSION: The need for pelvic and/or femoral osteotomies should be considered in conjunction with closed or open reduction in the treatment of developmental dysplasia of the hip in children between the ages of one and four years.