Impact of D-dimer level on postinterventional coronary flow and in-hospital MACE in ST-segment elevation myocardial infarction.

OBJECTIVE: Preintervention thrombus burden in the infarct-related artery is an independent predictor of no-reflow and adverse outcomes in coronary artery disease. The role of D-dimers in the acute phase of ST-elevated myocardial infarction (STEMI) during primary percutaneous coronary intervention (PCI) has not been fully elucidated. We aimed to investigate the predictive value of serum D-dimer levels on the outcome of patients with STEMI. METHODS AND RESULTS: A total of 266 consecutive patients presenting with STEMI within the first 12 h of symptom onset were included in this study. Patients were divided into two groups based on the postinterventional Thrombolysis In Myocardial Infarction (TIMI) flow grade score. Postinterventional TIMI grades of 0, 1, or 2 were defined as no-reflow (group 1) and angiographic success was defined as TIMI 3 flow (group 2). D-dimer levels were significantly higher in patients with postinterventional no-reflow than in patients with postinterventional TIMI grade 3 flow (686 ± 236 µg/ml-418 ± 164 µg/ml, p < 0.001). Multivariate logistic regression analysis showed that D-dimer level was an independent predictor of postinterventional no-reflow (OR: 1.005; 95 % CI: 1.003-1.007; p < 0.001) and in-hospital major adverse cardiovascular events (MACE; OR: 1.002; 95 % CI: 1.000-1.004; p = 0.029). Receiver operator characteristics analysis provided a cut-off value of 549 µg/ml for D-dimer for predicting no-reflow with an 83 % sensitivity and an 81 % specificity, and 544 µg/ml for predicting in-hospital MACE with a 69 % sensitivity and a 67 % specificity. CONCLUSION: In conclusion, D-dimer levels measured on admission may be an independent predictor of no-reflow, which is also a predictor of adverse outcomes in patients with STEMI.

Preclinical impairment of myocardial function in rheumatoid arthritis patients. Detection of myocardial strain by speckle tracking echocardiography.

OBJECTIVES: The incidence of heart failure is higher in patients with rheumatoid arthritis (RA) than in the general population and contributes to elevated cardiovascular mortality and morbidity rates. Impaired myocardial function can be detected by a novel echocardiographic method, speckle tracking echocardiography (STE), when conventional methods have yielded normal findings. The aim of our study was to investigate the effect of disease duration on myocardial strain and strain rate parameters in patients with RA. METHODS: This cross-sectional study included 37 RA patients [n=16, female gender n=16, mean age, 45.7 ± 9 years in the early-stage disease (ESD); n= 21, female gender n=19, 45.7 ± 16.8 years in the advanced-stage disease (ASD) group] who were compared according to early disease duration and advanced-stage disease (2.8 ± 1.2 vs. 14.6 ± 6.8 years, respectively). Hypertension, diabetes mellitus, and other cardiovascular risk factors were excluded. Offline analysis of STE was performed and data between the two groups were compared. RESULTS: RS, RSR-E, and RSR-E/A values were statistically significantly lower in patients with ASD. Circumferential strain and strain rate were similar between the two groups. Except for LSR-E/A values, LS, LSR-S, LSR-E, and LSR-A values were decreased in patients with ASD. CONCLUSION: RA patients without clinical evidence of cardiovascular disease and in the absence of traditional cardiovascular risk factors can be followed up with STE. In this way, early impairment of myocardial deformation can be detected before the appearance of any clinical evidence of cardiac involvement.

The effects of different prosthetic materials on the formation of collagen types in incisional hernia.

OBJECTIVE: The aim of this study was to determine the rate of collagen Type I/Type III for different meshes. METHOD: Fifty rats were used. Five groups were formed: prolene (n = 10), mersilene (n = 10), parietex (n = 10), e PTFE (n = 10) and control group (n = 10). In all animals, laparotomy was performed using a midline incision. After that four different kinds of meshes are placed into the retro-rectus plane and fixed with a non-absorbable suture. Rectus superficial fascia and skin are closed. In the control group, repairment is done primarily. Thirty days later, meshes are found through the incisions that were done previously. Scar tissues above and near by meshes and also in the control group are taken, and in these tissue samples, the ratio of Type I/III is evaluated histochemically. RESULTS: The Prolene mesh was found to contain more collagen fibers than e PTFE. As a result of the histopathologic evaluation, it was seen that Group I contained statistically significantly more collagen density than the other four groups (p < 0.05). Moreover, the collagen Type I/III ratio in the specimen taken from the top part and the surrounding area of Group I was found significantly higher than the collagen Type I/III ratios of the rest of the groups (p < 0.05). CONCLUSION: As a conclusion, the ratio of collagen Type I/III is the highest in the prolene group.

Occult spinal dysraphism and its association with hip dysplasia in females.

We examined the pelvic radiographs of two groups of patients (more than 12 years of age) from six medical centres. Hip dysplasia was considered to be present if Shenton's line was broken and more than one third of the femoral head was revealed to be uncovered in an antero-posterior radiograph of the pelvis. Patients with hip dysplasia due to teratological or neurological causes were excluded. There were 291 patients with treated or untreated hip dysplasia in the dysplastic group. The control group of 415 individuals was collected from consecutive outpatients (with a pre-set standardised female/male ratio) for whom an antero-posterior radiograph of the pelvis had been made in one of two medical centres and which did not disclose any abnormality of the hip joints. The aim of the study was to assess the co-existence of hip dysplasia and occult spinal dysraphism. Radiographs of all patients were examined, and any partial or complete defect of the posterior vertebral arch was recorded. In the dysplastic group, a defect was recorded in 23% (67/291) radiographs and in the control group in 12% (48/415). In both groups, L5 and S1 were the most commonly recorded sites with a defect. In the dysplastic group, a defect was recorded in 56/190 females and in the control group in 30/302 females. In males, there was no significant difference between the recorded findings in the two groups. In females with hip dysplasia, occult spinal dysraphism seems to be fairly common.

Results of treatment of the extensive volar wrist lacerations: 'the spaghetti wrist'.

'Spaghetti wrist' describes a volar wrist laceration in which at least 10 structures, inclusive of tendons, at least one major nerve and usually one major vessel are divided. This retrospective study, was performed between January 1990 and December 1995 at the Department of Orthopaedic and Traumatology of Erciyes University Medical School. The outcome of 21 patients who sustained simultaneous laceration of the median and ulnar nerves as well as flexor tendons at the wrist is described. The mean follow-up was 6.4 years. The flexor tendons were assessed using criteria from Lister et al. Vascular status was assessed clinically. Ulnar and median nerve repair results at the final control were assessed according to Seddon's criteria. Furthermore, the ulnar nerve was assessed according to the power of the first dorsal interosseous muscle, and the median nerve assessed by the function of abductor pollicis brevis and sensory function modality. Primary nerve repair yielded satisfactory results, the median nerve repair achieving a better outcome than the ulnar nerve. Most patients regained a functional range of wrist movement at the final control.

Femoral shaft fractures in children treated by closed reduction and early spica cast with incorporated supracondylar Kirschner wires: a long-term follow-up results.

38 children between 1 and 10 years of age with femoral shaft fractures were treated by closed reduction and early spica cast with incorporated supracondylar Kirschner wires and followed up prospectively. Overrides of maximum 15 mm, medial and anterior angulations less than 15 degrees and lateral angulation up to 5 degrees were considered acceptable. Posterior angulation and malrotation were not accepted. Of the 38 children examined at a mean of 65.6 months (range, 58-80 months) after fracture, none had any residual skeletal deformity and joint stiffness. At long-term follow-up, maximal shortening was 11 mm and overgrowth was 6 mm. The only factor associated with unacceptable shortening was shortening > 15 mm at the time of spica cast application. We believe that close follow-up during the first 3 weeks after cast application is important in order to achieve an acceptable final outcome. On the other hand this method of treatment is simple, safe and effective. It dramatically decreases hospital stay and cost of treatment and allows rapid return of the patients to their family environment.

Role of trauma on acute haematogenic osteomyelitis aetiology.

In this study we attempted to assess the role of trauma in acute haematogenic osteomyelitis (AHO). Twenty-four 6-8 week-old white New Zealand rabbits were divided into three groups. Group 1 received an injury to the proximal tibias; group II received a standardized bacteraemia with Staphylococcus aureus; group III received both the trauma and the bacteraemia. Scintigraphy was done by Gallium-67 citrate and, histopathologic examination was used for the diagnosis of osteomyelitis. In contrast to group I, AHO was seen in one case in group II and in all cases of group III.

The callotasis method of limb lengthening.

Limb lengthening by the callotasis technique of De Bastiani and use of the Orthofix external fixator was performed on 25 femurs and tibias of 23 patients between June 1989 and March 1995 in our clinic. Twenty femoral and five tibial segments were lengthened. Simultaneous lengthening of the femur and tibia was performed in two limbs. The mean duration of follow-up was 35.4 months (range, 12 to 81 months). Age at surgery ranged from 9 to 25 years (16.4 years on average). Poliomyelitis was the most common cause (69.6%) of the leg length discrepancy. The maximal achieved lengthening was 8 cm and the shortest 4 cm, with an average of 5.11 cm (13.6% of original bone length). The mean healing index was 38.6 days/cm; the complication rate was 36%. We conclude that limb lengthening by the De Bastiani method is a satisfactory procedure for pediatric and adult patients with moderate limb-length discrepancies.

Flexor tendon repair in zone 2 followed by early active mobilization.

The results following primary and delayed primary repair in zone 2 flexor tendon injuries were evaluated prospectively in 88 fingers of 71 patients using two different early postoperative mobilization programmes. In 33 patients, the Kleinert rubber band passive flexion method was used. In the remaining 38 patients, the early active mobilization programme was used. All patients were reviewed 1 year after operation and the results assessed by the Strickland criteria. During this evaluation maximum grip strength was also measured. The results were excellent or good in 78% of digits and mean grip strength was 84% of the uninjured hand in the Kleinert rubber band passive flexion group. In the early active mobilization group, excellent or good results were achieved in 85% of the digits and the mean grip strength was 90% of the uninjured hand. There were two early ruptures in each group.

One-stage treatment of congenital dislocation of the hip in older children.

We reviewed the results of a primary one-stage combined operation in 47 patients (55 hips) who were > or = 4 years and had congenital dislocation of the hip. At a mean follow-up of 7.5 years (2-16 years), 67% of the whole series had good or excellent clinical results, and 65% were good or excellent radiologically. Avascular necrosis occurred in four patients, and redislocation also occurred in four patients. We concluded that most of the children who are > or = 4 years and who have congenital dislocation of the hip can successfully be treated with an extensive one-stage operation consisting of open reduction combined with innominate osteotomy and femoral varus, derotation, and shortening osteotomy.

Closed Ender nailing of adolescent femoral shaft fractures.

Twenty-seven adolescents with 29 femoral shaft fractures, between the ages of 10 and 16 years, were treated with closed flexible Ender intramedullary nailing from 1989 to 1992 in our clinic. In one patient who had a fracture of the distal third of the femoral shaft, the nail was inserted proximal to distal (antegrade nailing). In the other patients, the nails were inserted distal to proximal (retrograde nailing). Clinical and radiological follow up averaged 32 months (18-56 months). Hospitalization averaged 15 days (7-28 days). All fractures healed with one significant leg length discrepancy of 1.7 cm in a patient who had developed osteomyelitis. There was no significant angulation or malrotation. All patients had a normal gait and were able to participate in full activities. There was one deep wound infection in a patient with an open fracture of the femoral shaft. There were no non-unions, delayed-unions or psychological complications. For this age group, this treatment of femoral shaft fracture should be considered owing to the functional recovery with low morbidity and cost, providing early ambulation, early discharge from hospital and early return to school.

The chondrogenic potential of free autogenous periosteal and fascial grafts for biological resurfacing of major full-thickness defects in joint surfaces (an experimental investigation in the rabbit).

In the present study, 40 rabbits were used, 30 of them for the experiment and 10 as controls. Full layer defects of 7-14 mm which were produced on knee joint cartilage were repaired with free autogenous periosteal and fascial grafts. The defects were made on the weight bearing areas of the medial condyles of the femurs of rabbits. The full layer periosteal grafts which were taken from the upper parts of the anterior tibia of 15 rabbits were located so that the combium layer faced the joint, and sutured to synovial membrane with 6.0 vicryl. The defects of the other rabbits were covered with fascial grafts obtained from fascia lata and were sutured to synovial membrane with 6.0 vicryl. No grafting was performed on the 10 rabbits in the control group after production of defects. The rabbits were immobilized for two hours postoperatively, and then allowed to be active. The rabbits in the experimental group were sacrificed in the third, sixth and ninth weeks respectively, and the rabbits of the control group were sacrificed in the ninth week. The distal femurs of 40 rabbits were removed and examined both macroscopically and histologically. The collagen phenotype was determined biochemically. When the assessments were made, it was noticed that the joint faces of the rabbits which were repaired with periosteal grafts were smooth, a tissue resembling hyaline joint cartilage had developed, and the synthesis of collagen of type II increased. On the other hand, the joint faces of the rabbits which were repaired with fascial grafts were not smooth, immature cartilage had with fibrous tissue developed, and the synthesis of type II collagen accounted for 50 per cent. The joint faces of the control group were course and covered with fibrous tissue, and the collagen synthesized was type I. According to these findings, we suggest that the biological repair of joint cartilage defects is possible with free autogenous periosteal grafts.