The histopathological effects of sleep disorders on striated muscle in rats.

OBJECTIVES: To histopathologically examine the change in gastrocnemius muscle created by sleep disorder in rats. METHODS: This study was carried out at Giresun University, Turkey from December 2018 to January 2021. A total of 30 Wistar rats were separated into 3 groups as the control group (CG), absence of rapid eye movement (REM) sleep (ARS) group, chronic absence of sleep (CAS) group. The lack of sleep was created in all rats. At the end of 21 days, all the rats were euthanized. Degeneration and regeneration findings, and expressions of muscle RING finger 1 (MuRF1), muscle atrophy F-box (MAFbx), tumor necrosis factor (TNF), cyclooxygenase 2 (COX 2), insulin-like growth factor 1 (IGF1) in the gastrocnemius muscles were evaluated histopathologically and immunohistochemically. RESULTS: Degeneration was found to be greater in the ARS and CAS groups compared to the CG. Regeneration was determined to be significantly lower in the CAS group compared to the ARS group and control group. The number of atrophic fibres was greater in the CAS and ARS groups than in the control group. The IGF1 staining in the CAS group was found to be stronger than in the other 2 groups. CONCLUSION: This study demonstrated an increase in findings of degeneration in the gastrocnemius muscle of rats with a lack of sleep. The regeneration was reduced in the group with chronic lack of sleep.

The clinical results of lower trapezius tendon transfer with the peroneus longus allograft augmentation combined with interpositional repair with fascia lata in massive irreparable rotator cuff tears.

OBJECTIVES: To investigate the clinical results of lower trapezius (LT) tendon transfer and interpositional repair that were performed simultaneously in patients with massive irreparable rotator cuff tears. METHODS: Between 2018 and 2020 years, 16 patients with massive irreparable rotator cuff tears that were treated with LT tendon transfer and interpositional repair at the same time were included in this study. The mean follow-up period was 29±3 months (24-39 months) and the mean age of patients was 62±9 years (42-73 years). The acromio-humeral distance, active range of motions, Visual Analog Scale (VAS) scores, University of California-Los Angeles (UCLA) scores and Constant-Murley scores were made preoperatively and at the final follow-up. RESULTS: At the final follow-up, forward flexion was increased from 109˚±24.7 to 144˚±22.21 (p=0.005), abduction from 60˚±16.33 to 135˚±16.33 (p=0.005) and external rotation from 12˚±16.87 to 35˚±14.34 (p=0.005). Total UCLA scores were 5.9±2.13 to 22.7±5.29 (p=0.005), Constant-Murley scores were 24±9.43 to 50.2±14.28 (p=0.008), VAS scores were 6.1±1.1 to 2.4±1.35 (p=0.007), mean acromio-humeral distances were 4.64±0.85 mm (3.42-6.23 mm) to 6.58 mm (5.25-8.21 mm) (p=0.005) preoperatively and at the final follow-up. Except one patient who had a frozen shoulder any significant complication was detected. CONCLUSION: Adding interpositional repair to the LT tendon transfer in patients with posterior superior irreparable rotator cuff tear seems to have satisfactory short to mid-term clinical outcomes without an increase in complications.

Evaluation of Necrotic, Edematous and Inflammatory Changes in Bone Marrow and Soft Tissue After Irrigation with Different Concentrations of NaOCl Solution: An Experimental Study in Rat Tibia.

OBJECTIVE: We aimed to investigate effects of different concentrations (0.5-5%) of Sodium Hypochlorite (NaOCl) solution on healthy tissues, and determine the optimal concentration that does not harm to tissue. MATERIALS AND METHODS: 30 tibias of 15 male Wistar albino rats were used. The tibias were randomly divided into 5 groups (Salin, 0.5%, 1%, 2.5%, and 5% NaOCl). Tibias were reamed intramedullary, and irrigated with 20 ml of saline or increasing concentrations of (0.5-5%) NaOCl. The tibias were embedded in paraffin and the sections were stained with hematoxylin-eosin. All sections were assessed for edema, acute inflammation, or necrosis according to their density, in bone marrow and soft tissues. RESULTS: Pairwise comparisons revealed that irrigation of tibia with saline or 0.5% NaOCl solutions was not statistically significant in terms of necrosis in the bone marrows (p=0.320). However, irrigation of rat tibia with saline caused less necrosis in the bone marrows compared to high concentrations (1%, 2.5%, and 5%) of NaOCl (saline and 1% NaOCl, p=0.017; saline and 2.5% NaOCl, p=0.0007; saline and 5% NaOCl, p=0.001). CONCLUSION: As an irrigation solution, the effects of 0.5% NaOCl are similar to those of saline in terms of edema, inflammation, and necrosis. There is a need for evaluation of necrosis for extended periods such as one week or one month by immunohistochemical methods and flow cytometry.

Evaluation of different intraarticular injection volumes to assess optimum efficient amount; an experimental study in rat knee joints.

INTRODUCTION: The injection amount of solutions differs in wide ranges, from 20 to 200 µL in intraarticular injections experiments that was carried out with rats. The 10-fold difference between applied volumes is not acceptable since injection errors might affect the outcomes of the studies significantly. The excessive amount of solution that was injected into the knee joint of rats might end up with leakage of the solution from injection aperture, and damage the articular structures etc. In our preliminary experiments, we mentioned problems during the injection of excessive amount of solution into the rat knee joint. The main purpose of the present study, which was performed with rat knee joints, was to evaluate the applicability of different amounts of solutions used in experiments and to determine the optimal volume for intraarticular injection in rats. METHODS: The volume of 100 µL water-based stain was administered into knee joints of non-living rats. The legs were dissected to evaluate the possible presence of injected solution outside the knee joint. Then, the decreasing volumes (100 µL, 50 µL, 40 µL and 30 µL) of X-ray contrast solution (lobitridol) were applied into the knees of living rats to investigate whether systemic circulation acts on the leakage outside the joint. The X-ray images of all these joints were also taken to confirm the results. RESULTS: In nonliving rats, the place where water-based strain overflow from the knee joint was pointed out. The place of leakage is where the tendo musculi extensor digitorum longus leaves outside the joint. In living rats, by using contrast solution, an overflow was noticed in the subdermal place with the intraarticular injection volumes of 100 µL, 50 µL, and 40 µL. No overflow was observed with the intraarticular injection volumes of 30 µL X-ray contrast solution. DISCUSSION: In conclusion, the injection volume for the knee joints of rats should not exceed the 30 µL for optimum efficiency.

Minimally Invasive Surgical Approach Using an Equal-Sized Plate as an External Guide to Lateral Malleolar Fractures.

BACKGROUND: For minimally invasive percutaneous plate osteosynthesis (MIPPO) techniques applied to fractures of the lateral malleolus, there is no external guide for inserting the plate, determining the incision, and inserting the screws as used for fractures in other regions. With MIPPO, fluoroscopy exposure is unavoidable. The MIPPO technique is advantageous for patients; however, the unavoidable problem with this method for the surgical team is repeated exposure to fluoroscopy. To expose the surgical team to least radiation, we used a novel technique with an equal-sized plate as an external guide. We present the results of patients treated with this technique. METHODS: Patients with isolated lateral malleolar fracture who underwent MIPPO using an equal-sized anatomical lateral malleolar plate as an external guide were retrospectively investigated. VAS scores on postoperative day 1 and AOFAS scores at final evaluation were noted. RESULTS: Twenty-six patients were included in the study. Mean ± SD follow-up was 42.46 ± 14.11 months. Mean ± SD VAS score on postoperative day 1 was 3.76 ± 2.58. On final evaluation, prominent implant was identified in two patients, with mean ± SD AOFAS score of 98.00 ± 2.17. No other complications were observed. CONCLUSIONS: Using an equal-sized plate as external guide may ensure less use of fluoroscopy while determining the incisions. Until an external guide is produced commercially for minimally invasive fixation of lateral malleolar fractures, this method ensures determination of incisions and insertion of screws without requiring the use of fluoroscopy and may be reliably used for minimally invasive surgery.

Intra-articular injection of hydrogen sulfide decreased the progression of gonarthrosis.

Hydrogen sulfide (H2S) is found in both the plasma and synovial fluid of patients with gonarthrosis. In the present study, we investigated whether intra-articular injection of sodium hydrosulfide (NaSH) (1 mM, 30 µL), a H2S donor, might affect gonarthrosis in rats. Gonarthrosis was induced surgically in the left knees of rats and left for 6 weeks for the development of disease. Then, intra-articular injections of NaSH or methylprednisolone (1 mg/kg, 30 µL) were administered to rats. Half of each group was sacrificed at the end of the first day and the other half was sacrificed at the end of 4 weeks to evaluate early and later effects of injections on gonarthrosis. The injury induced by anterior cruciate ligament resection and medial meniscectomy in rats caused the development of gonarthrosis. As the duration lengthened after gonarthrosis induction, the progression of the disease continued. According to the modified Mankin Scoring System, intra-articular injection of NaSH histopathologically slowed the progression of gonarthrosis, whereas methylprednisolone was ineffective. In addition, NaSH decreased apoptosis in rat knees with gonarthrosis. Each treatment did not cause injury to healthy knees. Our results lead to the consideration that intra-articular NaSH administration may be effective in the progression of gonarthrosis.

Comparison of Anesthetic Administration According to Method of Hip Surgery.

OBJECTIVE: The aim of this study is to compare total hip prosthesis (THP), partial hip prosthesis (PHP), and proximal femoral nail (PFN) patients in terms of the chosen anesthetic method. METHODS: A total of 850 patients who underwent hip surgery were divided into 3 groups according to the operation type: PHP (n=281), PFN (n=393), and THP (n=176). The type of anesthesia administered, interventions during anesthesia, and complications were retrospectively evaluated. The groups were compared in terms of patient age, American Society of Anesthesiologists (ASA) scores, chosen anesthetic method, operation duration, colloid use during operation, use of antihypertensive medication, use of vasoconstrictor medication, development of hypotension, blood transfusion administered, development of cardiac arrest, requirements for intensive care after operation, and use of a central catheter. RESULTS: In the THP group, the mean age of patients was significantly lower as compared to the PHP and PFN groups. The duration of operation was lower in the PFN group as compared to the other two groups. In the THP group, general anesthesia was significantly high, while in the PFN group, regional anesthetic administration was high. While colloid use was greater in the PFN group, the blood transfusion rate was higher in the THP group. The use of antihypertensive medication was higher in the THP group as compared to the other groups. CONCLUSION: Although all three anesthetic methods could be used in hip surgery, the type of anesthesia should be chosen according to the type of hip surgery considering the duration of operation, age of the patient, and blood lost during the operation.

The results of Bankart repair without capsular plication in patients with recurrent traumatic anterior shoulder dislocation.

PURPOSE: The aim of this study was to evaluate the results of patients with recurrent anterior shoulder dislocation, who had been treated with repair of the Bankart lesion without capsuler plication. MATERIAL AND METHOD: The study included 22 shoulders of 22 patients (16 males and 6 females) with a mean age of 28 years, who underwent Bankart repair between 2011 and 2014. Patients with bilateral shoulder instability, multiple instability, >25% glenoid bone loss, and those with a history of shoulder surgery were not included in the study. The average follow-up time was 21.2 months. Evaluation was made of the preoperative number of dislocations, postoperative recurrence, functional status, and daily activity performance of the patients. Shoulder range of motion was measured. The results were evaluated using the Rowe shoulder score and the Oxford shoulder instability score. RESULTS: Recurrence was observed in only one patient who had a shoulder dislocation after trauma, thus giving a recurrence rate of 4.5%. Shoulder range of motion was full in all except that one patient. The mean Rowe shoulder score was 95.5 (excellent) and Oxford shoulder stability score was 44.6 (excellent). CONCLUSION: No recurrent shoulder dislocation was observed in patients who underwent Bankart repair surgery. Plication was not performed with the Bankart repair. Close to full range of motion was obtained in all patients. In conclusion, Bankart repair alone can be considered to be sufficient for the treatment of traumatic recurrent anterior shoulder instability.

Results of minimal invasive coracoclavicular fixation by double button lift-up system in Neer type II distal clavicle fractures.

AIM: We aimed to evaluate clinical and functional outcomes of indirect fracture reduction performed by coracoclavicular fixation with minimal invasive double button lift-up system in Neer type IIa unstable fractures of distal clavicle. MATERIAL AND METHODS: 22 patients with Neer type 2 distal clavicle fracture were enrolled in that prospective study. All patients underwent indirect reduction and osteosynthesis performed by coracoclavicular fixation with minimal invasive double button lift-up system. Postoperative follow-up was carried out clinically and radiologically with plain X-rays and utilization of Constant and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES) shoulder scores. Mean follow-up time was 15 months. A standard sling was applied for 2 weeks, postoperatively. Rehabilitation program was started on postoperative day 1. RESULTS: Mean age was 39 (range: 21-60), 18 of the patients were male. Right dominant extremity was affected in 14 patients. Mean duration of the surgical intervention was 40 min (range: 30-55 min). Mean union time was found to be 14 weeks (range: 7-21 weeks). Mean postoperative ASES and Constant scores were 79.9 (66.9-88.3) and 82.2 (71-100), respectively. The duration of return to normal daily activities were found to be 4.5 months. Any loss of reduction, AC joint arthrosis, and clavicular shortening were not detected in X-rays. CONCLUSION: This study has demonstrated that indirect osteosynthesis performed by coracoclavicular fixation with double button lift-up system in the treatment of unstable Neer type IIa fractures of the distal clavicle had successful clinical, radiological, and functional outcomes.

The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities.

AIM: To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame) in patients with lower extremity shortness and deformity. MATERIALS AND METHODS: The study comprised 17 patients (14 male, 3 female) who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure's level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. RESULTS: The mean age of the patients was 24.58 years (range, 5-51 years). The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6-31 months) from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1-6 cm). The mean duration of fixator application was 202.7 days (range, 104-300 days). The mean External Fixator Index was 98 days/cm (range, 42-265 days/cm). The mean Distraction Index was 10.49 days/cm (range, 10-14 days/cm). CONCLUSION: The computer-assisted external fixator system (spider frame) achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity.

An evaluation of meniscus tears in lateral tibial plateau fractures and repair results.

BACKGROUND: Soft tissue injuries may co-occur with tibial plateau fractures. These injuries may include medial or lateral ligament ruptures, peroneal nerve lesions, anterior cruciate ligament ruptures, and meniscus tears. OBJECTIVE: The aim of this study was to investigate the frequency of meniscus tears in lateral tibial plateau fractures and to evaluate the clinical and radiological results of meniscus repairs. MATERIALS AND METHOD: The study included 19 patients who underwent surgery for a closed lateral tibial plateau fracture. Anteroposterior and lateral radiographs of the knee, followed by magnetic resonance imaging (MRI) examinations, were undertaken for all cases. The clinical and radiological evaluation of the surgical treatment results was performed according to the Rasmussen criteria. RESULTS: Meniscus lesions were found in 10 (52.6%) patients. Nine meniscus tears were found in patients with type 2 fractures, and one meniscus tear was found in a patient with a type 3 fracture. All of the menisci were separated from the peripheral capsule adhesion point. On the MRI examination during follow-up, all of the repaired lateral menisci were determined to be in their original anatomic location. CONCLUSION: For successful outcomes in lateral plateau fractures, it is essential to determine whether there is a meniscus tear. In cases with meniscus tears, meniscus repair can be easily performed and should be considered because it has a positive impact on the treatment outcome.

Effects of the lower extremity external fixators on the sexual life of males.

OBJECTIVE: In tibial fractures, the use of an external fixator (EF) may be associated with sexual dysfunction (SD) in sexually active male patients. We aimed to investigate the influence of EF applied for tibial fracture on the sexual life in male patients. METHODS: We retrospectively evaluated 137 male patients who presented with tibial fractures and underwent surgical intervention with unilateral or circular EF. The patients completed the Brief Sexual Function Inventory (BSFI) form during the interview. We evaluated the incidence of the development of SD and the severity of SD with the use of an EF, and the relation with the type of EF and SD was investigated. The responses were compared with the results of the completed BSFI forms of 119 male patients who were treated with internal fixation (IF) for tibial fractures. RESULTS: In total, 108 patients (mean age, 42.8 years) treated with EF accepted the invitation and filled the form. The score of those patients were worse compared with that of the patients who were treated with IF (p<0.001). Postoperative sexual functions were the same with the preoperative sexual function in 12 patients (11%). However, the postoperative scores were decreased in 96 (89%) patients, which meant that the sexual functioning was impaired. None of the patients reported persistent SD. CONCLUSION: EF in the cruris may impair sexual functions in males. The rate of SD was higher in male patients who were treated with EF. Thus, SD might be associated with physical, psychological, and social limitations caused by EF.

Effects of positive end-expiratory pressure on arthroscopic shoulder surgery under general anesthesia.

OBJECTIVE: Our study is a prospective, randomized study on patients undergoing arthroscopic shoulder surgery in the beach-chair position to evaluate the effects of positive end-expiratory pressure (PEEP) on hemodynamic stability, providing a bloodless surgical field and surgical satisfaction. METHODS: Fifty patients were divided into two groups. Group I (n=25) had zero end-expiratory pressure (ZEEP) administered under general anesthesia, and group II (n=25) had +5 PEEP administered. During surgery, intraarticular hemorrhage and surgical satisfaction were evaluated on a scale of 0-10. During surgery, at the 5th, 30th, 60th, and 90th minutes and at the end of surgery, heart rate, mean arterial pressure (MAP), and positive inspiratory pressure were recorded. At the end of the surgery, the amount of bleeding and duration of the operation were recorded. RESULTS: In group I, the duration of operation and amount of bleeding were found to be significantly greater than those in group II (p<0.05). The surgical satisfaction score and clarity of the surgical field were found to be significantly lower in group I than in group II (p<0.05). MAP values in group I were significantly lower than those in group II. The SPO² values in group I were significantly lower than those in group II. CONCLUSION: Adding PEEP to the ventilation parameters of arthroscopic shoulder surgery in the beach-chair position reduces the amount of hemorrhage in the surgical field and thus increases surgical satisfaction without requiring the creation of controlled hypotension.

Effects of hyaluronic acid (Hyalonect) on callus formation in rabbits.

OBJECTIVE: Bone fragment and graft stabilization are important during reconstructive surgery of cases with comminuted fractures and bone defects. We examined the effect of Hyalonect surgical mesh on the healing dynamics of metaphyseal bone defects created in rabbit tibiae. METHODS: Approximately 5-mm defects were created on the anterior aspect of the proximal tibial metaphysis of 80 male rabbits. The rabbits were randomly assigned to four groups: Group I, bone defects left alone (control group); Group II, bone defect covered with Hyalonect; Group III, bone defect filled with allograft; and Group IV, bone defect filled with allograft and covered with Hyalonect. RESULTS: No significant histological differences were noted between Groups II and III or Groups III and IV at 3 and 6 weeks. At 3 weeks, Groups II, III, and IV had significantly better healing than Group I (p<0.05). In addition, Group IV showed significantly better healing than Group II at 3 and 6 weeks. At 6 weeks, only Group IV showed better healing than Group I (p<0.05). Radiologically, Groups II, III, and IV showed better healing than Group I at 3 and 6 weeks (p<0.05). CONCLUSION: Hyalonect application and bone grafting significantly accelerated the healing process when used alone or together. Hyalonect application along with bone grafting resulted in better early radiological healing than bone grafting alone.

Measurement of the knee joint line in Turkish population.

OBJECTIVE: The aim of the present study was to determine the knee joint line level by its distance to the adductor tubercle and the apex of the fibular head in the Turkish population. METHODS: The study included 117 knees of 108 patients (63 males, 45 females; mean age: 31.3 years, range: 16 to 82 years). Femoral width and the distance from the apex of the fibular head to the joint line as well as the distance from the adductor tubercle to the joint line were measured on anteroposterior radiographs. RESULTS: Mean femoral width was 87.2 mm. The average distance from the adductor tubercle to the joint line was 47.9 mm and from the fibular head to the joint line was 20.5 mm. A linear correlation was found between the distance from the adductor tubercle to the joint line and femoral width, with a ratio of 0.55. There was no significant correlation between the distance from the fibular head to the joint line and femoral width. CONCLUSION: There was a linear correlation between the femoral width and the adductor tubercle-joint line distance irrespective of any factors such as age, gender and height. Therefore, the adductor tubercle can be used as a reliable landmark to determine the joint line level for easy evaluation and measurement during surgery.

Osteoid osteoma treated with radiofrequency ablation.

Purpose. Our aim is to evaluate the results of treatment with computed tomography (CT) guided percutaneous radiofrequency ablation for osteoid osteomas which were localized in a difficult area for operation. Materials and Methods. Glenoid, distal tibia, humerus shaft, proximal humerus, and in third finger of the hand proximal phalanx were involved in one patient. Proximal femur was involved in three patients, distal femur was involved in three patients, and proximal tibia was involved in two patients. 9 males and 4 females were aged 4 to 34 years (mean age: 18.5 years). All patients had pain and were evaluated with X-rays, CT, bone scintigraphy, and MRI. In all patients, RF ablation was performed with local anesthesia. The lesion heated to 90°C for 6 minutes. Results. All of the patients achieved complete pain relief after ablation and were fully weight bearing without any support. In all patients, there was soft tissue edema after the procedure. During follow-up, all patients were free from the pain and there was no sign about the tumor. There was no other complication after the process. Conclusion. CT guided RFA is a minimally invasive, safe, and cost-effective treatment for osteoid osteoma placed in difficult area for surgery.

Relationship between axillary nerve and percutaneously inserted proximal humeral locking plate: a cadaver study.

OBJECTIVE: The aim of this study was to investigate the relationship between the axillary nerve and the percutaneously inserted proximal humeral locking plate and to evaluate the risk of axillary nerve injury during percutaneous plate insertion. METHODS: The study included 50 shoulders of 25 fresh frozen cadavers. A 5 cm incision was made from the anterolateral border of the acromion to the arm and a 5-hole 3.5-mm proximal humeral plate was inserted. The axillary nerve was then dissected. Plate holes which crossed the axillary nerve were noted. The distance between the axillary nerve and the lateral edge of the acromion and the length of the arm were measured and their relations evaluated with a correlation test. RESULTS: The average arm length was 319 mm. The average distance between the axillary nerve and the lateral edge of the acromion was 60 mm. There was a significant correlation between the arm length and acromion-axillary nerve distance (p<0.05). The plate was inserted under the deltoid fascia in all shoulders except one. There were no axillary nerve lesions. In 1 case, the distal end of the plate was inserted in the deltoid muscle. No constant relationship between the plate holes and the axillary nerve was detected. CONCLUSION: There is a risk of axillary nerve injury during percutaneous plate insertion. It must be ensured that the plate is inserted under the deltoid fascia during the surgery. The axillary nerve must be visible during application of the screws due to the impossibility of knowing which holes cross the axillary nerve.

Surgical treatment of the neglected achilles tendon rupture with Hyalonect.

BACKGROUND: The purpose of this study was to report the management and outcomes of ten patients with chronic Achilles tendon rupture treated with a turndown gastrocnemius-soleus fascial flap wrapped with a surgical mesh (Hyalonect). METHODS: Ten men with neglected Achilles tendon rupture were treated with a centrally based turndown gastrocnemius fascial flap wrapped with Hyalonect. Hyalonect is a knitted mesh composed of HYAFF, a benzyl ester of hyaluronic acid. The Achilles tendon ruptures were diagnosed more than 1 month after injury. The mean patient age was 41 years. All of the patients had weakness of active plantarflexion. The mean preoperative American Orthopaedic Foot and Ankle Society score was 64.8. RESULTS: The functional outcome was excellent. The mean American Orthopaedic Foot and Ankle Society score was 97.8 at the latest follow-up. There were significant differences between the preoperative and postoperative scores. Ankle range of motion was similar in both ankles. Neither rerupture nor major complication, particularly of wound healing, was observed. CONCLUSIONS: For patients with chronic Achilles tendon rupture with a rupture gap of at least 5 cm, surgical repair using a single turndown fascial flap covered with Hyalonect achieved excellent outcomes.

Cerebrotendinous xanthomatosis presenting with bilateral achilles tendon xanthomata: a case report.

Xanthomas are described as deposits in the skin and subcutaneous tissues. Mostly known as pseudotumors, xanthomas consist of connective tissue containing mainly cholesterol, triglycerides, and numerous foamy macrophages. Bilateral Achilles tendon xanthomata is pathognomonic for cerebrotendinous xanthomatosis in the case of normal cholesterol levels but increased cholestanol levels in serum. In this article, we present findings regarding bilateral xanthomas of Achilles tendons in a patient with cerebrotendinous xanthomatosis.

Effects of calcitonin on knee osteoarthritis and quality of life.

There has been a recent interest in calcitonin as a potential treatment for osteoarthritis, based on its metabolic activities in both bone turnover and cartilage. The aim of this study was to evaluate the effects of nasal form calcitonin on knee osteoarthritis and quality of life in women who receive calcitonin treatment for postmenopausal osteoporosis. Two hundred and twenty postmenopausal women, aged between 55 and 65 years with knee pain and knee osteoarthritis, graded II-III by using Kellgren-Lawrence radiographic scoring system, were included. Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, the quality of life questionnaire of the European Foundation for Osteoporosis (QALEFFO-41) and visual analog scale were used for the algofunctional assessments. Need of rescue analgesic was recorded. Pain (P < 0.001), stiffness (P < 0.05), functional capability (P < 0.05) and total score of WOMAC (P < 0.05) revealed statistically significant improvements after 3 months of the treatment and remained consistent throughout 1 year of the treatment period. Participants experienced significant reductions in WOMAC perceptions of pain (-53 %), joint stiffness (-44 %) and limitations in physical function (-49 %) at the end of 1 year of calcitonin treatment. Need of rescue analgesic intake was reported to have decreased approximately by 60 % at the end of the 1-year treatment period. QUALEFFO_41 scores improved: 37.6 (baseline), 30.9 (3 months), 28.0 (6 months) and 24.4 (1 year). In conclusion, nasal calcitonin treatment provided dual action on osteoporosis and osteoarthritis with significant improvements in quality of life and algofunctional results in knee osteoarthritis.