[The factor structure of schizophrenic symptoms: which model is supported by independent item analysis?]. / Sizofreni belirtilerinin faktör yapisi: bagimsiz madde analizi nasil bir modeli destekliyor?

OBJECTIVE: Most studies that have investigated the symptom dimensions of schizophrenia utilizing the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS), both global rating scales, favored a 3-factor model. Only a few studies have examined the factor structure at the item level and they suggest a wider dimensional structure. The factor structure of schizophrenic symptoms has not been previously studied in Turkey, nor has the construct validity of these scales. The present study sought to determine the factor structure of the independent items and the construct validity of the scales. METHOD: The study included 180 schizophrenia patients (diagnoses based on DSM-IV criteria). The standard statistical methods of principal component analysis (PCA) and varimax rotation were used to extract factors. RESULTS: PCA of the global items yielded a 3-factor solution, representing positive, negative, and disorganization dimensions. Item-level factor analysis revealed 12 factors: Psychomotor poverty, positive formal thought disorder, auditory/visual hallucinations, social and occupational dysfunction, bizarre delusions, attention/stereotypy, paranoid features, somatic hallucinations/delusions, appearance, grandiose/religious delusions, inappropriate affect, and delusions of jealousy. CONCLUSION: Consistent with previous studies, neither the global nor the item-level factor structures supported the simple positive-negative dichotomy or the composition of the sub-scales; therefore, future studies should make use of the single items, especially when positive symptoms are being studied.

"Sandwich technique" in the surgical treatment of primary complex fractures of the femur and humerus.

In this prospective study, our aim was to determine the clinical and radiographic outcomes of the surgical treatment of primary complex problem femoral and humeral shaft fractures treated by a new technique called "sandwich technique." A total of 45 patients with comminuted, complex and/or osteopoenic fractures of the femur or humerus (30 femoral and 15 humeral fractures) were treated using this technique. The patients were followed up for a mean of 25 months. In 24 (85.7%) of 28 patients with femoral fractures and in 14 (93.3%) of 15 patients with humeral fractures, union was achieved within 3-6 months of the operation (mean: 4.5 months). The total union rate was 88.4%. The pseudoarthrosis rate was 12%. There was no infection or implant failure seen during the follow-up period. The cortical allograft struts can be used to provide collateral support to weakened osteopoenic/osteoporotic bone. This technique provides a union rate of about 88% in osteoporotic and/or complex primary humerus or femur fractures.

[Hip fracture-dislocation (Pipkin type IV) associated with an apparent traumatic aortic valve rupture. Case history]. / Kalça kirikli-çikigi (Pipkin tip-IV) ile beraber görülen travmatik aort kapak rüptürü. "Olgu sunumu".

Traumatic aortic valve rupture with resultant aortic insufficiency is a rare complication of blunt trauma. Here reported is a case with a posterior fracture-dislocation of the hip (Pipkin type-IV) and an undisplaced sternum fracture who developed hemodynamic instability in the clinical follow-up and was diagnosed having a traumatic aortic valve rupture using echocardiography. He first was treated with a biological valve replacement. Two weeks later a total hip arthroplasty combined with the osteosynthesis of the posterior wall of the acetabulum was performed. Sternum fracture healed conservatively. In multiply injured patients especially with a blunt thorax trauma hemodynamic instability despite appropriate fluid replacement should rise the suspicion of cardiac injuries, especially traumatic aortic valve rupture. Echocardiography is a simple but reliable method for the diagnosis.

Acute aortic valve regurgitation secondary to blunt chest trauma.

Blunt injury to the cardiac valves leads to progressive acute ventricular failure, which often requires urgent surgical management. In this case report, we describe an acute aortic valve rupture caused by air-bag inflation during an automobile accident. Laceration of an aortic valve cusp was treated successfully with urgent aortic valve replacement. A concomitant orthopedic injury was treated electively 15 days after cardiac surgery Acute aortic valve rupture is a very rare complication of blunt chest trauma. We discuss how to diagnose and manage this potentially catastrophic event.

Anterior instrumentation for adolescent idiopathic scoliosis.

Thirty-two patients with adolescent idiopathic scoliosis underwent anterior fusion with rigid single rod (third generation instrumentation) and titanium mesh cages. The mean follow-up was 31 (24-45) months and the mean age was 14.9 years. There were 8 patients with King type I, 10 with type II, 6 with type III, 4 with type IV and 4 with lumbar curves. Titanium mesh cages were used in all the lumbar procedures and at the cranial and caudal ends of the instrumented area in thoracic cases. All the patients were immobilized in an orthosis for 3-6 months postoperatively. Mean preoperative primary coronal Cobb angle of 56 degrees was improved to 8.6 degrees. Average correction rate was 84%. Sagittal balance was restored with a mean thoracic kyphosis of 28 degrees and a mean lumbar lordosis of 38 degrees. Spontaneous secondary curve decompensation did not occur and postoperative thoracolumbar junctional kyphosis was not seen. One case had to be revised due to proximal screw pull out and loss of correction.

Early relapse of psychotic symptoms after an initial response to olanzapine.

This is a report of two cases with schizophrenia in which a good response to olanzapine in an acute 6-week treatment phase was obtained, followed by early relapse without any clear contributing factors. Referring to a few other case reports of early relapse after an initial response to atypical antipsychotics other than olanzapine, the possibility is discussed that rapid displacement of these drugs due to loose binding could play a role in early relapse.

Psychosocial adjustment after testicular cancer treatment.

PURPOSE: The high cure rate in testicular cancer has provoked investigations relating to the quality of life in long-term survivors. We determine the psychosocial consequences of the disease especially in regard to sexual and professional performance. MATERIALS AND METHODS: Among the testicular cancer patients treated with various treatment modalities 140 rendered free of disease for at least a year were included in this study. General Health Questionnaire 28 and a general survey were used to determine quality of life issues. RESULTS: Regarding the sexual life of these patients, problems related to libido, erection and ejaculation increased significantly during treatment and subsequently recovered but did not return to baseline after treatment. During treatment the frequency of sexual intercourse and/or masturbation decreased significantly in all patients. Of the single patients 35% thought that medical history would be a concern for the potential spouse. Regarding professional lives, 22.4% thought that they had better performance after treatment compared to before therapy, whereas only 6.1% reported it to be worse. When professional performance was analyzed according to the treatment modalities those who had received radiotherapy did worse. General Health Questionnaire scores indicated that patients with this disease had a positive view of life compared to that of the normal population. CONCLUSIONS: Although we observed a substantial recovery in sexual life after treatment, it was evident that therapy did have a negative effect on sexual functions. There was no effect on occupational performance and perspective of life, which may be related to the fact of having overcome a life threatening disease.

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Test-retest reliability of the alcohol and drug use disorder sections of the schedules for clinical assessment in neuropsychiatry (SCAN).

This report presents the results of a test-retest reliability study of the alcohol and drug dependence, as well as harmful use/abuse were investigated in Ankara, Turkey and Farmington, Connecticut (US). Reliabilities for the past year, prior to past year, and lifetime diagnosis of alcohol and drug use disorders were evaluated using ICD-IO, DSM-III-R and DSM-IV criteria. The results indicate that SCAN alcohol and drug diagnosis have good to excellent levels of reliability for dependence across different substances, different diagnostic systems, and different cultural groups. Diagnostic classification of alcohol and drug abuse/harmful use was considerably less reliable. Implications of the findings are discussed.

[Proteus syndrome. Clinical and differential diagnostic markers]. / Proteus-Syndrome. Klinische und differentialdiagnostische Merkmale.

A case with various skeletal abnormalities, soft tissue masses and skin lesions diagnosed as Proteus syndrome is reported. Proteus syndrome is included in the differential diagnosis of many disorders, because of the polymorphous nature of its clinical manifestations. It is a rare disorder and leads to functional disabilities as well as cosmetic and psychological problems. Early diagnosis and careful follow-up with appropriate surgical interventions is important in preventing long-term complications.

Formulation and in vitro-in vivo evaluation of buccoadhesive morphine sulfate tablets.

Buccoadhesive controlled-release systems for the delivery of morphine sulfate were prepared by compression of hydroxypropyl methylcellulose (HPMC) with carbomer (CP), which served as the bioactive adhesive compound. The release behavior of systems containing 30 mg of morphine sulfate and various amounts of the two polymers was found to be non-Fickian. The adhesion force was significantly affected by the mixing ratio of HPMC and CP in the tablet, and the weakest adhesion force was observed at a ratio of 1:1 (HPMC:CP). Interpolymer complex formation was confirmed between HPMC and CP in acidic medium by turbidity, viscosity, and FT-IR measurements. The amount absorbed (percentage of the drug loaded) of the controlled-release buccoadhesive tablets in six healthy volunteers and was 30 +/- 5%.

[Therapy of arthrofibrosis after ligament reconstruction of the knee joint]. / Die Therapie der Arthrofibrose nach Bandeingriffen am Kniegelenk.

The development of arthrofibrosis in a serious complication of knee ligament injury or knee ligament surgery. The fibrosis is caused by a pathologic quantity or quality of collagen fiber formation in the knee or in the capsular structures, causing irreversible loss of range of motion, restricted patellar motion and finally patella baja with frank osteoarthritis of the patella. The major factors inducing fibrosis are notch impingement, development of a cyclops on an anterior cruciate ligament graft, scarring of the fat pad and the retinacula and adhesions in the recesses of the joint. Our therapeutic concept includes aggressive physiotherapy and an early arthroscopic procedure if conservative measures fail. A posterior capsulotomy is performed from a posteromedial arthrotomy in cases with flexion contracture persisting over a number of years. In 16 patients reviewed 17 months after arthroscopic treatment of arthrofibrosis the average improvement in range of motion was 13 degrees for extension and 25 degrees for flexion. A further 7 patients with chronic flexion contractures persisting for 1 year or more were treated with a posterior capsulotomy and reviewed 18 months after surgery. The average gain for extension was 15 degrees in these patients at follow-up.

[Replacement of the posterior cruciate ligament and Clancy biceps tenodesis. Technique and results]. / Hinterer Kreuzbandersatz und Bizepstenodese nach Clancy. Technik und Ergebnisse.

Operative treatment of chronic combined posterior/posterolateral knee instability is difficult. If the osseous anatomy of the leg causes a varus loading of the knee, we perform a high tibial valgus osteotomy as first step. Since 1988 we have been using a special drill guide system for reconstruction of the posterior cruciate ligament. The tunnels are drilled with the instruments placed through the notch and with image intensifier control. We prefer a bone-tendon-bone-patellar tendon autograft or allograft for replacement of the posterior cruciate ligament. The procedure is combined with a biceps tenodesis as described by Clancy. Rerouting of the biceps tendon over the origin of the lateral collateral ligament puts tension on the posterolateral corner and augments the collateral ligament. It was possible to review 16 out of 18 cases treated in this way at an average of 18 months after surgery. Preoperatively, all had a 2 to 3+ posterior drawer and a reversed pivot shift. At follow-up, 10 had a 1+ posterior drawer, 3 a 1-2+ drawer and 3 a 2+ drawer; 5 patients still had a reversed shift. KT-1000 measurements revealed 8 mm (4-12 mm) posterior translation. The Lysholm Score averaged 83 points and the Tegner Score 4.0 at follow-up.

[Arthroscopic therapy of arthrofibrosis of the knee joint]. / Die arthroskopische Therapie der Arthrofibrose des Kniegelenks.

Arthrofibrosis following ACL reconstruction is a well-recognized and disturbing complication. It may result in a greater functional deficit than the original ACL deficiency. The purposes of this retrospective study were to present our results of arthroscopic arthrolysis and gentle manipulation in 16 consecutive cases in the past almost 3 years, to determine and define the etiology and risk factors, to make recommendations regarding prevention and to develop a time-related management concept. All the 16 patients had previously undergone open ACL reconstruction and had developed arthrofibrosis. The average time from the index surgery to arthrolysis was 7.4 months (range 2.5-18.5 months) and the average follow-up was 17.6 months (range 6-38 months). After pathology-oriented arthroscopic debridement, notchplasty, cyclops resection etc., and following manipulation of the knee, range of motion was found to be improved in all cases at the final follow-up. The average of extension deficit was decreased from 20.0 degrees to 7.0 degrees and the flexion deficit from 34.4 degrees to 9.9 degrees. Only three patients regained normal range of motion compared to the other side. The only complication was an avulsion fracture of the fibula head which did not cause any lateral instability. No patient gained motion at the expense of joint stability. Patella baja was present in two and patellofemoral pain in seven cases at the final follow-up. Three patients underwent further surgery after the final follow-up. Arthrofibrosis, while having many causes, appears to be a preventable complication.(ABSTRACT TRUNCATED AT 250 WORDS)

[Allogeneic cruciate ligament replacement. Perspectives and initial clinical results]. / Der allogene Kreuzbandersatz. Perspektiven und erste klinische Ergebnisse.

There is a continuing search for the ideal substitute for the cruciate ligaments. Autogenous tissues have been widely used as a replacement. The use of allografts is an attractive alternative: no donor side morbidity, decreased operative time, smaller incisions, especially with new endoscopic techniques, unlimited supply with a choice of graft sizes in multiple ligament reconstructions and a long shelf-life are some of the distinct advantages that allografts offer. They may be useful in circumstances where there is no suitable autologous substitute or the available tendon is too short to span the joint cavity. The preparation of an allograft requires appropriate donor selection and screening, careful surgical tissue procurement, and safe and effective processing techniques. At the present time, the issue of secondary sterilization of allografts remains controversial. Subclinical immune response and the possibility of transmission of infectious agents have to be considered. The early results in the literature and in our small series are encouraging; however, long-term results are necessary prior to widespread use of allografts in cruciate ligaments reconstructions. The authors believe that allografts should presently be reserved for use as an alternative to prosthetic ligaments in situations where autografts are unavailable or inappropriate.