Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis.

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. There is a need for biomarkers that can be used for the diagnosis of sepsis and the early identification of patients at high risk of death. In this study, we aimed to investigate the relationship between Mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT), and copeptin in sepsis. A total of 28 sepsis, 32 septic shock, and 30 control patients were included in our prospective study. Patients' MR-proADM, PCT, and copeptin levels were recorded. Sequential organ failure assessment scores, length of hospital stay, and 30-day mortality were also recorded. These values were compared between the sepsis, septic shock, and control groups. The mean age of all participants was 64.04 ± 15.83 years. In the study, 37 (61.6%) patients were female and 23 (39.3%) were male. There was no statistically significant difference in gender/age between all patient groups and the control group (for all, p > 0.05). We found a significant difference between the survivors and nonsurvivors in terms of MR-proADM, PCT, and copeptin levels. There was a significant difference between the sepsis and septic shock groups in terms of MR-proADM and PCT. A significant correlation was found between the length of hospital stay and MR-proADM and copeptin. MR-proADM, PCT, and copeptin may be useful in the prognosis of sepsis and to predict the length of stay in hospital and mortality.

How successful is "pleural sound sign" in the identification of pneumothorax?

OBJECTIVE: In the present study, in thorax ultrasonography (USG) Doppler images obtained from cases with occult pneumothorax, we investigated the status of pulsatile pleural sounds over the pleural line and called these as the pleural sound sign (PSS). The purpose of the present study was to identify the efficacy of the proposed PSS in diagnosing pneumothorax and to compare it with the other USG findings including the sliding lung sign (SLS) and seashore sign (SSS). METHODS: The present study included 66 consecutive patients who were referred to the emergency unit with a blunt trauma from October 2009 to January 2010 at a tertiary university hospital. RESULTS: Of the 66 patients, 34 were in the patient group, and 32 were in the control group. Males accounted for 66.7% (n=44) of the study population. In predicting pneumothorax, the areas under receiver operating characteristic (ROC) curves of PSSmax and PSSdifference were 0.989 and 0.990, respectively. While the sensitivity of the SLS was 88% and the sensitivity of the SSS was 56%, the specificities of the SLS and SSS were 100%. Based on our findings, accuracy ranking was as follows: PSSmax = PSSdifference > SLS > SSS. CONCLUSION: New applications of thorax USG are rapidly growing. Our findings have to be confirmed in a large patient series. PSS is not a novel method, but it enhanced the importance of USG in the diagnosis of pneumothorax. We can stipulate that it can replace thorax computed tomography imaging particularly for the diagnosis of occult pneumothoraxes.

Clinical and functional outcomes and proprioception after a modified accelerated rehabilitation program following anterior cruciate ligament reconstruction with patellar tendon autograft.

OBJECTIVES: The aim of this study was to evaluate the clinical and functional outcomes and proprioceptive function in patients who received a modified accelerated rehabilitation program after anterior cruciate ligament (ACL) reconstruction with a patellar tendon (PT) graft. METHODS: The study included 38 patients (33 men, 5 women; mean age 27.6 ± 6.4 years; range 18 to 45 years) who underwent ACL reconstruction with a PT graft and participated in a modified accelerated rehabilitation program. Only six patients were athletes. Isokinetic strengths of concentric knee extension and flexion were measured with the Cybex isokinetic dynamometer, and static balance was tested with the Sport-KAT device. For proprioceptive assessment, active repositioning was measured at knee flexions of 40°, 20°, and 5° with an isokinetic dynamometer. Activity levels and subjective functional results were evaluated with the Tegner activity scale and Lysholm knee score, respectively. For objective functional testing, single leg hop, triple leg hop, and one-legged crossover hop tests were used. Knee stability was assessed with the Lachman test and anterior drawer test and knee range of motion was measured. The mean follow-up period was 16.2 ± 9.8 months. RESULTS: There was no graft failure during the follow-up. Twenty patients (52.6%) had hypoesthesia at the donor site and 15 patients (39.5%) had anterior knee pain. Before surgery, all the patients had positive results in the Lachman and anterior drawer tests. After surgery, the Lachman test was negative in 32 patients (84.2%), while six patients (15.8%) had grade 1 laxity. The mean Lysholm knee score showed a significant increase postoperatively (p<0.001). The mean preoperative and postoperative Tegner activity scores were not significantly different (p>0.05). There were no significant differences in the range of motion between operated and uninjured extremities (p>0.05). The two extremities were similar in proprioception and balance (p>0.05). Isokinetic quadriceps muscle strength was significantly decreased in the operated extremity only in extension at 60°/sec angular velocity (p<0.05). Other muscle strength measurements were similar in both extremities. The ratios of flexion/extension muscle strength were significantly greater in the involved extremity at all angular velocities (p<0.05). The mean performance scores of three functional tests were more than 85% of the uninvolved extremity. All the patients returned to preinjury daily activities or sports activities in 6 to 12 months postoperatively. CONCLUSION: We had satisfactory clinical, proprioceptive, and functional results in achieving dynamic and static stability of the knee with the modified accelerated rehabilitation program after ACL reconstruction with a PT graft.

[Patellofemoral joint dynamics in patients with gonarthrosis]. / Gonartrozlu hastalarda patellofemoral eklem dinamigi.

OBJECTIVES: Although the tibiofemoral joint has been evaluated in most of the gonarthrosis studies, the relationships between gonarthrosis and the patellofemoral joint have usually been disregarded. In this study, the dynamics of the patellofemoral joint in gonarthrosis has been evaluated. PATIENTS AND METHODS: Dynamic and kinematic axial computed tomography scans were obtained in 33 knees of 22 patients (19 females, 3 males; mean age 67.0 +/-3.2; range 58 to 75 years) who were scheduled for total knee arthroplasty due to the gonarthrosis. The control group consisted of 28 knees of 14 normal volunteers (11 females, 3 males; mean age 25 +/- 4.6; range 10 to 46 years) without any knee complaints or disorders. Sulcus, congruence and patellar tilt angles were measured on axial images which were obtained in different flexion angles of the knee (0 degrees, 10 degrees, 20 degrees, 30 degrees, 40 degrees and 60 degrees), both with and without contraction of the quadriceps muscle. ANOVA and paired-t tests were used for statistical analysis. RESULTS: Patellar tilt increased significantly in gonarthrotic patients compared to the controls (p < 0.05). The congruence angle was significantly lower in patients at 0 degrees and 10 degrees of knee flexion, but higher at 20 degrees, 30 degrees, 40 degrees and 60 degrees than controls (p < 0.05). The congruence angle increased significantly with the contraction of the quadriceps in controls, but no significant changes were observed in patients. CONCLUSION: Dynamics of the patellofemoral joint is different in patients with gonarthrosis than normal volunteers. Patellofemoral complaints following knee arthroplasties may be related to these differences.

[The accuracy of the clinical diagnosis of meniscal tears with or without associated anterior cruciate ligament tears]. / Menisküs yirtiklarinin klinik tanisi ve eslik eden ön çapraz bag lezyonunun taniya etkisi.

OBJECTIVES: Meniscal tears and anterior cruciate ligament (ACL) tears commonly coexist in sports injuries. The purpose of this study was to analyze the influence of ACL deficiency on our ability to diagnose meniscal tears. METHODS: The study included patients with a clinical diagnosis of medial meniscal tears with (group A; 26 patients; 22 males, 4 females; mean age 26.6 years; range 18 to 67 years) or without (group B; 17 males; mean age 28.2 years; range 19 to 49 years) associated ACL tears. Patients with lesions other than meniscal or ACL tears were excluded. Clinical evaluations were made with the use of medial joint line tenderness, McMurray, and hyperextension tests. Preoperative diagnoses were compared with arthroscopic results and the accuracy of the tests used were calculated. The two patient groups were also compared with regard to the Lysholm scale parameters and total Lysholm scores. Fisher's exact test and Mann-Whitney U-test were used for statistical analysis. RESULTS: Medial joint line tenderness was present in 82% in group A, and 73% in group B. McMurray test was positive in 82% in group A, and 62% in group B; hyperextension test was positive in 73% in group A, and 61% in group B. The total Lysholm scores were significantly different, being 69 in group A, and 61 in group B (p<0.05). CONCLUSION: Our findings suggest that the accuracy of a clinical diagnosis of a meniscal tear is decreased by the presence of an ACL tear. The coexistence of meniscal and ACL tears requires a more careful clinical evaluation and a more frequent need for magnetic resonance imaging.