Efficacy and cost-effectiveness of the cell saver system in instrumented posterior fusion with thoracic and lumbar vertebral fractures.

BACKGROUND: The aim of our study was to determine the efficacy and cost-effectiveness of intraoperative autotransfusion that uses the cell saver system (CSS) in patients undergoing posterior instrumentation and fusion of thoracic and lumbar vertebral fractures. METHODS: We divided 121 patients who were to undergo posterior instrumentation and fusion due to thoracic and lumbar vertebral fractures into two groups: 59 patients (23 males and 36 females) were in the cell saver group, and 62 patients (22 males and 40 females) were in the control group. Hemoglobin, hematocrit, and red blood cell (RBC) values were recorded for all patients preoperatively, on the postoperative first, second, and third days, and on the hospital discharge day. Transfusion rates and numbers of allogeneic erythrocyte transfusions, as well as the costs of transfused total auto- and allogeneic transfusions were compared. RESULTS: The numbers of erythrocyte suspensions transfused perioperatively were 0.2±0.6 units in the cell saver group and 0.7±1.4 units in the control group (p=0.01). Statistically significant differences were noted between the two groups on the postoperative first, second, and third days in terms of hemoglobin, hematocrit, and RBC values. These differences had disappeared by the hospital discharge day. The average cost of perioperative blood transfusions was $431±27.4 in the cell saver group and $34.5±66.25 in the control group (p<0.001). CONCLUSION: The use of the CSS was not cost-effective, but it was particularly successful at reducing the rate and the number of units of postoperative allogenic blood transfusions.

Tuberculous Tenosynovitis of the Wrist: A Report of Two Cases with Special Reference to Magnetic Resonance Findings.

BACKGROUND: Tuberculous tenosynovitis of the wrist is rare among cases of musculoskeletal tuberculosis. It is a slow, progressive disease with silent symptoms, leading to a late diagnosis. Also, it can be misdiagnosed as inflammatory arthritis, pyogenic infections, and inflammatory tenosynovitis. Thus, patients present with destructive changes of the bone and joint, as well as abscesses, often receive incorrect or unnecessary medical and surgical treatment. DISCUSSION: Well-documented anamneses along with physical examinations and radiologic imaging methods, such as computed tomography (CT) and magnetic resonance imaging (MRI), can be useful in the diagnosis of tuberculous tenosynovitis. All chronic synovitis of the wrist with longstanding pain should be considered as mycobacterial infection and an important differential diagnosis. Early diagnosis followed by extensive debridement and antituberculous chemotherapy provides good functional results. CONCLUSION: This article presents the cases of two patients with wrist tuberculous tenosynovitis and the respective MRI findings. It also includes a literature review.

Ginkgo Biloba improves bone formation during fracture healing: an experimental study in rats.

OBJECTIVES: Ginkgo biloba extract (EGb 761) is a plant extract obtained from the leaves of the G. biloba tree. The aim of this study was to assess the histological and radiological effects of G. biloba extract on fracture healing in an experimental fracture model using rat femurs. METHODS: Forty-eight female Sprague-Dawley rats (weight: 195-252 g; age: 20 weeks) were used in the study. The rats were randomly divided into six groups (n=8). A transverse fracture was made in the middle of the right femur of each rat and fixed with a Kirschner wire. The G. biloba groups received 60 mg/kg oral G. biloba extract once daily. No medication was given to the control groups. On days 7, 21 and 35, both sets of femurs were evaluated radiologically and histopathologically. RESULTS: Histological evaluation revealed that the G. biloba groups had significant differences at 21 and 35 days (p<0.05). The G. biloba group showed a significant difference in terms of bone formation on day 21 when compared to the control group (p<0.05). CONCLUSIONS: This study indicated that the use of G. biloba extract accelerated fracture healing. Both radiological and histological differences were detected, but the histological differences were more remarkable. Level of Evidence I, High Quality Randomized Trial.

OBJETIVOS: O extrato de Ginkgo biloba (EGb 761) é um extrato vegetal obtido das folhas da árvore Ginkgo biloba. O objetivo deste estudo foi avaliar os efeitos histológicos e radiológicos do extrato de Ginkgo biloba sobre a consolidação de fraturas em um modelo experimental de fratura em fêmures de rato. MÉTODOS: Foram utilizados 48 ratos Sprague-Dawley fêmeas (peso: 195-252 g, idade: 20 semanas). Os ratos foram divididos randomicamente em seis grupos (n = 8). Uma fratura transversal foi feita no meio do fêmur direito de cada rato e fixada com fio de Kirschner. Os grupos G. biloba receberam 60 mg/kg de G. biloba por via oral uma vez por dia. Não foi administrada nenhuma medicação aos grupos de controle. Nos dias 7, 21 e 35, ambos os fêmures foram avaliados radiológica e histopatologicamente. RESULTADOS: A avaliação histológica revelou que os grupos G. biloba apresentaram diferenças significativas aos 21 e 35 dias (p < 0,05). O grupo G. biloba mostrou uma diferença significativa em termos de formação óssea no dia 21 quando comparado com o grupo controle (p < 0,05). CONCLUSÕES: Este estudo indicou que o uso de extrato de G. biloba acelerou a consolidação de fraturas. As diferenças radiológicas e histológicas foram detectadas, mas as diferenças histológicas foram mais notáveis. Nível de Evidência I, Estudo Clínico Randomizado de Alta Qualidade.

Ginkgo Biloba improves bone formation during fracture healing: an experimental study in rats / Ginkgo Biloba melhora a formação dos ossos durante a consolidação da fratura: estudo em ratos

ABSTRACT OBJECTIVES: Ginkgo biloba extract (EGb 761) is a plant extract obtained from the leaves of the G. biloba tree. The aim of this study was to assess the histological and radiological effects of G. biloba extract on fracture healing in an experimental fracture model using rat femurs. METHODS: Forty-eight female Sprague-Dawley rats (weight: 195-252 g; age: 20 weeks) were used in the study. The rats were randomly divided into six groups (n=8). A transverse fracture was made in the middle of the right femur of each rat and fixed with a Kirschner wire. The G. biloba groups received 60 mg/kg oral G. biloba extract once daily. No medication was given to the control groups. On days 7, 21 and 35, both sets of femurs were evaluated radiologically and histopathologically. RESULTS: Histological evaluation revealed that the G. biloba groups had significant differences at 21 and 35 days (p<0.05). The G. biloba group showed a significant difference in terms of bone formation on day 21 when compared to the control group (p<0.05). CONCLUSIONS: This study indicated that the use of G. biloba extract accelerated fracture healing. Both radiological and histological differences were detected, but the histological differences were more remarkable. Level of Evidence I, High Quality Randomized Trial.

RESUMO OBJETIVOS: O extrato de Ginkgo biloba (EGb 761) é um extrato vegetal obtido das folhas da árvore Ginkgo biloba. O objetivo deste estudo foi avaliar os efeitos histológicos e radiológicos do extrato de Ginkgo biloba sobre a consolidação de fraturas em um modelo experimental de fratura em fêmures de rato. MÉTODOS: Foram utilizados 48 ratos Sprague-Dawley fêmeas (peso: 195-252 g, idade: 20 semanas). Os ratos foram divididos randomicamente em seis grupos (n = 8). Uma fratura transversal foi feita no meio do fêmur direito de cada rato e fixada com fio de Kirschner. Os grupos G. biloba receberam 60 mg/kg de G. biloba por via oral uma vez por dia. Não foi administrada nenhuma medicação aos grupos de controle. Nos dias 7, 21 e 35, ambos os fêmures foram avaliados radiológica e histopatologicamente. RESULTADOS: A avaliação histológica revelou que os grupos G. biloba apresentaram diferenças significativas aos 21 e 35 dias (p < 0,05). O grupo G. biloba mostrou uma diferença significativa em termos de formação óssea no dia 21 quando comparado com o grupo controle (p < 0,05). CONCLUSÕES: Este estudo indicou que o uso de extrato de G. biloba acelerou a consolidação de fraturas. As diferenças radiológicas e histológicas foram detectadas, mas as diferenças histológicas foram mais notáveis. Nível de Evidência I, Estudo Clínico Randomizado de Alta Qualidade.

Pseudoaneurysm of the Common Digital Artery with Magnetic Resonance Imaging and Surgical Findings.

Pseudoaneurysms are rare and are most commonly caused by blunt trauma. Taking a clinical history and doing an examination are very helpful to clinicians in making a diagnosis. In addition, imaging methods are very useful in distinguishing a pseudoaneurysm from soft-tissue tumors. Early diagnosis and treatment are crucial in preventing the development of possible complications. The treatment approach varies according to the localization and size of the lesion and presence of complications. We present a case-with imaging and surgical findings-of a pseudoaneurysm in a 27-year-old male in the second web interval after a penetrating trauma.

Pseudoaneurysm of the Radial Artery on the Hand Secondary to Stabbing.

Pseudoaneurysm of the radial artery is extremely rare. It usually occurs secondary to trauma, interventional procedures, and infections. Symptoms occur due to mass effect by the pseudoaneurysm, digital ischemia, or nerve suppression. B-mode and color Doppler ultrasonography are the first choice in diagnosis. The pathognomonic ultrasound sign of pseudoaneurysm is the turbulent flow, which is called the "ying-yang" sign. Bandages, ultrasound probe compression, ultrasound-guided thrombin injection, covered stents, and surgical ligation can be used in treatment. In here, we present the case of a 28-year-old woman who developed a radial artery pseudoaneurysm after a stabbing injury in her hand and discuss the radiological and treatment options.

Imaging of unilateral adrenal hemorrhages in patients after blunt abdominal trauma: Report of two cases.

Adrenal hemorrhage following blunt abdominal trauma is extremely rare. Most of the lesions are unilateral and right sided. Although often asymptomatic, life-threatening adrenal insufficiency may develop in the bilateral adrenal gland hemorrhage. Isolated adrenal injuries are very rare. They are often associated with other organ injuries. The mortality rates of patients range from 7% to 32%. In this report, we present the computed tomography and magnetic resonance imaging findings of unilateral adrenal hemorrhages in two patients with a history of fall from a height.

Open Dislocation of Ankle without Fracture Treated with an External Fixator.

Ankle dislocations are orthopedic emergencies that require immediate treatment to avoid neurovascular impairment. They are usually accompanied by one or more comminuted fractures of the ankle mortis. In rare circumstances, such as high-energy trauma, the ankle dislocations may not be accompanied by concomitant malleolar fractures and, thus, are named "pure ankle dislocations". We presented a very rare and interesting case of an open medial dislocation of the ankle without associated fracture in an 18-year-old man with no known predisposing risk factors. The patient was admitted to the emergency department after sustaining a catastrophic trampoline accident resulting in severe inversion of the right ankle. The patient was treated with an external fixator and was mobilized early in the post-surgical course. Despite initial presentation that revealed lack of posterior tibial pulse, the post-surgical course was uneventful, with full functional recovery and joint mobility. The primary goals of treatment are immediate reduction of the joint and relief of neurovascular stress. External fixation is a prompt, fairly easy treatment that one should keep in mind in pure ankle dislocations. Nonetheless, ligamentous restoration and early mobilization were the key elements as seen in our case for full functional recovery.

Evaluation of the Posterior Tibial Slope in Noncontact ACL Injuries Using Magnetic Resonance Imaging.

This study investigated whether an increased posterior tibial slope (PTS) was a risk factor for noncontact anterior cruciate ligament (ACL) injuries. We retrospectively evaluated the Magnetic Resonance (MR) images of 60 patients with noncontact complete ruptures of the ACL and 60 age-matched, healthy individuals with normal knee MR images. We measured the medial and lateral PTS on the sagittal T1W images separately in both the patients with complete ACL ruptures and the control group, as described by Hudek et al. Medial and lateral PTS were investigated between two groups .The patients with complete ACL ruptures had a statistically significantly (p<0.01) larger PTS on the lateral tibial condyle than the control group (4.5° and 3.8°, respectively). However, there was no statistically significant differences between the two groups' medial PTS. Also, the lateral PTS was greater in the complete ACL group than the control group in both females and males (p<0.01).

The Occupancy of the Components in the Cervical Spine and Their Changes with Extension and Flexion.

Study Design Retrospective case series. Objectives The kinematics of the cervical spine has been investigated by many researchers. However, the occupancy of the disk bulges, spinal cord, ligamentum flavum, and the rest of the canal as well as the changes of these structures with motion have not yet been investigated. The goal of this study is to investigate these dynamic changes. Methods The kinetic magnetic resonance images of 248 patients (124 men and 124 women) were evaluated, and the occupancy of each structure for each cervical level at neutral, flexion, and extension were calculated. Results Whole canal anteroposterior (AP) diameters showed significant differences between neutral-extension and flexion-extension at the C4-C5 and C5-C6 levels (p < 0.05). The mean disk bulges showed significant differences between neutral-flexion and flexion-extension at the C4-C5, C5-C6, C6-C7, and C7-T1 levels (p < 0.01). The mean spinal canal AP diameter showed significant differences between flexion-extension and neutral-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p < 0.05). There were significant differences between neutral-flexion at the C4-C5, C5-C6, and C6-C7 levels (p < 0.05). The mean thickness of the ligamentum flavum showed significant differences between flexion-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p < 0.001). There were significant differences between neutral-extension at the C3-C4 and C5-C6 levels (p < 0.05). There were significant differences between neutral-flexion at the C5-C6 and C6-C7 levels (p < 0.05). The mean thickness of the spinal cord showed significant differences between neutral-flexion at the C2-C3 and C3-C4 levels (p < 0.05). There were significant differences between flexion-extension at the C3-C4 and C4-C5 levels (p < 0.01). The rest of the canal showed significant differences between neutral-extension and flexion-extension at the C3-C4, C4-C5, C5-C6, and C6-C7 levels (p < 0.005). There were significant differences between neutral-flexion at the C5-C6 and C6-C7 levels (p < 0.01). Conclusions The occupancy of each structure in the cervical spine for each level was revealed by this study. In addition, the dynamic changes in the cervical spine with flexion and extension were seen to have different characteristics for each level.

Vascular leiomyoma of an extremity: Report of two cases with MRI and histopathologic correlation.

Vascular leiomyoma is a benign, usually solitary tumor arising from the tunica media of the vein. It can occur anywhere in the body wherever smooth muscle is present. These masses are commonly found in the uterus, urogenital tract and gastrointestinal tract but also less commonly in the extremities. They occur more often in the lower extremities than the upper extremities. Females are more affected than males and are generally seen in the third and fourth decades of life. We present magnetic resonance imaging, and histopathologic features of two pathology proven subcutaneous vascular leiomyomas of the hand and lower leg.

Does spinal anesthesia increase the pain and anxiety after total knee arthroplasty? a randomized prospective study.

OBJECTIVES: In this study, postoperative pain and anxiety level of the patients who were scheduled for spinal anesthesia (SA) and remained awake during the operation and patients who were scheduled for general anesthesia (GA) and were asleep during the operation were assessed. PATIENTS AND METHODS: Thirty-six patients who underwent total knee arthroplasty in our clinic were randomly divided into two groups. The first group (SA group) was given spinal anesthesia during operation (heavy marcaine), while the second group (GA group) underwent general anesthesia (propofol + nitric oxide). Hospital anxiety-depression (HAD) scores and visual analog scale (VAS) scores of the patients were calculated postoperatively. The patients were asked to score anxiety by the physicians. RESULTS: The mean postoperative HAD score was 24.68 in GA group, and 29.62 in SA group (p>0.05). The physicians score for patients' anxiety after surgery was 1.05 in GA group, and 1.69 in SA group (p<0.05). The mean postoperative VAS of the patients was 8.42 in GA group, and 8.87 in SA group (p>0.05). No statistically significant differences were found between the SA group and GA group in terms of HAD scores. No significant differences were found between the mean postoperative VAS scores of the groups. A statistically significant difference was found between the two groups for the physician's score for patients' postoperative anxiety. CONCLUSION: Our study results showed that total knee arthroplasty under spinal anesthesia was not associated with mood changes in patients and no increase in postoperative pain was seen.

Liberação percutânea do dedo em gatilho com micro bisturi oftalmológico vitreorretiniano de lâmina 19 / Percutaneous trigger finger release with microvitreoretinal 19 gauge ophtalmologic knife

OBJETIVO: Desenvolver uma nova técnica de liberação percutânea do dedo em gatilho, usando microbisturi oftalmológico vitreorretiniano (MVR) de lâmina 19. MÉTODO: O tratamento conservador do dedo em gatilho inclui, com frequência, injeção local de esteroide. Esse método apresenta alta taxa de falha, sendo necessárias injeções repetitivas. Quando o tratamento conservador falha, recomenda-se a liberação a céu aberto da polia A1. Foram relatados vários métodos que empregam diversos instrumentos. Usamos um microbisturi oftalmológico vitreorretiniano (MVR, de microvitreoretinal blade) de lâmina 19 na liberação percutânea do dedo em gatilho. RESULTADOS: Liberamos 50 dedos em gatilho por via percutânea com essa lâmina. CONCLUSÃO: Foram obtidos resultados satisfatórios em 45 deles (90 por cento). Nivel de Evidência VI, série de casos.

OBJECTIVE: Conservative treatment of trigger finger includes often local injection of steroid. This has a high rate of failure and repeated injections may be required.METHODS: When conservative treatment fails, open release of the A1 pulley is recommended. Various methods using various instruments have been reported. We used 19 gauge microvitreoretinal (MVR) ophthalmic knife in percutaneous release of trigger finger.RESULTS: We released 50 trigger fingers percutaneously with this knife. Satisfactory results were achieved in 45 of them (90%). Conclusion: Object of this study is to produce a new technique for percutaneous release of trigger finger using 19 gauge microvitreoretinal (MVR) ophthalmic knife.CONCLUSION: Satisfactory results were achieved in 45 of them (90%). Level of Evidence: Level IV cases series.