Influence of Infraspinatus and Subscapularis Pathologies on Supraspinatus Muscle Atrophy - A Retrospective Cohort Study.

INTRODUCTION: Many factors could affect the supraspinatus (SSP) muscle after tendon rupture. We aimed to determine how infraspinatus and subscapularis tendon problems affect supraspinatus muscle atrophy associated with tears, in a retrospective cohort study conducted in a tertiary-level centre. MATERIAL AND METHODS: Fifty-eight patients with a full-thickness SSP tendon tear who fulfilled the inclusion criteria were enrolled in the study. They were evaluated for tear retraction, fatty degeneration, and other rotator cuff tendon pathologies. Supraspinatus muscle was assessed using the Goutallier classification, and its average area was also measured. Accompanying lesions of the subscapularis and infraspinatus tendons and degree of supraspinatus muscle atrophy were evaluated using magnetic resonance imaging. RESULTS: Our results showed that supraspinatus tendon tears ranged between 3mm and 41mm, and the estimated average cross-sectional area of the SSP muscle was 247.6mm2. Any degree of infraspinatus tendon pathology, ranging from tendinosis to full-thickness tears, was significantly correlated with the SSP muscle area (P < 0.05). The subscapularis tendon pathologies did not show a similar correlation. The interobserver and intraobserver reliabilities of the measurements were graded as excellent. CONCLUSION: Impairment of any of the rotator cuff muscles may affect the other muscles inversely. Our study showed that all infraspinatus tendon pathologies and partial subscapularis tears affect and alter the SSP muscle belly. We suggest early intervention for supraspinatus tears to avoid further fatty degeneration, as muscle atrophy and fatty degeneration progress in combination with the accompanying lesions.

Influence of Infraspinatus and Subscapularis Pathologies on Supraspinatus Muscle Atrophy - A Retrospective Cohort Study

@#Introduction:Many factors could affect the supraspinatus (SSP) muscle after tendon rupture. We aimed to determine how infraspinatus and subscapularis tendon problems affect supraspinatus muscle atrophy associated with tears, in a retrospective cohort study conducted in a tertiary-level centre. Materials and Methods:Fifty-eight patients with a fullthickness SSP tendon tear who fulfilled the inclusion criteria were enrolled in the study. They were evaluated for tear retraction, fatty degeneration, and other rotator cuff tendon pathologies. Supraspinatus muscle was assessed using the Goutallier classification, and its average area was also measured. Accompanying lesions of the subscapularis and infraspinatus tendons and degree of supraspinatus muscle atrophy were evaluated using magnetic resonance imaging. Results: Our results showed that supraspinatus tendon tears ranged between 3mm and 41mm, and the estimated average cross-sectional area of the SSP muscle was 247.6mm2. Any degree of infraspinatus tendon pathology, ranging from tendinosis to full-thickness tears, was significantly correlated with the SSP muscle area (P < 0.05). The subscapularis tendon pathologies did not show a similar correlation. The interobserver and intraobserver reliabilities of the measurements were graded as excellent. Conclusion: Impairment of any of the rotator cuff muscles may affect the other muscles inversely. Our study showed that all infraspinatus tendon pathologies and partial subscapularis tears affect and alter the SSP muscle belly. We suggest early intervention for supraspinatus tears to avoid further fatty degeneration, as muscle atrophy and fatty degeneration progress in combination with the accompanying lesions.

Diverticular disease and posture during defecation : a prospective comparative study.

BACKGROUND AND STUDY AIMS: Although several factors are thought to be responsible for the development of colonic diverticulosis (CD), the underlying pathogenesis is still obscure and needs clarification. The aim of this study was to determine the prevalence, location and clinical features of CD and especially to detect whether there is an association between CD and postures during defecation. PATIENTS AND METHODS: This prospective study enrolled 757 patients. The subjects were divided into two groups as a diverticulosis group (D group, n:95) and non-diverticulosis group (non-D group, n:662). RESULTS: The median patient age was 54.9±13.2 years. CD frequency was 12.5% (n:95). The most commonly involved part of the colon was the sigmoid colon (56.8%). Diverticula location was on the left in 45.3% (n:43), on the right in 24.2% (n:23) and on both sides of the colon in 30.5% (n:29). Patients in the D group were older (p<0.001) and were predominantly female (p:0.04). The frequency of sitting during defecation (Western type toilet) was higher in the D group compared to the non-D group (72.2% vs 53.5%; p:0.007). The use-time of a Western-type toilet was longer in the D group compared to the non-D group (p:0.04). In multivariable logistic regression analysis, age and toilet type were independent risk factors for the development of diverticulosis. CONCLUSION: Sitting during defecation seems to increase the risk of CD.

Multiple extensor tendons reconstruction with hamstring tendon grafts and flap coverage for severe dorsal hand injuries.

Treatment of patients with traumatic loss of skin and multiple extensor tendons on the dorsum of the hand is a challenge. The aim of this study was to assess the outcome after reconstruction of soft tissues and multiple extensor tendons in patients who suffered traumatic loss of skin and multiple extensor tendons. Ten patients were enrolled in the study. These patients underwent single-stage reconstruction with autogenous hamstring tendon grafts for multiple extensor tendon defects and fasciocutaneous flaps for coverage of dorsal hand defects. In total, 25 tendons (2 tendons in 5 patients and 3 tendons in 5 patients) were reconstructed. The semitendinosus tendon was used in all patients and the gracilis tendon was added in five patients for tendon reconstruction. Total tendon length requiring reconstruction was between 9cm and 31cm. Free anterolateral thigh flaps were used in six patients and reverse pedicled forearm flaps were used in four patients. According to Miller's scoring system, 8 fingers had excellent results, 12 fingers had good results and 5 fingers had fair results at the final follow-up. Hamstring tendons can be used satisfactorily for primary reconstruction of multiple digital extensor tendons due to their availability and compatibility, with a fasciocutaneous flap. LEVEL OF EVIDENCE: IV.

The gastric accommodation response to meal intake determines the occurrence of transient lower esophageal sphincter relaxations and reflux events in patients with gastro-esophageal reflux disease.

BACKGROUND: Gastro-esophageal reflux (GER), the retrograde flow of gastric contents into the esophagus is a physiologic phenomenon, which can evoke symptoms and/or lesions in the esophagus (=gastro-esophageal reflux disease or GERD). Proton pump inhibitors (PPIs) reduce gastric acidity; however, as they are unable to control transient lower esophageal sphincter relaxations (TLESRs), the main mechanism for reflux in GERD, they do not abolish reflux. TLESRs occur predominantly in the postprandial period, and they are believed to be triggered by gastric distention. Gastric accommodation (GA) is the physiologic response to gastric distention and serves to prevent a rise in gastric wall tension during food intake. We aimed to study the relationship between GA and TLESRs, as they both are triggered by gastric distention. METHODS: We studied 12 GERD patients (average age 37 years [range 18-62], 7m/5f) and nine healthy volunteers (average age 27 years [range 22-36], 2m/7f) using high resolution manometry-impedance measurement before and after a mixed meal challenge. We determined the number of TLESRs (with or without reflux) and measured pre- and postprandial IGP. The change in IGP between the pre- and postprandial period (ΔIGP) is used as surrogate for GA. We also measured LES pressure before and after the meal and calculated the change (ΔLESp). KEY RESULTS: There were no statistical differences between pre- and postprandial IGP in GERD and healthy volunteers and similarly, there was no significant difference between pre- and postprandial LES pressures in GERD patients and healthy volunteers. The number of TLESRs (with or without reflux) was similar in GERD and healthy volunteers. More importantly, we did observe a negative correlation between ΔIGP and the number of TLESRs, irrespective of whether they were associated with reflux or not, in the GERD patients (without reflux r = -0.67, p = 0.017; with reflux r = -0.81, p = 0.0014). The same observations were found in healthy volunteers, where ΔIGP and the number of TLESRs are significantly inversely correlated (without reflux r = -0.87, p = 0.0045; with reflux r = -0.75, p = 0.021). We could not establish a correlation between ΔLESp and the number of TLESRs, neither in GERD patients nor in healthy volunteers. CONCLUSIONS & INFERENCES: This is the first study showing a clear negative correlation between ΔIGP and the number of TLESRs, irrespective of whether they were associated with reflux or not, both in GERD patients and in healthy subjects. These results suggest that TLESRs and GA are closely linked, probably through activation of mechanoreceptors involved in triggering of TLESRs.

Investigation of schizophrenic patients from Istanbul, Turkey for the presence of West Nile virus.

Association of some neurotropic viruses like Borna Disease virus and Herpes virus with schizophrenia is better explained. However, the role of West Nile virus (WNV) infection in schizophrenia is not well documented. Therefore, this study was performed to investigate possible association between schizophrenia and presence of antibodies and WNV RNA in schizophrenic patients. For this, 200 blood samples from patients with schizophrenia and 200 from control groups were collected in Istanbul, Turkey. WNV RNA was not detected in any of the 200 patients and 200 controls analyzed by real-time RT-PCR. One hundred and twelve sera of schizophrenic patients and 162 of controls were analyzed for the presence of IgG antibodies to WNV by a commercial IgG-ELISA (Euroimmun, Germany). Antibodies to WNV were detected in 6 schizophrenic patients and 5 controls. ELISA positive patients had antipsychotic therapy. The difference between groups in terms of seropositivity to WNV was not statistically significant (p = 0.887, p = 0.148). Known symptoms of schizophrenia were observed in these patients, and interestingly majority had close contact to cats in the past and come from agricultural area of Turkey where potential area of mosquitoes and bird habitat. In conclusion, the results of this study show that antibodies to WNV in people do not seem to be associated with schizophrenia. However, detecting antibodies to WNV in schizophrenic patients suggests that WNV infection should be considered in endemic areas as it may play role in psychiatric diseases.

Clinical and pathological characteristics of occult breast cancer and review of the literature.

PURPOSE: Occult breast cancer is defined as axillary metastasis without clinically and/or radiologically evident primary tumor. In female patients presenting with isolated axillary nodes with adenocarcinoma, the most likely primary cancer is an invasive breast carcinoma. Herein we present our experience over this issue, together with a brief review of the literature about this clinically challenging condition. METHODS: We retrospectively analyzed 1215 consecutive breast cancer patients treated at our clinic between 2004- 2010. Four of these patients presented with axillary nodal metastasis without clinical and radiological evidence of a primary breast tumor. RESULTS: The incidence of occult breast cancer in our clinic was 0.32%. Median follow-up was 8 months. All patients were alive and remained free of disease at the end of the follow-up period. CONCLUSION: The prognostic factors for occult breast carcinoma are similar to that of its overt counterpart. The number of axillary lymph node involved and the hormone receptor status are considered significant prognostic predictors. Further studies with randomization and longer followup are needed for the establishment of a safe management plan.

First report on the phylogeny of bovine norovirus in Turkey.

Bovine norovirus (BoNoV) is an important cause of diarrhea in calves and has been reported in several countries. The aims of this study were to investigate for the first time the presence of norovirus in Turkish calves by real-time reverse transcription-polymerase chain reaction (qRT-PCR) and to determine the phylogeny of any circulating strains. Fecal samples from 70 diarrheic calves were collected and analysed by SYBR Green qRT-PCR. BoNoV was detected in fecal samples from six calves. The capsid gene was partially sequenced, and phylogenetic analysis was performed. This showed that the six Turkish BoNoVs clustered with the GIII-2 prototype.