The role of ASA score and Charlson comorbidity index in predicting in-hospital mortality in geriatric hip fracture patients.

OBJECTIVE: We aimed to determine the role of American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index (CCI) in determining in-hospital mortality and other factors associated with mortality in patients over 65 years of age who underwent surgery for hip fracture during our study, including the COVID-19 process. PATIENTS AND METHODS: Between January 1st, 2020, and December 31st, 2021, 200 patients over 65 years of age who underwent hemiarthroplasty or internal fixation for hip fracture after low-energy trauma were retrospectively evaluated. RESULTS: Of the 200 patients included in the study, 130 were female and 70 were male. The median ASA score was 3 (IQR: 2-3), and the median CCI was 3 (IQR: 5-7). Forty-two of 137 (68.5%) patients with intertrochanteric fractures and 22 of 63 (31.5%) patients with femoral neck fractures (34.4%) died. The median time to surgery was 4 days (IQR: 3-6). Among chronic diseases, cardiac pathologies were the most common (57%, n=114). There were statistically significant differences in ASA scores (p=0.0001 [z=-5.472]), CCI scores (0.0001 [z=-6.156]), presence of cardiac disease [p=0.0001 (χ²=32.155)] and presence of neurological disease [p=0.045 (χ²=4.007)] compared to mortality. ASA and CCI scores were significantly higher in people with mortality. As a result of the multivariate model established with these factors, which were found to be significant in univariate analyses, only the presence of cardiac disease (p=0.0001) and the increase in CCI scores (p=0.0001) were found to have a statistically significant increasing effect on mortality. CONCLUSIONS: CCI and cardiac pathology were associated with mortality. The type of hip fracture, surgical method, and anesthesia method were not associated with mortality.

In vivo cartilage tissue engineering.

BACKGROUND: Biologic treatment options for cartilage injuries require chondrocyte expansion using cell culture. Clinical application is accomplished in two surgical sessions and is expensive. If isolation of chondrocytes and stimulus for proliferation and extracellular matrix synthesis can be achieved in vivo, the treatment can be performed in one session and the cost can be reduced. METHODS: A 2.5-cm diameter full-thickness chondral defect was created in the knees of five groups of sheep. In one group, some of the chondral tissues obtained from the creation of the defect were diced into small pieces and were placed into the defect and were covered with a collagen membrane (MIV group). In the other group, the collagen membrane was soaked in collagenase prior to usage. In the next group, the collagen membrane was soaked in both collagenase and growth factors. Matrix-induced autologous chondrocyte implantation (MACI) was applied to another group in two sessions, and the last group was left untreated. After 15 weeks of follow-up, repair tissues were compared macroscopically, histomorphometrically, and biochemically for tissue concentrations of glycosaminoglycan and type II collagen. RESULTS: MACI and MIV groups demonstrated better healing than others and were similar. Addition of collagenase or growth factors did not improve the results. Addition of collagenase did not have detrimental effect on the surrounding cartilage. CONCLUSIONS: With the described method, it is possible to obtain comparable results with MACI. Further studies are also needed to see if it works similarly in humans.

Acute bilateral isolated foot drop: Report of two cases.

Foot drop is defined as the weakness of the foot and ankle dorsiflexion. Acute unilateral foot drop is a well-documented entity, whereas bilateral foot drop is rarely documented. Slowly progressing bilateral foot drop may occur with various metabolic causes, parasagittal intracranial pathologies, and cauda equina syndrome. Acute onset of bilateral foot drop due to disc herniation is extremely rare. Here we present two cases of acute bilateral foot drop due to disc herniation. The first patient was a 45-year-old man presented with acute bilateral foot drop, without any sign of the cauda equina syndrome. Lumbar magnetic resonance imaging of the patient revealed L4-5 disc herniation. To our knowledge, this is the first presented case of acute bilateral foot drop without any signs of cauda equina syndrome caused by L4-5 disc herniation. The second patient was a 50-year-old man who was also presented with acute bilateral foot drop, and had T12-L1 disc herniation with intradural extension. Also this is the first presented case of T12-L1 disc herniation with intradural extension causing acute bilateral foot drop. We performed emergent decompressive laminectomy to both of the patients and extrude disc materials were excised. Both of the patients were recovered with favorable outcome.

The prognostic value of plasma Δ-copeptin levels in patients with isolated traumatic brain injury.

PURPOSE: Traumatic brain injury (TBI) is one of the most common causes of death among trauma patients. Earlier prediction of possible poor neurological outcomes, even upon admission to the emergency department, may help to guide treatment. The aim of this prospective study was to assess the predictive value of plasma copeptin levels for early morbidity and mortality in patients with isolated TBI. METHODS: This prospective study comprised 53 patients who were admitted to the emergency department with isolated TBI. Forty-two of these patients (group I) survived at least 1 month after the TBI; the other 11 (group II) did not. Plasma levels of copeptin were measured in these TBI patients at admission and 6 h after trauma, and were compared with those of healthy volunteers (group III). RESULTS: At admission, the copeptin levels of the TBI patients (groups I and II combined) were not statistically significantly different from those of the control group (III). The copeptin levels 6 h after trauma were also not statistically significantly different from those at admission. Δ-Copeptin levels (the difference between the copeptin level at the 6th hour after trauma and that at admission) were higher in the patients who died within a month of the TBI. Further, Δ-copeptin levels were higher in patients who showed no improvement in the modified Rankin score when compared with patients with an improved modified Rankin score. The best cutoff point for Δ-copeptin was 0.51 ng/ml for predicting mortality and 0.23 ng/ml for predicting improvement in the modified Rankin score. CONCLUSIONS: Plasma Δ-copeptin levels may help physicians predict the prognoses of patients suffering from traumatic brain injury.

Effect of magnesium sulphate on bleeding during lumbar discectomy.

We assessed the effect of magnesium on the amount of bleeding, coagulation profiles and surgical conditions during lumbar discectomy under general anaesthesia. Forty patients, of ASA physical status 1-2 and aged 18-65 years, undergoing single-level microscopic lumbar discectomy, were randomly assigned to magnesium sulphate (50 mg.kg(-1) in 100 ml saline over 10 min followed by a continuous infusion of 20 mg.kg.h(-1) ) or saline. The mean (SD) estimated blood loss was 190 (95) and 362 (170) ml in the magnesium and saline groups, respectively (mean difference = 172 ml; 95% CI 84-260 ml). The median (IQR [range]) Fromme's scale score for surgical conditions for the magnesium and saline groups were 2 (2-3 [2-3]) and 3 (2-3 [3-4]), respectively (p < 0.05). The bleeding time, haemoglobin, platelet count, prothrombin time, international normalised ratio and fibrinogen levels were similar in the two groups. The activated partial thromboplastin time was prolonged in the magnesium group immediately postoperatively and at 6 h after surgery. After the bolus of magnesium, the heart rate was higher and the mean arterial pressure lower in the magnesium group. The use of magnesium sulphate during lumbar discectomy decreases blood loss, and provides better surgical conditions without marked haemodynamic effects.