Adding hormones sequentially could be an effective approach for IVM of dog oocytes.

There have not been successful and repeatable methods for in vitro embryo production in the dog. Up to date, only one blactocyst has been achieved on in vitro culture. Since reproductive physiology of the dog is different from that of other mammalian species, it seems that a suitable method for in vitro production of canine embryos is still far from being designed and routinely applied, and an effective protocol is needed. Therefore, the aim of the present study was to examine the effects of adding hormones sequentially, for mimicking the dog's in vivo endocrine milieu, on maturation of immature dog oocytes in vitro. At the end of the 96 h IVM period, nuclear maturation rates were evaluated by the aceto-orcein staining method. In comparison relating IVM rates, the sequential hormone addition was more beneficial on IVM rates (MI + MII) than the traditional hormone addition and control groups (48.1%, 38.9% and 23.0% respectively; P < 0.0001). As a result, hormone addition sequentially may be an effective approach for the IVM of the immature dog oocytes. We suggest that attempts to define the adequate conditions for IVM in the dog should extend towards this new perspective.

Diagnostic accuracy of magnetic resonance imaging versus computed tomography in stress fractures of the lumbar spine.

AIM: To compare the diagnostic accuracy of magnetic resonance imaging (MRI) with computed tomography (CT) in stress fractures of the lumbar spine. MATERIALS AND METHODS: Radiological and clinical data from 57 adolescents and young adults with a diagnosis of stress injury of the lumbar spine were retrospectively reviewed. All cases had undergone both 1.5 T MRI and 16-section CT examinations. All MRI and CT images were retrospectively reviewed and evaluated in separate sessions. The fracture morphology (complete/incomplete, localization) and vertebral levels were noted at both the CT and MRI examinations. Bone marrow/peri-osseous soft-tissue oedema was also determined at MRI. RESULTS: In total, 73 complete and 32 incomplete stress fractures were detected with CT. Sixty-seven complete, 24 incomplete fractures and eight stress reactions were detected using MRI in the same study group. Marrow oedema was also seen in eight of the complete and 20 of the incomplete fractures. The specificity, sensitivity, and accuracy of MRI in detecting fracture lines were 99.6, 86.7, and 97.2%, respectively. MRI was more accurate at the lower lumbar levels in comparison to upper lumbar levels. CONCLUSION: MRI has a similar diagnostic accuracy to CT in determining complete fractures with or without accompanying marrow oedema and incomplete fractures with accompanying marrow oedema, especially at the lower lumbar levels, which constitutes 94% of all fractures. At upper lumbar levels and in the incomplete fractures of the pars interarticularis with marked surrounding sclerosis, MRI has apparent limitations compared to CT imaging.

"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.

Surgical outcome of thoracolumbar burst fractures with flexion-distraction injury of the posterior elements.

Between 1991 and 2002 we treated 48 patients surgically for thoracolumbar burst fractures associated with flexion-distraction injury of the posterior elements. The degree of kyphotic deformity and the degree of vertebral wedging deformity were measured on plain lateral radiographs. The spinal canal compromise was measured on computer tomography. The mean postoperative follow-up was 70 (24-108) months. The preoperative kyphosis averaged 25.7 degrees and the mean sagittal index was 28.8 degrees . The mean wedging deformity of the fractured vertebral body was 46% (24-66%). The mean preoperative spinal canal compromise secondary to retropulsed bony fragments was 64%. Immediately after surgery, the correction of kyphosis averaged 98%. There was no loss of correction at the final follow-up. A satisfactory reduction and good stabilisation with solid fusion were achieved in all cases.

Myositis ossificans of psoas muscle: magnetic resonance imaging findings.

Myositis ossificans is a benign, localized, self-limiting ossifying soft tissue mass with unknown pathogenesis. It may be confused with a malignant tumor of bone or soft tissues, especially in the early stages of the disease. In this report, we present a case of myositis ossificans affecting unilateral psoas muscle, which to our knowledge is a very uncommon location. There was no history of trauma. We describe the imaging findings and clues to early diagnosis of myositis ossificans.

[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.

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.

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.

An anterior approach to the cervicothoracic junction of the spine (modified osteotomy of manubrium sterni and clavicle).

Standard anterior approaches to the cervicothoracic junction of the spine provide inadequate exposure. For this reason, various techniques of exposure are developed. One of these is Sundaresan's technique in which a part of the manubrium sterni and medial clavicle is resected. This technique provides good visibility and working area at the lesion level but causes a significant bony defect. We modified Sundaresan's technique and did not damage the sternoclavicular joint. After decompression and fusion was completed, the osteotomized segment was replanted. We performed this technique in a case of Pott's disease and had no problem with union at the osteotomy sites.

Indomethacin for prevention of heterotopic ossification after total hip arthroplasty.

Twenty-four patients (29 hips) undergoing total hip arthroplasty were routinely given 75 mg of indomethacin daily for 4 weeks after operation and reviewed radiographically for heterotopic ossification (HO) for a minimum of 6 months. A comparison group of 25 patients (27 hips) without indomethacin treatment was formed and studied in the same manner. This group of patients received the usual postoperative analgesic treatment, which is diclofenac sodium twice daily parenterally for 5-10 days. The indomethacin group also received the same treatment. In the indomethacin group no patient had grade II, III, and grade IV HO and the incidence of grade I HO was 31% (nine patients). In the comparison group one patient (3%) had grade I, three (11%) grade II, and eight (30%) grade III HO. These findings suggested that indomethacin effectively prevented higher grades of HO following total hip arthroplasty. Two patients not included in the study had gastrointestinal bleeding and recovered after withdrawal of the drug.

Open traumatic posterior dislocation of the hip. A case report.

A case of open traumatic posterior dislocation of the hip is presented. The femoral head and neck were completely out of the skin and there were accompanying fractures of the acetabular floor, the ischial ramus and the greater trochanter. To our knowledge, such a case has not been reported previously and this, together with its interesting mechanism, has led us to report the case. It was followed for 18 months and roentgenographic and 99mtechnetium sulphur colloid scanning studies showed avascular necrosis and osteoarthritis.

Complete subtalar release in clubfeet.

Complete subtalar release was performed in 18 children with 22 clubfeet between 1987 and 1989. The ages of the patients ranged from 3.5 months to 8.5 years. The patients were evaluated at 9 to 30 months (average 19 months). Twenty procedures were performed through the Cincinnati incision, and the remaining two through two separate posteromedial and posterolateral incisions. At 6 weeks, the pins were removed and cast immobilization was discontinued at 3 to 3.5 months. Complications were superficial necrosis in three feet, and extensive posteromedial skin necrosis in one foot. No recurrences were encountered. Overall results were very good in 18, and good in four feet.