Treatment of Hip Dislocation in Cerebral Palsy with Extraarticular Intervention.

PURPOSE OF THE STUDY Hip dislocation is one of the major causes of disability in children with cerebral palsy (CP). Surgical treatment can be achieved using different techniques including proximal femoral varus derotation osteotomy (FVDRO), pelvic osteotomies, and open hip reduction (OHR). However, we claim that pathologies originating from extraarticular structures in the dislocated hip in CP can be reconstructed by extraarticular methods and OHR may not always be necessary. Therefore, this study aims to discuss the results of hip reconstruction with extraarticular intervention in patients with CP. MATERIAL AND METHODS In total, 141 hips (95 patients) were included in the study. All patients underwent FVDRO, either with or without a Dega osteotomy. Changes in the Acetabular Index (AI), Migration Index (MI), neck-shaft angle (NSA), and center-edge angle (CEA) were assessed on the preoperative, postoperative, and final follow-up anterior-posterior radiographs of the pelvis. RESULTS Median age was 8 years (range between 4-18 years). The average follow-up duration was 5 years (range between 2-9 years). Changes in AI, MI, NSA and CEA values were statistically significant for postop and follow-up periods when compared to preoperative values. Of the 141 operated hips, 8 (5.6%) hips required revision surgery due to redislocation/resubluxation detected at the follow-ups, and unilateral operation can be accepted as a risk factor for redislocation. CONCLUSIONS Our results demonstrate that reconstructive treatment consisting of FVDRO, medial capsulotomy (in the case of reduction difficulty) and transiliac osteotomy (in the case of acetabular dysplasia) provides satisfactory outcomes in hip dislocation in CP. Key words: hip displacement, cerebral palsy, hip reduction.

The MRI Effect in Clinical Decision Process in Perthes' Disease: "More Complex Imaging, More Complicated Surgeries".

PURPOSE OF THE STUDY Radiographs are preferred for understanding the deformity and containment in Legg-Calvé-Perthes disease (LCPD), as well as for treatment planning, but plain radiographs provide only static information and are inadequate for dynamic assessment of the joint. Magnetic resonance imaging (MRI) has been shown to be superior to other diagnostic modalities. The aim of this study was to determine the importance of hip MRI in LCPD treatment decision-making processes between pediatric orthopedic surgeons and orthopedic surgery residents. MATERIAL AND METHODS Eight orthopedic surgery residents and eight pediatric orthopedic surgeons were invited to retrospectively evaluate hip radiography images and MRI sections of 34 patients with LCPD. The treatment choices were divided into two groups as conservative and surgical. Gwet's AC1 analysis was used to establish the relative level of intra-observer agreements. The correlation between the professional experience and the agreement parameters was also evaluated using the Pearson correlation coefficient. ANOVA was used to compare multiple groups. p ≤ 0.05 was statistically significant. RESULTS For both groups most preferred treatment method was conservative approaches based on plain radiography and MRI. The resident group showed a significant shift from conservative treatment to surgical treatment choices after MRI evaluation. The difference between the frequencies of each treatment choice for pediatric orthopedic surgeons was not statistically significant among different imaging modalities, but a comparison of the changes in surgical treatment revealed a significant difference between the imaging modalities, with a trend towards more complicated treatment choices. DISCUSSION Conservative methods were the most preferred treatment choice in the study, as it is common. It was observed that treatment choices changed when patients were evaluated together with MRI. Compared to plain radiographs, MRI provides sufficient and particular information for evaluating the structures of the hip joint components. CONCLUSIONS We found that consideration of MRI data in LCPD patients changed treatment recommendations substantially towards more complicated surgical procedures. We consider this to be an 'MRI effect' where using a more complex imaging modality leads surgeons to more complicated treatment modalities in LCPD. Key words: imagnetic resonance imaging, reliability, MRI effect, Perthes disease, children.

Anxiety disorders comorbidity in pediatric bipolar disorder: a meta-analysis and meta-regression study.

OBJECTIVE: Anxiety disorders (AD) are known for its comorbidity and negative impact on the course of adult bipolar disorder (BD). However, there is limited research on AD comorbidity in pediatric BD (PBD). Here, we aimed to conduct a meta-analysis and meta-regression study about the comorbidity and covariates of AD and PBD. METHOD: We systematically searched relevant articles published until May 2019, as defined in PRISMA guidelines. Variables for associated features and prevalence of AD were extracted. RESULTS: Thirty-seven articles represented data for the analysis. Lifetime any AD comorbidity was 44.7%; panic disorder (PD) was 12.7%; generalized anxiety disorder (GAD) was 27.4%; social phobia was 20.1%; separation anxiety disorder (SAD) was 26.1%; and obsessive-compulsive disorder (OCD) was 16.7%. Childhood-onset studies reported higher GAD and SAD comorbidity, while adolescent-onset studies reported higher PD, OCD, and social phobia. Age of onset, gender, comorbidity of ADHD, substance use, oppositional defiant disorder and conduct disorder affected each anxiety disorders' comorbidity with PBD differently. CONCLUSION: Anxiety disorders are highly comorbid with PBD. Early-onset PBD increases the risk of AD. Biopsychosocial aspects of this comorbidity and its course needs to be evaluated further.

How does electronic cigarette smoking affect sinonasal symptoms and nasal mucociliary clearance?

OBJECTIVE: is to evaluate the sinonasal symptom scores and mucociliary clearance (MCC) after starting to use electronic cigarette METHODOLGY: This prospective randomized single-blind clinical trial was conducted between March 2013 and November 2013. Patients (n=98) admitted to smoking cessation clinic were divided into two groups; Electronic cigarette smokers (group 1) and non-electronic cigarette smokers (group 2). SNOT-22 and saccharin transit time for MCC were evaluated before starting electronic cigarettes and after the third months. RESULTS: SNOT-22 scores and MCC time were evaluated between groups and within groups after 3 months. SNOT 22 scores and MCC measurements showed no difference between groups before the cessation of cigarette smoking (p >0.05). SNOT 22 results of both groups revealed statistically significantly lower scores after the three months (p < 0.05). However, SNOT-22 scores of group 2 was significantly better than group 1 (p > 0.05). Comparison of MCC results of group 2 revealed statistically significantly lower scores after the three months (p < 0.05). However, group 1 did not show any significant difference after three months (p > 0.05). There was a significant difference between the groups at the third month measurements (p < 0.05). CONCLUSIONS: Although EC is widely used as a method of quitting smoking, it has negative effects on the sinonasal symptoms and MCC.

Protective effects of anise in prevention of cerebral ischemia reperfusion injury in rats.

The aim of this study is to determine the protective efficacy of anise in cerebral ischemia and reperfusion injury in rats. In this study, 28 Wistar Albino rats, weighing 250-300 grams (g), were used. Four groups were formed with 7 rats in each group. Group 1 (n=7): Control group, Group 2 (n=7): Anise group, 5 mL/kg/day of anise aqueous extract prepared according to Gamberini's protocol was given orally by gavage for 30 days. Group 3 (n=7): Cerebral ischemia reperfusion (CIR) group, at the beginning of the experiment, 30 minutes of cerebral ischemia and 1 hour of reperfusion were induced and the animals were sacrificed by exanguination. Group 4 (n=7): Anise+ CIR group, After administering 30 days of anise's aqueous extract, CIR was induced and the study was terminated. TOS values of the Anise+ CIR group was significantly lower than that of the CIR group (p<0.05). Il-6 and TNF-α values of the CIR group were significantly higher than the Anise+ CIR group (p<0,05). Our study revealed that anise ameliorates oxidative damage and inflammation due to cerebral ischemia/reperfusion, by reducing the levels of inflammatory cytokines (TNF-α, Il-6).

The prevalence of interdigital erythrasma in southern region of Turkey.

BACKGROUND: Erythrasma is a skin infection which is caused by Corynebacterium minutissimum. Interdigital erythrasma is the most common form. OBJECTIVE: The aim of this study was to detect the frequency and risk factors of interdigital erythrasma in patients with clinically suspected tinea pedis. METHODS: This study was conducted between June and December 2010 and included 122 patients who had interdigital foot lesions. All patients were examined using a Wood's lamp. The smears were stained using Gram's method. Direct examination was performed using 20% potassium hydroxide. Sabouraud dextrose agar and brain heart infusion agar were used for cultures. Moreover, the demographical characteristics of patients, concomitant diseases and clinical findings were also recorded. Cases that were found to be positive on Wood's lamp examination and/or Gram staining/culture were considered as erythrasma. RESULTS: The rate of erythrasma was found to be 46.7%. The mean age was 43.6 years, and the disease was more prevalent in men. The most common clinical finding was desquamation. Mycological examination was found as positive in 40.35% of the patients. No growth was observed in bacteriological cultures. It was found that using only Wood's lamp examination or Gram staining resulted in 11 (9%) and 19 positive patients (15.6%), respectively, whereas using both Wood's lamp examination and Gram staining concurrently resulted in 27 positive patients (22.1%). CONCLUSION: Interdigital erythrasma is a commonly seen condition and can clinically mimic tinea pedis. A Wood's lamp is a good diagnostic tool, but Gram staining, particularly in those with a negative Wood's lamp result, may be a useful method.

Investigation of the effects of naringin on intestinal ischemia reperfusion model at the ultrastructural and biochemical level.

We aimed to evaluate the ultrastructural effect of reversing cellular damage, occurring in rats due to ischemia-reperfusion (I/R) in the intestine, with naringin implementation through biochemical parameters. Rats were divided the sham/control, I/R and the naringin groups (n = 7). For I/R group, 120 min of ischemia and 120 min of reperfusion was applied to the superior mesenteric artery. In the naringin group, after 120 min, 50 mg/kg naringin was implemented, and then 120 min of reperfusion was applied. Morphological evaluation was performed via Chiu score and electron microscopy. The antioxidant parameters were examined. Chiu score in I/R (p < 0.01) and naringin (p < 0.05) groups were higher than the sham/control group. In ultrastructural level some irregularity were observed in I/R group. Although it decreased in the naringin group, the damage was observed to continue. Malondialdehyde (MDA) amount and Superoxide dismutase activity (SOD) in I/R group were higher in comparison to the sham/control group (p < 0.01), while glutathione peroxidase activity (Gpx) was found to be lower (p < 0.01). SOD (p < 0.05) and MDA (p < 0.01) were decreased by naringin group. Gpx was decreased in I/R group compared to sham/control group (p < 0.01) and elevated due to naringin administration (p < 0.05). Catalase activity was observed to decrease in the naringin group compared to control and I/R groups (p < 0.01). It was determined that naringin provided limited healing at the ultrastructural level but also effected recovery within antioxidant parameters.

Turkish Society of Cardiovascular Surgery (TSCVS) Proposal for use of ECMO in respiratory and circulatory failure in COVID-19 pandemic era.

The document is prepared to guide the members of the The Turkish Society of Cardiovascular Surgery (TSCVS) and other extracorporeal membrane oxygenation (ECMO) centers worldwide to share experiences in using ECMO in COVID-19 pandemic.

Bilateral spigelian hernia concomitant with multiple skeletal anomalies and fibular aplasia in a child.

A child with Spigelian hernia, concomitant multiple skeletal anomalies and whole body hemihypoplasia and fibular aplasia is presented here. Irrespective of the patient's age at presentation, Spigelian hernias associated with anomalies are congenital in origin. This case emphasizes the fact that a bilateral Spigelian hernia can occur in children together with multiple skeletal anomalies.

The importance of cyst fluid analysis for differentiation of pancreatic cyst.

Cystic abnormalities of the pancreas encompass a wide variety of lesions ranging from the non-malignant pseudo-cyst to neoplastic lesions. Although cystic neoplasms of the pancreas are rare, differentiation is important in determining the proper treatment. A 55-year-old female presented with a cystic abdominal mass. Her computed tomography scan showed a cystic mass of 102 x 99 x 97 mm which was well-circumscribed and homogeneous with few thin septations and mild contrast enhancement of the fibrous wall located in the body of the pancreas. Percutaneous diagnostic aspiration of the cyst fluid was performed under ultrasonic guidance for proper diagnosis and management, which revealed a CEA greater than 200 ng/ml (0-3) and amylase within normal limits 30 U/L (< or = 100). High CEA and normal amylase values supported the diagnosis of mucinous cystadenoma rather than pseudo-cyst. With these findings, the patient underwent distal pancreatectomy with splenectomy. Pathological analysis revealed a mucinous cystadenoma of the pancreas. This report is a confirmation that cyst fluid analysis can provide a pre-operative classification of these diagnostically difficult lesions.

Naringin protects viscera from ischemia/reperfusion injury by regulating the nitric oxide level in a rat model.

We investigated the effects of naringin on small intestine, liver, kidney and lung recovery after ischemia/reperfusion (I/R) injury of the gut. Rats were divided randomly into four groups of eight. Group A was the sham control; group B was ischemic for 2 h; group C was ischemic for 2 h and re-perfused for 2 h (I/R); group D was treated with 50 mg/kg naringin after ischemia, then re-perfused for 2 h. Endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expressions were detected by immunolabeling. We also measured arginase activity, amounts of nitric oxide (NO) and total protein. iNOS was increased significantly in the small intestine, liver and kidney in group C. iNOS was decreased significantly only in small intestine and lung in group D. eNOS was increased significantly in the small intestine, liver and lung in group C. eNOS was decreased in small intestine, liver and lung in group D; however, eNOS was decreased in the kidney in group C and increased in the kidney in group D. The amount of NO was decreased significantly in all tissues in group D, but arginase activity was decreased in the small intestine and lung, increased in the kidney and remained unchanged in the liver in group D. The total protein increased in the small intestine and liver in group D, but decreased significantly in the kidney and lung in group D. Naringin had significant, salutary effects on the biochemical parameters of I/R by decreasing the NO level, equilibrating iNOS and eNOS expressions, and decreasing arginase activity.

Pharmacomechanical thrombectomy of upper extremity deep vein thrombosis.

BACKGROUND: This study aims to evaluate the efficacy and safety of ultrasound-accelerated catheter-directed thrombolysis (UACDT) in the treatment of upper extremity deep vein thrombosis (UEDVT). METHODS: We conducted a prospective, observational cohort study of consecutive patients with acute UEDVT with low-dose UACDT using the Ekosonic® Endovascular System (EKOS Corporation, Bothell, WA, USA) at a single center from September 2012 until October 2014. Overall, sixteen patients (11 males and 6 females, age range 18 to 70 years, mean age, 45.6 years) were included in the study protocol. The primary efficacy outcome was complete thrombus clearance. The primary safety outcomes were recurrence of thrombosis within the follow-up visit and major bleeding within 96 hours of the procedure initiation. RESULTS: The median tissue plasminogen activator (tPA) dose for all patients in our study was 16.81±2.51 mg (range 15 to 28 mg) and the median infusion time was 15 hours. Complete thrombus clearance was achieved in 11 (68.8%) patients, and partial clearance was detected in 3 (18.8%) patients. Of 16 patients with UEDVT, two had gastrointestinal bleeding, and two had puncture site bleeding. CONCLUSIONS: This prospective study demonstrates effectiveness and safety of ultrasound accelerated thrombolysis in patients with UEDVT.

Mesenchymal stem cells increase antioxidant capacity in intestinal ischemia/reperfusion damage.

BACKGROUND: Mesenchymal stem cells (MSCs) may have beneficial effects in reversing intestinal damage resulting from circulatory disorders. The hypothesis of this study is that MSCs increase antioxidant capacity of small bowel tissue following intestinal ischemia reperfusion (I/R) damage. METHODS: A total of 100 rats were used for the control group and three experimental groups, as follows: the sham control, local MSC, and systemic MSC groups. Each group consisted of 10 animals on days 1, 4, and 7 of the experiment. Ischemia was established by clamping the superior mesenteric artery (SMA) for 45min; following this, reperfusion was carried out for 1, 4, and 7days in all groups. In the local and systemic groups, MSCs were administered intravenously and locally just after the ischemia, and they were investigated after 1, 4, and 7days. The superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (Gpx) activities, as well as malondialdehyde (MDA) and total protein levels, were measured. Histopathological analysis was performed using light and electron microscopy. The indicators of proliferation from the effects of anti- and pro-inflammatory cytokines were evaluated using immunohistochemistry. RESULTS: MDA was increased (P<0.05) in the sham control group and decreased (P<0.05) in the MSC groups. SOD, CAT, and Gpx were decreased in the local MSC group (P<0.05). The highest level of amelioration was observed on day 7 in the local MSC group via light and electron microscopy. It was found that the MSCs arrived at the damaged intestinal wall in the MSC groups immediately after injection. Pro-inflammatory cytokines interleukin-1ß (IL1ß), transforming growth factor-ß1 (TGFß1), tumor necrosis factor-α (TNFα), IL6, MIP2, and MPO decreased (P<0.05), while anti-inflammatory cytokines EP3 and IL1ra increased (p<0.05) in the local and systemic MSC groups. In addition, proliferation indicators, such as PCNA and KI67, increased (P<0.05) in the local and systemic MSC groups. CONCLUSIONS: Parallel to our hypothesis, MSC increases the antioxidant capacity of small bowel tissue after intestinal I/R damage. The MSCs migrated to the reperfused small intestine by homing and reduced oxidative stress via the effects of SOD, CAT, and Gpx, as well as reducing the MDA level; thus, they could increase antioxidant capacity of intestine and have a therapeutic effect on the damaged tissue. We think that this effect was achieved via scavenging of oxygen radicals, suppression of pro-inflammatory cytokines, and increasing the expression of anti-inflammatory cytokines.

Nonsteroidal anti-inflammatory drugs, short-chain fatty acids, and reactive oxygen metabolism in human colorectal cancer cells.

Nonsteroidal anti-inflammatory drugs (NSAIDs) and short-chain fatty acids are effective suppressors of colorectal cancer that may work in part by accentuating apoptosis of transformed cells. Since reactive oxygen species (ROS) can play an important role in regulating cell growth and cell death, we determined the effect of the NSAIDs indomethacin and salicylic acid, and the short-chain fatty acids butyrate and propionate on ROS metabolism in the HT-29 human colorectal carcinoma cell line. We find that all of these agents increase cellular peroxide generation, as determined by two independent assays. Arachidonic acid was also found to increase ROS generation, and could synergize with indomethacin in this reaction. The NSAIDs and short-chain fatty acids under study all possess a carboxyl group, and this carboxyl group is essential for salicylic acid's ability to increase ROS production. Although the two NSAIDs examined increase peroxide production, they were both found to suppress superoxide generation by vitamin K3 (menadione), a redox cycling compound similar to those found in the colon. The short-chain fatty acids did not have this activity. The ability of these NSAIDs and short-chain fatty acids to alter cellular ROS metabolism may contribute to their chemopreventive activity.

NSAIDs and butyrate sensitize a human colorectal cancer cell line to TNF-alpha and Fas ligation: the role of reactive oxygen species.

The nonsteroidal antiinflammatory drugs (NSAIDs) indomethacin and salicylic acid and the short chain fatty acid butyrate are effective colon cancer chemopreventive agents that increase reactive oxygen species (ROS) generation in colon cancer cells. Here we demonstrate that these agents sensitize the normally resistant human HT-29 colon cancer cell line to apoptosis induced by TNF-alpha or a Fas ligating antibody. The role of ROS in this sensitization is supported by the finding that direct exposure of the cells to H2O2 is sufficient for sensitization. Neither TNF-alpha nor Fas ligation alter basal or chemopreventive agent-activated ROS generation, suggesting that the death ligands and chemopreventive agents act in a complementary fashion. The dual chemopreventive agent/death ligand treatments do not increase Fas, TNF receptor 1, Bak or c-myc expression (although salicylic acid moderately induces of Fas expression). Cell death does correlate with alterations in NF-kappa B activity: the NSAIDs, butyrate and H2O2 enhance c-Rel complex formation by TNF-alpha and provide an overall enhancement of NF-kappa B activation by Fas. The antioxidant N-acetylcysteine (NAC) blocks cell death and NF-kappa B activation induced by Fas ligation, suggesting a potential role for NF-kappa B in Fas-induced apoptosis in these cells. The effects of NAC on TNF-alpha-induced cell death are more complex, with NAC being marginally protective and itself enhancing the formation of c-Rel containing complexes at higher concentrations (25 mM). The influence of NSAIDs and butyrate on ROS generation and death ligand sensitivity may be relevant to their ability to suppress colon carcinogenesis.

Correction of rotational deformity of the tibia in cerebral palsy by percutaneous supramalleolar osteotomy.

A percutaneous supramalleolar osteotomy with multiple drill holes and closed osteoclasis was used to correct rotational deformities of the tibia in patients with cerebral palsy. The technique is described and the results in 247 limbs (160 patients) are reported. The mean age at the time of surgery was 10.7 years (4 to 20). The radiographs were analysed for time to union, loss of correction, and angulation at the site of the osteotomy. Bone healing was obtained in all patients except one in a mean period of seven weeks (5 to 12). Malunion after loss of reduction at the site of the osteotomy developed in one tibia. Percutaneous supramalleolar osteotomy of the tibia is a safe and simple surgical procedure.

Recombinant human erythropoietin administration in cardiac surgery.

OBJECTIVE: Postoperative anemia and multiple blood transfusions are still important problems in cardiac surgery. During the past few years, there have been some reports indicating that multiple recombinant human erythropoietin infusions starting at least 2 weeks before the operation induced erythropoiesis. We aimed to reduce the risk of adverse reactions of high doses of recombinant human erythropoietin and reduce the period of hospitalization by using it only once, 4 days before the operation. METHODS: Twenty-five patients received recombinant human erythropoietin 4 days before the operation, and 28 patients comprised the control group. All the hematologic parameters of the patients are measured on the day of admission, the day before the operation (fourth day), the first day after the operation, and 1 week later. RESULTS: In the recombinant human erythropoietin group the mean hemoglobin concentration increased on the morning of the operation (14.5 +/- 0.52 g/dL in the recombinant human erythropoietin group and 12.4 +/- 0.65 in the control group, P <.05). To maintain hemoglobin levels at greater than 8.5 g/dL, 330 +/- 33 mL of homologous transfusion was required in the recombinant human erythropoietin group, whereas 680 +/- 75 mL was required in the control group (P <.01). CONCLUSION: Recombinant human erythropoietin induces erythropoiesis rapidly, even when it is used with a low single dose just 4 days before the operation. No adverse reactions were seen with this kind of recombinant human erythropoietin treatment.

Primary pericardial mesothelioma.

Primary pericardial mesothelioma is an extremely rare tumor. This case illustrates the typical late presentation of primary pericardial mesothelioma with symptoms and signs of constrictive pericarditis. An unusual feature was the complete encasement of the heart by the tumor. No satisfactory treatment was available.

Acetaminophen inhibits NF-kappaB activation by interfering with the oxidant signal in murine Hepa 1-6 cells.

A toxic dose of acetaminophen (APAP) reduces the activity of NF-kappaB in mouse liver. NF-kappaB inactivation may be important for APAP toxicity, as this transcription factor can play a central role in maintaining hepatic viability. We recently reported that APAP likewise inhibits serum growth factor activation of NF-kappaB in a mouse hepatoma cell line (Hepa 1-6 cells). Here we present evidence that APAP's antioxidant activity may be involved in this NF-kappaB inhibition in Hepa 1-6 cells. Like the antioxidants N-acetylcysteine (NAC) and pyrrolidinedithiocarbamate (PDTC), APAP was found to suppress the H(2)O(2)-induced oxidation of an intracellular reactive oxygen species probe (dihydrodichlorofluorescein) in Hepa 1-6 cells. Treatment of Hepa 1-6 cells with H(2)O(2) was sufficient for NF-kappaB activation and IkappaBalpha degradation, and APAP was able to block both of these events. The APAP inhibition of NF-kappaB activation by serum growth factors may also be due to APAP's antioxidant activity, as the antioxidants NAC and PDTC likewise inhibit this activation. The potential role of NF-kappaB and oxidant-based growth factor signal transduction in APAP toxicity is discussed.