Prophylactic Cerclage Cabling Decreases the Intraoperative Periprosthetic Fracture Rate during Cement-Less Total Hip Arthroplasty in Patients with Severe Developmental Hip Dysplasia.

PURPOSE OF THE STUDY Cementless stems in highly dysplastic hips are considered to increase the risk of femoral fracture and associated morbidity. Several authors speculated to use prophylactic cabling in this patient group to prevent intraoperative fractures. This study aims to reveal objective results regarding the perioperative complications in a large and consecutive patient group with respect to use of prophylactic cabling. MATERIAL AND METHODS A retrospective comparative study was planned. A total of 122 consecutive patients with dysplastic hips of Crowe type 3 or 4, operated on with total hip arthroplasty (THA) and shortening osteotomy using a rectangular femoral stem were included. Patients were stratified according to use of a diaphyseal prophylactic cerclage cable. Perioperative complications were recorded. Clinical outcome was measured in terms of Harris Hip Score and Visual Analog Scale (VAS) for pain. All results were compared between the groups. RESULTS The mean follow-up time was 27 months. Two (2%) versus five (14%) patients had a fracture at the diaphyseal level in cabled versus non-cabled groups. Difference between groups was statistically significant (p=0.01). Relative risk of fracture in case of a non-cabling was 5.8 (p=0.03). Eleven (9%) patients had a non-displaced fracture at the metaphyseal level. No significant differences were detected with respect to preoperative clinical outcome scores or change in these scores between groups. CONCLUSIONS Femoral diaphyseal fracture rates are low when cementless, rectangular stems are used in dysplastic high riding hips. Prophylactic cerclage cabling further decreases the fracture risk and eases treatment in case of a fracture without causing additional complications and therefore is recommended. Key words: intraoperative fracture, periprosthetic fracture, total hip arthroplasty, cerclage cabling, developmental hip dysplasia, transverse shortening osteotomy.

Attitudes of Dermatologic Patients Towards COVID-19 Vaccines: a Questionnaire-Based Survey.

The objective of this paper is to evaluate the attitudes of patients with various dermatologic diseases towards coronavirus disease (COVID-19) vaccines. The present questionnaire-based study was conducted on patients admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between January 1 and 31, 2021. The study population was divided into two groups based on their ages: (1) < 40 age group (n = 188) and (2) ≥ 40 age group (n = 111), and answers given to 35 specific questions were compared between the groups. The older group had significantly higher levels of anxiety compared to the younger group (p = 0.017). Although approximately 60% of cases in the older group were dedicated to being vaccinated, 40% of the younger participants were not sure about vaccination (p < 0.001). The most frequently demanded vaccine types were the inactivated and mRNA vaccines in the elderly and young groups, respectively (p < 0.001). Statistically significant positive weak correlations were observed for age, chronic disease of medication, and presence of severe COVID 19 cases in the environment (r = 0.125 p = 0.031, r = 0.184 p = 0.001, r = 0.122 p = 0.035, respectively). Dermatologic patients had generally positive attitudes towards COVID-19 vaccination, and their preferences were affected by age.

The utility of immunoglobulin A/complement 3 and immunoglobulin G/immunoglobulin M ratios in the assessment of disease activation in patients with Behçet disease.

OBJECTIVE: Pathogenesis of Behçet disease (BD) has not yet been clearly revealed and there is no ideal test for the estimation of disease activation at present. This study aimed to assess the efficiencies of IgG/IgM and IgA/C3 ratios in determining activation of BD. METHOD: This retrospective cohort study consisted of 140 patients with BD. Patients were divided into two groups: (1) active BD (n = 89) and (2) inactive BD (n = 51) and were compared in terms of demographic features, clinical characteristics and laboratory test results. IgA/C3 and IgG/IgM ratios were compared according to organ system involvement; receiver operating characteristic (ROC) curve analysis was performed in order to assess the performance of IgA/C3 and IgG/IgM ratios in determining patient disease status. RESULTS: Significantly higher levels of erythrocyte sedimentation rate, C-reactive protein, IgA, G, C4, IgA/C3, IgG/IgM ratios (p = .007 for IgA and p < .001 for others) and significantly lower levels of IgM and C3 were observed in patients with active BD (p < .001). The IgG/IgM ratio was significantly higher in patients with vascular involvement (p = .017) and the IgA/C3 ratio was significantly higher in patients with arthritis (p = .007). Cut-off values of 0.019 (70.8% sensitivity, 62% specificity) and 7.08 (84.3% sensitivity, 80% specificity) were determined for IgA/C3 and IgG/IgM ratios, respectively. CONCLUSION: IgA/C3 and IgG/IgM ratios may be used as additional parameters for the assessment of BD status.

A cutoff value for the Systemic Immune-Inflammation Index in determining activity of Behçet disease.

BACKGROUND: Behçet disease (BD) is an immune-mediated vasculitis-like syndrome characterized by recurrent aphthous lesions and various systemic manifestations. Inflammatory markers may be useful to assess disease severity. The Systemic Immune-Inflammation Index (SII) (neutrophils × platelets/lymphocytes) has been widely used in oncology since 2014, with promising results. AIM: To assess the efficiency of the SII in determining activity of BD. METHODS: This retrospective cohort study was conducted on patients with BD who were admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between 1 January 2010 and 31 December 2019. Patients were divided into two groups based on their disease status upon admission: (i) active BD (n = 103), and (ii) inactive BD (n = 63). Clinical characteristics, demographic features, type of medications, full blood count parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin and SII were compared between the groups. Furthermore, receiver operating characteristic curve analysis was performed to assess the performance of the SII in determining disease severity upon admission to hospital. RESULTS: Higher numbers of white blood cells, platelets and neutrophils, greater red cell distribution width, higher levels of ESR, CRP and ferritin, and higher SII were observed in the active disease group (P < 0.001). The cutoff value of 552 × 103 /mm3 was found to have 81% sensitivity and 82% specificity. CONCLUSION: The SII may be used as an additional indicator for the assessment of BD status and physicians should be cautious in patients with SII levels of > 552 × 103 /mm3 ) at the initial evaluation of the patients.

The Place of Atopy in the Aetiology of Acute Appendicitis in Children.

OBJECTIVE: Appendicitis, the most common cause of abdominal pain requiring surgery in children, refers to inflammation of the vermiform appendix. The aetiology of appendicitis is multifactorial, although it is affected by several precursor factors. The purpose of this study was to investigate whether allergic diseases cause a predisposition to appendicitis. SUBJECTS AND METHODS: One hundred and sixteen patients who underwent surgery for acute appendicitis and who had a diagnosis of acute appendicitis confirmed pathologically, and a control group of 124 individuals of similar ages and genders, were enrolled. The level of inflammation of appendiceal material in cases diagnosed with acute appendicitis was classified pathologically. The skin prick test (SPT) was used to determine allergic sensitization. RESULTS: A significant difference was determined between the patient and control groups in terms of skin prick positivity (p < 0.05). CONCLUSIONS: While there are several known factors implicated in the causation of acute appendicitis, the cause cannot be identified in some cases. We think that atopy may also be a risk factor in the development of acute appendicitis.

High frequency of submicroscopic genomic aberrations detected by tiling path array comparative genome hybridisation in patients with isolated congenital heart disease.

BACKGROUND: Congenital heart disease (CHD) is the most common birth defect and affects nearly 1% of newborns. The aetiology of CHD is largely unknown and only a small percentage can be assigned to environmental risk factors such as maternal diseases or exposure to mutagenic agents during pregnancy. Chromosomal imbalances have been identified in many forms of syndromic CHD, but very little is known about the impact of DNA copy number changes in non-syndromic CHD. METHOD: A sub-megabase resolution array comparative genome hybridisation (CGH) screen was carried out on 105 patients with CHD as the sole abnormality at the time of diagnosis. RESULTS: There were 18 chromosomal changes detected, which do not coincide with common DNA copy number variants, including one de novo deletion, two de novo duplications and eight familial copy number variations (one deletion and seven duplications). CONCLUSIONS: Our data show that submicroscopic deletions and duplications play an important role in the aetiology of this condition, either as direct causes or as genetic risk factors for CHD. These findings have immediate consequences for genetic counselling and should pave the way for the elucidation of the pathogenetic mechanisms underlying CHD.

Fine mapping of a de novo interstitial 10q22-q23 duplication in a patient with congenital heart disease and microcephaly.

In this study we report a female patient with an interstitial duplication of a region (10q22-q23) which is rarely reported in the literature. We fine mapped the aberration with array CGH, which revealed an 18.6-Mb duplication, covering 89 annotated genes, at 10q22.2-q23.33. There were no other deletions or duplications elsewhere in the genome. The main clinical features of the patient are microcephaly and congenital heart disease, which are likely to be caused by dosage effect of one or several genes in the duplicated region. Similar phenotypes have been found in other patients with 10q11-q22 duplications and in two out of three patients with 10q22-q25 duplications. However, most of the duplication cases were investigated only by conventional chromosome analyses, and fine mapping of these and other duplications of 10q22-q23 are warranted for genotype-phenotype comparisons.

Two independent chromosomal rearrangements, a very small (550 kb) duplication of the 7q subtelomeric region and an atypical 17q11.2 (NF1) microdeletion, in a girl with neurofibromatosis.

Most patients with neurofibromatosis (NF1) are endowed with heterozygous mutations in the NF1 gene. Approximately 5% show an interstitial deletion of chromosome 17q11.2 (including NF1) and in most cases also a more severe phenotype. Here we report on a 7-year-old girl with classical NF1 signs, and in addition mild overgrowth (97th percentile), relatively low OFC (10th-25th percentile), facial dysmorphy, hoarse voice, and developmental delay. FISH analysis revealed a 17q11.2 microdeletion as well as an unbalanced 7p;13q translocation leading to trisomy of the 7q36.3 subtelomeric region. The patient's mother and grandmother who were phenotypically normal carried the same unbalanced translocation. The 17q11.2 microdeletion had arisen de novo. Array comparative genomic hybridization (CGH) demonstrated gain of a 550-kb segment from 7qter and loss of 2.5 Mb from 17q11.2 (an atypical NF1 microdeletion). We conclude that the patient's phenotype is caused by the atypical NF1 deletion, whereas 7q36.3 trisomy represents a subtelomeric copy number variation without phenotypic consequences. To our knowledge this is the first report that a duplication of the subtelomeric region of chromosome 7q containing functional genes (FAM62B, WDR60, and VIPR2) can be tolerated without phenotypic consequences. The 17q11.2 microdeletion (containing nine more genes than the common NF1 microdeletions) and the 7qter duplication were not accompanied by unexpected clinical features. Most likely the 7qter trisomy and the 17q11.2 microdeletion coincide by chance in our patient.

Impact of low copy repeats on the generation of balanced and unbalanced chromosomal aberrations in mental retardation.

Low copy repeats (LCRs) are stretches of duplicated DNA that are more than 1 kb in size and share a sequence similarity that exceeds 90%. Non-allelic homologous recombination (NAHR) between highly similar LCRs has been implicated in numerous genomic disorders. This study aimed at defining the impact of LCRs on the generation of balanced and unbalanced chromosomal rearrangements in mentally retarded patients. A cohort of 22 patients, preselected for the presence of submicroscopic imbalances, was analysed using submegabase resolution tiling path array CGH and the results were compared with a set of 41 patients with balanced translocations and breakpoints that were mapped to the BAC level by FISH. Our data indicate an accumulation of LCRs at breakpoints of both balanced and unbalanced rearrangements. LCRs with high sequence similarity in both breakpoint regions, suggesting NAHR as the most likely cause of rearrangement, were observed in 6/22 patients with chromosomal imbalances, but not in any of the balanced translocation cases studied. In case of chromosomal imbalances, the likelihood of NAHR seems to be inversely related to the size of the aberration. Our data also suggest the presence of additional mechanisms coinciding with or dependent on the presence of LCRs that may induce an increased instability at these chromosomal sites.

A simple, pain-free treatment for ingrown toenails complicated with granulation tissue.

BACKGROUND: The treatment of ingrown toenail complicated with granulation tissue is usually partial or total nail avulsion with or without matricectomy. It costs loss of occupational power, however, because most patients cannot go to work or school for some time after surgery, and it is a costly and uncomfortable procedure for most patients. OBJECTIVE: This study aimed to find an easy, painless, and inexpensive alternative. MATERIALS AND METHODS: Seven patients with ingrown toenails complicated with granulation tissue are included. A small apparatus was applied on the nails, granulation tissue was chemically cauterized, and a foot bath was recommended twice daily. They were followed on a weekly basis or every other week until recovery. None of the patients received systemic treatment. RESULTS: All seven patients were completely cured without requiring surgery and/or systemic treatment. The procedure did not have any effect on their daily life. The follow-up examination of the patients at 6 months revealed that they were totally cured, and there were no recurrences. CONCLUSION: Patients with ingrown toenails complicated by granulation tissue might have an inexpensive and pain-free treatment alternative, although new studies with more patients are required.

Spontaneous rupture of the spleen in secondary amyloidosis: a patient with rheumatoid arthritis.

A 63-year-old man who had had a history of rheumatoid arthritis presented with shock and hemoperitoneum, without a history of trauma. An emergency laparatomy revealed hemoperitoneum and splenic rupture with massive bleeding. Splenectomy was performed. Histopathological examination of the spleen revealed amyloid deposition in the wall of the vessels. Rectal biopsy revealed amyloid deposition in mucosa that indicating amyloidosis was systemic. Histochemical studies showed that amyloid was secondary or AA.

The diffusion of nimesulide gel into synovial fluid: a comparison between administration routes.

BACKGROUND: Nimesulide is available in gel formulation and applied mainly for topical pain management. However, its passage to the synovial fluid is not yet clear. The aim of this study was to evaluate if topical administered nimesulide passes into the synovial fluid and to compare its concentration with the oral nimesulide administration regimen. METHODS: Synovia and plasma nimesulide concentrations were investigated in patients after topical (Sulidin gel 1%) and oral (Mesulid tablet) drug administration. 34 adult outpatients who were scheduled to have an arthroscopic knee examination for mainly meniscal tears repair and who had knee pain during this period were enrolled in the first part of the study. One group received topical nimesulide gel to the skin of the knee whereas the second group received oral 2 x 100 mg nimesulide tablets, 4-7 days before the planned arthroscopy. Synovial fluid and plasma samples were taken simultaneously during the arthroscopy and analyzed using HPLC. In addition, an open-label pilot study was performed to investigate the efficacy and safety of 1-week administration of nimesulide gel. 63 knee osteoarthritis patients were asked to complete the WOMAC Osteoarthritis Index questionnaire before and 1 week after use of Sulidin gel applied 3 times daily. RESULTS: Synovia and plasma nimesulide concentrations were 19.7 +/- 8.6, 11.8 +/- 3.0 and 1958.8 +/- 397.5, 3631.9 +/- 799.3 ng/ ml for topical and oral administration groups, respectively. There was a significant (paired Student's t-test) improvement after 1 week nimesulide treatment in all WOMAC Osteoarthritis Index parameters measured. CONCLUSION: Nimesulide passes into the synovial fluid after topical administration and may have potential benefits in knee osteoarthritis treatment. The actual efficacy and safety of topical nimesulide gel administration should be investigated in a long-term, randomized, placebo-controlled clinical trial.

Is growth hormone a radioprotective agent?

There is currently substantial clinical interest in growth hormone (GH) as a protective agent against radiation-related normal tissue injury. To further assess the potential radiation injury-preventive effects of GH, these effects were studied in rats by using a radiation-induced skin injury model. Group 1 received neither GH nor irradiation (control group). Group 2 received 30 Gy of gamma irradiation as a single dose to the right hind legs of the rats (radiation group). Group 3 and 4 received the same irradiation plus either 0.01 U/kg/day GH (RT + 0.01 GH group) or 0.02 U/kg/day GH (RT + 0.02 GH group) subcutaneously. Clinically and histopathologically, acute skin reactions were assessed by two independent experts in radiation oncology and pathology, respectively. Irradiation increased dermatitis in rats when compared with the control group. The severity of radiodermatitis in the rats in the RT + 0.01 GH and RT + 0.02 GH groups was significantly lower than that in the RT group; radiodermatitis developed earlier in the RT group than in the other groups. GH was efficacious in preventing epidermal atrophy, dermal degeneration such as oedema and collagen fibre loss, and hair follicle atrophy, but not better than in the control group. These results are preliminary to studies that will be performed with higher doses of GH in radiation-treated cancer patients, with the aim of reducing radiation-induced toxicity.

Magnetic resonance imaging findings in chronic carbon monoxide intoxication.

PURPOSE: To define the cranial magnetic resonance imaging (MRI) features of the chronic stage of carbon monoxide (CO) poisoning in patients with and without neuropsychiatric sequelae. MATERIAL AND METHODS: Eight patients who had neither symptoms nor neurological sequelae and eight patients with neuropsychiatric sequelae were included in the study. Patients aged between 9 to 57 (mean 32.2 years). All patients had been comatose at initial admittance and awoke after normobaric 100% oxygen therapy within 1-7 days. In this study, the patients were being examined with routine cranial MRI between 1 and 10 years (mean 3.4 years) after exposure to CO. RESULTS: The most common finding was bilateral symmetric hyperintensity of the white matter, which was more significant in the centrum semiovale, with relative sparing of the temporal lobes and anterior parts of the frontal lobes on T2-weighted and FLAIR images in all patients. Cerebral cortical atrophy was seen in 10 patients; mild atrophy of cerebellar hemispheres in 8; and vermian atrophy in 11. Corpus callosum was atrophic in one patient. Bilateral globus pallidus lesions were seen in three patients. The lesions were hypointense on T1-weighted images and hyperintense on T2-weighted and FLAIR images. CONCLUSION: Patients with severe CO intoxication may develop persistent cerebral changes independently of their neuropsychiatric findings in the chronic stage. They may present with characteristic MRI findings as described here, even if asymptomatic. The history of CO exposure is therefore helpful for recognizing and interpreting the MRI findings of chronic stage CO intoxication.

Spontaneous rupture of hepatocellular carcinoma: a case report and review of literature.

Hepatocellular carcinoma (HCC) has a tendency for fatal spontaneous rupture leading to massive haemorrhage. A 64-year-old man presented with sudden, severe epigastric pain for 6 h. Systolic blood pressure was 80/50 mmHg, and pulse rate was 100/min. The patient's history did not reveal any operation or disease up to date. Contrast enhancement-axial computed tomography (CT) scan showed a tumoral lesion with a necrotic centre measuring 6 x 5 cm within 6th segment of the liver and a fluid collection (haemoperitoneum) at the periphery of the liver. At exploratory laparotomy, the liver was found to be cirrhotic, and an actively bleeding tumour confirmed in 6th segment of the liver. The tumour was resected. Post-operative recovery was unremarkable, and the patient was discharged on the 14th post-operative day. Ruptured HCC should be included in the differential diagnosis of non-traumatic intra-abdominal haemorrhage.

Trichoptysis caused by intrapulmonary teratoma: computed tomography and magnetic resonance imaging findings.

We describe a 9-year-old child with a history of trichoptysis caused by intrapulmonary teratoma and we present the CT and MRI findings of the teratoma. A heterogeneous mass containing cystic and solid elements was detected on both CT and MRI scans. Histopathological examination confirmed the diagnosis of teratoma. Teratomas arising from lung parenchyma, as in this case, are extremely rare in childhood. In the thoracic region, the most common localization of teratomas is the anterior mediastinal compartment. We also discuss the CT and MRI findings and the differential diagnosis of teratomas.

Prognostic significance of morphologic parameters in renal cell carcinoma.

Many morphologic parameters have been used in prognostic studies in renal cell carcinoma. In this study, the relationship between these parameters and prognosis was investigated. This study includes 75 patients who were treated with radical nephrectomy between 1985 and 2001. Pathological stage (TNM), grade (Fuhrman nuclear grade) cell type (UICC and AJCC), histologic pattern, tumour size, vascular invasion and multifocality were used as prognostic parameters. There were 34 female and 41 male patients with mean age of 54.5 +/- 12.5. The mean size of the tumour was 76.9 +/- 37.2 (30-200) mm. Of the patients, 40 had pT1, 21 pT2, nine pT3 and two pT4 diseases. Twenty-eight patients had Grade 1, 29 Grade 2, 15 Grade 3 and three Grade 4 tumour. According to cell type, 63 had clear cell, six papillary and six undifferentiated types. Five had multifocal and seven had vascular invasion. In conclusion, nuclear grade and tumour stage were found as the most important prognostic indicators.