The first (double) hand transplantation in Turkey.

In September 2010, a bilateral hand allotransplantation was performed on a 28-year-old man who had suffered amputations at the level of 1/3 of the proximal forearm on the right and 1/3 of the distal forearm on the left 2 years previously. This was the first hand transplantation case in Turkey. Preoperative organization, legal difficulties, technical aspects of the operation, and immunosuppressive regimen are detailed herein. The early results of the first composite tissue allograft (CTA) transplantation are also reported. The results were encouraging for all future types of CTA transplantation, including hand and face. Following the early promising outcome of the first case of hand transplantation in Turkey, we have accelerated preparation of regulations for CTA transplantation, including hand and face allotransplantation.

Concurrent gene therapy strategies effectively destroy synoviocytes of patients with rheumatoid arthritis.

Objectives. Rheumatoid arthritis (RA) is characterized by the chronic inflammation of the synovial joints resulting from the hyperplasia of synovial cells and the infiltration of lymphocytes, macrophages and plasma cells. Currently, the aetiology of RA is not known, and new treatment modalities are needed to prevent the disease progression. Apoptosis induction of synovial cells through the use of death ligands has been explored as a treatment modality for RA. Thus, the primary objective of this study was the testing of the efficacy of adenovirus delivery of human TRAIL (Ad5hTRAIL) for the treatment of patients with RA. Methods. Primary synovial cell cultures were established from eight patients with RA. Adenovirus permissiveness of synovial cells was determined by the infection of synoviocytes with adenovirus vector encoding green fluorescent protein (AdEGFP). TRAIL sensitivity of synoviocytes was assessed through the infection with Ad5hTRAIL vector using Live/Death Cellular Viability/Toxicity kit from Molecular Probe. TRAIL receptor profiles of synoviocytes were revealed by real-time RT-PCR assays followed by flow cytometric analyses. Results. While the presence of TRAIL death receptors were necessary for the induction of cell death, high levels of TRAIL-R4 decoy receptor expression on surface were correlated with TRAIL resistance. A DcR2 siRNA approach in combination with Ad5hTRAIL infection eliminated apoptosis-resistant RA synovial fibroblasts. Conclusion. Because a DcR2 siRNA approach in combination with Ad5hTRAIL infection exterminated RA synoviocytes to a greater extent than Ad5hTRAIL alone, the modulation of TRAIL receptor expression might be a new gene therapy strategy to sensitize RA synoviocytes to TRAIL.

Shoulder adhesive capsulitis and shoulder range of motion in type II diabetes mellitus: association with diabetic complications.

This study was done to examine the association between shoulder adhesive capsulitis and chronic diabetic complications and diseases closely related to diabetes in Akdeniz University Hospital. Shoulder adhesive capsulitis were evaluated in 297 consecutive type II diabetic patients attending an outpatient diabetic clinic. Shoulder adhesive capsulitis was detected in 86 patients (29%). There was a significant association between shoulder adhesive capsulitis and limited joint mobility (p = 0.006), shoulder adhesive capsulitis and Dupuytren's disease (p = 0.003). Odds ratios (OR) for carpal tunnel syndrome, limited joint mobility, and Dupuytren's disease with shoulder adhesive capsulitis were respectively 1.4, 2.1, and 2.4 [95% confidence interval (CI), respectively, 0.7-2.9, 1.2-3.69, and 1.3-4.4]. Also, shoulder adhesive capsulitis was associated with the age of patients (p = 0.000) and the duration of diabetes (p = 0.03). When other associations between shoulder adhesive capsulitis and diabetic complications were compared, it was associated with retinopathy [p = 0.014, OR = 2.2 (95% CI 1.1-4.2)], but there was no association with neuropathy or macroproteinuria. On the other hand, the degrees of passive abduction, internal rotation, external rotation motions of shoulder joints in the all patients were correlated with age of patients, duration of diabetes, neuropathy, and the other hands' problems (Dupuytren's disease, limited joint mobility) (p<0.05). The presence of shoulder adhesive capsulitis may indicate presence of organ involvement.

Fractures due to hypocalcemic convulsion.

We report on two cases of patients in whom hypocalcemic seizures during hemodialysis led to right scapular body fracture in one and bilateral femoral neck fractures in the other.

Arthroscopic removal of an osteoid osteoma at the talar neck.

The case of a 14-year-old girl with osteoid osteoma of the talar neck that localized subperiostaly with a 1-year history of persistent ankle pain is presented. The diagnosis was made on the basis of clinical appearance, radiography, technetium-99m diphosphonate scintigraphy, and magnetic resonance imaging findings. Subsequently, she underwent arthroscopic excision of the lesion using a motorized burr and curette. After the intervention, there was prompt relief of symptoms and no recurrence during a follow-up period of 22 months. However, pathological study of the arthroscopic shavings failed to confirm the preoperative diagnosis. We concluded that the arthroscopic excision of an osteoid osteoma in an accessible location on the talar neck is an appropriate surgical intervention, but it should be done by using nonmotorized instruments for better pathological examination of the lesion.

A case of intrapulmonary teratoma presenting with hair expectoration.

Benign cystic teratomas of the lung are extremely rare. Up to the present time, around 30 cases have been reported in the literature. We report an additional case, a 28-year-old woman, admitted with the complaint of expectoration of hair. Histopathological, clinical, and Ct features are presented.

Scapulothoracic dissociation: a case report.

Scapulothoracic dissociation has been described as a "closed traumatic forequarter amputation" and is characterized by massive soft tissue swelling of the shoulder, lateral displacement of the scapula, neurovascular injuries (brachial plexus, subclavian artery), an osseous-ligamentous injuries. In addition to the lateral displacement of the scapula, an acromioclavicular separation, a displaced fracture of the clavicle or sternoclavicular separation can be identified on plain X-rays. This injury pattern has been infrequently reported. We present a patient who had a previously unreported combination of roentgenographic findings, and in whom the diagnosis was revealed by computed tomographic evaluation.

Metastatic follicular carcinoma of the thyroid simulating sarcoma of the limb.

We report a case of metastatic follicular carcinoma of the thyroid presenting with clinical and radiological manifestations simulating a sarcoma of the humeral region. Thus left arm amputation was performed. Histopathological examination revealed the condition.

Tarsal tunnel syndrome secondary to neurilemoma of the medial plantar nerve.

A neurilemoma of the medial plantar nerve was observed in a 52-year-old Caucasian female. She was diagnosed with tarsal tunnel syndrome by clinical and electromyographic examination. This case was followed up for 18 months and has been presented as a very rare cause of tarsal tunnel syndrome. Relevant literature was reviewed.

Effect of chronic halothane exposure on lipid peroxidation, osmotic fragility and morphology of rat erythrocytes.

Effect of chronic halothane exposure on hepatic and erythrocyte lipid peroxidation and erythrocyte osmotic fragility and morphology were determined in rats exposed to 0.4% halothane, 8 h per day for 40 days. Hepatic lipid peroxidation was increased in the halothane-treated group compared to controls. Lipid peroxidation was not increased by halothane exposure in erythrocytes without hydrogen peroxide, but after peroxide supplementation lipid peroxidation increased more in the erythrocytes of halothane-exposed rats than in control rats. We have observed significant morphological changes in erythrocytes from halothane-treated rats. In addition, erythrocytes of halothane-treated rats were more fragile in saline solutions compared to those of controls. Our results suggest that chronic halothane exposure is not only hepatotoxic but also affects erythrocyte membrane structure and stability.