Evaluating the effectiveness of interventions targeting only the acetabular side in the surgical treatment of Legg-Calvé-Perthes disease.

OBJECTIVE: This study aims to show the effectiveness of only acetabular-side surgeries for hips affected by Legg-Calvé-Perthes disease. PATIENTS AND METHODS: Twelve patients who underwent two different acetabular osteotomies -pembersal osteotomy and triple osteotomy - were evaluated retrospectively. Clinically, patients were examined for hip range of motion, flexion contracture, and hip extensor and abductor strength; the results were evaluated using the Harris hip score. Radiologically, the hips were assessed according to three different radiological parameters: lateral center edge angle, acetabular width, and acetabular head index at the preoperative, early postoperative, and last follow-up periods. The hips were classified according to Herring classification preoperatively and according to Stulberg classification at the last follow-up. RESULTS: Statistically significant improvement was observed in patients both clinically and radiologically. It was observed that pembersal osteotomy significantly corrected the lateral center edge angle better than triple osteotomy while also correcting the other two radiological parameters, but no statistically significant difference was observed between these methods. CONCLUSIONS: Only acetabular-side surgeries are effective and safe methods that do not require femoral intervention for hips affected by Legg-Calvé-Perthes disease and that do not show significant complications.

Comparison of the analgesic effects of pulse radiofrequency and cryoablation in rabbits with mental nerve neuropathic pain.

PURPOSE: After mental nerve injury, several sensory disorders may occur. The alterations in sensation may differ from mild paresthesia to complete anesthesia, or neuropathic pain. Neuropathic pain is a difficult clinical condition to manage. The aim of this study was to compare the analgesic effects of pulsed radiofrequency (PRF) and cryoablation in an experimental mental nerve neuropathic pain model in rabbits. MATERIALS AND METHODS: Fifteen rabbits were divided into three groups. One-third to one-half of the mental nerve was ligated with 4-0 silk sutures. In Group 1, a nonconducting PRF electrode was placed on the mental nerve for 6 min, whereas the mental nerve was exposed to PRF in Group 2. In Group 3, the cryoablation was processed. The responses to thermal and mechanical stimuli were measured at the 1st, 2nd, 3rd, and 4th weeks. RESULTS: There were no statistically significant differences among the groups for thermal withdrawal latency to heat stimulation in any weeks (P > 0.05). However, a significant difference was found between the groups (P < 0.05) in the 3rd and 4th weeks for mechanical withdrawal latency values. CONCLUSIONS: Both PRF and cryoablation therapies are successful in the treatment of experimentally induced mental nerve neuropathic pain in rabbits.

Comparative determination of ventilatory efficiency from constant load and incremental exercise testing.

The analysis of the relationships between minute ventilation (VE) to CO2 output (VCO2), referred to as ventilatory efficiency, in response to incremental exercise testing, is considered a useful index for assessing the presence and severity of cardiopulmonary and metabolic diseases. The effects of constant load exercise testing performed at work intensity associated with anaerobic threshold (AT) and respiratory compensation points (RCP), on the accurate measurements of ventilatory efficiency are not well known. The aim of this present study was to investigate the reliability of the VE/VCO2 ratio obtained from constant load exercise tests performed with two important metabolic rates (at the AT and RCP) and compare it to that of those of incremental exercise tests. A total of 20 young male (20.8±0.4 yr) subjects initially performed an incremental exercise test and then two constant load exercise tests, on different days. Respiratory and pulmonary gas exchange variables were used to estimate AT and RCP. A paired t-test was used to analyse data. AT and RCP (average) occurred the at 60% and at 71% of peak O2 uptake, respectively. The lowest VE/VCO2 ratio recorded within the first 2 minutes of constant load exercise tests with a work load of AT (26.4±0.3) and RCP (26.7±0.5) was not statistically different from the lowest ratio obtained from the incremental exercise tests (26.0±0.7). In the constant load exercise test, despite the different metabolic rates, the increase in ventilation corresponded closely with the increase in CO2 production, reflecting an optimal ventilation and perfusion ratio. Clinicians should consider the constant load exercise test work load associated with AT and RCP as it provides a meaningful lowest value for ventilatory efficiency.

Environmental evaluation of natural radioactivity in soil near a lignite-burning power plant in Turkey.

Natural radionuclides are released into the environment together with fly ash from the coal-burning power plant and cause an increase in the natural radioactivity in environmental samples. The study concerns to the evaluation the influence of Kangal lignite-burning power plant (LBPP) with a power of 457 MWe, which has been in operation since 1989, on natural radionuclide a concentration in surface soil samples around it. Activity concentrations of natural radionuclides (226Ra, 232Th, 40K and 222Rn) in the soil samples, and emanation coefficient (EC) and mass (ERM) and surface (ERS) exhalation rate of radon were determined by using a gamma-ray spectrometer with an HPGe detector. The average values of 226Ra, 232Th, 40K and 222Rn, EC, ERM and ERS were found as 37±5, 17±3, 222±30Bqkg-1 and 9±1kBqm-3, 12%, 12.1 µBq kg-1 s-1 and 7.1mBqm-2 s-1, respectively. Absorbed gamma dose rate in outdoor air and the corresponding effective dose rate from external exposure and excess lifetime cancer risk were estimated to evaluate radiological hazards for human population. The results revealed that the Kangal LBPP has caused a small increment in 226Ra concentration in the studied area. No influence was observed for 232Th and 40K.

The role of exercise in migraine treatment.

This review aims to provide a comprehensive overview of the literature on the use of exercise for migraine treatment with regard to its efficacy, mechanism of action and role in practice. Many randomized studies have reported the efficacy of prophylactic treatment of migrane with medications such as beta blockers or antiepileptic drugs. Studies on alternative approaches, like aerobic exercise and biofeedback, are however limited but also considered to be effective. Scientific databases were searched with keywords "exercise" and "migraine". The resulting publications were gathered, examined and discussed throughly. Past studies had limitations and were few in number, but more recent randomized controlled studies have concretely provided level of evidence about the effectiveness of exercise in prophylactic treatment of migraine. Core properties of exercise like intensity, duration, frequency, type and warming up period are required to be monitored while treating migraine to increase the beneficial effects and, also to prevent injuries and side effects which may include exertional headache. Isometric neck exercise is helpful when the migraine is accompanied by neck pain. Patient population with low beta endorphin level in blood, high physical fitness and high motivation receives significant benefits from the exercise treatment. The action of exercise on migraine is in general related to neurochemical factors, psychological states and increase in cardivascular and cerebrovascular fitness. Considering its effectiveness and minimal side effects, migraine patients should often be encouraged to practice physical exercise with intensity, frequency and duration that should be carefully instituted to achieve the most beneficial outcome while preventing potential injuries and side effects.

The effect of levosimendan combined with 20% lipid emulsion treatment on survival from bupivacaine induced toxicity in experiment.

BACKGROUND: Recent reports demonstrated that levosimendan improved post-resuscitation myocardial function in rat and pig models. MATERIALS AND METHODS: Rabbits were randomized into 4 groups as 12 rabbits in each group. Bupivacaine 10 mg/kg was injected as an intravenous bolus to all groups. Basic life support was performed by mechanical ventilation and manual external chest compressions. After 1 min, animals in the group 1 received 1.5 ml/ kg saline 0.9% solution, and animals in the groups 2 and 4 received 5 ml/kg 20% lipid emulsion for 1 min through the ear vein followed by continuous infusion at 0.25 ml/kg/min. Three additional boluses of 1.5 ml/ kg lipid emulsion were repeated at 5-min intervals. The group 3 received fluid resuscitation plus levosimendan (3 µg/kg/min) 1 min after asystole and the group 4 received both levosimendan and lipid emulsion treatment. Return of spontaneous circulation and hemodynamic metrics were obtained in 20 minutes. RESULTS: The number of rabbits that survived after cardiac resuscitation was lower in the Groups 1 (0%) and 3 (33.3%) than in the Group 4 (91.7%) with a statistically significant difference (p < 0.001). The number of rabbits that survived resuscitation was higher in the Group 4 than in the Group 2 (66.7%), though not with a statistically significant difference (p = 0.317). The median duration of cardiac arrest in the Group 4 was significantly shorter than that in the other three groups (p < 0.001). CONCLUSIONS: In this rabbit model of bupivacaine-induced cardiac arrest, resuscitation with combined iv lipid emulsion and levosimendan was more efficacious than lipid alone (Tab. 3, Ref. 24).

Natural radioactivity, radon exhalation rates and indoor radon concentration of some granite samples used as construction material in Turkey.

It is very important to determine the levels of the natural radioactivity in construction materials and radon exhalation rate from these materials for assessing potential exposure risks for the residents. The present study deals with 22 different granite samples employed as decoration stones in constructions in Turkey. The natural radioactivity in granite samples was measured by gamma-ray spectrometry with an HPGe detector. The activity concentrations of (226)Ra, (232)Th and (40)K were found to be in the range of 10-187, 16-354 and 104-1630 Bq kg(-1), respectively. The radon surface exhalation rate and the radon mass exhalation rate estimated from the measured values of (226)Ra content and material properties varied from 1.3 to 24.8 Bq m(-2) h(-1) with a mean of 10.5±1.5 Bq m(-2) h(-1) and 0.03-0.64 Bq kg(-1) h(-1) with a mean of 0.27±0.04 Bq kg(-1) h(-1), respectively. Radon concentrations in the room caused from granite samples estimated using a mass balance equation varied from 23 to 461 Bq m(-3) with a mean of 196±27 Bq m(-3). Also the gamma index (Iγ), external indoor annual effective dose (Eγ) and annual effective dose due to the indoor radon exposure (ERn) were estimated as the average value of 1.1±0.1, 0.16±0.02 mSv and 5.0±0.7 mSv, respectively, for the granite samples.

Investigation of the activity level and radiological impacts of naturally occurring radionuclides in blast furnace slag.

The activity level and possible radiological impacts of naturally occurring radionuclides on the health of workers and members of the public, as a result of utilisation of blast furnace slag (BFS) samples as a substitute for aggregate in road construction were investigated by using a gamma-ray spectrometer and potential exposure scenarios given in Radiation Protection 122. The mean activity concentrations of the (226)Ra, (232)Th and (40)K in BFS samples were found to be 152.4, 54.9 and 183.1 Bq kg(-1), respectively. These values are compared with typical values measured in BFS samples from the European Union countries, which are 270, 70 and 240 Bq kg(-1) for (226)Ra, (232)Th and (40)K, respectively. The values of radium equivalent activity index calculated for BFS samples were within the recommended safety limits. The highest total annual effective doses evaluated as 0.9 and 0.4 mSv y(-1) for members of the public and workers, respectively, were lower than the annual limit of 1 mSv y(-1).

A survey of distribution of terrestrial radionuclides in surface soil samples in and around the Osmaniyeprovince, Turkey.

The purpose of this survey was to determine the distribution of terrestrial radionuclides ((238)U, (232)Th and (40)K) in surface soil samples collected from different locations in and around Osmaniye and assess the radiological implications of outdoor external exposure. The activity concentrations of (238)U, (232)Th and (40)K in soil samples ranged from 2.6 to 38.1 Bq kg(-1) with a mean of 10.4±0.7 Bq kg(-1), 3.7-40.5 Bq kg(-1) with a mean of 12.2±0.7 Bq kg(-1) and 30.0-639.7 Bq kg(-1) with a mean of 243.4±12.8 Bq kg(-1), respectively. The concentrations of these radionuclides, presented in this article, were compared with those obtained from similar studies related to Turkey reported in the literature as well as earth's crust average values. The results of the activity concentrations were used to assess the external absorbed gamma dose rate (GDR) in outdoor air and the annual effective dose (AED). The outdoor absorbed GDRs fluctuate from 5.2 to 53.6 nGy h(-1) with a mean of 22.4±9.5. The corresponding mean AED is found to be 0.03 mSv.

New needle holder facilitates percutaneous fluoroscopy-guided sacroiliac puncture.

PURPOSE: To evaluate the success of a new guidance device for sacroiliac joint puncture. MATERIAL AND METHODS: The device was first tested on a human anatomical model and thereafter on two groups of patients. In the first group (n=8), the traditional hand-guided method was used, and in the second group (n=10) the needle-holder device. The parameters evaluated in each group were "the number of attempts", defined as the number of skin punctures, and "fluoroscopy-injection time", defined as the time from the beginning of the fluoroscopy to the end of the correct insertion of the needle into the joint. RESULTS: Sacroiliac injection with the new device required significantly fewer attempts (2.1 +/- 2 versus 4.3 +/- 3) and shorter fluoroscopy injection times (8.9 +/- 3 min versus 15 +/- 5 min; P<0.05). CONCLUSION: The new guidance device makes sacroiliac joint injection easier and prevents unnecessary exposure to radiation during the procedure.

Desflurane anaesthesia increases sister chromatid exchanges in human lymphocytes.

BACKGROUND: We investigated genotoxic effects of desflurane on the frequency of sister chromatid exchange (SCE) in peripheral blood lymphocytes of patients during and after anaesthesia. METHODS: Fifteen female patients, ASA classification I-II, aged 26-54 years, undergoing elective surgery were enroled in this study. Anaesthesia was induced by injection of thiopental 5-7 mg/kg and fentanyl 1 microg/kg. Vecuronium 0.1 mg/kg was given to facilitate tracheal intubation. Anaesthesia was maintained with desflurane 5-6% in an oxygen/air mixture (FiO(2) 0.3). N(2)O was not used for any patient. Using a heparinized syringe, venous blood was collected in patients before anaesthesia. Additional venous blood samples were taken from all patients at 60 and 120 min after the initiation of anaesthesia. Post-operative blood samples were taken and first, third, seventh and twelfth day samples were coded. RESULTS: Number of SCEs per cell at 60 and 120 min were significantly higher than the number of SCEs per cell before anaesthesia. In addition, number of SCEs per cell at 1, 3 and 7th post-operative days were significantly higher than pre-operative levels (P < 0.05). There was no difference between pre-operative number of SCEs per cell and 12th post-operative day levels (P > 0.05). CONCLUSION: In the present study, because exposure to desflurane increased sister chromatid exchange in human lymphocytes in our group of patients, we conclude that this agent may be capable of producing genetic damage.

Toxic hepatitis associated with paroxetine.

Hepatotoxicity is a rare complication of paroxetine, a selective serotonin reuptake inhibitor. Regarded as safe in therapeutic use, there have been reports of cases of severe hepatic dysfunction with gross elevations of transaminase levels that may be related to this drug. We report here severe adverse cholestatic and hepatocellular injury in a patient taking paroxetine probably due to an immune-mediated hypersensitivity reaction.

Correlations between aerobic capacity, pulmonary and cognitive functioning in the older women.

Regular aerobic exercise improves aerobic capacity and increases brain blood flow and oxygenation. Exercise also stimulates the reticular activating system and leads to a centrally excited state thereby makes the brain active and alert. In the present study, an aerobic exercise program consisting of submaximal level calisthenic exercises was devised for relatively healthy women between 60 and 80 years old, attending a solidarity center for the aged for daily activities. The effects of exercise on aerobic fitness, and the correlations between aerobic capacities, pulmonary functions and cognition were evaluated. Following a general health examination, 45 female volunteers fulfilling the international criteria of exercising standards for the aged were included in the program. The rhythmic and entertaining calisthenic exercises were performed by the older women for four months, three days a week, 40 or 50 minutes a day. Tests for aerobic capacities, pulmonary functions, and some neuropsychologic performances were carried out during the sedentary period and after the exercise program. The results revealed significant improvements in aerobic capacity, pulmonary functions, and some of the cognitive functions after the 4-month exercise program. We found strong relationships between aerobic capacities and cognitive functioning. Overall, the subjects expressed their happiness and well being on every occasion, during and after the exercise program.