The efficacy of palbociclib and ribociclib in the first-line treatment of metastatic hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer in male patients: a Turkish oncology group (TOG) study.

INTRODUCTION: Male breast cancer, comprising approximately 1% of all breast cancer cases, often leads to the exclusion of male patients as a criterion in clinical trials. While the efficacy of Cyclin-dependent kinases 4 and 6 (CDK 4/6) inhibitors has been established in metastatic hormone receptor-positive (HR +) and human epidermal growth factor receptor 2-negative (HER2 -) breast cancer in women, limited data exist on their effectiveness in male patients. We aimed to evaluate the efficacy and safety of palbociclib or ribociclib in male patients with breast cancer. METHODS: This study is a multicenter, retrospective study. We included male patients with HR + and HER2-metastatic breast cancer who received palbociclib or ribociclib as first-line treatment. Our primary endpoints were progression-free survival (PFS), overall response rates (ORR), and drug-related adverse effects. RESULTS: A total of 46 male patients from 27 institutions were enrolled. The median age at initiation of CDK 4/6 inhibitors was 63.64 ± 13.69 years, with a median follow-up of 21.33 (95% CI 14.92-27.74) months. The ORR were 84% for palbociclib and 76.2% for ribociclib. The mPFS for the entire cohort was 28.06 months (95% CI 18.70-37.42). No significant difference in PFS was observed between palbociclib and ribociclib (mPFS: 24.46 months (95% CI 11.51-37.42) vs 28.33 months (95% CI 14.77-41.88), respectively, p = 0.211). No new adverse events were reported. DISCUSSION: This study demonstrates that palbociclib and ribociclib are effective and safe options for first-line treatment in male patients with HR + /HER2 - metastatic breast cancer. However, further prospective studies are warranted to establish their efficacy in this population.

Effects of Potentially Inappropriate Medications in Older Patients with Gastrointestinal System Cancer.

Objective: Potentially inappropriate medications (PIM) is a crucial problem in the geriatric population. The amount of prescription and unadherence increase because of the different problems encountered in cancer patients. Our aim was to evaluate the effects of PIM in patients with gastrointestinal system cancer and to investigate its relationship with chemotherapy side effects, mortality, and progression. Methods: This retrospective cohort study assessed 154 patients with gastrointestinal system cancer. Demographics and disease features, the presence of PIM according to the "TIME-to-STOP" criteria and baseline laboratory parameters were recorded. The effects of PIM on survival and adverse treatment events were evaluated. Results: 66.9% of the cases were male and 33.1% were female. The mean age was 71.9±6.4 years. The most common side effects of chemotherapy are nausea, vomiting, kidney injury, and pain. The most frequently used prescriptions among the 98 PIMs were gliclazide, hyoscine N-butylbromide, simethicone, diphenoxylate atropine, and thiocolchicoside. PIM was detected in 68.1% of the participants. Chemotherapy side effects were more common in PIM group (p<0.001, odds ratio =5.6). PIM had no effect on mortality. Factors associated with mortality were age, stage, albumin, creatinine, operation history, and progression. A significant relationship was found between age, cancer stage, albumin, creatinine, operation history, and PIM in the regression model. There was no relationship between PIM and progression-free survival. Conclusion: Chemotherapy toxicity may increase with PIM detected on diagnosis. We suggest that PIM is an important factor in predicting the side effects of chemotherapy and minimizing the adverse effects.

Nivolumab-induced sensory ganglionopathy.

INTRODUCTION: Nivolumab is s a human monoclonal antibody. Due to its widespread use in many cancers, including Merkel cell carcinoma, adverse reactions associated with nivolumab, such as neuropathies, endocrinopathies, gastrointestinal problems, and skin toxicities have been increasing. Sensory ganlionopathy is rarely observed in these patients. CASE DESCRIPTION: We present a 63-year-old male with a medical history of Merkel cell carcinoma that recurred two times in the inguinal region. After undergoing surgery with adjuvant radiotherapy, a second surgery was performed. The patient suffered from tingling in all four limbs plus difficulty in walking after initiation of the third dose of nivolumab. MANAGEMENT AND OUTCOME: After 1 month of 1 mg/kg/day methylprednisolone treatment, he showed significant improvement. Subsequently, the systemic corticosteroid regimen was tapered to 5 mg every other day. The treatment resulted in significant improvement in all extremities. DISCUSSION: Sensory ganlionopathy can be seen as a side effect of an immune checkpoint inhibitor, even though it is very extraordinary. This is the case in the literature to develop sensory ganlionopathy due to nivolumab. We believe that patients using nivolumab may develop sensory ganlionopathy and management should be taken on this point.

Is C-Reactive Protein/Albumin Ratio of Advanced-Stage Non-small Cell Lung Cancer Patients Able to Predict Mortality in the Admission for Palliative Care?

CONTEXT: Lung cancer is frequent and mortal cancer. The predicting mortality may be helpful for cancer management. AIM: The purpose of the study was to evaluate the role of baseline C-reactive protein (CRP)/albumin ratio (CAR) in relation to hospital mortality, the setting of advanced stage non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: The present study is a retrospective analysis and included 77 adult patients with Stage IV NSCLC who were hospitalized for supportive care. All patients are divided into two groups as survivors and nonsurvivors. CAR on the admission was compared between groups. The correlation between CAR and the death time was investigated. The cutoff level of CAR was calculated, and patients with a high level were described in two groups. RESULTS: For all participants, the mean age was 63.0 ± 9.9 years, and the median values of CRP and albumin levels were 15.3 mg/dl (1-51.5) and 5.7 g/dl (0.02-22.7), respectively. CAR was significantly lower in the survivor group. By receiver operation curve analysis, the cutoff levels of CRP and CAR were determined as 10.8 and 3.5, respectively. The odds ratio of mortality was 3.85 (1.49-9.94 95% confidence interval [CI], P = 0.006) for higher than cutoff levels of CAR. The odds ratio was 3.38 (1.32-8.65 95% CI, P = 0.01) for higher CRP levels. There was a significant but weak negative correlation between the time of death and both CRP and CAR in the nonsurvivor group (r = -0.46, P = 0.002; r = -0.48, P = 0.001, respectively). CONCLUSION: The present study showed that CAR was significantly increased in nonsurvivors. CAR may be a cheap, easy, and effective tool for predicting the death and its time of hospitalized NSCLC patients.

Is Thiol-Disulphide Homeostasis an Indicative Marker in Prediction of Metastasis in Lung Cancer Patients.

BACKGROUND: Thiol/disulfide (SH/SS) homeostasis plays an essential and dynamic role in our body and in various cellular activities and pathways such as cell death, regulation of enzyme activities, mechanisms of transcription and cellular signal transduction. Lung cancer is the most commonly seen cancer type in the adult population. Therefore, prediction of metastases gains importance in this population. METHODS: We included 150 patients with lung cancer who attended Kirikkale University Medical Faculty Hospital between June 2017 and June 2018. Our purpose was to evaluate whether metastases can be predicted in lung cancer patients by testing SH/SS homeostasis as a novel and easily applicable biochemical test. RESULTS: The mean age of the patients was 63.8 ± 8.1 (41 - 71) years. Advanced stage lung cancer, adenocarcinoma, squamous-cell and small cell lung cancers, and other types were detected in 54.7%, 42.7%, 41.3%, 13.3%, and 2.7% of the patients, respectively. SS values of the patients with advanced stage lung cancer were higher than in patients with early stage lung cancer (p < 0.001). It was determined that the patients with advanced stage lung cancer had statistically significantly higher mean values of SS, SS/SH (%), and SS/total SH (%) than patients with early stage lung cancer and that a statistically significantly lower mean value of SH/total SH (%) was found in advanced stage compared with early stage lung cancer patients. No statistically significant difference was found between the patient groups with advanced and early stage lung cancer regarding mean values of native SH and total SH levels. CONCLUSIONS: It can be concluded that SH/SS parameters may vary in advanced and early stage lung cancer patients; however, further studies should be conducted with SH/SS parameters in order to use them as indicators of cancer severity in lung cancer patients.

Effects of B2O3 (boron trioxide) on colon cancer cells: our first-step experience and in vitro results.

Boron oxide (B2O3) is derived from dehydration of boric acid and is a colorless, semitransparent, crystalline compound that is moderately soluble in water. On the other hand, boron oxide is chemically hygroscopic. This gives the molecule the ability to soak up water and adhere to tissues. Boron oxide can be used locally after tumor debulking in inoperable tumors and especially when the tumor-free margin distance cannot be provided. For all these reasons we aimed to evaluate the in vitro test results of B2O3 in terms of cytotoxicity, genotoxicity, apoptosis, and necrotic effects on L929 fibroblast cells and DLD-1 colorectal adenocarcinoma cells. Our studies demonstrated that boron oxide compounds appear to be highly cytotoxic for both cell lines according to WST cell viability assay (44.22% and 18.36% on DLD-1 and L929, respectively). Although no genotoxic effects were observed, boron oxide compounds showed antiproliferative effects for both cell lines. The prepared boron oxide compounds may hold the potential to be applied locally to the remaining tissue after surgery and further research and evaluation will be needed to determine its effectiveness.

Evaluation of the Brachial Plexus With Shear Wave Elastography After Radiotherapy for Breast Cancer.

OBJECTIVES: The aim of this study was to analyze the elasticity characteristics of the brachial plexus by shear wave elastography (SWE) in patients receiving radiation therapy (RT) for breast cancer and to compare them with their contralateral brachial plexus to evaluate whether elasticity properties can be used as supporting findings for the early diagnosis of brachial plexus involvement in patients receiving RT. METHODS: A prospective analysis with electromyography and SWE was performed on 23 brachial plexuses of patients receiving RT for breast cancer and their contralateral brachial plexuses. An electromyographic device was used for nerve conduction studies. Evaluations were done by the same investigator, and superficial electrodes were used in the recordings. A quantitative analysis of the brachial plexus with SWE was performed, with values in kilopascals on a color scale ranging from 0 (red, soft) to 150 (dark blue, hard) kPa. RESULTS: Mean SWE values ± SD were 51.0 ± 14.0 kPa for the ipsilateral brachial plexuses of patients receiving RT and 18.0 ± 4.2 kPa for the contralateral brachial plexuses. Statistically significant differences were observed between the groups in the analysis of SWE values (P < .001). No significant correlation was found between the nerve conduction parameters and elastographic values (P > .05). CONCLUSIONS: Shear wave elastography showed that the brachial plexuses of patients receiving RT were stiffer than the unaffected brachial plexuses. Brachial plexus stiffening may be associated with fibrotic processes.

Could erythropoietin reduce the ovarian damage of cisplatin in female rats?

The aim of this study is to investigate whether erythropoietin (EPO) can reduce the ovarian damage of cisplatin or not. Thirty, female, Wistar-Albino rats were used in the study. Control group (N = 10): Intraperitoneal saline infusion, Cisplatin group (N = 10): Intraperitoneal 7 mg/kg cisplatin, Cisplatin + EPO group (N = 10): Intraperitoneal 7 mg/kg cisplatin and subcutaneous 200 IU/kg/day EPO. Serum AMH concentrations were measured by enzyme-linked immunosorbent assay kit of AMH. Follicular counts were evaluated according to mean diameter of the follicles. Ovarian damage; including follicular cell degeneration, vascular congestion, hemorrhage, and inflammation was scored histologically using a graduated scale. Posttreatment AMH levels of cisplatin group were significantly lower than control and cisplatin + EPO groups. In cisplatin group, there was a significant decrement in posttreatment AMH level compared to pretreatment AMH level. The total damage score of cisplatin group was significantly higher than scores of control and cisplatin + EPO groups. The mean primordial follicle counts of control and cisplatin + EPO groups were significantly higher than that of cisplatin group (p = .007 and p = .003). The results of this study revealed that EPO administration to cisplatin chemotherapy could ameliorate the ovarian damage. Erythropoietin administration to chemotherapeutic agents might suggest to protect ovarian failure and infertility.

Signet-ring Cells in the Skin: A Case of Late-onset Cutaneous Metastasis of Gastric Carcinoma and a Brief Review of Histological Approach.

Up to 10% of patients with visceral malignancies develop skin metastases during their clinical course and these metastases constitute about 2% of all skin cancers. Skin metastasis may be the first sign of a clinically silent visceral cancer or represent recurrence of an internal malignancy. In both situations, they are associated with poor prognosis, which can partly be attributed to underdiagnosis. In this paper, a case of relapsing gastric adenocarcinoma, which manifested itself as asymptomatic cutaneous papules and nodules on a patient's head and neck, is reported and histopathological approach to the cutaneous lesions containing signet-ring cell is briefly reviewed.

Changes in the choroidal thickness in reproductive-aged women with iron-deficiency anemia.

BACKGROUND: The aim of this study was to investigate the potential significance of the central macular thickness (foveal thickness-FT) and choroidal thickness (CT) in the eyes of patients with iron-deficiency anemia, the most common form of the anemia, via enhanced-depth imaging optical coherence tomography (EDI-OCT). We also investigated whether such changes might serve as an early indicator of underlying hematological disease. METHODS: This prospective clinical study compared 96 female patients with iron-deficiency anemia and 60 healthy female control subjects. The macular and choroidal thicknesses in the temporal and nasal subfoveal areas were measured using enhanced-depth imaging optical coherence tomography (EDI-OCT) at 500 and 1500 microns and in five different regions (FCT, T1500, T500, N500, and N1500). RESULTS: The mean ages of the patients and healthy controls were 34.08 ± 10.39 years and 32.29 ± 8.28 years, respectively (P =0.232). There were no significant changes in macular thickness between the groups (225.58 ± 19.76 vs. 222.45 ± 13.51, P =0.2). The choroidal thickness was significantly reduced in the patient group relative to the controls at all measured points (foveal choroidal thickness, P = 0.042; nasal-500 microns, P = 0.033; temporal-500 microns, P = 0.033; and temporal-1500 microns, P = 0.019). At some points, the choroidal thickness findings correlated with the hemoglobin values (temporal-500 microns, r = -0.287, P = 0.001; nasal-500 microns, r = -0.287, P = 0.005; nasal-1500 microns, r = -0.245, P = 0.016; and temporal-1500 microns, r = -0.280, P = 0.06). CONCLUSIONS: Patients with iron-deficiency anemia had a significantly reduced choroidal thickness.

Good outcomes of patients with stage IB endometrial cancer with surgery alone.

BACKGROUND: Most patients with endometrial cancer have stage I disease. Adjuvant therapy in stage IB (formerly IC) endometrial cancer is controversial, treatment options including observation or brachytherapy/ radiotherapy in grade 1-3 patients with or without chemotherapy. The purpose of this study was to assess the outcomes of our patients with stage IB endometrioid endometrial cancer. MATERIALS AND METHODS: Sixty two patients with stage IB endometrial cancer and endometrioid histology were retrospectively evaluated. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy, bilateral pelvic and paraaortic lymph node dissection and omentectomy. Adjuvant radiotherapy was discussed with patients and utilized by those who accepted. Adjuvant chemotherapy was not given to any of the patients. RESULTS: Median age was 62 (range, 42-95). Ninety percent of the patients had grade 1-2 disease. Thirteen patients (21%) received intra vaginal brachytherapy (IVBT) and one received whole pelvic radiotherapy (WPRT). Median follow-up time was 46 months (range, 9-77 months). Three patients experienced recurrence (4.8%), two of them died on follow-up and one was still alive at last visit. Two patients with recurrence had FIGO grade 2 tumors and one had a grade 3 tumor. Two patients (3.2%) died without evidence of recurrent disease. Relapse free survival at 5 years was 94.4% and overall survival was 93.1%. CONCLUSIONS: Patients with stage IB disease in our study demonstrated relatively low recurrence rates although the majority of them received no adjuvant treatment. Surgery alone may be sufficient for most patients with this stage of endometrial cancer.

Impact of treatment strategies on local control and survival in uterine carcinosarcomas in Turkey.

BACKGROUND: The purpose of this study was to determine the clinical characteristics, patterns of recurrence and survival outcomes in patients with uterine carcinosarcomas treated in our institution. MATERIALS AND METHODS: Records of 26 patients diagnosed between 2007 and 2011 with uterine carcinosarcoma were retrospectively evaluated for demographic features, tumor characteristics, treatment regimens and patient outcomes in terms of DFS and OS RESULTS: Median age was 61 (range 43-78). 10 patients (38%) had stage I disease at diagnosis, 3 (12%) had stage II, 4 (15%) had stage III and 9 (35%) had stage IV. Sixteen patients (62%) received chemotherapy with paclitaxel and carboplatin for 6 cycles. One patient underwent radiotherapy. Median follow up was 17 months. Sixteen patients relapsed and 13 died during follow up. Considering recurrence, 5 out of 16 patients had lung metastases, one had brain metastases and 9 had only intraabdominal recurrence. The 3 year DFS was 37% and the 3 year OS was 30%. CONCLUSIONS: Our data show that uterine carcinosarcomas tend to be at advanced stage at diagnosis and despite the use of chemotherapy, overall prognosis is poor. Surgery remains the mainstay of treatment. More effective adjuvant strategies are needed to reduce relapse and death rates.

The effect of therapeutic ultrasound on metallic implants: a study in rats.

OBJECTIVE: To investigate whether therapeutic ultrasound (US) use over metallic implants has the potential for adverse effects as a result of greater temperature increases at the tissue-metal interface. DESIGN: A randomized controlled trial. SETTING: A research laboratory. ANIMALS: Sprague-Dawley rats (N=40; weight, 230-300g) were used and divided into 3 study groups. INTERVENTIONS: In group 1, both limbs of 10 rats were used for evaluation of temperature changes. Metal pins were placed into the femur of the left limb, and the right limbs were used as controls. A thermal sensor was placed into the medulla to record the elevation of tissue temperature during US application. In groups 2 and 3 with 15 rats in each, a midshaft femoral fracture was produced, and intramedullary fixation was performed with metal pins. Group 2 received US treatment for 5 minutes daily and continued for 27 days. Group 3 served as controls. MAIN OUTCOME MEASURES: The rats in groups 2 and 3 were killed on postoperative day 30. The specimens were evaluated by radiology, histopathology, and biomechanics. RESULTS: The presence of metal in bone did not cause an increased temperature rise. US application did not increase or decrease callus formation, and there was no tissue necrosis. The average removal torques of pins in groups did not show a significant difference. CONCLUSIONS: Internal fixation with metallic implants may not be a contraindication for therapeutic US treatment.

Management of kikuchi-fujimoto disease using glucocorticoid: a case report.

Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a self-limiting, benign, and rare systemic lymphadenitis with unknown etiology. The cardinal symptoms are fever, lymphadenopathy and night sweat; consequently, it is first necessary to rule out infectious, lymphoproliferative, and connective tissue diseases such as systemic lupus erythematosus. Histology can allow diagnosis by demonstrating necrotizing histiocyte lymphadenitis. Disease, which has no specific treatment, self-limits itself in 1 to 6 months clinically. However, non-steroid anti-inflammatory agents can be given for symptomatic treatment and there are reports using corticosteroids and antibiotics in complicated cases. This article concerns a 32-years-old female who diagnosed Kikuchi-Fujimoto disease and treated with glucocorticoid.

Preventing blood-induced joint damage with the use of intra-articular iron chelators: an experimental study in rabbits.

INTRODUCTION: This animal model was designed to evaluate the effect of intra-articular iron-chelator treatment in the prevention of blood-induced joint disease. METHOD: Thirty domestic male rabbits were divided into three equal groups. One milliliter of homologous blood was injected into the left knee of each rabbit in groups 1 and 2. In the second group, 0.1 ml desferroxamine mesilate (DM) was also injected to the blood. In group 3, the animals received injections of 0.1 DM which was mixed with equal amounts of sterile saline solution. The joints were injected three times each week for 12 weeks. At the end of 12 weeks, the knee joints of each rabbit were examined. RESULTS: The synovium in group 1 was found statistically significantly thicker than in group 2. Obvious erosion and ulceration of the cartilage were seen in all joints in group 1 and absent in group 2. Iron-chelator treatment reduced the formation of blood-induced joint damage in rabbit knees by inhibiting the iron-catalyzed formation of destructive oxygen metabolites that has an effect on joint cartilage and synovium.

Combination of luque instrumentation with polyaxial screws in the treatment of myelomeningocele kyphosis.

Rigid congenital kyphosis in myelomeningocele is associated with an important morbidity with skin breakdown, recurrent infection, and decreased function. Kyphectomy is the classic treatment to restore spinal alignment; however, surgery is associated with morbidity and long-term complications. The purpose of this retrospective study was to examine the authors' experience using combination of Luque instrumentation with posterolaterally placed polyaxial screws in the treatment of myelomeningocele kyphosis. From June 1999 to June 2003, 7 patients were treated and followed up for an average of 68.6 months. The average age at the time of the operation was 7 year and 1 month. All patients underwent vertebral excision from just above the apex of vertebral deformity to realign the sagittal deformity. Posterolaterally placed polyaxial screws were used in combination with segmental Luque instrumentation. Kyphotic deformity averaged 104 degrees before surgery, 15.2 degrees after surgery, and 18.5 degrees at the latest follow-up. The average loss of correction was 3.3 degrees. The average blood loss was 611 mL. Complications occurred in 2 of 7 patients were superficial wound breakdown and deep wound infection that required rotational flap closure. Kyphectomy with posterior instrumentation by using Luque technique in the combination with polyaxial screws is reliable method for correcting rigid kyphotic deformity in patients with myelomeningocele. Rigidity of the construct, greater correction capacity, and low profile instrumentation by the help of posterolateral insertion of the polyaxial screws and wiring were the distinct advantages of this technique.

Conservative treatment of Charcot artroparthy in a series of spina bifida patients: the experience of one center and review of the literature.

The present study was performed to evaluate the use of patellar tendon-bearing ankle foot orthesis for the treatment of Charcot arthropathy in a series of patients with spina bifida. A cohort of 350 spina bifida patients, ages ranging between 12 months and 22 years were evaluated in our clinic between June 1993 and March 2004. Charcot arthropathy was seen in five of these children. Treatment was initiated with nonsteroidal anti-inflammatory drugs, oral bisphosphonates and immobilization. No change was observed in the patients' symptoms after a month of treatment. At this time, a patellar tendon-bearing ankle foot orthesis was prescribed and used for a period of 6 to 24 months. All patients improved within 2 months. At the end of 2 years of follow-up, three patients are still using the brace without any complaints. One patient still has symptoms, although she is wearing her brace, but she has had significant improvement compared with the initiation of therapy. Non-weight-bearing, immobilization and surgery are the known treatment choices in Charcot arthropathy. Little experience exists about this entity and its treatment. Our experience reveals that the patellar tendon-bearing ankle foot orthesis leads to significant improvement in children with Charcot arthropathy without surgery and immobilization.

[Talectomy for the treatment of neglected pes equinovarus deformity in patients with neuromuscular involvement]. / Nöromusküler tutulumlu hastalarda ihmal edilmis pes ekinovarus deformitesinin talektomi ile tedavisi.

OBJECTIVES: We evaluated talectomy operations performed for the correction of neglected pes equinovarus deformity of the foot in patients with neuromuscular involvement. METHODS: Eleven patients (2 females, 9 males; mean age 9.5 years; range 3 to 20 years) with various neurological disorders underwent 17 talectomy operations for the correction of neglected pes equinovarus deformity. Diagnoses were spina bifida in seven patients, arthrogryposis multiplex congenita in two patients, and spinal muscular atrophy and poliomyelitis in two patients, respectively. None of the patients had a previous surgery for pes equinovarus deformity. Preoperatively, three patients and one patient could walk in home settings with and without support, respectively, whereas seven patients could not walk at all. A protective orthosis was used in all the patients postoperatively. Achillotomy and posterior capsulotomy were performed prior to talectomy when needed. The results were evaluated with the use of a functional rating system and radiographs. The mean follow-up was 50 months (range 24 to 108 months). RESULTS: The results were good in 12 feet and fair in five feet. Seven patients could walk without support, and three patients could walk with support. One patient required re-operation for residual deformity of the foot and skin wounds due to poor compliance with the protective orthosis. One patient could not ambulate despite a plantigrade foot. CONCLUSION: Talectomy is a limb-saving procedure for the treatment of neglected pes equinovarus deformity. Its success relies not only on obtaining a plantigrade foot but also on a proper postoperative orthotic control.

[Surgical management of orthopedic problems in adult patients with cerebral palsy]. / Beyin felçli eriskin hastalardaki ortopedik sorunlarin cerrahi tedavisi.

OBJECTIVES: We evaluated the results of surgical treatment for orthopedic problems in adult patients with cerebral palsy. METHODS: Nine adult patients with cerebral palsy (4 females, 5 males; mean age 22 years; range 19 to 29 years) were managed surgically to lessen pain, correct deformities and contractures, and enhance their mobilization potential. Seven patients underwent bilateral multiple-level tendinous and/or musculotendinous release procedures involving the lower extremities, of whom two patients underwent additional triple arthrodesis, and one patient underwent extension osteotomy in the knee. One patient was treated with proximal femoral and distal tibial derotation osteotomies and bilateral hamstring release for knee flexion contractures. Finally, one patient was treated with posterior fusion with instrumentation for thoracolumbar scoliosis. Before surgery, four patients were community ambulators, and one patient could walk only with the aid of bilateral crutches. Four patients with total body involvement could not walk, but they could sit without support except for one patient with scoliosis. The mean follow-up was 25 months (range 8 to 49 months). RESULTS: On final evaluations, eight patients could walk without support, and one patient who could not sit preoperatively managed to sit without support. Three patients developed bilateral, five patients developed unilateral superficial skin wounds at the back of the heels associated with cast/brace use, and deep wound infection was encountered in the patient with scoliosis. All the wounds healed with early debridements and antibiotic therapy, together with the modifications made in cast/brace applications, without the need for implant removal. CONCLUSION: Surgical treatment of orthopedic problems in adult patients with cerebral palsy is of substantial importance in enhancing their sitting and walking capacities, and in restoring their community-based relations and activities.