Investigation of the Importance of Knee Position during Femoral Tunnel Reaming; Figure 4 versus Hyperflexion.

Introduction: We aimed to compare whether the visualisation provided by arthroscopic hyperflexion and Figure 4 has an effect on femoral tunnel placement in patients undergoing single bundle Anterior Cruciate Ligament Reconstruction (ACLR). Material and methods: We retrospectively evaluated 93 patients who underwent single-band ACLR for Anterior Cruciate Ligament (ACL) injury between 2016 and 2019. Eighty patients met the inclusion criteria with a minimum follow-up of 12 months. We divided the patients into Group 1 (figure 4) and Group 2 (hyperflexion). We analysed the demographic, radiological and functional outcomes of the patients. The functional Lysholm score, operative time, radiological Quadrant method (% proximal-distal and % anterior-posterior) measurements, tunnel lengths, axial and coronal plane angles, and iatrogenic chondral injury in the medial femoral condyle were evaluated. Results: Iatrogenic chondral injury developed in the medial femoral condyle in a total of seven patients in both groups: one patient in group 1 (Figure 4) and six patients in group 2 (Hyperflexion). Although statistically insignificant, iatrogenic medial femoral condyle damage was less in group 1. The statistical analysis between surgical operation time (p = 0.046) and tunnel lengths (p = 0.042) was significant. Conclusion: The position of figure 4 provides visualisation of lateral intercondylar notch better than hyperflexion. In the reaming stage, the medial femoral condyle is less damaged in group 1 (Figure 4). In ACLR, which has a long learning curve, short surgery time is seen as an important advantage for surgeons who have just started doing ACLR. We think that it can be used as an alternative method to hyperflexion in the learning process and maybe shorten the learning curve process.

Early results of a domed tibia, mobile bearing lateral unicompartmental knee arthroplasty from an independent centre.

AIM: The aim of this study is to determine the short-term outcome of lateral unicompartmental knee arthroplasty (UKA) using a domed tibia, mobile bearing prosthesis. The primary outcome measure was revision due to bearing dislocation and the secondary measure was functional outcome. METHODS: From 2005 to 2009, a total of 64 knees, in 58 patients, were identified as having the domed tibia, mobile bearing lateral UKA with a minimum 2-year follow-up. Forty-one females and 17 males with a mean age of 71years (range 44 to 92, median 72) were reviewed. The mean follow-up period was 38months (range 24 to 61, median 36). The primary outcome measure was re-operation and revision rate, particularly due to bearing dislocation. The secondary outcome assessed was a patient reported outcome measure (PROM) using the Oxford Knee Score (OKS) and compared using Student's Paired T-test. RESULTS: There were four knees that underwent further surgery for any reason. Two patients required revision of the implant (3.1%). There were no cases of bearing dislocation in this series. The mean pre-operative OKS was 24 (range 9 to 36) and the mean post-operative score was 42 (range 23 to 48 p<0.0001). CONCLUSION: This study from an independent centre, reporting on the short-term results of the domed tibia, mobile bearing lateral UKA supports the safety and efficacy of the procedure as a treatment option in the patients with lateral compartment osteoarthritis (OA) of the knee. LEVEL OF EVIDENCE: This is a level 4; case series study.

The effects of intramuscular tenotomy on the lengthening characteristics of tibialis posterior: high versus low intramuscular tenotomy.

BACKGROUND: Lengthening of soft-tissue contractures is frequently required in children with a wide variety of congenital and acquired deformities. However, little is known about the biomechanics of surgical procedures which are commonly used in contracture surgery, or if variations in technique may have a bearing on surgical outcomes. We investigated the hypothesis that the site of intramuscular tenotomy (IMT) within the muscle-tendon-unit (MTU) of the tibialis posterior (TP) would affect the lengthening characteristics. METHODS: We performed a randomized trial on paired cadaver tibialis posterior muscle-tendon-units (TP-MTUs). By random allocation, one of each pair of formalin-preserved TP-MTUs received a high IMT, and the other a low IMT. These were individually tensile-tested with an Instron(®) machine under controlled conditions. A graph of load (Newtons) versus displacement (millimetres) was generated for each pair of tests. The differences in lengthening and load at failure for each pair of TP-MTUs were noted and compared using paired t tests. RESULTS: We found 48% greater lengthening for low IMT compared to high IMT for a given load (P = 0.004, two tailed t test). Load at failure was also significantly lower for the low IMT. These findings confirm our hypothesis that the site of the tenotomy affects the amount of lengthening achieved. This may contribute to the reported variability in clinical outcome. CONCLUSIONS: Understanding the relationship between tenotomy site and lengthening may allow surgeons to vary the site of the tenotomy in order to achieve pre-determined surgical goals. It may be possible to control the surgical "dose" by altering the position of the intramuscular tenotomy within the muscle-tendon-unit.

Comparison of the effects of on-pump versus off-pump coronary artery bypass surgery on serum prostate-specific antigen levels.

AIM: To compare the effects of coronary artery bypass operation with or without extracorporeal circulation on serum total prostate-specific antigen levels. METHODS: Seventy-six men with a mean age of 57.04+/-9.27 years (range 44-77 years), who underwent coronary artery bypass surgery were enrolled to the study. In 50 patients (Group I), coronary revascularization was performed using extracorporeal circulation, and in 26 patients (Group II) coronary bypass grafting was performed on the beating heart without using extracorporeal circulation. All the patients had serum total prostate-specific antigen levels measured preoperatively and twice postoperatively in the first and fifth postoperative days. Differences in mean total prostate-specific antigen levels between the two groups in the postoperative period were analysed. RESULTS: The mean preoperative total prostate-specific antigen levels in Group I and Group II were 1.28+/-1.13 ng/mL and 1.11+/-0.93 ng/mL, respectively, and there was no significant difference in the preoperative total prostate-specific antigen values between the two groups (P=0.519). In Group I, postoperative means were 4.96+/-6.29 ng/mL and 5.86+/-9.09 ng/mL in the first and fifth days, respectively (P=0.0001, P=0.0001). Total prostate-specific antigen means in the same postoperative period for Group II were 2.13+/-2.72 ng/mL and 2.00+/-2.20 ng/mL, respectively (P=0.014, P=0.024). The comparison of total postoperative prostate-specific antigen levels between the groups showed significantly higher elevation in Group I (postoperative day 1: P=0.013; day 5: P=0.05). CONCLUSIONS: Coronary revascularization can cause a statistically significant rise in serum total prostate-specific antigen levels. This rise is more marked in patients undergoing conventional coronary revascularization.

Assessment of marine pollution in Izmir Bay: nutrient, heavy metal and total hydrocarbon concentrations.

Izmir Bay (western Turkey) is one of the great natural bays of the Mediterranean. Izmir is an important industrial and commercial centre and a cultural focal point. The main industries in the region include food processing, oil, soap and paint production, chemical industries, paper and pulp factories, textile industries and metal processing. The mean concentrations showed ranges of 0.01-0.19 and 0.01-10 microM for phosphate, 0.10-1.8 and 0.12-27 microM for nitrate+nitrite, and 0.30-5.8 and 0.43-39 microM for silicate in the outer and middle-inner bays, respectively. The TNO(x)/PO(4) ratio is significantly lower than the Redfield's ratio and nitrogen is the limiting element in the middle-inner bays. Diatoms and dinoflagellates were observed all year around in the bay and are normally nitrogen limited. Metal concentrations ranged between Hg: 0.05-1.3, Cd: 0.005-0.82, Pb: 14-113 and Cr: 29-316 microg g(-1) in the sediments. The results showed significant enrichments during sampling periods from Inner Bay. Outer and middle bays show low levels of heavy metal enrichments except estuary of Gediz River. The concentrations of Hg, Cd and Pb in the outer bay were generally similar to the background levels from the Mediterranean. The levels gradually decreased over the sampling period. Total hydrocarbons concentrations range from 427 to 7800 ng g(-1) of sediments. The highest total hydrocarbon levels were found in the inner bay due to the anthropogenic activities, mainly combustion processes of traffic and industrial activities. The concentrations of heavy metals found in fish varied for Hg: 4.5-520, Cd: 0.10-10 and Pb: 0.10-491 microg kg(-1) in Izmir Bay. There was no significant seasonal variation in metal concentrations. An increase in Hg concentration with increasing length was noted for Mullus barbatus. A person can consume more than 2, 133 and 20 meals per week of fish in human diet would represent the tolerable weekly intake of mercury, cadmium and lead, respectively, in Izmir Bay. Heavy metal levels were lower than the results in fish tissues reported from polluted areas of the Mediterranean Sea.

Posterior divergent dislocation of the elbow in children and adolescents: a report of three cases and review of the literature.

Divergent dislocation of the elbow is defined as a specific elbow dislocation in which the distal humerus is forced between the proximal radius and ulna, resulting in separation or divergence of the proximal forearm bones. This is an uncommon injury in children, with 14 cases reported in the last 23 years. The authors report three additional cases and the findings from cadaver elbow dissections in which the injury was reproduced. The authors propose that there is only one type of divergent dislocation, resulting from indirect forces transmitted to the elbow from a fall on the outstretched hand. The injury predominantly occurs in younger children because joint laxity is a predisposing cause. Early recognition, followed by a closed reduction and a 3- to 4-week period of cast immobilization, should result in a full recovery for most children.

Accuracy of computed tomography guided core needle biopsy of musculoskeletal tumours.

BACKGROUND: The accurate diagnosis of musculoskeletal tumours is important for successful treatment. Image guided biopsy is gaining increasing acceptance for obtaining tissue for diagnosis. The aim of the present study is to assess the accuracy of computed tomography (CT)-guided core needle biopsy of musculoskeletal tumours. METHODS: This is a retrospective study on a series of 127 patients with a musculoskeletal tumour. The biopsies were performed over a 4-year period from 1998 to 2001. The accuracy of the CT-guided core needle biopsy was determined by comparing the histology of the biopsy with the final histology of the specimen obtained at open biopsy or surgical resection of the tumour. The effective accuracy was determined by the accuracy of the biopsy to distinguish between a benign and malignant tumour. RESULTS: Computed tomography guided core needle biopsy in the present series has an overall accuracy of 80.3%. The effective accuracy as determined by a malignant versus benign lesion was 89%. There were 86 malignant tumours with a biopsy accuracy of 81.4% and there were 41 benign tumours with a biopsy accuracy of 78%. The positive predictive value (PPV) of a malignant tumour is 98.9% and the PPV of benign tumour 90.2%. The most common site of biopsy was from the femur and thigh, together accounting for 39.4% of the tumours. The most common tumours in this series were liposarcoma (n = 12), osteosarcoma (n = 11) and giant cell tumour (n = 11). There were no reported complications arising from the biopsy. CONCLUSION: Computed tomography guided core needle biopsy is a safe and effective procedure that is important in the diagnosis and management of musculoskeletal tumours. It should be performed in a specialized institution with a multidisciplinary musculoskeletal tumour team.

Monitoring of eutrophication and nutrient limitation in the Izmir Bay (Turkey) before and after Wastewater Treatment Plant.

The distribution of inorganic nutrients and phytoplankton chlorophyll-a was investigated and N/P ratios were determined in Izmir Bay during 1996-2001. The average concentrations showed ranges of 0.01-0.19 and 0.01-10 microM for phosphate-phosphorus; 0.11-1.8 and 0.13-27 microM for (nitrate+nitrite)-nitrogen, 0.30-4.1 and 0.50-39 microM for silicate and 0.02-4.3 and 0.10-26 microg l(-1) for chlorophyll-a in the outer and middle-inner bays, respectively. The results are compared with the values obtained from the relatively unpolluted waters of the Aegean Sea. The N/P ratio is significantly lower than the assimilatory optimal (N/P=15:1) in conformity with Redfield's ratio N/P=16:1. Nitrogen is the limiting element in the Izmir Bay. Phosphate, which originates from detergents, is an important source for eutrophication in the bay, especially in the inner bay. In early 2000, a Wastewater Treatment Plant (WTP) began to treat domestic and industrial wastes. This plant treats the wastes about 60% capacity between 2000 and 2001. The sampling periods cover before and after treatment plant. Although the capacity of wastewater plant is sufficient for removal of nitrogen from the wastes, it is inadequate for removal of phosphate. This is also in accordance with the decreasing N/P ratios observed during 2000-2001 (after WTP) in the middle-inner bays.

Trace metal and organochlorine residue levels in red mullet (Mullus barbatus) from the eastern Aegean, Turkey.

The levels of trace metals and organochlorine residue were determined in red mullet (Mullus barbatus) in the framework of a MED-POL II Project for the Aegean Sea during 1994-1998. Samples were analyzed seasonally from July 1994 to January 1998. The concentrations of trace metals found varied with Hg: 16-200 microg kg(-1), Cd: 0.57-4.5 microg kg(-1) and Pb: 40-207 microg kg(-1) wet weight. The order of trace metal concentrations found in Mullus barbatus was Pb > Hg > Cd. Correlation coefficients were calculated between Hg, Cd, and Pb concentrations and fork lengths to be Hg: 0.5852, Cd: -0.081, Pb: 0.5823, respectively. Cadmium levels are lower than the results in fish tissues reported from Mediterranean regions. The results of organochlorine residues measured varied between Aldrin: 0.10 and 0.61 microg kg(-1), t-DDD: 0.86 and 4.5 microg kg(-1) and t-DDE: 10 and 18 microg kg(-1) wet weight. Correlation coefficients for measured organochlorine residues and fork lengths are Aldrin: 0.6422, t-DDD: 0.2237 and t-DDE: 0.5484. The levels of mercury, lead and organochlorine residues are similar to the results in fish from Mediterranean countries.

Comparison of four different denture cushion adhesives--a subjective study.

Four cushion adhesives (Fittydent I; Fittydent II, introduced as an advanced formula; Protefix; and Seabond) were compared clinically through patients subjective evaluations. Maxillary dentures of 32 patients were relined and the mandibular dentures were scored by Kapur index before the application of different treatments. The cushion adhesives were used only with the existing mandibular prosthesis. The four treatments were applied to the patients in groups of 8 by allocating each group randomly to one of the four sequences of treatments determined by latin square design. Each patient took each treatment only once. The adhesives were applied by the authors as recommended by the manufacturers. Patients used each material for 24 h and, through a questionnaire, they evaluated the seven following aspects of each different cushion material: retention, duration of retention, effects on ability to chew, effects on other oral functions, cleansing of dentures, cleansing of gums, and an overall evaluation of materials. Both Fittydent products significantly improved denture retention and the ability to chew. The patients who expressed 'much better' chewing with Fittydent products, had mandibular dentures rated poor or fair.

The role of denture cleansers on the whitening of acrylic resins.

Dentists and denture wearers have reported that the regular use of a denture cleanser causes whitening of dentures. The whitening effect of denture cleansers on acrylic resin dentures was investigated using four different types of agents on six different types of acrylic resin discs. The color values of the samples were measured using a reflectometer. The greatest whitening effect was seen on autopolymerizing acrylic resins for one of the denture cleansers with all the resins tested.

Orthodontic intervention in adult patients as an adjunct to prosthetic and restorative dentistry.

Combined orthodontic-prosthodontic procedures will enhance the results of restorative treatment in adult patients. Restoration of malposed teeth using prostheses alone will fail both esthetically and functionally. Rotation, spacing or crowding and tipped teeth will compromise the final restoration if left untreated. Correction of axial inclination will prevent pulp exposure during preparation, as well as improving the periodontal status of the involved teeth. Cooperation between the orthodontist and the prosthodontist will ensure a more favorable final result. Cases treated in this manner are presented, illustrating the orthodontic treatment and the successful end results.

The biological effects of implanted magnetic fields on the bone tissue of dogs.

Five titanium caps were implanted in the mandibles of five dogs. Three caps contained Sm-Co mini magnets and two caps were empty. The aim of this study was to determine if implanted magnetic fields had any biological effects on the bone tissue of dogs. At the end of 6 months, the animals were sacrificed and segments containing implants and segments from the side opposite the implants, for control, were removed. Sections were made from the specimens and no pathology was seen upon microscopic examination.

Effect of the major connector on abutment tooth and denture base movement: an in vitro study.

This in vitro study investigated the effect of the major connector on distal abutment tooth and denture base movements when loads were applied to a partial denture with extracoronal attachments. A brass mechanism was constructed for load application, and the abutment and base movements were measured in three planes using a kinesiograph. It was determined that cutting the major connector affected the degree of abutment tooth movement but not the direction. After cutting the major connector, the base movement increased in all three planes with the different forces applied. The direction of the base movement changes only in the buccolingual plane.

Abutment teeth with extracoronal attachments: the effects of splinting on tooth movement.

This in vitro study investigated the effects of splinting on abutment tooth movement when loads were applied to a removable partial denture framework with extracoronal attachments. The abutment tooth movements occurring in the vertical, frontal, and sagittal planes were measured with a kinesiograph modified for the purpose. It was demonstrated that splinting abutment teeth resulted in a significant decrease in the mesiodistal and buccolingual movements of the distal abutment under vertically applied loads. The direction of the abutment tooth movement was related to the type of loading and was unaffected by splinting. Bilateral loading produced significantly less movement of the single abutment tooth mesiodistally and buccolingually than unilateral loading.