[Venous thromboembolism prophylaxis in major orthopaedic surgery: A multicenter, prospective, observational study]. / Majör ortopedik cerrahilerde venöz tromboemboli profilaksisi: Cokmerkezli, prospektif, gözlem çalismasi.

OBJECTIVES: We investigated risk factors for venous thromboembolism (VTE), prophylaxis measures employed, and incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing major orthopaedic surgery (MOS). METHODS: An open, multicenter, prospective, observational study was conducted in 21 medical centers, comprising 899 patients. Of these, 316 patients (35.2%) underwent total hip arthroplasty (THA), 328 patients (36.5%) underwent total knee arthroplasty (TKA), and 255 patients (28.4%) underwent surgery for hip fractures (HF). Pharmacologic prophylaxis was employed in all the patients. RESULTS: Risk factors for VTE were seen in 73.2% of the patients, the most common being obesity (72%) and prolonged immobilization (36.3%). Low-molecular-weight heparin (91.1%) and fondaparinux (8.9%) were used for prophylaxis, which was short-term in 273 patients (30.4%) and long-term in 626 patients (69.6%). Mechanical prophylaxis was performed with compression stockings in 610 patients (67.9%) and by intermittent pneumatic compression in 67 patients (7.5%). During three-months of follow-up, symptomatic DVT and PE were seen in eight (0.9%) and four patients (0.4%), respectively. Mortality occurred in 10 patients (1.1%). Complications of major and minor bleeding were seen in eight (0.9%) and 40 (4.5%) patients, respectively. CONCLUSION: Effective VTE prophylaxis is associated with low risk of clinically apparent DVT and PE in MOS.

Examination of developmental models of occupational burnout using burnout profiles of nurses.

AIM: This paper is a report of a study to identify the occupational burnout profiles of a sample of nurses in Turkey and to examine alternative developmental models of burnout based on these profiles. BACKGROUND: Previous findings on causal links between components of occupational burnout have largely been inconclusive. There are divergent models of inter-temporal ordering of emotional exhaustion, depersonalization and personal accomplishment, which are the three dimensions of burnout. METHOD: Data were collected with 248 nurses from five hospitals in Turkey in 2007. The Maslach Burnout Inventory was used to collect burnout data and the Job Descriptive Index was used to measure satisfaction with coworkers and supervisors. Following validity and reliability analyses of these instruments, burnout profiles were identified using cluster analysis and the resulting profiles were validated using analysis of variance. RESULTS: Three burnout profiles were identified and validated. Findings suggest a coupling of emotional exhaustion and depersonalization. That is, nurses who reported higher levels of emotional exhaustion also reported higher levels of depersonalization. Examination of the profiles suggested a non-linear relationship between personal accomplishment and emotional exhaustion or depersonalization. More specifically, nurses with higher emotional exhaustion or depersonalization did not always report lower personal accomplishment. CONCLUSION: Partial support for the developmental model that endorses temporal precedence of emotional exhaustion was found. The model that emphasizes temporal precedence of depersonalization was not supported. Depersonalization was found to be a dysfunctional coping strategy with respect to emotional exhaustion. Emotional exhaustion rather than depersonalization or perceptions of personal accomplishment should be screened for early detection and prevention of burnout.

Hip arthroplasty for ochronosis.

Alkaptonuria is a metabolic disorder in which homogentisic acid oxidase is absent. Therefore, homogentisic acid accumulates in cartilage and connective tissues. We can diagnose ochronotic arthropathy, a manifestation of long standing alkaptonuria, through careful radiological, physical, and laboratory examination. In this report, we describe 4 cases of ochronotic arthropathy to which we applied cementless total hip prosthesis due to severe hip involvement.

Anterior tibial compartment syndrome due to the pyomyositis in a patient with rheumatoid arthritis. A case report.

Anterior tibial compartment syndrome was developed due to pyomyositis in a 33-year-old male patient with rheumatoid arthritis while receiving steroid therapy during the follow-up period. The preoperative physical examination, laboratory findings, MRI images, intraoperative observation and postoperative histopathological examinations confirmed the association with pyomyositis. The surgical drainage and antibiotic treatment were effective, and in the follow-up period, neuromuscular dysfunctions disappeared completely within 6 months. The patient has been asymptomatic for 4 years of follow-up. To date, anterior tibial compartment syndrome due to pyomyositis in a case with rheumatoid arthritis has not been reported.

The effect of ultrasound on the healing of muscle-pediculated bone graft in spinal fusion.

STUDY DESIGN: A rabbit model of posterolateral intertransverse process spine arthrodesis with and without the application of low-intensity ultrasound was used. OBJECTIVE: To determine the effects of low-intensity ultrasound on the healing of muscle-pediculated bone graft. SUMMARY OF BACKGROUND DATA: Earlier animal and clinical studies demonstrated the efficacy of low-intensity ultrasound stimulation in the acceleration of osteogenesis and fracture healing. This is the first study in which the beneficial effects of ultrasound on the healing of muscle-pediculated bone graft in spinal fusion have been assessed. METHODS: In this study, 20 New Zealand rabbits were randomly assigned to two groups to undergo either spinal fusion using muscle-pedicle bone graft with ultrasound (ultrasound group) or muscle-pedicle bone graft without ultrasound (control group). Muscle-pediculated bone grafts were prepared from the posterosuperior iliac crest, erector spine muscle, and internal and external oblique muscle. This graft was placed bilaterally between the L5 and L6 transverse processes. Ultrasound was performed 20 minutes per day over the rabbits' lumbar spine. The rabbits were killed 6 weeks after surgery. The lumbar spines were evaluated radiologically, macroscopically, and histologically. RESULTS: By macroscopic and radiologic findings, fusion was detected in 11 control group rabbits (55%) of the control group, and in 17 ultrasound group rabbits (85%). The fusion success rate for the rabbits treated with low-intensity ultrasound were statistically higher (P <0,05) than that for the control group. Histologic specimens showed increased bone formation in the fusions exposed to ultrasound. Mature fusions were present in rabbits that received ultrasound. CONCLUSION: Low-intensity ultrasound in white rabbits increased the rate and quality of spinal fusion using muscle-pediculated bone grafts.