Can The Systemic Immune-Inflammation Index (SII) and Charlson Comorbidity Index (CCI) be used to predict mortality in patients with necrotizing fasciitis?

PURPOSE

This study aimed to determine the impact of mortality and morbidity indices on the diagnosis and prognosis of patients suffering from necrotizing fasciitis.

METHODS

A retrospective analysis was performed on 41 patients (26 females, 15 males) with necrotizing fasciitis (NF). The SII (Systemic Immune-Inflammation Index) was computed using the formula SII = (P × N)/L, where P, N, and L measure the counts of peripheral platelets, neutrophils, and lymphocytes, respectively. This study evaluated the clinicopathological characteristics and follow-up information to assess the comparative effectiveness of SII, CCI (Charlson Comorbidity Index), and LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) scores as mortality and morbidity indices for patients with NF.

RESULTS

The optimal cut-off for SII was determined to be 455. The SII value in the group with mortality was significantly higher compared to the group without mortality (p < 0.05). The CCI value in the group with mortality was significantly higher than the group without mortality (p < 0.05). The SII and CCI values were found to be effective in distinguishing between patients who suffered mortality and those who did not.

CONCLUSION

SII is a powerful tool for predicting mortality in patients with necrotizing fasciitis (NF). The SII index provides a novel, easily accessible, and inexpensive indicator for monitoring the progress and predicting the survival of patients with NF.

Mortality analyses of elderly patients with proximal femoral fracture during the pandemic: vaccination affects or not

PURPOSE

To evaluate the mortality rate, intensive care unit (ICU) referral, and Charlson comorbidity index (CCI) between different types of vaccinated and non-vaccinated patients operated on due to intertrochanteric femoral fracture (IFF) during the pandemic.

METHODS

Ninety-six patients (43 males, 53 females) who had proximal femur nails (PFN) for the IFF during the pandemic were included in the study. The patients were divided into four subgroups; non-vaccinated, and different types of vaccinated. Mortality rates, ICU referrals, and CCI relations were evaluated.

RESULTS

No significant difference was observed in terms of demographic data such as age, gender, side, CCI, and ICU referrals between the subgroups (p = 0.164, p = 0.546, p = 0.703, p = 0.771, p = 0.627 respectively). The mortality rate was significantly lower in the Sinovac + BioNTech subgroup (p = 0.044).

CONCLUSION

No relationship was found between mortality rate, ICU referral, and CCI in different types of vaccinated and non-vaccinated patient subgroups.

Comparison of Functional and Radiological Outcomes of Transforaminal Lumbar Interbody Fusion and Posterolateral Fusion Techniques in the Treatment of Lumbar Spinal Stenosis

BACKGROUND

This study aimed to compare posterolateral fusion with transforaminal lumbar interbody fusion (PLF + TLIF) and PLF only in terms of revision surgery rates and complications, as well as functional and radiological outcomes in lumbar spinal stenosis (LSS) patients.

METHODS

Seventy-one patients (37 patients in the PLF + TLIF group and 34 patients in the PLF only group) who underwent surgery due to LSS between January 2013 and December 2016 were retrospectively investigated. Functional evaluation was performed by using the McGill-Melzack Pain Questionnaire (MPQ), Roland Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI) scales pre-and postoperatively. Radiological evaluation was made by examining adjacent vertebrae, posterior ligamentous complex (PLC) morphology, and sagittal balance on magnetic resonance imaging (MRI).

RESULTS

Postoperative MPQ, RMDQ, and ODI scores were significantly better in the PLF + TLIF group (p < 0.001, p < 0.001, and p = 0.001, respectively). The complication rate was significantly higher in the PLF only group (p = 0.026). In the PLF + TLIF group, postoperative functional scores showed significant improvement in terms of the instrumented segment and level of interbody fusion. Postoperative functional scores showed significant improvement in PLF + TLIF patients with no complications, no revision surgery, no postoperative MRI findings, and neutral sagittal balance compared to the preoperative functional scores (p < 0.001).

CONCLUSION

PLF + TLIF is significantly superior in terms of functional scores and complications, despite the statistical similarity in terms of postoperative MRI findings and sagittal balance between the groups. Surgeons should prefer PLF + TLIF for the surgical treatment of LSS for better results.

Does plate-screw density affect the functional outcomes in the treatment of proximal humerus fractures?

BACKGROUND

The aim of the study is to evaluate the relationship between plate-screw density (PSD), functional results, and complication rates in the treatment of proximal humerus fractures (PHFs) with proximal humerus locking anatomical plate (PHLAP).

METHODS

Consecutive 43 patients (22 females and 21 males) who underwent PHLAP for the treatment of PHF between 2010 and 2016 were evaluated. AO classifications were used for the classification of fractures. Based on the biomechanical stability the-ory of Erhardt et al., the patients were divided into two groups as <60% and >60% according to the number of screws fixed to the humeral head for the determination of PSD. The patients were divided into two groups as PSD <60% (n=21) and PSD>60% (n=22) according to the number of screws fixed to the humeral head for the determination of PSD. Functional results were evaluated using the Constant-Murley shoulder score (CMS). Radiological evaluation was performed with collodiaphyseal angle (CDA), varus-valgus angulation, avascular necrosis (AVN), and arthrosis. The groups were compared in terms of demographic characteristics, functional results, radiological scores, and complications.

RESULTS

The mean age was 54.47±17.43 years and the mean follow-up time was 19.51±5.27 months. Although the CMS scores of patients with a PSD of over 60% were higher than those below 60%, the CMS score did not differ statistically. In groups, the mean CDA of the operated shoulder was significantly lower than that of the non-injured side (p=0.002). Eight patients had varus angulation, whereas two patients had humerus head AVN. No significant relationship was observed between PDS and functional scores, radiolog-ical results, and complications.

CONCLUSION

Functional results of PSD >60% are higher than PSD <60% group but there is no statistical difference between groups according to functional, radiological results, and complications.

Fibular fixation improves ankle functional outcomes and alignment in the intramedullary nailing of distal third tibiofibular diaphyseal fractures

PURPOSE

The study aims to determine the effect of fibular fixation on alignment and fracture healing of tibia, and ankle functional outcomes in the treatment of distal third tibiofibular diaphyseal fractures.

METHODS

Consecutive 111 patients (33 females and 78 males) with distal third tibiofibular diaphyseal fracture who met the inclusion criteria were included in the study. Patients were divided into two groups as those who underwent fibular fixation with tibia intramedullary nailing (study group) and those who did not (control group). Groups were compared in terms of demographic features, trauma and fracture characteristics, functional and radiological outcomes.

RESULTS

No significant difference was observed between the groups in terms of demographic features, trauma characteristics, complications, and follow-up time (p > 0.05). Surgery time was significantly lower in the control group (p = 0.001). Ankle joint range of motion, AOFAS score, OMAS score, and full weight-bearing time were significantly better in the fibular fixation group (p = 0.023, p = 0.001, p = 0.001 and p = 0.039, respectively). Significantly better coronal alignment and sagittal alignment were found in the fibular fixation group (p = 0.001 and p = 0.001, respectively). Patients who underwent fibular fixation had significantly better radiological outcomes in terms of fibular rotation angle and ankle arthrosis (p = 0.000 and p = 0.022, respectively).

CONCLUSION

Fibular fixation not only contributes to fracture union, early full weight-bearing, and alignment but also improves ankle functional outcomes in the distal third tibiofibular fractures treated with intramedullary nailing for tibia.

LEVEL OF EVIDENCE

Level III, retrospective study.

Erectile Dysfunction after Conservative Treatment of Sacral Fractures in Males without Injury to the Urinary System

BACKGROUND

This study aimed to determine the incidence of erectile dysfunction (ED) reported by patients, and to define the prognostic relationship between ED and conservatively treated sacral fracture without urethral injury.

METHODS

Patients aged between 20 - 50 years who were sexually active and had no known sexual dysfunction prior to the trauma were included in the study. Seventy-seven patients (47 married, 30 single) treated conservatively for sacral fracture between April 2012 and February 2017 were retrospectively screened. Patients were compared in terms of age, marital status, body mass index (BMI), trauma mechanism, additional system injury, functional outcomes, and complications. Functional outcomes were assessed using the International Index of Erectile Function (IIEF-5) and the Majeed pelvic fracture functional assessment scale (MPS).

RESULTS

No statistically significant difference was observed between fracture types with respect to age, BMI, follow-up, marital status, trauma mechanism, and accompanying injury. The incidence of ED was 27.3% for those that received conservative treatment after sacrum fracture. The mean score of IIEF-5 was 18.6 ± 6.6 and MPS was 77.2 ± 13.2. There was no significant relationship between the injury type of the patients and the IIEF-5 and MPS scores (p = 0.593 and p = 0.907, respectively). The lowest IIEF-5 score was found in Denis type 2 fractures (p = 0.020).

CONCLUSION

The frequency of ED was higher in Denis type 2 sacrum fractures. Sexual function should be questioned in the follow-up, especially in those fracture types.

Micro-Computed Tomography Analysis of Fit of Ceramic Inlays Produced with Different CAD Software Programs

PURPOSE

The aim of this study was to evaluate marginal and internal fit of ceramic inlays designed with different computer-aided design software programs.

MATERIALS AND METHODS

11 typodont mandibular first molars were prepared as a ceramic class II mesioocclusal inlay cavity. Teeth were scanned using 3Shape TRIOS Intraoral Dental Scanner. The scan data, which was obtained in the form of a STL file, was designed in three different CAD systems (CEREC, KaVo, and Planmeca). The obtained STL scan data was exported to design inlay using three different CAD systems (CEREC, KaVo, and Planmeca). An independent 5-axis milling unit was used to manufacture the feldspatic inlay restorations. 11 measurements for each teeth were made by using micro-ct to evaluate the marginal and internal fit. One-way ANOVA was used to determine the statistical difference between groups, and Tukey posthoc test was used to determine intra-group differences.

RESULTS

According to repeated ANOVA test results, a statistically significant difference was found between the groups for the variables A, D, and F. There was no statistically significant difference between the groups in linear measurements for other measurement points and volumetric measurements (p⟩0.05).

CONCLUSION

Software programs of different systems affects the marginal and internal fit of inlay restorations.

The effect of fibrin clot and C vitamin on the surgical treatment of Achilles tendon injury in the rat model✰

BACKGROUND

This study aimed to determine the histological, biochemical, and biomechanical efficacy of fibrin clot and vitamin C in the healing of Achilles tendon ruptures (ATR) in a rat model.

METHODS

52 adult Wistar-Albino rats (300-450 g) were used in the study. 12 rats were divided into four groups as Monitor (Group I), Control (Group II), Fibrin Clot (Group III), Fibrin Clot with vitamin C (Group IV). Four rats were used for fibrin clot preparation. Fibroblast Growth Factor (FGF) and Vascular Endothelial Growth Factor (VEGF) were measured on the 3rd, 7th, 14th, and 21st days. Four rats were sacrificed on the 21st day from each group for histological evaluation. The rest of the rats were sacrificed at 42nd day, half for biomechanical and a half for histological evaluation.

RESULTS

The 42nd-day HSS score of group IV was significantly lower than those of group I, group II and group III (p = 0.036, p = 0.019, and p = 0.036, respectively). Group IV showed a significantly higher Maximum force N value than those of group I, group II and group III (p = 0.034, p = 0.034 and, p = 0.025, respectively). The blood FGF and VEGF levels of group III and group IV on the 3rd, 7th, 14th, and 21st days were higher than those of group I and group II (p < 0.05).

CONCLUSION

Fibrin clot and vitamin C produced a stronger tendon structure in terms of biomechanics while providing histological and biochemically better quality tendon healing in the surgical treatment of ATR. This model can be used to accelerate high-quality tendon healing after ATR.

LEVEL OF EVIDENCE

Level II, experimental study.

Comparison of two types of fixation for proximal tibial epiphysiodesis: An experimental study in a rabbit model

Objectives

In this study, we describe a novel hemiepiphysiodesis technique to prevent implant-related perichondrial ring injury in a rabbit model.

Materials and methods

Proximal tibial epiphyseal plates of a total of 16 white New Zealand rabbits were used for this animal model. The subjects were divided into three equal groups as follows: Group 1 (Kirschner wire [K-wire]/cerclage), Group 2 (8-plate) right-hind legs, Group 3 (Control) left hind legs. Using anteroposterior radiography, the medial slope angle (MSA), articular line-diaphyseal angle (ALDA), and the angle between screws of 8-plate in lateral X-ray tibial slope angle (TSA) were measured. The radiographs were taken early postoperative (Day 1) and on sacrification day (Week 8). The histological evaluation of the perichondrial ring was made on a 7-mm axial section that stained with Safranin O/fast green at X10 magnification.

Results

In both K-wire and 8-plate groups, the early postoperative ALDA and TSA were greater than the sacrification ALDA and TSA (p=0.028 and p<0.001, respectively). The early postoperative MSA was lower than the sacrification MSA in groups, (p<0.001). The MSA in the control group was lower than the K-wire and 8-plate groups (p<0.001 and p=0.009; respectively). The perichondrial ring thickness of the K-wire group was greater than the 8-plate group in histological evaluation (p<0.001).

Conclusion

Both of the K-wire and 8-plate groups showed similar angulation effects in the proximal tibia, although histologically less damage to the perichondrial ring was observed in the K-wire group, compared to the 8-plate group.

Could percutaneous fixation with crossed Schanz pins be an alternative to open reduction in the treatment of intra-articular calcaneal fractures?

PURPOSE

Despite modern operative techniques and a considerable number of studies in the literature, the best treatment for calcaneal fractures remains an enigma for orthopaedic surgeons. The purpose of the study was to compare clinical and radiographic outcomes between anatomic calcaneal plate (ACP) fixation and crossed Schanz pin (CSP) fixation in the treatment of Sanders type II and III displaced intra-articular calcaneus fractures (DICFs).

METHODS

Consecutive 65 patients (49 males, 16 females) who underwent surgery for DCIFs between January 2009 and February 2013 were retrospectively evaluated. The patients were divided into two groups as ACP and CSP according to the operative technique. The groups were compared in terms of demographic features, injury mechanism, operation time, fluoroscopy exposure, complications, full weight-bearing time, functional, and radiological outcomes.

RESULTS

VAS-rest score did not differ significantly between the groups while the VAS-activity score was significantly higher in the CSP group (p = 0.001 and p = 0.645, respectively). Foot Function Index (FFI) was significantly lower, Maryland Foot Score (MFS) and the American Orthopaedic Foot and Ankle Society-hindfoot score (AOFAS) were significantly higher in the ACP group (p = 0.047, p = 0.016, and p < 0.001, respectively). While no difference was observed between the preoperative and the early post-operative (1st day) Böhler angle and Gissane angle, both were significantly higher in the ACP group at the post-operative last control (p < 0.001 and p < 0.001, respectively).

CONCLUSION

Although crossed Schanz pin fixation shortens the operation time in displaced intra-articular calcaneus fractures compared to anatomic calcaneal plate, increased fluoroscopy exposure rates and low functional and radiological outcomes are disadvantageous of crossed Schanz pin. Anatomic calcaneal plate is still a better technique for preserving the alignment and elevating the displaced intra-articular segment for good to excellent mid-term results.

The Influence of Lumbar Modifiers on Functional and Radiological Outcomes in the Brace Treatment of Lenke Type 1 Adolescent Idiopathic Scoliosis

BACKGROUND

Brace treatment prevents the progression of scoliosis and reduces surgical treatment rates. However, the efficacy of brace treatment varies depending on the patient's age, gender, curve magnitude and type, structure of the curve, and patient compliance at the beginning of treatment.

METHODS

Between January 2009 and April 2015, 106 Lenke type 1 AIS consecutive patients (69 females, 37 males) who were treated with a brace were examined in three groups according to Lenke classification lumbar modifiers. The patients were evaluated at pre-bracing and 1 and 2 years after bracing. The Scoliosis Research Society 22 (SRS-22) and Oswestry Disability Index (ODI) were used for functional evaluation. Radiological evaluation revealed the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, trunk shift, shoulder asymmetry, and body height difference.

RESULTS

Functional and radiological evaluation showed a statistically significant improvement in Lenke 1A, 1B, and 1C at 1 and 2 years after bracing compared to the pre-bracing (p = 0.000, p = 0.000, and p = 0.000, respectively). Lenke 1C had the best ODI score and followed by decreasing values of 1B and 1A respectively (p = 0.009). Lenke 1B had the best SRS-22 score and the mean scores of 1A and 1C were equal (p = 0.017). There was no significant difference between the groups in the parameters other than the trunk shift in radiological evaluation (p = 0.043).

CONCLUSIONS

Significant improvement was observed in all types of lumbar modifiers at the end of the 2nd year compared to pre-bracing. The best improvement in the ODI score was in the 1C modifier, whereas the best improvement in the SRS-22 score was in the 1B modifier. The type of lumbar modifier should be directly taken into consideration before starting brace treatment in Lenke type 1 AIS.

LEVEL OF EVIDENCE

Level III, retrospective study.

Efficacy and cost-effectiveness of the cell saver system in instrumented posterior fusion with thoracic and lumbar vertebral fractures

BACKGROUND

The aim of our study was to determine the efficacy and cost-effectiveness of intraoperative autotransfusion that uses the cell saver system (CSS) in patients undergoing posterior instrumentation and fusion of thoracic and lumbar vertebral fractures.

METHODS

We divided 121 patients who were to undergo posterior instrumentation and fusion due to thoracic and lumbar vertebral fractures into two groups: 59 patients (23 males and 36 females) were in the cell saver group, and 62 patients (22 males and 40 females) were in the control group. Hemoglobin, hematocrit, and red blood cell (RBC) values were recorded for all patients preoperatively, on the postoperative first, second, and third days, and on the hospital discharge day. Transfusion rates and numbers of allogeneic erythrocyte transfusions, as well as the costs of transfused total auto- and allogeneic transfusions were compared.

RESULTS

The numbers of erythrocyte suspensions transfused perioperatively were 0.2±0.6 units in the cell saver group and 0.7±1.4 units in the control group (p=0.01). Statistically significant differences were noted between the two groups on the postoperative first, second, and third days in terms of hemoglobin, hematocrit, and RBC values. These differences had disappeared by the hospital discharge day. The average cost of perioperative blood transfusions was $431±27.4 in the cell saver group and $34.5±66.25 in the control group (p<0.001).

CONCLUSION

The use of the CSS was not cost-effective, but it was particularly successful at reducing the rate and the number of units of postoperative allogenic blood transfusions.

Relationship of epicardial fat tissue thickness with oxidant biomarkers in chronic kidney disease

INTRODUCTION AND OBJECTIVE

IMA and MPO are elevated in serum in case of end-stage renal disease. Epicardial fat tissue thickness has been considered an indicator for cardiovascular diseases recently. The present study was aimed to examine the relationship of epicardial fat tissue thickness (EFTT) with IMA and MPO levels in patients with CKD.

MATERIALS AND METHODS

Predialysis CKD patients admitted to the Nephrology outpatient clinic, patients on haemodialysis and healthy volunteers were included, 111 patients were in the study. EFTT measurement was performed with the transthoracic view using an ECHO device.

RESULTS

The analysis conducted among the groups in terms of IMA, MPO levels, and EFTT revealed a statistically significant difference (p < 0.001). It was determined to be the lowest in the healthy volunteers, slightly increased in the pre-dialysis group whereas it was quite high in the haemodialysis group. According to the correlation test performed, we observed that IMA, MPO levels, and EFTT were found to be highly correlated to progression of CKD.

CONCLUSION

We believe that we have introduced three novel follow-up parameters, such as: IMA, MPO, EFTT to literature for the follow-up of CKD. As the levels of IMA MPO and EFTT increase, the severity of CKD increases (Tab. 4, Fig. 1, Ref. 25).

Comparison of the functional results of radial head resection and prosthesis for irreparable mason type-III fracture

BACKGROUND

The radial head is essential for the rotational stability of the forearm and resistance to valgus stress. Radial head fractures are the most common elbow fracture in adults. Various treatment options are available, depending on the fracture severity. However, the treatment of Type-III fractures is controversial. The aim of this study was to evaluate functional results in patients with irreparable Mason Type-III radial head fractures treated with radial head resection or prosthesis.

METHODS

Fourteen irreparable Mason Type-III radial head fracture patients treated with radial head resection (n=7) or radial head prosthesis (n=7) were evaluated in this multicenter, retrospective study. Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow and Wrist scores were used to determine clinical outcomes. A hydraulic hand dynamometer was used to measure grip strength on the operated and unoperated sides to avoid potential bias. Measurements were made three times for each extremity, and the mean value was recorded. Grip strength was calculated as a percentage of the strength of the unoperated side.

RESULTS

Functional outcomes for resection and prosthesis patients were the following: mean DASH scores, 25.8 and 17.2; mean Mayo Elbow scores, 74 and 84.1; mean Mayo Wrist scores, 84 and 92.5; and maximum grip strengths, 48.8% and 77.8%, respectively. The range of motion of the respective resection and prosthesis groups were as follows: flexion, 112.14° and 104.29°; extension, -10.00° and -25.00°; pronation, 70.00° and 47.86°; and supination, 70.00° and 52.14°.

CONCLUSION

Although range of motion was restricted in the radial head resection group, functional results and grip strength were superior in patients treated with a radial head prosthesis. These results support the radial head prosthesis as a superior treatment modality for patients with irreparable Mason Type-III radial head fractures with respect to patient satisfaction and functional outcomes.

Medial mini-open versus percutaneous pin fixation for type III supracondylar fractures in children

BACKGROUND

The present objective was to compare medial mini-open and percutaneous treatment of pediatric supracondylar fractures according to fluoroscopy time, duration of surgery, and iatrogenic ulnar nerve injury.

METHODS

A total of 104 Gartland type III supracondylar humerus fractures were prospectively evaluated between 2011 and 2013. Patients were divided into 2 groups according to type of fixation. In Group A (41 patients), medial pin was inserted with mini-open incision with 2 lateral pins inserted percutaneously. In Group B (63 patients), all pins were inserted percutaneously. Mean follow-up time was 14.1±1.2 months in Group A, and 14.6±2.1 months in Group B. All patients were postoperatively evaluated for nerve injury with both motor and sensory function assessment. Length of surgery, total fluoroscopy time, fluoroscopy time for medial pin insertion, Baumann's angle, humeral capitellum angle, final carrying angle, and range of motion were recorded.

RESULTS

Sensorial evaluation showed that Group A had 3 poor, and 1 fair results, and Group B had 2 poor, and 1 fair results. No statistically significant differences were observed, including no differences in either surgery or total fluoroscopy times between groups. However, fluoroscopy time during medial pin placement was significantly lower in the mini-open group.

CONCLUSION

In conclusion, similar results of both techniques were observed, and both carry risk of iatrogenic ulnar nerve injury. Medial pin placement is easier and less demanding when used with mini-open technique.

Fourth and fifth carpometacarpal fracture dislocations

OBJECTIVE

The aim of this study was to evaluate the mid-term results of patients with surgically treated 4th and 5th carpometacarpal (CMC) fracture dislocation.

METHODS

The study included 9 CMC dislocation patients (9 males; mean age: 31.2 years, range: 20 to 40 years) treated with open reduction and internal fixation between 2008 and 2012. Mean follow-up period was 19.4 months. Mean interval between trauma and operation was 10.7 (range: 3 to 35) days. Radiological evaluation was performed at the final follow-up. Hand grip power was measured using a hand dynamometer and the injured and uninjured sides were compared.

METHODS

There was a statistically significant difference compared to the injured side in hand dynamometer measurements (p<0.05). Three patients experienced pain during heavy labor. Among these cases, 2 had delayed diagnosis and 1 a comminuted CMC dislocation and was unable to return to his previous job. There were no recurrent dislocations or revision surgery due to complications.

CONCLUSION

Early diagnosis and treatment of 4th and 5th CMC dislocation results in good anatomical and functional results. Delayed or incorrect diagnosis of this region causes severe radiological and functional problems. Detailed physical and radiological examination can prevent CMC dislocation from being overlooked.

A new joystick technique for unsuccessful closed reduction of supracondylar humeral fractures: minimum trauma

BACKGROUND

The purpose of this study was to compare operation duration, radiological and functional results of the open reduction with either posterior or lateral approach and closed reduction with joystick method in unsuccessful closed reduction of displaced (Gartland type III) supracondylar humeral fractures.

METHODS

Between February 2010 and August 2011, 37 patients who were not obtained satisfactory reduction with classic closed reduction attempts for three times in operating room were included in this study. Patients were treated with three different surgical methods. Group I have 13 patients who had joystick and lateral K-wire-assisted closed reduction, group II have 12 patients who had open reduction by lateral approach, and group III have 12 patients who had open reduction by posterior approach. In final follow-up, AP and lateral radiographs of both elbows were taken and bilateral Baumann angles, lateral humerocapitellar angles, carrying angles, and elbow range of motion were measured. These angles and operation times compared between the groups. The functional and cosmetic outcome of surgery was evaluated by criteria of Flynn et al.

RESULTS

There was no statistical significance difference between Baumann angles, lateral humerocapitellar angles, and carrying angles of fractured and uninjured sides in between three groups (respectively, p = 0.761, p = 0.354, p = 0.750). In group I, operation duration is shorter than the other groups. Functional scoring showed that in group I and group II, all patients have satisfactory results; however, in group III, three patients (25%) had poor results. In the perspective of cosmetic results, all three groups have satisfactory results.

CONCLUSIONS

When classical closed reduction fail, lateral joystick and K-wire-assisted reduction is a useful way to make and maintain the reduction. Functional and radiological results are as good as lateral and posterior open approaches. Short operation time is an advantage. This method reduces the risk of complications due to repeated closed reduction and open reduction in unsuccessful closed reduction in pediatric supracondylar humeral fractures.

LEVEL OF EVIDENCE

Level III.

Increased uric acid levels in bipolar disorder: is it trait or state?

The aim of the present study was to compare uric acid levels between disease and remisson episodes of bipolar disorder (BD) and healthy individuals and to investigate whether uric acid levels were related with clinical properties and the course. Uric acid levels were compared in 43 BD patients with manic episode, 20 BD patients with depressive episode, 41 BD patients in remission and 43 healthy individuals. Informations regarding disorder was recorded using SKIP-TURK, the severity of episode was measured with Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS). Uric acid levels were found higher in manic, depressive and euthymic bipolar patients than those in healthy individuals. In cases in remission period, a moderate relation was present between uric acid levels and the age of onset. A moderate relation was found in manic episode between first and second week YMRS scores and uric acid levels, and a strong relation was found in depressive episode between first and second week HDRS scores and uric acid levels. While decrease in uric acid levels in manic episode was found to be associated with the decrease in YMRS scores, no such relation was shown in depressive episode. Our findings stress the impairment in purinergic functions in all episodes of BD. This impairment seems to be associated with clinical properties of BD.

A complete low cost radon detection system

Monitoring the (222)Rn activity through the 1200 km long Northern Anatolian fault line, for the purpose of earthquake precursory, requires large number of cost effective radon detectors. We have designed, produced and successfully tested a low cost radon detection system (a radon monitor). In the detector circuit of this monitor, First Sensor PS100-7-CER-2 windowless PIN photodiode and a custom made transempedence/shaping amplifier were used. In order to collect the naturally ionized radon progeny to the surface of the PIN photodiode, a potential of 3500 V was applied between the conductive hemi-spherical shell and the PIN photodiode. In addition to the count rate of the radon progeny, absolute pressure, humidity and temperature were logged during the measurements. A GSM modem was integrated to the system for transferring the measurements from the remote locations to the data process center.

A single dose of erythropoietin attenuates lipid peroxidation in experimental liver ischemia-reperfusion injury in the rat fetus

OBJECTIVE

The aim of the study was investigate the effectiveness of recombinant human erythropoietin (r-Hu-EPO) in attenuating the severity of experimental liver ischemic injury in fetal rats.

METHODS

The animals were divided randomly into four groups. In the control group, fetal whole liver tissue was taken immediately after laparotomy from pregnant animals. In the ischemia-reperfusion (I/R) group, tissue samples were taken immediately after I/R injury. In the vehicle group, 0.4 ml of human serum albumin solution and in the treatment group, r-Hu-EPO (5000 IU/kg) in 0.4 ml of human serum albumin solution were given intraperitoneally, 30 min before I/R injury, as a single dose. Thiobarbituric acid-reactive substances (TBARS) were estimated to demonstrate lipid peroxidation.

RESULTS

Lipid peroxidation byproducts increased after I/R injury. Administration of r-Hu-EPO reduced TBARS after I/R injury.

CONCLUSION

Further investigations are needed to understand the mechanism of the hepatoprotective effect of erythropoietin and the clinical importance of ischemic liver injury in the fetus.

The effects of etomidate, thiopental, and propofol in induction on hypoperfusion-reperfusion phenomenon during laparoscopic cholecystectomy

BACKGROUND

A hypoperfusion-reperfusion human model is observed during and soon after laparoscopic surgery. The aim of the study was to research the preventive effects of etomidate, thiopental, and propofol in induction on hypoperfusion- reperfusion phenomenon during laparoscopic cholecystectomy.

METHODS

Thirty-six consecutive ASA I-II patients were randomized into three groups of 12 patients each. Anaesthesia was induced with etomidate in group 1, thiopental in group 2, and propofol in group 3. Venous blood samples were obtained at different time points for measurement of plasma malondialdehyde (MDA) levels. Arterial blood and gastric juice samples were obtained for the calculation of gastric intramucosal pH (pHi). Also changes in aminotransferases, alkaline phosphatase and total bilirubin levels were assessed.

RESULTS

There was a significant decrease in pHi at 1 min before desufflation (BD) and 20 min after desufflation (AD) compared with before insufflation (BI) in all groups. Plasma level of MDA was significantly increased in group 1 at 1 min BD and 20 min AD compared with before induction of anaesthesia (baseline). Malondialdehyde levels were decreased significantly in group 3 and increased non-significantly in group 2 at the same time points. Also AST and ALT levels were significantly increased in both groups 1 and 2 at 24 h postoperatively.

CONCLUSION

Propofol with antioxidant activity may offer many advantages by scavenging reactive oxygen species and their metabolites in case of anticipated hypoperfusion-reperfusion phenomenon, such as would occur in laparoscopic surgery.