Effect of superoxide anions on red blood cell rheologic properties

The human red blood cell (RBC) is known to be susceptible to oxidant damage, with both structural and functional properties altered consequent to oxidant attack. Such oxidant-related alterations may lead to changes of RBC rheologic behavior (i.e., deformability, aggregability). Two different models of oxidant stress were used in this study to generate superoxide anions either internal or external to the RBC. Our results indicate that generation of superoxide within the RBC by phenazine methosulfate decreases RBC deformability without effects on cell aggregation. Conversely, superoxide generated externally by the xanthine oxidase-hypoxanthine system primarily affects RBC aggregability: the shear rate necessary to disaggregate RBC was markedly increased while the extent of aggregation decreased slightly. Increased disaggregation shear rate (i.e., greater aggregate strength) as a result of superoxide radical damage may adversely affect the dynamics of blood flow in low-shear portions of the circulation, and may also play a role in the no-reflow phenomena encountered after ischemia-reperfusion.

Red blood cell aggregation in experimental sepsis

Red blood cell (RBC) aggregation was investigated in a rat model of sepsis with special emphasis on RBC-related factors. Sepsis was produced by cecal ligation/puncture, whereas another group had only laparotomy (sham operation); blood samples also were obtained from control, unoperated-on animals. RBC aggregation was measured in autologous plasma and in 3% dextran 70, 18 hours after the operations, by using a Myrenne Aggregometer system and the zeta sedimentation ratio (ZSR) method. RBC aggregation in autologous plasma was found to be enhanced in both sham-operated and septic animals and was consistent with their increased plasma fibrinogen levels. However, RBC aggregation in dextran was significantly higher than control only in the sepsis group. RBCs from septic animals also aggregated more in septic plasma compared with RBCs from control animals. In the sepsis group, RBC deformability was significantly decreased, whereas RBC lipid peroxidation was significantly increased. Our results thus confirm the known increase of RBC aggregation in septicemia and, in addition, demonstrate marked alterations of intrinsic RBC properties that further enhance red cell aggregation.

A new material for prevention of peritendinous fibrotic adhesions after tendon repair: oxidised regenerated cellulose (Interceed), an absorbable adhesion barrier

In this experimental study, we aimed to examine the ability of absorbable oxidised regenerated cellulose (Interceed, TC-7, Johnson & Johnson, USA) to inhibit the formation of peritendinous fibrotic adhesions after tendon repair in rats. Both Achilles tendons of 23 female Wistar-Albino rats weighing between 350 and 450 grams were cut and repaired. On the right side, Interceed absorbable adhesion barriers were wrapped around the repaired tendon (group I). On the left, the same procedures were applied except for the Interceed wrapping and these were grouped as control (group II). Animals were sacrificed at postoperative day 28 and macroscopic and histological examination was performed. All the animals survived and no tendon rupture was observed. No wound dehiscence, wound infection or exposure of repaired tendons occurred. Macroscopically, there were three (13.1%) tendons without adhesion formation and 20 (86.9%) tendons with inferior adhesion formation in group I; on the other hand, there were 16 tendons (69.5%) with medium grade adhesion formation and seven tendons (30.5%) with severe peritendinous adhesion formation in group II (control group) (p<0.05). Histologically, adhesion formation was absent in 11 tendons (47.8%) and slight in 12 tendons (52.2%) in group I; while in group II, it was slight in two (8.6%), moderate in 15 (65.2%) and severe in six tendons (26.2%) (p<0.05). Sixteen (69.5%) of 23 tendons in group I and 11 (47.8%) of 23 tendons in group II showed no inflammatory reaction (p<0.05). Nineteen (82.6%) tendons in group I and only one tendon in group II showed excellent to good tendon healing (p=0.00). According to our results, we feel that Interceed may have an intraoperative role to play in the reduction of adhesions after surgical tendon repair. This study suggests that absorbable oxidised regenerated cellulose merits further evaluation as a potential treatment to inhibit the formation of peritendinous adhesions. Rigorous and extensive controlled trials should be undertaken on patients undergoing tendon repair with or without this barrier.

A new material for prevention of epidural fibrosis after laminectomy: oxidized regenerated cellulose (interceed), an absorbable barrier

Epidural fibrosis, which may cause persistent back and leg pain, may develop after laminectomy. Several materials have been used in attempts to minimize epidural fibrosis, with varying results. We evaluated the efficacy of an absorbable cellulose adhesion barrier in preventing epidural fibrosis. In 25 New Zealand white rabbits, laminectomies were performed at L3 and L5 vertebrae. The dura mater was covered by the adhesion barrier (Interceed, TC7, Johnson & Johnson, USA) at L3 laminectomy site (group 1), with L5 laminectomy site serving as an internal control (group 2) in each animal. There was no neurological deficit in any of the animals during the postoperative period. Animals were sacrificed at postoperative day 28. The lumbar spine was removed en bloc and placed in neutral, buffered formalin for 72 h. The specimens were then decalcified and embedded in paraffin. Permanent sections of 5 to 7 microm were stained with hematoxylin and eosin and Masson trichrome dye. Epidural fibrosis was evaluated in a double-blinded manner. The extent of epidural fibrosis was graded as 0, no reaction seen; 1, mild reaction; 2, moderate reaction; 3, extensive reaction, and 4, severe reaction. The histological findings of each group were compared. For the statistical analysis, Wilcoxon signed rank test was used. In group 1, the fibrotic tissue formation was minimal in 19 and moderate in 6 laminectomy sites. In group 2, the fibrotic tissue formation was determined as being extensive in 17 and moderate in 8 laminectomy sites. Statistical analysis showed significant decrease in epidural fibrosis in group 1 (P<0.05). This study showed that Interceed, which is commercially available in the market, especially for abdominal and gynecological surgeries, could be used to prevent epidural fibrosis.

A rare and frequently unrecognised pathology in children: femoral hernia

A femoral hernia is the protrusion of the abdominal contents through the femoral canal. It accounts for less than 1% of all groin hernias in children and is often confused with inguinal hernia or other inguinal pathologies. Preoperative misdiagnosis has been reported to be between 40 and 75%. We believe that misdiagnosis and mistreatment usually occur due to insufficient physical examination, knowledge and experience about childhood femoral hernias. Here, we report and discuss the clinical appearance and treatment approach of three patients operated with the diagnosis of femoral hernias.

Erythrocyte deformability in high-tension and normal tension glaucoma

The exact cause of primary open angle glaucoma is still unknown. Intraocular pressure is a major factor but it is impossible to explain the whole mechanism of glaucomatous optic nerve damage with only increased intraocular pressure. Other factors play important roles in the development of glaucoma. With this point of view, vascular factors have been implicated in the pathogenesis of glaucoma. We tried to determine the etiopathogenetic role of decreased erythrocyte deformability in normal tension glaucoma and high-tension glaucoma. The study group consisted of 16 patients with the diagnosis of normal tension glaucoma, 17 patients with the diagnosis of high-tension glaucoma, and 24 patients as controls. Independent t-tests were used to compare the three groups two by two for age, hematocrit, mean cell volume, plasma protein level, cardiovascular risk factors, and erythrocyte deformability. There was no statistically significant relationship (p>0.05) between the groups concerning the erythrocyte deformability. When we consider all of 57 patients, we found that both increasing age (>60 years) and greater mean cell volume (>84 fl) had a statistically significant relationship with decreased erythrocyte deformability (p<0.05). When we performed Pearson correlation analysis, we found that only mean cell volume and erythrocyte deformability had a statistically significant relationship (r = 0.31, p = 0.02). We conclude that decreased erythrocyte deformability is not a major factor in the ethiopathogenesis of normal tension glaucoma and high-tension glaucoma.

Admission neutrophil-to-lymphocyte ratio and postoperative mortality in elderly patients with hip fracture

BACKGROUND

Hip fractures in elderly patients are associated with a high mortality rate. Most deaths associated with hip fracture result from complications after surgery. Recent studies suggest that the neutrophil-to-lymphocyte ratio (NLR), which is a laboratory marker used to evaluate systemic inflammation, may be useful to estimate excess mortality. This study aimed to investigate the prognostic value of admission NLR in elderly patients with hip fracture.

METHODS

We evaluated patients admitted to the Orthopaedic Surgery Department of Balikesir-Edremit State Hospital. Inclusion criteria were female gender, age between 65 and 80 years, ASA score of 3, unstable intertrochanteric fracture treated with hemiarthroplasty, and time between fracture and surgery less than 72 h. Patients with multiple fracture, previous same side or other side hip surgery, pathological fracture, such as fracture caused by tumor or metabolic bone disease (e.g., Paget's disease), and malignancies were excluded from this study (purposive sampling technique). Finally, "case" (group 1) was defined as patients who died within 1 year after surgery, whereas "control" (group 2) was defined as patients who survived. Patients in group 1 and 2 were statistically compared in terms of NLR value on hospital admission. A total of 22 patients (44%) were included in group 1, and 28 (56%) were included in group 2.

RESULTS

We found that the admission NLR values of patients in the mortality group were significantly higher than those of patients in the control group (p<0.001). The cutoff value of NLR was calculated as 4.7 on ROC analysis.

CONCLUSION

We believe that the NLR value at admission could be used for risk stratification of mortality in elderly patients with hip fracture.

Hypertrophic pyloric stenosis in twins; genetic or environmental factors

The etiology of infantile hypertrophic pyloric stenosis (IHPS) remains obscure. Over 120 years after the condition has become a clinical entity the debate whether the cause of IHPS is genetic, environmental or both, has not yet reached a final conclusion. Herein, we present a pair of monozygotic male twins with IHPS together with a review of the literature. We aimed to support genetic pre-disposition in the epidemiology of IHPS, adding a twin data to the literature and to review the associated articles about the pathogenesis and inheritance patterns.

Does pregnancy-induced hypertension affect the electrophysiology of the heart?

Pregnancy-induced hypertension (PIHT) increases both maternal and neonatal mortality and morbidity in pregnant women. We sought to investigate the electrocardiographic findings in pregnant women with PIHT. Seventeen pregnant women (29.4 ± 5 years) with PIHT and 24 pregnant women (27.3 ± 6.1 years) with normal blood pressure (control group) were included in the study. A 12-lead surface electrocardiogram was used to evaluate the electrocardiographic parameters. Pregnant women with PIHT had higher blood pressure (p = 0.001). The Tp-e interval was longer in PIHT pregnant women at 83.5 ± 7.8 ms versus 75.8 ± 8.4 ms in the control group (p = 0.007). The Tp-e/QTc ratio was higher in pregnant women with PIHT than that in healthy controls (0.19 ± 0.02 vs. 0.18 ± 0.02, respectively). This study demonstrated that Pd, QTd and the P wave durations were similar in the PIHT pregnant women and control group, but the Tp-e and Tp-e/QTc ratio were higher in pregnant women with PIHT than in normotensive pregnant women.

Effect of erythrocyte deformability on myocardial hematocrit gradient

Myocardial hematocrit gradient was determined between epicardium and endocardium of the left ventricular wall in rat heart under the influence of erythrocyte deformability alterations. Hematocrit determinations were performed by measuring two different radionuclides labeling plasma (125I-labeled albumin) and erythrocytes (99mTc) in 100-microns-thick left ventricular myocardium slices. Myocardial hematocrit gradient calculated after exchange transfusions with partially hardened red blood cell suspensions was compared with the results of the control group, in which the exchange transfusions were done using normal, hematocrit-matched blood. In the control group, the hematocrit value in the myocardium adjacent to epicardium was 0.331 +/- 0.076 l/l and decreased to 0.232 +/- 0.054 l/l near the endocardium. Myocardial hematocrit between these two was represented by a linear gradient. In the group with impaired erythrocyte deformability, the hematocrit value was 0.359 +/- 0.074 l/l in the epicardial myocardium and remained at 0.341 +/- 0.082 l/l in the endocardial layer. These results indicate that tissue hematocrit gradient in the left ventricular myocardium may be disturbed if erythrocyte deformability is altered.

Implementation of the Ottawa ankle rules by general practitioners in the emergency department of a Turkish district hospital

BACKGROUND

The present objective was to assess implementation of the Ottawa ankle rules (OAR) as a method of fracture prediction in the emergency department (ED) of a Turkish state hospital.

METHODS

Patients who presented to the ED of our hospital with acute ankle injury were evaluated. All were examined by a general practitioner, after which a series of ankle and foot x-rays (anteroposterior and lateral) were performed. Radiography was examined by a radiologist and an orthopedic surgeon, both of whom were blinded to OAR results. Radiographic results were compared to results of OAR implementation. Sensitivity and specificity of the OAR in the diagnosis of fracture was calculated.

RESULTS

A total of 251 (61.97%) patients were diagnosed as positive (+) for fracture after OAR implementation, 154 (38.02%) as negative (-). Clinically significant fracture was detected in 62 (15.3%) patients. A total of 61 (98.4%) patients with significant fracture were OAR (+); 1 (1.6%) was OAR (-). However, 190 (55.4%) patients without fracture were OAR (+); 153 (44.6%) were OAR (-) (p<0.001). Sensitivity, specificity, and positive and negative predictive values of OAR implementation in the prediction of fracture were 98.39%, 44.61%, 24.30%, and 99.35%, respectively. Area under the curve (AUC) was 0.71. According to these results, it was determined that use of radiography could be reduced by 38.02% if the OAR were implemented.

CONCLUSION

The OAR are a highly sensitive means of screening of patients with acute ankle and mid-foot injuries. Application of the OAR by well-trained general practitioners can lead to significant reduction in the number of x-rays performed, thereby reducing cost of treatment and radiation exposure, in addition to saving time for patients and staff.

The effect of skin transplantation on tumor growth in mice

BACKGROUND

Skin allograft is an immunostimulant. Skin allograft activates effector arms of the immune system including the cytotoxic T lymphocytes, activated macrophages, and natural killer cells. These cells may be involved in the destruction of tumor cells.

METHODS

Balb/c mice were divided into the study (n = 10) and control (n = 10) groups. Alloskin grafts 1 cm in diameter from the backs of Swiss albino mice were placed on the backs of balb/c mice (study group). The same size autoskin grafts from the backs of other balb/c mice were used for the control group. Fourteen days after grafting, we inoculated 1,000 Ehrlich ascites tumor cells intraperitoneally into both groups. Two days after tumor inoculation, we used secondary allografts and autografts (which were about 2 to 3 mm in diameter) for the same groups. We followed up graft survival and animal survival in both groups.

RESULTS

All 10 of the autografted mice died between the 18th and 25th days owing to malignancy. In the allografted group, 2 mice died (1 on day 17 and the other on day 23). Allograft rejection had not occurred in these 2 mice at the time of their death. The other 8 mice in the same group rejected allograft, on average within 9 days (9+/-3, median 8). These 8 mice were alive and without apparent health problems during the 4 months of follow-up.

CONCLUSION

Allo-skin graft rejection may help rejection of tumor cells and may be of use in immunotherapy of cancer.

Diagnostic accuracy of fat pad sign, X-ray, and computed tomography in elbow trauma: implications for treatment choices-a retrospective study

Introduction

Identifying skeletal injuries significantly impacts patient outcomes in trauma cases. This study aims to compare the diagnostic accuracy of X-ray (XR) and computed tomography (CT) in detecting elbow fractures among patients presenting at the emergency department (ED). Additionally, the study assesses the potential contribution of the fat pad sign to enhancing the diagnostic accuracy of XR images in identifying elbow fractures. The secondary aim focused on evaluating the precision of XR imaging in determining the necessity for surgical intervention among patients presenting with elbow trauma.

Methods

Conducted retrospectively at an ED within a secondary hospital, this study included patients with elbow trauma between January 1, 2017, and January 1, 2020, who underwent both XR and CT imaging of the elbow joint. Following the application of exclusion criteria, the analysis comprised 183 patients based on remaining image data.

Results

When comparing XR to CT for fracture detection, XR exhibited a sensitivity of 46.9%, specificity of 85.9%, positive predictive value (PPV) of 79.3%, negative predictive value (NPV) of 58.4%, area under the curve (AUC) of 0.664. Considering the fat pad sign in XR as a fracture indicator, the sensitivity is 60.2%, specificity is 81.2%, PPV is 78.7%, NPV is 63.9% and AUC is 0.707. A significant difference was found when comparing the AUCs obtained with and without considering the fat pad sign (p = 0.039). Regarding surgical treatment decision-making, XR showed a sensitivity of 50%, specificity of 100%, PPV of 95%, NPV of 100%, and an AUC of 0.750 when compared to CT.

Conclusion

The findings indicate that XR alone is insufficient for detecting elbow fractures and determining the need for surgical treatment. Incorporating the fat pad sign improves the diagnostic accuracy of XR. In cases where suspicion of fracture is high, considering CT imaging is crucial to avoid missed diagnoses, prevent complications, and guide treatment decisions effectively.

Surgical treatment of tennis elbow: percutaneous release of the common extensor origin

Twenty six patients who had undergone percutaneous release of the common extensor tendon for lateral epicondylitis were investigated. Fourteen were female and twelve were male. The mean follow-up period was 32 months. Symptoms had been present for an average of 8.9 months. Before the surgery, all the patients were surgically treated with conservative methods; only those that did not respond to conservative methods were surgically treated. The common extensor origin was released percutaneously. Pain relief was achieved on average eight weeks after surgery. The clinical results were evaluated in terms of pain, activity level and patient satisfaction. The results were excellent in twenty-four patients, good in one and poor in one. Release of the common extensor origin appears as a commendable treatment in patients with lateral epicondylar pain not relieved by conservative management.

Biomechanical comparison of two fixation methods for pediatric femoral neck fractures: an in vitro study using ovis aries lambs

OBJECTIVE

In pediatric patients, femoral neck fracture is a relatively rare injury with a high complication rate despite proper diagnosis and treatment. Fixation of femoral neck fractures is usually performed with screws placed along the neck axis. In this study, we aim to compare two different implants and methods in terms of biomechanics.

MATERIALS AND METHODS

Twenty-eight right-left fresh femur bones of 6-month-old male Ovis aries lambs grown on the same farm were used. Bones were randomly divided into 4 groups (n=7). In group 1, the Delbet type III femoral neck fracture model was fixed with two 4.5 mm cannulated screws, one screw crossing the physis. In group 2, two 4.5 mm cannulated screws, which did not cross the physis, were used. In group 3, Delbet type III femoral neck fracture model was fixed with a 3.5 mm proximal femoral anatomical plate and five screws, one screw crossing the physis. Finally, in group 4, Delbet type III femoral neck fracture model was fixed with one 3.5 mm proximal femoral anatomical plate and five screws that did not exceed the physis.

RESULTS

Biomechanical tests were performed using a Zwick/Roell AllroundLine 100 kN device. While axial failure burden (F = 6.819, p<.05, d = .46) and axial stiffness (F = 3.576, p<.05, d = .30) have been found to be significantly different between the independent treatment groups, axial failure displacement (F = .622, p>.05) and axial failure energy (F = .727, p>.05) have been found not to be significant between the independent groups. The effect sizes of the axial failure load and axial stiffness variables were 0.46 and 0.30, respectively, suggesting a moderate clinical effect. The highest axial failure load was recorded in group 3, while the smallest load was recorded in group 2. Similarly, the axial stiffness level in group 3 was statistically higher than the axial stiffness measurement recorded in group 2, p<.05.

CONCLUSIONS

Consequently, we found that the biomechanical fixation success was the highest with a 3.5 mm proximal femoral anatomical plate, a 3.5 mm locking screw crossing the physis, and five 3.5 mm screws.

Unilateral Renal and Spermatic Cord Agenesis Accompanying to the Ureteral Extraperitoneal Inguinal Herniation in An Infant

Ureteroinguinal herniation is a rare event, usually diagnosed during the surgical repair of inguinal hernias and most reported cases have occurred in obese men during the fifth and sixth decades of life. Here, we describe the first case of unilateral renal and spermatic cord agenesis accompanying to the ureteral inguinal herniation in an infant.