Treatment preferences of orthopedic surgeons for closed, isolated middle-third diaphyseal long bone fractures without neurovascular injury in children: A cross- sectional survey

Objective: This study aimed to assess the treatment trends and the factors influencing the treatment methods of Orthopaedic Surgeons in closed, isolated, middle-third diaphyseal long bone fractures without any neurovascular injury in children.

Methods: This was a cross-sectional electronic survey of Turkish Orthopaedic Surgeons who were active members of the Turkish Society of Children’s Orthopaedics (TSCO) and still managing the children’s fractures in their daily clinical practice. An initial e-mail including the electronic survey followed by three reminder e-mails was sent to 110 members, and then reminder telephone calls were made.

Results: The survey response rate was 66/110 (60%). In recent years, a definitive trend to surgical treatment was not seen 98%, 77%, 39%, and 88% of the responders in the closed humerus, forearm, femur, and tibia mid-shaft fractures, respectively. Neither the years of expertise nor the intensity of daily pediatric patients of the participants did not affect the treatment trend in any fracture scenarios. The patient’s age was the most cited factor influencing the responders’ decisions on whether conservative or surgical treatment would be performed in each fracture scenario. The most cited lowest age limits for surgical treatment inclosed mid-shaft fractures of the humerus, forearm, femur, and tibia, were the adolescent age group, 10-12 years, six years, and ten years, respectively.

Conclusion: This is the first study assessing the daily clinical practice of members of TSCO in the management of closed, isolated, non-complicated middle-third diaphyseal long bone fractures in children just before the covid-19 pandemic started. A marked tendency toward surgical treatment is seen in femur mid-shaft fractures, followed by forearm mid-shaft fractures up to a certain level. The patient’s age is the main determinant of the responders’ decisions on the type of treatment in closed, isolated, non-complicated middle-third diaphyseal long bone fractures in children.

Recurrent anterior shoulder instability in patients 40-60 years old. Accompanying injuries and patient outcomes of arthroscopic repair

BACKGROUND

Accompanying injuries are frequently seen in middle aged patients with recurrent instability. The aim of this study was to elucidate the associated injuries, report patient outcomes of the following arthroscopic instability surgery regarding 40-60 years old patients with recurrent shoulder instability.

METHODS

Patients that underwent arthroscopic instability surgery due to recurrent shoulder instability between February 2008 and November 2015, and which were 40-60 years old were included and evaluated retrospectively. Minimum follow-up duration was 24 months. Anterior-inferior labral injuries and accompanying pathologies such as rotator cuff tears and SLAP lesions were documented. Postoperative patient-reported outcome evaluation was made using Oxford Shoulder Instability Score.

RESULTS

Among 355 patients that underwent arthroscopic instability surgery, 88 patients which had pathology of recurrent instability were in the range of 40-60 years old. Patients who had previous shoulder surgery or fracture (n = 8) epileptic seizure history (n = 3), neurologic deficit (n = 2) were excluded from the study. 75 patients were included with a mean follow-up 69 ± 23 months (32-125). The percentage of middle-aged and elderly (40-60 years old) was 24.8% among recurrent shoulder instability patients. 44% had isolated Bankart lesion whereas 56% revealed multiple pathologies. Bankart + SLAP lesions were found in 32%, whereas Bankart + Rotator Cuff tears in 26.7% (13 isolated supraspinatus, 4 supraspinatus + subscapularis, 1 isolated subscapularis full-thickness and 2 partial-thickness supraspinatus tears). The mean Oxford Shoulder Instability Score was 38.4 ± 5.2 (26-48). The scores of patients which were treated with labrum and rotator cuff repair (median 42, range 30-48) were significantly better than the patients who were treated with isolated labrum repair (median 39, range 20-46) (p = 0.015). There was no difference regarding patients with or without SLAP repair (median 39 vs 39 and range 30-48 vs 20-48, respectively) (p = 0.702).

CONCLUSIONS

Arthroscopic repair of capsulolabral lesions is a safe and successful technique in 40-60 years old patients. Furthermore, the presence of repaired rotator cuff tears led to even superior results. Accompanying SLAP lesions did not affect the results.

STUDY DESIGN

Retrospective Case Series.

LEVEL OF EVIDENCE

4, Retrospective Case Series.

The implant density does not change the correction rate of the main and the accompanying curves: A comparison between consecutive and intermittent pedicle screw constructs

OBJECTIVE

The aim of this study was to evaluate the clinical outcomes and the coronal correction rate of the main and accompanying curves of adolescent idiopathic scoliosis (AIS) corrected with pedicle screws inserted consecutively or intermittently.

METHODS

The prospectively collected data of 60 patients (8 men and 52 women; mean age: 14.6±2.5 years) who underwent corrective surgery for AIS between January 2010 and December 2015 were reviewed retrospectively. Two groups were constituted according to the pedicle screw construct type: consecutive pedicle screw construct (CPSC) and intermittent pedicle screw construct (IPSC) groups. The preoperative, early postoperative, and 24-month follow-up radiographs and the Scoliosis Research Society-22 (SRS-22) scores were reevaluated. The Cobb angle of the main and accompanying curves, the correction rate, and the flexibility of the curves were calculated.

RESULTS

The mean preoperative Cobb angles were 57.03° and 57.46°, the mean postoperative Cobb angles were 14.93° and 14.4°, and the mean correction rates were 76.22% and 75.31% in IPSC and CPSC groups, respectively (p>0.05). The preoperative and postoperative accompanying curve magnitudes and correction rates were similar (p>0.05). These radiographic outcomes were also consistent with the SRS-22 scores.

CONCLUSION

Both the pedicle screw constructs had satisfactory outcomes following the surgery, which were confirmed by both the SRS-22 scores and radiographs taken perioperatively and at follow-ups. The IPSC and CPSC groups did not demonstrate a significant change in the correction rate of the main and minor or major accompanying structural and nonstructural curves, and also in the SRS-22 scores.

LEVEL OF EVIDENCE

Level III, Retrospective comparative study.

Serum and knee synovial fluid matrix metalloproteinase-13 and tumor necrosis factor-alpha levels in patients with late-stage osteoarthritis

OBJECTIVE

The aim of this study was to compare serum and synovial fluid levels of matrix metalloproteinase-13 (MMP-13) and tumor necrosis factor-alpha (TNF-α) in 2 stages of osteoarthritis, and investigate their correlation with Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores.

METHODS

Forty-two patients (mean age: 64±8.8 years) with grade 3 and grade 4 knee osteoarthritis according to Kellgren-Lawrence criteria were enrolled in the study and underwent total knee arthroplasty. TNF-α and MMP-13 levels were measured preoperatively from venous blood samples and intraoperatively from knee synovial fluid via enzyme-linked immunosorbent assay. Preoperative and 1-month postoperative knee functions were assessed by WOMAC.

RESULTS

Grade 4 synovial fluid MMP-13 (4.76±5.82 pg/ml) was elevated compared to grade 3 (3.95±4.45), whereas grade 3 serum MMP-13 (1.128±0.308 pg/ml) was found elevated compared to grade 4 (1.038±0.204) (p=0.438, p=0.430, respectively). Grade 4 serum TNF-α (0.253±0.277) was elevated compared to grade 3 (0.206±0.219), whereas grade 3 synovial fluid TNF-α (0.129±0.052) was elevated compared to grade 4 (0.118±0.014). Positive correlation was observed between synovial fluid MMP-13 levels and postoperative WOMAC scores. Mean serum TNF-α (0.226±0.246 pg/ml) was elevated compared to synovial levels (0.124±1.59), and synovial MMP-13 (4.31±1.24) was elevated compared to serum levels (1.089±1.519).

CONCLUSION

Despite the systemic increase in TNF-α levels concordant with osteoarthritis grade, MMP-13 levels are elevated via local manner, with a significant correlation with WOMAC scores.

Comparison of multimodal intraoperative neurophysiological monitoring efficacy in early childhood and school aged children undergoing spinal surgery

OBJECTIVE

The aim of this study was to compare the performance of multimodal intraoperative neurophysiological monitoring (MIONM) in children below and over 6 years of age.

METHODS

43 children, diagnosed with spinal pathologies were divided into two cohorts according to their age and enrolled in the study. Those under the age of 6 consisted group A, whereas those between the age of 6 and 11 consisted group B. All patients underwent spinal surgical procedures according to their diagnosis. A standard anesthesia protocol was given to both groups. Baseline somatosensory evoked potentials (SSEPs) and transcranial electrical motor evoked potentials (tcMEPs) were recorded and evaluated at specific time points for each patient.

RESULTS

Except for the SSEPs in three cases, tcMEPs and SSEPs were recorded for all patients. There was no false-negative whereas 9 false positive recordings due to physiological conditions that all recovered intraoperatively. In 10 patients, MIOMN recorded more than %50 decrement, in which 8 had the kyphosis component. The tcMEPs fully recovered by the end of the operation except for the patient with post-tuberculosis kyphosis. There was no statistically significant difference in the mean threshold values with regard to transcranial stimulus intensity for the tcMEPs between the two groups.

CONCLUSION

Compared to school aged children, both SSEPs, tcMEPs recordings are feasible and MIONM is effective for early childhood patients undergoing spinal surgery.

LEVEL OF EVIDENCE

Level III, Diagnostic Study.

Chondromyxoid fibroma of the pubic ramus: a case report and literature review

Chondromyxoid fibromas (CMF) are benign cartilaginous bone tumors which are found most frequently in the metaphyses of long bones. They comprise less than 1% of primary bone neoplasms. We report an interesting incidental case of a 43-year-old woman with a CMF of the left pubic ramus, presenting with complaints of gradual onset of left groin pain over a period of 2 years. According to radiological examination, a malign chondroid bone tumor was excluded, and histopathological examination confirmed the diagnosis of CMF. The patient underwent aggressive curettage and bone grafting 6 years ago. Pelvic bones are encountered as rare localizations for CMFs. Pubic ramus is accepted as an exceptional site for this benign bone tumor of cartilaginous origin. To our knowledge, no any other CMF case in this localization has been reported in the literature. In atypical regions such as the pelvis and pubic ramus, CMF must be considered for differential diagnosis of malign tumors.

Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome

BACKGROUND

Platelet-rich plasma therapy has the potential to promote peripheral nerve regeneration through the autologous supply of growth factors. Therefore, this study aimed to compare the effects of platelet-rich plasma injections with the effects of corticosteroid injections in the treatment of carpal tunnel syndrome.

METHODS

In total, 40 patients with mild carpal tunnel syndrome were equally divided into two groups. Nerve conduction studies were carried out, and the Boston Carpal Tunnel Questionnaire was administered to both groups before treatment. One group of patients received platelet-rich plasma injections, and the patients in the other group received corticosteroid injections into the carpal tunnel. The patients were followed for 6 months. After 3 and 6 months, the nerve conduction studies and the Boston Carpal Tunnel Questionnaire were repeated.

RESULTS

Although distal motor latencies did not change in either of the groups during the follow-up period, improvements in sensory nerve conduction were recorded after 3 months in both groups. However, there was no significant difference between the groups in the nerve conduction studies. In the Boston Carpal Tunnel Questionnaire, both the symptom severity score and the functional capacity score of the platelet-rich plasma group were significantly better than those of the corticosteroid group after 3 months, although there were no significant differences after 6 months.

CONCLUSIONS

Platelet-rich plasma injections may be considered for the temporary symptomatic relief of mild carpal tunnel syndrome.

Serum and knee synovial fluid matrixmetalloproteinase-13 and tumor necrosis factor-alpha levels in patients with late stage osteoarthritis

Objective

To compare the levels of MMP-13 and TNF-α in late stage osteoarthritis, define their predominant pathways and investigate their correlation with McMaster Universities Arthritis Index scores.

Patients and methods

A total of 42 patients (mean age 64 ± 8.8) with grade 3 and grade 4 knee osteoarthritis according to Kellegren- Lawrence criteria and who were scheduled for total knee arthroplasty were enrolled in the study. TNF-alpha and MMP-13 levels were measured preoperatively from venous blood samples and intraoperatively from knee synovial fluid via ELISA. Preoperative and 1 month postoperative knee functions were assessed by McMaster Universities Arthritis Index.

Results

Grade 4 synovial fluid MMP-13 (4.76 ± 5.82) was elevated compared to grade 3 (3.95 ± 4.45) (p = 0.438), whereas grade 3 serum MMP-13 (1.128 ± 0.308) was found elevated compared to grade 4 (1.038 ± 0.204) (p = 0.430). Grade 4 serum TNF-α (0.253 ± 0.277) was elevated compared to grade 3 (0.206 ± 0.219) whereas grade 3 synovial fluid TNF-α (0.129 ± 0.052) was elevated compared to grade 4 (0.118 ± 0.014). Positive correlation was observed between synovial fluid MMP-13 levels and postoperative WOMAC scores. Mean serum TNF-α level (0.226 ± 0.246 pg/ml) was found higher compared to synovial level (0.124 ± 1.59), synovial MMP-13 level (4.31 ± 1.24) was found higher compared to serum level (1.089 ± 1.519).

Conclusion

Despite the systemic increase in TNF-α levels concordant with osteoarthritis grade, MMP-13 levels are elevated via local manner with a significant correlation with WOMAC scores.

Level of evidence

Level IV, Diagnostic study.

Impact of oxidative stress on early postoperative knee function and muscle injury biochemical markers: Is it possible to create an ischemic preconditioning effect in sequential ischemic surgical procedures?

OBJECTIVE

Simultaneous bilateral total knee arthroplasty (TKA) with prolonged tourniquet time has the potential to trigger ischemia-reperfusion injury, which can adversely affect knee function. Studies suggest that the magnitude of injury is less if it occurs following an ischemic event which takes place in another part of the body, known as ischemic preconditioning (IPC). The purpose of this study was to investigate the impact of oxidative stress on muscle injury and knee function and to elucidate if potential IPC effect can attenuate ischemia-reperfusion injury metabolites and prevent poor functional outcomes in single-stage bilateral TKA.

METHODS

Thirty patients who underwent single-stage bilateral TKA under tourniquet were enrolled in the study. All procedures were initiated from the right limb. Upon completion of the procedure, the left tourniquet was inflated 20 minutes after the first tourniquet was deflated. The tourniquet time was noted. Pre- and postoperative levels of malondialdehyde (MDH), creatine kinase (CK), and lactate dehydrogenase (LDH) were evaluated. Knee function was assessed postoperatively at 1 month using WOMAC score.

RESULTS

Postoperative levels of MDH, CK, and LDH were significantly increased in both extremities compared to preoperative levels. Serum MDH, CK, and LDH levels were not found to be correlated with tourniquet time for either extremity. Compared to the left extremity, the right extremity revealed increased postoperative oxidative stress, which was indicated by elevated serum MDH, CK, and LDH levels. Although tourniquet time and postoperative serum MDH, CK, and LDH levels were not found to be correlated with WOMAC index in either knee, the average change in WOMAC score at 1 month postoperatively was found to be higher in the left knee compared to the right.

CONCLUSION

The biochemical and functional outcomes can be attributed to potential IPC effect. During bilateral TKA, a 20-minute interval between tourniquets can create IPC effect and attenuate the magnitude of ischemia-reperfusion injury, preserving better functional outcomes.

Impact of Alprazolam on Comorbid Pain and Knee Functions in Total Knee Arthroplasty Patients Diagnosed with Anxiety and Depression

Purpose:

Studies report 19-33% postoperative moderate-severe pain and dissatisfaction in uncomplicated total knee arthroplasty (TKA), even after 1 year. High rates of undiagnosed depression and anxiety may have a strong impact on these unfavourable outcomes. Here we aimed to investigate the efficacy of alprazolam on postoperative analgesic use and knee functions.

Methods:

Seventy-six patients with a mean age of 65 ± 9.3 years (range 46-80) diagnosed with mild-moderate anxiety or depression according to the Hamilton anxiety scale (HAS) and Beck Depression Inventory (BDI) that underwent TKA were evaluated in the study. Group 1 patients were subjected to alprazolam treatment in addition to an analgesic/antiinflammatory drug, whereas Group 2 consisted of patients receiving only the standard postoperative pain management protocol. Visual analog scale (VAS) and postoperative analgesic use (g/day) were calculated to evaluate the magnitude of pain experienced. Preoperative and postoperative knee functions were assessed from the patients’ Knee Society Score and Knee Society Functional Score records.

Results:

A positive correlation was found between the preoperative HAS, BDI, and total postoperative analgesic use in both groups. Although the decrease in VAS was significant in both groups, postoperative analgesic need (4.25 ± 0.30 g) in Group 1 was less compared to Group 2 (4.81 ± 0.41 g) (p=0.01). The mean change in postoperative (1 month) Knee Society Score and Knee Society Functional Score were also significantly improved in Group1 compared to Group 2.

Conclusion:

Alprazolam can reduce postoperative analgesic use and improve knee functions by reducing the pain threshold, and enhancing overall mood via its antidepressive and anxiolytic properties in patients undergoing TKA diagnosed with mild-moderate anxiety/depression.

Surgical management of bone metastases from urological malignancies: an analysis of 70 cases

OBJECTIVE

The purpose of this study was to evaluate symptomatic bone metastases from urological malignancies and the efficacy of surgical treatment of bone metastases in achieving local tumor control.

METHODS

This was a retrospective observational study of patients diagnosed with bone metastases from urological malignancies who died from their diseases between 2002 and 2013. Data on clinicopathology, number and sites of bone metastasis, time to first and subsequent metastasis, survival after metastasis, nature of metastasis (blastic, mixed, lytic), type of surgical reconstruction, systemic affections, and visceral organ metastasis for 70 bone metastases from deceased urological malignancies patients (55 male, 15 female) with evidence of bone metastasis were statistically analyzed.

RESULTS

Forty-three patients (61.42%) had renal cell carcinoma (RCC), 15 patients (21.43%) had prostate cancer, and 12 patients (17.15%) had bladder carcinoma as primary diagnosis. Osteolytic lesions were most prevalent (n=61; 87%). The most common surgical modality for extremities was wide resection with prosthetic replacement (42 patients), followed by wide resection or wide resection with bone cement application with internal fixation (21 patients); 65 patients were treated with limb salvage procedures, and 2 patients were treated with amputation. Overall median survival was 13 months for RCC, 16 months for prostate carcinoma, and 11 months for bladder carcinoma patients.

CONCLUSION

Detection of bone metastases in patients with urological malignancies influences the treatment strategy. Diagnosis of bone metastases may be delayed in urologic malignities; thus, these patients receive long-term clinical follow-up.

Isolated scapula fracture: Ice hockey player without trauma

Introduction

Scapular fractures are generally occur from in high-energy traumas and are associated with a high incidence of morbidity and mortality.

Presentation of case

We present an unusual scapular fracture that occurred with a rare mechanism. A 23-year-old male patient who led an active sports life for 10 years and played ice hockey for the last 5 years. In a competition, he felt a sudden pain in his right scapula after hit the puck. He did not experience any direct trauma to his shoulder and there was no evidence of any pathological fracture. The fracture was isolated in the scapular body and it was classified as type 4, according to Hardegger classification. The was patient immobilized with a Velpau bandage for three weeks and then treated with physiotherapy for shoulder rehabilitation.

Discussion

The fracture mechanism was likely a disharmonius contracture of the agonist and antagonist muscles of the shoulder joint while hitting the puck.

Conclusion

Scapular fractures are generally seen along with other injuries, but in this case we wanted to emphasize that care has to been taken to diagnose an isolated scapular fracture while assessing shoulder pain.

•

We tried to present a rare fracture of scapula.

•

We showed a different aspect for scapula fracture.

•

Care has to be taken for diagnosing of an isolated scapular fracture.

Quantitative evaluation of hyaline articular cartilage T2 maps of knee and determine the relationship of cartilage T2 values with age, gender, articular changes

OBJECTIVE

To identify changes in knee joint cartilage transverse relaxation values depending on the patient's age and gender and to investigate the relationship between knee joint pathologies and the transverse relaxation time.

PATIENTS AND METHODS

Knee MRI images of 107 symptomatic patients with various pathologic knee conditions were analyzed retrospectively. T2 values were measured at patellar cartilage, posteromedial and posterolateral femoral cartilage adjacent to the central horn of posterior meniscus. 963 measurements were done for 107 knees MRI. Relationship of T2 values with seven features including subarticular bone marrow edema, subarticular cysts, marginal osteophytes, anterior-posterior cruciate and collateral ligament tears, posterior medial and posterior lateral meniscal tears, synovial thickening and effusion were analyzed. T2 values in all three compartments were evaluated according to age and gender.

RESULTS

A T2 value increase correlated with age was present in all three compartments measured in the subgroup with no knee joint pathology and in all patient groups. According to the ROC curve, an increase showing a statistically significant difference was present in the patient group aged over 40 compared to the patient group aged 40 and below in all patient groups. There is a statistically difference at T2 values with and without subarticular cysts, marginal osteophytes, synovial thickening and effusion. T2 relaxation time showed a statistically significant increase in the patients with a medial meniscus tear compared to those without a tear and no statistically significant difference was found in T2 relaxation times of patients with and without a posterior lateral meniscus tear.

CONCLUSIONS

T2 cartilage mapping on MRI provides opportunity to exhibit biochemical and structural changes related with cartilage extracellular matrix without using invasive diagnostic methods.

Accuracy and safety of percutaneous US-guided needle biopsies in specific focal liver lesions: comparison of large and small needles in 1300 patients

AIM

The aim of this study was to compare small size aspiration needles with large size cutting needles in focal liver lesions for using small needles instead of large ones without on-site cytopathologist.

METHODS

Percutaneous ultrasonography-guided liver biopsy was evaluated retrospectively in a biopsy cohort study of 1300 patients. In this series, 690 patients were biopsied with large size (<19G) cutting needles and 610 with small size (20G) aspiration needles. On-site cytopathologist was not present in the biopsy-room at any intervention. Needles were compared for diagnostic accuracy and safety for various focal liver diseases.

RESULTS

We had diagnostic accuracy rate of 85.0% in small needle group vs. 96.9% in large needle group with metastasis (P<0.001). This rate was 85.5% in small needle group vs. 97.9% in large needle group with hepatocellular carcinoma (P=0.039). Accuracy rates of them were not different in hemangioma (P=0.277) and infection-inflammation (P=0.470). This rate was 75.0% in small needle group vs. 98.9% in large needle group with regenerative nodules (P=0.018). These rates were not different in focal steatosis (P=1.000). Sensitivity, specificity, and accuracy were 85.1%, 100%, and 89.2%, respectively. Only 2 (0.15%) major complications were found with small needles in uncooperative patients. Any major complication was not seen in hemangioma.

CONCLUSION

In uncertain diagnosis with modern imaging, we propose that large size cutting needles should be used in suspected liver metastasis, hepatocellular carcinoma, and regenerative nodules if cytopathologist was not present. Small needles can be successfully used as well as large ones in focal steatosis, infection-inflammation, and hemangioma of liver in unclear diagnosis.

Fine-needle aspiration biopsy of cervical lymph nodes: factors in predicting malignant diagnosis

The objective of the study was to determine the predicting factors in malignant diagnosis in ultrasonography guided fine-needle aspiration biopsy of cervical lymph nodes. Design is retrospective follow-up study. Ultrasonography guided fine-needle aspiration biopsies of cervical lymph nodes were performed in 290 patients. The mean age was 45.5 ± 14.4 years (range; 15-85). 207 (71.4%) and 83 (28.6%) were women and men, respectively. Cytopathologist was not present in any biopsy procedure. Factors in predicting malignancy were age, gender, presence of primary malignancy, localization (Level 1-6), hypoechogenicity with loss of echogenic hilum, microcalcification, cystic feature, minimum and maximum sizes, and index value (minimum size/maximum size). Factors were analyzed by univariate and multivariable tests. The mean minimum size and index value of the lymph nodes were 10.4 ± 5.5 mm and 0.58 ± 0.18, respectively. Age, gender, microcalcification, cystic feature, minimum size, and index value were poor predictors in malignancy. Predictors were presence of primary malignancy (p-< 0.001), the level of localization (p=0.001), and hypoechogenicity (p-< 0.001)- in malignancy. Microcalcification and cystic parts were specific US findings of metastasis of thyroid carcinoma; nevertheless cystic parts were seen more specific finding in the other malignancies. Malignant lymph nodes were often found in the presence of primary malignancy, mid neck and lower neck localizations as Level 3-6, and markedly hypoechoic lymph nodes. In 131 patients with a primary thyroid carcinoma, the predictors for malignancy were localization where the most often regions were Level 3, 4, and 6 and hypoechogenicity. Malignancy rate was relatively low in patients with thyroid malignancy than those with non thyroid malignancies in Level 5. Level 6 was the most difficult area for biopsy due to postoperative changes. Microcalcification was specific only in thyroid carcinoma, whereas cystic parts were more specific in the other malignancies

A first insight into the genetic diversity and population structure of Mycobacterium tuberculosis in Zonguldak, Turkey

This study evaluated the molecular epidemiology and biodiversity of Mycobacterium tuberculosis isolates in Zonguldak, Turkey, and investigated the presence and significance of the LAM7-TUR clone by spoligotyping and mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR) analysis. In total, 128 isolates were tested by spoligotyping; 25 selected isolates representative of the LAM7-TUR clone and similar types were also tested by MIRU-VNTR analysis. In total, 47 distinct patterns were revealed by spoligotyping, represented by 13 clusters containing between two and 28 isolates (94 isolates in total), and 34 unique patterns (a clustering rate of 73%). Using MIRU-VNTR analysis, the clustering relationships revealed by spoligotyping were confirmed. The most common spoligotyping profile was SIT53, followed by SIT41 (LAM7-TUR) and SIT50. The SIT284 clone was another phylogeographically specific clonal complex whose presence in Turkey may be endemic. The LAM7-TUR genotype was highly prevalent in Zonguldak.

Effect of human somatotropin hormone on cultured rat islets

Because growth hormone (GH) improves the insulin secretion capacity of isolated human fetal islets in vitro, we sought to show that it positively influences isolated rat islets. Islets isolated from Wistar albino rats by a modified automated system were cultured in media containing 87% RPMI 1640, 10% FCS, 2% antibiotic-antimycotic, and 1% L-glutamine for 12 +/- 2 days. The cultured islets were divided into two groups: growth hormone negative (Group I) and growth hormone positive (Group II). On the 5th day we observed a decrease in the islet cell counts in both groups (Group I 28% versus Group II 45%). On the 10th day, the decrease continued in the GH-negative group (59%), while the count remained stable in the GH-positive group. The viability of rat islets was determined by fluorescein diacetate (FDA) plus propidium iodide (PI) staining. In comparison to the peripheral green, central orange-red staining pattern of Group I islets upon fluorescent microscopy, Group II showed more compact islets. Cultured islets seemed to be brighter than those without GH in the cultured islets. In conclusion, we observed that 2 weeks of incubation in the presence of GH acts positively on cultured rat islets for both their amount and their viability.

Fine needle aspiration biopsy in hepatic Echinococcus multilocularis

OBJECTIVE

To determine the fine needle aspiration biopsy (FNAB) findings in hepatic Echinococcus multilocularis.

STUDY DESIGN

FNAB and tru-cut liver needle biopsy were applied in 14 hepatic E multilocularis cases. Cytologic smears were stained with May-Grünwald-Giemsa and periodic acid-Schiff (PAS) stain. Tissue sections were stained with hematoxylin-eosin (HE) and PAS stain.

RESULTS

In tissue sections, homogeneous, thin, cystic structures of various dimensions strongly stained with PAS. Mucoid material was stained with PAS in the cystic structures. Wide, coagulative necrosis was observed in all cases. In some cases there were foreign body-type giant cells at the periphery of the lesion. In all the cytologic smears there were an intense necrotic ground, PAS-positive hyaline cuticular structures and mucoid globules; in some cases there were foreign body-type giant cells.

CONCLUSION

The above cytologic characteristics are basic diagnostic criteria for FNAB of E multilocularis.

Hypernatremia in two collodion babies

Two cases of collodion babies with hypernatremia are presented, and the importance of this electrolyte abnormality in skin disorders is also stressed.