Relationship between grip strength and hand bone mineral density in healthy adults

The aim of this study was to assess site-specific relationship of hand bone mineral density (BMD) with hand size, pinch and grip strength in healthy people aged 19-50 years. A total of 143 healthy volunteers participated in the study (mean age: 34 years). One hundred-six were premenopausal women (mean age: 34 years) and 37 were men (mean age: 34 years). Grip and pinch strength was measured by a Jamar dynamometer (Jamar, Irvington, NY). Second, third and fourth middle phalanx BMD were measured on a MetriScan densitometer (Hayward, CA) and mean value of these three phalanxes were used in the analysis. There was not a significant correlation between hand BMD and grip, pinch strength or hand size in premenopausal women. A significant correlation between hand BMD and grip strength was found in men (right hand; r=0.44, p=0.007, left hand; r=0.33, p=0.05). Hand size was not correlated with hand BMD both in men and in women. The short-term precision for RA was estimated as 0.44%. This is the first report of a site-specific relationship of BMD measured by radiographic absorptiometry with hand size, pinch and grip strength in healthy men and premenopausal women. Our results revealed that there is a moderate correlation between hand-grip strength and hand BMD in men. Hand size does not predict hand BMD both in men and women. Radiographic absorptiometry is a practical and reproducible method to detect bone mineral density of hands and may be a valuable screening tool for osteoporosis.     

A custom-made distraction device for experimental mandibular distraction osteogenesis

Distraction osteogenesis has recently become popular in craniofacial reconstruction, after it was first described for long bones. Despite the widespread clinical use of this technique, currently, lack of an ideal experimental model for small animals hampers investigations focused on its molecular basis, which warrants further elucidation. The authors developed a new device for distraction of the rat mandible and, to asses its effectiveness, practiced on 30 animals assigned to either an acute 3-mm distraction group (n = 7) or a gradual distraction group (0.25 mm twice a day for 6 days; n = 23). The authors applied the devices to a localization that allowed them to perform the ostomies posterior to the molar teeth. Because of a U-shaped plate that the authors used for posterior pin fixation, their device maintained its stability until the end of the study, despite the delicate anatomy of the bone at the posterior part of the mandible. Additionally, the authors described a practical and easy method of transient mandibular stabilization method that facilitates the manipulations while the mouth is open for safer airway control during surgery. This new nutrition technique with enteral feeding solution solved the problem of progressive weight loss after surgery. Application of the device was easy and practical, without demanding complex manipulations. The authors did not observe any device dislodgement or a high rate of accidental fractures during the manipulations. They demonstrated that the device works properly and is able to create ossified regenerate bones that fill the entire distraction gap, which can be used for various investigations during distraction osteogenesis.     

Hemodynamic and transesophageal echocardiographic analysis of global and regional myocardial functions, before and immediately after coronary artery bypass surgery

AIM: We investigated the effect of coronary artery bypass grafting (CABG) surgery on global and regional myocardial function; before and immediately after coronary artery bypass grafting and 1 month after the operation. METHODS: Twenty-five patients who were undergoing elective CABG were evaluated. Transesophageal echocardiography (TEE) was used to evaluate both global and regional myocardial function. Intraoperative TEE images of the left ventricle were obtained after cannulation but before cardiopulmonary bypass (CPB), 5 and 30 minutes after the termination of CPB. Same time, hemodynamic parameters were recorded. Transesophageal echocardiography evaluation was repeated one month after the operation. RESULTS: Global left ventricular function was significantly depressed 5 minutes after CPB. At the 30 minutes after CPB, left ventricular function has returned to pre-CPB baseline levels. Global left ventricular function was significantly increased at 30 days following CABG surgery. The myocardial segments that were normal before CABG had reduced contractile functions at 5 minutes after CABG but normal segments showed a significant improvement from 5 to 30 minutes. The function of this region could not reach its initial status. The segments that had severe impairments of contractile function before the revascularization showed significant improvements at 30 minutes following CABG. CONCLUSIONS: In conclusion, a successful coronary revascularization provides an improvement in contractility in cases with chronic regional left ventricular dysfunction that is not related to irreversible necrosis.     

The prevalence of coeliac disease as detected by screening in children with iron deficiency anaemia

AIM: Iron deficiency anaemia is a frequent finding seen in coeliac disease, which can be diagnosed alone or with other findings. In this study, our aim was to determine the prevalence of coeliac disease in children with iron deficiency anaemia without significant gastrointestinal symptoms. METHODS: There were 135 children with iron deficiency anaemia in the patient group (group 1), and 223 healthy children without iron deficiency anaemia in the control group (group 2) in this study. Antiendomysial antibody (EMA) IgA test was given to both groups. Antiendomysial antibody-positive patients underwent small intestine biopsy. RESULTS: The mean age was 7.2+/-4.6 (2-16) y in the patient group (group 1) and 8.2+/-3.8 (2-16) y in the control group (group 2), and no significant difference between the two groups was detected. In terms of gender, there was a significant difference between groups 1 and 2 (M/F: 74/61 and 98/125, respectively) ( p<0.05). EMA was positive in six cases in group 1 (4.4%), and villous atrophy and/or inflammation in the lamina propria with increased intraepithelial lymphocytes was seen on small intestine biopsy in these patients. In the control group, EMA was negative in all children. In detailed histories of patients with coeliac disease diagnosis, recurrent iron deficiency anaemia/pica was found in four patients (66.7%) and occasionally foul-smelling or watery stool attacks were seen in four patients (66.7%). Three of these six patients (50%) had short stature. CONCLUSION: The prevalence of coeliac disease was high in patients with iron deficiency anaemia; therefore, gastrointestinal findings should be further examined for coeliac disease, and the possibility of coeliac disease should be investigated in patients with recurrent iron deficiency anaemia and short stature.     

Primary tuberculosis of the breast

Primary tuberculosis of the breast is a rare disease. Mammographic, sonographic, and computed tomographic features of a case of primary tuberculosis in the breast are presented. Differential diagnosis with other benign and malign diseases of the breast can be difficult with imaging methods. In endemic areas, tuberculosis should be considered in the differential diagnosis of breast tumors.     

Course of the innervation supply of medial head of triceps muscle and anconeus muscle at the posterior aspect of humerus (anatomical study)

Introduction In elbow surgery; posterior side of joint has been described as the front door for accessing the elbow pathologies. Triceps splitting, triceps reflection, posterolateral Kocher, posteromedial Bryan-Morrey, modified MacAusland transolecranon approaches are the well known posterior surgical approaches. In the English literature, release and transposition of ulnar nerve on the medial side was fully described in posterior approaches. We believe that there was a need to identify the structures at the lateral aspect of the elbow while an iatrogenic injury may inversely effect an excellent radiological result. Therefore, we exposed the detailed innervation supply to the anconeus muscle and medial head of triceps muscle and tried to show possible denervation sites of these two structures during posterior approaches.Materials and methods This study was performed on 14 elbows in formalin-preserved 7 cadavers. We exposed the course of the innervation supply to the medial head of triceps muscle and anconeus muscle and tried to show possible denervation sites of these two structures during posterior approaches. The branching pattern of radial nerve innervating anconeus muscle and its deriving level from radial nerve was identified. Distance from a vertical line which is passing through lateral epicondyle to branching point was measured.Results The mean distance of the branching point of the nerve to medial head of triceps muscle and anconeus was 168.3 mm (range 130.36–185.4). The nerve to anconeus muscle ran along the posterior aspect of the humerus from the horizontal line passing through lateral epicondyle at a distance of 142.20 mm (range 153.72–136.41) medial to olecranon and at a distance of 47.45 mm (range 77.13–30.14) lateral to olecranon.Conclusion Although splitting the fibers of triceps proximaly increases the exposure of the posterior humerus, innervation of the lateral portion of the medial head of triceps muscle and anconeus muscle may be jeoparadized. Therefore, surgeons who have interest in elbow surgery; (1) should revise the course of the nerve to medial head of triceps and anconeus muscle, (2) be aware of possible iatrogenic injury of the extensor muscles of the elbow via transtricipital approaches, (3) try to choose a more conservative posterior surgical approach.     

The role of reoperation in the management of endometrial carcinoma found in simple hysterectomy

OBJECTIVE: To evaluate our experience in patients with endometrial cancer found in simple hysterectomy. METHODS: Forty patients treated for endometrial cancer after simple hysterectomy were evaluated, retrospectively. Twenty-one patients (Group 1) underwent surgical staging procedure while 19 patients were not subjected to complementary surgical staging procedure (Group 2). RESULTS: The mean age was 53.80 years. Residual disease following reoperation was found in only four patients (19.0%). The three of them who were considered Stage IC (two Grade 1, one Grade 2) were found to be Stage IIIC and one patient who was considered Stage IB (Grade 2) was found to be Stage IIIC. The overall recurrence rates in Groups 1 and 2 were 4.8% versus 10.5% (P > 0.05). The overall disease-free survival rates were 95.24% in Group 1 and 87.50% in Group 2 (P > 0.05). Considering the patients who received postoperative adjuvant radiotherapy (RT), the overall disease-free survival rates were 88.89% in Group 1 and 84.62% in Group 2 (P > 0.05). CONCLUSION: We believe that complementary surgical staging may have benefit in patients with incompletely staged endometrial carcinoma excluding Stage IA G1 cases, since the recurrence rate has rising and disease-free survival estimate has decreasing tendencies in incompletely staged patients than that in complementary surgically staged ones.