Conservative treatment of eminentia intercondylaris fractures of the tibia in children

Seventeen patients (16 children, 1 adolescent) were reviewed 31 months to 71 months after sustaining the common childhood fracture of the eminentia intercondylaris of the tibia. The aim was to assess long-term results and prognosis by clinical and radiological examination and to discover whether conservative treatment was adequate for type I and type II fractures according to Meyers and McKeever. Early improvement occurred in all patients after conservative treatment, but long-term results were not satisfactory in displaced fractures,which were treated with closed reduction and immobilization in extension. Therefore, anatomic reduction and rigid fixation should be obtained for displaced fractures of the eminentia intercondylaris of the tibia.     

Percutaneous mitral balloon valvuloplasty in rheumatic mitral stenosis without heparin

BACKGROUND AND AIM OF THE STUDY: Customarily, heparin is used to prevent embolic complications arising during percutaneous mitral balloon valvuloplasty (PMBV), but this may prolong hospital stay and increases the risk of bleeding, hemopericardium and cardiac tamponade. The study aim was to assess in-hospital complications of PMBV performed without heparin. METHODS: Rheumatic mitral stenosis patients undergoing PMBV between February 1997 and March 2000, either with (18 males, 91 females; mean age 37.5 +/- 8.8 years) or without (15 males, 119 females; mean age 37.5 +/- 15.1 years) heparin at conventional doses, were included in the study. Neurologic and cardiac examinations were conducted after PMBV and repeated before discharge from hospital. RESULTS: There was no statistically significant difference between groups in terms of age, gender, NYHA class, presence of atrial fibrillation, spontaneous echo contrast, left atrial appendix thrombus, left atrial diameter and mitral valve echo score. There was no difference between groups with regard to procedural success, mitral valve area and gradient attained, or rates of mitral insufficiency. Ten patients in the heparin group required transesophageal echocardiography (TEE) guidance during PMBV (p <0.001). The mean duration of PMBV was greater in the heparin group due to increased use of TEE guidance during septal puncture. During follow up, no patients in the non-heparin group had hemopericardium, cardiac tamponade, embolic event or death; by comparison, in the heparin group one patient had hemopericardium and one had a cardiac tamponade. No major bleeding episode requiring transfusion occurred in either group, but six and 10 cases of minor bleeding at access sites occurred in the non-heparin and heparin groups, respectively (p = NS). Duration of hospitalization was statistically longer in the heparin group than in the non-heparin group. CONCLUSION: Avoidance of heparin did not lead to an increase in embolic complications. The vascular access sites were withdrawn early, thereby reducing the duration of hospital stay and time to ambulation. This method did not cause any increase in numbers of vascular complications and blood transfusions.     

Effect of timing of chest tube removal on development of pericardial effusion following cardiac surgery

BACKGROUND: There are no standard criteria for the timing of drain removal. The objective of this study was to determine whether the macroscopic appearance of chest tube drainage fluid to serosanguineous may be used as a criteria for drain removal. METHODS: 2,359 patients were assessed retrospectively and 80 randomized patients were followed prospectively who underwent cardiac surgery. In both parts of the study, patients were divided into two groups according to the timing of drain removal. Group I consisted of patients whose chest tubes were removed as soon as the macroscopic appearance of the drainage fluid turned to serosanguineous. Group II consisted of patients whose chest tubes were removed at the second postoperative day when the drainage output declined to less than 50 mL in a five-hour period. In the retrospective part, cases of hemodynamically significant pericardial effusion observed within seven days postoperatively were reviewed. In the prospective part, just before the drain removal, the fluid sample hematocrit obtained from the drain lines and patients' blood hematocrit were measured and recorded. Patients were evaluated with echocardiography for pericardial effusion. RESULTS: No statistically significant difference was detected in the frequency of hemodynamically significant pericardial effusion and incidence or amount of pericardial effusion between the two study groups. The drain hematocrit to blood hematocrit ratios before drain removal showed a significant correlation with pericardial effusion.The strength of correlation between the drain hematocrit to blood hematocrit ratios before drain removal and pericardial effusion was also studied using receiver operating characteristic curve, which suggests that a drain hematocrit to blood hematocrit ratio of < or = 0.3 is strongly predictive that pericardial effusion would be absent or mild between the fifth and seventh postoperative days. CONCLUSIONS: It is safe to remove the chest tubes as soon as the macroscopic appearance of the drainage fluid turns to serosanguineous since this practically indicates cessation of active bleeding.     

The relation between tooth loss and bone mass in postmenopausal osteoporotic women in Turkey: a multicenter study

 The purpose of this study was to investigate the associations of tooth loss with skeletal bone mass, years since menopause, educational level, current smoking status, dietary calcium intake, and number of pregnancies in postmenopausal osteoporotic women in Turkey. The study population consisted of 1171 postmenopausal women aged 40–86 years (mean age, 61.19 ± 7.28 years). A detailed history was obtained from all women, including relevant lifestyle parameters, risk factors, and measurements of weight and height. Women were separated into three groups according to the number of teeth remaining as group 1 (edentulous, 457 women), group 2 (10 or fewer teeth, 232 women), and group 3 (more than 10 teeth remaining, 482 women). There was no significant difference among the three groups in mean age and menopausal age (P < 0.05). Body mass index of group 1 was significantly higher than that of group 2 (P < 0.01). Educational level was significantly different between three groups: groups 1 and 2 (P < 0.001), groups 1 and 3 (P < 0.0001), and groups 2 and 3 (P < 0.001). Educational level was lowest in group 1 and highest in group 3. Despite a low ratio of cigarette smoking in general, a smoking habit was most prevalent in group 3 and least in group 2. The ratio of women receiving adequate calcium was significantly lower in group 1 than in other groups (P < 0.001); mean calcium intake was similar in all groups. The number of pregnancies was significantly higher in group 1 than in other groups (P < 0.001). Lumbar bone mineral density (BMD) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001). Although no significant difference was found between groups 1 and 3, femoral neck BMD of group 2 was less than in others, and differences between groups 1 and 2 and between groups 2 and 3 (P < 0.001) were significant. Lumbar bone mineral content (BMC) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001), and lumbar BMC in group 2 was significantly higher than in group 3 (P < 0.05). Femoral neck BMC in group 1 was significantly higher than in groups 2 and 3 (P < 0.001). In conclusion, lumbar BMD and BMC in the edentulous group were significantly lower, whereas femoral neck BMD and BMC were significantly higher in edentulous group compared with the others. Our findings indicated that improvement in lifestyle factors and nutritional strategies for the treatment and prevention of osteoporosis may have additional benefit in reducing tooth loss. Received: February 18, 2002 / Accepted: June 21, 2002 Offprint requests to: A. Gur     

Behçet's disease: diagnostic and prognostic aspects of neurological involvement

This study was conducted to describe clinical and prognostic aspects of neurological involvement in Behçet's disease (BD). Patients referred for neurological evaluation fulfilled the criteria of the International Study Group for Behçet's Disease. We analyzed disability and survival by the Kaplan-Meier method, using Kurtzke's Extended Disability Status Scale (modified for BD) and the prognostic effect of demographic and clinical factors by Cox regression analysis. We studied 164 patients; of the 107 diagnostic neuroimaging studies: 72.1% showed parenchymal involvement, 11.7% venous sinus thrombosis (VST) and the others were normal. CSF studies were performed in 47 patients; all with inflammatory CSF findings (n=18) had parenchymal involvement. An isolated increase in pressure was compatible with either VST or normal imaging. The final diagnoses were VST (12.2%), neuro-Behçet's syndrome (NBS) (75.6%), isolated optic neuritis (0.6%), psycho-Behçet's syndrome (0.6%), and indefinite (11%). VST and NBS were never diagnosed together. Ten years from onset of BD 45.1% (all NBS) reached a disability level of EDSS 6 or higher, and 95.7±2.1% of the patients were still alive. Having accompanying cerebellar symptoms at onset or a progressive course is unfavorable. Onset with headache or a diagnosis of VST is favorable. Two major neurological diagnoses in BD are NBS and VST. These are distinct in clinical, radiological, and prognostic aspects, hence suggesting a difference in pathogenesis.     

Methotrexate and misoprostol used alone or in combination for early abortion

The purpose of this study was to compare the outcome and side effects of using the drugs methotrexate and misoprostol, alone or in combination, to induce abortion. A total of 108 subjects who had requested elective termination of pregnancy and medical abortion at 9 weeks gestation or less were randomized into three groups. The first group received 50 mg/m² intramuscular (IM) methotrexate on day 1 and, if the hCG level had risen by >50% of the initial level on day 4, a second dose was given. They were then followed-up at weekly intervals up to day 21. Group 2 received 800 μg vaginal misoprostol on day 1 and, if ultrasound showed a gestational sac on day 4, they received a repeat dose and were re-examined on day 7. Group 3 received 50 mg/m² methotrexate intramuscularly followed 3 days later by 800 μg vaginal misoprostol and were re-examined on day 7. Complete abortion occurred in 25 (69%) of the 36 subjects in group 1, 21 (58%) of the 36 subjects in group 2, and 32 (89%) of the 36 subjects in group 3. The complete abortion rate in group 3 was significantly higher than that of both group 1 and group 2 (p <0.05). The incomplete abortion rate was significantly higher in group 2 as compared with both of the other groups (p <0.05). There were significant differences between the mean gestational age of the successful abortions and the failures in group 1 (no abortion occurred at more than 49 days gestation), but not in groups 2 or 3. Vaginal bleeding in subjects who successfully aborted began within 16 ± 4 days in group 1 after the first dose, and within 24 h in 18 (86%) of the 21 subjects in group 2 and 27 (84%) of the 32 subjects in group 3 after the misoprostol dose. The drugs caused no serious or prolonged side effects. The combination of methotrexate and misoprostol is a more effective abortifacient regimen than when either drug is used alone.     

Radiographic changes in the lumbar spine in former professional football players: a comparative and matched controlled study

Heavy physical work and activity lead to degenerative changes, especially in the lumbar spine. We aimed to find out the occurence of radiographic changes (vertebral osteophytes, heights of lumbar dicsc, concavity index) and abnormalities of the lumbar spine in former professional football (association football or soccer) players according to their specialization (goalkeeper, defender, midfielder, forward) in their past professional sport life. We included 70 male former professional football players and 59 men as the control group. The football players group consisted of 15 defenders (21%), 29 midfielders (41%), 18 forwards (26%) and 8 goalkeepers (12%). Their mean professional football life was 11.04 years and the mean time period after their retirement was 13.87 years. Radiographs of both groups were taken to measure the disc height, concavity index and to determine osteophytes and abnormalities of the lumbar spine. FFbH-R score was assessed for daily activities. The mean FFbH-R score of football players was lower than that of the control group (P = 0.005). The total number of osteophytes in the player group was higher than in the control group (P = 0.001). The mean disc height of L1–L2 in football players was higher than in the control group (P = 0.045). The mean disc height of T12–L1 in goalkeepers was higher than in forward players (P = 0.019). The mean concavity index of L1 in forward players was lower than in defenders (P = 0.018). The mean disc heights of T12–L1 and L2–L3 were both higher in players whose professional sport life was >10 years than in players with ≤10 years (P = 0.018, P = 0.016). The mean disc height of L5–S1 was higher in players who had continued sport activity after retirement (P = 0.025). No statistically significant result was obtained with the rest of the variables. Playing football is heavy work. The decreased height of lumbar discs and the lower value of concavity index of forward players are because the lumbar spine of forward players is loaded more than in the rest of the players. Presented in part orally at Eurospine 2006, İstanbul, Turkey, 25–28 October 2006. Presented in part as poster at XXXVI Scientific Congress of Polish Orthopaedic and Traumatology Society, Katowice, Polland, 28–30 September 2006.     

Predictive value of image cytometry for diagnosis of lung cancer in heavy smokers.

The Research Institute for Diagnosis and Treatment of Early Lung Cancer (RIDTELC) Lung Study was initiated to determine whether lung cancer screening by automated sputum cytometry combined with conventional sputum cytology and auto-fluorescence in addition to white light bronchoscopy could enhance the detection rate of early lung cancer. The present study analyses the initial findings to evaluate the efficiency of automated sputum cytology in predicting the diagnosis of lung cancer. In this study, malignancy grade was used as a predictive parameter for lung cancer. In total, 2,480 heavy smokers (>30 pack-yrs), aged 50-74 yrs, with no previous cancer in the last 5 yrs, received chest radiology, conventional sputum cytology and sputum cytometry screening. In total, twenty-seven lung cancers were diagnosed, representing a prevalence of 1.1%, 25 of which provided sputum samples. Positive automated sputum cytology results were seen in 176 smokers (7.2%), 10 (0.4%) of whom had severe dysplasia or higher lesions (positive results) by conventional sputum cytology examination. Out of 25 tumour cases, 20 had suspicious results using automated sputum cytology, representing 80% sensitivity. One patient out of 24 with tumours had positive results on conventional sputum cytology, representing a sensitivity of 4.2%. For all stages of squamous cell lung cancer and later stage adenocarcinoma the sensitivity of automated sputum cytology was 100%. For adenocarcinoma stage I sensitivity was 25%. In conclusion, DNA analysis of sputum slides by automated sputum cytology may be a suitable tool for the detection of early lung cancer and the characterisation of a high-risk group with pre-invasive lesions for follow-up.