What leads to unfavourable Cybex test results for quadriceps power after modified tension band osteosynthesis of patellar fractures?

This study recruited 20 patients who had undergone modified tension band wiring for patellar fracture, with a mean follow up of 30 months. Subjects were grouped according to results of Cybex isokinetic testing at 60 degrees /s angular velocity. Subjects with <30% deficit as compared with the contralateral knee constituted group I, and those with >30% similar deficit formed group II. Plain radiography and HSS scoring were also performed. According to patient satisfaction, HSS scoring and Cybex testing, results were good in 80%, 90% and 55% of cases, respectively. Statistical analysis revealed that there were no significant differences between the two groups in terms of age, gender, duration of follow up, fracture type (two-part or comminuted), dominancy, time interval between trauma and surgery, or duration of immobilisation. The number of patients with >1 mm articular incongruity postoperatively was significantly higher in group II, which also had significantly higher incidences of >1 cm thigh atrophy and pain and thus increased deficits. We suggest that articular incongruity should be limited strictly to 1mm in surgery for patellar fractures.     

Alteration of Epidermal Growth Factor Receptor Expression Following Ischaemia of Renal Tissue

This study was aimed to investigate Epidermal Growth Factor Receptor (EGF-R) expression after ischaemic injury in renal tissue and the effects of calcium channel blockers in the prevention of damage due to ischaemic insult. Simple nephrectomy was performed in a group of Sprague-Dawley rats, and kidneys were grouped according to cold ischaemia time (1, 6, 12, 24 and 48 hours, respectively) and to the type of calcium channel blockers (diltiazem and verapamil) used. EGF-R expression status was investigated in each group by immunohistochemistry on paraffin sections. Overall expression of EGF-receptor was detected in 8 822.8%) kidneys. In terms of localization of EGF-receptor expression cortical tubular staining was detected in 8 (100%) kidneys, medullar tubular staining in (62.5%) kidneys and glomerular mesangial staining in 5 (62.5%) kidneys. There was no difference between various ischaemia times and different calcium channel blockers used. It has been concluded that hypoxia and cold ischaemia causes widespread down-regulation of EGF-receptor expression in renal tissue regardless of treatment with calcium channel blockers.     

Early Left Atrial Mechanics and Volume Abnormalities in Subjects with Prehypertension: A Real Time Three‐Dimensional Echocardiography Study

The aim of this study was to evaluate left atrial (LA) volume and mechanical functions by real time three‐dimensional echocardiography (RT3DE) in prehypertensive subjects. The study included 54 (34 male and 20 female) prehypertensive subjects and 36 (14 male and 22 female) healthy control subjects. Transthoracic echocardiography and RT3DE were performed in all patients. Interventricular septum thickness and isovolumetric relaxation time were significantly higher in prehypertensives than in controls (10.7 ± 0.7 vs. 10.1 ± 0.8 P = 0.001 and 89.9 ± 10 vs. 82.4 ± 11 P = 0.002, respectively). LA maximum volume, volume before atrial contraction, total and active stroke volume, total and active emptying fractions, expansion index, and LA max volume index were significantly higher in prehypertensives when compared with controls (P < 0.0001 for all). However, the passive emptying fraction was significantly lower in prehypertensives than controls (45.7 ± 5.6 vs. 48.6 ± 4.1, P = 0.006), and the minimum LA volume between the two groups was similar. The main finding of this study was that although LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions. These parameters may be important in showing hemodynamic and structural changes in cardiac tissue caused by prehypertension.     

Sclerosing stromal tumour of the ovary: A case report and the review of literature

Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. To date, 208 cases have been recorded in the literature. Most patients have menstrual irregularities and pelvic pain. Infertility and virilisation have also been described. In this article, histopathological features and differential diagnosis of the benign sclerosing stromal tumour were described together with the literature data. It is imperative to consider the differential diagnosis of a sclerozing stromal tumour of the ovary in a young woman with an ovarian tumour. A combination of morphological, immunohistochemical, radiological and clinical findings is needed in differentiating the tumour from thecoma, fibroma/fibrosarcoma, lipoid tumours and Krukenberg tumour.     

The effect of placental removal method on perioperative hemorrhage at cesarean delivery; a randomized clinical trial

Purpose

The aim of this prospective randomized clinical study is to compare whether the removal methods of placenta during cesarean section have an impact on perioperative hemorrhage.

Methods

One hundred women with singleton term pregnancies undergoing elective cesarean section through lower segment transverse incision under general anesthesia were included in this study. They were randomly allocated to two groups according to the type of removal of the placenta from the uterus after childbirth; manually or spontaneously. The main outcome measures were change in hemoglobin levels after cesarean section. The secondary outcomes were operative time, required transfusions and postcesarean endometritis.

Results

Fifty patients were randomized to the manual removal group and 50 to the spontaneous group. The demographic characteristics of the two groups were similar. There were no difference in terms of change in hemoglobin levels after cesarean section between two groups (1.6 ± 1.0 and 1.5 ± 1.0, respectively; P = 0.711). In addition, none of the patients required blood transfusion and showed postpartum infections.

Conclusion

There is not an association between the method of removal of the placenta and postpartum blood loss in cesarean section deliveries.     

The effect of acute internal problems for mortality in respiratory intensive care unit patients

Acute internal problems in the respiratory intensive care unit (ICU) and risk factors affecting mortality in the acute treatment applications were investigated. All patients in 20-bed intensive care unit for chest diseases enrolled to this prospective observational cohort study during 2008. Patients were classified as living in group 1 and deaths in group 2. Demographics and acute internal problems (arrhythmias, acute kidney-liver failure, dopamine, doputamin, perlinganit infusion) were recorded. Multiple regression analysis was performed for factors affecting mortality. There were 603 patients during the study period, group 1, n= 503 (83.4%), group 2, n= 100 (16.6%). Both groups were similar in terms of age and gender. Odds ratio (OR), 95% confidence interval (CI), p value for internal problems of acute risk factors for mortality were found as; septic shock OR: 22.52, CI 8.11-62.57, p< 0.000; need of perlinganit infusion OR: 9.28, CI: 1.61-53.37, p< 0.012; the presence of arrhythmia, OR: 7.81, CI: 3.46-17.65, p< 0.000; acute renal failure, OR: 2.88, CI: 1.24-6.65, p< 0.013 and the need for dopamine OR: 2.83, CI: 1.06-7.65, p< 0.037, respectively. Internal problems such as cardiac and renal dysfunction can devolop in respiratory ICU patients with pulmonary diseases and these problems constitude additional risk factors for mortalitiy. While the number of ICU is increasing with new health policies, each internal requirement and personnel equipped to treat the problem quickly must be considered.     

Prenatal diagnosis of mobile flap-like tissue on the ventricular septal defect in a newborn with trisomy 18

Trisomy 18 is the second most common autosomal trisomy in liveborn infants. Various congenital malformations, mental retardation, and high rate of infant mortality in the first year of life are characteristic features of trisomy 18. Congenital heart disease occurs in over 90% of these patients and the most common cardiac lesions are ventricular septal defect, patent ductus arteriosus and atrial septal defect. This is a case report of a baby born with trisomy 18 (postnatal diagnosis) in whom there was an unusual echocardiographic appearance of a mobile structure ("flap-like") around the area of a VSD-which was imaged prenatally.