Disorders associated with osteopoikilosis

Although osteopoikilosis is generally considered an accidental finding, several developmental dysplasias coexisting with this disorder have been reported. However, all authors have mentioned only one coexisting finding, and most of them are case reports. We report a family in whom various members had osteopoikilosis with 5 different associated lesions. We suggest that osteopoikilosis is a bone manifestation of a generalized fibroproliferative or stenosing disease.     

Evaluation of Extensor Mechanism in Revision Knee Arthroplasty

Background

The success of revision total knee arthroplasty depends on adequate exposure that does not produce complications. The purpose of this study was to compare the results of revision total knee arthroplasty between V-Y quadricepsplasty (QP) and quadriceps snip (QS) approaches.

Assessment of pain-related fear in patients with the thrust plate prosthesis (TPP): due to hip fracture and hip osteoarthritis

The aim of this study is to determine the differences between hip fracture and hip arthrosis groups and to assess pain related fear of injury in patients who were operated using the TPP following hip fracture or hip arthrosis. Fifty-eight patients (mean age = 63.9 ± 10.3 years) who were operated using the TPP, following hip fracture (hip fracture group; n = 25) or coxarthrosis (coxarthrosis group; n = 33) were recruited. All of the measurements were performed after a follow-up time of at least 2 years. Functional level by Harris Hip Scoring System (HHS), pain related fear by Tampa Scale for Kinesiophobia (TSK) and pain intensity by numerical rating scale (NRS) was evaluated. There were no significant differences between demographic and clinical characteristics of two groups. However, pain intensity was higher in coxarthrosis group than hip fracture group. There was no correlation between the TSK scores and either Harris scores or NRS scores (p > 0.05) in the hip fracture group. No correlation between NRS and TSK was found in coxarthrosis group but there was a significant correlation between TSK and HHS. TSK scores were high in both groups. High TSK scores proved us that the patients with TPP had fear of movement even they had enough physical performance. The coxarthrosis group had higher pain intensity. Rehabilitation clinicians should consider pain-related belief which is more important than pain intensity and functional level in coxarthrosis patients.     

Anomalous systemic arterial supply to normal Basal segments of the left lower lobe of the lung: therapeutic implication

We describe a 5-month old infant who presented with a continuous murmur and enlargement of the left heart. The patient's diagnosis was an anomalous systemic arterial supply to basal segments of the left lower lobe characterized by a lack of a pulmonary arterial supply. This condition was treated without lobectomy. To our knowledge, this report is the first to describe an anomalous systemic arterial supply to basal segments of the lower lobe of the left lung with a single arterial supply that was treated in childhood without lung resection. Our case offers an alternative treatment to surgical lobectomy for this abnormality.     

Low frequency of HLA-B27 in ankylosing spondylitis patients from Turkey

ObjectivesAnkylosing spondylitis is strongly associated with HLA-B27. However, the strength of the association with HLA-B27 and the clinical features may vary in different parts of the world. The aim of this study is to compare the clinical features of AS and the frequencies of HLA-B27 and its alleles in patients from Turkey with other series.MethodsOne hundred and twelve patients (72 male/40 female) fulfilling the modified New York criteria for the classification of AS and 55 (27 male/28 female) healthy controls were typed for HLA-B27 and allele frequencies by sequence specific primer (PCR/SSP) method and assessed for clinical manifestations.ResultsMale to female ratio was 1.8, mean age at disease onset was 23.5 and 24.1% of patients reported juvenile onset of symptoms. Peripheral arthritis was seen in 52.7% of patients. Family history (p = 0.01) and peripheral arthritis (p = 0.02) were more frequent in females and spinal involvement in males. HLA-B27 was found to be positive in 70% of patients and associated with younger mean age, uveitis and shorter time elapsed from symptom to diagnosis. The frequency of HLA-B27 alleles associated with SpA was not different between ankylosing spondylitis patients and healthy controls.ConclusionLow frequency of HLA-B27 and clinical variations in ankylosing spondylitis may be due to different genetic and/or environmental factors in Turkey.     

Gait assessment in patients with thrust plate prosthesis and intramedullary stemmed prosthesis implanted to each hip

Introduction There has not been any study regarding comparative gait analysis in patients with intramedullary stemmed prosthesis (ISP) and thrust plate prosthesis (TPP) implanted to each hip. Patients and methods Four patients (three females and one male) who had undergone operation due to coxarthrosis were selected. The mean age was 60.5 (37–78) years. TPP and ISP had been implanted to the left and right hip, respectively, in three patients, and one patient received TPP to the right and ISP to the left hip. Gait was analyzed with a BTS Elite System consisting six cameras and two Kistler force plates using Helen Hayes marker set to assess the gait parameters. The clinical outcome was also evaluated according to Harris hip score (HHS). Results The average HHS was 95.0 (82–100) points after a mean follow-up of 45.0 (30–50) months for TPP and 94.5 (80–100) points after a follow-up of 60.0 (14–122) months for ISP. Neither of the HHS scores and follow-up time nor gait parameters obtained from the TPP-implanted side were statistically different when compared to those of the ISP-implanted side. Conclusion TPP and ISP as the implants with their own biomechanical specifications did not produce any remarkable difference in gait.     

Integration of Mycobacterium tuberculosis Drug Susceptibility Testing and Genotyping with Epidemiological Data Analysis To Gain Insight into the Epidemiology of Drug-Resistant Tuberculosis in Malatya,Turkey

Drug-resistant tuberculosis (TB) presents a major challenge to global TB control. To gain a better understanding of drug-resistant TB epidemiology in Malatya, Turkey, we conducted the present study using 397 Mycobacterium tuberculosis clinical isolates collected from Malatya, Turkey, in recent years (2000-2007). Resistance to any anti-TB drug was found in 29% (114 of 397) of the study isolates, while the multidrug resistance (MDR) rate was ∼4.5% (18 of 397). Resistances to isoniazid (15.5%) and streptomycin (13.4%) were about twice as high as resistance to rifampin (RMP) (6.3%) and ethambutol (EMB) (6.0%). Importantly, 28% (7 of 25) of the RMP-resistant isolates were non-MDR isolates, as when a significant proportion of RMP-resistant isolates in a population are non-MDR, the predictive value of molecular detection of RMP resistance for MDR can be significantly reduced. Both identical and varied drug resistance patterns were seen in the same genotyping-defined clusters, suggesting that both primary and acquired resistance have contributed to the drug-resistant TB epidemic in Malatya, Turkey. In addition, drug-resistant cases were found to be more likely to be males (odds ratio [95% confidence interval], 1.82 [1.13, 2.94]), suggesting a potential role of gender in the epidemiology of drug-resistant TB in the study population. This study demonstrates that the integration of drug susceptibility testing with genotyping and epidemiological data analysis represents a useful approach to studying the epidemiology of drug-resistant TB.Tuberculosis (TB) remains an important global public health problem, and global TB control is further challenged by the rising epidemics of drug-resistant TB worldwide (29). In 2008, the World Health Organization (WHO) reported that worldwide resistance to any of the anti-TB drugs accounted for 20% of all reported TB cases while an estimated 5.3% of all reported TB cases had multidrug resistance (MDR), defined as resistance to, at least, isoniazid (INH) and rifampin (RMP) (28). Furthermore, globally, only 10% of the roughly 500,000 people who develop MDR TB each year receive treatment, leading to more possible cases of MDR TB (9). Because of the disparities in TB control around the world, a better understanding of the dynamics and driving forces of drug-resistant TB epidemics would contribute to the development of more effective strategies for global TB control.Turkey, with a population of around 70 million, had an annual TB incidence of 27.9 per 100,000 people in 2007 (6). Although the TB incidence in Turkey has decreased by half since 1985, several studies have shown the proportion of drug-resistant TB cases to be higher than the global average (3, 5, 10, 11, 20, 24, 26). In 2005, Surucuoglu and colleagues reported that the rate of resistance to any anti-TB drugs among 355 isolates of Mycobacterium tuberculosis obtained from western Turkey was 21.1%, while another study found that among the 1,513 TB cases diagnosed in Istanbul, Turkey, in 2005, 19% were resistant to at least one drug (20, 25). These rates are similar to the rates of drug resistance found in some of the Eastern European countries that are considered to have the highest drug resistance rates in the world (3). The high drug resistance rate poses a major challenge to the control of TB in Turkey. Previous studies of different populations have found that both host and microbial factors can play a role in drug-resistant TB epidemics. Microbial factors such as specific spoligotype families have been implicated as risk factors. TB genotypes belonging to the Beijing and Latin American and Mediterranean (LAM) families are associated with drug resistance (18, 23).Although previous studies reported high rates of drug-resistant TB infection in different regions of Turkey and several studies reported genotyping results of M. tuberculosis isolates collected from different regions of Turkey (10-12), few assessed associations of microbial and host characteristics with drug-resistant TB cases and attempted to determine the factors driving the epidemic of drug-resistant M. tuberculosis infection in the population. To gain a better understanding of the epidemiology of drug-resistant TB in Malatya, Turkey, we analyzed 397 M. tuberculosis clinical isolates collected from Malatya, Turkey, during the time period between 1 January 2000 and 31 December 2007 and their corresponding epidemiological data. Malatya is the third biggest city in Turkey and has a population of approximately 722,000 and an annual TB incidence of 28.5 per 100,000 (6).     

Venous collapsibility index changes in children on dialysis

AIM: Hypervolemia is an important factor for the development of cardiac failure in end-stage renal disease. The aims of this study are to evaluate whether collapsibility index (CI) is a useful method to assess the volume status in children on haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), and to test whether the small amounts of fluid removed after a single dialysis exchange will be reflected by a change in CI in peritoneal dialysis patients. METHODS: Sixteen CAPD, nine HD patients aged from 5 to 18 years and 27 age- and sex-matched healthy children were enrolled in the study. Inferior vena cava diameters were measured from subxiphoidal long axis position in 2 cm to its junction to right atrium and CI were calculated. RESULTS: The collapsibility index was significantly lower in HD patients before HD and in the CAPD group before dialysate exchange when compared with the controls. No significant difference was found between the CAPD and HD groups. We observed significant increase in CI after HD, CI values reached nearly to control levels after HD. Ultrafiltrate was 1.93 +/- 0.98 kg in HD, 0.23 +/- 0.09 kg in the CAPD group. Although the change in CI values before and after dialysate exchange was significant in the CAPD group, there was still a significant difference between the CI values of the control group and the CAPD patients after dialysate exchange. CONCLUSION: We suggest that serial measurements of CI in children will be a useful guide to assess the volume changes in an individual instead of a single measurement.