Steroid Injection and Biomarker Levels in the Treatment of Unicameral Bone Cysts: Can we Estimate the Result?

BackgroundSteroid injection is a common method in the treatment of unicameral bone cysts (UBC). In this study, the relationship between the clinical results and inflammatory molecules’ levels in the cyst fluid was evaluated after three repeated steroid injections in UBC subjects.MethodsTwenty-one patients diagnosed with UBC were treated with methylprednisolone acetate (MPA) injections. Patients were given three injections, each containing MPA, 6–8 weeks apart. Plain radiographs were obtained and cyst healing was evaluated according to modified Neer classification. Cyst fluid samples were taken. Samples were taken at first and last operations and were studied using the ELISA method to examine IL-1β, PGE2, MMP-1, and VEGF-A levels.ResultsThere were 17 and 4 cases localized to the humerus and femur, respectively. The mean follow-up period was 36.9 months. Complete recovery was achieved in 13 patients (61.9%) receiving MPA. Four patients (19%) recovered with residual lesions. One patient (4.7%) did not respond to steroid injections at all. In three patients (14.2%) the cyst recurred. Results were satisfactory in 17 patients (80.9%) and totally unsuccessful in 4 patients (19%). IL-1β, PGE2, and MMP-1 levels in cyst fluid were not affected by injection (p > 0.05), but VEGF-A levels decreased significantly with cyst healing (p = 0.01).ConclusionSteroid injection is a good choice in the treatment of UBC because of its less aggressive and relatively good outcome. It may be considered to evaluate the response to treatment by performing biomarker monitoring especially VEGF-A in repeated injections.Level of EvidenceLevel II study.     

Comparison of Kinesiotaping,Exercise and Subacromial Injection Treatments on Functionality and Life Quality in Shoulder Impingement Syndrome: A Randomized Controlled Study

PurposeDisturbance of scapulohumeral rhythm has been shown to play a major role in subacromial impingement syndrome. Exercise, taping and subacromial injection are first ray conservative treatment modalities. We aimed to correct scapulohumeral rhythm with kinesio taping and exercise program via focusing on especially periscapular muscles not on glenohumeral structures to achieve scapulothorasic stabilization.Material and MethodsSeventy five patients were divided into three groups randomly with different treatment modalities which are only exercise group (Group 1), kinesiotaping + exercise group (Group 2), and injection + exercise group (Group 3). Western Ontario Rotator Cuff Index (WORCI), Quick Disability of arm, shoulder, hand (Q-DASH), Constant- Murley Scores (CMS) were evaluated for each patient at the beginning, 15th and 60th days and compared in time and technique manner. Scores were analyzed statistically with One-way ANOVA and Chi-square tests.ResultsAll the three groups had better results in short and long term follow ups as compared to initial admission. But in the second group 15th and 60th day results were superior to other groups significantly (p < 0,001).ConclusionsMost of recent studies using kinesio taping were focused on mechanical correction of humerus which will be an impaired treatment to correct the main cause of impingement. Not only mechanical correction of periscapular muscles and also stabilization of scapulae will help to gain scapulohumeral rhythm.     

Diabetes mellitus in intraductal papillary mucinous neoplasms: A systematic review and meta-analysis

BackgroundOur current knowledge of diabetes mellitus in intraductal papillary mucinous neoplasm is very limited and its prevalence and predictive value for malignant transformation are not clear. This study sought to systematically review the literature to define the prevalence of diabetes mellitus in intraductal papillary mucinous neoplasm and to evaluate the association of diabetes mellitus with the progression to high-grade dysplasia or invasive cancer.MethodsA PubMed/Medline systematic search was performed to identify studies reporting data on preoperative diabetes mellitus in intraductal papillary mucinous neoplasm. Articles meeting the predefined inclusion criteria were analyzed and a meta-analysis was performed. The study was preregistered (PROSPERO ID: CRD42020153581).ResultsFrom the initially detected 827 studies, 27 studies including resected patients with histologically confirmed intraductal papillary mucinous neoplasm were included. The global prevalence of preoperative diabetes mellitus was 25% (1,112 of 4,412); whereas new-onset/worsening diabetes mellitus was reported in 6% of patients (68 of 1,202). The meta-analysis revealed that patients with pre-existing diabetes mellitus had an increased risk of harboring a main pancreatic duct involvement (risk ratio 1.43, 95% confidence interval: 1.21–1.69, P < .001), high-grade dysplasia (risk ratio 1.27, 95% confidence interval: 1.01–1.59, P = .04), and invasive cancer (risk ratio 1.61, 95% confidence interval: 1.33–1.95, P < .001).ConclusionThe prevalence of diabetes mellitus in intraductal papillary mucinous neoplasm is high, and diabetic patients demonstrate an increased risk of a more aggressive disease. Therefore, diabetes mellitus should be increasingly considered in the stratification of patients with intraductal papillary mucinous neoplasm. Further investigations to determine the mechanisms behind the association with progression should be carried out.     

Risperidone induced reproductive toxicity in male rats targeting leydig cells and hypothalamic–pituitary–gonadal axis by inducing oxidative stress

Risperidone (RIS), a commonly used drug during a lifetime for the treatment of schizophrenia, causes some adverse effects in the male reproductive system; however, there is no comprehensive reproductive toxicity study of RIS. For this purpose, male rats were administered orally for 1.25, 2.5 and 3 mg/kg RIS for 28 days and the sperm count, motility, morphology, DNA damage and the histological changes in testicular tissue were evaluated. Follicle-stimulating hormone (FSH), luteinising hormone (LH) and serum levels of testosterone, which are the main hormonal regulators of reproduction, and testicular glutathione (GSH), catalase (CAT), superoxide dismutase (SOD) and malondialdehyde (MDA) levels as the indicators of oxidative stress were determined. Normal sperm morphology was decreased in RIS groups and histopathological degeneration occurred in testis tissue dose-dependently. Serum LH levels were not altered; however, FSH and testosterone levels decreased in the high-dose group. Histopathologic examination showed RIS toxicity targeted Leydig cells, which might be associated with impairment of the hypothalamic–pituitary–gonadal (HPG) axis. GSH levels were decreased and MDA levels were increased in the high-dose group which was evaluated as indicators of oxidative stress. In conclusion, RIS caused reproductive toxicity in male rats by inducing oxidative stress and disrupting hormonal regulation.     

The relationship between premature ejaculation and the timing of pre-adult circumcision

We aimed to investigate the relationship between premature ejaculation and the age when men had been circumcised before adulthood. A total of 2,768 sexually active male patients aged between 18 and 65 years were included in this study. A multicentre study was conducted prospectively with the participation of 20 centres. A survey consisting of 12 questions prepared by the researchers, as well as the validated Turkish versions of the five-item Premature Ejaculation Diagnostic Tool, was administered to all participants. The study included 1,603 participants who met the inclusion criteria. There was no significant difference in the Premature Ejaculation Diagnostic Tool and self-reported ejaculation time between the participants who had been circumcised at different ages during childhood. Remembering circumcision experience with fear or anxiety did not increase the risk of sexual dysfunction compared to the participants who described their experience with happiness or with no particular emotion. There was no significant difference in Premature Ejaculation Diagnostic Tool scores or the self-reported ejaculation time of the participants circumcised at different ages. The age of childhood circumcision, having a fearful or anxious circumcision experience, does not affect the risk of premature ejaculation in adult life.     

Does a Laparoscopic Approach to Distal Pancreatectomy for Cancer Contribute to Optimal Adjuvant Chemotherapy Utilization?

Annals of Surgical Oncology - Although laparoscopic distal pancreatectomy (LDP) versus open approaches (ODP) for pancreatic adenocarcinoma (PDAC) is associated with reduced morbidity, its impact on...     

Genotyping in 46 patients with tentative diagnosis of Treacher Collins syndrome revealed unexpected phenotypic variation

To define the range of phenotypic expression in Treacher Collins syndrome (TCS; Franceschetti-Klein syndrome), we performed mutation analysis in the TCOF1 gene in 46 patients with tentative diagnosis of TCS and evaluated the clinical data, including a scoring system. A total of 27 coding exons of TCOF1 and adjacent splice junctions were analysed by direct sequencing. In 36 patients with a clinically unequivocal diagnosis of TCS, we detected 28 pathogenic mutations, including 25 novel alterations. No mutation was identified in the remaining eight patients with unequivocal diagnosis of TCS and 10 further patients, in whom the referring diagnosis of TCS was clinically doubtful. There is no overt genotype-phenotype correlation except that conductive deafness is significantly less frequent in patients with mutations in the 3' part of the open reading frame. Inter- and intrafamilial variation is wide. Some mutation carriers, parents of typically affected patients, are so mildly affected that the diagnosis might be overlooked clinically. This suggests that modifying factors are important for phenotypic expression. Based on these findings, minimal diagnostic criteria were defined: downward slanting palpebral fissures and hypoplasia of the zygomatic arch. The difficulties in genetic counselling, especially diagnosis of family members with a mild phenotype, are described.     

Low-Energy Hawkins Type III Talar Neck Fracture-Dislocation With Neurovascular and Tendon Entrapment in a Pediatric Patient

Several serious complications can occur after talar neck fractures. However, these fractures are extremely rare in children. We present a pediatric low-energy Hawkins type III fracture-dislocation that had excessive displacement accompanied by neurovascular and tendon entrapment. A 9-year-old male patient referred to our hospital 5 hours after jumping off a swing in a children's playground. An excessively displaced talar neck fracture-dislocation was observed at the initial evaluation. The patient underwent urgent surgery. The tibialis posterior flexor digitorum longus tendons, posterior tibial artery, and tibial nerve were entrapped at the fracture site. The talar neck fracture was reduced using open reduction. The neurovascular structures and tendons were removed from the fracture site. The fracture was fixed using two 4.5-mm cannulated screws. The patient was able to bear full weight at 10 weeks postoperatively. At 6 months, the patient was able to walk unassisted with full ankle range of motion. However, at 2 years, his American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score had decreased to 72 points, and we observed avascular necrosis in the talar head. In conclusion, talar fractures are rare but can lead to serious complications. In the pediatric population, even low-energy trauma, such as had occurred in our patient, can result in severe displaced fracture-dislocations. After severe displaced fracture-dislocations, important soft tissue structures can become entrapped between fracture fragments, and surgeons should be aware of this situation when considering using closed reduction.     

Introducing clinical pharmacy services to cardiovascular clinics at a university hospital in Northern Cyprus

Background Clinical pharmacists are the primary source of scientifically valid information and advice on the safe, rational, and cost-effective use of medications. However, ward-based clinical pharmacy services are not well optimized in Northern Cyprus. Objective Ward based clinical pharmacy services were introduced and evaluated in cardiovascular clinics. Setting Cardiology and cardiovascular surgery departments in a tertiary university hospital. Methods A prospective interventional study introduced and documented clinical pharmacy services for 120 days. Drug-related problems were classified using the Pharmaceutical Care Network Europe PCNE DRP classification tool V6.2. Main outcome measure Interventions proposed and acceptance rate of recommendations. Results A total of 133 patients were reviewed, and, 81 patients had drug-related problems. Only 402 (93.1%) of the 432 suggested interventions were accepted and regarded as clinically relevant. Drug-related problems primarily involved antihypertensive, diuretic, and antithrombotic agents. Treatment effectiveness was the major type of drug-related problems (107; 49.3%) followed by adverse drug reactions (74; 34.1%). Drug dose and selection were the most frequent causes of drug-related problems. Add/change/stop medications were the most common types of intervention at the prescriber level. A total of 171 (78.8%) of the identified 217 drug-related problems were solved, 4 (1.8%) of the problems were partially solved, 32 (14.7%) problems were unsolved, and 10 (4.6%) problems had unknown outcomes. Conclusion Clinical pharmacy services may have optimized therapy effectiveness and prevent adverse effects. The pharmacist interventions were highly accepted by cardiologists; this may indicate the presence of a great opportunity and need to optimize and implement CPS in other hospitals in Northern Cyprus.