Radiographic measurement of the sagittal plane deformity in patients with osteoporotic spinal fractures evaluation of intrinsic error

Cobb method has been shown to be the most reliable technique with a reasonable measurement error to determine the kyphosis in fresh fractures of young patients. However, measurement errors may be higher for elderly patients as it may be difficult to determine the landmarks due to osteopenia and the degenerative changes. The aim of this study is to investigate the intrinsic error for different techniques used in evaluation of local sagittal plane deformity caused by OVCF. Lateral X-rays of OVCF patients were randomly selected. Patient group was composed of 28 females and 7 males and the mean age was 62.7 (55–75) years. The kyphosis angle and the vertebral body height were analyzed to reveal the severity of sagittal plane deformity. Kyphotic deformity was measured by using four different techniques; and the vertebral body heights (VBH) were measured at three different points. The mean intra-observer agreement interval for kyphosis angle measurement techniques ranged from ±7.1 to ±9.3° while it ranged from ±4.5 to ±6.5 mm for VBH measurement techniques. The mean interobserver agreement interval for kyphosis angle ranged from ±8.2 to ±11.1°, while it was between ±4.5 to ±6.5 mm for vertebral body height measurement techniques. This study revealed that although the intra and interobserver agreement were similar for all techniques, they are still higher than expected. These high intervals for measurement errors should be taken into account when interpreting the results of correction in local sagittal plane deformities of OVCF patients after surgical procedures such as vertebral augmentation techniques.     

Antioxidant status in patients with osteoporosis: A controlled study

ObjectiveWe aimed to investigate serum antioxidant enzymes and nitric oxide (NO) levels in postmenopausal women with osteoporosis (OP) and in healthy controls; and to determine the relationship between these enzymes, NO and clinical parameters in this present study.MethodsForty-five postmenopausal women fulfilling OP diagnostic criteria of World Health Organization (WHO) and 42 postmenopausal healthy women without OP were enrolled. Patients in the study population were selected among individuals that were not pre-diagnosed or pre-treated for OP. Patients with metabolic bone diseases, fracture history, which were smokers, alcohol users and taking antioxidant drug treatment, were excluded from the study. Dual Energy X-ray Absorptiometry (DXA) results, body mass indices and demographic data were recorded. Erythrocyte catalases (CAT), glutathione reductase (GR) enzyme activities and erythrocyte glutathione (GSH) levels, plasma malondialdehyde (MDA) levels were measured by spectrophotometer whereas plasma nitrite+nitrate (NOx) levels were measured by ELISA microplate-reader.ResultsPatients had significantly lower GR (P < 0.01) enzyme activity and higher levels of MDA (P < 0.01) and NO (P < 0.01) than non osteoporotic healthy controls. There was no significant difference between both groups in erythrocyte GSH levels and CAT activities. Total femoral BMD measurements significantly correlated with MDA levels (P = 0.001). There was no significant relationship between other antioxidants and lumbar or femoral BMD.ConclusionOxidative stress may play an important role in postmenopausal bone loss and therefore it might be considered when pathogenesis of postmenopausal OP has been investigated.     

Relationship between enthesitis,clinical parameters and quality of life in spondyloarthritis

ObjectiveTo investigate the involvement of enthesis and its correlation with clinical and quality of life parameters in patients with spondyloarthritis (SpA).MethodsOne hundred and eighteen patients who comply with the SpA classification criteria of the European Spondylarthropathy Study Group (ESSG) were included into the study. Clinical parameters such as morning stiffness, rest pain, activity pain, tender joints and swollen joints were evaluated. Enthesitis were assessed by Mander Enthesis Index (MEI). The quality of life was assessed by Short Form-36 (SF-36).ResultsThe incidence of enthesitis in patient with SpA was found at a rate of 84.9%. There was a significant correlation between MEI and morning stiffness, disease duration, tender joints and six subgroups of SF-36. The highest correlation was found between MEI and number of tender joint (p < 0.001).ConclusionEnthesitis is commonly seen among patients with SpA. Enthesitis also affects the life quality of patients negatively.     

The Change in Surgical Practice from Subtotal to Near-Total or Total Thyroidectomy in the Treatment of Patients with Benign Multinodular Goiter

Background  Although total thyroidectomy is the procedure of choice in patients with thyroid carcinoma, this surgical approach has emerged as a surgical option to treat patients with benign multinodular goiter (BMNG), especially in endemically iodine-deficient regions. The aim of this study was to review our experience with patients with BMNG in an endemically iodine-deficient region treated by either subtotal or total/near-total thyroidectomy, and to document whether total or near-total thyroidectomy decreased the rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma in comparison to the patients with BMNG treated initially by subtotal thyroidectomy. Methods  Two thousand five hundred ninety-two patients with BMNG were included. There were 1695 bilateral subtotal thyroidectomies (group 1) and 1211 total or near-total thyroidectomies (group 2) for BMNG during this period. All patients were euthyroid and had no history of hyperthyroidism, radiation exposure, or familial thyroid carcinoma. Any patient with preoperative or perioperative suspicion of malignancy or hyperthyroidism was excluded. Results  Bilateral subtotal thyroidectomy was performed in 1695 patients (58.3%) in group 1 and total or near-total thyroidectomy in 1211 patients (41.7%), in group 2, respectively. The incidence of incidental thyroid carcinoma was found to be 7.2% (n = 210/2906). Although the rate of permanent hypoparathyroidim and transient or permanent unilateral recurrent laryngeal nerve (RLN) palsy were not significantly different between the two groups, transient hypoparathyroidism was significantly higher in group 2 than in group 1 (8.4% vs. 1.42%; p < 0.001, odds ratio [OR] = 52.98). The incidence of thyroid carcinoma was significantly higher in group 2 (10.7%, n = 129/1211) than in group 1 (4.68%, n = 81/1695) (p < 0.001; OR = 39.1).Thirty-eight patients in group 1 (2.24%) underwent completion thyroidectomy, whereas completion thyroidectomy has been not indicated in group 2 (p = 0.007). Two of 38 patients (5.26%) had thyroid papillary microcarcinoma on their remnant thyroid tissue. The rate of recurrent goiter was 7.1% in group 1. The average time to recurrence in group 1 was 14.9 ± 8.7 years. Six of 121 patients with recurrent disease (4.95%) has been operated on. Conclusions  Subtotal thyroidectomy resulted in a significantly higher rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma compared with total or near-total thyroidectomy in patients with BMNG. The extent of surgical resection had no significant effect on the rate of permanent complications. We recommend total or near-total thyroidectomy in BMNG to prevent recurrence and to eliminate the necessity for early completion thyroidectomy in case of a final diagnosis of thyroid carcinoma.     

Correlation of Dietary Intakes and Biochemical Determinates of Nutrition in Hemodialysis Patients

Objective. The purpose of this study was to determine the effect of dietary intakes on nutritional indicators of patients on hemodialysis. Method. This study was carried out at the hemodialysis unit at the Ministry of Health, Ankara Hospital, from 2003–2004. Sixty-seven patients on regular hemodialysis were enrolled in the study. Nutritional status was assessed by biochemical parameters (urea, uric acid, creatinine, Na, K, Cl, Ca, P, alkaline phosphatase, SGOT, SGPT, cholesterol, total protein, albumin, hemoglobin, hematocrit) and anthropometric measurements (height, dry weight, body mass index), and dietary intakes were calculated. Results. In this study, the mean age of the patients was 45.3 ± 13.49, and the duration of hemodialysis was 4.9 ± 3.64 year. Dialysis time was 12.4 ± 2.7 h/week. The ratio of individuals with BMI of 20 kg/m² or below this value was 19.4%. Blood hemoglobin and hematocrit levels were below than the recommended level. Mean serum urea (148.0 ± 27.76 mg/dL) and creatinine (8.8 ± 2.13 mg/dL) were found to be high, while a significant negative correlation was found between blood urea level and dietary fat (p < 0.01, r = ?0.31). A significant positive correlation was found between vitamin B₁, vitamin B₆, folate, potassium, iron, and magnesium; between uric acid and vitamin D; between blood creatinine level and dietary vitamin B₁, vitamin B₆, folate, vitamin C, potassium, iron, magnesium; between blood potassium level and dietary vitamin C only; and between blood cholesterol level and dietary vitamin D only (p < 0.01).     

The effect of histopathologic and clinical features on allograft survival in renal transplant patients with antibody-mediated rejection

Background: Antibody-mediated rejection is a frequent cause of graft failure; however, prognostic indications of this complication have not been well defined. The aim of this study was to evaluate the association of histopathological and clinical features and to determine the effect of these findings on allograft survival in patients with AMR.

Methods: Fifty-two patients suffered from AMR (30 male; mean age 39?±?11 years) were included in the study. Data were investigated retrospectively and graft survival was analyzed. All transplant biopsies were evaluated according to Banff 2009 classification.

Results: Of the 52 cases, 45 were transplanted from living-donors. Twenty-one patients were diagnosed in the first 3-months after transplantation. Graft survival was 65% at 12 months and 54% at 36 months. Mean serum creatinine at time of biopsy was 3.8?±?3.6?mg/dL. Thirty-five of the 52 cases showed diffuse C4d positivity, 12 cases showed focal and 5 remained C4d negative. One of the patients died, 13 experienced graft loss and 38 survived with functioning grafts. Serum creatinine levels at time of biopsy were correlated with graft survival (p?=?.021: OR?=?1.10: 95 % CI?=?1.015–1.199). In terms of the impact of pathological findings; tubulitis (p=.007: OR?=?2.62: 95 % CI?=?1.301–5.276), intimal arteritis (p=.017: OR?=?2.85: 95% CI?=?1.205–6.744) and interstitial infiltration (p=.004: OR?=?3.37: 95% CI?=?1.465–7.752) were associated with graft survival.

Conclusions: Serum creatinine at time of biopsy, tubulitis, intimal arteritis and interstitial infiltration were significantly associated with graft survival. Antibody-mediated rejection is associated with reduced long-term graft survival.     

The effect of transpedicular intracorporeal grafting in the treatment of thoracolumbar burst fractures on canal remodeling

Short-segment posterior instrumentation for the treatment of thoracolumbar burst fractures has been reported with a high rate of failure. Transpedicular intracorporeal grafting in combination with short-segment instrumentation has been offered as an alternative to prevent failure. However, concern still remains about the potential complication of further canal narrowing or failure of remodeling with this technique. The purpose of this prospective, randomized, controlled study is to evaluate the effect of transpedicular intracorporeal grafting on spinal canal restoration and remodeling in a group of patients treated with short-segment instrumentation for thoracolumbar burst fractures. Twenty-one patients with thoracolumbar burst fractures were randomised into transpedicular grafting (TPG) (n=11) and non-transpedicular grafting (NTPG) (n=10) groups, and were prospectively followed for an average of 50 months (range 25-85 months). Groups were similar in age, type of fracture, load sharing classification and kyphotic deformity. Preoperative, postoperative and follow-up computed tomographic (CT) images through the level of pedicles were obtained, corrected for differences in magnification, and digitized. Areas of the spinal canals were measured and normalized by the estimated area at that level (average of adjacent levels). Average kyphosis was 19.7 degrees+/-6.2 degrees at presentation, was corrected to 1.9 degrees+/-4.9 degrees by operation, but was found to have deteriorated to 9.1 degrees+/-6.4 degrees at final follow-up. There were no differences between groups regarding the evolution of sagittal deformity. Spinal canal narrowing was 38.5+/-18.2% at presentation, 22.1+/-19.8% postoperatively, and it further improved to -2.5+/-16.7% at follow-up, similar for both groups. Our results demonstrate that transpedicular intracorporeal grafting in the treatment of burst fractures does not have a detectable effect on the rate of reconstruction of the canal area or on remodeling. Spinal canal remodeling was observed to occur in all patients regardless of grafting.     

Measurement of vertebral rotation in standing versus supine position in adolescent idiopathic scoliosis

Thirty-three structural curves of 25 patients with adolescent idiopathic scoliosis were evaluated using computed tomography (CT) scans and plain radiography. The average Cobb angle on standing radiographs was 55.72 degrees and was observed to be corrected spontaneously to 39.42 degrees while the patients were in supine position (29.78% correction). Average apical rotation according to Perdriolle was 22.75 degrees on standing radiographs and 16.78 degrees on supine scanograms. The average rotation according to Aaro and Dahlborn on CT scans was 16.48 degrees. Radiographic measurements were significantly different from axial CT slice or scanogram measurements (p = 0.000), but the two latter measurements, both obtained in the supine position, did not appear to be different (p = 0.495). Deformities on the transverse plane as well as on the coronal plane are influenced by patient positioning. If the patient lies supine, the scoliosis curve corrects spontaneously to some degree on both planes. Measurements obtained from the scanograms by the Perdriolle method in the supine position are very similar to those obtained by CT. Perdriolle's is a simple, convenient, and reliable method to measure rotation on standing radiograms.     

Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure?

STUDY DESIGN: A prospective, randomized study comparing two treatment methods for thoracolumbar burst fractures: short-segment instrumentation with transpedicular grafting and the same procedure without transpedicular grafting. OBJECTIVE: To evaluate the efficacy of transpedicular grafting in preventing failure of short-segment fixation for the treatment of thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: Short-segment pedicle instrumentation for thoracolumbar burst fractures is known to fail early because of the absence of anterior support. Additional transpedicular grafting has been offered as an alternative to prevent this failure. However, there is controversy about the results of transpedicular grafting. METHODS: Twenty patients with thoracolumbar burst fractures were included in the study. The inclusion criterion was the presence of fractures through the T11-L3 vertebrae without neurologic compromise. The patients were randomized by a simple method into two groups. Group 1 patients were treated using short-segment instrumentation with transpedicular grafting (TPG) (n = 10), and Group 2 patients were treated by short-segment fixation alone (NTPG) (n = 10). Clinical (Likert's questionnaire) and radiologic (sagittal index, percentage of anterior body height compression, and local kyphosis) outcomes were analyzed. RESULTS: The two groups were similar in age, follow-up period, and severity of the deformity and fracture. The postoperative and follow-up sagittal index, percentage of anterior body height compression, and average correction loss in local kyphosis in both groups were not significantly different. The failure rate, defined as an increase of 10 degrees or more in local kyphosis and/or screw breakage, was also not significantly different (TPG = 50%, NTPG = 40%, P = 0.99). CONCLUSIONS: Short-segment transpedicular instrumentation of thoracolumbar burst fractures is associated with a high rate of failure that cannot be decreased by additional transpedicular intracorporeal grafting.