Solitary thoracic osteochondroma causing spinal compression: Case report

Spinal osteochondromas are very rare, and they present with nonspecific localized pain owing to bone involvement. Diagnosis is made based on direct X-ray and computed tomography (CT) imaging of the exophytic bone lesion with pedunculated or sessile structure. Although asymptomatic patients can be observed, surgical excision is the main treatment modality. We present the case of a 34-year-old man with solitary thoracic osteochondroma. The patient presented with complaints of pain in the legs, numbness, and inability to walk. The diagnosis was confirmed with CT imaging showing calcified heterogeneous bone lesion originating from the left side of T1-2 facet joint. After total excision, histopathological examination revealed the diagnosis of osteochondroma. No new clinical or radiological findings were detected in the 10-month follow-up.     

Postoperative assessment of nosocomial transmission of COVID-19 after robotic surgical procedures during the pandemic

ObjectivesTo assess potential nosocomial coronavirus disease-2019 (COVID-19) transmission in patients who underwent robot-assisted laparoscopic procedures during the pandemic.Material and methodsProspective study in patients undergoing robot-assisted laparoscopy in urology or gynaecology within 2 academic hospitals. Patients underwent local preoperative COVID-19 screening using a symptoms questionnaire. Patients with suspicious screening underwent coronavirus real time-polymerase chain reaction (RT-PCR) and were excluded from robotic surgery if positive. Patients with symptoms postsurgery were systematically tested for coronavirus by RT-PCR. One-month postsurgery, all patients had a telephone consultation to evaluate COVID-19 symptoms.ResultsSixty-eight patients underwent robotic surgery during the study period (median age: 63-years [IQR: 53–70], 1.8 male: female ratio). Oncology was the main indication for robotic surgery (n = 62, 91.2%) and 26 patients (38.2%) received a chest CT-scan prior to surgery. Eleven patients (16.2%) were symptomatic after surgery of whom only 1 tested positive for coronavirus by RT-PCR (1.5%) and was transferred to COVID-19 unit with no life-threatening condition. No attending surgeon was diagnosed with COVID-19 during the study.ConclusionsRobot-assisted laparoscopic surgery seemed safe in the era of COVID-19 as long as all recommended precautions are followed. The rate of nosocomial COVID-19 transmission was extremely low despite the fact that we only used RT-PCR testing in symptomatic patients during the preoperative work-up. Larger cohort is needed to validate these results.     

Cross-cultural adaptation,validity and reliability of Turkish version of Oxford Ankle Foot Questionnaire for children with congenital talipes equinovarus

BackgroundThe purpose of the study was to evaluate the reliability and validity of the Turkish version of the Oxford Ankle Foot Questionnaire (OxAFQ) to provide cultural adaptation.MethodsThis study involved translation, back translation, and cross-cultural adaptation. Forty-nine patients with congenital talipes equinovarus were evaluated using the Turkish version of OxAFQ. Turkish version of the Childhood Health Assessment Questionnaire (CHAQ) was used as a gold standard to validate the Turkish version of the OxAFQ. The validation was assessed with Spearman correlation analysis by using CHAQ. The reliability of the questionnaire was assessed with Cronbach alpha (internal consistency) and exploratory factor analysis.ResultsHigh validity was found between OxAFQ and CHAQ (r = -0.422?0.292) (p < 0.01). Reliability analysis showed that OxAFQ had a high level of Cronbach alpha (α = 0.88?0.96) and internal consistency (ICC = 0.90?0.96).ConclusionThe Turkish version of OxAFQ is a valid, reliable and useful quality of life questionnaire in patients with congenital talipes equinovarus and it is proper for use by health professionals and researchers.     

Causes of increased renal medullary echogenicity in Turkish children

The primary disorders of 50 children with increased renal medullary echogenicity on renal ultrasound were studied; 28 girls and 22 boys aged from 1 month to 16 years were classified into four groups based on underlying disease and ultrasound findings. Group 1 was composed of 17 patients with distal renal tubular acidosis (34%); intense echoes throughout the pyramid were predominant. Group 2 consisted of 14 patients with vitamin D toxicity (28%) and an intense echogenic rim around the pyramids. Group 3 included 10 patients with different types of tubulopathies. A slight hyperechogenic rim around the sides and tip of the medullary pyramids was detected. Group 4 was made up of 9 patients with rare underlying conditions. Abdominal X-rays detected medullary calcinosis in only 12 (24%) of the total 50 patients. Ultrasonography appears to be an important tool in the early diagnosis of increased renal medullary echogenicity and medullary nephrocalcinosis.     

Haematologic consequences of viral infections including serum iron status

Twenty-seven children with mumps or chickenpox were taken as a model to evaluate the haematological consequences of viral infections including serum iron status. Blood samples were obtained from all patients at presentation and on the 21 st day of the disease. While haemoglobin, haematocrit, and meam corpuscular volume levels were similar in two measurements (P>0.05), the mean leucocyte, absolute lymphocyte and thrombocyte counts, mean serum iron, serum iron binding capacity and transferrin saturation levels were lower at presentation than on the 21 st day of the disease. The serum iron levels were below 30 g/dl in 16 (59.2%) patients at presentation while only 4 (14.8%) had low values on 21 st day. Twenty-four (88.9%) patients had an increment in the serum iron binding capacity levels and 2 (7.6%) reached values above the normal range on the 21 st day. Int 21 (77.8%) patients, the transferrin saturation levels were below the expected ranges at presentation but 26 (96.3%) showed an increment on the 21 st day. However, the mean ferritin level was higher at presentation. Therefore, during the evaluation of patients for anaemia, the presence of a recent acute viral infection should be documented so as to avoid unnecessary iron medication.     

MRI and MRS in HMG-CoA lyase deficiency

3-Hydroxy-3-Methylglutaryl coenzyme A lyase (HMG-CoA) deficiency is a rare inborn error of leucine catabolism. The disease is characterized by recurrent episodes of metabolic acidosis, hyperammonemia without ketosis, hypoglycemia, lethargy, hepatomegaly, and seizures. This study has evaluated the magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) findings of three patients with HMG-CoA deficiency. The common findings on all of the MRI scans were multiple, coalescent, marked lesions in periventricular white matter and arcuate fibers, most prominently in frontal or periatrial regions that were superimposed on diffuse, slightly hyperintense subcortical white matter signal. Involvement of the caudate nucleus and the dentate nucleus were observed in the reported patients. MRS studies by both STEAM and PRESS spectra of all patients revealed a decrease in N-acetylaspartate and elevation in both myoinositol and choline. A pathologic peak at 1.33 ppm, which is compatible with lactate, and a particular peak at 2.42 ppm in all patients were also found. The combination of both MRI and MRS findings could be considered as being specific in patients with HMG-CoA lyase deficiency.     

The place of diuretic enhanced Doppler sonography in distinguishing between obstructive and non-obstructive hydronephrosis in children

OBJECTIVE: In an attempt to differentiate obstructive from non-obstructive dilation of the renal collecting system in children, a prospective clinical study was carried out. MATERIAL AND METHODS: During duplex Doppler sonography examination in 23 children resistive index (RI) and pulsatility index (PI) and RI ratio values before and after intraverous furasemide administration were compared with the findings obtained with diuretic renogram examination (t(1/2)). RESULTS: Evaluation of the results demonstrated that diuresis RI and PI determination may aid differentiation of severely obstructed renal units from those with slight (equivocal) or no obstruction. CONCLUSION: Kidneys with severe UPJ obstruction tended to have more elevated RI and PI values than the non-obstructed or equivocally obstructed ones. Again, determination of RIR values for each kidney showed the same elevation in severely obstructed kidneys, while non-obstructive or indeterminately obstructed ones demonstrated statistically insignificant changes.     

A cluster of nosocomial Klebsiella oxytoca bloodstream infections in a university hospital.

BACKGROUND: On February 19, 2003, four patients (patients 1-4) in the neurology ward underwent cranial magnetic resonance angiography (MRA) and developed fever within 1 hour afterward. Klebsiella oxytoca was isolated from blood cultures of patients 1 through 3. OBJECTIVE: To identify the source of this cluster of nosocomial K. oxytoca bloodstream infections. DESIGN: Outbreak investigation. SETTING: A 1,000-bed university hospital. METHODS: The infection control team reviewed patient charts and interviewed nursing staff about the preparation and administration of parenteral fluids. The procedure of cranial MRA was observed. Arbitrarily primed polymerase chain reaction (AP-PCR) was performed to show the clonal relationship among these three strains. RESULTS: AP-PCR revealed that three K. oxytoca isolates had the same molecular profile. Cranial MRA was found to be the only common source among these patients. During MRA, before injection of the contrast medium, normal saline solution was infused to check the functioning of the intravenous catheter. Use of the solution for multiple patients was routine, but the access diaphragm of the bottle was not cleansed. The bottle of normal saline solution used on February 19 had already been discarded and the culture sample taken from the solution on the day of observation was sterile. CONCLUSIONS: We speculate that normal saline solution became contaminated during manipulation and that successive uses might have been responsible for this cluster. Poor aseptic techniques employed during successive uses appear to be the most likely route of contamination. Use of parenteral solutions for multiple patients was discontinued.