Sciatic nerve compression by an extrapelvic cyst secondary to wear debris after a cementless total hip arthroplasty: A case report and literature review

INTRODUCTIONPolyethylene (PE) wear debris after total hip arthroplasty (THA) may cause formation of a soft tissue mass due to inflammatory reaction. To the best of our knowledge we report the first case in whom the diagnosis was made after examination of the hip, pelvis and lumbar spine with detailed radiological methods and the plain radiographs showed no signs of loosening of the THA.PRESENTATION OF CASEWe report a 52 years-old woman who presented with a cyst causing sciatic irritation in her gluteal region due to wear debris after THA. Magnetic resonance imaging (MRI) was useful in detecting the cyst. Resolution of the cyst occured after subtotal cystectomy and revision of the acetabular components.DISCUSSIONAlthough plain radiographs can show signs of the underlying pathology; such as osteolysis, loosening of the components and wear of the PE liner, they are unable to detect cystic lesions. Cystic lesions may be an early sign of wear debris.CONCLUSIONThis case shows us that sciatic neuropathy with no evidence of nerve root impingement on lumbar MRI in a patient with THA requires also examination of the hip and pelvis with detailed radiological methods, such as MRI, in addition to plain radiography. Removal of the source of debris via revision surgery following subtotal cystectomy leads to the resolution of the remaining portion of the cyst and also relief of the symptoms of sciatic nerve compression.     

Spontaneous decrease in the size of a residual thoracic intradural lipoma

Intradural spinal lipomas of thoracic cord are quite rare. It is known that lipomas are hamartomas, which change their size with alterations of body fat. An 18-year-old male patient, with a thoracic intradural lipoma showing spontaneous decrease in the size of a residual lipoma and tethering of the cord 4 years after surgery, is presented in this report.     

The effects of mitomycin C and 5-fluorouracil/triamcinolone on fibrosis/scar tissue formation secondary to subglottic trauma (experimental study)

PURPOSE: The aim of the study was to compare the effects of mitomycin-C (MMC) and 5-fluorouracil/triamcinolone acetonide (5-FU/TA) on the development of fibrosis/scar tissue formation of rabbit subglottic area, which is injured acutely. MATERIALS AND METHODS: After standardized trauma to subglottic area the rabbits were divided into those that received treatment and those that did not (controls). The subjects were treated with either topical 0.4 mg/mL MMC or 5 mg 5-FU/TA injection. Those groups were further divided into subgroups depending on the time of examination: at 2 or 6 weeks. Each subgroup had 4 rabbits. The specimens were examined histopathologically and the measurements were performed using a software. RESULTS: The fibrosis indices (FIs) of the treated subgroups were significantly less than the FIs of their corresponding control subgroups (P<.05). The difference in FIs of the MMC-treated and 5-FU/TA-treated groups was not statistically significant (P>.05). MMC and 5-FU/TA did not interfere with regeneration of the epithelium although in 2 cases treated with 5-FU/TA the regenerated epithelium showed squamous metaplasia. CONCLUSIONS: Both MMC and 5-FU/TA decrease fibrosis/scar tissue formation secondary to experimentally induced acute subglottic trauma. There is no significant difference between the effects of the 2 drugs.     

A questionnaire survey among Turkish physicians about sleep disorders

We aimed to assess the knowledge of Turkish physicians about sleep disorders and the attitude of the physicians towards sleep medicine. We prepared a 24-item-questionnaire, 7 of the questions were about the attitudes of the physicians and 17 of them were about the knowledge of the physicians. We applied the questionnaire in all university and educational hospitals in Ankara, which is the capital city and the second largest city of Turkey. Two-hundred-fifteen medical doctors from 5 different specialties accepted to answer the questionnaire, and 168 (78%) of them completed the questionnaire. 47% of the physicians rated themselves as they had little knowledge about sleep disorders, and 45% as they had enough knowledge about sleep disorders, however, the overall score was not high. They answered only 45.3% of the questions correctly. In the light of this survey, we concluded that medical education on sleep disorders should be extended both in length and in content to improve the quality of sleep disorders medicine in Turkey.     

Immune function in children with classical phenylketonuria and tetrahydrobiopterin deficiencies

BACKGROUND: An increased susceptibility to infections has been observed in some patients with phenylketonuria (PKU), which is not well known whether it is due to alterations of plasma essential amino acid concentrations or to some other factors. OBJECTIVE: This study is designed to establish B cell and T cell functions in 44 children with classical PKU and tetrahydrobiopterin (BH4) deficiencies and the effects of too high plasma phenylalanine (PA) concentrations (16.53 to 30.54 mg/dL) on the same parameters. DESIGN: B and T cell functions of 33 children with classical PKU (divided into two groups based on fasting mean plasma PA concentrations: Group-I = 20.9 +/- 3.7 mg/dL, Group-II = 3.8 +/- 1.02 mg/dL), and 11 children with BH4 deficiencies (Group III) were studied. The results were compared between the groups and referenced with previously reported values from healthy controls. RESULT: Delayed type skin hypersensitivity responses to purified protein derivative (PPD) in Group I and phytohaemagglutinin (PHA) in Group I, III were lower than the other groups and healthy controls. Plasma IgG and IgM concentrations of Group I was lower than the reference values. Although mean serum zinc and iron levels of all patients were lower than published values of healthy children, zinc and iron deficiencies in Group I, III were much more prominent as compared to Group II. CONCLUSION: The somewhat low plasma IgG concentrations in Group I may be related to the very high plasma PA levels, however the role of zinc deficiency as a causal factor can not be ruled out. BH4 metabolism defects do not appear to affect the same parameters. Impaired delayed skin hypersensitivity responses in Group I and III can be explained by severe serum zinc deficiency. In the light of this study, we conclude that in order to establish a causal relationship between PKU and immune functions, further studies need to be conducted after the correction of micro-nutrient status of such children.     

Effects of topical application of mitomycin-C and 5-fluorouracil on myringotomy in rats.

OBJECTIVE: The effects of topical application of Mitomycin-C (MMC) and 5-fluorouracil (5-FU) for maintaining myringotomy patency were investigated in this experimental study. STUDY DESIGN: We performed simple myringotomy with a knife on 140 tympanic membranes of 70 rats. Rats were divided in two study groups and a control group. Each study group had 60 tympanic membranes, and the control group had 20. We applied Mitomycin-C (0.4 mg/ml) in Group A, 5-fluorouracil (50 mg/ml) in Group B topically, and sterile saline in the control group for 10 minutes. Examination was made with otoendoscope on days 1, 3, 5, 7, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, and 70, and patency rates were recorded. RESULTS: MMC and 5-FU Groups remained open for a mean of 46.17 days and 14.62 days, respectively. The control ears healed within 10.4 days. Fibrosis of the MMC-treated group was the same as that of 5-FU-treated groups. Fibrosis of both study groups was significantly lower than that of the control group. CONCLUSIONS: MMC is more effective than 5-FU, which is more effective than the simple myringotomy procedure in extending the patency of myringotomies in rat tympanic membranes (p < 0.05). Both medications are useful as an adjunct in preventing myringotomy closure.