Center-of-pressure displacement during postural changes in relation to pressure ulcers in spinal cord-injured patients

OBJECTIVE: To evaluate the center-of-pressure displacement in spinal cord-injured patients, to investigate dynamic sitting stability and its relationship with pressure ulcers. DESIGN: Sixteen spinal cord-injured patients and 18 healthy volunteers were included in the study. For the assessment of dynamic sitting stability, center-of-pressure displacement during maximum unsupported forward, backward, and right- and left-sided trunk leaning were measured with a seat sensor system, which was placed between the subject's buttocks and chair. RESULTS: Center-of-pressure displacements in all directions in spinal-injured patients were smaller than healthy volunteers (P < 0.05). Center-of-pressure displacements for high- and low-thoracic spinal cord-injured patients were not significantly different. History of previous pressure ulcer was not different between high- and low-thoracic spinal cord-injured patients (chi = 0.90, P = 0.62). Mean center-of-pressure displacement during forward and backward leaning were smaller in patients with pressure ulcer history (P = 0.04 and 0.03, respectively). CONCLUSIONS: The results of this study suggest that impaired dynamic sitting stability is associated with pressure ulcer development.     

Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation

The combination of anterior and posterior instrumentation provides the most stable repair for burst fractures of the thoracolumbar spine. However, the use of both approaches on a trauma patient may increase morbidity. Stabilization of three columns through only one approach can provide an effective outcome. We treated eight patients with burst fracture involving the thoracic or lumbar vertebrae by the application of anterior and posterior stabilization instruments through only the posterior approach. The desired stabilization was obtained in all patients. The advantages are the absence of the risks of the anterior approach, facilitation of the placement of anterior and posterior stabilization devices through only one approach, preserving the unity of the anterior longitudinal ligament, the effect of the anterior corpus in preventing displacement of the cage, application of compression on the pedicle screw system to both decrease the kyphosis angulation due to collapse of vertebra and to help the stabilization of the cage, repair of the dural tears at the posterior side, prevention of cage displacement by distraction and thus leaning on the endplates, and ease of performance by a neurosurgeon alone.     

Evaluation of genitofemoral nerve motor conduction in inguinoscrotal pathologies

Aim

Inguinoscrotal pathologies are commonly seen in childhood. The genitofemoral nerve (GFN) is responsible for sensitive innervations of scrotal region and the motor innervations of cremasteric muscle. GFN also innervates the afferent and efferent pathways of cremasteric reflex. A prospective study was performed to evaluate the possible relation between inguinoscrotal pathologies and GFN motor functions.

Methods

Patients with inguinal hernia, hydrocele, undescended or retractile testicles, aged between 2-12 years were enrolled in the study. Bilateral latency and duration of GFN motor conductions (GFNMC) were obtained electrophysiologically by surface electrodes. GFNMC recordings of non-pathological sides were assessed as control group. Latency and duration of each group were compared with control group (Mann-Whitney U test). P values lower than .05 were considered significant.

Results

Seventy-three electrophysiologic evaluations were investigated in inguinal hernia (n:18), hydrocele (n:9), undescended testicle (n:14), retractile testicle (n:12) and control (n:20) groups. There was no age difference between groups and controls. Latency was significantly prolonged in inguinal hernia group when compared with control group (P = .028). Although the latencies were shortened in undescended testicle group, no significant difference detected (P > .05).

Conclusion

Prolonged latencies in inguinal hernia may be a result of nerve trap caused by hernia sac. GFN motor functions showed no causative role in other inguinoscrotal pathologies. It can be also suggested that clinical features of other inguinoscrotal pathologies were not affected by GFN motor functions. Electrophysiological studies in younger age groups with large number of patients are needed to support our suggestions.     

Assessment of anti-inflammatory and antinociceptive activities of Daphne pontica L. (Thymelaeaceae)

The n-hexane, diethylether, ethyl acetate and methanol extracts from roots, leaves, stems and flowers with young leaves of Daphne pontica L. (Thymelaeaceae) were investigated for their in vivo anti-inflammatory and antinociceptive activities. For the anti-inflammatory activity assessment, carrageenan-induced hind paw edema, PGE(2)-induced hind paw edema and 12-O-tetradecanoyl-13-acetate (TPA)-induced mouse ear edema models and for the antinociceptive activity, p-benzoquinone-induced abdominal constriction test were used. Only ethyl acetate extracts of the roots showed significant anti-inflammatory activity on carrageenan-induced (22.7-32.0% inhibition) and PGE(2)-induced hind paw edema (3.2-27.3% inhibition) as well as 12-O-tetradecanoyl-13-acetate (TPA)-induced mouse ear edema (47.8-43.3% inhibition) models at 50 mg/kg dose without inducing any apparent gastric lesion or acute toxicity, whereas the other extracts were shown to be ineffective. In addition to roots, ethyl acetate extracts of the stems exhibited 19.5-29.9%; 5.3-23.9%; 36.6-28.1% inhibition on carrageenan-induced and PGE(2)-induced hind paw edema as well as 12-O-tetradecanoyl-13-acetate (TPA)-induced mouse ear edema models, respectively. On the other hand, none of the extracts showed any significant antinociceptive activity.     

Right atrial angiosarcoma: a case report

A 32-year-old female patient presented with dyspnea and palpitation, and transthoracic echocardiography revealed the presence of pericardial effusion. Pericardiosynthesis was performed for drainage. Because of the rapid accumulation of effusion and the presence of a right atrial mass on follow-up echocardiography, a computed tomography scan was done that revealed a right atrial defect and the presence of advanced pericardial effusion. The patient was prepared for an emergency operation. The mass on the right atrial wall was approached via a midsternal incision with cardiopulmonary bypass. The tumor filled the right atrial cavity, compressed vital structures, extended to the right ventricle, and had local metastases. As the tumor did not appear to be curable with surgery, a palliative approach was adopted. The right atrial free wall and tissues causing cardiac obstruction were totally removed, the tumor itself was partially excised, and local metastases were sampled. The resulting right atrial wall defect was closed with a Dacron patch. The operation ended uneventfully, and the clinical status and vital and hemodynamic findings of the patient returned to normal. The pathological diagnosis based on the samples obtained during the operation was angiosarcoma. The patient had an uneventful postoperative period and was then referred to an oncology center for clinical recovery. No findings of local recurrence or metastases were observed during the postoperative follow-up. The patient completed her combination therapy and currently is free of any clinical problems at her 13th postoperative month. We believe that advancements in radiotherapy and chemotherapy regimes combined with surgery (radical, if possible) for the treatment of cardiac angiosarcomas may provide better survival and quality-of-life results.     

The effects of Toradol on postoperative intimal hyperplasia in a rat carotid endarterectomy model: laboratory research

Carotid endarterectomy (CEA) and more recently carotid artery stenting are the treatments of choice for atherosclerotic disease of the extracranial carotid arteries; however, early restenosis caused by neointimal hyperplasia confounds surgical therapy. Oxidative stress has been implicated in the progression of intimal hyperplasia. The authors hypothesized that ketorolac tromethamine (Toradol), a nonsteroidal antiinflammatory drug that is a potent cyclooxygenase inhibitor, would decrease oxidative stress and thereby reduce intimal hyperplasia in a rat CEA model. Twenty-nine male Sprague-Dawley rats underwent CEA and were divided into 3 treatment groups as follows: (1) control (placebo), (2) 7.5 mg/kg Toradol, and (3) 10 mg/kg Toradol. Toradol treatment began 2 days before CEA and continued for 2 weeks. Two weeks after endarterectomy, carotid arteries were fixed, harvested, and examined for platelet activity (platelet reactive units), oxidative stress (malondialdehyde and glutathione), and intimal hyperplasia (measured as percentage of luminal stenosis). Platelet activity, malondialdehyde and glutathione, and intimal hyperplasia were all significantly lowered in both 7.5- and 10-mg/kg doses of Toradol versus control. Toradol given daily beginning 2 days before CEA and ending 2 weeks after the procedure was effective at significantly reducing platelet activity, oxidative stress, and intimal hyperplasia development in the rat without any increase in bleeding. Although the mechanism of action of this reduction is not completely understood, one possible explanation may be through the inhibition of reactive oxygen species production.     

Perspectives of psoriasis patients in Turkey

BackgroundPsoriasis is a chronic skin disease that can have severe psychosocial effects. The aim of this study was to assess the perspectives of psoriasis patients regarding their illness.MethodsOne hundred and ten psoriasis patients in the 18–65 age group were included. Data were collected via a “face to face interview” method. The questionnaire included mainly three topics (socio-demographic characteristics of patients; self-evaluations of patients about their disease; knowledge and attitudes about psoriasis).ResultsThe majority of the patients stated that psoriasis as a socially troubling disease. Almost half of them believed that “stress and unhappiness” was a predisposing factor of their illness. Belief that the occurrence of the disease was due to a contagious infectious agent was the second most frequent factor that patients emphasized. “Signs and symptoms of psoriasis” was the most frequent difficulty patients faced because of psoriasis. Most of the patients who still have their parents, those who have a closest friend in life, and more than half of the patients who have their closest friend at work all stated that there was a change in social relations, mostly arising from their counterparts. More than half of the married patients stated that there was a change in social relations, mostly arising from their spouses.ConclusionPsoriasis is more than a cosmetic nuisance and can be associated with psychosocial effects that seriously affect patients’ lives and social relations. Increasing the patients’ knowledge of the disease could have a positive effect on the relations the psoriasis patients have within their social environment.