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Rezvani A.,Bezmialem Foundation University | Ergin O.,Ministry of Health | Karacan I.,Vakif Gureba Training and Research Hospital | Oncu M.,Bagcilar Training and Research Hospital
Spine | Year: 2012

STUDY DESIGN.: A prospective, controlled clinical study performed in a tertiary care center. OBJECTIVE.: To determine reliability and validity of low-tech measurements in assessment of range of motion (ROM) of lumbar flexion in ankylosing spondylitis (AS). SUMMARY OF BACKGROUND DATA.: ROM measurements of lumbar flexion in patients with AS and healthy subjects are evaluated using original Schober test (OST), modified Schober index (MSI), and modified-modified Schober test (MMST) and compared with radiography. METHODS.: Fifty patients with AS and 17 healthy subjects were included. A tape measure was used for measuring OST, MSI, and MMST, and goniometer was used for measuring angle of lumbar ROM on lateral radiographical views in erect position and maximal forward bending position. RESULTS.: Angle between L1 and S1 vertebrae displayed a change upon flexion by 18.2° ± 18.7° in AS group and 30.4° ± 11.1° in controls (P = 0.002). Angle between L3 and S1 vertebrae was detected to change upon flexion by 25.3° ± 25.4° in AS group and 46.7° ± 14.2° in controls (P = 0.0001). A weak correlation was observed between MSI, OST, and L1-S1 radiographical mobility measurements as (P = 0.018 and P = 0.063) and MSI, OST, and L3-S1 radiographical mobility measurements as (P = 0.009 and P = 0.024), respectively for AS. There were correlations between MSI, OST, and radiographical mobility measurements in patients with AS (r = 0.333, P = 0.018, and r = 0.363, P = 0.009, respectively). There was a correlation between OST and radiographical mobility measurements in controls (r = -0.504, P = 0.039). Intrarater reliability was determined to be excellent for OST, MSI, and MMST. CONCLUSION.: Despite excellent intrarater reliabilities for OST, MSI, and MMST, only a weak correlation could be established between OST, MSI, and MMST and radiographical analysis. MMST was found not to reflect lumbar spine angular motions. Although MSI reflected spinal mobility better than OST, both seemed to reflect lumbar spine angular motion poorly. © 2012, Lippincott Williams & Wilkins.

Ozger H.,Istanbul University | Bulbul M.,Vakif Gureba Training and Research Hospital | Eralp L.,Istanbul University
Strategies in Trauma and Limb Reconstruction | Year: 2010

Bone and soft tissue malignancies are associated with serious diagnostic and therapeutic problems in every level of pubertal growth in children. Current treatment modality preferred in bone and soft tissue tumors is wide resection of tumor followed by the reconstruction of consequent defect by various methods. Chemotherapy and radiotherapy are applied for systemic effects to the patient pre- and post-operatively and for local effects that facilitate the surgical procedure. Mostly, it is very difficult to control problems following wide resection and reconstruction. In this study, our aim is to discuss the problems encountered in different resection and reconstruction approaches in childhood bone and soft tissue tumors, and the recommended solutions addressed to these problems. From 1990 to 2003, a total of 68 patients (38 female, 30 male) with a mean age of 13.1 (1.5-18) were included in the study. 85.3% of patients were diagnosed as osteosarcoma and the rest was Ewing's sarcoma. Seventy-five percent of patients had stage IIB disease. The lesions of 34 patients were detected to be in distal femur, 26 in proximal tibia and fibula, 4 in foot and ankle joint, and the remaining 4 in pelvis. As reconstructive surgery, 40 patients had modular prosthesis, vascularized fibular graft was performed in 13 patients, and 10 patients underwent arthrodesis with vascularized fibular graft. 20.6% of patients had shortened limb, infection was detected in 4 patients, laxity in 5, and restricted motion in 4 as complication of prosthesis. With sacrificed physis, 13 patients had a mean value of 4.6 cm limb shortness. Limb salvage surgery has been considered as the gold standard treatment in orthopedic oncological surgery. More understanding of the biology of sarcoma, introduction of new effective chemotherapeutic agents, development of new techniques concerning the surgical resection, advances in diagnostic methods, and improvements in reconstructive surgery all make a major contribution to limb salvage surgery. Since some problems are still encountered, we offer a therapeutic algorithm for complications in the management of childhood tumors that we have encountered so far. © Springer-Verlag 2009.

Onol S.Y.,Vakif Gureba Training and Research Hospital | Onol F.F.,Sakarya Training and Research Hospital
BJU International | Year: 2010

Between 2004 and 2008, 38 consecutive adult patients were treated with the this procedure for uncomplicated idiopathic hydrocele. The mean (range) operative duration was 34.3 (18/39) min and the mean aspirated fluid volume was 245 (120/900) mL. All patients were discharged within 24h and the mean time to resume normal daily activity was 5 (3/21) days. There was no haematoma or wound infection after surgery in any patient. Five patients required additional bed rest and anti-inflammatory drugs for mild persistent oedema and hardening of the scrotum. With a mean (range) follow-up of 28 (6/54) months, 37 (97) patients were cured. Re-accumulation of fluid was diagnosed in one patient 30 months after surgery, and was managed with aspiration plus sclerotherapy. The technique described might not be suitable in recurrent hydroceles with a history of previous scrotal surgery, and multiloculated or septated hydroceles. In these cases, identification and mobilization of the parietal layer of the tunica vaginalis might be precluded by fibrosis of the scrotal wall, and could require a larger skin incision and more extensive dissection. A multiloculated hydrocele might require repeated aspirations and prolong the duration of the procedure. © 2010 BJU International.

Tugal-Tutkun I.,Istanbul University | Onal S.,Marmara University | Garip A.,Istanbul University | Garip A.,Ludwig Maximilians University of Munich | And 4 more authors.
Archives of Ophthalmology | Year: 2011

Objective: To describe a series of patients with bilateral acute iris transillumination, pigment dispersion, and sphincter paralysis. Methods: We reviewed the medical records and clinical photographs of 26 patients seen at 5 centers in Turkey and Belgium between March 16, 2006, and July 6, 2010. Observation procedures included clinical examination, anterior segment color photography, gonioscopy, laser flare photometry, and pupillometry. Results: All 26 patients (20 women and 6 men; mean [SD] age, 43.2 [10.5] years) had bilateral involvement. Twenty-three patients (88%) had acute-onset disease with severe photophobia and red eyes. Nineteen patients (73%) had a preceding flulike illness and used systemic antibiotics, including moxifloxacin. Diagnostic laboratory workup was unremarkable. There was pigment discharge into the anterior chamber, and flare was elevated in the absence of inflammatory cells. Most patients had severe diffuse transillumination of the iris and mydriatic distorted pupils. Pupillometry revealed a compromised reaction to light. The most serious complication was an intractable early rise in intraocular pressure. Gonioscopy revealed heavy pigment deposition in the trabecular meshwork. Although symptoms were relieved promptly by application of topical corticosteroid, the median duration of pigment dispersion was 5.25 months. Conclusions: Bilateral acute iris transillumination with pigment dispersion and persistent mydriasis is a new clinical entity that is not an ocular adverse effect of oral moxifloxacin treatment, as previously suggested. The etiopathogenesis of this entity remains to be elucidated. ©2011 American Medical Association. All rights reserved.

Kocabora M.S.,Vakif Gureba Training and Research Hospital
Bulletin de la Société belge d'ophtalmologie | Year: 2010

This study aimed to evaluate and compare outcomes of phacoemulsification surgery with purely torsional ultrasound in coaxial small incision procedures. This study was a prospective observational series of 50 eyes of 50 patients with age-related cataracts. There were two groups each with 25 eyes. Group 1 eyes were treated with microcoaxial phacoemulsification using a 2.4 mm temporal clear corneal incision; group 2 eyes were treated with phacoemulsification using a 3.2 mm temporal clear corneal incision. Both groups underwent a standardised surgical procedure using purely torsional ultrasound. Outcome measures were best corrected visual acuity, percentage increase in postoperative corneal thickness, and surgically-induced astigmatism assessed at day 1, week 1, month 1 and month 3 postoperatively. Both groups were comparable with respect to age, cataract grading and intraoperative parameters such as cumulative dissipated energy and irrigation volume. The only statistically significant outcome difference was surgically induced astigmatism at postoperative day 1 (higher in group 2). Intraoperative and early postoperative complications were similar in both groups. Coaxial phacoemulsification with purely torsional ultrasound produced satisfactory results for 2.4 mm and 3.2 mm incisions. There were no differences in outcomes between groups.

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