Özcan, Seçkin; Kockara, Nizamettin; Konya, Petek

AMAÇ: Bu çalışmanın temel amacı, diyabetik ayak sebebiyle yara debridmanı yapılan hastalardan elde edilen örneklerdeki mikroorganizmalar ile antibiyotik direnci veya duyarlılığı arasındaki ilişkiyi değerlendirmektir.GEREÇ VE YÖNTEM: Bu retrospektif çalışmada 2013 - 2018 yılları arasında iki ayrı merkezde diyabetik ayak nedeniyle debridman yapılan hastalar değerlendirildi. Hastaların yaş, cinsiyet gibi demografik verileri kaydedildi. Diyabetik ayak yaralarından alınan derin doku örneklerinden izole edilen mikroorganizma ve antibiyogram sonuçları kaydedildi.BULGULAR: Diyabetik ayak nedeniyle debridman yapılan 84 hasta (47 erkek, 37 kadın) çalışmaya dahil edildi. Yaşları 26 ile 87 arasında değişmekte olup, ortalama yaş 63.2 ± 16 idi. 44 (% 53) numunede bakteri üremesi (29 gram-pozitif ve 15 gram-negatif) tespit edildi. En fazla izole edilen mikroorganizmalar sırasıyla Staphylococcus aureus ve Escherichia coli idi. İzole edilen stafilokoklardan sadece biri metisiline dirençliydi. Escherichia coli'den biri geniş spektrumlu beta-laktamaz (ESBL) (+) idi.SONUÇ: Diyabetik ayak enfeksiyonunda izole edilen bakteriler gram (-) ve gram (+) özellikte olup, tedavi planlanırken bu durum göz önünde bulundurulmalıdır.

Kockara, Nizamettin; Yurten, Hakan; Rıdvan, Altay

OBJECTIVE: Treatment of Developmental Dysplasia of Hip (DDH) in early period is easier and less invasive than the treatment in late period. For diagnosing of developmental hip dyasplasia, ultrasonography before femoral head ossification is critical. Ultrasonography (USG) should be in accordance with predetermined standards. In this study, we aimed to determine the relationship between unstandardized USG measurements and the incidence of late presenting DDH.MATERIAL AND METHODS: We investigated children (aged 0-1) with hip sonograms and pelvis X-rays recorded in the hospital database. One hundred and thirty children were included in this study (260 hips), 82 (63.1%) were female and 48 (36.9%) were male. We divided hip ultrasonography images into two groups according to their compliance with the criteria defined by Dr. Graf. The ultrasonography images that met the criteria formed the Graf group (GG) and those that did not formed the Control group (CG). The angles specified by the radiologists in their reports were taken into consideration. Diagnoses obtained by ultrasonography were compared with those obtained by pelvis X-ray image.RESULTS: When unstandardized ultrasonographies were examined, it was found that plane error in 47 (35.2%) hips, incorrect detection of anatomical markers in 34 (25.3%) hips, and both errors were performed together in 53 (39.5%) patients. In the diagnosis of developmental hip dysplasia, the sensitivity and specificity of the GG group are higher than the CG group.CONCLUSIONS: According the result of this study, standard hip ultrasonographies are necessary to diminish the prevalence of late presenting DDH.

Soytürk, Mehmet; Topal, İsmail

OBJECTIVE: Iodine deficiency is the most common cause of thyroid diseases. We aimed to investigate the relationship between iodine deficiency, thyroid gland volume and academic success in middle-aged children of iodide-poor Kemah source salt, which is widely used in our region.MATERIAL AND METHODS: 185 students studying in Kemah region was involved in the research. The type of table salt which the students involved in the study used in their homes was questioned. Urine iodine level and measures of ultrasonography and thyroid gland volume were carried out.RESULTS: It was discovered that while 133 (71.9%) of the students had severe iodine deficiency and 39 (21%) had mild-moderate iodine deficiency, 13 of them (7.1%) had normal urinary iodine levels. Iodine deficiency was observed in 133 (95.7%) of 139 students using Kemah source salt, whereas out of 46 students using iodised table salt, 39 (84.8%) had iodine deficiency (p <0.001). It was also found that among 185 students included in the study, 124 (65.4%) had normal but 61 (34.6%) had increased thyroid gland volume. Thyroid volume was found significantly high in Kemah source salt users (p = 0.001). Students with low urine iodine levels had low school success (p = 0.001). CONCLUSIONS: The iodine content of low source salts, which are used traditionally in some regions, increases iodine deficiency rate in children and decreases children’s academic achievement. This situation should be taken into consideration in prevention studies of iodine deficiency and the level of knowledge of local people on this should be increased.

Sofu, Hakan; Çamurcu, İsmet Yalkın; Özcan, Seçkin; Üçpunar, Hanifi; Konya, Mehmet Nuri; Duman, Serda

OBJECTIVE: The main purpose of this study was to evaluate the relationship between indications and complications of implant removal surgery. MATERIAL AND METHODS: The data of patients who underwent implant removal surgery between 2011 and 2014 were evaluated from our medical records. Patients’ age, gender, anatomical site of implant and the type of the implant were evaluated. The interval between the fracture treatment and implant removal were recorded for all patients. The indications for implant removal surgery were analyzed and their relationships with complications were evaluated by Pearson Chi-Square test. RESULTS: 276 patients (116 female, 160 male) with the mean age of 36.2 ± 18.4 (range, 5 to 79 years) years underwent removal of 279 implants. The mean interval from initial operation to implant removal operation 27.9 ± 33 months (range, 0.25 to 240 months). The most common anatomical sites of implants were tibia in 93 patients (33.6 %), femur in 63 patients (22.8 %) and fibula in 39 patients (14.1 %). Implant removal was indicated for implant failure in 54 patients (20%), for deep infection in 21 patients (8%), for implant irritation in 167 patients (60%), for pseudoarthrosis in 9 patients (3%), for only patient’s demand in 44 patients (16%) and for only surgeon’s demand in 40 patients (14%). Overall complication rate was 17%. There was a significant correlation between the implant removal due to infection and postoperative refracture and infection (r=0.101 p<0.001 and r=0.273 p<0.001, respectively). Significant correlation was obtained between implant removal due to implant failure and pseudoarthrosis and the need of new implant as expected (r=0.375 p<0.001 and r=0.639 p<0.001, respectively). CONCLUSIONS: Complications related to implant removal surgery has a relationship with implant removal indications such as infection, pseudoarthrosis, and implant failure.

Sofu, Hakan; Mercan, Ahmet Şükrü; Şahin, Vedat; Konya, Mehmet Nuri; Aydin, Bahattin Kerem; Yilmaz, Ertan

AMAÇ: Antiembolik ajanlar ortopedi ve travmatoloji kliniklerin-de özellikle artroplasti, tümör ve travma cerrahilerinde embolizm problemlerini azaltmak için rutin olarak kullanılmaktadır. Fonda-parinuks’un kırık iyileşmesi üzerine etkisi belirsizdir. Bu çalışmanın amacı sıçan modeli kullanarak fondaparinuksun kırık iyileşmesi üzerine etkisinin incelenmesi ve enoksaparinin etkisi ile karşılaş-tırılmasıdır.GEREÇ VE YÖNTEM: 64 adet Wistar-Albino sekiz gruba randomize olarak ayrıldı. Genel anestezi altında sol femur kapalı standart kırıkları oluşturuldu. Kontrol grupları (A, B), heparin grupları (C, D), enoksaparin grupları (E, F), ve fondaparinuks grupları (G, H), sırasıyla izotonik NaCl (1cc/gün), heparin (1000 anti Xa IU/kg/gün), enoksaparin (100 anti Xa IU/kg/gün) ve fondaparinuks (0.2mg/kg/ gün) olacak şekilde 14 gün süre ile uygulandı. A, C, E, G gruplarındaki sıçanlar postoperatif 14. günün, B, D, F, H gruplarındakiler ise 28. günün sonunda sakrifiye edildiler. Tüm femurların radyolojik incelemesi standart ön-arka ve yan grafiler kullanılarak Goldberg sınıflamasına göre yapıldı. Histolojik inceleme ise Huo histolojik iyileşme sınıflamasına göre yapıldı. Bu çalışmanın istatiksel analizleri GraphPad Prisma V.3 paket programı kullanılarak yapıldı. Sonuçlarda anlamlılık p<0.05 düzeyi olarak belirlendi.BULGULAR: Radyolojik incelemede, ikinci ve dördüncü hafta so-nundaki sonuçlar incelendiğinde, gruplar arasında istatiksel olarak anlamlı fark saptanmadı. Histolojik incelemede ise heparin almış olan H grubundaki iyileşme sonuçları diğer gruplarla karşılaştırıldı-ğında istatiksel olarak anlamlı şekilde kötü olarak saptandı. Diğer gruplar arasında histolojik açıdan, heparin grubu hariç, istatiksel olarak anlamlı bir fark saptanmadı. Ayrıca histolojik ve radyolojik olarak fondaparinuks ve enoksaparin grupları arasında kırık iyileş-mesi üzerine etkileri arasında istatiksel olarak anlamlı fark saptan-madı (p>0.05).SONUÇ: Çalışmamızda fondaparinuksun enoksaparin ile karşılaş-tırıldığında kırık iyileşmesi üzerine herhangi ekstra olumlu etkisini saptamadık. Fondaparinuks uygulamasının kırık iyileşmesi üzerine negatif bir etkisi saptanmamış olması nedeniyle travma vakaların-da embolizm problemlerini önlemede kullanılabileceği kanaatin-deyiz.

Sofu, Hakan; Çamurcu, İsmet Yalkın; Konya, Mehmet Nuri; Aydin, Bahattin Kerem; Kockara, Nizamettin

OBJECTIVE: The main purpose of the present study was to evaluate to what degree the change in metatarsal length can affect the clinical outcomes in patients who underwent either a distal chevron or a proximal cres-centic metatarsal osteotomy for hallux valgus. MATERIALS AND METHODS: Sixty-two patients were included in this study. Nine of the patients were male and 53 were fe-male. The mean age of the patients during the surgical intervention was 45.9 years. Thirty patients underwent crescentic proximal metatarsal osteotomy and 32 un-derwent distal chevron metatarsal osteotomy as the treatment of hallux valgus. The mean follow-up was 24.3 months. Postoperatively, clinical as well as the radiographic evaluation was carried-out at the end of the forth week, third, sixth and twelfth months, and annually thereafter. The American Orthopedic Foot and Ankle Society forefoot (AOFAS) score, Visual Analo-gue Scale (VAS), metatarsal length, hallux valgus angle (HVA), and intermetatarsal angle (IMA) were evaluated. RESULTS: The mean HVA as well as the mean IMA improved significantly in both group of patients. The mean change in the length of the first metatarsal was -2.8 mm in distal chevron group and -1.2 mm in cres-centic proximal osteotomy group. The mean correc-tion of hallux valgus angle was 13.6 degrees in distal chevron osteotomy whereas it was 20.4 degrees in crescentic proximal osteotomy. The patients with >3 mm of shortening had significantly worse VAS scores. We did not observe any non-union or avascular nec-rosis of the metatarsal head. At the latest follow-up, 8 patients from DCMO group and 5 patients from CPMO group mentioned that they would not recommend surgery to others with similar complaints. CONCLUSION: Distal chevron osteotomy lead shorte-ning of the first metatarsal bone resulting in transfer metatarsalgia and worse pain scores more commonly than crescentic proximal metatarsal osteotomy.

Kulhan, Mehmet; Tokgöz, Vehbi Yavuz; Öner, Soner Recai; Kulhan, Gözde; Ozeren, Mehmet; Sipahi, Mehmet

OBJECTIVE: Evaluation of relationship between uterine artery doppler findings, alpha fetoprotein (AFP) and be-ta-human chorionic gonadotropin (β-hCG) levels for pe-rinatal outcomes. MATERIALS AND METHODS: First fifty pregnant with <18 weeks of gestation who were admitted to the clinic from July 2009 were to be examined. The study included forty nine of pregnants and they were followed prospe-ctively. Serum concentrations of AFP and β-hCG measured between 16-18 weeks of pregnancy and suprapubic doppler ultrasonography for uterine artery performed between 22-24 weeks of pregnancy were noted. Hyper-tension before pregnancy or previous pregnancies with preeclampsia-eclampsia, history of recurrent pregnancy loss, history of low birth weight newborn, history of car-diac or renal disease, diabetes mellitus and anticoagula-tion or aspirin treatments were determined as exclusion criteria. Chi-square test was performed for comparision of datas because of non-parametric specialities. RESULTS: The ages of the pregnants were between 19 and 35. The mean gravidity and parity of the study cohort were 2.1 and 1.6 respectively. There were no correlations among uterine artery doppler findings, serum β-hCG le-vels and perinatal outcomes. Serum AFP concentrations were significantly higher in all patients with intrauterine growth restriction (IUGR). Also 4 patients had IUGR, 9 pa-tients had preterm labor, 7 patients had gestational dia-betes, 2 patients had preeclampsia, 2 patients had fetal distress and 6 patients had fetal meconium. There were no correlations for perinatal outcomes except IUGR. CONCLUSION: A number of tests performed to predict adverse obstetric outcomes but the benefits are limited. Developing of more specific serum markers and ultraso-nography parameters in order to determination of risks during pregnancy, would be very useful for preventive medicine and treatment of complications.

Tınar, Şivekar; Yıldırım, Yusuf; Balsak, Deniz; Töz, Emrah

Anal inkontinans, gaz ve dışkının istem dışı kaçırılması-dır. Fekal inkontinans vajinal doğumun çok korkulan bir komplikasyonudur. Bu durum sfinkter yırtılması, pudental sinir hasarlanması ya da her ikisi ile birlikte olabilmektedir. Anal inkontinans prevelansı araştırılan topluluğa göre farklılık göstermektedir. Genel olarak 30-90 yaş arası kadınlar incelendiğinde, en az bir aylık sürede katı veya sıvı dışkı tutamama prevalansı %7.7dir. Vajinal doğum veya sezaryen doğumdan 6 ay sonra anal inkontinans %13-25 arası olmakta fakat bu 12 aylık bir sürede %1-6 aralığına düşmektedir. Anal inkontinans yaşam kalitesi üzerinde önemli bir etkisi vardır. Kadınlarda en önemli neden doğum travmasıdır. Anal sfinkter defekti ile birlikte perine yırtılması %1-9 arasında değişmektedir. Tanımlanmamış sfinker hasarı %18-35 olarak yüksek bir değerdedir. Pudental nöropati doğumunun ikinci evresinde ıkınma ile birlikte sinirin gerilmesi ve fetal başın inmesi ile oluşmaktadır. Hatta bazen doğumun birinci evresinde bile olmaktadır. Sfinkter hasarı ve pu-dental nöropati risk faktörleri forsepsli doğum, büyük fetüs ölçüsü ve uzamış ikinci doğum evresidir. Özellikle ilk doğum süresince fekal inkontinans riski göz önünde bulundurulmalıdır. Rutin epizyotomi sfinker hasarını engellememekte hatta sebebiyet verebilmektedir. Anal inkontinanslı kadınların tedavi yaklaşımı altta yatan etyoloji temelli olmalıdır. Başlangıç tedavisi olarak önerilen tıbbi yaklaşım nadiren etkilidir. Prmer anal sfinkter cerrahisi yapılan hastaların yarısı kısa ve uzun dönemde kontinans problemi ile karşılaşabilmektedirler. Bu çalışmada obstetrik yaralanmaya bağlı olarak ortaya çıkan ve ‘Anterior Overlapping Sfinkteroplasti’ yöntemiyle başarı bir şekilde tedavi edilen anal inkontinanslı bir olguyu sunuyoruz.