ObjectiveTo compare the levels of MMP-13 and TNF-α in late stage osteoarthritis, define their predominant pathways and investigate their correlation with McMaster Universities Arthritis Index scores.Patients and methodsA total of 42 patients (mean age 64 ± 8.8) with grade 3 and grade 4 knee osteoarthritis according to Kellegren- Lawrence criteria and who were scheduled for total knee arthroplasty were enrolled in the study. TNF-alpha and MMP-13 levels were measured preoperatively from venous blood samples and intraoperatively from knee synovial fluid via ELISA. Preoperative and 1 month postoperative knee functions were assessed by McMaster Universities Arthritis Index.ResultsGrade 4 synovial fluid MMP-13 (4.76 ± 5.82) was elevated compared to grade 3 (3.95 ± 4.45) (p = 0.438), whereas grade 3 serum MMP-13 (1.128 ± 0.308) was found elevated compared to grade 4 (1.038 ± 0.204) (p = 0.430). Grade 4 serum TNF-α (0.253 ± 0.277) was elevated compared to grade 3 (0.206 ± 0.219) whereas grade 3 synovial fluid TNF-α (0.129 ± 0.052) was elevated compared to grade 4 (0.118 ± 0.014). Positive correlation was observed between synovial fluid MMP-13 levels and postoperative WOMAC scores. Mean serum TNF-α level (0.226 ± 0.246 pg/ml) was found higher compared to synovial level (0.124 ± 1.59), synovial MMP-13 level (4.31 ± 1.24) was found higher compared to serum level (1.089 ± 1.519).ConclusionDespite the systemic increase in TNF-α levels concordant with osteoarthritis grade, MMP-13 levels are elevated via local manner with a significant correlation with WOMAC scores.Level of evidenceLevel IV, Diagnostic study.
This study investigated ovarian function and adnexial pathology following total abdominal hysterectomy with preservation of both ovaries compared with that in a control group. Data from 29 patients who had undergone total abdominal hysterectomy at age < or =40 years and 42 menopausal patients with no previous ovarian pathology were evaluated retrospectively. The mean (+/- SD) age of menopause was 49.7 +/- 1.5 years in the total abdominal hysterectomy group and 50.1 +/- 1.3 years in the control group; this difference was not statistically significant. The incidences of cyst and hydrosalpinx were 31% and 6.9%, respectively, in the total abdominal hysterectomy group and 44.8% and 0%, respectively, in the control group. The increased incidence of cysts in the total abdominal hysterectomy group was statistically significant. In conclusion, patients who undergo total abdominal hysterectomy without oophorectomy do not experience premature menopause. Preservation of the ovaries may avoid the disadvantages of hormone replacement therapy at the expense of a higher risk of developing adnexial pathology.
Amaç: Bu çalışmada benign ve malign sakrum tümörleri ve enfeksiyonları olan, tek merkezden 73 olgunun klinikopatolojik özellikleri ve tedavi yöntemleri değerlendirildi. Hastalar ve yöntemler: Temmuz 1991 -Aralık 2013 tarihleri arasında tedavi edilen ve sakral bölgede benign, malign tümörü ve enfeksiyonu olan 73 hasta (42 erkek, 31 kadın; ort. yaş 48.9 yıl) 25.4 ay ortalama takip süresi ile geriye dönük olarak incelendi ve literatür incelemesi yapıldı. Otuz altı hasta cerrahi yöntemle tedavi edilirken 37 hasta medikal yöntemle tedavi edildi. Elli dört hastaya malign, 19 hastaya benign veya enfeksiyöz tümör tanısı konuldu. Bulgular: Malign tümörlü 54 hastada 20 hasta ile metastaz en yaygın tanı iken, bunu 11 hasta ile kordoma ve 10 hasta ile multipl miyeloma takip etti. Yaygın benign lezyonlar dört hastada osteomiyelit ve üçer hastada dev hücreli tümör ve schwannoma idi. Lokal nüks %50'lik oran ile en sık kordoma ve kondrosarkoma grubunda görüldü. Beş metastatik hastalıklı, bir kondrosarkomlu ve bir kordomalı olmak üzere yedi hasta takiplerde kaybedildi. Sakral rezeksiyon sonrası yedi hastada üriner ve anal inkontinans gelişirken, dört hastada derin ve iki hastada yüzeyel enfeksiyon bildirildi. Sonuç: Malign sakral tümörlerde yüksek komplikasyon oranları nedeniyle parsiyel veya total sakrektomi ile geniş rezeksiyonlar uygulamalıyız. Sakrektomi sonrası olası bir nüks riskine karşı kordoma ve kondrosarkoma hastaları yakından incelenmeli ve bu sırada sinir kökleri mümkün olduğunca korunmalıdır. Sakral lokalizayonda yüksek nüks oranları nedeniyle benign tümörlerde agresif küretaj ile adjuvan yöntemler birleştirilmelidir.Anahtar sözcükler: Küretaj; osteomiyelit; retrospektif çalışmalar; sakrum.Objectives: This study aims to evaluate the clinicopathologic characteristics and treatment modalities of 73 patients with benign and malign sacral tumors and infections from a single institution. Patients and methods: Seventy-three patients (42 males, 31 females; mean age 48.9 years), who were treated between July 1991 and December 2013, with benign, malign tumors, and infections of the sacrum were retrospectively analyzed for a mean follow-up period of 25.4 months, and a review of the literature was conducted. While 36 patients were treated surgically, 37 were treated medically. Fifty-four patients were diagnosed with malign, and 19 with benign or infectious tumors. Results: In 54 patients with malign tumors, metastasis was the most common diagnosis in 20 patients followed by chordoma in 11, and multiple myeloma in 10 patients. Common benign lesions were osteomyelitis in four patients, and giant cell tumor and schwannoma in three patients each. Local recurrence was most commonly observed in the chordoma and chondrosarcoma groups with a rate of 50%. Seven patients including five with metastatic disease, one with chondrosarcoma, and one with chordoma died during follow-ups. While urinary and anal incontinence developed in seven patients after sacral resection, deep infection was reported in four, and superficial infection was rep...
This is the report of a 33-year-old female patient who was admitted to the Emergency Department with bilateral capitellum humerus fracture after a fall from a height. The patient was surgically treated with open reduction and internal fixation for both elbows, with 3 Kirschner wires on the right elbow and one mini-fragment screw on the left. Surgical intervention was carried out in emergency conditions. Following an early physical rehabilitation programme at the end of the 1st week, the roentgenograms in the 9th week showed acceptable bone union. However, in the 2nd year of follow-up the patient had consistent pain and 35 degrees of flexion loss in her right elbow due to degenerative change. The literature reveals only two reports of such cases. Thus, this rare case of bilateral capitellum humerus showed that early mobilisation after anatomic reduction and stable fixation with a mini-screw provided the optimal outcome.
Desmoid tumors are rare, soft-tissue neoplasms that do not metastasize, but exhibit aggressive growth and local invasion. They originate most frequently from abdominal fascial structures, although they can also appear at extra-abdominal sites. The most common extra-abdominal locations include the shoulder, chest wall, back, thigh, and head and neck. In children, desmoid tumors are more infiltrative, having a tendency towards osseous involvement more frequently than in adult patients. We report acase of a supraspinatus muscle desmoid tumor in a female patient with clavicle destruction.
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