Biomedical subjects

Bülent Erol

Publications and source records attributed to Bülent Erol.

At least 19 recordsLinked to original sources

PubMed2006

[Surgical treatment of hand deformities in multiple enchondromatosis: a case report].

Multiple enchondromatosis (Ollier's disease) is a rare disease characterized by widespread enchondromas. In general, the short tubular bones of the hand are involved, with progressive lesions resulting in cosmetic problems and functional deformities. Diaphysectomy and reconstruction with structural autografts or allografts are usually recommended in the treatment of extensive enchondromas involving the fingers. Curettage and grafting and ray amputation are other surgical procedures that can be applied depending on the severity of involvement. A 25-year-old woman with enchondromatosis presented with severe swelling and deformities on her fingers in both hands. The majority of the lesions were managed by diaphysectomy and reconstruction with structural grafts; ray amputation, curettage and grafting were performed for more severe lesions. During a long-term follow-up (left hand 6 years, right hand 5.5 years) cosmetic and functional results were acceptable.

Abnormalities, Multiple↗

PubMed2006

[Treatment of comminuted intra-articular fractures of the distal radius by open reduction and volar plating in adults].

BACKGROUND: We herein present the mid-term results of the adult patients with comminuted intra-articular fractures of the distal radius who were treated by palmar plating. METHODS: Between 1999 and 2003, open reduction and palmar plating were performed in 23 of the patients who had surgical treatment for comminuted intra-articular fractures of the distal radius. Nineteen patients (11 females, 8 males; mean age 34; range 22 to 54 years) with regular follow-up were included in the study. In the majority of patients only one wrist was involved (7 dominant - 12 nondominant). Preoperative evaluation included patient's history, physical examination, and radiological studies (plain radiographs, computed tomography). The patients were classified according to AO classification as 7 type B [B1 (1); B2 (3); B3 (3)] and 12 type C [C1 (7); C2 (5)]. The surgical procedure included internal fixation by using plates and screws with palmar approach. Range of motion exercises were started immediately after the operations. The patients were followed clinically and radiographically, with an average follow-up time of 28 months (range, 13-47 months). Complications were recorded. RESULTS: Union was achieved in all patients. Radiographic parameters including the radial height, radial inclination, palmar tilt, and articular congruency have been corrected in the operation and remained unchanged until the last follow-up. According to the Gartland and Werley's classification, there were 9 (47%) excellent, 7 (37%) good, and 3 (16%) fair results. No perioperative and postoperative complications were recorded, except for three wound problems and one prolonged scar tenderness. CONCLUSION: Palmar plating is a safe and effective treatment for comminuted intraarticular fractures of the distal radius, regardless of direction of displacement of the distal fragment.

Adult↗

PubMed2006

[Image-guided minimal invasive surgical resection of osteoid osteomas of the long bones].

OBJECTIVES: In this prospective study, we evaluated the efficiency of image-guided minimal invasive surgical resection of osteoid osteomas of the long bones. METHODS: Fourteen patients (11 males, 3 females; mean age 13 years; range 4 to 22 years) with osteoid osteoma of the long bones underwent image-guided minimal invasive intralesional extended curettage. Preoperatively, all the patients were evaluated by plain radiographs, computed tomography (CT), bone scintigraphy, and magnetic resonance imaging (MRI). Localization of the nidus was determined by measurements on thin-section (1-1.5 mm) CT scans and MR images and complete excision of the nidus was performed by image-guided minimal invasive technique. All the patients were evaluated by visual analog scale or faces pain scale to determine pain levels before and after surgery. The mean follow-up period was 17 months (range 13 to 31 months). RESULTS: The mean visual analog scale scores were 7.9+/-1.2 (severe pain) and 0.3+/-0.6 (no pain) before and after surgery, respectively (p<0.05). Bone grafting or internal fixation were not required during operations. No perioperative or postoperative complications or recurrences were encountered. Early mobilization was possible in all the patients. At the final follow-ups, all the patients were asymptomatic and had full functional use of their operated extremities. CONCLUSION: Image-guided minimal invasive surgery is effective in the local control of osteoid osteomas affecting the long bones and causes less morbidity. This technique also provides a good identification of the nidus intraoperatively.

Adolescent↗

PubMed2006

[Primary surgical repair with the Krackow technique combined with plantaris tendon augmentation in the treatment of acute Achilles tendon ruptures].

OBJECTIVES: We evaluated the long-term results of acute Achilles tendon ruptures treated with primary end-to-end repair with the Krackow technique combined with augmentation using the plantaris tendon. METHODS: Thirty-six patients (31 males, 5 females; mean age 34 years; range 21 to 42 years) underwent primary surgical repair for acute Achilles tendon ruptures. Most of the patients (31/36) were involved in regular sportive activities. Surgery included end-to-end repair with the Krackow technique (locking-loop) combined with plantaris tendon augmentation. All the patients received a standardized progressive postoperative rehabilitation program. The results were evaluated with respect to time to return to work and preinjury activity levels and by a scoring system covering objective and subjective parameters. The mean follow-up was 54 months (range 28 to 78 months). RESULTS: At surgery, 34 patients (94.4%) and two patients (5.6%) were found to have complete and partial ruptures, respectively. The mean operation time was 50 minutes (range 40 to 70 minutes). The patients returned to work after a mean of eight weeks (range 6 to 9 weeks) and to preinjury sportive activities after a mean of 17 weeks (range 14 to 20 weeks). The overall mean scoring was good (88 out of 100) at the end of a year follow-up. Early or late complications included superficial wound infections in five patients and partial rupture recurrence in one patient. CONCLUSION: Our results showed that the Krackow technique combined with plantaris tendon augmentation and a rehabilitation protocol aiming early motion enabled physiological tendon healing.

Achilles Tendon↗

PubMed2005

Effect of drain placed in the donor site in the early postoperative period after arthroscopically assisted anterior cruciate ligament reconstruction with quadrupled hamstring tendons.

BACKGROUND: No scientific study has addressed the effects of the routine use of postoperative drains in the donor site after arthroscopic anterior cruciate ligament reconstruction using hamstring tendons. HYPOTHESIS: Patients who have drains placed in their donor sites have less lower extremity edema, more motion, and more comfort in the early postoperative period. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Thirty-four patients undergoing arthroscopically assisted quadruple hamstring tendon anterior cruciate ligament reconstruction were randomly assigned to either receive a drain for 24 hours placed at the donor site (17 patients) or have no drain at the donor site (17 patients). Data were collected on postoperative days 1, 3, 5, and 7 regarding knee flexion, knee extension, thigh circumference, leg circumference, and visual analog scale (measuring pain). RESULTS: In the study group versus the control group, there were increased knee flexion measurements on postoperative day 7 (84 degrees vs 69 degrees , P < .05); smaller thigh circumference measurements on postoperative day 7 (36.8 vs 40.1 cm, P < .05); smaller leg circumference measurements on postoperative days 3 (33.2 vs 36.4 cm, P < .05), 5 (32.7 vs 36.0 cm, P < .05), and 7 (31.8 vs 35.7 cm, P < .001); and a lower visual analog scale score on postoperative days 3 (40.38 vs 57.50, P = .001), 5 (38.46 vs 60.35, P = .001), and 7 (38.07 vs 61.43, P = .001). CONCLUSION: Drain placement at the donor site after anterior cruciate ligament reconstruction gives more comfort to the patient and provides better flexion within the first week.

Adolescent↗

PubMed2005

Molecular analysis of congenital scoliosis: a candidate gene approach.

The etiology of congenital scoliosis is largely unknown. The severe vertebral disorder, spondylocostal dysostosis type 1, is associated with a homozygous delta-like 3 (DLL3) mutation. Scoliosis has been observed in a heterozygous DLL3 carrier, raising the possibility of its involvement in congenital scoliosis. We present the first molecular study of congenital scoliosis by analysis of the candidate gene DLL3 and demonstrate one novel missense variant. However, no novel or previously described mutations are present in our cohort, indicating that DLL3 mutations may not be a major cause of congenital scoliosis. Additionally, we have evaluated patients with congenital scoliosis not diagnosed with a known syndrome and identified a significant number of associated renal and cardiac anomalies and familial incidence of idiopathic scoliosis in this group.

Abnormalities, Multiple↗

PubMed2005

Use of continuous horizontal mattress suture techniques in microsurgery: an experimental study in rats.

PURPOSE: The purpose of this study was to determine whether the continuous horizontal mattress suture technique can replace the continuous simple suture technique and to compare the results with other microvascular suture procedures. METHODS: Sixty-four femoral arteries of 32 Sprague-Dawley rats were used in this study. The animals were divided equally into 4 groups with 16 anastomoses in each group. The arteries (0.8-1.0 mm diameter) were anastomosed by using the continuous horizontal mattress suture technique in group I, interrupted horizontal mattress suture technique in group II, simple interrupted suture technique in group III, and simple continuous suture technique in group IV. At the end of the anastomosis time, leakage, and patency were assessed and graded in all groups. On the 14th day after surgery the rats were killed and 5 patent specimens from each group were examined under light microscopy for histology. One specimen from each group was prepared for scanning of the endothelial surface under electron scanning microscopy. RESULTS: Group I anastomoses were performed the most quickly. Groups I and III anastomoses had 100% patency rates. Under light microscopy the edge eversion was apparent consistently and under electron microscopy all endothelial surfaces were intact and no suture material was seen in groups I and II. In group III some suture material was covered by endothelial cells and lumen surfaces were torn; endothelization also was rough compared with groups I and II. In group IV suture material was seen in the lumen because of a loose suture knot. The endothelium also was not regular. CONCLUSIONS: The horizontal mattress suturing technique is the only technique in which the suture material never contacts the lumen. Continuous horizontal mattress suture technique is superior to the other microvascular procedures and is the safest and fastest procedure for microvascular anastomosis in rats.

Anastomosis, Surgical↗

PubMed2005

Effect of metatarsophalangeal joint position on the reliability of the tangential sesamoid view in determining sesamoid position.

BACKGROUND: Lateral displacement of the sesamoids of the first toe relative to the metatarsal head is a common finding in hallux valgus deformity. Several methods have been described for quantifying the amount of subluxation from anteroposterior radiographs but a tangential sesamoid radiograph has been determined to be the best view to evaluate sesamoid displacement. METHOD: We evaluated the sesamoid position at different angles of the first metatarsophalangeal (MTP) joint to determine the effect of first MTP joint dorsiflexion on sesamoid position when tangential sesamoid view radiographs are made. Sesamoid positions of 22 feet with hallux valgus were graded from the short axis computed tomography (CT) images obtained with the MTP joint in 0, 35, and 70 degrees of dorsiflexion. RESULTS: Approximation of the sesamoids to reduction was apparent as dorsiflexion of the first MTP joint increased. CONCLUSION: Different dorsiflexion degrees of the first MTP joint when tangential sesamoid radiographs are made modulate the position of the sesamoids and may lead to misclassification on grading.

Hallux Valgus↗

PubMed2005

[Surgical management of hip instabilities in children with spina bifida].

OBJECTIVES: We evaluated the results of surgical management of hip instability in children with spina bifida (SB). METHODS: Twenty-eight hips of 26 patients (16 girls, 10 boys; mean age 4.5 years; range 3 to 6 years) were surgically managed for hip instability (subluxation/dislocation) associated with SB. Twenty-four patients (2 bilateral dislocations) had low-level lesions (L4-sacral) and a potential to walk, of which 16 patients presented with unilateral dislocation with functional problems including significant (>2 cm) limb-length discrepancy and scoliosis. Two patients had high-level lesions (thoracic-L3) associated with unilateral dislocations and were unable to walk. Those with a high-level lesion and some patients (9/26 hips) with a low-level lesion also had hip flexion contractures. Treatment included open reduction, pelvic osteotomy, proximal femoral osteotomy when necessary, and a spica cast. The patients were clinically and radiographically monitored for a mean of 38 months (range 30 to 48 months). RESULTS: Of 16 patients with functional problems, 14 patients had improvement in their gait patterns, while limb-length discrepancy and scoliosis persisted in two. The remaining 10 patients maintained their preoperative functional statuses. The mean range of motion of the hips decreased postoperatively; however, none of them developed joint stiffness. Early postoperative complications included superficial wound infections in three patients, and distal femoral diaphyseal fractures in two patients. Three patients required removal of the implants in the sixth month due to subcutaneous prominence thereof. Late radiographs of three patients showed recurrent subluxations, which did not require any intervention. CONCLUSION: Although surgical treatment of hip problems associated with high-level lesions may be unrewarding in children with SB, those associated with low-level lesions can be successfully managed with proper surgical indications.

Child↗

PubMed2005

[Surgical management of orthopedic problems in adult patients with cerebral palsy].

OBJECTIVES: We evaluated the results of surgical treatment for orthopedic problems in adult patients with cerebral palsy. METHODS: Nine adult patients with cerebral palsy (4 females, 5 males; mean age 22 years; range 19 to 29 years) were managed surgically to lessen pain, correct deformities and contractures, and enhance their mobilization potential. Seven patients underwent bilateral multiple-level tendinous and/or musculotendinous release procedures involving the lower extremities, of whom two patients underwent additional triple arthrodesis, and one patient underwent extension osteotomy in the knee. One patient was treated with proximal femoral and distal tibial derotation osteotomies and bilateral hamstring release for knee flexion contractures. Finally, one patient was treated with posterior fusion with instrumentation for thoracolumbar scoliosis. Before surgery, four patients were community ambulators, and one patient could walk only with the aid of bilateral crutches. Four patients with total body involvement could not walk, but they could sit without support except for one patient with scoliosis. The mean follow-up was 25 months (range 8 to 49 months). RESULTS: On final evaluations, eight patients could walk without support, and one patient who could not sit preoperatively managed to sit without support. Three patients developed bilateral, five patients developed unilateral superficial skin wounds at the back of the heels associated with cast/brace use, and deep wound infection was encountered in the patient with scoliosis. All the wounds healed with early debridements and antibiotic therapy, together with the modifications made in cast/brace applications, without the need for implant removal. CONCLUSION: Surgical treatment of orthopedic problems in adult patients with cerebral palsy is of substantial importance in enhancing their sitting and walking capacities, and in restoring their community-based relations and activities.

Adult↗

PubMed2005

[Talectomy for the treatment of neglected pes equinovarus deformity in patients with neuromuscular involvement].

OBJECTIVES: We evaluated talectomy operations performed for the correction of neglected pes equinovarus deformity of the foot in patients with neuromuscular involvement. METHODS: Eleven patients (2 females, 9 males; mean age 9.5 years; range 3 to 20 years) with various neurological disorders underwent 17 talectomy operations for the correction of neglected pes equinovarus deformity. Diagnoses were spina bifida in seven patients, arthrogryposis multiplex congenita in two patients, and spinal muscular atrophy and poliomyelitis in two patients, respectively. None of the patients had a previous surgery for pes equinovarus deformity. Preoperatively, three patients and one patient could walk in home settings with and without support, respectively, whereas seven patients could not walk at all. A protective orthosis was used in all the patients postoperatively. Achillotomy and posterior capsulotomy were performed prior to talectomy when needed. The results were evaluated with the use of a functional rating system and radiographs. The mean follow-up was 50 months (range 24 to 108 months). RESULTS: The results were good in 12 feet and fair in five feet. Seven patients could walk without support, and three patients could walk with support. One patient required re-operation for residual deformity of the foot and skin wounds due to poor compliance with the protective orthosis. One patient could not ambulate despite a plantigrade foot. CONCLUSION: Talectomy is a limb-saving procedure for the treatment of neglected pes equinovarus deformity. Its success relies not only on obtaining a plantigrade foot but also on a proper postoperative orthotic control.

Adolescent↗

PubMed2004

Absorbable self-reinforced polylactide (SR-PLLA) rods vs rigid rods (K-wire) in spinal fusion: an experimental study in rabbits.

Several clinical and experimental reports have evaluated the spinal application of bioabsorbable material for plating the anterior lumbar and cervical spine, and in anterior and posterior lumbar interbody spinal fusion. Nevertheless, the use of these materials in posterolateral interlaminar fusion has yet to be elucidated in the literature. The effects of bioabsorbable self-reinforced polylactide rod (SR-PLLA) implantation, rigid fixation (K-wire) and non-implantation with posterior interlaminar fusion were compared using a rabbit model. Twenty-four mature domestic rabbits were divided into three groups. Eight received implantation with SR-PLLA, eight with K-wire, and eight were fused without instrumentation. The animals were killed at 12 weeks and evaluated by posteroanterior radiography, manual palpation and histological examination for the presence of fusion. Successful fusion was achieved in all of the animals in both implanted groups (SR-PLLA and K-wire), whereas solid fusion was not detected in any of the specimens in the non-implanted group. Computed tomography (CT) scans were used to detect fusion mass volume. The fusion mass in the SR-PLLA implanted group had a mean volume of 1,196 mm3 +/- 167 mm3 vs 1,061 mm3 +/- 181 mm3 for the K-wire implanted group (not significant) and 711 mm3 +/- 407 mm3 (p<0.05) for the non-implanted group. The results of this study suggest that the stabilization properties of both SR-PLLA rods and K-wire seem to be sufficient for spinal fusion, but using SR-PLLA is especially advantageous, since they do not require a removal operation and do not interfere with magnetic resonance imaging (MRI).

Absorbable Implants↗

PubMed2004

Urine 8-isoprostane F2alpha concentrations in patients with neurogenic bladder due to spinal cord injury.

BACKGROUND: Isoprostanes are prostaglandin-like end products of arachidonic acid peroxidation that are produced by a free radical-catalyzed mechanism. Considering its free radical-dependent formation and potent contractor effect, it is postulated that isoprostane 8-iso PGF2alpha may play an important role in oxidative stress-related smooth muscle dysfunction. These substances may also influence bladder activity directly by effects on the smooth muscle. The present study was designed to measure traditional biochemical parameters (MDA, TAS, vitamin E) in plasma and 8-iso PGF2alpha concentrations in urine of patients with spinal cord injury and to evaluate the relation of urinary isoprostane concentrations to the bladder function. METHODS: All spinal cord patients underwent urodynamic evaluations. The biochemical tests were performed in both hyperreflexic bladder group (n = 23) and areflexic bladder group (n = 10), and the findings were compared to those of the patients with normally functioning bladder (controls, n = 19). RESULTS: Urine 8-iso PGF2alpha concentrations were significantly increased in hyperreflexic group (median value 0.89 pg/mg creatinine) compared to both control (0.52 pg/mg creatinine) and areflexic groups (p < 0.001). The lowest concentrations of urinary 8-iso PGF2alpha were observed in the areflexic group (0.22 pg/mg creatinine), and these were positively correlated to the plasma MDA concentrations in areflexic patients (p = 0.05; r = 0.684). CONCLUSION: Isoprostanes may be involved in the pathogenesis of neurogenic bladder dysfunction. It may be of value to determine the urinary concentrations of 8-iso PGF2alpha in order to distinguish areflexic bladders from the hyperreflectics.

Adult↗

PubMed2004

Accessory lateral meniscus: a case report.

Explore the source record for details and available documents.

Adult↗

PubMed2004

[Long-term results of open surgical repair of rotator cuff tears].

OBJECTIVES: We evaluated the long-term results of rotator cuff tears treated by open surgical repair. METHODS: Ninety shoulders of 88 patients (36 females, 52 males; mean age 57 years; range 36 to 75 years) with rotator cuff tears were treated by open surgical repair and acromioplasty. A three-staged rehabilitation program was implemented following surgery. Objective evaluations were made with the use of the Constant-Murley scoring system. Pain was assessed through a visual analog scale. The mean follow-up period was 61 months (range 24 to 102 months). RESULTS: The mean Constant-Murley score increased from preoperative 41.7 (range 12 to 82) to postoperative 79.7 (range 42 to 100) (p<0.0001). The mean preoperative and postoperative pain scores were 7.5 (range 4 to 10) and 1.25 (range 0 to 5), respectively (p<0.0001). Only eight patients (9%) showed dissatisfaction with the surgical outcome. The remaining 80 patients (91%) were satisfied with the outcome and returned to their previous night comfort and daily activities. None of the patients had postoperative nerve palsy or limitations in shoulder functions. Two patients (2.2%) developed superficial soft tissue infections that disappeared following multiple wound debridements. CONCLUSION: Our long-term results favor open surgical repair and acromioplasty in the treatment of patients with rotator cuff tears.

Adult↗

PubMed2004

[Late results of arthroscopic and open anterior acromioplasty].

OBJECTIVES: We evaluated the results of arthroscopic or open anterior acromioplasty after a mean follow-up of two years in the treatment of impingement syndrome. METHODS: The study included 145 patients who underwent anterior acromioplasty through open surgery (90 patients; mean age 56 years; range 36 to 70 years) or arthroscopic surgery (55 patients; mean age 49 years; range 32 to 58 years). Comparisons were made between both groups with regard to preoperative and postoperative Constant scores, activity, pain, range of motion, and strength scores, and durations for postoperative pain, hospital stay, and return to work. The mean follow-up was 24 months (range 12 to 60 months) for both groups. RESULTS: The mean Constant scores increased from preoperative 32.6 to postoperative 80.5 and from 25.5 to 83.1 with open and arthroscopic surgery, respectively. No significant differences were found between the two groups with regard to pre- and postoperative Constant scores, activity, pain, range of motion, and strength scores (p>0.05). However, patients who underwent arthroscopic surgery exhibited shorter durations in the following: hospital stay (1.36 vs 1.72 days), delay in return to work (9 vs 16 days), and postoperative pain (6 vs 8 weeks) (p<0.05). According to subjective patient evaluations, arthroscopic results were good or excellent in 47 patients (85.5%), satisfactory in six patients (10.9%), and poor in two patients (4.6%); open surgery results were good or excellent in 76 patients (84.4%), satisfactory in 10 patients (11%), and poor in four patients (4.6%). CONCLUSION: Both treatment options seem to be equally effective in the treatment of impingement syndrome in the absence of rotator cuff tears.

Acromioclavicular Joint↗

PubMed2004

[Low back pain among children and adolescents].

OBJECTIVES: We presented our experience with the diagnosis and treatment of low back pain in children. METHODS: We retrospectively reviewed 29 children (15 girls, 14 boys; mean age 12 years; range 9 to 17 years) who were treated for low back pain and had appropriate follow-ups. Etiologic causes were sought by clinical evaluation, radiologic studies, and laboratory tests. Patients with unknown etiology underwent symptomatic treatment. The mean follow-up period was 42 months (range 12 to 96 months). RESULTS: Etiology was determined in 26 patients (89%), which included spondylolysis/spondylolisthesis (n=8), Scheuermann's disease (n=6), neoplasia (n=5), discitis/vertebral osteomyelitis (n=4), and lumbar disc herniation (n=3). Spondylolysis was managed conservatively, except for one patient who had in situ spinal fusion for associated spondylolisthesis. Five patients with Scheuermann's disease were treated conservatively, while one patient required spinal fusion. Surgical treatment with biopsy, curettage, and bone grafting was performed for all neoplasias, but one which was followed-up conservatively. Two patients with discitis were managed with antibiotic treatment and two patients with vertebral osteomyelitis (Pott's abscess) underwent both medical treatment and surgical drainage and stabilization with strut graft. Lumbar disc herniation was treated conservatively in two patients, while one had surgical treatment with excision of disc fragments and limited laminectomy. Finally, all the patients became asymptomatic on final examinations. CONCLUSION: Serious consideration should be given to persistent low back pain in children. Clinical, radiologic, and laboratory findings can be elaborated into etiologic diagnoses and complete relief can be achieved with appropriate treatment.

Adolescent↗

PubMed2004

[Muscle and tendon injuries in children and adolescents].

The pediatric athlete with open physeal plates is more susceptible to growth plate injuries and avulsion fractures than to ligament and muscle-tendon injuries that most often occur in adults. Muscle contusions and strains are common injuries in young athletes. Although they are rare in the early and middle stages of childhood, they become quite common during the growth spurt period. Healing of muscle tissues is much more rapid in children than that in adults, but it must be ensured that full motion and full strength are regained before returning to sports activities, because recurrences of injuries may result in more serious complications such as myositis ossificans. On the other hand, acute tendinous injuries are quite rare in children; however, repetitive submaximal stress may lead to overuse syndromes. This article reviews the basic anatomy and function of skeletal muscle and discusses the physiopathology of muscle-tendon injuries, and the methods of treatment and prevention, with particular focus on the growing child.

Adolescent↗