Biomedical subjects
Publications and source records attributed to Baransel Saygi.
The lateral meniscus tends to have more developmental variation than the medial counterpart. This is a report of an accessory discoid layer of lateral meniscus. All arthroscopic, magnetic resonance imaging and histopathological views are presented.
BACKGROUND: Infection around an implanted orthopaedic device is a devastating complication, and the treatment of infections involving slime-forming bacteria is especially difficult. The purpose of the present study was to evaluate the effectiveness of a proteolytic enzyme, serratiopeptidase, in the eradication of a periprosthetic infection in an in vivo animal model. METHODS: In sixty Sprague-Dawley rats, the medullary canal of the right femur was drilled through the intercondylar notch and was inoculated with a Staphylococcus epidermidis strain (ATCC 35984) with a high slime-producing capacity. The cavity was filled with polymethylmethacrylate cement, and a Kirschner wire that had contact with the knee joint was inserted. None of the animals received any treatment for two weeks. Twenty rats were killed at two weeks after the inoculation in order to determine if the infection had become established. The remaining forty rats were randomized into two groups. One group received serratiopeptidase enzyme injections into the knee joint in addition to antibiotic therapy for four weeks, and the other group received intra-articular saline solution injections together with the same antibiotic therapy. The animals from both groups were killed two weeks after the end of therapy (on Day 56). The knee specimens were evaluated bacteriologically and histologically to determine the prevalence of persistent infection and the effects of the enzyme on local tissue. RESULTS: At two weeks, inoculated bacteria grew on culture of specimens from twelve (63.2%) of nineteen animals in the no-treatment group. Microbiological testing suggested that infection persisted in only one (5.6%) of eighteen animals in the serratiopeptidase-and-antibiotic group, whereas it was present in six (37.5%) of sixteen animals in the antibiotic-only group (p = 0.001). Histological evaluation showed similar results (kappa = 0.92). CONCLUSIONS: Serratiopeptidase was effective for eradicating infection caused by biofilm-forming bacteria in this experimental animal model. The antibiofilm property of the enzyme may enhance antibiotic efficacy in the treatment of staphylococcal infections.
OBJECTIVES: We evaluated tendon holding capacities of suture materials that are commonly used in repair of Achilles tendon ruptures. METHODS: Achilles tendons of 60 sheep were removed by incisions 2-cm proximal to the calcaneal insertion and 1-cm distal to the musculotendinous junction. The tendons were randomly divided into six groups and sutures were placed with the Kessler technique at the distal end of the tendons using one of the following suture materials: 2 polydioxanone (PDS), 1 PDS, 2 Vicryl, 1 Vicryl, 2 Ethibond, and 1 Prolene. The distal end of the suture material was left free. Each specimen was mounted in an Instron machine, with the tendon being placed proximally and the suture material distally. The system was loaded with a displacement rate of 20 mm/min. RESULTS: Failure of all the specimens was due to pull-out of the suture material through the tendon. There were no failures due to suture breakage. The highest and the lowest tendon holding capacities were found with 2 PDS and 2 Ethibond sutures, respectively. CONCLUSION: Following Achilles tendon repair, the healing period, in particular the first three weeks, is precarious for pull-out of the suture material through the tendon. Thus, tendon holding capacity of the suture material is an important factor for the strength of the repair. Among the tested suture materials, 2 PDS was found to have the highest tendon holding capacity.
PURPOSE: Menisci are known to have receptors mainly concentrated at the anterior and posterior horns. Although they are purported to send afferent impulses to the central nervous system, this function has not been thoroughly evaluated. The purpose of the study was to investigate whether stimulation of the menisci initiates a cortical response. The reaction of the end organ to the reflex arc is also evaluated. TYPE OF STUDY: Prospective case series. METHODS: Fourteen patients with normal medial menisci were included in the study. Different parts of the knee joint (the posterior horn and the body of the medial meniscus, the medial femoral condyle, the capsule, and the joint space) were electrically stimulated by a probe during arthroscopy. The cortical response was monitored with somatosensory-evoked potentials (SEPs). The compound muscle action potentials (CMAPs) of the semimembranosus, quadriceps, and biceps femoris muscles were also monitored with electroneuromyography (ENMG). RESULTS: Among the stimulated parts, only the posterior horn of the meniscus produced cortical responses. No response was obtained with stimulation of the medial femoral condyle, the body of the medial meniscus, the capsule, or the joint space. Stimulation of the posterior horn of the medial meniscus produced a measurable amount of CMAP latency for the semimembranosus muscle, but not for the quadriceps and biceps femoris muscles. CONCLUSIONS: Stimulation of the posterior horn of the medial meniscus produces reproducible cortical SEPs and results in ENMG-verified response of the semimembranosus muscle where no response of the semimembranosus muscle is detected with stimulation of the other parts of the knee. CLINICAL RELEVANCE: The knowledge that only the horns of the medial meniscus have mechanoreceptors in the medial compartment of the knee helps to understand patients' signs and symptoms in medial compartment disease.
BACKGROUND: The initial treatment of Morton neuromas consists of conservative methods that include shoe modifications and steroid injections. The purpose of this prospective study was to compare the efficacy of these two methods to determine which is more effective as the initial treatment method. METHODS: Eighty-two patients with Morton neuromas were randomly assigned to receive either footwear modification with orthoses or steroid injections as initial treatment. Outcomes were evaluated at 1 month, 6 months, and 12 months. RESULTS: Patient satisfaction was significantly better (p < 0.01) in the group treated with steroid injections than those treated with shoe modifications at all three followup intervals. At 12-month followup, 82% of those treated with steroid injections had complete or partial relief of pain compared to 63% of those treated with footwear modifications alone. CONCLUSION: Steroid injections as initial treatment and shoe modifications with steroid injections at 6 months appear to give better results in Morton neuromas than shoe modifications alone, but the difference in the two groups were not statistically significant at one year followup.
OBJECTIVES: Hyaluronic acid (HA) is used in osteoarthritis, especially for the control of pain. In this study, we investigated the effect of intra-articular HA on experimental osteoarthritis of early stage. METHODS: Osteoarthritis was induced in both knees of 10 rabbits by transecting the anterior cruciate ligament under intramuscular anesthesia with ketamine and xylazine. Intra-articular HA at a dose of 0.6 ml (15 mg/ml) and physiologic saline solution (0.6 ml) were injected into the right and left knees, respectively, three times with a week interval. Three rabbits died during the study period and were excluded. The remaining rabbits were sacrificed in the 12th week via high dose anesthesia to remove the distal femora for histological evaluation using the Mankin scale and for measurements of the cartilage area. RESULTS: The mean cartilage areas calculated in HA- and saline-injected knees differed significantly (1.097 mm2 and 0.477 mm2, respectively; p<0.05). The overall mean Mankin score was significantly lower in HA-injected knees (3.57 versus 11.14; p<0.05). Although, there were no significant differences between the two groups with respect to cellular abnormality, matrix staining, and tidemark continuity (p>0.05), the mean scores for the structure of the cartilage were significantly different (0.86 versus 4.43; p<0.05). The integrity of the tidemark was preserved in all the HA-administered knees, though a notable disruption was observed in four control knees. CONCLUSION: Our results suggest that HA delays the development of osteoarthritis at early stages through exerting a chondroprotective effect.
Wilson osteotomy of the first metatarsal is a technically simple and reliable operation for the correction of the hallux valgus (HV) deformity. The major anatomic components of the osteotomy are the osteotomy angle and the distance of the osteotomy to the first metatarsophalangeal (MTP) joint. Lateralization of the first metatarsal head is the rationale for correction of the deformity. The main disadvantage of the technique is the considerable shortening of the first metatarsal. The relation between the amount of HV correction, first metatarsal shortening, and the anatomic parameters of the osteotomy was evaluated. Radiographs of 46 feet of 32 patients were retrospectively evaluated after an average follow-up period of 31.4 months. From the preoperative, early postoperative, and last control radiographs, the amount of HV correction, first metatarsal shortening, the osteotomy angle, the distance of the osteotomy to the first MTP joint, and lateralization of the first metatarsal head were measured. The presented study indicated that the osteotomy angle and the lateral displacement of the metatarsal head have a significant correlation with the amount of HV correction. Distance of the osteotomy to the first MTP joint has no relevance with the repair of the deformity. A positive linear correlation was present between the osteotomy angle and the first metatarsal shortening. Because the amount of first metatarsal shortening has significant influence over the clinical result, the main aim in a Wilson osteotomy should be maximum lateral displacement of the metatarsal head with a minimum osteotomy angle.
Congenital absence of the lateral sesamoid is an extremely rare condition. We present a case of congenital absence of the lateral sesamoid in which magnetic resonance imaging was performed. The literature is reviewed regarding the clinical significance of this anomaly.
A 19-year-old woman presented with pain at the lateral side of the fifth toe of her left foot, which was separated from the adjacent toe. Initial examination suggested dislocation of the fifth metatarsophalangeal joint due to a past fracture. Radiographs showed a mass arising from the proximal phalanx of the little toe, with no medullary and cortical continuity. Excisional biopsy of the mass was performed, and a histologic diagnosis of bizarre parosteal osteochondromatous proliferation of bone (Nora's lesion) was made.