Biomedical subjects

Metin Ozalay

Publications and source records attributed to Metin Ozalay.

At least 19 recordsLinked to original sources

PubMed2006

Absence of the medial sesamoid bone associated with metatarsophalangeal pain.

Pain at the first metatarsophalangeal (MTP) joint can result from inflammation, chondromalacia, flexor hallucis brevis tendinitis, osteochondritis dessecans, fracture of a sesamoid bone, avascular necrosis of sesamoids, inflamed bursae, intractable keratoses, infection, sesamoiditis, gout arthropathy, and rheumatoid arthritis. Congenital absence of a sesamoid bone is extremely rare. We present a 17-year-old male patient with pain at the plantar aspect of the right MTP joint associated with congenital absence of the medial sesamoid. There was tenderness and the range of motion was minimally restricted. He described the pain as necessitating changes in his social life. On radiographs, the medial hallucial sesamoid was absent on the right side. The MTP joint was also evaluated using magnetic resonance imaging (MRI). A metatarsal pad was prescribed and the patient was satisfied with the treatment at the 2 months follow-up period. MRI revealed no pathological tissue at the medial sesamoid site. Hallucial sesamoids absorb pressure, reduce friction, protect the tendons, act like a fulcrum to increase the mechanical force of the tendons, and provide a dynamic function to the great toe by elevating first metatarsal head. Congenital absence of these bones is very rare but we must consider it in a patient with MTP joint pain.

Adolescent↗

PubMed2006

Necrotizing soft-tissue infection of a limb: clinical presentation and factors related to mortality.

BACKGROUND: Necrotizing fasciitis is a rare and often fatal soft-tissue infection. Prompt diagnosis and immediate aggressive surgical debridement of all compromised tissues are critical to reducing morbidity and mortality in these rapidly progressive infections. The purpose of this study was to analyze the clinical presentation and evaluate factors that determine mortality associated with this uncommon surgical emergency. METHODS: The study retrospectively investigated the medical records of 22 patients who were diagnosed and treated for necrotizing fasciitis of the lower extremity, 14 of whom had involvement of the foot (nine patients) or foot and ankle (five patients) at our hospital. The data collected for each of the 22 patients were age, sex, underlying systemic factors, location of infection, duration of symptoms, portal of entry of infection, initial diagnosis on admission, physical, radiographic and laboratory findings, microbiological cultures, the type of therapy used (debridement or amputation), treatment outcome, and number of days in the hospital. RESULTS: A total of 23 extremities of 22 consecutive patients with necrotizing fasciitis who underwent surgical debridement or amputation were retrospectively reviewed. Radical surgical debridement was done in 16 extremities initially, and this treatment was repeated a mean of two times (range one to four debridements) to completely remove all the necrotic tissue. Nine patients (41%) required below-knee or above-knee amputation. There were three deaths, one related directly to sepsis and organ failure, one due to gastrointestinal hemorrhage, and one caused by pulmonary embolism. There were no significant differences between patients who had the amputations and those who did not with respect to mortality rate or age (p = 0.538 and p = 0.493, respectively). Those who died were significantly older than the survivors (p = 0.038). CONCLUSIONS: The diagnosis of necrotizing fasciitis should be considered for any individual who has unexplained limb pain, especially if that person has diabetes mellitus or chronic liver disease. There was no difference in mortality rates between patients with or without amputation. The primary treatment is early and aggressive debridement of involved skin, subcutaneous fat, and fascia.

Adult↗

PubMed2005

Giant chondroblastoma of the scapula with pulmonary metastases.

A 53-year-old man presented with a 12-year history of a progressively growing solid mass at his left shoulder. A 39x30x18-cm and 14.440-kg mass including the scapula was resected. Pathologic features were specific for chondroblastoma. During the 36-month follow-up, he had multiple inoperable metastatic lesions in his lungs. Histology of the transthoracic needle biopsy showed the metastatic nodules had features specific for chondroblastoma; however, the microscopic features additionally had hyperchromasia and increased mitotic activity in some areas. In the English literature, there are a few cases of chondroblastoma located in the scapula. It is exceptional to see this lesion in the sixth decade of life and with pulmonary metastases.

Bone Neoplasms↗

PubMed2005

Time dependent changes in patellar tracking with medial parapatellar and midvastus approaches.

The aim of this study was to compare the alteration of patellar tracking by time, which was performed through two different approaches: midvastus and medial parapatellar. Twenty-one patients undergoing simultaneous bilateral primary total knee replacements were randomized prospectively to perform the surgery via a medial parapatellar approach on one knee and midvastus approach on the other knee. All of the patellae were resurfaced. Preoperative, early and late postoperative (mean 22 month) skyline views of the patellae were taken. We found that preoperative 2.24 degrees lateral tilt of patella had not changed by time at the midvastus side (2.95 degrees and 2.57 degrees ). Moreover, preoperative 0.48% lateral subluxation of the patella for midvastus approach had not changed (1.48% and 1.67%). Although 2.19 degrees patellar lateral tilt had not significantly changed at the early postoperative period, which was performed via medial parapatellar approach, there had been a significant increase to 5.38 degrees by time (P=0.037) compared to the preoperative radiographs. Additionally, the preoperative lateral subluxation of the patella (0.57%) at the medial parapatellar side had increased to 5.43% at the early (P=0.009) and 5.62% at the late (P=0.012) postoperative measurements. Midvastus approach is superior to medial parapatellar approach concerning the late patellar tracking.

Aged↗

PubMed2005

Arthroscopic treatment of solitary benign intra-articular lesions of the knee that cause mechanical symptoms.

PURPOSE: Most cases of knee locking and giving-way are caused by meniscal tears, loose bodies, or chondral lesions. Intra-articular benign tumors or tumor-like lesions can present with symptoms that resemble acute mechanical derangement. From a database of 2,200 arthroscopic interventions, 19 cases of intra-articular masses that presented with catching and locking symptoms in the knee were retrospectively analyzed. TYPE OF STUDY: Case series. METHODS: Our review revealed 33 patients with benign intra-articular masses in the knee joint. Nineteen of these individuals had sought medical attention for mechanical symptoms of catching or locking. The other 14 patients had a variety of symptoms including pain, swelling, and limitation of knee motion, but did not have mechanical symptoms. Age, sex, history of trauma, knee pain and effusion, medical illnesses, physical examination, arthroscopic findings, and pathologic findings were noted. RESULTS: The average age of the 6 male and 13 female patients was 37.5 years (range, 18 to 58 years). Preoperative magnetic resonance imaging confirmed the diagnosis in 7 cases and 12 cases were diagnosed during knee arthroscopy. The mean follow-up time after surgery was 52.5 months (range, 6 to 120 months). Pathologic examination of the lesions revealed 15 cases of localized pigmented villonodular synovitis (79%), 1 lipoma arborescens (5%), 1 pseudocyst (5%), and 2 nonspecific synovial masses (11%). None of the lesions showed malignant transformation. CONCLUSIONS: Solitary benign intra-articular lesions should be considered a rare cause of mechanical knee symptoms. Localized pigmented villonodular synovitis originating from the extensor mechanism or fat pad is the most common solitary intra-articular mass lesion in the knee and usually arises in the patellofemoral compartment. Recurrence has not occurred in our series, which includes 14 of 19 patients with greater than 24 months follow-up. LEVEL OF EVIDENCE: Level IV.

Adolescent↗

PubMed2005

Mechanical strength of four different biceps tenodesis techniques.

PURPOSE: The aim of this study was to compare the biomechanical properties of 4 different biceps tenodesis techniques. TYPE OF STUDY: Biomechanical experiment. METHODS: Four groups of fresh sheep shoulders (28 total) with similar shape characteristics were used. Biceps tenodesis was performed using the following techniques: group 1 (n = 7), tunnel technique; group 2 (n = 7), interference screw technique; group 3 (n = 7), anchor technique; and group 4 (n = 7), keyhole technique. Each construct was loaded to failure and the groups were compared with respect to maximum load in Newtons and deflection at maximum load in millimeters. The results were statistically analyzed with 1-way analysis of variance, the Bonferroni post hoc test and the Student t test or the nonparametric Mann-Whitney U test. RESULTS: The calculated average maximum loads were 229.2 +/- 44.1 N for the tunnel technique, 243.3 +/- 72.4 N for the interference screw, 129.0 +/- 16.6 N for the anchor technique, and 101.7 +/- 27.9 N for the keyhole technique. Statistical testing showed no statistically significant differences between groups 1 and 2, groups 3 and 4, or groups 2 and 3 with respect to maximum load and deflection at maximum load (P = .09/P = .49, P = .41/P = .79, and P = .06/P = .82 for load/deflection in the 3 comparisons, respectively). However, all other group comparisons revealed significant differences for both parameters (group 1 v group 4 [P < .01/P < .01]; group 1 v group 3[P < .01/P = .01]; and group 2 v group 4 [P = .007/P = .003]). CONCLUSIONS: The strongest construct was made with the interference screw technique, followed by the tunnel, anchor, and keyhole techniques. There were no statistically significant differences between the interference screw and tunnel techniques with respect to maximum load or deflection at maximum load. CLINICAL RELEVANCE: Although it is difficult to extrapolate in vitro data to the clinical situation, the interference screw technique has better initial biomechanical properties and may produce improved clinical outcomes.

Alloys↗

PubMed2005

Arthroscopic debridement and grafting of an intraosseous talar ganglion.

We report the case of a 41-year-old man with right ankle pain and swelling who had an intraosseous talar ganglion in the medial part of talar dome. A surgical procedure was performed using the 3-portal arthroscopic approach. The softened chondral surface was removed and the content of the cyst was discharged arthroscopically. The sclerotic rim was abraded until the bleeding spongious layer was seen. A grafting procedure was also performed arthroscopically. A trocar was introduced into the defect from the superomedial portal. Autografts were impacted using a cylindrical rod through the trocar into the defect. The clinical and radiologic results at the 1-year follow-up were satisfactory. We encountered no complications postoperatively. We conclude that arthroscopic debridement and grafting of an intraosseous ganglion adjacent to the articular surface may be a better option compared with open surgery.

Adult↗

PubMed2005

Remote cerebellar hemorrhage after a spinal surgery complicated by dural tear: case report and literature review.

OBJECTIVE AND IMPORTANCE: This report presents a case in which cerebellar hemorrhage occurred after lumbar decompression surgery that was complicated by dural tear and prolonged cerebrospinal fluid leakage. Remote cerebellar hemorrhage after spinal surgery is extremely rare. Our objective is to describe this unusual complication, discuss the possible mechanisms of remote cerebellar hemorrhage, and review the literature. CLINICAL PRESENTATION: A 73-year-old woman underwent surgery for lumbar spinal stenosis. A dural tear occurred during decompression, and the patient developed remote cerebellar hemorrhage on postoperative Day 2. INTERVENTION: The cerebellar hemorrhage was treated surgically, and a biopsy of hemorrhagic brain parenchyma revealed an arteriovenous malformation. CONCLUSION: Although it is an extremely rare complication, remote cerebellar hemorrhage should be kept in mind as a possible complication of spinal surgery, especially in operations complicated by dural tears.

Aged↗

PubMed2005

Accuracy and outcome of sonographically guided intra-articular sodium hyaluronate injections in patients with osteoarthritis of the hip.

OBJECTIVE: The aim of this study was to evaluate the accuracy and outcome of sonographically guided intra-articular sodium hyaluronate injections in patients with osteoarthritis of the hip. METHODS: The prospective study involved 10 patients who had the diagnosis of unilateral hip osteoarthritis. The mean age of the patients was 63.2 years (range, 27-80 years). Depending on patient body weight, either a 3.5- to 5-MHz convex transducer or a 5- to 12-MHz linear transducer was used to examine each affected joint. Every subject received 3 injections of sodium hyaluronate, 1 per week for 3 consecutive weeks. With real-time sonographic monitoring, each joint was penetrated with a 20-gauge Chiba needle. Contrast medium was injected initially, and proper intra-articular placement was verified with computed tomography before the hyaluronate injection. Each patient's outcome was assessed on the basis of visual analog scale results and Western Ontario and McMaster Universities osteoarthritis index findings that were recorded before the set of injections and 2, 4, and 6 months after the third injection. RESULTS: Computed tomography confirmed accurate placement in all 30 injections in the study. The visual analog scale and the Western Ontario and McMaster Universities osteoarthritis index scores showed that 80% of the patients had less pain in the joint at 6 months after the last injection. CONCLUSIONS: Sonographically guided intra-articular injection of sodium hyaluronate for patients with hip osteoarthritis is easy to perform and is a safe, economical, and well-tolerated form of treatment. In contrast to fluoroscopic or computed tomographic guidance, the sonographic technique exposes neither the patient nor the physician to radiation.

Adult↗

PubMed2004

Primary clear cell sarcoma of rib.

Clear cell sarcoma (malignant melanoma of soft tissues) is a very rare soft tissue neoplasm. It generally arises in tendons and aponeuroses. Although metastasis of malignant melanoma to bone is not uncommon, primary clear cell sarcoma of bone is an extremely rare neoplasm. To our knowledge five cases have been reported in the English literature. We present a case of primary clear cell sarcoma of bone in a 28-year-old woman arising in the left ninth rib. We treated the patient with total excision of the mass and postoperative radiotherapy. The patient is alive and well without local recurrence or distant metastasis at 33 months after surgery.

Adult↗

PubMed2004

Synovial cysts of proximal tibiofibular joint causing peroneal nerve palsy: report of three cases and review of the literature.

INTRODUCTION: Synovial cyst of the proximal tibiofibular joint is a very rare condition, for which there is no consensus regarding treatment. CASE PRESENTATION: We present three patients who had synovial cysts of proximal tibiofibular joint that caused peroneal nerve palsy. We discuss the special features of synovial cysts and review the literature. CONCLUSION: We consider the best treatment of synovial cysts originating from proximal tibiofibular joint and causing peroneal nerve palsy to be total surgical removal as soon as possible after the diagnosis is made. It should be kept in mind that despite surgical treatment the neurological symptoms may not recover.

Adult↗

PubMed2004

Iatrogenic medial dislocation of hallucal sesamoids with hallux varus in an adolescent.

BACKGROUND: Iatrogenic hallux varus is a rare deformity linked to bunion surgery at late adult age. Here reported is the first adolescent case of acquired hallux varus and medial dislocation of both sesamoid bones. CASE REPORT: The patient had had a surgical intervention under his first metatarsophalangeal joint when he was 10 years old. Correction of the deformity with a tendon transfer and medial capsular release alone-as was recommended for adults-was impossible in this adolescent, 8 years after the index surgery. Excision of the contracted medial structures and repair of the lateral retinaculum of the fibular sesamoid obtained a perfect correction of the dislocated sesamoid bones.

Adolescent↗

PubMed2004

The timing of tourniquet release and its influence on blood loss after total knee arthroplasty.

We performed a prospective, randomized study on 76 patients (82 knees) scheduled for total knee arthroplasty to determine the effect of tourniquet release and hemostasis on the peri- and postoperative blood loss. Patients were randomly divided in two groups. Posterior cruciate retaining tricompartmental total knee prostheses were used in all. In group 1, the tourniquet was deflated intraoperatively after the prosthetic components were settled and hemostasis was done. In group 2, the tourniquet was released after the wound was closed and a compressive bandage was applied. Mean blood drainage was 880.85 ml (320-1,315) in group 1 and 745.36 ml (220-1,175) in group 2 ( p=0.03). The mean number of blood transfusions given, hemoglobin and hematocrit values, operation time, and tourniquet time were similar in both groups. Intraoperative tourniquet release and hemostasis does not reduce total blood loss in total knee arthroplasty.

Aged↗

PubMed2004

[A comparison between single- and two-staged bilateral total knee arthroplasty operations in terms of the amount of blood loss and transfusion, perioperative complications, hospital stay, and cost-effectiveness].

OBJECTIVES: We compared bilateral total knee arthroplasty (TKA) operations performed at a single session or at two separate sessions with respect to perioperative complications, the amount of blood loss and transfusion, the length of hospital stay, and the overall cost. METHODS: The study included 39 patients (34 females, 5 males; mean age 68.1 years; range 52 to 88 years) and 16 patients (13 females, 3 males; mean age 66.8 years; range 52 to 83 years) who underwent bilateral TKA for osteoarthritis at a single session and at two separate sessions, respectively. Staged operations were interspersed with a mean interval of 8.3 months (range 2 to 24 months). The two groups were compared with respect to perioperative complications, the amount of blood loss and transfusion, the length of hospitalization, and the overall cost. RESULTS: The amount of blood loss and transfusion, the length of intensive care unit stay, and the occurrence of perioperative complications did not differ significantly between single- and two-staged operations (p>0.05). However, the mean length of hospital stay (10.48 days versus 17.19 days; p=0.01) and the mean overall cost (p=0.03) were significantly less in single-staged operations. Perioperative complications accounted for 12.8% (n=5) and 25% (n=4) in single- and two-staged operations, respectively, all of which developed in patients who had a preexisting cardiologic disease. CONCLUSION: In view of its advantages, single-staged bilateral TKA seems to be an appropriate alternative in selected patients.

Aged↗

PubMed2003

Type 4 median nerve entrapment in a child after elbow dislocation.

UNLABELLED: CASE STUDIED: Median nerve entrapment is a rare, serious complication of elbow dislocation. We report a Type 4 median nerve entrapment after elbow dislocation in a 10-year-old boy. Radiologically Matev's sign and a new radiological finding-a sclerotic tunnel at the lateral side of the olecranon-were seen. TREATMENT: The patient was treated by excising the damaged segment and reanastomosing the nerve 13 months after the injury.

Child↗

PubMed2003

Benign noninfectious subcutaneous emphysema of the hand.

A 17-year-old girl presented pain and subcutaneous crepitation in the left hand. Because of lack of systemic symptoms, non-infectious cause was considered. Radiographic and magnetic resonance imaging revealed subcutaneous emphysema. A chest x-ray was reported as normal but chest computerised tomography revealed pneumomediastinum. On the third day of the hospitalisation, subcutaneous emphysema spread to arm, shoulder, head, left hemithorax, back, bilateral supraclavicular, cervical, submandibular and periorbital regions. Pneumomediastinum and subcutaneous emphysema disappeared during 6 weeks of follow up with conservative methods. This might have prevented unnecessary surgical intervention. This report demonstrates that benign non-infectious subcutaneous emphysema of the hand due to pneumomediastinum should be kept in mind in hand surgery.

Adolescent↗

PubMed2003

Primary hydatid disease of the quadriceps muscle: a rare localization.

BACKGROUND: Hydatidosis is a protozoal infestation which generally involves the liver and the lungs. Primary skeletal muscle hydatidosis without involving the thoracic and abdominal organs is extremely rare. METHODS: A 48-year-old farmer presented with a mass in the quadriceps muscle that had persisted for 10 years. Clinical and radiological investigations revealed a primary hydatid cyst of the vastus medialis of the quadriceps muscle. We did not find any visceral organ involvement. Wide excision was performed without destroying the cyst wall. Then 400 mg albendazole was given daily for 3 months postoperatively. RESULTS: At the 7th postoperative month, the patient was symptom-free, and the laboratory test results were in the normal ranges. CONCLUSION: Primary muscular hydatidosis is a rare disease and should be kept in mind in the diagnostic work-up of a cystic mass of a skeletal muscle.

Albendazole↗

PubMed2003

Bilobed flaps for nonhealing ulcer treatment.

Healing of round ulcers may be difficult particularly in the plantar area. Rigidity and thickness of the plantar skin do not allow fusiform excision and primary suturing. The bilobed flap is a simple reconstructive technique principally used to repair substantial defects in the facial region. The authors' experience with this local flap in the foot is presented with good short-term results. Between 1995 and 1998, five female and seven male neuropathic foot patients with round plantar ulcers were treated with bilobed flaps. The average age of the patients was 50 (range, 15-76). The average size of the ulcers was 1.6 cm (1-3.2 cm). Debridement and orthotic insoles were used at least for 3 months before considering bilobed flaps. Seven patients were diagnosed as type II diabetes mellitus, four patients had cerebral palsy, and another patient had meningomyelocele. The minimal follow-up period was 1 year (average, 19.5 months). The only complication was wound dehiscence at the lateral side of the heel in a type II diabetic. Subsequently, this complicated ulcer was managed with a sliding flap and skin graft without further problem. The study concluded that nonhealing foot ulcers can be effectively treated with a bilobed skin flap of healthy tissues rotated from nonweightbearing parts of the sole.

Adolescent↗