Biomedical subjects

Sinan Karaoglu

Publications and source records attributed to Sinan Karaoglu.

12 recordsLinked to original sources

PubMed2005

Treatment of femoral nonunions by using cyclic compression and distraction.

UNLABELLED: Eleven patients with femoral diaphyseal nonunions after intramedullary nailing were treated with cyclic compression and distraction with an external fixator over the nail. We evaluated the limitations of this technique and whether patients having this closed procedure could achieve union without additional operative procedures. Patients with hypertrophic nonunions (n = 4) were treated with gradual compression of the nonunion site. Cyclic compression and distraction was done in patients with oligotrophic (n = 2) or atrophic nonunions (n = 5) to stimulate consolidation. The average age of the patients was 32.9 years (range, 21-48 years), and the average followup was 40.5 months (range, 24-64 months). Union was achieved in an average of 5.8 months in all patients after one operation and without additional surgical intervention. However, pain necessitating strong analgesic agents and pin-related complications consisting of osteomyelitis, septic arthritis, and pin breakage in the atrophic nonunion group were a major limitation of this technique. Based on our study, the cyclic compression and distraction technique can be used in hypertrophic and oligotrophic nonunions that have failed one or more prior exchange nailings. However, it might not be an option for treatment of patients with atrophic nonunions unless pin-site problems are resolved. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗

PubMed2004

Sodium hyaluronate regulating angiogenesis during Achilles tendon healing.

The aim of this study was to evaluate the effect of SH (sodium hyaluronate-NaHA) on vascular endothelial growth factor (VEGF) and type IV collagen expression during the Achilles-tendon healing process. Adult New Zealand white rabbits (n=32) aged 4 months and weighing 2.7-3.9 kg were used. The rabbits were randomly divided into two groups, and each group was divided into two subgroups and monitored for 6 and 12 weeks. Tendo calcanei were incised transversely and repaired. An injection of 0.5 ml NaHA (15 mg/ml) was administered between the tendon and paratenon of the right leg and repeated twice at one-week intervals. Equal numbers of animals were sacrificed at the 6th and 12th weeks, and the repaired tissue was examined macroscopically and histologically for the presence of VEGF and type IV collagen expression every week. The decrease in the amount of adhesion tissue and the acceleration of tendon healing in the NaHA group were significantly high when compared with control groups at 6 and 12 weeks (p<0.001, p<0.05). In the NaHA group, due to vascular proliferation VEGF immunostaining was strongly positive in the 6th week (p<0.05), and remained positive in the 12th week (p<0.05). Similar immunostaining findings were detected for type IV collagen in the 6th week. However, there was a significant decline in immunostaining rate in the 12th week (p<0.05). The increases in VEGF and type IV collagen expression following SH administration might be an indication that SH may partly be involved in regulation of angiogenesis.

Achilles Tendon↗

PubMed2004

When to inject analgesic agents intra-articularly in anterior cruciate ligament reconstruction: before or after tourniquet releasing.

PURPOSE: To evaluate 2 different applications of an intra-articular (IA) mixture composed of 40 mL 0.25% bupivacaine and 2 mg morphine in anterior cruciate ligament (ACL) reconstructions, before and after tourniquet release. TYPE OF STUDY: Prospective, double-blind, randomized, clinical trial. METHODS: Forty patients who underwent ACL reconstruction were prospectively randomized into 2 groups. Group 1 was injected with IA morphine with bupivacaine 10 minutes before tourniquet release. Group 2 was injected with IA morphine with bupivacaine injection after tourniquet release, after a 30-minute period of waiting with closed drainage. Visual analog scale scores were recorded at 10 and 30 minutes and at 1, 2, 4, 8, 12, and 24 hours after surgery. Detailed records were kept of the amount of analgesic drug required. RESULTS: In pain scores, there was no difference between the 2 groups except for 30 minutes postoperatively (P = .005). The first analgesic requirement time was significantly lower in group 2 (P < .001) and the total amount of opioid used was lower in group 2 (P = .037) than those in group 1. There was no difference between the 2 groups in terms of operation time (P = .484), although there was a significant difference between groups in terms of tourniquet time (P = .024). CONCLUSIONS: We conclude that IA analgesic injection after tourniquet release is more beneficial to obtain postoperative analgesia in ACL reconstructions than the same injection before tourniquet release. LEVEL OF EVIDENCE: Level I.

Analgesia↗

PubMed2003

Bilateral luxatio erecta humeri.

BACKGROUND: Inferior dislocation of the glenohumeral joint or luxatio erecta humeri is a rare form of injury, accounting for only 0.5% of all shoulder dislocations. Bilateral cases are even less frequent, with only eight cases reported in the literature. METHOD AND RESULT: We report one case of bilateral inferior dislocation of the shoulder. The patient made a complete functional recovery within 2 years after treatment by closed reduction and rehabilitation. CONCLUSION: Based on this case and the pertinent literature, the pathophysiology, diagnosis, and treatment of this rare injury are discussed.

Accidents, Home↗

PubMed2003

Bilateral vs. unilateral spinal anesthesia for outpatient knee arthroscopies.

This prospective randomized study compared unilateral and bilateral spinal anesthesia with respect to intraoperative and postoperative complications, and time to discharge from hospital for knee arthroscopies in outpatients. We studied 70 ASA I patients scheduled for elective outpatient knee arthroscopy. The patients were randomly allocated into two groups to receive either 3 ml (15 mg) 0.5% hyperbaric bupivacaine (bilateral group) or 1.5 ml (7.5 mg) 0.5% hyperbaric bupivacaine (unilateral group). The duration of motor and sensory block and the time to discharge from the hospital were all recorded. Perioperative complications such as hypotension, bradycardia, nausea, vomiting, urinary retention, if present, were recorded. The patients were interviewed by telephone 7 days later, and each patient was asked about headache or backache. The duration of motor and sensory block, and the time to discharge from hospital was shorter in the unilateral group than in the bilateral group. Three patients in the bilateral group were treated for hypotension. Bradycardia occurred in two patients in the bilateral group, and three patients required temporary bladder catheterization due to delay in recovery of spontaneous urination. Nausea and vomiting occurred in three patients in bilateral group. Nine patients in the bilateral group and six patients in the unilateral group developed postspinal headache. Backache occurred in five patients in the bilateral group and in six patients in the unilateral group. Our data indicate that the use of unilateral spinal block is a suitable technique for knee arthroscopies in outpatients.

Adult↗

PubMed2002

Bilateral obturator dislocation of the hip.

A case of a traumatic bilateral obturator dislocation of the hip and right side acetabular fracture in a 23-year-old man is presented. The patient was managed conservatively. After follow-up time of 24 months, the result was excellent. The importance of a pelvic radiograph and physical examination of the extremities after significant major trauma are emphasized.

Accidents, Traffic↗

PubMed2002

Comparison of analgesic effects of intra-articular tenoxicam and morphine in anterior cruciate ligament reconstruction.

This study compared the analgesic effect of intra-articular injection of tenoxicam with that of morphine on postoperative pain after anterior cruciate ligament (ACL) reconstruction. Forty-two patients undergoing arthroscopically ACL reconstructions using hamstring tendons underwent the same anesthetic protocol. The patients were randomized to receive 25 ml normal saline, 20 mg tenoxicam in 25 ml normal saline, or 2 mg morphine in 25 ml normal saline. Postoperative pain was assessed using a visual analogue scale and measuring analgesic requirements. We found both that both intra-articular tenoxicam and intra-articular morphine provided better analgesia than that in the control group. Although pain scores were similar between tenoxicam and morphine groups 30 min postoperative, the analgesic requirements in with tenoxicam were significantly lower than those with morphine group 3-6 h postoperatively.

Adult↗

PubMed2002

An unidentified pitfall of Endobutton use: case report.

We report a case study of a patient who underwent bone-patellar tendon-bone ACL reconstruction using an Endobutton. Although the fact that the Endobutton did not pass outside the femoral cortex was realized after the operation, Lachman's test was negative. The Endobutton appeared to hang onto the femoral tunnel as an anchor, and it was decided to observe rather than intervene. One year later no laxity had developed, and a second-look arthroscopy showed a good ligament reconstruction. Although it is quite easy to perform, Endobutton fixation in ACL surgery requires that maximum care be taken to ensure that the Endobutton has flipped.

Adult↗

PubMed2002

Improving the biomechanical properties of the T-fix using oblique direction: in vitro study on bovine menisci.

UNLABELLED: This study compared pullout strengths of the T-fix device versus horizontal suture toward improving T-fix biomechanical properties. Twenty bovine medial menisci were used for this study. Four groups were tested and mean tearing stress were obtained. In group 1 a standard T-fix suture was performed (50.2+/-4.2 N); in group 2 horizontal mattress sutures were placed in the meniscus using 2-0 vicryl (54.6+/-4.2 N); in group 3 three T-fix suture anchors were placed: the central suture a double suture anchor and those on either side single suture anchors, resulting in two horizontal sutures (61.8+/-3.8 N); in group 4 we modified the technique used in group 3. The double suture anchor was placed the incision, at a 30 degrees angle oblique to the horizontal (71.0+/-5.9 N). There was a statistically significant difference between groups 3 and 4 but not between groups 1 and 2. IN CONCLUSION: Using a T-fix suture anchor in the standard technique has similar biomechanical properties to the horizontal mattress suture. To improve the tensile properties of the T-fix suture a double T-fix suture anchor should be used obliquely to the other two single T-fix sutures on either side.

Animals↗

PubMed2002

Experimental repair of segmental bone defects in rabbits by demineralized allograft covered by free autogenous periosteum.

Using an experimental model of segmental bone defect in the ulna of rabbits we investigated the effect on bone healing of fresh cancellous autograft (FCA), demineralized deep-frozen allograft (DDA), and demineralized deep-frozen allograft covered with free autogenous periosteum (DDAwP). Radiologically, it was found that the results of the FCA and DDAwP groups were superior to those of the DDA group. This superiority was statistically significant after the 3rd to the 9th week for the FCA group, and the 6th to the 9th week for the DDAwP group. However, bone formation and union in the DDA group reached the same level of those in the other groups after 12 weeks. When the all histological findings were compared at the 12th week, the FCA and DDAwP groups were statistically superior to the DDA group in terms of proximal union. On distal union, the FCA group was statistically superior to the DDA group. Biomechanically, the FCA and DDAwP groups were statistically superior to the DDA group in terms of maximum torque and energy absorption. The DDAwP group was superior to the DDA group in term of stiffness. We conclude that ossification could be more easily achieved if demineralized deep-frozen allograft is covered with periosteum when faced with the need for quicker and better quality bone integration.

Animals↗

PubMed2001

Effects of epinephrine in local anesthetic mixtures on hemodynamics and view quality during knee arthroscopy.

We compared three different methods of anesthesia for outpatient knee arthroscopy in terms of perioperative surgical conditions, pain, and hemodynamics. In a prospective and double-blind study ( n=130) the patients were randomized into three groups. A 50-ml mixture composed of 20 ml 0.5% bupivacaine hydrochloride, 10 ml 2% lidocaine hydrochloride, and 20 ml 0.9% sodium chloride was prepared for local anesthesia. The knee joint was injected with 40 ml of the mixture. The portal sites were then injected with 10 ml of the mixture in group I. Using the same technique 250 micro g epinephrine was added to the same mixture in group II. In group III the knee joint was injected with 40 ml of the mixture, and only 50 micro g epinephrine was then added to 10 ml of the mixture left before the portal site injections. A tourniquet was not used. There were some statistically significant changes in hemodynamic data. Also the data on visual analogue scale scores, time of arthroscopy, and amount of liquid used for intra-articular flushing in group II and III were significantly lower than those in group I. According to our experience, bleeding in arthroscopy comes mostly from portal incision to intra-articular field, except when performing extensive synovial shaving, ligament reconstruction, and lateral retinacular release. Therefore, when hemostasis is obtained at portals, the arthroscopic view becomes clearer. We think that adding epinephrine to only portal site injections is sufficient to obtain a clear view and, furthermore, when carrying out arthroscopy in this manner, no significant changes are encountered in heart rate, mean arterial pressure, pain during arthroscopy, or time of arthroscopy.

Adrenergic Agonists↗

PubMedDate not supplied

Treatment of midclavicular nonunion: comparison of dynamic compression plating and low-contact dynamic compression plating techniques.

In this study a comparison of patients with midclavicular nonunion, treated by a combination of internal fixation with dynamic compression plate (DCP) or low-contact DCP (LC-DCP) and application of autogenous corticocancellous chips or sculptured graft on nonunion areas, was performed. Time to union in the patients treated with LC-DCP fixation was shorter than in those treated with DCP fixation (P <.001). Union was obtained in all patients treated with LC-DCP fixation and in 87.5% of those treated with DCP fixation. All of those treated with LC-DCP fixation returned to their original jobs, whereas two patients treated with DCP fixation had to change jobs. According to the Disabilities of the Arm, Shoulder, and Hand functional score, at the last follow-up visit, functional outcomes of the patients treated with LC-DCP fixation were more satisfactory (P <.001). The addition of internal fixation of the clavicle with DCP or LC-DCP to application of autogenous corticocancellous chips, or sculptured graft on nonunion areas in patients with midclavicular nonunion, shortens the time to union, increases union rates, and provides satisfactory functional outcomes.

Adult↗