BACKGROUND: Ideal positioning and best coverage of the tibial base plate are essential in total knee arthroplasty. There are 2 types of tibial base plates: symmetric and asymmetric. The superiority of one to the other is still controversial. The aim of this study was to compare symmetric and asymmetric tibial base plates for total knee arthroplasty in terms of rotational alignment and coverage. METHODS: The study was conducted on a total of 80 cadaveric tibial bones. Two surgeons were asked to place 20 symmetric (group 1) and 20 asymmetric (group 2) tibial base plates taking care to ensure the best coverage that they were able to determine. Afterwards, the rotational errors and coverage were assessed with reference to the posterior tibial margin and posterior condylar axis on the three-dimensional computed tomography (3D CT) scan. In the second part of the study, the surgeons were asked to place 20 symmetric (group 3) and 20 asymmetric (group 4) base plates taking care to ensure the best rotational alignment. The rotational errors and the areas uncovered or overstuffed after the application were measured on the 3D CT scan. RESULTS: On the comparison of rotational errors, while there was no significant difference between group 1 and group 2 in terms of coverage (p = 0.624), the mean external rotation error was significantly greater in group 2 (p = 0.034). On the comparison of coverage, while there was no significant difference between group 3 and group 4 in terms of rotation (p = 0.36), the mean ratios of the uncovered tibial surface to the total tibial surface (p = 0.041) and also the overstuffed area to the total base plate surface (p = 0.029) were significantly greater in group 4. CONCLUSIONS: The determination of correct size and rotation of the tibial component is essential for favorable outcomes of total knee arthroplasty. In this study, the symmetric tibial base plate design was more effective than the asymmetric design in providing the ideal tibial rotation and coverage.
Arthroplasty ; Arthroplasty, Replacement, Knee* ; Cadaver ; Knee ; Prosthesis Implantation ; Surgeons ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: In this study, we examined the role of inflammatory parameters in an apical mural thrombus with a reduced ejection fraction due to large anterior myocardial infarction (MI). SUBJECTS AND METHODS: A total of 103 patients who had suffered from heart failure, 45 of whom had left ventricular apical thrombus (AT) after a large anterior MI, were enrolled in the study. A detailed clinical history was taken of each participant, biochemical inflammatory markers, which were obtained during admission, were analyzed and an echocardiographical and angiographical evaluation of specific parameters were performed. RESULTS: There were no statistically significant differences in terms of age, gender, and history of hypertension, diabetes mellitus, and atrial fibrillation between both groups (p>0.05). Similarly there were no statistically significant differences in terms of biochemical and echocardiographic parameters (p>0.05). However, there were significant differences in terms of neutrophil lymphocyte ratio (p=0.032). After a multivariate regression analysis, neutrophil lymphocyte ratio (NLR) was an independent predictor of thrombus formation (β: 0.296, p=0.024). The NLR >2.74 had a 78% sensivity and 61% specifity in predicting thrombus in patients with a low left ventricular ejection fraction. CONCLUSION: In this study, neutrophil lymphocyte ratios were significantly higher in patients with apical thrombus.
Atrial Fibrillation ; Diabetes Mellitus ; Echocardiography ; Heart Failure ; Humans ; Hypertension ; Inflammation ; Lymphocytes* ; Myocardial Infarction* ; Neutrophils* ; Stroke Volume ; Thrombosis*

PURPOSE: Although spontaneous intramural hematomas of the gastrointestinal tract are very rare, they may be observed with the use of oral anticoagulant, though less frequently in cases of hematological malignancy and other bleeding disorders. Cases diagnosed as spontaneous intramural hematoma have been assessed in our clinic. METHODS: The cases, which were diagnosed as spontaneous intramural hematoma in the gastrointestinal tract (SIHGT) following anamnesis, physical examination, biochemical, radiological and endoscopic findings from July 2008 to July 2012, have been assessed retrospectively. RESULTS: Seven out of 13 cases were women and the mean age was 65.1 years (34 to 82 years). The most frequent complaint on admission was abdominal pain. The most frequent location of SIHGT was the ileum (n = 8). Oral anticoagulant use was the most common cause of etiology (n = 12). In 10 cases, International normalized ratio values were higher than treatment range (2 to 3, where mechanical valve replacement was 2.5 to 3.5) and mean value was 7.6 (1.70 to 23.13). While 12 cases were discharged without problems with medical treatment, one case with acute myeloid leukemia died in the intensive care unit following cerebrovascular attack. CONCLUSION: Spontaneus bleeding and hematomas that may arise in connection with bleeding diathesis may be fatal in cases with long-term oral anticoagulant treatment and insufficient follow-up. In management of these cases, it may be necessary to arrange conservative follow up and/or initialize low molecular weight heparin, and administer vitamin K as well as replace blood products and coagulation factors when indicated.
Abdominal Pain ; Anticoagulants ; Blood Coagulation Factors ; Disease Susceptibility ; Female ; Follow-Up Studies ; Gastrointestinal Tract ; Hematologic Neoplasms ; Hematoma ; Hemorrhage ; Heparin, Low-Molecular-Weight ; Humans ; Ileum ; Intensive Care Units ; International Normalized Ratio ; Leukemia, Myeloid, Acute ; Physical Examination ; Vitamin K

BACKGROUND: Mastectomy in male transgender patients is an important (and often the first) step toward physical manhood. At our department, mastectomies in transgender patients have been performed for several decades. METHODS: Recorded data were collected and analyzed for all male transgender patients undergoing mastectomy over a period of 24 years at our department. RESULTS: In total, 268 gender-reassigning mastectomies were performed. Several different mastectomy techniques (areolar incision, n=172; sub-mammary incision, n=96) were used according to patients’ habitus and breast features. Corresponding to algorithms presented in the current literature, certain breast qualities were matched with a particular mastectomy technique. Overall, small breasts with marginal ptosis and good skin elasticity allowed small areolar incisions as a method of access for glandular removal. In contrast, large breasts and those with heavy ptosis or poor skin elasticity often required larger incisions for breast amputation. The secondary correction rate (38%) was high for gender reassignment mastectomy, as is also reflected by data in the current literature. Secondary correction frequently involved revision of chest wall recontouring, suggesting inadequate removal of the mammary tissue, as well as scar revision, which may reflect intense traction during wound healing (36%). Secondary corrections were performed more often after using small areolar incision techniques (48%) than after using large sub-mammary incisions (21%). CONCLUSIONS: Choosing the suitable mastectomy technique for each patient requires careful individual evaluation of breast features such as size, degree of ptosis, and skin elasticity in order to maximize patient satisfaction and minimize secondary revisions.
Amputation ; Breast ; Cicatrix ; Elasticity ; Humans ; Male ; Mastectomy ; Methods ; Patient Satisfaction ; Retrospective Studies ; Skin ; Thoracic Wall ; Traction ; Transgender Persons ; Wound Healing

The implantation of bioengineered scaffolds into lesion-induced gaps of the spinal cord is a promising strategy for promoting functional tissue repair because it can be combined with other intervention strategies. Our previous investigations showed that functional improvement following the implantation of a longitudinally microstructured collagen scaffold into unilateral mid-cervical spinal cord resection injuries of adult Lewis rats was associated with only poor axon regeneration within the scaffold. In an attempt to improve graft-host integration as well as functional recovery, scaffolds were seeded with highly enriched populations of syngeneic, olfactory bulb-derived ensheathing cells (OECs) prior to implantation into the same lesion model. Regenerating neurofilament-positive axons closely followed the trajectory of the donor OECs, as well as that of the migrating host cells within the scaffold. However, there was only a trend for increased numbers of regenerating axons above that supported by non-seeded scaffolds or in the untreated lesions. Nonetheless, significant functional recovery in skilled forelimb motor function was observed following the implantation of both seeded and non-seeded scaffolds which could not be correlated to the extent of axon regeneration within the scaffold. Mechanisms other than simple bridging of axon regeneration across the lesion must be responsible for the improved motor function.
Adult ; Animals ; Axons* ; Collagen ; Forelimb ; Humans ; Rats ; Regeneration* ; Spinal Cord Injuries* ; Spinal Cord* ; Tissue Donors