Background: Septic arthritis of the shoulder is a rare but devastating condition that may lead to joint destruction. There are few studies and limited outcome data on shoulder arthroplasty for infected native shoulders with end-stage glenohumeral arthritis (GHA).Hence, this study aimed to demonstrate the clinical outcomes of two-stage implantation in reverse shoulder arthroplasty (RSA) using an antibiotic spacer in the first stage for this challenging condition. Methods: We conducted a retrospective study on two-stage implantation in RSA in infected shoulders. Patients were diagnosed with end-stage GHA due to primary shoulder sepsis or infection following non-arthroplasty shoulder surgery. Laboratory data, range of motion (ROM), and functional scores including American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were assessed prior to spacer placement and at the latest follow-up. Furthermore, intraoperative and postoperative complications were recorded. Results: In this study, 10 patients with a mean age of 54.8 ± 15.8 years (range, 30–77 years) were included. The mean follow-up period was 37.3 ± 9.1 months (range, 25–56 months). All postoperative ROM measurements and functional scores were improved significantly. Although no reinfection was observed, a total of 5 complications including 2 hematomas, 1 intraoperative humeral fracture, 1 humeral stem loosening, and 1 anterior deltoid dysfunction were observed in 4 patients after a follow-up period of at least 2 years after RSA. Conclusions Two-stage implantation in RSA is an effective method for improving the function and controlling the infection in postinfectious end-stage GHA in native shoulders.

Rationale: Endophthalmitis is an uncommon but serious ocular infection often resulting in probable visual loss. Bacteroides fragilis is a rare cause of endophthalmitis. Patient concerns: A 46-year-old male patient complained of eye pain and low vision after pars plana vitrectomy. Diagnosis: Bacteroides fragilis endophthalmitis after pars plana vitrectomy was diagnosed. Interventions: Pars plana vitrectomy and silicone oil implantation were performed. Outcomes: Early treatment and choice of tamponade in endophthalmitis after pars plana vitrectomy may possibly prevent evisceration and progression of endophthalmitis. Lessons: Bacteroides fragilis can be seen in cases of endophthalmitis after pars plana vitrectomy.

Objective: Ultrasound-guided infraclavicular nerve block (IB) has become a well-established method in several outpatient procedures; however, its use in emergency departments (EDs) remains limited. The aim of this study was to compare procedural sedation and anlagesia (PSA) and IB in the pain management for patients who underwent forearm fracture reduction in the ED. Methods: This prospective randomized study included 60 patients aged 18 to 65 years, who visited the ED with forearm fractures. They were randomly divided into two groups: Group PSA (n=30) and Group IB (n=30). The pain scores of patients were evaluated before and during the procedure with the visual analog scale. Complications and patient and operator satisfaction levels were recorded. Results: There was no difference between the two groups in terms of demographic characteristics. The median (interquartile range) pain scores observed during the procedures were significantly higher in Group PSA than in Group IB (4 [4–6] vs. 2 [0–2], respectively; P<0.001). Patient and operator satisfaction levels were significantly higher in Group IB (P<0.001). Oxygen desaturation was statistically higher in Group PSA than in Group IB (40.00% vs. 3.33%, respectively; P=0.002). Conclusion IB was an effective alternative for reducing pain and increasing patient satisfaction in ED patients undergoing forearm fracture reduction.

Background: Pillar pain may develop after carpal tunnel release surgery (CTRS).This prospective double-blinded randomized trial investigated the effectiveness of extracorporeal shock wave therapy (ESWT) in pillar pain relief and hand function improvement. Methods: The sample consisted of 60 patients with post-CTRS pillar pain, randomized into two groups. The ESWT group (experimental) received three sessions of ESWT, while the control group received three sessions of sham ESWT, one session per week. Participants were evaluated before treatment, and three weeks, three months, and six months after treatment. The pain was assessed using the visual analogue scale (VAS). Hand functions were assessed using the Michigan hand outcomes questionnaire (MHQ). Results: The ESWT group showed significant improvement in VAS and MHQ scores after treatment at all time points compared to the control group (P < 0.001). Before treatment, the ESWT and control groups had a VAS score of 6.8 ± 1.3 and 6.7 ± 1.0, respectively. Three weeks after treatment, they had a VAS score of 2.8 ± 1.1 and 6.1 ± 1.0, respectively. Six months after treatment, the VAS score was reduced to 1.9 ± 0.9 and 5.1 ± 1.0, respectively. The ESWT group had a MHQ score of 54.4 ± 7.7 before treatment and 73.3 ± 6.8 six months after. The control group had a MHQ score of 54.2 ± 7.1 before treatment and 57.8 ± 4.4 six months after. Conclusions ESWT is an effective and a safe non-invasive treatment option for pain management and hand functionality in pillar pain.

Background: Pillar pain may develop after carpal tunnel release surgery (CTRS).This prospective double-blinded randomized trial investigated the effectiveness of extracorporeal shock wave therapy (ESWT) in pillar pain relief and hand function improvement. Methods: The sample consisted of 60 patients with post-CTRS pillar pain, randomized into two groups. The ESWT group (experimental) received three sessions of ESWT, while the control group received three sessions of sham ESWT, one session per week. Participants were evaluated before treatment, and three weeks, three months, and six months after treatment. The pain was assessed using the visual analogue scale (VAS). Hand functions were assessed using the Michigan hand outcomes questionnaire (MHQ). Results: The ESWT group showed significant improvement in VAS and MHQ scores after treatment at all time points compared to the control group (P < 0.001). Before treatment, the ESWT and control groups had a VAS score of 6.8 ± 1.3 and 6.7 ± 1.0, respectively. Three weeks after treatment, they had a VAS score of 2.8 ± 1.1 and 6.1 ± 1.0, respectively. Six months after treatment, the VAS score was reduced to 1.9 ± 0.9 and 5.1 ± 1.0, respectively. The ESWT group had a MHQ score of 54.4 ± 7.7 before treatment and 73.3 ± 6.8 six months after. The control group had a MHQ score of 54.2 ± 7.1 before treatment and 57.8 ± 4.4 six months after. Conclusions ESWT is an effective and a safe non-invasive treatment option for pain management and hand functionality in pillar pain.

Objective: We investigated the importance of metabolic parameters measured with 18F-fluorodeoxyglucose positron-emission tomography integrated with computed tomography (FDG-PET/CT) for predicting progression-free survival (PFS) and overall survival (OS) in cervical cancer with complete metabolic response (CMR) after chemoradiotherapy (ChRT). Methods: The clinical data and PET parameters including standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of 122 patients having CMR in post-treatment 18F-FDG-PET/CT delivered a median of 3.9 months after ChRT completion were analyzed. Results: With a median follow-up of 8.4 years, 55 patients (45%) presented with disease a median of 19.7 months after ChRT. For SUVp, MTVp, TLGp, SUVln, MTVln, and TLGp, the cut-off values for OS determined by receiver operating curve analysis were 15.8, 48.7 cm3, 552.3, 8.7, 7.0 cm3, respectively. All metabolic PET parameters were significant prognostic factors for OS and PFS in univariate analysis. International Federation of Gynecology and Obstetrics (FIGO) stage was predictive of both OS and PFS, while pelvic and/or para-aortic lymph node metastasis were predictive of OS only. In multivariate analysis, FIGO stage ≥IIB, MTVp ≥49.8 cm3, and TLGp ≥597.4 were predictive of worse OS. Advanced stage, presence of lymph node metastasis, higher TLGp, and larger MTVln were significant factors for poor PFS rates. Conclusion We found that advanced stage and higher TLGp values were significant predictors for poor survival and higher progression rates. Volumetric PET parameters could be used to predict treatment outcomes in patients with CMR after definitive ChRT.

PURPOSE: The use of nondepolarizing neuromuscular blocking agents (NMBAs) may affect intraoperative neuromonitoring (IONM) during anesthesia used during thyroid and parathyroid surgery. METHODS: The use of sugammadex was evaluated in a prospective clinical study during thyroid surgery. Between July 2018 and January 2019, 129 patients were prospectively randomized to either the sugammadex group (group B) or the control group (group A). Group A patients underwent standardized IONM during thyroidectomy, while group B patients used an NMBA-reversal protocol comprised of rocuronium (0.6 mg/kg) in anesthesia induction and sugammadex (2 mg/kg) after first vagal stimulation (V0). A peripheral nerve stimulator was used to monitor the neuromuscular transmission. RESULTS: In our clinical study, it took 26.07 ± 3.26 and 50.0 ± 8.46 minutes to reach 100% recovery of laryngeal electromyography at injection of the sugammadex group (2 mg/kg) and the control group, respectively (P < 0.001). The train-of-four ratio recovered from 0 to >0.9 within 4 minutes after administering 2 mg/kg of sugammadex at the beginning of resection. Surgery time was significantly shorter in group B than in group A (P < 0.001). Transient recurrent laryngeal nerve (RLN) paralysis was detected in 4 patients from group A and in 3 patients from group B (P = 0.681). There was no permanent RLN paralysis in the 2 groups. CONCLUSION: Our clinical study showed that sugammadex effectively and rapidly improved the inhibition of neuromuscular function induced by rocuronium. The implementation of the nondepolarizing neuromuscular block recovery protocol may lead to tracheal intubation as well as favorable conditions for IONM in thyroid surgery.
Anesthesia ; Clinical Study ; Electromyography ; Humans ; Intubation ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Paralysis ; Peripheral Nerves ; Prospective Studies ; Recurrent Laryngeal Nerve ; Thyroid Gland ; Thyroidectomy

BACKGROUND:Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of fal s from height and their relationship to the mortality. METHODS:A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively. Demographic parameters, fall characteristics and their effect to mortality were evaluated statistically. RESULTS:The study comprised of 292 (63.5％) men and 168 (36.5％) women patients. The mean age of all patients was 27±24.99 years. Twenty-six (5.6％) patients died and the majority of them were in ≥62 years old group. The highest percentage of falls was at 0–5 years age group (28.3％). People fell mainly from 1.1–4 metres(m) level (46.1％). The causes of falls were ordered as unintentional (92.2％), workplace (8.1％) and suicidal (1.7％). Skin and soft tissue injuries (37.4％) were the main traumatic lesions. CONCLUSION:Age, fall height, fall place, linear skull fracture, subarachnoidal hemorrhage, cervical fracture, thoracic vertebra fracture and trauma scores had statistically significant effect on mortality. The casualties died because of subarachnoid hemorrhage mostly.

Periprosthetic joint infection (PJI) due to Salmonella is rare. It frequently occurs patients receiving immunosuppressive medicine. We describe two periprosthetic Salmonella infection of two immunocompromised patients. Both of patients were receiving azathioprine and prednisolone therapy. First patient presented six years after total hip arthroplasty with a huge abscess on her right thigh that was reached to femoral component through the lytic area of lateral femur. Second patient presented with drainage from his hip and he had undergone two-step revision surgery for PJI 3 months ago. There is no consensus in the treatment of periprosthetic salmonella infections. We prefer two-step revision surgery for these infections as previously described in the literature.
Abscess ; Arthroplasty, Replacement, Hip ; Azathioprine* ; Consensus ; Drainage ; Femur ; Hip ; Humans ; Immunocompromised Host ; Joints* ; Prednisolone* ; Salmonella Infections ; Salmonella* ; Thigh

PURPOSE: The aim of this study was to appraise the some mechanical properties of polymethyl methacrylate based denture base resin polymerized by copolymerization mechanism, and to investigate the cytotoxic effect of these copolymer resins. MATERIALS AND METHODS: 2-hydroxyethyl methacrylate (HEMA) and isobutyl methacrylate (IBMA) were added to monomers of conventional heat polymerized and injection-molded poly methyl methacrylate (PMMA) resin contents of 2%, 3%, and 5% by volume and polymerization was carried out. Three-point bending test was performed to detect flexural strength and the elasticity modulus of the resins. To determine the statistical differences between the study groups, the Kruskall-Wallis test was performed. Then pairwise comparisons were performed between significant groups by Mann-Whitney U test. Agar-overlay test was performed to determine cytotoxic effect of copolymer resins. Chemical analysis was determined by FTIR spectrum. RESULTS: Synthesis of the copolymer was approved by FTIR spectroscopy. Within the conventional heat-polymerized group maximum transverse strength had been seen in the HEMA 2% concentration; however, when the concentration ratio increased, the strength decreased. In the injection-molded group, maximum transverse strength had been seen in the IBMA 2% concentration; also as the concentration ratio increased, the strength decreased. Only IBMA showed no cytotoxic effect at low concentrations when both two polymerization methods applied while HEMA showed cytotoxic effect in the injection-molded resins. CONCLUSION: Within the limitations of this study, it may be concluded that IBMA and HEMA may be used in low concentration and at high temperature to obtain non-cytotoxic and durable copolymer structure.
Denture Bases ; Elastic Modulus ; Hot Temperature ; Polymerization* ; Polymers* ; Polymethyl Methacrylate ; Spectroscopy, Fourier Transform Infrared ; Spectrum Analysis