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Öğe Calcaneal stress fractures in amateur football players(Springer-Verlag France, 2000) Orhan, Zafer; Parmaksızoğlu, Atilla Sancar; Kayıran, E.Stress fractures resulting from physical exercise have been recognized since 1855, when Breithaupt reported foot pain and swelling in a group of Prussian soldiers feet (1,8). They typically occur in normal bones which are subjected to repeated cyclic force but the strength of the force applied on the bone should not be strong enough to result in an acute fracture. For this reason stress fractures are generally seen in military recruits, ballets, dancing students, athletic trainers who participate in repetitive travmatic sporting activites (1,5). In our country, football games among amateur players has become popular especially on small football areas covered by carpets, but the floor is concrete. In this paper a case of calcaneus stress fracture following a football game which was performed on small football area, is presented. Although repetitive physical exercise is the cause in most of the reported stress fractures cases our report demonstrate it is not essential and it seems that the hard concrete floor of the football area is the cause.Öğe Cervical brucellosis mimicking cervical disc herniation(2006) Tezer, Mehmet; Orhan, Zafer; Ozturk, Cagatay; Sarier, Mercan; Hamzaoglu, AzmiBrucellar spondylitis may be difficult to diagnose. Initial plain radiographs of the spine may show mild degenerative lesions. Although, magnetic resonance imaging of spine is mostly helpful to establish the disease, in some cases, it may lead to misdiagnosis. The aim of this report was to present a case of brucella infection involving the cervical spine that was falsely diagnosed and underwent to surgery for cervical disc herniation. Since the spinal form of brucellosis has no specific symptomatology, a patient has symptoms with mimicking the cervical hernia, with a history of disabling pain more severe than radicular pain, and especially who reside in countries where the disease is endemic, the brucella infection should be kept in mind in the differential diagnosis and specific diagnostic investigations such as brucella agglutination tests should be made before any treatment procedure. © Springer-Verlag 2005.Öğe Characterization of biodegradable chitosan microspheres containing vancomycin and treatment of experimental osteomyelitis caused by methicillin-resistant staphylococcus aureus with prepared microspheres(Elsevier Science Bv, 2006) Cevher, Erdal; Orhan, Zafer; Mulazimoğlu, Lütfiye; Şensoy, Demet; Alper, Murat; Yıldız, Ayça; Özsoy, YıldızThe biodegradable chitosan microspheres containing vancomycin hydrochloride (VANCO) were prepared by spray drying method with different polymer:drug ratios ( 1: 1, 2:1, 3:1 and 4: 1). Thermal behaviour, particle size and distribution, morphological characteristics, drug content, encapsulation efficiency, in vitro release assessments of formulations have been carried out to obtain suitable formulation which shows sustained-release effect when implanted. Sterilized VANCO loaded microspheres were implanted to proximal tibia of rats with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis. Intramuscular (IM) injection of VANCO for 21 days was applied to another group for comparison. After 3 weeks of treatment, bone samples were analysed with a microbiological assay. According to the results, encapsulation efficiency and yield of microspheres in all formulations were higher than 98% and 47%, respectively. Particle sizes of microspheres were smaller than 6 mu m. All microsphere formulations have shown sustained-release effect. In vitro drug release rate decreased due to the increase in polymer:drug ratio but no significant difference was seen between these results (p > 0.05). Based on our in vivo data, rats implanted VANCO-loaded chitosan inicrospheres and administered IM injection showed 3354 3366 and 52500 25635 colony forming, unit of MRSA in 1g bone samples (CFU/g), respectively. As a result, implanted VANCO-loaded microspheres were found to be more effective than IM route for the treatment of experimental osteomyelitis.Öğe Comparison of accuracy of three-dimensional spiral computed tomography, standard radiography, and direct measurements in evaluating facial fracture healing in a rat model(Lippincott Williams & Wilkins, 2004) Özçelik, Derya; Hüthüt, İlkay; Kuran, İsmail; Bankaoğlu, Müjdat; Orhan, Zafer; Mayda, Atilla SenihComplex maxillofacial fractures demand a detailed understanding of the three-dimensional (3D) pattern of injury. Evaluation of the outcome of the facial fracture repair additionally requires optimal demonstration of fracture gap, bony union, fibrous callus or incorporation of fracture ends, presence of incomplete fusion, or pseudoarthrosis. Although 3D computed tomography (CT) is reliably used for the diagnosis of complex facial fractures, its value in facial fracture healing is unknown. An experimental study was conducted to determine the accuracy of 3D spiral CT scans in evaluating facial fracture healing during the early and late postoperative periods. In 10 adult Wistar Albino rats, a standardized bone defect (3 mm) was created within the mid portion of each zygomatic arch (n = 20). At 10 and 20 weeks postfracture, gap distance displayed by 3D CT and plane radiography (posteroanterior) were measured. At 20 weeks postfracture, intraoperative measurement was also performed. A comparison between 3D CT, radiography, and intraoperative findings was performed. At 10 weeks postfracture, the fracture sites displayed larger bone defects in imaging with 3D CT than with plane radiography. The difference between groups was statistically significant (P < 0.05). The mean defect size imaged by 3D CT was 0.91 +/- 0.82 turn (standard deviation) and by plane radiography was 0.42 +/- 0.16 mm. At 20 weeks postfracture, the mean defect size imaged by 3D CT was 0.56 +/- 0.64 mm, and by plane radiography was 0.38 +/- 0.22 mm. The difference between groups was not statistically significant (P > 0.05). The defect size imaged by both plane radiography and 3D CT was significantly less than the measurement obtained from the intraoperative assessment (P < 0.05). It was concluded that 3D CT has limited benefit in the detection of newly formed bone at week 10 and in the detection of fibrous callus, which can eventually give rise to the bony tissue. Plane radiography is more valid during the early postoperative period (week 10), because it can detect the fibrous callus and newly formed bone more precisely. Gap distance between fracture ends could be determined by 3D CT accurately at week 20, although there was a tendency, which was not statistically significant, to overestimate the amount of bone defect measured by 3D CT when compared with that of plane radiography.Öğe The effect of extracorporeal shock waves on a rat model of injury to tendo achillis - a histological and biomechanical study(British Editorial Soc Bone Joint Surgery, 2004) Orhan, Zafer; Özturan, Kutay; Güven, Aysel; Çam, KamilThe effects of extracorporeal shock waves (ESWT) on tendon healing were assessed by observing histological and biomechanical parameters in a rat model of injury to the tendo Achillis. The injury was created by inserting an 18-G needle through tendo Achillis in 48 adult Wistar albino rats. The animals were divided into three groups. The first group received radiation only after the operation. The second received no shock waves and the third had 500 15 KV shocks on the second post-operative day. All the rats were killed on the 21st day after surgery. Histopathological analysis showed an increase in the number of capillaries and less formation of adhesions in the study group compared with the control group (p = 0.03). A significantly greater force was required to rupture the tendon in the study group (p = 0.028). Our findings suggest a basis for clinical trials using ESWT.Öğe The effects of extracorporeal shock waves on the rat achilles tendon: is there a critical dose for tissue injury?(Springer, 2004) Orhan, Zafer; Çam, Kamil; Alper, Murat; Özturan, KutayIntroduction: Extracorporeal shock waves (ESW) have been extensively studied in the field of orthopedics. Experimental and focused, well-designed clinical studies have suggested the clinical utilisation of ESW in several pathologies including delayed bone union, tennis elbow, and plantar fasciitis. However, the unwanted detrimental effects of ESW on various tissues have been questioned by some authors. In this experimental study, the effects of ESW were investigated at different intensity applications on the Achilles tendons of rat. Materials and methods: A total of 32 adult Wistar albino rats was divided into four groups. The first three groups received 1000 impulses of 0.15 MJ/mm(2) 1500 impulses of 0.15 mJ/mm(2), and 2000 impulses of 0.20 mJ/mm(2), respectively. The last group was kept as the control group. Subsequently, Achilles tendons were harvested for histological studies from all rats at the 3rd week after a single application of ESW. Results: There were no histological abnormalities observed in the Achilles tendons of the first two groups compared with the control group. No alteration in the histological configuration was observed, and consequently the pathologist who had been blinded could not differentiate these rats from the control group by light microscopy. However, in the high intensity group (2000 impulses of 0.20 mJ/mm(2)), grade II and III disorganisation of collagen fibers was noticed in 7 out of 8 rats, which was not detected in any of the rats from the first two groups (p<0.05). Consequently, the pathologist could distinguish the majority of the rats (7 out of 8) of this group from the remaining ones. Meanwhile, grade I lymphocyte infiltration was observed in some sections of the rats receiving the highest ESW dose. Conclusion: This study confirms that ESW application at high intensity is associated with detrimental tissue effects. Additionally, it was suggested that the extent of tissue injury caused by ESW is dose-related.Öğe Ekstrakorporeal şok dalgası tedavisinin sıçanlarda kırık iyileşmesi üzerine etkileri(2001) Orhan, Zafer; Alper, Murat; Şenel, Ferda; Yılmaz, Necati; Sayar, ÜmitAmaç: Tibia diafizlerinde kırık oluşturulduktan sonra Kirschner teliyle intramedüller tespit yapılan sıçanlarda, düşük enerjili şok dalgasının kırık iyileşmesi üzerine etkileri radyolojik, histolojik ve sintigrafik olarak incelendi. Çalışma planı: Ortalama ağırlıklar 200 gr (180-220 gr) olan üç aylık (2.5-4 ay) Wistar-albino tipi sıçanlardan dört ve alt haftalık gruplar oluşturuldu. Tüm sıçanlarda parmakla bastırarak skopi kontrolunda sağ tibia diafizlerinde transvers kırık oluşturuldu ve kırıklar intramedüller olarak K-teliyle tespit edildi. Birinci (çalışma) ve ikinci (kontrol) gruplarda 14'er adet, üçüncü (çalışma) ve dördüncü (kontrol) gruplarda beşer sıçan yer aldı. Kırık sonrası deney gruplarındaki sı çanlara 0, 5, 9, 14 ve 19. günlerde 14 kV gücünde 200'er şok dalgası uygulandı. Sıçanlarda dördüncü ve altıncı haftalarda radyolojik inceleme yapıldı. Birinci ve ikinci grup dördüncü haftada öldürülerek histolojik olarak incelendi. Üçüncü ve dördüncü gruplar altıncı haftada osteoblastik aktivite açısından sintigrafik olarak incelendi ve sonrasında histolojik tetkik için anesteziyle öldürüldü. Sonuçlar: Radyolojik skorlar dört ve altıncı haftalarda deney grubunda anlamlı derecede daha yüksekti (sırasıyla p=0.002 ve p=0.011); histolojik olarak ESWT grubunda daha yüksek oranda kemiksel kaynama saptandı. (sırasıyla p=0.027 ve p=0.001). Sintigrafi çalışmasında statik çalışmada 10 dakikalık sayımda kontrol grubuna göre daha yüksek değerler elde edildi (p=0.039). Çıkarımlar: Çalışmamızda elde edilen radyolojik, histolojik ve sintigrafik veriler ESWT uygulamasının kırık iyileşmesini hızlandırdığını gösterdi.Öğe Ekstrakorporeal şok dalgası tedavisinin tendon dokusuna etkileri: Sıçanlarda deneysel çalışma(2000) Orhan, Zafer; Alper, Murat; Demirkaya, Mehmet; Özturan, KutayAmaç: Son yıllarda gündeme gelen ekstrakorporeal şok dalgası tedavisi, kaynama gecikmesi, omzun kalsifiye tendiniti, tenisçi dirseği ve plantar fasyitis tedavisinin de aralarında olduğu bir çok hastalıkta kullanılmaktadır. Bu tedavinin tendon ve komşu dokulara muhtemel zararlı etkilerini ortaya koymak amacıyla sıçanlarda deneysel bir araştırma gerçekleştirdik. Çalışma planı: Otuz iki adet Wistar albino cinsi sıçan sekizerlik dört gruba ayrıldı. İlk üç deney grubuna sırasıyla 14 kV’ lik 1000, 14 kV’lik 1500 ve 18 kV’lik 2000 şok dalgası uygulandı. Dördüncü grup kontrol grubunu oluşturdu. Bu enerji şiddeti ve şok dalgası uygulamasının sıçanların aşil tendonlarına etkisi araştırıldı. Sonuçlar: 14 kV 1000 şok ve 14 kV 1500 şok gruplarında belirgin bir histopatolojik değişiklik görülmedi. 18 kV 2000 şok uygulanan grupta ise liflerde hafif derecede dizilim bozukluğu ve seyrek lenfositler görüldü. Çıkarımlar: Histopatolojik değişikliklerin 18 kV 2000 şok dalgasından itibaren gözlenmesi nedeniyle, yüksek enerjili şok dalgası uygulamalarında olası doku değişikliklerini göz önüne almak gerekir.Öğe EXPERIMENTAL EVALUATION OF TIGECYCLINE AND TEIKOPLANIN IN THE TREATMENT OF IMPLANT RELATED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) OSTEOMYELITIS(Int Journal Pharmaceutical Sciences & Research, 2014) Orhan, Zafer; Degirmenci, Erdem; Oktas, Birhan; Karaduman, Okan; Kir, Gozde; Mulazimoglu, LutfiyeTreatment of implant related MRSA osteomyelitis is a real challenge both for the physician and the patient. We evaluated the comparative efficacy of tigecycline, a novel broad-spectrum glycycline antibiotic and the glycopeptide antibiotic teicoplanin in the treatment of implant related MRSA osteomyelitis in an experimental rat model. Implant related MRSA osteomyelitis was studied in tibial metaphysis of 60 rats. When compared to the control groups, the number of microorganisms was found to be significantly lower in the study groups, but there was no statistically significant difference between tigecycline and teicoplanin respectively. Tigecycline with its good tissue penetration and lower side effects was found to be as effective as teicoplanin in implant related MRSA osteomyelitis, even if the implant is retained. It could be considered as an alternative to glycopeptides because of the efficacy and because of the lower adverse effects in long term usage. Further studies are warranted to suggest a standard medical treatment for implant-related osteomyelitis.Öğe An experimental study on the application of extracorporeal shock waves in the treatment of tendon injuries: Preliminary report(Springer Japan, 2001) Orhan, Zafer; Alper, Murat; Akman, Yavuz; Yavuz, Özlem; Yalçıner, AltanThe use of low-energy extracorporeal shock wave therapy (ESWT) has recently been introduced in pseudoarthrosis, fracture, and wound healing for both clinical and experimental purposes. In this study, we created an experimental rat model to investigate the histopathological and biochemical effects of ESWT in the healing of tendon injury that may accompany fractures. Twenty-eight rats were used for the histopathological investigation. The right achilles tendon of the rat was cut and then sutured, using Modified Kessler stitches method. Five hundred shock waves, set at 14kV, were applied to the achilles tendon under fluoroscopic guidance. Fourteen rats that underwent a sham operation served as the control group. Biochemical studies were done on 20 rats, divided into four groups of 5 rats in each. The first and second groups received 500 shock waves, at 14kV, after the cutting and repairing of the Achilles tendon. To measure hydroxyproline levels, the rats in the first and second groups were killed on postoperative days 3 and 9, respectively. The third and fourth groups served as controls. Hydroxyproline levels were found to be high in the study groups. The histopathological findings and the increased hydroxyproline levels revealed that ESWT may facilitate tendon healing after trauma.Öğe Ön çapraz bağ tamiri sonrasında menüsküs iyileşmesinin histolojik ve radyolojik takibi: Deneysel çalışma(2000) Demirkaya, Mehmet; Kara, Hasan; Yıldırım, Yakup; Orhan, Zafer; Şirvancı, MustafaAmaç: Ön çapraz bağ (ÖÇB) rekonstrüskiyonu yapılan dizlerde menüsküs yırtıklarının iyileşmesi (tamir yapılan ve yapılmayan) histolojik ve radyolojik olarak incelendi. Çalışma planı: Sekiz koyun rastgele olarak dört gruba ayrılıp, ÖÇB hepsinde tamamen çıkartıldı ve medial menüsküs 1/3 periferal bölümde longitidunal yırtık oluşturuldu. Her iki dizde ÖÇB rekonstrüksiyonu yapılıp sağ dizlerde menüsküs yırtıkları sütüre edildi. Tamir sonrası 1, 2, 3 ve 6. haftalarda ikili gruplar halinde kesilen koyunların dizleri manyetik rezonans görüntüleme ile incelendi; ardından menüsküs iyileşmesi histolojik olarak değerlendirildi. Sonuçlar: Manyetik rezonans görüntülemede birinci ve ikinci haftalarda hem kontrol hem de çalışma grubundaki menüsküslerde yırtık bölgesine kontrast madde geçişi gözlenirken, üçüncü ve altıncı haftalarda her iki grupta da geçiş gözlenmedi. Histolojik incelemelerde Henning kriterlerine göre bazı menüsküslerde iyileşmeme (1, 2 ve 3. haftalarda %50’den fazla rezidüel yarık) ve parsiyel iyileşme (6. hafta %10-50 arası rezidüel yarık) görülürken tam iyileşme (%10’dan az rezidüel yarık) hiçbir örnekte görülmedi. Çıkarımlar: Rekonstrüksiyon yapılan dizlerde, tamir edilen ve edilmeyen gruplarda menüsküs iyileşmesinin normal seyrinde devam etmesi ve ÖÇB’nin oluşturduğu stabilite nedeniyle, menüsküslerde liflenmeye ve kompleks yırtıklara rastlanmamış olması, ÖÇB rekonstrüksiyonlu dizlerde menüsküs tamirinin gereksiz olduğunu göstermektedir.Öğe Penetrating type intraosseous ganglion cyst of the lunate bone (vol 54, pg 247, 2005)(Univ West Indies Faculty Medical Sciences, 2005) Tüzüner, Tolga; Subaşı, Mehmet; Alper, Murat; Kara, Hasan; Orhan, ZaferIntraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion Cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.Öğe Preparation and In vivo evaluation of gelatine implants containing EGF-PLGA microspheres in tendon healing(University of Istanbul, 2007) Orhan, Zafer; Cevher, Erdal; Gül, Mine Orlu; Alper, Murat; Özçelik, Derya; A?artan, Canan; Öner, FilizEpidermal Growth Factor (EGF) has been shown to improve tissue healing according to several well-design experimental studies. The possible role of EGF in tendon healing has not been defined. However, the main drawback of studies on the efficiency of EGF is to provide a long-term constant supply of EGF to target cells. In this respect, we hypothesized that the microspheres contained EGF would overcome this problem by providing a constant local supply of EGF. This study had investigated the role of EGF-loaded microspheres in a rat model for tendon heali*ng. EGF-loaded particles were prepared by double emulsion solvent evaporation method and embedded into gelatine implant. Implants containing microspheres which are equivalent to 10?g EGF (I-MS EGF10) and 2?g EGF (I-MSEGF2) were applied to Wistar albino rats. Histological and biomechanical studies were performed on to 21 days treated rats. I-MSEGF10 group showed prominent fibrosis and increased neoangiogenesis. Although, there was no major difference between I-MSEGF10 group and negative control group for the fibroblast and collagen proliferation (p>0.05), the difference for inflammation was statistically significant between same groups (p<0.05). Consequently, the approach of combining EGF and microspheres to extend the EGF release and in the same time increasing the contact time of EGF to tendon tissue was achievable. However, according to the obtained histological and biomechanical results, gelatine implants including EGF loaded microspheres were not found effective in tendon healing.Öğe The preparation of ciprofloxacin hydrochloride-loaded chitosan and pectin microspheres - their evaluation in an animal osteomyelitis model(British Editorial Soc Bone Joint Surgery, 2006) Orhan, Zafer; Cevher, Erdal; Mülazımoğlu, Lütfiye; Gürcan, Duygu; Alper, Murat; Araman, Ahmet; Özsoy, YıldızCiprofloxacin hydrochloride-loaded microspheres were prepared by a spray-drying method using pectin and chitosan. The effects of different polymers and drug ratios were investigated. The most appropriate carriers were selected by in vitro testing. A rat methicillin-resistant Staphylococcus aureus osteomyelitis model was used to evaluate the effects of the loaded microspheres. The drug was released rapidly from the pectin carrier but this was more sustained in the chitosan formulation. Chitosan microspheres loaded with ciprofloxacin hydrochloride were more effective for the treatment of osteomyelitis than equivalent intramuscular antibiotics.Öğe The shortcomings of computer-aided measurement of migration for the prediction of failure of three forms of acetabular fixation by survival analysis and migration study to ten years(Wichtig Editore, 2006) Scott, Gareth; Nakagawa, Shigeru; Orhan, Zafer; Freeman, MichaelWe studied, to ten years, migration by vertical displacement and angular change using a digitizer and standard radiographs and survival of three methods of acetabular fixation in primary hip replacement. Two implants were uncemented metal-backed components, one version of which was hydroxyapatite-coated. Both types had 28 mm polyethylene inserts. The third type was a cemented all-polyethylene cup with a 28 mm internal diameter All cups articulated with a Freeman neck-retaining stem. The purpose was to see if the early migration data predicted the long-term outcome and could be used to forecast implants that would fail for the purpose of pre-market assessment. No statistical differences were found between the groups in the parameters studied. At the threshold accuracies of our migration measurements (three millimetres and three degrees) at three years, we could not identify components that would subsequently fail. However, migration less than these threshold values and the absence of radiolucent lines were strongly associated with implant survival at ten years. Our system was insufficiently accurate for pre-market surveillance.Öğe Sodium fusidate-poly(D,L-lactide-co-glycolide) microspheres: Preparation, characterisation and in vivo evaluation of their effectiveness in the treatment of chronic osteomyelitis(Taylor & Francis Ltd, 2007) Cevher, Erdal; Orhan, Zafer; Şensoy, Demet; Ahıskalı, Rengin; Kan, Pei LeePurpose: The aim of this study was to prepare poly(D, L- lactide-co-glycolide) (PLGA) microspheres containing sodium fusidate ( SF) using a double emulsion solvent evaporation method with varying polymer: drug ratios (1: 1, 2.5: 1, 5: 1) and to evaluate its efficiency for the local treatment of chronic osteomyelitis. Methods: The particle size and distribution, morphological characteristics, thermal behaviour, drug content, encapsulation efficiency and in vitro release assessments of the formulations had been carried out. Sterilized SF-PLGA microspheres were implanted in the proximal tibia of rats with methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis. After 3 weeks of treatment, bone samples were analysed with a microbiological assay. Results: PLGA microspheres between the size ranges of 2.16-4.12 mu m were obtained. Production yield of all formulations was found to be higher than 79% and encapsulation efficiencies of 19.8-34.3% were obtained. DSC thermogram showed that the SF was in an amorphous state in the microspheres and the glass transition temperature ( Tg) of PLGA was not influenced by the preparation procedure. In vitro drug release studies had indicated that these microspheres had significant burst release and their drug release rates were decreased upon increasing the polymer: drug ratio (p < 0.05). Based on the in vivo data, rats implanted with SF-PLGA microspheres and empty microspheres showed 1987 +/- 1196 and 55526 +/- 49086 colony forming unit of MRSA in 1 g bone samples (CFU/g), respectively (p < 0.01).Öğe Spontaneous leg haematoma in a patient anticoagulated with nadroparin for suspected pulmonary thromboembolism [1](2004) Balbay, Öner; Tüzüner, Tolga; Arbak, Peri; Orhan, Zafer; Erbaş, Mete; Aydogßan, IekerFixed-dose, subcutaneous Low Molecular Weight Heparin (LMWH) is as effective and safe as adjusted-dose, intravenous unfractionated heparin (UFH) for the initial management of venous thromboembolism and symptomatic pulmonary thromboembolism [1–4]. Clinical experiences indicate that bleeding is a major side effect, not only of UFH, but also of LMWH [5]. An 81-year-old woman (60 kg) was admitted with a clinically suspected pulmonary embolism (SPE) with a 2-day history of pleuritic chest pain and dyspnoea. Her past medical history showed congestive heart failure, atrial fibrillation (AF) and hyperthyroidism, immobilisation due to femoral head fracture 7 years previously. Propylthiouracilcoumadin, aspirin, perindopril, spironolactone, and digoxin were started in May 2000 and propylthiouracil and coumadin was discontinued after 3 months follow-up. Owing both to SPE and chronic AF she was started on nadroparin subcutaneously twice daily 5700 UI AXa/ 0.6 ml. The ventilation/perfusion scan of the lung was reported as having low probability of pulmonary embolism and a duplex ultrasound of the lower limbs was negative for DVT the night after the symptoms started. Despite these findings anticoagulant treatment was continued due to the chronic AF. Except for slightly raised white blood cells and a raised creatinine on admission her laboratory results and coagulation parameters were within normal limits. Two days after anticoagulant treatment, she complained of sudden onset of left leg pain with the finding of a tender haematoma (measuring 51025 cm). There was no history of trauma. Together with nadroparin aspirin was also discontinued.Öğe Tendon iyileşmesinde ekstrakorporeal şok dalgası tedavisi: Sıçanlarda deneysel çalışma(2001) Orhan, Zafer; Alper, Murat; Yavuz, Özlem; Akman, Yavuz; Yalçıner, AltanAmaç: Düşük enerjili ekstrakorporeal şok dalgası tedavisinin (ESWT) kırıklara eşlik edebilen tendon dokularındaki zedelenmelerin iyileşmesine etkileri sıçanlar üzerinde araştırıldı. Çalışma planı: Histopatolojik tetkik için 28 sıçan kullanıldı. Sıçanların sağ aşil tendonları kesilerek modifiye Kessler yöntemi ile sütüre edildi. Aşil tendonlarına skopi kontrolünde 14 kV gücünde 500 şok dalgası uygulandı. Cerrahi onarım yapılan ve ESWT uygulanmayan 14 sıçan kontrol grubuna alındı. Biyokimya çalışması için de 20 sıçan beşerli dört gruba ayrıldı. Sıçanların aşil tendonları kesilip sütüre edilerek birinci ve ikinci gruba 14 kV gücünde 500 şok dalgası uygulandı. Birinci grup üçüncü günde ikinci grup dokuzuncu günde öldürülerek hidroksiprolin düzeyleri ölçüldü. Üçüncü ve dördüncü grup kontrol grubunu oluşturdu. Sonuçlar: Histolojik incelemede, ESWT uygulanan grupta ikinci haftada granülasyon dokusu belirgin olarak daha selüler, daha vaskülarize ve yoğun iltihabi infiltrasyon içermekteydi ve çok sayıda multinükleer dev hücre vardı. Üçüncü haftada ESWT grubunda iyileşmenin kontrol grubuna göre daha iyi ve düzenli olduğu, fibrillerde düzensizliğin, yoğun lenfosit ve histiosit infiltrasyonunun azaldığı ve çok daha az sayıda multinükleer dev hücre içerdiği görüldü. Deney grubunda hidroksiprolin düzeylerinin yükseldiği görüldü. Çıkarımlar: Deney grubundaki histopatolojik bulgular ve artmış hidroksiprolin düzeyleri ESWT uygulamasının tendon iyileşmesini hızlandırdığını gösterdi.Öğe Tibia plato kırıklarının cerrahi tedavisinde sonuçları etkileyen faktörler(2000) Kayıran, Etel; Orhan, Zafer; Parmaksızoğlu, Atilla; Erdemir, Ahmet; Yazıcı, NuzhetAmaç: Tibia plato kırıklarının cerrahi tedavisinde sonuçları etkileyen faktörleri incelemek. Çalışma planı: Tibia plato kırığı nedeniyle cerrahi tedavi gören 28 hastanın (23 erkek, 5 kadın; ort. yaş 41.53; yaş dağılımı 15-68) 28 dizi retrospektif olarak değerlendirildi. Kırıklar ve klinik sonuçlar Hohl sınıflandırma sistemine ve kriterlerine göre değerlendirildi. Sonuçlar: Ortalama izleme süresi 22.14 ay (dağılım 5-80 ay) idi. Hohl kriterlerine göre dokuz hastada çok iyi (%32.2), 13 hastada iyi (%46.2), iki hastada orta (%7.1) ve dört hastada kötü (% 14.3) sonuç alındı. Orta ve kötü sonuç alınan altı hastanın ikisinde tip 3, birinde tip 4, üçünde ise tip 7 kırık vardı. Postoperatif dönemde 4-6 hafta alçı tespiti uygulanan 18 hastanın ikisinde (%11.1); 7-10 hafta uygulanan 10 hastanın dördünde (%40) orta ve kötü sonuç görüldü. Kontrol grafilerinde 0-3 mm çökme saptanan 13 hastanın yedisinde çok iyi, altısında iyi sonuç alındı. Tibia platosunda 4-10 mm çökme olan 15 hastanın altısında tatmin edici olmayan sonuçlar görüldü. Kontrol grafilerinde 0-9 mm kondiler genişleme olan 26 hastanın dördünde orta ve kötü sonuç elde edilirken, 9 mm üzerinde kondiler genişleme olan iki hastada kötü sonuç saptandı. Beraberinde fibula kırığı görülen 10 hastanın dördünde (%40) tatminkar olmayan sonuçlar elde edildi. Bu hastaların üçünde beş derecenin üzerinde angülasyon vardı. Çıkarımlar: Tibia plato kırığı olan hastalarda kırık tipi, anatomik redüksiyonun sağlanması, postoperatif tespit süresi ve beraberinde fibula kırığının bulunmasının klinik sonuçları etkileyen faktörler olduğu görüldü.Öğe An unusual presentation of peroneal neuropathy secondary to pigmented villonodular synovitis: a case report(Springer, 2009) Orhan, Zafer; Oktas, Birhan; Yildirim, UmranPigmented villonodular synovitis (PVS) is a benign proliferative disorder of unknown origin that affects synovial joints, most commonly the knee. The joint knee can be affected by localized or diffuse form. Diffuse PVS, the aggressive form of the disease is much more problematic, especially when it extends extra-articularly, and is associated with high recurrence rates. Although this disease is categorized as an inflammatory process rather than a neoplasm, it may be locally destructive and involve muscles, tendons, bone and skin. Neural involvement of the disease is rather rare, and only limited knowledge about neuropathy due to PVS we have yet. The presentation of the disease in our patient is a peroneal neuropathy which is the first reported case in English language literature of PVS of the knee seen with extra-articular tissue involvement.
