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Öğe Alveolar rhabdomyosarcoma of the hand: a very rare case of soft tissue sarcoma(Duzce University Medical School, 2014) Sarman, Hakan; Tosun, Bilgehan; Baran, TuncaySoft tissue sarcomas of extremities are very rare and generally have a bad prognosis. Rhabdomyosarcomas are soft tissue sarcomas that, while extremely rare in adults, are one of the most common neoplasms in children and adolescents. Extremities are unusual sites of origin for rhabdomyosarcomas and usually associated with unfavorable outcome. Complete surgical removal of the tumor represents a major factor in terms of survival. Our study presents the case of primary alveolar rhabdomyosarcoma of the left hand in a 22 years old male who was treated by fifth ray amputation after an incomplete tumor excision. The patient is still tumor-free after 4 years following operation.Öğe Anticancer drugs with chemotherapeutic interactions with thymoquinone in osteosarcoma cells(Verduci Publisher, 2016) Sarman, Hakan; Bayram, Recep; Benek, Bedri SelimOBJECTIVE: Osteosarcoma (OS) is the most common primary malignant tumor of the bone. Treatment options include surgery, chemotherapy, and radiotherapy. Following surgery, multi-agent chemotherapy drugs are effective but are associated with significant side effects and toxicity. Thymoquinone (TMQ) is a pharmacological component of black cumin that has multiple anti-tumorigenic effects. The goal of this study was to determine the effect of TMQ in combination with chemotherapy drugs on the growth inhibition of osteosarcoma and the potential clinical utility of TMQ in the treatment of OS. MATERIALS AND METHODS: We evaluated the effects on the MG63 OS cell line when TMQ, 5-fluorouracil, and oxaliplatin combinations were applied that MG63 OS cell line viability was measured with the cell proliferation and apoptosis assay according to dose and time-dependent effects. RESULTS: Application of 10 mu M TMQ combined with 5FU and OXA at a low concentration of 1 mu M that was discovered an ineffective dose of the used drugs as anticancer decreased cell viability and increased apoptosis in cells at a significant rate at 48 and 72 h. CONCLUSIONS: TMQ has potential benefits in preventing the onset and progression of chemotherapy drug-induced toxicity and side effects, and may reduce resistance to chemotherapy drugs. We consider that TMQ may be a potential therapeutic drug for OS and/or other cancers.Öğe Arthroscopic fixation with intra-articular button for tibial intercondylar eminence fractures in skeletally immature patients(Lippincott Williams & Wilkins, 2016) Memişoğlu, Kaya; Müezzinoğlu, Ümit Sefa; Atmaca, Halil; Sarman, Hakan; Kesemenli, Cumhur CevdetThe aim of this study was to describe our experiences with arthroscopy-guided intra-articular button fixation in the treatment of displaced tibial eminence fractures in skeletally immature children. Eleven adolescent patients with an average age of 12.2 years were treated arthroscopically between January 2005 and February 2007. At follow-up evaluation at 69 months, we did not find any instability. Only minimal differences were found in the functional outcomes (Lysholm and International Knee Documentation Committee scores: 95.7 and 94.3, respectively). None of the patients had a leg-length discrepancy defined at the time of the final follow-up. The advantages of this technique are as follows: (a) it is a simple and reliable arthroscopic technique with a direct view, (b) the fixation is stable, (c) there is no need to remove the implant, (d) minimal physeal interruption in a pediatric skeletally immature population, and (e) no additional arthroscopic portal.Öğe Assessment of postoperative tendon quality in patients with achilles tendon rupture using diffusion tensor imaging and tendon fiber tracking(Elsevier Science Inc, 2015) Sarman, Hakan; Atmaca, Halil; Çakır, Özgür; Müezzinoğlu, Ümit Sefa; Anık, Yonca; Işık, CengizAlthough pre- and postoperative imaging of Achilles tendon rupture (ATR) has been well documented, radiographic evaluations of postoperative intratendinous healing and microstructure are still lacking. Diffusion tensor imaging (DTI) is an innovative technique that offers a noninvasive method for describing the microstructure characteristics and organization of tissues. DTI was used in the present study for quantitative assessment of fiber continuity postoperatively in patients with acute ATR. The data from 16 patients with ATR from 2005 to 2012 were retrospectively analyzed. The microstructure of ART was evaluated using tendon fiber tracking, tendon continuity, fractional anisotropy, and apparent diffusion coefficient values by way of DTI. The distal and proximal portions were measured separately in both the ruptured and the healthy extremities of each patient. The mean patient age was 41.56 +/- 8.49 (range 26 to 56) years. The median duration of follow-up was 21 (range 6 to 80) months. The tendon fractional anisotropy values of the ruptured Achilles tendon were significantly lower statistically than those of the normal side (p - .001). However, none of the differences between the 2 groups with respect to the distal and proximal apparent diffusion coefficient were statistically significant (p = .358 and p = .899, respectively). In addition, the fractional anisotropy and apparent diffusion coefficient measurements were not significantly different in the proximal and distal regions of the ruptured tendons compared with the healthy tendons. The present study used DTI and fiber tracking to demonstrate the radiologic properties of postoperative Achilles tendons with respect to trajectory and tendinous fiber continuity. Quantifying DTI and fiber tractography offers an innovative and effective tool that might be able to detect microstructural abnormalities not appreciable using conventional radiologic techniques. (C) 2015 by the American College of Foot and Ankle Surgeons. All rights reserved.Öğe The Association of Omentin Levels in Non-Diabetic Postmenopausal Women with Bone Mineral Density and Total Body Composition(2015) Özlü, Tülay; Sarman, Hakan; Alçelik, Aytekin; Işık, Cengiz; Yazıcı, Selma; Tosun, Mehmet; Caglar, HilalObjectives: Positive relation between body mass and bone mineral density (BMD) is thought to be due to weight bearing effect. However, adipose tissue derived adipokines may have important effects on bone. Obese women have decreased levels of omentin in circulation which is related with adverse metabolic events. The hypothesis was that performed in this study, we aimed to study the association of omentin levels with body composition and BMD in non-diabetic postmenopausal women. Methods: Postmenopausal women aged 40 to 70 years, scheduled for BMD testing were prospectively evaluated. Patients with known diabetes, chronic renal failure, chronic liver disease, malabsorption, inflammatory bowel disease, <40 and >70 years of age were excluded. BMD and body composition were measured by DXA (GE-Lunar DPX pro). Fasting blood samples were obtained for analysis of complete blood count, glucose, creatinine, lipid profile and omentin. Statistical analyses were performed by using SPSS version 18 for windows. P<0.05 was considered statistically significant. Results: Mean age of the patients in the osteoporosis group was higher than that of the control group (59.1±7.6 vs 53.3±5.7, p<0.05). Mean omentin level was higher in osteoporosis group than in osteopenia and control groups (479.7±141.6 vs 342.3±173.6 and 346.8±127.2, p<0.05). Total body fat mass, muscle mass and the T score of lumbar spine had a negative correlation with omentin levels (r=-0.252, -0.276, -0.344, p<0.05). Conclusions: Body composition does not seem to effect omentin levels. Women with a lower BMI have increased omentin levels. Higher omentin levels are associated with lower T scores at the lumbar spine.Öğe Bel ağrısının sık görülmeyen bir nedeni: Radyasyon osteoiti(2015) Bunyamin, Koc; Boyraz, İsmail; Sarman, Hakan61 yaşında bayan hasta polikliniğimize bel ağrısı yakınmasıyla başvurdu. Hastaya yaklaşık 11 ay önce endometrium kanseri nedeniyle total abdominal histerektomi, bilateral salpingooferektomi, omentektomi ve pelvik paraaortik lenf nodu disseksiyonu yapılmış. Cerrahi tedaviyi takiben uygulanan radyoterapiden yaklaşık 4 ay sonra hastanın bel ağrısı yakınmaları başlamış. Hastanın ağrısı daha çok bel kısmındaydı ve bacaklarına vurmuyordu. Yapılan muayenede lomber hareketleri açık, düz bacak kaldırma testi negatifti, siyatik valleks hassasiyeti yoktu ve nörolojik muayenesi normal olarak değerlendirildi. Hastanın tam kan sayımında beyaz küre: 7340/µL, hemoglobin:13,6g/dl, trombosit:287000/µL idi. Sedimantasyon 36, alkalen fosfataz, kalsiyum ve fosfor normal sınırlar içerisinde idi. Olası bir kemik metastazını değerlendirmek amacıyla çekilen tüm vücut kemik sintigrafisi; diz eklemlerinde dejeneratif değişikliklerle uyumlu artmış aktivite tutulumları dışında normal olarak değerlendirildi. Hastanın çekilen lomber vertebral magnetik rezonans görüntülemesinde (MRG) lomber 3-4; 4-5 ve lomber 5 sakral 1. vertebralar arasında bulging mevcuttu. Ayrıca lomber 4. vertebra korpus alt bölümü ile lomber 5. vertebrada ve sakral düzeyde hem T1 hem de T2 kesitlerde hiperintens sinyal intensite değişimi vardı (Resim 1,2). Tarif edilen görünüm radyoloji doktoru tarafından radyoterapiye bağlı olabileceği yönünde yorumlanmıştı. Hasta kliniğimize yatırıldı ve oral analjezik başlandı ve fizyoterapi uygulandı.Öğe Bel Ağrısının Sık Görülmeyen Bir Nedeni; Radyasyon Osteoiti(2015) Bunyamin, Koc; Boyraz, Ismail; Sarman, Hakan-Öğe A child patient followed-up with the diagnosis of recurrent complex regional pain syndrome(Galenos Yayincilik, 2016) Boyraz, İsmail; Koç, Bünyamin; Sarman, Hakan; Özkan, Hilal; Tönük, BurakComplex regional pain syndrome is a clinical condition that features a group of typical symptoms, including spontaneous pain, edema, tenderness, swelling of an extremity along with varying degrees of sweating, warmth and/or coolness, flushing, discoloration, and shiny skin. A 12-year-old female patient referred to the department of pediatrics with complaints of swelling, pain, reddening, and movement difficulty in her right hand. Her attacks repeated 3 times. Cervical stellate ganglion blockage relieved symptoms immediately at the last attack.Öğe Clonus: Definition, mechanism, treatment(Medical Association of Zenica-Doboj Canton, 2015) Boyraz, İsmail; Uysal, Hilmi; Koç, Bunyamin; Sarman, HakanClonus is involuntary and rhythmic muscle contractions caused by a permanent lesion in descending motor neurons. Clonus may be found at the ankle, patella, triceps surae, wrist, jaw, biceps brachii. In general, clonus may occur in any muscle with a frequency of 5-8 Hz and the average period of oscillations of the ankle clonus is approximately 160–200 ms. Plantar flexion (PF) comprises 45% of the period, dorsifleksion (DF) comprises 55% of the period. The first beat is always longer, with the time shortening in continuing beats and becoming stable in the 4th or 5th period. The exact mechanism of clonus remains unclear. Two different hypotheses have been asserted regarding the development of clonus. The most widely accepted explanation is that hyperactive stretch reflexes in clonus are caused by self-excitation. Another alternative explanation for clonus is central generator activity that arises as a consequence of appropriate peripheral events and produces rhythmic stimulation of the lower motor neurons. The durations of clonus burst were found longer than the durations of Soleus medium-latency reflex (MLR). There is a similarity in their nature, although the speed and cause of the stretch of triceps surae differ in the MLR and the clonus, and there is a sufficient period of time for group II afferents and for other spinal mechanisms to be involved in the clonus, together with Ia afferents. Clonus can be treated by using baclofen, applying cold, botox or phenol injections. © 2015 Medical Association of Zenica-Doboj Canton. All rights reserved.Öğe Comment on "the effect of a community-based, primary health care exercise program on inflammatory biomarkers and hormone levels''(Hindawi Ltd, 2015) Koç, Bünyamin; Sarman, Hakan; Boyraz, İsmailWe read with great interest the recent paper by C. B. Papini et al. in which the authors examined “impact of a communitybased exercise program in primary care on inflammatory biomarkers and hormone levels” in the 1-year quasiexperimental study [1]. The authors very clearly discussed the relation between exercise and inflammation. They concluded that community-based exercise program can result in a decrease or maintenance of inflammatory biomarkers after 1 year, and it has the potential to be a viable public health approach for chronic disease prevention.This study displayed that public health exercise intervention delivered in lowincome communities has the potential to use a beneficial effect and improve or maintain inflammatory biomarkers profiles, supporting the prevention of chronic diseases. The authors did not discuss exclusion criteria in this paper. However it is well established that any type of systemic inflammation, autoimmune disorders, and malignant or chronic illnesses may affect inflammatory biomarkers and hormone levels [2]. Also obesity is related to elevated serum levels of some inflammatory markers, such as leptin, TNF- ��, and CRP [3, 4]. Because of high prevalence of these conditions, we believe that these situations may have a role in the results of the paper by C. B. Papini et al.Öğe Comparison of high-intensity laser therapy and ultrasound treatment in the patients with lumbar discopathy(Hindawi Ltd, 2015) Boyraz, İsmail; Yıldız, Ahmet; Koç, Bünyamin; Sarman, HakanThe aim of the present study was to evaluate the efficiency of high intensity laser and ultrasound therapy in patients who were diagnosed with lumbar disc herniation and who were capable of performing physical exercises. 65 patients diagnosed with lumbar disc were included in the study. The patients were randomly divided into three groups: Group 1 received 10 sessions of high intensity laser to the lumbar region, Group 2 received 10 sessions of ultrasound, and Group 3 received medical therapy for 10 days and isometric lumbar exercises. The efficacy of the treatment modalities was compared with the assessment of the patients before the therapy at the end of the therapy, and in third month after the therapy. Comparing the changes between groups, statically significant difference was observed in MH(mental health) parameter before treatment between Groups 1 and 2 and in MH parameter and VAS score in third month of the therapy between Groups 2 and 3. However, the evaluation of the patients after ten days of treatment did not show significant differences between the groups compared to baseline values. We found that HILT, ultrasound, and exercise were efficient therapies for lumbar discopathy but HILT and ultrasound had longer effect on some parameters.Öğe Comparison of semi-invasive "internal splinting" and open suturing techniques in achilles tendon rupture surgery(Elsevier Science Inc, 2016) Sarman, Hakan; Müezzinoğlu, Ümit Sefa; Memişoğlu, Kaya; Aydın, Adem; Atmaca, HalilThe goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes compared with open surgery. (C) 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.Öğe The Demographic Characteristics of Patients Admitted to the Emergency due to Low Back Pain(2015) Boyraz, İsmail; Duran, Arif; Koç, Bünyamin; Erkuran, Mansur Kürşad; Sarman, Hakan; Yazıcı, SelmaAmaç: 2007-2015 yılları arasında bel şikayetiyle acile başvuran hastaların demografik özelliklerini incelemek istedik Gereç-Yöntem: Abant İzzet Baysal Üniversitesi Tıp Fakültesi Hastanesi ve Kamu Hastaneler birliğine bağlı acil servislere 2007- 2015 yılları arasında bel şikayetiyle acile başvuran hastalar retrospektif olarak kayıtlardan incelendi. Hastaların demografik özellikleri ve hasta bilgileri kayıtlardan elde edildi. Acile başvurduğunda ilk teşhisi bel olan hastalar çalışmaya dahil edildi. Travma veya kaza geçiren, akut kırık teşhisi konulmuş olan hastalar incelemeye dahil edilmedi. Hastaların yaş, cinsiyet, başvuru zamanının hangi saat, gün, ay, yıl ve mevsimde olduğu, acilde ne kadar kaldığı ve başka servise sevk edilmişse hangi bölüme sevk edildiği ve orda kaç gün yattığı incelendi. Cerrahi servislerden birine sevk edilmişse cerrahi yapılıp yapılmadığı kaydedildi. Bulgular: Bel ağrısı teşhisiyle acile başvurmuş ve tedavi almış toplam hasta sayısı 43233 idi. Bunlardan 22372 hasta yaklaşık % 51.7’si erkek, 20861 hasta yaklaşık %48.3’ü kadındı.11 hasta Genel cerrahiye nakledilmiş, 14 hasta Ortopedi ve Travmatoloji servisine, 3 hasta Kadın Hastalıkları ve Doğum servisine, 1 hasta üroloji servisine, 1 hasta Göğüs Cerrahisi servisine, 699 hasta Beyin Cerrahi servisine yatırılmış. 5 hasta Algoloji, 3 hasta Çocuk Hastalıkları, 20 hasta Enfeksiyon Hastalıkları, 89 hasta Fizik Tedavi ve Rehabilitasyon, 9 hasta Dahiliye, 5 hasta Kardiyoloji, 11 hasta Nöroloji, 1 hasta Yoğun Bakım servisine yatırılmıştır. Sonuç: Hastanın anemnezi ve fizik muayenesi çok iyi yapılırsa gereksiz tetkik ve tedavilerin önüne geçilmiş olur. Yapılacak geniş çaplı çalışmalar sayesinde acil hekimlerinin karşılaşabilecekleri bel ağrılı hastadaki teşhis ve tedavi stratejisinin belirlenmesi konusunda izleyecekleri bir paradigma oluşturulabilir.Öğe Diyabetes mellitüs ve periferik organ tutulumu: Güncel tedavi seçenekleri(2014) Işık, Cengiz; Sarman, Hakan; Şahin, Abdullah Alper; Kargi, Ertugrul; Sarman, Züleyha; Erkuran, Mansur Kürşad; Boyraz, İsmailDiyabetes mellitüs bireylerin ve toplumların uzun süreli yaşam şekline etki eden kronik, multisistemik ve tedavi seçenekleri çeşitlilik gösteren bir hastalıktır. Hastalığın kendisinin vücutta yaptığı değişimler kadar uzun dönemde periferik organlarda oluşturduğu hasarlar sonucu önemli morbidite ve mortalite nedenidir. Bu derlemede Diyabetes mellitüs kendisinin direkt yaptığı dahili hastalıktan ziyade periferik organ tutulumu sonucu gelişen komplikasyonları ve tedavi seçeneklerini literatür eşliğinde değerlendirmeyi amaçladık.Öğe Effect of robotic training on walking and balance in patient with Hereditary Spastic Paraplegia(Medical Investigations Soc, 2016) Boyraz, İsmail; Koç, Bünyamin; Sarman, Hakan; Özdemir, MesutOur patient was 22 years old and was being followed with pure Hereditary Spastic Paraplegia. He was provided with robot assisted-gait training combined with physiotherapy. Robot-assisted gait training lasted 40 minutes per a day and 20 sessions training. enforced about 7 weeks and three times in a week. Strenghten, stretching and balance exercise were applied as physiotherapy every day. He was evealuated in terms of functional ambulation category, Medical Research Council (MRC) Scale for muscle strength, Modified Ashworth Scale (MAS), 6-minute walking test, 10-meter walking test, timed up and go, Berg Balance Scale before and after treatment. After the treatments, the patient could walk more confidently and speedy. Robotic training can contribute to physiotherapy as plus to improve patient walking and balanceÖğe Efficacy of intraarticular application of ketamine or ketamine-levobupivacaine combination on post-operative pain after arthroscopic meniscectomy(Springer, 2015) Işık, Cengiz; Demirhan, Abdullah; Yetiş, Tevfik; Öktem, Korgun; Sarman, Hakan; Tekelioğlu, Ümit Yaşar; Duran, TuranTo evaluate the efficacy of intraarticular injection of ketamine or ketamine plus levobupivacaine on post-operative analgesia in patients undergoing arthroscopic meniscectomy. A prospective, randomized, double-blind study was performed on 60 patients aged 18-65 years who planned to undergo elective arthroscopic meniscectomy. The patients were divided into three groups: the ketamine group (n = 20) received 1.0 mg/kg of intraarticular ketamine in 20 ml of normal saline, the ketamine-levobupivacaine group (n = 20) received 0.5 mg/kg of intraarticular ketamine plus 50.0 mg of 0.25 % levobupivacaine in 20 ml of normal saline, and the control group (n = 20) received 20 ml of intraarticular normal saline. A visual analogue scale (VAS) was used to determine the efficacy of analgesia at 1, 2, 4, 6, 8, 12, and 24 h post-operatively. There were statistically significant differences in the median VAS scores among the three groups according to Bonferroni adjustment at all time points (p < 0.01), with the exception of 6 and 24 h post-operatively. The median VAS scores at 1, 2, and 4 h post-operatively were higher in the control group than in the two treatment groups (p < 0.001). The median VAS scores in the control group at 1, 2, 4, 6, 8, and 12 h post-operatively and those in the ketamine group at 4, 8, and 12 h post-operatively were significantly higher than those in the ketamine-levobupivacaine group (p < 0.05). Intraarticular ketamine provides effective post-operative analgesia. Addition of intraarticular levobupivacaine to ketamine may provide better amelioration of pain after outpatient arthroscopic meniscectomy. I.Öğe Efficacy of intraarticular application of ketamine or ketamine-levobupivacaine combination on post-operative pain after arthroscopic meniscectomy (vol 23, pg 2721, 2015)(Springer, 2016) Işık, Cengiz; Demirhan, Abdullah; Yetiş, Tevfik; Ökmen, Korgün; Sarman, Hakan; Tekelioğlu, Ümit Yaşar; Duran, TuranPurpose To evaluate the efficacy of intraarticular injection of ketamine or ketamine plus levobupivacaine on post-operative analgesia in patients undergoing arthroscopic meniscectomy. Methods A prospective, randomized, double-blind study was performed on 60 patients aged 18–65 years who planned to undergo elective arthroscopic meniscectomy. The patients were divided into three groups: the ketamine group (n = 20) received 1.0 mg/kg of intraarticular ketamine in 20 ml of normal saline, the ketamine–levobupivacaine group (n = 20) received 0.5 mg/kg of intraarticular ketamine plus 50.0 mg of 0.25 % levobupivacaine in 20 ml of normal saline, and the control group (n = 20) received 20 ml of intraarticular normal saline. A visual analogue scale (VAS) was used to determine the efficacy of analgesia at 1, 2, 4, 6, 8, 12, and 24 h post-operatively. Results There were statistically significant differences in the median VAS scores among the three groups according to Bonferroni adjustment at all time points (p < 0.01), with the exception of 6 and 24 h post-operatively. The median VAS scores at 1, 2, and 4 h post-operatively were higher in the control group than in the two treatment groups (p < 0.001). The median VAS scores in the control group at 1, 2, 4, 6, 8, and 12 h post-operatively and those in the ketamine group at 4, 8, and 12 h post-operatively were significantly higher than those in the ketamine–levobupivacaine group (p < 0.05). Conclusion Intraarticular ketamine provides effective post-operative analgesia. Addition of intraarticular levobupivacaine to ketamine may provide better amelioration of pain after outpatient arthroscopic meniscectomy. Level of evidence I.Öğe El ve el bilek tümörlü hastalarda eksizyonel biyopsi sonuçlarının değerlendirilmesi(2014) Sarman, Hakan; Işık, Cengiz; Şahin, Abdullah Alper; Kuru, Tolgahan; Kızılay, Hasan; Taştan, Şemsi; Besinli, BirsenAmaç: El ve el bileği tümörleri vücudun diğer bölgelerindeki tümöral oluşumlardan farklılık gösterir. Kas - iskelet sisteminin herhangi bir yerinde ki tümörler elde de görülebilir. Ancak eldeki kitlelere kozmetik nedenler, hareket kısıtlılığı, ağrı olması, şişlikten dolayı malign tümör olması yönündeki endişelerden dolayı daha erken opere edilmekte dir. Yöntem : Çalışmamızda Gölcük Necati Çelik Devlet Hastanesi Ortopedi ve Travmatoloji Kliniğine başvurup el ve el bileğine uygulanan eksizyonel biyopsi sonuçlarını geriye dönük olarak inceledik. Bulgular: Çalışmaya dahil edilen toplam 30 olgunun yaş orta laması 37, 6 (14 -79) idi, olguların 9’u erkek, 21’ikadındı. Eksize edilen tümörlerin 18 tanesi sağ ekstremiteden, 12 tanesi sol üst ekstremiteden, 8 tanesi el palmarından ve 22 tanesi el dorsalindendi. Patoloji sonucunda 29 kitle benign karakterdeyken 1 ta nesi malign karakterdeydi. Sonuç : Hastanenin sanayi yerleşimi olması nedeniyle mesleki açıdan çoğunluğunu gangliyon kisti oluşturmaktadır. Çalışma sonuçları literatürde paralellik göstermektedir. Fakat çalışmanın çok merkezli olmaması ve kayıt sisteminin yetersizliği ki karşılaşılan vakaların beklenen sayıdan daha az olduğunu göstermektedir.Öğe Erişkin radius distal uç kırıklarında konservatif tedavi sonuçlarının, karşı taraf el bileği ile karşılaştırılması: Radyolojik ve fonksiyonel değerlendirme(2014) Uslu, Mustafa; Arıcan, Mehmet; Işık, Cengiz; Sarman, Hakan; Boyraz, İsmailAmaç: Erişkin hastalarda kapalı redüksiyon ve uzun kol alçı ile tedavi edilen distal radius uç kırıklarının radyolojik ve fonksiyonel sonuçları karşı taraf el bileği ile karşılaştırılarak değerlendirildi.Yöntemler: Ocak 2010-Aralık 2010 tarihleri arasında 77 hastaya distal radius uç kırığı için konservatif tedavi uygulandı. Kırıklar prospektif olarak incelendi ve AO ile Frykman sınıflama sistemi kullanıldı. Radyolojik ve anatomik sonuçlar Stewart skorlama kriteri ile değerlendirildi. Fonksiyonel sonuçlar kol, omuz ve el sakatlık sorgulaması (Q-DASH) ve Stewart II skorlama kriterleri değerlendirildi. Hastaların ortalama takip süresi 12 aydı.Bulgular: 40 hastanın sağ el bileğinde, 37 hastanın sol el bileğinde kırık mevcuttu. Frykman sınıflamasına göre 46 olgu tip I-II kırık, AO sınıflamasına göre 59 olguda 23,A2,1 ve 23,A2,2 kırık tespit edildi. Stewart radyolojik ve anatomik skorlama kriterine göre 77 hastanın toplam 57'sinde mükemmel, 17'sinde iyi, 3'ünde orta sonuç elde edildi. Stewart II'ye göre fonksiyonel skorlama kriterler sonuçları değerlendirildiğinde, 57 hastada mükemmel, 8 hastada iyi, 12 hastada orta sonuç alındı. Q-DASH skoru ortalama puanı 6,37 olarak bulundu. Komplikasyon oranlarımız %12,98 idi. İki hastada median sinirde hafif derecede tuzaklanma, dört hastada ulna stiloidinde kaynamama, bir hastada distal radioulnar eklemde hassasiyet, üç hastada distal radioulnar eklemde hassasiyet ve median sinirde hafif derecede tuzaklanma idi.Sonuç: Distal radius kırıkları tedavisinde kapalı redüksiyon ve alçılı tespit halen etkin ve son derece ucuz bir tedavi yöntemi olarak görülmektedirÖğe Flexor tendons repair : effect of core sutures caliber with increased number of suture strands and peripheral sutures. A sheep model(Elsevier Masson, Corporation Office, 2014) Uslu, Mustafa; Işık, Cengiz; Özşahin, Mustafa; Özkan, Arif; Yaşar, Mehmet Akif; Sarman, HakanBackground: Surgeons have aimed to achieve strong repair so as to begin early active rehabilitation programs for flexor tendon injury. Multi-strand suture techniques were developed to gain improved gap resistance and ultimate force compared with the respective two-strand techniques. In vivo studies indicate that multiple strands may cause ischemia during the intrinsic healing process by decreasing the total cross-sectional area of the injured site, unless the total cross-sectional area of the sutures is not decreased. Hypothesis: The hypothesis was to design an in vitro study to understand the biomechanical relationship between suture calibers of core sutures with increased number of suture strands and peripheral suture on final repair strength. Materials and methods: Sixty fresh sheep forelimb flexor digitorum profundus tendons were randomly placed into three groups (A, B, and C), each containing 20 specimens, for tendon repair. Two-, four-, and eight-strand suture techniques were respectively used in Groups A, B, and C. A simple running peripheral suture technique was used in Subgroups A2, B2, and C2. For each repaired tendon, the 2-mm gap-formation force, 2-mm gap-formation strength, maximum breaking force and maximum breaking strength were determined. Results: Differences in 2-mm gap-formation force and 2-mm gap-formation strength were found between Subgroups A1 and A2, B1 and B2, and Cl and C2. Between Groups A and B, A and C, and B and C, there was no difference as well. Conclusion: Both the number of strands and the ratio between the total suture volume and tendon volume at the repair site are important for ideal repair. If the total cross-sectional area of the sutures is equal in 2-strand, 4-strand, and 8-strand procedure, there is no difference in the strength of the repair. A decrease in caliber size suture requires more passes to achieve the same strength. Instead, it is much better to use peripheral suture techniques to improve the strength of the repair with larger diameter 2-strand core sutures. (C) 2014 Published by Elsevier Masson SAS.
