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Yayın Bilateral non-traumatic hip fractures in a heavy smoker COPD patient on inhaled steroids(SpringerLink, 2016) Sanel, Selim; Sezgin, Gülbüz; Sarıman, Nesrin; Üğütmen, Ender; Solakoğlu, CanBilateral proximal femoral fractures without trauma are very rare conditions. They have been reported in connection with osteoporosis, renal osteodystrophy, parathyroid disease, tumors, epileptic seizures, electroconvulsive therapy, and postirradiation. Method We present a case of a 75-year-old man with bilateral hip fractures. No trauma, neurological, endocrinological disorder, or malignancy was reported in his history. He had a background of chronic obstructive pulmonary disease (COPD) and had been taking inhaled steroids (budesonide) 800 µg per day for 10 years. He was a heavy smoker with a smoking history of 120 packs/year. His complaints had initially started as pain on the left hip and groin and then had progressed to the right in 10 days. Plain x-rays of the pelvis showed left femoral neck and right subtrochanteric femoral fractures. Fixation with proximal femoral nail of the right hip and partial arthroplasty of the left hip was performed on the following day after his admission. Pathological examination revealed osteoporosis in bone samples from both hips. Result COPD and osteoporosis have some common risk factors. Smoking, decreased exercise capacity, inhaled, or oral steroid therapy may increase osteoporosis and risk of bone fractures by decreasing bone mineral density. Non-traumatic femoral fractures may occur in patients on long-term inhaled steroid treatment for chronic airway diseases such as asthma and COPD. Conclusion History of COPD with corticosteroid use may be used as a diagnostic tool to identify patients having osteoporosis. Preventive measures can be performed by monitoring high-risk patients with bone mineral densitometry, WHO fracture risk assessment tool (FRAX tool), serum calcium, and vitamin D levels to prevent bone fractures. Treating those patients with the lowest effective dose of corticosteroids should be targeted.Yayın Bilateral, locked, recurrent anterior shoulder dislocation: case report(TURKISH JOINT DISEASES FOUNDATION, 2015) Sanel, Selim; Sencan, Savas; Ocguder, Ali; Solakoglu, CanBilateral anterior dislocation of the shoulder is a rare condition. Most of the cases are seen as posterior dislocations which generally occur during diffuse tonic-clonic contractions of epileptic seizures or after being exposed to strong electric shock. In this article, we report a 21-year-old epileptic patient who had severe bilateral shoulder pain and joint restriction. Diagnoses of bilateral, locked, anterior shoulder dislocation and Hill-Sachs lesions were made with shoulder X-rays and computed tomography. Arthroscopic Bankart repair and remplissage technique were applied in surgical treatment of both shoulders. Posterior dislocations of shoulder usually occur during epileptic seizures but anterior dislocations are rare in the literature. This may lead to delay in diagnosis. Computed tomography scan may be helpful in making diagnosis in uncertain patients. It should not be forgotten that recurrent anterior dislocations may be seen in epileptic patients. Such dislocations should be followed up regularly and instability must be treated to prevent excessive damage to the shoulder.Yayın Comparison of intra-articular bupivacaine-morphine with bupivacaine-tenoxicam combinations on post-operative analgesia in patients with arthroscopic meniscectomy: a prospective, randomised study(SPRINGER, 2016) Sanel, Selim; Arpaz, Osman; Unay, Koray; Turkmen, Ismail; Simsek, Selcuk; Ugutmen, EnderAim There are many alternatives for post-operative pain relief in patients who have had general anaesthesia. The aim of this study was to evaluate the efficacy of intra-articular bupivacaine + morphine and bupivacaine + tenoxicam applications in post-operative pain control in patients undergoing knee arthroscopy with general anaesthesia. Method This was a prospective study. Standard anaesthesia procedures were applied to each patient, and the 240 patients chosen at random were then divided into two groups. Each group received a different combination of drugs for this double-blind study. The first group (group A: 120 patients) received 0.5 % bupivacaine 100 mg + tenoxicam 20 mg (22 ml); the second group (group B) received 0.5 % bupivacaine 100 mg + morphine 2 mg (22 ml); both groups received their drugs at the end of the intra-articular operation before tourniquet deflation. Before the operation, patients were asked about their post-operative pain at particular periods over the following 24 hours using the visual analogue scale (VAS) and the numeric rating scale (NRS). An additional analgaesic requirement and possible side effects were also recorded. Results Group A patients needed analgaesics sooner after operation than patients in group B. In Group B, VAS and NRS values were statistically higher compared with group A at the 12th hour. There were also fewer side effects seen in group A versus group B. Conclusion Effective and reliable results were obtained in post-operative pain control in bupivacaine added to the morphine or tenoxicam groups following arthroscopic meniscectomy. In the tenoxicam group, patients reported less pain, fewer side effects and less need for analgesics at 12 hours after the operation.Yayın Effects of Smoking and Hemoglobin Values on Femoral Bone Marrow Resonance Signal Intensity(YERKURE TANITIM & YAYINCILIK HIZMETLERI A S, 2017) Arslan, Gozde; Sanel, Selim; Cubuk, Rahmi; Gemici, Aysegul Akogan; Inci, ErcanObjective: The aim of our study is to evaluate the correlation of residual-reconverted red bone marrow areas of distal femoral metaphysis with the age, gender, weight and hemoglobin (hgb) values and smoking. Material and Methods: 150 non smoking and 62 smoking patients were included in the study. The residual red bone marrow areas in the distal femoral metaphysis in MRI (Magnetic Resonance Imaging) images were examined by two radiologists. The size of the residual red bone marrow area and the age, gender, weight and hemoglobin values of the patients were compared by using the Oneway Anova Test, Tukey HSD Test, Fisher's Exact Test and Pearson Chi-Square Test. Results: In our study, residual red marrow areas were detected higher in smoking male and female patients when compared to non-smoking patients (p=0.004; p<0.01), (p=0.026; p<0.05). Residual red marrow areas were more common in female patients when compared to male patients (p=0.004; p<0.01). We haven't seen significant effect of weight, hemoglobin values and age on these areas (p>0.05). Conclusion: We have determined correlation between reconverted-residual red marrow areas, female sex and smoking behavior. In the correlation existing group; we are not in favor of mentioning these areas on MRI reports of the knee. But they should be phrased in reports considering the probability of malignancy if they are hypointense compared to adjacent muscle groups on T1-weighted sequences; if they are extensive involved in bone tissue; if they show epiphyseal extension or if there is accompanying soft tissue mass.Yayın Evaluation of analgesic regimens in total knee arthroplasty, retrospective study(KARE PUBL, 2017) Tulgar, Serkan; Selvi, Onur; Senturk, Ozgur; Serifsoy, Talat Ercan; Sanel, Selim; Meydaneri, SertacOBJECTIVE: Analgesic therapies have an immense role in early rehabilitation period after total knee arthroplasty (TKA) and multimodal approaches should be considered as the first choice of treatment. In this retrospective study, the aim was to evaluate the effectiveness of multimodal analgesic therapies for TKA, including femoral nerve block (FNB) and patient controlled analgesia (PCA). METHODS: The data of 79 patients who underwent TKA between January and December 2016 were retrospectively evaluated. In all, 63 patients met the inclusion criteria. Hemodynamic records and Visual Analogue Scale (VAS) pain scores for postoperative 0, 2, 4, 6, 9, and 12 hours were evaluated and patients were separated into 3 groups. Group 1: FNB with 0.25% bupivacaine, Group 2: FNB with 0.166% bupivacaine, and Group 3: No FNB. RESULTS: The average age of the patients was 64.3 +/- 14.9 years and average body mass index (BMI) was 32.5 +/- 5.3 kg/m(2). There was no statistical difference between groups in age, gender, American Society of Anesthesiologists (ASA) classification of physical health scores, BMI, or anesthesia type (p<0.05). When VAS scores at postoperative time intervals were compared, there was a statistically significant difference between Group 1 and Group 2 (p>0.05). When difference between Groups 1 and 3 and Groups 2 and 3 were compared, the difference was statistically significant for VAS 0 (p>0.05). Additional analgesic use was highest in Group 3. CONCLUSION: This study demonstrated that FNB significantly decreases postoperative pain intensity and additional analgesia requirement in patients undergoing TKA. A concentration of 0.166% bupivacaine is as effective as a concentration of 0.25% when used as part of a multimodal analgesia regimen in TKA.Yayın Pentoxifylline Inhibits Epidural Fibrosis in Post-Laminectomy Rats(INT SCIENTIFIC LITERATURE, INC, 2016) Kelten, Bilal; Erdogan, Hakan; Antar, Veysel; Sanel, Selim; Tuncdemir, Matem; Kutnu, Muge; Karaoglan, Alper; Orki, TulayBackground: The aim of this experimental study was to investigate the effectiveness of intramuscular pentoxifylline in the prevention of postoperative fibrosis. Material/Methods: We divided 16 adult Wistar albino rats into 2 equal groups: treatment and control. Both groups underwent L1 vertebral total laminectomy to expose the dura. The intramuscular treatment group received pentoxifylline. Four weeks later, epidural fibrosis was studied in both groups using electron microscopy, light microscopy, histology, biochemistry, and macroscopy. Results: The evaluation of epidural fibrosis in the 2 groups according to macroscopic (p<0.01) assessment and light microscopy revealed that epidural scar tissue formation was lower in the treatment group compared to the control group (p<0.001) and the number of fibroblasts was also decreased significantly in the pentoxifylline-treated group (p<0.05). More immature fibers were demonstrated in the treatment group by electron microscopy in comparison with the control group. In biochemical analysis, a statistically significant decrease was detected in hydroxyproline, which indicates fibrosis and myeloperoxidase activity, and shows an inflammatory response (P<0.001). Conclusions: Systemic pentoxifylline application prevents postoperative epidural fibrosis and adhesions with various mechanisms. Our study is the first to present evidence of experimental epidural fibrosis prevention with pentoxifylline.Yayın Short-term results of surgical treatment with cephalomedullary nails for basicervical proximal femoral fractures(Universa Press, 2015) Taşkıyan, Levent; Üğütmen, Ender; Sanel, Selim; Söylemez, Mehmet Salih; Özkan, Korhan; Solakoğlu, CanThe treatment of basicervical femoral fractures remains controversial. The aim of this study was to examine the efficacy of intramedullary nail use in the surgical treatment of basicervical fractures. In total, 28 patients with basicervical fractures treated with proximal femoral nails were examined retrospectively. Fracture healing was observed in all patients, who were followed at least for 6 months. While the average radiological fracture healing timing was ~10.5 (8-14) weeks, clinical fracture healing occurred in 6 (5-9) weeks on average. Screw cut-out, avascular necrosis, femur fracture, and surgical wound infections did not occur in any patient. Severe collapse (> 10%) was not noted in any patient. The postoperative mean Harris hip score was 81.2 ± 21.3. Osteosynthesis application with a proximal femoral nail in basicervical proximal femur fractures is a surgical treatment that can be performed with minimally invasive techniques without open surgery. This is a rapid, sound, and simple treatment method with low morbidity.
