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Öğe Acute flaccid myelitis outbreak through 2016-2018: A multicenter experience from Turkey(Elsevier Science Ltd., 2021) Ünver, Olcay; Türkdoğan, Dilşad; Güler, Serhat; Kipoğlu, Osman; Güngör, Mesut; Paketçi, Cem; Carman, Kürşat Bora; Öztürk, Gülten; Maraş Genç, Hülya; Özkan, Mehpare; Olgaç Dündar, Nihal; Işık, Uğur; Karatoprak, Elif; Kılıç, Betül; Özkale, Murat; Bayram, Erhan; Yarar, Coşkun; Sözen, Hatice Gülhan; Sager, Güneş; Sakarya Güneş, Ayfer; Kahraman Koytak, Pınar; Karadağ Saygı, Evrim; Ekinci, Gazanfer; Saltık, Sema; Çalışkan, Mine; Kara, Bülent; Yiş, Uluç; Aydınlı, NurAim: We aim to describe the demographic characteristics, etiology, neurophysiology, imaging findings, treatment, prognosis, and prognostic factors of acute flaccid myelitis. Methods: The clinical data, laboratory test and, magnetic resonance imaging (MRI) results of pediatric patients diagnosed with acute flaccid myelitis according to the Centers for Disease Control criteria between August 1, 2016, and December 31, 2018, from 13 centers in Turkey were reviewed. Results: Of the 34 cases identified, 31 were confirmed (91.2%). Eighteen patients (55.9%) were boys. The median patient age was 4 years (interquartile range 2.5–6.9 years). Most of the patients were admitted in 2018 (n = 27). A preceding history of a febrile illness was reported in all patients, with a median of 4 days (interquartile range 3–7 days) before symptom onset. Thirty-one patients had T2 hyperintensity on spinal MRI, and 18 patients had cerebrospinal fluid pleocytosis. The most common infectious agents were entero/rhinoviruses (n = 5) in respiratory specimens. All patients except one received immunotherapy either alone or in combination. Among 27 patients with follow-up data 24 had persistent weakness. Involvement of four limbs together with an abnormal brain MRI at onset were associated with a poor prognosis. Conclusion: The number of patients with acute flaccid myelitis increased since 2012, spiking with every 2-year interval, largely in the pediatric population. The median age decreases with every outbreak. Clinicians should be aware of the clinical picture for early collection of specimens and early start of rehabilitation programs. Further studies are needed to better characterize the etiology, pathogenesis, risk factors, and treatment of this rare condition.Öğe Çocuk suprakondiler humerus kırıklarında cerrahi tedavi(Haseki Eğitim ve Araştırma Hastanesi, 2014) Bayram, Erhan; Kaya, İbrahim; Sungur, İbrahim; Yılmaz, Murat; Ordu, Samed; U?raş, Ali Akın; Çetinus, Mahmut ErcanAmaç: Bu çalışmanın amacı pediatrik suprakondiler kırıkların sıklığını, artan yaşın cerrahi tedavi şekline ve kırık tespitinde kullanılan pin sayısına etkisini araştırmaktır. Yöntemler: Kliniğimizde opere edilmiş Gartland tip 2-3 suprakondiler humerus fraktürü olan 149 hasta çalışmaya dahil edildi. Hastalar açık ya da kapalı redüksiyon ile tedavi edilenler olarak gruplandırıldı ve bu grupların hasta yaşı ile ilişkisi incelendi. Bulgular: Hastaların yaşı ve kullanılan toplam pin sayısı arasındaki ilişkiye bakıldığı zaman yaş arttıkça kullanılan pin sayısındaki artış anlamlı bulundu (p=0.000). Hastaların yaşındaki artış ile açık redüksiyona duyulan ihtiyaçta artış olduğu görüldü (p=0.005). Sonuç: Gartland tip 2 veya 3 suprakondiler humerus kırıklarında kapalı redüksiyon ve çapraz ya da lateral kondilden yollanan diverjan 2 adet Kirschner teli etkin bir tedavidir. Hasta yaşı arttıkça hem kapalı redüksiyon şansımız hem de 2 adet Kirschner teli ile yeterli stabilite elde etme şansımız azalmaktadır. (Haseki T›p Bülteni 2014; 52: 43-6)Öğe Comparison of short term results of type IIB2 middle third clavicular fractures treated with figure of eight bandage and locked plate fixation(SAGE Publications Ltd, 2014) Malkoç, Melih; Korkmaz, Özgür; Bayram, Erhan; Şeker, Ali; Yılmaz, Murat; İşyar, MehmetObjectives: Most acute displaced midshaft clavicular fractures conventionally have been treated nonoperatively with the expectation of a high probability of fracture union, good functional outcomes, and a high level of patient satisfaction. However, the outcome of nonoperative treatment is not as favorable as once thought and there has been a growing trend to treat these fractures surgically We aimed to evaluate and compare the short term results of conservative treatment and locked plate fixation in the treatment of type IIB2 clavicula fractures according to Robinson classification in this study. Methods: Thirty eight patients with type IIB2 clavicula fractures according to Robinson classification were retrospectively reviewed. 20 patients who were treated conservatively were enrolled as group A and 18 patients who were operated with locked plate and screws were enrolled as group B. All patients were evaluated with Constant and Oxford scores in their last follow up control. For the patients that were treated conservatively (Group A) figure of eight bandage were applied for six week. Patients (Group B) were operated under general anesthesia in the beach chair position. A straight incision was made over the fracture line. Butterfly or free fragments in comminuted fractures were fixed to the main fragment with a lag screw in 3 patients before fracture reduction and plate fixation. Fracture reduction was performed with taking care of minimal periosteal stripping. After reduction of the main fragments, titanium alloy, locked anatomic compression plate were applied on the superior surface of the clavicle. A minimum of six cortexes were fixed with 3.5 mm locked cortical screws on the medial and lateral sides of the fracture. We did not need any Auto- or allografts during the surgery. Statistical analysis was performed between the scores of two groups. Conservative and surgical treated groups Oxford scores and Constant scores had normal distribution. For this reason Student's t test, and Non-parametric version of Student’s t test Mann Whitney U test were performed. 95% confidence interval and p <0.05 was considered significant as statistically. Results: Mean follow up period is 18 months (12-24 months). At the last follow-up, mean Constant score is 79.5 (98-43) and mean Oxford score was 46.35(49-44) for group A. In group B mean Constant score is 89.3(100-77) and mean Oxford score is 46,6(48-44) at the last follow-up. There were no patients who require any revision surgery in group B. Bone healing was detected in all fractures radiologically in both groups. There was no statistically significant difference between Oxford scores of the two groups (p=0,570). There was statistically significant difference between Constant scores of the two groups whereas results of Group B were better than group A (p=0,013) Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes. Conclusion: Surgical treatment with locked plate fixation in type IIB2 clavicle fractures according to Robinson Classification, can be the first treatment choice with better cosmetics, lower complication rate, and better outcomes. © The Author(s) 2014.Öğe Effective of postoperative shoulder imbalance on patient stisfaction with surgial treatment of adolescent idiopathic scoliosis(Galenos Publishing, 2015) Güler, Olcay; Bayram, Erhan; Yılmaz, Murat; Erdil, Mehmet Emin; Uğraş, Ali Akın; Mahiroğulları, MahirObjective: We aimed to evaluate whether there is a relation between the level of shoulder imbalance after scoliosis surgery and patients' satisfaction with treatment. Materials and methods: Twenty-three patients with adolescent idiopathic scoliosis (18 females, 5 males; mean age, 15.9 years; age range, 13-24 years), who were treated by posterior instrumentation and fusion and followed up for an average of 35.4 months (range, 24-67 months) postoperatively, were included in this retrospective clinical study. In order to evaluated shoulder balance on coronal plane, three parameters were measured on postoperative radiography: first rib angle, radiographical shoulder height, and clavicle angle. For the assessment of patients' satisfaction with scoliosis surgery, Scoliosis Research Society (SRS)-22r Patient Questionnaire was used.Results: Fusion was obtained in all patients. On radiography, mean first rib angle was 2.5º±2.8º, shoulder height was 6.0±5.4 mm, and clavicle angle was 1.7º ± 1.5º. The mean values for SRS22r domain scores were between 3.3 and 3.8, being lowest for mental health and highest for pain and self-image. There was no significant correlation between radiographic parameters and total or domain scores of SRS-22r.Conclusions: Shoulder imbalance is a common undesirable effect of correcting thoracic curve in surgical treatment of adolescent idiopathic scoliosis. However, unless it is severe, shoulder imbalance does not cause patient dissatisfaction.Öğe Kalça artroskopisi: Haseki deneyimi(2013) Kaya, İbrahim; Uğraş, Akın; Sungur, İbrahim; Yılmaz, Murat; Bayram, Erhan; Ertürk, Ahmet; Çetinüs, ErcanAmaç: Anatomik olarak derin yerleşimli ve rijit olan kalça eklemi ve çevresinin patolojilerinin tanısı ve tedavisinde kalça artroskopisinin yeri irdelendi ve klinik tecrübelerimiz paylaşıldı. Gereç ve Yöntem: 2011 ve 2012 yılları arasında kliniğimize aksama ve kasıkta ağrı nedeni ile başvuran kalça artroskopisi yapılan hastalar değerlendirildi. Ortalama yaş 35.8 (alt-üst sınır: 17-58)yıl olan olguların üçü bayan, 12’si erkek 15 olgu değerlendirildi. Olguların ameliyat öncesi ve sonrası Harris kalça skoruna bakıldı. Bulgular: Olguların ortalama Harris kalça skoru ameliyat öncesi 62.7 (54-86) iken, ameliyat sonrası 92.5 (82-100) olarak saptandı. Üç hastamızda CAM tipi sıkışma saptanıp traşlandı, beş hastada labrum yırtığı saptanıp ikisi dikildi, diğerleri debride edildi. Bir hastada osteokondral lezyon(OCD) saptanıp ters mozaikoplasti yapıldı. Bir hastada lokalize femur başı avasküler nekroz saptanarak anterior mini açık mozaikoplasti yapıldı. İki hastada eklem içinden serbest cisim, bir hastada eklem içi mermi çıkarıldı. İki hastada eklem içi patoloji saptanmadı. Sonuçlar: Kalça artroskopisi eklem içi ve çevresindeki patolojilerin tanı ve tedavisinde deneyimli ellerde yapıldığı zaman iyi sonuçlar veren minimal invaziv bir tanı ve tedavi yöntemidir. Tekniğin başarısı yüksek olmakla birlikte nörojenik komplikasyonlar açısından cerrah portal yerleşiminde dikkatli olmalı, traksiyon süresini kısa tutmaya çalışmalıdır.Öğe Short-term results of robinson type 2B2 clavicular fractures treated conservatively or surgically(Slack Inc, 2016) Malkoç, Melih; Korkmaz, Özgür; Bayram, Erhan; Örmeci, Tuğrul; İşyar, Mehmet; Yılmaz, Murat; Şeker, AliThe most frequently treated injuries, representing approximately 82% of all clavicular fractures, involve the midshaft clavicle. Historically, most acute displaced midshaft clavicular fractures were treated nonsurgically. However, the outcomes of nonsurgical treatment have recently been thought to be not as good as expected in the past, and the trend is to treat these fractures surgically. The goal of this study was to evaluate the short-term clinical outcomes of Robinson type 2B2 clavicular fractures treated conservatively vs with locked plate fixation. Among 59 patients included in the study, 30 patients (mean age, 45 +/- 13.7 years; range, 30-62 years) treated conservatively were designated as group A, and 29 patients (mean age, 38.8 +/- 11.1 years; range, 20-60 years) treated with locked plate fixation were designated as group B. All patients were evaluated using Oxford and Constant scoring systems at final follow-up. Mean follow-up was 18 months (range, 12-24 months). In group A, mean Constant score was 70.5 +/- 15.1 (range, 98-43) and mean Oxford score was 46.6 +/- 1.3 (range, 49-44) at final follow-up. In group B, mean Constant score was 89.2 +/- 8 (range, 100-77) and mean Oxford score was 46.5 +/- 1.2 (range, 48-44) at final follow-up. Callus was detected radiographically in both groups at 6-week follow-up. Patients in groups A and B started active range-of-motion exercises at weeks 6 and 3 after treatment, respectively. Locked plate fixation of Robinson type 2B2 clavicular fractures can be the first treatment option because of good clinical results, low complication rates, and good cosmesis.Öğe Travmatik anterior omuz çıkıklarında artroskopik bankart tamiri(2013) Kaya, İbrahim; Ertürk, Ahmet; Uğraş, Akın; Bayram, Erhan; Sungur, İbrahim; Yılmaz, Murat; Ordu, Samed; Çetinus, ErcanAmaç: Tekrarlayan anterior omuz çıkığı tedavisinde yapılan artroskopik bankart tamiri sonuçları tartışıldı. Gereç ve Yöntem: Tekrarlayan omuz çıkığı nedeni ile artroskopik bankart tamiri yapılan 16 hasta değerlendirmeye alındı. Dört hasta bayan, 12 hasta erkekti. Tüm hastalara direkt radyografi ve manyetik rezonans görüntüleme yapıldı. Sonuçlar Rowe ve Constant skoru ile değerlendirildi. Bulgular: Ortalama çıkma sayısı 10.2, ortalama Rowe skoru 90.6 ve ortalama Constant skoru 94.3 bulundu. İki hastada eşlik eden süperior labral anterior ve posterior tamir yapıldı. Üç hastada Hill Sachs defekti, üç hastada ise glenoid kenarda defekt mevcuttu. Bir hastamızın ameliyattan 15 ay sonra yeni travma sonrası nüks omuz çıkığı görüldü; tekrar opere edildi. Bir hastamıza vida eklem içi penetrasyonu nedeni ile revizyon yapıldı. Ortalama takip süresi 32.6 aydı. Sonuç: Artroskopik Bankart tamirinin klinik sonuçları iyidir. Ameliyat öncesi çıkık sayısı fazla olan hastalarda revizyon cerrahisine ihtiyaç olabilir; dikkatli olunmalıdır.
