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Öğe Alpha-fetoprotein (AFP) elevation gastric adenocarcinoma and importance of AFP change in tumor response evaluation(Asian Pacific Organization for Cancer Prevention, 2015) Tatli A.M.; Urakci Z.; Kalender M.E.; Arslan H.; Taştekin D.; Kaplan M.A.Background: Elevated serum alpha-fetoprotein (AFP) levels in adults are considered abnormal. This parameter is used mostly in the diagnosis and follow-up of hepatocellular carcinomas and yolk sac tumors. Among the other rare tumors accompanied with elevated serum AFP levels, gastric cancer is the most common. In this study, we evaluated the follow-up and comparison of the treatment and marker response of patients with metastatic gastric cancer who had elevated serum AFP levels. Materials and Methods: We performed a retrospective study, including all consecutive patients with advanced gastric cancer, who received systemic chemotherapy with elevated AFP level. Results: Seventeen metastatic gastric cancer patients with elevated AFP levels at the time of diagnosis were evaluated. Fourteen (82.4%) were males and three (17.6%) were females. The primary tumor localization was the gastric body in 8 (76.4%), cardia in 7 (41.2%), and antrum in 2 (11.8%). Hepatic metastasis was observed in 13 (76.4%) at the time of diagnosis. When the relationship of AFP levels and carcinoembryonic antigen (CEA) response of the patients with their radiologic responses was evaluated, it was found that the radiologic response was compatible with AFP response in 16 (94.1%) patients and with CEA response in 12 (70.6%); however, in 5 (29.4%) patients no accordance was observed between radiological and CEA responses. Conclusions: Follow-up of AFP levels in metastatic gastric cancer patients with elevated AFP levels may allow prediction of early treatment response and could be more useful than the CEA marker for follow-up in response evaluation.Öğe Comparison between the results of intramedullary nailing and compression plate fixation in the treatment of humerus fractures(2003) Kesemenli C.C.; Subaşi M.; Arslan H.; Necmioglu S.; Kapukaya A.OBJECTIVES: The results of open reduction and internal fixation of humeral shaft fractures by either an intramedullary nail or a dynamic compression plate were compared. METHODS: The study included 60 patients (43 males, 17 females; mean age 38 years; range 19 to 61 years) with humerus fractures. Thirty-three patients were treated with intramedullary nails and 27 patients with dynamic compression plates. Functional results were evaluated according to the Stewart and Hundley's criteria. The two methods were compared. The mean follow-up period was 42 months (range 28 to 72 months). RESULTS: Healing times did not differ between the two treatment groups (p>0.05). Radial nerve palsy occurred only in the dynamic compression plate group, with four patients being affected. On the other hand, the rate of non-union was significantly higher in patients treated with intramedullary nailing (p<0.05). CONCLUSION: No ideal fixation technique exists in the treatment of humerus fractures. Despite higher non-union rates, intramedullary nailing may be the method of choice in the treatment of humerus fractures because of such advantages as low morbidity, small dissection of soft tissues, and greater ease of application.Öğe Congenital patellar aplasia in conjunction with trisomy 8. A case report(2004) Arslan H.; Kapukaya A.; Kayikçi C.; Demircan A.Congenital patellar aplasia and hypoplasia are quite rare. Bilateral flexion deformity of the fifth finger, patellar aplasia in the right knee and patellar hypoplasia in the left knee were noted in a 6-year-old boy brought in for treatment of curvature of both little fingers. Active and passive movements of the knees were within normal range, and the quadriceps muscle was of normal strength. Trisomy 8 was determined on chromosome analysis. In contrast with the literature, the patellar abnormality was not concomitant with any other syndromes in our case, and most clinical findings of trisomy 8 were absent.Öğe Distraction osteotomy for malunion of the distal end of the radius with radial shortening(2003) Arslan H.; Subasi M.; Kesemenli C.; Kapukaya A.; Necmioglu S.The treatment and outcomes of distraction osteotomy in 9 patients with malunion of the distal radius with radial shortening are presented. The patients had an average age of 32 years (range: 14 to 36 years) and comprised 7 males and 2 females. Ulnar inclination was below normal in all patients, volar inclination was below normal in 8 patients, and the average radial length discrepancy was 7.6 mm (range: 4 to 16 mm). Angulations in the distal radius were corrected by manipulation after osteotomy, and shortening by callus distraction. In order to achieve normal radial length, distraction was performed for an average of 10.2 days (range: 7 to 19 days), and union occurred in an average of 10.7 weeks (range: 9 to 13 weeks). During the waiting period between distraction and consolidation, impairment of ulnar and volar inclination recurred in 3 patients, and translation of the distal fragment necessitating correction occurred in 3 patients. No cases of nonunion or malunion were observed. In all patients, there was a decrease in cosmetic and pain-related complaints, and improvement in wrist movements. Distraction osteotomy is a simple and effective treatment for malunion of the distal radius with concurrent radial shortening. However, the position of the distal fragment should be followed up until consolidation.Öğe Early prophylactic autogenous bone grafting in type III open tibial fractures(2004) Kesemenli C.C.; Kapukaya A.; Subaşi M.; Arslan H.; NecmioğLu S.; Kayikçi C.The authors report the results achieved in patients with type III open tibial fractures who underwent primary autogenous bone grafting at the time of debridement and skeletal stabilisation. Twenty patients with a mean age of 35.8 years (range, 24-55) were treated between 1996 and 1999. Eight fractures were type IIIA, 11 were type IIIB, and 1 was type IIIC. At the index procedure, wound debridement, external fixation and autogenous bone grafting with bone coverage were achieved. The mean follow-up period was 46 months (range, 34-55). The mean time to fixator removal was 21 weeks (range, 14-35), and the mean time to union was 28 weeks (range, 19-45). Skin coverage was achieved by a myocutaneous flap in 2 patients, late primary closure in 4, and split skin grafting in 14. One (5%) of the patients experienced delayed union, and 1 (5%) developed infection. In tibial type III open fractures, skin coverage may be delayed, using the surrounding soft tissue to cover any exposed bone after thorough debridement and wound cleansing. Primary prophylactic bone grafting performed at the same time reduces the rate of delayed union, shortens the time to union, and does not increase the infection rate.Öğe The effects of osteoporosis on distraction osteogenesis: An experimental study in an ovariectomised rabbit model(2003) Arslan H.; Ketani A.; Gezici A.; Kapukaya A.; Necmioğlu S.; Kesemenli C.; Subasi M.The effects of oestrogen deficiency-associated osteoporosis on callus distraction were investigated in rabbits. Twenty-four female New Zealand rabbits 5 to 6 months old were used. Ovariectomy was performed on 12 rabbits, which composed the osteoporotic model group. Six weeks later, osteotomy was carried out and Ilizarov external fixators were applied to the right proximal tibial metaphyses in both the osteoporotic model group and the control group. Beginning one week postosteotomy, the metaphyses were distracted 0.35 mm twice daily for 3 weeks, and the average length increase obtained for both groups was 17.2 mm (minimum: 16.8, maximum: 19 mm). Following a postdistraction waiting period of 6 weeks for newbone formation, the subjects were sacrified and specimens were examined histopathologically. Radiography was carried out at one-week intervals during the distraction period and at 2-week intervals during the waiting period, and scintigraphy was performed at the end of each period. On histopathologic examination, a significant difference in callus remodeling was observed between the control and osteoporotic model groups. On radiologic evaluation it was observed that, while both groups had inadequate callus tissue at the end of the waiting period, callus formation and remodeling occurred later in the model group than in the control group, and the new bone was more osteoporotic. Osteoporosis associated with estrogen deficiency adversely affects the outcome of callus distraction. Nonetheless, radiographic findings in rabbits indicate that the effects may not be so great as to preclude clinical procedures. It was concluded that these results should be supported with clinical studies.Öğe The floating knee in adults: twenty-four cases of ipsilateral fractures of the femur and the tibia(2003) Arslan H.; Kapukaya A.; Kesemenli C.C.; Necmioglu S.; Subaşi M.; Coban V.OBJECTIVES: We evaluated the presenting features of ipsilateral femoral and tibial fractures in adults, and the effects of both fracture type and severity of skeletal injury on the results. METHODS: The study included 24 patients (22 men, 2 women; mean age 38 years; range 17 to 75 years). According to the classification by Letts et al., the types of the fractures were as follows: type A (7), type B (2), type C (5), type D (7), and type E (3). Femur fractures were treated by locked intramedullary nails, AO plates, plate-screws, unilateral external fixator, or dynamic condylar screws, and tibia fractures by external fixator, plate-screws, locked intramedullary nailing, or with conservative methods. Amputation at the fracture level was required in a patient with type 3C open tibia fracture. The mean follow-up was 3.2 years (range 1.3 to 7 years). RESULTS: According to the criteria by Kalström and Olerud, the results were excellent in three patients, good in nine patients, fair in five patients, and poor in six patients. The mean skeletal injury scores were 4.4 and 3 in patients having fair and poor results and in those with good and excellent results, respectively. Fair and poor results corresponded to type A (1 patient), type C, type D, or type E fractures. Five patients with type 3 open fractures had fair or poor results. Thirteen patients (54%) had at least one complication. CONCLUSION: Patients with type C, D, or E fractures and those with greater skeletal injury scores are more likely to have fair or poor results due to the open nature of the fracture and to increased involvement of the knee joint. Although there is not an ideal method, rigid internal fixation seems to be more appropriate in fractures other than type 3 open tibia fractures.Öğe Management of comminuted closed tibial plafond fractures using circular external fixators(2005) Kapukaya A.; Subasi M.; Arslan H.Various types of external fixators have been used to treat Ruedi and Allgöwer Type III pilon fractures, as serious complications can occur using conventional treatment principles. However, insufficient reduction and loss of reduction are two of the main disadvantages of external fixator treatments. We conducted a retrospective review of 14 patients with severe highly comminuted closed fractures of the distal tibia (Ruedi type III) treated using cross-ankle external fixators. Five patients underwent closed reduction, while the others required open reduction using minimal incision techniques. The reduction score, reduction loss, early and late complications, and ankle symptoms and functions were evaluated. The patients were followed for an average of 48 months (range: 31 to 84); superficial wound infection developed in one case and minimal angular deformity in another. In ten cases, the reduction of the articular surface was anatomical; in the other four cases, it was non-anatomical. Except for one case which developed an angular deformity, no loss of reduction was observed. On radiological control, only one case did not display osteoarthrosis; in the other 13 cases, osteoarthrosis was diagnosed at different levels. The most important disadvantage of this technique is retarded joint movement. Nevertheless, for such fractures, we consider cross-ankle circular external fixators as an alternative treatment method because it combines the advantage of a minimal risk of deep infections with better stabilisation of the limb, while providing early mobilisation. © 2005, Acta Orthopædica Belgica.Öğe Metacarpal lengthening by distraction osteogenesis in childhood brachydactyly(2001) Arslan H.Metacarpal lengthening was performed by callus distraction in six children with brachydactyly. Four of the patients were girls and two were boys, with ages ranging from 10 to 14 years (mean age: 12 years). Four of the patients had brachydactyly resulting from injury to the hand and damage to the epiphysis related to infection, while the other two had congenital brachymetacarpia. Two patients had short thumbs, two had short index fingers, and the remaining two had short ring fingers. General anesthesia with a pneumatic tourniquet was used during surgery for all patients. Distraction was initiated on the sixth day following osteotomy, and distractions of 0.25 mm were carried out at 12-hour intervals. Adequate length was achieved in an average of 37 days (32-44), and adequate union of the bone in an average of 12.2 (11.5-15) weeks. No bone grafting was done. In one patient with congenital brachymetacarpia, it was not possible to achieve the desired length because of bending in the Kirshner wires, but union of the bone occurred without difficulty, and the outcome was satisfactory. Although single-stage metacarpal lengthening by callus distraction is time-consuming, it is a simple procedure without complications, which can be used in children with brachydactyly.Öğe The middle period outcome of partial patellectomy for the treatment of comminuted patella fractures(2001) Kesemenli C.C.; Subaşi M.; Kirkgöz T.; Arslan H.; Necmioglu S.The fracture of the biggest sesamoid bone patella is encountered at a rate of 1% of all skeletal injuries. Partial patellectomy is advised in the treatment of comminuted fractures of patella. In this retrospective study, we evaluated 18 of 25 patients who had partial patellectomy in our clinic between 1986-1997. Five patients were female (%27.8) and 13 were male (%72.2). The mechanisms of injuries were as follows: 11 (%61) motor vehicle accidents; 4 (%22) falls from flat-roofed house; 2 (%11) gunshot; and 1 (%5) subsidence. The mean age of the patients was 34.3 (range, 13-65). Ten left (%55) and eight right (%45) partial patellectomy were performed. Ten (%55) patients had also additional pathologies. The median follow-up time was 5.2 years (range, 2-11 years). Patients were very well in the last follow-up. According to Cincinnati Knee Score, which was improved by Noyes, 5 patients (%30) had excellent, 8 (%42) good 3(%17) moderate and 2 (%11) bad results. In conclusion, in the following years, enlargement in patellar articular surface and ossification, which is developed compensationally in the extensor mechanism may be detected and misevaluated as osteoarthrosis. Hence, we determined that they had not restricted knee joint functions in our cases.Öğe Popliteal artery injuries associated with fractures and dislocations about the knee(2001) Subasi M.; Cakir O.; Kesemenli C.; Arslan H.; Necmioglu S.; Eren N.The authors present the results of a retrospective review of popliteal artery injuries associated with fractures and dislocations about the knee. They treated 41 patients with popliteal artery injuries associated with either fractures about the knee or knee dislocations. Thirty-five of the patients were males, 6 females; the mean age was 23 years. The delay before accessing the hospital was 17 hours (range: 3 hours to 10 days). Thirty-two fractures were open. Together with the vascular injury, 12 femoral fractures, 20 tibial and fibular fractures, 5 knee dislocations, 4 femoral + tibial fractures were identified. Twenty-three patients underwent external fixation, 8 internal fixation, 6 plaster cast immobilization, 4 minimal osteosynthesis and plaster cast immobilization. The arterial injury was treated by end-to-end anastomosis in 5 cases, saphenous vein anastomosis in 29 cases and thrombectomy in 7 cases. Nine patients were amputed. Delay in surgery, blunt trauma, extensive soft tissue defect and bone fracture or dislocation, are associated with high amputation rate following popliteal artery injury. The influence of each of these factors alone on the amputation rate could not be evaluated in this study, as no statistically significant correlation could be demonstrated.Öğe Treatment of humeral diaphyseal nonunions by interlocked nailing and autologous bone grafting(2002) Kesemenli C.C.; Subasi M.; Arslan H.; Necmioğlu S.; Kapukaya A.Twenty seven patients with humeral diaphyseal nonunion treated with interlocked nailing and autogenous bone grafting were retrospectively assessed. The mean age was 37 years (28 to 59 years). There were 16 women and 11 men. An average of 11 months (8 to 36 months) had elapsed between the initial trauma or treatment and presentation in our clinic. The nonunion site was in the distal third of the humerus in 18 patients (66%) and in the middle third in 9 (34%). Seventeen (73%) had hypertrophic and 10 (37%) atrophic nonunion. Patients were treated with locked intramedullary nailing and autogenous cancellous bone grafting. The mean follow-up was 42 months (28 to 62 months), and the mean time to union was 4.8 months (2.5 to 11 months). Three patients developed superficial infection. Union was achieved in all cases but one, in which there was multiple nerve injury. According to Steward and Hundley's scoring, results were good in 24 patients, fair in 2, and poor in one. Interlocked nailing and autologous bone grafting has a good rate of union provided nails of appropriate diameter are used and distal and proximal locking is performed correctly. We think that its low rate of infection, low risk of injury to the radial nerve, and low requirement for soft tissue dissection make it a suitable choice in the treatment of nonunions of the humeral diaphysis.Öğe Treatment of intertrochanteric fractures in elderly patients with Leinbach type endoprostheses(2001) Kesemenli C.; Subaşi M.; Arslan H.; Kirkgöz T.; Necmioglu S.Intertrochanteric fractures are seen in elderly ages and occur mostly by minor trauma. Mortality and morbidity rates are high and internal fixation and external methods are used for the treatment. Twenty-seven patients with intertrochanteric fractures who were at the mean age of 78 ranging between 71-95 and were treated by Leinbach type endoprosthesis during 1995-1999 were evaluated. Fourteen (%51) patients were female and 13 (%49) were male. The patients underwent operation as early as they were convenient. If they could, they were advised to walk at the second or third day of the operation. Two (%7) patients died at the end of the operation and 1 (%3.7) patient died during the first week after the operation. The patients were followed up mean 14(5-21) months and evaluated according to the criteria of American Academy of Orthopedic Surgeons which displayed good results in %80 of patients. In elderly patients with intertrochanteric fractures due to pathologies and related complications and also complications due to immobilization are seen frequently. Treatment with endoprosthesis is thought to be helpful in decreasing these complications and early mobilization of the patients.Öğe Treatment of traumatic bone defects by bone transport(2001) Kesemenli C.; Subasi M.; Kirkgoz T.; Kapukaya A.; Arslan H.This study retrospectively evaluates the results of the management using the callus distraction method, of 19 patients who had developed bone defects following acute trauma. Sixteen patients were males, with a mean age of 19.4 years (6-41 years). Thirteen patients developed bone defects as a result of high-velocity gunshot injuries, and six had defects caused by traffic accidents. The location of 12 fractures was the tibia, and seven were in the femur. The mean follow-up period was 23.6 (12-40) months. The mean length of the bone defect was 6.8 cm (4-16 cm), the distraction index was 13.3 days/cm (7.5-18 days/cm) and the external fixation index was 36.6 days/cm (32.5-46 days/cm). Fifteen (9%) pintract infections were observed among those who underwent circular external fixation and four (10%) in cases who underwent unilateral external fixation. There were no deep infections. Refracture was noted in one patient (5%), and two (11%) had delayed union at the target site. One patient developed nonunion at the target site. For the treatment of large bone defects, the callus distraction method may be an alternative option to conventional treatment methods.Öğe The treatment outcomes of children with Gustilo-Anderson grade II and grade III open fractures of the long bone(2002) Arslan H.; Necmioglu S.; Kesemenli C.; Subaşi M.; Ersuz H.BACKGROUND: We evaluated the treatment results in thirty-two children who had grade 2 and 3 open fractures according to classification of Gustilo-Anderson. METHODS: There were 21 (%65) male and 11 female (%35) patient and the mean age was 9 years (range, 4-14 years). There were 18 (%56) grade-2, 7 (%22) grade-3A, 5 (%15) grade-3B, and 2 (%6) grade-3C open fracture. All fractures were irrigated and debrided, and then fixed with external fixators. The average duration of follow-up was 11 months (range, 6-28 month). RESULTS: All fractures healed. Inadequate recovering was detected in four patients who had nerve injury, in addition the joint limiting contracture occurred on six patients. CONCLUSION: Fracture union without segmental bone loss is not a significant problem in open fractures in children, and that joint contractures, compartment syndrome and nerve injuries negatively affect the late outcomes.
