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Öğe Multiple Metastatic Tuberculosis Abscesses and Pott's Disease in an Immunocompetent Patient: Case Report(Ortadogu Ad Pres & Publ Co, 2011) Ates, Gungor; Ozmen, Cihan Akgul; Yildiz, Tekin; Kisin, Bulent; Akyildiz, LeventMetastatic tuberculous abscess (tuberculous gumma) is a rare form of cutaneous tuberculosis. A 16 years old female presented with painless cutaneous swelling at her neck and right thigh. She also suffered from back pain. She was diagnosed as soft tissue abscess according to ultrasound findings. These abscesses were painless and fluctuant. Chest computed tomography revealed an abscess involving the chest wall and the paravertebral area. Smear and sputum culture were negative for M. tuberculosis. In addition, smears and cultures of the abscess were negative for bacteria and fungi. There was no history of tuberculosis and no contact with patients with contagious tuberculosis. M. tuberculosis grew in the abscess culture. She was diagnosed as tuberculous gumma and Pott's disease. The patient recovered after antituberculous treatment. Subcutaneous abscess should be considered as tuberculosis abscess based on the negative smear and nonspecific culture results of pus.Öğe Post therapeutic lower extremity rotational profiles in children with DDH(British Editorial Soc Bone Joint Surgery, 2008) Arslan, Huseyin; Ersoz, Huseyin; Kisin, Bulent; Kapukaya, Ahmet; Necmioglu, SerdarPurpose The purpose of this study was to investigate post-therapeutic lower extremity rotational profiles in children with developmental dislocation of the hip (DDH), the differences between these values and those of normal children, and the relationship between these differences and clinical and radiological results. Methods In 82 lower extremities of 64 patients, the footprogression angle was measured clinically and the transmalleolar axis angle photographically, and hip rotations and thigh-foot angle were measured both clinically and photographically. The data obtained were compared with Staheli's data for normal children. In addition, clinical and radiographic data were compared within subgroups and with Staheli's data. Student's t-test and one-way ANOVA were used for statistical evaluation. Results The medial rotation of the hip, the average clinical value was 44.668, and the photographic value was 42.288. Lateral rotation of the hip, the average clinical value was 38.018, and the average photographic value was 37.298. Thigh-foot angle, his angle was clinically 8.238 and photographically 9.688. Angle of the transmalleolar axis, the photographic average was 21.598. Foot-progression angle, the clinical average was 10.708. It was determined that the lower extremity rotational profiles of children with DDH treated after walking did not differ from those of normal children, but that the internal and external hip rotations of McKay type III and IV patients were below those of normal children and of McKay type I and II patients. Conclusion Lower extremity rotational profiles in children with DDH who received appropriate treatment were the same as those for normal children.Öğe Segmental Bone Loss in Pediatric Lower Extremity Fractures: Indications and Results of Bone Transport(Lippincott Williams & Wilkins, 2015) Arslan, Huseyin; Ozkul, Emin; Gem, Mehmet; Alemdar, Celil; Sahin, Ilhami; Kisin, BulentBackground: In this study, we evaluated the results of external bone transport, which was applied to 11 patients with traumatic bone loss who had not completed their bone development. Methods: The average age of the 9 male and 2 female patients was 10.6 (range, 8 to 16) years. Eight of the defects were located in the tibia, whereas the other 3 were in the femur. The average defect was 5.4 (range, 4.5 to 8.5) cm. External bone transport was applied in the early period in 7 patients, whereas in 4 patients it was performed due to nonunion. Bifocal osteosynthesis and single osteotomy were performed in 2 patients with type B2 nonunion. Compression to the nonunion region and lengthening in the osteotomy region were applied. In 2 patients with type B1 nonunion, and the other 9 patients who had external bone transport, the gap was eliminated by bifocal osteosynthesis, single osteotomy, and bone transport to the osteotomy line. Results: The mean follow-up period was 21 (range, 13 to 48) months. Complete union was achieved in all patients without any bone operation or graft application. No refracture was observed after the removal of the external fixator, and the average hospitalization time was 16 (range, 7 to 65) days. The average external fixation time was 4.2 (range, 3.5 to 5.5) months, and the mean external fixator index was 0.8 months (23 d/cm). The mean bone healing time was 5.1 (range, 4.6 to 6) months. Conclusions: To initially consider the open fractures with true or in situ bone loss in children as anticipated nonunion, and determine the treatment strategies regarding this fact, may prevent nonunion and shorten the healing period. Bone transport in the treatment of traumatic bone defects in children is an easy biological procedure, with lower complications but higher success ratios.Öğe Should routine pelvic osteotomy be added to the treatment of DDH after 18 months ?(Acta Medica Belgica, 2014) Arslan, Huseyin; Sucu, Ekim; Ozkul, Emin; Gem, Mehmet; Kisin, BulentThe treatment of developmental dysplasia of the hip (DDH) between ages 1-3 years is controversial. Particularly controversial is the age after which pelvic osteotomy should be added to the treatment. In the present study, the outcomes of DDH patients aged 1-3 years treated with anterior open reduction alone were evaluated, and the relationship between inadequate acetabular development, the need for secondary pelvic osteotomy, and age was investigated. A total of 53 patients (70 hips) who had begun walking, who had undergone open reduction through an anterolateral approach, who had a follow-up period of at least 2 years, and who had Tonnis grade III and IV hip dysplasia were included in the study. They were grouped according to treatment age (pre-18 months : Group I; post-18 months : Group II), and the two groups were compared with regard to radiological and functional outcomes and the need for a secondary acetabular procedure. In Group I there were 29 hips (mean age : 16.09 months) and in group II there were 41 hips (mean age : 23.1 months), and the mean follow-up period was 48.9 months. According to the modified Trevor score, in Group I outcomes were excellent in 23 hips (79.3%) and good in 6 hips (20.7%), while in group II outcomes were excellent in 30 hips (73.2%), good in 10 hips (24.4%), and fair in 1 hip (2.1%). The difference between outcomes was not significant (P > 0.05). Inadequate acetabular development was determined in 11 hips in group I (37.9%) and in 16 hips in group II (39%). There was no difference between groups in terms of inadequate acetabular development or the need for acetabular prodecures (p > 0.05). No significant difference was determined between DDH patients treated before 18 months and those treated after 18 months with regard to unsatisfactory acetabular development or the need for secondary acetabular procedures. According to these results, reduction prior to 18 months does not always achieve satisfactory acetabular development, and secondary acetabular procedures are not always necessary in patients who undergo reduction after 18 months. In the treatment of DDH, the decision to perform primary pelvic osteotomy in addition to open reduction should be made not according to whether the patient is older or younger than 18 months, but according to stability, and all patients should be followed closely with regard to the need for pelvic osteotomy.Öğe Surgical treatment outcome for open supracondylar humerus fractures in children(Acta Medica Belgica, 2013) Ozkul, Emin; Gem, Mehmet; Arslan, Huseyin; Alemdar, Celil; Demirtas, Abdullah; Kisin, BulentAlthough numerous studies have been conducted on supracondylar humerus fractures in children, there is only a limited number of studies regarding the outcome of open fractures. In this study, the early and late outcome of open supracondylar humerus fractures in children were evaluated. The outcome in 26 children (19 males, 7 females) treated for open supracondylar humerus fractures was evaluated retrospectively. The mean age was 7.3 years (range : 4 to 14) and the mean follow-up period was 43 years (range : 2-8). According to the Gustilo-Anderson classification, 18 patients (69%) had type 1 and 8 patients (31%) type 2 open fractures. Nine patients (34%) presented with a nerve injury. Distal pulses could not be detected in four patients (15%). Functional outcomes were evaluated according to the scoring criteria by Flynn et al. Pin tract infection developed in one patient (3%). Artery repair via an anterior approach was performed in one patient. In nine patients with neurological symptoms, nerve functions were restored within three to six months. The mean union time was six weeks (5-8 weeks). According to the scoring criteria by Flynn et al, an excellent outcome was achieved in 23 patients, and a successful outcome in 3 patients. According to these findings, although vascular and nerve injuries frequently accompany open supracondylar humerus fractures in children, the late radiological and functional outcome was as good as in closed fractures.
