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Öğe Missed diagnosis of a rare retro-patellar juxta-articular angioleiomyoma: A case report(Sage Publications Ltd, 2024) Ghayyad, K.; Xavier, J.; Sarli, N. M.; Golovachev, N.; KILIÇ, Ali İhsan[No abstract available]Öğe Letter to correlation of immediate prevalence of cervical squamous cell precancers and cancers with HPV genotype and age in women with LSIL cytology(Wiley, 2024) Yavuz, Onur; Karaca, İbrahim[No abstract available]Öğe Use of cervical fascia to prevent pharyngocutaneus fistula after total laryngectomy(Wiley, 2024) Zorlu, Mehmet Ekrem; Kertmen, Canberk; Aysel, Abdulhalim; Yilmaz, Fatih; Dalgic, Abdullah; Müderris, TogayObjective: This study aimed to compare the pharyngocutaneous fistula (PCF) between patients who underwent reconstruction using cervical fascia after total laryngectomy and those who did not and to investigate the factors affecting PCF rates. Methods: We retrospectively compared 22 patients operated between February 2021 and March 2023 who received cervical fascia flap as the study group and 21 patients operated between January 2018 and March 2023 who did not receive fascia flap as the control group. The study included patients who underwent total laryngectomy for Stage 3 and 4 squamous cell laryngeal cancer. Results: We included 43 patients, with 22 (51.2%) and 21 patients (48.8%) in the study and control groups, respectively. The age and sex were not different between the two groups (p=0.471, p=0.176, respectively). The distribution of patients as per sex, smoking, alcohol use, chronic obstructive pulmonary disease, diabetes mellitus, coronary artery disease, and multiple comorbidities was similar in both groups (p>0.05). PCF was observed in one patient (4.5%) and seven patients (33.3%) in the study and control groups, respectively. The PCF rate was significantly lower in the study group (p=0.021). When the relationship between flap use and risk factors was compared by correlation analysis, a moderate negative relationship was found between flap use and PCF (p=0.015, r=-0.370). Conclusion: The use of a cervical fascia flap is effective in reducing fistula rates after total laryngectomy. Its main advantages include being technically simpler than alternative techniques, locally available, cost-effective.Öğe Tip surgery in dorsal preservation rhinoplasty: the effect of modified low septal strip septoplasty on tip plasty(Springer, 2025) Celik, Vasfi; Tuluy, Yavuz; Bozkurt, Gokcen cakirBackgroundThe aim in tip surgery is to provide rotation, derotation, projection and deprojection. In this study, we aimed to show the effects of modified low septal strip septoplasty, septal extension graft, TIG technique and additional maneuvers on tip shape in dorsal preservation rhinoplasty (DPR) and to discuss our clinical results.Patients and MethodsOne hundred eighty-nine patients who underwent DPR with modified low septal strip septoplasty between November 2021 and August 2023 were included in the study. Demographic data, complications, revision surgeries and follow-up periods of the patients were analyzed retrospectively.ResultsThe mean age of the patients is 29.58 +/- 9.04 (17-65). The mean follow-up period was 14, 50 +/- 2,98 months. Complications were observed in 1.1% of the patients (n=2/189). Revision surgery was performed in all these patients. Residual hump in 2 were observed and dorsum rasping was performed under local anesthesia. No tip revision was performed on any patient.ConclusionsA strong tip fixation is achieved with the modified low septal septoplasty technique described in this publication, and when combined with septal extension graft, tongue in groove technique and other suture techniques, an effective and permanent tip plasty can be performed in DPR.Level of Evidence IIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.Öğe Quality of life and somatic physical function of patients with colorectal cancer who underwent oxaliplatin-based systemic chemotherapy: a prospective study(Springer, 2024) Tuğral, Alper; Kebabçı, Eyup; Aribas, Zeynep; Akyol, Murat; Can, Aysegul; Bakar, YeşimintroductionThis study aimed to study the potential effects of oxaliplatin-based chemotherapy on cardiorespiratory fitness, handgrip strength (HGS), body composition, and quality of life (QoL) of stages III-IV colorectal cancer (CRC) patients before the first cycle (T0) and after the last cycle of systemic adjuvant/neoadjuvant chemotherapy (T1).MethodsCardiorespiratory fitness, HGS, body composition, and QoL were evaluated with the six-minute walk test (6MWT), hydraulic hand dynamometer, body composition analyzer, and Functional Assessment of Cancer Therapy-Colon (FACT-C) questionnaire in both T0 and T1, respectively.ResultsTwenty-eight CRC patients were included in this study. The total walked distance (TWD) was found to be decreased from T0 to T1 (499.72 m vs. 488.56 m); however, this change was not significant (z = -.706, p = 0.48). Type of chemotherapy whether adjuvant or neoadjuvant also showed no significant effect on TWD (z = -.1.372, p = .17 vs z = -1.180, p = .238, respectively). The QoL was significantly decreased (T0 = 118.35 vs T1 = 110.77, t = 2.176,p = 0.05). The TWD was significantly correlated with the physical well-being (PWB) subscale of FACT-C (r = .64, p = 0.001) as well as with HGS (r = .46, p = .018) in T0. After controlling for age, type of chemotherapy, and type of regimen, the HGS did not show a significant difference from T0 to T1 (F(1,23) = 1.557, p = .22, eta p2 = .06). However, the effect of time x gender showed significant difference from T0 to T1 (F(1,23) = 4.906, p = .037, eta p2 = .17).ConclusionThis study showed the decreased QoL and physical well-being of CRC patients who underwent oxaliplatin-based treatment. In addition, the gender effect of decreased HGS should be considered further when planning an oncological rehabilitation program.Öğe Uterine isthmus contractions during pregnancy(Mosby-Elsevier, 2024) Yavuz, Onur; Karaca, İbrahim[No abstract available]Öğe Characteristics of femoral neck fractures in osteogenesis imperfecta: Series of four-teen consecutive hips in twelve patients(Elsevier Sci Ltd, 2024) Vahabi, Arman; Kaya, Huseyin; Cagiran, Zeynep; Sozbilen, Murat Celal; Kurt, Cengizhan; Gunay, HuseyinIntroduction: While long bone fractures are commonly seen in individuals with Osteogenesis Imperfecta (OI), femoral neck fractures (FNF) are exceedingly rare. There is a lack of comprehensive data regarding the etiology of FNFs, their characteristics, and the treatment protocols. Our aim was to determine the characteristics of femoral neck fractures in children with OI. Materials and methods: This study was conducted as retrospective series covering period of January 2011December 2022. Total of 14 femoral neck fractures in 12 patients were included into final analysis. Age, gender, fracture location, ambulation level, injury mechanism, Sillence type, pre-fracture collo-diaphyseal angle, presence of previous implants and applied treatments were noted. Results: The mean age was 9.3 (range: 3 -16), 8 out of 12 patients were males. Sillence type 3 OI was most common (50 %) type. Among 12 patients, 2 (16.6 %) were restricted ambulatory while 5 (41.6 %) were nonambulatory. Seven patients had prior femoral implants. Six fractures were managed non-operatively, while others underwent surgery, with cannulated screws (42.8 %) or plate osteosynthesis (7.1 %). All eight cases (100 %) with minor trauma or unknown origin were Sillence type 3 -4, displaying varus deformity. FNFs that occured in mobile patients required higher-energy traumas. Conclusion: Femoral neck fractures in OI showed differing trauma mechanisms in ambulatory vs. non-ambulatory patients. Non-surgical treatment may be considered with in patients with high-risk anesthesia concerns, requiring higher level clinical studies.Öğe Comment on blood biomarkers to distinguish complicated and uncomplicated appendicitis in pediatric patients(Elsevier Taiwan, 2024) Bilir, Cemal[No abstract available]Öğe Posteroinferior glenosphere positioning is associated with improved range of motion following reverse shoulder arthroplasty with a 135° inlay humeral component and lateralized glenoid(Mosby-Elsevier, 2024) Pak, Theresa; Ardebol, Javier; Kılıç, Ali İhsan; Sears, Benjamin W.; Lederman, Evan; Werner, Brian C.; Moroder, PhilippBackground: Optimal glenosphere positioning in a lateralized reverse shoulder arthroplasty (RSA) to maximize functional outcomes has yet to be clearly defined. Center of rotation (COR) measurements have largely relied on anteroposterior radiographs, which allow assessment of lateralization and inferior position, but ignore scapular Y radiographs, which may provide an assessment of the posterior and inferior position relative to the acromion. The purpose of this study was to evaluate the COR in the sagittal plane and assess the effect of glenosphere positioning with functional outcomes using a 135 degrees degrees inlay stem with a lateralized glenoid. Methods: A retrospective review was performed on a prospectively maintained multicenter database on patients who underwent primary RSA from 2015 to 2021 with a 135 degrees degrees inlay stem. The COR was measured on minimum 2-year postoperative sagittal plain radiographs using a best-fit circle fit method. A best-fit circle was made on the glenosphere and the center was marked. From there, 4 measurements were made: (1) center to the inner cortex of the coracoid, (2) center to the inner cortex of the anterior acromion, (3) center to the inner cortex of the middle acromion, and (4) center to the inner cortex of the posterior acromion. Regression analysis was performed to evaluate any association between the position of the COR relative to bony landmarks with functional outcomes. Results: A total of 136 RSAs met the study criteria. There was no relation with any of the distances with outcome scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, visual analog scale). In regard to range of motion (ROM), each distance had an effect on at least 1 parameter. The COR to coracoid distance had the broadest association with ROM, with improvements in forward flexion (FF), external rotation (ER0), and internal rotation with the arm at 90 degrees (IR90) (P < .001, P = .031, and P < .001, respectively). The COR to coracoid distance was also the only distance to affect the final FF and IR90. For every 1-mm increase in this distance, there was a 1.8 degrees degrees increase in FF and 1.5 degrees increase in IR90 ((3 (3 = 1.78, 95% confidence interval [CI] 0.85-2.72, P < .001, and (3 = 1.53, 95% CI 0.65-2.41, P < .001; respectively). Conclusion: Evaluation of the COR following RSA in the sagittal plane suggests that a posteroinferior glenosphere position may improve ROM when using a 135 degrees degrees inlay humeral component and a lateralized glenoid. Level of evidence: Level IV; Case Series; Treatment Study (c) 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.Öğe Patients 75 years or older with primary glenohumeral arthritis and an intact rotator cuff show similar clinical improvement after reverse or anatomic total shoulder arthroplasty(Mosby-Elsevier, 2024) Ardebol, Javier; Flores, Adrian; Kılıç, Ali Ihsan; Pak, Theresa; Menendez, Mariano E.; Denard, Patrick J.Background: The optimal management of primary glenohumeral arthritis (GHOA) in the elderly is an ongoing topic of debate. The purpose of this study was to compare functional outcomes and complications in patients aged 75 years or older treated with anatomic total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) for primary GHOA with an intact rotator cuff. Methods: A retrospective study was performed on a prospectively maintained database which was queried for patients 75 years of age or older who underwent TSA or RSA for primary GHOA with an intact rotator cuff at a single institution between 2012 and 2021 with minimum 2 -year follow-up. Patient -reported outcomes (PROs), including Visual Analog Scale for pain, American Shoulder and Elbow Surgeons, and Subjective Shoulder Value, as well as active range of motion including forward flexion, external rotation, internal rotation, were collected preoperatively and postoperatively. Complications, reoperations, and satisfaction were also recorded. The percentage of patients achieving clinically significant improvement was evaluated with the minimally clinical important difference, substantial clinical benefit, and patient acceptable symptomatic state for each PRO. Results: One -hundred and 4 patients were available for analysis, including 67 TSA patients and 37 RSAs with a mean follow-up of 39.4 months. Preoperative baseline characteristics, PROs, and range of motion were similar between groups. RSA was more commonly performed for eccentric glenoid wear (Walch B2/B3, 62% vs. 22%; P < .001). While clinical outcomes improved comparably in both groups, the TSA cohort showed significantly greater improvement in external rotation (36 degrees vs. 26 degrees ; P = .013). Both cohorts had low revision (3% for TSA vs. 0% for RSA) and complication (7% for TSA vs. 5% for RSA; P = .677) rates. Satisfaction was similar in both groups (93% for TSA vs. 92% for RSA; P = .900). Clinically significant improvement was comparable between groups based on the American Shoulder and Elbow Surgeons score (minimally clinical important difference, 93% for TSA vs. 100% for RSA; substantial clinical benefit, 82% vs. 95%; patient acceptable symptomatic state, 67% vs. 78%; P > .05). Conclusion: In this retrospective small sample size comparison study, TSA and RSA provide similar short-term clinical outcomes for patients 75 years and older with primary GHOA and an intact rotator cuff. Complication and revision rates are comparably low at shortterm follow-up. Our data suggests that advanced age alone should not be used as a decision -making tool for TSA vs. RSA in the setting of primary GHOA with an intact rotator cuff. Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study (c) 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.Öğe Pelvic floor imaging in women with hemorrhoidal disease: An anatomical feasibility study(Royal College Surgeons Edinburgh, 2024) Kebapçı, Eyüp; Karaca, İbrahim; Şenkaya, Ayşe Rabia; Hacıoğlu, Ali DorukObjective: To compare pelvic floor muscle and organ structures in women with and without hemorrhoidal disease (HD) using magnetic resonance imaging (MRI). Material and methods: Pelvic MRI measurements and computer-based medical records of women diagnosed with HD between January 2018 and March 2021 were analyzed. Parameters including pubococcygeal distance, puborectal distance, posterior anorectal angle, obturator internus muscle area, presence of levator ani muscle defect, genital hiatus length, vaginal length, uterocervical angle, cervix-upper vagina angle, and cervix-middle vagina angle were evaluated. The control group consisted of women without HD, matched for age and body mass index. Results: Puborectal hiatus distance was higher in the HD group (59.2 +/- 8.7 mm vs. 55.5 +/- 7.1 mm, p = 0.03). Similarly, the distance to the M line was greater in the HD group (18.3 +/- 4.8 mm vs. 16 +/- 4.6 mm, p = 0.04). Obturator internus muscle area was found to be lower in the HD group compared to the non-HD group (1721 +/- 291.4 mm(2) vs. 1897.5 +/- 352.5 mm(2), p = 0.02). Additionally, the presence of unilateral levator ani muscle defect was higher in HD patients (p = 0.03). There was a negative correlation between birthweight and obturator internus muscle area (r = -0.388, p = 0.02), and a positive correlation with M line distance (r = 0.344, p = 0.04). Conclusion: Levator ani muscle defects and obturator internus muscle area, indicators of pelvic floor dysfunction, are more common in patients with hemorrhoidal disease.Öğe Empowering health literacy: Turkiye's health literacy zction plan 2022-2026(Oxford Univ Press, 2024) Soganda, S. Y.; Öztop, Mehmet Burak; Uner, S.; Ornek, M.; Kerman, G.[No abstract available]Öğe Is frozen embryo transfer truly a risk factor for postpartum hemorrhage?(Wiley, 2024) Yavuz, Onur; Karaca, Ibrahim[No abstract available]Öğe Comparison of forearm and intra-arterial blood pressure measurements according to body and arm positions in obese patients(Wiley, 2025) İsmailoğlu, Elif Günay; Aygün, Hakan; Şahan, Seda; Ergin, Eda; Geçtan, ElizRationaleNoninvasive blood pressure (BP) monitoring is very important also difficult for accurate diagnosis and monitor of obese patients.AimsThe study aimed to assess the agreement between forearm arm BP and intra-arterial BP values in a different body and arm positions in obese patients.MethodsThe descriptive study was carried out on 60 intensive care patients with a body mass index above 30 kg/m2 who were monitored with invasive radial BP in the general and surgical intensive care units. BP values obtained from the upper arm and forearm with different arm and body positions were compared with intra-arterial BP results. Bland-Altman analysis and correlation coefficient were used for the accuracy of upper and forearm noninvasive BP reading in different positions.ResultsThe best agreement was found between the forearm systolic BP in the supine and half-sitting position with the arm down and intra-arterial BP values. Also, the best agreement in diastolic BP was found between the half-sitting and half-sitting position with the arm down and intra-arterial BP.ConclusionsForearm systolic BP measurement, especially in the supine and half-sitting position with the arm below the heart level position, was best agreement with intra-arterial measurement, regarded as the gold standard. For this reason, it is more appropriate to use forearm BP measurement in obese patients monitored in intensive care to obtain accurate results.Öğe Splenic artery doppler waveforms in gestational diabetes and association with fetal pancreas: a prospective case-control study(Karger, 2024) Golbasi, Hakan; Bayraktar, Burak; Golbasi, Ceren; Omeroglu, Ibrahim; Cakir, Zubeyde Emiralioglu; Can, Sevim Tuncer; Pehlivanoğlu, Osman ÇağlarIntroduction: This study evaluated fetal pancreas size and echogenicity, and splenic artery (SA) waveforms in pregnant women with gestational diabetes mellitus (GDM). Methods: This prospective case-control study was performed from October 2022 to November 2023 and included 124 pregnant women (62 with GDM and 62 controls). Pancreatic circumference, pancreatic echogenicity, umbilical artery Doppler measurements (systolic/diastolic ratio [S/D] and pulsatility index [PI]), SA Doppler measurements (S/D, PI, peak systolic velocity [PSV], time-averaged maximum velocity, and pressure gradient [PG] mean and maximum) values were compared between the GDM and control groups. Results: The mean pancreatic circumference was higher and grade 2/3 echogenicity was more common in the GDM group, while grade 1 echogenicity was more common in the control group (p < 0.001 and p < 0.001, respectively). SA S/D and PI measurements were significantly higher in the GDM group than in the control group (p < 0.001 and p = 0.001, respectively). Moreover, PG(max) was significantly higher in the GDM group than in the control group (p = 0.038). Pancreatic circumference was positively correlated with SA PSV (p = 0.004). Additionally, pancreatic circumference was positively correlated with PG(mean) and PG(max) (p = 0.010 and p = 0.016, respectively). The increase in pancreas echogenicity was positively correlated with SA S/D and PI measurements (p = 0.007 and p = 0.002, respectively). PG(max) was also positively correlated with increased pancreas echogenicity (p = 0.023). Conclusion: This study showed that fetal pancreas size and echogenicity were significantly higher in pregnant women with GDM than in controls. SA Doppler waveforms were consistent with an increase in vascular resistance associated with elevations of both S/D and PI in the GDM group.Öğe Effect of surface coatings on endothelialization and biofilm in PTFE vascular grafts(Sage Publications Ltd, 2025) Erkan, Muhammet Huseyin; Boga, Mehmet; Salih, Hanife; Barbarus, Emin; Rahman, Ömer Faruk; Sakarya, SarhanPolytetrafluoroethylene (PTFE) grafts are of great importance for vascular surgery and many methods have been developed to improve their biocompatibility. The most important of these methods is the coating of the inner surfaces of the grafts. In this study, the effects of surface coatings used in vascular grafts on endothelialization and bacterial biofilm formation were investigated. Three different PTFE graft types, heparin coated, carbon coated and uncoated, were compared. HUVEC cell culture was used for endothelialization experiments and Staphylococcus aureus strain was used for biofilm formation. Endothelialization was evaluated by inverted microscopy and scanning electron microscopy (SEM). Heparin-coated grafts showed more biofilm formation than other graft types (p < 0.01). Moderate biofilm formation was observed in carbon-coated grafts (p < 0.05). When evaluating endothelialization, heparin-coated grafts showed more cell adhesion in the first days, but lagged behind the other graft types in the following days. Carbon-coated grafts showed more endothelial cell proliferation in the long term. While biofilm formation was high in heparin-coated grafts, carbon-coated grafts provided better endothelialization. Our study showed that the coating of PTFE grafts significantly affects biocompatibility and infection risk.Öğe Flexible reamer use to overcome entry point errors in proximal femoral nail application in severe obese intertrochanteric fracture patients(BMC, 2024) Horoz, Levent; Kılıç, Ali İhsan; Kircil, Cihan; Cakmak, Mehmet FevziIntroduction Proximal femoral nailing (PFN) offers biomechanical benefits for intertrochanteric fractures but can lead to higher complication rates from poor reduction and technique errors, particularly in obese patients. Incorrect entry points may cause reduction loss, iatrogenic fractures, and misplaced lag screws. The study aims to investigate the effect of using an oriented flexible reamer instead of a rigid reamer on clinical and radiological results to obtain a medial entry point and better positioning of the nail in the intramedullary area in obese intertrochanteric fracture patients. Materials and methods A retrospective analysis was conducted on patients aged 65 years and older who underwent PFN treatment between March 2020 and June 2022 at a single institution, with at least 1-year postoperative follow-up. Patients were divided into two groups: those applied with a flexible reamer and a rigid reamer. Parameters analyzed from postoperative radiographs included tip-apex distance (TAD), calcar-referenced tip-apex distance (CalTAD), reduction quality, femoral neck-shaft angle, and lag screw placement. Complication rates and types were recorded for each group. Result The analysis included 91 patients, with 45 treated using a flexible reamer and 46 treated using a rigid reamer. There was no statistical difference between the two groups regarding age, gender, BMI, and AO class distributions of the patients (p > 0.05). The Femur neck shaft angle was significantly higher in the flexible reamer group (p < 0.001). As a result of the reduction types analysis, medial type reduction was significantly higher in the group where the flexible reamer was applied (p < 0.001). The CalTAD was shorter in the Flexible reamer group (p = 0.005). Complications and the need for reoperation were statistically significantly higher in the rigid reamer group (p < 0.048). Conclusion The oriented flexible reamer reduces application-related errors in patients undergoing proximal femoral nail (PFN) treatment due to intertrochanteric fracture. The oriented flexible reamer technique allows a more medial entry point. Oriented flexible reamer creates enough space on both fracture sides at the level of intertrochanteric fracture to avoid nail pass-related complications. Level of evidenceLevel III, Case-control study.Öğe Determining the patient acceptable symptom state (PASS) for shoulder strength after subscapularis arthroscopic repair and evaluating the preoperative predictors for PASS achievement(Sage Publications Inc, 2024) Gonzalez-Morgado, Diego; Ardebol, Javier; Kılıç, Ali İhsan; Noble, Matthew B.; Galasso, Lisa A.; Menendez, Mariano E.; Denard, Patrick J.Background: Restoring shoulder strength after arthroscopic rotator cuff repair (ARCR) is critical, but there is limited understanding as to what patients consider satisfactory postoperative strength.Purpose: To determine the Patient Acceptable Symptom State (PASS) values for the Constant score strength parameter and internal rotation (IR) strength in patients who underwent ARCR for rotator cuff tears involving the subscapularis (SSC) muscle and evaluate for associations between preoperative and intraoperative patient characteristics with PASS achievement.Study Design: Case-control study; Level of evidence, 3.Methods: A retrospective analysis was conducted on prospectively collected data for 278 patients with an SSC tear (isolated or combined) who underwent ARCR and had minimum 2-year follow-up data. Functional outcomes (patient-reported outcomes, range of motion, Constant strength, and IR strength) were assessed preoperatively and at the latest follow-up. The overall, male, and female PASS values for postoperative strength measures were evaluated using receiver operating characteristic analysis. Correlation and logistic regression analyses were used to evaluate the relationship between preoperative variables and PASS achievement for Constant and IR strengths.Results: The mean follow-up time was 72.8 months. The overall, male, and female PASS values were 9.9 lb (4.5 kg), 14.5 lb (6.6 kg), and 8.5 lb (3.9 kg), respectively, for Constant strength and 15.2 lb (6.9 kg), 20.7 lb (9.4 kg), and 12.1 lb (5.5 kg), respectively, for IR strength. Older age, high fatty infiltration of the SSC tendon (Goutallier grades 3 and 4), and failure of SSC healing correlated negatively with PASS attainment for the strength measures. High fatty infiltration of the supraspinatus and infraspinatus muscles correlated negatively with Constant strength. Decreased coracohumeral distance (CHD) and larger SSC tears correlated negatively with achieving PASS for IR strength. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.Conclusion: This study established the PASS values for Constant and IR strengths for patients after ARCR involving the SSC tendon. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.Öğe The subscapularis healing index: A new scoring system for predicting subscapularis healing after arthroscopic repair(Sage Publications Inc, 2024) Kılıç, Ali İhsan; Zuk, Nicholas A.; Ardebol, Javier; Galasso, Lisa A.; Noble, Matthew B.; Menendez, Mariano E.; Denard, Patrick J.Background: Previous research has emphasized the effect of prognostic factors on arthroscopic rotator cuff repair (ARCR) success, but a specific focus on subscapularis (SSC) tendon repair healing is lacking. Purpose: To identify prognostic factors for SSC healing after ARCR and develop the Subscapularis Healing Index (SSC-HI) by incorporating these factors. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective study using prospectively maintained data collected from patients with isolated or combined SSC tears who underwent ARCR between 2011 and 2021 at a single institution with a minimum 2-year follow-up. Functional outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and visual analog scale (VAS) pain scale. SSC tendon healing was evaluated via ultrasound at the final follow-up. Multivariate logistic regression analysis was performed to determine the factors affecting SSC healing, and based on these factors, the SSC-HI, which ranges from 0 to 15 points, was developed using odds ratios (ORs). Results: Among 1018 ARCR patients, 931 met the inclusion criteria; 279 returned voluntarily for postoperative SSC ultrasound assessment. The overall healing failure rate was 10.8% (30/279). Risk factors for healing failure included female sex (P = .008; OR, 3.119), body mass index (BMI) >= 30 (P = .053; OR, 2.323), supraspinatus fatty infiltration >= 3 (P = .033; OR, 3.211), lower SSC fatty infiltration >= 2 (P = .037; OR, 3.608), and Lafosse classification >= 3 (P = .007; OR, 3.224). A 15-point scoring system comprised the following: 3 points for female sex, 2 points for BMI >= 30, 3 points for supraspinatus fatty infiltration >= 3, 4 points for lower SSC fatty infiltration >= 2, and 3 points for Lafosse classification >= 3. Patients with <= 4 points had a 4% healing failure rate, while those with >= 9 points had a 55% rate of healing failure. Patients with a healed SSC reported significantly higher ASES (healed SSC: Delta ASES, 44.7; unhealed SSC: Delta ASES, 29; P < .01) and SSV (healed SSC: Delta SSV, 52.9; unhealed SSC: Delta SSV, 27.5; P < .01) and lower VAS (healed SSC: Delta VAS, -4.2; unhealed SSC: Delta VAS, -3; P < .01) scores compared with those with an unhealed SSC. Conclusion: The SSC-HI scoring system integrates clinical and radiological factors to predict SSC healing after surgical repair. Successful SSC healing was found to be associated with enhanced functional outcomes, underscoring the clinical relevance of SSC healing prediction in the management of these tears.Öğe Minimally invasive extracorporeal circulation versus conventional cardiopulmonary bypass in patients undergoing cardiac surgery (MiECS): Rationale and design of a multicentre randomised trial(Sage Publications Ltd, 2024) Anastasiadis, Kyriakos; Antonitsis, Polychronis; Papazisis, Georgios; Haidich, Bettina; Liebold, Andreas; Punjabi, Prakash; Gunaydin, SerdarIntroduction The ultimate answer to the question whether minimal invasive extracorporeal circulation (MiECC) represents the optimal perfusion technique in contemporary clinical practice remains elusive. The present study is a real-world study that focuses on specific perfusion-related clinical outcomes after cardiac surgery that could potentially be favourably affected by MiECC and thereby influence the future clinical practice.Methods The MiECS study is an international, multi-centre, two-arm randomized controlled trial. Patients undergoing elective or urgent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or combined procedure (CABG + AVR) using extracorporeal circulation will be randomized to MiECC or contemporary conventional cardiopulmonary bypass (cCPB). Use of optimized conventional circuits as controls is acceptable. The study design includes a range of features to prevent bias and is registered at clinicaltrials.gov (NCT05487612).Results The primary outcome is a composite of postoperative serious adverse events that could be related to perfusion technique occurring up to 30 days postoperatively. Secondary outcomes include use of blood products, ICU and hospital length of stay (30 days) as well as health-related quality of life (30 and 90 days).Conclusions The MiECS trial has been designed to overcome perceived limitation of previous trials of MiECC. Results of the proposed study could affect current perfusion practice towards advancement of patient care.
