RESUMEN
Background: This study aimed to investigate whether periprosthetic joint infection (PJI) can be predicted by the C-reactive protein-to-lymphocyte ratio (CLR), whether this ratio increases the accuracy of PJI diagnosis, and whether it is more sensitive than other blood values and ratios. Methods: The patients were divided into two groups: the septic revision (SR) group and the aseptic revision (AR) group. In cases of septic revision, the diagnosis of PJI was made based on the criteria proposed by the European Bone and Joint Infection Society (EBJIS). The groups were compared in terms of age, sex, body mass index, comorbidity, and preoperative laboratory results. The sensitivity, specificity, and diagnostic performance of the values and ratios were analyzed and compared. Results: The receiver operating characteristic (ROC) analysis for the CLR gave a diagnostic value of 15.52, which provided a sensitivity of 91.1% and a specificity of 64.2% for PJI. The CLR gave lower specificity and higher sensitivity compared to the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) values. The ROC analysis showed that the CLR had a similar area under the curve (AUC) with the ESR and CRP (0.808). The CLR had a higher specificity than other ratios (platelet volume ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio) and a higher value of the AUC. In the multivariate analysis, the CLR (hazard ratio, 1.088; 95% confidence interval, 1.063-1.113; p < 0.001) was found to be a significant risk factor. As CLR increased by one unit, the risk of PJI increased by 1.088 times, and it was statistically significant (p < 0.001). Conclusions: The findings of this study suggest that CLR can serve as a valuable screening tool for diagnosing PJI. CLR demonstrated higher sensitivity in predicting PJI compared to ESR and CRP, and it exhibited greater specificity than other infection markers.
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Artritis Infecciosa , Artroplastia de Reemplazo de Cadera , Infecciones Relacionadas con Prótesis , Humanos , Proteína C-Reactiva , Biomarcadores , Infecciones Relacionadas con Prótesis/etiología , Artroplastia de Reemplazo de Cadera/efectos adversos , Artritis Infecciosa/cirugía , Sedimentación Sanguínea , Linfocitos/química , Estudios RetrospectivosRESUMEN
OBJECTIVES: This study aims to analyze whether the lateral posterior condylar offset (LPCO) and lateral posterior tibial slope (LPTS) values are associated with the presence of fabella by evaluating the frequency of fabella, its location, and whether it is bilateral and the relationship of the fabella with age, sex, and the presence of osteoarthritis. PATIENTS AND METHODS: Between January 2016 and December 2020, computed tomography (CT) scans including 1,952 knee regions of 1,220 patients (861 males, 359 females; mean age: 54.5±19.7 years; range, 10 to 98 years) were retrospectively analyzed. Age, sex, and the presence of fabella whether unilateral (left or right) or bilateral were recorded. Of the patients with a bilateral knee CT, those with fabella on one side and without on the other were studied further to investigate the effect of fabella on the posterolateral corner (PLC). In these patients, the LPCO and LPTS values, presence of knee osteoarthritis, fabella-femoral distance, and sagittal anterior-posterior diameter of the fabella were evaluated. RESULTS: While there was no evidence of fabella in 867 (71.1%) patients, it was present in 353 (28.9%) patients. The linear correlation analysis revealed that the correlations between the right LPCO and the right LPTS (r=-0.295; p<0.001) and between the left LPCO and the left LPTS (r=-0.574; p<0.001) were significant. It was observed that LPTS decreased with increasing LPCO. According to the results of the point biserial correlation analysis, there was a significant correlation between the presence of fabella on the right side and the right LPCO value (r=-0.643; p<0.001) and between the presence of fabella on the left side and the left LPCO (r=-0.284; p=0.024). When the two knees were compared, fabella was less present in the knee whose LPCO was higher than that of the other knee, whereas it was more common in the knee whose LPCO was lower than that of the other knee. We found a significant correlation between each side's fabella and LPCO values and between the presence of fabella on the left side and the left LPTS. CONCLUSION: The presence of fabella in the knee joint may be associated with LPCO and LPTS values of the knee. The comparison of the two knees of the same patient may reveal that if a fabella is present in a knee, the LPCO value of that knee is lower than that of the other knee. We believe that the reason for this is that the presence of fabella increases the distance to the center of rotation of the knee joint.
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Osteoartritis de la Rodilla , Huesos Sesamoideos , Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Anciano , Prevalencia , Estudios Retrospectivos , Articulación de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/epidemiologíaRESUMEN
BACKGROUND: C-reactive protein-to-lymphocyte ratio (CLR), C-reactive protein/albumin (CRP/ALB), and CRP are prognostic factors for outcome and survival in oncology and digestive surgery. CLR has not been studied for the prediction of mortality in hip fracture. The aim of this study is to investigate whether there is an association between pre-operative CLR, CRP/ALB, and CRP levels in patients with hip fracture and patient survival. METHODS: The medical reports of the patients who underwent surgery with a diagnosis of hip fracture in our hospital between January 2016 and December 2019 were retrospectively reviewed. The patients were divided into two groups (Group E: Those who died within 1 month and Group S: Those who died after the 1st month or those who survived). A total of 19 parameters, namely, included ' blood parameters including hemoglobin, C-reactive protein, albumin, lymphocytes, neutrophils, monocytes, platelets, PLR, NLR, LMR, CLR CRP/ALB ratios, gender, American Society of Anesthesiologists, Charlson Comorbidity Index, delirium, infections, repeated surgeries, and type of anesthesia were evaluated preoperatively and on the post-operative 2nd and 5th days and 1 month. RESULTS: A total of 165 patients with the mean age of 83.09±8.52 years who met the inclusion criteria were studied. The pre-op-erative means of CRP, neutrophil count, CLR ratio, and CRP/ALB ratio were statistically significantly higher in Group E than in Group S (p=0.016, p=0.023, p=0.035, and p=0.044, respectively). The univariate regression analysis showed that age, pre-operative Hb level, CRP, and CRP/ALB ratio were significant predictors of the 1-month mortality (ß=-0.335, p=0.049; ß=0.411, p=0.028; ß=3.632, p=0.007; and ß=-3.280, p=0.008; respectively). When we performed the ROC curve analysis, the CRP/ALB ratio had the highest AUC, with the highest sensitivity and specificity. The cutoff value of CRP/ALB ratio was found to be 12.42. CONCLUSION: We found that the pre-operative CRP/ALB ratio is an important parameter for predicting the first 30-day mortality in elderly patients with intertrochanteric femur fractures. For this reason, we recommend that CRP and albumin be checked in prepa-ration for routine pre-operative anesthesia.
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Proteína C-Reactiva , Fracturas de Cadera , Anciano , Anciano de 80 o más Años , Biomarcadores , Proteína C-Reactiva/análisis , Fracturas de Cadera/cirugía , Humanos , Pronóstico , Estudios Retrospectivos , Albúmina Sérica/análisisRESUMEN
The purpose of this study was to compare Prostaglandin E(2) (PGE(2)) levels in gingival crevicular fluid (GCF) of young adults with maxillary constriction during tooth- and bone-borne expansion. Thirty patients, 15 females and 15 males, with a mean age of 17.3 +/- 2.8 years were divided into three groups. Group I consisted of 10 patients, five females and five males, treated by transpalatal distraction (TPD) as a bone-borne device, group II 10 patients, five females and five males, with a Hyrax appliance as a tooth-borne device, and a control group of 10 patients, five females and five males, without any expansion appliances. GCF samples were collected with filter paper strips at six observation periods in order to evaluate the effect of heavy orthopaedic forces in both groups. In group II, the samples were additionally collected at two pre-treatment time points in order to evaluate the effect of the forces generated by the separators. An automated enzyme immunoassay was used to measure PGE(2) in the GCF. The differences within the groups were evaluated with a pairwise t-test and the differences between the groups were determined by the Mann-Whitney U-test. The mean PGE(2) level was significantly elevated on day 4 after placement of the separators in group II (P < 0.05). The PGE(2) values in group II were significantly different to those in group I and the controls at all observation periods. Lower PGE(2) levels were observed in group I compared with group II and the controls. Expansion using the TPD method could potentially enhance the prognosis of the teeth by inducing more skeletal dental changes when compared with the Hyrax appliance.
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Dinoprostona/análisis , Líquido del Surco Gingival/química , Osteogénesis por Distracción/métodos , Técnica de Expansión Palatina , Adolescente , Fenómenos Biomecánicos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Maxilar/cirugía , Diseño de Aparato Ortodóncico , Retenedores Ortodóncicos , Osteogénesis por Distracción/instrumentación , Osteotomía/métodos , Técnica de Expansión Palatina/instrumentación , Estrés MecánicoRESUMEN
During septorhinoplasty procedures lacrimal drainage systems are susceptible to injury because of the close relationship of the nasal bones. Most of the injuries to the system remain asymptomatic. Here we report a case of septorhinoplasty which was complicated by acute dacryocystitis postoperatively. The patient was treated successfully with appropriate medical therapy.
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Dacriocistitis/etiología , Tabique Nasal/cirugía , Complicaciones Posoperatorias , Rinoplastia/métodos , Enfermedad Aguda , Adulto , Humanos , MasculinoRESUMEN
A 24-year-old man with a bilateral cleft lip and palate was treated by a multidisciplinary team composed of an orthodontist, plastic surgeon, and prosthodontist with assistance from an engineer. Before treatment, clinical photographs, dental casts, lateral and posteroanterior cephalograms, periapical and panoramic radiographs, and three-dimensional computed tomography (3D CT) images were obtained. He presented with a narrow and retrognathic maxilla with a 23-mm anterior open bite. Following maxillary expansion with rapid palatal expansion, a Le Fort I maxillary osteotomy was performed, and an internal distractor was placed. After a 5-day latency period, internal maxillary distraction was performed at a rate of 1 mm/day achieved by two activations per day. Cephalometric analysis showed a 7-mm maxillary advancement. Mandibular bilateral sagittal split osteotomy was also performed to close the open bite following maxillary distraction and a 3-month stabilization period. Finally, the treatment was completed with prosthetic rehabilitation. The changes in speech production were evaluated using an automatic speech recognition system.
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Labio Leporino/cirugía , Fisura del Paladar/cirugía , Fijadores Internos , Osteogénesis por Distracción/instrumentación , Cefalometría , Prótesis de Recubrimiento , Humanos , Imagenología Tridimensional , Masculino , Mandíbula/cirugía , Maxilar/cirugía , Modelos Dentales , Mordida Abierta/cirugía , Osteotomía Le Fort , Técnica de Expansión Palatina , Grupo de Atención al Paciente , Fotografía Dental , Radiografía de Mordida Lateral , Radiografía Panorámica , Retrognatismo/cirugía , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVE: To determine whether interleukin 1beta (IL-1beta) levels are elevated around microscrew implants that are used as anchorage for tooth movement. MATERIALS AND METHODS: Ten young adults, aged 16.3 +/- 2.5 years and with all four premolars extracted , comprised the study group. Twenty maxillary microscrew implants were placed bilaterally in the alveolar bone between the maxillary second premolars and first molars as anchorage units for distal movement of the maxillary canines. The maxillary canines served as the treatment group, and the microscrew implants were designated as the implant group. The mandibular canines were used as controls. Peri-microscrew implant crevicular fluid (MICF) and gingival crevicular fluid (GCF) were collected at the beginning of tooth movement (2 weeks after implant placement); at 24, 48, and 168 hours later; and on days 14 and 21. An automated enzyme immunoassay was used to measure 1L-1beta in the MICF and the GCF. RESULTS: The mean 1L-1beta level in the treatment group was significantly elevated at 24 hours (P = .003 < .05) and 48 hours (P = .003 < .05), whereas the levels in the control and implant groups did not change significantly during the experimental period. Also, the mean 1L-1beta level of the treatment group was significantly higher that in both the control and implant groups at 24 and 48 hours. CONCLUSIONS: The microscrew implants did not demonstrate increased 1L-1beta levels during tooth movement. This supports the concept that microscrew implants might be useful as absolute anchorage devices.
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Tornillos Óseos , Líquido del Surco Gingival/química , Interleucina-1beta/análisis , Métodos de Anclaje en Ortodoncia/instrumentación , Técnicas de Movimiento Dental/instrumentación , Adolescente , Femenino , Humanos , Masculino , Estadísticas no Paramétricas , Factores de TiempoRESUMEN
An adult male patient who presented with an anterior open bite and a narrow maxilla was treated using a transpalatal distractor (TPD). Transpalatal distraction is a technique for orthopedic maxillary expansion, in which distraction osteogenesis is used. In this technique, the angulation and location of the TPD are critical because they may affect the ratio of skeletal/dental expansion. Any incorrect placement of a TPD may also damage the surrounding blood vessels and premolar roots. This case report introduces a new and easy method for the accurate placement of a TPD using the TPD transporter in an adult patient.