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The aim of the study was to evaluate the clinical and radiological outcomes in a series of patients undergoing open wedge high tibial osteotomy (OWHTO) using tibial cancellous autograft harvested from the osteotomized medullary canal which is not reported in the literature before. Patients with medial compartment osteoarthritis were treated with OWHTO and tibial cancellous auto- grafting performed from the osteotomized medullary canal and used for bone void filling. Seventy patients (seventy-two knees) treated with OWHTO were analyzed. All patients started partial weight-bearing with crutches the day after surgery and full-weight bearing eight weeks after surgery, according to radiological evaluation. Fifty-seven women and 13 men with a mean age of 54.2±8.1 years were evaluated in this study. The mean correction angle was 8.4±2.5° (range: 5.3°-14.3°). The osteotomy sites of all patients were grafted with tibial cancellous autografts. In all patients bony union was detected after surgery. No implant failures or major complications were en- countered. Clinical and radiological findings revealed that bone void filling with the harvested autograft from the osteotomized medullary canal may be a satisfactory and reliable option in OWHTO.

Background This study aims to refine the biomechanical properties of a new Kirschner wire locking and compressing implant called EFECE.Methods EFECE implants are 5 mm in length, cylinder-shaped wire locking and compressing implants with an 8 mm radius and a hole for insertion of 1.2 mm Kirschner wire. The EFECE implant contains two pieces that are attached to each other with threads. The top piece functions as a cap, while the second piece contains three gloves for the insertion of magnetically active three balls. The locking mechanism is applied with the help of the balls in the cone-shaped gloves. The locking strength of these implants is determined through the following methods: for group 1, distraction force is applied to the devices until failure is reached, and then maximum force and total extension at the time of failure are evaluated; for group 2, cyclic distraction forces are applied to the implants against cyclic loading, and then the presence of failure and the maximum extension in a cycle are evaluated.Results In group 1, the mean pullout strength was 920 Newton, and the mean extension was 5 mm. In group 2 there was no failure, and the mean maximum extension was 1.2 mm.Conclusions EFECE implant holding power is sufficient for fracture stabilization. Our results show that these implants can be used for fracture fixation. The characteristics associated with this procedure (compression along Kirschner wires, freedome from bone quality fixation, percutaneous surgical technique, and the use of magnets for implant removal) may change surgical daily practice in the near future.

With the widespread use of mobile applications in daily life, it has become crucial for enterprise software companies to quickly develop these applications for multiple platforms. Cross-platform mobile application development is one of the most adopted solutions for rapid development. Since most of these solutions do not generate native code for the underlying platform, the artefacts generally do not satisfy the requirements defined at the beginning of the project. This study designed and implemented a native code generation framework called Nativator built as a cloud service. The framework, which is capable of producing native code for iOS and Android platforms using web-based user interfaces, was implemented based on an open source compiler platform called “Roslyn”. Four case studies were performed to analyze the execution performance of the applications built with the proposed framework. The experimental results demonstrated that the execution performance of the applications built with Nativator is comparable with the applications generated via the state-of-the-art mobile application development framework called Xamarin. Because this framework was implemented as a cloud service, it has several advantages over traditional approaches such as access from anywhere, no installation and flexible and more resources from cloud infrastructure.

Retrospective cohort.The purpose of this study is to compare the anterior-posterior surgery to posterior-only vertebra resection for congenital kyphoscoliosis in pediatric patients.Vertebral column resection is a very powerful correction technique mainly used in the treatment of severe and rigid spinal deformities. The technique can be applied with combined anterior and posterior vertebral column resection (APVCR) or posterior-only vertebral column resection (PVCR) approaches. PVCR has gained popularity recently due to several apparent advantages, but APVCR is still believed by some to be a viable alternative, despite the use of an anterior exposure.A retrospective chart and radiographic review was performed including the patients with congenital kyphoscoliosis up to 16 years of age who were operated on by a single senior surgeon in our department after 2005. The data included surgical time, estimated blood loss, duration of hospital and postoperative intensive care unit stay, intraoperative and postoperative complications. Preoperative, postoperative, and follow-up radiographs were evaluated for scoliosis, kyphosis, and spinal balance.Twenty-six patients (20 girls, 6 boys) met the inclusion criteria. APVCR was performed on 17 (median age, 13.2 y) and PVCR on 9 (median age, 10.7 y). Scoliosis correction at the time of last follow-up was 54.3% and 52.6% for APVCR and PVCR, respectively, whereas the average kyphosis correction was 25.4 degrees in APVCR and 30.1 degrees in PVCR group. Surgical time, hospital stay, and estimated blood loss were all significantly higher in the APVCR group, whereas the complication rates were similar. No neurological or vascular complications were encountered.This study showed that although the operative time and surgical blood loss were higher with APVCR, there were no major complications and the radiologic outcomes were similar between APVCR and PVCR. APVCR should be considered as an acceptable technique especially in deformities where PVCR would be technically difficult or at the beginning of the spine surgeon's learning curve.Level III.

Introduction. We discuss a rare gastrointestinal stromal tumor (GIST) case detected at the 10th postpartum week and we want to pay attention to the challenges and improvements in the diagnosis, surgery, chemotherapy, and follow-up of this rare tumor accompanied with the review of the current literature. Case Presentation. A 32-year-old multiparous woman presented with abdominal swelling 10 weeks after her second vaginal birth. Abdominal examination revealed a mass starting from the pelvic level and extending to the right upper quadrant. Radiological examinations showed a solid, multiloculated, and hypervascular mass starting from the pelvis and extending to the transverse colon. En bloc mass with a 20 cm jejunal segment resection and a left pelvic side wall peritonectomy with omentectomy was performed. The pathologic examination revealed a high-risk GIST which originated from the jejunum and disseminated to the peritoneum. The patient has been given imatinib 400 mg/day since then. She did not reveal any progression during the 15-month follow-up postoperatively. Conclusion. GIST tumors are rare and there is not sufficient information in the literature regarding its management. In this patient having high risk GIST and GIST sarcomatosis we successfully treated the patient by surgery and adjuvant imatinib chemotherapy.

Objective: The aim of this study was to determine the effect of pentoxifylline (PTX) on angiogenesis and the healing of a critical-sized segmental defect of the radius diaphysis in a rat model, using radiological and histological grading systems.Methods: The study included 24 female Sprague-Dawley rats (weight: 300±20 g) divided into 4 groups. A critical-sized segmental defect was created in the radius diaphysis in all rats. In Group 1, morcellized iliac crest autografts were used to fill the segmental bone defect. In Group 2, segmental bone defects were filled using morcellized iliac crest autografts, and 25 mg/kg/day PTX was applied intraperitoneally. In Group 3, the segmental bone defects were not filled, and in Group 4 the segmental bone defects were left unfilled, and an intraperitoneal (IP) dose of 25 mg/kg/day PTX was applied. Rats were sacrificed at postoperative Week 8, and defects were evaluated using radiographic, histological and immunohistochemical methods.Results: There were significant differences between Group 1 and 2 according to radiological evaluation (p=0.003) and quality of union at the defect site (p=0.01). Union quality was higher in Group 4 than Group 3 (p=0.01). Cluster of differentiation 31 (CD31) and vascular endothelial growth factor (VEGF) levels were higher in Group 2 than in Groups 3 and 4.Conclusion: According to radiological and histological parameters, PTX appears to improve angiogenesis and healing of segmental cortical bone defects of the radius in a rat model., Amaç: Bu çalışmanın amacı; pentoksifilinin (PTX) anjiogenezis ve sıçan radius diafizi “critical-sized” segmenter kemik kaybı modelinde iyileşme üzerine etkisini radyolojik ve histolojik derecelendirme sistemleri kullanılarak değerlendirilmesidir.Çalışma planı: Bu çalışmaya 24 female Sprague Dawley sıçan (ağırlık: 300±20 gram) katılmıştır ve 4 gruba ayrılmıştır. Sıçanların radius diafizlerinde “critical-sized” segmenter kemik kaybı oluşturuldu. Grup 1’de morselize iliak krest otogreftleri segmenter kemik defektini doldurmada kullanıldı. Grup 2’de segmenter kemik defekti morselize iliak krest otogreftleri ile dolduruldu ve günlük intraperitoneal olarak 25 mg/kg PTX uygulandı. Grup 3’te kemik defekti doldurulmadı. Grup 4’te kemik defekti doldurulmadı ve günlük intraperitoneal olarak 25 mg/kg PTX uygulandı. Postoperatif sekizinci haftada sıçanlar feda edildi. Defektler radiografik, histolojik ve immünokimyasal metodlar ile değerlendirildi.Bulgular: Group 1 ve 2 arasında radyolojik değerlendirme sonucunda (p=0.003) ve defekt bölgesinde kaynama kalitesi açısından (p=0.01) belirgin farklılık izlendi. Kaynama kalitesi grup 4’te grup 3’e göre fazlaydı (p=0.01). CD-31 ve VEGF seviyeleri grup 2’de grup 3 ve 4’e göre fazlaydı.Çıkarımlar: Radyolojik ve histolojik parametrelere göre; pentoksifilinin angiogenezis ve sıçan radius diafizi “critical-sized” segmenter kemik kaybı modelinde iyileşme üzerine olumlu etkisi bulunmaktadır.Bu çalışmanın amacı; pentoksifilinin (PTX) angiogenesis ve sıçan radius diafizi “critical-sized” segmenter kemik kaybı modelinde iyileşme üzerine etkisini radyolojik ve histolojik derecelendirme sistemleri kullanılarak değerlendirilmesidir.Gereç ve yöntemBu çalışma üniversitemiz Etik kurul onayı alındıktan sonra Hayvan Araştırma Laboratuvarlarında yapılmıştır

Aneurysmal bone cysts (ABCs) are vascular lesions with well-defined radiological signs. A fairly common MRI finding in both ABC and other primary bone tumors with high vascularity is the presence of cysts with fluid-fluid levels. Metastatic lesions with fluid-fluid leveling have not previously been defined in the literature. We report three cases of fluid-fluid leveling of the axial skeleton in metastatic lesions. Two patients had single-level and one multi-level neoplastic disease with distinctive cysts showing fluid-fluid levels on MRI evaluation. Diagnosis of gastric carcinoma in two patients and breast carcinoma in the third was achieved with trocar biopsies. At the time of this report all patients had completed initial oncologic treatments and were disease free., Anevrizmal kemik kistleri (AKKler) radyolojik özelliklerinin iyi tanımlandığı vasküler lezyonlardır. Sıvı-sıvı seviyelerinin olduğu kistler, damarlanması fazla AKK ve diğer primer kemik tümörlerinin her ikisinde de oldukça sık rastlanan bir MRG bulgusudur. Sıvı-sıvı seviyesi veren metastatik lezyonlar ise literatürde hiç tanımlanmamıştır. Bu çalışmamızda, metastatik lezyonlarda aksiyel iskelette sıvı-sıvı seviyesi veren 3 olgu bildiriyoruz. Olguların ikisinde tek seviyede, diğerinde birçok seviyede neoplastik hastalık ve MRG değerlendirmesinde sıvı-sıvı seviyesi veren belirgin kistler bulunmaktaydı. Trokar biyopsisi ile hastaların ikisi mide kanseri, diğeri meme kanseri tanısı aldı. Bu çalışmanın hazırlandığı sırada hastalar temel onkolojik tedavilerini almış ve iyileşmişlerdi.

STUDY DESIGN A longitudinal case study. OBJECTIVE To determine whether pedicle screws placed in an immature spine exert effect on the continued growth of the vertebral body. SUMMARY OF BACKGROUND DATA Pedicle screws have revolutionized surgical treatment of spinal deformities by allowing a mode of secure fixation that provides consistently better correction rates in adults and adolescents. In the young child, however, the trajectory of pedicle screws takes them through an open physis: the neurocentral cartilage. There exists little information regarding the possible effect of pedicle screws inserted at a young age on further development of the spine and the spinal canal. METHODS Patients undergoing pedicle screw instrumentation of at least 2 levels before the age of 5 years (60 mo) for the first time for any diagnosis and who had been followed for at least 24 months were included. Measurements were performed in instrumented and adjacent noninstrumented levels without visible deformity in pre- and postoperative cross-sectional images and compared using statistical methods. RESULTS Ninety segments in 15 patients met the inclusion criteria (average age at instrumentation 46.3 mo [range, 29-60 mo]). Forty segments had no screws and 50 had at least 1 screw. Pedicle length and vertebral body diameter had significantly increased in both groups, whereas spinal canal parameters did not change significantly. No significant difference was observed between the growth rates in levels with or without screws in pedicle length, vertebral body diameter, or spinal canal parameters (anterior-posterior and interpedicular diameters, and area). CONCLUSION Pedicle screw instrumentation performed before the age of 5 years does not cause a negative effect on the growth of pedicles, the transverse plane of the vertebral body, or the spinal canal. It can be safely performed in the treatment of deformity in this age group.

BACKGROUND: The aim of this study was to evaluate whether plate fixation with screws in an oblique fashion would change the strength of the fixation to bending forces and whether any relationship existed between deformity and increased strength of fixation. METHODS: Rear leg tibias from 2-year to 3-year-old sheep were affixed with the help of a custom-made guide to a six-hole dynamic compression plate and divided into three groups. In group 1, fixation was performed using screws perpendicular to the plate axis in two planes. In group 2, screws were placed at a 20-degree angle to the axis of the shaft and perpendicular to the transverse plane. In group 3, the screws were placed at a 20-degree angle to the shaft axis and 7 degrees on the transverse plane. Gap-close bending and side-bending tests were performed in a three-point bending fashion. The maximum moment of force and deformation at the time of the failure was analyzed. RESULTS: In gap-close bending tests, mean maximum moment of forces for groups 1, 2, and 3 was 51.90 Nm, 67.47 Nm, 82.05 Nm, respectively (p

The congenital upper lip sinuses are rare and they have previously been reported only in 40 cases. We have presented a case report of congenital midline upper lip sinus in an elderly age. Although the treatment modality is very easy and successful in any cases, the etiology of this rare congenital situation has been obscure and further studies should be done to find out.

Dear Editor, In 2013, a student-oriented working group called STARSurg (The Student Audit and Research in Surgery) directed to medical students and surgical residents was founded in the UK. STARSurg is a group offering students the opportunity to participate in high-quality studies and encouraging them to be clinicians engaged in active research in the future (1). The first study of STARSurg was joined by more than 250 students from 109 hospitals. This study was related to the post-operative impacts of nonsteroidal anti-inflammatory drugs in patients undergoing major gastrointestinal tract surgery, and was performed prospectively on 1500 patients. All participants were co-authors in the publication on completion of the study (2). STARSurg have been established in all schools in England and Ireland, and now includes more than 180 hospitals. All manuscripts of STARSurg projects can be accessed through PubMed and can be used as references. Everyone involved in studies is included in these publications. In some countries, students do not have the opportunity to participate in surgical research. It is expected that students would benefit from such type of working groups by actively participating in projects in collaboration with students from various countries, and that their research related abilities would improve. Students were invited to the ESCP (European Society of Coloproctology) Congress in Dublin in September 2015, to hold a meeting aiming to develop an international research network. The student-oriented research model developed by STARSurg was discussed, and it was decided to conduct a cohort study focused on international students at the beginning of 2016. The students, guided by experienced surgeons in this debate, chose to investigate the relationship between obesity and complications following major gastrointestinal surgery. This study was based on the Determining Surgical Complications in the Overweight (DISCOVER) study that was successfully held in the UK and Ireland by STARSurg (3). During this session in Dublin, students decided to work in partnership and to establish a working group they called EuroSurg. This group has active members in Ireland, Italy, Spain, Turkey, Netherlands and United Kingdom, and these countries also have a national management committee of their own. Students from each participating country focused on publishing their results in the ESCP Congress in 2016, while developing the international cohort study protocol. This initiative is supported by STARsurg, ESCP, Societa Italiana di Chirurgie Colo-Rettal and many experienced surgeons. The letters sent by EuroSurg working group was published online in the Colorectal Disease (4). This article stated that EuroSurg is conducted by students and residents, that it is supported by ESCP, as well as listing the countries participating in EuroSurg. In Turkey, most medical students and surgical residents are not involved in formal research education and their participation to studies is limited. An official network supporting, controlling, and improving residents and students’ research skills should be established. More than 120 students from 20 Medical Faculty from Turkey has been included in this study. STARSurg decided to benefit from social media to be in constant contact with participants (5). EuroSurg was able to recruit many participants from more than 60 universities in Europe by using this method since December 2015. We invite all interested students, residents and surgeons to register to our website to take part in the unique opportunity of the Eurosurg working group (www.eurosurg.org) (6).