The aim of this study was to measure patient and staff doses simultaneously for some complex x-ray examinations. Measurements of dose-area product (DAP) and entrance skin dose (ESD) were carried out in a sample of 107 adult patients who underwent different x-ray examinations such as double contrast barium enema (DCBE), single contrast barium enema (SCBE), barium swallow, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), and various orthopaedic surgical procedures. Dose measurements were made separately for each projection, and DAP, thermoluminescent dosimetry (TLD), film dosimetry and tube output measurement techniques were used. Staff doses were measured simultaneously with patient doses for these examinations, with the exception of barium procedures. The measured mean DAP values were found to be 8.33, 90.24, 79.96 Gy cm(2) for barium swallow, SCBE and DCBE procedures with the fluoroscopy times of 3.1, 4.43 and 5.86 min, respectively. The calculated mean DAP was 26.33 Gy cm(2) for diagnostic and 89.76 Gy cm(2) therapeutic ERCP examinations with the average fluoroscopy times of 1.9 and 5.06 min respectively. Similarly, the calculated mean DAP was 97.53 Gy cm(2) with a corresponding fluoroscopy time of 6.1 min for PTC studies. The calculated mean entrance skin dose (ESD) was 172 mGy for the orthopaedic surgical studies. Maximum skin doses were measured as 324, 891, 1218, 750, 819 and 1397 mGy for barium swallow, SCBE, DCBE, ERCP, PTC and orthopaedic surgical procedures, respectively. The high number of radiographs taken during barium enema examinations, and the high x-ray outputs of the fluoroscopic units used in ERCP, were the main reasons for high doses, and some corrective actions were immediately taken.

Background:We present the results of primary repair of acute tendo Achilles (TA) rupture augmented with gastrosoleus turn down flap technique.Patients and Methods:78 consecutive patients with a complete acute rupture of the Achilles tendon operated between 1993 and 2004 were included in study. We performed a modification of the Lindholm technique in which the primary Kessler suture repair of the tendon was augmented by a turn-down ~3 cm × 10 cm gastrosoleus aponeurosis flap. In all cases, a short-leg circular walking cast was applied at 90° of the ankle dorsiflexion for 3 weeks and all the patients were encouraged to full weightbearing ambulation immediately. After removal of the cast, isometric and isokinetic ankle exercises were performed for 3 weeks. Modified Rupp Score was used to evaluate the subjective satisfaction.Results:All of patients returned to daily activity and 54 (69%) of them returned to previous sport activity. The tendon repair failed in two patients and they were reoperated with an allograft. Three patients developed infection and one of them required débridement. One developed deep venous thrombosis and two permanent sural nerve injuries were encountered. One of the patients had a severe skin necrosis, which was treated with rotation flap. The mean Rupp score was 29 (3–33).Conclusion:Primary repair of acute tendo Achilles rupture augment with gastrosoleus turn down flip technique in combination of immediate weightbearing ambulation provides a good outcome, but is associated with similar complication rates to the previous literature.

ObjectiveThe aim of this biomechanical experimental study was to evaluate the resistance of each posterior ligamentous complex structure of the thoracic and lumbar spine to compression forces and to measure the shifting load to the intervertebral disc when each PLC structure was interrupted.MethodThe study was conducted on 4 groups for thoracic and lumbar region as intact, supraspinous ligament interrupted, interspinous ligament/ligamentum flavum combination interrupted and facet joint capsule interrupted. Pre and post anterior vertebral body height, the highest compression force and pressure changes in the intervertebral disc during 40 N loading were measured.ResultsA significantly different degree of resistance to compression force was determined in each posterior ligamentous complex structure in the thoracic and lumbar spine samples. The combination of interspinous ligament and ligamentum flavum was found to be the most effective structure to resist compression forces (p = 0.001 in both groups). The effect of the supraspinous ligament in thoracic and lumbar segments was found to be similar to that of the interspinous ligament and ligamentum flavum combination (p = 0.008 and p = 0.006, respectively). The least effective structure was observed to be the facet joint capsule. Compression forces were significantly increased in the intervertebral disc as a result of the disruption of supraspinous ligament (p = 0.0032 and p = 0.0029, respectively in thoracic and lumbar segments) and combination of interspinous ligament/ligamentum flavum (p = 0.0019 and p = 0.0021, respectively in thoracic and lumbar segments).ConclusionThe interspinous ligament/ligamentum flavum combination and supraspinous ligament are the largest contributor to resisting applied compression moments in the sheep thoracic and lumbar spine. As a result of the loss of resistance to compression forces, there will be a shift of a great proportion of this force onto the intervertebral disc.Level of evidenceLevel V.

Despite the advantages that new derotation-based systems have brought to the treatment of scoliosis, the debate continues, especially regarding adolescent idiopathic scoliosis. Problems like decompensation, junctional kyphosis, and insufficient sagittal plane alignment are met with new proposals. We now are using a technique and system, the Ibn-I Sina Spinal System (IBS), that we think is able to overcome these problems. It makes use of sublaminar wires, hooks, screws, and rods for correction. The main innovation is that the major corrective force is a controlled translation force acting simultaneously on all segments of the curve. A retrospective assessment of 25 patients treated with this system showed that besides dealing well with decompensation and junctional kyphosis problems, the technique was superior in sagittal plane adjustments, mainly in that it carried the normal kyphosis to its physiologic location. IBS has proved easy and successful in scoliosis treatment, especially with lordotic rigid curves. We encountered no neurologic injury or instrument failure. In addition to these advantages, ease of preoperative planning and application, decreased operation time, easy removal or revision, and versatility and safety of the system has made the Ibn-I Sina Spinal System (IBS) a treatment of choice, especially for adolescent idiopathic scoliosis cases, in some centers in Turkey.

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The current study aimed to provide intraoperative smooth wake-up test and postoperative effective analgesia by segmental epidural analgesia and wound infiltration in patients undergoing posterior fusion surgery. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Fifteen ASA I-II adolescent patients aged 11-16 undergoing posterior fusion and instrumentation were included to the study. After general anesthesia with standard intravenous anesthesia, epidural catheter was inserted to all patients in lateral decubitus position. Following confirmation of the place of the catheter under scopy, initially 3-4 ml of prepared mixture was administered from the catheter and then the catheter was retracted and during retraction, 1-2 mL of the mixture was given to each segment. Neuromonitorization was achieved with motor evoked potential (MEP). Postoperative pain was evaluated with visual analogue scale (VAS). Paracetamol infusion and nonsteroidal antiinflammatory analgesics were given for routine postoperative pain management. Intravenous patient-controlled analgesia with morphine was prepared to be given in case of VAS score higher than 40. R Re es su ul lt ts s: : In all patients effective analgesia was achieved for postoperative 24 hours. No side effects and hemodynamic impairment were observed. The highest pain scores were obtained at the postoperative 12 th hour and during movement. There was no requirement for morphine patient controlled anesthesia (PCA) as VAS values were lower than 40. The sleep quality of patients and the patient satisfaction were very good in all patients. C Co on nc cl lu us si io on n: : Segmental epidural analgesia with a preoperatively placed epidural catheter and wound infiltration is a simple and reliable method for effective pain control in posterior fusion and instrumentation surgery in patients with adolescent idiopathic scoliosis. K Ke ey y W Wo or rd ds s: : Levobupivacaine; analgesia, epidural; scoliosis; anesthesia, local Ö ÖZ ZE ET T A Am ma aç ç: : Çalışmanın amacı, posterior füzyon cerrahisi uygulanan hastalarda preemptif segmental epidural analjezi ve yara yeri infiltrasyonu ile intraoperatif yumuşak wake-up testi ve etkin postoperatif analjezi sağlamaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Posterior füzyon ve enstrümentasyon uygulanacak 15 ASA I-II adolesan hasta (11-16 yaş aralığında) çalışmaya dâhil edildi. Standart intravenöz anesteziklerle genel anestezi uygulanmasının ardından tüm hastalara lateral dekübit pozisyonda epidural kateter yerleştirildi. Skopi altında kateter yerinin doğrulanmasını takiben hazırlanan karışımdan ilk olarak 3-4 ml verildi ve daha sonra kateter çekilerek her segmente 1-2 ml verildi. Nöromonitörizas-yon motor uyarılmış potansiyel (MEP) ile sağlandı. Postoperatif ağrı, visual analog skalası (VAS) ile değerlendirildi. Rutin ağrı tedavisi için parasetamol infüzyon ve nonsteroid-antiinflamatuar ilaçlar verildi. VAS skoru 40'ın üzerinde olması durumunda morfin ile intravenöz...

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