Yazar "Senaran, Hakan" seçeneğine göre listele
Listeleniyor 1 - 20 / 20
Sayfa Başına Sonuç
Sıralama seçenekleri
Öğe The associated effects of untreated unilateral hip dislocation in cerebral palsy scoliosis(LIPPINCOTT WILLIAMS & WILKINS, 2006) Senaran, Hakan; Shah, Suken A.; Glutting, Joseph J.; Dabney, Kirk W.; Miller, FreemanIntroduction: The presence of a unilateral-hip dislocation in children with cerebral palsy (CP) may cause problems with sitting imbalance, pressure ulcers, and hip pain. There is a dynamic interplay between hip dislocation, pelvic obliquity (PO), and scoliosis. The effect of an untreated unilateral hip dislocation on the rate of curve progression of CP scoliosis has not been defined in the literature. The purpose of this study is to investigate the effect of unilateral hip dislocation on PO and the rate of curve progression in children with spastic quadriplegic CP. Methods: Patients with spastic quadriplegic CP who had spine radiographs at the time of initial presentation with scoliosis and at the latest follow-up were evaluated. Twenty-three children with spastic CP who had an untreated unilateral hip dislocation and scoliosis constituted the study group. The control group consisted of 83 quadriplegic CP patients with scoliosis and well-located hips. The rate of curve progression, incidence of PO, and the rate of PO progression at follow-up were compared between the 2 groups. Results: The mean ages of patients with a unilateral dislocation and with well-located hips at initial radiograph were 10.4 and 10.5 years, respectively. The mean follow-up was 3.5 years. The mean rate of scoliosis curve progression in patients with a unilateral hip dislocation was 12.9 degrees per year. In the control group, the mean progression rate was 12.2 degrees per year. The incidence of PO at follow-up was 74% in scoliotic patients with a dislocation and 63% in scoliotic patients with normal hips. Using repeated-measures analysis of variance, unilateral hip dislocation was found to have no significant effect on scoliosis progression; however, progression of PO was significantly increased in the hip dislocation group (P < 0.05). Pelvic obliquity was corrected after posterior spinal fusion to the sacrum with pelvic fixation, without reducing the hip(s) at the same surgery. Conclusion: Unilateral hip dislocation causes a significant increase of PO but does not affect the rate of scoliosis curve progression.Öğe Avascular necrosis rate in early reduction after failed Pavlik harness treatment of developmental dysplasia of the hip(LIPPINCOTT WILLIAMS & WILKINS, 2007) Senaran, Hakan; Bowen, J. Richard; Harcke, H. TheodoreOur hypothesis is that hips with developmental dysplasia (DDH), which fail Pavlik harness treatment and are reduced within 3 months of age, have a low rate of avascular necrosis (AVN). Inclusion criteria are as follows: diagnosis of DDH within 2 months of birth, failure of reduction or stabilization by Pavlik harness treatment, surgical reduction of the hip advised to be performed within 3 months of age, and follow-up for Salter criteria of AVN. Twenty-one consecutive cases (35 hips) met the inclusion criteria. Nineteen cases (31 hips) were initially reduced within 3 months of age, and none of these cases developed AVN. After Pavlik harness failure, initial closed reduction was achieved in 33 (94%) of 35 hips, and open reduction required in 2 (6%) of 35 hips. At latest follow-up, one (3%) of 35 hips had AVN. At the time of reporting, 1 (3%) of the 35 hips has required an additional procedure (Pemberton osteotomy) for residual dysplasia. There were 2 outlier cases (4 hips) in which the parents delayed the reduction and 1 case developed unilateral AVN, which was reduced after the proximal femoral ossification center developed at 7 months of age. The data presented in the current study support our hypothesis.Öğe Cerebral palsy and spinal deformities(TURKISH ASSOC ORTHOPAEDICS TRAUMATOLOGY, 2009) Yazici, Muharrem; Senaran, HakanCerebral palsy is a common static encephalopathy and can present as multiple musculoskeletal problems. Increased peripheral muscle tone causes joint contractures and decreased functional capacity. The risk for scoliosis increases parallel with the severity of musculoskeletal involvement. Scoliosis adversely affects the functional capacity, daily care, and nutrition in disabled children. Conservative treatments including physical therapy, bracing, and botulinum toxin injections do not prevent the progression of scoliosis in most of the patients and surgical treatment becomes mandatory. With the use of pedicle screws, three-plane fixation is possible, making posterior instrumentation and fusion effective in correction of severe curves and obviating anterior surgery.Öğe Diagnosis of Hyperostosis of the Medial Calcaneal Tubercle Similar to a Heel Spur(AMER PODIATRIC MED ASSOC, 2013) Altan, Egemen; Senaran, Hakan; Can, Nuray; Aydin, Bahattin Kerem; Erkocak, Omer FarukCalcaneal osteochondromas are rare conditions. To our knowledge, we present the first report of a calcaneal osteochondroma in an adolescent patient that was surprisingly similar to a heel spur, and, in addition, symptoms due to compression of the medial plantar nerve were present.Öğe Difficult thoracic pedicle screw placement in adolescent idiopathic scoliosis(LIPPINCOTT WILLIAMS & WILKINS, 2008) Senaran, Hakan; Shah, Suken A.; Gabos, Peter G.; Littleton, Aaron G.; Neiss, Geraldine; Guille, James T.Study Design: Retrospective radiographic and clinical consecutive case series. Objective: The objective of this study was to identify patients treated with posterior spinal fusion and pedicle screw instrumentation for adolescent idiopathic scoliosis (AIS) in whom it was not possible to place a planned pedicle screw, and describe the possible difficulties in screw placement. Summary of Background Data: Despite the knowledge of anatomic characteristics of upper thoracic spine pedicles and considerable experience in thoracic pedicle screw placement, inserting pedicle screws in some patients with AIS may be difficult. Methods: We reviewed 96 patients with AIS in whom the intent was to use an all-screw construct in 2004. Placement of the pedicle screws was usually by the freehand method, with intraoperative fluoroscopy used as needed. If a screw could not be safely placed after multiple attempts, a down-going supralaminar or transverse process book was placed. Medical records were reviewed and radiographs were measured by one of the authors. Results: We identified 17 cases (18%) in which a hook had been placed. All cases had a major thoracic curve (Lenke 1, 2, and 3) and the single hook had always been placed at the most cephalad level of the construct on the patient's right side. The most common levels for hook placement were T3 and T4; these pedicles were noted to be sclerotic, narrow, and have a moderate amount of rotation on the preoperative posterior-anterior and side bending radiographs. Conclusions: Care should be exercised during pedicle screw instrumentation in the apical region of the proximal thoracic curve, whether structural or nonstructural, especially in the concavity. The preoperative radiographs may give helpful clues to intraoperative challenges of pedicle screw insertion at the uppermost level of instrumentation. Hook fixation was satisfactory in this scenario.Öğe The effect of platelet-rich plasma on osteochondral defects treated with mosaicplasty(SPRINGER, 2014) Altan, Egemen; Aydin, Kerem; Erkocak, Omer; Senaran, Hakan; Ugras, SerdarPurpose This study investigated the efficacy of platelet-rich plasma (PRP) on articular surfaces on which the mosaicplasty technique was performed. Our hypothesis was that PRP can accelerate the osseointegration process and enhance the quality of articular integrity after the mosaicplasty procedure. Methods Standard defects were created in the femoral groove of both patellofemoral joints of 12 New Zealand rabbits. PRP solution was placed inside the defect before fixation of the osteochondral autografts and injected inside the involved joint after capsular closure of the tested knees. The contralateral knees served as the control sides. The animals were euthanized three or six weeks after mosaicplasty, and both limbs were assessed according to Pineda's histological grading scale. Significance level was set at p <= 0.05 a priori, and the Mann-Whitney U test was used for statistical analysis. Results Histologic findings at the interface between the transferred autograft and the original cartilage revealed better integration of the adjacent surfaces in the mosaicplasty with PRP group three weeks after the procedure; the difference was significant (p < 0.05). However, no significant difference in the transition zone was observed between the groups six weeks after the experiment (p = 0.59). Conclusions Our animal model showed that adjunctive use of PRP produced a better healing response and resulted in superior histological scores after three weeks compared with the mosaicplasty-only procedure. Interpretation of our results is important in terms of rapid return to previous activity levels. Thus, application of PRP can represent a valid therapeutic option for improving the efficacy of mosaicplasty by stimulating the local healing response.Öğe The effects of spinal anesthesia on auditory patients(ELSEVIER IRELAND LTD, 2016) Colpan, Bahar; Apiliogullari, Seza; Erdur, Omer; Celik, Jale Bengi; Duman, Ates; Senaran, Hakan; Ozturk, KayhanObjectives: Persistent or transient hearing loss (HL) is a less-recognized complication of spinal anesthesia (SA) in the pediatric population, although it has been previously reported in adults. The primary aim of this study was to investigate the effects of SA on auditory function in the pediatric population. Methods: After gaining institutional approval and parental consent, 30 American Society of Anesthesiologists physical status I-II children between 4 and 15 years undergoing lower extremity orthopedic surgery were enrolled in this prospective study. Spinal blocks were performed in the midline with a 25G Quincke needle using 0.5% hyperbaric bupivacaine. Transient evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) tests were administered before surgery and one-day postoperative. Children with detected HL were retested on postoperative day seven. Preoperative and postoperative results were compared. A Wilcoxin Signed-Ranks test (with Bonferroni correction) was used for statistical analyses. Results: There was no statistically significant HL in the postoperative period compared to the preoperative period. In 29 of 30 patients, no difference was detected at any frequency tested. In one patient, TEOAE and DPOAE tests were found to be decreased on postoperative day one. In this patient, control tests were found to be improved on postoperative day seven. Conclusions: Administration of SA may results in a low probability of transient hearing loss with no clinical significance in children 4-15 years of age. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Öğe Enoxaparin and Heparin Comparison of Deep Vein Thrombosis Prophylaxis in Total Hip Replacement Patients(Springer, 2006) Senaran, Hakan; Acaroğlu, Emre; Özdemir, H. Mustafa; Atilla, BülentIntroduction: We compared the efficacy and safety of standard heparin to that of low molecular weight heparin (Enoxaparin) in 100 hip replacement patients. Materials and methods: A total of 100 patients who underwent total hip replacement surgery were randomised to receive a study medication. Enoxaparin was administered to 50 patients (prophylaxis with subcutaneous injection of 40 mg of Enoxaparin daily was initiated 12 h preoperatively), and heparin (subcutaneous standard heparin initiated 8 h preoperatively on a dose of 5,000 IU and continued to 15,000 IU per day in three equal dosages every 8 h) was given to 50 patients. Each treatment was continued until the patients were discharged from the hospital. They were made to undergo lower extremity duplex ultrasonography for deep vein thrombosis before discharge and discontinued from medication if no pathology was found. The primary parameter to determine the efficacy was the prevalence of venous thromboembolic disease. The primary parameter to determine safety was the prevalence of major bleeding. Results: Two patients in the heparin group developed DVT, which was detected by routine duplex ultrasonography at the end of hospitalisation, and two patients in the exoparine group were detected with late DVT during the postoperative period of 6 weeks. Seven patients had minor and major bleeding in both the groups. Six patients in the heparin group discontinued from medication because of hepatic, renal dysfunctions, and serious discharges from the wound. Conclusion: Enoxaparin is as safe and as effective as standard heparin in total hip replacement surgery.Öğe Incomplete periacetabular acetabuloplasty(INFORMA HEALTHCARE, 2014) Aydin, Bahattin Kerem; Senaran, Hakan[Abstract not Available]Öğe Reconstruction of Foot and Ankle Defects with a Free Anterolateral Thigh Flap in Pediatric Patients(THIEME MEDICAL PUBL INC, 2015) Acar, Mehmet Ali; Gulec, Ali; Aydin, Bahattin Kerem; Erkocak, Omer Faruk; Yilmaz, Guney; Senaran, HakanBackground There are a limited number of published studies describing reconstruction with an anterolateral thigh (ALT) flap following lower extremity injury in pediatric patients. The aim of this study was to present our experiences with the application of a free ALT flap not only in the reconstruction of soft tissue defects around the pediatric foot arid ankle but also in patients with bone, tendon, and ligament injuries that require repair. Materials and Methods Reconstruction with a free ALT flap was performed in 11 pediatric patients (mean age, 8.9 years; range, 3-15 years) between November 2010 and February 2013. The modes of injury were as follows: six traffic accidents, three firearm accidents, one agricultural machinery accident, and one bicycle chain accident. A retrospective evaluation of the applied surgical procedures was performed: flap size, perforator type and number, placement area, site of anastomosis, closure of the donor site, complications, and flap survival. Results The mean size of the skin flap was 83.2 mm(2) (range, 48-117 mm(2)). Except for two patients, there were two perforators in the obtained flaps, which were 75% musculocutaneous and 25% septocutaneous. To strengthen the Achilles tendon in one patient, the ALT, together with the fascia lata, was raised as a composite flap. This flap was used as a "sensate flap" in three patients with defects in the heel area and as a "perforator flap" in seven patients. Anastomosis was performed in the anterior tibial artery in five patients and in the posterior tibial artery in six patients. Primary closure was performed for the donor site in all patients. Due to venous thrombus after 24 hours in one patient, reexploration was performed, and blood flow was regained with a vein graft. In the same patient, partial necrosis developed on the lateral edge of the flap; after debridement of the necrotic areas, closure was performed with a split thickness skin graft. After the ALT flap procedure, the primary flap survival rate was 90.9%. Conclusion The free ALT flap could be a safe, reliable, and aesthetically appealing option for foot/ankle resurfacing in children after traumatic soft tissue loss. The ALT flap can cover a far greater area and provide the versatility needed to optimize soft-tissue coverage.Öğe The risk of progression of scoliosis in cerebral palsy patients after intrathecal Baclofen therapy(LIPPINCOTT WILLIAMS & WILKINS, 2007) Senaran, Hakan; Shah, Suken A.; Presedo, Ana; Dabney, Kirk W.; Glutting, Joseph W.; Miller, FreemanStudy Design. Retrospective radiographic and medical chart review with matched control group. Objective. To identify the effect of intrathecal baclofen on the incidence of scoliosis, rate of curve progression, and pelvic obliquity compared with a matched cohort. Summary of Background Data. Although intrathecal baclofen therapy (ITB) has been shown to be effective in decreasing spasticity, case reports have described some children receiving ITB in whom progressive scoliosis was noted; other authors have described no effect on the spinal column. A controlled study has not been performed. Methods. All patients with spastic CP treated with ITB between 1997 and 2003 at a single institution were reviewed. A total of 107 patients undergoing ITB for a minimum of 2 years were identified, of which 26 patients subsequently developed or had progression of scoliosis. Twenty-five age, gender, and gross motor function classification system (GMFCS) score-matched quadriplegic CP patients with scoliosis who did not receive ITB constituted the control group used to compare the rate of curve progression and pelvic obliquity. Results. The average curve progression for the baclofen group after pump implantation was 16.3 per year; and for the control group was 16.1 per year. Both groups' curves progressed over time during growth ( P = 0.001), but baclofen did not have an independent effect on curve progression ( P = 0.181). Average pelvic obliquity for the 2 groups increased over time ( P = 0.001), but there was no difference between the groups ( P = 0.536). Twelve of 57 patients (21%) developed scoliosis after pump implantation during a mean of 3.6 years of follow-up. Thirty of 92 matched control patients (32%) not treated with ITB within the same time interval had scoliosis by maturity. Conclusion. This study demonstrates that ITB has no significant effect on curve progression, pelvic obliquity, or the incidence of scoliosis when compared with an age, gender, and GMFCS score-matched control group of patients with spastic CP without ITB.Öğe Short-Term Functional Outcomes of First Metatarsophalangeal Total Joint Replacement for Hallux Rigidus(SAGE PUBLICATIONS INC, 2013) Erkocak, Omer Faruk; Senaran, Hakan; Altan, Egemen; Aydin, Bahattin Kerem; Acar, Mehmet AliBackground: Although metatarsophalangeal (MTP) arthrodesis has been advocated by many authors, implant arthroplasty appears to be successful option in advanced hallux rigidus (HR). The aim of our study was to evaluate the early results of the ToeFit-Plus prosthesis for the treatment of HR. Methods: Between December 2007 and January 2011, a total of 26 toes of 24 patients with MTP arthritis of the great toe were treated with ToeFit-Plus implant. The average follow-up time was 29.9 (range: 25 to 62) months. All patients were evaluated clinically and radiographically. Postoperative satisfaction and function were scored according to the American Orthopaedic Foot and Ankle Society (AOFAS) score. Pain was assessed with the use of a visual analogue scale. Results: Mean preoperative AOFAS score improved from 42.7 (range: 36 to 59) to 88.5 (range: 59 to 98) at the final follow-up (P < .01). Preoperative average visual analogue scale pain scores improved from 7.4 preoperatively to 1.9 at the final follow-up (P < .01). The average MTP joint range of motion improved from 25.9 degrees preoperatively to 53.8 degrees at the final follow-up. No radiologic loosening was found, but radiolucency was observed in 2 patients with this implant. No revision was required for any of the patients during the follow-up period. Conclusions: This total first MTP joint prosthesis yielded good functional outcome and high patient satisfaction level with low early complication rate. Preservation of joint movement and good pain relief with early mobilization were the advantages of this procedure. Salvage arthrodesis remains an option if future revisions are indicated.Öğe Short-term results of early (before 6 months) open reduction of dislocated hips in arthrogryposis multiplex congenita(LIPPINCOTT WILLIAMS & WILKINS, 2016) Aydin, Bahattin K.; Yilmaz, Guney; Senaran, Hakan; Durgut, FatihThe aim of this study was to report the results of early open reduction of hip dislocations in infants with arthrogryposis multiplex congenita. Seven patients who were under 6 months of age at the time of hip reduction, with a mean follow-up period of 47.5 +/- 11.3 months after surgery, were included in this study. Four of seven patients (six of 13 hips) required additional hip surgeries during their follow-up. The short-term results of early open reduction of hips were not promising as most of the patients required additional hip surgeries. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.Öğe Spinal anaesthesia for orthopaedic surgery in children with cerebral palsy: Analysis of 36 patients(PROFESSIONAL MEDICAL PUBLICATIONS, 2015) Onal, Ozkan; Apiliogullari, Seza; Gunduz, Ergun; Celik, Jale Bengi; Senaran, HakanBackground and Objective: Cerebral palsy is one of the most common childhood neuromuscular diseases in the world. Spinal anaesthesia in children is an evolving technique with many advantages in perioperative management. The aim of this retrospective study was to provide first-hand reports of children with cerebral palsy who underwent orthopaedic surgery under spinal anaesthesia. Methods: Records of the children with cerebral palsy who underwent orthopaedic surgery under spinal anaesthesia between May 2012 and June 2013 at Selcuk University Hospital were investigated. In all patients, lumbar puncture was performed in lateral decubitus position with mask sevoflurane-nitrous oxide anaesthesia. In patients who were calm prior the spinal block, inhalation anaesthesia was terminated. In patients who were restless before the spinal block, anaesthesia was combined with light sevoflurane anaesthesia and a laryngeal mask. From anaesthesia records, the number of attempts required to complete the lumbar puncture, and the success rates of spinal anaesthesia and perioperative complications were noted. Data were expressed as numbers and percentages. Results: The study included 36 patients (20 girls and 16 boys). The mean age was 71 months. The rate of reaching subarachnoid space on first attempt was 86%. In all patients, spinal anaesthesia was considered successful. In 26 patients, laryngeal mask and light sevoflurane anaesthesia were required to maintain ideal surgical conditions. No major perioperative complications were observed. Conclusion: Spinal anaesthesia alone or combined with light sevoflurane anaesthesia is a reliable technique with high success rates in children with cerebral palsy undergoing orthopaedic surgery.Öğe Subtalar Fusion in Cerebral Palsy Patients Results of a New Technique Using Corticocancellous Allograft(LIPPINCOTT WILLIAMS & WILKINS, 2011) Senaran, Hakan; Yilmaz, Guney; Nagai, Mary K.; Thacker, Mihir; Dabney, Kirk W.; Miller, FreemanBackground: Valgus deformity of the hindfoot in cerebral palsy (CP) patients is common and causes functional deterioration and shoe fitting problems together with skin ulcerations. Our aims in this study are, to present an intra-articular technique of subtalar fusion using allograft and internal fixation to achieve stabilization and second to report the results and clinical outcome of a series of intra-articular subtalar arthrodesis performed in CP children. Methods: We performed a retrospective review of radiographs and medical records of 145 children with CP who underwent intra-articular subtalar fusion from January 1994 to December 2004. The subtalar joint was fixed through the anterior facet with a cannulated screw whereas the anterior aspect of the calcaneus was parallel to the anterior aspect of the head of the talus. Tricortical iliac crest allograft was placed into the sinus tarsi and the denuded posterior facet area. Results are grouped as good, satisfactory, and poor according to the radiographic and clinical outcomes. Results: The mean age at the time of surgery was 12.7 years (range: 5 to 20 y) and the average follow-up was 4.8 years (range: 2 to 11 y). Good results were obtained in 242 feet (96%). Satisfactory results were obtained in 6 feet (2%) which were painless pseudoarthrosis of subtalar joint in 2 feet and screw removal was required in 4 feet because of pain. Nonunion of the subtalar joint together with recurrence of deformity was observed in 5 feet (2%) which is accepted as poor result and required revision surgery. No deep infections, implant failure, allograft failure were observed in a mean of 4.8 years. Conclusions: Our described technique of intra-articular subtalar joint fusion is safe and reliable in CP children with high rate of satisfactory results.Öğe Thrombosis and thrombocytosis in a thousand rheumatologic cases(2011) Cipil, Handan; Kargılı, Ayşe; Senaran, Hakan; Uz, Ebru; Kaasapoğlu, Benan; Alıcı, Özlem; Koşar, AliBu çalışmanın amacı romatolojik hastalıklarda trombo-sitoz ve tromboz insidansının belirlenmesidir. 2001-2008 yılları arasında romatolojik hastalık tanısı ile izlenmiş 1000 vaka (771 kadın, 229 erkek) retrospektif olarak tarandı. Herbir hastalık için tromboz vetrom-bositoz insidansı belirlendi. Trombositoz (platelet sayısı 400 000/mm3) vakaların 89'unda (%8,9) mevcuttu. Pulmoner emboli ve derin venöz tromboz sırası ile 8 (%0,8)ve 14 (%1,4) vakada mevcuttu. Pulmoner embolisi olan hastaların 2'sinde trombositoz vardı. Trombositoz romatoid artrit, Sjögren sendromu, Sistemik lupus eritematozis, Behçet hastalığı ve sklerodermada daha sıktı. Tromboz ise Behçet hasta-lığında daha sıktı. Romatolojik hastalıklarda trombositoz ile tromboz arasında ilişki saptanmadı. Ciddi komplikasyonların gelişmesini önlemek için roma-tolojik hastalığı olan hastalar tromboz varlığı açısından değerlendirilmelidir.Öğe Treatment of Clubfoot With Ponseti Method Using Semirigid Synthetic Softcast(LIPPINCOTT WILLIAMS & WILKINS, 2015) Aydin, Bahattin Kerem; Sofu, Hakan; Senaran, Hakan; Erkocak, Omer Faruk; Acar, Mehmet Ali; Kirac, YunusRandomized controlled clinical trial.The main purpose of the present study was to comparatively analyze the effectiveness, advantages, and the complications of using semirigid synthetic softcast with respect to plaster of Paris (POP) during the treatment of clubfoot deformity.The study group consisted of 196 babies (249 feet). A total of 133 feet treated by an orthopedic referral center using semirigid synthetic softcast were included in group A whereas the other 116 feet treated by another orthopedic clinic using POP cast were included in group B. The Pirani scores, number of cast applications, time period until Achilles tenotomy, any skin problems due to the cast itself, and/or cast removal were recorded. A final parent satisfaction score was also obtained.The mean Pirani sores were significantly improved from the first administration to the time before Achilles tenotomy in both groups. There was no significant difference according to the number of casts applied until tenotomy. The slippage of the cast and skin lesions was significantly more common in group B. Higher parent satisfaction levels were detected in group A.Semirigid softcast has been found as superior to POP in the aspects of parent satisfaction and cast-related complication rates.Öğe Treatment of the Lower Extremity Contracture/Deformities(LIPPINCOTT WILLIAMS & WILKINS, 2017) van Bosse, Harold J. P.; Ponten, Eva; Wada, Akifusa; Agranovich, Olga E.; Kowalczyk, Bartlomiej; Lebel, Ehud; Senaran, HakanLower extremity deformities of patients with arthrogryposis multiplex congenita present a wide spectrum of severity and deformity combinations. Treatment goals range from merely ensuring comfortable seating and shoe wear, to fully independent and active ambulation, but the overarching intention is to help realize the patient's greatest potential for independence and function. Treatment of hip and knee contractures and dislocations has become more interventional, whereas treatment of foot deformities has paradoxically become much less surgical. This article synopsizes the treatment strategies presented in September 2014 in Saint Petersburg, Russia at the second international symposium on arthrogryposis.Öğe Unilateral spinal anesthesia in a pediatric patient with Duchenne muscular dystrophy: a case report(WILEY-BLACKWELL, 2013) Apiliogullari, Seza; Oc, Bahar; Kara, Inci; Celik, Derya; Duman, Ates; Senaran, Hakan[Abstract not Available]Öğe A Very Uncommon Complication Following Vaccination: Necrotizing Fasciitis and Myonecrosis: Case Report(Ortadogu Ad Pres & Publ Co, 2010) Senaran, Hakan; Karalezli, Nazım; Öğün, Tunç CevatNecrotizing fasciitis (NF) and myonecrosis is a potentially lethal soft tissue infection characterized by extensive muscular, fascial and subcutaneous tissue necrosis. In this paper, we report an 18-month-old boy admitted to a health clinic three days after Hepatitis-B vaccine injection with cellulitis at his left lateral arm and axilla. He was recommended oral antibiotics, however in the fifth day after vaccination he became lethargic, there were pseudo-paralysis, edema, crepitus on palpation and cutaneous necrosis was observed at axillary region and at posterior arm. With the diagnosis NF and myonecrosis, all the necrotic tissue including pectoralis major, triceps brachii, and most of the rotator cuff muscles were excised. After cutaneous grafting, the wounds healed, but functional recovery of the shoulder joint was poor at 4 year follow-up. Early diagnosis of NF and myonecrosis with debridment of necrotic tissue can prevent severe life threatening complications.
