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Bipolar hemiarthroplasty for femoral neck fracture in elderly: post-operative results and complications

Aim: In this study, we aimed to evaluate preliminary results and determine the rate of complications of bipolar hemiarthroplasty in patients aged 65 and older.

Material and Methods: Patients aged 65 years and older with femoral neck fractures who underwent surgery at 7A Military Hospital from September 2013 to September 2018 were included into this study. The research is a descriptive and prospective study. 

Results: A total of 60 patients were studied. Aside from 1 deceased, 59 cases with 59 joints were replaced and followed up for an average of 15.3 months. Age and gender were not associated with the outcome of treatment. Implants included Zimmer 29, Serf 13, Stryker 9, and Depuy 9. There were 28 joints using cement and 32 joints cementless. The position of the stem was neutral in 54 cases, valgus in two instances, and varus in 4 cases. There were no loosen stem case. The cement technique was used in 17 cases (68%) type A and 8 cases (32%) Type B, according to Barrack classification. Clinical results according to Harris were as follows: 31 cases were very good, 12 cases were good, 5 cases were mean, and 11 cases were poor, equivalent to other authors. There were 6 cases of short limbs that reduced patient satisfaction. One case of incision infection was cleaned twice and stabilized after four weeks. One case of acetabulum worn after 32 months, but there were no clinical signs; one case dead from a stroke four weeks after  the  surgery without association with the operation.

Discussion: Poor results are often caused by a combination of medical problems or aging. Early surgery provided better results than late surgery. There was no damage to blood vessels, nerves, fractures, or death during surgery. The bipolar hemiarthroplasty in the elderly group with very good and good rates accounted for a high proportion (72.88%). Early surgery was better (90%) compared to late surgery (69.38%). There were a few complications due to surgery. 

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Evaluation of the alveolar antral artery position in the lateral sinus wall using cone-beam computed tomography

Aim: The aim of this study was to evaluate the prevalence and anatomic position of the alveolar antral artery (AAA) in different tooth regions of patients who underwent maxillary cone-beam computed tomography (CBCT) imaging.

Materials and Methods: CBCT images of 150 patients (59 males and 91 females) were included in the study. On the coronal images, localization of AAA relative to sinus lateral wall, the diameter of AAA and classification of AAA diameter were recorded for 1st premolar, 2nd premolar, 1st molar, and 2nd molar teeth levels separately.

Results: The prevalence of the detected arteries significantly increased antero-posteriorly from the 1st premolar to the 2nd molar (P<0.05). The mean diameter of the AAA was found to be 0.91±0.33 mm (range 0.25-2.90 mm) and the mean diameter of the AAA was significantly greater in males than in females (P=0.001). The AAA diameter increased antero-posteriorly from the 1st premolar to the 2nd molar. When evaluating the position of the arteries in the lateral wall of the sinus, the most frequent type of arteries was intraosseous (57.7%), followed by intrasinusal (39.0%) and superficial (3.3%). It was observed that 95.24% of all superficial type of AAAs was in the 2nd molar region. 

Discussion: AAA is an important structure and the clinician should be aware of location and course of the artery for surgical procedures. Careful evaluation of the AAA in maxillary sinus on CT images before surgery could reduce the possibility of excess bleeding, especially in molar areas.

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Prediction of hospital mortality by MELD Na+ score for esophageal variceal bleeding

Aim: Esophageal variceal bleeding is one of the most serious complications resulting from portal hypertension. It is seen in approximately 50-60% of cirrhosis patients, and bleeding recurs within 24 hours of diagnosis in 60-75% of cases. The MELD score is a system used to reveal the severity of advanced liver disease. Its principal sphere of use is  finding organs for liver transplantation, and it is also used to predict survival in patients with cirrhosis associated with infectious pathologies, esophageal variceal bleeding, fulminant hepatitis, and alcoholic cirrhosis. 

Materials and Methods: Patients presenting with esophageal variceal bleeding were reviewed retrospectively. Sixty-four patients meeting the study criteria were included. The age, sex, etiological causes of esophageal varices, histories, laboratory values at the time of presentation, hospitalization status, endoscopy results, and outcomes of the patients were determined. MELD and MELD Na+ scores were calculated, and their success in predicting mortality was analyzed.

Results: Seventy-five percent of the cases were men, and patients’ mean age was 60.91 ± 12.61 years. Sixty-three patients presented with bloody vomiting. Sixty-two of the 64 patients were hospitalized. Mortality was observed in 11 of the hospitalized patients. MELD score, MELD Na+ score, bilirubin and creatinine exhibited statistically significant correlation with mortality (pMELD =0.003, pMELD Na<0.001, pbil=0.001 and pcre=0.007, respectively), while no relation was determined with hemoglobin, age, INR or serum Na+ (p>0.05). 

Discussion: MELD Na+ score,  bilirubin and creatinine values are important and significant parameters in determining in-hospital mortality in patients presenting with esophageal variceal bleeding and are more important than MELD scores. Emergency department and other physicians can more easily be alert to potential mortality using this easily calculated scoring. 

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