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Öğe A novel designed chitosan based hydrogelwhich is capable of consecutively controlled release of TGF-Beta 1 and BMP-7(Turkiye Klinikleri, 2013) Yılmaz, İbrahim; Gökay, Nevzat Selim; Gökçe, Alper; Tonbul, Murat; Gökçe, ÇiğdemObjective: Both Bone Morphogenetic Protein 7 (BMP-7) and Transforming Growth Factor Beta 1 (TGF-ß1) have stimulating effects on chondrocyte proliferation. These growth factors act at different time points of the biological repair process. We aimed to design a hydrogel, which would enable consecutive controlled release of the growth factors. Material and Methods: We designed a chitosan particle impregnated Poly (vinylalcohol) (PVA)-borax hydrogel (CPBH). CPBH allowed controlled release of BMP-7 and TGF-ß1 at different time points. Hydrogel structure was analyzed by Scanning Electron Microscope (SEM). The release kinetics of Growth Factors (GFs) were determined with enzyme-linked immunosorbent assay (ELISA) and UV-spectrophotometer. Chondrocyte viability and toxicity were tested through CellTiter 96® Non-Radioactive Cell Proliferation (MTS) ELISA. Results: The designed hydrogel showed high swelling and mucoadhesion characteristics under acidic conditions. CPBH released BMP-7 first and rapidly and TGF-ß1 consecutively and slowly. It also allowed controlled release of protein/peptide based drugs for 21 days without altering their bioactive properties. At the end of 21 days, 82.62% of BMP-7 and 98.34% of TGF-ß1 were consecutively released. The difference between the groups was significant (for TGF-ß1, p<0.05 and for BMP-7, p<0.001). Conclusion: The controlled and slow release of growth factors has been shown to be beneficial on cartilage regeneration. As it is not cytotoxic, we suggest that this hydrogel might be used in medical and pharmaceutical applications areas. © 2013 by Türkiye Klinikleri.Öğe Arthroscopic synovectomy in the treatment of functional ankle instability: Outcomes and gait analysis(Springer-Verlag France, 2015) Altan, Egemen; Özbaydar, Mehmet Uğur; Tonbul, Murat; Şenaran, H.; Temelli, Y.; Akalan, E.Background Natural consequence of repetitive ankle sprains is the chronic ankle instability. Objective of this study was to clarify the gait patterns of functional ankle instability (FAI) patients after arthroscopic synovectomy, but also assessment of postoperative recovery. Patients and methods Arthroscopic synovectomy was performed to 14 FAI patients with history of unilateral repetitive ankle sprains, pain, and subjective sensation of instability. At a mean 54 months of follow-up (27-84), clinical assessment was conducted with respect to pain, number of ankle sprains, and American Orthopaedics Foot and Ankle Society (AOFAS) scores. Gait analysis was conducted to determine the temporospatial, kinetic and kinematic parameters at the last follow-up. Results Mean AOFAS scores increased from 68 (range 55-75) to 89 (range 77-100) points (P<0.01). Mean ankle sprains was 13 in a period of 23 (range 14-48) months (0.58 per month) and decreased to three sprains in a mean time period of 54 months (0.053 per month) (P<0.01). Mean preoperative and postoperative VAS scores were 8.0 and 2.9, respectively (P<0.01). During gait analysis, no significant differences were found in ankle joint, including foot progression angles, ankle dorsi-plantar flexion degrees and ground reaction forces (P>0.01). Among temporospatial parameters, only double support time showed a significant difference (P<0.01). All patients were satisfied from the procedure and returned to their previous activity level. Conclusion Improved long-term clinical results and scores were obtained in our patient group when compared with the preoperative scores. Also, three-dimensional gait analysis showed that the involved ankles demonstrate similar gait patterns to the uninvolved ankles in patients with FAI. © Springer-Verlag France 2014.Öğe Çapraz bağlayıcı ve büyüme faktörü emdirilen hidrojel sistemlerinden kontrollü ilaç salımı: Sistematik inceleme(2012) Gökçe, Alper; Yılmaz, İbrahim; Tonbul, Murat; Gökay, Nevzat Selim; Bircan, Rifat; Gökçe, ÇiğdemAmaç: Bu çalışmada, dünya genelinde son 31 yılda yapılan çalışmalar içerisinde, kontrollü ilaç taşıma sistemi olan ve çapraz bağlayıcı ilavesi ile biodegradasyona uğratılmış büyüme faktörü emdirilen hidrojelin, kıkırdak dejenerasyonunun tedavisindeki yeri sistematik olarak incelenerek konu hakkında daha büyük bir fotoğrafı görebilmek amaçlandı. Gereç ve Yöntem: Bu çalışmada, elektronik veritabanlarında dil kısıtlaması olmadan, The Cochrane Collaboration The Cochrane, The Cochrane Library (Issue 2 of 12, Feb. 2011), Ovid MEDLINE (1950 to 5th March Week 1 2011), ProQuest, US National Library of Medicine National Institutes of Health (NLM) ve PubMed, Elektronik ortamda veritabanlarında literatür taraması yapılarak, Mayıs 1970 ile 5 Mart 2011 tarihleri arasında kıkırdak , kontrollü salım , çapraz bağlayıcı , büyüme faktörü ve hidrojel üzerine yapılmış ve basılı olan deneysel çalışmalar VE , VEYA şeklinde tarandı. Elde edilen makaleler arasından, inceleme kriterlerini karşılayan dört adet makale çalışmaya dahil edildi. P değeri <0.05 heterojenite açısından istatistiksel olarak anlamlı kabul edildi. Sonuç: İlk tarama sonrasında ortaya konan 957.829 adet makaleden 88 adet makale tam olarak incelendi. Kontrollü ilaç taşıma sistemi olan hidrojelin çapraz bağlayıcı ile biyodegradasyon süresi uzatıldığında ve içerisine büyüme faktörleri emdirildiğinde, kıkırdak dejenerasyonuna etkilerinin yeri üzerine literatür içerisinden dört tanesi kriterlerimizi karşıladı. İstatistiksel değerlendirme amacıyla yapılan heterojenite testi sonucu, null hipotezi reddedildi (p=.75). Bulgular: Çapraz bağlayıcı ilavesi ile biyodegradasyon süresi uzatılan ve içerisine büyüme faktörü emdirilmiş kontrollü ilaç taşıma sistemi olan hidrojelin, kıkırdak hasarı tedavisindeki yeri hakkında yeterli bir kanıt bulunamamıştır. Klinik kullanımına ilişkin yorum yapabilmek amacıyla in-vivo, daha uzun dönem fonksiyonel sonuçlar veren, randomize kontrollü çalışmalara gereksinim duyulmaktadır.Öğe Comparison of two different measurement methods to determine glenoid bone defects: area or width?(Mosby-Elsevier, 2014) Altan, Egemen; Özbaydar, Mehmet Uğur; Tonbul, Murat; Yalçın, LeventBackground: This study compared two different techniques that have been used to measure the glenoids of patients with recurrent anterior shoulder dislocation. Methods: We analyzed 36 patients who had received arthroscopic Bankart repair for anterior shoulder instability. Retrospectively, 3-dimensional computed tomography images of both shoulders were available for these patients. Two measurement methods were compared to determine the glenoid defects. One of these techniques is based on linear measurement, previously defined as the glenoid index. The other method is based on surface area measurement. Subsequently, 3 more diameters and the average values obtained from these diameters were compared with the surface measurement method. Pearson correlation coefficient (r) was assessed to determine the relationship. Results: There was an almost perfect relationship between measurement methods when the defect area was less than 6% of the inferior glenoid circle (r, 0.915; P < .001). This relation decreased and the difference became more pronounced (r, 0.343; P=.657) when the bone loss exceeded 14% of the inferior glenoid circle. The highest correlations with the actual defects were the average values obtained from 4 different diameters (r, 0.964; P < .001) and the 4-o'clock position of the single diameter measurements (r, 0.860; P=.001). In addition, 11 patients had crescent-like defects, demonstrating a relatively low correlation between the measurement methods (r, 0.679; P=.021). Conclusion: Although the best correlation was achieved from average values obtained from different diameter positions, in practical use, we advise a linear measurement to estimate the glenoid bone loss at the 4-o'clock position to achieve a high correlation between the measurement techniques. Level of evidence: Level III, Diagnostic Study. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.Öğe Consecutively controlled release of TGF-Beta 1 and BMP-7 for synergistic growth of chondrocyte culture(Current Biology Ltd, 2011) Gökçe, Alper; Yılmaz, İbrahim; Gökay, Nevzat Selim; Tonbul, Murat; Gökçe, Çiğdem[No Abstract Available]Öğe El bileğinde lipoma arboserens(2013) Özdelice, Tuba; Gönen, Korcan Aysun; Tonbul, Murat; Yıldırım Güzelant, Aliye; Serdaroğlu, ÖnerLipoma arboresens, etyolojisi bilinmeyen nadir bir intra-artiküler lezyondur. Genellikle dizde yerleşir.Sinoviyal membranın yaygın villöz proliferasyonu, subsinoviyal membranın ve subsinoviyal yağ dokusunun hiperplazisiyle karakterizedir.Yavaş gelişen ağrısız şişlik en sık bulgudur.Bu makalede lipoma arboresens için nadir bir lokalizasyon olan el bileği yerleşimli olgu sunulmuştur.Öğe Giant Cell Tumor of Second and Third Metatarsals and a Simplified Surgical Technique: Report of Two Cases(Elsevier Science Inc, 2011) Yurdoğlu, Cihangir; Altan, Egemen; Tonbul, Murat; Özbaydar, Mehmet UğurGiant cell tumor (GCT) is a rare benign tumor that often arises in tendon sheath as well as long bones of the lower extremity in adults, although localization in the metatarsus is rare. In this report, the authors describe the rare case of GCT localized to the third metatarsal GCT in a skeletally mature 17-year-old girl, and also describe the results of distal metatarsal resection with Kirschner wire stabilization for the treatment of this condition. (C) 2011 by the American College of Foot and Ankle Surgeons. All rights reserved.Öğe Massive Retracted Irreparable Rotator Cuff Tears: What Is the Effect of Conservative Therapy?(Gunes Kitabevi Ltd Sti, 2014) Yıldırım Güzelant, Aliye; Sarıfakıoğlu, Ayşe Banu; Gonen, Aysun Korcan; Özbaydar, Mehmet Uğur; Bekmezci, Taner; Adas, Mujdat; Tonbul, MuratIntroduction: Massive, irreparable, retracted cuff tears, without surgical intervention need to be treated with conservative therapy. In this study we aimed to determine the efficacy of conservative treatment in such tears. Material and Methods: We retrospectively reviewed 33 patients with massive rotator cuff tears treated nonoperatively. Data were obtained from direct examination, medical records, plain radiographs, and magnetic resonance imaging (MRI). Radiographic classification has been made by plain AP views. The fatty muscle degeneration and the stage of retraction of the cuff were evaluated with MRI. Rehabilitation program was given to all patients. Results: The mean age at the initial examination was 71 (range, 50-84) years. The mean follow-up time was 5.5 (range, 2-10) years. Patients with Grade 3-5 tears and Stage III retractions had a higher incidence of fatty muscle degeneration of the subscapularis muscle. Deltoid muscle strength was found to be increased significantly at the latest follow-up. Conclusion: Exercise therapy should be kept in mind as a kind of rehabilitation method in patients with a symptomatic massive rotator cuff tear. It's essential that more randomised clinical investigations have to be conducted to find out the best management practice for this condition.Öğe Relationship Between the Size of Bone Marrow Edema of the Talus and Ankle Pain(Amer Podiatric Med Assoc, 2011) Tonbul, Murat; Yıldırım Güzelant, Aliye; Gönen, Aysun; Baca, Emre; Özbaydar, Mehmet UğurBackground: We sought to determine the changes in the size of the edema observed on MRI scans and its relation to the patient's pain during activity and pain during rest in bone marrow edema. Methods: A total of 26 patients were followed up at 3-month intervals for a period of 1 year. During the follow-ups, magnetic resonance imaging scans of the patients' ankles were obtained; the scores obtained on the American Orthopaedic Foot and Ankle Society functional rating scale and visual analog scale were determined. The changes in these parameters and the correlation between them were examined. Results: The size of the edema as observed on magnetic resonance imaging scans decreased, and the pain during activity and rest decreased. Although there is a correlation between the decrease in the edema size observed on magnetic resonance imaging scans and decrease in the pain during activity, there is no correlation between the decrease in the edema size observed on magnetic resonance imaging scans and the decrease in pain during rest. Conclusions: Patients can be informed more precisely, that the pain during rest and activity may not decrease after the third and sixth month, respectively. Magnetic resonance imaging may not alter after the ninth month, so it may not be necessary to be performed again. (J Am Podiatr Med Assoc 101(5): 430-436, 2011)Öğe Spinopelvic Parameters in a Turkish Population: A Study on 120 Healthy Individuals that Could Facilitate Treatment Planning(Ortadogu Ad Pres & Publ Co, 2012) Tonbul, Murat; Yıldırım Güzelant, Aliye; Gökçe, Alper; Gökay, Nevzat Selim; Yılmaz, İbrahim; Demirok, MehmetObjective: To obtain data that could be beneficial for investigation of spine and pelvis parameters in a healthy Turkish population sample and planning surgery in patients who have spine deformities. Material and Methods: These seven parameters were analyzed in standing lateral graphies of 120 healthy individuals in 3-18 and 19-50 age groups: Thoracal kiphosis (TK), thoracal tilt (TT), lumbar lordosis (LL), lumbar tilt (LT), sacral slop (SS), pelvic tilt (PT) and pelvic incidence (PI). Results: Spinopelvic parameters differed between groups however correlations between these parameters were similar. PI was significantly correlated with SS and PT. Significant correlations were detected in parameters between neighbouring anatomic regions. Pelvic morphology (PI) was cofirmed to arrange sagittal sacropelvic orientation (SS and PT). Sacral orientation (SS) was detected to be correlated with lumbar spine shape (LL) and orientation (LT). Conclusion: Results of this study may be stated to be able to be used as markers to provide normal spinopelvic balance in Turkish patients with spinal deformities.Öğe The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis(Wolters Kluwer Medknow Publications, 2012) Gökçe, Alper; Öztürkmen, Yusuf; Mutlu, Savas; Gökay, Nevzat Selim; Tonbul, Murat; Caniklioğlu, MustafaBackground: An accepted comprehensive clinical approach to the deformed spine with tuberculous infection is still lacking. We aimed to determine the usage of a staged algorithm in the treatment of kyphotic spine with tuberculous infection and to present the clinical results of the patients treated with the help of this protocol. Materials and Methods: 54 patients (28 females, 26 males) with a mean age of 39.2 (22-76) years. Preoperative, early postoperative, and followup clinical and radiologic results were evaluated retrospectively. The patients were classified into Kaplan A (kyphotic deformity < 30 degrees), Kaplan B (kyphotic deformity 30 degrees-60 degrees) and Kaplan C (kyphotic deformity > 60 degrees). They were operated by posterior instrument with anterior debridment (Kaplan A), debridment with anterior bone grafting (Kaplan B) and anterior column resection and bone grafting in Kaplan C. Results: Tuberculous involvement were seen at more than one level in 40 patients and paraspinal abscess were detected in 31. Preoperative focal kyphotic deformity was reconstructed with an average of 19 (9-38) degrees. Twenty-six patients had neurologic compromise with different severities and 12 of them improved after the surgical intervention. Improvement in work ability and pain status was detected in 52 and 61 of the patients, respectively. Wound complications responding to medical care were detected in nine patients. Initial kyphotic deformity was found as an important parameter in selecting the surgical procedure. Conclusion: Regarding resected amount of infected osseous material, as planned preoperatively, have resulted with better concordance between anterior and posterior column heights and better sagittal alignment. We could correct kyphosis and improve sagittal balance with staged algorithm as used by us.Öğe The role of simple elbow dislocations in cubitus valgus development in children(Springer, 2014) Adaş, Müjdat; Bayraktar, Mehmet Kürşad; Tonbul, Murat; Uzun, Metin; Çakar, Murat; Tekin, Ali Çağrı; Esenyel, MeltemWe investigated the functional and radiological outcomes of conservatively treated simple traumatic elbow dislocations and subsequent incidence of cubitus valgus development in children. Eleven patients (one female, ten male; mean age 9.8 years, range seven to 12 years) who presented to our hospital with simple elbow dislocations and were conservatively treated between July 2008 and September 2010 were included in the study. All were posterolateral closed dislocations. None of the patients had accompanying elbow fractures. All patients had pre- and postoperative radiographic examinations. The carrying angle of the involved elbow was measured and compared to the contralateral non-injured elbow during follow-up. The incidence and severity of cubitus valgus development was assessed. The functional and clinical outcomes were evaluated using the Mayo Elbow Performance Scale. The mean monitoring period was 24.3 months (range 19-30 months). All patients had satisfactory good and excellent results (85-100 points; mean 96.8 points) according to the Mayo Elbow Performance Scale. The final average elbow flexion was 137A degrees (range, 130-145A degrees) and average extension was 8.6A degrees (range 0-20A degrees) with full supination and pronation in traumatic elbow. Four patients (36.4 %) had an average increase (cubitus valgus) of 14.5A degrees (10-20A degrees) in carrying angle compared to the other elbow. While isolated traumatic dislocation of the elbow is uncommon among children, it can be successfully treated by urgent closed reduction, proper fixation of the elbow and appropriate timely rehabilitation. However, it should be considered that some patients may develop cubitus valgus deformity in a later period. Therefore, each patient with a simple traumatic elbow dislocation should be followed, and the parents should be informed of the potential for any deformity development.Öğe Yenidoğan kalça ultrasonografisi(2012) Tonbul, Murat; Gökay, Nevzat Selim; Demirok, Mehmet; Gökçe, AlperAmaç: Tüm yenidoğanlara uyguladığımız kalça ultrasonografisi sonuçlarımızı inceleyerek elde ettiğimiz verileri literatürle karşılaştırmayı ve konuya dikkat çekmeyi amaçladık. Gereç ve Yöntemler: Tüm yenidoğanlar, tarama programına alınarak fizik bakı ve ultrasonografi ile kalça eklemleri incelendi. Ebeveynler, gelişimsel kalça displazisi (GKD) hakkında bilgilendirildi. Pediatrik Ortopedi Derneğince tavsiye edilen Kalça Ultrasonografi Kayıt Formu dolduruldu. Bebeklere, Grafın statik kalça ultrasonografi metodu uygulandı. Ortolani ve Barlow testleri yapıldı ve abdüksiyon kısıtlılığı, Allis bulgusu ve pili asimetrisi varlığı araştırıldı. Geç dönemde ilk bulgularımız hastaların tekrar değerlendirilmesiyle doğrulandı. Bulgular: Altmış bebeğin (29 erkek, 31 kız) 120 kalçası çalışmaya dahil edildi. Fizik bakıda hiçbir hastada patolojik veri elde edilmedi. Ultrasonografik incelemeler ortalama 3,5 dk. sürdü. Ortalama anne yaşı 25 (19-38) yıldı. Pozitif aile öyküsü ve kundaklama öyküsü oranları % 3tü. Ortalama hamilelik süresi 38.5 (35-40) haftaydı. Bebeklerin başvuru süresindeki ortalama yaşı 20 (1-153) gündü. Ultrasonografik inceleme sonucunda, tüm kalça tipleri Tip 1b olarak ölçüldü. Ortalama 4,5 yıl sonra klinik ve radyolojik tetkiklerle kalçaların hiçbirinde patoloji saptanmadı. Sonuç: GKD erken tanısında kalça ultrasonografisi, fizik bakıyla beraber en güvenilir yöntemdir. Tüm yenidoğan kalçalarının ultrasonografik olarak taranması en idealidir. Ülkemiz koşullarında bunun maliyeti düşünüldüğünde, en azından riskli yenidoğanların ve pozitif fizik bakı bulgusu bulunan bebeklerin kalça eklemleri kesinlikle ultrasonografik olarak incelenmelidir.
