Makale Arama

Breast reconstruction is an essential part of the breast cancer threapy. The transverse rectus abdominis musculocutaneous (TRAM) flap has been widely used for reconstruction of the breast. Partial loss of the flap is still a major problem. The defficiency of flap perfusion may cause partial necrosis of the flap. Periferic vasodilatation may increases flap viability. The aim of this study is evaluation of affect of nebivolol on rat TRAM flap perfusion. Nebivolol is a selective β1 adrenergic receptor antagonist that causes a direct vasodilator effect attributed to the action on vascular nitric oxide (NO). In this study 30 male spraque–dawley rats were used. A pedicled TRAM flap based upon the the right inferior epigastric artery was elevated and reapproximated. Animals were randomly assigned to 5 treatment groups (n:6). Group 1 received no nebivolol. Groups 2 through 5 were administered 100 mg/kg nebivolol orally 24 hours preoperatif; in addition groups 2 to 4 received orally postoperatif for 7 days. Group 3 also received intraoperatively; groups 4 and 5 were given nebivolol orally for 7 days before the 24 hours preoperatif treatment. Seven days after surgery skin paddles were photographed and assessed for viability. In seventh day blood lactate levels were measured. Statically significant differences were found in all experimental groups relative to the controls. Group 4 displayed the greatest improvement in flap viability, significantly better than other nebivolol groups. This study indicates that nebivolol may provide a useful pharmacologic tool for reducing iscemia-reletad necrosis in TRAM flaps.

Thrombotic thrombocytopenic purpura (TTP) is a rare and fatal disorder characterized with microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, fever, and kidney failure. The reason of TTP and optimal treatment method of TTP is still unknown. However, today, therapeutic plasma exchange (plasmapheresis) and / or plasma infusion is considered as the standard treatment method for these patients. In this study, the clinical characteristics and outcome of 18 patients with TTP treated with plasma exchange at the Department of Hematology, Meram Faculty of Medicine, Necmettin Erbakan University, between 2008 and 2011 years were evaluated retrospectively. Among the patients, 6 were male, 12 were females, median age was 39 (21-66), 8 were idiopathic, 7 were postpartum, 1 was post operative periods of prosthetic operation, 1 was pesticide exposure and 1 was NSAII induced TTP. The first admission of patients were evaluated for symptoms and complete blood counts, coagulation tests, BUN (blood urea nitrogen), creatinine, LDH (lactic dehydrogenase) levels were performed. All patients were initially treated with a daily plasma exchange plus steroids, which was continued until the normalization of platelet count and the level of LDH. In this study, a total of 165 plasmapheresis procedures were performed to total 18 cases. Fresh frozen plasma (FFP) was used as fluid of replacement. Of the 18 patients, 15 were discharged with complete remission (n:12) and partial remission (n:3), and 3 had no response and died of progressive neurological fingings and acute renal failure. Untreated TTP has a high mortality that may be as great as 90%. However, the rate of this mortality is dramitacally changed with plasma exchange treatment. As a result, today, plasma exchange is the most effective treatment available for treatment of TTP.

Aim: In this retrospective study, our patients with nephrotic syndrome (NS) were evaluated according to age, sex, etiology, response to steroid, prognosis, and compared with national data and the literature. Material and method: 141 children with nephrotic syndrome (NS) who admitted to the Department of Pediatric Nephrology of Selcuk University between January 2000 and December 2006 were assessed. Patients were classified into two groups according to etiology as primary and secondary NS. Results: 59% of the patients were male and 41% of them were female. Male/female ratio was 1.44, and median age was 9 (0.3-18.5) years. It is observed that 81.5% of the cases had primary and 18.5% had secondary NS. 67 of the patients with primary NS were male and 48 of them were female. Median age was 8 (0.3-18) years. 16 of the patients with secondary NS were male and 10 of them were female. Median age was 14 (7.5-18.5) years. Of patients with primary NS, 76.5% had steroid-responsive, and 22.6% steroide resistant. %64.8 of the patients with steroid responsive NS developed one and more relapses. Percentage of rare and frequent relapses were 3.4% and 61.3%, respectively. Our results showed that mesangioproliferative glomerulonephritis (MesPGN) was the most common histopathologic diagnosis, 15 (45%) of the 31 biopsied patients with primary NS were found to have MesPGN. Henoch Schonlein purpura nephritis was diagnosed in 14 (53.8%) patients and it was the most common cause of secondary NS. As a result, NS frequency and response to rate of steroid therapy are similar to present literature finding. However, frequent relaps ratio was lower than the others studies. Conclusion: We think that further research including more patients population and multiple center and control studies to investigate NS events to reveal causes of concerning with regional, national or race differences at the childhood period is warranted.

Aerosol glucocorticoids and bronchodilators are highly effective in the treatment of obstructive lung disease. Treatment failures can often be attributed to poor patient compliance or incorrect use of the inhaler. IVe surveyed the patients with chronic We showed that training in application associated with demonstration and subsequent exercise reduces the error ratio to a tolerable level in COPD patients.obstructive pulmonary disease (COPD) to assess their knovvledge of and ability to use four widely used inhaler devices; metered-dose inhaler, turbuhaler and diskus. Fourteen paitents with COPD were asked to demonstrate the use of each device using placebo inhalers. The inhalation technique was assessed in ten steps. Correct use was considered if 10 points were obtained. This study showed a high incidence of incorrect usage of inhalers amongst COPD patients.

Aim: Axillary defects mostly occur after burn contracture releases or hidradenitis suppurativa debridements. Reconstruction of this type of defect is a challenge since the ultimate aim is maintaining a pliable coverage with full mobility of the shoulder joint. Scapular flap is one of the reconstructive options in axillary defect coverage. This study is aiming to present reconstruction of axillary defects with scapular island flaps for different indications and to discuss the outcomes of the donor sites so as to suggest it as a workhorse flap in axillary reconstruction.
Patients and Methods: A total of 7 patients treated with 8 scapular island flaps between 2015 and 2019 were included retrospectively. Five patients were operated for hidradenitis suppurativa and 2 patients reconstructed for axillary contracture. All scapular flap pedicles were skeletonized and transferred to the axilla through the triangular space.
Results: Flap dimensions ranged from 84cm2 to 128 cm2 without exceeding 8cm of the width. Donor site scars widened between 3 months to 6 months post-operatively and independent of patient age. Donor site scars ranged from 1.5-2.6 cm after at least 3 months of follow-up. All flaps survived without any complication except one with a tip necrosis that healed with secondary intention.
Conclusion: Scapular island flaps can cover defects of the axilla created by various causes. Horizontal extension of the flap protects it from burn scar involvements of the posterior axillary line and the arm. Although widening of the scars seems to be a disadvantage, thin and pliable skin coverage with ease

Pemphigus is a group of autoimmune mucocutaneous diseases characterized by intraepithelial separation. Herpes gestationis is one of the rarely seen types of pemphigus. Its incidence is about 1/ 50000 - 1/ 60000. In our article we present a 25 years old patient in her 10th week of pregnancy presented to our clinic because of vaginal bleeding. The patient complained of an itching lesion on the upper quadrant of her left breast for which she was consulted to Dermatology department. The patient was discharged with the antihistaminic treatment that was advised by the dermatologist. After 10 days the patient presented with generalized, itching, erythematous, pustular lesions. A biopsy was taken from the lesion and the result was herpes gestationis. After 4 weeks of steroid therapy the lesions regressed. The patient is still taking methyl prednesolone treatment and on routine pregnancy control. Herpes gestationis is usually seen in the 2nd-3rd trimester of pregnancy. When herpes gestationis is suspected from lesions appearing in the first trimester the diagnosis should be confirmed by biopsy.

Organizing pneumonia (OP) is characterized histopathology cally by tufts of fibroblasts and immature collagen filling of respiratory bronchioles and alveoli. Symptoms are usually nonspecific and include cough and dyspnea. Radiograph cally, OP frequently manifests as patchy bilateral infiltrates that can be relapsing and migratory. Cryptogenic organizing pneumonia (COP) may be defined as having non-specific symptoms which can ultimately be described as a subset of the OP that cannot be attributed to any reason. Forty-nine-year-old female patient admitted with the complaints of 2 year exertional dyspnea and 20 day dry cough. The patient was diagnosed of pneumonia and prescribed with antibiotics; however, no improvement was observed in her complaints and lung graphics. The physical examination of the patient, routine laboratory analyses, collagen tissue markers and bronchoscopy were normal. In chest X-Ray, there were 4 nodular density approximately 1 cm in size, in the upper zone. In thorax CT, there were irregular contours multiple nodules, and the biggest one was approximately 35x7 mm in the upper lobes and in the superior of the left lower lobe of lungs. Acid fast bacteria was negative at bronchoalveolar lavage. The patient was diagnosed COP as clinically and radiologically. Then, systemic cortico steroid therapy was started. A complete clinical recovery was observed in the sixth month of the treatment and at the control thorax CT displayed that nodular lesions were disappeared completely. In the cases that were not respond to antibiotic therapy and patients having radiologically mobile and temporary infiltrations may be taken into consideration in the differential diagnosis.

We present a case of Jessner's lymphocytic in-filtrate of the skin in a 40-year-old man. The patient had non healing ch•onic inflarnmatory erit-hemapustulous lesions on the face and uppeı- pan of the auı•icles. bilaterally. First histopathologic di-agnosis of the patient was "Discoid lupus ery-thematosus". The lesions appeared on the ,face and made a deformity on the nose. In o•der to achieve exact diagnosis and treatment, all the lesions on the face excised and reconstructed hy a split skin grafit. Auricular lesions that were not treated such a this way, heakd spontaneously. Histopathologic exa-mination of the specimen that was excised from the lesion and healthv skin. revealed that the diagnosis is Jessner's lymphocvti• infiltrate. The reason of spontaneous healing of the auricular lesions exp-lained with no exposure of the auricles to sunshine.

The renin angiotensin system is thought to be modulated by gonadal steroids. After unilateral nephrectomy and unilateral nephrectomy + bilateral ovariectomy, occured changes were investigated in this study. Right nephrec- tomized and rigth nephrectomized + bilateral ovariectomized female rats left kidneys were examined histopatho- logically after four week. Severe inflammatory reaction was observed in only nephrectomized rats after four week. Moreover acut renal ischaemia was observed in the unilateral nephrectomized + total ovariectomized rats left kid- ney. Our results showed that gonadal steroids may have a role in modulating acut renal ischaemia.

Aim: Many options have been reported in reconstruction of the facial defects such as skin grafting, local flaps and free flaps. The extended V-Y flap, a modified V-Y advancement flap, is very useful in closing defects following excision of large facial lesions. Herein, we presented our 6 years experience for covering of the large facial defects with extended V-Y flaps. Material and Method: This procedure was applied to 27 patients with age ranging from 38 to 79 between 2001 and 2007. All operations were performed under local anaesthesia. The lesions were either squamous cell carcinomas, basal cell carcinomas, malignant melanoma, trichilemmoma, seborrheic keratosis or actinic keratosis and they were localized in the malar area, infraorbital area, lateral nasal aspect, the zygomatic area and the forehead. The size of the defects ranged from 3 x 3 cm to 6 x 5, 5 cm. Results: All of the flaps were achieved suitable closure of defects. The functional and aesthetic results were satisfactory for patients, and no tumor recurrence was observed during the 9 to 17 months follow-up period. Conclusion: Extended V-Y flap can be used reliably for the reconstruction of large facial tissue defects.

Decubitus ulcers can develop in immobilized patient. Patients with spinal cord injury and elderly patients are at high risk. We presented 36 patient with pressure sore that we operated between May 1994 and January 2000 and our reconstructive procedures. Sacral, trochanteric and ischial pressure sores we are included the study, other sites were excepted. As 3 patient with ischial ulcer were accepted because of recurrence, there were no recur- rence for sacral and trochanteric ulcers. This recurrences were not depend on surgical techniçues perhaps due to pressure. Selecting the proper surgical technique for decubitus ulcer, is important eitherpreventing recurrence and funtional loss. We revievved our experience with reconstruction of decubit ulcers betvveen 1994 and 2000 years.

Aim: Kluyvera sp., a Gram-negative bacterium in Enterobacteriaceae family, may give rise to such infections as urinary system infections, enteritis, soft tissue infections and sepsis in children. It is known that Kluyvera species is an opportunistic pathogen detected in immunosuppressed hosts as well as in immunocompetent ones. Considering that it may enlight future studies related to Kluyvera infections, studies in the literature have been scanned. Material and Method: The data about Kluyvera spp. isolates were obtained retrospectively from clinical microbiology records. Result: It was seen that, of the 3 Kluyvera isolates, 1 was a urine specimen, and the other 2 were from umbli cal area. In this study, antimicrobial susceptibility studies of the clinically significant Kluyvera isolates showed susceptibility patterns similar to those reported in the medical literature, namely trends of resistance to ampicillin and first- and second-generation cephalosporins. Moreover none of the clinically significant isolates were resistant to amikacin, ciprofloxacin, gentamycin, and trimethoprim+sulfametoxazole. Conclusion: It was concluded in the light of both the studies in the literatüre and this study that rare and opportunistic organisms, such as Kluyvera may be an infection cause in children.

Aim: To present a squamous cell metaplasia of bladder which is induced by a rarely seen pathology called recurrent eosinophilic cystitis. Case report: Twenty four years old female patient, admitted to our clinic with frequent urination, suprapubic pain and dysuria. Microscopic hematuria was found in urine analysis. We performed cystoscopy under general anestesia and an edematous, ulcerative lesion located at the trigone was found. The lesion was resected transuretrally. Pathology revealed eosinophilic cystisis. The patient began antihystaminics and aniticholinergics. The symptoms of the patient relapsed 2 months after medical treatment. This time the cystoscopy revealed a similiar lesion in a different area than the first one. The lesion was resected transurethrally. The biopsy revealed squamous cell metaplasia of epithelium and eosinophilic cell infiltration. Patient began steroid and antihistaminic combination postoperstively. The patients has been followed up to 6 months without any symptom. Result: Medical treatment is effective in the control of reccurencies of eosinophilic cystitits. Recurrent eosinophilic cystitis might cause squamous cell metaplasia in the bladder mucosa.

Aim: To evaluate the efficacy of a single döşe epidural corticosteroid injection in the treatment of lumbosacral radiculopathy secondary to lumbar disc herniation. Methods: We administered single dose epidural injection of steroid and local anestetic mixture in 31 patients with radicular pain due to lumbar disc herniations. Outcome was measured using a visual analog scale ranging from 0 to 10; straight leg raising test (SLR) values; a measurement of finger-to-floor distance; a patient satisfaction scale; and a Roland Morris low back pain questionnaire. Results: Thirty one patients were followed fors ix weeks. We found significant improvement in all parameters in patients at second day, second week and 6th. Week postinjection (p<0.05). Conclusions: We concluded that single-shot epidural corticosteroid injection is effective in the treatment of lumbar radicular pain due to lumbar disc herniations.

Abstract

Animal bites to the face can cause serious defects. In select cases when the avulsed part has been carefully preserved and brought-in with the patient, replantation may be the best solution.

In other cases, few strategies are present. The classical “watchful waiting” strategy to treat such patients could be described as letting the wound to heal and only then, initiate reconstruction. Wound scarring and patient’s psychological disturbance due to prolonged rehabilitation are its biggest disadvantages. However, a proactive method with reconstruction initiated early during the convalescent phase, can result in faster rehabilitation.

Herein, we present detailed description of a successful early reconstruction of the perioral area in a teenage girl following a dog bite; the reconstruction encompassing the anatomical, functional and aesthetic spectrum. Thus, we believe, proactive strategy has a huge potential in the modern era of reconstructive head and neck surgery.

Adult onset Still’s disease is a systemic disease of unknovvn etiology. Clinical and laboratory features are not pathognomonic. The diagnosis is difficult and based upon Yamaguchi’s criteria after exclusion of infectious diseases, hematologic process or autoimmune diseases. Treatment is not well codified but steroids represent the most efficient therapy to control fever and systemic manifestations. Search for new treatments and specific markers of adult onset Still’s disease are needed. İn this study, we present the cases of two patients with adult onset Still’s disease and revievv of the literatüre.

Castleman’s disease is a rare lymphoproliferative disorder of unknown etiology exactly. Although the disease most commonly appears in the mediastinal lymph nodes, it can be occur in cervical, retroperitoneal, axillary and other regions lymph nodes. There is no gender predominance and often occurs in young adults. Two histological variants as hyaline-vascular and plasma cell type have been described. Clinically it is also divided in two types: a localized type, which is usually asymtomatic and presented as a mass or swelling. Systemic (multicentric) type is characterized nonspecific symptoms such as fever, anaemia, generalized lymphadenopathy and hepatosplenomegaly Complete surgical excision is curative for localized form. Although systemic type is usually treated with radiation therapy, corticosteroids and chemotherapy, there is no certain treatment. We herein reported a neck mass diagnosed as hyaline vascular type Castleman’s disease.

\r\n\r\n\r\n\r\n

Aim: Dexamethasone is used for prevention of postoperative nausea and vomiting (PONV). Most important side effect of steroid use is adrenal suppression. In this study we aimed to evaluate the effects of single dose of 2, 4, 8 mg dexamethasone on adrenal glands by measuring serum cortisol levels, and also in preventing postoperative nausea and vomiting. Material and Method: Forty patients scheduled for elective total nasal reconstruction under general anesthesia were included to the study. Patients were randomly divided into four groups. Immediately before the induction of anesthesia 2 ml intravenous serum physiologic to group S, 2 mg dexamethasone to group D2, 4 mg dexamethasone to group D4, 8 mg dexamethasone to group D8 were applied. Blood sampling was done from the patients at preoperative visit day (t0), preinduction and before dexamethasone injection (t1), after induction at 2. (t2), 6.(t3), 9. (t4),12. (t5),18.(t6), 24.(t7) and 72. (t8) hours for measurement of serum cortisol levels. Results: Demographic data, anesthetic and surgical times were similar in the groups. The 8 mg and 4 mg dexamethasone doses were found to be more effective than the control and D2 groups in prevention of PONV. In 4 and 8 mg groups no increase was observed in the cortisol levels. In 8 mg group there was significant suppression in cortisol levels between 9.and 24.hours of induction. Conclusion: Both 4 and 8 mg dexamethasone doses are effective for prevention of PONV. Because 8 mg dexamethasone causes suppression of serum cortisol levels, we think that the application of 4 mg dexamethasone is safer than 8 mg.

In this article we give attention on the special feature of the steroid drugs ar,d their uses in otorinolarengology with review the literature.

A fifty two year old woman sustaining bilateral hand injurles after a traffic accident was admitted to our clinic. She had right thumb amputation from the carpometacarpal level, tendon and skin loss in the right hand secönd finger, loss of the 2-3 extensor tendons and the overlying dorsal skin in the left hand. Reconstruction in a single session was planned and palmaris longus tendons from both hands were taken and used as intercalary grafts for extensor tendon losses after which the skin loss was covered with a radial forearm flap. Afterwards, the second injured finger in the right hand was taken and pollicisized using the Buck Gramcko technique. At the last follow-up examination 8 months after the injury, she was able to pick up small objects and grip large and heavy objects using her right hand. The range of motion of the wrist and the fingers of the left hand was completely restored. The importance of treatment design tailored individually for each patient was stressed in this case.

Many different aproaches were reported for the reconstruction of columella defects that local flaps through microvascular tissue transfer. There was a columella defects in 22 years old male patient because of the explo- sion of bomb and the reconstruction was not thought by a local flap owing to large scar tissues next to the defect. After the dissectlon of wide adhesion of the septum nasi spongostan tampons were put into new plane. Then 2x1,5 cm diameter skin island flap with angular artery pedicul was prepared on the right nasolabial skin and transferred to the defect in order to the reconstruction of columella. The flap was folded and sutured. İt was made the flap thin by defatting 3 weeks later. The result was acceptable aesthetically. The results and short operative time for this flap were thought us that it is an alternatlve to the microvascular reconstruction and morbidity of the donor area was acceptable.

In this retrospective investigation, 106 children diagnosed as anaphylactoid purpura between 1983-1990 were evaluated. The disease was mostly encountered 5-14 years old. There was no sex predilection. 38% of the patients had predisposan factors and most of them were respiratory tract in-fections. The important symptorns were cutaneous manifestations, abdornirzal pain, limp pain consec-utively. Skin (100%), gastrointestinal system (65%), kidneys and musculoskeletal system (42%) were mainly allected. The leading cutaneous manifestations were purpuras and petechias. 38% of the pa-tients with gastrointestinal manifestations had hemorrhage. One patient was diagnosed as pancreaii-tis. The percent of the recurrences was 15%. The noticable laboratory abnormalities were the increas-ing of erythrocyte sedimentation rate, the elongation of prothrombin time, CRP and ASO positivity. [Jetirn perforation was developed during corticosteroid therapy in a case.

The most important problem with taze reconstruc-don of mandibular defect is the rejection of the mate-rial used. Up to date, various methods such as alloplastk reconstruction, free vascularizedfiaps, osteotrziyocu-tanöz flap and partide osseos greft have been de-scribed. in Iliis article we presented a patient who had multiple trıaxillofacial fractures and osseos tissue loss in mandible due to an accident that we have used reconstruction with free costal graft for the defect of mandibular fractures and other techniques have been revieved in literature.

The most important problem with taze reconstrucdon of mandibular defect is the rejection of the material used. Up to date, various methods such as alloplastk reconstruction, free vascularizedfiaps, osteotrziyocutanoz flap and partide osseos greft have been de-scribed. in Iliis article we presented a patient who had multiple trıaxillofacial fractures and osseos tissue loss in mandible due to an accident that we have used reconstruction with free costal graft for the defect of mandibular fractures and other techniques have been revieved in literature.

Purpose: It was aimed to present the clinical and functional results of the patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow.

Methods: 14 patients who underwent tumor resection and endoprosthetic reconstruction due to malignant tumor in the elbow circumference between 2011-2018 in our clinic were included in the study. While 4 of the patients were primary tumors (1 fibromixoid sarcoma, 1 leimyosarcoma, 1 multiple myeloma and 1 ewing sarcoma), 10 were distant organ metastases (4 breast cancer, 3 lung cancer, 1 stomach cancer, 1 renal cell cancer and 1 thyroid cancer). Musculoskeletal Tumour Society (MSTS) score and Mayo elbow performance score (MEPS) and survival were evaluated.

Results: The minimum follow-up period of the patients was 7 months, and the maximum follow-up period was 55 months. The mean MEPS score of the patients was 67.5 ± 12.0 (range, 45-90), and the mean of the MSTS score was 19.4 ± 2.3 (range, 16-24). Recurrence occurred at follow-up in 3 patients and exitus at follow-up in 7 patients. In this study, the median survival time of the patients was 44 months. The 1-year survival rate was 70.1% while the 3-year survival rate was 54.5%.

Conclusion: Pain and functional results are satisfactory in patients who undergo tumor resection and endoprosthetic reconstruction due to malignant tumor around the elbow. In the future, studies with larger patient series are needed.

Aim: We aimed to report our experience of a digital artery perforator flap use in fingertip and pulp defects reconstruction

 Materials and Methods: 8 patients underwent reconstruction with digital artery perforator flap for their finger defects were enrolled in the study. The patients were evaluated in terms of etiology, sex, age, comorbidities and outcomes.  The size of the flaps ranged from 20 x10 mm to 25 x20 mm.

 Results: The average age of the patients was 43,6 (range:19-66) years. 6 of 8 flaps survived completely and healed uneventfully.1 flap was totally lost where as 1 flap had partial skin necrosis.  No patients complained of cold intolerance or residual joint contracture. Mild hooked nail deformity occurred in one of the patients.

 Conclusions:  The DAPF is a reliable and versatile flap for fingertip defect reconstructions in non smoker patients without comorbidities. Single-stage operating procedure, ease of harvest, rapid recovery and preservation of digital arteries are the most important advantages.