Cem Aydogan

Use of telemedicine and telephone consultation in decision-making and follow-up of burn patients: Initial experience from two burn units

OBJECTIVE This study investigated the use of telemedicine in decision-making and follow-up of burn patients. METHODS The Konya Burn Unit was established in July 2003, and up to December 2009, 187 patients were admitted to this unit, all of them were consulted-via audiovisual transmission of data (telemedicine)-to the same burn surgeon at the Ankara Burn Referral Center of our hospital network. Three basic systems are currently used: live interactive video, store-and-forward images, and telephone. The demographic data and burn criteria of the patients were investigated. Changes in the number of televisits and patient management were analyzed. RESULTS During the 66-month timeframe, 525 televisits were performed on 187 patients. There were 126 males (67.4%) and 61 females (32.6%). The mean total burn surface area (percentage of total burn surface area burned) was 23.3 ± 17.8% (range, 3-95%). Nine of the 187 patients (4.8%) died owing to multiorgan failure and sepsis. As a result of these televisits, 21 patients (11.2%) were transferred to our referral center. The number of dead and transferred patients decreased during the study. CONCLUSIONS Telemedicine is appropriate and cost-effective for treatment and follow-up of patients in burn units with personnel with limited experience.

Assessment of the Effectiveness of Silver- Coated Dressing, Chlorhexidine Acetate (0.5%), Citric Acid (3%), and Silver Sulfadiazine (1%) for Topical Antibacterial Effects Against the Multi-Drug Resistant Pseudomonas Aeruginosa Infecting Full-Skin Thickness Burn Wounds on Rats

The aim of this study was to compare the effects of four different topical antimicrobial dressings on a multi-drug resistant Pseudomonas aeruginosa contaminated full-thickness burn wound rat model. A total of 40 adult male Wistar albino rats were used. The control group (group 1), silver sulfadiazine (1%) group 2, chlorhexidine acetate (0.5%) group 3, citric acid (3%) group 4, and silver-coated dressing group 5 were compared to assess the antibacterial effects of a daily application to a 30% full-skin thickness burn wound seeded 10 minutes earlier with 10(8) CFU (colony forming unit)/0.5 mL of a multi-drug resistant Pseudomonas aeruginosa strain. Five groups (1 control group and 4 treatment groups) were compared. The administration of third-degree burns to all rats was confirmed based on histopathologic data. The tissue cultures from groups 2 and 5 exhibited significant differences compared to those of the other 3 groups, whereas no significant differences were observed between groups 1, 3, and 4. The effectiveness of the treatments was as follows: 1% silver sulfadiazine > silver-coated dressing > 3% citric acid > 0.5% chlorhexidine acetate > control group. Our results supported the efficacy of topical therapy by silver sulfadiazine and silver-coated dressing on infections caused by multi-drug resistant Pseudomonas spp.

Burns or phytophotodermatitis, abuse or neglect: confusing aspects of skin lesions caused by the superstitious use of fig leaves.

As a superstition, homemade decoctions are believed to be beneficial for several diseases. This kind of medical therapy, however, can lead to serious adverse effects. In this report, we present three cases from a single family. Each of the family members developed phytophotodermatitis after the application of a fig leaf decoction. The most severe effect was in the case of a 13-year-old boy who had been bathed with the fig leaf decoction; the two other cases were the parents who prepared and applied the medicine to their childs skin to heal the boys congenital mental-motor retardation. Silver sulfadiazine was used for wound care. The mother was discharged 6 days after admission, the father, after 8 days, and the boy, after 14 days. Burnlike wounds in all three cases healed completely.

Effect of static magnetic field on experimental dermal wound strength.

Context: An animal model. Aim: We sought to evaluate the effect of static magnetic fields on cutaneous wound healing. Materials and Methods: Male Wistar rats were used. Wounds were created on the backs of all rats. Forty of these animals (M group) had NeFeB magnets placed in contact with the incisions, either parallel (Pa) and perpendicular (Pr) to the incision. The other 40 animals (sham [S] group) had nonmagnetized NeFeB bars placed in the same directions as the implanted animals. Half of the animals in each group were killed and assessed for healing on postoperative day 7 and the other half on postoperative day 14. The following assessments were done: gross healing, mechanical strength, and histopathology. Statistical Analysis Used: Intergroup differences were compared by using the Mann-Whitney U or t test. Values for P less than 0.05 were accepted as significant. Results and Conclusions: There were no differences between the magnetic and sham animals with respect to gross healing parameters. The mechanical strength was different between groups. On postoperative day 14, the MPr14 had significantly higher scores than the other groups. When static, high-power, magnetic fields are placed perpendicular to the wound, increased wound healing occurs in the skin of the experimental model.

Effect of Topical Platelet-Rich Plasma on Burn Healing After Partial-Thickness Burn Injury.

Background To investigate the effects of platelet-rich plasma on tissue maturation and burn healing in an experimental partial-thickness burn injury model. Material/Methods Thirty Wistar albino rats were divided into 3 groups of 10 rats each. Group 1 (platelet-rich plasma group) was exposed to burn injury and topical platelet-rich plasma was applied. Group 2 (control group) was exposed to burn injury only. Group 3 (blood donor group) was used as blood donors for platelet-rich plasma. The rats were killed on the seventh day after burn injury. Tissue hydroxyproline levels were measured and histopathologic changes were examined. Results Hydroxyproline levels were significantly higher in the platelet-rich plasma group than in the control group (P=.03). Histopathologically, there was significantly less inflammatory cell infiltration (P=.005) and there were no statistically significant differences between groups in fibroblast development, collagen production, vessel proliferations, or epithelization. Conclusions Platelet-rich plasma seems to partially improve burn healing in this experimental burn injury model. As an initial conclusion, it appears that platelet-rich plasma can be used in humans, although further studies should be performed with this type of treatment.

A prospective clinical study of flow-mediated dilatation in burn injury.

The authors investigated endothelial function using flow-mediated dilatation (FMD) in burn patients. This study was done in burn patients with specific criteria on admission. Blood lipid profile at 1st day, high-sensitivity C-reactive protein, and FMD were assessed at 1st and 7th days, as well as at 1st and 3rd months. The highest values of high-sensitivity C-reactive protein were detected on the 7th day, which were significantly higher than those at 1st and 3rd months. The lowest value of FMD was observed on the 7th day. FMD values were higher during the 1st month compared with the 7th day. The highest value of FMD was detected in the 3rd month. It was found that FMD values measured at 7th day and 1st month were significantly lower in patients with a burn percentage of 40 or greater. Our results suggest that inflammation is more prominent on 7th day following burn. The decrease in FMD values on 7th day after injury can be attributed to endothelial damage. The increase in FMD on 3rd month after burn is attributable to effective burn treatment and gradual decrease of inflammatory mediators. The data from this study suggest that there is endothelial dysfunction and low-grade inflammation in burn patients. This condition is more prominent in patients with a burn ratio greater than 40%. Burn patients more frequently have impaired FMD, which may be indicative of arterial endothelial dysfunction and a marker for increased atherosclerosis.

Surgical interventions for late complications of arteriovenous fistulas.

Our aim was to determine the most effective surgical treatment for arteriovenous fistula (AVF) complications after all other methods of salvage have failed. We evaluated 110 patients for 139 complications that occurred after the initial AVF placement and for whom surgical intervention was the last hope for retaining fistula access. Vascular steal syndrome and venous hypertension were the most common complications seen in our patients. The anastomoses of 17 of the vascular steal syndrome cases were narrowed either by stitches or by a polytetrafluoroethylene graft. The second most performed revision surgery was excision of the aneurysm and repair with primary suturing, followed by excision of the aneurysm and interposition grafting. Successful surgical outcomes were achieved in 111 of 139 procedures after revision surgery without constructing a new AVF. AVF salvage surgery is of paramount importance in order to increase the patency rate, which prolongs survival and increases the patients quality of life.

Corner-Saving Renal Artery Anastomosis for Renal Transplantation

Renal transplantation is the preferred treatment for most patients with end-stage renal disease. Postoperative vascular complications that significantly affect graft loss include stenosis and renal artery thrombosis. Our transplant team has performed 1635 procedures since 1975. Since December 2003, we have performed a corner-saving technique for the renal artery anastomoses in 183 recipients. In this study, we retrospectively analyzed the outcome data from these procedures in 43 women and 140 men of overall mean age of 31.6 years (range, 7-66 years). Graft tissue was obtained from deceased donors in 47 and from living donors in 136 recipients. The mean age of the donors was 39.8 years (range, 6-67 years). The graft renal arteries were spatulated from the posterior walls of the renal artery to provide wide anastomoses. Using this technique, a renal artery stenosis occurred at 5 months after renal transplantation in 1 recipient (0.54%). It was treated successfully with balloon angioplasty and placement of an intraluminal stent. We did not encounter any instances of renal artery thrombosis during a mean follow-up of 20.6 +/- 11.6 months (range, 1-40 months). During follow-up, 5 recipients died, and 9 returned to hemodialysis. At the time of this writing, the remaining 169 recipients (92.3%) are alive with good graft function. In conclusion, owing to its low complication rate, we believe our new corner-saving technique to be the safest way to perform a renal artery anastomosis.

213 tiroidektomi olgusunun değerlendirilmesi: Hakkari deneyimi

GIRIŞ Tiroid hastaliklari tum dunyada ve ozellikle ulkemiz gibi bircok endemik bolgede sik gorulmektedir. Ilk defa 1872’de Theodor Kocher tarafindan yapilan tiroidektomi ameliyati o donemden beri genel cerrahi kliniklerinde en sik uygulanan ameliyatlar arasindaki yerini almistir. Tiroid hastaliklarinda hipertiroidizm, basi bulgulari, kozmetik nedenler ve malignite suphesi gibi nedenler cerrahi tedavi endikasyonlarini olusturmaktadir (13). Genel olarak cok yaygin olarak yapilan ve mortalitesi oldukca dusuk olan tiroidektomi ameliyatinin uygulanan cerrahi yonteme ve deneyime bagli olarak morbiditesi degismektedir (4,5). Secilen cerrahi yontem ne olursa olsun hastaligin cerrahi olarak endikasyonunun konulmasindan tedavi asamasina kadar ki surecte hasta ve hekime bagli bircok komplikasyon karsimiza cikmaktadir. Bu retrospektif calismada uzmanlik gorevine yeni baslayan ve genel anlamda tiroidektomi uygulamalarinda deneyimsiz olarak kabul edilen hekimlerin tiroid hastaliklarinin cerrahi tedavisindeki yeri tartisilmaya calisilmistir. Bu degerlendirme yapilirken de calisilan cografik bolgenin sosyal ve kulturel kosullari da goz onune alinarak farkli bir bakis acisi olusturulmaya calisilmistir.