Inci Gokalan Kara

Comparison of two methods of controlled mobilisation of repaired flexor tendons in zone 2

The results after primary repair of zone 2 flexor tendon injuries were evaluated in 263 fingers in 192 patients using two different early-controlled mobilisation programmes. There were 126 men and 66 women (age range 18 to 57 years) divided into two groups. Ninety-eight patients with 137 fingers were treated by early active mobilisation with dynamic splinting method according to a modified Kleinert regimen (Washington regimen), and 94 patients with 126 fingers were managed with a controlled passive movement regimen postoperatively. During this evaluation patients were evaluated for total active movement (TAM), grip strength, and disabilities of arm, shoulder, and hand (DASH) questionnaire. All patients were also reviewed 12 weeks after operation and the results assessed by the Buck-Gramcko-II system. Total active movement was “excellent” in the Washington regimen group (n=119, 87%), while excellent results of the fingers were achieved in the controlled passive movement group (n=94, 75%). The mean grip strength of the injured hand was 89% that of the non-injured side in the Washington regimen group, compared with 81% in the controlled passive movement group. The mean DASH score was 30 and 42 in the two groups, respectively. We think that controlled active mobilisation with dynamic splinting improves the outcome in the upper extremity, including range of movement, grip strength, and functional state of the hand in repairs of the flexor tendons.

Effects of Antibiotics and Saccharomyces boulardii on Bacterial Translocation in Burn Injury

PurposeTo investigate the effects of antibiotics and the probiotic, Saccharomyces boulardii, on indigenous microflora and bacterial translocation (BT) in burned rats.MethodsTwenty-three male albino rats were divided into a sham burn group (group 1, n = 7) exposed to 21°C water, a burn + antibiotic group (group 2, n = 8), and a burn + antibiotic + S. boulardii group (group 3, n = 8) exposed to 95°C water for 10 s, producing a full-thickness burn to 30% of the total body surface area. Ampicillin-sulbactam (1 000 mg/kg per day) was given as two doses via an orogastric feeding tube to groups 2 and 3. Saccharomyces boulardii (1 mg/g body weight per day) was given as two doses via the same route to group 3. All rats were killed on the fifth day postburn and cultures of the mesenteric lymph nodes, liver, spleen, blood, and cecal contents were done.ResultsThe incidences of BT were 0% (0/7) in group 1, 87.5% (7/8) in group 2, and 37.5% (3/8) in group 3. A significant increase in the BT incidence was found in group 2 (P ≪ 0.01), while a significant decrease was found in group 3 when compared with group 1. The total bacteria count of cecal flora was significantly lower in group 3 than in group 1 (P ≪ 0.01). The decrease in Gram-negative bacteria in the cecal flora was significant in group 3.ConclusionThese results suggest that the incidence of BT in burn injury is enhanced by using an antibiotic, and that S. boulardii decreases the incidence of antibiotic-induced BT. Thus, we conclude that S. boulardii can effectively protect the intestinal ecologic equilibrium and prevent BT in burn injury victims.

The Tessier Number 5 Cleft With Associated Extremity Anomalies

OBJECTIVE Oblique facial clefts are rare congenital deformities. They constitute 0.22% of all facial malformations. In this case report, an oblique facial cleft defined as Tessier number 5 is presented. The number 5 cleft of Tessier is one of the most rare congenital facial clefts; review of the literature revealed 20 patients. This case was also demonstrated with associated limb anomalies, suggesting that the patient may have been affected by the amnion rupture sequence. The teratology of these malformations is discussed, and attention is drawn to the amniotic rupture sequence as a possible cause.

The effect of trimetazidine on the survival of rat island skin flaps subjected to ischemia-reperfusion injury.

The effect of trimetazidine (TMZ) on flap ischemia-reperfusion injury was investigated in rat inferior epigastric artery flaps. Twenty-six rats, divided into four experimental groups—nonischemic group (group 1, N = 5), ischemic control group (group 2, N = 7), preischemic TMZ-treated group (group 3, N = 7), and postischemic TMZ-treated group (group 4, N = 7)—were used. Rat inferior epigastric artery flaps were rendered ischemic by occluding the feeding femoral artery, and they were reperfused by releasing the clamps after 11 hours in groups 2 through 4. Group 3 rats were given TMZ (3 mg per kilogram, intravenously) diluted in saline before application of the clamp, and group 4 rats were given TMZ before clamp removal. Flap survival was scored on postoperative day 8. All flaps in the nonischemic control group (group 1) survived completely. The ischemic control group (group 2) demonstrated a 6.3 ± 4.3% survival area. In the preischemic TMZ group (group 3) the mean survival area was 76.9 ± 6.1%, and in the postischemic TMZ group (group 4) it was 76.8 ± 5.6%. TMZ-treated flaps showed a significant increase in survival area regardless of the time of administration (p = 0.001, group 3 vs. group 2; p = 0.001, group 4 vs. group 2). This finding suggests that TMZ has a beneficial effect on the prevention or treatment of arterial ischemic flaps.

Congenital midline cervical cleft.

A14-year-old male was referred to our clinic for the treatment of a nipple-like protuberance on the lower one-third of the ventral neck. According to the patient’s history, the lesion was noticed at birth. On examination, there was a slit-like, reddened atrophic skin in the midline of the ventral neck with a nipple-like structure at the cephalic end (Fig 1). There was a sinus tract in the caudal end, which spontaneously discharged mucoid material. When the fistula tract was examined with a rigid probe, a narrow channel, 2 cm in length, was detected. The tract was coursing toward the suprasternal notch and ending abruptly anterior to the strap muscles. Apart from this lesion in the neck, the patient was otherwise normal. The neck ultrasound scan showed a normal thyroid gland without evidence of a thyroglossal cyst or fistula. The lesion was totally excised and the defect was closed with Z-plasty.

Does corticosteroid usage in rhinoplasty cause mood changes

In this study, the psychological effects of single-dose corticosteroids administered to patients who had undergone rhinoplasty were assessed. A total of 30 rhinoplasty patients were included in the study and were randomly assigned to 1 of 2 groups. Preoperatively, patients completed the Bech Rafaelsen Mania Scale and the Beck Depression Inventory. Dexamethasone 10 mg was given intravenously just before surgery to the first group, but no medication was administered to the second group. On the first postoperative day, patients were seen again, and the Bech Rafaelsen Mania Scale and the Beck Depression Inventory were again completed. Periorbital edema and ecchymosis were graded, and psychological well-being was measured on a standard visual analog scale. All patients and physicians were blinded to treatment until the end of the study. Results show that administration of a single-dose of dexamethasone 10 mg caused neither euphoria nor depression. No significant differences were observed between steroid and control groups in terms of patients’ psychological well-being. With single-dose dexamethasone, periorbital edema was significantly reduced on the first 2 postoperative days, and upper eyelid ecchymosis was significantly decreased only on the first postoperative day. However, preoperative steroid administration had no influence on ecchymosis of the lower eyelid. The authors conclude that single-dose dexamethasone 10 mg can be used safely to reduce periorbital edema and ecchymosis in rhinoplasty patients.

Comparison of static and dynamic splinting regimens for extensor tendon repairs in zones V to VII

Abstract The aim of this prospective, randomised, controlled trail was to compare two methods of rehabilitating extensor tendon repairs in zones V–VII. Patients who incurred simple and complete lacerations of their extensor tendons in zones V–VII enrolled into the study and underwent either static splinting (n = 25) or dynamic splinting (n = 27) after primary acute repair of tendons. Extension lag, flexion deficit, total active motion (TAM), grip strength, and functional status of upper extremities were measured. TAM was improved in the dynamic group when compared with the static group in the injured digits at 4 weeks (p = 0.001), at 12 weeks (p = 0.05), and at 6 months (p = 0.001). Grip strength outcomes demonstrated improved grip force for the dynamic group when compared with the static group at 12 weeks (p = 0.001). There were no ruptures in either group. Also, a better functional level was found in the dynamic splinting group at 6 months (p = 0.001). The findings of the current study suggest that dynamic splinting of complex lacerations of the extensor tendons in zones V–VII provides improved functional outcomes at 4 and 12 weeks and 6 months when compared with static splinting.

Persistent buccopharyngeal membrane

An 18-year-old girl presented with hearing problems. An otoscopic examination revealed chronic otitis media in her left ear, and an oral examination detected mucous membranes bilaterally closing the oropharyngeal isthmus laterally, from the soft palate to just behind the base of the tongue (Fig 1). Her uvula was huge and the oropharygeal istmus was a 2-cm-diameter perforation that communicated the oral cavity to the oropharynx. Her larynx and hypopharynx were normal, and she denied any previous caustic ingestion or injury to her pharynx. No other anomalies were detected apart from the left chronic otitis media, and she had no problems eating or drinking. The patient underwent a tympanoplasty operation on her left ear under general anesthesia by nasotracheal intubation. No surgical treatment was required for the persistent buccopharyngeal membrane (BPM). Following examinations revealed an intact tympanic membrane with normal hearing levels.

Effects of Oriental Sweet Gum Storax on Porcine Wound Healing

ABSTRACT Purpose: The objective of the present study was to assess the effects of oriental sweet gum (Liquidambar orientalis Mill.) storax on partial-thickness and full-thickness wounds compared to conventional wound dressings in a porcine model. Methods: Six young Yorkshire pigs were used. Sixteen square excisional wounds measuring 3 × 3 cm were performed per animal. The wounds were allocated to one of the four treatment modalities: storax, hydrocolloid dressing, silver sulfadiazine, and control groups. Partial-thickness wounds were created in two pigs, and tissue samples were harvested on days 4 and 8, respectively. Full-thickness wounds were created in four pigs, and tissue samples were taken on days 4, 8, 14, and 21, respectively. Histologically, all wounds were examined for re-epithelialization and granulation tissue formation. Tissue hydroxyproline content and wound contraction areas were measured. Results: In storax-applied group, there was a greater depth of granulation tissue at 4 and 8 days compared to all other groups (p < .0125), and there was a faster re-epithelialization at 21 days compared to both hydrocolloid dressing and control groups in full-thickness wounds (p < .0125). Tissue hydroxyproline content and wound contraction did not differ significantly between the groups. Conclusion: The results of this study indicate that topical application of storax enhanced both re-epithelialization and granulation tissue formation in full-thickness wounds. Further studies are indicated in this important area of wound healing research to evaluate the clinical efficacy of this storax and search for the mechanisms that explain its effects.

Sclerosing lipogranuloma of male genitalia

Sclerosing lipogranuloma of the male genitalia is a rare condition presenting with subcutaneous masses on the penis and scrotum. The cause and pathogenesis of this lesion have been the subject of considerable interest as it still lacks a well defined etiology. The main hypothesis about the pathogenesis is exogenous lipid degeneration related to subcutaneous injection of foreign bodies such as paraffin or topical use of oily drug preparations for penile augmentation. However, in some cases this granulomatous inflammatory lesion may be due directly to allergic mechanisms induced by heat, cold, or trauma. We present the case of a 32-year-old man with penile sclerosing lipogranuloma and discuss the cause and mechanisms of this process.