Mehmet Bekerecioglu

Evaluation of dynamic magnetic resonance imaging in assessing velopharyngeal insufficiency during phonation.

Background: Velopharyngeal insufficiency (VPI) expresses the structural and neuromuscular disorder of soft palate and pharyngeal walls inhibiting the normal functions of velopharyngeal (VP) sphincter mechanism. In this study, efficacy of dynamic magnetic resonance imaging in the diagnosis of VPI is investigated. Materials and Methods: A total of 32 cases, 16 controls and 16 cleft palates, were included in this study. T1 fast spin echo-weighted imaging during rest, dynamic investigations with True-fast imaging with steady-state precession sequence during /sss/ and /mmm/ phonations were performed. Results: During /sss/ phonation, complete closure was observed in the control group, whereas mean VP opening was 4.11 cm2 preoperatively and 0.21 cm2 postoperatively in the cleft palate group. In the postoperative period, only 3 patients did not have complete closure. In the second operations, performed 6 months later, only muscle repair was done. All 3 had complete closure. Conclusions: In cleft palate cases with delayed diagnosis, appropriate application of muscle repair will be sufficient for anatomic repair of VPI without any extra procedures. In addition, dynamic magnetic resonance imaging is an objective, noninvasive, reliable, and effective modality that may be used in the diagnosis and treatment of VPI without any extra investigations.

Immunohistochemical study on histogenesis of congenital epulis and review of the literature

Congenital epulis is a very rare lesion found only in newborn infants. This tumor is multiple in about 10% of reported cases, rarely with the simultaneous involvement of the maxilla and mandibula, as in this article. In the presented case, light microscopy demonstrated large eosinophilic granular cells arranged in solid nests that are separated by thin fibrovascular areas. The tumors In the maxilla and mandibula were investigated with a panel of polyclonal and monoclonal antibodies, and using immunoperoxidase methods on formalin‐fixed, paraffin‐embedded sections. Immunohistochemical studies revealed strong and diffuse cytoplasmic staining for neuron specific enolase and vimentin. However, all other reactions were negative. These results suggest that the congenital epulis may be derived from uncommitted nerve‐related mesenchymal cells.

Effects of abdominoplasty on respiratory functions: a prospective study.

The short-term and the long-term effects of abdominoplasty on the respiratory function of healthy adults are not known because of a lack of studies on this subject. Theoretically one might suggest that abdominoplasty can cause respiratory decompensation resulting from musculofascial plication, which reduces the respiratory reserve by decreasing intra-abdominal volume and diaphragmatic excursion. This prospective study was performed to evaluate the short-term effects of abdominoplasty on the pulmonary function of 14 consecutive otherwise healthy subjects. Calculation of the body mass index, measurement of the waist circumference, and the distance from xiphoid to umbilicus, and spirometry were performed for each subject preoperatively, and they were repeated at 10 and 30 days after the operation. The mean values of body mass index (p < 0.001), waist circumference (p < 0.05), and the distance from xiphoid to umbilicus (p < 0.001) were all decreased significantly by postoperative day 10. Comparison of the spirometric measurements showed a significant improvement in the mean forced vital capacity (p < 0.01) on day 30 postoperatively, whereas the mean forced expiratory volume in first second did not change throughout the study period. The authors conclude that abdominoplasty could improve pulmonary function in healthy subjects by increasing the forced vital capacity.

Comparison of the rate of palatal fistulation after two-flap and four-flap palatoplasty

We studied 73 repairs of cleft palate (48 cleft lip and palate and 25 isolated cleft palate) done during a 7-year period (January 1996–October 2002) by the same plastic reconstructive surgeon. Two-flap or four-flap palatoplasty techniques were used to provide tension-free, three-layer repairs for patients with cleft palate. Their ages ranged from 10–244 months (mean 27). The postoperative follow-up period ranged from 6 to 60 months (mean 21). There was a palatal fistulation rate of 7% (5/73). There were two fistulas after two-flap palatoplasty (5%, 2/39), and three fistulas after four-flap palatoplasty (9%, 3/34). The mean diameter was 7.8 mm (range 5.1 to 13). There was no significant difference between the two techniques.

Eicosanoids and inflammatory cells in frostbitten tissue: prostacyclin, thromboxane, polymorphonuclear leukocytes, and mast cells.

&NA; The pathophysiology of cold injury is still controversial. An inflammatory process has been implicated as the underlying mechanism and certain anti‐inflammatory substances such as ibuprofen and acetylsalicylic acid have been used in the clinical treatment of frostbite injury. It has been postulated that the progressive ischemic necrosis is secondary to excessive thromboxane A2 production, which upsets the normal balance between prostacyclin (prostaglandin I2) and thromboxane A2. It was aimed to clarify the pathophysiology of cold injury in this study. Twenty‐one New Zealand White rabbits, each weighing 1.2 to 2.9 kg, were divided into control (n = 10) and frostbitten (n = 11) groups the randomly. The rabbit ears in the frostbitten group were subjected to cold injury, and the levels of thromboxane A2 (as thromboxane B2) and of prostaglandin I2 (as 6‐keto‐prostaglandin F1&agr;) and the number of inflammatory cells (polymorphonuclear leukocytes and mast cells) were measured in normal and frostbitten skin of rabbit ears. The levels of 6‐keto prostaglandin F1&agr; and thromboxane B2, the stable metabolites of prostaglandin I2 and thromboxane A2, respectively, were increased in a statistically significant way (p < 0.002) by frostbite injury; however, thromboxane B2 increased more than 6‐keto prostaglandin F1&agr;. Polymorphonuclear leukocytes and mast cells, absent in normal skin, were present in the frostbitten skin. There was a statistically significant (p < 0.01) correlation between the time a rabbit ear was maintained at below ‐ 10°C and skin survival and between the weights of rabbits and skin survival (p < 0.024). All these findings suggest that inflammation is involved in frostbite injury; a decrease in prostaglandin I2/thromboxane A2 ratio could be one of the factors leading to necrosis; the bigger the animal, the better its ability to counter frostbite. (Plast. Reconstr. Surg. 101: 1881, 1998.)

The Effects of Exogenous Melatonin on Peripheral Nerve Regeneration and Collagen Formation in Rats

BACKGROUND Peripheral nerve damage that requires surgical repair does not result in complete recovery because of collagen scar formation, ischemia, free oxygen radical damage, and other factors. To date, the best treatment method has not yet been determined. In this study, we designed an experimental peripheral nerve injury model, and researched the possible effects of melatonin hormone, based on evidence of its strong antioxidant and cell-protective effects via mimicking the effects of calcium channel blockers. MATERIALS AND METHODS We randomized 24 healthy female albino rats into three groups: the pinealectomy group, melatonin group, and control group. In the pinealectomy group, craniotomy, pinealectomy, sciatic nerve transection, and coaptation were performed, and 0.9% NaCl was injected intraperitoneally. In the melatonin group, craniotomy (without pinealectomy), sciatic nerve dissection, and coaptation were performed, and melatonin was injected intraperitoneally, instead of NaCl. In the control group, craniotomy (without pinealectomy), sciatic nerve dissection and coaptation, and intraperitoneal NaCl injection were performed. In each group, nerve recovery was evaluated histologically, functionally, and electrophysiologically. Functional and electrophysiologic evaluations were conducted before surgery and at 4 and 12 wk. RESULTS At 4 wk, no significant difference was observed between the groups. However, at 12 wk, significant electrophysiologic and functional improvement was observed only in the melatonin group. CONCLUSIONS Melatonin seems to have a beneficial effect on nerve recovery. However, this effect is not effective at physiologic doses. Future comparative studies with melatonin versus other nerve-regenerating agents are necessary to determine the clinical utility of melatonin hormone.

Cutaneous Undifferentiated Small (Merkel) Cell Carcinoma, that Developed Synchronously with Multiple Actinic Keratoses, Squamous Cell Carcinomas and Basal Cell Carcinoma

Merkel Cell Carcinoma (MCC) is an uncommon undifferentiated neuroendocrine tumor, arising in skin mainly on sun‐exposed areas. We present an unusual case of primary cutaneous undifferentiated small cell carcinoma that co‐existed with six other lesions; 2 actinic keratoses, 3 squmaous‐cell carcinomas and a basal‐cell carcinoma. HE stained sections revealed MCC located in the mid‐dermis, co‐existing with severe actinic keratosis. Immunohistochemically, the tumor cells reacted to cytokeratin 20, epithelial membrane antigen, chromogranin and neuron specific enolase. This is an unusual case of cutaneous MCC co‐existing with six other different lesions. The concurrent development of MCC, squamous‐cell and basal‐cell carcinoma in the same patient indicates the pluripotent epidermal stem cell origin of these tumors. Further research is needed to enlighten the factors inducing this divergent differentiation.

The association between silicone implants and both antibodies and autoimmune diseases

Silicones are widely used materials in many fields of medicine and largely are believed to be biologically inert. However, some investigators have reported that silicone implants are associated with an increased incidence of autoimmune disorders. In this study, we evaluated the capsular tissue of silicone implants and the sera of implant patients and controls for antisilicone antibodies and nonspecific immunoglobulins (IgG, IgA, IgM, and IgE). Our study group included 15 patients (eight men and seven women) undergoing reconstructive procedures for burn scars, in whom we used silicone implants, and 15 sex-matched controls undergoing reconstructive surgery for burn scars without using silicone implants. By immunofluorescence, we discovered strong capsular binding of IgG and weak capsular binding of IgM; antisilicone antibody levels were significantly higher in capsular tissue than elsewhere. Serum IgE also was higher in patient vs control subject sera. In conclusion, silicone materials do lead to an immune response consisting of antisilicone antibodies most evident immediately adjacent to the implant itself.

A New Technique for Closure of Large Meningomyelocele Defects

Background:Although small meningomyeloceles may be amenable to direct closure by undermining of the surrounding skin, the closure of large meningomyelocele defects is a challenging reconstructive problem. Purpose:Here, we present a new surgical procedure for the closure of large meningomyelocele defects. Material and Methods:In this procedure, after neurosurgical repair and closure of the placode, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 3 years, this new technique, namely Mutaf triangular closure procedure, was used for the closure of large meningomyelocele defects in 5 patients, aged between 2 days to 6 weeks. The defect size was 10.4 × 7.5 cm on average. Results:In all patients, a tension-free 1-stage closure was obtained. Except one with a minimal hematoma, all patients healed with no complication. There was no patient with late breakdown of the wound during 2 years of mean follow-up. Conclusions:Besides the 2 major advantages of short operative time and minimal blood loss, our technique provides a well-vascularized soft tissue padding over the neural tissues, and no suture line overlies the cord closure. With these advantages, this new technique seems to be a useful and safe solution for closure of large meningomyelocele defects.

THE EFFECT OF GINGKO BILOBA EXTRACT (Egb 761) AS A FREE RADICAL SCAVENGER ON THE SURVIVAL OF SKIN FLAPS IN RATS: A comparative study

Free radicals may have a role in pedicle flap necrosis. We undertook this study to compare the effect of various antioxidants and scavengers of free radicals such as vitamin E, vitamin C, deferoxamine, and Gingko biloba extract (Egb 761) on McFarlane caudal-based dorsal rat flaps. Fifty rats were divided into five groups of 10 animals each. One group served as a control (saline) group. The remaining four groups were given vitamin C 340 mg/kg, deferoxamine 150 mg/kg, Egb 761 100 mg/kg, and vitamin E 20 mg/kg. The necrosed area of flap was significantly reduced in the deferoxamine (p < 0.001), Egb 761 (p < 0.001), and vitamin C (p < 0.05) groups compared with the control group. Vitamin E had no effect on distal flap necrosis (p = 0.20).