Stellate ganglion ischemia on the prevention of pulmonary vasospasm during bilateral carotid artery ligation: The first experimental study

Fatal pulmonary edema and hemorrhage are significant complications of endovascular treatment in steno-occlusive carotid artery disease; a rational mechanism has not been adequately examined in the literature so far. We investigated if cervical sympathetic ganglia ischemia prevents pulmonary vasospasm on the prognosis of bilateral common carotid artery ligation (BCCAL). Twenty-three adult New Zealand rabbits (4.2 ± 0.3 kg) were randomly divided into three groups: the control group (G1, n = 5), the sham group (G2, n = 6), and the BCCAL group (G3, n = 12). Common carotid arteries were dissected bilaterally in G2/G3, and permanent BCCAL was applied to only in G3. All animals were followed for 3 weeks and decapitated under general anesthesia. Histopathological changes in stellate ganglia and severity of pulmonary vasospasm-related lung edema and hemorrhage were investigated. Results were analyzed by the Kruskal–Wallis test. Two animals of G3 dead within three weeks and the remainder were sacrificed three weeks later. Subpleural petechial foci and an endotracheal bloody fluid collection were grossly observed in the lungs. Histopathologically, pulmonary artery vasospasm, perivascular and subintimal edema, interalveolar hemorrhage, and alveolar wall destructions were observed with less ischemic-degenerated neuron density-determined stellate ganglia animals. Neurodegeneration of stellate ganglia may have a beneficial effect on the prevention of lung injury during steno-occlusive carotid artery disease.     

Repeated tissue expansions on split-thickness skin graft in a patient with neurocutaneous syndrome

Soft tissue expansion is a mechanical process that increases the surface area of local tissue available for reconstructive procedures. In most cases, adjacent tissue that matches the recipient site in color, texture, and hair-bearing quality is preferred for tissue expansion. In this particular case with neurocutaneous syndrome, the defects that resulted from removal of parts of a giant hairy nevus overlying the latissimus dorsi muscle bilaterally were grafted with a split-thickness skin graft. Two expanders were then placed under the latissimus dorsi muscles. After full expansion of the grafted area, some part of the remaining nevus surrounding the grafted area was removed and the defects were covered with the expanded skin graft obtained after deflation of the expanders. The expanders placed under the latissimus dorsi muscle in the first operation were reused in the second operation to obtain a second expansion of the skin graft. After the second expansion of the skin graft, the expanders were deflated and another portion of the remaining nevus surrounding the grafted area was removed. The resulting defects were again covered with the excess expanded skin graft. Although repeated expansion of the skin graft is a time-consuming and laborious process, it eliminates the need for taking repeated skin grafts; it decreases skin graft donor site morbidity; it decreases possible infectious complications of tissue expansion by decreasing the number of surgical interventions to the expander pocket; and it increases the aesthetic outcome by keeping all the surgical scars around the grafted area without extending them into healthy surrounding skin.     

Use of Cortoss as an alternative material in calvarial defects: the first clinical results in cranioplasty

A clinical series of 13 patients who underwent cranioplasty using a new quick setting material, namely Cortoss, was done over 3-year period. Thus, the primary objective of this study is to evaluate the role of Cortoss in the treatment calvarial defects which were mainly due to trauma (4 patients), tumor or tumor-like lesions (5 patients), middle cerebral infarction (3 patients), and gun shot wound (1 patient). The surgical technique was found to be simple and effective. Long-term follow-up (mean 24.3 months) demonstrated satisfactory results in terms of surgical (functional) and cosmetic outcomes.None of the patients developed complications including infections, foreign body reactions or material leakage. The results led us to suggest that the use of Cortoss in the case of calvarial defects seems to be safe, effective, quick, and a feasible method for cranioplasty. We conclude that the mechanical, immunologic, and technical-grafting properties of Cortoss, together with its superior esthetic and psychological effects, probably will make it the best material for cranioplasty.     

An experimental model of traumatic nasoethmoidal cerebrospinal fluid fistula

Cerebrospinal fluid fistula secondary to head trauma is a potentially dangerous problem and precise localization and radical treatment is mandatory. The diagnostic technique is either computed tomography cisternography or MR cisternography. For evaluating the safety of diagnostic modalities and efficacy of treatment especially in terms of surgery, animal studies demonstrating traumatic cerebrospinal fistula model are indispensable not only for neurosurgeons but also for neuroradiologists. The authors in this paper describe a traumatic cerebrospinal fistula in an animal model using rabbits. The cerebrospinal fluid leakage was demonstrated successfully in all eight rabbits and was verified by computed tomography cisternography. The results led us to conclude that rabbit model of traumatic cerebrospinal fluid fistula is safe and has low mortality and morbidity rates. Further studies including larger number of animals should be considered in order to verify safety more accurately.     

Orbital foreign body penetrating from the cheek

This study emphasizes the importance of diagnostic first aid procedures to avoid the consequences of trauma due to foreign body. A 20-year-old man referred to our hospital with a history of having a sharp penetrating injury to his right eye. Computed tomography evaluation reported right globe perforation and intraorbital glass foreign body measuring 4 x 7 cm was removed. Perforated eye was repaired and traumatic cuts were sutured. Orbital and ocular injuries are common, and delays in management may lead to complication. A team approach is the best technique for these patients.     

Effects of different light-curing units and obturation techniques on the seal of the Resilon/Epiphany system

The purpose of this study was to compare the sealing ability of a resin- and polymer-based root canal obturation system (Resilon; Resilon Research LLC, Madison, CT/Epiphany; Clinical Technologies, Wallingford, CT) used in conjunction with different light-curing units and obturation techniques. A total of 120 decrowned single-rooted human teeth were used. After preparation of the root canals with 0.06 taper nickel-titanium rotary files to size 30, the roots were randomly assigned into three experimental groups according to the obturation technique used: (1) single cone, (2) cold lateral compaction, and (3) System B + Obtura. In all groups, the specimens were randomly assigned into four subgroups according to the polymerization method that was used to cure Epiphany sealer from the coronal aspect: (1) quartz-tungsten-halogen (QTH), (2) light-emitting diode (LED), (3) plasma-arc curing (PAC), and (4) chemical cure (uncured). Leakage was measured by the fluid-filtration method at 1 day and 1 week. Statistical analysis was performed by using Kruskal-Wallis and Wilcoxon signed-rank tests at p < 0.001. Fluid conductance of all groups increased significantly within time (p < 0.001). The tested obturation techniques had no significant effect on the leakage values (p = 0.433). The following statistical ranking was obtained for fluid-filtration values: uncured > PAC > LED > QTH (p < 0.001).     

Bilateral tonsillar adenoid cystic carcinoma

Adenoid cystic carcinoma is a malignant epithelial tumor of the salivary glands. It accounts for less than 1% of all head and neck cancers and less than 10% of all salivary gland neoplasms. It shows slow and indolent growth rate, low probability of regional nodal metastases, high propensity for perineural invasion, multiple and/or delayed recurrences and high incidence of distant metastases. It is the most frequently encountered malignant tumor of the minor salivary glands. The oral cavity and the oropharynx are the most common sites followed by the parotid, submandibular gland, paranasal sinuses, larynx, trachea, and pharynx, in frequency order. In this report an adenoid cystic carcinoma of oral cavity localized in the left palatine tonsil and right peritonsillar tissue was presented.     

Ischemia-modified albumin in the diagnosis of acute mesenteric ischemia: a preliminary study

Ischemia-modified albumin (IMA) is a sensitive marker of myocardial ischemia, skeletal muscle ischemia, pulmonary embolism, and stroke. However, there are no studies showing whether IMA increases in mesenteric ischemia. The aim of this study was to determine whether IMA was elevated in acute mesenteric ischemia. This case-controlled study was performed in an emergency department of a university hospital. The measurement of IMA levels in patient plasma yielded means of 0.264 +/- 0.057 absorbance units (ABSU) in the thromboembolic occlusion of the superior mesenteric artery (SMA) group and 0.163 +/- 0.025 ABSU in the control group. When plasma IMA levels in the thromboembolic occlusion SMA group were compared with those in the control group, statistically significant increases in IMA were observed in the occlusion group (P = .003). Findings indicating that IMA may have a place in the diagnosis of acute mesenteric embolism were obtained in this preliminary study. Further prospective studies are needed to see if IMA is clinically useful in the early detection of thromboembolic occlusion of the SMA.