A rare complication of lumbar disk surgery: Ureteral avulsion

A 49-year-old woman was admitted to our clinic with high fever, left lumbar pain and a mass at the flank following spinal surgery for disk disease. Complete left ureteral avulsion with urinoma formation was detected and she was treated with ureteroureterostomy. As in this case shows that the possibility of ureteral injury to the ureter during surgery for a disk hernia should be familiar to all neurosurgeons, orthopedic surgeons and urologists. When the diagnosis is made during early postoperative period, good results with preservation of the kidney can be achieved.     

Use of free dorsoulnar perforator flap in the treatment of postburn contractures of the fingers

BACKGROUND: Burns of the hand cause not only the impairment of hand function but also cosmetic deformity. Cases with dysfunctional hands with severe contractures increase if rehabilitation of the acutely burned hand is not done properly. PURPOSE: We present the use of free dorsoulnar perforator flap in the treatment of postburn contractures as an alternative when local flaps cannot be used. METHODS: Free dorsoulnar perforator flap was used in the treatment of seven hands with postburn contracture. Five of them had multiple digital postburn flexion contractures. Combined use of cross-finger and side finger transposition flaps was preferred when the adjacent finger was suitable for being cross-finger flap donor. When the adjacent finger was not suitable for being cross-finger flap donor, the free dorsoulnar perforator flap was preferred. Two of the patients had postburn web contractures. Free dorsoulnar perforator flap was used to release the web and to form a new web commissure. CONCLUSION: The free dorsoulnar perforator flap could be a good alternative to cover the defects created with the hand contracture release.     

Use of rhomboid flap and double Z-plasty technique in the treatment of chronic postburn contractures

BACKGROUND: Multiple reconstructive methods have been used for the treatment of postburn scar contractures including skin grafting, geometric relaxation techniques, local flaps and free flaps. PURPOSE: In the present study, the authors evaluated efficiency of the use of rhomboid flap and double Z-plasty technique in the treatment of chronic postburn contractures. METHODS: Twelve white male with postburn scar contracture were treated using rhomboid and double Z-plasty technique. The cause of burn, duration of contracture, postoperative follow-up period, preoperative and postoperative motion lag of joints and improvement in motion were recorded. CONCLUSIONS: All operations were successful. Severe contracture lines crossing flexion folds can be released effectively by using rhomboid flap and double Z-plasty technique without distorting the specialized flexion areas and with broken scar lines which is essential to avoid from recurrence.     

Hypoechoic space formation with periprostatic nerve block: myth or reality?

INTRODUCTION: The most efficacious and commonly applied anesthetic technique for prostate biopsy is periprostatic block. In a previous publication, the creation of a 'hypoechoic space' at the injection site was described. This was reported to be a routine and essential part of the technique in various subsequent series. We were interested in assessing the incidence of the formation of such a hypoechoic area, and more importantly, whether it had any impact on pain management. MATERIALS AND METHODS: One hundred and eleven consecutive patients were prospectively evaluated. Local anesthetic consisted of 2.5 ml of 2% lidocaine for each side of the prostate. Infiltration was done within the neurovascular space at the base of the prostate just lateral to the junction between the prostate and the seminal vesicle. The creation of a hypoechoic nodule was recorded in three categories: no formation, unilateral or bilateral formation. Three groups were compared regarding the intensity of pain using a numeric analog scale. RESULTS: No hypoechoic area was formed in 30 (27%) patients. A unilateral nodule was created in 40 (36%), and a bilateral nodule was seen in 41 (37%) patients. The median pain scores were 3.3, 2.5 and 1.3 for the no hypoechoic wheal, unilateral and bilateral wheal groups, respectively (p<0.0001). CONCLUSION: Our results suggest that the creation of a hypoechoic space with anesthetic infiltration for prostate biopsy is indeed an important aspect of the technique with regard to pain control; however, it may not be accomplished in every case.     

Morphine modulates inducible nitric oxide synthase expression and reduces pulmonary oedema induced by alpha-naphthylthiourea

This study was designed to investigate the possible participation of morphine in pulmonary oedema induced by alpha-naphthylthiourea (ANTU), which is a well-known noxious chemical agent in the lung. Injection of ANTU (15 mg/kg i.p.) produced pulmonary oedema as indicated by an increase in lung weight/body weight ratio and pleural effusion reaching a maximum within 4 h in rat. Administration of morphine prior to ANTU significantly inhibited to pulmonary oedema with a dose-dependent manner. The protective effect of morphine is prevented by peripheral opioid receptor antagonist, naloxone methiodide. ANTU-treated rats were shown positive by inducible nitric oxide synthase immunohistochemical staining. There was no staining in the control group. On the other hand, the degree of staining was markedly reduced in tissue sections by morphine. These results suggest that previous administration of subcutaneous morphine has preventive effect on ANTU-induced pulmonary inflammatory reaction and its effect mediated via peripheral opioid receptors. Application of naloxone with ANTU has no effect on the lung parameters indicating that endogenous opioids do not modulate ANTU-induced damage.     

Pandemic H1N1 influenza infection in children with acute leukemia: a single-center experience

In English literature, there are only 2 specific series of pandemic H1N1 influenza infection in children with leukemia. To increase knowledge about pandemic influenza in children with leukemia and better understand the risk factors for severe disease, we have presented the clinical characteristics of 8 children with acute leukemia and pandemic influenza treated at our center. The mean age of the children (4 girls and 4 boys) was 6.7±2.0 years (range, 4 to 10 y). All these children [3 acute lymphoblastic leukemia and 5 acute myeloid leukemia (AML) cases] were receiving chemotherapy during the course of infection, except 1 who was found to be H1N1 positive at the same time that she was diagnosed with AML. Among the other 7 patients undergoing chemotherapy, 4 were receiving induction, 1 was receiving consolidation, and 2 were undergoing maintenance chemotherapy. In our series, 1 patient with AML had a fatal course. She had recently received a chemotherapy bloc. Her neutrophil count was 0 during the course of H1N1 infection. She developed acute respiratory distress syndrome within a short time after the symptoms commenced and she died within 4 days. In conclusion, the clinical course of H1N1 infection may be fatal in rare cases of leukemic children receiving chemotherapy. Thus, vaccination is advisable for all leukemic children, especially for those under maintenance chemotherapy, as it might be life saving during such pandemics.     

Passive smoke exposure of female rats caused aortic atherosclerotic precursor lesions in their offspring

The aim of this study was to evaluate the presence and degree of preclinical atherosclerosis in pups of pregnant rats exposed to cigarette smoke. Abdominal aorta examined for atherosclerotic lesions and intimal medial thickness of the abdominal aorta was measured by image analysis. The study groups showed endothelial cellular losses, marked intimal injuries, elastic fiber damages, mononuclear cellular infiltration, and irregularities in internal elastic membrane, with pronounced damages as integrity losses and local fragmentations. The results provide evidence for development of an atherosclerotic process in the neonatal period, even in prenatal stage, long before the formation of smoke-related cardiovascular diseases.     

Complete blood count using VCS (volume, conductivity, light scatter) technology is affected by hyperlipidemia in a child with acute leukemia

Asparaginase, an effective drug in the treatment of childhood acute lymphoblastic leukemia (ALL), has become an important component of most childhood ALL regimens during the remission induction or intensification phases of treatment. The incidence range of asparaginase‐associated lipid abnormalities that are seen in children is 67–72%. Lipemia causes erroneous results, which uses photometric methods to analyze blood samples. We describe a case of l ‐asparaginase‐associated severe hyperlipidemia with complete blood count abnormalities. Complete blood count analysis was performed with Beckman COULTER^® GEN·S? system, which uses the Coulter Volume, Conductivity, Scatter technology to probe hydrodynamically focused cells. Although an expected significant inaccuracy in hemoglobin determination occurred starting from a lipid value of 3450 mg/dl, we observed that triglyceride level was 1466 mg/dl. Complete blood count analysis revealed that exceptionally high hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration levels vs. discordant with red blood cell count, mean corpuscular volume, and hematocrit levels. Total leukocyte count altered spontaneously in a wide range, and was checked with blood smear. Platelet count was in expected range ( Table 1 ). Thus, we thought it was a laboratory error, and the patient’s follow‐up especially for red cell parameters was made by red blood cell and hematocrit values.

Table 1. Patient’s complete blood count analysis according to the days of induction

Impact of body mass index on seminal oxidative stress

Male obesity has been linked with a reduction in sperm concentration and motility, an increase in sperm DNA damage and changes in reproductive hormones. Recent large observational studies have linked male obesity with a reduced chance of becoming a father. One of the potential underlying pathological mechanisms behind diminished reproductive performance in obese men is sperm oxidative stress. The primary aim of this study was to determine if sperm oxidative stress was more common in obese/overweight men. A total of 81 men had their body mass index (BMI) correlated with seminal reactive oxygen species (ROS) production (Nitro Blue Tetrazolium assay), sperm DNA damage (TUNEL), markers of semen inflammation (CD45, seminal plasma PMN elastase and neopterin concentration) and routine sperm parameters, together with reproductive hormones. The principal finding from this study was that oxidative stress did increase with an increase in BMI, primarily due to an increase in seminal macrophage activation. However, the magnitude of this increase was small and only of minor clinical significance as there was no associated decline in sperm DNA integrity or sperm motility with increasing ROS production. Increased BMI was also found to be significantly linked with a fall in sperm concentration and serum testosterone, and an increase in serum oestradiol.