Morbilliform drug eruption due to pegylated α-interferon can show complete regression after switching to non-pegylated interferon

Pegylated or non-pegylated α-interferon are frequently used medications for the treatment of both chronic hepatitis B and chronic hepatitis C. Skin disorders, which are mainly comprised of eczematous dermatitis, are frequently seen during treatment with this drug. However, drug eruption or morbilliform eruptions due to interferons have been rarely reported so far. We herein describe a patient who developed morbilliform drug eruption under treatment with pegylated interferon. She was able to continue treatment after switching from pegylated interferon to conventional interferon.     

The initial treatment of meningocele and myelomeningocele lesions in adulthood: experiences with seven patients

This is a retrospective study of patients having undergone surgical treatment of spina bifida cystica (SBC) lesions in adulthood. The objectives were to assess the clinical, radiological, and surgical characteristics of SBC lesions in adults. There is almost no study assessing these characteristics. Seven adult male patients with SBC lesions, ages between 20 and 23 (mean 21.1), had their primary evaluations between 1995 and 1999 in the Military Hospital, Ýzmir, and Gülhane Military Medical Academy, Ankara. A temporary cerebrospinal fluid leak in the patient with the thoracic lesion and a temporary partial urinary incontinence in the patient with the lumbosacral lesion occurred. The most common preoperative complaint was low back pain. This improved in three of four patients (75%) but did not disappear. Although it is rare, an adult with an untreated SBC is a possible entity. These lesions should be included in the differential diagnosis of dorsal midline lesions in adults. Even though they appear as a simple spinal meningocele clinically, preoperative MR imaging and CT are necessary and helpful in the precise diagnosis and surgical planning.     

Bilateral total knee arthroplasty in chronic, neglected congenital dislocation: a case report

This article describes a case of bilateral congenital knee dislocation treated with bilateral total knee arthroplasty. The patient had pain and disability while walking before the operation. Implants used in the surgery were constrained stems and they were applied with bone cement. After 6 years of follow-up, her joint range of motion at both knees was satisfactory and she was pain-free. The patient’s Knee Society Score and Functional Score improved from preoperative values of 12 and 0 for the right knee and 20 and 0 for the left knee to postoperative values of 55 and 15 for the right knee and 65 and 30 for the left knee. In the late presenting cases of the congenital knee dislocation, total knee arthroplasty has proved to be one of the treatment options with satisfactory outcomes.     

A Large Calcified Saccular Aneurysm in a Patient with Aortic Coarctation

Coarctation of the aorta (CA) accounts for 5% of all congenital heart disease. One of the most feared complications of coarctation of the aorta is the development of saccular aortic aneurysm. In this paper, we described a 20-year-old man with coarctation of the aorta in association with a large calcified saccular thoracic aneurysm just distal to the coarcted segment detected both in aortography and magnetic resonance angiography (MRA).     

Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion

We evaluated the efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) in patients with distal ureteral stone. In addition, we tried to determine the predictive value of Hounsfield Unit (HU) of the stone in the success of MET. A total of 75 patients with a distal ureteral stone of 5–10?mm diameter were randomly divided into three groups. Group 1 (n?=?25) received tamsulosin 0.4?mg/d; group 2 (n?=?25) received nifedipine 10?mg/day p.o and group 3 (n?=?25) received diclofenac sodium 50?mg p.o. when required. At the beginning of each treatment, the HU of the stone was also measured using a non-contrast computerized tomography in all the patients. The results were evaluated at week four. The mean age of the patients was 36.8 (range, 16–68) years. Stone expulsion was observed in 19 (76%) patients in group 1, 16 (64%) patients in group 2 and 9 (36%) patients in group 3 (p_group1-3?=?0.004, p_group2-3?=?0.048 and p_group1-2?=?0.355). The mean expulsion time was 9, 9.1 and 10.3 d, respectively (p_group1-3?group2-3?group1-2?=?0.619). The mean diclofenac sodium dose per patient was 544, 602 and 1408?mg in groups 1, 2 and 3, respectively (p_group1-3?group2-3?group1-2?=?0.977). The mean HU of the stone in patients with and without a successful MET was 363 and 389, respectively (p?=?0.462). Our results showed that MET with both nifedipine and tamsulosin provided a similar increase in the expulsion rate for distal ureteral stones. HU does not seem to be a predictive parameter for stone expulsion.     

Subacute reconstruction of lower leg and foot defects due to high velocity-high energy injuries caused by gunshots, missiles, and land mines

The present study reviews 215 male patients suffering high velocity-high energy injuries of the lower leg or foot caused by war weapons such as missiles, gunshots, and land mines. They were treated in the Department of Plastic and Reconstructive Surgery at Gulhane Military Medical Academy (Ankara, Turkey) between November 1993-January 2001. Severe soft-tissue defects requiring flap coverage and associated open bone fractures that were treated 7-21 days (mean, 9.6 days) after the injury were included in the study. Twenty-three of 226 extremities (10.2%) underwent primary below-knee amputation. The number of debridements prior to definitive treatment was between 1-3 (mean, 1.9). Gustilo type III open tibia fractures accompanied 104 of 126 soft-tissue defects of the lower leg. Sixty-four bone defects accompanied 83 soft-tissue defects of the feet. Eighteen local pedicled muscle flaps and 208 free muscle flaps (latissimus dorsi, rectus abdominis, and gracilis) were used in soft-tissue coverage of 209 defects. Overall, the free muscle flap success rate was 91.3%. Bone defects were restored with 106 bone grafts, 25 free fibula flaps, and 14 distraction osteogenesis procedures. Osseous and soft-tissue defects were reconstructed simultaneously at the first definitive treatment in 94% of cases. The mean follow-up after definitive treatment was 25 (range, 9-47) months. The average full weight-bearing times for lower leg and feet injuries were 8.4 months and 4 months, respectively. Early, aggressive, and serial debridement of osseous and soft tissue, early restoration of bone and soft-tissue defects at the same stage, intensive rehabilitation, and patient education were the key points in the management of high velocity-high energy injuries of the lower leg and foot.     

Preoperative analgesia management with rofecoxib in thoracotomy patients

OBJECTIVE: Pain management after thoracotomy is significant because pain reduces the postoperative respiratory performance. In this study, the analgesic efficacy and safety of rofecoxib in thoracotomy patients were evaluated. DESIGN: A prospective, randomized, double-blind, and placebo-controlled study. SETTING: This study was performed in the Meram Medical School of Selcuk University Departments of Cardiovascular Surgery and Anesthesiology. PARTICIPANTS: Sixty patients undergoing elective thoracic surgery via thoracotomy were randomized to receive either oral placebo or rofecoxib, 50 mg, 1 hour before surgery. INTERVENTIONS: All patients received a standard anesthetic. Pain scores, sedation scores, heart rate, mean arterial pressure, respiratory rate, analgesic requirements, and side effects were noted 2, 4, 8, 12, 18, 24, 32, 40, and 48 hours after operation. MEASUREMENTS AND MAIN RESULTS: There were no significant differences between the 2 study groups with respect to demographics, sedation score, intraoperative blood loss, and postoperative drainage. Compared with placebo, morphine consumption and pain scores at rest and during coughing were significantly lower with rofecoxib. CONCLUSIONS: The preoperative administration of rofecoxib, 50 mg, provides significant analgesia for postoperative pain relief and decreases additional opioid requirements after thoracotomy.     

Fertility preservation medicine: A new field in the care of young cancer survivors

Treatment modalities for numerous oncological and non‐oncological conditions result in gonadal insufficiency and infertility. Furthermore, pelvic‐abdominal radiation may result in uterine damage resulting in poor reproductive outcomes such as preterm birth, low birth weight, and spontaneous abortion in adult survivors of childhood cancers. In response to the recognition of the impact of cancer treatments on fertility, several fertility preservation techniques have been developed. In prepubertal children, fertility preservation options are usually limited to ovarian cryopreservation because of sexual immaturity, but oocyte freezing can be performed in adolescent children. Two prospective randomized studies showed no benefit of gonadal suppression with GnRH analogs to preserve gonadal function and thus this treatment should not be recommended. For adult survivors of childhood cancer who experienced reproductive failure, third party reproduction techniques are highly successful. Pediatr Blood Cancer 2009;53:267–273. © 2009 Wiley‐Liss, Inc.     

Serum prolidase activity in systemic sclerosis

Systemic sclerosis, also known as scleroderma, is a complex systemic inflammatory autoimmune disease that targets the vasculature and connective tissue-producing cells and components of the innate and adaptive immune systems. The disease is characterized by a hardening of the skin and an increased synthesis of collagen. Prolidase is a specific imidodipeptidase involved in collagen degradation. The aim of this study was to search the serum prolidase activity (SPA) in the two subtypes of systemic sclerosis: diffuse and limited cutaneous systemic sclerosis. For this purpose, 35 patients diagnosed with systemic sclerosis (24 diffuse and 11 limited) and 41 healthy control subjects were included in the study. SPA was determined using Myara’s method, which is a modification of Chinard’s method. SPA did not differ between the scleroderma patients and controls (p = 0.467). However, SPA was significantly lower in diffuse form than in both limited form and control subjects (p = 0.021 and p = 0.024, respectively). SPA also did not differ between the limited form and control subjects (p = 0.145). Scleroderma is characterized by excessive deposition of collagen and tissue fibrosis due to the reduced collagen degradation. SPA is reduced in scleroderma patients, especially in diffuse form. Circulating autoantibodies, oxidative stress, and decreased physical activity may contribute to this process.     

YouTube como fonte informativa sobre bloqueios do plexo braquial: avaliação de conteúdo e valor educativo

Background and objectives

YouTube, the most popular video‐sharing website, contains a significant number of medical videos including brachial plexus nerve blocks. Despite the widespread use of this platform as a medical information source, there is no regulation for the quality or content of the videos. The goals of this study are to evaluate the content of material on YouTube relevant to performance of brachial plexus nerve blocks and its quality as a visual digital information source.