Extended Lateral Supramalleolar Flap for Very Distal Foot Coverage: A Case With Arteriovenous Malformation

Arteriovenous malformation of the foot is very uncommon, and surgical closure after its treatment with embolization and total excision may be challenging for the foot surgeon, particularly in distally localized lesions. A popular method to cover these difficult wounds is free-tissue transfer, which is a highly demanding procedure. Alternatively, distally based regional flaps have been occasionally reported for clinical use in such distant foot defects. Herein, we present a 36-year-old female patient with a diagnosis of arteriovenous malformation arising in the distal medial plantar and dorsal surfaces of the right foot. After surgical resection of the vascular lesion preceded by a misapplied embolization procedure, an extended lateral supramalleolar flap was successfully transferred to the defect area, covering it completely. Functional and aesthetic outcome was satisfactory after 6 months follow-up. Extended lateral supramalleolar flap is a useful and reliable choice for distal foot reconstructions.     

Body mass index, percent body fat, and bone mass in a cohort of Chinese twins aged 6 to 18 years

Introduction This report examines the relationship of body mass index (BMI), percent body fat (%BF), and bone mass in a cohort of male and female twins recruited from Anhui province, China, ages 6–18 years—577 male pairs (mean age = 11.4) and 478 female pairs (mean age = 11.6). Methods Whole body bone mineral content (WBMC) in (g), whole body bone area (WBA) in (cm²), and %BF were measured using DEXA (Lunar Prodigy, USA). Regression analysis of within-pair differences was used to assess the strength of the association, and the analysis was stratified by gender and age group, where age cut-offs were based on ages at spermarche or menarche estimated from large population based studies in China. Males were stratified at ages before 14 and age 14–18, and females at ages prior to 12 and age 12–18. Results Univariately, BMI and %BF were associated with WBMC and WBA in the younger males and females, and in older males; %BF was significant only in older females. Multivariate models included both BMI and %BF. Among the younger males, age < 14, BMI and %BF were significantly associated with WBMC and WBA. In the younger females, age < 12, %BF was only significant to WBA. In the older age group, only BMI was significant to WBMC and WBA in females, but in males, BMI was positively associated, and %BF was negatively associated with both bone measures. Discussion These findings show that association between BMI and %BF and bone mass differ across gender and developmental stages, and %BF appears to be beneficial at younger ages, but detrimental or non-beneficial at older ages of development.     

Lupus vulgaris in a patient with systemic lupus erythematosus and persistent IgG deficiency

We present the case of a patient with juvenile onset systemic lupus erythematosus (SLE) who developed a persistent, acquired hypogammaglobulinaemia with IgG deficiency. The hypogammaglobulinaemia was probably a complication of high dose corticosteroid treatment. The serum IgG level remained subnormal despite intravenous immunoglobulin therapy. Lupus vulgaris, which developed on the nasal cartilage in this patient with SLE, is not an expected finding. This patient is probably the first reported case of SLE associated with lupus vulgaris.     

Audiovestibular disturbance in patients with systemic lupus erythematosus.

OBJECTIVE: The aim of this study was to evaluate the audiovestibular disturbance in patients with systemic lupus erythematosus (SLE). STUDY DESIGN AND SETTING: Twenty-eight patients with SLE and 28 healthy control subjects were included. Pure-tone audiometry, impedance audiometry, and electronystagmography (ENG) were used for baseline evaluation. Laboratory tests were carried out. Cranial and brain stem magnetic resonance imagings (MRI) were undertaken. RESULTS: Nineteen (67%) patients reported audiovestibular symptoms. Sensorineural hearing loss was found in 6 (21%) patients. Abnormal results on ENG were significantly higher (50%) (P < 0.01). Abnormal laboratory data were available from 26 patients (P < 0.05). MRI did not show any pathosis. CONCLUSION: The audiovestibular disturbances in SLE are more prevalent than previously recognized. Although no cause and effect relationship can be established by this type of study, it appears that a relationship exists. SIGNIFICANCE: Audiologic research should be directed toward routine, pure tone audiometry, and ENG assessment for patients with SLE to enable crucial treatment.     

Hand grip increases shoulder muscle activity: An EMG analysis with static handcontractions in 9 subjects

We examined 4 shoulder muscles-the supraspina-tus, infraspinatus, the middle portion of the deltoid and the descending part of the trapezius-with electromyography (EMG) in abducted and flexed arm positions, in 9 healthy subjects. the subjects were asked to produce a static handgrip force of 30% and 50% of maximal voluntary contraction (MVC) in 8 different arm positions. in all positions, the subjects held a dynamometer in the hand. the myoelectric activity in the shoulder muscles with only the dynamometer in the hand was compared to the EMG activity when static contractions were added. There was an association between static handgrip and shoulder muscle activity, as revealed by EMG. the EMG activity increased in the supraspinatus muscle in humeral flexion from and above 60° and in 120° abduction. in the infraspinatus muscle, the changes were less; a significant increase, however, was noticed in flexion. in the deltoid muscle there was a tendency towards increased activity in positions lower than 90°, in the higher arm positions, the activity decreased. There was no significant alteration regarding the EMG activity of the trapezius.

Our findings imply that high static handgrip force, particularly in elevated arm positions, increases the load on some shoulder muscles. the stabilizing muscles (the rotator cuff) were more influenced than the motor muscles by hand activity. Handgrip activity is important to evaluate while assessing shoulder load in manual work and in clinical evaluations of patients with shoulder pain.     

Effects of pinealectomy and exogenous melatonin on rat hearts

The effects of pinealectomy and administration of melatonin, the major secretory product of the pineal gland, which is a direct free radical scavenger and an indirect antioxidant, were studied in rat hearts on the basis of cardiac morphology and biochemical findings. Three groups of Wistar rats were used: one group was the sham-operated control, one group consisted of pinealectomized rats and one group consisted of pinealectomized rats that were treated with melatonin. Serum cholesterol, tissue levels of malondialdehyde (MDA) and reduced glutathione (GSH), and heart weight were determined. Histochemical staining with the Van Gieson, PAS/Alcian blue at pH 2.5 and Masson's trichrome methods were performed in addition to hematoxylin-eosin staining. Levels of serum cholesterol and tissue MDA, and heart weight were increased in pinealectomized rats whereas GSH levels did not change. Melatonin administration reversed these effects. Microscopically, myocardial fibrosis and myxomatous degeneration of cardiac valves were detected in all pinealectomized rats. It can be concluded that pinealectomy of rats causes morphological changes in rat hearts, and short-term application of melatonin does not reverse these changes.     

Continuing medical education in Turkey: Recent developments

Background  

The Turkish Association of Medicine founded a Continuing Medical Education Accreditation Committee in 1993 to evaluate and accredit scientific meetings and publications. The aims of this project were to raise the standards of meetings and to introduce compulsory revalidation and re-certification for physicians in Turkey.