Successful treatment of invasive pulmonary aspergillosis in an immunocompetent host

Immunocompromised individuals are susceptible to pulmonary Aspergillus infection, but invasive Aspergillus infection is extremely rare in the presence of normal immunity. A case of invasive pulmonary aspergillosis in an immunocompetent 57-year-old female who was successfully treated with liposomal amphotericin-B is reported here.     

Paracardiac Gossypiboma (Textiloma) in 2 Patients

Gossypiboma, also called textiloma, results when a cotton matrix such as a gauze pad or surgical sponge is left in a body cavity after surgery. The diagnosis of gossypiboma can be challenging. In symptomatic patients, operative removal of the pad or sponge is recommended; however, the decision to operate might be less immediately clear in asymptomatic patients. We report the cases of 2 patients in whom we diagnosed paracardiac gossypiboma. In addition, we briefly review other cases and discuss the treatment of asymptomatic patients.     

Three-dimensional evaluation of social smile symmetry

Objective:To evaluate the social smile symmetry using three-dimensional (3D) stereophotogrammetric images.Materials and Methods:The study was conducted with 3D facial images of 30 individuals (age range 13–25 years). The rest position was considered as the reference image and the social smile image was aligned on this image using the best-fit alignment method. The spatial differences between the same points established on both images using 3D analyses were determined for right and left points in X, Y, and Z planes.Results:The highest difference related to spatial distance in right and left points was −0.56 mm (95% confidence interval [CI], −1.19, 0.06 mm) between right and left commissure (Com) points. The difference was not significant, and the Bland-Altman upper and lower limits were −3.85 mm and 2.71 mm, respectively. The highest difference for the transversal plane was found in Com points, similarly to the spatial distance (mean: 0.50 mm, 95% CI, −2.62, 1.02 mm). The differences between the changes in the left and right points in the Y and Z plane were not significant (P > .05).Conclusions:The social smile was observed to show asymmetry in varying amounts in the different directions. Asymmetry increases in some cases, specifically for the corners of the mouth.     

An alternative method of transperitoneal graft introduction in aortobifemoral bypass surgery

Aorto-iliac occlusive (AIO) disease is one of the most common forms of arteriosclerosis obliterans (ASO).1 The gold-standard treatment of this disease is aortofemoral bypass surgery, according to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) study.1-3Surgeons have performed this procedure for many years with good long-term results. Vascular damage, bleeding, intestinal damage, ileus, myocardial infarction and renal failure are considered short-term complications. Secondary aorto-enteric fistula, sexual dysfunction, infection, graft thrombosis and anastomotic pseudo-aneurysm may be considered long-term complications.4-6 Among these complications, vascular damage, intestinal damage and aorto-enteric fistulae usually occur while introducing the graft into the femoral area.If the tunneller, which was specifically designed for aortofemoral bypass procedures, is not available for some reason, long, blunt-tipped tunnelling forceps are used instead. A nylon tape is taken through the tunnel with the tunnelling forceps after the tunnel is created. Aortic anastomosis is performed after heparinisation.Connecting the distal ends of the graft to the femoral area is performed in the conventional method by introducing the forceps into the tunnel a second time and pulling the graft through the tunnel. In an alternative method, the nylon tape that is taken through the tunnel with the tunnelling forceps is tied to the graft, which is pulled through into the femoral area. By not introducing the forceps a second time into the tunnel, complications caused by the forceps may be reduced. The results of both methods were analysed for postoperative bleeding, vascular injury and intestinal complications.     

Relationship between voice function and skeletal effects of rapid maxillary expansion

Objective:To evaluate the effects of rapid maxillary expansion (RME) on the vocal quality, maxillary central incisors, midpalatal suture, and nasal cavity in patients with maxillary crossbite.Materials and Methods:Coronal CT scans of 30 subjects (14 boys, 16 girls; mean age, 12.01 ± 0.75) were taken before RME (T0), and at the end of the expansion phase (T1). Voice samples of all patients were recorded with a high-quality condenser microphone (RODE NT2-A) on a desktop computer at T0 and T1. Statistical analyses were performed using a paired-sample t-test. The degree of association between the changes in the voice parameters and nasal width was assessed with Pearson''s correlation.Results:RME treatment produced a significant increase in the transverse dimensions of the midpalatal suture and nasal cavity between T0 and T1 (P < .05). The maximum F0 and jitter (%) results were shown to decrease statistically significantly from T0 to T1 (P < .001 and P = .042, respectively). Between T0 and T1, shimmer (%) and shimmer (dB) exhibited statistically significant increases (P = .037 and P = .019, respectively).Conclusions:After RME therapy, voice quality differences were found to be associated with increases in nasal width.     

Percutaneous cannulated screw fixation in the treatment of distal radius fractures

Purpose

The aim of this study was to determine the results of closed reduction and percutaneous fixation of distal radial fractures with standard 4.0-mm cannulated screw.

Methods

We collected prospective outcomes data for 20 patients between 18 and 60?years of age (mean 39) with acute, displaced, extraarticular and unstable fractures of the distal radius treated with closed reduction, percutaneous cannulated screw fixation and early mobilization. The visits at months 2, 6 and 12 were specified as index follow-up visits and assessments of motion, grip strength and standard radiographs were performed. The Gartland Werley functional scores and the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores were recorded.

Results

Mean values of flexion, extension, pronation and supination on the injured side were up to 70?% of those on the uninjured side at 2?months postoperatively. By 12?months, range of motion values on the injured side showed continuous and significant improvement and flexion, extension, pronation, supination and ulnar deviation reached up to 90?% of those on the uninjured side. A large and significant improvement was seen from 2 to 6?months in the QuickDASH score. A smaller improvement was seen from 6 to 12?months, which was judged not to be significant. Radiographic values were close to anatomic parameters, and the alignment was maintained at 12?months follow-up. No complications occurred.

Conclusions

Cannulated screw fixation appears to be an effective means of allowing immediate range of motion of the wrist, resulting in a rapid and comfortable functional recovery while maintaining alignment to bone healing.     

Plasma protein oxidation in aging rats after alpha-lipoic acid administration

In the present study, we investigated whether alpha-lipoic acid administration could have prooxidant or antioxidant effect on oxidative protein damage parameters such as protein carbonyl, nitrotyrosine, advanced oxidation protein products, and protein thiol, as well as oxidative stress parameters such as total thiol, nonprotein thiol, and lipid hydroperoxide in the plasma proteins of aged rats. Alpha-lipoic acid (100 mg/kg body wt/day) was administrated intraperitoneally to the Sprague-Dawley rats for 14 days. Protein carbonyl, nitrotyrosine, and advanced oxidation protein products levels were increased, protein thiol, nonprotein thiol, and total thiol levels were not changed in the plasma proteins of aged rats with alpha-lipoic acid administration. In aging rats with and without alpha-lipoic acid administration, plasma lipid hydroperoxide levels were significantly increased compared with those of the control group. The increased levels of protein oxidation markers such as protein carbonyl, nitrotyrosine and advanced oxidation protein products in the plasma proteins of alpha-lipoic acid-administrated aged rats compared with nonadministrated aged rats suggests that protein oxidation is increased in alpha-lipoic acid-administrated aged rats. We assume that an explanation for our findings regarding alpha-lipoic acid administration on protein oxidation markers in the plasma proteins of aged rats may be due to the prooxidant effects of alpha-lipoic acid.     

Coronary atherosclerosis distribution and the effect of blood glucose level on operative mortality/morbidity in diabetic patients undergoing coronary artery bypass grafting surgery: a single center experience.

OBJECTIVE: The study aim was to investigate the effect of blood glucose level on atherosclerotic lesion distribution and the contribution to the operative mortality/morbidity in diabetic patients who underwent coronary artery bypass grafting (CABG). METHODS: Between 1986-2003, a total of 2095 patients with diabetes mellitus underwent CABG. The analysis was carried out retrospectively from the clinical records. The patients were divided into four groups according to the blood glucose levels that were obtained when they first applied to hospital; Group 1 (492 patients with blood glucose < 120 mg/dl), group 2 (1112 patients with blood glucose - 120-200 mg/dl, group 3 (261 patients with blood glucose 201-250 mg/dl) and group 4 (230 patients with blood glucose > 250 mg/dl). One way ANOVA test was used for the statistical analysis of continuous variables and Chi-square test was used for analyzing the categorical variables. RESULTS: Emergent operation rate due to acute ischemia gradually increased from Group 1 to Group 4 and reached 6.6% in Group 4 (p=0.005). Operation time and the duration of cardiopulmonary bypass and cross clamp were significantly longer in patients with high blood glucose levels (p<0.05). Necessity for inotropic drug administration postoperatively (p<0.05) and mechanical support (p<0.05) were significantly higher also. The hospital mortality in group 3 was 9.6% and in group 4 was 11.3% (p=0.09). No statistically significant difference was found in terms of morbidity between the groups (p>0.05). The multi-vessel coronary artery disease was more common in groups with high blood glucose level (p<0.05). As the blood glucose level raised, patients were more frequently (p<0.05) confronted with distal left anterior descending artery, middle circumflex artery and right coronary artery lesions. CONCLUSION: Uncontrolled blood glucose level not only increased the perioperative complications but also the incidence of middle and distal coronary artery lesions. It is necessary to diagnose and aggressively treat the high blood glucose level especially before the CABG.