Reconstruction of soft tissue defects of the hand using the shape-modified radial forearm flap.

We have reconstructed soft tissue defects in 121 hands with radial forearm flaps. So that the flap perfectly fitted the defect, and to minimise the size of the donor site, we divided the flap into two or three components in each case. We call this the shape-modified radial forearm flap. Of the 118 patients, 113 had complete survival of the flap. The follow-up time was 1 to 15 years. The donor sites were closed primarily in all patients, giving good aesthetic results. The shape-modified radial forearm flap seems to be reliable, and makes it possible to adjust the flap according to the defect. The donor area can be closed primarily in all cases.     

Genetic features of retinitis pigmentosa in Turkey

Sixty-two cases with retinitis pigmentosa from 42 index families were investigated to reveal the genetic features of the disease in Turkey. There were 42 propositi of whom 5 had a systemic syndrome associated with retinitis pigmentosa. Of the remaining 37 cases the condition was autosomal recessive in 21 (56.8%), sporadic in 12 (32.4%), autosomal dominant in 3 (8.1%) and X-linked recessive in one (2.7%). Sporadic cases may be more frequent as many hereditary cases are not brought to medical attention in rural families. Male preponderance among sporadic cases may indicate that there may be more X-linked cases. Nine out of 21 cases initially classified as sporadic displayed parental consanguinity and they were included as having autosomal recessive trait. Large families with autosomal recessive inheritance may prove valuable in linkage analysis and in defining future gene abnormalities.     

Henoch Schönlein purpura and amebiasis

Abstract The pathogenesis of Henoch Schonlein purpura (HSP) is unknown but is believed to result from an immune complex reaction to various antigenic stimuli, such as infectious agents. However, its association with Entamoeba histolytica has not been reported before. We present an 11 -year-old boy with HSP, confirmed by the demonstration of leukocytoclastic vasculitis from skin and diffuse endocapillary proliferative glomerulonephritis, together with immunoglobulin A and complement component C3 deposition from renal biopsies. Cysts and trophozoites of Entamoeba histolytica were detected from the stool of the patient at the same time and disappeared after the treatment with metranidasole. The temporal association of these two disorders is either coincidental or due to a causal relationship between them.     

How nurses approach ethical problems in Turkey

Previously, nurse's adherence to ethical standards meant obedience to the physician and loyalty to the hospital; now, however, it means following ethical standards and rules set forth by professional codes of ethics. The International Council of Nurses' Code for Nurses (1973) has been the model for professional codes of ethics in countries throughout the world. ⁴ Using ICN's Code as a framework, a study was conducted in 1993 to find out how nurses in Turkey respond to ethical dilemmas. Below, a summary of the findings.     

Umbilical cord and maternal blood leptin concentrations in intrauterine growth retardation.

Leptin, the ob gene product, plays an important role in the regulation of body fat mass and weight. In previous studies, it was demonstrated that leptin is detectable in human fetal cord blood as early as at 18 weeks of gestation and that serum leptin concentrations are significantly reduced in small gestational age newborns. In the present study, we investigated whether umbilical and maternal serum leptin concentrations correlate with intrauterine growth retardation (IUGR). In addition, we aimed to determine the relationships between leptin concentration in the maternal and cord blood. We studied 40 newborn infants (21 female and 19 male; gestational age, 38-42 weeks) and their mothers. Of the infants studied, 10 had IUGR. Serum leptin concentrations were measured by radioimmunoassay. All newborns had detectable leptin concentrations. Leptin concentrations were significantly lower in newborns with IUGR and in their mothers (n = 10; 3.53 +/- 1.42 ng/ml, 6.75 +/- 1.47 ng/ml, respectively) than in infants experiencing normal growth and their mothers (n = 30; 5.58 +/- 2.98 ng/ml, 9.85 +/- 6.50 ng/ml, respectively) (p < 0.01 for newborns, p < 0.05 for mothers). There was no significant correlation between umbilical leptin concentration and maternal leptin concentration (r = 0.229; p = 0.155) in all study groups but, significantly, a correlation was observed in the group with IUGR (r = 0.736; p = 0.015). There were no significant correlations between both umbilical and maternal leptin concentrations and parity, delivery type and gestational age. There was a correlation between umbilical leptin concentration and birth weight of newborns (r = 0.383; p = 0.015) but no correlation with body mass index (BMI) of the newborns (r = 0.034; p = 0.834). Maternal leptin concentrations correlated with maternal weight and BMI (r=0.606; p=0.000, r=0.535; p=0.000, respectively). There was no correlation between maternal leptin concentrations and birth weight of the newborns (r=0.179; p=0.269) and with BMI of the newborns (r = 0.146; p = 0.367). There was no gender difference in leptin concentrations in the newborns (n=21; 5.50 +/- 3.37 ng/ml, for females; n = 19; 4.58 +/- 1.98 ng/ml for males) (p = 0.296). In summary, we have shown that IUGR is associated with a decreased leptin concentration in newborns and their mothers. The association between umbilical serum leptin and birth weight in this and other studies suggests a pivotal role of fetal leptin in regulating fetal growth and development.     

A case of uncontrolled severe asthma patient with coexisting carcinoid tumor presenting as pneumomediastinum

Introduction: Patients with inadequately controlled or uncontrolled asthma are at a greater risk of attacks for asthma requiring emergency room visits or hospital admissions. There is a significant correlation between the severity of the disease and the severity of exacerbations. Patients with poorly controlled asthma are at a higher risk for complications. Case study: We present a 24-year-old aspirin-intolerant, uncontrolled asthma patient with the complication of pneumomediastinum. Results: Severe symptoms persisted after the resolution of the pneumomediastinum despite intense anti-inflammatory and anti-obstructive therapy. A bronchoscopy revealed an endobronchial lesion and she was diagnosed with a carcinoid tumor. Conclusion: This case is an example of the importance of re-evaluating asthma patients who do not respond to standard medical treatment. Clinicians should be aware of the complications associated with asthma attacks such as pneumomediastinum and the possibility of a differential diagnosis that worsen asthma symptoms such as a carcinoid tumor.     

From the Cover: Carnivorous leaves from Baltic amber

The fossil record of carnivorous plants is very scarce and macrofossil evidence has been restricted to seeds of the extant aquatic genus Aldrovanda of the Droseraceae family. No case of carnivorous plant traps has so far been reported from the fossil record. Here, we present two angiosperm leaves enclosed in a piece of Eocene Baltic amber that share relevant morphological features with extant Roridulaceae, a carnivorous plant family that is today endemic to the Cape flora of South Africa. Modern Roridula species are unique among carnivorous plants as they digest prey in a complex mutualistic association in which the prey-derived nutrient uptake depends on heteropteran insects. As in extant Roridula, the fossil leaves possess two types of plant trichomes, including unicellular hairs and five size classes of multicellular stalked glands (or tentacles) with an apical pore. The apices of the narrow and perfectly tapered fossil leaves end in a single tentacle, as in both modern Roridula species. The glandular hairs of the fossils are restricted to the leaf margins and to the abaxial lamina, as in extant Roridula gorgonias. Our discovery supports current molecular age estimates for Roridulaceae and suggests a wide Eocene distribution of roridulid plants.Plant carnivory is traditionally defined as the attraction, capture, and digestion of prey by vegetative traps, with the subsequent uptake of nutrients (1, 2). Some carnivorous plants, however, challenge the boundary of the botanical carnivory concept because they depend on commensal organisms for the digestion of their prey (2, 3). The most famous representative of those plants is Roridula, placed in the monogeneric family Roridulaceae that is endemic to a few localities in the southwestern Cape of South Africa (4, 5).The resinous glandular leaves of both extant species, Roridula dentata and Roridula gorgonias, capture plenty of arthropods. The sticky trapping glue of Roridula is a viscous lipophilic resin containing triterpenoids as major component, which does not allow dissolution of digestive enzymes (6). Consequently, the secretory glands of Roridulaceae lack enzymatic activity (7, 8). For prey-derived nutrient uptake, Roridula depends on two obligately associated heteropteran Pameridea species (family Miridae, “capsid bugs”), which feed on the trapped animals (5, 9). In this “digestive mutualism” (10), the nutrient-rich fecal compounds of these “Roridula bugs” are incorporated by Roridula through nanometer-sized cuticular gaps and serve for a better alimentation in a nutrient-poor habitat (7, 8, 10, 11). The benefit of nutrient uptake from captured prey is the essential criterion for the concept of botanical carnivory (1, 2) and thus includes Roridulaceae (11, 12).Here, we report two leaf fossils from Eocene Baltic amber possessing the relevant morphological features of an adhesive flypaper trap plant that we assign to the Roridulaceae lineage (Figs. 1–3). Both specimens originate from the Jantarny amber mine near Kaliningrad (Russia). The amber-bearing sediments of this fossil site date to 35–47 million years ago (13, 14).Open in a separate windowFig. 1.Carnivorous leaves from Eocene Baltic amber. (A) Overview of the leaf enclosed in amber specimen GZG.BST.27310 showing the adaxial tentacle-free side in slightly oblique view and stalked glands at the margin and on the abaxial side; arrowhead points to the exceptional long tentacle stalk with several branched oak trichomes attached. (B) Overview of the leaf enclosed in amber specimen GZG.BST.27311, showing abundant tentacles on the abaxial side. (C) Margin of abaxial leaf surface with tentacles of different size classes and nonglandular hyaline trichomes. (D) Leaf apex tapering into a sole tentacle. (E and F) Glandular heads with central pore (arrowheads) from both leaves. (Scale bars: A and B, 1 mm; C and D, 100 µm; E, 10 μm; F, 40 μm.)Open in a separate windowFig. 3.Carnivorous leaf from Eocene Baltic amber (A and B; GZG.BST.27310) and leaves of extant Roridula gorgonias (C and D). (A) Exceptionally long tentacle stalk (with several branched oak trichomes attached) of the fossil leaf representing the fifth size class of stalked glands. (B and C) Overviews showing the tentacle-free adaxial surface and tentacles along the leaf margins. (D) Partial leaf tip showing different size classes of stalked glands. (Scale bars: A, 100 µm; B, 500 µm; C and D, 1 mm.)     

Involvement of Rho kinase (ROCK) in sepsis-induced acute lung injury

Indirect acute lung injury is associated with high morbidity and mortality. We investigated the link between Rho kinase (ROCK) activation and apoptotic cell death in sepsis induced acute lung injury. This hypothesis was tested by administering a specific, selective inhibitor of ROCK (Y-27632) to rats subjected to cecal ligation and puncture (CLP). Rats were randomly divided into 4 groups as; sham-operated, sham + Y-27632, CLP and CLP + Y-27632. Twenty-four hours later, each experiment was terminated and lungs analyzed. Histopathology was assessed by hematoxylin-eosin staining and the presence of apoptosis was evaluated through the TUNEL assay. Pulmonary activity of caspase 3 and ROCK 1 & 2 were measured by western blot. Interstitial edema, severely damaged pulmonary architecture with massive infiltration of the inflammatory cells and an increase in lung tissue TBARS levels as well as 3-NT to total tyrosine ratios were observed in untreated CLP animals. Pretreatment of animals with Y-27632, reduced lung injury in the CLP induced septic rats in each of these parameters of lung injury (p<0.05). Western immunoblot revealed active caspase cleavage and increased expression of active fragment of ROCK 1 & 2 in the CLP group. TUNEL assay showed an increase in percentage of apoptotic cells when comparing the CLP group with the CLP + Y-27632 group. These results suggest an important role of Rho kinase in sepsis induced lung injury by a mechanism that might be related to oxidative and/or nitrosative stress mediated caspase cleavage leading to apoptosis.     

An unusual renal presentation of Wegener's granulomatosis

A 63-year-old woman was admitted to our clinic with arthralgia, microhematuria and a pleural based solid mass in lower lobe basal segment of right lung seen in computerised tomogram of thorax. She was diagnosed as Wegener's granulomatosis by histopathological findings of right thoracotomy, wedge resection and decortication. The patient had positive antineutrophil cytoplasmic antibodies (c-ANCA) in serum and tissue specimens. Histopathologic examination of the renal biopsy specimen revealed the diagnosis of tubulointerstitial nephritis. We report this case because of the unusual histologic type of renal involvement by reviewing the literature.