Multiple pyogenic granulomas on the face after landmine injury

Abstract:  In this report, we present a 13-year-old male patient with multiple pyogenic granulomas (PG) on the face after landmine injury. To the best of our knowledge, PG after landmine injury has not been reported previously. The case has been reported in view of its rarity and its etiology.     

Ovarian reserve testing before and after laparoscopic tubal bipolar electrodesiccation and transection

Objective

To find out whether tubal sterilization leads to loss of ovarian reserve, we assessed the hormonal and ultrasonographic parameters of ovarian reserve in women who underwent laparoscopic tubal sterilization by bipolar electrodesiccation and transection.

Study design

In this preliminary study, laparoscopic tubal sterilization was performed on 49 healthy women who had voluntarily requested elective surgical sterilization. Among the current ovarian reserve indicators, in the early proliferative phases, preoperative (baseline) and postoperative (third month) serum follicle-stimulating hormone (FSH), estradiol (E2), and anti-Mullerian hormone (AMH) levels, ovarian volume, and antral follicle counts (AFCs) were determined. Analysis of these hormonal and ultrasonographic parameters of ovarian reserve preoperatively and postoperatively was the main outcome measure.

Results

Preoperative and third-month postoperative FSH, LH, E2, and AMH levels did not reveal statistically significant differences (p = 0.101, p = 0.180, p = 0.254, and p = 0.079; respectively). The ultrasonographic indicators of ovarian reserve did not change in terms of total ovarian volume and total AFC (p = 0.793 and p = 0.098, respectively).

Conclusions

Short-term follow-up study results revealed a slight but non-significant change in the current ovarian reserve markers, especially in the AMH levels.     

Comparison of Outcomes of Standard and Oncoplastic Breast-Conserving Surgery

Purpose

The aim of this study is to determine and to compare the oncological outcomes of bilateral reduction mammoplasty to standard breast-conserving surgery for breast cancer.

Methods

One hundred sixty-two patients who received a quadrantectomy because of breast cancer (group 1) and 106 breast cancer patients with macromastia who underwent breast-conserving surgery via bilateral reduction mammoplasty (group 2) between 2003 and 2010 were enrolled in this study.

Results

The mean follow-up time was 37 months for group 1 and 33 months for group 2. Surgical margins were wider than 2 mm in 82.7% and 10 mm in 76.5% of the patients in group 1. Eleven percent of patients had positive surgical margins in this group. When compared to group 2, the rates were 89%, 84%, and 8.4%, respectively. Three patients (1.8%) in group 1 and one patient (0.9%) in group 2 had local recurrence of the disease and received a mastectomy. No statistical significances were noted for either local recurrence or overall survival between the two groups.

Conclusion

Bilateral reduction mammoplasty has some advantages as compared to the standard conventional breast-conserving surgery techniques without having any unfavorable effects on surgical margin confidence, local recurrence, and survival rates.     

Comparison of the effects of dexmedetomidine versus fentanyl on airway reflexes and hemodynamic responses to tracheal extubation during rhinoplasty: A double-blind, randomized, controlled study

Background: Stimulation of various sites, from the nasal mucosa to the diaphragm, can evoke laryngospasm. To reduce airway reflexes, tracheal extubation should be performed while the patient is deeply anesthetized or with drugs that do not depress ventilation. However, tracheal extubation during rhinoplasty may be difficult because of the aspiration of blood and the possibility of laryngospasm. Dexmedetomidine and fentanyl both have sedative and analgesic effects, but dexmedetomidine has been reported to induce sedation without affecting respiratory status.Objective: The aim of this study was to compare the effects of dexmedetomidine and fentanyl on airway reflexes and hemodynamic responses to tracheal extubation in patients undergoing rhinoplasty.Methods: This double-blind, randomized, controlled study was conducted at the Erciyes University Medical Center, Kayseri, Turkey. Patients classified as American Society of Anesthesiologists physical status I or II who were undergoing elective rhinoplasty between January 2007 and June 2007 with general anesthesia were eligible for study entry. Using a sealed-envelope method, the patients were randomly divided into 2 groups (20 patients per group). Five minutes before extubation, patients received either dexmedetomidine 0.5 μg/kg in 100 mL of isotonic saline or fentanyl 1 μg/kg in 100 mL of isotonic saline intravenously. All patients were extubated by anesthesiologists who were blinded to the study drugs, and all were continuously monitored for 15 minutes after extubation. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and oxygen saturation using pulse oximetry (SpO₂) were recorded before anesthesia, after drug administration, after skin incision, at the completion of surgery, and 1, 5, and 10 minutes before and after tracheal extubation. Any prevalence of laryngospasm, bronchospasm, or desaturation was recorded.Results: Forty patients (25 men, 15 women; mean [SD] age, 24.86 [7.43] years) were included in the study. Dexmedetomidine was associated with a significant increase in extubation quality compared with fentanyl, reflected in the prevalence of cough after extubation (85% [17/20] vs 30% [6/20] of patients, respectively; P = 0.001). There were no clinically significant decreases in HR, SBP, DBP, or SpO₂ after extubation with dexmedetomidine or fentanyl. In the dexmedetomidine group, HR was not significantly increased after extubation; however, in the fentanyl group, HR was significantly increased compared with the preextubation values (all, P = 0.007). HR was significantly higher in the fentanyl group compared with the dexmedetomidine group at 1, 5, and 10 minutes after extubation (all, P = 0.003). Compared with preextubation values, SBP was significantly increased at 1 and 5 minutes after extubation in the dexmedetomidine group (both, P = 0.033) and at 1, 5, and 10 minutes after extubation in the fentanyl group (all, P = 0.033). The postoperative sedation scores and the extubation, awakening, and orientation times were not significantly different between the 2 groups. In the dexmedetomidine group, bradycardia (HR <45 beats/min) was observed in 2 patients and emesis was observed in 2 patients. In the fentanyl group, emesis was observed in 3 patients, bradycardia in 2 patients, vomiting in 1 patient, and shivering in 1 patient; vertigo was reported in 1 patient. There were no significant differences in the prevalence of adverse events between the 2 groups.Conclusion: The findings in the present study suggest that dexmedetomidine 0.5 μg/kg IV, administered before extubation, was more effective in attenuating airway reflex responses to tracheal extubation and maintaining hemodynamic stability without prolonging recovery compared with fentanyl 1 μg/kg IV in these patients undergoing rhinoplasty.     

The relationship between P wave dispersion and diastolic dysfunction

We investigated the relationship between P wave dispersion, which is easily measured on the surface electrocardiogram and may be used in evaluating the risk of atrial fibrillation, and left ventricular diastolic function. There were 133 patients: 73 with diastolic dysfunction and 60 without. P wave dispersions were calculated by measuring minimum and maximum P wave duration values on the surface electrocardiogram. The relationships between P wave dispersion and the presence, cause, severity, and echocardiographic measurements of diastolic dysfunction were investigated. P wave dispersion was 53 +/- 9 ms in patients with diastolic dysfunction and 43 +/- 9 ms in the control group (P < 0.01). When patients were grouped according to stage of diastolic dysfunction, P wave dispersion was 48 +/- 7 ms in stage 1, 54 +/- 8 ms in stage 2, and 58 +/- 9 ms in stage 3. As the severity of diastolic dysfunction increased, P wave dispersion increased but the difference did not reach statistical significance (P < 0.05). When the cause of diastolic dysfunction was considered, P wave dispersion was 53 +/- 8 ms in patients with ischemic heart disease and 52 +/- 9 ms in patients with left ventricular hypertrophy (P > 0.05). We conclude that P wave dispersion increases in diastolic dysfunction, but that this increase is not related to the severity or cause of diastolic dysfunction. When clinical and echocardiographic variables are taken into account, there is a weak but significant correlation only between P wave dispersion and left ventricular ejection fraction.     

Risk factors for mortality in geriatric hip fractures: a compressional study of different surgical procedures in 785 consecutive patients

Background

Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes.

Methods

We included 785 patients age 65 years or older, with hip fractures. Operative treatment consisted of external fixation, internal fixation, total hip arthroplasty and hip hemiarthroplasty. Age, gender, type of fracture, type of surgery performed, American Society of Anesthesiology (ASA) grade, clinical comorbidities, anesthesia type, blood transfusion requirement, time to surgery, intensive care unit requirement, operation length and length of hospital stay and number of comorbidities were documented.

Results

During the study period, 785 patients (262 male, 523 female) were included to study, Overall mortality rate was 37.2 % (292/785). Their age ranged between 65 and 100 years (mean 81). Surgery type Kaplan–Meier cumulative mortality curves suggested no significant difference between four different types of surgery groups (p = 0.064). Transfusion requirement was significantly lower in external fixation group comparing to other groups (p = 0.014). Cox regression analysis showed the number of comorbidities 2 and ≥ 3 (p = 0.0027, p = 0.015), transfusion requirement (p = 0.0001), ASA 4 (p = 0.016) to be significant predictors of mortality.

Conclusions

Transfusion requirement, ASA grade 4 and having more than two comorbidities are risk factors for mortality in geriatric hip fractures. Type of surgical intervention and fracture type had similar mortality rates in our patient population.

     

A very large, rapidly developing, congenital giant cell fibroblastoma in a 5-month old infant

Giant cell fibroblastoma is an uncommon soft tissue neoplasm that occurs in childhood. It seems to be the juvenile form of dermatofibrosarcoma protuberans, which is seen less frequently in children. Only one congenital case has been reported previously. In this report, we present a 5-month-old girl with a rapidly and atypically growing mass located on the upper part of the right scapula. We think that our case is very interesting, because no similarly large lesion (12 cm x 10 cm x 8 cm) related to giant cell fibroblastoma has been previously reported in the published work.