Vascular reconstruction in Buerger's disease: is it feasible?

Purpose: Thromboangiitis obliterans (Buerger's disease) is a clinical syndrome characterized by segmental occlusions of the distal vessels. Although a cessation of using nicotine products usually helps, nevertheless a surgical revascularization may be needed in cases of stage III and IV limbs. Because of the distal and segmental nature of the disease, these procedures are rarely feasible. This article focuses on the feasibility of performing a vascular reconstruction in thromboangiitis obliterans. Methods: Thirty-six of 94 patients (38.3%) who were followed by the Peripheral Vascular Unit of Istanbul Medical Faculty were selected for revascularization and 27 of 36 (81%) patients underwent revascularization procedures. Results: During a 36-month follow-up, the patency rates at the 12th, 24th, and 36th months were 59.2%, 48%, and 33.3%, respectively. The limb salvage rate was 92.5%. Conclusions: Since patients affected by Buerger's disease consist a group of young population who are still in their productive stages, every effort should be taken to obtain a limb salvage in the ischemic period. Although the patency rates do not seem promising, the limb salvation rate was quite satisfactory. Received: October 29, 2001 / Accepted: July 2, 2002 Reprint requests to: Ş. Dilege     

Connexin 32 mutation in a Turkish family with X-linked Charcot-Marie-Tooth disease

In the present work, we describe a large Turkish family (N=39) with Charcot-Marie-Tooth disease, which is the most commonly inherited peripheral neuropathy. The subjects were from four generations, including six hemizygote patients and nine heterozygote carrier females. Symptoms appeared in late childhood in males (mean age=13.5) but later in carrier females (mean age=33.5). The peripheral nerve conduction was more severely affected in males than females. Genomic DNA was isolated from peripheral white blood cells. Using SSCP technique (single strand conformation polymorphism analysis), abnormal patterns of migration were observed in 15 subjects: 6 of them were hemizygote males and 9 were heterozygote carrier females. We identified a mutation of the Cx32 gene, consisting of a guanine to adenine transition at position 271 (271G-A). The results suggested relations between degenerative processes and position of Cx32 mutations.     

Malaria: knowledge and behaviour in an endemic rural area of Turkey

This cross-sectional study was conducted to determine the knowledge and behaviour of people in the Sanliurfa province of Turkey regarding the prevention of malaria. A modified 30-cluster sampling method based on the traditional Expanded Programme for Immunization coverage surveys was employed to select a representative sample from 210 households. A questionnaire that focused on sociodemographic characteristics, knowledge and behaviour of malaria prevention, treatment-seeking behaviour and the use of antimalarials was applied. Eighty-nine percent of respondents knew at least one of the classical symptoms of malaria, and fever and chills were the most commonly reported symptoms (78.6%). Of the people interviewed, 33% believed that malaria can be acquired from dirty water, by changing place of residence, by working in cotton or tomato fields, or from malaria patients' belongings. None of the respondents knew how mosquitoes acquire the parasite. Twenty-five percent of respondents believed that elimination of breeding sites was one way to prevent malaria, and 8% identified the use of bednets. Fifty-five percent of respondents reported protective behaviours that are not directly associated with malaria transmission. Almost 47% of respondents reported that they completed their antimalarials, and only 21% of respondents indicated that they would seek treatment for febrile disease from physicians or a malaria unit. Understanding community perceptions of aetiology, symptom identification and treatment of malaria is an important step towards disease control.     

Autosomal dominant periodic fever with AA amyloidosis: tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in a Turkish family

We investigated the presence of tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in a Turkish family with recurrent fever and systemic reactive (AA) amyloidosis. A missense mutation in exon 3 of the TNFRSF1A gene, resulting in an amino acid substitution Phe60Leu (F60L) was found in the proband and his father. These are the first confirmed TRAPS cases in the Turkish population. This family highlights the importance of onsidering all the causes of inherited fevers and performing thorough clinical and genetic investigations to secure a diagnosis, even in populations in which familial Mediterranean fever (FMF) is highly prevalent.     

Long-term ultrasonographic follow-up of plantar fasciitis patients treated with steroid injection

OBJECTIVE: To evaluate the long-term efficacy of steroid injection for plantar fasciitis using clinical parameters and high-resolution ultrasonography. MATERIAL AND METHODS: Thirty patients (27 female and three male) with plantar fasciitis and 30 healthy controls matched by age, gender and body mass index (BMI), were enrolled in this study. Seventeen of the patients had bilateral and 13 had unilateral (six right, seven left) plantar fasciitis. Palpation-guided steroid injection was applied to the 47 heels of 30 plantar fasciitis patients. Ultrasound examination and pain intensity with visual analog scale (VAS) were assessed three times in each plantar fasciitis patients; before injection and at 1 and 6 months after steroid injection. Ultrasonography was performed to the controls at initial assessment. RESULTS: The plantar fascia was remarkably thicker in the plantar fasciitis group than in controls (P < 0.001). The thickness of the plantar fascia and mean VAS values in the plantar fasciitis group decreased significantly 1 month after steroid injection (P < 0.001, P < 0.001, respectively) and a further decrease was noted 6 months postinjection (P < 0.001, P < 0.001, respectively). Strong correlation was found between the changes of plantar fascia thickness and VAS values 1 month after (P < 0.001, r: 0.61) and 6 months after (P < 0.001, r: 0.49) steroid injection. The incidence of hypoechoic fascia was 73% in the plantar fasciitis group before steroid injection. It decreased significantly at 1 and 6 months postinjection (33% and 7%, respectively, P < 0.001). Gross fascia disruption or other side effects were not observed after steroid injection. CONCLUSION: Steroid injection could be used in plantar fasciitis treatment for its positive long-term effects.     

Domestic violence: a tragedy behind the doors

OBJECTIVE: To explore the prevalence, type, frequency and causes of domestic marital violence among Turkish women in a socio-economically developed metropolitan setting. METHODS: A cross-sectional study was performed in 2003. All married women, aged 18 years and over, who were visiting any of the 50 primary health care units for different purposes were asked to participate in the study. Of 1427 asked, 1010 gave consent and completed face-to-face interviews. Multiple correspondence analysis, and logistic regression were used for statistical analyses. RESULTS: Domestic violence was statistically significantly associated with educational level. Illiterate women reported marital abuse 2.6 times more than university or more educated women. No statistically significant relationship was observed between domestic marital violence and women's age or occupation, marital duration or family income. The most frequently reported type of violence was physical, followed by psychological. Among women reporting domestic violence, those with the lowest educational level and income were experiencing all types of domestic violence frequently. CONCLUSION: Placing more importance on educating girls could be a key component of preventing domestic violence.     

An adult adrenal neuroblastoma: a case report

Neuroblastoma of the adrenal gland is an extremely rare tumour in adulthood although it is one of the most common malignancies in childhood. In this report, we present a 52-year-old man who had a left adrenal mass on preoperative imaging. On laboratory, slightly elevated catecholamine metabolites were detected in the urine that was collected over 24 hours. He was operated and the mass was resected in en-block manner along with the regional lymph nodes. The histopathological examination of the specimen revealed the diagnosis of neuroblastoma. He had no metastatic disease at the time of diagnosis and received chemotherapy after the operation. However, the prognosis was poor and he died 10 months after the operation. Although neuroblastoma of adrenal gland is rare in adulthood, it should be considered in the differential diagnosis for patients with adrenal masses.     

Combined intraoral and nasal approach to Tessier No:0 cleft with bifid nose

The surgical correction of craniofacial clefts is an extremely difficult field in pediatric plastic surgery. Facial clefts are rare entities that most plastic surgeons will rarely have to manage. Various surgical techniques devised by some authors for facial clefts have not still widely accepted.The bifid nose deformity is generally an indicator of Tessier No:0 clefts, with various degrees of skeletal problems. The nasal roof area is an important key point in determining the appropriate surgical technique for reconstruction. In this report, a case of Tessier No:0 with a moderate nasal bifidity and ours novel surgical repair technique combining oral and nasal incision are presented.