Candida albicans endocarditis and a review of fungal endocarditis: case report

Endocarditis due to fungal etiology is rare, but it is the most severe form of infective endocarditis. Fungal endocarditis is commonly complicated by systemic embolizations, and the difficulty in isolating the fungi with routine blood cultures complicates the diagnostic process. In these culture-negative cases of endocarditis, etiologic diagnosis is made with histopathologic examination of the cardiac valve, embolic materials, and systemic ulcers. In this case report, the presented patient with fungal endocarditis and its neurologic complications was treated with a surgical and medical approach.     

Clitoromegaly in type 2 neurofibromatosis: a case report and review of the literature

OBJECTIVE: Genitourinary neurofibromatosis (NF) is a rare disorder and clitoral involvement has been reported infrequently. In the English literature there are only 26 reported cases with clitoral involvement in NF. CASE: A 28-year-old female with clitoral enlargement, previously diagnosed with NF 2, was successfully treated by removal of the clitoral mass that increased in size during the previous two years. Clitoroplasty was performed while preserving the glans of clitoris. Histopathologic examination revealed plexiform neurofibroma. CONCLUSION: To the best of our knowledge the patient is the 27th reported clitoromegaly case with NF, but the first case reported with NF 2 or central NF in the English literature.     

Conservative treatment of eminentia intercondylaris fractures of the tibia in children

Seventeen patients (16 children, 1 adolescent) were reviewed 31 months to 71 months after sustaining the common childhood fracture of the eminentia intercondylaris of the tibia. The aim was to assess long-term results and prognosis by clinical and radiological examination and to discover whether conservative treatment was adequate for type I and type II fractures according to Meyers and McKeever. Early improvement occurred in all patients after conservative treatment, but long-term results were not satisfactory in displaced fractures,which were treated with closed reduction and immobilization in extension. Therefore, anatomic reduction and rigid fixation should be obtained for displaced fractures of the eminentia intercondylaris of the tibia.     

Effects of current and potential dental etchants on nerve compound action potentials

In this study, a 35% phosphoric acid gel (3M Scotchbond etchant), a nonrinse etchant (NRC), and two EDTA-containing conditioners (RC-Prep and File-Eze) were tested in vitro for blocking nerve conductance evoked in the rat sciatic nerve after local application. The phosphoric acid gel and NRC completely and irreversibly inhibited conductance. On the other hand, RC-Prep reduced the compound action potentials (cAPs) by 50% in 120 min. With File-Eze, the reduction in cAPs was less than 50% after an application time of 160 min (61.8 +/- 1.8%). At 160 min the cAPs in the RC-Prep group had been inhibited by 62.4%. These results indicated strong neurotoxic effects of phosphoric acid and NRC when applied directly on exposed pulp in the total etch procedure.     

Experimental fascial flap model in the dog: free flap of the dorsal thoracic fascia

For years, various types of fascial flaps have been used in clinical practice; however, there are many unanswered questions regarding their basic physiology, anatomy and histopathologic changes occurring after transfer. Simple and reliable flap models are needed to investigate these questions, but very few of these flap models have been described in experimental animals to date. The purpose of this study was to describe a new reliable fascia flap model in the dog-the dorsal thoracic fascia flap. This fascia is defined as the anatomic layer that contains the blood supply to the scapular and parascapular fasciocutaneous flaps. Fourteen adult dogs were used in this experiment. The vascular anatomy of the dorsal thoracic fascia was studied by anatomic dissection and microangiography. Anatomic dissection revealed that the main axial vessel supplying the dorsal thoracic fascia was the superficial branch of the thoracodorsal vessel. Based on the vascular pedicle, fascia flaps generally measuring 15 x 24 cm were created. At gross observation, all of these large flaps based solely on the vascular pedicle were observed to be well-perfused. Microangiographic examination revealed the intense vascularity of the superficial branches of the thoracodorsal vessels in the whole area of all flaps. It was concluded that this is a simple and reliable fascial flap model which can be prepared as a free or pedicled flap. It has a consistent, long vascular pedicle with large vessel diameters supporting a large fascial flap.     

Propofol anaesthesia and metabolic acidosis in children

BACKGROUND: We aimed to investigate the effect of propofol infusion anaesthesia on acid-base status and liver and myocardial enzyme levels of children during short-term anaesthesia. METHODS: Thirty-six children, aged 3-12 years, were randomized into two groups. In group P (n = 18), induction and maintenance were performed with propofol, 3 mg x kg-1 and 20, 15 and 10 mg x kg-1 x h-1, respectively. In group H (n = 18) following induction with 5 mg x kg-1 thiopenthal, anaesthesia was maintained with 2-3% halothane. Blood samples were obtained following anaesthesia induction and 30, 60 and 120 min after discontinuation of anaesthesia. RESULTS: There was no difference in lactate dehydrogenase, myocardial creatininephosphokinase, aspartate aminotransferase, alanine aminotransferase and cholesterol levels between and within the groups. All postoperative triglyceride levels were higher and pH levels were lower in group P than group H (P < 0.05) and there was no difference within the groups. CONCLUSIONS: In these healthy patients, short-term use of propofol did not result in significant acidaemia, nor alterations in hepatic or myocardial enzyme levels.     

Local versus general anesthesia for carotid endarterectomy: report of 329 cases

Since stroke is an important cause of morbidity and mortality, carotid endarterectomies are used frequently to reduce the risk of stroke and death. Unfortunately, an inherent risk of the carotid endarterectomy procedure is that surgery itself may result in stroke. At this point the question is which method of anesthesia, local or general, is better to protect and monitorize the brain function during cross-clamp period in carotid endarterectomies? In the authors' center, 365 carotid endarterectomies were applied to 329 patients between 1990 and 2001; 165 operations were done under general anesthesia and the other 200 operations were done under local anesthesia. These 2 groups, general (group I) and local anesthesia (group II), were studied retrospectively according to preoperative and postoperative data. In group I, the rate of major stroke was 7.3%, but this rate was 1% in group II (p < 0.05). Intraoperative shunts were used in 50 (30.3%) operations of group I, but the usage of shunt was 8% (16 operations) in group II (p < 0.0001). The hospitalization period was also much shorter in group II than in group I. The time of hospitalization was 4.1 +/-1.9 days in group I and 2.4 +/-1.1 days in group II (p < 0.0001). In terms of cost analysis, the mean costs were 1007.14 dollars +/-135.71 dollars in group I and 885.71 dollars +/-78.57 dollars in group II (p < 0.0001). In short, the local procedure was more cost-effective. As a result, in carotid endarterectomy procedures, the authors prefer local anesthesia to achieve better brain function monitoring and to reduce hospitalization time and cost.     

Buccal midazolam for treatment of prolonged seizures in children

Midazolam is a relatively new anticonvulsive agent in the benzodiazepine group. It has a short onset of duration and is practical for use, providing several alternatives such as intravenous, intramuscular, and intranasal routes. The buccal route could be an alternative choice for seizure control in an emergency setting. However, no sufficient reports are available on buccal midazolam administration. The present study was designated to examine the efficacy of buccal midazolam in children at different ages with seizures of more than 5 min duration. Nineteen previously unreported children, aged from 1 month to 15 years, were treated with a 0.3 mg/kg dose of buccal midazolam; 13 had prolonged seizures, and six had status epilepticus, with a duration of 5-45 min (mean 22 min). Sixteen of 19 seizures (84.2%) stopped within 10 min of buccal midazolam being given. The drug efficacy in patients with status epilepticus was 50%. However, all patients with convulsions shorter than 30 min showed a perfect response (100%). Convulsion episodes stopped within 3.89+/-2.22 min (median time 3 min). Seizure duration was correlated with cessation of seizure (r=0.76, P<0.001). No clinically important side effects were seen in any patient. On the basis of this experience, we concluded that a 0.3 mg/kg dose of buccal administration of midazolam might offer an effective treatment in all ages of children.     

Etiology of deafness at the Yeditepe School for the deaf in Istanbul

OBJECTIVE: The etiology of deafness can be classified as genetic, acquired and unknown. An unknown etiology was a high incidence in previous reports. The aim of this study is to explore the etiology of deafness and to reduce the cases in the unknown group. METHODS: This study was conducted on 162 students at the Yeditepe School for the deaf. Otologic, physical and psychological examinations were performed by a team of doctors including four otologists, a geneticist, a dentist, an ophthalmologist and an audiologist. RESULTS: A genetic cause was identified in 41.35%, acquired 37.65% and unknown 20.98%. Genetic etiologies were stratified as familial and syndromic subgroups. A familial cause was found in 60 of 162 children and in 22 of those 60 cases, the parents had a consanguineous marriage. There was 11 cases associated with a syndrome. Ninety four minor abnormalities have been established in some deaf children. Febrile convulsion (36%) was identified as the most common etiology in acquired cases. CONCLUSION: In contrast with other studies the consanguineous marriage was present in 36.6% of the familial cases and 38.8% in total of the school. An unknown etiology was reported in high rates in previous reports. These unknown cases could be described as a part of a syndrome by a crowded team of consultants. Evaluation of early diagnostic criterias and minor abnormalities can help us to provide early rehabilitation of deafness in childhood.     

Electromyographic biofeedback in the treatment of the hemiplegic hand: a placebo-controlled study

OBJECTIVE: To evaluate the efficacy of electromyographic (EMG) biofeedback treatment in the functional recovery of the hemiplegic hand. DESIGN: A total of 27 patients were randomly assigned to EMG biofeedback or placebo EMG biofeedback groups. Both treatments were applied five times a week for a period of 20 days. In addition, the patients in both groups received an exercise program according to the Brunnstrom's neurophysiologic approach. Goniometric measurements for wrist extension, scale for judging the performance of drinking from a glass, Brunnstrom's stages of recovery for hand, and surface EMG potentials were used for the clinical assessments. All patients were assessed before treatment and after 20 treatment sessions. RESULTS: The results showed that there were statistically significant improvements in all variables in both groups, but the improvements in active range of motion and surface EMG potentials were significantly greater in the EMG biofeedback group at the end of the treatment. CONCLUSION: Our study demonstrates the potential benefits of EMG biofeedback in conjunction with neurophysiologic rehabilitation technique to maximize the hand function in hemiplegic patients.