Paraumbilical perforator-based pedicled abdominal flap for extensive soft-tissue deficiencies of the forearm and hand

A new paraumbilical-based pedicled abdominal flap was used in 11 patients with extensive soft-tissue defects of the forearm and hand. With a relatively narrow pedicle, large flaps up to 5- x 14-cm can be raised. Another advantage of this flap is the comfortable position of the hand and forearm for the patient. The main disadvantage is the conspicuous abdominal scars like the other pedicled abdominal flaps.     

Investigation of<Emphasis Type="Italic"> Helicobacter pylori</Emphasis> colonization in laryngeal neoplasia

Helicobacter pylori has been investigated in several other organ systems and localizations such as the oral cavity, but has not been investigated extensively in squamous cell carcinoma of the larynx, a region that could be directly exposed to the bacterium by the oral route or gastro-esophageal reflux. Only serological studies are available regarding the relation between H. pylori and laryngeal cancer, yielding conflicting results. To our knowledge, there is no study investigating the presence of H. pylori in laryngeal squamous cell carcinoma tissue. The purpose of this study was to investigate the presence of H. pylori in laryngeal squamous cell carcinoma tissue and to investigate the possible role of this organism in the etiopathogenesis of laryngeal cancer. Specimens from 50 patients with laryngeal cancer who underwent total or partial laryngectomy between March 1999 and December 2002 were examined by histopathological and immunohistochemical methods to detect H. pylori. The presence of H. pylori was also investigated histopathologically in 50 benign laryngeal biopsy specimens. In our study, we demonstrated that H. pylori was not present in laryngeal squamous cell carcinoma tissue or in the benign lesions. We could not find any evidence indicating that H. pylori played a role at the tissue level in the pathogenesis of laryngeal carcinoma.     

Determination of the changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue

The purpose of this study was to determine changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue. This study also attempted to determine the possible relationship between the predictive factors of intubation difficulty by using the intubation difficulty scale, which was introduced by Adnet et al., duration of suspension laryngoscopy and changes in hypoglossal nerve function after suspension laryngoscopy. The study was performed on 39 patients who underwent suspension laryngoscopy for benign glottic pathology. Pre-operative airway assessment was evaluated by the intubation difficulty scale and the duration of suspension laryngoscopy was recorded. Needle electromyography of the tongue was performed three or four weeks after the suspension laryngoscopy. After needle electromyography of the tongue, increased polyphasia was found in 13 patients (33 per cent), bilaterally in three of them. The interference pattern was reduced in two of these 13 patients. There was no statistically significant difference in predictive factors of intubation difficulty and the duration of the operation between these 13 patients with increased polyphasia and the remaining 26 patients with completely normal electromyography findings. These findings show that, in spite of normal clinical tongue function, subclinical changes can be detected by needle electromyography of the tongue after suspension laryngoscopy.     

Should hyperbaric oxygen be added to treatment in idiopathic sudden sensorineural hearing loss?

At present, there is still no agreement about the therapy of idiopathic sudden sensorineural hearing loss (ISSHL). Hyperbaric oxygen (HBO) is used in the therapy of ISSHL to increase the partial oxygen pressure and the oxygen concentration in the inner ear and also to improve the blood profile and the microcirculation. In our prospective randomized study, we aimed to investigate the therapeutic effects of HBO therapy in the 1st 2 weeks of the onset of ISSHL. Fifty-one hospitalized patients with confirmed ISSHL who had received therapy were grouped randomly into two groups. Twenty-one patients (group I) received steroids, plasma expander dextrans (rheomacrodex), diazepam, pentoxiphylline and salt restriction, and 30 patients (group II) received the same basic treatment with the addition of HBO therapy. Audiological assessments of the patients were performed before and after the treatment. The hearing gains at frequencies of 250, 500, 1,000, 2,000 and 4,000 Hz were calculated separately. The level of hearing loss at the five frequencies was assessed in three groups at the first visit: equal or below 60 dB, between 61–80 dB and equal or above 81 dB. The average of the mean hearing gains at the five frequencies of the patients according to the age groups in group II was compared. The mean hearing gains at the five frequencies were compared between the two groups, and statistically significant improvement was detected in all the frequencies except at 2,000 Hz in group II. The mean hearing gains in group II were found to be significantly high in patients with initial hearing levels up to 60 dB in comparison to patients with initial hearing levels below 60 dB. When age groups and mean hearing gains were compared, there was no statistically significant difference in group I. In group II, the mean hearing gains were 39.1±18.3 dB in patients younger than 50 years and 22.7±11.3 dB in patients older than 50 years (P=0.044). In conclusion, the addition of HBO therapy to conventional treatment modalities significantly improves the outcome of ISSHL, especially at the frequencies of 250, 500, 1,000 and 4,000 Hz and in hearing loss of above 61 dB. Furthermore, HBO therapy was found to be more effective in patients younger than 50 years.     

Physical activity decreases the risk of stroke in middle-age men with left ventricular hypertrophy: 40-year follow-up (1961-2001) of the Seven Countries Study (the Corfu cohort)

Left ventricular hypertrophy (LVH) is a dominant characteristic of cardiovascular mortality. We investigated the interaction between physical activity and LVH on stroke mortality, based on a 40-year follow-up of the Corfu cohort from the Seven Countries Study. The population studied consisted of 529 rural men (40-59 years old) enrolled in the Study at 1961. LVH was electrographically confirmed according to Minnesota coding. Physical activity levels were assessed by self-reports of habitual, occupational and leisure-time activities. Cox proportional hazard models were used to evaluate exercise levels with respect to stroke mortality in people with and without LVH. During the follow-up, 461 (87%) died, and 74 (16%) of these deaths were due to stroke. LVH was present in 40 (7.5%) men. A total of 362 (68%) men were defined as physically active. Physical activity was associated with a lower risk of stroke (hazard ratio=0.65, P<0.05). On the other hand, LVH had 5.8-fold the risk of stroke (P<0.001) among sedentary and 4.5-fold the risk (P<0.001) among physically active men, after controlling for several potential confounders. However, moderate physical activity decreased the risk of stroke by 49% in men with LVH as compared to sedentary without LVH (hazard ratio=0.51, P<0.01), while hard exercise did not confer any significant reduction in stroke risk. We revealed the benefits from moderate physical activity on stroke mortality among men with LVH. Physicians and other health-care professionals should encourage patients with LVH to adopt a physically active lifestyle.     

Effects of sleep deprivation, nicotine, and selenium on wound healing in rats

Effects of sleep deprivation (SD), nicotine, and selenium (Se) on wound healing were studied in 50 male rats (Sprague-Dawley strain). Full-skin-thickness burns were produced in animals. Then, SD, nicotine, and Se administrations were applied to animals in different groups. Wound healing was assessed by pathological analysis of wound by counting fibroblasts, capillary vessels, polymorphonuclear leucocytes (PNLs), and by measuring radiolabeled immunoglobulin G (IgG) amount in wound area by radio-pharmaceutical and immunoscintigraphic procedures. The number of fibroblasts and capillary vessels were higher in control and Se groups than in sleep deprivation and nicotine groups, and the number of PNLs and the radiolabeled polyvalent IgG levels were higher in SD and nicotine groups than in control and Se groups. The results suggest that SD and nicotine may delay wound healing and that Se supplementation may accelerate wound healing by preventing nicotine-induced oxidative stress and lipid peroxidation.     

Visual and auditory event related potentials in epileptic children: a comparison with normal and abnormal MRI findings

Visual and auditory event related potentials (VERPs and AERPs) in 32 epileptic children with magnetic resonance imaging (MRI) abnormalities and 18 with normal MRI were recorded and compared to the data of 21 healthy children. Of all 50 epileptic children (34 male, 16 female) aged 14.42+/-4.27 (7-20) years, 21 were medically intractable and receiving polytherapy. The mean latencies of N2 and P3 components of VERPs and AERPs in all epileptic children were significantly higher than those of the controls (P<0.05). Epileptic children with structural abnormalities had more prolonged latencies of N2 and P3 components of AERPs and VERPs than those of the healthy children (P<0.05). The epileptic children with normal MRI had significantly more prolonged latency of N2 and P3 of VERPs and P3 of AERPs than those of the controls (P<0.05). The difference of the mean latency of N2 and P3 components or the mean amplitude of P3 components of ERPs between the two epileptic groups was insignificant. The type of medication (mono- versus polytherapy) did not affect the wave components of ERPs. We suggest that epileptic activity, itself, leads to prolonged N2 and P3 components of AERPs and VERPs. The presence of structural abnormality indicated by imaging is not a predictor of ERPs abnormalities.     

Thyroid status and leptin in Basedow-Graves and multinodular goiter patients

In this study it was of interest to investigate the relationship between plasma leptin levels and thyroid function in recently diagnosed 27 Basedow-Graves patients and 22 multinodular goiter patients brought to euthyroid state with 1 mo of propylthiouracil (PTU) treatment. A group of 15 control subjects matched for age, gender, and body mass index were also studied. In Basedow-Graves patients there were significantly higher T4 and T3 levels accompanied by a marked fall in plasma thyroid-stimulating hormone (TSH). In multinodular goiter patients with PTU, the plasma T3 and T4 levels were significantly lower than in Basedow-Graves and TSH was markedly higher. However, TSH values in multinodular goiter patients were signifcantly lower than the control Plasma leptin levels were unchanged in all groups. These data suggest that leptin levels are not affected by thyroid dysfunction.     

Case Report: Severe Skin Burn at the Site of the Indifferent Electrode After Radiofrequency Catheter Ablation of Typical Atrial Flutter

Although radiofrequency (RF) catheter ablation has been shown to be an effective treatment strategy in patients with supraventricular tachycardia, RF ablation may lead to potentially serious complications. We describe a case of a 65-year old man who was transferred for catheter ablation of typical atrial flutter. 21 RF applications (mean energy: 81±9 watts) were applied in the temperature-controlled mode (70[emsp4 ]°C) between a 8-mm tip electrode and an indifferent electrode using a high-power RF generator (100 watts) until bi-directional atrial isthmus block was achieved. After the procedure, a third-degree skin burn (10×2[emsp4 ]cm) was observed at the lateral edge of the adhesive indifferent electrode whereas the medial edge of the electrode was not fully attached to the skin surface. This case is one out of 1128 ablation procedures (0.09%) at our institution using a high-power RF generator. The present study demonstrates a severe skin burn induced by mal-attachment of an indifferent electrode during RF ablation. Long RF energy application times, high-power settings, and heavy sedation may have contributed to the observed severity of skin damage.