V–Y advancement flap closures for complicated pilonidal sinus disease

Background and aims Hair entry into the midline is the generally accepted theory in pilonidal sinus formation. This theory is also involved in the pathogenesis of the recurrence after different types of operations for pilonidal sinus disease. The relationship of the suture lines and the midline was evaluated in this study.Patient and methods Thirty-four patients with stage 4 or recurrent pilonidal sinus disease who underwent V–Y advancement flap closure were randomized into two groups: vertical suture line unrelated to midline (VLUM, n=18) and vertical suture line related to midline (VLRM, n=16).Results None of the patients with or without a suction drain developed flap necrosis, local haematomas or seromas. The median length of the postoperative hospital stay was 3 days for theVLRM group and the VLUM group (p>0.05). The median follow-up period was 32 months. During the follow-up period, two recurrences were determined 22 and 15 months after operation in the VLRM group. Recurrences were situated in the scar tissue over the midline.Interpretation and conclusion Routine application of suction drains is not recommended after V–Y advancement flap closure. Avoidance of the relationship of the postoperative suture line and the midline, if possible, offers a safe method of definitive reconstruction.     

Enteric and rectal duplications and duplication cysts in the adult

Alimentary tract duplication and duplication cysts are rare congenital malformations. The ileum is the most frequently affected site. However, alimentary tract duplication and duplication cysts can occur at any point along the gastrointestinal tract. Early diagnosis and prompt surgical treatment is the best way to prevent associated morbidity. This article presents the cases of three patients admitted to Gulhane Military Medical Academy with signs of acute abdomen, intra-abdominal mass and chronic abdominal pain. These patients were found to have enteric duplication, duplication cyst and/or retro-rectal cyst. The literature on alimentary tract duplications is reviewed.     

Relationship between grip strength and hand bone mineral density in healthy adults

The aim of this study was to assess site-specific relationship of hand bone mineral density (BMD) with hand size, pinch and grip strength in healthy people aged 19-50 years. A total of 143 healthy volunteers participated in the study (mean age: 34 years). One hundred-six were premenopausal women (mean age: 34 years) and 37 were men (mean age: 34 years). Grip and pinch strength was measured by a Jamar dynamometer (Jamar, Irvington, NY). Second, third and fourth middle phalanx BMD were measured on a MetriScan densitometer (Hayward, CA) and mean value of these three phalanxes were used in the analysis. There was not a significant correlation between hand BMD and grip, pinch strength or hand size in premenopausal women. A significant correlation between hand BMD and grip strength was found in men (right hand; r=0.44, p=0.007, left hand; r=0.33, p=0.05). Hand size was not correlated with hand BMD both in men and in women. The short-term precision for RA was estimated as 0.44%. This is the first report of a site-specific relationship of BMD measured by radiographic absorptiometry with hand size, pinch and grip strength in healthy men and premenopausal women. Our results revealed that there is a moderate correlation between hand-grip strength and hand BMD in men. Hand size does not predict hand BMD both in men and women. Radiographic absorptiometry is a practical and reproducible method to detect bone mineral density of hands and may be a valuable screening tool for osteoporosis.     

Leukocyte oxidant and antioxidant status in asthmatic patients

BACKGROUND: Oxidative stress mediated by reactive oxygen species (ROS) is recognized to contribute significantly to the inflammatory process of bronchial asthma (BA). These species are released into the airway by activated inflammatory cells such as leukocytes. In this study, we aimed to determine whether the oxidant-antioxidant balance is changed in leukocytes of patients with BA. METHODS: Thirty eight patients (21 male, 17 female) aged 22-68 years and controls of 32 subjects (18 male, 14 female) aged 20-63 years were included in the study. A total of 10 mL venous blood was drawn, leukocytes were separated and lipid peroxidation (LPO), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and vitamin C levels were determined in both patients and controls. RESULTS: Leukocyte LPO and SOD activity in the patient group were higher than that of controls (p <0.001 and p <0.05, respectively). However, leukocyte GSH-Px and vitamin C levels in the patient group were lower than that of controls (p <0.01 and p <0.001, respectively). CONCLUSIONS: The results suggest that there are alterations in a wide array of oxidants and antioxidants with balance shifting toward increased oxidative stress in BA.     

Low income and education levels may cause medication overuse and chronicity in migraine patients

BACKGROUND: Frequent analgesic drug intake, especially in migraine patients, may induce the risk of medication overuse headache (MOH). The various conditions that may affect the development and the features of MOH have not been determined yet. AIM: To compare MOH patients with migraine as pre-existing headache and episodic migraine patients according to socioeconomic and educational variables. METHODS: Forty-six MOH patients with migraine as pre-existing headache and 61 migraine patients were included into study. The headache characteristics, socioeconomic and educational variables of MOH and migraine groups and subgroups divided according to the education (low/high education subgroups), and income (low/high income subgroups) levels were evaluated. RESULTS: We found that mean duration of education was shorter in MOH patients than migraine patients. There was a negative correlation between duration of education and duration of MOH. The mean duration of MOH was longer and rate of low-income level was higher in patients with low-education level. The duration of education was lower in MOH patients with low income. The frequency of migraine attacks and low-income rate was also higher in low-educated migraine patients. The duration of education was shorter in migraine patients with low income. CONCLUSION: We report that migraineurs with low socioeconomic status may have risk of developing MOH. A better identification of patients at risk of drug-associated headache may contribute to improved health in a group of patients with MOH.     

Diameter of the Infrarenal Abdominal Aorta in Children with Cerebral Palsy

The diameters of the infrarenal abdominal aorta by ultrasonography have not yet been reported in children with cerebral palsy (CP). Because the demand for the surgical applications of the abdominal aorta probably increases in the CP population owing to their prolonged life-span, we planned a study to assess the diameter of the infrarenal abdominal aorta by ultrasonography in children with CP and to compare them with those of healthy subjects. The study comprised 60 children with CP and 95 age- and sex-matched healthy children. The diameter of the infrarenal abdominal aorta was measured by B-mode ultrasonography. The correlation between the aortic diameter, weight, height, body surface area (BSA), and body mass index was studied. The diameter of the infrarenal abdominal aorta was found to be smaller in children with CP than in healthy children (p < 0.05). There was a significant correlation between the aortic diameter, weight, height, and BSA in both groups (p < 0.05). When a vascular surgical treatment is needed in children with CP, the probability of a small-diameter infrarenal abdominal aorta should be considered.     

Visceral childhood leishmaniasis in Kağizman, eastern Turkey: a new endemic area

Visceral leishmaniasis is endemic in some areas of Turkey; however, it has not been reported previously from the eastern part of the country. We reviewed 21 cases of visceral leishmaniasis admitted from eastern Turkey, 60% of whom were from the same region, Ka?izman.