Reconstruction of a burned breast with vertical mammaplasty: a case report

The right upper extremity, axilla, and right anterior hemithorax of a 25-year-old female had been burned with milk when she was 4. Breast tissue developed in a flattened form because of the burn to the entire anterior hemithorax; the nipple–areolar complex was far lower than it should have been; no inframammary fold had developed and the appearance was highly asymmetrical. A vertical mammaplasty was used to restore the nipple–areolar complex to its normal position, and a full-thickness skin graft taken from the groin was used to form an inframammary fold. In this way, the two asymmetrical breasts were given an acceptable symmetry.     

Effect of delivery mode on postpartum neonatal body temperatures

Objective: It is known that general and local anesthesia practices disrupt the delicate balance of thermoregulation center which is already sensitive to very tiny differences of temperatures in a normal subject. We aimed to evaluate and compare the rectal temperatures of newborns born with normal vaginal delivery and cesarean section.

Methods: We performed a prospective study of 106 term newborn – 40 born with normal vaginal delivery (group 1) and 66 born with cesarean section [51 spinal anesthesia (group 2), 15 general anesthesia (group 3)]. Only term babies were included in the study. Babies of eclamptic, pre-eclamptic and diabetic mothers and babies with chronic systemic diseases were excluded. Pregnants who underwent elective cesarean section were included in the study. Adolescent pregnants, pregnants with increased risks and pregnants with complicated operations were excluded. Mothers’ temperatures were measured before and after the interventions. Rectal temperatures of the babies were measured immediately after birth.

Results: Environmental temperature was maintained at 22–24?°C. Pre-operative mother temperatures were 36.31?±?0.30?°C in group 1, 36.36?±?0.26?°C in group 2 and 36.39?±?0.19?°C in group 3 (p?=?0.414). Post-operative mother temperatures were 36.39?±?0.27?°C in group 1, 36.29?±?0.31?°C in group 2 and 36.25?±?0.28?°C in group 3 (p?=?0.215). Rectal temperatures of the babies born with normal vaginal delivery were significantly higher than the others. It was lowest in the general anesthesia group (37.5?±?0.6?°C, 37.2?±?0.2?°C and 36.8?±?0.4?°C in group 1, 2 and 3, respectively). The temperature differences between groups were statistically significant p?<?0.001).

Conclusions: In conclusion, it is worthy to note that temperatures of the newborns can differ according to the delivery mode. Physicians and health professionals that take care of the newborns should be aware of this difference.     

Corneal Topographic Changes After Phacoemulsification Through Steep Axis Incision

PURPOSE: To evaluate the effect of 5.5 mm sutured and 4.0 mm sutureless corneal incisions after phacoemulsification on corneal topograpy. MATERIAL AND METHODS: Twenty eyes of 20 patients that underwent phacoemulsification with IOL implantation were randomly divided into two. The first group received a PMMA IOL through a sutured 5.5 mm corneal incision. The second group received a foldable hydrophilic acrylic IOL through a sutureless 4.0 mm incision. Complete ocular examination and computerized corneal topography (Keratron Corneal Analyzer, Software version 3.2, Optikon 2000, Italy) were performed preoperatively, at 1 week, and 1 month postoperatively. The Maloney indices [best fit sphere (BFS), best fit cylinder (BFC) and topographic irregularity (TI)] were provided by the Keratron Corneal Analyzer. RESULTS: There was no statistically significant difference in the mean BFS between the groups preoperatively (p = 0.305), at postoperative week 1 (p = 0.362), and at postoperative month 1 (p = 0.160). The BFC was significantly higher in the 5.5 mm incision group than in the 4.0 mm incision group preoperatively (p = 0.025), however, there was no statistically significant difference between the groups at postoperative week 1 (p = 0.909), and at postoperative month 1 (p = 0.382). There was no statistically significant difference in the mean TI between the groups preoperatively (p = 0.494) and at postoperative week 1 (p = 0.271). However the mean TI at postoperative month 1 was significantly higher in the 5.5 mm incision group than the 4.0 mm incision group (p = 0.05). CONCLUSION: The 5.5 mm sutured incisions caused an increase in TI at 1 week and 1 month postoperatively. For a more rapid visual rehabilitation, 4.0 mm sutureless incisions are recommended.     

The effects of ondansetron and granisetron on electrocardiography in children receiving chemotherapy for acute leukemia

5-HT3 receptor antagonists, including granisetron and ondansetron, are widely used in the prophylactic treatment of chemotherapy-induced nausea and vomiting. Although the cardiac safety of granisetron and ondansetron has been investigated in several adult studies, there is no report investigating the effects of those agents on electrocardiography (ECG) in children. The effects of intravenously infused (over 30 seconds) 0.1 mg/kg ondansetron and 40 microg/kg granisetron on ECG were assessed in 22 children receiving high-dose methotrexate therapy for acute lymphoblastic leukemia. The ECG recording was obtained at before and just after the infusion, and repeated at 1, 3, 6, and 24 hours of treatment. Granisetron administration resulted in a statistically significant decrease of mean heart rate at 1 and 3 hours, and significant prolongation of mean QT and QTc dispersions at 1 hour of infusion. In patients treated with ondansetron, no meaningful change was observed. In conclusion, intravenous granisetron but not ondansetron causes clinically asymptomatic and transient changes on ECG measurements in children receiving high-dose methotrexate therapy.     

Endovascular treatment of ruptured intracranial aneurysms during pregnancy: report of three cases

Subarachnoid hemorrhage from an intracranial aneurysm during pregnancy is a rare complication with high maternal and fetal morbidity-mortality. We report three cases of ruptured intracranial aneurysms during pregnancy, treated by the minimal invasive endovascular approach.     

Interleukin-6 levels in hyperemesis gravidarum

INTRODUCTION. Hyperemesis gravidarum (HG) is associated with higher levels of serum beta-hCG levels and hyperthyroidism. Interleukin-6 (IL-6), a pro-inflammatory cytokine, is reported to enhance secretion of beta-hCG from trophoblastic cell line. METHODS. We measured serum levels of IL-6, thyroid hormones and beta-hCG of hyperemetic patients and gestational age-matched controls to search for a difference between the two groups. RESULTS. There was a significant difference in beta-hCG ( p=0.028), though IL-6 levels were higher in the hyperemetic group, it did not reach a significant level. Interleukin-6 positively correlated with beta-hCG ( r=0.38 and p=0.13).     

Using porcine small intestinal submucosa in intestinal regeneration

Small intestinal submucosa (SIS) is an unusual tissue that promotes constructive tissue remodeling when applied as a xenogeneic material. The aim of our experimental study was to assess its effectiveness in intestinal regeneration. Twenty white New Zealand rabbits were anesthetized and underwent celiotomy. A 6-cm antimesenteric incision was created at the jejunal segment. An elliptical SIS graft measuring 6 cm long and 2 cm wide was sutured to the jejunal defect as a patch graft. Thirteen living rabbits were divided into groups of three and the grafts were harvested at postoperative weeks 2, 4, and 6. The obtained specimens were evaluated for gross and histologic appearance. In morphometric examination, in the 2, 4, and 6 weeks groups, the diameters of grafted intestines were larger than preoperatively by 50%, 25%, and 25% respectively; also the grafts had contracted to 0%, 25%, and 50% of their original sizes respectively. At the end of 2 weeks, the grafts were intact without evidence of epithelial regeneration. By 4 weeks, intestinal tissue regeneration was started, and epithelial coverage of the grafts was detected. The grafts were covered with a complete intestinal mucosa at 6 weeks. Remarkable regeneration marked fibroplasia, angiogenesis, and mild mononuclear cell infiltration had also occurred throughout the grafts at 6 weeks. Porcine SIS appeared an effective biodegradable scaffold, facilitating regeneration of intestinal tissue. These results suggest that SIS may be useful to increase the mucosal surface of intestine and may provide a new substance for short gut syndrome in the future.     

Severe alloimmune hemolytic anemia after renal transplantation

Alloimmune hemolytic anemia is a rare complication following allogeneic organ transplantation. Despite that some other drugs have also been reported, in the majority of cases this complication has been associated with cyclosporine therapy. We here present a case of severe alloimmune hemolytic anemia due to ABO minor incompatibility after renal transplantation in a patient treated with tacrolimus.     

Familial juvenile polyposis coli with congenital heart disease

Seven cases of familial juvenile polyposis coli (FSPC) and one case of familial adenomatous polyposis coli (FAPC) were described in two generations of a family. Of five siblings, one had FJPC with mitral insufficiency, one had Fallot's tetralogy, and the other three, also with FJPC, had had pulmonic stenosis and died. Congenital heart disease was observed in neither the father nor the aunt. The grandfather also had FAPC, without congenital heart disease. To the best of our knowledge, this association has not previously been reported in the literature. For this paper members of the family were studied and the literature was reviewed.Presented at the 6th International Congress of Pediatric Surgery, Istanbul, 29th August – 1st September, 1989 Offprint requests to: M. Pul