Peroneal nerve palsy due to rare reasons: a report of three cases

Peroneal nerve entrapment was diagnosed in three patients (2 males, 1 female) by clinical and electrophysiological studies. Of these, one patient had postural bilateral involvement due to prolonged squatting, while two patients had mechanically-induced entrapment. Initially, all the patients were treated conservatively with a drop-foot splint and vitamin B. One patient responded to treatment; in one patient with bilateral involvement, right-sided peroneal nerve palsy improved. Upon detection of no clinical and electrophysiological improvement after three months of conservative treatment, surgical decompression was performed in two patients, which resulted in a successful outcome in the patient with bilateral palsy. Incomplete recovery was obtained in the other patient with diabetic polyneuropathy.     

Complications of otitis media requiring surgical intervention

BACKGROUND: Although the incidence of complications of otitis media that require surgical interventions has decreased substantially over the past few years, it is a prevailing condition for which clinicians should remain vigilant. METHODS: We conducted a 3-year review [June 1998 to June 2001] in our hospital of surgical records of patients with complications of otitis media that were treated surgically. RESULTS: There were 16 patients with complications of otitis media, of which nine [56%] were intracranial; brain abscess and lateral sinus thrombosis were the most common intracranial complications. Extracranial complications were present in 15 [94%] of the patients; mastoid abscess [40%] was the most common extracranial complication. Seven [44%] patients had two or more concomitant complications. All patients with intracranial complications recovered well with no neurological deficits after aggressive antibiotic therapy and initial surgical treatment by neurosurgeons. Modified radical mastoidectomy was the most common surgical otological procedure that was performed in these cases.CONCLUSIONS: Aggressive antibiotic therapy and combined management of cases by otologists and neurosurgeons are the key to reducing the morbidity and mortality of the serious complications of otitis media.     

Tumefactive fibroinflammatory lesion of the head and neck

The term tumefactive fibroinflammatory lesion is used to describe an unusual fibrosclerosing disorder that behaves in a malignant way clinically but is histologically benign. Lesions in the head and neck are believed to be part of the broader fibrosclerosing syndrome which include pseudotumour of the orbit, Reidel's thyroiditis, sclerosing cholangitis and mediastinal fibrosis. Clinical diagnosis is often difficult and relies heavily on histopathology. Steroid therapy is suggested as the first line of management, while surgery or radiation therapy is reserved for failures.     

Transit time flow measurement and outcome in coronary artery bypass grafting for surgeon and trainee

BackgroundTrainees need to operate under appropriate supervision to become competent. Transit time flow measurement (TTFM) is useful in detecting intraoperative graft failures during coronary artery bypass grafting (CABG). This study aims to compare the intra- and postoperative outcomes, including TTFM, of isolated CABG performed by a single consultant versus trainees and to determine the relationship between the pulsatility index (PI) and postoperative outcomes.MethodsThis retrospective study included 155 isolated CABG cases. Intraoperative outcomes included duration of cardiopulmonary bypass (CPB) and aortic cross-clamp and TTFM for arterial and venous grafts. Postoperative outcomes included common postoperative complications and mortality. The odds ratios of postoperative complications and mortality for arterial and venous grafts with PI ≤3 relative to grafts with PI >3 were determined with multiple logistic regression.ResultsThe duration of CPB and aortic cross-clamp was significantly shorter in the consultant’s group. TTFM for both arterial and venous grafts were similar and no significant differences in postoperative complications and mortality were detected between the two groups. Patients with arterial grafts with PI ≤3 were less likely to require an intra-aortic balloon pump (IABP) or be ventilated for a prolonged period. No significant differences in postoperative outcomes and mortality were detected between venous grafts with PI ≤3 and PI >3.ConclusionsTrainees can achieve good results in isolated CABG with appropriate case selection. Patients with arterial grafts with PI ≤3 have better postoperative outcomes.     

PTEN and ERG expression in MRI-ultrasound guided fusion biopsy correlated with radical prostatectomy findings in men with prostate cancer

Background

Conventional systematic prostate biopsies (SBx) have multiple limitations, and magnetic resonance imaging (MRI)-ultrasound fusion targeting is increasingly applied (fusion biopsies [FBx]). In our previous studies, we have shown that loss of the tumor suppressor gene phosphatase and tensin homolog (PTEN) in radical prostatectomy (RP) specimens predicts poor disease-specific survival, and in active surveillance (AS), PTEN loss in SBx predicts an adverse AS outcome, although SBx PTEN status does not correlate well with the corresponding RP status. Here, we have hypothesized that PTEN and erythroblast transformation-specific related gene (ERG) status in FBx correlate better with RP than they would in SBx.

Methods

A total of 106 men, who had undergone FBx and subsequent RP in a single center between June 2015 and May 2017 were included. Fifty-three of the men had concomitant or previous SBx's. All biopsy and RP specimens were collected, and tissue microarrays (TMA) were constructed from RP specimens. Immunohistochemical stainings for PTEN and ERG expression were conducted on biopsies and RP TMAs and results were compared by using Fisher's exact test.

Results

The immunohistochemical predictive power of FBx, determined by the concordance of biopsy PTEN and ERG status with RP, is superior to SBx (77.6% vs 66.7% in PTEN, 92.4% vs 66.6% in ERG). FBx was superior to SBx in correlation with RP Gleason Grade Groups and MRI prostate imaging reporting and data system scores.

Conclusion

FBx grading correlates with RP histology and MRI findings and predicts the biomarker status in the RP specimens more accurately than SBx. A longer follow-up is needed to evaluate if this translates to better prediction of disease outcomes, especially in AS and radiation therapy where prostatectomy specimens are not available for prognostication.

     

Poly (adp-ribose) synthetase inhibition reduces oxidative and nitrosative organ damage after thermal injury

Poly (ADP-ribose) synthetase (PARS) is a nuclear enzyme activated by DNA single-strand breakage, which can be triggered by reactive oxygen and nitrogen species. Activation of this enzyme depletes the intracellular concentration of energetic substrates such as nicotinamide adenine dinucleotide (NAD). Eventually, this process results in cell dysfunction and cell death. PARS inhibitors have successfully shown benefits in several experimental models of ischemia-reperfusion injury, inflammation, and sepsis. In our experimental study, we investigated the role of 3-aminobenzamide (3-AB), a nonspecific PARS inhibitor, in systemic organ damage after burn. Twenty-four Wistar rats were randomly divided into three groups. The sham group (n=8) was exposed to 21°C water, and the burn group (n=8) and the burn-plus-3-AB group (n=8) were exposed to boiling water for 12 s to produce a full-thickness burn of 35–40% of total body surface area. In the burn-plus-3-AB group, 3-AB 10 mg/kg was given intraperitoneally 10 min before thermal injury. Twenty-four hours later, tissue samples were obtained for biochemical analysis from lung, intestine, and kidney. In the burn group, tissue malondialdehyde, myeloperoxidase, and 3-nitrotyrosine levels in all organs were significantly increased compared with the sham group (p<0.05). Pretreatment with 3-AB significantly reduced burn-induced organ damage (p<0.05). These data provide evidence of the relationship between the PARS pathway and lipid peroxidation in systemic organ damage after thermal injury.     

Fronto-orbital leptomeningeal cyst manifested with exophthalmus

A 41-year-old female patient with fronto-orbital leptomeningeal cyst is presented. After decompression of the cyst, repair of bone and dura defects were achieved with autogenous bone grafts and pericranial flap. Our case was very interesting in several aspects: a head trauma at 3 years of age and manifestation of clinical symptoms (headaches and exophthalmia) after almost 4 decades that had been progressive for 6 months and a rare location (fronto-orbital region) that required a special management. A thorough history is crucial in such cases because clinical symptoms might appear after decades. An old fracture that is surrounded by thin calvarial tissue in conjunction with intracranial cystic formation should make one take a leptomeningeal cyst into consideration in differential diagnosis. Extensive dissection and adequate access osteotomies followed by repair with autologous and vascular tissues are the key factors for a successful outcome in the management of fronto-orbital pathologies.     

Importance of identifying the course of the recurrent laryngeal nerve in total and near-total thyroid lobectomies

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.     

Morphology and dynamics of the ulnar nerve in the cubital tunnel after percutaneous cross-pinning of supracondylar fractures in children's elbows: an ultrasonographic study

After the 12.6-month (3-30) follow-up period, the morphology and dynamics of the ulnar nerve in the cubital tunnel were examined with ultrasonography on operated (group 1) and opposite (group 2) elbows of 13 children who had percutaneous cross-pin fixation for displaced supracondylar humerus fractures. When we compared group 1 and group 2, nerve morphology was similar (P>0.05), but nerve dynamics were found to be decreased or absent for seven (54%) elbows in group 1 (P<0.05). The medial K-wire may damage the ulnar nerve dynamics in the cubital tunnel.