The gluteal perforator-based flap in repair of pressure sores.

The gluteal perforator-based flap is designed according to the localisation of sacral perforator vessels. These vessels penetrate the gluteus maximus muscle and reach the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus. The gluteal perforator-based flaps described in this paper are highly-vascularised, have minimal donor site morbidity, do not require the sacrifice of the gluteus maximus muscle and rarely lead to post-operative complications. We believe these easy-to-perform flaps might be considered as the first choice in the repair of gluteal pressure sores.     

Correlation of low back pain caused by lumbar spinal stenosis and depression in women: a clinical study

Objective:

Low back pain (LBP) due to spinal stenosis may be one of the most debilitating symptoms to decrease the quality of life. The cause and effect association of LBP and depression is vague. Pain may also be a somatization symptom of depression. This is more frequent in the female population. This clinical study was designed to evaluate the correlation between the level of back pain caused by lumbar spinal stenosis and depression in the female population.

Method:

The study included 50 consecutive female patients with spinal stenosis. The stenosis diagnosis is made by neurological examination and neuro-imaging. The study group was psychiatrically evaluated and grouped as those with and without depression. Visual analog scale (VAS), Oswestry disability index (ODI) and Hamilton Depression Scale (HDS) were utilized in initial evaluation of the group.

Results:

Twenty-one patients with lumbar spinal stenosis had depression (DLS Group) and 29 did not (LSS Group). Mean HDS scores were 8.97 and 32.48 for Group LSS and Group DLS, respectively. There was a statistically significant difference between the VAS scores of the groups (the mean VAS scores were 5.6 and 7.6, for groups LSS and DLS, respectively). The mean ODI values for LSS (65.24?±?4.58) and DLS (75.1?±?6.7) groups were also significantly different. In Group DLS, there were positive correlations between ODI and VAS with HDS (p?Conclusion: Our findings indicated a relationship between lumbar spinal stenosis associated pain levels and depression. However, the cause and result relationship still needs to be established yet.     

Are Discrete Coronary Artery Fistulae Different from Coronary Arteriovenous Malformations?

AIM: To delineate whether coronary arteriovenous malformations have different properties than classical discrete coronary artery fistulae. METHODS: Group 1 included 17 patients with discrete coronary fistula that represents a coronary artery fistula draining into any cardiac chamber. Group 2 included six patients with coronary arteriovenous malformations representing extensive coronary artery malformation. Cardiopulmonary bypass was used in 12 of the Group 1 patients and 5 in Group 2. RESULTS: There was no operative mortality in either group. Following a hemodynamically nonsignificant residual fistulous communication, which was detected by repeat coronary angiography in Group 2; we changed our surgical technique of suture ligation on beating heart. Then we preferred pulmonary arteriotomy and sutured the orifice of coronary arteriovenous malformations from within the chamber. CONCLUSIONS: Coronary arteriovenous malformations have different morphology and also complex progression properties when compared with discrete coronary artery fistulae. Surgical repair of coronary arteriovenous malformation should be done by suturing the multiple drainage holes inside the draining chamber. Suture ligation of coronary arteriovenous malformation is difficult due to the fragile vessel.     

Glycosaminoglycans in childhood urinary tract infections

It has been suggested that urinary glycosaminoglycans (GAGs) form a natural defense mechanism against urinary tract infections (UTIs). This study investigated whether urinary GAGs play a role in pediatric UTIs, and whether urinary GAG level can be used to differentiate upper UTI from lower UTI. Forty-one children with UTIs (33 girls and eight boys; mean age 5.4+/-3.7 years) and 46 age- and sex-matched healthy children (35 girls and 11 boys; mean age 6.6+/-3.9 years) were included in the study. Urinary GAG levels were measured at the onset of acute infection and after a 10-day course of antibiotic treatment. Group GAG findings were compared, and comparisons were also made with the patients divided according to sex and according to UTI type (upper versus lower). The mean urinary GAG level in the patient group at the onset of acute infection (pretreatment) was significantly higher than the mean level in the control group (132.2+/-104.8 mg/g vs 42.2+/-27.1 mg/g creatinine, respectively; P <0.01). In the patient group, the mean urinary GAG level after antimicrobial therapy was significantly lower than the pretreatment level (75.9+/-52.1 mg/g vs 132.2+/-104.8 mg/g creatinine, respectively; P <0.01). However, the mean post-treatment level was still higher than the mean level in the controls ( P <0.05). There was no significant difference in urinary GAG levels when patients were categorized as upper versus lower UTI ( P >0.05). The study results suggest that GAGs play an important role in the pathogenesis of UTIs in children, and that measurement of urinary GAGs may be a valuable noninvasive method for evaluating UTIs in this patient group. However, this assay cannot be used to differentiate upper UTI from lower UTI in children.     

Early prediction of urinary tract infection with urinary neutrophil gelatinase associated lipocalin

Neutrophil gelatinase associated lipocalin (NGAL) is a protein identified in human neutrophil granules. The aim of the study was to assess whether urine level of NGAL (uNGAL) could represent a novel, reliable marker of urinary tract infection (UTI) and to determine the optimal cutoff level for uNGAL to predict UTI in children. Sixty patients with symptomatic UTI and 29 healthy controls were enrolled the study. Urine NGAL was measured by enzyme-linked immunosorbent assay. A dimercaptosuccinic acid (DMSA) radionuclide scan was performed within 7 days in the patients with UTI in an attempt to distinguish pyelonephritis from cystitis. Mean uNGAL level was significantly higher in the UTI group than in the controls (91.02 ng/ml vs 14.29 ng/ml, p = 0.0001) and using a cutoff 20 ng/ml for uNGAL for diagnosis of UTI, sensitivity, and specificity were 97% and 76%, respectively [area under the curve (AUC): 0.979]. Mean uNGAL/creatinine ratio (uNGAL/Cr) was also significantly higher in the UTI group [201.81 ng/mg creatinine (Cr) vs 18.08 ng/mg Cr; p = 0.0001], and using a cutoff 30 ng/mg Cr for uNGAL/Cr for diagnosis of UTI, sensitivity and specificity were 98% and 76%, respectively (AUC: 0.992). In conclusion, both uNGAL and uNGAL/Cr can be used as a novel, sensitive marker for early prediction of UTI in the absence of acute kidney injury and chronic kidney disease, and the optimal cutoff value for prediction of UTI is lower than the values determined for acute kidney injury. Further investigations with larger patient groups are required to confirm our results.     

Radiation exposure to premature infants in a neonatal intensive care unit in Turkey

OBJECTIVE: The aim of this work was to determine the radiation dose received by infants from radiographic exposure and the contribution from scatter radiation due to radiographic exposure of other infants in the same room. MATERIALS AND METHODS: We retrospectively evaluated the entrance skin doses (ESDs) and effective doses of 23 infants with a gestational age as low as 28 weeks. ESDs were determined from tube output measurements (ESD(TO)) (n = 23) and from the use of thermoluminescent dosimetry (ESD(TLD)) (n = 16). Scattered radiation was evaluated using a 5 cm Perspex phantom. Effective doses were estimated from ESD(TO) by Monte Carlo computed software and radiation risks were estimated from the effective dose. ESD(TO) and ESD(TLD) were correlated using linear regression analysis. RESULTS: The mean ESD(TO) for the chest and abdomen were 67 microGy and 65 microGy per procedure, respectively. The mean ESD(TLD) per radiograph was 70 microGy. The measured scattered radiation range at a 2 m distance from the neonatal intensive care unit (NICU) was (11-17 microGy) per radiograph. Mean effective doses were 16 and 27 microSv per procedure for the chest and abdomen, respectively. ESD(TLD) was well correlated with ESD(TO) obtained from the total chest and abdomen radiographs for each infant (R(2) = 0.86). The radiation risks for childhood cancer estimated from the effective dose were 0.4 x 10(-6) to 2 x 10(-6) and 0.6 x 10(-6) to 2.9 x 10(-6) for chest and abdomen radiographs, respectively. CONCLUSION: The results of our study show that neonates received acceptable doses from common radiological examinations. Although the contribution of scatter radiation to the neonatal dose is low, considering the sensitivity of the neonates to radiation, further protective action was performed by increasing the distance of the infants from each other.     

Interpleural versus epidural analgesia with ropivacaine for postthoracotomy pain and respiratory function

STUDY OBJECTIVE: To evaluate the impact of interpleural analgesia (IP) on postthoracotomy pain and respiratory function as an alternative to thoracic epidural analgesia (TEA). DESIGN: Prospective, randomized study. SETTING: Tertiary-care military hospital. PATIENTS: Sixty young patients scheduled for elective thoracic surgery (correction of aorta coarctation and patent ductus arteriosus). INTERVENTIONS: Patients were randomized into two groups to receive either IP or TEA for postthoracotomy pain management. MEASUREMENTS: Patients in the IP group (n = 30) had a catheter inserted between the parietal and visceral pleura by a surgeon, and 0.2% ropivacaine was given through this catheter. In the TEA group, ropivacaine was administered through a thoracic epidural catheter. The impact of both methods on pain control, respiratory function, and pulmonary complications was analyzed and compared. MAIN RESULTS: The frequency of atelectasis and pleural effusion was also significantly high in the IP group (P < 0.01). Respiratory function and postoperative pain scores were better in the TEA group (P < 0.01). Arterial blood gas analysis on the fifth postoperative day was significantly better in the TEA group. CONCLUSION: Thoracic epidural analgesia has more beneficial effects on respiratory function and postoperative pain after thoracotomy than does IP.     

Protective effects of antioxidant medications on limb ischemia reperfusion injury

BACKGROUND: N-acetylcysteine, beta-glucan, and coenzyme Q(10) were shown to have antioxidant and anti-inflammatory effects on reperfusion injury. The aim of our study was to determine and evaluate the effects of these agents on ischemia reperfusion injury of limb. MATERIAL AND METHOD: Forty-four New Zealand white rabbits, all female, weighing between 2.3 to 4.2 (mean 3.8) kg, were used in the study. Four study groups were arranged of 11 animals each, by randomization. The first group was the control group (Group C), the other groups were the Group Q, which was medicated with coenzyme Q10, the Group betaG, which was medicated with beta-glucan, and the Group N, medicated with N-acetylcysteine. After baseline measurements, for the ischemia-reperfusion experiments, common iliac artery was clamped and collateral flow was occluded by a rubber arterial tourniquet wrapped around the thigh at the proximal third of the leg. After 60 min of transient ischemic period, the limb was perfused for 180 min. After perfusion, biopsy was taken from the adductor magnus muscle. Second blood sampling was done after reperfusion period. Blood and tissue analysis were done and evaluated statistically. RESULTS: Baseline and post-reperfusion levels of glutathione peroxidase (GPx), super oxide dismutase (SOD), malonyldialdehyde (MDA), and nitric oxide (NO) changed significantly. While MDA levels increased in the control group, it decreased in the other study groups. The increase in GPx and SOD levels were significant in all groups except the control group. Levels of NO were found to have decreased in the control group, whereas it had increased in the other groups. CONCLUSION: Antioxidant medication may help lowering limb ischemia reperfusion injury. All mentioned medications in our study are shown to be able to have an effective role for preventing ischemia reperfusion injury to some extent through their antioxidant properties.     

Repeated paracentesis for treatment renal failure after heart transplantation in patient with ascites

We report a case of orthotopic heart transplantation in a 42-year-old man who had cardiomyopathy with severe biventricular heart failure, ascites, and large umbilical hernia. He successfully received an orthotopic heart transplantation. After heart transplantation, renal failure was noted. Ascites and renal failure were successfully managed with repeated paracentesis. His cardiac and abdominal symptoms subsided gradually following transplantation. His umbilical hernia was repaired 55 days after the heart transplantation because of strangulation. In this case study, we report a patient with ascites who was treated for postoperative renal failure with repeated paracentesis.     

Pedicled LIMA graft to the posterior coronary artery: which side to be anastomosed,dorsal or ventral?

It has not clearly been defined in the literature which side of the pedicled LIMA graft should be anastomosed to the posterior coronary arteries. Using the ventral side of pedicled LIMA graft causes an 180 degree torsion of the pedicle. Sometimes this torsion may cause reduction or cessation of LIMA flow as we have seen in two of our patients. In this paper we point out that using the dorsal side of the pedicled LIMA graft for anastomosis to the posterior coronary arteries is helpful.