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Limb-girdle muscular dystrophy (LGMD) is a heterogeneous inherited disorder affecting the skeletal muscle and frequently also involve the heart and in LGMD; development of dilated cardiomyopathy is common and usually the predominant feature. Arrhythmias and conduction disease can be associated with the development of cardiomyopathy.

Aim: To determine the association of vitamin D with insulin resistance and obesity in children. Methods: A total of 92 obese and 58 non-obese children aged 5-17 years were evaluated. Data were collected related to anthropometric (weight, height), and biochemical parameters (fasting plasma glucose, serum insulin, serum 25-hydroxyvitamin D, lipid profile, vitamin B12, parathormone) and physical examination (blood pressure, acanthosis nigricans, stria, lipomastia). Insulin resistance (IR) was calculated using the homeostasis model assessment (HOMA). HOMA-IR = fasting insulin level (mu U/ml) x fasting glucose (mg/dL)/405. A HOMA-IR value >2.5 was defined as insulin resistance. Results: According to the US Endocrine Society classification, vitamin D deficiency (0-20 ng/ml) was determined at significantly higher rates in the obese group than in the control group (p < 0.001). The rate of subjects with a vitamin D level of 20-30 ng/ml was significantly lower in the obese group than in the control group (p < 0.001) Within the obese group a statistically significant difference was determined between the insulin resistant and non-insulin resistant groups in respect of serum 25-hydroxyvitamin D levels (p = 0.001) and vitamin B12 levels (p = 0.001). A significant negative correlation was determined between serum 25-hydroxyvitamin D and HOMA-IR (r=-0.256, p = 0.016) and insulin (r = -0.258, p = 0.015). The systolic blood pressure (p = 0.001) and diastolic blood pressure (p = 0.003) values were significantly different in the control and obese groups. A statistically significant difference was determined between the control and obese groups in terms of the levels of insulin, HOMA-IR, HbA1c, cortisol, LDL, total cholesterol, HDL, triglyceride, hemoglobin, MCV, MPV, and calcium. Conclusion: The prevalence of vitamin D deficiency was higher in obese children compared to normal weight and overweight children. Serum 25(OH)D levels showed a negative correlation with insulin and HOMA-IR. Serum 25(OH)D is associated with insulin resistance independently of obesity. (C) 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved. WOS:000594532200001 2-s2.0-85087172099 PubMed: 32616391

Purpose Although the Oberg-Manske-Tonkin (OMT) classification has been recommended by the International Federation of Societies for Surgery of the Hand owing to some insufficiencies of the Swanson classification system, it has not achieved a universal adoption by hand surgeons. In this study, we hypothesize that the OMT classification can be used easily to classify congenital upper extremity anomalies. We also aim to make epidemiological analysis of congenital upper extremity anomalies with the OMT classification and to compare the applicability of the OMT and the Swanson classifications. Methods We retrospectively analyzed 711 patients and 833 extremities operated on between 2012 and 2017. Photographs, plain x-rays, and brief medical histories of the patients were evaluated by 4 plastic surgeons. Two independent evaluations were made by each surgeon in 1-month interval using these classification systems. Results Total number of upper extremity anomalies recorded was 1050. Of the 711 patients operated on, 122 had bilateral anomalies. The anomalies were identified in 833 extremities because many extremities had more than a single diagnosis. We were able to classify all of the anomalies within the OMT classification. The OMT classification gives better reliability results compared with the Swanson classification according to intrarater and interrater reliabilities. Conclusions Compared with the Swanson classification system based on phenotypic evaluation of the extremity, the OMT classification system is easier to apply and the association of the anomaly with the embryologic origin during evaluation is possible. We believe that multiple studies from different centers will boost the international acceptance of the OMT classification.

Aneurysmal bone cyst (ABC) is a benign expansile bone tumor without metastasis capability. Only 3–4% of ABCs occur in the hand and they mainly take place in metaphysis’ of long bones like metacarpals or phalanges. Carpal ABCs have been reported as individual case reports in the literature due to rarity. A patient presented with pain in her right wrist. Magnetic resonance imaging revealed a well circumscribed one cm sized mass in the pisiform bone that resembled an aneurysmal bone cyst. Total pisiformectomy was performed. Treatment options are total excision or curettaging in ABCs. But rarity of these lesions may delay the diagnosis process for the inexperienced surgeon.

The purpose of this retrospective study was to compare the outcomes of paediatric and adult fingertip replantation within a single institution. Our retrospective study found no significant difference in the survival rate between the paediatric (10/12) and adult (22/26) groups. At 6 months follow-up, there was no significant difference in sensory recovery between both groups, as measured with Semmes–Weinstein testing, but a significant difference in mean static two-point discrimination testing values between the paediatric (4.0 mm) and adult (6.2 mm) groups. Moreover, the mean time for regaining sensation was faster in paediatric patients (1.3 months) as compared with adult patients (4.1 months). Five children and four adults received erythrocyte transfusion. Paediatric fingertip replantation has similar survival rates, faster and better sensory nerve recovery as compared with adults despite a higher erythrocyte transfusion rate. Although technically demanding, paediatric fingertip replantation is recommended, whenever possible, because of the good outcomes achievable. Level of evidence: IV

To assess the efficacy and toxicity of hypofractionated radiotherapy (RT) alone in treatment-resistant symptomatic keloids.Six patients with a total of 13 inoperable large keloid lesions and no response to previous treatments were admitted to our department between 2017 and 2019. All patients were examined for detailed wound localization, size, contour, and color assessment, and for objective and subjective symptoms. Response to treatment was graded as "complete remission" in case of full symptomatic relief and75% decrease in lesion size, as "partial remission" in case of partial symptomatic relief and 25-75% decrease in lesion size, and as "stable disease" in case of no symptomatic relief or25% decrease in lesion size. Patients were followed up monthly for the first 3 months and every 3 months thereafter by physical examination.A total dose of 37.5 Gy external RT in five fractions was prescribed by 6‑MeV electrons in 4 patients and 6‑MV photons in 2 patients. Complete response was obtained in all patients at the 6‑month control. All patients were satisfied with cosmetic results at their last control. Grade 2 dermatitis developed in all patients during the second week of RT but resolved completely in all after 6 months following the end of RT.In keloids that are unresponsive to standard treatment, hypofractionated RT using a total dose of 37.5 Gy in five fractions is feasible.

BACKGROUND The junction between upper and lower lateral cartilages, known as "the scroll area," is an important determinant of the spatial relationship between the middle and lower nasal thirds. OBJECTIVES We offer a graduated and reproducible surgical technique of scroll area management that takes into consideration anatomic, functional, and aesthetic relationships. METHODS This study was a retrospective review of the recorded intraoperative information to investigate the frequency of the use of scroll reconstruction techniques and perioperative parameters that relate to unintended component alterations in the scroll area. A total of 364 consecutive primary open approach rhinoplasty cases performed by the first author (O.B.) between July 2011 and September 2015 were included in the study. RESULTS Of the 364 cases who underwent primary open approach rhinoplasty, 329 received some form of scroll reconstruction. Scroll reconstruction was performed in all deviated cases, and 88% of straight noses. The most common technique for scroll reconstruction was overlapping repair (88.3%). As expected, both alar rim and alar crease asymmetries were very frequent in the deviated nose group, 89.4% and 75% respectively. Alar rim and alar crease asymmetries were frequent enough in the straight nose group to deserve special attention, 14.2% and 10.4% respectively. CONCLUSIONS With careful attention to anatomic details of the scroll area, nasal tip refinements can be performed with predictable safety and accuracy. Our approach is a graduated, reproducible, and individualized way of scroll area management that aims to create the ideal cartilage configuration while preventing unintended component alterations. LEVEL OF EVIDENCE: 4

Intramuscular myxoma (IM) is a benign, soft tissue neoplasm of mesenchymal origin. We report our experience with this tumour. This clinical study comprised 11 cases of IM that were operated on between March 2008 and June 2016. Tumour location and size, results of pre-operative radiological studies, preop-erative biopsies, pathology examinations, applied surgical method and post-operative complications were reported for all patients. In total, nine patients with 11 IMs with a mean age of 60.0 years were assessed. Mean follow-up was 39.2 months. Tumours were located in the right thigh (5 patients, 7 IM), left gluteal area (2 patients, 2 IM), right gluteal area (1 IM) and left thigh (1 IM) ranging from 2 × 1 cm to 10 × 17 cm Pre-operative radiological diagnoses were cystic lesion, abscess, bursitis, fibrosarcoma, fibroma, lipoma, malign mesenchymal tumour and IM. Pre-operative biopsy was performed for five cases. All tumours were removed via simple excision and were pathologically consistent with IM. No complication or recurrence was observed during the follow-up period. IM is a relatively rare benign tumour, the pre-operative diagnosis of which using radiological and clinical methods is quite difficult, creating pre-operative diagnostic confusion. It is generally diagnosed by microscopic examination. Simple excision with a small margin of surrounding tissue is considered to be sufficient for its treatment.

Platelet-rich plasma therapy has the potential to promote peripheral nerve regeneration through the autologous supply of growth factors. Therefore, this study aimed to compare the effects of platelet-rich plasma injections with the effects of corticosteroid injections in the treatment of carpal tunnel syndrome.In total, 40 patients with mild carpal tunnel syndrome were equally divided into two groups. Nerve conduction studies were carried out, and the Boston Carpal Tunnel Questionnaire was administered to both groups before treatment. One group of patients received platelet-rich plasma injections, and the patients in the other group received corticosteroid injections into the carpal tunnel. The patients were followed for 6 months. After 3 and 6 months, the nerve conduction studies and the Boston Carpal Tunnel Questionnaire were repeated.Although distal motor latencies did not change in either of the groups during the follow-up period, improvements in sensory nerve conduction were recorded after 3 months in both groups. However, there was no significant difference between the groups in the nerve conduction studies. In the Boston Carpal Tunnel Questionnaire, both the symptom severity score and the functional capacity score of the platelet-rich plasma group were significantly better than those of the corticosteroid group after 3 months, although there were no significant differences after 6 months.Platelet-rich plasma injections may be considered for the temporary symptomatic relief of mild carpal tunnel syndrome.

Summary Introduction Non-melanoma skin cancer is the most common type of skin cancer of the nasal dorsum and the medial canthal region, which is caused by chronic sun exposure. Limited adjacent tissue and the need for aesthetically pleasing result make the reconstruction of these regions very challenging. To overcome this challenge, we designed a perforator propeller flap based on the central artery. Methods Between January 2014 and November 2015, we covered the nasal or medial canthal defects of 22 patients with central artery perforator propeller flaps. Results The mean age of the patients was 60.4 years (range: 47–81 years). The median follow-up period was 7.5 months (range: 2–23 months). The pathological diagnoses were basal cell carcinoma for 14 patients and squamous cell carcinoma for the remaining eight patients. The size of the defects ranged from 2 × 2 to 3.5 × 4 cm, and that of the flaps ranged from 2 × 3.5 to 3.2 × 6 cm. We did not observe any major complications requiring surgery, such as total flap loss, hematoma, or dog-ear deformity. However, venous congestion was seen in five patients and partial flap necrosis (that healed without intervention) in two patients. Conclusion The central artery perforator propeller flap is a reliable and versatile flap for the reconstruction of the nasal dorsum and medial canthal region. Reconstruction with this flap is a single-stage procedure that can cover large defects without causing dog-ear deformity or eyebrow asymmetry compared with other local flap options.

Background The repair of retracted flexor tendons is a challenging problem for hand surgeons. The tendon stump should be handled in an atraumatic manner because any microtrauma to the sheath and tendon can lead to poor functional outcomes. Methods Twenty-three patients with flexor zone 2 injuries and intraoperative finding of retracted tendons were randomly divided into two groups: endoscopic retrieval group and proximal incision group. A flexible endoscope and a flexible grasping forceps were used for endoscopic retrieval of the retracted flexor tendons. The groups were compared in terms of infection rate, neurovascular complications, regional pain, total range of active motion (TAM) and functional outcomes. Results Age, gender, average preoperative pain and general pain perception scores were similar between the two groups. We found a significantly shorter duration of operation and better pain scores at 1–2 weeks in the endoscopic group than in the other group (p = 0.002 and p = 0.020, respectively). A significant difference in TAM was demonstrated between the groups at 3 to 5 weeks (p = 0.003). Conclusion The surgical procedure presented here has the advantages of direct visibility of the proximal tendon end and retrieval in an atraumatic manner, with better results and decreased morbidity. It is a promising approach and can be used as a routine procedure in retracted tendon cases.

Background The effect of a spreader flap on the keystone area and the upper bony vault depends on the structural strength and cephalic extent of upper lateral cartilages, both of which can be significantly variable among individuals. Objectives The authors present a novel cephalically extended osseocartilaginous composite spreader flap technique that was designed to overcome the limitations of a conventional spreader flap on the keystone area upper bony vault, in patients with cephalically short and structurally weak upper lateral cartilages and thin nasal bones. Methods This study was a retrospective review of the recorded perioperative information to investigate the frequency of the use of the composite spreader flap technique and perioperative parameters that relate to postoperative dorsal deformities. One-hundred-seventy-six consecutive primary open approach rhinoplasty cases performed by the first author (O.B.) between November 2015 and February 2017 were included in the study. Patient data were obtained from rhinoplasty data sheets, standardized photographs, and postoperative physical examinations. Results Of the 176 cases who underwent primary open approach rhinoplasty whose data were reviewed for the purpose of this study, 38 (32 females, 6 males) had dorsal reconstruction with the use of a composite spreader flap. Seventeen patients had a deviated nose with an asymmetric bony pyramid. In 8 patients, the composite spreader flap was used unilaterally. No patients in the composite spreader flap group had a postoperative dorsal deformity or required surgical revision. Conclusions Composite flap preparation extends the reliability and the reach of the spreader flap technique beyond its previous borders. Level of Evidence: 4

Unlike Hymenolepis nana that transmits directly from person to person, the transmission of Hymenolepis diminuta to human is via accidentally ingesting of arthropods carrying cysticercoid larvae as intermediate host. In places with poor hygienic conditions, this cestod may cause seldom infections especially in children. Studies carried out on various populations have reported the prevalence rate of H.diminuta between 0.001% and 5.5%. Although the reported cases are mostly children, the disease can be seen in every age group. In this report, a pediatric case of H.diminuta infection is presented. A twenty one-month-old male patient with the symptoms of vomiting 3-4 times a day along with mud-like diarrhea continuing for a week was admitted to the pediatric outpatient clinic. According to the history, it was learned that the house where he lived was above a barn and there was a history of insect swallowing. Laboratory findings revealed iron-deficiency anemia. The macroscopic appearance of the stool was in a pale clay-like form, and by direct microscopic examination with lugol solution, 70-75 μm in diameter, thick-shelled and six central hookleted eggs that are characteristic for H.diminuta were identified. A six-day course of oral niclosamide was administered to the patient beginning with 500 mg on the first day and 250 mg on the following five days, together with the treatment for the iron deficiency anemia. After fifteen days, the oral niclosamide treatment was repeated. No H.diminuta eggs were detected in the parasitological examination performed one month after completion of the second round of treatment. This case has been presented to call attention to the importance of patient anamnesis and microscopic examination in the diagnosis of H.diminuta infection which is a rarely seen parasitosis.

Anterior septal height is an important determinant of nasal tip projection. Accordingly, the anterior septal extension technique has proven itself to be a powerful tool for achieving long-lasting nasal tip projection in rhinoplasty. However, anterior septal extension does not protect against postoperative loss of nasal tip rotation unless an additional suspension strategy is used. A tip-suspending transfixion suture is the authors’ strategy for supporting nasal tip rotation whenever an anterior septal extension technique is performed. Of 156 rhinoplasties performed by the authors between 2010 and 2012, a cohort of 22 droopy-tip rhinoplasties was extracted in which the described technique was used. The patients in this cohort were included in a retrospective nasal tip projection and rotation analysis. The nasolabial angle (NLA) and Goode ratio measurements were compared between preoperative, 3-week postoperative, and 1-year postoperative profile-view photographs. The NLA and the Goode ratio measurements were significantly higher in the 3-week postoperative group than in the preoperative group, indicating an effective gain in both tip projection and rotation. The NLA and the Goode ratio measurements did not differ statistically between the postoperative 3-week and postoperative 1-year groups, indicating long-term maintenance of nasal tip position. A tip-suspending transfixion suture is an easy method for securing nasal tip rotation when used in conjunction with an anterior septal extension. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

WOS: 000340684700009 PubMed: 24519672 The objective of the current study was to determine the prevalence and the degree of iodine deficiency after mandatory salt iodization in Yigilca's school-aged children. A total of 806 school children aged 6-19 years were evaluated. The prevalence of goiter in children aged 6-12 and 13-19 years was 20.3 and 23.8%, respectively. The prevalence of hypothyroidism in children aged 6-12 and 13-19 years was 10.4 and 18.9%, respectively. The median serum free tetraiodothyronine (fT4) levels in children aged 6-12 and 13-19-years were 1.16 ng/dL and 0.91 ng/dL, respectively. The median urinary iodine concentration levels in children aged 6-12 and 13-19 years were 83 mu g/l and 78 mu g/l, respectively. The frequency of autoimmune thyroid disease was 2.1% in Yigilca's SAC. Goiter and iodine deficiency problems remain in rural areas of the West Black Sea Region of Turkey.

Background: The pigment density and texture of breast skin are not uniform. Especially in patients with massive breasts, lower pole skin can be significantly darker and coarser than the upper pole skin. Nipple areola reconstructing (NAR) reduction mammaplasty is a technical modification of the “free nipple” procedure in which the original nipple areola complex (NAC) is discarded and the new NAC is reconstructed from coarse pigmented lower pole skin using a modified skate flap purse-string technique. Objectives: The authors review their initial clinical experience with NAR reduction mammaplasty. Methods: Between 2010 and 2012, 16 patients (31 breasts) underwent the NAR procedure, and these cases were retrospectively reviewed for patient demographics, preoperative topographic breast measurements, amount of reduction per breast, and complications. The operative goal was to obtain the smallest breast size that can be achieved with tension-free wound closure. Patient satisfaction was also assessed. Results: Breast reductions varied from 1150 to 2850 g/breast (average, 1590 g/breast), and patients were followed up for a minimum of 1 year (average, 15.9 months). No major local or systemic complications were encountered. Two patients required touch-ups for the correction of minor periareolar irregularities resulting mainly from the inversion of wound closure. At 1 year, average score for general satisfaction was 4.6, and the average score for NAC satisfaction was 3.9, on a scale from 1 (not satisfied) to 5 (extremely satisfied). Conclusions: NAR reduction mammaplasty enables the surgeon to perform massive reductions, design different non–NAC-bearing glandular pedicles for breast shaping, and obtain tension-free closure without the fear of ischemic complications. Level of Evidence: 4 ![Graphic][1] [1]: /embed/inline-graphic-1.gif

Prolonged mean life expectancy gives rise to a more populated and older patient group. With increasing number of cases during the past decades, older patients are regarded as candidates for microsurgical interventions. Whether advanced patient age is an independent risk factor for microsurgical reconstruction is still an ongoing matter of debate.The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, CINAHL and EMBASE databases were screened for combination of the key words "elderly", "geriatric", "advanced age", "free flap", "microsurgery", free tissue transfer" by using time limits between 1989 and 2015.According to results of the meta-analysis, there was no significant difference in the flap success rates(P =.39, CI = 0.848 to 2.329) and surgical complication rates (P = .83, CI = 0.792 to 1.163) between the young and elderly patient groups. However, the systemic complication rates(P = .02, CI = 1.468 to 3.572), preoperative ASA scores(P .0001, CI = 0.342 to 1.078), and mortality rates (P = .03, CI = 2.636 to 9.055) were found to be significantly higher in the elderly patients.Although an increased rate of systemic complications and mortality has been associated with advanced age, our study results showed no significant difference between the flap success rates and surgical complications. A successful reduction in systemic complications would bring the risk level of reconstructive microsurgical interventions of the elderly patient group to the level of the young patient group. © 2017 Wiley Periodicals, Inc. Microsurgery 37:442-450, 2017.

Background Craniofacial structures have an intimate relationship with the central nervous system in the embryologic development period and the developmental abnormalities of the face and skull that are frequently associated with malformations of the central nervous system. Additional intracranial and extracranial malformations in a patient with craniofacial deformity may negatively affect the outcome of the surgery and the quality of life. Patients and methods A retrospective analysis of a total of 123 patients with craniofacial anomalies was performed. Physical examination notes, ophthalmologic findings, computed tomography, and magnetic resonance imaging reports were retrospectively analyzed, and intracranial and extracranial malformations and ophthalmologic problems in each group were categorized. Results Of the patients with nonsyndromic craniosynostosis, 29% had intracranial and extracranial malformations. Of them, 17% had ophthalmologic problems. Of the patients with syndromic craniosynostosis, 34% had intracranial and 31% had extracranial malformations. In the patients with craniofacial cleft, 60% had intracranial and 30% had extracranial malformations. The most common intracranial malformations are hydrocephaly, Chiari type 1 malformation, and corpus callosum disorders. Conclusions A multidisciplinary approach is essential in the evaluation and follow-up of individuals with craniofacial abnormalities. Conventional radiography and three-dimensional computed tomography of the bony skeleton and axial scanning of the soft tissues is our first-step routine. Brain magnetic resonance imaging should be performed in patients with multiple-suture synostosis, syndromic synostosis, and craniofacial clefts to rule out central nervous system and soft tissue malformations. During the postoperative first year, conventional x-rays are sufficient to evaluate the craniofacial area. Central nervous system disorders may cause major headaches, muscle weakness, hearing problems, extreme fatigue, poor motor coordination, and cognitive and social disabilities even when their intelligence quotient is normal. Therefore, every effort should be performed to search and treat additional malformations. Prevention of additional morbidities improves surgical and social outcomes.

Postoperative changes following superior pedicle breast reduction are closely related to the pattern of skin resection. We have observed that the superior pedicle, short horizontal scar breast reduction technique provides a stable breast shape in the long term. We test the validity of our clinical observations through objective analysis of postoperative dimensional changes following superior pedicle, short horizontal scar breast reduction. Of 42 patients who underwent superior pedicle, short horizontal scar breast reductions between January 2011 and June 2012, 38 (75 breasts) were available for long-term follow-up. The midclavicular point-to-superior areolar border distance (A), the inferior areolar border-to-inframammary fold (IMF) distance (B), and the areolar diameter (C) were measured and recorded at the time of (1) preoperative markings, (2) first postoperative visit, and (3) 2-year postoperative follow-up visit. The specifications of the preoperative markings were recorded to analyze their correlation with actual breast dimensions. The superior border of the nipple–areola complex (NAC) was located, on average, 1.2 cm higher at the first postoperative visit when compared with the markings (P

Basal and squamous cell carcinomas are the most common malignant cutaneous lesions affecting the nose. With the rising incidence of skin cancers, plastic surgeons increasingly face nasal reconstruction challenges. Although multiple options exist, optimal results are obtained when "like is used to repair like". We aimed to introduce a simple algorithm for the reconstruction of nasal defects with local flaps, realizing that there is always more than one option for reconstruction.We retrospectively reviewed 163 patients who underwent nasal reconstruction after excision of non-melanoma skin cancer between March 2011 and April 2014. We analyzed the location of the defects and correlated them with the techniques used to reconstruct them.There were 66 males and 97 females (age, 21-98 years). Basal cell carcinoma was diagnosed in 121 patients and squamous cell carcinoma in 42. After tumor excision, all the defects were immediately closed by either primary closure or local flap options such as Limberg, Miter, glabellar, bilobed, nasolabial, V-Y advancement, and forehead flaps.Obtaining tumor-free borders and a pleasing aesthetic result are major concerns in nasal reconstruction. Defect reconstruction and cosmesis are as important as rapid recovery and quick return to normal daily activities, and these should be considered before performing any procedure, particularly in elderly patients.

Age-related changes in proliferative activity in human gingival epithelium are uncertain. Proliferating cell nuclear antigen (PCNA) is a nuclear protein associated with the cell cycle. Nuclear PCNA immunoreactivity is found in the proliferative compartment of normal tissues. The aims of this study were to investigate the localization of PCNA expression in oral gingival epithelium (OGE) and to define the age-related changes as to PCNA-proliferative index (PI) in inflamed as well as healthy gingiva. Mitotic index (MI) was also used as a conventional marker of cell proliferation. Additionally, the effect of aging upon the maximum epithelial thickness (MET) was determined.Twenty older (65 to 85 years) (study) and 20 middle-aged (35 to 45 years) (controls) subjects were included in the study. Biopsies were obtained both from healthy and inflamed gingiva. The expression of PCNA was evaluated in formalin-fixed, paraffin-embedded gingival samples using an immunoperoxidase technique and PC 10 monoclonal antibody to PCNA. Hematoxylin and eosin stained sections were used for the quantitative measurement of MI and MET.All the tissue sections contained positive staining cells for PCNA in the gingival epithelium. Although PCNA expression was observed both in the basal and suprabasal layers, it was more prominent in the suprabasal layers. PI in inflamed gingiva was significantly higher in the older group. However, no significant difference was observed between the study and control groups with respect to PI in healthy gingiva. When all the subjects taken into the study were analyzed as a single group, PI in the inflamed gingival samples were found to be increased with aging. Nevertheless, no age-related change was noted in MI and MET. In both the study and the control groups, PI, MI, and MET were found to be increased due to inflammation.Our data indicate that PCNA expression in inflamed gingiva is higher in older subjects. Furthermore, a significant correlation was noted between aging and PCNA expression in inflamed gingiva. As there is no increase in mucosal epithelial thickness despite increased proliferation, we speculate that the duration of the PCNA+ phase in cell cycle may be longer in older subjects. This study also implies that PCNA immunolocalization can be used as an index of the state of cell proliferation in both biological and pathological events of the gingiva and/or other mucosal tissues.

WOS: 000320857300004, PubMed ID: 23637041, Streptococcus pneumoniae is the most common etiological cause of complicated pneumonia, including empyema. In this study, we investigated the serotypes of S. pneumoniae that cause empyema in children. One hundred fifty-six children who were diagnosed with pneumonia complicated with empyema in 13 hospitals in seven geographic regions of Turkey between 2010 and 2012 were included in this study. Pleural fluid samples were collected by thoracentesis and tested for 14 serotypes/serogroups using a Bio-Plex multiplex antigen detection assay. The serotypes of S. pneumoniae were specified in 33 of 156 samples. The mean age +/- the standard deviation of the 33 patients was 6.17 +/- 3.54 years (range, 0.6 to 15 years). All of the children were unvaccinated according to the vaccination reports. Eighteen of the children were male, and 15 were female. The serotypes of the non-7-valent pneumococcal conjugated vaccine (non-PCV-7), serotype 1, serotype 5, and serotype 3, were detected in eight (14.5%), seven (12.7%), and five (9.1%) of the samples, respectively. Serotypes 1 and 5 were codetected in two samples. The remaining non-PCV- 7 serotypes were 8 (n = 3), 18 (n = 1), 19A (n = 1), and 7F/A (n = 1). PCV-7 serotypes 6B, 9V, 14, 19F, and 23F were detected in nine (16.3%) of the samples. The potential serotype coverages of PCV-7, PCV-10, and PCV-13 were 16.3%, 45.4%, and 60%, respectively. Pediatric parapneumonic empyema continues to be an important health problem despite the introduction of conjugated pneumococcal vaccines. Active surveillance studies are needed to monitor the change in S. pneumoniae serotypes that cause empyema in order to have a better selection of pneumococcal vaccines., GlaxoSmithKlineGlaxoSmithKline, The study was supported by GlaxoSmithKline.

There are several different causes of the deformities of the external auditory canal requiring reconstruction such as tumors, burns, trauma, and malformations. Many surgical approaches with varying success for the reconstruction of the external auditory canal (EAC) have been favored, including secondary healing, skin grafting, and a variety of local skin flaps. Unfortunately, the major drawback of the previously defined techniques is the resulting stenosis of the EAC. A 73-year-old white man was admitted to our clinic because of an unhealing ulcerated lesion at the superior and posterior one third of the left external auditory canal, involving the most internal part of the concha. Preserving the superior one third of the helix, left auricle and the EAC was surgically removed en bloc. To reconstruct the surgical defect, a snail flap was designed on the ipsilateral cervical region and based posteriorly on the left mastoid region. Twisting the flap on its main axis, as mentioned, created a final shape resembling a snail and a tube with epithelium-lined canal inside. At the postoperative first-year visit, the patient's endoscopic examination showed no sign of recurrence, tympanoplasty graft was intact, and the EAC was patent without signs of stenosis. Our experience with the laterocervical flap supports the fact that this flap does not cause stenosis, hearing loss, and therefore should be concerned as one of the first choices of treatment for the reconstruction of EAC.

WOS: 000307687000003 PubMed: 22976603 Purpose: This study was aimed to determine the effect of maximum voided volume (MVV) on the efficacy of desmopressin. which is commonly used to treat primary monosymptomatic nocturnal enuresis (PMNE) in children and adolescents. Materials and Methods: Bladder capacity was measured with different methods in 52 patients with PMNE, and the effect of bladder capacity on desmopressin therapy was investigated. Results: Patients with PMNE in whom MVV was 70% or less of estimated bladder capacity were found to be unresponsive to desmopressin therapy. Conclusion: The MVV can be measured before desmopressin therapy in patients with PMNE as a marker to predict treatment success. Our results suggest that desmopressin should not be used in patients with low MVV. (J Nippon Med Sch 2012; 79: 255-258)

Acute brucellosis is a zoonotic disease seen in childhood, with non-specific complaints and clinical findings that can affect the locomotor, gastrointestinal, genitourinary, hematologic, cardiovascular, respiratory, and central nervous systems. Particularly in endemic regions, it occurs as a result of consumption of unpasteurized milk and dairy products. In this study, clinical and laboratory findings of children with acute brucellosis are presented.Data for 147 patients, aged 2-16 years, were evaluated retrospectively.The most frequent complaints and clinical findings were abdominal pain and fever. Other complaints and clinical findings included arthralgia, myalgia, loss of appetite, weakness, sweating, fatigue, headache, arthritis, hepatomegaly, and splenomegaly. Anemia was the most frequent hematological abnormality detected; other abnormalities included leukopenia, thrombocytopenia, and pancytopenia.Childhood brucellosis can cause non-specific complaints and particularly anemia and leukopenia as hematological abnormalities. It is easily treated, however, with appropriate antibiotics.

Background Gastroesophageal reflux (GER) is a disorder that is common by seen in childhood and may lead to severe complications. In this study, we ascertained the incidence of GER among the children who had typical and atypical complaints of GER and whether there was a difference between two groups comparing the findings of 24-hour pH-meter. Methods 39 out of 70 patients with typical and atypical GER symptoms were diagnosed as GER by 24-hour pH-meter monitoring. The patients were divided into three groups, those having gastrointestinal complaints, those having respiratory complaints and those having both gastrointestinal and respiratory symptoms. Results Evaluated the GER prevalence in these groups, it was found to be 60% in the gastrointestinal group, 48.6% in the respiratory group and 75% in the mixed group. When pH-meter measurements of GER positive patients were compared within the clinical groups, the fraction of time that pH was lower than 4 was found to be significantly higher in the mixed group (p = 0.004). Conclusions The coexistence of gastrointestinal and respiratory symptoms in the patients with GER may be related to the severe reflux.

WOS: 000270644400025 PubMed: 18824318 Objective: The aim of this study was to investigate the effect of fatty infiltration of the liver (FIL) on the Doppler waveform pattern in the hepatic veins of obese children. Methods: In this prospective study, 59 patients with diffuse FIL and 45 normal healthy children who served as control group underwent hepatic vein B-mod and duplex Doppler sonography. The Doppler sonography spectrum of the right hepatic vein was classified into three groups: triphasic waveform, biphasic waveform, and monophasic or flat waveform. Results: There was a statistically significant difference in the phasicity of hepatic venous flow between patients and control subjects (p < 0,001). The Doppler flow pattern in the right hepatic vein was triphasic in 28 (47.5%), biphasic in 28 (47.5%), and monophasic in 3 (5%) children with fatty liver, while it was triphasic in 43 (95.6%) and biphasic in 2 (4.4%) control subjects. There was an inverse correlation between the sonographic grade of fatty infiltration of the liver and the phasicity of hepatic venous flow (r = -0.479, p < 0.001). Conclusions: Abnormal right hepatic vein Doppler waveform, biphasic as well as monophasic, can be seen in healthy obese children with diffuse FIL. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

Background Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir. Methods The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed. Results A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate. Conclusion Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination.

dikici, bunyamin/0000-0001-7572-6525 WOS: 000207602800035 PubMed: 18614441 Gianotti-Crosti syndrome (papular acrodermatitis of childhood), which was first described in 1955, is a nonspecific rash that usually consists of the abrupt onset of pink flesh coloring, smooth or lichenoid, flat-topped papules. It was first related to hepatitis B virus (HBV) infection; however, cases not associated with HBV infection were reported as well. Although a type of delayed hypersensitivity reaction is speculated as a cause, exact pathogenesis still remains unclear. The prognosis is favorable and successful management relies upon general supportive and symptomatic care. We report a seven-year-old boy diagnosed with Gianotti-Crosti syndrome with monomorphous papules on his cheeks, buttocks and extremities associated with hepatitis B virus infection.

WOS: 000249541400016 PubMed: 17374471 Objective: To determine the relationship between thyroid blood flow and anthropometric measurements, pubertal stage, and thyroid and gonadotropic hormones. Materials and methods: We examined 123 healthy school-aged children prospectively (69 boys (56.1%) and 54 girls (43.9%), 7-17 years old). Their sex, age, body weight, height, body mass index (BMI), and pubertal stage were determined. Serum thyrotropin, free thyroxine, luteinizing hormone, and follicle stimulating hormone were measured in both genders, along with testosterone in boys and estradiol in girls. The peak systolic velocity (PSV), resistance index (RI), and pulsatility index (PI) of the superior thyroid artery were determined. The correlations between the Doppler parameters and these factors were investigated. Results: There were no differences in age, weight, height, BMI, thyroid volume, PSV, RI, or PI between boys and girls (P>0.05). The PSV and PI showed strong correlations with age, height, weight, puberty stage, thyroid volume, and BMI. The RI showed a strong inverse correlation with age, height, weight, puberty stage, and thyroid volume and a weak inverse correlation with the BMI. Conclusion: Determination of the thyroid arterial flow in normal healthy children is important during a Doppler ultrasound (US) examination. Doppler US parameters and their percentiles should be described in healthy children from different age groups, and these percentiles will aid in interpreting Doppler US in children. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

Defects in the central upper lip are difficult to close because of the unique anatomy and limited reconstructive options. Therefore, for every individual patient, reconstructive goals must be prioritized. Reconstructive priorities for an old patient with a large full-thickness oncologic defect are clearly different than those of a teenager with a residual deficiency after cleft repair. Authors aim to share their experience of 2 cases in which large central upper lip oncologic defects have been reconstructed in a single stage using subcutaneous pedicled nasolabial island flap, which provides a single-stage reconstruction by recruiting tissue from the cheek. It obsoletes the need for a lip adhesion. Lip adhesion-related feeding problems are eliminated, oral aperture circumference is maintained, and oral function is preserved. For the elderly male, a full beard is an advantage because it hides both the cheek and the lip scars.

Amitraz is an insecticide/acaricide of formamidine pesticides used worldwide to control ectoparasites in animals. Amitraz poisoning is a rare disorder characterized by central nervous system (CNS) and respiratory depression, bradycardia, hypotension, hypothermia, hyperglycemia,nausea and vomiting. Poisoning may occur either by oral inhalation and dermal route. In this study, we present seven pediatric patients with amitraz poisoning. The initial symptoms were unconsciousness, dizziness and vomiting; and emerged within 30-150 minutes. The length of stay in the intensive care unit (ICU) was between 18-62 hours.