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Purpose: Returning to work requires a certain period of time for patients who have suffered a hand injury as a result of a work accident. Evaluating the factors influencing the time to return to work (time off work) is aimed. Methods: A total of 111 patients were involved in the study. Data collected from medical records and phone reviews. Independent variables such as age, gender, Hand Injury Severity Scale (HISS) score, fracture on plain radiography, treatment method (surgical/conservative), physical demand of the occupation, mechanism of injury, and physiotherapy were reviewed. Afterwards, the relationship between these variables and time to return to work has been evaluated. Results: In 111 subjects, 107 were able to resume their previous jobs after the injury. Average time to return to work was 58.6 days among patients who were able to return to work. It took more time for patients to return to work which were considered heavy/very heavy. Patients with fractures, higher HISS scores, who were treated surgically and undergone physiotherapy returned to work later. The effect of age, gender and mechanism of injury was statistically insignificant. Conclusion: HISS score and fracture on radiography can be used to predict time off work following surgery. If the necessary counseling is given to the patients with these conditions, it will be easier to plan the return of the patients to their lives.

Capsular contracture is the most common complication following breast augmentation. Recently, prophylaxis studies aiming to inhibit the release of profibrotic substances to prevent capsular contracture have gained in importance. This study investigated the effects of cromolyn sodium, montelukast, and zafirlukast on capsular contracture in a rat model.Thirty female Wistar albino rats were randomly divided into five groups: control, sham, cromolyn sodium, montelukast, and zafirlukast. Intraperitoneal injections were administered daily to the sham (1 ml per day), cromolyn sodium (10 mg/kg per day), montelukast (10 mg/kg per day), and zafirlukast (1.25 mg/kg per day) groups 1 month before surgery. Miniature breast implants were then placed on the backs of the rats in each group. Injections were continued for the next 3 months. The rats were subsequently killed, and the capsules were harvested and assessed histopathologically. The histopathologic outcomes were acute inflammation status, inflammation severity, synovial metaplasia, foreign body reaction, mast cell count, and capsular thickness.The cromolyn sodium, montelukast, and zafirlukast groups had less acute inflammation and lower mean inflammation severity scores, foreign body reaction occurrence, mast cell counts, and capsular thickness than the control and sham groups ( p0.05). These parameters were better in the cromolyn sodium group than in the montelukast and zafirlukast groups ( p0.05).Cromolyn sodium appears to inhibit capsular contracture more efficiently than montelukast and zafirlukast. This report may be a pioneer study for the prophylactic use of cromolyn sodium in capsular contracture.The prophylactic administration of cromolyn sodium appears to reduce capsular contracture more efficiently than that of montelukast and zafirlukast. This report might constitute a pioneer study for the prophylactic use of cromolyn sodium in capsular contracture.

Son yıllarda sıkça tartışılan küreselleşme olgusu sadece devletleri değil aynı zamanda tüm vatandaşları da etkilemektedir. Değişen bu koşullarda kamu hizmeti üreticileri, halkı artık hizmet talep eden değil hizmet götürülmesi gereken bir grup olarak görmeye başlamak zorunda kalmışlardır. Bu kapsamda hizmet götürme sürecinde günümüzde büyük ölçüde bilgi teknolojilerinden ve elektronik hizmetlerden yararlanılmaya başlanılmıştır. Ülke çapında e-devlet, yerel yönetimler için e-belediyecilik olarak adlandırılan bu süreç, kamunun sunduğu tüm hizmetlerin vatandaşlara farklı yollarla ulaştırılmasında ve yeni hizmetlerin geliştirilmesinde ön plana çıkmaktadır. Yerel yönetimlerin dünya çapında kazandığı önemden etkilenen Türkiye’de belediyecilik yeni düzenlemeler ile kayda değer bir gelişme göstermiştir. Merkezin hantallığından kurtulmak için devredilen hizmetlerle belediyeler daha çok yetki ve bu yetkiye paralel görev sahibi olmuşlardır. Böylece belediyeler hizmet talep eden vatandaşların bu isteklerini karşılamak için ister istemez hizmet iletim mekanizmalarını geliştirmek ve çeşitlendirmek zorunda kalmışlardır. Bu süreci 2019 yılı sonunda ortaya çıkan ve dünyaya hızla yayılan Covid-19 pandemisi de geri dönülmez bir şekilde hızlandırmıştır. İşte bu amaçla kamu sektöründe e-devlet veya e-belediyecilik uygulamaları hızla önem kazanmış ve yaygınlaşmıştır. Söz konusu bu kapsamda makalenin amacı, Ankara Su ve Kanalizasyon İdaresi (ASKİ)’nin kullandığı ve proje kapsamında çalışmalar yürüttüğü faaliyet örnekleri ile su ve kanalizasyon idarelerinin yararlandığı veya yararlanabileceği elektronik belediyecilik uygulamaları hakkında bilgiler vermek ve genel bir değerlendirme yaparak önerilerde bulunmak olarak belirlenmiştir. ASKİ’nin sunduğu e-belediyecilik uygulamaları incelendiğinde vatandaşa daha hızlı, kaliteli ve güvenli hizmet sunumunda büyük ilerleme sağlandığı ancak hizmetlerin bir nebze dağınık olduğu sonucuna ulaşılmıştır.

It is clinically vital to determine the best technique to reconstruct thumb defects with satisfactory esthetic and functional outcomes. We aimed to quantitatively present the safety, versatility, limitations, advantages, and functional results of the first dorsal metacarpal artery flap (FDMAF) and evaluate its outcomes in thumb defect reconstruction by comparing it with the other current surgical options.A total of 21 patients underwent thumb defect reconstruction. They were evaluated with the following parameters: Etiology, age, timing of reconstruction, flap vitality, Semmes-Weinstein monofilament (SWM) test, static two-point discrimination (2PD) test, pain, cortical reorientation, cold intolerance questionnaire, and Michigan hand outcomes questionnaire. Their functional outcomes were evaluated by comparing their scores with the other current surgical options published in the literature.The mean follow-up period was 22.3 months. The mean pain score of the flap was 0.4±0.6 and no patient had pain in the donor area (range, 0-10). The sensory outcome was 'good' (8.6 mm) based on the static 2PD test. The mean SWM test score was 4.02 g. Patient satisfaction was 4.6 according to the Michigan hand outcomes questionnaire (range, 0-5). The cold intolerance questionnaire scores showed that the patients had mild cold intolerance (mean, 10.5; range 0-100). Complete cortical reorientation was seen in 81% of the patients.Restoration of the innervation of thumb defects is possible with the FDMAF with high satisfaction rates based on our results. The absence of the microsurgical vessel or nerve repair facilitates the surgery, shortens its duration, and reduces morbidity, reserving the microsurgical options for more complicated cases. Therefore, it can be concluded that the FDMAF is an effective flap with great modifications for complicated thumb defects but surgeons should consider their clinical outcomes and prolonged surgery when choosing which technique to be used.

Bu araştırmanın amacı yeni nesil matematik sorularına ilişkin ortaokul matematik öğretmenlerinin yaklaşımlarının incelenmesidir. Bu amaç doğrultusunda araştırmacı ve bir alan uzmanı tarafından altı adet açık uçlu sorunun yer aldığı veri toplama aracı uzman görüşü alınarak oluşturulmuştur. Araştırmanın katılımcı grubunu 2019-2020 eğitim öğretim yılında Gaziantep il merkezi, ilçeleri ve köylerinde MEB’e bağlı ortaokullarda görev yapan 208 ortaokul matematik öğretmeni oluşturmaktadır. Katılımcılar kolay erişilebilirlik ve gönüllük esasına dayalı olarak belirlenmiştir. Veri toplama aracı zümre whatsapp gruplarına Google form aracılığıyla gönderilerek katılımcıların veri toplama aracını cevaplamaları istenmiştir. Araştırma nitel betimsel olarak desenlenmiştir. Araştırmadan elde edilen veriler içerik analizine tabi tutularak kod ve kategoriler oluşturulmuştur. Araştırma sonucunda öğretmenlerin bir kısmının soruların dış görünüşüne odaklanarak bu soruları yapısal / şekilsel olarak ele aldıkları tespit edilmiştir. Öğretmenlerin diğer kısmının ise ağırlıklı olarak bu soruları; beceri temelli olan ve kavramsal ve işlemsel öğrenmeyi sağlayan sorular olarak kavramsallaştırdıkları görülmüştür. Bununla beraber katılımcıların bir kısmı bu soruların uzunluğuna dikkat çekerek bu soruların aşırı zor olduğuna vurgu yapmıştır. Diğer taraftan yeni nesil matematik sorularının öğrencilerin becerilerini geliştirdiği ve öğrencilere becerileri kazandırdığı ağırlıklı olarak vurgulanmıştır.

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.

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 and >75% 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 or

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

Heterozygous inactivating mutations in the glucokinase gene cause the mildest form of maturity-onset diabetes of the adolescents. However, homozygous or compound heterozygous mutations in the glucokinase gene are a rare cause of permanent neonatal diabetes mellitus. Herein, we present the case of a male child with permanent neonatal diabetes mellitus whose mutational analysis revealed a novel homozygous deletion mutation in the glucokinase gene. The male proband of Turkish ancestry from consanguineous parents was born at 37 weeks gestation with a birth weight of 1870 g (

Our aim was to create a new rodent hind limb lymphedema model lacking the fibrosis effect induced by radiotherapy and subjected to the inhibition of lymphangiogenesis via sirolimus (rapamycin) to maintain a chronic lymphedema model and investigate its reliability for human treatment modalities.Forty-two Sprague-Dawley rats were randomly assigned to 7 groups: (1) surgery control, (2) vehicle-surgery control, (3) vehicle control, (4) rapamycin control, (5) surgery with 1 mg/kg per day rapamycin, (6) surgery with 1.5 mg/kg per day rapamycin, and (7) surgery with 2 mg/kg per day rapamycin. All surgeries were performed on the right hind limbs, with the left hind limbs also considered as a control. The drug and its solvent were administered daily into the relevant groups intraperiteonally. The presence of lymphedema was investigated by weekly limb circumference measurements, microcomputed tomography, fluorescence lymphography using indocyanine green dye, and microscopic evaluation at the end of the sixth week to determine any histological changes in the hind limbs.In group 1, lymphedema was observed for 2 weeks (P = 0.032), whereas in groups 5, 6, and 7, lymphedema lasted for 3 weeks (P0.05.) Fluorescence using indocyanine green revealed that the edema was totally resolved after 6 weeks of surgery by a well-developed superficial lymphatic organization instead of the normal distinct vessel structure. Histologically, groups 1, 5, 5, and 7 demonstrated a significant increase in both the number of macrophages (P0.001) and newly formed lymphatic vessels in the right side surgically treated hind limb (P0.05).Despite the extreme surgical destruction and lymphangiogenesis inhibition in the rat model, the sustained lymphedema did not last3 weeks. Because of the rapid neolymphangiogenesis in murines and a different wound healing mechanism, they should not be considered as an appropriate model for research on human lymphedema in first place.

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.

Background Kounis syndrome is a rare cause of myocardial infarction. Pericarditis, which is one of the complications of myocardial infarction, can also develop after kounis syndrome. Case Presentation A 19 year old female patient with no known previous disease history, referred to emergency department with anaphylactic shock after bee stinging. After clinical stabilisation, further investigation showed ECG changes and elevated high sensitive troponin T (hs-troponin T) levels, which led to the diagnosis of Kounis Syndrome and the patient was referred to the Cardiology Intensive Care Unit. During the diagnostic work-up and patient follow-up's, a new onset chest pain led to the diagnosis of Pericarditis Epistenocardica. Conclusions This case report discusses the clinical case and current medical management and treatment of Kounis Syndrome and Pericarditis epistenocardica.

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.

Cumhuriyet Halk Partisi (CHP), 1942 ile 1947 yillari arasinda, “CHP Sanat Mukâfati” adli bir yarisma duzenlemistir. Ulusal duzeyde gerceklestirilen ve para odullu olan bu yarismaya, donemin entelektuel kesimi buyuk bir ilgi gostermistir. Yarisma, hem Ikinci Dunya Savasi’nin gerceklestigi hem de savas sonrasinda Turkiye’de cok partili siyasal yasama gecildigi bir donemde yapilmistir. Bu nedenle de ekonomik, toplumsal ve siyasal alanda buyuk zorluklarin yasandigi yillara denk gelmistir. Buna karsin, 1944 yili haric yarisma, soz konusu tarihler arasinda kesintisiz olarak duzenlenmistir. CHP, ulkede guzel sanatlar alanindaki ilerlemeye katkida bulunmak ve halkin sanatin egitici ve eglendirici yonlerinden yararlanmasina olanak tanimak amaciyla boyle bir yarisma duzenlemistir. Ote yandan CHP, inkilâbin ideolojisinin sanat eserleri yoluyla yerlesmesi icin, propaganda amacli olarak da bu yarismalardan yararlanmak istemistir.

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

There is high tendency to ignore the diagnosis as the incidence of the injury of parotid gland and its duct is relatively rare. In order to prevent the long-term complications such as facial deformities, sialoceles, cutaneous fistulae, salivary gland cysts and gustatory sweating (Frey’s syndrome) and to restore the parotid gland functions, it is important for the duct injuries to be diagnosed and treated immediately. 3 patients consulted to Plastic Surgery Clinic from the Emergency Room of Hacettepe University following maxillofacial trauma was reviewed in this study. Exploration of the facial nerve and Stenon duct was planned for all patients within the first 72 hours following the injury. Following intraoral catheterization of the Stenon duct through the papilla with an epidural catheter, microsurgical end-to-end anastomosis was performed. Concurrently, 100 Units of botulinum toxin A was injected at standardized 8 points on the parotid gland. Postoperative MR sialography revealed patency in all patients at the end of postoperative first year. The mean postoperative parotid volume of the injured and non-injured sides were 19,82±10,55 and 17,79±10,98 respectively and the results were found to be comparable. Fibrillation potentials in the postoperative electromyography recordings and clinical examination demonstrated the nerve regeneration. In conclusion, botulinum toxin A is appears to be effective in both treatment of the injuries of the duct accompanied by glandular involvement in the acute setting, as well as prevention of the long term complications.

BACKGROUND 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. METHODS 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. RESULTS 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

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.

Turkiye, Montreux Bogazlar Sozlesmesi’nin imzalanmasi ile birlikte ulkenin guvenligini, bagimsizligini ve toprak butunlugunu ilgilendiren bir sorunu kendi lehine cozumlemistir. Soz konusu sorunun cozumunu saglamak icin, muzakereye acik ve barisci bir politika izlemistir. Turkiye’nin, sorunlarin cozumune yonelik bu yaklasimi, sorunlarin cozumu konusunda saldirgan bir tavrin benimsendigi bir donemde, dunyada takdirle karsilanmistir. Montreux Bogazlar Sozlesmesi’nin imzalanmasi, Turk kamuoyu tarafindan zafer olarak degerlendirilmis ve coskulu sekilde kutlanmistir.

PubMed ID: 30688282 In the neonates, tracheal atresia and tracheoesophageal fistula (TEF) surgery may result in hemodynamic instabilization, leading to cerebral perfusion insufficiency due to the retraction of the pulmonary vessels and truncus brachiocephalicus. We represented one male and one female neonates which were performed thoracoscopic primary repair of TEF through right thoracotomy at the 3th and 4th postpartum day. Anesthesia was induced using sodium thiopental (5 mg/kg), fentanyl 4 mcg, and rocuronium (0.5 mg/kg) given through intravenous route. Sevoflurane 2% and 50% O2in air were used for the maintenance therapy. During the right lung compression to expose posterior esophagus, no value was observed on the pulse oximeter (PO) probe placed on the right hand, and radial artery was not palpated. At the same time, oxygen saturation was observed as 96%-97% on the left foot probe. As the right cerebral oximeter values (rSO2) were rapidly decreased to 31%, the lung compression was ceased. Right pulse oximeter and right rSO2measurements return to the baseline levels. For the second case - different from the first case -both left and right rSO2was rapidly decreased to 40% levels and return to the baseline levels after was removed the retractors. Right PO and right and left cerebral rSO2values returned to baseline immediately when the retractor compression was ended During the operations involving the great vessels in neonates, cerebral perfusion could be preserved using cerebral oximeter. Cerebral oximeter is more efficient than pulse oximeter for detecting cerebral tissue oxygenation and could be helpful to minimize neuronal damage in the neonates. © 2019 African Journal of Paediatric Surgery | Published by Wolters Kluwer - Medknow.

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.

Background: The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications. Materials and Methods: 34 consecutive patients who underwent fingertip replantation between 2007 and 2014 were retrospectively reviewed with respect to the Tamai and Yamano classifications. The medical charts from record room were reviewed. The mean age of the patients was 36.2 years. There were 30 men and 4 women. All the injuries were complete amputations. Of the 34 fingertip amputations, 19 were in Tamai zone 2 and 15 were in Tamai zone 1. When all the amputations were grouped in reference to the Yamano classification, 6 were type 1 guillotine, 8 were type 2 crush and 20 were type 3 crush avulsions. Results: Of the 34 fingertips, 26 (76.4%) survived. Ten (66.6%) of 15 digits replanted in Tamai zone 1 and 16 (84.2%) of 19 digits replanted in Tamai zone 2 survived. There were no replantation failures in Yamano type 1 injuries (100%) and only two failed in Yamano type 2 (75%). Replantation was successful in 14 of 20 Yamano type 3 injuries, but six failed (70%). The percentage of success rates was the least in the hybridized groups of Tamai zone 1-Yamano type 2 and Tamai zone 1-Yamano type 3. Although clinically distinct, the survival rates between the groups were not statistically significantly different. Conclusions: The level and mechanism of injury play a decisive role in the success of fingertip replantation. Success rate increases in proximal fingertip amputations without crush injury.

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 use of caffeine is not recommended prior to elective microsurgery due to its demonstrated negative effects on vessel anastomosis by the presumed sympathomimetic induction of vasoconstriction. In this study, we aimed to elucidate the systemic and local effects of caffeine on vessel diameter, anastomosis patency, and degree of intimal hyperplasia during the healing process. Methods Twenty-five rats were randomly assigned to five groups: (1) negative control, (2) preoperative systemic caffeine, (3) postoperative systemic caffeine, (4) perioperative systemic caffeine, and (5) a local caffeine group. Both the right and left femoral arteries were used. Ten anastomoses were performed per group. The arterial diameter was measured by micrometer, anastomosis patency was assessed surgically and histologically, and the histological examination was conducted 3 weeks postoperatively to determine intimal hyperplasia. Results The overall patency rate was 96%. Mild vasoconstriction was observed in the systemic caffeine groups (statistically insignificant); however, there were no negative effects on anastomosis patency. Local caffeine irrigation resulted in significant vasodilatation in the local caffeine group (p = 0.001); a similar effect was not observed in the other groups. There was a significant decrease in the intima/media ratio in the local caffeine group (p Conclusion The systemic administration of caffeine, although statistically insignificant, has an observable effect on vasoconstriction. However, it does not appear to have negative effects on anastomosis patency regardless of its application period (pre-, post-, or perioperatively). The local application of caffeine resulted in considerable vasodilatation as opposed to the vasoconstriction effect in the systemic caffeine groups. Decreased intimal hyperplasia at the anastomosis edge, and antifibrotic properties in the surgical field were also observed in this group. Histologically, the local caffeine group demonstrated an additional beneficial effect on anastomosis remodeling.

Smoking is a leading cause of flap failure. Varenicline-assisted smoking cessation has shown beneficial effects on vascular endothelial function. The aim of this study was to determine whether varenicline conveys beneficial effects for skin flap survival. Twenty-four rats were randomly divided into four groups of six. The rats in the control group received normal saline subcutaneous injections, and those in the nicotine group received subcutaneous nicotine injections. The rats in the varenicline group received varenicline intraperitoneally, and those in the nicotine-varenicline group received both nicotine and varenicline. At the end of week 3, the dorsal skin flaps were raised in all rats. On postoperative day 7, the flaps were evaluated by direct observation, microangiography, and light microscopy. The mean necrotic area of the flaps was significantly greater in the nicotine group than in the control group (49.2 ± 4.71 vs. 22.03 ± 0.93%, respectively

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

Mustafa Kemal Ataturk, tedavi olmak amaciyla gittigi Karlsbad’da bir gunluk tutmustur. Afet Inan tarafindan yayima hazirlanan soz konusu gunlukten, Ataturk’un birtakim kisilik ozelliklerine, aliskanliklarina kisaca ozel yasamina dair bazibilgiler elde edilebilmektedir. Ote yandan gunluk, onun yasadigidonemin sorunlarina yonelik urettigi cozum onerileri ile dusunce dunyasina yonelik bilgileri de barindirmaktadir.

Background The effect of a columellar strut graft on final nasal tip position has been a subject of ongoing debate. The purpose of this study was to retrospectively analyze a series of 100 consecutive primary rhinoplasty cases performed without the use of columellar strut grafts, with a specific focus directed toward comparing preoperative, morphed, and actual postoperative changes in nasal tip position. Methods Data were collected from patient charts and digital images of 100 consecutive primary open rhinoplasty patients. Preoperative, morphed, and actual postoperative digital images were quantitatively analyzed using image-processing software to compare various anatomical features, including nasal tip projection, nasolabial angle, and Goode ratio. Patient satisfaction regarding long-term postoperative results was also surveyed. Results Primary rhinoplasty did not demonstrate a universal trend toward either an increase or a decrease in nasal tip projection. The planned changes in nasal tip projection, nasal tip rotation, and nasal profile proportions were obtained with statistically significant accuracy without the use of columellar strut grafts. The overall incidence of columellar contour irregularities was 3 percent. Conclusion In primary open approach rhinoplasty, if native anatomical support structures of the nasal tip are preserved or reconstructed, preoperative goals regarding nasal tip projection, nasal profile proportions, and columellar integrity can be consistently achieved without using columellar strut grafts.

The pectoralis major musculocutaneous flap (PMMF) is a commonly used flap for head and neck reconstruction. It was first described by Hueston andMcConchie1 in 1968 as a rotational flap to repair a sternal defect. The flap was to be redescribed with respect to head and neck reconstruction by Ariyan in 1979.2,3 Although the increased use of free-tissue transfers to reconstruct complex bony and soft-tissue defects has overshadowed the PMMF to some extent, in several cases the PMMF still has its advantages, including its proximity to the head and neck, the simplicity of harvesting, and its use as an alternative when microsurgical flap failure occurs.

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.