How Approprıate are the Lengths of Syringe Needles Used for Subcutaneous Injections to the Children at School Age?

ABSTRACT Objectives: To define the normal ranges of the thicknesses of the skin and subcutaneous tissues via ultrasonography, and determine whether the current syringe needle-lengths used for the subcutaneous injections were appropriate. Methods: The thicknesses of the skin and subcutaneous tissues of 2244 students were measured at the left arm using ultrasonography. The patients were divided into three groups based on their age: 6-8, 9-12 and 13-17 years. Results: The thicknesses of the skin, subcutaneous tissue and skin-subcutaneous tissue were found to be positively correlated with their age, body mass index (BMI) and body surface area. All these were observed to be gender related. There was the possibility to make intramuscular injections for 50%, 25% and 25% of boys within the age groups of 6-8, 9-12 and 13-17 years, respectively. For girls, the risk of intramuscular injection was 25% for all the age groups. Conclusion: The study showed that the skin and skin-subcutaneous tissue thicknesses varied as a function of the patients' age, gender, BMIs and body surface areas.

Comparative evaluation of ceftriaxone- and cefotaxime-induced biliary pseudolithiasis or nephrolithiasis: A prospective study in 154 children.

BACKGROUND: Biliary lithiasis, or sludge, and nephrolithiasis have been reported as a possible complication of ceftriaxone therapy. However, no study related to cefotaxime-induced biliary pseudolithiasis or nephrolithiasis was observed in the literature. Therefore, we investigated the comparative formation of biliary pseudolithiasis and nephrolithiasis after cefotaxime and ceftriaxone therapies. METHODS: The patients treated with ceftriaxone or cefotaxime were enrolled during the study period. Ultrasound imaging of the biliary and urinary tract was performed in all patients before and after the treatment. The patients with a positive sonographic finding at the end of treatment were followed up with monthly ultrasonography for 3 months. RESULTS: The present study showed that abnormal biliary sonographic findings were demonstrated in 18 children (20.9%) treated with ceftriaxone, 13 (15.1%) had biliary lithiasis, 5 (5.8%) had biliary sludge and 1 (1.2%) had nephrolithiasis. Abnormal biliary sonographic findings were demonstrated in only four (5.9%) children treated with cefotaxime who had biliary sludge and only one (1.5%) had nephrolithiasis. It was observed that older age was at significantly higher risk of developing biliary sludge or stone formation. Receiver operating characteristic analysis was performed to determine the residual risk and analysis found that 4.5 years was the cut-off value for age. CONCLUSIONS: The present study is unique in the literature for reporting for the first time gall bladder sludge and nephrolithiasis associated with cefotaxime use. Therefore, patients treated with cefotaxime should be monitored for serious complications like patients treated with ceftriaxone. Nevertheless, if third-generation cephalosporin is used, cefotaxime is recommended to be used rather than ceftriaxone.

Comparison of the effect of the rotation palatoplasty and V-Y pushback palatoplasty techniques on palate elongation with magnetic resonance imaging.

Most surgical techniques used in cleft palate repair require the extension of the palate to the pharynx. However, no adequate information exists regarding the extent to which this elongation obtained during operation continues in late postoperative period. In this study, we compared and measured palate elongation in patients with a cleft palate who underwent a V-Y pushback or rotation palatoplasty, by means of magnetic resonance images obtained before and 1 year after surgery. The hard palate, soft palate, and total palate lengths were measured for all of the patients, and the velopharyngeal opening area width was calculated. In patients who underwent the V-Y pushback technique (n=13), the total palate and soft palate lengths were shortened by an average of 0.10 and 0.14cm after surgery, respectively. However, the hard palate length was elongated by an average of 0.13cm. In the rotation palatoplasty group (n=13), the total palate, hard palate, and soft palate lengths were elongated by 0.57, 0.10, and 0.49cm, respectively. The velopharyngeal opening was narrowed by 0.06cm(2) using the V-Y pushback technique and by 0.29cm(2) using the rotational palatoplasty. This study demonstrated that the palate does not elongate during the V-Y pushback technique, as expected. However, rotational palatoplasty elongates the soft palate.

Endovenous laser ablation treatment with 980 nm diode laser for saphenous vein insufficiency: 6 months follow up results.

OBJECTIVE: Superficial venous insufficiency is a common problem associated with varicose veins which, if untreated, may progress to venous ulceration. Endovenous laser ablation (EVLA) is a new, minimally invasive method for management of superficial venous insufficiency and varicose veins. The aim of this study was to demonstrate the effectiveness of 980 nm EVLA for treatment of symptomatic saphenous venous insufficiency and to present its early outcomes. METHODS: Thirty-eight great saphenous veins and 5 small saphenous veins in 40 patients with saphenofemoral reflux were treated with 980 nm diode endovenous laser equipment. The diameter and length of the vein treated, total laser energy and energy density (Joules/cm) delivered were recorded. To determine the severity of the venous disease Venous Clinical Severity Score (VCSS) and Visual Analogue Scale (VAS) were used. Patients were followed up for 6 months after the procedure. Complications were recorded prospectively. RESULTS: Forty-three saphenous veins in 40 patients were treated. The mean age of the patients was 39.9 (range 21-72) years. The mean diameter and length of the veins were 4.9 mm (range, 3.5 to 8.5 mm) and 30.2 cm (range, 16 to 50 cm), respectively. At 6 months follow-up, total occlusion rate was 95.4% (41/43), and recanalization rate was 4.6%. Significant decrease was observed for VCSS and VAS scores after the procedure. No major complication was detected. CONCLUSION: EVLA treatment for superficial venous insufficiency is safe and can be carried out under local anaesthesia in an outpatient setting with good patient satisfaction and low complication rates.

Incidence of bla NDM-1 gene in Escherichia coli isolates at a tertiary care referral hospital in Northeast India.

PURPOSE: Increasing reports on New Delhi metallo-ß-lactamase-1 (NDM-1) producing Escherichia coli constitute a serious threat to global health since it is found to be highly resistant to most of the currently available antibiotics including carbapenems. This study has been performed to find out the incidence blaNDM-1 in E. coli isolates recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. MATERIALS AND METHODS: A total of 270 non-duplicated E. coli isolates were recovered from the various clinical samples at a tertiary care referral hospital in Northeast India. All isolates with reduced susceptibility to meropenem or ertapenem (diameter of zones of inhibition, ≤ 21 mm) were further phenotypically confirmed for carbapenemase production by modified Hodge test. All screened isolates were also subjected to the polymerase chain reaction detection of blaNDM-1 gene and additional bla genes coding for transmission electron microscopy, SHV, CTX-M, and AmpC. RESULTS: Out of 270 E. coli isolates, 14 were screened for carbapenemase production on the basis of their reduced susceptibility to meropenem or ertapenem. All screened isolates were found to be positive for blaNDM-1 . Each of the blaNDM-1 possessing isolate was also positive for two or more additional bla genes, such as blaTEM , blaCTX-M and blaAmpC . Phylogenetic analysis showed very less variation in blaNDM-1 gene with respect to blaNDM-1 possessing E. coli isolates from other parts of India and abroad. CONCLUSIONS: Our findings highlight the incidence of blaNDM-1 in E. coli isolates with a reduced susceptibility to meropenem or ertapenem.

Prioritizing areas for malaria control using geographical information system in Sonitpur district, Assam, India.

OBJECTIVE: To identify the malaria hot spots at health subcentre level in an endemic district using a geographical information system (GIS). The results will be useful for rapid retrieval of malaria information, and to prioritize malaria control efforts in identified hot spots. STUDY DESIGN: Extraction, analysis and synthesis of relevant data. METHODS: Malaria epidemiological data from 2006 to 2009 were analysed to determine the annual parasitic index, slide positivity rate, annual blood examination rate and Plasmodium falciparum percentage for each health subcentre in the district. Maps were produced using GIS, and integrated to identify the malaria hotspots. RESULTS: Out of 288 health subcentres, GIS identified 10 hot spots at extremely high risk of malaria and 14 hot spots at high risk of malaria. Malaria may flare up in these hot spots whenever favourable transmission conditions arise. Health authorities have been advised to establish control measures in these selected hot spots for timely prevention. CONCLUSION: There is a need for adequate monitoring and allocation of available resources for better interventions in the malaria hotspots. The GIS model used in this study can be used, even at village or cluster level, to pin point the malaria hot spots, and information can be updated and retrieved easily.

The relation between pelvic varicose veins and lower extremity venous insufficiency in women with chronic pelvic pain.

PURPOSE: To determine the relation between pelvic varicose veins and lower extremity venous insufficiency in women with chronic pelvic pain. METHODS AND MATERIALS: This study was done in Yuzuncu Yil University Faculty of Medicine, Department of Radiology, with patients who were referred for abdominal and pelvic imaging between January 2007 and April 2008. A total of 1029 women with pelvic imaging study were included in the study. The presence of venous dilatations (diameter > 5 mm) in parauterine and paraovarian localizations were accepted as pelvic varicose veins. In all patients, endometrial thickness was measured and lower extremity venous system was examined with Doppler ultrasonography to assess possible associated venous insufficiency. All patients were undergone questionnaire for frequency of delivery, age, and chronic pelvic pain. RESULTS: Pelvic varicose veins were discovered with transabdominal ultrasound and computerized tomography in 56 of 1029 patients. Various degrees of associated lower extremity venous insufficiency were also discovered in 44 of 56 patients (78,6%) with pelvic venous dilatation. Of the 44 patients with lower extremity venous insufficiency, 21 were bilateral, 9 were right-sided, and 14 were left-sided. Endometrial thickness was significantly increased in patients with pelvic venous dilatation. CONCLUSION: The presence of pelvic varicose veins is significantly associated with lower extremity venous insufficiency. Since the diagnosis of lower extremity venous insufficiency plays an important role in deciding the course of treatment, lower extremity Doppler ultrasonography examination would be useful to include in the evaluation of pelvic varicose veins.

The involvement of distinct neural systems in patients with obsessive-compulsive disorder with autogenous and reactive obsessions.

OBJECTIVE: To investigate the regional metabolite abnormalities and changes after treatment in patients with OCD with autogenous and reactive obsessions. METHOD: We assessed right anterior cingulate cortex (ACC) and amygdala-hippocampal region (Am + Hpp) N-acetyl-aspartate (NAA), choline (Cho) and creatine (Cr) concentrations and NAA/Cr and Cho/Cr ratios using single-voxel proton magnetic resonance spectroscopy in 15 patients with autogenous obsessions (OCD-A), 15 patients with reactive obsessions (OCD-R) and 15 healthy controls (HC). Measurements were repeated after 16 weeks of fluoxetine treatment. RESULTS: Baseline ACC NAA/Cr ratios of both OCD groups were significantly lower than HC. OCD-A group had significantly lower baseline NAA/Cr ratios in the Am + Hpp than other groups. These differences were more likely to be explained by higher Cr levels in ACC. We found no significant differences and changes for Cho levels and Cho/Cr ratios between groups and within groups. Significant increase in NAA/Cr ratios of OCD-A group found in the Am + Hpp was more likely to be explained by increased NAA levels. No significant changes were found in ACC NAA/Cr ratios. CONCLUSION: While disturbed energy metabolism in ACC might reflect a common pathology in patients with OCD regardless of symptom dimension, alterations in mesiotemporal lobe are more likely for autogenous obsessions.

Kirschner wire fixation for scaphoid fractures: an experimental study in synthetic bones.

We have studied the biomechanical stability in vitro of three different Kirschner (K) wire configurations in three types of simulated scaphoid waist fractures. The fractures were created with a saw in Sawbones models. There were three fracture patterns: perpendicular to the long axis of the scaphoid model; and 30° and 20° oblique to that. Two 1.2 mm. K-wires were used in each scaphoid. The three configurations were: parallel; 20° oblique; and crossing. The oblique or crossing configurations of K-wires were the most stable depending on the fracture pattern.

Rare site giant cell tumors: report of two cases on phalanges of the finger and review of literature.

Giant cell tumor (GCT) of bone arising from a phalanx of a finger is extremely rare. We report two cases of GCT arising from a phalanx of a finger. One case presented with recurrence following the amputation of the left ring finger (performed elsewhere). He was treated successfully with ray amputation. The other case was treated primarily by intralesional curettage and autogenous bone graft. At their most recent follow-ups (80 and 24 months, respectively), both were recurrence free and had returned to their previous occupational and recreational activities.

Over-winter survival in subadult European rabbits: weather effects, density dependence, and the impact of individual characteristics.

The survival probability of an individual may be limited by density-dependent mechanisms and by environmental stochasticity, but can also be modified by individual characteristics. In our study, we investigated over-winter survival of subadults of an enclosed European rabbit Oryctolagus cuniculus population in a temperate zone habitat over the period 1992-2002. We: (1) selected for appropriate models to explain individual variation in over-winter survival and the animals' autumn body mass, the latter was used as a measure of the individual pre-winter body condition; and (2) aimed to compare the sensitivity of the target variables on the realised variation of the factors considered. Model selection based on information theory revealed that individual over-winter survival was best explained by the combination of autumn body mass, winter temperature, population density and sex, where the probability of survival was higher in females than in males. According to this model, the probability of survival reacted most sensitively to variation in the autumn body mass and in winter temperature. Individual autumn body mass was best explained by the combination of the date of birth, population density, and weather conditions by means of the percentage of rainy days during the first 2 months after the animals had emerged above ground, where the autumn body mass was negatively related to the percentage of rainy days. The chosen model suggested that the autumn body mass reacted most sensitively to variation in the date of birth. Combining these models, we found that weather conditions during two different periods of time as well as population density, sex and the date of birth operated together to determine the probability of over-winter survival. In particular, the study points out the high impact of environmental stochasticity on over-winter survival: (1) by direct effects of winter temperature conditions, and (2) by the indirect action of weather conditions to which the animals were exposed during the early period of juvenile development.

Reconstruction of skin and tendon defects from wound complications after Achilles tendon rupture.

Four patients who developed combined tendon and overlying skin defects following operative repair of ruptured Achilles tendon were presented. Three patients had an infected wound. The average interval from the first operation for repairing the ruptured Achilles tendon and the reconstructive procedure was 46.2 days (range, 5-65 days). All patients were treated with a one-stage operation including radical debridement, reconstruction of the Achilles tendon defects using vascularized or nonvascularized tendon grafts, transfer of peroneus brevis for augmentation, and skin coverage with a free flap. The patients recovered uneventfully. The average follow-up period was 39.2 months (range, 18-79 months). In all patients, an evaluation of the clinical outcome, the performance of the calf muscles using a computerized dynamometer, and structural changes of the reconstructed Achilles tendon using magnetic resonance (MR) imaging were made. The clinical outcome was excellent in three patients and good in one. In isokinetic testing (Cybex-Norm), strength was found to be normal in one patient and abnormal in three patients. MR images revealed an intratendinous area of homogenous and normal intensity signal, and a significant increase in thickness and width in all levels of the reconstructed Achilles tendon. The authors conclude that it is possible to obtain satisfactory function in patients with complex wounds in the region of the Achilles tendon.

Reconstruction of soft tissue and bone defects in lower extremity with free flaps.

This article reports our experiences treating soft tissue and bone defects in the lower extremity with free flaps. One of the most common causes for lower extremity wounds are high-energy injuries. These kinds of injuries contain soft tissue and bone defects beyond neurovascular complications. The rate of infection and nonunion is very high in these injuries. Between 1988 and 1996, we applied 33 flaps to 28 patients. The numbers and kinds of the free flaps are as follows: 12 latissimus dorsi, nine radial forearm, seven lateral arm, three vascularised fibula grafts with skin, one gracilis, and one medial plantar flap. Three free flaps were lost (12%). The success rate is 88%. The advantage of free flaps is that they allow the reconstruction of the large defects in one-session operations. Thus, they decrease the rate of infection and increase that of nonunion. The patient returns to his active life at an earlier stage.

Eight years experience in crush and avulsion type finger amputation.

Between July 1986 and July 1994, we studied 125 total finger amputations due to crush and avulsion type injuries at the Izmir Hand and Microsurgery Hospital. Of the 125 fingers replanted, 88 were successful, for a general survival rate of 70.4%. In the period between 1986 and 1991, we performed end-to-end anastomoses and achieved a survival rate of 48.3% (Group I). Between 1991 and 1994, with the application of a primary interpositional vein graft for the required indications in this type of injury, the general survival rate increased to 77.1% (Group II; P < 0.05). We conclude that the significant increase in the survival rate in Group II is related to both the increased experience of the surgical team and the application of the primary interpositional vein graft.

Rolling belt injuries in children.

The rolling belts on agricultural machinery attract children who unconsciously grab them. The injuries produced include friction burns, injuries to flexor tendons, digital nerves and arteries, skin in zone 2 and fractures. Subtotal or total amputation may occur. We present the results of such injuries to 44 fingers in 16 children aged 1 to 9. The functional results are not satisfactory. In order to grade the results we have devised a classification to this injury. The survival rate for all fingers was 71%, but in the fingers with circulatory problems the survival rate was 50%. On functional assessment seven patients had a good result, seven moderate, and two fair.

Replantations and their functional results: the Turkish experience.

The development of microsurgery with regard to replantation of severed extremities has in Turkey been a relatively recent although rapid process. The first revascularization was performed by our team in Izmir in 1986. By 1988 a 24-hr emergency replantation service was available and a special surgery branch hospital in hand and microsurgery was established in 1991. This hospital was the first of its kind in Turkey and one of the few in the world. Here we present our replantation series comprising 83 patients treated between July, 1986, and December, 1990. From a total of 83 patients, 136 extremities were involved, with only 24 of 136 lost; a success rate of 82%. Functional results were rated as excellent or good in 49 cases.