Independent predictors of mortality in subacute and chronic stroke patients: A single center study in Turkey.

BACKGROUND: Although the long-term survival and related predictors have been identified in stroke patients, there is little evidence about the mortality rates and its associated factors in stroke patients treated in rehabilitation units. OBJECTIVE: To evaluate 5-year mortality rates of patients with stroke and its relationship with the clinical characteristics after inpatient subacute-chronic rehabilitation. METHODS: The files of 1016 stroke patients (482 male, 534 female) who received inpatient rehabilitation program were examined retrospectively. Patients' characteristics and functional ambulation category were recorded at the end of the rehabilitation program. The survival probability was estimated using the Kaplan-Meier method and the univariate effects of predictors were determined using the log-rank test. The possible factors determined with univariate analyses were checked in the Cox regression analysis. RESULTS: A total of 273 patients (32%) died within 5 years after stroke. Age (p< 0.001, RR: 1.06, 95% CI: 1.05-1.08), presence of coronary artery disease (p= 0.003, RR: 1.53, 95% CI: 1.16-2.03) and poor walking ability (p< 0.001, RR: 2.06, 95% CI: 1.49-2.86) were independent prognostic factors for increased mortality. CONCLUSIONS: About one-third of the rehabilitation patients died within 5 years after stroke. As independent ambulation was a strong predictor for long-term survival, it should be provided via rehabilitation techniques. Future studies are proposed to determine the effects of rehabilitation methods on mortality rates.

Isolated fibrous dysplasia of the zygomatic bone.

Fibrous dysplasia is a nonneoplastic, hamartomatous, developmental disease of the bone of obscure etiology. The disease is generally presented as a continuously growing, painless mass at late childhood. It is mostly seen in the maxilla and the mandible in facial skeleton. Involvement of the zygomatic bone is far rarer. Fibrous dysplasia of the zygomatic bone may cause orbital dystopia, diplopia, proptosis, loss of visual acuity, swelling, mass formation, or facial asymmetry. We present 2 cases of fibrous dysplasia with isolated zygomatic bone involvement.

What should be the treatment modality in giant cutaneous lipomas? Review of the literature and report of 4 cases.

We present three females (20, 39 and 58 years old) and one male patient (47 years old), admitted to our clinic with 3-20 years history of giant lipomas on periscapular (n = 2), posterior cervical (n = 1) and abdominal areas (n = 1), respectively. The sizes of the tumours ranged from 15 x 14 cm(2) to 35 x 25 cm(2) weighing 1900-12 350 g. In all cases, the diagnosis of the lesions was by physical examination and confirmed with computed tomography, magnetic resonance imaging and ultrasonography. Incisional biopsy or aspiration cytology were used to exclude liposarcoma. Three lesions with surrounding capsule formation and lipofibromatous changes underwent open surgery. In one case, as the capsule formation was not evident, suction assisted lipectomy was attempted. However, no aspirate could be evacuated possibly due to the fibrotic nature of the lesion and open surgery was performed. The follow-up period was 14 months to 5 years and no recurrence was noted.

A large Guyon's canal lipoma without neuropathy in a child.

Lipomas originating from Guyon's canal are uncommon tumors. There are rare reports of adult cases, often with nerve compression findings. However, so far, no report had described this tumor in the pediatric age group. This article presents an 8-year-old boy who presented with a 3-year history of slowly growing hypothenar mass. Exploration yielded a large lipoma (35×55×44 mm) originating from the proximal Guyon's canal, which resides within the hypothenar musculature. The lesion was excised totally, and histological evaluation confirmed the diagnosis. The follow-up period was uneventful, and complete cure was attained. To the best of our knowledge, this is the first report of a lipoma deriving from the Guyon's canal in a child. Despite its huge mass, no signs of nerve compression were detected. This inconsistency between children and adult patients may be due to anatomical and physiological differences of the Guyon's canal and attending nerves and muscles. In children, the structures forming the canal may be more expandable to let such a bulk grow without neuropathy.