Medial gastrocnemius muscle flap for the reconstruction of unhealed amputation stumps.

OBJECTIVE: Unhealed amputation stumps after transtibial amputation are common and often require reamputation futher up the leg. The aim of our study is to describe our experience with medial gastrocnemius muscle flap coverage following a transtibial amputation. METHOD: We retrospectively examined the records of patients who had an unhealed transtibial amputation stump who were then treated with a medial gastrocnemius muscle flap. RESULTS: We identified seven patients, all had diabetes mellitus and an initial amputation by the long posterior flap technique. All of the flap reconstructions of the amputation stumps ultimately survived. A mild knee flexion contracture was seen in two amputees, whereas full range of motion in the knee was observed in the remaining five amputees. None have required further surgical intervention. CONCLUSION: Medial head of gastrocnemious flap is an option for the reconstruction of the unhealed stump, particularly in the cases where stump shortening will not be feasible.

Survival evaluation of the patients with diabetic major lower-extremity amputations.

PURPOSE: The purpose of this study was to evaluate the survival after major lower-limb amputation, at a level either below (BKA) or above (AKA) the knee, in diabetic patients. METHODS: A total of 140 diabetic patients who underwent major lower-limb amputation during the period of 2001-2011 were enrolled in the study. The patients were grouped as below-knee and above-knee amputations. The differences in survival by age, gender, amputation level and revision surgery were investigated. The clinical follow-up periods and the results of the patients with major lower-limb amputation were retrospectively assessed. RESULTS: The mean follow-up period was 24.87 months (range 0.06-120 months). The mortality rate of series was 32.8 % for 1 year and 70 % for 5 years. One-year mortality rate was 24.6 % and 5-year mortality rate was 66.3 % in below-knee group, 1-year mortality rate was 43.3 % and 5-year mortality rate was 83.3 % in above-knee group. The difference between mortality rates of these groups was significant (p: 0.019). There was no statistically significant difference according to age and gender (p: 0.543 and 0.568). The previous minor amputations were found to have no effect on mortality (p: 0.471). CONCLUSION: Routine utilization of diabetes follow-up, screening and treatment programs with a multidisciplinary approach might be mandatory to handle early multisystem involvement-prevent major amputation, and increase survival rate in diabetic patients. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.

Evaluation of the olfactory memory after spinal anesthesia: a pilot study.

BACKGROUND: The aim of this study was to investigate the effect of spinal anesthesia (SA) on olfactory memory using Brief-Smell Identification TestTM (B-SIT). PATIENTS AND METHODS: This, prospective, clinical study was performed on 40 ASA physical status I-III patients, between 18-65 years of age undergoing a planned elective minor surgery under SA. All participants were preoperatively informed about B-SIT and the mode of application of the test according to the information in the book. B-SIT was applied to each patient preoperatively and the scores were recorded. B-SIT was reapplied to all patients on the 1st and 2nd postoperative days and the scores were recorded. Moreover, development of postdural puncture headache (PDPH) and/or neurological symptoms (such as hearing loss, diplopia) were checked. RESULTS: Postoperative headache was observed in 7 of the participants and 3 of them was diagnosed to have PDPH. No statistically significant difference was observed in the olfactory memory evaluation of the patients suffering from headache and the 3 patients diagnosed with PDPH. No statistically significant difference was observed in the correct odor answer ratio between the preoperative and postoperative 1st and 2nd days (p > 0.05). CONCLUSIONS: We confirm that SA does not affect olfactory memory. Further studies are necessary to confirm the results of our pilot study in a larger sample.

Long-term neurological outcome of acute encephalitis.

To understand the viral etiology of acute childhood encephalitis in Elazig, Eastern Turkey, 36 children aged between 4 months and 14 years who were treated in a regional medical center between January 1995 and June 1999 were studied. Viral etiology was identified in 16 of 34 (47.1 per cent) cases and the most frequently detected pathogens was mumps (seven cases, 20.6 per cent). No specific etiology was found in 18 (52.9 per cent) cases. Among the survivors, mental and/or focal neurological deficits persisted in 18 (52.9 per cent). Two children died and 32 survived, of whom 16 were left with no neurological sequel, 10 had persistent neurological sequel, and eight recovered with some degree of handicap. Improvement in the general health and sanitation of the population, and the universal use and development of new vaccination will significantly reduce the incidence of viral encephalitis.

Bacteriological and PCR analysis of clinical material aspirated from otitis media with effusions.

Otitis media with effusions (OME) can lead to significant hearing loss in childhood. Although previous studies have shown that bacterial DNA is present in a significant percentage of effusions sterile by culture, whether the DNA represents viable organisms or 'fossilized remains' is unknown. The aim of the present study was the determination of Streptococcus pneumonia, Moraxella catarrhalis and Haemophilus influenza in the clinical materials from OME. For this purpose, effusion samples aspirated from the mid-ear were analyzed bacteriologically. Samples were also tested with polymerase chain reaction (PCR) assay. A total of 37 samples obtained from 20 patients aging between 4 and 14 were analyzed. In 17 patients, both ears demonstrated effusions, whereas in three patients, only one ear had effusions. In aerobic bacterial culture assays, nine samples (24.3%) showed bacterial growth. None of the samples were positive for anaerobic culture experiments. PCR analysis of the samples showed that 35 samples (94.5%) contained bacterial DNA. In 19 samples, only one bacterial species and in 16 samples more than one bacterial species were detected. The results of this study demonstrate that effusion fluid from otitis media cases contain a battery of bacterial species and these bacteria might play roles in the pathogens of OME. Our results indicate the PCR technique is more specific and sensitive in detection of bacteria in middle-ear effusion of OME, compared with conventional methods.

Bacteremia during tonsillectomy.

OBJECTIVE: To investigate bacteremia in patients who underwent tonsillectomy with a dissection method due to chronic tonsillitis, which may lead to dramatic results in patients that have a cardiovascular infection risk. In this study, it was explored whether the tonsil surface and the tonsil tissue interior microorganisms are different or not, and whether these microorganisms carry bacteremia development risk. METHODS: Forty patients were enrolled in the study in ENT Clinic, Firat University. A bacteriological research was performed on patients with no treatment with antibiotics for a month before the operation. Tonsil surface and deep tissue cultures were performed, and venous blood samples were taken for cultures before and after the operation. RESULTS: Surface and deep tissue cultures of tonsils of the cases represented a different result in 27.5% of the patients. No reproduction was observed regarding the blood cultures taken before tonsillectomy. Bacteremia was found in blood samples of ten patients (25%) taken immediately after tonsillectomy. CONCLUSION: Hence, it has been concluded that different microorganisms may be present among the tonsil surface and tonsil deep tissue cultures and that bacteremia may develop after tonsillectomy. Therefore, to prevent the possible dramatic outcomes after tonsillectomy the required measures during the preoperative period should be taken into consideration, especially in patients that have chronic tonsillitis with cardiovascular disease.

Auditory brain stem evoked potentials in patients with leprosy.

Nineteen, randomly selected male patients with lepromatous leprosy were evaluated electrophysiologically. All of these patients had long-standing disease and were treated with dapsone alone. There were statistically significant differences between the values obtained in this group of leprosy patients compared to 20 age-matched controls in auditory brain stem evoked potentials (ABEP). The findings are consistent with a pathologic process located mainly between the cochlear nucleus and the lateral lemniscus in the auditory brain stem pathways. It should be emphasized that our patients had long-standing disease which was treated with dapsone. ABEP could very well be different in leprosy patients diagnosed early and treated for relatively short periods with multidrug therapy. Brain stem evoked response audiometry may be useful for evaluating the possibility of brain stem involvement in leprosy.