Comparative evaluation of single and combined efficacy of dipyridamole, ketotifen and quercetin on cyclosporine induced hepatorenal toxicity.

Cyclosporine is an immunosuppressive drug that is used to prevent tissue rejection in organ transplants and to treat autoimmune diseases such as psoriasis and rheumatoid arthritis. It has important toxic effects in many organs such as the liver and kidney. The aim of this study was to determine and compare the effectiveness of the single and combined treatment of dipyridamole, which is a vasodilator and has an antioxidant effect, ketotifen which is toll-like receptor-4 inhibitory and has an antioxidant effect, quercetin which is an antioxidant and has an anti-inflammatory effect in cyclosporine-induced hepatorenal toxicity. Forty-eight Wistar Albino rats were divided into 7 groups. The research period was 21 days. The cyclosporine increased serum ALT and AST levels, in contrast to their increased levels prevented by all the treatments. The serum creatinine level decreased significantly with ketotifen and combined treatment, while cyclosporine partially increased serum creatinine and urea levels. The urine microalbumin and protein levels were increased significantly by cyclosporine, whereas they decreased with dipyridamole treatment. The protein levels decreased by quercetin and combined treatments. The kidney injury molecule- 1 and retinol-binding protein levels were increased by the cyclosporine, while ketotifen treatment partially decreased them. In conclusion, ketotifen and dipyridamole can prevent cyclosporine- induced hepatorenal toxicity and quercetin can increase the effectiveness of this treatment.

Change in the amputation profile in diabetic foot in a tertiary reference center: efficacy of team working.

Diabetic foot is a serious complication of diabetes mellitus and the risk of lower extremity amputation is very high in this population when compared with people without diabetes. We have previously reported the lower-extremity amputation rate and significant factors in determining the risks for patients who had been admitted to Hacettepe University Hospital, a tertiary reference center for Turkey, between the years 1992 and 1996. In January 2000, a diabetic foot care team including an infectious diseases specialist, orthopaedic surgeons, endocrinologists, a plastic and reconstructive surgeon, a radiologist, and a diabetic foot nurse was assembled. To determine whether a change has occurred in the rate and the risk factors of lower extremity amputations after the establishment of this team, medical records of 66 patients (39 men, 27 women) with diabetic foot who had been admitted to Hacettepe University Hospital between 2000 and 2002 have now been retrospectively analysed. The grade distribution of diabetic foot according to Wagner classification was quite similar in the two studies (grade 1: 0 % vs. 4.5 %, grade 2: 15.6 % vs. 19.7 %, grade 3: 48 % vs. 33.3 %, grade 4: 24.4 % vs. 30.3 %, grade 5: 11.5 % vs. 12.1 % in the former and current study, respectively). The overall amputation rate in the current study was 39.4 % (36.7 % in the former study). Ray amputation (35 %) and below-knee amputations (30 %) were the two most commonly applied procedures. The rates of Syme, above knee, other amputations (i.e., Boyd, talonavicular amputations and partial calcanectomy) were 8 %, 8 % and 19 %, respectively. These data suggest that amputation is still a frequently encountered outcome for our patients with diabetic foot, but the amputation profile has changed. The implementation of a diabetic foot care team has relatively decreased the rate of major amputations in an attempt for limb salvage to improve the quality of life of the patients. Presence of osteomyelitis, peripheral vascular disease and gangrene still remain as significant predictors of amputation in our population.

Bilateral congenital pits of the upper lip.

Congenital sinuses, fistulas, dimples, or pits of the lips are uncommon congenital malformations. In the upper lip they are extremely rare, and only one third of them are placed laterally. The authors present a patient with bilaterally placed upper lip pits associated with speech disorders, a short and everted upper lip with an orbicularis muscle defect in the midline, slight hypertelorism, and low-set ears. Orbicularis muscle repair and tubercle augmentation were performed. No further treatment was administered to the upper lip pits because of lack of symptoms. This is the third bilateral case of the sinus or pit of the upper lip reported in the literature.

Unilateral virginal breast hypertrophy.

A case of unilateral virginal breast hypertrophy with a review of the etiological factors and treatment modalities is presented. A 16-year-old girl presented with progressive enlargement of the left breast of 5 months' duration. The result of the mammographic examination was consistent with cystosarcoma phyllodes. Fine-needle aspiration biopsy revealed giant fibroadenoma. Although some of the characteristics of the fine-needle aspiration biopsy specimen were suspicious for cystosarcoma phyllodes, there were no adequate epithelial structures, which are obligatory for the diagnosis. The patient was treated with subcutaneous mastectomy and subpectoral insertion of a silicone gel implant. The histopathological examination was consistent with virginal hypertrophy. The breast maintained its volume with no further growth in the affected or in the normal breast after 4 years of follow-up.

Is it necessary to use the angular artery to feed the scapular tip when preparing a latissimus dorsi osteomyocutaneous flap?: case report.

This report demonstrates the possibility of elevation of the scapular tip with the latissimus dorsi muscle based on the thoracodorsal artery only, when an additional and substantial amount of bone is required for complex reconstruction. The patient was a 37-year-old man who developed an epidermoid carcinoma arising from the left maxillary sinus. After wide excision and radical resection of the tumor and the invaded structures, an osteomyocutaneous latissimus dorsi flap was prepared. With the muscle, the 12th rib was included in the flap to reconstruct the orbital floor and zygomatic arch, and the scapular tip was also elevated to reconstruct the hard palate. The skin island over the muscle was designed according to reconstructive requirements, including the buccal lining, nasal lateral wall lining, and coverage of the scapular tip at its new location to reconstruct the hard palate. All of these structures were successfully reconstructed with a single pedicle branch arising from the thoracodorsal artery. Postoperative early and late bone scans showed living bone at the zygomatic arch and hard palate.

Evaluation of velopharyngeal insufficiency with magnetic resonance imaging and nasoendoscopy.

Several radiological methods have been utilized to assess velopharyngeal function. The more recent imaging technique, magnetic resonance imaging (MRI), which has a number of advantages over radiographic and computed tomographic imaging, has been used rarely for evaluating velopharyngeal insufficiency. In this study, 5 normal volunteers and 10 patients with surgically repaired cleft palate were examined with MRI using midsagittal, coronal, and axial images. Nasoendoscopy was also performed to complete and confirm the diagnoses. Complete and tight closure of the velopharynx and full backward and upward movement of the soft palate was observed in volunteers. In coronal images, medial movement of lateral pharyngeal walls could also be seen. Despite this, patients with surgically repaired cleft palate had some degree of motion of the soft palate, ranging from no movement to maximal movement. In most of the patients, short soft palates with restricted motion was seen. MRI visualizes the velopharyngeal sphincter in all planes and provides high-resolution images of the soft tissues. Objective measurements can be made as well. In this study, MRI and nasoendoscopy were used together in the diagnosis of velopharyngeal insufficiency and gave satisfactory results.

Effect of silicone breast implants on myocardial imaging.

The authors investigated the effect of silicone breast implants (SBIs) on thallium-201 myocardial perfusion scintigraphy. Twenty-nine patients with SBIs and 14 control subjects were included in the study. All of the participants underwent a resting thallium-201 myocardial perfusion study. Comparison of the thallium images between patients with SBI and control subjects was done both visually and semiquantitatively. On visual analysis, neither image distortion nor image artifact attributable to the SBIs was noted. Semiquantitative analysis revealed that in patients with SBIs, the uptake values of the anteroseptal, anterolateral, lateroanterior, and lateroinferior myocardial walls was slightly, but significantly, lower than those of control subjects: anteroseptal, 87.7+/-6.0% vs. 92.8+/-5.1%; anterolateral, 88.0+/-5% vs. 92.6+/-4.5%; lateroanterior, 87.4+/-5% vs. 91.4+/-4.7%; and lateroinferior, 86.0+/-6.0% vs. 91.7+/-7.0%. The uptake value of the remaining walls in patients with SBIs were not significantly different than the control subjects. In conclusion, SBIs did cause a significant decrease in uptake values of the myocardial walls, which should be considered during interpretation of the images.

Evaluation of soft-tissue morphology of the face in 1,050 young adults.

Anthropometry of the face has always been an interesting subject for artists and plastic surgeons. Since ancient times, many rules have been proposed for the ideal face. The authors measured directly vertical and horizontal proportions of the face and inclinations of the soft-tissue facial profile in 1050 young Turkish adults. Differences between the facial measurements of subjects from seven different geographic regions were analyzed. Some of the measurements were compared further with the measurements of other populations in the literature, and the validity of the neoclassical canons were tested. The special head height measure was shorter than the special face height in the majority of our study group (women/men: equal height, 13%/15%; longer special head height, 28%/30%; shorter special head height, 59%/55%). Faces with three equally high-profile sections were not seen in women or in men. When the forehead height was compared with the nose height, equality was present in a small percentage of the population (women/men: equal height, 17%/18%; longer forehead, 41%/ 42%; shorter forehead, 42%/40%). The nose height was equal to the lower face height in a minority of the population (women/men: equal height, 10%/11%; longer nose, 9%/11%; shorter nose (81%/78%). The forehead height was shorter than the lower face height in the majority of the population (women/ men: equal height, 8%/9%; longer forehead, 12%/13%; shorter forehead, 79%/78%). The intercanthal distance was shorter than the nose width in the majority of the population (women/men: equal width, 20%/19%; wider intercanthal distance, 35%/37%; narrower intercanthal width, 65%/68%). The population was distributed evenly in regard to the variations of the orbital proportion canon (women/men: equal intercanthal width and eye fissure length, 31%/36%; wider intercanthal distance, 34%/27%; narrower intercanthal width, 35%/37%). The mouth width was greater than 1.5 times the nose width in the majority of the population (women/men: equal width, 6%/5%; wider mouth, 53%/54%; narrower mouth, 41%/41%). The nose width was narrower than one quarter of the face width in the majority of the population (women/men: equal width, 4%/3%; wider nose, 30%/39%; narrower nose, 66%/58%). The nose inclination was equal to the ear inclination in a very small fraction of subjects (women/ men: equal inclination, 3%/3%; greater nose inclination, 88%/87%; less nose inclination, 9%/9%). To sketch an outline of the average facial profile in the population studied, a convex facial profile is revealed, with the forehead and the chin retrodisplaced minimally with respect to the midface. The neoclassical canons were found to be invalid for the majority of the population in this study, and different proportional analytic results were obtained.

The effect of onlay Medpor implants on mandibular growth in young rabbits: an experimental study.

Medpor implants were placed on the periosteum of the mandible in infant rabbits to study their effects on growth. Three months later radiological and histopathological studies were performed in situ and after removal of the mandible. The authors demonstrate that implants did not affect normal development of the mandible; however, there was a decrease in bone thickness and a mononuclear cell reaction was caused where the implant came in contact with the bone.

Spontaneous autoinflation of saline-filled mammary implants: postoperative volume determination by magnetic resonance imaging.

Autoinflation of saline-filled mammary implants has recently been reported in the literature. Except for a few controversial hypotheses, the cause of autoinflation has not been clarified. The need to remove implants for accurate measurement of fill volume has been a deterrent to studies of autoinflation. To measure in situ volumes of saline-filled mammary implants, a noninvasive technique using magnetic resonance imaging (MRI) was developed. Measurements were performed manually on every MRI slice by tracing the outline of the implant with a hand-driven cursor. The accuracy of this MRI technique was assessed by measurements of tissue expanders containing known volumes of saline. To evaluate for autoinflation in mammary implants, a prospective clinical study to compare initial fill volumes of saline-filled mammary implants with 3- and 18-month postoperative volumes, calculated from magnetic resonance imaging (MRI) studies, was designed. A total of 12 patients (23 breast implants) implanted between 1994 and 1996 was included in the study. Volume data were compared by statistical analysis. MRI-determined volumes 3 months postoperatively were significantly larger than reported initial fill volumes, indicating that most saline-filled mammary implants included in the study autoinflated to some extent. Comparison of MRI-determined volumes 3 and 18 months postoperatively revealed no significant differences, indicating that saline-filled mammary implants remain stable and inflated between 3 and 18 months postoperatively. As a result of this study we believe that autoinflation of saline-filled mammary implants occurs more frequently than previously thought.

Life satisfaction, self-esteem, and body image: a psychosocial evaluation of aesthetic and reconstructive surgery candidates.

Psychology should be an important part of a plastic surgery procedure in order to buoy up the patient so that he gains a consequent relief of psychiatric and social problems. It is a fact that reconstructive surgery patients also seek psychological stability and a better appearance that is acceptable to society. While the life satisfaction, self-esteem, and body image of the individual who seeks aesthetic plastic surgery has been a special concern in the plastic surgery literature, data about reconstructive surgery patients are usually lacking. To understand the factors influencing the aim of an individual seeking plastic surgery, this prospective controlled clinical study was designed. We hypothesized that they should have lower life satisfaction and self-esteem and more distorted body images than the "normal" population. Three hundred individuals were included in the study. Both the aesthetic surgery group (AG) and the reconstructive surgery group (RG) consist of 100 (n = 100) subjects. Individuals chosen randomly from the total population seen in the 12-month period were included regardless of the type of procedure, body region, or type of trauma as well as whether or not their wish for surgery was justified by the staff. The third group, the control group (CG), also consists of 100 (n = 100) subjects and was chosen from the "normal" population. All 300 subjects were asked to complete four scales: the Socio-Demographic Questionnaire, Life-Satisfaction Index (LSI), Self-Esteem Inventory (SEI), and Body-Image Inventory (BII). Results were collected and compared. The LSI results for the two surgical groups were found to be similar to those for the CG, with the RG demonstrating the lowest level. For the SEI there was a significant difference between the two surgical groups, being in favor of the AG, and a greater difference was noted between the CG and the RG. BII results showed no significant difference among the three groups. As a result, although there may be some, a regular person who seeks an aesthetic procedure should not be considered a psychologically disturbed individual at face value and each case should be evaluated individually in the preoperative consultation. Similarly, individuals who present for reconstructive procedures and wish further aesthetic refinements should be evaluated and treated exactly as pure aesthetic candidates.

Metastatic malignant blue nevus: a case report.

This report presents a 63-year-old Caucasian woman with a malignant blue nevus, which is an extremely rare form of melanoma originating from or associated with a preexisting blue nevus. The background blue nevus on the left upper arm, which had been present for 5 to 6 years, increased in size and darkened in color for 3 months prior to histological diagnosis of malignant blue nevus. Although the tumor looked much like a nodular melanoma clinically, the diagnosis of malignant blue nevus was established histologically. The patient had a poor outcome due to metastatic spread of the tumor to the visceral organs 1 year following the initial excision of the tumor. To distinguish this rare tumor from other melanocytic lesions, strict histological criteria are needed to make the diagnosis of malignant blue nevus. Differential diagnosis includes cellular blue nevus, atypical cellular blue nevus, primary malignant melanoma, and metastatic melanoma to the dermis. Malignant blue nevus is most commonly seen on the scalp. The tumor has an aggressive behavior and metastasizes in the majority of patients. This paper describes the second reported case of malignant blue nevus involving the upper arm. Clinical and histological features of this uncommon tumor are presented, along with a review of the literature.

A case of popliteal pterygium treated along with nerve expansion.

The presence of a short sciatic nerve in the free edge of a popliteal pterygium makes this syndrome a surgical challenge. We present a case of popliteal pterygium that was treated by nerve expansion. The range of motion of the patient's knee joint was between 30 and 120 degrees. A 75-cc tissue expander was placed under the sciatic nerve and filled with 5 cc of saline solution weekly. When a total of 60 cc was reached, wound dehiscence was observed, and the procedure had to be stopped. The maximum extension obtained was 160 degrees. Since the expansion process had to be stopped early, the elongation attained by expansion was less than expected. We conclude that the nerve expansion method can be used as a good alternative treatment modality for patients with popliteal pterygium.