A novel method for flap delay vacuum assisted flap delay: an experimental study in rabbits.

Flaps are the workhorse of plastic surgery practice. The delay procedures have been defined to prevent flap necrosis. The golden standard method of delay is a surgical delay. On the other hand, a major drawback of surgical delay is two sessions of surgery. Efforts have been made to omit one session and increase the patient safety and decrease the costs. The writer's aim was to evaluate the effects of topical negative pressure, applied prior to flap elevation, on flap survival, perfusion and compare the results with the surgical delay. In a rabbit random flap model, prior to elevation, the writers used a topical negative pressure system on the lateral thoracic region of, for induction of delay and compared the results with surgical delay and the control group. The total and necrotic flap areas, necrosis ratio, histomorphometric vascular density, immunohistochemical evaluation of neovascularization (CD31/CD34), Laser Doppler images and computerized tomography contrast uptake were used to compare the groups. In all of the parameters, the vacuum assisted flap delay was equivalent to surgical delay. Both were superior to non-delayed flaps. Control group had 65.56 ± 18.02% flap necrosis rate, while Surgical Delay group had 37.31 ± 30.74% and Vacuum Assisted Flap Delay group had 19.58 ± 27.35%. Vacuum Assisted Flap Delay did not require an extra operation for the delay procedure. The mechanism of action in the vacuum-assisted flap delay is unclear. The clinical significance should be studied further. However, vacuum assisted flap delay seems to be a promising method in the clinical setting.

New Evidence for Causal Central Mechanism of Hyperglycemia in Subarachnoid Hemorrhage Secondary to Ischemic Degenerative Disruption of Circuitry Among Insular Cortex, Nodose Ganglion, and Pancreas: Experimental Study.

INTRODUCTION: Although hyperglycemia is a serious complication of subarachnoid hemorrhage, its pathophysiologic mechanism based on neural circuitry has not been known. MATERIALS AND METHODS: Twenty-five rabbits were divided into 4 groups, with 5 in the control group. The SHAM and study groups received 1 mL saline and 1 mL autologous arterial blood into the sylvian cisterna, respectively. Blood glucose values (BGVs) of all animals were recorded 3 times weekly. After 2 weeks, animals were decapitated. BGVs, the number of normal and degenerated neuron densities (DNDs) of insular cortex (IC), and nodose ganglia, degenerated islands of Reil's surfaces values, were estimated by stereologically and analyzed statistically. RESULTS: The mean blood glucose values were measured as 101 ± 10 mg/dL in the control group (n = 5), 114 ± 11 mg/dL in the SHAM group (n = 5), and 137 ± 12 mg/dL in the subarachnoid hemorrhage (SAH) group (n = 15). The DND of the nodose ganglion was 10 ± 3/mm3 in the control group, while it was 45 ± 7/mm3 in the SHAM group and 1688 ± 191/mm3 in the SAH group. The DND of the IC was 65 ± 12/mm3 in the control group, 689 ± 112/mm3 in the SHAM group, and 3709 ± 643/mm3 in the SAH group. In addition, the proportion of degenerated surface areas in the islet of Langerhans was 0.3% in the control group, 6% in the SHAM group, and 28% in the SAH group. CONCLUSION: There is an important linear relationship among the blood glucose levels, DND of the IC, and nodose ganglia and degenerated surface areas of IL following experimentally induced sylvian SAH.

The prevalence of coronary artery anomalies with coronary computed tomography.

BACKGROUND/AIM: In this study, the aim is to investigate the prevalence of various coronary artery anomalies (CAAs), evaluated by 256-detector row coronary computed tomography (CCT), within the Turkish population. MATERIALS AND METHODS: We included 2973 patients who had received CCT. The high take-off right coronary artery (RCA) and left coronary artery (LCA), the RCA arising from the left sinus (LS), the LCA arising from the right sinus (RS), the circumflex artery (CX) arising from the RS, the single coronary ostium originating from the RS, the CX arising from the RCA, and the RCA arising from the pulmonary artery were evaluated. RESULTS: Seventy-nine patients (2.65%) were diagnosed with CAAs. The frequency of high take-off of the RCA, LCA, and both was 0.1%, 0.67%, and 0.06%, respectively. Frequency of separate ostium of the left anterior descending artery and CX was 0.67%. The frequency of RCA originating from the LS, CX originating from the RS, LCA originating from the RS, LCA and RCA originating from the pulmonary artery, and CX originating from the RCA was 0.50%, 0.10%, 0.23%, 0.03%, and 0.20%, respectively. CONCLUSION: In this study, CCT was demonstrated to be a high-quality imaging modality for the detection of CAAs.

How to close open choledochotomy: primary closure, primary closurewith T-tube drainage, or choledochoduodenostomy?

BACKGROUND/AIM: Although common bile duct stones are generally treated endoscopically, surgery is required if endoscopic removal is impossible. The aim of this study was to compare the surgical options in such patients. MATERIALS AND METHODS: A total of 282 patients with common bile duct stones underwent open choledochotomy; primary closure was applied in 48 (17.0%), primary closure with T-tube drainage in 81 (28.7%), and choledochoduodenostomy in 153 (54.3%) patients. RESULTS: Postoperative complications were seen in 8 (16.7%) patients in the primary closure, 33 (40.7%) patients in the primary closure with T-drainage, and 37 (24.2%) patients in the choledochoduodenostomy group. No significant differences were observed among the groups (P > 0.05). The mean postoperative hospital stays in the primary closure, primary closure with T-tube drainage, and choledochoduodenostomy groups were 5.5, 13.5, and 8.9 days, respectively. The mean postoperative hospitalization was significantly shorter in the primary closure group than in the other groups (P < 0.05). CONCLUSION: Primary closure is a safe and feasible method in selected patients.

An isolated single L-II type coronary artery anomaly: A rare coronary anomaly.

The incidence of congenital artery anomalies is 0.2-1.4%, and most are benign. Single coronary artery (SCA) anomalies are very rare. The right coronary artery (RCA) originating from the left coronary system is one such SCA anomaly, and the risk of sudden cardiac death (SCD) increases if it courses between the pulmonary artery and aorta and coexists with other congenital heart diseases. Additionally, coursing of the RCA between the great vessels increases the risk of atherosclerosis. We herein present the case of a 57 year-old man who was admitted to our cardiology outpatient clinic and diagnosed with an SCA anomaly in which the RCA arose from the left main coronary artery (LMCA) and coursed between the pulmonary artery and aorta. However a critical stenosis was not detected in imaging techniques, and myocardial perfusion scintigraphic evidence of ischaemia was found in a small area. Therefore, he was managed with conservative medical therapy.

Evaluation of hepatocellular carcinoma with computed tomography perfusion imaging.

AIM: To evaluate the role of computed tomography (CT) perfusion imaging in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Seventeen patients (9 men, 8 women) with newly diagnosed HCC, proven by biopsy, were evaluated with 256-slice helical CT. Perfusion parameters of blood flow (BF), blood volume (BV), arterial perfusion (AP), portal perfusion (PP), and hepatic perfusion index (HPI) were calculated in the normal liver parenchyma and HCC samples. RESULTS: A total of 21 histologically proven HCC lesions were evaluated from CT perfusion images. BF, BV, AP, and HPI values were shown to be significantly higher (P < 0.05) in the HCC lesions than in the normal liver parenchyma. Conversely, PP values were found to be significantly lower (P < 0.05) in HCC relative to liver parenchyma. CONCLUSION: CT perfusion imaging has the ability to evaluate tumor assessment, characterization, and neoangiogenesis in HCC.