The relationship between depression, anxiety, personality traits and coping strategies of patients with euthyroid Hashimoto's Thyroiditis

Background and objectives: We aimed to investigate the depression and anxiety levels and to explore the coping strategies and personality traits of patients with euthyroid Hashimoto Thyroiditis (HT). Methods: The study population consisted of 108 outpatients with euthyroid HT. The participants completed the Hospital Anxiety and Depression Scale (HADS), the Big Five Personality Inventory (BFI), and the Coping With Problems Experienced Inventory (COPE). Results: Depression scores were negatively correlated with emotion-focused and problem-focused coping style scores. Emotion-focused and problem-focused coping style scores were negatively correlated with neuroticism, and positively correlated with openness scores. Emotion-focused coping style scores were also positively correlated with agreeableness scores. Dysfunctional coping style scores were negatively correlated with conscientiousness scores. Higher agreeableness and anxiety scores as well as lower neuroticism scores were predictive of emotion-focused coping style scores. Problem-focused coping style scores were predicted by lower depression scores. Dysfunctional coping style scores were predicted by lower conscientiousness scores. Conclusions: The present study points the importance of taking personality features and individual coping strategies into account when evaluating patients with HT. Determining the personality features and coping strategies might be useful for identifying patients in need of particular counseling and support

No disponible

Rare craniofacial anomaly: Tessier no. 2 cleft.

Four cases of facial cleft that fit the anatomic description of the rare Tessier no. 2 cleft, with two patients having the no. 12 cleft extending to the cranium as no. 2 clefts, are presented. In all patients, clinical expressions of the anomaly were different. Thus, diverse surgical procedures were used in all cases. These cases and review of the literature help to define the soft-tissue and bony course of these clefts, and also emphasize the role of three-dimensional computed tomography scan imaging to show the bony cleft route. The diagnosis and treatment plan of the no. 2 cleft as well as its cranial counterpart are discussed in this report.

Cross-facial nerve grafting as an adjunct to hypoglossal-facial nerve crossover in reanimation of early facial paralysis: clinical and electrophysiological evaluation.

Reanimation of a spontaneous and synchronous smile, and sufficient depressor mechanism of the lower lip presents a surgical challenge in facial paralysis. Hypoglossal-facial nerve crossover and cross-facial nerve grafting are the best options if the mimetic muscles around the mouth are still viable in patients in whom the facial nerve was sacrificed at the brainstem. Although good muscle tone and facial motion have been obtained by hypoglossal-facial nerve crossover, smile is dependent on conscious tongue movement. Cross-facial nerve grafting provides a voluntary and emotion-driven smile, but requires two coaptation sites, which leads to substantial axonal loss and a long regeneration time. This method was not successful in activating the depressor mechanism. The first stage is the classic "baby-sitting" procedure, in which the bulk of the mimetic muscles was maintained by the rapid reinnervation of the hypoglossal-facial nerve crossover during the regeneration period of the cross-facial nerve graft, and temporalis muscle transfer to the eyelids is performed. During the second stage, the cross-facial nerve graft that used the thickest zygomaticobuccal branch on the healthy side was coapted with the corresponding branches on the paralyzed side. The hypoglossal-facial nerve crossover continued to innervate the depressor muscles. Good spontaneous smile and sufficient depressor mechanism were achieved by cross-facial nerve grafting and hypoglossal-facial nerve crossover respectively, and these techniques are demonstrated by the authors clinically and electrophysiologically.

Marjolin's ulcers arising in burn scars.

Epidermoid carcinoma in nonhealing scar tissue, known as Marjolin's ulcer, is not uncommon and is thought to behave in a more aggressive fashion than those from other causes. Between 1982 and 1997, 56 patients with Marjolin's ulcer were treated at our center, Ege University Medical School, Izmir, Turkey. All lesions were secondary to various kinds of burns. Forty of these patients could be followed up 5 years or more. These 40 patients' medical records were reviewed retrospectively.

Nasal dermoid sinus cysts and the role of open rhinoplasty.

All suspected congenital abnormalities of the nose require further evaluation. The nasal dermoid sinus cyst (NDSC) is one of the many midline nasal masses that often pose diagnostic and treatment dilemmas for the plastic and reconstructive surgeon. NDSCs are distinct from other facial dermoids in their potential for involving deeper contiguous structures, and intracranial extension. Accurate diagnosis and effective treatment are essential to avoid craniofacial skeletal deformation, cyst rupture, and infection that could cause cutaneous, ocular, or intracranial complications. A comprehensive discussion of the embryogenesis, pathogenesis, diagnosis, and surgical management of the NDSC is presented to delineate the role of open rhinoplasty in optimizing the management of this congenital nasal deformity.

Reanimation of early facial paralysis with hypoglossal/facial end-to-side neurorrhaphy: a new approach.

The classic hypoglossal transfer to the facial nerve invariably results in profound functional deficits in speech, mastication, and swallowing, and causes synkinesis and involuntary movements in the facial muscles despite good reanimation. Techniques such as a hypoglossal/facial nerve interpositional jump graft and splitting the hypoglossal nerve cause poor functional results in facial reanimation and mild-to-moderate hemiglossal atrophy, respectively. Direct hypoglossal/facial nerve cross-over through end-to-side coaptation without tension was done in three fresh cadavers and four patients. The patients had facial paralysis for less than 7 months. Complete mobilization of the facial nerve trunk and its main branches beyond the pes anserinus from the stylomastoid foramen, division of the frontal branch, if necessary, and superior elevation of the hypoglossal nerve after dividing the descendens hypoglossi, thyrohyoidal branches, occipital artery, and retromandibular veins were performed. The end of the facial nerve was hooked up through both a quarter of a partial oblique neurotomy and a perineurial window at the side of the hypoglossal nerve. Temporalis muscle transfer to the eyelids and the first stage of cross-facial nerve transfer were performed simultaneously. None of the patients experienced hemiglossal atrophy, synkinesis, and involuntary movements of the facial muscles. Regarding facial reanimation, one patient had excellent, one patient good, and the others fair and poor results after a follow-up of at least 1 year.

The role of periosteum and different dissection types on callus formation: quantitative analyses with scintigraphy in a rabbit mandible model.

In this experimental study, the effects of different dissection types and the role of the periosteum on callus formation were investigated. Forty-five rabbits were divided into three groups of 15 rabbits. In the first group, a classic subperiosteal dissection was performed to reach the mandible. In the second group, the dissection was done extraperiosteally between the periosteum and the muscle. In the third group, the periosteum at the osteotomy line was stripped out bilaterally both on the lingual and the buccal sides (1.5 cm wide on each side). In all groups, linear vertical osteotomy was performed using an oscillating saw, and fracture fragments were fixed with surgical wire. The animals were evaluated using biomechanical (traction test), histological, and scintigraphic methods. The most durable callus in the traction test and, scintigraphically, the most rapid remodeling were seen in the second group. The histological study performed during week 3 revealed immature callus formation in the first and second groups, and no such formation in the third group. At week 8 the callus was mature in the first two groups and in the third group it was seen but not mature.

Transsacral usage of a pure island TRAM flap for a large sacral defect: a case report.

A pedicled transverse rectus abdominis musculocutaneous (TRAM) flap was used to reconstruct a large sacral defect retroperitoneally. Muscle and superiorly located skin were elevated on the deep inferior epigastric pedicle. The flap was transposed retroperitoneally from the abdominal wall to the sacral region of the patient. The selection criteria for this particular flap are discussed and compared with other reconstructive choices.

Complications in craniofacial surgery: the Turkish experience.

The records of 71 patients who underwent 75 consecutive craniofacial procedures involving a transcranial component have been analyzed retrospectively to assess the incidence and type of complications encountered during the 14-year period of 1985 to 1998 at Ege University Hospital, Department of Plastic and Reconstructive Surgery. The results were compared with those of similar reports from other craniofacial centers. Operations were classified into six groups according to their type to evaluate effectively their complication rates. Complications were also graded in terms of their severity. Serious complications were seen in 12 patients (16.8%), whereas life-threatening complications were seen in 6 patients (8, 4). The mortality rate was 2.7%. It is determined that complication incidence was notably higher in the group that underwent monobloc frontofacial advancement. A decrease in the rate of serious complications occurred with increased experience with the surgery. The results of our study indicate that although craniofacial surgery carries an inherent risk for significant complications, the risk can be minimized and the rate of mortality and major complications kept to an acceptable level by a careful and experienced craniofacial team.

Modified temporalis muscle transfer for paralytic eyelids.

The major problems in paralytic eyelids are the inability to close the eye, lower lid sagging, and epiphora. The upper eyelid is responsible for most of the opening and closing of the eye, whereas a lower eyelid positioned properly against the globe is necessary for collection and flow of the tear fluid. Modification of temporalis muscle transfer, a classic technique, was planned to restore these functions selectively in paralytic eyelids. Twelve unilateral and one bilateral irreversible facial paralysis patients with different degrees of lagophthalmos and ectropion were included. Twice as much muscle mass (in thickness) to the upper eyelid than the lower was taken and passed submuscularly 5 to 6 mm away from the limbus for stronger motion of the upper eyelid, and a thinner muscle mass was passed subcutaneously beneath the lower cilia for longevity of the correction of ectropion and epiphora. Fixation of these strips was performed to the medial canthal ligament and 3 to 4 mm above it. The average duration of follow-up was 35.5 months. Excellent eyelid closure and correction of ectropion and epiphora were achieved with one procedure in all patients without creating a cosmetic deformity.

Modified McIndoe procedure for vaginal agenesis.

Between 1982 and 1997, 29 patients with congenital absence of the vagina underwent modified McIndoe vaginoplasty at the Division of Plastic and Reconstructive Surgery, Ege University Medical School, Izmir, Turkey. As a modification, an X incision was utilized instead of a straight-line horizontal or sagittal incision. During the first postoperative week, a perforated Pyrex rigid mold was used. This was replaced with an unperforated mold at the end of the first week. These patients' medical records were reviewed retrospectively. Complications encountered included infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, and vaginal stricture. All complications were treated except the stress urinary incontinence, and the final results were satisfactory.

A modified fixation method in supraorbital bar advancement.

In almost all congenital craniofacial deformity reconstructions there is a need to advance the supraorbital bar. This bar, which is fixed by several techniques, should be firm enough to minimize a relapse. In this paper a new modification during osteotomy of the supraorbital bar is presented that provides firmness and prevents relapse even without grafts. The last 15 patients with craniofacial anomalies were operated with this modification. At the stage of the supraorbital bar osteotomy, bilateral small triangles are created at the end of the bar. Then, on the lateral orbital rim, two small notches are created in which to place these triangles. By fixating these triangles to the notches, sliding of the bar and subsequent relapse is prevented, and also the fixation provided is much more rigid.

Aplasia cutis congenita with epidermolysis bullosa: a case report.

A child with epidermolysis bullosa and aplasia cutis congenita is presented. This is a very rare condition that represents an unusual manifestation of epidermolysis bullosa. Management of aplasia cutis congenita is controversial and may be conservative, surgical, or a combination of the two. In this patient, surgical treatment with split-thickness skin grafts failed, and conservative treatment using silver-sulfadiazine cream dressings was instituted.

Management of frontoethmoidal (sincipital) encephalocele.

Frontoethmoidal encephaloceles are congenital malformations that cause complex deformities in the frontal, orbital, and nasal regions. As the term implies, with frontoethmoidal encephaloceles, intracranial material has herniated through the dural and skull defect. In this report, 21 patients with frontoethmoidal encephalocele operated by a craniofacial team are presented, and accompanying anomalies, results, and complications are discussed.

Prophylactic use of ondansetron for emesis after craniofacial operations in children.

Children who undergo craniofacial operations are especially at risk of postoperative nausea and vomiting. These operations are more complex than the craniotomies for resective procedures. Postoperative vomiting is a common occurrence that can delay recovery and result in cerebrospinal fluid leak and fistula formation in these patients. Ondansetron, a selective serotonergic antagonist, is effective in reducing postoperative nausea and vomiting in several high-risk populations. In a randomized, double-blind, placebo-controlled study, the authors compared the prophylactic use of intravenous ondansetron 0.15 mg/kg with induction of anesthesia versus a placebo of normal saline 0.3 ml/kg with induction. A second dose was given 8 hours after the first dose. After surgery, episodes of vomiting were recorded separately in 0 to 2 hours, 2 to 6 hours, 6 to 12 hours, 12 to 24 hours, and 24 to 48 hours. Postoperative vomiting is significantly reduced in the ondansetron group compared with the placebo group (P = 0.000258). Ondansetron is effective in the prevention of postoperative vomiting in the pediatric population undergoing craniofacial operations.

Congenital infiltrating lipomatosis of the face.

Congenital infiltrating lipomatosis of the face is a rare clinical entity. Since it was first described by Slavin and colleagues in 1989, only a few cases have been reported in the literature. A 6-year-old girl with congenital infiltrating lipomatosis of the right side of the face is presented, and treatment modalities are discussed.

Intraorbital osteoma and surgical strategy.

The most common tumoral lesion of the bony orbital region is osteoma. It is an infrequent and benign tumor, and generally attacks the craniofacial skeleton, but intraorbital involvement is extremely rare. After necessary radiologic examinations (radiographs and computed tomography scanning), surgery should be planned according to the tumor's localization. In the case presented here, osteoma originated mainly from the medial orbital wall. Therefore, for better surgical exposure, extra- and intracranial approaches were planned and carried out. The mass was removed successfully. At the 3-year follow-up, no recurrence was shown.

Gunshot wounds of the face in attempted suicide patients.

PURPOSE: The purpose of this retrospective study was to evaluate the functional and cosmetic results of the treatment of gunshot wounds associated with attempted suicide that resulted in facial injury. PATIENTS AND METHODS: The records of 12 patients with facial injury resulting from gunshot wounds with a suicidal origin, who were hospitalized and treated at Ege University Hospital, Department of Plastic and Reconstructive Surgery, were reviewed. RESULTS: All injuries were limited to the head and neck region; in only one patient did intracranial penetration occur. Mandibular fractures were detected in all cases. Fractures of the maxilla were present in 11 patients. Eight patients suffered from zygomatic fractures. Perforating ocular trauma was present in two cases. Soft tissue repair was performed by primary closure, local flaps, or skin grafts, and rigid fixation was used for fractures. Procedures such as distant flaps or bone grafting were left for delayed reconstruction. CONCLUSION: Only 3 of 12 patients returned for follow-up and reconstruction. It was therefore concluded that relatives of these patients believe that the repair of such deformities, even if it is a functional deformity, is not necessary. Thus, in such cases, one should do as much reconstruction as possible at the primary surgical intervention.