Effect of Transplant on Platelet Function Markers (P-Selectin and Platelet Aggregation) and Adiponectin in Renal Transplant Patients.

OBJECTIVES: In chronic kidney disease, both bleeding and thrombotic complications are observed, although with expected recovery after a successful transplant. Adiponectin has protective properties with respect to atherogenesis and inflammation. Plasma adiponectin levels are markedly elevated among patients with end-stage renal disease and are lower after kidney transplant. However, this topic is still debated in the literature. Here, we evaluated the effect of transplant on platelet function markers (P-selectin and platelet aggregation) and adiponectin in renal transplant patients. MATERIALS AND METHODS: Our study included 14 renal transplant patients. Preoperative and week 1, month 1, month 6, year 1, and year 2 samples after transplant were studied. In addition to plasma adiponectin, P-selectin levels, and platelet aggregation tests, biochemical tests and coagulation parameters were also studied. RESULTS: We observed a significant decrease in adiponectin levels 2 years after transplant. Platelet function tests with ADP and collagen were significantly improved, and no changes in P-selectin, ristocetin, and epinephrine levels were observed. CONCLUSIONS: According to our findings, glomerular filtration rate has an important effect on platelet function, but adiponectin levels became normal only in the second year after transplant. Late improvement of low-density lipoprotein cholesterol and adiponectin after transplant suggested to us that patients with kidney transplant may still have risk of cardiovascular events, especially in the first years.

Pauci-immune lupus nephritis: possibility or co-incidence?

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized with immune complex formation and renal involvement of lupus and may include several kinds of pathological conditions, but mostly, it is associated with immune complex-induced glomerular disease. Pauci-immune lupus nephritis is a very rare condition. We describe a 45-year-old female patient with pauci-immune crescentic necrotizing lupus nephritis and briefly discuss the possible mechanism and pathogenesis.

A Rare Type of Upper Extremity Injury: Penetrating Injuries Caused by Blunt-edged Items.

BACKGROUND: Penetrating upper extremity injury is a common encountered cause of significant loss of labor force and it is generally caused by sharp items. This article presents five rare cases of penetrating hand and forearm injury caused by blunt-edged items in conjunction with a detailed discussion of the mechanism and management of the injury. METHODS: Five patients with a mean age of 37.6 were treated for upper extremity trauma caused by "blunt-edged items" such as corrugated iron fence, garden wires, iron stick or iron safety fence between 2009 to 2014. All patients were operated under general anesthesia after performing detailed physical examination and x-ray imaging. RESULTS: The explorative surgery of the affected limbs revealed no nervous or vascular injury. In two patients, partial tear of the muscles bellies of intrinsic hand muscles (opponens pollicis and adductor pollicis); in two patients, partial extensor digitorum communis tendon laceration and in the remaining patient, partial tear of the third annular pulley were the only encountered injuries. The physical examinations performed in the last visit of each patient revealed, complete healing of the affected limb without any functional, vascular or sensorial deficiency in a mean follow-up period of 19.2 months. CONCLUSIONS: Despite their initial horrible appearance, injuries caused by "blunt-edged items" are quite harmless to the affected limb because they follow weak anatomic spaces of the extremity and cause minimal tissue damage leaving all vascular and nervous structures intact.

Effects of Deferoxamine on Fat Graft Survival.

The most important problem in fat transplantation is the unpredictable rates of resorption. Deferoxamine (DFO) is an iron-chelating agent with many useful functions including stimulating angiogenesis and antioxidant nature. The purpose of the study is to evaluate the effects of DFO on fat graft viability in rat model. A total of 24 Wistar rats were divided into three groups and 0.5 g of the left inguinal fat pad was extracted. In control group, fat grafts were implanted to the parascapular area without performing any procedure. In sham group, they were implanted in 0.2 mL saline solution followed by serial saline injections for 1 month. In the study group, fat grafts were implanted in 0.2 mL saline solution and 300 mg DFO followed by serial DFO injections for 1 month. At the postoperative second month, fat grafts were taken back and sent for histopathologic examination. The weight measurements of biopsy specimens in the study group demonstrated significantly higher than in the other two groups. Inflammation and fibrosis rates were also found to be significantly higher in the study group compared with the other groups; however, no significant difference in the apoptosis rates was detected between the groups. Fat grafts enriched with DFO showed significant increase in fatty tissue content in the study group compared with the control and sham groups. DFO increases the fat graft survival in rats and it may be a useful addition in autologous fat grafting procedures to increase fat graft viability and obtain maximal long-term durability.

Increasing the survival of transverse rectus abdominis musculocutaneous flaps with a Botulinum toxin-A injection: A comparison of surgical and chemical flap delay methods.

BACKGROUND: Botulinum toxin type-A (Bot-A) is a commonly used drug for both cosmetic and therapeutic purposes. The effects of Bot-A on skin and muscle flaps and the related mechanisms have been described previously. In this study, we used a rat transverse rectus abdominis musculocutaneous (TRAM) flap model to examine the effects of Bot-A on the skin island, which is perfused by the rectus abdominis muscle according to the angiosome concept. METHODS: Forty female rats were divided into five groups, including control and sham groups. In the control group, a TRAM flap was raised and sutured back after inserting a silicone sheath underneath the flap. In the sham group, the flap was raised 1 month after injecting saline into the muscle. In the chemical delay group, the flap was raised 1 month after injecting 10 IU of Bot-A. In the surgical delay group, the flap was raised 2 weeks after ligating the cranial epigastric artery. In the surgical and chemical delay group, a Bot-A injection was performed initially, a cranial epigastric artery was ligated after 2 weeks, and a TRAM flap was raised after the first month. In all groups, laser Doppler examination, photographic documentation, and analysis of the flap survival rates were performed. In the histopathological evaluation, the diameter measurements of the caudal epigastric vessels, vascular density measurements using CD31 stain, and apoptotic rate estimation using the Tunnel method were performed. RESULTS: The necrosis ratios, arterial cross-sectional diameters, and microvascular density measurements were significantly superior compared to those of control and sham groups; however, there was no significant difference between the delay groups. There was also no difference in the laser Doppler measurements between the groups and the zones of the TRAM flaps. CONCLUSION: An injection of Bot-A increases muscular circulation and flap survival of TRAM flaps in rats.

Extradigital Glomus Tumor Revisited: Painful Subcutaneous Nodules Located in Various Parts of the Body.

BACKGROUND: Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors located outside the hand region are rare and the diagnosis is often difficult due to their low incidence and lack of distinct clinical features in the physical examination. The presented article contains five cases of extradigital glomus tumors with a short review of the literature. PATIENTS AND METHODS: Five cases of extradigital glomus tumor were included in the study. All lesions were purple colored subcutaneous nodules with sharp pain by digital palpation. All lesions were examined with ultrasound imaging were operated under local anesthesia using loupe magnification. RESULTS: Among five patients, only one patient was female with a mean age of 35. Two lesions were located at the arm region, two at the crural region and one at the sternal area. The smallest nodule was 0.5 cm and the biggest lesion was 2 cm in diameter. In all the cases, the early postoperative period was uneventful without any surgical complication or acute recurrence. The postoperative 1(st) year examination of all patients revealed complete resolution of the pain and no recurrence was encountered. CONCLUSIONS: Glomus tumor should be kept in mind in the differential diagnosis of all painful subcutaneous lesions especially for those with purple reflection on the skin surface. In this manner, patients with extradigital glomus tumors may be diagnosed earlier and unnecessary and wrong treatments may be prevented.

Effects of cinacalcet treatment on QT interval in hemodialysis patients.

OBJECTIVE: Cinacalcet is a calcimimetic drug that acts via calcium-sensing receptors (CaSRs) and increases the sensitivity of CaSRs on the parathyroid gland; thus, it lowers calcium and phosphorus levels as well as parathormone levels. Prolongation of the QT interval is recognized as a risk factor for the development of ventricular arrhythmias and sudden death. Patients with end-stage renal disease (ESRD) are sensitive for QT prolongation and torsade de pointes more than the normal population. In this study, we aimed to evaluate the effects of cinacalcet on the electrocardiogram (ECG), particularly changes in the QT interval, in patients with ESRD. METHODS: Thirty-seven patients (21 males and 16 females) undergoing maintenance hemodialysis for at least 12 months were included in this retrospective study. Patients receiving cardioactive and antiarrhythmic drugs and those having a history of any cardiac or cerebrovascular events, active malignancy, and infections were excluded. Baseline ECG measurements of patients were performed over the newest ECG measurements that were obtained within 1 month before initiating the cinacalcet treatment, and the ECG measurements of patients after the cinacalcet treatment were performed according to the most recent ECG that was taken within the last 1 week in the clinic. We recorded the heart rate and QT values of patients before and after treatment and then calculated the corrected QT values (QTc). The Statistical Package for the Social Sciences (SPSS) ver. 21.0 was used for statistical analysis. RESULTS: The mean age of patients was 52.24±14.49 years. Prolongation of QTc was statistically significant compared with the baseline QTc value (baseline: 396.62±42.04 msec; after treatment: 404.97±43.47 msec; p=0.031). We found a positive correlation between the prolongation of QTc and treatment dose of cinacalcet (p<0.005, r=0.560). CONCLUSION: Clinicians should be very careful for life threatening cardiac side effects while increasing the dose of cinacalcet treatment in hemodialysis patients who have a borderline or prolonged QTc interval.

Effects of Different Concentrations of Injectable Collagenase Enzyme on Capsular Tissue Around Silicone Implants: A Preliminary Experimental Study for the Development of a New Treatment Strategy.

OBJECTIVES: In recent studies, collagen organization was blamed for the formation of capsular contracture which is still a challenging problem after silicone implant-based breast operations. In this study, effects of different concentrations of collagenase enzyme derived from Clostridium histolyticum on the capsular tissue formation around the silicone implants were investigated. The injectable form of collagenase has a routine clinical use in the treatment of both Dupuytren's and Peyronie's diseases. MATERIALS AND METHODS: Thirty-two Wistar albino rats were randomized into four groups. A 2 × 1 × 0.3-cm-sized silicone block was inserted inside a dorsal subcutaneous pocket in all groups. After 2 months of insertion, capsule thicknesses around the implants were detected under ultrasonography. This was followed by injection of isotonic saline, 150, 300, and 600 IU in Gr-1, 2, 3, and 4, respectively. All the animals were sacrificed at the end of the first week for histologic sampling to determine fibroblast proliferation, vessel density of the tissue, necrosis, edema, inflammation, and capsule thickness. All the data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests and compared for significance of the results. RESULTS: There was no significant difference in terms of capsule thinning between the 300 and 600 IU groups but in both groups thinning was significantly higher than the sham group. In the 150 IU group there was no significant thinning as compared to the sham group (p > 0.05). However, complications such as skin necrosis, infection, and seroma formation were seen only in the 600 IU injection group. The optimal safe and effective dose of the enzyme was accepted as 300 IU. The 300 IU injection provided up to 89 % thinning in the capsule tissue. There was thinning of the collagen bundles parallel to capsule thickness. In the 600 IU group, micro-pores were encountered at the thinnest points. CONCLUSION: However, the late results and recurrence rates of capsular contracture were not included in this study; collagenase seemed effective for the reduction of capsular tissue around the implants. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Facial Artery Perforator and Depressor Anguli Oris Muscle Chimeric Flap: A New Design of an Old Flap.

BACKGROUND: The aim of this study was to investigate the reliability and outcomes of the facial artery perforator and separately elevated depressor anguli oris (DAO) muscle chimeric flap for the reconstruction of partial or total lower lip defects. METHODS: Eleven patients with malignant skin tumors located at the lower lip were operated between 2013 and 2015. After the excision of the tumor with adequate clear margins using margin controlled excision technique, an appropriate flap fitting to the resultant defect based on the perforators of the facial artery and DAO muscle was prepared and placed into the defect. The DAO muscle activity was tested with electromyography in the postoperative first year examination. RESULTS: Besides 1 patient with transient venous insufficiency, all the flaps healed well without a partial or total flap loss. The mean follow-up period was 10 months. No new primary tumor or recurrence was observed. Although in 1 patient, transient asymmetric smiling and mild drooling was observed, the overall oral competence results were found to be quite satisfactory. The electromyography evaluation of DAO muscle of 5 patients who reached the postoperative first year examination showed action potential results in normal limits with a slight decrease. All patients were satisfied with the final esthetic and functional result. CONCLUSIONS: The facial artery perforator and depressor angel oris muscle chimeric flap is a valuable option for reconstruction of lower lip defects providing esthetically and functionally good results.

Continuous Suction Drainage of Postoperative Hematoma and Seroma Using Cystofix Device.

UNLABELLED: In this study, an easy and useful method used for the drainage of seroma and hematoma formations occurring after operations requiring extensive tissue undermining is presented. The method utilizes the trocar of the conventional suprapubic urinary catheterization system in combination with the catheter of the negative pressure vacuum drainage system. It provides quick, safe, and painless seroma and hematoma evacuation and can easily be performed in office setting. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.

Reconstruction of Acquired Breast Hypoplasia by Subcutaneous Scar Releasing and Repeated Fat Grafting Combination.

Breast hypoplasia may have a congenital or acquired etiology. One of the acquired reasons is postinfectious scars, which results in skin restriction and breast hypoplasia in the long term. Reconstruction of breast hypoplasia is performed by autologous tissues, implants, or both. In this report we present a hypoplastic breast reconstruction by subcutaneous scar releasing and multiple autologous fat grafting in a 21-year-old female with a right breast hypoplasia due to postinfectious scar. No complications were observed at 24 months follow-up after treatment by subcutaneous scar releasing and repeated (three times) fat grafting. Safe and natural reconstruction of mild breast hypoplasia due to fibrotic scars can be accomplished by performing a combination of subcutaneous scar releasing and multiple fat grafting.

Dislocation of Mandibular Condyle Into Middle Cranial Fossa: Two Alternative Methods for Two Patients.

Dislocation of the mandibular condyle into the middle cranial fossa is rare, and the number of cases discussed in published studies is limited. Various treatment routes have been suggested, and the entire published data are based on the presentations of single cases. The present report presents 2 cases of dislocation of the mandibular condyle into the middle cranial fossa. The first case was treated with closed reduction in the early stage; however, the second case, which was treated in the late stage, required open reduction. Both the methods of reduction and the key aspects of diagnosis are discussed.