Our Clinical Algorithmic Approach for Meningomyelocele Defects Reconstruction with Fasciocutaneous Flaps.

AIM: To evaluate fasciocutaneous flaps used for reconstruction of meningomyelocele defects in our clinic and to suggest an algorithm for flap selection. MATERIAL AND METHODS: A retrospective analysis of 45 patients with meningomyelocele, who underwent repair with fasciocutaneous flaps, was carried out. Preoperative and postoperative photos were analyzed. The defect areas were measured by Adobe Photoshop CC. Limberg flap, bilateral Limberg flaps, bilateral bipedicled advancement flaps, bilobed flap and reading man flap were performed. RESULTS: Wound dehiscence and partial necrosis occurred in 8 patients. All wounds were managed conservatively and healed successfully. No other complications were observed. The mean defect size for all patients was 36 cm². The mean defect size was 45.3 cm² in bilateral bipedicled flaps cases; 33.5 cm² in bilateral Limberg flaps cases; and 19.6 cm² in the unilateral Limberg flap cases. According to the algorithm, a unilateral Limberg flap or bilobed flap or reading man flap can be used for the defects smaller than 25 cm²; bilateral Limberg flaps can be used for the defects between 25 and 35 cm²; and bilateral bipedicled advancement flaps can be used for the defects larger than 35 cm². CONCLUSION: Fasciocutaneous flaps can be preferred in meningomyelocele defect reconstruction due to the easy planning of flaps, easy and fast flap elevation, and low complication rates due to their reliable circulation. The measurement of the defect area allows this algorithm selecting a flap in a more practical way.

Comparison of automated quantification and semiquantitative visual analysis findings of IQ SPECT MPI with conventional coronary angiography in patients with stable angina.

OBJECTIVE: The aim of this study was to assess the validity of automated quantitative and semiquantitative visual analysis of total perfusion deficit (TPD) using the IQ SPECT gamma camera system compared to conventional coronary angiographically detected significant coronary artery disease (CAD). METHODS: The study included patients with suspected CAD who underwent myocardial perfusion single photon emission computed tomography and conventional coronary angiography. The summed stress score (SSS), summed rest score (SRS), and summed difference score (SDS) (semiquantitative visual analysis results) were assessed using a 5-point scale in a standard 17-segment model, and TPD (stress, rest, and ischemic TPD) was quantified using automated software. RESULTS: In all, 84 patients (Group 1, those who underwent revascularization) had significant coronary artery lesions, and 81 (Group 2) had non-significant lesions. The median interquartile range values were: stress-TPD (sTPD): 16 (3.5- 33.5) vs 9.2 (2-17.9), rest-TPD: 9.4 (2.2-18.8) vs 4 (1-11), and 6.9 (1.9-14.1) vs 3.4 (1-6.1) for ischemic-TPD (iTPD) in Group 1 and Group 2, respectively. To detect ischemia, the optimal cut-off points were 9.5 (sensitivity: 75%, specificity; 60%) for sTPD, and 4.5 (sensitivity: 56%, specificity: 73%) for iTPD. There were significant correlations between quantitative and semi-quantitative methods in detection of significant coronary artery disease (sTPD-SSS: r=0.954, sTPD-SDS: r=0.746, iTPD-SSS: r=0.654, iTPD-SDS: r=0.759; p<0.05 for all). CONCLUSION: The quantitative analysis and summed stress scores produced by the IQ SPECT system appear to be a useful and valid method to detect significant CAD.

Development of severe hyponatremia due to cerebrospinal fluid leakage following meningomyelocele surgery in a newborn.

Cerebrospinal fluid leakage following meningomyelocele surgery is a frequent complication in the wound-healing period and is associated with wound dehiscence. CSF loss can cause severe hyponatremia, especially in the newborn and early infancy periods when dietary sodium content is relatively low. Hyponatremia in the newborn period can result in adverse neurodevelopmental outcomes. In addition, hyponatremia's cerebral effects can increase complications in neurosurgery patients. The authors present the case of a newborn in whom CSF leakage from the operative site and severe hyponatremia developed following meningomyelocele surgery. To the best of their knowledge, severe hyponatremia caused by CSF leakage after meningomyelocele surgery has not been previously reported in the literature.

The Effects of Stereotactic Cerebroventricular Administration of Albumin, Mannitol, Hypertonic Sodium Chloride, Glycerin and Dextran in Rats with Experimental Brain Edema.

AIM: To evaluate the effects of cerebroventricular administration of hyperoncotic/hyperosmotic agents on edematous brain tissue in rats with experimental head trauma. MATERIAL AND METHODS: The study included 54 female Sprague-Dawley rats with weights ranging between 200 and 250 g. Six experimental groups were examined with each group containing 9 rats. All rats were exposed to head trauma, and treatment groups were administered 2 µl of one of the drugs (albumin, mannitol, hypertonic sodium chloride (NaCl), glycerin and dextran) 6, 12 and 24 hours after the trauma via the cerebroventricular route and using a stereotactic device. Rats were sacrificed 48 hours after the trauma, and brain tissues were extracted without damage. Biochemical analyses including reduced glutathione (GSH), nitric oxide (NO), malondialdehyde (MDA), tumor necrosis factor alpha (TNF-α), and interleukin 1 beta (IL-1ß) were performed on the injured left hemisphere. RESULTS: Compared with the control group, the albumin, mannitol, 3% NaCl and glycerin treatment groups revealed dramatic increases in GSH levels (p < 0.001). Levels of MDA, which is the end-product of brain edema and lipid peroxidation, failed to show a statistically significant decrease, but there was a decreasing trend observed in the inter-group comparisons. NO levels were also decreased in the 3% NaCl treatment group. An analysis of TNF-α and IL-1ß, two proinflammatory cytokines associated with the trauma, revealed that IL-1ß decreased significantly in all treatment groups (p=0.001), whereas no significant difference was detected in TNF-α levels. CONCLUSION: Cerebroventricular administration of hyperoncotic/hyperosmotic agents provides substantial effects on the treatment of brain edema.