Factors responsible for early postoperative mental alterations after bilateral implantation of subthalamic electrodes.

INTRODUCTION: Early postoperative mental changes are the most frequent problem after bilateral subthalamic electrode implantation. The study aims to find an association between them and factors related to patient, disease and surgery, including the size of the third ventricle as brain atrophy marker. MATERIAL AND METHODS: The study included 80 patients with bilateral subthalamic electrodes implanted for motor complications of Parkinson's disease (PD). Patients' age, disease and motor complications duration, medication, neuropsychological tests, surgical reports, third ventricle length (intercommissural distance) and width (intermammillary distance) were analysed. RESULTS: Early mental alterations requiring treatment were observed in 25.0% of patients with higher age being significant predictor. The duration of PD motor complications, L DOPA equivalent dose, DSR Mattis, third ventricle length and width were not statistically significant predictors. The incidence of postoperative mental alteration with intermammillary distance > 8 mm was 60%. The percentage of left sided electrodes implanted in anterior trajectory is significantly higher in patients with early mental changes. CONCLUSIONS: Higher age is a risk factor for early postoperative mental changes, but not disease, late motor complications duration and parameters describing third ventricular size except the excessive intermammillary distance. Left sided electrode implanted in anterior position is a risk factor.

Is there any gender-specific impact in the treatment of patients with basal cell carcinoma in the head and neck region?

Background: There are no current studies concerning gender-specific impact on the treatment of BCCs. We performed a retrospective analysis with the aim of showing that selection of treatment by physician and patients' evaluation concerning quality of life and aesthetic outcome has a gender-specific impact. Methods: Overall, 47 patients treated by excision of BCC from the head and neck region at our department from 2015 to 2020 were included. Defects were closed via flap, split-thickness skin graft. or primary closure. Pain, scar quality, patient satisfaction and quality of life were ascertained by the Skin Cancer Index (SCI), the Basal and Squamous Cell Carcinoma Quality of Life (BaSQoL) questionnaire, Patient and Observer Scar Assessment Scale (POSASv2.0EN) and Vancouver Scar Scale (VSS). Results: Women received significantly more flaps than split-thickness skin grafts (p = 0.025). The coverage method was independent of surgeons' gender.Patient's POSAS were higher in women (p = 0.087), and observer's POSAS (p = 0.229) and VSS (p = 0.7) showed no significant difference between genders.SCI and BaSQoL scores showed that women are significantly more critical than men after BCC treatment (SCI p = 0; BaSQoL p = 0.022). Furthermore, dermatological follow-up frequency was significantly higher in women (p = 0.035). Conclusion: We determined the gender-specific impacts on the treatment of patients with BCCs regarding methods of closure, post-interventional dermatological follow-ups, quality of life, scar quality, and overall patient satisfaction. No difference in scar quality was found when assessed by physicians.

Ektacytometry Analysis of Post-splenectomy Red Blood Cell Properties Identifies Cell Membrane Stability Test as a Novel Biomarker of Membrane Health in Hereditary Spherocytosis.

Hereditary spherocytosis (HS) is the most common form of hereditary chronic hemolytic anemia. It is caused by mutations in red blood cell (RBC) membrane and cytoskeletal proteins, which compromise membrane integrity, leading to vesiculation. Eventually, this leads to entrapment of poorly deformable spherocytes in the spleen. Splenectomy is a procedure often performed in HS. The clinical benefit results from removing the primary site of destruction, thereby improving RBC survival. But whether changes in RBC properties contribute to the clinical benefit of splenectomy is unknown. In this study we used ektacytometry to investigate the longitudinal effects of splenectomy on RBC properties in five well-characterized HS patients at four different time points and in a case-control cohort of 26 HS patients. Osmotic gradient ektacytometry showed that splenectomy resulted in improved intracellular viscosity (hydration state) whereas total surface area and surface-to-volume ratio remained essentially unchanged. The cell membrane stability test (CMST), which assesses the in vitro response to shear stress, showed that after splenectomy, HS RBCs had partly regained the ability to shed membrane, a property of healthy RBCs, which was confirmed in the case-control cohort. In particular the CMST holds promise as a novel biomarker in HS that reflects RBC membrane health and may be used to asses treatment response in HS.

[The "safe" flap - Preoperative perforator-mapping and intraoperative perfusion assessment to reduce flap-associated morbidity - Consensus statement of the German Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels]. / Der sichere Lappen ­ Präoperatives Gefäß-Mapping und intraoperative Perfusionsmessung zur Reduktion der lappenbedingten Morbidität.

Reconstructive microsurgery using free and pedicled flaps has become a reliable method with a high success rate. Preoperative perforator mapping and intraoperative assessment of perfusion might further reduce flap-associated morbidity.There are various techniques for perforator mapping and perfusion measurement, but no guidelines regarding their use. Therefore, an expert panel at the 40th Annual Meeting of the German-Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels (DAM) discussed and critically reviewed the current literature. The consensus statement represents the expert opinion based on the available literature and provides recommendations regarding the use of preoperative perforator mapping and intraoperative perfusion measurement.

[The dorsal flag flap for alternative skin coverage for defects of the thumb tip: case reports]. / Der dorsale fähnchenlappen zur alternativen defektdeckung an der daumenkuppe: fallberichte.

PURPOSE: This case report describes the use of the dorsal flag flap in contrast to its standard indication (dorsal and palmar defects of the proximal finger phalanx) for defect coverage of the thumb tip in three patients. PATIENTS AND METHOD: In 2006, defects of the thump tip were covered with a dorsal flag flap in three male cases. After 6 - 9 months a clinical evaluation was performed with special focus on pain, aesthetic aspect, sensibility and function. RESULTS: Primary wound healing without complications was observed in all cases. No functional impairments or pain have been reported, the aesthetic aspect was satisfying for the patients. All flaps showed an intact protection sensibility (in terms of pressure and pain perception). The subjective shortcoming of the sensitivity like numbness was not distracting to any of the patients. CONCLUSION: The dorsal flag flap is a good alternative for covering tissue defects at the thumb tip compared to local flap grafts or neurovascular long-distance flaps with satisfying results.

[Long-term results after resection arthroplasty in patients with arthrosis of the thumb carpometacarpal joint: comparison of abductor pollicis longus and flexor carpi radialis tendon suspension]. / Ergebnisse nach Resektions-Suspensions-Arthroplastik bei Rhizarthrose: Vergleich der Abductor pollicis longus- mit der Flexor carpi radialis-Sehnensuspension.

PURPOSE/BACKGROUND: This retrospective analysis focused on a comparison of long-term results in patients who underwent resection of the trapezium with subsequent arthroplasty and tendon suspension using either the abductor pollicis longus (APL) or the flexor carpi radialis (FCR) tendon. METHOD AND MATERIAL: Based upon a positive history along with a clinical and radiological examination, 20 patients underwent suspension arthroplasty using the APL tendon (APL group) and 21 patients suspension arthroplasty using the FCR tendon (FCR group) after trapeziectomy. In both groups mean age (APL group: 60.4 +/- 5.3; FCR group: 61.7 +/- 6.8 years), pain severity according to the Visual Analogue Scale (VAS; APL group: 6.7 +/- 1.9; FCR group: 6.9 +/- 1.7), severity of arthrosis in the thumb carpometacarpal joint according to the Eaton-Littler classification (APL group: 3 +/- 0.7; FCR group: 3.2 +/- 0.6) and time interval from onset of symptoms to surgery (APL group: 27 +/- 8.1; FCR group: 41.5 +/- 14.1 months) did not significantly differ. Each patient of both groups was treated surgically and reviewed by one experienced hand surgeon. Both groups received the same standardized postoperative treatment. RESULTS: In the APL group the mean operative time was significantly shorter (31.7 +/- 9.5 min) than in the FCR group (48.7 +/- 7.9 min). The follow-up period from surgery to the final examination was similar in both groups (APL group: 23.1 +/- 12.2; FCR group: 31 +/- 17.6 months). At the time of the final examinations, no statistically significant differences were found when analyzing the results of the DASH score (APL group: 20.1 +/- 15.1; FCR group: 29.3 +/- 15.7), the self-administered hand ability score (APL group: 1.7 +/- 0.6; FCR group: 2.1 +/- 0.6) and the VAS (APL group: 1.1 +/- 1.6; FCR group: 0.8 +/- 1.5). The time period from surgery to the offset of postoperative pain was also comparable in both groups (APL group: 5 +/- 1.8; FCR group: 5.3 +/- 2.5 months). The range of abduction in the first carpometacarpal joint after arthroplasty, parallel and perpendicular to the dorsum of the hand, was also similar in both groups (APL group: 63.4 +/- 14.3 degrees /62.1 +/- 11 degrees ; FCR group: 67.8 +/- 12.7 degrees /66 +/- 12.1 degrees ). However, patients enrolled in the APL group revealed significantly better results compared to patients in the FCR group regarding grip-strength, key and pinch grip (APL group: 23.9 +/- 9.7/6.6 +/- 2.4/6.2 +/- 2.8 kg; FCR group: 17 +/- 7.2/4.5 +/- 1.5/3.6 +/- 1.5 kg). CONCLUSION: Both techniques led to highly satisfactory results as seen in DASH and VAS data together with a near normal range of abduction in the first carpometacarpal joint in all enrolled patients. However, in direct comparison the APL procedure is technically easier to perform with significantly shorter surgery time recorded and significantly higher values in all force parameters compared to the FCR procedure.

Human cloning: Eastern Mediterranean Region perspective.

Recent advances in genomics and biotechnology have ushered in a new era in health development. Therapeutic cloning possesses enormous potential for revolutionizing medical and therapeutic techniques. Cloning technology, however, is perceived as having the potential for reproductive cloning, which raises serious ethical and moral concerns. It is important that the Islamic countries come to a consensus on this vital issue. Developing science and technology for better health is a religious and moral obligation. There is an urgent need for Muslim scholars to discuss the issue of stem cell research and cloning rationally; such dialogue will not only consider the scientific merits but also the moral, ethical and legal implications.

[Comparative Cost Effectiveness of Clostridium Histolyticum Collagenase (Xiapex®) and Partial Fasciectomy for the Treatment of Dupuytren's Contracture in Austria]. / Kosteneffektivität der Behandlung von Patienten mit Dupuytren-Kontraktur mit mikrobieller Collagenase Clostridium histolyticum (Xiapex®) im Vergleich zur partiellen Fasziektomie in Österreich.

INTRODUCTION: Since Dupuytren's contracture is a common disorder, the costs for its surgical treatment impose a considerable burden on the healthcare system. For the first time in the German-speaking area, this study aimed to provide a comparative cost-effectiveness analysis for partial fasciectomy vs. treatment with Clostridium histolyticum collagenase (CCH). METHODS: A retrospective monocentric study of the period from 2012 to 2014 comprised 40 patients with previously untreated Dupuytren's contracture of one finger. 20 outpatients received one CCH treatment (Group 1), while 20 inpatients underwent partial fasciectomy (Group 2). The direct pre-interventional treatment and post-interventional costs were compared. RESULTS: The direct post-interventional and postoperative results were comparable. Group 1 (CCH) showed a mean reduction in contracture of 96.4%; in Group 2 (partial fasciectomy), this was 97.7%. There were fewer complications in Group 1 than in Group 2. Mean treatment costs in Group 1 were € 1 458.60 and in Group 2, € 5 315.20. CONCLUSION: Treatment with CCH is more cost effective than with partial fasciectomy. This is due to greater costs for personnel, time and surgical material, as well as the treatment of the more frequent complications in Group 2. Despite the limited comparability, our findings are consistent with the present international literature.

One-stage reconstruction of isolated and combined tendon defects with the vascularized adductor magnus tendon graft: Surgical technique and preliminary results.

INTRODUCTION: Secondary reconstructions of isolated and combined tendon defects are still a challenge for plastic surgeons. Due to its reliable anatomy, reconstructive potential and low donor-site morbidity, the medial femoral condyle is an ideal area for harvesting isolated and combined tendon flaps. This study evaluates our preliminary results with the vascularized adductor magnus tendon flap. PATIENT AND METHODS: The study included six patients who received a vascularized tendon flap (upper extremity: three patients; lower extremity: three patients) from 2011 to 2015. For three patients, the adductor magnus tendon was used as a single flap; for the other three patients, the tendon was included in a composite flap. A retrospective chart review provided the patients' demographic data, surgical details and the post-operative course. The further objective and patient-reported outcome was evaluated with a long-term follow-up. RESULTS: All of the free vascularized flaps healed without complications and with good vascularization upon duplex ultrasonography. One patient did, however, require revision surgery in the late post-operative course. At the end point, all patients showed good functional results without any donor-site morbidity. CONCLUSION: For carefully selected isolated and combined tendon defects on the upper and lower extremities, the vascularized adductor magnus tendon flap provides a reliable and versatile method for microsurgical reconstruction.

Effect of exposure to silica in inducing autoimmune hepatitis: an experimental animal-controlled study.

OBJECTIVE: The aim of this experimental study is to investigate the effect of subcutaneous and oral sodium silicate in inducing the autoimmune hepatitis. MATERIALS AND METHODS: Twelve Brown Norway rats were studied, six rats were challenged with Sodium Silicate and the rest were challenged with normal saline as a control group. At 14th week post-sodium silicate or normal saline exposure, the rats were sacrificed. Histopathological studies were conducted in six positive autoantibodies responding silicate group rats and then compared with an equal number of negative autoantibodies responding control rats. RESULTS: The liver findings from sodium silicate group of animals showed a histopathological reaction in 3/6 (50%) compared with 0/6 of the corresponding control saline group (p = 0.09). However, the absolute differences in the percentage between the two groups was 50%, the subcutaneous sodium silicate sub-group showed hepatic tissue response close to being statistically significant level (p = 0.05). CONCLUSIONS: After correlating the results with autoantibodies including serum antinuclear antibodies and anti ribo-nucleoprotein response of the same rats, it is concluded that sodium silicate play a role in inducing the autoimmune hepatitis in a genetically susceptible rat model.

Convulsions caused by endrin poisoning in Pakistan.

From July through September 1984, acute convulsions caused by endrin poisoning occurred in the subdistrict of Talagang, Attock District, Punjab province, Pakistan. Eighteen of the 21 affected villages were surveyed; 70% of the cases for which ages were known (106 of 152) were in children 1 to 9 years of age; 9.8% of all affected persons (19 of 194) died. The outbreak occurred in villages on the main roads of the subdistrict and peaked in early September. Endrin was detected in the blood of 12 of 18 patients with a history of convulsions but was not found in the blood of four hospitalized control patients. One composite sugar sample taken from the homes of three persons had an endrin level of 0.04 ppm. Because of the high toxicity, repeated association with large-scale outbreaks of neurologic illness, and the difficulties of monitoring distribution, endrin should not be used for agricultural purposes.

Transmission of Salmonella worthington by oropharyngeal suction in hospital neonatal unit.

An outbreak of Salmonella worthington infection in a neonatal unit occurred in a pediatric ward of Holy Family Hospital, Rawalpindi, Pakistan. The index case was a prematurely born male child from whose clinical specimens S. worthington was recovered. After this finding 40 infants kept in that nursery were included in an investigation. Major symptoms were diarrhea, septicemia and jaundice. Three developed meningitis. Disease morbidity rate was 45% and mortality occurred in 16.6% of the total positive cases. The source of infection was traced to a contaminated rubber tubing of a suction apparatus which was used for oropharyngeal suction of the babies. S. worthington was recovered from the clinical specimens of all 18 babies who received suction. Multiple drug resistance of these S. worthington strains was found.

Red Dracunculus medinensis.

Two instances of the emergence of a bright-red worm from humans in Pakistan are described. A 25-year-old man and a 26-year-old woman, unrelated and living in separate households, were observed in 1987 and 1988, respectively, to have emergent worms typical in size and location for Guinea worm disease, except for the color of the worms. The posterior end of 1 worm was recovered and appeared to be a female Dracunculus medinensis. Histologic sections provided insufficient information to determine the cause of the red color, although we could exclude blood as the cause.

Water-borne hepatitis E virus epidemic in Islamabad, Pakistan: a common source outbreak traced to the malfunction of a modern water treatment plant.

During December 1993 and in the first three months of 1994, an explosive water-borne epidemic of hepatitis E virus (HEV) occurred in two sectors of Islamabad, Pakistan. In a survey of a population of 36,705 individuals, a total of 3,827 cases of acute icteric hepatitis were recorded with an overall attack rate (AR) of 10.4%. The etiologic role of HEV in the epidemic was proven by demonstrating anti-HEV IgG and HEV IgM in the tested serum samples. The water-borne nature of the epidemic was suggested by a study of the case distribution according to water supply. Prior to the epidemic, there had been an operational breakdown in a water treatment plant that distributed water to the affected areas while transforming its purification system from slow sand to rapid sand filtration. The primary source of water for the plant was derived from a heavily contaminated stream. The highest AR (16.3%) was observed in the areas where the source of drinking water was exclusively from the purification plant, followed by ARs of 12.4% and 5.3% for those receiving 50% and 30% or less of their water supply from the treatment plant, respectively, while the lowest AR (1.8%) was observed in the neighboring areas that did not receive water from this source. The AR was significantly higher in the group 11-30 years of age (15.3%) as compared with children less than 11 years of age (1.4%) and also relative to the group greater than 30 years of age (10.5%). The AR among the 162 recorded pregnant females was 21.6%, which was higher than that found among nonpregnant females of child-bearing age (10.9%). All four reported adult deaths occurred among females in their third trimester of pregnancy with a case fatality rate of 11.4%, while the other four fatal cases were newborn infants of mothers with acute icteric hepatitis. Although the aggregation of cases within households was significantly related to family size, the temporal relationship between cases in households with two or more cases revealed that 83.7% of 1,463 presumed secondary cases occurred within one month of the first case in the same household, which is not suggestive of person-to-person transmission of disease. The termination of providing water from the source was effected, which was followed by an apparent decrease in cases.

Detection of anti-Leishmania antibodies in blood collected on filter paper by the direct agglutination test.

Human capillary blood drawn by finger pricking was absorbed on Whatman no. 4 filter paper and tested for anti-Leishmania antibodies using the direct agglutination test (DAT). Over 1400 filter paper samples were collected from L. infantum endemic areas in northern Pakistan and compared with 569 serum samples obtained from the same area. Eleven filter paper samples (0.8%) gave positive results (antibody titre > or = 1:3200), compared with 8 serum samples (1.4%); the difference was not statistically significant (P = 0.35). The filter paper eluates compared well with their homologous sera, and were strongly correlated with respect to antibody titre (r = 0.7, P < 0.0001).

Leishmania infantum in the Himalayas.

Visceral leishmaniasis (VL) was first reported in Pakistan over 30 years ago from the remote north-eastern Himalayan region. Sporadic cases are now widely reported from the Northern Areas, part of North-West Frontier Province (NWFP) and Punjab Province, together with Azad Jammu and Kashmir (AJK). Two hundred and thirty-nine cases, mostly young children, have been reported in the last decade; 52% were under 2 years old, and 86% were aged less than 5 years; the male:female ratio was 3:1. In a cross sectional study of the population in 14 endemic villages, 1938 individuals of all ages were randomly skin-tested with leishmanin and 27.4% gave a positive result. The leishmanin response rate increased with age. In some areas, almost 70% of the adults over 40 years old were positive. Leishmanin positivity appeared to cluster among households (P = 0.0003), but clinical cases among households did not (P = 0.472). The leishmanin response pattern in the foci of Chilas and AJK reflected an endemic pattern of disease, whereas that seen in the Baltistan foci suggested interrupted transmission. Human sera collected in endemic villages were tested for anti-Leishmania antibodies, 580 by enzyme-linked immunosorbent assay and direct agglutination test (DAT), and another 1403, as blood samples on filter paper, were tested by DAT alone. Isolations of Leishmania were made from 15 patients, 11 from bone marrow, 3 from normal skin and one from spleen. The parasites were typed as Leishmania infantum zymodeme LON-49 (= MON-1).

Chironomid midges as a cause of allergy in the Sudan.

Hypersensitivity to Chironomidae (non-biting midges) has been a problem in the Sudan since about 1927 and appears to be due to increased breeding of a single chironomid species, Cladotanytarsus lewisi (Freeman). Mass emergence of the midges in thought to be related to the larval diet of algae and diatoms, the numbers of which are greatly enhanced by the retention of plant nutrients in lacustrine conditions resulting from interruption to the natural flow of the Nile by the construction of dams. Immunological studies in allergic individuals using an allergen extract prepared from C. lewisi indicate that the concentration of specific immunoglobulin E ("allergic antibody") directed against C. lewisi is raised in patients with established hypersensitivity to the midge but not in control subjects. The concentration of specific IgE is also related to the severity of clinical symptoms. These results indicate that this widespread and important "man made" hypersensitivity in the Sudan has the features of well recognized immediate-type allergy commonly associated with pollens and other air-borne allergens.

The role of dogs in the epidemiology of human visceral leishmaniasis in northern Pakistan.

Infantile visceral leishmaniasis (VL) was first reported from north Pakistan over 3 decades age in the remote valleys of the western Himalayas. These foci were reported as being completely devoid of domestic dogs. The later emergence of sporadic cases of infantile VL in the sub-Himalayan region of the country, where dogs are abundant, enabled us to investigate the prevalence of canine disease and study its relation with disease in humans. A serological survey in dogs by direct agglutination test (DAT) and enzyme-linked immunosorbent assay (ELISA) indicated that 18% (DAT) and 26.6% (ELISA) harboured anti-Leishmania antibodies, with older dogs showing higher prevalence; 10% of the infected dogs had no clinical signs of leishmaniasis. Deoxyribonucleic acid (DNA) probing by 32P-labelled Lmet 2 cDNA probe showed high sensitivity with aspirates obtained from the popliteal lymph nodes of dogs but not with skin snips. Parasites isolated from dogs in these foci were identified as L. infantum by isoenzyme characterization.

Serodiagnosis of Asian leishmaniasis with a recombinant antigen from the repetitive domain of a Leishmania kinesin.

rK39 is a recombinant product of the 39 amino acid repeats found in a kinesin-like gene of visceral Leishmania spp. This and other antigens were compared for immunodiagnostic potential by enzyme-linked immunosorbent assay with sera from confirmed cases of Asian cutaneous and visceral leishmaniasis. In preliminary trials, rK39 proved superior to 2 purified Leishmania antigens, a cytosolic protein (p36) and a membrane protein (gp63), for immunodiagnosis of visceral leishmaniasis. Of the 53 visceral cases from China and Pakistan assayed, 52 were seropositive (98%) at a 10(-1) dilution with 36 ng of rK39. End point titrations of 27 highly positive samples yielded anti-rK39 antibody titres ranging from c. 10(-3) to beyond 10(-4). Antigen titrations with one positive serum further revealed that rK39 was 25-fold more sensitive than Leishmania whole cell soluble lysates. 31 cutaneous leishmaniasis cases from Turkey assayed for anti-rK39 antibody gave reactions ranging from negative or marginally positive to positive. In Brazil, all cutaneous and mucocutaneous leishmaniasis cases gave negative results in this assay.

Evaluation of a Brucella enzyme immunoassay test (ELISA) in comparison with bacteriological culture and agglutination.

An ELISA test for IgG and IgM antibrucella antibodies was found to be effective in diagnosis of human brucellosis. Assays for IgG and IgM in 30 culture-positive cases gave significant ELISA values. By the standard agglutination test, 10% of these cases gave readings less than 1:160. These are considered insignificant, taking 1:160 as the accepted cut-off value. Moreover, in an extra 135 samples from suspected brucella cases, where only serology was requested (77.6% of all cases), 7.4% were found to have IgM brucella antibodies by ELISA. In all of these, the corresponding agglutination titres were less than 1:80 and hence reported as insignificant. We report the detection of IgG and IgM antibodies in samples from patients with both acute and chronic disease. In few patients with acute disease, only IgM was detected. These findings are discussed in comparison with earlier studies. Finally, the ELISA test, in addition to measuring antibody classes directly, also detects incomplete antibodies. By this, it can efficiently replace the 2 mercaptoethanol test (2ME) and the Coomb's antihuman-globulin test. This saves considerable laboratory cost and time.