Chain purse-string suture used to shorten the vertical incision in vertical breast reduction.

BACKGROUND: Reduction mammaplasty is one of the most frequently performed operations in plastic surgery. Breast scarring can be troublesome for both the patient and the surgeon. This report offers an easy method for suturing a vertical incision that provides a better shape in final breast appearance. METHODS: In this study, 10 patients with an average age of 33 years (range, 27-44 years) underwent short-scar medial pedicle breast reduction. For the patients who underwent a medium reduction (401-800 g), after the excision of sufficient glandular and skin tissue, the vertical incision was closed as follows. Loose subcuticular sutures were placed, starting from the top of the incision and proceeding toward its bottom. In the distal corner of the incision, counterpart suturing was performed out through the opposite direction before the wound was approximated. In this way, the suture chain was completed. At the top of the incision, the sutures were pulled tight to gather the skin in a short vertical scar. RESULTS: The patients were followed up on the average for 12 months after the surgery. The majority of the patients were sufficiently satisfied with the results of the operations, including the scar length and the final appearance. Pseudoptosis did not occur. CONCLUSION: The findings show that the reported technique is an improvement over the existing vertical incision method by allowing for faster and simpler closure and resulting in a better breast shape and scar length. The bidirectional continuous suture is performed as a purse string in the longitudinal incision. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. 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 .

Maternal deaths associated with H1N1 influenza virus infection in Turkey: a whole-of-population report.

OBJECTIVE: To review the clinical and demographic characteristics of pregnant and postpartum women who died as a consequence of influenza A H1N1 (2009) infection in Turkey. DESIGN: A review of the records for pregnant and postpartum women who died as a consequence of H1N1 influenza virus infection. SETTING: Nationwide in Turkey. POPULATION: Thirty-six pregnant or postpartum women who died as a result of confirmed pandemic H1N1 influenza virus infection. METHODS: Using the General Directorate of Mother and Child Health and Family Planning (MCHFP) Registry of the Ministry of Health of Turkey, we identified all pregnant and postpartum women who died as a result of confirmed influenza A H1N1 (2009) infection between 29 October and 31 December 2009. MAIN OUTCOME MEASURE: Maternal mortality as a result of H1N1 virus infection. RESULTS: The average time from symptom onset to initial presentation for health care was approximately 2.5 days, and the mean time from symptom onset to the receipt of antiviral medication was approximately 5.5 days. Only one-fifth of all women received early antiviral treatment (administered 2 days or less after symptom onset) and only one woman was vaccinated for H1N1 influenza 1 week before the onset of symptoms. The cause-specific maternal mortality ratio for H1N1 influenza infection in Turkey was estimated to be 3.01. The calculated risk of death associated with H1N1 influenza virus infection was approximately four times higher in pregnant and postpartum women than in the general population (relative risk, 3.88; 95% confidence interval, 2.77-5.43). CONCLUSIONS: Pregnant women are at increased risk for complications of, and death from, H1N1 influenza infection. Prompt evaluation and antiviral treatment of influenza-like illness should be considered in such women. Vaccination for H1N1 influenza may reduce the total number of deaths in pregnant and postpartum women. The high cause-specific maternal mortality rate suggests that H1N1 influenza virus infection may have increased the 2009 maternal mortality ratio in Turkey.

Current iodine status in Turkey.

OBJECTIVES: To evaluate the current nationwide iodine status in Turkey by determining urinary iodine concentrations (UIC) and household salt iodine content. A follow- up monitoring study was also conducted in 30 urban areas. METHODS: A school-based survey was conducted in 2007 by using multistage 'proportionate to population size' (PPS) cluster sampling method. The study population was composed of 900 school-age children (SAC) from different urban, suburban, and rural areas. UIC and iodine content of the table salt used at home were analyzed. RESULTS: Median UIC was 107 microg/l (147 in urban, 42 in suburban and rural areas, p<0.001). There were severe iodine deficiency (ID) in 7.2%, moderate and mild ID in 20.6% and 19.3%, of the SAC, respectively. UIC was sufficient (>100 microg/l) in 50% of the study population, whereas it was excessive (>300 microg/l) in 10.5% of them. Of the 900 salt samples, 662 (73.5%) were iodized and 508 samples (56.5%) contained adequately iodized salt (iodine content >15 ppm). UIC of the study population and salt iodine levels correlated well (r=0.42, p<0.001). CONCLUSIONS: Moderate to severe ID still exists in 27.8% of the Turkish population, which is much better compared to 1997 and 2002 surveys (i.e. 58%, 38.9%, respectively). The follow-up monitoring study (in 2007) demonstrated that ID has been eliminated in 20 of 30 cities surveyed, and median UIC was 130 microg/l. ID has been eliminated in most of the urban population, however, it is still an important problem in rural areas and in particular geographical regions, which should be the target of future programs.

Fatal orbital necrotizing fasciitis secondary to stenotrophomonas maltophilia associated stomatitis.

An 81-year-old woman with diabetes mellitus presented with signs of orbital cellulitis and a gangrenous ulcer on the right palate. Biopsy analysis confirmed a diagnosis of necrotizing fasciitis. Surgical debridement of necrotic tissues and enucleation of the right eye were performed. Stenotrophomonas maltophilia was isolated from the specimens. The patient remained stable under antibiotic therapy and underwent reconstructive surgery. To the best of our knowledge, this represents a rare case of orbital necrotizing fasciitis developing secondary to S. maltophilia infection. Orbital necrotizing fasciitis is rare; the early clinical features may be similar to those of cellulitis. To prevent devastating complications, the former condition must be kept in mind, particularly in immunocompromised patients.

Inhibin A/B in HMG or recombinant FSH ovarian stimulation with cetrorelix medication.

The inhibins are valuable factors in the assessment of the quality of an ovarian stimulation cycle. In spite of good clinical results with recombinant FSH and multiple dose LHRH- antagonist (Cetrotide((R))) administration, there remains a theoretical concern that in cycles stimulated with recombinant FSH, devoid of any LH activity, not enough endogenous LH is available to guarantee good follicle maturation. A total of 287 serum samples from 41 patients was assessed: 20 patients received ovarian stimulation with recombinant FSH, 21 patients with HMG and multiple dose Cetrotide administration. Inhibin A and B were measured on cycle days 2 and 6, the day of HCG administration, the day of embryo transfer as well as 7 and 14 days after the transfer. The two patient groups were similar with regard to age, amount of gonadotrophins required and number of follicles >18 mm and 15-18 mm. Inhibin A and B concentrations were comparable throughout the stimulation, thus indicating the equality of ovarian stimulation with recombinant FSH/HMG and midcyclic antagonist administration. Higher inhibin B concentrations throughout the stimulation were correlated with a higher oocyte yield. The small number of pregnancies prevented assessment of the relationship between inhibin B values and pregnancy rate.

Hypoglycemia in small-for-gestational-age neonates'.

In this prospective study, we investigated the frequency of hypoglycemia and the proper intervals for screening in small-for-gestational-age (SGA) neonates. We determined test-strip blood glucose values at two, three, six, 12, 24 and 48 hours of age in 25 SGA and 16 appropriate-for-gestational-age (AGA) infants who were born after 37 completed gestational weeks at the Obstetrics Clinics of Sisli Etfal Hospital. Serum glucose determination was immediately done if a test-strip value was less than 40 mg/dl. The frequency of hypoglycemia in SGA neonates was significantly higher (p:0097) than in AGA neonates. The first three hours, the sixth hour and the 48th hour postnatally were the most common hours for encountering hypoglycemia. Clinical signs were not true indicators of hypoglycemia. These data suggest that screening for hypoglycemia in SGA neonates should continue for 48 hours.

Newborn PKU screening in Turkey: at present and organization for future.

At present, pkenylketonuria screening is a national child health program in Turkey which is carried out collaboratively by the Ministry of Health and three University Children's Hospitals in Ankara, Istanbul and Izmir. Since 1986 the number of cities included in the screening program has gradually increased, now and it covers all the metropolises the country. A total of 383 babies were found with persistent hyperphenylalaninemia (1:4,172) among 1,605,582 babies screened by the Guthrie test at the Hacettepe Screening Center in Ankara. By taking into account pretreatment phenylalanine levels and phenlyalanine tolerances at five years of age, the numbers of classical and mild-moderate phenylketonuria and mild hyperphenylalaninemia cases were 216, 102 and 58, respectively. The major problems encountered in the screening program and in management of the detected cases were unsatisfactory sample collection, early discharge from maternity hospitals, difficulties in reaching some detected cases, and noncompliance with dietary therapy due to illiterate parents or to lack of social insurance. To screen and treat all newborns for phenylketonuria and to include at least hypothyroidism in the screening program, there is a need for a more disciplinary intersectoral approach than exists at present.

Iodine status and goiter prevalence in Turkey before mandatory iodization.

Endemic goiter is an important public health problem in Turkey. Legislation for mandatory iodization of household salt was passed in July 1999. Current study is aimed at ascertaining the goiter prevalence and iodine nutrition in school-age children (SAC) living in known endemic areas of Turkey. Sonographic thyroid volumes (STV) and urinary iodine concentrations (UIC) of 5,948 SAC from 20 cities were measured between 1997-1999. STV of 31.8% of the SAC examined stayed above the upper-normal limits for the same age and gender recommended by the World Health Organization (WHO). Goiter prevalence ranged between 5 to 56% and median UIC ranged between 14 to 78 microg/l, indicating severe to moderate iodine deficiency (ID) in 14 and mild ID in 6 of the cities surveyed. Neither of the cities was found to have sufficient median UIC levels. The current study shows that endemic goiter is an important public health problem and iodine nutrition is inadequate nationwide. It also provides reliable scientific evidence and shows the need for a controlled and effective iodine supplementation program nationwide. Mandatory iodization of household salt seems to be the essential measure taken for the moment, additional measures may be needed in the near future.