The effect of scrotal reconstruction with skin flaps and skin grafts on testicular function.

Due to its unique composition, the reconstruction of scrotal skin defects is a major clinical challenge. This study was designed to evaluate the effects of scrotal reconstruction, using skin grafts and skin flaps, on spermatogenesis. In Group 1, the rats did not undergo surgery and were used as controls. In Group 2, after removal of all of the scrotal skin to expose the testicles, the defect was repaired using a skin flap from the right groin region. In Group 3, the reconstruction was achieved using skin grafts. All the rats were killed at 2 months postoperatively and evaluated. The mean wet weights of the testicles in the control group were significantly higher compared with that of the graft group. The mean height of the germinal epithelium was significantly greater in the control and flap groups compared with that of the graft group. The Johnsen score for spermatogenesis in the control group was higher than that in the graft group. The use of flaps resulted in testicular function that was comparable to that of the control group, whereas the use of grafts resulted in diminished testicular function. Therefore, we suggest that flaps may be the first choice for scrotal reconstruction.

Temperament and character traits of women admitted for breast reduction and comparison with body perception.

BACKGROUND: Reduction mammaplasty improves self-esteem and low body perception. Previous reports comprise either retrospective data or sectional analysis in which women were evaluated postoperatively. Furthermore, temperament and character properties of women applying for breast reduction have not been investigated. This study aimed to compare the temperament and character traits of women admitted for breast reduction surgery with those of healthy volunteers and to investigate the interaction of body perception with temperament and character. METHODS: The study enrolled 24 patients admitted for reduction mammaplasty and 24 healthy women. The study participants received the Temperament and Character Inventory (TCI) and the Rosenberg Self-Esteem Scale (RSE) questionnaires. The RSE questionnaire was completed again by the patients 6 months after the operation. RESULTS: Of the temperament scales, the persistence scale was significantly lower for the patients. Only the reward dependence subscale of the temperament scale was significantly higher for the patients. Self-esteem (RSE) was significantly lower for the patients than for the control subjects preoperatively, whereas, it rose significantly after the operation. The RSE showed a negative correlation with self-directedness and its subscales of being responsible and resourceful. A significant negative correlation also was found between RSE and empathy. CONCLUSIONS: Women with large breasts try to develop adaptable character properties against chronic troubles. However, the temperament scale of persistence decreases in this process. Similar temperament and character traits of women with and those without large breasts suggest that patients desire breast reduction for functional rather than cosmetic purposes.

Evaluation of mental foramina in adult living crania with MDCT.

PURPOSE: Multi-detector Computed Tomography (MDCT) is an exquisite technique in demonstrating the cranial foramina. This study aimed to assess the anatomic variations and locations of mental foramina in living adult mandible by MDCT. METHODS: MDCT data of 100 dentulous adult subjects were collected from the high-resolution examinations that covered the mandible. Presence and number of foramina, their diameter and distance from the mid line that is mid sagittal plane and alveolar ridge were recorded. RESULTS: Mental foramina was clearly identified, localized and characterized in all subjects. Duplication was observed in four patients. Among them, one subject had bilateral accessory foramina. Mid line distances were significantly higher in men than women. Distances and diameters of right foramina were insignificantly higher in the males. Also, left foramina was insignificantly wider in women. Positive correlations were noticed between the measurements of right and left foramina. CONCLUSIONS: This is the first study on mental foramina in living mandible with MDCT. With its tremendous capabilities, MDCT may be established in anatomical studies and preoperative planning.

Superficial Acral Fibromyxoma: A case report.

INTRODUCTION: Superficial Acral Fibromixoma is a benign and rare tumor of the soft tissues, also it called digital fibromyxoma. It is a painful, slow growing solitary mass that is frequently observed in the fingers, toes and nail beds. Local recurrence is often associated with a positive margin. PRESENTATION OF CASE: A 54-year-old male patient had admitted to local state hospital with complaint of a two-lobed mass lesion in the 5th finger of the right hand. The lesion was closely adjacent to the 5th finger flexor tendon. The specimen of the patient undergoing excisional biopsy was sent to our pathology department. CONCLUSION: Superficial Acral Fibromyxoma is one of the rare benign myxoid neoplasms. Its treatment is surgical excision. We reported the case for its rarity and to keep in mind in the acral region neoplasms.

Pilomatricoma: a review of six pediatric cases with nine lesions.

Pilomatricoma, although rare, is the second most frequent benign skin tumor in childhood. It is a hard, painless, slowly progressing subcutaneous tumor that is commonly located in the head-neck region, especially periorbital, and in the upper extremities. Histopathologic characteristics are distinctive. In this study, we performed a retrospective review of the records of our pediatric patients with pilomatricoma. We discuss herein the diagnosis and management of this uncommon skin tumor, and compare our experience with the previous literature. Pilomatricoma should be included in the differential diagnosis of superficial pediatric head and neck masses by any physician involved with pediatric tumors.

Repair of wide myelomeningocele defects with the bilateral fasciocutaneous flap method.

OBJECTIVE: Five large myelomeningocele defects repaired by bilateral fasciocutaneous flaps are presented in this article. PATIENTS AND METHODS: After the neurological repair, bilateral fasciocutaneous flaps were raised, transposed over the midline, and sutured to each other. RESULTS: All operations lasted shorter than one hour and no major complication was noted in the follow-up. Three of the defects were in the thoracolumbar and two in the lumbosacral regions. The areas of the defects were between 5x6 cm (30 cm2) and 8x10 cm (80 cm2). CONCLUSION: The bilateral fasciocutaneous flap technique offers a shorter operation duration and lower bleeding rate; it is simple to learn and practice and does not abolish alternative operation techniques.

Chondroid syringoma in a child.

Chondroid syringoma is a myxoid tumor of the skin, which has a reported incidence of <0.01% among primary skin tumors. The majority of these tumors occur in the head and neck regions of adult males. The correct diagnosis is made by histopathologic examination. We present the first instance of chondroid syringoma in a child, which, to the best of our knowledge, has not been reported previously in the English language literature.

Effect of short-term use of oral smokeless tobacco on random- pattern skin flap survival in rats.

We investigated the effects of smokeless tobacco on the survival of random-pattern skin flaps in rats. Twenty rats were divided into two groups (n=10 each). In the experimental group 200 mg smokeless tobacco (Maras powder) (1 mg nicotine) was inserted intraorally once a day for seven days under general anaesthesia. It was not given to the control group, but the rats were similarly anaesthetised with ketamine. On day 8, plasma cotinine concentrations were measured. The random-pattern dorsal skin flaps measuring 3 x 10 cm were then raised and resutured. Percentage survival area was assessed after a further eight days. The mean (SD) survival was 39 (7)% in the experimental, and 65 (8.9)% in the control, groups (p=0.0001). The mean (SD) plasma cotinine concentrations were 124.4 (73) ng/ml and <10 ng/ml, respectively. Smokeless tobacco use increased the incidence of flap necrosis in random-pattern skin flaps in rats.

Evaluation of amniotic fluid as a skin graft storage media compared with RPMI and saline.

We aimed to assess and compare the histological changes of grafts stored in Roswell Park Memorial Institute-1640 solution (RPMI), amniotic fluid (AF), and saline. Amniotic fluid which has abundant nutrients, proteins, and growth factors, and antimicrobial features may be an easily achievable and cheap alternative for the short term preservation of skin grafts. Discarded surgical skin pieces obtained from 15 trauma patients were divided into three groups as RPMI, AF, and saline. The specimens were evaluated at days 7, 14, 21, and 28 for histological alterations by a 3-point scoring scale. Histological scores in the grafts stored in amniotic fluid and RPMI were found significantly lower than those stored in saline (p<0.01). No significant difference was detected between AF and RPMI stored grafts. AF may be a good alternative for skin graft preservation as demonstrated by histological changes. New studies with multiple AF donators and repeated experiments will be worthwhile. Besides, restrictions of some ethical and legal issues for AF use should be solved.

Presence of interferon regulatory factor-1 in aggressive and nonaggressive histological variants of Basal cell carcinoma specimens.

BACKGROUND: Expression of Interferon regulatory factor-1 (IRF-1) has been demonstrated in a variety of cancers previously. To the best of our knowledge, there is only one report about the IRF-1 expression in basal cell carcinoma (BCC) specimens, which has demonstrated increased expression of the IRF-1 gene in BCC versus normal skin. Furthermore, IRF-1 expression has not been compared between aggressive and nonaggressive subtypes of BCC before. AIMS: Our aim is to examine the relation between IRF-1 staining patterns of aggressive and nonaggressive histological subtypes of BCC. MATERIALS AND METHODS: Thirty-seven archival tissue specimens from 33 BCC patients were stained for cytoplasmic and nuclear IRF-1. Twenty-five tumors were grouped as nonaggressive and 12 were grouped as aggressive histological variants, according to the established criteria. RESULTS: IRF-1 was not only expressed in tumor cells, but also in some surrounding inflammatory cells. There was no significant difference between the groups for cytoplasmic or nuclear IRF-1 staining. Aggressive or nonaggressive histological subtypes did not show any statistical difference for gender, relapse, treatment method, or localization. When staining was compared with gender, relapse, treatment method, localization, and tumor grades, no significant difference was found. CONCLUSIONS: Interferon seems to be expressed in BCCs with both aggressive and non aggressive histology. Further studies are needed to elaborate the precise diagnostic and prognostic roles and utility of interferon in the treatment of BCC.

Histological assessment of skin grafts stored in amniotic fluid and saline.

We investigated the efficacy of amniotic fluid as a substance in which to store grafts; it is rich in nutrients, proteins, and growth factors, and has well-known antimicrobial features. We compared it with the widely-used and practical saline. Split-thickness grafts 4 × 4 cm were prepared from the back of 20 rats and divided into four groups (n = 5 each). The rolled grafts were wrapped in gauze dampened with saline or amniotic fluid and placed into refrigerators in sterile containers for storage. On days 7, 14, 21, and 28, histological examinations were made. A semiquantitative evaluation of the histological damage to the skin was made by scoring its degree of severity. Compared with saline, histological scores in the grafts stored in amniotic fluid were found to be significantly lower on the 14th, 21st, and 28th days (p values on days 14, 21, and 28; cell swelling: 0.014, 0.006, and 0.005, respectively; nuclear swelling: 0.003, 0.006, and 0.007, respectively; nuclear pleomorphism: 0.004, 0.005, and 0.003, respectively; nuclear haloes: 0.015, 0.005, and 0.005, respectively; nuclear pyknosis: 0.003, 0.005, and 0.003, respectively; dermo-epidermal clefting: 0.005, 0.003, and 0.003, respectively; eosinophilia and mitosis: 0.003, 0.006, and 0.004, respectively; dermal collagen: 0.003, 0.003, and 0.003, respectively). Amniotic fluid maintained preservation better for skin grafts than saline. Comparison with other modern storage media would be beneficial.

The prognostic importance of trauma scoring systems in pediatric patients.

PURPOSE: Traumas are among important causes of morbidity and mortality in the pediatric group. Our aim was to evaluate the predicting effects of general trauma scores on mortality and morbidity rates. METHODS: The files of 74 patients, who were admitted to our hospital with trauma between the years 2006 and 2008, were retrospectively investigated. Patients' ages, sex, types of trauma, the time between the trauma and entrance to the hospital, vital and laboratory findings, length of hospital stay, length of intensive care unit (ICU) stay, surgical interventions, the organs affected by the trauma, morbidity, and mortality rates were recorded., glasgow coma scale (GCS), abbreviated injury scale (AIS), trauma score-injury severity score (TRISS), revised trauma score (RTS), injury severity score (ISS), pediatric trauma score (PTS), specific trauma scores for lung, liver, and spleen were calculated using the data in the files. RESULTS: The mean age of patients was 7.0+/-4.34 (1-16) years and 50% of them were men. The types of the trauma were blunt in 66 (89.2%) patients, penetrating in 5 (6.8%) patients and injury due to gun shot in 3 (4.1%) patients. The mean time between the trauma and entrance to the emergency service was 80.40+/-36.67 (10-120) min. Emergency operation and elective surgery was performed in 13 (17%) and 20 (27%) patients, respectively. The mean length of hospitalization was 4.50+/-7.93 (1-35) days.Seven (9.5%) patients needed ICU. The morbidity and mortality rates were 60.8% (n=45) and 2.7% (n=2), respectively. AIS, ISS, TRISS and PTS were independent predictors of morbidity (p<0.05). AIS and ISS were independent predictors of the length of hospital stay (p<0.05). RTS, TRISS, ISS and PTS were independent predictors of the need for ICU (p<0.05). Among laboratory findings, blood glucose, AST and ALT were found to be independent predictors of liver trauma. CONCLUSION: ISS was found to be more valuable than other trauma scoring systems for prognostic evaluation of pediatric trauma patients. On the other hand, blood glucose, AST, and ALT are easily available, cheap, and valuable alternative laboratory findings in prognostic evaluation.

Variations of supraorbital foramina in living subjects evaluated with multidetector computed tomography.

BACKGROUND: We aimed to evaluate the anatomic variations of supraorbital foramina/notches in living subjects using multidetector CT (MDCT) related to age, sex, and side. METHODS: Computer records of 399 patients (207 men and 192 women) referred for high-resolution CT examinations were evaluated for presence, shape, width, and distance from the nasion. RESULTS: The most common presentation was single notch. Presence of double foramen/notch was higher in the right. Bilateral notches were wider in men. Bilateral foramina and left notches were located more lateral in men. Notches were closer to nasion than foramina. Positive correlations were found between right and left sides for the diameters and distances to nasion. Widths of foramina showed negative correlation with the distances to nasion. CONCLUSIONS: This is the first study showing supraorbital foramen/notch variations in living crania. MDCT should be established in anatomical studies and may be used in preoperative evaluation.

Concurrent large spindle cell and ordinary lipomas.

The number of reported coexistences of ordinary lipoma and spindle cell lipoma is very limited in the literature. We present a patient with neighboring large spindle cell lipoma and ordinary lipoma in the posterior neck. Clinical, radiologic, and histologic findings of the case are presented with distinguished figures. Complete surgical removal confirmed the diagnoses. These lipomatous tumors may develop coincidentally and magnetic resonance imaging is overtly adequate in identifying their nature.

Radiologic and histologic assessment of diced cartilage grafts for cranial bone defects of rabbits: an experimental study.

This study was performed to experimentally evaluate the viability and coverage of diced cartilage grafts for cranial defects. Biparietal bone defects were prepared in each of 20 rabbits. Otogenous bone grafts were fixed to one side, whereas cartilage grafts taken from the right ear, diced, and wrapped with oxidized regenerated cellulose (Surgicel) were placed on other side. Parenchymal impression, contour, and ossification of all grafts in the 16 rabbits surviving after 8 weeks were evaluated with computed tomography and magnetic resonance imaging. The existence of ossification was examined pathologically. Parenchymal impression was significantly more frequent in bone grafts than in cartilage grafts (p < 0.05). This difference probably is attributable to the application technique. There was no significant radiographic difference in other parameters between the two groups. No significant difference in ossification was found. In conclusion, ossification was seen radiologically and pathologically in diced cartilage grafts. Because of autogenicity, ease of shaping, absence of postoperative warping, reduced resorption rates, and inherent viability and ossification properties, the authors suggest that diced cartilage grafts may be an alternative material for cranial defects, especially for frontal cranial reconstruction in which deformities may cause aesthetic and functional disabilities. The authors believe that further long-term studies also are needed.