The effect of intrahepatic cholestasis of pregnancy and ursodeoxycholic acid treatment on Doppler parameters of fetal and maternal circulation.

OBJECTIVES: We aimed to evaluate feto-maternal blood flow parameters using Doppler ultrasonography (USG) in pregnant women with intrahepatic cholestasis of pregnancy (ICP) and the effect of ursodeoxycholic acid (UDCA) treatment on these parameters. MATERIAL AND METHODS: This prospective cohort study was performed at Dr. Sami Ulus Women's and Children's Health Teaching and Research Hospital, in Turkey between September 2022 and February 2023. Sixty pregnant women, 30 with ICP disease and 30 healthy women were included in the study. Obstetric Doppler parameters were measured by USG at diagnosis and after 48 hours of UDCA treatment for the ICP group. RESULTS: The obstetric Doppler parameters did not significantly differ in the ICP group and the healthy control group. The Doppler findings were similar after UDCA treatment in the ICP group. Gestational week at delivery and birth weight were lower in the ICP group in our study. CONCLUSIONS: We demonstrated that pregnant women with ICP had similar obstetric Doppler parameters when compared with healthy pregnant women and that the UDCA agent used for treatment of ICP disease did not affect these parameters.

Removal of two antidepressant active pharmaceutical ingredients from hospital wastewater by polystyrene-coated magnetite nanoparticles-assisted batch adsorption process.

This study employed simple polystyrene-coated magnetite nanoparticles (PS@MNPs)-assisted batch adsorption process for the removal of two antidepressant active ingredients (amitriptyline HCl and sertraline HCl) from hospital wastewater. Dominant parameters of the adsorption process including pH, adsorbent amount, and contact period were optimized through the univariate approach to enhance the adsorption efficiency. Upon reaching optimum adsorption conditions, equilibrium experiments were performed by spiking the adsorbates in hospital wastewater in the concentration range of 100-2000 µg/L. The concentrations of the adsorbates in the effluent were calculated using the matrix-matching calibration strategy to enhance the accuracy of quantification. A validated switchable solvent-based liquid phase microextraction (SS-LPME) method was employed to enrich the two active pharmaceutical ingredients (APIs) prior to sensitive determination with GC-MS (gas chromatography-mass spectrometry). The equilibrium data were mathematically modeled employing the Langmuir and Freundlich adsorption isotherm models. The isotherm constants were calculated, and the results showed that both the isotherm models fitted well with the experimental data. The efficient and simple batch adsorption strategy reported in this study was successfully employed to remove amitriptyline HCl and sertraline HCl from hospital wastewater at low concentrations.

Spatio-temporal distribution of microplastic pollution in surface sediments along the coastal areas of Istanbul, Turkey.

Microplastics (MPs) have become prevalent in various environmental compartments, including air, water, and soil, attracting attention as significant pollutant parameters. This study investigated the prevalence of MP pollution in surface sediments along Istanbul's Marmara Sea, encompassing the megacity and the Bosphorus. A comprehensive sampling approach was employed, covering 43 stations across four seasons and depths ranging from 5 to 70 m. The objective was to assess the impact of terrestrial, social, and industrial activities on MPs. The average concentrations varied per season, with fall, winter, spring, and summer values recorded as 2000 ± 4100, 1600 ± 3900, 4300 ± 12,000, and 9500 ± 20,300 particles/kg-DW. The study identified river stations in the Golden Horn and sea discharge locations as hotspots for high concentrations. Notably, the dominant shape shifted from fibers in fall, winter, and spring to fragments during summer, coinciding with mucilage occurrences. The study identified 11 different polymers, with polyethylene (44 %) and polypropylene (31 %) being the most common.

Low loaded Pt-Co catalyst surfaces optimized by magnetron sputtering sequential deposition technique for PEM fuel cell applications: physical and electrochemical analysis on carbon paper support.

A series of thin Pt-Co films with different metal ratios were deposited by using the sequential cosputtering directly on a commercial hydrophobic carbon paper substrate at room temperature and in ultra-high vacuum (UHV) conditions. Their electrocatalytic properties toward the oxygen reduction reaction were investigated in 0.5 M H2SO4 solution by means of cyclic voltammetry (CV) and linear sweep voltammetry (LSV) on rotating disc electrode (RDE). The results showed that Pt particles, deposited by dc-magnetron gun, surround the large Co-clusters deposited by rf-magnetron gun. In addition, the increase of Co content led to an increase in the electrochemical active surface area (EASA) from 23.75 m2/gPt to 47.54 m2/gPt for pure Pt and Pt:Co (1:3), respectively, which corresponded the improvement of the utilization of Pt by a factor of 1.91. This improvement indicated that the sequential magnetron cosputtering was one of the essential technique to deposit homogeneous metal clusters with desirable size on the gas diffusion layer by adjustment plasma parameters.

Surface modified iron magnetic nanoparticles assisted Fenton digestion and extraction method for cadmium determination.

This study presents a Fenton digestion method for milk samples based on UV irradiation for cadmium determination using flame atomic absorption spectrometry. The method was developed as an alternative to microwave digesters, using very basic apparatus and easy to acquire chemicals. Fenton digestion process was performed by the help of citric acid coated magnetic nanoparticles. Optimum conditions of the digestion process were applied to milk samples to evaluate analytical performance of the method. Limit of detection and limit of quantification values calculated for cadmium in milk were 0.53 and 1.8 mg/L, respectively. The method was applied to three different milk samples to validate the method's suitability and accuracy. Percent recovery values calculated for the samples spiked at two different concentrations ranged between 86 and 111%. Due to differences in the content of the spiked and control/standard milk samples, exact matrix matching calibration strategy using the same brand of milk sample in the preparation of calibration standard was employed and the accuracy of cadmium quantification was greatly enhanced (≈100%).

Influence of the color of composite resin foundation and luting cement on the final color of lithium disilicate ceramic systems.

STATEMENT OF PROBLEM: Lithium disilicate restorations are commonly used, particularly in the anterior region. The color of the underlying composite resin foundation (CRF) and luting cement may negatively affect the color of lithium disilicate ceramic restorations. PURPOSE: The purpose of this in vitro study was to investigate the effect of CRF and resin cement materials on the color of lithium disilicate ceramics in 2 different translucencies. MATERIAL AND METHODS: Twenty disks (11×1.5 mm, shade A2) were fabricated from medium-opacity (mo) (n=10) and high-translucency (ht) (n=10) lithium disilicate (Lds) blocks (IPS e.max Press). Five CRF disks (11×3 mm) were fabricated in 5 different shades (A1, A2, A3, B2, C2) and 30 resin cement disks (11×0.2 mm) in the shades of translucent (Tr), universal (Un=A2), and white-opaque (Wo). Ceramic specimens were placed on each CRF, and the resin cement combination and color was measured with a spectrophotometer. CIELAB color coordinates were recorded, and the color coordinates of both ceramics on the shades of the A2 CRF and resin cement were saved as the control. Color differences (ΔE00) between the control and test groups were calculated. Data were analyzed with 3-way analysis ANOVA and compared with the Tukey HSD test (α=.05). RESULTS: The ΔE00 values were influenced by the shades of the CRF, resin cement materials, and also their interactions (P<.05). The ΔE00 values were not affected by the ceramic type. The ΔE00 values of the Wo cement groups (1.73 to 2.96) were significantly higher than those of the other cement shades (0.88 to 1.29) for each ceramic type and CRF shade (P<.05). CONCLUSIONS: Lithium disilicate ceramics in 2 different translucencies were similarly influenced by the color of the underlying cement and CRF. When translucent and universal cement shades were used, the core shade did not affect the final color of the ceramics. White opaque cement caused clinically unacceptable color changes in both ceramics on all shades of CRFs except the C2 CRF and when high translucency ceramic was used on the A2 CRF. These changes were clinically acceptable, but perceptible.

Electricity Production and Characterization of High-Strength Industrial Wastewaters in Microbial Fuel Cell.

Microbial fuel cells (MFCs) convert electrochemical energy into electrical energy immediately and have a big potential usage for the same time wastewater treatment and energy recovery via electro-active microorganisms. However, MFCs must be efficiently optimized due to its limitations such as high cost and low power production. Finding new materials to increase the cell performance and reduce cost for MFC anodes is mandatory. In the first step of this study, different inoculation sludges such as anaerobic gum industry wastewater, anaerobic brewery wastewater and anaerobic phosphate were tested, and MFC that was set up with anaerobic gum industry wastewater inoculation sludge exhibited the highest performance. In the second step of this study, various wastewaters such as chocolate industry, gum industry and slaughterhouse industry were investigated for anode bacteria sources. Several electrochemical techniques have been employed to elucidate how wastewaters affect the MFCs' performance. Among all the mentioned wastewaters, the best performance was achieved by the MFCs fed with slaughterhouse wastewater; this device produced a maximum power density of 267 mW·m-2.

[An alternative biphasic nutrient medium for the diagnosis of cutaneous leishmaniasis]. / Kutanöz leysmanyazis tanisinda alternatif bifazik nutrient besiyeri.

Cutaneous leishmaniasis (CL) caused by the Leishmania spp. parasites, is a disease characterized by nodulo-ulcerative lesions in the skin. CL is transmitted to humans by infected sandflies during blood sucking, and is endemic in about 98 countries over the world. The demonstration of amastigotes via microscopic examination, and the growth of promastigotes in NNN (Novy-MacNeal-Nicolle) medium are gold standard methods for laboratory diagnosis. The aim of this study was to compare the biphasic NNN medium that is frequently used in routine laboratories with the biphasic nutrient medium that can be prepared easily in microbiology laboratories, for the growth of promastigotes. In the study, the aspiration fluid sample was used as clinical sample which was obtained from the skin lesion of a 47-year-old female patient admitted to Izmir Katip Celebi Ataturk Education and Research Hospital dermatology outpatient clinic and pre-diagnosed as CL. The aspirate sample taken from the lesion was evaluated with microscopy, cultivation in two different media and real-time polymerase chain reaction (Rt-PCR) methods. In microscopic examination Leishmania amastigotes were observed in Giemsa-stained smears prepared from the aspiration fluid. In Rt-PCR performed by using specific primers and probes targeting ITS1 region of Leishmania parasite, a melting-curve compatible with L.tropica was detected. For cultivation, triple inoculations of the aspirate sample into NNN (NNN + RPMI 1640 + 10% fetal calf serum) and nutrient media (nutrient agar + nutrient broth + 10% fetal calf serum) were used. The cultures were incubated at 27°C for 10 days, and the number of propagated promastigotes were counted on the third, seventh and tenth days. The growth of Leishmania promastigotes was detected in both media on the third day. The number of promastigotes grown in NNN medium on the third, seventh and tenth days were 105/ml, 106/ml and 108/ml, respectively. Those values in nutrient medium were 106/ml, 107/ml and 108/ml on the third, seventh and tenth days, respectively. Although the number of promastigotes on the third and seventh days were higher in nutrient medium than NNN medium, the number of cultivated promastigotes were equal on the tenth day. As a result, nutrient medium is considered to have an impact in the diagnosis of CL, by providing an alternative to the routine medium used and can readily be available in microbiology and parasitology laboratories with long shelf-life. It was concluded that biphasic nutrient medium could be used as a supplementary medium for diagnosis in laboratories in the absence of NNN medium or can not be provided.

The development of catalytic performance by coating Pt-Ni on CMI7000 membrane as a cathode of a microbial fuel cell.

Performance of cathode materials in microbial fuel cell (MFC) from dairy wastewater has been investigated in laboratory tests. Both cyclic voltammogram experiments and MFC tests showed that Pt-Ni cathode much better than pure Pt cathode. MFC with platinum cathode had the maximum power density of 0.180 W m(-2) while MFC with Pt:Ni (1:1) cathode produced the maximum power density of 0.637 W m(-2), even if the mass mixing ratio of Pt is lower in the alloy were used. The highest chemical oxygen demand (COD) removal efficiency was around 82-86% in both systems. The cyclic voltammogram (CV) analyses show that Pt:Ni (1:1) offers higher specific surface area than Pt alone does. X-ray diffraction (XRD) and Scanning Electron Microscopy (SEM) results showed that entire Pt:Ni (1:1) alloys can reduce the oxygen easily than pure platinum, even though less precious metal amount. The main outcome of this study is that Pt-Ni, may serve as a alternative catalyst in MFC applications.

Influence of different staining beverages on color stability, surface roughness and microhardness of silorane and methacrylate-based composite resins.

AIM: To investigate the influence of different staining beverages on color stability, surface roughness and microhardness of silorane and methacrylate-based composite resins. MATERIALS AND METHODS: Three different composite resins (Filtek Silorane, Filtek P60, Filtek Supreme XT) were tested. Thirty cylindrical specimens (10 × 2 mm) per material were prepared and polished with a series of aluminum-oxide polishing disks. Each group was then randomly subdivided into three groups according to the test beverages: distilled water (control), cola and coffee. The samples were immersed into different beverages for 15 days. Color, surface roughness and microhardness values were measured by a spectrophotometer, prophylometer and Vickers hardness device respectively, at baseline and after 15 days. The data were subjected to statistical analysis. RESULTS: Immersion in coffee resulted in a significant discoloration for all the composites tested, although the color change was lower in Filtek Silorane than that of MBCs (p < 0.05). All the composites tested showed similar surface roughness changes after immersion in different beverages (p > 0.05). Besides coffee caused more roughness change than others. Immersion in coffee caused highest microhardness change in Filtek Supreme XT (p < 0.05). CONCLUSION: Cola and coffee altered, to some degree, the color, surface roughness and/or microhardness of the tested resin composites, depending on the characteristics of the materials.

[The investigation of malaria cases in Manisa between 2008-2012]. / Manisa Ilinde 2008-2012 Yillari Arasinda Saptanan Sitma Olgularinin Degerlendirilmesi.

OBJECTIVE: We aimed to determine the malaria prevalence in a 5-year period by using the data obtained from Malaria Control Center associated with the Manisa Province Public Health Office Infectious Diseases Department in Manisa between 2008 and 2012. METHODS: The data were evaluated according to age, gender, type of parasite, and the places of travel. RESULTS: In this study, six imported malaria cases were detected in blood samples from 86,955 patients by the Malaria Control Center, associated with the Manisa Province Public Health Office Infectious Diseases Department, with active and passive surveillance between 2008 and 2012. Positivity rate was 0.007%. CONCLUSION: Imported malaria cases, due to increasing international travel and migration, have a serious endemic potential based on unsuitable or insufficient prophylaxis, although malaria cases have decreased notably by successful eradication studies in Turkey. This paper was prepared especially in order to point out this subject, because all of the cases were imported.

Reliability and reproducibility of classifications for distal radius fractures.

OBJECTIVE: The aim of this study was to evaluate the interobserver reliability and intraobserver reproducibility of the Universal, AO, Fernandez and Frykman classifications for distal radius fractures. METHODS: Fifty standard sets of posteroanterior and lateral roentgenograms of displaced distal radius fractures were classified two times by two groups of evaluators at 2-month intervals. The first group consisted of 10 orthopedic surgeons with a minimum of 5 years of experience. The second group consisted of 10 orthopedic residents in their first two years of practice. Interobserver reliability and intraobserver reproducibility were assessed using Cohen's kappa test. RESULTS: None of the classifications achieved good- very good reliability levels. The Fernandez classification had a moderate and the others had a fair interobserver agreement kappa coefficient. All classifications had fair kappa intraobserver agreement although the Frykman and Fernandez classifications had better results. CONCLUSION: None of the classification systems were superior in terms of reliability and reproducibility. The reliability and reproducibility rates of all four classifications were insufficient.

The correction of maxillary defciency with internal distraction devices: a multidisciplinary approach.

AIM: The purpose of this case report is to present the orthodontic, surgical and restorative treatments in the case of an operated cleft lip and palate and severe maxillary defciency in a 14-year-old female patient. BACKGROUND: Only orthodontic treatment could be ineffcient for cleft lip and palate patients characterized with maxillary hypoplasia. Orthodontic and surgical treatment shows suffcient results, especially with severe skeletal defciency. CASE REPORT: A cleft lip and palate patient required complex multidisciplinary treatment to preserve health and restore esthetics. Dental leveling and alignment of the maxillary and mandibular teeth were provided before the surgery. Maxillary advancement and clockwise rotation of the maxillary-mandibular complex was applied by a Le Fort 1 osteotomy with two internal distraction devices. After the active treatment including orthodontic treatment and orthognathic surgery, upper full mouth ceramic restoration was applied. CONCLUSION: This report shows the efficiency of internal distraction devices in cleft lip palate patients and exemplifes the multidisciplinary care required for such diffcult cases. Clinical signifcance: Stable improved occlusion and skeletal relations were observed after a follow-up examination period of 12 months.

Alternative treatment procedure in the case of fractured abutment of adhesive bridge: a clinical report.

UNLABELLED: In this case report, an alternative approach was presented for treatment of coronal fracture including pulp of maxillary central incisor, one of the abutments of an adhesive bridge, by using fiber post and tooth's own fractured component. The patient was referred to our clinic with the complaint of pain from the upper right central incisor and mobility of the adhesive bridge in maxillary anterior segment. It was realized that, the upper right central incisor, one of the abutments of the adhesive bridge, had been fractured at middle thirds of the crown including the pulp chamber. After dismounting the adhesive bridge and completion of the root canal treatment, a fiber post was placed into the fractured tooth. The fractured component, adherent to adhesive bridge retainer, was concorded to the fiber post. The whole structure was cemented with adhesive resin. A 1-mm-wide groove was made along the fracture line and restored with composite resin. The patient was evaluated clinically and radiographically at 12 and 30 months after the treatment. CLINICAL SIGNIFICANCE: Adhesive cementation of fractured component by supporting the remaining tooth structure with a fiber post is an inexpensive and conservative treatment alternative when the fractured component is compatible with the remaining tooth structure in cases of tooth fractures including the pulp chamber at anterior segment.

The effect of excisional arthroplasty with palmaris longus tendon on carpal height ratio in Stage 3 Kienböck's disease.

OBJECTIVE: Treatment methods in Kienböck's disease remain controversial despite the long-term awareness of the disease by orthopedic surgeons. Currently, excisional arthroplasty with a palmaris longus tendon ball is one of the most frequently used treatment methods. The aim of this study was to evaluate the long-term results of thirty-eight patients who had been treated with excisional arthroplasty and palmaris longus tendon ball, as well as the effect of this method on carpal height. METHODS: In this study, we retrospectively evaluated 38 patients (mean age: 30.4 years; range: 17-64 years) with Stage 3 Kienböck's disease who underwent excisional arthroplasty between 1978 and 2008. According to the Lichtman classification, 8 patients were classified as Stage 3a and 30 patients were classified as Stage 3b in Kienböck's disease. The mean duration of follow-up after surgery was 81.3 (range: 25 to 264) months. The outcomes were evaluated with joint range of motion, grip strength and functional assessment of Nakamura and radiographic changes in carpal height. RESULTS: According to the Nakamura's scoring system the results were excellent in 22 (57.9%) patients, good in 13 (34.2%) and moderate in 3 (7.9%). Comparison of pre and postoperative range of motion of the wrist revealed an average increase in wrist extension of 10° (p<0.05), and an average decrease in ulnar deviation of 4° (p<0.05) after the operation. No significant difference was observed when comparing other joint range of motion parameters. Dynamometric grip strength measurements revealed significant differences between the healthy and operated sides (67.6 kgf vs. 45.9 kgf, respectively; p<0.05). The decrease in the revised carpal height ratio were significant. CONCLUSION: According to patient satisfaction rate and clinical results, the outcome of excisional arthroplasty with palmaris longus tendon ball in Stage 3 Kienböck's disease is satisfactory. However, carpal height reduction and development of degenerative changes may be expected in long-term follow-up.

[Extensor indicis proprius transfers for extensor pollicis longus ruptures secondary to rheumatoid arthritis]. / Romatoid artritte ekstansör pollisis longus kopmalari için ekstansör indisis proprius transferi.

OBJECTIVES: We evaluated the results of extensor indicis proprius (EIP) to extensor pollicis longus (EPL) transfers for EPL ruptures secondary to rheumatoid arthritis. METHODS: Twenty-four patients (7 males, 17 females; mean age 41 years; range 22 to 72 years) with rheumatoid arthritis underwent EIP to EPL transfer for 25 ruptures. The mean duration from rupture to surgery was 4.3 months (range 1.5 to 11 months). Functional assessment of the fingers was made using a specific EIP-EPL evaluation method developed by Lemmen et al. Pinch and grip strengths were measured. Range of motion of the metacarpophalangeal and interphalangeal joints of the thumb was compared with the normal side. Patient satisfaction was evaluated by a visual analog scale. The mean follow-up period was 6.2 years (range 4.7 to 7.9 years). RESULTS: Functional results were perfect in 14 fingers (56%), good in six fingers (24%), moderate in four fingers (16%), and poor in one finger (4%). The pinch and grip strengths were 86% and 92% of the uninvolved hand, respectively. The mean visual analog scale score was 74 (range 24 to 99). Compared to the uninvolved side, the range of motion of the thumb and index finger decreased by 23 degrees and 7 degrees , respectively, with a 9% loss of interphalangeal motion and a 17% loss of metacarpophalangeal motion in thumb extension. Independent extension of the index finger was possible in 21 hands. CONCLUSION: The results of EIP to EPL transfers are successful in ruptures secondary to rheumatoid arthritis.

[Giant cell tumor at the wrist: a review of 23 cases]. / El bileginde dev hücreli tümör: yirmi üç olgunun incelenmesi.

OBJECTIVES: We evaluated patients who underwent surgical treatment for giant cell tumor of the wrist with regard to recurrence rates, factors influencing tumor recurrence, complications, and postoperative functional and emotional status of the patients. METHODS: The study included 23 patients (6 males, 17 females; mean age 31.6 years; range 12 to 74 years) who were treated surgically for giant cell tumor of the wrist. Grading, assessment of surgical margins, and functional evaluation were performed according to the Enneking's criteria. The effects of tumor volume, soft tissue extension, and selected surgical therapy on recurrence were investigated. Joint movements and stability, postoperative pain, presence of deformity, muscle strength, limitations in functional activities, and patient satisfaction were evaluated. The mean follow-up period was 6.7 years. RESULTS: Of all the patients, 69% had stage 2 and 23% had stage 3 tumors. There was no significant correlation between tumor volume and recurrence (p=0.22). Recurrences were observed in three (33%) of nine patients with soft tissue extension and in four (28.6%) of 14 patients without soft tissue extension. Recurrence rates were 33.3% in those who were treated by curettage alone (n=3), 50% with curettage and grafting (n=6), 50% with curettage and bone cement (n=2), and 16% in those who underwent wide excision (n=12). CONCLUSION: The most important factor influencing recurrence rate in giant cell tumors is the extent of surgical resection. At least marginal resection must be considered in patients with stage 2 and 3 lesions especially in cases with soft tissue extension. Adjunctive therapy should be added if curettage is considered.

[Thumb duplication: an analysis of 72 thumbs]. / Cift basparmak anomalisi: 72 olgunun degerlendirilmesi.

OBJECTIVES: The aim of this study was to evaluate patients who were operated on for a duplicated thumb. METHODS: Sixty-seven patients (41 females, 26 males; mean age 2.5 years; range 6 months to 20 years) underwent surgery for a total of 72 duplicated thumbs between 1982 and 2003. Five patients had bilateral involvement. The anomaly was on the right in 39 cases, and on the left in 33 cases. Clinical and radiographic evaluations were made according to the Wassel classification. The Bilhaut-Cloquet technique was used in 13 symmetrically duplicated thumbs, while simple excision of the unserviceable part was performed in the remaining. Patient satisfaction was assessed with the use of a visual analog scale after a mean follow-up period of 3.6 years (range 1 to 10 years). RESULTS: Nail deformity was present in all cases treated by the Bilhaut-Cloquet technique. These thumbs did not exhibit growth retardation, but interphalangeal joint motion was limited in five, while seven had a larger size compared to the normal side. Limited range of motion was detected in eight cases (11.9%), affecting the metacarpophalangeal joint in one, and the interphalangeal joint in the others. Seventeen patients (25.4%) developed an angulation of more than 10 degrees in the alignment of the thumb. Secondary procedures were necessary in 25 cases (37.3%), including collateral ligament reconstruction (n=12; 17.9%), tendon rerouting (n=3; 4.5%), corrective osteotomy (n=5; 7.5%), and arthrodesis of the interphalangeal joint (n=5; 7.5%). Patient satisfaction with the surgical outcome was 85% (n=57). CONCLUSION: It is important to evaluate and treat the skin, nail, bone, and the ligaments in a simultaneous manner in order to obtain a good reconstruction and to decrease both the complications and the need for subsequent operations.

[Free radial forearm flap transfer for the reconstruction of the Achilles tendon and soft tissue defect: a case report]. / Asil tendon ve yumusak doku defektinin rekonstrüksiyonunda serbest radial önkol flep transferi: Olgu Sunumu.

Reconstruction of the soft tissue defects around the Achilles tendon is a difficult challenge. This condition traditionally has been treated with staged procedures. We report a case treated with a one stage procedure. A neuromusculocutaneous radial forearm free flap was used for the reconstruction of an achilles tendon and for covering the overlying large soft tissue defect caused by a gun shot injury. The defect on the Achilles tendon was 15 cm in length and soft tissue loss was 18 x 10 cm. The flap including flexor carpi radialis muscle tendon was applied over the Achilles tendon. A terminolateral arterial anostomosis was performed on the tibialis posterior artery. There was no complication except a mild superficial infection on the lateral side of the flap treated by antibiotherapy. A satisfactory functional result was obtained. Application of a free neuromusculocutaneous radial forearm composite flap is a good technique to cover achilles tendon and soft tissue defects and to restore the function as a one stage procedure.

[Giant-cell tumors of the tendon sheath involving the hand or the wrist: an analysis of 141 patients]. / El ve el bileginde tendon kilifinin dev hücreli tümörü: 141 hastanin degerlendirilmesi.

OBJECTIVES: Giant-cell tumors of the tendon sheath localized in the hand or wrist were retrospectively reviewed with respect to diagnosis, surgical treatment, and postoperative complications. METHODS: During a 21-year period, a total of 141 patients (83 females, 58 males; mean age 37.5 years; range 6 to 77 years) underwent surgery for 146 lesions that developed in the hand (n=134) or the wrist (n=12). Involvement was on the right side in 77 patients, and on the left side in 64 patients. The mean follow-up period was 3.5 years (range 6 months to 11 years). RESULTS: On presentation, the most common symptom was the presence of a painless soft tissue mass. The most frequent localization was the volar part (76%) of the second (27%) and the third (24) fingers, or the proximal phalanx (57%). Forty per cent of tumors were encountered at ages between 30 and 50 years. The duration of symptoms ranged from one month to five years and the highest number of presentations fell within the first six months. In eighteen patients, radiologic studies showed osseous involvement, being cortical sclerosis in 12 patients, and erosion in eight patients. Postoperative complications included digital nerve injuries in four patients, superficial infection in three patients, and joint stiffness in 12 patients. Twenty-three patients (16%) developed recurrences within a mean of 3.7 years (range 2 months to 7 years). CONCLUSION: Taking high rates of recurrences into consideration, surgery for giant-cell tumors of the tendon sheath requires wide surgical exposure, attentive skills, and the use of magnification.