Effectiveness of the sternocleidomastoid muscle contraction asymmetry and filter: cervical vestibular evoked myogenic potential.

OBJECTIVE: This study aimed to determine the precautions that can be taken to increase the reliability of the vestibular evoked myogenic potentials test without being affected by the asymmetry of the sternocleidomastoid muscle and the issues that should be considered in the interpretation of vestibular evoked myogenic potential results if these precautions are not taken. METHOD: Individuals with sternocleidomastoid muscle activity of less than 30 µV in cervical vestibular evoked myogenic potential testing and an asymmetry ratio of more than 0.35 were excluded. In our study, individuals were divided into different groups according to sternocleidomastoid muscle asymetry. RESULTS: A total of 53 individuals were included in the study. Intergroup comparisons were made to determine the effect of electromyogram scaling and filter use on amplitude asymmetry ratio according to sternocleidomastoid muscle asymmetry. CONCLUSION: Keeping the sternocleidomastoid muscle asymmetry not exceeding 10 µV maximises the reliability of cervical vestibular evoked myogenic potentials. As a result of our study, it can be concluded that in clinical applications the asymmetry should not exceed 20 µV.

An unusual cause of chemical peritonitis.

We report a case of chemical peritonitis associated with a bispyridine derivate used for abdominal lavage.

Laparoscopic cholecystectomy in a patient with situs inversus totalis.

Situs inversus is a rare anomaly characterized by transposition of organs to the opposite side of the body. In this group of patients, cholelithiasis is observed with a frequency similar to the normal population. Herein, we report a patient with situs inversus totalis who underwent a successful laparoscopic cholecystectomy. Diagnostic pitfalls and technical details of the operation are discussed in the context of the available literature.

Laparoscopic double cholecystectomy.

Gallbladder anomalies, although rarely seen, can be a challenge to the surgeon. There are many cases in the literature in which double gallbladder has been missed at the first operation. A case in which accessory gallbladder was suspected, confirmed at the operation, and managed successfully by laparoscopic cholecystectomy is described. The lack of specific symptoms and findings and the inaccuracy of imaging methods may cause missed diagnoses. The laparoscopic surgeon should always be aware of this abnormality.

A case of renal artery stenosis secondary to chronic pancreatitis.

We report a case of renal artery stenosis most probably secondary to chronic pancreatitis. The patient had a traumatic pancreatic fistula. This was followed by numerous attacks of pancreatitis in the following years. At a relatively young age, he developed hypertension. Examinations revealed a right renal artery stenosis which was successfully treated by a percutaneous angioplasty. This rare complication should be kept in mind as a possible complication of pancreatitis.

Experimental study of the effect of different meshes on bacterial translocation.

Implantation of intraabdominal biomaterials promotes bacterial translocation (BT). In this study we planned to determine the effect of different types of mesh on the induction of BT. Swiss albino mice were divided into four groups: control, polypropylene (PP), polyglactin 910 (PG), and dura mater (DM). At hour 0, an abdominal wall defect was created in all animals. In the control group the defect was closed primarily. PP, PG, and DM meshes were used to repair the defects such that the intestines were in contact with the mesh in the remaining three groups. BT was evaluated 4, 24, and 48 hours later. At 4 hours total BT increased in the PP group compared with that in the control (p = 0.0321) and DM (p = 0.0098) groups. At 24 hours the PG group had increased BT compared with the controls (p = 0.0392) and the DM group (p = 0.0274), whereas the PP group had increased BT compared with the DM group only (p = 0.0477). At 48 hours both PG and PP groups had increased BT compared with controls (p = 0.0431 and p = 0.0001, respectively); the PP group had also increased BT compared to the DM group (p = 0.001) and the PG group (p = 0.017). In the control, DM, and PP groups there was no intragroup statistical difference. In the PG group there was a significant increase in BT at 24 hours compared to that at 4 hours (p = 0.0274). Prosthetic meshes led to increased BT compared to that with the DM mesh. This effect might be attributed to the different organic and physical properties of the meshes.

Effect of intraperitoneal and extraperitoneal insertion of mesh on bacterial translocation: does it make a difference?

OBJECTIVE: To asses the effect of insertion of mesh, with or without contact with the peritoneum, on the induction of bacterial translocation. DESIGN: Open experimental study. SETTING: Surgical research laboratory, Turkey. SUBJECTS: 158 Swiss albino mice. INTERVENTIONS: A defect in the abdominal wall was created. In the control group, the defect was closed primarily. In the extraperitoneal group, polypropylene mesh was sutured over the abdominal wall after primary closure of the peritoneum and in the intraperitoneal group, polypropylene mesh was sutured to close the created defect so that it was in contact with the intestines. MAIN OUTCOME MEASURES: Bacterial translocation at 4, 24 and 48 hours. RESULTS: Insertion of mesh in contact with the peritoneum led to increased bacterial translocation to mesenteric lymph nodes at 4 (p = 0.02) and 48 (p = 0.03) hours compared with insertion without contact. CONCLUSION: Contact between a foreign body and the peritoneum is required to induce bacterial translocation.

Social, educational and vocational status of 48 young adult females with gonadal dysgenesis.

OBJECTIVE: The purpose of this study was to evaluate the educational, vocational and social function of young adults with gonadal dysgenesis. DESIGN: Forty-eight female patients with gonadal dysgenesis (17, 45XO; 26, 45XO/46XX or other mosaics; and five pure gonadal dysgenesis) followed by our multidisciplinary team from childhood, were re-evaluated in adult age. RESULTS: Mean age +/- SD at diagnosis was 11.4 +/- 5.0 years and mean age at the time of survey was 29.6 +/- 6.3 years. The mean final height for the patients was 145.5 +/- 8.3 cm (range 134-170 cm). Mean verbal IQ (WISC-R) for the 39 subjects tested was 101.4 +/- 20.7 and mean performance IQ was 86.8 +/- 17.7. No difference in verbal IQ levels was found between the various karyotype groups. Twenty-five had an academic education. All were employed except for one housewife; 37 work in white collar professions. A significant correlation was found between verbal IQ and education (P = 0.005) and between verbal IQ and profession (P = 0.005). Twenty-three served in the army. Fourteen are married: three have an adopted child and two a child born after in vitro fertilization (IVF); others are waiting for IVF or adoption. Five patients had some form of psychiatric problem that required psychiatric or psychological treatment in the past (two had transitory anorexia nervosa and three behavioural problems). Sixty-three per cent reported having wide and satisfactory social relations but limited to female friends. CONCLUSION: Positive adjustment in the professional area and fair adjustment in the social area were not related to physical stigmata or to any other independent variable tested, but rather to intellectual ability and a high degree of achievement motivation.

Intestinal Behçet's disease: surgical experience in seven cases.

Seven cases of Behçet's disease involving the intestines are reported. The terminal ileum and the ileocecal area was involved in all seven cases, with complications requiring surgical treatment. Primary right hemicolectomy and ileal resection was performed in six, and ileal resection in one patient who required a secondary right hemicolectomy because of leakage from the small bowel anastomosis. In two patients the disease was classified as complete and in five patients as incomplete. The results of this experience with seven cases of intestinal Behçet's disease have demonstrated that the complications may be serious, and that surgical treatment should be considered more readily.

Gastritis cystica polyposa.

Gastritis cystica polyposa was diagnosed in five patients between ages 29 and 61 years. All five had been operated on for peptic ulcer disease three to 26 years earlier, when gastroenteric anastomoses had been made. The presenting complaint was abdominal pain, nausea and vomiting, or gastrointestinal bleeding. The lesions, located on the gastric side of the anastomosis, consisted of polypoid mucosal changes associated with hyperplasia and cystic dilatation of glands. Radiologic and endoscopic findings were often nondiagnostic, and surgical intervention was necessary to relieve obstruction and to rule out carcinoma. Resection of the gastrojejunostomy site and choosing anastomotic techniques to minimize bile reflux into the stomach appear to be the preferred methods of treatment.

The impact of long-term therapy by a multidisciplinary team on the education, occupation and marital status of growth hormone deficient patients after termination of therapy.

Forty-two GH deficient patients (14 isolated GH deficiency (IGHD), 28 multiple pituitary hormone deficiencies (MPHD), 23 males and 19 females) were evaluated after termination of hGH therapy and achievement of final height. IGHD patients were found to score higher in intelligence quotients (IQ) than the MPHD patients. The educational and occupational achievements of all patients positively correlated with their IQ level. Three patients achieved only elementary education, 26 completed high school and 13 had higher education. Thirty patients who had completed their education were employed, whereas 12 continued to study. Seventeen of the male patients and five females served in the Army. Eight patients were married and half of the single patients reported having a stable relationship with the opposite sex. The hypopituitary patients did not differ in five out of seven subscales of the human services rehabilitation scale when compared to a normal control group. These results which vary from those previously reported demonstrate the importance of long-term psychosocial counselling initiated at the time of diagnosis as part of the therapeutic approach in hypopituitary patients.

Psychosocial aspects of young adult growth hormone deficient patients previously treated with human growth hormone--a preliminary report.

This paper describes a multidisciplinary approach to treating patients with hGH deficiency. The team includes paediatric endocrinologists, social workers and psychologists, and is felt to provide a much better standard of care, producing subjects who are well integrated into society.

Intellectual and psychosocial functions of children, adolescents and young adults before and after operation for craniopharyngioma.

An evaluation of intellectual, personal and social functioning was made in 16 young patients with craniopharyngioma. No changes were found in the overall IQ verbal and performances scores before and after operation, however, discrepancies between verbal and performance scores suggest that one of the manifestations of craniopharyngioma in children are disturbance in cognitive functions. The decrease in the quality of life of the patients and their families manifested through the deterioration of familial and social relationships and the decrease in scholastic achievements lead to the conclusion that children with craniopharyngioma and their families require close psychological supervision and counselling both before and after surgery.