Determination of periodic deformation from InSAR results using the FFT time series analysis method in Gediz Graben.

Permanent Scatterers (PS) point velocities obtained by the interferometric synthetic aperture radar (InSAR) method are generally determined using the linear regression model, which ignores periodic and seasonal effects. In this study, software was developed that can detect periodic effects by applying fast Fourier transformation (FFT) time series analysis to InSAR results. Using the FFT time series analysis, the periodic components of the surface movements at the PS points were determined, and then the annual velocity values free from periodic effects were obtained. The study area was chosen as the Gediz Graben, a tectonically active region where aseismic surface deformations have been observed in recent years. As a result, using the developed method, seasonal effects were successfully determined with the InSAR method at the PS points in the study area with a period of 384 days and an average amplitude of 19 mm. In addition, groundwater level changes of a water well in the region were modeled, and 0.93 correlation coefficient values were calculated between seasonal InSAR displacement values and water level changes. Thus, using the developed methodology, the relationship between the tectonic movement in the Gediz Graben in Turkey and the seasonal movements and the change in the groundwater level was determined.

The relationship between intracoronary thrombus burden and atherogenic index in patients with ST-elevation myocardial infarction.

OBJECTIVE: Increased coronary thrombus load is a strong predictor of adverse cardiovascular (CV) outcomes. Identifying predictors of intracoronary thrombus burden may contribute to the management of ST-segment elevation myocardial infarction (STEMI). We aimed at evaluating the relationship between the atherogenic index (ATI) and coronary thrombus burden in patients presenting with STEMI. PATIENTS AND METHODS: 139 patients who presented with STEMI and underwent primary percutaneous coronary intervention were included in this study. Angiographic thrombus burden was classified as previously defined in the myocardial infarction (TIMI) study group. RESULTS: The patients were divided into two groups as those with high and low thrombus load. Independent predictors of high thrombus burden were ATI (OR: 4.23, 95% CI: 2.38-7.5; p<0.001), serum creatinine level (OR: 17.4, 95% CI: 3.03-101.4; p=0.001) and non-LAD involvement (OR: 0.363, 95% CI: 0.14-0.92; p=0.034). The association of ATI with thrombus load was independent from HDL and TGL levels. CONCLUSIONS: The atherogenic index can be used as a reliable marker for increased coronary thrombus burden, which is associated with adverse CV outcomes.

Evaluation of heart rate variability and night-time blood pressure measurements in patients with idiopathic sudden sensorineural hearing loss.

OBJECTIVE: The aim of this study is to investigate the role of the autonomic nervous system in the etiology of idiopathic sudden sensorineural hearing loss (ISSHL) by measuring heart rate variability (HRV) and night-time blood pressure levels. PATIENTS AND METHODS: A total of 58 patients, 31 ISSHL patients (group 1) and 27 healthy volunteers (control group; group 2), were included in this study. Clinical and ambulatory blood pressure measurements and Holter electrocardiography were performed in both groups. After these evaluations, HRV parameters and night-time blood pressure values were determined. RESULTS: Mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) measured at night-time were higher in group 1 compared to group 2 (p < 0.05). Heart rate variability parameters were lower in group 1 than in group 2. CONCLUSIONS: In patients with ISSHL, elevated blood pressure at night-time and reduced heart rate variability suggest that autonomic nervous system dysfunction might play a role in the etiopathogenesis of the disease. The measurements of ambulatory blood pressure and heart rate variability can reveal more enlightening data in the determination of the etiology of ISSHL and guiding the treatment.

Terminal QRS distortion and severity of coronary artery disease in ST-elevation myocardial infarction.

BACKGROUND: Grade 3 ischemia (G3I) is defined as ST elevation with distortion of the terminal portion of the QRS complex on electrocardiograms (ECGs) of patients with ST-segment elevation myocardial infarction (STEMI). Although the association between G3I and short- and long-term cardiovascular events is well established, its mechanism is unclear. We assessed the association between G3I on the admission ECG and SYNTAX score (SS) in patients with STEMI undergoing primary percutaneous coronary intervention. PATIENTS AND METHODS: The study population consisted of 312 patients with STEMI. Baseline ECGs of the patients were analyzed for grade of ischemia; the online latest updated version (2.11) of the SS calculator was used to determine the SS (http://www.syntaxscore.com). Patients were divided into two groups according to their grade of ischemia: grade 2 ischemia (G2I) or G3I. Also, patients were classified according to their SS as SS < 22 (low) or SS ≥ 22 (high). RESULTS: There were 211 patients in the low SS group and 101 patients in the high SS group. G3I was present in 31.1 % (n = 97) of the study population. SS was significantly higher in patients with G3I than in patients with G2I (20.1 ± 8.8 vs. 13.7 ± 7.1, p < 0.001). G3I was significantly higher in patients with high SS (50.5 % vs. 21.8 %, p < 0.001). Multivariate logistic regression analysis revealed that G3I (p < 0.001), diabetes (p = 0.013), age (p = 0.016), and anterior MI (p = 0.011), were independent predictors of high SS. CONCLUSION: In conclusion, G3I was independently related to high SS. We suggest that elevated SS in patients with G3I may explain the relationship between G3I and the poor outcome observed in these patients. Furthermore, the prediction of high SS by means of G3I in patients with STEMI may help determine the most appropriate revascularization method and prevent procedure failure.

Impact of enuresis nocturna on health-related quality of life in children and their mothers.

OBJECTIVE: Nocturnal enuresis (NE) is a common childhood disorder. As children age and NE persists, it may become more stressful for both them and their caregivers. The aim of the present study was to assess the impact of NE on the quality of life of children who were diagnosed with NE, and their mothers, and to compare the results with a healthy control group. SUBJECTS AND METHOD: Eighty-two children with NE, and their mothers, and 93 healthy children and their mothers were enrolled in the study. The sociodemographic data were evaluated. The Pediatric Quality of Life Inventory 4.0 Scales (PedsQL 4.0) were used to assess the children's health-related quality of life (HRQoL); and the World Health Organization Quality of Life Instrument; short form (WHOQOL-BREF) was used for the mothers' HRQoL. RESULTS: The PedsQL 4.0 mean scores for the children with NE group were as follows: total score, 68.74; physical health score, 72.79; psychosocial health score, 66.56. The scores for the children in the control group were as follows: total score, 80.98; physical health score, 81.11; psychosocial health score, 80.88. The WHOQOL-BREF scores for the mothers of the children with NE were as follows: physical health score, 67.90; psychosocial health score, 62.66; social relationships score, 60.90; environmental area score, 61.04. The WHOQOL-BREF scores for the mothers in the control group were as follows: physical health score, 75.96; psychosocial health score, 72.39; social relationships score, 72.18; environmental area score, 67.44. CONCLUSIONS: Nocturnal enuresis negatively affects the quality of life of both children and their mothers. Therefore, when physicians see children with enuresis, they should also be aware of the effect of NE on the mothers' quality of life.

Assessment of effect of irbesartan and nebivolol on the left atrium volume and deformation in the patients with mild-moderate hypertension.

BACKGROUND: We aimed to assess the effects of irbesartan and nebivolol on the left atrium (LA) volume and deformation in the patients with mild-moderate hypertension. PATIENTS AND METHODS: The study comprised of 160 patients (mean age: 55.6±9.6 years), who had Stage 1 or 2 hypertension according to the European Society of Cardiology (ESC) and have not been receiving antihypertensive therapy. The patients were assigned to treatment groups; irbesartan (n=80) and nebivolol (n=80). The patients were clinically and echocardiographically reevaluated on the 6th and 12th months after the onset of treatment. RESULTS: There was no difference between the two treatment groups in terms of baseline demographic, clinical and echocardiographic characteristics. Moreover, no difference was observed between the treatment groups on the 6th and 12th months. Intragroup analyses revealed that systolic blood pressure (SBP) and diastolic blood pressure (DBP) significantly decreased in time and diastolic function parameters were improved. However, whilst significant increase was observed in conduit volume, decrease was observed in other volumes of the LA in the irbesartan and nebivolol groups. This significant change was observed on the 6th month in both treatment groups. LA global peak systolic strain (LAGLSs), LA global peak systolic strain rate (LAGLSRs), LA global peak strain rate during early ventricular diastole (LAGLSRe) and LA global peak strain rate (LAGLSRa) during late ventricular diastole (LAGLSRa) values began to be significantly increased after 6 months of treatment in both treatment groups. CONCLUSIONS: We found that nebivolol, which is a new generation beta blocker, is effective as irbesartan with proven efficacy in improving LA volume and LA myocardial performance in patients with mild-moderate hypertension. Moreover, we determined that strain and strain rate, which are the new echocardiographic parameters, are effective as LA volumes in assessing LA functions.

Comparison of effects of nebivolol, carvedilol and irbesartan on left ventricular hypertrophy associated with hypertension.

OBJECTIVES: The aim of this study was to investigate if the new generation beta-blockers are as effective as irbesartan, which is an angiotensin receptor blocker (ARB), on left ventricular hypertrophy (LVH). PATIENTS AND METHODS: The study included 85 patients (average age: 56.6±9.6 year) with stage 1 and 2 hypertension, who previously didn't receive an antihypertensive treatment, but diagnosed with LVH echocardiographically. The patients were divided into three different treatment groups: irbesartan (n=28), nebivolol (n=25) and carvedilol (n=32). The patients were reassessed clinically and echocardiographically at 3, 6 and 12 months after the treatments. RESULTS: There was no statistically significant difference in baseline left ventricular mass index (LVMI) and other parameters among the three treatment groups (p > 0.05). Although there was no significant decrease in LVMI in irbesartan and carvedilol groups at 3 months after the treatment (p > 0.05), the values measured at 6 and 12 months (p < 0.0001) were significant. The decrease in LVMI in the nebivolol group was significant at 3, 6 and 12 months (p < 0.0001). There was a significant difference in measurements at 12 months (p < 0.05). CONCLUSIONS: Both of the new generation beta-blockers were more effective than irbesartan in the regression of LVH. A significant regression in LVH was observed 3 months after nebivolol treatment and 6 months after irbesartan and carvedilol treatments.

Anaphylaxisduring skin test with vecuronium

No disponible

The effect of external beam irradiation timing on skin graft survival.

BACKGROUND: The purpose of this study was to evaluate skin graft integrity after external beam irradiation in a rat model. METHODS: Forty-eight male Wistar rats were randomly assigned to 8 groups (A, B, C, D, A(c), B(c), C(c) and D(c)). A rectangular full-thickness skin graft was raised and reapplied to its original bed on the dorsum of each rat. Groups A(c), B(c), C(c) and D(c) were the control groups and were not given postoperative irradiation. After grafting, 25 Gy unfractioned cobalt(60) irradiation was administered to groups A, B, C and D on postoperative days 10, 20, 30 and 40, respectively. Histological samples were obtained 8 weeks after grafting. Dermal and epidermal thickness were measured by the KS-400 image analysis program. RESULTS: The difference in the epidermal and/or dermal thickness between the irradiated groups was not found to be significant. Furthermore, when histological features and the image analysis of the irradiated groups were compared with each other, there were no significant differences between the groups. CONCLUSIONS: Although we are aware that experimental results may not directly translate to the clinical setting, the present study indicates that external radiotherapy can be performed to skin-grafted areas as early as 10 days postoperatively.

Distant muscular (rectus femoris) metastasis from laryngeal squamous cell carcinoma.

OBJECTIVE: We report an extremely rare case of distant metastasis to the rectus femoris muscle from a laryngeal squamous cell carcinoma. METHOD: We present a case report and a review of the world literature concerning distant skeletal muscle metastasis from head and neck squamous cell carcinoma. RESULTS: The patient showed no evidence of distant muscular recurrence at follow up after 21 months; however, two years later he died from brain and suprarenal metastases. CONCLUSION: This report describes the first case of haematogenous distant metastasis to the left rectus femoris muscle from a laryngeal squamous cell carcinoma, without evidence of cervical lymph node metastases. To the best of our knowledge, this is the second reported case of muscular distant metastasis without cervical lymph node involvement. Although the prognosis associated with skeletal muscle metastasis is considered to be poor, surgical excision may be indicated for an isolated muscular metastasis.

Analysis of pediatric burns in a tertiary burns center in istanbul, Turkey.

INTRODUCTION: The factors and demographic features of pediatric patients with burns in eastern and western cultures differ from each other. In this retrospective study, our aim was to identify the demographic features of pediatric burns presenting to our tertiary burn center catering to a large population from Istanbul. METHODS: The demographic data and information of 358 children with burns admitted to the GMM HTH burn center in Istanbul over a 7-year period (2001-2008) were retrospectively reviewed. RESULTS: 48 children with burn injuries were hospitalized in our burn center during the study period. Out of the total of 358 patients, 33.79% (121) were infants and toddlers, 39.66% (142) were in early childhood and 26.53% (95) belonged to the late childhood age group. Males were predominantly affected, the total male to female ratio being 1.3:1. 297 (82.9%) of the 358 subjects resided in urban environments and 61 (17.1%) lived in rural areas. Scalds accounted for more than half (88.16%) of all burns, followed by contact (4.96%), flame (3.43%), electrical (1.52%), chemical (1.52%) and sunburn (0.38). Boiling water was the commonest agent, followed by hot tea. The three most frequent areas of burns were the upper limb (126 cases, 31.18%), followed by the lower limb (105 cases, 25.9%), and the trunk (94 cases, 23.26%). The majority (74%) of the patients had burns covering up to 10% of TBSA, and in 98.8% of the patients' the burn size was less than 30% of TBSA. CONCLUSION: This study demonstrates that the epidemiological features of pediatric burn patients, based on a review of such patients admitted to our burn center, differ in many aspects between eastern and western populations. Scalds occurring in a domestic setting, with mild to moderate burns, caused the vast majority of hospital admissions. It is necessary to improve the preventive programs and strategies in order to reduce the incidence of pediatric burn trauma.

Fasciotomy in crush injury resulting from prolonged pressure in an earthquake in Turkey.

OBJECTIVES: The authors report on the patients treated in a clinic who were injured in the earthquake that took place in north western part of Turkey in 1999 and was reported to be measured at 7.4 on the Richter scale. This catastrophe killed over 16 000 people while injuring more than 23 000 people. The type of housing was varied and entrapment occurred in single, two or more storey buildings. METHODS: 35 patients were admitted to the plastic surgery department after the earthquake. The hospital is about 400 km from the disaster site. Although all the transported victims had intravenous lines, few had adequate volume replacement. Sixteen had an urgent fasciotomy at the time of admission. The procedures were performed between 8 and 21 hours after extrication. After fasciotomy, all non-viable muscle content was removed but an attempt was made to retain as much viable muscle as possible. RESULTS: Amputation was required on four patients (25%). Fasciotomy incisions were closed with skin grafting in eight cases, and with primary closure in four cases. CONCLUSION: Prompt fasciotomy in earthquake victims will be both life saving and can prevent some of the severe and dangerous complications after crush syndrome.

Cross-foot island instep flap: a new use of instep skin flap for management of persistent wounds after complex plantar foot reconstruction.

When presented with an extensive soft-tissue defect involving the sole of the foot, reconstruction with free muscle flaps covered by a split-thickness skin graft is the proposed method of treatment. However, persistent graft breakdown and a chronic wound of the weight-bearing flap is a challenging problem during the late postoperative period, as experienced by the authors in their patients with high-energy-induced lower extremity injuries. The authors used the instep flap as an island cross-foot flap to manage persistent graft breakdown that involved skin-grafted muscle flaps transferred previously to the heel in 3 patients and to treat a chronic wound involving an amputation stump in 1 patient. The vascular pathology of the injured extremities indicated a cross-leg procedure instead of a free flap transfer. Pedicles were wrapped with split-thickness skin grafts and flaps were harvested superficial to the plantar fascia. Pedicles were divided during postoperative week 3, and no complications related to the operation or to immobilization have been encountered during the postoperative follow-up. During the 1-year follow-up, durable coverage, free from development of open wounds, has been achieved, and patients have expressed their satisfaction. In the case of complicated, high-velocity foot injuries, the authors suggest that this procedure be kept in mind as an alternative treatment option because it has some advantages over conventional cross-leg procedures.

Lower extremity salvage using a free flap associated with the Ilizarov method in patients with massive combat injuries.

Nine patients with massive combat injuries of the lower extremities were treated with Ilizarov bone transport in conjunction with free muscle flap coverage. In 4 patients soft-tissue coverage was applied first, and distraction osteogenesis was initiated 4 to 6 weeks later. In 3 patients both methods were applied simultaneously, and in 2 patients soft-tissue coverage occurred after distraction. The bones healed well, and all flaps survived. The segmental defects ranged from 8 to 16.5 cm in greatest dimension. The total disability time from initial injury ranged from 16 to 25.5 months. In all patients, full union of the tibia was achieved, and no osteomyelitis occurred. However, in 2 patients the applied flap became depressed, necessitating another flap operation. Despite late treatment in all 9 patients, successful results were obtained. Maintaining the original length of the tibia and providing timely, definitive treatment offer the best outcome for repair of massive injuries of the lower extremities. The Ilizarov transport method, used in combination with muscle flap coverage, represents an effective therapy for repair of massive injury of the lower extremities.

Recontruction of facial defects and burn scars using large size freehand full-thickness skin graft from lateral thoracic region.

Reconstruction of facial defects due to trauma, burn scar and congenital deformities is very challenging for reconstructive surgeons. Although many alternative techniques have been suggested, the ideal technique has not been described yet. Full-thickness skin grafting procedures are one of the options, but when larger grafts are needed, donor site morbidity is problematic. Full-thickness skin graft harvested from lateral thoracic region has some advantages for face reconstruction with its larger size, similar colour, thickness, skin quality and texture.

A new bisabolene derivative from the essential oil of Prangos uechtritzii fruits.

The fruits of endemic Prangos uechtritzii Boiss. & Hausskn. (Umbelliferae) were subjected to hydrodistillation and microdistillation. The resulting volatiles were investigated by GC-MS to determine the composition of the essential oils. 109 compounds representing 86.7% and thirty-two compounds representing 90.0% were identified and isolated by two different techniques, respectively. Column chromatography of the essential oil yielded a new bisabolene ether (7-epi-1,2-dehydrosesquicineole), which was characterized by spectral methods (GC-FTIR, 1D-, 2D NMR and HRESIMS).

Brachytherapy: reconstructive options and the role of plastic surgery.

The objectives of this study were to evaluate reconstructive methods for patients receiving brachytherapy after cancer ablation. This retrospective review evaluated 19 patients who received brachytherapy and reconstruction between 1991 and 1998. The average age of the patient was 61.9 years and the average follow-up was 2.9 years. Lesions were located in the upper extremity (N = 6), trunk (N = 2), and lower extremity (N = 11). In all patients, early postoperative brachytherapy was initiated 5 days after wound closure. The average radiation dose was 47 Gy (range, 45-50 Gy) and was delivered over a 3 to 5-day period. In each case, varying numbers of catheters were employed (average, 8 +/- 5 catheters). Free flap coverage was performed in 8 patients, and the latissimus dorsi was used most often. Pedicled regional flaps were employed in 11 patients (58%). Sixteen patients (84%) had additional external beam irradiation, and 10 patients (52%) underwent preoperative chemotherapy. All flaps survived with a demonstrated low complication rate (10%). In 2 patients, partial flap necrosis and infection occurred. Three donor site complications were observed and included wound dehiscence in 2 patients and hematoma in 1 patient. Cumulative effects of external beam radiation and brachytherapy did not affect the complication rate. Location of the defect did not alter the incidence of complications. Wound complications did not delay functional rehabilitation in these patients; however, hospital stay was longer. In 8 patients local recurrence occurred (42%) between 6 and 36 months after surgery whereas in 6 patients (32%) distant metastasis was observed. Ten patients are currently alive without evidence of disease. One of the most important concerns about early postoperative brachytherapy is wound healing. With careful planning and precise reconstructive techniques, the use of brachytherapy as a part of salvage or primary surgery does not lead to increased wound morbidity. Reconstructive procedures and a multidisciplinary approach have allowed the delivery of brachytherapy in these complicated patients with low morbidity.

Supratrochlear artery flap for the repair of lower eyelid defects.

An island pattern flap in the treatment of lower eyelid cicatricial ectropion is described. The flap is based on the supratrochlear artery and its associated veins. The donor site can be closed easily primarily. The very thin thickness of the pedicle increases the rotational arc of the flap. However, this procedure requires two stages and there is a slight bulkiness of the flap, both of which are major drawbacks of this method. This flap was used to restore missing supporting soft tissue of the lower eyelid in the clinical cases described herein.