Active in Sleep: Iron Guanidine Catalyst Performs ROP on Dormant Side of ATRP.

Copolymers are the answer to property limitations of homopolymers. In order to use the full variety of monomers available, catalysts active in more than one polymerization mechanism are currently investigated. Iron guanidine catalysts have shown to be extraordinarily active in ROP of lactide and herein prove their versatility by also promoting ATRP of styrene. The presented iron complex is the first polymerizing lactide and styrene simultaneously to a defined block copolymer in a convenient one-pot synthesis. Both mechanisms work hand in hand with ROP using the dominantly present FeII species on the dormant side of the ATRP equilibrium. This orthogonal copolymerization by a benign iron catalyst opens up new pathways to biocompatible polymerization procedures broadening the scope of ATRP applications.

A device for the functional improvement of lagophthalmos.

A new device was tested on rabbits for the improvement of lagophthalmos, which causes dryness and irritation of the eye and may cause blindness if untreated. In the presented study, 14 rabbits were injected with local anesthetic to induce temporary facial palsy leading to lagophthalmos on one side. To provide functionality to the upper eyelids, ferromagnetic steel plates were either implanted within the eyelid or taped on the eyelid surface. The device detected blinking in the nonparalytic side and moved the anesthetized paralytic eyelid by pulling the steel plate electromagnetically. The control group (n = 5) did not wear the device, and they could not shut their paralytic eyelids. The treatment group with the external placement of the metal plate (n = 4) and the treatment group with the implant (n = 5) wore the device for artificial blinking. All animals were observed during the experiments, and blinking was recorded on digital video. The data collected from video records were analyzed to test the statistical difference of blinking between control and the treated groups. The results showed that the treatment groups could artificially move their paralytic eyelids. Furthermore, the treatment group with the implant showed a noticeable similarity in eyelid position compared with healthy (nonparalytic) eyes.

Does partial expander deflation exacerbate the adverse effects of radiotherapy in two-stage breast reconstruction?

BACKGROUND: The optimum protocol for expander volume adjustment with respect to the timing and application of radiotherapy remains controversial. METHODS: Eighteen New Zealand rabbits were divided into three groups. Metallic port integrated anatomic breast expanders of 250 cc were implanted on the back of each animal and controlled expansion was performed. Group I underwent radiotherapy with full expanders while in Group II, expanders were partially deflated immediately prior to radiotherapy. Control group did not receive radiotherapy.The changes in blood flow at different volume adjustments were investigated in Group II by laser Doppler flowmetry. Variations in the histopathologic properties of the irradiated tissues including the skin, capsule and the pocket floor, were compared in the biopsy specimens taken from different locations in each group. RESULTS: A significant increase in skin blood flow was detected in Group II with partial expander deflation. Overall, histopathologic exam revealed aggravated findings of chronic radiodermatitis (epidermal atrophy, dermal inflammation and fibrosis, neovascularisation and vascular changes as well as increased capsule thickness) especially around the lower expander pole, in Group II. CONCLUSIONS: Expander deflation immediately prior to radiotherapy, may augment the adverse effects, especially in the lower expander pole, possibly via enhanced radiosensitization due to a relative increase in the blood flow and tissue oxygenation.

Hard palate perforation due to invasive aspergillosis in a patient with acute lymphoblastic leukemia.

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunosuppressed patients. Primary oral invasive aspergillosis is a rare condition. We present an acute lymphoblastic leukemia (ALL) patient with hard palate perforation due to invasive aspergillosis. Two months after the appearance of the fungal lesions, perforation of the hard palate was seen despite amphotericin-b and itracanazole therapy. After debridement of necrotic tissue the patient was followed for spontaneous closure for 6 months but it was seen that the fistula persisted despite the disappearance of the infection. The patient was operated for closure of the palatal fistula and there was no recurrence in 6 months of follow up. Surgical and medical management was performed successfully. Invasive oral aspergillosis is a potentially lethal disease and it should be considered in immunosuppressed patients with oral lesions.

Molecular correlates of temporomandibular joint disease.

OBJECTIVE: The relation between disease severity and the known mediators of pain, inflammation, and tissue damage-prostaglandin E 2 (PGE 2 ), leukotriene B 4 (LTB 4 ), malondialdehyde (MDA), nitric oxide (NO), and myeloperoxidase (MPO)-was examined in the synovial fluid of patients with internal derangement (ID) of the temporomandibular joint (TMJ). STUDY DESIGN: Thirty-two patients with ID were classified according to Wilkes by clinical and radiological examinations, and TMJ synovial fluid samples were obtained by arthrocentesis. PGE 2 and LTB 4 levels were measured by ELISA kits, MDA levels were determined by a fluorometric method, myeloperoxidase activity was determined by an end-point method, and NO levels were measured by Griess reaction. RESULTS: The earliest significant increase was observed in NO levels (stage II) and this elevation persisted in the subsequent stages. The first significant elevation in PGE 2 and LTB 4 levels and MPO activity were observed in stage III. Both PGE 2 and LTB 4 levels were increased in stage III and were correlated with each at this stage and in the subsequent stage. Significant increases in MDA levels were observed only in stage IV. At stage IV there was correlation between MDA and PGE 2 , MDA and LTB 4 , and MDA and MPO. The relation between PGE 2 and MDA was the most powerful one. CONCLUSION: Results of this cross-sectional study point out the relation between disease severity and levels of some molecular mediators in synovial fluid of TMJ. Longitudinal studies are needed to explore the role of these molecular mediators in the progression of ID.

Management of airway obstruction in a severe case of juvenile hyaline fibromatosis.

Juvenile hyaline fibromatosis (JHF) is an extremely rare, genetic disease with unknown etiology. It is characterized by cutaneous nodules and flexural joint contractures, along with hypertrophy of the gingival and oral mucosa, which is probably the most striking and morbidity-related feature of the disease. An advanced case of JHF with prominent growth retardation, recurrent respiratory tract infections, and impending upper respiratory tract obstruction due to severe hypertrophy of the oral mucosa and gingiva is presented. Surgical excision of the hypertrophic oral mucosa and cutaneous nodules in the scalp was performed. No major recurrence of the mucosal lesions was observed at the first postoperative year.

Augmentation mammaplasty by medial periareolar incision.

Various techniques and different types of incisions have been used for breast augmentation, the choice of which depends on regional and physical characteristics of the patient, an indication for the operation, and the decision of the patient and the operator. The periareolar approach is ideal for cases of developmental hypomastia that have adequate skin and glandular tonus and with minimum ptosis. The disadvantages of this method are a hypopigmented scar on the pigmented areola and a decrease in sensitivity of the nipple-areola. This article presents the experiences of the Department of Plastic and Reconstructive Surgery of the University of Istanbul, Faculty of Medicine between 1995 and 1998, on medial periareolar submuscular augmentation approaches to five cases. During this follow-up period we had no major complications.

"Extracorporeal loop" (blind loop): an alternative microsurgical technique for prelaminated flap transfer.

Free tissue transfer is frequently used for reconstruction in the head and neck region. In patients who suffer tissue loss due to a high-energy trauma, the reconstructive surgeon is often faced with a large gap between the defect and the site of anastomosis outside the zone of injury. Utilization of long vein grafts for reestablishment of blood flow to the transferred tissue vessels is a common procedure. Arteriovenous fistula (AVF) formation on the side table is an alternative solution. In this paper, an "extracorporeal loop" (blind loop) technique is presented as an alternative microsurgical method for prelaminated flap transfer to two different traumatic recipient areas in the face (nose and ear).

Free nipple reduction mammaplasty with a horizontal scar in high-risk patients.

Women with extremely large and ptotic breasts have many complaints and difficulties during daily life. Conventional reduction mammaplasty techniques are not convenient because the presence of excess tissue beneath and over a long pedicle may cause nipple-areola complex necrosis. These patients mostly have systemic health problems so they benefit from a shorter operative procedure. The amputation method is an option providing rapid surgical operation time and little blood loss but it may lead to a flat, unaesthetic breast with poor projection. In this paper we present an alternative amputation with the use of a backfolded dermoglandular flap and free nipple graft. The inferior pole is amputated. The deepithelialized breast tissue is left on the superior pedicle extending below the 7-cm vertical limb mark. This deepithelialized tissue is tucked to give more central mound projection. The aesthetic outcomes, such as well-rounded breasts with good projection and a hidden scar at the submammary sulcus, have led us to perform this technique, which was first described by the Mansteins in 1997.