Coronary Flow Velocity Reserve in Burn Injury: A Prospective Clinical Cohort Study.

The authors sought to evaluate coronary microvascular function and left ventricular diastolic dysfunction using transthoracic Doppler echocardiography in burn patients. In this study, 32 adult burn patients with partial or full-thickness scald burns that were hospitalized and treated were included. The control group was matched for age and sex and was composed of otherwise healthy volunteers. Transthoracic Doppler echocardiography examinations and simultaneous laboratory tests for cardiac evaluation were performed on the sixth month after burn injury as well as with the control group. High-sensitivity C-reactive protein levels were significantly higher in the burn patients than in controls (5.17 ± 3.86 vs 2.42 ± 1.78; P = .001). Lateral isovolumic relaxation time was significantly higher in the burn injury group than in the control group (92.7 ± 15.7 vs 85.5 ± 8.3; P = .03). Baseline coronary diastolic peak flow velocity of the left anterior descending artery was similar in both groups. However, hyperemic diastolic peak flow velocity and coronary flow velocity reserve (2.26 ± 0.48 vs 2.94 ± 0.47; P < .001) were significantly lower in the burn injury group than in the control group. Coronary flow velocity reserve was significantly and inversely correlated with high-sensitivity C-reactive protein, burn ratio, creatinine, and mitral A-wave max velocity. At the sixth month of treatment, burn patients had high-sensitivity C-reactive protein levels during this period, suggesting that inflammation still exists. In addition, subclinical coronary microvascular and left ventricular diastolic dysfunction can occur in burn patients without traditional cardiovascular risk factors. However, these results must be supported by additional studies.

[A Splenic Infarct Developing After Plasmodium falciparum Infection]. / Plasmodium falciparum Infeksiyonu Sonrasi Gelisen Bir Splenik Infarkt.

Plasmodium vivax malaria is usually seen in our country. Plasmodium falciparum malaria is also detected in the patients who have travelled abroad. A 33 year old male patient applied to our hospital for control. One month ago our patient had travelled to Angola where P. falciparum malaria is endemic. He had been diagnosed with malaria in Iran and successfully treated with quinine, doxycycline, and clindamycin. This time in our patient without any complaints, splenomegaly and splenic infarction were found. In our patient follow-ups it was observed that splenic infarction shrank. Therefore, in this article we present this rare complication.

A prospective clinical study of flow-mediated dilatation in burn injury.

The authors investigated endothelial function using flow-mediated dilatation (FMD) in burn patients. This study was done in burn patients with specific criteria on admission. Blood lipid profile at 1st day, high-sensitivity C-reactive protein, and FMD were assessed at 1st and 7th days, as well as at 1st and 3rd months. The highest values of high-sensitivity C-reactive protein were detected on the 7th day, which were significantly higher than those at 1st and 3rd months. The lowest value of FMD was observed on the 7th day. FMD values were higher during the 1st month compared with the 7th day. The highest value of FMD was detected in the 3rd month. It was found that FMD values measured at 7th day and 1st month were significantly lower in patients with a burn percentage of 40 or greater. Our results suggest that inflammation is more prominent on 7th day following burn. The decrease in FMD values on 7th day after injury can be attributed to endothelial damage. The increase in FMD on 3rd month after burn is attributable to effective burn treatment and gradual decrease of inflammatory mediators. The data from this study suggest that there is endothelial dysfunction and low-grade inflammation in burn patients. This condition is more prominent in patients with a burn ratio greater than 40%. Burn patients more frequently have impaired FMD, which may be indicative of arterial endothelial dysfunction and a marker for increased atherosclerosis.

Successful skin homografting from an identical twin in a severely burned patient.

Flame burns are a serious condition and usually have high morbidity and mortality because they affect large areas of the body surface as well as the lungs. In these patients, it is especially difficult to find healthy skin for grafting if they have more than 70% third-degree burns. Repeated autografting or synthetic wound care materials are the only treatment options to cover burned areas. Partial-thickness skin grafting from the patient's identical twin sibling may be an alternative treatment option, if possible. Here, we report a patient with severe flame injury treated with skin from his identical twin. The patient had third-degree burns covering 70% of his body surface. Initial treatment consisted of fluid and electrolyte replacement, daily wound care, and surgical debridements, as well as nutritional support. After initial treatment, we performed a successful skin grafting from his identical twin. Skin grafting between identical twins might be an alternate method for severely burned patients.

Simulating future urban growth in the city of Kahramanmaras, Turkey from 2009 to 2040.

City of Kahramanmaras has witnessed a rapid growth in the last five decades due to its agricultural and industrial potential. Urbanization has brought great challenges to the sustainable development of cities, especially in developing countries. A modeling system that could provide regional assessments of future development and explore the potential impacts of different regional management scenarios would be useful for the future health of the cities. The main goal of this study was to create a modeling system capable of depicting, quantitatively and graphically, the growth impacts of two land use policies and trends in the city of Kahramanmaras. Given its success with regional scale simulation, its ability to incorporate different levels of land protection through an "excluded" layer, and the relative ease of implementation and computation, the model developed by Keith Clarke from University of California at Santa Barbara, known as SLEUTH, was adopted for this study. SLEUTH is a pixel-based cellular automaton (CA) model and has been applied to several cities worldwide successfully. The model was calibrated using historic time series of developed areas derived from Landsat Thematic Mapper (TM) imagery between 1984 and 2009, and future growth was projected out to 2040. Two alternative growth scenarios were modeled: (1) current trends, and (2) managed growth: regions with high landscape potential were protected from urbanization. This application of the SLEUTH model demonstrates an ability to address a range of regional planning issues and provides useful information for the cities' future planning and development.

Use of telemedicine and telephone consultation in decision-making and follow-up of burn patients: Initial experience from two burn units.

OBJECTIVE: This study investigated the use of telemedicine in decision-making and follow-up of burn patients. METHODS: The Konya Burn Unit was established in July 2003, and up to December 2009, 187 patients were admitted to this unit, all of them were consulted-via audiovisual transmission of data (telemedicine)-to the same burn surgeon at the Ankara Burn Referral Center of our hospital network. Three basic systems are currently used: live interactive video, store-and-forward images, and telephone. The demographic data and burn criteria of the patients were investigated. Changes in the number of televisits and patient management were analyzed. RESULTS: During the 66-month timeframe, 525 televisits were performed on 187 patients. There were 126 males (67.4%) and 61 females (32.6%). The mean total burn surface area (percentage of total burn surface area burned) was 23.3 ± 17.8% (range, 3-95%). Nine of the 187 patients (4.8%) died owing to multiorgan failure and sepsis. As a result of these televisits, 21 patients (11.2%) were transferred to our referral center. The number of dead and transferred patients decreased during the study. CONCLUSIONS: Telemedicine is appropriate and cost-effective for treatment and follow-up of patients in burn units with personnel with limited experience.

Using LiDAR technology in forestry activities.

Managing natural resources in wide-scale areas can be highly time and resource consuming task which requires significant amount of data collection in the field and reduction of the data in the office to provide the necessary information. High performance LiDAR remote sensing technology has recently become an effective tool for use in applications of natural resources. In the field of forestry, the LiDAR measurements of the forested areas can provide high-quality data on three-dimensional characterizations of forest structures. Besides, LiDAR data can be used to provide very high quality and accurate Digital Elevation Model (DEM) for the forested areas. This study presents the progress and opportunities of using LiDAR remote sensing technology in various forestry applications. The results indicate that LiDAR based forest structure data and high-resolution DEMs can be used in wide-scale forestry activities such as stand characterizations, forest inventory and management, fire behaviour modeling, and forest operations.

Impact of laparoscopy on frequency of surgery for treatment of gallstones.

Although the indications for laparoscopic cholecystectomy are generally the same as those for open cholecystectomy, there has been a suspicion that indications for cholecystectomy have broadened and the spectrum of patients undergoing this procedure has changed. This study was designed to determine whether surgeons and patients have lowered the threshold for proceeding to cholecystectomy with use of laparoscopic cholecystectomy. Discharge data were collected for all patients who underwent an elective operation in general surgery clinics in Ankara Numune Teaching and Research Hospital between 1990 to 2001. The rate of total cholecystectomy to all elective operations and rate of laparoscopic technique to all cholecystectomies were analyzed. Total number of operations and rate of cholecystectomy were relatively stable over 6 years prior to laparoscopy. With the introduction of laparoscopic cholecystectomy, although total number of elective operations seems stable, the proportion of cholecystectomy to all operations showed an increase. Our study could not explain the increase of total number of cholecystectomies since the widespread introduction of laparoscopy. First, it may be due to changing selection criteria for surgical treatment of gallstones. Second, surgery may have been done for asymptomatic gallstones. And third, patients with moderate symptoms who refused the (open) operation in the past may now be more willing to undergo a laparoscopic cholecystectomy.