First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey.

AIM: To report, for the first time, the incidence and prevalence of childhood Type 1 diabetes in Turkey using a nationwide registry. METHODS: Information on birth date, city of birth, diagnosis date and gender of all patients with Type 1 diabetes aged < 18 years were obtained from the Turkish Social Security Institute for the period from January 2011 to December 2013. RESULTS: There were 17 175 prevalent cases of Type 1 diabetes over the 3-year period. The prevalence of Type 1 diabetes was 0.75/1 000 (95% CI 0.74-0.76) and was higher in girls than in boys (0.79 vs 0.72 /1 000; P < 0.01). There were 2465 incident cases in 2013. The incidence was slightly higher among girls (50.6%) than boys (49.4%); the girl:boy case ratio was 1.02. The incidence was 10.4/100 000 for boys and 11.3/100 000 for girls. The age-standardized incidence rate was 10.8 per 100 000 (95% CI 10.1-11.5) according to the WHO standard population, estimated using the direct method. The mean patient age at diagnosis was 10.6 ± 4.6 years. The highest proportion of cases (40.6%) was diagnosed in children aged 10-14 years. CONCLUSIONS: This is the first study to report the incidence and prevalence of Type 1 diabetes in children in Turkey. The incidence of Type 1 diabetes reflects the geographical location of Turkey, bridging Asia and Europe, with the incidence being higher than in Asia but lower than in Europe.

The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease.

OBJECTIVE: Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder. PATIENTS AND METHODS: Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up. RESULTS: Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn's disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months. CONCLUSION: In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn's disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL.

Aspartame induces angiogenesis in vitro and in vivo models.

Angiogenesis is the process of generating new blood vessels from preexisting vessels and is considered essential in many pathological conditions. The purpose of the present study is to evaluate the effect of aspartame on angiogenesis in vivo chick chorioallantoic membrane (CAM) and wound-healing models as well as in vitro 2,3-bis-2H-tetrazolium-5-carboxanilide (XTT) and tube formation assays. In CAM assay, aspartame increased angiogenesis in a concentration-dependent manner. Compared with the control group, aspartame has significantly increased vessel proliferation (p < 0.001). In addition, in vivo rat model of skin wound-healing study showed that aspartame group had better healing than control group, and this was statistically significant at p < 0.05. There was a slight proliferative effect of aspartame on human umbilical vein endothelial cells on XTT assay in vitro, but it was not statistically significant; and there was no antiangiogenic effect of aspartame on tube formation assay in vitro. These results provide evidence that aspartame induces angiogenesis in vitro and in vivo; so regular use may have undesirable effect on susceptible cases.

Results from a multicentre international registry of familial Mediterranean fever: impact of environment on the expression of a monogenic disease in children.

BACKGROUND AND AIM: Familial Mediterranean fever (FMF) is an autoinflammatory disease caused by mutations of the MEFV gene. We analyse the impact of ethnic, environmental and genetic factors on the severity of disease presentation in a large international registry. METHODS: Demographic, genetic and clinical data from validated paediatric FMF patients enrolled in the Eurofever registry were analysed. Three subgroups were considered: (i) patients living in the eastern Mediterranean countries; (ii) patients with an eastern Mediterranean ancestry living in western Europe; (iii) Caucasian patients living in western European countries. A score for disease severity at presentation was elaborated. RESULTS: Since November 2009, 346 FMF paediatric patients were enrolled in the Eurofever registry. The genetic and demographic features (ethnicity, age of onset, age at diagnosis) were similar among eastern Mediterranean patients whether they lived in their countries or western European countries. European patients had a lower frequency of the high penetrance M694V mutation and a significant delay of diagnosis (p<0.002). Patients living in eastern Mediterranean countries had a higher frequency of fever episodes/year and more frequent arthritis, pericarditis, chest pain, abdominal pain and vomiting compared to the other two groups. Multivariate analysis showed that the variables independently associated with severity of disease presentation were country of residence, presence of M694V mutation and positive family history. CONCLUSIONS: Eastern Mediterranean FMF patients have a milder disease phenotype once they migrate to Europe, reflecting the effect of environment on the expression of a monogenic disease.

Effect of supervision on ultrasonographic measurements. A blinded randomized cross-over study.

BACKGROUND: Musculoskeletal ultrasound is becoming an increasingly popular clinical tool in the hands of physiatrists. Herewith, although the role of direct supervision (by an expert) is universally recognized as the core element for appropriate ultrasound training, to our best notice, its impact on ultrasonographic measurements has not been studied quantitatively in the hitherto literature. AIM: To quantify the effect of supervision in the early period of musculoskeletal ultrasound training by using three different tissues (muscle-cartilage-tendon) as models. DESIGN: A blinded randomized cross-over study. SETTING: Physical Medicine and Rehabilitation Department of a University Hospital. POPULATION: A total of 9 sonographers (8 novice and 1 expert) were involved whereby the novice sonographers were randomly divided into two groups; Group A (N.=4) and Group B (N.=4). METHODS: All sonographers performed three thickness measurements; medial head of the gastrocnemius muscle, patellar tendon and femoral cartilage on the left lower limb of the same subject. The expert supervised Group A in the first half of the study (9 days), and Group B in the second half (9 days). Throughout the study period, all the participants were blinded to the data. Relative effectiveness, expert effect, order effect, treatment-period effect were studied for cross-over variance analysis. RESULTS: For all the three sites, measurements under the supervision of the expert were significantly different than those without him -p values pertaining to relative effectiveness, expert effect were 0.014, 0.013 for femoral cartilage; <0.001, <0.001 for gastrocnemius and <0.001, <0.001 for patellar tendon, respectively). For gastrocnemius muscle measurements, studying with the expert in the second half of the study (vs in the first half) was better concerning the precision of the measurements (order effect P<0.001). CONCLUSION: Supervision during measurements of novice sonographers is crucial and their data should otherwise be interpreted attentively.

Diagnosis of chronic brucellar meningitis and meningoencephalitis: the results of the Istanbul-2 study.

No detailed data exist in the literature on the accurate diagnosis of chronic brucellar meningitis or meningoencephalitis. A multicentre retrospective chart review was performed at 19 health centres to determine sensitivities of the diagnostic tests. This study included 177 patients. The mean values of CSF biochemical test results were as follows: CSF protein, 330.64 ± 493.28 mg/dL; CSF/ blood-glucose ratio, 0.35 ± 0.16; CSF sodium, 140.61 ± 8.14 mMt; CSF leucocyte count, 215.99 ± 306.87. The sensitivities of the tests were as follows: serum standard tube agglutination (STA), 94%; cerebrospinal fluid (CSF) STA, 78%; serum Rose Bengal test (RBT), 96%; CSF RBT, 71%; automated blood culture, 37%; automated CSF culture, 25%; conventional CSF culture, 9%. The clinician should use every possible means to diagnose chronic neurobrucellosis. The high seropositivitiy in brucellar blood tests must facilitate the use of blood serology. Although STA should be preferred over RBT in CSF in probable neurobrucellosis other than the acute form of the disease, RBT is not as weak as expected. Moreover, automated culture systems should be applied when CSF culture is needed.

The role of negative pressure wound therapy in the treatment of fourth-degree burns. Trends and new horizons.

The term "fourth-degree burn" is not very often found in the literature because it is often associated with lethal injury. These injuries are characterized by exposure of viable tissue such as tendon or bone and are associated with challenging wound closure. The goal of reconstruction is to provide adequate soft tissue coverage and restoration of function. Several treatment modalities have been used to serve this purpose. We present four male patients with fourth-degree burns of the extremities, treated with negative pressure wound therapy. The patients' age ranged from 15 to 49 yr (mean, 28 yr). The total body surface area burned ranged from 3 to 60% (mean, 34.25%). Negative pressure wound therapy was applied for 16-30 days (mean, 23.75 days). Three split-thickness skin grafts and one bipedicled local flap were performed. Wound closure was completed in 28 to 50 days. The results were satisfactory for both physicians and patients. Our longest follow-up was three years. The results achieved in this group of patients revealed the negative pressure wound therapy was a reliable alternative method in the treatment of fourthdegree burns.

Low frequency of a decreased ankle brachial index and associated conditions in the practice of internal medicine in a Turkish population sample.

AIM: Peripheral arterial disease (PAD) is a less known condition in the practice of internal medicine, mostly due to lack of specific symptoms and low rates of physician awareness. However, cardiovascular disease (CVD) incidence is not significantly different among patients with symptomatic or asymptomatic disease. Ankle brachial index (ABI) measurement is an easy and cost-effective tool for the diagnosis of PAD. In the present study, frequency of low ABI and associated factors were investigated in the setting of internal medicine practice. METHODS: Patients over 70 years of age and patients between 50 and 69 years with CVD or at least one atherothrombosis risk factor were included in the study. ABI was determined with handheld Doppler. Measurements were determined for both lower extremities. Lower of the right or left ABIs was taken as the final value. Low ABI was defined as ≤0.9. RESULTS: A total of 303 subjects between 50 and 83 years of age were enrolled (female/male: 186/117). Mean ABI was 1.14±0.15. A low ABI was detected in 15 cases (4.95%). Prevalence was 7% in females and 1.7% in males (P=0.039). Low ABI value was not associated with any of the demographic parameters, presence of major risk factors or basic laboratory values. A high ABI was found by 5.6%. CONCLUSION: In the present study, frequency of PAD as determined by ABI was found lower than those reported previously in most European countries. Nonetheless, our results showed that PAD affects at least 1 in 20 outpatients in the practice of internal medicine.

Evaluation of neurosensory alterations via clinical neurosensory tests following anterior maxillary osteotomy (Bell technique).

Neurosensory deficits are the most common complication following orthognathic surgery. Le Fort I and sagittal split ramus osteotomies have been widely studied but there is a lack of data about the neurosensory alterations resulting from anterior maxillary osteotomy (AMO). This paper evaluates the neurosensory alterations in cutaneous regions including lower eyelid, cheek, nose, upper lip and vestibular and palatal mucosal areas using simple clinical tests following AMO performed with Bell's incision so patients can be properly informed about the extent of sensory loss and its rate of recovery following AMO. Twenty-four sides of 12 patients (eight females; four males) with a mean age of 14.20 ± 1.86 years (range 12-17 years) were examined. Pin prick sensation, light touch sensation, static and dynamic two-point discrimination tests were used. Following AMO, vestibular mucosa, upper lip, nose and cheek were the most commonly affected sites. No alterations were detected in lower eyelid and palatal mucosa. The neurosensory deficits in cheek, nose and upper lip resolved 10 days after surgery. The vestibular mucosa showed normal sensation on day 30. In conclusion, following AMO, neurosensory alterations can occur, but it will resolve spontaneously in 30 days.

Cost analysis of acute burn patients treated in a burn centre: the Gulhane experience.

Even if calculating the exact cost of burn treatment is a very hard task, the study of cost analysis provides financial perspective. We performed a cost analysis study in our burn centre to respond to questions about total patient treatment cost and the length of hospital stay. We reviewed all patients admitted to the Gulhane Military Medical Academy Burn Centre in Ankara, Turkey, between March 2005 and August 2008. Forty-three patients with major burns were identified on the basis of the study criteria. The data regarding total treatment cost and the length of hospital stay for each type of burn (flame, scald, electric) were collected at the end of the study. The average total body surface area burned was 36 ± 7%.. The average duration of hospital stay was 73 ± 33 days. Patients with electrical burns stayed longer in hospital than patients with other types of burn injuries. Each one per cent of burn corresponded to a mean hospital stay of two days. The overall mean total cost was $US 15,250. The mean total cost of electrical burns was the highest, with $US 22,501 ± 24,039. Even if the costs associated with burn injury are higher than some other well-known health-related problems, they have not been much studied. Reports have produced different results, but it should be kept in mind that although the results of cost analysis studies may vary they must be performed in all newly established burn centres in order to form a financial overview.

Anatomical and functional outcomes in contusion injuries of posterior segment.

PURPOSE: To evaluate the clinical features, and anatomical and visual outcomes in patients with closed-globe contusion injury involving the posterior segment. METHODS: Retrospective review of posterior segment contusion injuries admitted to our tertiary referral center. RESULTS: In all, 115 patients (115 eyes) with complete data were reviewed. Surgery had been performed in 79 (69%) patients. The mean follow-up period was 6 months (range, 2-34 months). Retinal detachment, in 31% of eyes, was the most frequently encountered posterior segment pathology. The presence of retinal detachment was associated with poor visual outcome (<20/100), (P<0.001). Coexisting (five patients, 4%) and postoperative proliferative vitreoretinopathy (PVR) (two patients, 2%) was the main cause of failure in these cases. A significant positive correlation was obtained between initial and final visual acuity levels in both the medical treatment group and the surgical treatment group (P<0.05). The presenting visual acuity of <20/400 was associated with poor visual outcome (P<0.05 for both groups). Poor visual outcome in 13 patients with successful repair of retinal detachment was due to the macular lesions and the optic atrophy. CONCLUSION: Retinal detachment was the most frequently encountered posterior segment pathology subsequent to closed-globe contusion injuries. In addition to macular scarring and optic nerve damage, development of PVR has prognostic significance in these eyes.

Salivary infectious agents and periodontal disease status.

BACKGROUND AND OBJECTIVES: The potential of salivary microorganisms to diagnose periodontal disease and to guide periodontal treatment is a research topic of current interest. This study aimed to determine whether the salivary counts of periodontopathic microbes correlated with the periodontal pocket counts of the same infectious agents, and whether the salivary counts of the test infectious agents could distinguish among individuals with periodontal health and various types of periodontal disease. MATERIAL AND METHODS: The study included 150 systemically healthy adults, of whom 37 were periodontally healthy, 31 had gingivitis, 46 had chronic periodontitis and 36 had aggressive periodontitis. Each study subject contributed microbial samples from the two deepest periodontal pockets of the dentition and from whole saliva. Aggregatibacter actinomycetemcomitans, Campylobacter rectus, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Epstein-Barr virus were identified using the TaqMan real-time PCR methodology. Statistical analysis was performed using the Mann-Whitney U-test and the receiver operating characteristic statistics. RESULTS: C. rectus, F. nucleatum, P. gingivalis, P. intermedia and T. forsythia occurred with significantly higher copy-counts in salivary samples from patients with gingivitis, chronic periodontitis and aggressive periodontitis than from periodontally healthy individuals. A. actinomycetemcomitans only showed higher salivary copy-counts in subjects with aggressive periodontitis compared with subjects with healthy periodontium, and the salivary copy-counts of Epstein-Barr virus did not reveal any significant difference among the four subject groups studied. The diagnostic sensitivity for periodontitis was 89.19 for P. gingivalis and for T. forsythia and 86.49 for P. intermedia, with specificities ranging from 83.78 to 94.59. The optimal copy-counts per mL saliva for identifying periodontitis were 40,000 for P. gingivalis, 700,000 for T. forsythia and 910,000 for P. intermedia. CONCLUSION: Salivary copy-counts of P. gingivalis, T. forsythia and P. intermedia appear to have the potential to identify the presence of periodontitis, whereas the salivary level of the other test infectious agents may possess little or no diagnostic utility. Longitudinal studies are warranted to determine the ability of salivary copy-counts of major periodontopathic bacteria to predict future periodontal breakdown.

Is allergenic similarity predictable in respiratory allergies?

BACKGROUND: First degree relatives of patients with allergic diseases are at increased risk of having the disorder. However, it is not clear whether two such related patients with allergic diseases are sensitive to the same antigens or not. OBJECTIVE: The aim of this study to determine whether or not first degree relatives with respiratory allergies are more likely to be skin test positive to the same allergen extracts as unrelated patients. PATIENTS AND METHODS: Skin test results for 35 common aeroallergens were compared in 264 pairs of genetically related subjects and 264 pairs of age and sex matched, but unrelated, subjects. We calculate the percentages of the concordant and discordant results in each group. Results are compared by using chi2 test. RESULTS: For all related and unrelated groups combined, there were significant differences with mites (der. pteronyssinus, der. farinae) and some moulds (aspergillus mix and rhizopus nigricans) (p<0.05); When the groups were subdivided into parent-child pairs and same or different sibling pairs, and the same comparisons were made, a significant difference was only found in both sibling pairs (p<0.05), not in parent-child pairs (p>0.05). Since there was no both positivity with aspergillus mix and rhizopus nigricans in the two groups, these two allergens were excluded from the study. CONCLUSION: It is concluded that we could not say that if one or both of parents are atopic to any allergens, their child will be atopic to the same allergens. Besides, when a respiratory allergy occurs in siblings, only the one who has house dust mite allergy sensitivity can possess the similar antigen sensitivity.

Is allergenic similarity predictable in respiratory allergies?

Background: First degree relatives of patients with allergic diseases are at increased risk of having the disorder. However, it is not clear whether two such related patients with allergic diseases are sensitive to the same antigens or not. Objective: The aim of this study to determine whether or not first degree relatives with respiratory allergies are more likely to be skin test positive to the same allergen extracts as unrelated patients. Patients and Methods: Skin test results for 35 common aeroallergens were compared in 264 pairs of genetically related subjects and 264 pairs of age and sex matched, but unrelated, subjects. We calculate the percentages of the concordant and discordant results in each group. Results are compared by using x2 test. Results: For all related and unrelated groups combined, there were significant differences with mites (der. pteronyssinus, der. farinae) and some moulds (aspergillus mix and rhizopus nigricans) (p < 0.05); When the groups were subdivided into parent-child pairs and same or different sibling pairs, and the same comparisons were made, a significant difference was only found in both sibling pairs (p < 0.05), not in parent-child pairs (p > 0.05). Since there was no both positivity with aspergillus mix and rhizopus nigricans in the two groups, these two allergens were excluded from the study. Conclusion: It is concluded that we could not say that if one or both of parents are atopic to any allergens, their child will be atopic to the same allergens. Besides, when a respiratory allergy occurs in siblings, only the one who has house dust mite allergy sensitivity can possess the similar antigen sensitivity

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Mode of delivery and subsequent long-term sexual function of primiparous women.

Minimal information exists on unintended health consequences following childbirth, particularly in relation to mode of delivery. This study aimed to evaluate the impact of mode of delivery on long-term sexual satisfaction of women by using a validated questionnaire. Forty-five primiparous women who had cesarean deliveries and 90 primiparous women who had vaginal deliveries with mediolateral episiotomies enrolled in the study. Quality of sexual relations and sexual satisfaction were self-reported by using Golombock-Rust Inventory of Sexual Satisfaction. Prevalence of sexual dissatisfaction was compared between the two groups and logistic regression analysis was carried out to identify the predictors of sexual dissatisfaction. The prevalence of overall sexual dissatisfaction was 4.4% in cesarean group while it was 14.4% in vaginal delivery group (P=0.081). Vaginal delivery group demonstrated a trend toward higher prevalence of dissatisfaction in all subscales except sensuality area than cesarean group, however, differences between two groups did not reach to statistical significance. Degree of pleasure for relationship with the spouse was identified as a significant predictor for overall sexual dissatisfaction (P=0.008). Our findings suggest that sexual dissatisfaction should not be assumed simply a product of the delivery mode. Individual, socio-demographic, lifestyle and marital characteristics should also be taken into account.

ADMA, proteinuria, and insulin resistance in non-diabetic stage I chronic kidney disease.

The rationale of this study is based on the fact that, both proteinuria and elevated asymmetric dimethyl arginine (ADMA) levels have been linked to the progression of vascular disease. Currently, there is not enough knowledge about any association between the levels of proteinuria and ADMA levels. Seventy-eight non-diabetic patients (42 men, 36 women, mean age of 26.1+/-5.2 years) with proteinuria having normal glomerular filtration rate were enrolled along with 38 healthy subjects (20 men, 18 women, mean age of 26.9+/-5.9 years). Proteinuria was below 3.5 g/day in 40 patients and above 3.5 g/day in 38 patients. Both groups had similar age, gender, and body mass index distributions. Serum ADMA, symmetric dimethyl arginine (SDMA), immunoreactive insulin, and high sensitivity C reactive protein (hsCRP) levels were measured. Insulin resistance was determined by homeostasis model assessment (HOMA). Serum ADMA, SDMA, insulin, hsCRP levels, and HOMA indexes were significantly higher in patients than in healthy control subjects. The above parameters were higher in the nephrotic range proteinuria group when compared to patients having protein levels below 3.5 g/day. There were significant correlations between the levels of proteinuria and the above parameters. According to the regression analysis, levels of proteinuria and hsCRP were significant determinants of serum ADMA levels. Our results indicate that, independent of other risk factors, ADMA is directly associated with proteinuria. Further studies are recommended to find out whether elevated ADMA levels are implicated in the high cardiovascular risk of proteinuric nephropathies.

Adiponectin level is reduced and inversely correlated with the degree of proteinuria in type 2 diabetic patients.

AIMS: Adiponectin seems to be an important modulator for metabolic and vascular diseases. We aimed to measure plasma adiponectin levels in type 2 diabetic patients and investigate any association with the severity of proteinuria. METHODS: 80 patients (mean age, 46.9 +/- 5.1 years; body mass index (BMI), 25.8 +/- 1.98 kg/m2) and 47 healthy volunteers (mean age, 46.1 +/- 5.5 years; BMI 26.74 +/- 2.23 kg/m2) were included. Plasma adiponectin concentration, insulin levels, homeostasis model assessment (HOMA) indices, calculated glomerular filtration rate (GFR), high sensitive C reactive protein (hsCRP) and biochemistry panel were determined in all subjects. The association between adiponectin concentration and proteinuria was evaluated. Additionally, the relationship between adiponectin and hsCRP and calculated GFR were also investigated. RESULTS: Adiponectin levels in patients were significantly lower than those of controls (n = 80; 8.76 +/- 4.50 microg/ml for patients, n = 47; 24.27 +/- 5.59 microg/ml for controls, p < 0.001). Plasma adiponectin levels in patients with proteinuria were significantly lower than those without proteinuria (n = 43; 6.81 +/- 2.82 microg/ml for proteinuria, n = 37; 11.98 +/- 3.32 microg/ml for no proteinuria, p < 0.001). There was a significant negative correlation between plasma adiponectin concentrations and the degree of proteinuria (r = -0.433, p < 0.001). There were also significant negative correlations between adiponectin concentrations and insulin levels as well as HOMA index in the patient group (r = -0.322, p = 0.004; r = -0.301, p = 0.032). Additionally there was a significant negative correlation between adiponectin and hsCRP levels in the patient group (r = -0.872, p < 0.001). CONCLUSION: The results show that adiponectin is lower in patients with type 2 diabetes and the levels are negatively correlated with the severity of proteinuria.

Effects of tamoxifen on the serum leptin level in patients with breast cancer.

BACKGROUND: Leptin is a peptide hormone that has a role in the regulation of body weight and has effects on metabolic, neuroendocrine, reproductive and hematopoietic systems. Breast cancer has also been associated with obesity and reproductive hormones, especially estradiol. Only a few studies have investigated the relation between plasma leptin and risk of breast cancer and only one study evaluated the effect of tamoxifen on leptin levels in patients with breast cancer. METHODS: We investigated serum leptin levels in gender-, body mass index (BMI)- and age-matched breast cancer patients and healthy individuals (58 of each). RESULTS: Serum leptin levels were measured by radioimmunoassay (Human Leptin RIA Kit). Serum leptin levels in the breast cancer patients were significantly higher than those in the control group (27.00 versus 17.65 ng/ml, p = 0.019). There were no differences with respect to BMI and age between control and breast cancer patients. There were no significant differences in BMI and leptin levels between pre- and postmenopausal patients (27.00 +/- 1.39 and 27.19 +/- 0.81 kg/m(2), 26.81 +/- 6.25 and 27.06 +/- 2.98 ng/ml) (p > 0.05). We found no difference in serum leptin level between early and late stages of patients (22.38 versus 31.30 ng/ml, p = 0.086). However, the serum leptin level in patients using tamoxifen was significantly higher than that of patients not using tamoxifen (32.71 and 19.39 ng/ml, respectively p = 0.009). There was no correlation between CA 15-3 and leptin level (r = 0.069, p = 0.610). CONCLUSION: High serum leptin levels seen in breast cancer patients are not related to stage of the disease or to cancer itself but may be associated with the use of tamoxifen.

Muscle transposition and skin grafting for salvage of below-knee amputation level after bilateral lower extremity thermal injury.

Thermal injury to the lower extremity sometimes necessitates amputation around the knee joint. Knee function is so critical to prosthetic rehabilitation that every attempt should be made to salvage the knee joint. This report presents an unusual case of bilateral lower extremity flame burn requiring amputations. While the distal two-thirds of the legs and both feet were totally necrotic, the thermal damage was limited to skin and subcutaneous tissue sparing muscle and bone in the proximal one-third of the legs and posterior thighs. The below-knee amputation level was salvaged by muscle transposition over the anterior tibia and resurfacing of muscle cuffs with thick split-thickness skin grafts. The post-operative period was uneventful. Amputation stumps tolerated the below-knee prosthesis well and the patient attained independent functional prosthetic ambulation at the post-operative fourth month. It is known from the reconstruction of the plantar foot that skin-grafted muscle tissue tolerates weight bearing and shearing forces well. This principle can also be used for salvage aspects of the below-knee amputation level.

Skin grafting of the naso-orbital region as a single aesthetic unit.

With improved acute care, a higher percentage of more severely injured facial burn patients are surviving their burns. When the full face needs resurfacing, total facial resurfacing should ideally be done with a single sheet of full-thickness skin. Unfortunately, this type of single sheet total facial resurfacing is rarely possible or practical in the case of acute extensive burns. The nasoorbital region is a focal point of interpersonal communication and needs special emphasis. This report presents two patients with deep facial burns whose midface regions were resurfaced with thick split-thickness skin graft as a single aesthetic unit. Since there is no skin graft junction line on this region, a more homogeneous appearance and an aesthetically superior result could be achieved.