Analysis of a mini-outbreak of methicillin-resistant Staphylococcus aureus in a surgical ward by using arbitrarily primed-polymerase chain reaction.

In November 1995, an increase was noticed in the number of methicillin-resistant Staphylococcus aureus (MRSA) isolates from a surgical ward at Hacettepe University Hospital. All MRSA isolates obtained from clinical specimens in this ward (14 MRSA isolates from wound cultures of 10 patients) were collected prospectively for 10 weeks. Surveillance cultures were taken from ward personnel (nose cultures from 4 physicians, 7 nurses, 1 secretary, 1 waiter), 2 surgical dressing containers and 1 nebulizer. MRSA was isolated from one of the surgical dressing containers, the nebulizer and nose cultures of 3 physicians, 3 nurses and the ward secretary. Arbitrarily primed polymerase chain reaction (AP-PCR) analysis showed that most MRSA isolates belonged to 2 major clones (pattern A, pattern B). Pattern A was the most frequent one and was present in 4 clinical isolates, surgical dressing container-1. Pattern B was identified in 3 clinical isolates and nose culture of physician-3. AP-PCR analysis revealed that this mini-MRSA outbreak was caused by contamination of surgical dressing container with MRSA and nasal MRSA carriage in ward staff. AP-PCR seems to be a valuable typing method for analysis of nosocomial MRSA outbreaks because of its simplicity and rapidity.

Evaluation of soft-tissue morphology of the face in 1,050 young adults.

Anthropometry of the face has always been an interesting subject for artists and plastic surgeons. Since ancient times, many rules have been proposed for the ideal face. The authors measured directly vertical and horizontal proportions of the face and inclinations of the soft-tissue facial profile in 1050 young Turkish adults. Differences between the facial measurements of subjects from seven different geographic regions were analyzed. Some of the measurements were compared further with the measurements of other populations in the literature, and the validity of the neoclassical canons were tested. The special head height measure was shorter than the special face height in the majority of our study group (women/men: equal height, 13%/15%; longer special head height, 28%/30%; shorter special head height, 59%/55%). Faces with three equally high-profile sections were not seen in women or in men. When the forehead height was compared with the nose height, equality was present in a small percentage of the population (women/men: equal height, 17%/18%; longer forehead, 41%/ 42%; shorter forehead, 42%/40%). The nose height was equal to the lower face height in a minority of the population (women/men: equal height, 10%/11%; longer nose, 9%/11%; shorter nose (81%/78%). The forehead height was shorter than the lower face height in the majority of the population (women/ men: equal height, 8%/9%; longer forehead, 12%/13%; shorter forehead, 79%/78%). The intercanthal distance was shorter than the nose width in the majority of the population (women/men: equal width, 20%/19%; wider intercanthal distance, 35%/37%; narrower intercanthal width, 65%/68%). The population was distributed evenly in regard to the variations of the orbital proportion canon (women/men: equal intercanthal width and eye fissure length, 31%/36%; wider intercanthal distance, 34%/27%; narrower intercanthal width, 35%/37%). The mouth width was greater than 1.5 times the nose width in the majority of the population (women/men: equal width, 6%/5%; wider mouth, 53%/54%; narrower mouth, 41%/41%). The nose width was narrower than one quarter of the face width in the majority of the population (women/men: equal width, 4%/3%; wider nose, 30%/39%; narrower nose, 66%/58%). The nose inclination was equal to the ear inclination in a very small fraction of subjects (women/ men: equal inclination, 3%/3%; greater nose inclination, 88%/87%; less nose inclination, 9%/9%). To sketch an outline of the average facial profile in the population studied, a convex facial profile is revealed, with the forehead and the chin retrodisplaced minimally with respect to the midface. The neoclassical canons were found to be invalid for the majority of the population in this study, and different proportional analytic results were obtained.

Nasal speculum with positionally autoswitched and battery-operated fiber optic illumination.

We modified a Cottle-type nasal speculum with fiber optics to a positionally autoswitched and battery operated device. By avoiding the use of a fiberoptic cable, our speculum proved to be a practical and effective tool for intranasal illumination.

Macrodactyly: report of eight cases of a rare anomaly.

Macrodactyly or megalodactyly is a rare anomaly of the extremities. Neural factors are involved in the etiology. Presented here are eight cases which comprise five macrodactylous toes and three fingers. The mean age at first referral was 6.8 years. Six patients underwent resection of the proximal phalanges together with bulk reduction of the soft tissue mass. Only soft tissue reduction was performed in the remaining two patients. Skin necrosis was observed in two cases, one of which necessitated amputation at the proximal interphalangeal joint level. The functional outcome was evaluated as poor with limited range of motion and stiffness in the joints. As far as functional results are concerned, macrodactylous toes had a better prognosis than that of fingers. It was concluded that none of the available methods as yet gives ideal functional and cosmetic results in macrodactyly.

Microvascular ear replantation with no vein anastomosis.

In replantation of a totally amputated ear, the artery only was repaired with no vein repair. Venous stasis was successfully prevented by daily skin punctures during the first 4 days postoperatively. The elastic cartilage framework with no internally circulating blood constitutes the major percentage of the auricle mass. Thus the metabolic demand of the ear is relatively small, according to its small caliber nutrient vessels. Although the successful result in this single case report means neither a consistent procedure nor uniformly safe choice of treatment, the potential use of the single-artery repair with no accompanying vein anastomosis in ear replantations, we believe, deserves to be considered.

Modified use of gate flap for the reconstruction of the lower lip.

Surgical excision of advanced lower lip carcinomas with adequate safety margins, in some cases, causes defects as large as three-fourths of the width of the lip or total lip defects. This paper describes a modification of nasolabial 'gate flap' for reconstruction of extensive defects of the lower lip. Splitting the flap into skin and mucosal flaps provides the surgeon more skin on the inferior aspect of the reconstruction where he needs skin without any mucosa and more mucosa on the superior aspect of the reconstruction where he needs mucosa for reconstruction of the vermilion and lower labial sulcus. Four patients with total lower lip defects have been treated with this technique. The results were quite satisfactory both functionally and cosmetically.

Use of a subfascial pocket on the contralateral calf for salvage of an avulsed foot.

Cross-leg fasciocutaneous flaps have long been used for reconstruction of defects on the contralateral foot. This report describes the use of a cross-leg subfascial pocket for preservation of avulsed metacarpal and phalangeal bones and reconstruction of both plantar and dorsal aspects of the contralateral foot. The avulsed metacarpal bones and phalanges of the foot were embedded into a subfascial pocket prepared on the contralateral calf in the first operation. The gastrocnemius fasciocutaneous flap was then used for reconstruction of the contralateral foot. The avulsed structures were kept vital during the 20 days that elapsed between these two procedures.

Three cases of oblique facial cleft: etiology, tomographic evaluation and reconstruction.

Three cases of oro-ocular clefts from different families are presented. Two of the cases had a normal chromosomal constitution. The defects in each case were evaluated by computerized tomography computerized tomography prior to surgery. The theories concerning etiology and classification of oblique facial clefts are discussed in the light of computerized tomography scan findings. One of the cases had a history of maternal bromocriptine mesylate usage for prolactinoma, suggesting a teratogenic effect, but no similar cases have been reported in the medial literature.