How were Non-COVID pulmonary patients and diseases affected from COVID-19 pandemic period?

OBJECTIVE: This study aimed to focus on non-COVID-19 patients during the process when all physicians focused on COVID-19 patients. Patients with pulmonary diseases in the COVID-19 pandemic period were analyzed. MATERIAL AND METHODS: Non-COVID-19 cases who were hospitalized in the pulmonology clinic, outpatients, and patients who applied to the non-COVID-19 emergency service and requested a pulmonology consultation in the period from March 16, 2020 to May 15, 2020 and in the same period of the previous year (i.e., from March 16, 2019 to May 15, 2019) were included in this study. RESULTS: In the pandemic period, it was found that there was an 84% decrease in outpatient admissions, a 43% decrease in inpatients, and a 75% decrease in emergency services. During the pandemic period, in outpatient setting, male and younger case admissions increased, admissions with chronic obstructive pulmonary disease (COPD), and interstitial lung diseases decreased, whereas the frequency of admission to asthma, pneumonia, and pulmonary thromboembolism increased. In the period of the pandemic, patients with asthma, COPD, and lung cancer were less hospitalized, whereas patients with pulmonary thromboembolism, pneumonia, and pleural effusion were hospitalized more. In non-COVID-19 patient treatments during the pandemic period, usage of a metered dose inhaler increased. CONCLUSION: During the COVID-19 pandemic, non-COVID pulmonary pathologies decreased significantly, and there was a change in the profile of the patients. From now on, to be prepared for pandemic and similar extraordinary situations, to organize hospitals for the epidemic, to determine health institutions to which nonepidemic patients can apply, to make necessary plans in order not to neglect the nonepidemic patients, and to develop digital health service methods, especially telemedicine, would be appropriate.

Triple Combination Therapy for Pincer Nail Deformity: Surgical Matricectomy, Thioglycolic Acid, and Anticonvex Sutures.

BACKGROUND: Pincer nail deformity (PND) is characterized by an excessive transverse curvature of the nail plate that increases along the longitudinal axis of the nail. Although many conservative and surgical techniques have been used in clinical practice, an established consensus for the correction of PND has not been present yet. OBJECTIVE: Aim of the technique described in this article is to provide to restore the suitable nail-matrix system curvature by a simplified and quick approach, which could be seen as a synthesis of conservative and surgical treatments described in the literature. MATERIALS AND METHODS: Nineteen cases of pincer nail of the great toe in 14 patients were analyzed. After softening nail plate with 5% thioglycolic acid solution for at least half an hour, surgical bilateral matricectomy and 2 anticonvex sutures with 1-0 polypropylene were performed to ensure proper nail plate shape. Besides demographic data, visual analog scale (VAS) score for pain, width index, height index, patient and surgeon satisfaction scores, operation time, and the day of painless return to the daily activities were investigated. RESULTS: A statistical significance was observed in VAS score for pain, width, and height indices between preoperative and postoperative values. CONCLUSION: This report gives acceptable outcomes with a combination of surgery and conservative treatments.

Alternative method for the reconstruction of meningomyelocele defects: V-Y rotation and advancement flap.

OBJECT: Skin grafts, skin flaps, fasciocutaneous flaps, muscle flaps, and musculocutaneous flaps have been used for closure of large meningomyelocele (MMC) defects that cannot be closed primarily. The V-Y rotation advancement flap technique has been used successfully for the reconstruction of defects in different areas of the body. In the present study, the authors report on their novel use of this technique in both a binary and a quadruple (butterfly) flap manner for closure of large MMC defects. They also present an algorithm that they developed for the evaluation of MMC defects. METHODS: Between January 2011 and November 2013, 17 patients (13 girls and 4 boys) with extremely large MMC defects that could not be repaired by direct primary closure underwent reconstruction of the defects with binary and quadruple V-Y rotation and advancement flaps. With the patient prone, the axillary apices, the most craniad point of the intergluteal sulcus, and the posterior axillary lines were marked, and a rectangular area on the back was designed. Edges of the rectangular area and the transverse and longitudinal diameters of the defect were measured and the presence of kyphosis was noted. These measurements and their proportions were used to develop an algorithm for patient assessment. While binary flaps were planned over the transverse diameter of the defects, quadruple flaps were planned over the bisectors of the defects, which were closed by elevating fasciocutaneous flaps. RESULTS: For patients whose defect diameter to back width ratio was between 0.30 and 0.50 and whose mean ratio of defect area to donor area was between 0.09 and 0.15, binary V-Y rotation and advancement flaps were used. When these values were in the range of 0.50-0.66 and 0.16-0.35, respectively, quadruple V-Y rotation and advancement flaps were preferred. The mean duration of postoperative follow-up was 10.4 months. With the exception of minor complications, such as partial necrosis of 0.5 × 0.5 cm in a quadruple flap, all the flaps healed uneventfully. CONCLUSIONS: With this study, closure of MMC defects with V-Y rotation and advancement flaps has been defined for the first time in the literature. The use of this technique with multiple flaps is an effective alternative to other flap options for the closure of large MMC defects. The algorithm developed in the course of this study should facilitate evaluation and reconstruction planning for patients with MMC defects.

Effect of topically applied sildenafil citrate on wound healing: experimental study.

Wound healing is a complex process that necessitates organization of different cell types and several signalling molecules. The aim of this study is to evaluate the effect of different concentrations of sildenafil citrate, which decreases cGMP degradation, on wound healing by secondary intention.This study was performed using 25 Sprague Dawley rats weighing 200-250 grams. 4 dorsal defects were created. Four different treatment modalities which were 1% and 5% sildenafil citrate gel prepared with carbopol, pure carbopol gel without any drug in it and 0,9% NaCl solution; were applied to each lesion of the same rat. Randomly selected five rats (25 rats in total) were sacrificed on 3rd, 5th, 7th, 10th, and 14th days; and the effect of each modality was evaluated by means of defect area measurement, histopathological examination and measurement of tissue hydroxyproline levels.Sildenafil citrate gel application decreased the defect areas in a dose independent manner starting from 3rd day and dose dependent manner after 7th day. By means of vascularization, sildenafil citrate increased vascularity starting from 3rd day. The strength of acute inflammation was superior in sildenafil groups starting from 5th day; and the amount and maturation of granulation in the wound bed, as well as the strength of chronic inflammation were superior in defects treated with sildenafil citrate as early as 7th day.

The oblique split method: a novel technique for carving costal cartilage grafts.

IMPORTANCE: Autogenous rib cartilage is widely used in the septorhinoplasty cases with major structural grafting requirements. However, there is a risk of warping over time. OBJECTIVE: To introduce a novel method for carving costal cartilage grafts to obtain straight grafts of varying thicknesses and to eliminate the risk of warping. DESIGN: Between 2007 and 2011, a total of 43 consecutive patients underwent septorhinoplasty using autogenous costal cartilage grafts carved by the oblique split method (OSM). SETTING: The Ankara Training and Research Referral Hospital, Ankara, Turkey. PARTICIPANTS: The study included 43 patients with saddle nose deformity and revisional rhinoplasty with a depleted source. All patients were followed-up for a period ranging from 12 to 37 months (mean, 19.2 months) after surgery. INTERVENTIONS: All patients underwent open or closed septorhinoplasty. Autogenous costal cartilage was carved with the OSM to obtain grafts suitable for use as columellar strut, dorsal onlay, L-strut, lateral crural strut, caudal extension, and tip or speader grafts in selected cases. MAIN OUTCOME MEASURES: Patients were evaluated by inspection, palpation, and photographic documentation before surgery. Inspection, palpation, and photographic documentation were carried out every 6 months and 12 months after surgery and once a year thereafter. RESULTS: Patient satisfaction in terms of form and function was achieved in 41 patients (95%). Two patients required reoperation for further tip projection (n=1) and alar batten graft displacement (n=1). No complication was observed as a result of graft warping, resorption, or fracture. CONCLUSIONS AND RELEVANCE: The OSM provides straight costal cartilage grafts of varying thicknesses without the risk of warping. Because they strictly preserve their straight form, the grafts may safely be modified into rectangular shape or carved asymmetrically and/or have their edges beveled. Current data from this study suggest that the OSM offers a flexible and reliable reconstructive option for the rhinoplasty surgeon. LEVEL OF EVIDENCE: 4.

Does thrombocyte size give us an idea about thrombocytosis etiology?

In the presence of a pathogenetic mutation in JAK2 or MPL, a differential diagnosis of essential thrombocythemia (ET) from reactive causes is relatively simple. However, in patients with suspected ET who lack JAK2 and MPL mutations, the exclusion of secondary causes is especially important. The study was aimed to explore the clinical application of particularly mean platelet volume (MPV), hemoglobin, red blood cell indices, white blood cell, serum iron profile, and C-reactive protein level in the differential diagnosis of thrombocytosis. Medical records of 49 patients, consisting of reactive thrombocytosis (RT) and ET were retrospectively reviewed. The mean MPV level in RT group was 7.49 fL, and in ET group was 8.80 fL (P < 0.01). A cutoff point of <8.33 fL was found to have significant predictive value according to ROC curve analysis. This cutoff was associated with 83% positive predictive value (PPV) and 74% negative predictive value (NPV) in the diagnosis of ET and had a sensitivity of 65% and specificity of 89% for ET. Investigation of MPV is cheap, quick, and noninvasive, and may serve as a predictor of primary thrombocytosis. High sensitivity, specificity, PPV, and NPV enable this test an important tool and a possible surrogate marker in clinical practice.

The effect of metabolic syndrome upon the success of varicocelectomy.

We aimed to investigate the impact of metabolic syndrome (MetS) on the varicocele treatment. 101 patients underwent spermatic vein ligation between 2007 and 2010 were retrospectively analyzed. Those patients were divided into two groups as without (n: 56, Group 1) or with MetS (n: 48, Group 2). All the patients underwent left microsurgical subinguinal spermatic vein ligation. Groups were compared by the improvement on sperm parameters and spontaneous pregnancy rates at a mean of 19 (±4) months followup. When sperm parameters were compared postoperatively, the significant improvement in total sperm count, motile sperm count percentage, and normal sperm percentage was reported. The groups were compared to each other and the improvement seemed significantly better in Group 1. There was no statistically significant improvement difference in the normal sperm percentage between groups. Spontaneous pregnancy rate after two years was 45% in Group 1 and 34% in Group 2 (P < 0.05). Patients with MetS and varicocele improved after surgery, but not as well as the similar group without MetS. This may help to show that MetS can be a factor for male infertility.

Nasal hair matrix cyst mimicking dermoid cyst.

Dermoid cysts are primarily observed in the head and neck region. Nasal dermoids are uncommon. The terms nasal dermoid, nasal epidermoid, and nasal sebaceous cysts are used interchangeably by clinicians. Hair matrix cyst is a variant of epidermal cyst resembling the pattern of pilomatrixoma. Formerly, nasal hair matrix cyst has not been reported at all. Here, an additional pathologic proof is presented as well.

Evaluation and management of exposed high-density porous polyethylene implants: an experimental study.

Numerous autogenous and alloplastic materials have been used for restoration of contour deformities of the face. Alloplastic materials have come into use to replace autogeneous bone grafts because bone grafts are associated with donor site morbidity, resorption and difficulty in shaping. Porous high-density polyethylene (HDPPE) is a commercial product which is nonallergenic, nonantigenic, noncarcinogenic and nonresorbable, highly stable and somewhat flexible. It has pores of 125-250 mum which enable tissue ingrowth resulting in firm attachment and integration of the implant to the surrounding tissues. In this study we aimed to evaluate the fate of the exposed implants and proposed a method to manage the exposed medpor implants. Twenty rats were used for this experimental study. Three phases involving the implantation, exposition, and the closure of the implants were held respectively. Closure was performed in two groups: 1) After perforating the exposed implants; 2) Without perforating the exposed implants. No serious complications were seen. Perforated exposed implants when covered with flaps rather than grafts could be covered. Exposed implants were not covered easily as indicated by the previous studies. This study demonstrates that early closure of perforated implants with flaps can give the best clinical results when exposed implants are covered in a short period after exposition so that the ingrown fibrous tissues are still intact. We believe that grafting of the exposed medpor implants cannot be effective either in early or late period. Perforating the exposed implants yield successful results as ingrowth of the tissues are enabled.

An alternative technique for microsurgically unreplantable fingertip amputations.

Reattachment of the amputated fingertips as composite grafts has been performed for distal levels in children, with high rates of good outcome, but the majority of the reports emphasized that this procedure had success rates only up to 50% in adults. Several techniques to enhance composite graft take in adults have been defined. In this study, a technique to enhance nonmicrosurgical replantation of amputated fingertips as composite grafts is presented.Twenty-three patients were treated with this technique, 20 of which were adults. An area of skin on the amputation margin of the stump was deepithelized, and the amputated part was defatted to reattach the piece as a cap composite graft and to increase the contact area. The patients were evaluated after the operations regarding functional and esthetic outcome. Success rates of 86.95% in total and 85% in adults were achieved, with acceptable sensibility (with a mean value of 7.26 mm for the 2-point discrimination), minimal shortening (a mean value of 6.80 mm), and satisfactory esthetic outcome using this technique.

Combined use of hair and fibrin glue for soft tissue augmentation: experimental study.

A vast variety of alloplastic materials together with autogenous grafts have been used for the correction of contour deformities related to aesthetic and reconstructive purposes. Despite a number of well-tolerated materials, the ideal has not yet been reached, although well-tolerated autogenous grafts have higher rates of resorption and distortion. The limited volume of autogenous grafts and concerns about donor-site morbidity may obligate the surgeon to use implantation materials. Covering almost every property of an ideal implantation material, hair, an organic autogenous nonvital tissue, was used for soft tissue augmentation in this experimental study. Hair pellets of 10 New Zealand rabbits were prepared and shaped as 1 x 1 x 1-cm cubes with the help of fibrin sealant, then inserted subcutaneously. The materials were evaluated 4 months later. No complications such as infection or extrusion were seen. The materials were intact, with no signs of resorption, but the shapes were distorted due to the pressure of the surrounding tissues. Histopathologic findings also demonstrated that the hair was well tolerated by the adjacent tissues. Different processes may enable hair to be used as a filler material in clinical practice. Well-tolerated, nonresorbable injectable materials or shaped implants may be obtained at low cost using hair.

Kirschner-wire fixation for postburn flexion contracture deformity and consequences on articular surface.

Kirschner-wire (K-wire) fixation for 3-6 weeks is an approved method for stabilization of the fingers after the release of flexion contracture deformity. On the other hand, articular surface damage in small joints due to pin fixation is still a topic of debate. Reports claiming permanent joint destruction due to this procedure exist in the literature. To clarify this doubt, a prospective study was carried out in 72 patients with flexion contracture of the hand fingers. After the surgical release of the deformity, immobilization of the interphalangeal (IP) and metacarpophalangeal (MCP) joints was carried out with K-wire fixation for 3 weeks. Clinical evaluation of the patients was accomplished with total active motion (TAM), grip, and pinch force measurements, whereas magnetic resonance (MR) and radionuclide imaging were used as radiodiagnostic tools. Mean follow-up period of the patients was 32 months. Satisfactory results were obtained in terms of functional and esthetic aspects. Evaluation of the data derived from the clinical and radiologic measurements revealed no permanent articular surface damage. K-wire fixation was documented to be an invaluable therapeutic approach not only to prevent recurrence of the contracture deformity but also to stabilize the skin graft effectively. This technique was concluded to provide effective immobilization without permanent articular damage.

Reconstruction of heel defects with a proximally based abductor hallucis muscle flap.

The main goals of reconstruction of plantar defects include appropriate soft tissue coverage to facilitate weight bearing, and sufficient blood supply to prevent osteomyelitis. This retrospective study presents the clinical results of 11 patients who received a proximally based abductor hallucis muscle flap for coverage of calcaneal defects. The mean patient age was 43 years (range, 23-69 years). Four patients were women and 7 were men. Seven were non-diabetic patients with neurologic deficits of varying etiology or patients who had pressure ulcers after prolonged hospitalization. Four patients had diabetes with or without neurological deficits, and 6 patients had calcaneal osteomyelitis. In 6 patients, the origin of the muscle was dissected and rotated over the defect. The flap was elevated as an island flap in 5 patients. Postoperatively, partial flap loss was observed in 1 patient, who was then treated successfully with a fasciocutaneous flap. Two patients developed seroma and hematoma at the donor site, which resolved uneventfully after surgical drainage. The 6 patients with calcaneal osteomyelitis showed no recurrence after 1 year of follow-up. The abductor hallucis muscle flap provides enough stability and sufficient blood supply for calcaneal defects up to 3 x 6 cm.

Frontal scalp flap for aesthetic eyebrow reconstruction.

The eyebrow is an important subunit of facial aesthetics and expression. Partial or total absence of the eyebrow is an unacceptable and disturbing condition. Aesthetic eyebrow reconstruction is a challenging problem for the reconstructive surgeon. In this paper a simple and reliable procedure for eyebrow reconstruction is presented. An aesthetically satisfactory result was obtained and a perfect match with the undamaged eyebrow was achieved. In selected cases this technique may be a strong alternative to the procedures that had been defined earlier.

Clinicopathological evaluation of parotid gland tumors: a retrospective study.

Two hundred and thirty sequential parotid tumors seen from March 1985 to 1995 were reviewed for their clinical presentation, diagnostic evaluation, pathological diagnosis, treatment modalities, and age and sex distribution. An asymptomatic mass was the most common clinical presentation. All of the operations were performed by the same surgical team. Total and superficial parotidectomy was used for the treatment of the lesions and none of the patients underwent limited excision. Retrograde approach in 79 (34.4%) patients and anterograde approach in 151 (65.6%) was used. Eighteen patients with malignant tumors were followed up in cooperation with the radiation oncology clinic. Tumors were classified according to their histopathologic diagnosis. Among 192 (83%) benign and 38 (17%) malignant tumors, the most common benign tumor of parotid gland was pleomorphic adenoma (79.1%) while the most common malignant lesion was adenocystic carcinoma (44.7%). Incidences of pleomorphic adenoma, adenocystic and epidermoid carcinoma were greater in male patients. Complication rates in benign and malignant tumors were presented and statistically significant difference could not be found between anterograde and retrograde approach in terms of facial nerve injury (P > 0.05).