Management of skin necrosis after chemical matrixectomy with sodium hydroxide in ingrown toenail

Ingrown nail (unguis incarnatus) is a common condition associated with discomfort and morbidity. Thoughtful treatment choice and patient care by an experienced center is important for overall success. A 28 years old female patient presented with symptoms of chronic unguis incarnatus and a skin necrosis on right great toe. Patient history revealed that symptoms has aggravated after a recent treatment chemical matrixectomy into soft tissue with 10% sodium hydroxide following 10% acetate neutralization to the nail root by another center. Physical examination showed 1.8x0.7 cm full-thickness skin necrosis. Our team surgically removed the ingrown nail area with “Winograd” method. After debridement of necrosis, exposed extensor hallucis longus tendon was covered with a local transposition flap. Patient returned to work with full capacity on postop week 3. During 3 years of follow up no recurrence was observed. Treatment significantly improved mean patients foot function index (Preop:6.4±3.1 vs. 12months:1, p< 0.001) with high cosmetic satisfaction. It is not safe nor recommended to perform unproven, subdermal application based operations for unguis incarnatus patients. Well established surgical lateral matrix excision or ablation techniques are safe and successful treatment options. Evidence based care is important to achieve successful results and minimal morbidity and deformity

Association of vitamin D deficiency and urinary infection in newborn

Aim: To establish the relationship between urinary tract infection (UTI) in newborns and vitamin D deficiency. Material and methods: The study group consisted of 60 newborns followed in the neonatal intensive care unit due to UTI. The controls were 60 healthy newborns with similar distribution of gestational week. Vitamin D levels <15 ng/mL were defined as low. Results: The median serum 25(OH) D concentrations in the study group were lower than the control group (10,2 ng/mL and 16 ng/mL, respectively) (p=0,0001).  In the study group, the multivariate logistic regression analysis showed that a serum level of 25(OH) D<15ng/ml [odds ratio 7, 95%, confidence interval 1.72-28.33; p=0.006] may be a risk factor for UTI in newborns. Conclusion: Low level of 25(OH) D might be associated with an increased risk of UTI in term newborns

Evaluation of the effects of LMA supreme, baska mask LMA and endotracheal intubation on intracranial pressure in laparoscopic operations by measuring the diameter of the sonographic optic nerve sheath

Aim: The laryngeal mask (LMA) has been used for years to provide a safe and effective airway. Nowadays, it is also preferred in gynecological laparoscopic operations. In our study, we aimed to evaluate the effects of Baska Mask LMA (LMA-B), LMA Supreme (LMA-S) and ETT (endotracheal tube) applications on intracranial pressure in laparoscopic gynecological operations by measuring optic nerve sheath diameter (ONSD).  Methods:  Patients between the ages of 18-65 in ASA I-II-III physical status who were going to undergo laparoscopic gynecological operation were included in the study. The patients were divided into three groups by randomisation prospective as ETT, LMA-B and LMA-S. ONCD measurements were measured before general anesthesia (T0), 1 minute after induction (T1), 1 minute after intubation (T2), 3 minutes after intubation (T3), 10 minutes after the pneumoperitoneum and trendelenburg position (T4), and 30 minutes after the pneumoperitoneum and trendelenburg position (T5) and before extubation (T6). Results: 60 patients were included in the study. No statistical difference was found between the groups in terms of demographic characteristics and clinical data (all p>0.05). The change in ONSD within three different groups showed an increase in the measurements at the 10th and 30th minutes after the pneumoperitoneum and trendelenburg position; ETT (4.84±0.23 mm), LMA-S (4.83±0.28mm), and this increase was found to be the lowest in LMA-B (4.64±0.26 mm) application (p=0.61). Conclusion: we think that Baska Mask LMA can be preferred more than ETT and other LMA applications according to the indication and IBP follow-up can be done reliably with ONSD measurements

Empowered or disadvantaged? Investigating the impact of dentures restrictions on patients with stroke in the intensive care unit

Aim: The rate of denture use increases with aging. Stroke dramatically increases the risk of swallowing impairment, especially in the elderly population. The aim of this study was to investigate the swallowing safety of individuals in the intensive care unit who were not using their own dentures. Methods: This cross-sectional study was conducted on patients with ischemic stroke who scored 24 and above on the Mini Mental State Examination test admitted to Bolu Abant Izzet Baysal University Training and Research Hospital and monitored in intensive care unit. The severity of stroke, as measured by the National Institutes of Health Stroke Scale, and the clinical classification of stroke using the Bamford Classification were documented. The Acute Stroke Dysphagia Screening, including the 3-ounce water swallowing test, was used to examine the swallowing safety of the individuals. Results: A total of 16 individuals were included in the study. Individuals were divided into 2 groups: those with natural teeth and those who have dentures but are restricted in their use. The groups were similar with respect to stroke severity, stroke classification, age and gender. Considering swallowing safety, individuals who had dentures but were restricted from using them under intensive care conditions exhibited a higher level of success (p=0.041). Conclusions: As a result of this study, it has been shown that individuals who were restricted from wearing prosthesis in intensive care conditions and who continue oral nutrition with foods that do not require chewing are not at risk as much as thought. Restricting the use of denture, including those with palatal coverage, may provide an advantage in terms of swallowing safety due to an increased sensory field

Comparison of intravenous remifentanil and dexmedetomidine infusions' effects on intraocular pressure and hemodynamy in dacryosystorinostomy operations

Aim: To compare the effects of intravenous infusion of remifentanil and dexmedetomidine on intraocular pressure (IOP) and hemodynamics of patients who underwent dacryocystorhinostomy (DCR) operation. Methods: Ninety consecutive patients aged between 20 and 65 who had lacrimal duct stenosis or occlusion scheduled for elective DCR operation were included in the study. Patients were divided into 3 groups as control (Group C), remifentanil infusion (Group R) and dexmedetomidine infusion (Group D). Peroperative intraocular pressures and hemodynamics were evaluated.  Results: According to intraocular pressure levels; although the IOP decreased at the drug loading dose, induction, preextubation and postextubation, it was statistically significantly higher in Group C than in Group R and Group D (p<0,001). Concominantly, IOP was higher in Group R than in Group D during the time periods listed above. Although IOP measurements at the 1st and 5th minutes of intubation decreased compared to the preoperative value, they were higher than those in Group C, Group R, and Group D; 16.43±1.48 mmHg and 15.62±1.43 mmHg respectively (p < 0.001).  However, in these periods there was no statistically significant difference between Group R and Group D. In the postoperative period, the IOP measurements of Group D were significantly lower than those of Group C and Group R, 16.81±1.65 mmHg, 18.21±1.98 mmHg, 18.17±1.29 mmHg, respectively (p< 0.002). Blood pressure and heart rate values decreased more in Group R and Group D compared to Group C during the operation (p < 0.001).      Conclusions: Remifentanil and dexmedetomidine are agents that can be used in intravenous infusions for controlled hypotension in eye surgeries where low IOP is desired. Intraoperative hemodynamic effects are similar. However, considering that it decreases IOP values more in the intraoperative period and lowers IOP values in the postoperative period compared to remifentanil, we believe that dexmedetomidine can be preferred primarily

Cutaneous necrosis following endovascular embolization by using ethylene-vinyl alcohol copolymer for arterio-venous malformations

Arteriovenous malformations (AVMs) are intricate vascular anomalies marked by aberrant connections between dysplastic arteries and veins, often leading to a spectrum of complications. Treatment of AVMs consists of endovascular embolization, surgical resection or a combined approach. The endovascular embolization is an important and popular alternative treatment to reduce circulation of the nidus and prevent the development of collaterals and recurrence. However, local and systemic complications are quite common after repeated embolization, and surgical treatment is often required to manage such complications. This article presents a comprehensive analysis of a specific case, wherein a 32-year-old male patient with a gluteal AVM underwent ethylene vinyl alcohol copolymer (EVOH, Onyx®) embolization, subsequently developing large cutaneous necrosis. The core objective of this study was to search existing literature and provide insights into the management strategies employed in this unique scenario

Comparison of the efficiency of nomograms used to predict preoperative sentinel lymph node positivity in breast cancer with clinical findings, PET/CT images and laboratory parameters

Aim: To compare the efficacy of nomograms used to predict preoperative sentinel lymph node involvement in patients diagnosed with breast cancer and clinical findings, PET/CT imaging and laboratory parameters. Methods: In this retrospective study, patients who were operated for invasive breast carcinoma with sentinel lymph node biopsy in our Generel Surgery Department between 2015 and 2020, were identified from our database. Laboratory parameters (PLR, NLR, LMR and MPR) were calculated from the complete blood count taken within 24 hours before surgery. Memorial Sloan Kettering Cancer Center (MSKCC) method was used from nomograms. Patients were compared according to sentinel lymph node positivity. All obtained data were compared with statistical tests. Results: A total of 48 patients could be included in the study. A statistically significant correlation was found between physical examination, USG and PET/CT findings in terms of axilla positivity and pathology results (p<0.001, p=0.005 and p=0.002). The SUVmax value of the axilla was found to be statistically significantly higher in patients with positive SLNB group than in SLNB negative group (2.90±3.46 vs. 0.66±1.86, p=0.004). Although the rates of PLR, NLR, LMR and MPR among the laboratory parameters were higher in the SLNB positive group, they were not statistically significant (p=0.683, p=0.6, p=0.948 and p=0.354). MSKCC nomogram values were higher in SNLB positive group, however it was not statistically significant (p=0.243). Conclusion: In our study, clinical examination, laboratory testings, PET/CT imaging results and nomograms; on their own, have limited prediction about sentinel lymph node involvement. Therefore, we think it is necessary to design new algorithms that are more effective to predict axillary involvement and this will give better results in this regard

The role of diffusion-weighted imaging and ADC value in head and neck lesions

Aim:  To evaluate the contrast enhanced magnetic resonance imaging (MRI), diffusion weighted MRI findings of head and neck lesions in combination with histopathological diagnosis. Method: Forty-two patients referred to our university, department of Radiology between July 2008 and June 2011 with a prediagnosis of head-neck lesion. Patients whom underwent contrast enhanced MRI, diffusion weighted MRI, and incisional or excisional biopsy, were included in the study. Patients, whose MRI examinations were suboptimal due to any artefacts, were excluded. After determination of MRI parameters, such as signal intensity, enhancement pattern, apparent diffusion coefficient (ADC) value, and contrast enhanced MRI and diffusion weighted MRI examinations were evaluated by a radiologist who had ten years of experience. Histopathological evaluation was made by a pathologist who had no information about patients’ MRI findings. Results: The mean ADC value of benign and malignant lesions were 0.128x10-3±0.053 mm²/sn and 0.100x10-3±0.026mm²/sn respectively. ADC value was found to be significantly higher in benign lesions compared to malignant ones (p=0.032). Conventional MRI criteria such as signal intensity, internal structure, presence of cystic space and enhancement were found to be insignificant in the differentiation of benign and malignant lesions. Conclusion: Conventional MRI sequences are important in the diagnosis of head and neck lesions but not sufficient due to the overlapping findings. Diffusion weighted MRI, applied in addition to conventional MRI examination, is an efficient technique and has additional diagnostic value in determining nature of head and neck lesions in the preoperative period

Ageless window in minimally invasive cardiac surgery: Periareolar incision

Aim: To present the experiences and outcomes in patients who underwent minimally invasive cardiac surgery via periareolar incision. Methods: A total of 17 patients who underwent minimally invasive cardiac surgery via periareolar incision were included in the study.  Patients’ demographic data such as age and gender, diagnosis, type of procedure, postoperative complications and outcomes were recorded and retrospectively reviewed. Results: In the study population, 11 patients (64.7%) were female and 6 patients (35.3%) were male. The mean age of the patients was 57.6±16.3 years. In a patient with very large breast, the surgical incision was converted from periareolar to submammary incision due to poor exposure. Mortality occurred in one patients due to vasoplegic syndrome. Conclusion: The present analysis revealed that periareolar incision was a safe, effective and cosmetically satisfactory method for patients undergoing minimally invasive cardiac surgery

CRP-lymphocyte ratio as a novel marker of treatment response to hyperthyroidism with radioactive Iodine 131

Aim:  To compare CRP/lymphocyte ratio (CLR), a new inflammatory marker, before and after treatment of hyperthyroidism with Radioactive iodine 131 (RAI 131). Methods: Patients who received RAI 131 treatment for hyperthyroidism in the Department of Nuclear Medicine between January 2020 and May 2023 were included in this retrospective study. Age, gender, WBC, hemoglobin neutrophil, platelet, glucose, AST, ALT and CLR values were compared before and within 1 year of treatment. Results: There were 59 patients in the current study. 38 were women (64.4%) and 21 were men (33.3%). The mean age was 56.3±15.4 years. There was no statistically significant difference between before and after treatment values of WBC, hemoglobin, neutrophil, platelet, glucose, ALT and AST. However, CLR before treatment (1.74±2.34) was higher than after treatment (1±1.72) and the difference was statistically significant (p=0.048). Conclusions: CLR, an inflammatory marker, decreased in patients receiving RAI 131 treatment due to hyperthyroidism after treatment.  This supports that the presence of an inflammatory burden play an important role in thyroid pathologies. We think that this marker is a simple and useful marker that can be used to monitor the response of CLR to treatment in patients receiving RAI 131 therapy for hyperthyroidism