Enhancement of Tissue Expansion by Calcium Channel Blocker: A preliminary study

BACKGROUND: Reconstruction of the defects after surgical resection of tumors is one of the important issues in surgical oncology. It is essential that the defect should be covered with a tissue quite similar to the original one and is best achieved by harvesting tissue from an area adjacent to the defect. Tissue expansion is one of the most frequently used reconstructive techniques. A number of studies evaluated blood circulation, capsule formation, tissue tolerance, histomorphological changes and complications of expander placement. However, only a few attempted to enhance tissue expansion. This study we aimed to evaluate verapamil, a calcium channel blocker, to enhance tissue expansion. MATERIAL AND METHOD: Twelve New Zealand rabbits weighing between 900 gm and 1200 gm were assigned into study and control groups. High volume expanders (100, 200 or 300 cc) were placed into the subcutaneous tissue. Rabbits in the study group received verapamil. Expanders in the control group were inflated every three days to achieve same pressure as the study group. The size of the flaps was assessed by applying pressure on tip of the flap to demonstrate the contraction. Histopathological examinations were performed. RESULTS: By administering liquid earlier and more quickly less flap retraction was observed in the study group. In the control group expanders were exposed in two rabbits while no complication occurred in the study group. Following extraction of the expanders, the flaps were elevated and less retraction was observed in the study group compared to controls. CONCLUSION: Verapamil is safe when used topically and provides less retracted flaps. It can be suggested that verapamil acts on the myofibroblasts in the capsule around tissue expanders and thus increases efficiency of the expanders

Classroom Teachers’ Attitudes to Nutrition Education and the School Food Environment: An Online Survey in Turkey

The objective of this study to determine the attitudes of elementary school teachers in Turkey towards nutrition education, nutrition courses in schools and the school food environment and to analyze differences by gender. The study used a cross-sectional online survey design. Descriptive statistics were used for the demographic characteristics and teachers’ attitudes. Teachers’ attitudes by gender were analyzed using independent t tests. Participants were 1796 elementary classroom teachers in 527 schools, 56% male. Teachers rated highly that classroom nutrition education is very important (mean = 4.17 on a 5-point scale), and should be practical (3.66); that nutrition taught as a separate subject was more likely to be effective (3.99) and government agencies, universities, and teachers should collaborate to provide it (4.34). They agreed that the school food environment can have a positive influence on student nutrition habits (4.32). Women teachers judged all attitude statements more positively than men, many significantly so. Classroom teachers have very positive attitudes towards practical nutrition education in the classroom and improving the school food environment. Providing teachers with the necessary culturally-based curricula and skills and having them collaborate with relevant agencies and organizations may contribute to their effectiveness.Keywords: teacher attitudes, nutrition education, nutrition courses, school food environment, food serviceDOI: 10.7176/JHMN/75-1

The Advantages and Limitations of Ultrasound Elastography in Diagnosis of Thyroid Carcinoma

Thyroid nodules have high prevalence in the general population. Only minorities of thyroid nodules are malignant; nevertheless, still biopsies are performed in differential diagnosis of malignant and benign thyroid nodules. Conventional ultrasound is widely used in diagnosis and characterization of thyroid nodules. There are several suspicious ultrasound features that predict thyroid cancer, such as solid consistence, marked hypoechogenicity, taller-than-wide shape, irregular or microlobulated or spiculated margins, no peripheral hypoechoic halo, and micro- or macrocalcifications. However, none of these signs have high sensitivity or specificity nor high degree of confidence for diagnosis or exclusion of thyroid carcinoma. Ultrasound elastography, recently developed, promising, noninvasive technique that evaluates tissue stiffness, has become one of the main focuses in thyroid imaging. There are two ultrasound elastography methods: strain ultrasound elastography (also known as real-time elastography or qualitative elastography) and shear wave elastography (quantitative elastography and acoustic radiation force impulse imaging). The purpose of this chapter is to present the principles of thyroid application, advantages, and limitations of both ultrasound elastography techniques

Idiopathic isolated clitoromegaly: A report of two cases

BACKGROUND: Clitoromegaly is a frequent congenital malformation, but acquired clitoral enlargement is relatively rare. METHODS: Two acquired clitoromegaly cases treated in Atatürk Training Hospital, Izmir, Turkey are presented. RESULTS: History from both patients revealed clitoromegaly over the last three years. Neither gynecological nor systemic abnormalities were detected in either patient. Karyotype analyses and hormonal tests were normal. Abdominal and gynaecological ultrasound did not show any cystic lesion or other abnormal finding. Computerized tomography scan of the adrenal glands was normal. Clitoroplasty with preservation of neurovascular pedicles was performed for the treatment of clitoromegaly. CONCLUSION: The patients were diagnosed as "idiopathic isolated" clitoromegaly. To the best of our knowledge, there has been no detailed report about idiopathic clitoromegaly in the literature

The creation of new rotation arc to the rat latissimus dorsi musculo-cutaneous flap with delay procedures

BACKGROUND: Latissimus dorsi musculocutaneous flap is one of the most frequently performed reconstructive techniques in surgery. Latissimus dorsi muscle has two arcs of rotation. It is classified as type V muscle. This muscle can be elevated on the thoracodorsal artery to cover large defects in the anterior chest and also, the muscle can be elevated on the segmental vessels to cover midline defects posteriorly. The aim of this study was to create a new arc of rotation on a vertical axis for the muscle and investigate effectiveness of vascular and chemical delays on the latissimus dorsi muscle flap with an inferior pedicle in an experimental rat model. We hypothesized that the latissimus dorsi muscle would be based on inferior pedicle by delay procedures. METHODS: We tested two different types of delay: vascular and combination of vascular and chemical. We also tried to determine how many days of "delay" can elicit beneficial effects of vascular and combination delays in an inferior pedicled latissimus dorsi musculocutaneous flap. To accomplish this, 48 male Sprague-Dawley rats were randomly subjected to vascular or combination delay (vascular and chemical). In addition, one ear of each rat was assigned into a delay procedure and the other ear was used as a control. Results were evaluated macroscopically, and micro-angiography and histological examinations were also performed. As a result, there was a significant difference in viable flap areas between vascular delay alone and control groups (p < 0.05). RESULTS: The higher rate of flap viability was obtained in seven-day vascular delay alone. However, there was no significant difference in the viability between seven-day vascular delay and five-day vascular delay (p < 0.05), so the earliest time when the flap viability could be obtained was at five days. The rate of flap viability was significantly higher in the vascular delay combined with chemical delay than the control group (p < 0.05). CONCLUSION: The combination of vascular and chemical delays increased the rate of viability. Nevertheless, there was no significant difference between vascular delay alone and combination of vascular and chemical delays. Chemical delay did not significantly decrease the delay period. Better histological and microangiographical results were achieved in delay groups compared to control groups. We concluded that the arch of the latissimus dorsi musculocutaneous flap can be changed and the flap can be used for various purposes with the delay procedures

Cervicopectoral flap in head and neck cancer surgery

<p>Abstract</p> <p>Background</p> <p>Reconstruction of the head and neck after adequate resection of primary tumor and neck dissection is a challenge. It should be performed at one sitting in advanced tumors. Defects caused by the resection should be closed with flaps which match in color, texture and hair bearing characteristics with the face. Cervicopectoral flap is a one such flap from chest and neck skin mainly used to cover the cheek defects.</p> <p>Methods</p> <p>This study included twelve patients presenting with cancer of the head and neck to Izmir Ataturk Training Hospital and Adnan Menderes University Hospital. Tumor resection and neck dissection was performed in one session by the same surgeon. A single incision was made and a medially based cervicopectoral fascio-cutaneous flap was used for surgical exposure in neck dissection and for closure of defects after tumor resection.</p> <p>Results</p> <p>There was no major complication. Two flaps had partial superficial epidermolysis at the suture line. Good aesthetic and functional results were achieved.</p> <p>Conclusion</p> <p>The cervicopectoral flap is an excellent alternative for the reconstruction of head and neck. Harvesting and application of the flap is rapid and safe. Only a single incision is sufficient for dissection and flap elevation. This flap achieves perfect surgical exposure, makes neck dissection easy and allows one to perform both tumor resection and neck dissection in one session.</p