Comprehensiveness of online sources for patient education on otosclerosis

PurposeThis study aimed to assess the readability indices of websites including educational materials on otosclerosis.MethodsWe performed a Google search on 19 April 2023 using the term “otosclerosis.” The first 50 hits were collected and analyzed. The websites were categorized into two groups: websites for health professionals and general websites for patients. Readability indices were calculated using the website https://www.webfx.com/tools/read-able/.ResultsA total of 33 websites were eligible and analyzed (20 health professional-oriented and 13 patient-oriented websites). When patient-oriented websites and health professional-oriented websites were individually analyzed, mean Flesch Reading Ease scores were found to be 52.16 ± 14.34 and 46.62 ± 10.07, respectively. There was no significant difference between the two groups upon statistical analysis.ConclusionCurrent patient educational material available online related to otosclerosis is written beyond the recommended sixth-grade reading level. The quality of good websites is worthless to the patients if they cannot comprehend the text

Survival results according to Oncotype Dx recurrence score in patients with hormone receptor positive HER-2 negative early-stage breast cancer: first multicenter Oncotype Dx recurrence score survival data of Turkey

BackgroundThe Oncotype Dx recurrence score (ODx-RS) guides the adjuvant chemotherapy decision-making process for patients with early-stage hormone receptor-positive, HER-2 receptor-negative breast cancer. This study aimed to evaluate survival and its correlation with ODx-RS in pT1-2, N0-N1mic patients treated with adjuvant therapy based on tumor board decisions.Patients and methodsEstrogen-positive HER-2 negative early-stage breast cancer patients (pT1-2 N0, N1mic) with known ODx-RS, operated on between 2010 and 2014, were included in this study. The primary aim was to evaluate 5-year disease-free survival (DFS) rates according to ODX-RS.ResultsA total of 203 eligible patients were included in the study, with a median age of 48 (range 26-75) and median follow-up of 84 (range 23-138) months. ROC curve analysis for all patients revealed a recurrence cut-off age of 45 years, prompting evaluation by grouping patients as ≤45 years vs. >45 years. No significant difference in five-year DFS rates was observed between the endocrine-only (ET) and chemo-endocrine (CE) groups. However, among the ET group, DFS was higher in patients over 45 years compared to those aged ≤45 years. When stratifying by ODx-RS as 0-17 and ≥18, DFS was significantly higher in the former group within the ET group. However, such differences were not seen in the CE group. In the ET group, an ODx-RS ≥18 and menopausal status were identified as independent factors affecting survival, with only an ODx-RS ≥18 impacting DFS in patients aged ≤45 years. The ROC curve analysis for this subgroup found the ODx-RS cut-off to be 18.ConclusionThis first multicenter Oncotype Dx survival analysis in Turkey demonstrates the importance of Oncotype Dx recurrence score and age in determining treatment strategies for early-stage breast cancer patients. As a different aproach to the literature, our findings suggest that the addition of chemotherapy to endocrine therapy in young patients (≤45 years) with Oncotype Dx recurrence scores of ≥18 improves DFS

The effect of pulley location on tendon gliding resistance and thumbs function after tendon transfers for thumb opposition: Biomechanical cadaveric study

Başparmak oppozisyonu için yapılan tendon transferlerinin etkisi transfer edilen kasa, pulley yerleşimine ve bu yerleşim yerindeki tendon kayma drencine bağlıdır. Kas seçimi ve pulley yerleşimi üzerinde geniş çalışmalar mevcut iken, transferin başarısında veya yetmezliğinde potansiyel bir sebep olan pulley yerleşiminde kayma direnci ile ilglili çok az sayıda çalışmalar yapılmıştır. Çalışmamızın amacı; tendon transferinde en sık kullanılan 3 pulley lokalizasyonunda tendonun kayma drencini biyomekanik olarak karşılaştırmak ve en düşük kayma direnci oluşturan pulley yerleşimine karar vermektir.Çalışmada, kayma drencini hesaplamak için 8 taze donmuş kadavranın önkolu kullanıldı. Donör tendon olarak tüm kadavralarda 4. parmak fleksör dijitorum süperfisiyalis (FDS) seçildi. Oppozisyon tendon transferi için seçilen üç pulley; 1- Guyon kanal, 2- fleksör karpi ulnaris (FKU) loop pulley ve 3- Royle-Thompson pulley ( palmar aponörozun ulnar kenarı ile transvers karpal ligamanın distal kenarının birleşme yeridir). FDS tendonu tüm kadavra örneklerinde abduktör pollisis brevisin (APB) palmar-radial tarafına sütüre edildi. Transfer edilen tendonun kayma direnci ile fonksiyonel değerlendirilmesi 3 farklı pulley sahasında, modifiye edilmiş tendon kayma direnci düzeneğiyle direkt olarak ölçüldü. Fonksiyonel değerlendirme için; başparmak abduksiyonu ve oppozisyonu hassas cetvel kullanılarak sırayla başparmak ucu ile ikinci ve beşinci metakarp başı arasındaki mesafe ölçüldü.Royle-Thompson, Guyon kanal ve FKU loop pulleyleri içinde transfer edilen tendonun ortalama kayma direnci sırayla 129.83 (±103.57), 59.44 (±53.99), 45.37 (±42.03) (Newton) idi. Royle-Thompson pulleyinde kayma direnci FKU loop ve Guyon kanalı pulleylerinden istatistiksel olarak anlamlı daha yüksek bulundu (p < 0.05). Guyon kanal ile FKU loop pulleyleri arasında oluşan kayma direncinde istatistiksel olarak anlamlı fark yoktu. Fonksiyonel olarak; Royle-Thompson ile Guyon kanal pulleyi en fazla başparmak pulpasını beşinci parmak metakarp başına yaklaştırırken (oppozisyon) (p < 0.05), FKU loop pulley ise en fazla palmar abdüksiyon sağladı (p < 0.05).Sonuç olarak, Guyon kanal ile FKU loop pulleyleri 4. parmak FDS tendonu kullanılarak yapılan oppozisyon transferinde daha az kayma direnci üretir. Guyon kanal pulleyi ayrıca FKU loop pulleyi ile karşılaştırıldığında daha fazla oppozisyon hareketi sağladığından dolayı oppozisyon rekonstrüksiyonunda en uygun pulley yerleşimi Guyon kanalı olduğu tespit edildi.The function of tendon transfers for thumb opposition depends on the muscle transferred, pulley location and the amount of friction created at the pulley site. While muscle choice and pulley location have been extensively studied, few studies have examined friction at pulley site as a potential cause for transfer success or failure. The purpose of this study was to biomechanically compare the gliding resistance (GR) of 3 commonly used pulley sites and to determine the pulley location which produces the lowest GR on the transferred tendon.Eight fresh-frozen cadaver forearms were used to examine GR. The flexor digitorum superficialis (FDS) of the ring finger was used as a donor tendon in all 8 specimens. An oppositional transfer was created to the thumb using three pulley sites: 1.) Guyon?s canal (GC) 2.) a Flexor carpi ulnaris (FCU) loop pulley and 3.) a Royle-Thompson pulley (RT) which is placed at the junction between the ulnar border of the palmar aponeurosis and the distal edge of the transverse carpal ligament. The FDS was inserted into the palmar radial portion of the abductor pollicis brevis in all cases. GR and functional evaluation of the transferred tendon were measured directly in 3 different pulley sites using a tendon friction testing device modified from a previously described and validated gliding resistance testing machine. For functional evaluation of the thumb, thumb abduction and opposition were measured as the distances between the thumb tip and the second/fifth metacarpal heads by digital ruler respectively.The mean GR of the tendon within the Royle-Thompson, Guyon?s canal, and FCU loop pulleys was 129.83 (±103.57), 59.44 (±53.99) and 45.37(±42.03) (Newton) respectively. The GR for the RT pulley was found to be significantly higher than the FCU loop or GC (p < 0.05). There was no statistically significant difference between GC, and FCU loop pulley with regard to friction generated following transfer. Functionally the FCU loop pulley obtained the greatest amount of palmar abduction (p < 0.05), while the GC and RT pulleys produced the largest amount of opposition, as measured by the thumb pulp?s final distance from the fifth metacarpal head (p < 0.05).GC and a FCU loop produced lower friction when used as a pulley location for oppositional transfers using the ring FDS. Because the GC also produced greater oppositional motion when compared to the FCU loop, the most appropriate pulley for tendon transfer in opponensplasty was found Guyon?s canal pulley

Using pedicled rectus abdominis musculocutaneous flaps in thigh and lumber defects

AMAÇ: Daha önce tanımlanmış, fakat az kullanılan “ekstended” veya vertical rektus abdominis muskulokutan (“Ekstended” RAM, VRAM) fleplerinin çok nadir endikasyonlardaki kullanımları incelendi. GEREÇ VE YÖNTEM: Beş hastada, 28x8 ile 35x10 cm ebatlarında cilt adası içeren flepler kullanıldı. Dört flep uyluk ve diz proksimal bölgedeki defekt onarımları için inguinal ligamentin altından, bir flep lomber gölgedeki defekt onarımı için transabdominal olarak defekt alanlara taşındı. BULGULAR: Hiçbir olguda flep kaybı görülmedi. Bir olguda yara yeri enfeksiyonu gelişti ve cerrahi ile tedavi edildi. Uyluk ve lomber bölge defektleri onarımlarında düşük komplikasyon oranlarıyla “ekstended” RAM ve VRAM fleple başarılı transfer gerçekleştirildi ve çok güvenli ve uygun bir seçenek olduğu sunuldu. SONUÇ: Avantajları bol miktarda ve iyi kanlanan doku taşımasını sağlar, flep kolay ve hızlı hazırlanır ve mikrocerrahi deneyimi gerektirmez.BACKGROUND: A series of previously described but rarely used variations of the pedicled, extended or vertical rectus abdominis musculocutaneous flap ( Extended RAM, VRAM) were reviewed. METHODS: Skin paddle dimensions, ranged 8 to 28 cm in width and 10 to 35 cm in length, were used in five consecutive patients. Four flaps were placed deep to the inguinal ligament to repair the thigh as proximal to the knee region; the remaining one flap was passed transabdominally to cover the defect of the lumbar region. RESULTS: No flaps necrosis were seen and in one case wound healing problems required minimal operative intervention. Successful transfer of the VRAM and extended RAM with low rate of complication for the thigh and lumbar region defects were demonstrated to be safe and reasonable options of flap reconstruction. DISCUSSION: The flaps had the advantages of being robust and well- vascularized, easy and fast to harvest, and not requiring microsurgery experience

Management of temporomandibular joint ankylosis with temporalis fascia flap and fat graft

WOS: 000328309800015PubMed ID: 23465639Aim: Temporomandibular joint (TMJ) ankylosis is a serious problem that restricts jaw mobility and causes disturbances in facial and mandibular growth. The purpose of this paper is to present an easy and versatile method for the treatment of TMJ ankylosis to decrease postoperative complications such as re-ankylosis. Material and method: Eleven patients who presented with ankylosis of the TMJ underwent surgical release. After performing gap arthroplasty through a preauricular approach, the temporalis fascia flap was transposed to the gap. An autogenous fat graft was then obtained from the abdomen and used as interpositional material. The follow-up time was 3-5 years. Results: Re-ankylosis did not occur in any of the patients, and all had satisfactory mouth opening. Conclusion: Surgical treatment of TMJ ankylosis with gap arthroplasty, interposition of the temporalis fascia flap and fat grafting is an effective and easily procedure for preventing of re-ankylosis. The autogenous nature and close proximity to the joint are the main advantages of the temporalis fascia flap when compared with other interpositional materials, and the fat graft provides additional support by reducing pressure

Early and late term microsurgical free flap reconstruction and risks in high voltage electrical injury

The aim of the study is to discuss and compare the early and late micro vascular flap reconstruction's outcomes, importance, risks, advantages and disadvantages with review of our 13 high voltage electrical burn injury cases. Medical records have been reviewed for electrical burns in last three years. 13 cases fitting the criterion were included into the study. Four of them have been hospitalized for late complication such as severe contracture; nine of them have been hospitalized for acute treatment. Five patients had latissimus dorsi muscle flap, three patients had parascapular flap, two patients had latissimus dorsi and scapula osteomusculocutaneous flap, two patients had rectus abdominis musculocutaneous flap, and one patient had parascapular and scapular flap. Early reconstruction applied group showed a significant difference regarding to flap failure rates. Electrical injuries are more complex than regular burn injuries related with heat, and the reconstruction of these cases also should be special. One of the most important factor for free flap viability in electrical injury cases is surgery timing. All of the complications were seen in the patients who had surgery at 12th and 19th days after the electrical injury. No complication has seen in the group of patients who had surgery on late term period. However microsurgical reconstruction should be considered to cover exposed bony tissues on the extremities in the short term period in order to prevent possible limb shortening procedures

Early Clinical Outcomes with the Use of Decellularized Nerve Allograft for Repair of Sensory Defects Within the Hand

Nerve conduits have become an established option for repair of sensory deficits of up to 2 cm. More recently, decellularized nerve allograft has also been advocated as an option for nerve repair; however, no clinical studies have examined its efficacy for the treatment of sensory nerve defects. The aim of this study was to examine our early experience with the use of decellularized nerve allograft for repair of segmental nerve defects within the hand and fingers. From July 2007 to March 2008, seven patients who had ten nerve gaps were treated surgically using decellularized nerve allograft. Eight digital and two dorsal sensory nerves were repaired. The etiologies of the nerve defects were traumatic nerve transection in eight defects and neuroma resection and reconstruction in two defects. All of the affected nerves were pure sensory fibers. Functional recovery was evaluated by blinded hand therapist using moving and static two point discrimination tests. Implantation sites were also evaluated for any signs of infection, rejection, or graft extrusion. There were five men and two women with a mean age of 44 years (range 23–65). Mean nerve graft length was 2.23 cm with a range of 0.5–3 cm. Mean follow up time was 9 months (range 5–12). Average two point discrimination was 4.4 mm moving and 5.5 mm static at last recorded follow-up. There were no wound infections observed around the graft material and sensory improvement was observed in all of the patients despite this short-term follow-up. Re-exploration of two fingers was required for flexor tendon rupture in one and flexor tendon tenolysis in the other. In both cases, the nerve allograft was visualized and appeared well incorporated in the repair site. Decellularized nerve allografts were capable of returning adequate sensation in nerve defects ranging from 0.5 to 3 cm. There were no cases of infection or rejection. Decellularized nerve allograft may provide an option for segmental nerve gaps beyond 2 cm. Randomized comparative studies will be required to determine efficacy in comparison to collagen conduits or nerve autograft