Introduction: Main principle in reconstruction of lower lip, like in other tissues, is to reconstruct the defect by using similar tissues. In cases where defect is more than ⅔ of lower lip, reconstruction with local tissues causes microstomia. Although reconstruction of upper and lower lips with functional gracilis muscle flap, which was first performed by Burt, has been used in lip reconstruction of 13 patients in total by different authors (1, 2); no other functionally used flap has been encountered when reviewing the literature. Here are presented four cases in which patients underwent wide lower lip reconstruction due to squamous cell carcinoma, and in which we performed lower lip reconstruction with innervated serratus anterior muscle flap.
In order to get early information on the functional state of smaller myelinated fibers this article investigated the applicability of conduction velocity distribution on compound action potential recorded in experimentally demyelinated frog sciatic nerve. Conduction velocity distribution histograms were estimated by using the mathematical model the authors enhanced. The results suggest that by using appropriate conduction velocity distribution model the diagnosis time in demyelinating neuropathy may be shortened at least three times as compared with conventional conduction velocity assessment. Therefore, it may be concluded that a well-defined model designed for the estimation of the conduction velocity distribution may be used as a diagnostic tool for the early phase of peripheral demyelinating neuropathies.
Behcet disease (BD) is a chronic multisystem disorder characterized predominantly by recurrent episodes of occlusive vasculitis. According to the accumulated data, it is seen that intracranial hypertension generally develops secondary to the cerebral venous sinus thrombosis in BD. In the study, it was aimed in light of literature to discuss a case where intracranial hypertension occurred without venous sinus thrombosis. A 36-year-old female was evaluated for the symptoms of blurred vision in her left eye for the last 3 months and transient visual obscurations in her right eye beginning 3 days ago. It was found out that the patient had been diagnosed with BD one and a half months ago. Fundus examination revealed bilateral swollen optic discs. Lumbar puncture revealed an opening pressure of 360 mm H2O, with normal composition. The patient was diagnosed with intracranial hypertension developing secondary to BD according to modified Dandy criteria. Methylprednisolone 1000 mg intravenously (IV) for 5 days, followed by prednisolone 60 mg po, was administered. A significant improvement was observed in the complaints and papilledema of the patient. Inflammation could play a significant role in the intracranial hypertension developing without venous sinus thrombosis in BD. As a result, BD should be considered in the differential diagnosis in patients with intracranial hypertension especially in areas where the disease prevalence is high.
Amaç: Karpal tünel sendromu (KTS) tanısında manyetik rezonans görüntülemenin (MRG) yerinin klinik, elektrofizyolojik verilerle birlikte değerlendirilerek araştırılması amaçlandı. Gereç ve Yöntemler: Klinik ve elektrofizyolojik olarak KTS tanısı alan 21 hasta çalışmaya alındı. Median sinir alanı ve düzleşme oranı, radioulnar eklem (seviye 1), os psiforme (seviye 2) ve os hamatum (seviye 3) seviyelerinde fleksor retinakulum kalınlığıyla birlikte MRG'de değerlendirildi. Benzer yaş grubundaki 20 kişilik kontrol grubu ile MRG bulguları karşılaştırıldı. Klinik evre, elektrofizyolojik evre arasındaki korelasyonla birlikte Phalen ve Tinel testlerinin pozitif ya da negatif olma durumlarına göre; klinik, ve elektrofizyolojik evre arasındaki ilişkiye bakıldı. KTS tanısında MRG'nin seçiciliği, duyarlılığı, pozitif ve negatif prediktif değerleri de ROC analizi yapılarak değerlendirildi. Bulgular: KTS'li olgularda median sinir alanı radioulnar eklem, psiform kemik seviyesinde anlamlı derecede genişken median sinir düzleşme oranı tüm seviyelerde anlamlı derecede büyüktü (sırasıyla p=0,002, p=0,001 ve p=0,001). Fleksor retinakulum kalınlığı da KTS'li olgularda anlamlı derecede büyüktü (p=0,001). Klinik evre ile elektrofizyolojik evre arasında orta derecede korelasyon bulunurken (r=0,664, p=0,001), Tinel ya da Phalen testi pozitifliği ile klinik evre, ve elektrofizyolojik evre ortancaları benzer bulundu (sırasıyla p=0,880 ve p=0,841). Klinik değerlendirmede, MRG'nin pozitif sonucunun gerçekte KTS olma olasılığı olan pozitif prediktif değerlere bakıldığında ise; median sinir alanının seviye 2'de, düzleşme oranının seviye 3'te en yüksek olduğu (sırasıyla %82,4 ve %92,9) bulunmuş, fleksör retinakulum kalınlığının ise %85,7 olduğu görülmüştür. Sonuç: MRG, KTS tanısında tek başına kullanılabilecek kadar tanısal geçerliliği yüksek bir yöntem değildir. Buna karşın, konservatif tedavinin yetersiz ya da başarısız olduğu durumlarda KTS'nin nedenini bulmada özellikle karpal tünel içinde yer kaplayan lezyonlar ya da anatomik varyasyonların tanımlanmasında kullanılabilir.
OZET Methanol is a toxin with rare but serious effects on the central nervous system. It may cause severe visual dysfunction and mortality. This study presents the case of a 44-year-old man admitted to our clinic with bilateral amaurosis which developed after dental intervention for gingivitis. The patient was conscious and presented with stomach ache, nausea, vomiting, weakness, imbalance, and bilateral amaurosis; methanol poisoning was diagnosed. Upon examination, the absence of light perception in the eye and bilateral weakness in light reflexes were detected. Visually-evoked potentials (P100) could not be obtained. Hyper-intense lesions with bilateral putaminal localisation were observed on magnetic resonance imaging and bilateral pupil oedema was observed by fundus photography. The patient was treated with methyl prednisolone and intravenous vitamin B1. On the fifth day after admission, fluctuations in visual findings were observed, and light reflex loss and pupillary dilatation developed. Upon examination one and six months later, bilateral (total) amaurosis and bilateral optic atrophy were detected. This case demonstrates bilateral putaminal involvement after exposure to a very low dose of methanol.
Aim: Diagnosed with multifocal dystonia, the subjects without trauma, exposure to toxic substances, metabolic diseases or the history of chronic drug use were aimed to be discussed in light of literature. Case Report: A 62- year-old man was recruited to our clinic with the complaints of the pain on the right half of the neck, tenderness, contractions on both hands, more definite on the right. In his history, it was determined that the pain on the right half of the neck had been present for two years and the complaint of contraction on the right hand had just started after the right neck pain, and that contraction on the left hand had existed for one year. On his physical examination, a mass which could palpably be felt, in size of 1x1 cm, of neatly framed and tender was observed on the right half of the neck. On the neurologic examination, dystonia existed on both hands, moremarked on the right, and tonus had increased on both upper extremities in the nature of rigidity. On the cervical MRI, definite protrusion on C5-6, left paramedian protrusion on C5-6, C6-7 and cord impression on C5-6 were present. Conclusion: What makes our case remarkable is timely correlation between pain on right half of neck and beginning of dystonia on right upper extremity. Chronic pain could lead to movement disorder in the form of dystonia by disinhibitation of the silent spinal cord central pattern generator by causing hyperexitability of spinal interneurons.
Increased interest in the relationship between affective disorder and long-term health consequences has generated recent examinations of depression and stroke. Observations suggest that depressive disorder is associated with abnormal physiological and immunological responses and a resultant increase in inflammatory markers. Given the high prevalence of stroke and associated costs for the community, it is important to understand the mechanisms that may impact on the outcome to achieve the best possible prognosis.The view that inflammatory factors contribute to depression is predicated on findings that circulating cytokines and other inflammatory factors are increased in depressed patients. Therefore, it has been hypothesized that inflammation could be one of the mechanisms by which depression increases risk for ischemic stroke. Our aim was to determine whether there is any relationship between major depression and tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-18, brain-derived neurotrophic factor (BDNF), and neuron-specific enolase (NSE) in patients with acute ischemic stroke (AIS).This was as a cross-sectional design.This study has a cross-sectional design, and it was conducted in Necmettin Erbakan University, the Meram Faculty of Medicine in Konya, Turkey, between 2014 and 2015. Fifty-three AIS patients admitted to the hospital within the first 24 h after stroke onset were recruited. Major depression was ascertained by means of the structured clinical interview for the diagnostic and statistical manual of mental disorders, Fourth Edition/Clinical Version. The enzyme-linked immunosorbent assay was used to measure the serum levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE at admission.A total of 53 patients with a mean age of 65.9 years were recruited. Of these patients, 17 (32.1%) had major depression. Depressive and nondepressive patients had similar demographical and clinical features. There was no significant statistical difference between depressive and nondepressive patients with AIS with respect to levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE.This study suggests that in patients who have experienced AIS, there is no significant relationship between major depression and basal proinflammatory cytokines (TNF-α, IL-1 β, IL-18), BDNF, and NSE.
