Ramazan Altun | Maltepe University (original) (raw)

Papers by Ramazan Altun

Research paper thumbnail of Diced Cartilage Grafts in Rhinoplasty Surgery: Current Techniques and Applications

Plastic and Reconstructive Surgery, 2009

The use of diced cartilage grafts in rhinoplasty surgery was recently revived by Erol with the pu... more The use of diced cartilage grafts in rhinoplasty surgery was recently revived by Erol with the publication of his technique for "Turkish delight" grafts (i.e., diced cartilage grafts wrapped in Surgicel). The present study details the authors' experience with 50 consecutive diced cartilage grafts used in three configurations during a prospective study of 50 primary and secondary aesthetic rhinoplasty procedures performed by the senior author (Daniel). Part I consists of 22 diced cartilage grafts wrapped in Surgicel and placed in the radix (n = 14), radix/upper dorsum (n = 4), and full-length dorsum (n = 4). All grafts were performed adhering meticulously to Erol's technique without modification. This portion of the study was halted abruptly at 4 months because of the unexpected absorption and clinical failure of all diced cartilage grafts wrapped in Surgicel. Subsequently, five patients had revision surgery, and biopsy specimens were taken at the prior grafting site and analyzed histologically. After this clinical failure, part II of the study began, consisting of 20 patients who had diced cartilage grafts wrapped in fascia. The range of applications was comparable: radix (n = 12), radix/dorsum (n = 3), and full-length dorsum (n = 5). Because of our prior practice of overcorrecting by 20 percent with diced cartilage grafts wrapped in Surgicel, we had excessive amounts of material in six of our initial diced cartilage wrapped in fascia radix grafts, but no subsequent grafts. The overcorrections were easily reduced at 6 weeks to 11 months postoperatively using a pituitary rongeur under local anesthesia, and the material was sent for histologic analysis. Minimum 1-year follow-up of all 20 cases has shown maintenance of the grafts without evidence of absorption. Part III of this study comprised eight patients who had diced cartilage grafts without a fascial covering placed throughout the nose, including on the sides of osseocartilaginous rib grafts to the dorsum. At 14 months, there was no evidence that any of these grafts had been absorbed. Histologic analysis of the biopsy specimens from the diced cartilage grafts wrapped in Surgicel showed evidence of fibrosis and lymphocytic infiltrates with small amounts of Surgicel visible on birefringent microscopy. Remnants of cartilage were present but were metabolically inactive on the basis of negative glial fibrillary acidic protein staining. Control specimens of fresh septal cartilage and banked septal cartilage were remarkably similar to each other and demonstrated normal cartilage architecture and cellular activity. The diced cartilage grafts wrapped in fascia showed coalescence of the diced cartilage into a single cartilage mass, with viable cartilage cells and normal metabolic activity on the basis of glial fibrillary acidic protein staining. All of the diced cartilage grafts wrapped in Surgicel absorbed and failed to correct the clinical problem for which they were performed. All of the diced cartilage grafts wrapped in fascia and pure diced cartilage grafts did correct the clinical deformities and appear to have survived completely. The diced cartilage grafts wrapped in fascia placed along the dorsum were distinctly palpable throughout the postoperative period, as was one prior case with a 6-year follow-up. The authors' clinical experience confirms the experimental studies of Yilmaz et al. that question the use of Surgicel for wrapping diced cartilage grafts in clinical rhinoplasty surgery.

Research paper thumbnail of An Examination of Posttraumatic, Postsurgical Orbital Deformities: Conclusions Drawn for Improvement of Primary Treatment

Plastic and Reconstructive Surgery, 2009

A retrospective analysis was carried out on the records of 317 patients operated on by the senior... more A retrospective analysis was carried out on the records of 317 patients operated on by the senior author (S.A.W.) for orbital fractures between 1975 and 2007. Two hundred forty of the patients had been previously operated on elsewhere and required further correction (posttraumatic, postsurgical orbital deformity). A smaller group of patients (n = 77) were operated on primarily. The two groups were not, of course, similar, because the posttraumatic, postsurgical orbital deformity group had been operated on by a variety of surgeons with varying levels of experience and ability, and the group of patients operated on primarily had a larger percentage of fractures in the pediatric age group, because of the practice being partially based in a children's hospital, and a larger percentage of severe, compound orbital injuries, because of statewide referrals. Nevertheless, a number of causes for reoperation seen in the posttraumatic, postsurgical orbital deformity group were not seen in the primarily operated group. These included lower eyelid retraction attributable to use of the subciliary incision, displacement and extrusion of alloplastic materials, and fixation of fractures in a nonreduced position. These differences validate, in the authors' opinion, the application of the basic principles of craniofacial reconstruction set forth by Paul Tessier, listed in the text, to both the primary and secondary treatment of posttraumatic orbital deformities.

Research paper thumbnail of Is It Really Necessary to Make Wide Excisions for Basal Cell Carcinoma Treatment

Journal of Craniofacial Surgery, 2009

Basal cell carcinoma (BCC) is the common malignancy at the skin arising from the cells of the bas... more Basal cell carcinoma (BCC) is the common malignancy at the skin arising from the cells of the basal layer of the epithelium or from the external root sheath of the hair follicle. It usually occurs at sites with the greatest concentration of pilosebaceous follicles, and it is directly related to sun exposure. Metastasis is rare, but it recurs if it is inadequately treated. For preventive recurrence, BCC is often excised with wide skin margins. It leads to sacrifice of healthy tissue and causes morbidity problems. In our study, we make a treatment plan of excising the primary BCC with its natural tumor margin. Incomplete excision rates were compared between the patient group in which the excisions were performed according to the previously mentioned literature knowledge and the patient group in which excisions were made along the visible outer margins of erythema or induration area surrounding the tumor. In conclusion, there was no statistically significant difference between these 2 groups. This treatment modality is suitable for the excision of BCC, and it eliminates the need for the sacrifice of healthy tissue. This technique also offers the successful functional and aesthetic outcome.Therefore, unnecessary tissue sacrifice can be prevented with this method of treatment. We think our method is the new horizon to ongoing debate of safe excision concept of BCC.

Research paper thumbnail of Serum cytokines and bone metabolism in patients with thyroid dysfunction

Advances in Therapy, 2006

Hyperthyroidism is associated with increased bone turnover. Besides the hormones of calcium metab... more Hyperthyroidism is associated with increased bone turnover. Besides the hormones of calcium metabolism, locally produced factors are important in maintaining normal bone metabolism. Interleukin-6 (IL-6), in particular, has a major influence on bone turnover. In this study, serum IL-6 and tumor necrosis factor-alpha (TNF-α) levels, as well as bone turnover markers and relationships between them, were investigated in hyperthyroidism and hypothyroidism. A total of 20 female patients with hyperthyroidism, 15 with subclinical hyperthyroidism, 16 with hypothyroidism, and 15 with subclinical hypothyroidism constituted the patient groups. In all, 15 age-matched healthy female volunteers were recruited as controls. When compared with controls, serum TNF-a levels showed no significant difference in any of the patient groups (P<.05). In the groups with hyperthyroidism and subclinical hyperthyroidism, IL-6 levels were significantly higher compared with control group values (P< .05). Hyperthyroid patients showed higher levels of alkaline phosphatase (ALP) and osteocalcin, and a higher urinary deoxypyridinoline/creatinine ratio, compared with controls (P< .05). In subclinical hyperthyroidism, only ALP was found to be higher compared with control values. No significant correlations were made in any group between serum IL-6 or TNF-α level and bone turnover markers. Results suggest that serum IL-6 level and markers of bone turnover rate seem to be increased in hyperthyroidism. This finding may support the role of IL-6 in induction of bone turnover in hyperthyroid states.

Research paper thumbnail of Cranial Nerve Deficit Indicates Less Favorable Prognosis Than Advanced Cervical Nodal Disease In Patients With Nasopharyngeal Carcinoma

Fuel and Energy Abstracts, 2011

Purpose/Objective(s): To show that the presence of a cranial nerve (CN) deficit is a less favorab... more Purpose/Objective(s): To show that the presence of a cranial nerve (CN) deficit is a less favorable prognostic feature than the presence of advanced cervical nodal involvement (N3) in patients with nasopharyngeal carcinoma (NPC). Materials/Methods: We retrospectively reviewed the clinical findings and radiological findings in 250 NPC patients diagnosed consecutively between 1990 and 1998. Eighty-five patients who were also reviewed in terms of treatment outcome were found to have CN deficit or N3 regional disease only. The median follow-up was 36 months (range, 2 -200 months). Statistical analyses were performed using the chi-square test, and the Kaplan-Meier method. Results: At the time of diagnosis, 34 (40%) of the 85 had a CN deficit, and 51 (60%) had N3 regional involvement without CN deficit. Disease-free median survival was 7 months in patients with CN deficits and 34 months in patients with N3 cervical nodal involvement (p = 0.05). Overall median survival was 18 months in patients with CN deficits and 75 months in patients with N3 cervical nodal involvement (p = 0.01). Disease-free and overall median survivals were much higher among the 51 patients with N3 cervical nodal involvement (stage IVB) than among the 34 patients with CN deficits (stage IVA). Conclusions: The outcome of our patients with NPC proves that presence of CN deficits is a less favorable prognostic factor than advanced cervical nodal involvement, and a change in the subdivision of stage IV NPC concerning these characteristics of the disease is necessary. This change has the potential to put the emphasis again on local treatment for nasopharyngeal carcinoma.

Research paper thumbnail of Splinting after Carpal Tunnel Release: Current Practice, Scientific Evidence, and Trends

Plastic and Reconstructive Surgery, 2009

Postoperative splinting is common after carpal tunnel release, despite a lack of scientific evide... more Postoperative splinting is common after carpal tunnel release, despite a lack of scientific evidence supporting its value. The purpose of this study was to characterize postoperative splinting regimens among hand surgeons and to identify trends in splint use after this procedure. Questionnaires were mailed to members of the American Society for Surgery of the Hand. Recipients were asked to record whether and for how long they use splints after carpal tunnel release. They were also asked to indicate their training (i.e., orthopedic, plastic, or general surgery). Results were compared with those of previously conducted surveys. One thousand ninety-one questionnaires were returned, for a response rate of 48 percent. Fifty-three percent of respondents use splinting postoperatively. Duration of splinting varied tremendously, from 1 to 42 days. Splinting patterns were similar across all training backgrounds. In comparison with related surveys conducted in 1987 and 1997, a trend is evident toward less use of splinting after carpal tunnel release. The use and duration of splinting after carpal tunnel release vary widely among hand surgeons. This divergence of practice implies that there is little therapeutic benefit to splinting after this procedure, a concept supported by substantial scientific evidence and by a trend away from splinting over the past 20 years.

Research paper thumbnail of Changing pattern of antibiotic susceptibility in intensive care units: Ten years experience of a university hospital

Anaerobe

The study was performed to assess microorganisms and antibiotic susceptibility patterns during te... more The study was performed to assess microorganisms and antibiotic susceptibility patterns during ten years in intensive care units of a University Hospital. Infection Control Committee has active, prospective surveillance in ICUs for thirteen years. Ten years data of ICUs was evaluated retrospectively from surveillance forms. Microorganisms and their antibiotic resistance were recorded according to the years. During ten years, gram negative microorganisms were the most frequent isolated microorganisms from clinical specimens. Acinetobacter baumannii (21.8%), Pseudomonas aerigunosa (16%), Escherichia coli (10.4%) and Klebsiella pneumoniae (8%) were the most common gram negative microorganisms. However, Staphylococcus aureus was the most prevalent gram positive microorganism, the incidence decreased from 18.6% to 4.8% during ten years. Also antibiotic susceptibility of microorganisms changed during ten years. Carbapenem resistance increased from 44% to 92% in A. baumannii and ciprofloxacin resistance increased in E. coli from 28% to 60% and in K. pneumoniae from 21% to 55% during ten years. However, methicilin resistance decreased in S. aureus from 96% to 54%. In conclusion, antibiotic resistance is growing problem in ICUs. Rationale antibiotic policies and infection control measures will prevent the development of resistance.

Research paper thumbnail of Perforating arteries of the anteromedial aspect of the thigh: an anatomical study regarding anteromedial thigh flap

Surgical and Radiologic Anatomy, 2011

Purpose Because the skin of anteromedial thigh region usually is thinner, pliable, hairless it ca... more Purpose Because the skin of anteromedial thigh region usually is thinner, pliable, hairless it can be preferred based on the requirements of the recipient site. In this way more information is necessary about the perforators of anteromedial thigh region. The aim of this cadaveric study was described to provide useful knowledge about localizations and number of anteromedial thigh perforators. Methods Study was carried out on 16 lower extremities of 9 cadavers. The area in anteromedial aspect of the thigh searched for perforators was defined between the anterolateral border of sartorius and the posterior border of gracilis. The diameters of the dissected perforators were measured and the locations were documented. Results A total of 204 perforators were dissected in 16 lower extremities. The majority of musculocutaneous perforators were from gracilis (24 of 37) and there were at most 3 musculocutaneous perforators arising from gracilis muscle. 167 septocutaneous perforators were identified. Origin of all perforators was determined as 52 from deep femoral artery, 25 from proximal part of femoral artery and 127 from distal part of femoral artery and their branches. Perforators with the largest diameter were the ones arising from the intermuscular septa between the adductor (longus and magnus) and sartorius muscles. The mean diameter of the perforators was 0.75 ± 0.11 mm and ranged between 0.61 and 0.96 mm. Conclusions The septocutaneous perforators of the anteromedial aspect of the thigh are as much important as the musculocutaneous perforators and all they are with adequate to perform anteromedial thigh flap. This study provides numerical overview, useful perception about the localization of the perforators of the anteromedial aspect of the thigh and detailed anatomical basis for anteromedial thigh flap to be an important alternative.

Research paper thumbnail of Diced Cartilage Grafts in Rhinoplasty Surgery: Current Techniques and Applications

Plastic and Reconstructive Surgery, 2009

The use of diced cartilage grafts in rhinoplasty surgery was recently revived by Erol with the pu... more The use of diced cartilage grafts in rhinoplasty surgery was recently revived by Erol with the publication of his technique for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Turkish delight&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; grafts (i.e., diced cartilage grafts wrapped in Surgicel). The present study details the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; experience with 50 consecutive diced cartilage grafts used in three configurations during a prospective study of 50 primary and secondary aesthetic rhinoplasty procedures performed by the senior author (Daniel). Part I consists of 22 diced cartilage grafts wrapped in Surgicel and placed in the radix (n = 14), radix/upper dorsum (n = 4), and full-length dorsum (n = 4). All grafts were performed adhering meticulously to Erol&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s technique without modification. This portion of the study was halted abruptly at 4 months because of the unexpected absorption and clinical failure of all diced cartilage grafts wrapped in Surgicel. Subsequently, five patients had revision surgery, and biopsy specimens were taken at the prior grafting site and analyzed histologically. After this clinical failure, part II of the study began, consisting of 20 patients who had diced cartilage grafts wrapped in fascia. The range of applications was comparable: radix (n = 12), radix/dorsum (n = 3), and full-length dorsum (n = 5). Because of our prior practice of overcorrecting by 20 percent with diced cartilage grafts wrapped in Surgicel, we had excessive amounts of material in six of our initial diced cartilage wrapped in fascia radix grafts, but no subsequent grafts. The overcorrections were easily reduced at 6 weeks to 11 months postoperatively using a pituitary rongeur under local anesthesia, and the material was sent for histologic analysis. Minimum 1-year follow-up of all 20 cases has shown maintenance of the grafts without evidence of absorption. Part III of this study comprised eight patients who had diced cartilage grafts without a fascial covering placed throughout the nose, including on the sides of osseocartilaginous rib grafts to the dorsum. At 14 months, there was no evidence that any of these grafts had been absorbed. Histologic analysis of the biopsy specimens from the diced cartilage grafts wrapped in Surgicel showed evidence of fibrosis and lymphocytic infiltrates with small amounts of Surgicel visible on birefringent microscopy. Remnants of cartilage were present but were metabolically inactive on the basis of negative glial fibrillary acidic protein staining. Control specimens of fresh septal cartilage and banked septal cartilage were remarkably similar to each other and demonstrated normal cartilage architecture and cellular activity. The diced cartilage grafts wrapped in fascia showed coalescence of the diced cartilage into a single cartilage mass, with viable cartilage cells and normal metabolic activity on the basis of glial fibrillary acidic protein staining. All of the diced cartilage grafts wrapped in Surgicel absorbed and failed to correct the clinical problem for which they were performed. All of the diced cartilage grafts wrapped in fascia and pure diced cartilage grafts did correct the clinical deformities and appear to have survived completely. The diced cartilage grafts wrapped in fascia placed along the dorsum were distinctly palpable throughout the postoperative period, as was one prior case with a 6-year follow-up. The authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; clinical experience confirms the experimental studies of Yilmaz et al. that question the use of Surgicel for wrapping diced cartilage grafts in clinical rhinoplasty surgery.

Research paper thumbnail of An Examination of Posttraumatic, Postsurgical Orbital Deformities: Conclusions Drawn for Improvement of Primary Treatment

Plastic and Reconstructive Surgery, 2009

A retrospective analysis was carried out on the records of 317 patients operated on by the senior... more A retrospective analysis was carried out on the records of 317 patients operated on by the senior author (S.A.W.) for orbital fractures between 1975 and 2007. Two hundred forty of the patients had been previously operated on elsewhere and required further correction (posttraumatic, postsurgical orbital deformity). A smaller group of patients (n = 77) were operated on primarily. The two groups were not, of course, similar, because the posttraumatic, postsurgical orbital deformity group had been operated on by a variety of surgeons with varying levels of experience and ability, and the group of patients operated on primarily had a larger percentage of fractures in the pediatric age group, because of the practice being partially based in a children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s hospital, and a larger percentage of severe, compound orbital injuries, because of statewide referrals. Nevertheless, a number of causes for reoperation seen in the posttraumatic, postsurgical orbital deformity group were not seen in the primarily operated group. These included lower eyelid retraction attributable to use of the subciliary incision, displacement and extrusion of alloplastic materials, and fixation of fractures in a nonreduced position. These differences validate, in the authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; opinion, the application of the basic principles of craniofacial reconstruction set forth by Paul Tessier, listed in the text, to both the primary and secondary treatment of posttraumatic orbital deformities.

Research paper thumbnail of Is It Really Necessary to Make Wide Excisions for Basal Cell Carcinoma Treatment

Journal of Craniofacial Surgery, 2009

Basal cell carcinoma (BCC) is the common malignancy at the skin arising from the cells of the bas... more Basal cell carcinoma (BCC) is the common malignancy at the skin arising from the cells of the basal layer of the epithelium or from the external root sheath of the hair follicle. It usually occurs at sites with the greatest concentration of pilosebaceous follicles, and it is directly related to sun exposure. Metastasis is rare, but it recurs if it is inadequately treated. For preventive recurrence, BCC is often excised with wide skin margins. It leads to sacrifice of healthy tissue and causes morbidity problems. In our study, we make a treatment plan of excising the primary BCC with its natural tumor margin. Incomplete excision rates were compared between the patient group in which the excisions were performed according to the previously mentioned literature knowledge and the patient group in which excisions were made along the visible outer margins of erythema or induration area surrounding the tumor. In conclusion, there was no statistically significant difference between these 2 groups. This treatment modality is suitable for the excision of BCC, and it eliminates the need for the sacrifice of healthy tissue. This technique also offers the successful functional and aesthetic outcome.Therefore, unnecessary tissue sacrifice can be prevented with this method of treatment. We think our method is the new horizon to ongoing debate of safe excision concept of BCC.

Research paper thumbnail of Serum cytokines and bone metabolism in patients with thyroid dysfunction

Advances in Therapy, 2006

Hyperthyroidism is associated with increased bone turnover. Besides the hormones of calcium metab... more Hyperthyroidism is associated with increased bone turnover. Besides the hormones of calcium metabolism, locally produced factors are important in maintaining normal bone metabolism. Interleukin-6 (IL-6), in particular, has a major influence on bone turnover. In this study, serum IL-6 and tumor necrosis factor-alpha (TNF-α) levels, as well as bone turnover markers and relationships between them, were investigated in hyperthyroidism and hypothyroidism. A total of 20 female patients with hyperthyroidism, 15 with subclinical hyperthyroidism, 16 with hypothyroidism, and 15 with subclinical hypothyroidism constituted the patient groups. In all, 15 age-matched healthy female volunteers were recruited as controls. When compared with controls, serum TNF-a levels showed no significant difference in any of the patient groups (P<.05). In the groups with hyperthyroidism and subclinical hyperthyroidism, IL-6 levels were significantly higher compared with control group values (P< .05). Hyperthyroid patients showed higher levels of alkaline phosphatase (ALP) and osteocalcin, and a higher urinary deoxypyridinoline/creatinine ratio, compared with controls (P< .05). In subclinical hyperthyroidism, only ALP was found to be higher compared with control values. No significant correlations were made in any group between serum IL-6 or TNF-α level and bone turnover markers. Results suggest that serum IL-6 level and markers of bone turnover rate seem to be increased in hyperthyroidism. This finding may support the role of IL-6 in induction of bone turnover in hyperthyroid states.

Research paper thumbnail of Cranial Nerve Deficit Indicates Less Favorable Prognosis Than Advanced Cervical Nodal Disease In Patients With Nasopharyngeal Carcinoma

Fuel and Energy Abstracts, 2011

Purpose/Objective(s): To show that the presence of a cranial nerve (CN) deficit is a less favorab... more Purpose/Objective(s): To show that the presence of a cranial nerve (CN) deficit is a less favorable prognostic feature than the presence of advanced cervical nodal involvement (N3) in patients with nasopharyngeal carcinoma (NPC). Materials/Methods: We retrospectively reviewed the clinical findings and radiological findings in 250 NPC patients diagnosed consecutively between 1990 and 1998. Eighty-five patients who were also reviewed in terms of treatment outcome were found to have CN deficit or N3 regional disease only. The median follow-up was 36 months (range, 2 -200 months). Statistical analyses were performed using the chi-square test, and the Kaplan-Meier method. Results: At the time of diagnosis, 34 (40%) of the 85 had a CN deficit, and 51 (60%) had N3 regional involvement without CN deficit. Disease-free median survival was 7 months in patients with CN deficits and 34 months in patients with N3 cervical nodal involvement (p = 0.05). Overall median survival was 18 months in patients with CN deficits and 75 months in patients with N3 cervical nodal involvement (p = 0.01). Disease-free and overall median survivals were much higher among the 51 patients with N3 cervical nodal involvement (stage IVB) than among the 34 patients with CN deficits (stage IVA). Conclusions: The outcome of our patients with NPC proves that presence of CN deficits is a less favorable prognostic factor than advanced cervical nodal involvement, and a change in the subdivision of stage IV NPC concerning these characteristics of the disease is necessary. This change has the potential to put the emphasis again on local treatment for nasopharyngeal carcinoma.

Research paper thumbnail of Splinting after Carpal Tunnel Release: Current Practice, Scientific Evidence, and Trends

Plastic and Reconstructive Surgery, 2009

Postoperative splinting is common after carpal tunnel release, despite a lack of scientific evide... more Postoperative splinting is common after carpal tunnel release, despite a lack of scientific evidence supporting its value. The purpose of this study was to characterize postoperative splinting regimens among hand surgeons and to identify trends in splint use after this procedure. Questionnaires were mailed to members of the American Society for Surgery of the Hand. Recipients were asked to record whether and for how long they use splints after carpal tunnel release. They were also asked to indicate their training (i.e., orthopedic, plastic, or general surgery). Results were compared with those of previously conducted surveys. One thousand ninety-one questionnaires were returned, for a response rate of 48 percent. Fifty-three percent of respondents use splinting postoperatively. Duration of splinting varied tremendously, from 1 to 42 days. Splinting patterns were similar across all training backgrounds. In comparison with related surveys conducted in 1987 and 1997, a trend is evident toward less use of splinting after carpal tunnel release. The use and duration of splinting after carpal tunnel release vary widely among hand surgeons. This divergence of practice implies that there is little therapeutic benefit to splinting after this procedure, a concept supported by substantial scientific evidence and by a trend away from splinting over the past 20 years.

Research paper thumbnail of Changing pattern of antibiotic susceptibility in intensive care units: Ten years experience of a university hospital

Anaerobe

The study was performed to assess microorganisms and antibiotic susceptibility patterns during te... more The study was performed to assess microorganisms and antibiotic susceptibility patterns during ten years in intensive care units of a University Hospital. Infection Control Committee has active, prospective surveillance in ICUs for thirteen years. Ten years data of ICUs was evaluated retrospectively from surveillance forms. Microorganisms and their antibiotic resistance were recorded according to the years. During ten years, gram negative microorganisms were the most frequent isolated microorganisms from clinical specimens. Acinetobacter baumannii (21.8%), Pseudomonas aerigunosa (16%), Escherichia coli (10.4%) and Klebsiella pneumoniae (8%) were the most common gram negative microorganisms. However, Staphylococcus aureus was the most prevalent gram positive microorganism, the incidence decreased from 18.6% to 4.8% during ten years. Also antibiotic susceptibility of microorganisms changed during ten years. Carbapenem resistance increased from 44% to 92% in A. baumannii and ciprofloxacin resistance increased in E. coli from 28% to 60% and in K. pneumoniae from 21% to 55% during ten years. However, methicilin resistance decreased in S. aureus from 96% to 54%. In conclusion, antibiotic resistance is growing problem in ICUs. Rationale antibiotic policies and infection control measures will prevent the development of resistance.

Research paper thumbnail of Perforating arteries of the anteromedial aspect of the thigh: an anatomical study regarding anteromedial thigh flap

Surgical and Radiologic Anatomy, 2011

Purpose Because the skin of anteromedial thigh region usually is thinner, pliable, hairless it ca... more Purpose Because the skin of anteromedial thigh region usually is thinner, pliable, hairless it can be preferred based on the requirements of the recipient site. In this way more information is necessary about the perforators of anteromedial thigh region. The aim of this cadaveric study was described to provide useful knowledge about localizations and number of anteromedial thigh perforators. Methods Study was carried out on 16 lower extremities of 9 cadavers. The area in anteromedial aspect of the thigh searched for perforators was defined between the anterolateral border of sartorius and the posterior border of gracilis. The diameters of the dissected perforators were measured and the locations were documented. Results A total of 204 perforators were dissected in 16 lower extremities. The majority of musculocutaneous perforators were from gracilis (24 of 37) and there were at most 3 musculocutaneous perforators arising from gracilis muscle. 167 septocutaneous perforators were identified. Origin of all perforators was determined as 52 from deep femoral artery, 25 from proximal part of femoral artery and 127 from distal part of femoral artery and their branches. Perforators with the largest diameter were the ones arising from the intermuscular septa between the adductor (longus and magnus) and sartorius muscles. The mean diameter of the perforators was 0.75 ± 0.11 mm and ranged between 0.61 and 0.96 mm. Conclusions The septocutaneous perforators of the anteromedial aspect of the thigh are as much important as the musculocutaneous perforators and all they are with adequate to perform anteromedial thigh flap. This study provides numerical overview, useful perception about the localization of the perforators of the anteromedial aspect of the thigh and detailed anatomical basis for anteromedial thigh flap to be an important alternative.