Effect of Nasopharyngeal Irrigation on Early Eustachian Tube Functions in Patients Undergoing Adenoidectomy: A Clinical Prospective Study

Objective:The hypertrophic adenoid tissue can cause to eustachian tube dysfunction by mechanical or inflammatory effect both of which block the nasopharyngeal ostium of the eustachian tube. Adenoidectomy, with or without tonsillectomy, is the most common surgical procedure in children. In this study, we aimed to investigate whether nasopharyngeal irrigation for hemorrhage control in adenoidectomy patients has an effect on eustachian tube functions.Method:Patients who underwent adenoidectomy for adenoid hypertrophy evaluated on both the preoperatively and on the postoperative first day by otomicroscopic examination and with tympanometry for eustachian tube functions. Patients were divided into two groups according to nasopharyngeal irrigation type after surgery. Group 1 was the transnasal pressure irrigation group; group 2 was transoral passive irrigation group. Tympanometry was used to measure pressure, volumetric, and compliance values to compare pre- and postoperative values.Results:40 patients were included in the study. There was no significant difference between the age and sex distributions of the patients. Volume and compliance values between the groups were similar before and after the surgery. The mean pressure values of the tympanometry parameters were highly significantly different for the right ear and moderately different for the left ear in group 1; were significantly different for the right ear and highly significantly different for the left ear in group 2. Postoperative tympanometry types were seen as bilateral type C in 7 patients, as right side type C in 4 patients, as bilateral type B in 2 patients, as left side type C in 4 patients in group 1. However, in group 2, right side type B, left side type B and bilateral type C tympanogram were observed in 1 patient, 2 patients and 12 patients, respectively.Conclusion:In this study, we observed that the nasopharyngeal irrigation to control bleeding after adenoidectomy had adverse effect on the eustachian tube functions but larger series of studies are needed to confirm this

Larinks kanserinde prognostik bir belirteç olarak C-reaktif protein albümin oranı

During the past decade, several inflammation-based prognostic systems have been reported in the field of clinical oncology. Recently, C-reactive protein and albumin ratio (CAR) have showed their impact on a large variety of tumor types. The aim of this study is to evaluate the impact CAR on prognosis and 5-year survival (5yS) in patients operated for larynx cancer. Method: One hundred eighteen patients operated in our center between 2010 and 2015 were eligible for retrospective analysis. We evaluated the impact of the CAR and neutrophil to lymphocyte ratio (NLR) on the 5yS. Univariate and multivariate Cox regression analyses were performed to determine the associations of CAR. Results: The optimal cut-off level of CAR was at 0.993. A low and high CAR was assigned to 40.7% and 59.3% of patients, respectively. The 5yS rates of patients with a high CAR were worse than those in the low group (79.2% vs 73.2% p<0.05). Disease stage (p<0.001) and high level of NLR were also significant predictors of 5yS. CAR at diagnosis was associated with an unfavorable progress. Patients with stage III-IV disease had a significantly higher pretreatment CAR than patients with stage I-II disease [respectively 1.83±0.52 standard deviation (SD) and 0.58±0.38 (SD), p<0.01]. ROC analysis of overall survival of larynx squamous cell carcinoma revealed that CAR had a greater area under curve value (0.786) compared to NLR (0.695) (p<0.01). Conclusion: CAR is an independent prognostic marker in larynx cancer after being adjusted by other accompanying factors and the CAR could be a readily available biomarker in clinical setting.Geçtiğimiz on yıl boyunca, klinik onkoloji alanında enflamasyon temelli birkaç prognostik sistem bildirilmiştir. Son zamanlarda, C-reaktif protein ve albümin oranı (CAO), çok çeşitli tümör tipleri üzerinde prognostik belirteç olarak kendini göstermiştir. Bu çalışmanın amacı, larinks kanseri nedeniyle opere edilen hastalarda CAO’nun prognoz ve 5 yıllık sağkalım üzerine etkisini değerlendirmektir. Yöntem: 2010-2015 yılları arasında merkezimizde ameliyat edilen 118 hasta retrospektif analiz için uygun bulunmuştur. CAO ve nötrofil lenfosit oranın (NLO) 5 yıllık sağkalım üzerindeki etkisi değerlendirildi. CAO ile sağkalım ve prognoz arasındaki ilişkileri belirlemek için tek değişkenli ve çok değişkenli Cox regresyon analizi yapıldı. Bulgular: CAO’nun optimal cut-off seviyesi 0,993 olarak hesaplandı. Hastaların sırasıyla %40,7 ve %59,3’ünde düşük ve yüksek CAO saptandı. Yüksek CAO’lu hastaların 5 yıllık sağkalım oranları düşük gruptakilere göre daha kötü idi (%79,2’ye karşı %73,2, p<0,05). Hastalık evresi (p<0,001) ve yüksek NLO değeri de 5 yıllık sağkalım için anlamlı faktörler olarak izlendi. Tanıda CAO kötü prognoz ile ilişkili idi. Evre III-IV hastalığı olan hastalar, evre I-II hastalığı olanlara göre anlamlı olarak daha yüksek bir ameliyat öncesi CAO’ya [sırasıyla 1,83±0,52 standart sapma (SS) ve 0,58±0,38 (SS), p<0,01] sahipti. Gırtlak skuamöz hücreli karsinomun genel sağkalımının ROC analizi, CAO’nun NLO’ya (0,695) kıyasla daha yüksek (eğri altındaki alan) eğri altındaki alan değerine (0,786) sahip olduğunu ortaya koydu (p<0,01). Sonuç: CAO, eşlik eden diğer faktörlerden bağımsız olarak, larinks kanserinde bir prognostik faktördür ve CAO klinik ortamda kullanıma hazır bir biyobelirteç olabilir

Mucosal melanoma of the mandibular gingiva

Mukozal malign melanom (MMM) baş boyun bölgesinde ender görülen bir tümördür. MMM'ler deri malign melanomlarına (MM) göre çok daha agresiftirler. Diğer taraftan baş boyun bölgesinin kompleks bir anatomiye sahip olması tümörün cerrahi olarak tam eksizyonunu güçleştirir. Bu yüzden erken tanı ve erken tedavi ayrı bir önem kazanır. Oral kavite MMM'leri tüm oral malignitelerin % 0.5'ini oluştururlar. Mandibular gingivanın MMM'si de oldukça enderdir. Deri MM'lerinin değişik formları açık bir şekilde tanımlanmış olmasına karşın, MMM'lerle ilgili geniş seriler bulunmaması nedeniyle bu konudaki bilgi birikimi sınırlıdır Bu makalede, mandibular gingivada yerleşen MMM nedeniyle daha önce opere olmuş ve lokorejyonel nüks ile kliniğimize refere edilen 29 yaşındaki bir kadın hasta sunulmuş ve MMM'lerin klinik, histopatolojik özellikleri ile tedavi modaliteleri tartışılarak literatürle birlikte gözden geçirilmiştir.Mucosal malignant melanoma (MMM) is an uncommon tumour of the head and neck region. MMMs are much more agressive than cutaneous malignant melanomas (MM). Complete surgical excision of the tumour is difficult due to complex anatomy of the head and neck region. Therefore early diagnosis and early treatment deserve a special significance. Oral cavity MMMs account for 0.5 % of the oral malignancies. MMM of the mandibular gingiva is also very rare. Although various types of cutaneous MMs have been clearly described, data on MMMs is quite limited due to the lack of large series. In this article, we report a 29 year-old female patient who was previously operated for MMM of the mandibular gingiva. She was referred to our institution with locoregional recurrent disease. We discuss clinical and histopathological features of MMMs and therapeutic modalities in line with the literature

Repeated atmospheric pressure alteration effect on the cochlea in rats: Experimental animal study

OBJECTIVE: This study aimed to evaluate the effects of repeated pressure alterations on cochlear structures in rats in an attempt to understand indirectly the inner ear status of flight crew who are repeatedly exposed to pressure alterations. METHODS: There were 12 adult Wistar albino rats equally divided into 2 groups: Group 1 (controls) and Group 2 (study group). The animals in Group 2 were exposed to repeated pressure changes in a pressure cabin which is regulated by manometers. The animals in Group 1 were placed in the cabin without being exposed to pressure changes. Auditory brainstem response (ABR) testing was performed in all animals at the beginning and at the end of the study. After 12 wk the animals were sacrificed and their cochleas were investigated using scanning electron microscopy (SEM). RESULTS: In the study group, hearing decreases at 2 kHz, 4 kHz, 6 dB at 8 kHz, and 32 kHz were encountered at the end of 3 mo. On SEM evaluation of the control group, the outer hair cells (OHC) and stereocilia were normal throughout the cochlea. In the study group, there were irregularities in lateral surface connections and separations, collapse, and adhesions in the basal segment of the cochlea and partial loss of stereocilia throughout the cochlea. CONCLUSION: Repeated alterations in the atmospheric pressure can lead to damage in the inner ear with subtle or evident hearing loss. Frequent flyers like air workers may be at risk of inner ear damage, which may be considered an occupational health problem