Parotisin Dediferansiye Asinik Hücreli Karsinomu ve Tedavi Yaklaşımı: Nadir Bir Olgu Sunumu

Asinik hücreli karsinom parotis bezinde nadir görülen bir neoplazidir. Kadınlarda ve sıklıkla 40-50 yaşları arasında görülmektedir. Klinikte genellikle ağrısız yavaş büyüyen kitle şeklinde bulgu verir. Asinik hücreli karsinomların büyük kısmı parotisin yüzeyel lobunda yerleşir. Tedavisi cerrahi olup, iyi prognoza sahip tümörlerdir. Bu tümörlerin tedavisinde histolojik evreleme göz önünde bulundurulmalıdır. Histopatolojik olarak papiller, kistik, folliküler ve iyi prognozlu çeşitleri bulunmaktadır. Çok nadir olarak yüksek dereceli tümörlere dönüşen dediferansiye formu bulunmaktadır. Dediferansiye türleri klasik türlerine göre daha agresiftir; rekürrens, perinöral ve perilenfatik invazyon ile bunlara bağlı sistemik metastazlar daha sıktır. Bu yazıda sağ parotis bezinde bir yıldır olan kitle yakınması ile başvuran ve dediferansiye asinik hücreli karsinom tanısı koyulan 77 yaşındaki bir hasta ve yönetimi sunularak konu literatür bilgileri eşliğinde tartışıldı.Acinic cell carcinoma is a rare variant of neoplastic lesions in the parotid gland. It is more frequent in women and commonly seen in the 4th- 5th decades of life. The most common presentation of the condition is a painless and slow growing mass over the parotid gland. Majority of the acinic cell carcinomas are located on the superficial lobe of the gland. Primary treatment modality is surgery and the prognosis of the tumour is generally favorable. Histological grading should be kept in mind in the treatment of the condition. Histological subtypes of the tumour are papillary, cystic, and follicular and other variants have good prognosis. A rare form of the tumour is dedifferantiated variant which can be transformed into high grade tumours. The differantiated acinic cell carcinoma is more aggressive than the other forms and recurrent perineural and perilymphatic invasion and, therefore, systemic metasthasis are more common. In this article, the management of a 77-year-old case of dedifferentiated acinic cell carcinoma, who was admitted with the complaint of mass over the right parotid gland for one year, is presented along with the relevant literature

A Rare Cause of Headache: Superior Concha Over Pneumatization

Pnömatize süperior konka nadir bir başağrısı sebebidir. Nazal endoskopi, tanı için yetersiz kalabilir ve tanının doğrulanması için koronal bilgisayarlı tomografi gerekir. Medikal tedaviye rağmen 6 aydır baş ağrısı yakınması olan 52 yaşında bayan hasta kliniğimize başvurdu. Muayene ve görüntüleme yöntemleri sonucunda süperior konkada aşırı pnömatizasyon saptanan hastaya endoskopik sinüs cerrahisi uygulandı. Postoperatif dönemde hastanın şikayetlerinin gerilediği izlendiPneumatized superior concha is a rare cause of headache. Nasal endoscopy may not give sufficient information for diagnosis and coronal computerized tomography might be needed to confirm the exact diagnosis. A 52-year-old female patient with a complaint of chronic headache unresponsive to medical treatment for 6 months was admitted to our clinic. Endoscopic sinus surgery was commenced after the diagnosis of over pneumatized superior concha by physical examination and imaging techniques. Patient's complaints were relieved after the operatio

Pleomorphic Adenomas of the Parapharyngeal Space

Background. Parapharyngeal space is one of potential facial planes for neoplasms and infections and represents less than 1% of all head and neck tumours. Occurrence of the pleomorphic adenoma in the parapharyngeal space is a rarity. Case Presentation. Here, three giant pleomorphic adenomas of different sizes occupying the parapharyngeal space in three patients are reported. Extensive preoperative diagnostic workup was done in order to verify the nature and size of the tumour and the proximity to the large vessels. Review of the literature, clinical features, pathology, radiological findings, and treatment of these tumours are discussed. Conclusion. The excision of the tumor through submandibular transcervical approach, without cutting the mandible, turned out to be a safe and radical approach in all three cases

Tip II diyabetik hastalarda plazma homosistein düzeyleri ile koroner arter hastalığı ve endotel disfonksiyonu varlığı arasındaki ilişki

Objective: The causal relationship between hyper-homocysteinemia and cardiovascular morbidity and mortality is not clear. In this study, the relationship between levels of plasma homocysteine and the presen-ce of coronary artery disease and endothelial dysfunction in type II diabetic patients was evaluated. Material and Methods: The study group consisted of 50 type II diabetic patients who underwent exercise stress testing or thallium-201 myocardial perfusion imaging for the diagnosis of CAD. The study group was divided into two groups according to myocardial ischemic signs and angiographic Findings: Group I (n= 25), patients with CAD or Group II (n= 25), patients without CAD. Plasma homocysteine levels were compared among these groups. In addition, the study population was divided into two groups according to their plasma homocysteine levels: Group H (n= 23), patients with hyper-homocysteinemia or Group N (n= 27), patients with normo-homocysteinemia. Flow-mediated dilatation (FMD) and nitrate-induced dilatation (NID) as markers of the endothelial functions were compared among these different groups. Results: Male gender was dominant in Group I and patients with hyper homocysteinemia. Other clinical features such as lipid profiles, haemoglobin A1c, fibrinolytic and inflammatory activation markers did not different among the groups. Plasma homocysteine levels were significantly higher in Group I than in Group II (16.4 ;plusmn; 5.1 and 9.2 ;plusmn; 2.2 mmol/L, respectively; p;lt; 0.0001). In the second analysis evaluating the effect of hyper-homocysteinemia on endothelial function, determinations of FMD and NID were similar in Groups H and N. Conclusion: Our findings show what appears to be a synergistic contribution of hyper-homocysteinemia on the development of CAD in type II diabetic patients. The detection of hyper homocysteinemia may be important for the prediction of risk in diabetic patients. In addition, it may provide new approaches for primary and secondary prevention.Amaç: Diyabetik hastalarda hiperhomosisteinemi ile kardiyovasküler morbidite ve mortalite arasındaki nedensel ilişki tam olarak aydınlatılmamıştır. Bu çalışmada, tip II diyabetik hastalarda plazma homosistein düzeyleri ile koroner arter hastalığı (KAH) ve endotel disfonksiyonu varlığı arasındaki ilişki değerlendirildi. Gereç ve Yöntemler: Çalışmaya, KAH şüphesiyle efor testi veya Talyum-201 miyokard perfüzyon sintigrafisi yapılan 50, tip II diyabetik hasta alındı. Miyokardiyal iskemi belirtileri ve anjiyografik bulgulara göre hastalar 2 gruba ayrıldı; grup I (n= 25), KAH olan olgular ve grup II (n= 25) KAH olmayan olgular. Bu 2 grup arasında plazma homosistein düzeyleri karşılaştırıldı. Çalışma popülasyonu ayrıca plazma homosistein düzeylerine göre de 2 farklı gruba ayrıldı; grup H (n= 23), hiperhomosisteinemili olgular ve grup N (n= 27), normohomosisteinemili olgular. Bu 2 farklı grup arasında da endotel fonksiyonlarının göstergesi olarak brakiyal arterde akıma bağlı dilatasyon (FMD) ve nitratla indüklenmiş dilatasyon (NID) değerleri karşılaştırıldı. Bulgular: Grup I ve hiperhomosisteinemili olgularda erkek cinsiyet baskındı. Gruplar arasında diğer klinik özellikler, lipid profilleri, hemoglobin A1c, fibrinolitik ve inflamatuar aktivite göstergeleri açısından anlamlı farklılık saptanmadı. Plazma homosistein düzeyi, grup I de grup II’ye göre anlamlı derecede yüksek saptandı (sırasıyla 16.4 ± 5.1 ve 9.2 ± 2.2 mmol/L, p 0.0001). Homosisteinin endotel fonksiyonlarına olan etkisini değerlendiren 2. analizde, grup H ve N arasında FMD ve NID değerlendirmeleri benzerdi. Sonuç: Bulgularımız hiperhomosisteineminin, tip II diyabetik olgularda KAH gelişim riskine sinerjistik bir katkısı olduğunu göstermektedir. Diyabetik hastalarda hiperhomosisteineminin tanınması risk tahmininde önemli olabilir. Ayrıca yeni primer ve sekonder korunma önerileri sunulmasına olanak sağlayabilir

Does melatonin alleviate ototoxic effect caused by administration of cisplatin?

Aim: In this study, it was aimed to experimentally investigate the protective effects of melatonin in the cisplatin-induced ototoxicity. Material and Methods: Ten Wistar-albino rats were included in the study. Two equal groups were generated randomly as cisplatin and melatonin groups. Rats’ underwent Auditory Brainstem Response (ABR) and Distortion Product Otoacoustic Emission (DPOAE) testing before the drug administration and the results were recorded. Both tests were repeated 72 hours after the cisplatin administration in all rats. Results: Significant difference was found between the I-IV interval values before the treatment and after the treatment both in cisplatin and melatonin group. As well as the significant difference in hearing threshold value changes, statistically, significant differences in ABR-I and ABR-IV interval variations were also seen between the cisplatin and melatonin groups. A statistically significant decrease was found between the initial and final control SNR (signal-to-noise ratio) levels within the cisplatin group in the evaluations at 2000Hz, 3000Hz and 4000Hz. Statistically, significant differences were observed between SNR levels when the melatonin group was compared with the cisplatin group. Conclusion: Melatonin appears to reduce cisplatin-induced ototoxicity in rats. Although, the use of supplementary therapies targeting to reduce the toxic effects in clinical studies is still a controversial point

The impact of systemic and local administration of ascorbic acid on traumatic perforation of tympanic membrane and myringosclerosis

OBJECTIVE: In the present study, tympanic membranes (TM) harvested from myringotomized rats were analyzed histopathologically to compare the systemic and local effects of ascorbic acid on the development of myringosclerosis. MATERIALS and METHODS: Forty male Wistar-Albino rats weighing between 350-400 g were included in this study. Under otomicroscopic examination, a standard 2-mm myringotomy incision was made on the posteroinferior quadrant of the TM of both ears. Rats were randomized into five groups as control, topical ascorbic acid 50 mg/kg, systemic ascorbic acid 50, 100, and 200 mg/kg groups, each group containing eight rats. On the 15th day of the study, the rats were decapitated, and bullas of the rats were extracted. Sections were stained with hematoxylin-eosin and examined through light microscopy. Inflammation, distribution width of plaques, edema, and neovascularization were observed on the lamina propria. Thickness of the TM was evaluated under the microscope and scored semiquantitatively. RESULTS: When intergroup comparisons of parameters related to total TM thickness were performed, differences between the control group and topical AA (ascorbic acid) or systemic treatment groups were found to be statistically significant (p<0.005). A statistically significant difference was detected among control, topical and systemic 200 mg/kg ascorbic acid groups for the edematous lamina propria (p=0.003 and p<0.05, respectively). CONCLUSION: For the total TM thickness, systemic and topical ascorbic acid use was effective when compared with the control group. It has been concluded that systemic use of higher doses of (200 mg/kg) ascorbic acid is beneficial in the resolution of the edematous lamina propria