Puberte öncesi çocuklarda adenotonsillektomi sonrasında büyüme ve vücut kompozisyonundaki değişiklikler

Tonsillektomi ve adenoidektomi çocukluk döneminde uygulanan en sık cerrahilerdendir. Adenotonsiller hipertrofi ve kronik tonsillit çocukluk çağında büyüme ve geliĢmeyi yavaĢlatmakta, adenotonsillektomi sonrasında ise büyüme ve geliĢme hızlanmakta ve vücut kitle indeksi normal değerlerini yakalamaktadır. Fakat literatürde adenotonsillektomi sonrasında vücut kas kitlesi ve yağ kitlesindeki değiĢimleri inceleyen makale mevcut değildir. Bu çalıĢmanın amacı adenoidektomi veya adenotonsillektomi sonrasında prepubertal çocuklarda vücut yağ ve kas kitlesi değiĢimlerini incelemektir. 30 adet prepubertal çocuk adenotonsillektomi operasyonundan sonra 6 ay takip edilmiĢlerdir. EĢ zamanlı olarak 28 adet sağlıklı prepubertal çocuk ise kontrol grubu amaçlı takip edilmiĢtir. Beslenme alıĢkanlıkları ve fiziksel aktiviteleri 0. ve 6. ayda aileler tarafından doldurulan anket ile sorgulanmıĢtır. Boy, kilo, vücut yağ ve kas kitlesi oranları, vücut kitle indeksi, bazal metabolik hız ve obezite oranı biyoelektrik impedans analiz yöntemi kullanılarak operasyondan önce ve 6 ay sonrasında ölçülmüĢtür. Adenotonsillektomi sonrasında çalıĢma grubunda kas kitlesi, bazal metabolik hız artmıĢ, göreceli vücut kitle indeksinde ise anlamlı düzelme elde edilmiĢtir (p0,05). Büyüme parametreleri ve vücut kompozisyonları (yağ kitlesi, kas kitlesi, vücut yağ oranı, BMI Z-skoru, göreceli vücut kitle indeksi (relBMI) ve bazal metabolik hız) her iki zaman diliminde de iki grup arasında anlamlı farklılaĢma göstermemiĢtir. Sonuç olarak prepubertal çocuklarda adenoidektomi veya adenotonsillektomi operasyonu göreceli vücut kitle indeksinde düzelmeye yol açmakta ve vücut yağ yüzdesinde artıĢa neden olmadan sağlıklı büyüme geliĢmeyi hızlandırmaktadır. Tonsillectomy and adenoidectomy are frequently performed in childhood. Adenotonsillar hypertrophy and chronic tonsillitis have been associated with growth interruption during childhood and adenotonsillectomy have been related with growth improvement and increased body mass index scores. Yet, there is no study in the literature investigating the effect of adenotonsillectomy on distribution of body muscle and fat mass. The aim of this prospective study was to evaluate the body muscle and fat composition after adenoidectomy or adenotonsillectomy for healthy growth in children. 30 prepubertal children were followed up for 6 months after adenotonsillectomy. 28 age-matched healthy children were followed up for the same duration, as controls. Data on dietary habits and physical activity were obtained from questionnaires (0. and 6. months) that had been filled by the parents. Height, weight, the amount and ratio of body fat and muscle mass, body mass index, basal metabolic rate, relative body mass index were evaluated before and 6 months after surgery by using bioelectrical impedance analysis method. The muscle mass and basal metabolic rate of the study group increased and the relative body mass index improved significantly after adenotonsillectomy (p<0,05). In healthy children, the values of basal metabolic rate and muscle mass at 6 months were significantly higher than the initial levels but relative body mass index did not show significant difference. The increase in fat mass, percentage of body fat and BMI Z-score for both groups were not statistically significant. Growth parameters and body compositions (BMI Z-score, muscle and fat mass, percentage of body fat, relative body mass index, basal metabolic rate) did not differ between the study group and the controls, at both time points evaluated. The number of overweight and obese children did not change significantly in both groups. In conclusion, adenoidectomy or adenotonsilectomy lead to improvement in relative body mass index and promote healthy weight gain without increases in body fat precentage in prepubertal children

Effect of Suture Type and Suture Distance on Holding Strength in Nasal Septal Laceration Model

Objective:Septal mucosal-perichondrial flaps can be lacerated during the elevation of the flaps. Appropriate repair of the lacerations is essential to prevent the development of septal perforation during the healing process. We aimed to determine the superior suture type and suture distance to use in repairing the lacerations of nasal septal mucosal-perichondrial flaps.Methods:The study used 128 nasal septal mucosal-perichondrial flaps prepared from sheep heads. Experimentally induced lacerations on the mucosal-perichondrial flaps were sutured with two interrupted sutures using one of four suture materials (4-0/5-0 Polyglactin 910, 4-0/5-0 Polydioxanone) and leaving either 5 mm or 10 mm distance between the sutures. Maximum tissue holding strength (HSmax) was measured for each suture material and suture distance used.Results:Mean HSmax values were higher for Polyglactin 910 sutures (p<0.001) and 10 mm suture distance (p=0.008) when the groups were compared in terms of suture material and suture distance, respectively. There was no statistically significant difference between the mean HSmax values of sutures with 4-0 and 5-0 diameters (p=0.057).Conclusion:Polyglactin 910 suture material with 10 mm space between two adjacent sutures may be more durable than the other suture materials when repairing nasal septal mucosal lacerations