Concha nasalis superior un bağlanma anomalisi: Bir olgu sunumu

Concha nasalis superior CNS , labyrinthus ethmoidalis'in medial çıkıntısıdır. Meatus nasi superior'un çatısını oluşturur. Üç konkadan en küçük ve sığ olanıdır. CNS’nin lamina basalis’i koronal ve aksiyal olmak üzere iki parçaya sahiptir. Koronal parçası yukarıda kafa tabanına ve lateralde ise lamina papyracea’ya tutunur. Aksiyal parçası arkada sinus sphenoidalis’in ön yüzüne tutunurken, lateralde ise lamina papyracea’ya tutunur. Kronik baş ağrısı şikayetiyle kulak burun boğaz polikliniğine başvuran 52 yaşında, erkek hastaya çekilen bilgisayarlı tomografide, hastanın sol CNS'sinin bağlanma anomalisi tespit edilmiştir. Sol CNS’nin lamina basalisi’nin koronal parçası, kafatabanı yerine orbita medial duvarına tutunduğu belirlenmiştir. CNS’nin olağandan büyük olması, bağlanma anomalileri, pnömatizasyonu gibi anatomik varyasyonlar, klinisyenlerin tercih edecekleri cerrahi metodun belirlenmesinde oldukça önemlidir. Aynı zamanda olfaktor mukozayla kaplı oldukları için CNS ve concha nasalis suprema’nın gereksiz rezeksiyonlarından da kaçınılmalıdı

Swyer-james (macleod) syndrome: a case report

Swyer-James (MacLeod) sendromu, akciğerlerin bir veya birkaç lobunun ya da tamamının hiperlusent görünümü (havalanma fazlalığı), aynı tarafta hiler gölge azlığı, güçlükle görülebilen arter ağı ile karakterize radyolojik bir antitedir. Çocukluk çağında geçirilen pnömoni veya obliteratif bronþiolit ataklarına veya obliteratif vaskülite bağlı olabileceği düþünülmektedir. Öksürük þikayeti ile getirilen yedi yaþında erkek hastanın öyküsünden bir yaþında iken bronkopnömoni nedeniyle iki kez hastanede yattığı, baþka bir hastanede bronkoskopi yapıldığı yabancı cisim tespit edilemediği, ter testinin normal bulunduğu, kıþ aylarında sık sık hastalanarak öksürdüğü öğrenildi. Fizik muayenesinde genel durumu iyi idi. Solunum sisteminin muayenesinde sol tarafta solunum sesleri azalmıþ olarak iþitiliyor, inspiryumda ince raller ve ekspiryumda sibilan raller alınıyordu. Diğer sistem bulguları normaldi. Laboratuar tetkiklerinde tüberkülozu düþündürecek bir bulgu yoktu. A1 antitripsin düzeyi normaldi. Akciğerlerin bilgisayarlı tomografisinde de sol akciğer volümünde azalma, hiperlüsent görünüm, pulmoner arter dallarının küçülme ve incelme olduğu belirlendi. Bu bulgular ile Swyer-James (MacLeod) sendromu olduğu düþünüldü. Akciğerlerin perfüzyon sintigrafisinde sol akciğer parankiminin sağa oranla belirgin düzeyde inceldiği ve düþük düzeyde perfüzyon gösterdiği belirlendi. Akciğerlerin ventilasyon sintigrafisinde ise sol akciğer gösterilemezken sağ akciğerin normal sınırlarda ventile olduğu sapandı. Etyolojisi tam olarak aydınlatılmamıþ olan bu sendrom literatür bilgileri ıþığında tartıþmak amacıyla sunuldu.Swyer-James syndrome is a radiologic entity characterized by hyperlucency of one or several lobes, or even of one lung, scarce hilar shadow on the same side as the transradiency, and barely visible arterial network on the abnormal side of the thorax. Generally, it is acquired subsequent to viral bronchopulmonary infections in childhood. A seven year old boy was admitted to our hospital with complaining of a cough. He had been hospitalised for bronchopulmonary infections when he was one year old. During follow up, hyperlucency of the left lung was seen on his chest x-ray. However, sweat testing and bronchoscopy examinations were found normal. Physical examination showed markedly decreased breathing sounds in the left hemitorax with fine inspiratory crackles and expiratory wheezes. The chest x-ray revealed hyperlucency of the left lung. A diagnosis of Swyer James syndrome was confirmed by computerized tomographic scans of chest and perfusion and ventilation lung scintigraphy. Computerized tomography findings were hyperlucency and decreased volume of left lung and thin pulmonary artery branches. Small left lung parenchyma and decreased perfusion were found on radionuclide scans. The scan showed markedly diminished ventilation, diminished vascular flow and diminished perfusion unilaterally on the left lung. We suggest that this condition should be considered during the differential diagnosis of a patient with unilaterally hyperlucent lung

Hypothyroidism in Children with Serous Otitis Media

Objective:In this study, we aimed to evaluate the co-existence and prevalence of hypothyroidism in patients with otitis media with effusion (OME) and to determine the possible relationship between OME and hypothyroidism.Methods:The subject group consisted of 46 paediatric patients (26 boys, 20 girls), ranging in age from 4 to 14 years (mean age±SD 7.78±2.86 years), who were treated in the department of otorhinolaryngology for OME; the control group composed of 30 healthy children (20 boys, 10 girls), ranging in age from 3 to 14 years (mean age±SD 7.20±2.86 years). Triiodothyronine (Free T3), thyroxin (free T4), and thyroid-stimulating hormone (TSH) values of 46 children who were treated for OME, in addition to 30 healthy children, were evaluated.Results:Seven patients (15.2%) in the OME group, and one patient (3.3%) in the control group had subclinical hypothyroidism marked only by serum TSH elevations. All of the children in this study, regardless of whether from the subject or control group, had normal serum free T3 and free T4 levels. There was no significant difference between subject and control groups (p>0.05).Conclusion:Although there was no statistically significant difference between subject and control groups in this study, further studies with larger patient groups are needed to investigate the role of hypothyroidism in the aetiology of OME

Cog graft, a new septal extension graft for designing nasal tip rotation and projection in rhinoplasty

Background: Adjusting the nasal tip rotation and tip projection according to the patient's face and wishes is a very important stage in rhinoplasty with the use of a cog graft positioning the tip point in the appropriate place is possible by adjusting the nose length, tip projection and tip rotation together. Objective: The aim of this study is to facilitate positioning the tip rotation and projection in the appropriate place according to the patient's needs in rhinoplasty with Cog graft. Materials and methods: Cog graft was applied in 32 patients who underwent rhinoplasty. Cog graft was prepared from costal cartilage in 10 patients and from septal cartilage in 22 patients. Cog graft was prepared by shaping the superior edge of the septal extension graft like a gear wheel. It is fixed to provide desired projection to the caudal septum. In the position where rotation and projection are evaluated adequately, the graft is fixed with sutures. They were followed in average 18 months (between 6 and 24 months). Results: Twenty of the patients were primary cases and 12 were revision cases. The targeted rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. Conclusions: Cog graft is a useful graft with which we can adjust the nose length, projection and rotation appropriately and in a short time with a single graft

The hammer graft: A novel technique to provide dorsal support, tip projection, and rotation in rhinoplasty

Background: There are numerous cartilaginous grafts that can be used in rhinoplasty, depending on the specific needs of the patient. These include spreader grafts, dorsal onlay, tip grafts, septal extension, and columellar struts grafts, among others. Objective: The aim of this study is to demonstrate use of the hammer graft in rhinoplasty; this technique can be used to improve dorsal support, tip projection, and tip rotation using a single cartilage graft. Materials and methods: This novel graft was applied in 18 patients who underwent rhinoplasty. In revision patients, hammer graft was harvested from costal cartilage and in primary cases from septum cartilage. They were followed in average 12 months (between 6 and 18 months). Result: Three of these patients were revision cases and 15 were primary cases. In revision patients, hammer graft was harvested from costal cartilage and in primary cases from septal cartilage. The targeted results were achieved to a large extent in all patients. All patients had satisfactory esthetic results. Conclusion: The hammer graft as a single and stable graft useful support for the dorsal part, caudal part and extension part of the septum to be used in primary and revision rhinoplasty

Vertical alar lengthening technique in correcting short noses

Background: It is crucial that the nose length must be compatible with the face in order to obtain beautiful results that suits the face. Shorter and upturned noses appear as if the tip of the nose is cut from the front and gives a piggy appearance to the patient's face. Objective: The aim of this study is to obtain longer noses with increased tip definition by effectively lengthening the medial and lateral crura's in patients with short nose and Asian noses. Materials and methods: Vertical Alar Lengthening (VAL) technique was applied to 17 revision and 12 primary Asian noses. VAL technique consists of three steps. In the first step, the medial crus were lengthened by stealing from the lateral crus. Later, a lateral crural extension graft was applied to the shortened lateral crus, and the lateral crus was lengthened and sutured to the medial crus. In the final stage, a subdomal graft was placed and supported in the space formed underneath the alar tip between the mucosa and the new dome. They were followed in average 12 months (between 6 and 18 months). Results: VAL technique was applied to 17 revision and 12 primer Asian noses. Suggested surgical technique move the tip forward and downward reduced its cephalic rotation and lengthened the nose. Targeted tip point, rotation and projection results were achieved in all patients. All patients had satisfactory esthetic results. Conclusions: In revision cases and short nose deformities in Asian noses, the nasal tip point was extended forward and downward with the VAL technique, reducing its rotation and lengthening the nose

A condition mimicking lung mass appearance in childhood: Round pneumonia [Çocukta akcigerde kitle görünümünü taklit eden bir durum: Yuvarlak pnömoni]

In childhood, pneumonia is one of the major infectious diseases responsible for significant morbidity and mortality. Clinical and radiographic features of round pneumonia simulate pulmonary masses. Streptococcus pneumoniae, Mycobacterium tuberculosis, and Klebsiella pneumoniae are the most frequent etiologic agents of Round pneumonia in children. A two-year-old boy presented with fever, cough, respiratory distress, tachypnea, suprasternal-intercostal retractions, rales and expiratory wheezes. In the laboratory findings white blood cell count was 17300/mm 3, neutrophils 56%, erythrocyte sedimentation rate 54 mm/hour, C-reactive protein 68.84 mg/L, and chest radiogram showed right perihilar 2.5 cm density. In the chest computed tomography scan a 24 mm size irregular contoured consolidation-atelectasis complex in the superior segment of the lower lobe of right lung, demineralization at the right side of T5 vertebra and enlargement at the neural foramina was present. Thorax-abdomen magnetic resonance imaging was performed to exclude neuroblastoma. The spinal cord and neural foramina were normal. The case was discussed at the Aegean University Medicine Faculty Pediatric Respiratory-Allergy Council and the round consolidation with air bronchogram was consistent with round pneumonia. Clinical and radiographic recovery was performed after third generation cephalosporin treatment. In this case we aim to mention the round pneumonia which mimics lung masses

Investigation of the role of major respiratory viruses in the aetiology of nasal polyps using polymerase chain reaction technique

WOS: 000336213900009Objective: We aimed to identify the role of major respiratory viruses in the aetiology of human nasal polyps using polymerase chain reaction technique. Methods: Thirty patients with nasal polyps and a group of 20 healthy patients (control group) were included in this study. Mucosa was obtained from the polyps of patients with nasal polyposis and from the middle turbinate of the control group patients by means of biopsy. The samples were stored at -80 degrees C until molecular analysis by polymerase chain reaction was carried out. Results: In the control group, the human coronavirus and human rhinovirus were diagnosed in one of the patients and the human respiratory syncytial virus in another. In the group with nasal polyposis, the influenza B virus was identified in one of the patients and the human coronavirus in another. Conclusion: The results did not demonstrate a statistically significant relationship between nasal polyposis and respiratory viruses

Diode laser-assisted endoscopic dacryocystorhinostomy: A comparison of three different combinations of adjunctive procedures

WOS: 000321286600012PubMed ID: 23334177Chronic dacryocystitis is a frequently encountered condition which can be corrected by dacryocystorhinostomy. Today, the diode laser is increasingly put to use in such corrective operations. This study aims to answer the questions of which adjunctive procedures and which combinations of such procedures are necessary and effective in securing more successful outcomes in diode laser dacryocystorhinostomy. This prospective randomized study included eighty patients (13 male, 67 female) who underwent dacryocystorhinostomy in our hospital during the 2 year period of January 2009-January 2011. The patients were selected consecutively and were randomly allocated to three groups. Group 1 (30): diode laser + mitomycin C + silicone intubation; Group 2 (27): diode laser + silicone intubation; Group 3 (23): diode laser + mitomycin C. All patients were evaluated postoperatively on day 1, week 1, and on the 1st, 3rd, 6th, 12th, 18th, and 24th months. The postoperative evaluation consisted of preoperative and postoperative ostium measurements, recording postoperative complications, and calculating and comparing success rates and operative times. The mean ages of the patients were 63.4 for Group 1, 60.7 for Group 2, and 61.8 for Group 3. No statistically significant difference was found among the groups regarding pre- and postoperative ostium measurements. The success rates were 84.3, 80, and 76.9 % for Groups 1, 2, and 3, respectively. Complications noted in Group 1 were restenosis (3), premature silicone tube loss (1), development of granulation tissue (3), synechia (2), infection (2), and hemorrhage (3). Those for Group 2 were restenosis (5), premature tube loss (2), granulation (8), synechia (6), infection (3), and hemorrhage (4). Group 3 had 6 cases with stenosis, 5 with granulation, 3 with infection, 6 with synechia, and 5 with hemorrhage. The operative times of the groups were 25.5, 15.3, and 18.1 min, respectively, for Group 1, 2, and 3. All three groups had statistically significant differences regarding the duration of surgery, with p < 0.001, p < 0.001, and p = 0.002 for Group 1 and 2, Group 1 and 3, and Group 2 and 3, respectively. Our study showed that when diode laser DCR was combined with bicanalicular silicone intubation and intraoperative mitomycin C application, those adjunctive procedures, while increasing operative time, enhanced the success rate and diminished complications as compared to diode laser plus intubation and/or diode laser plus mitomycin C