The Effect of Blood Loss on the Hemodynamics of Pediatric Patients Undergoing Simultaneous Bilateral Cochlear Implantation

Objective: Our objectives were to find the mean blood loss volume and the mean hemoglobin decrease in patients undergoing simultaneous bilateral cochlear implant surgery, to determine whether they had clinical effects, and to calculate a minimum weight for pediatric patients that is independent of any age criteria.Methods: A retrospective chart review of the pre- and post-operative hemoglobin concentrations and mean blood loss volumes were calculated for children between 12-24 months of age who underwent cochlear implant surgery.Results: A postoperative decline in hemoglobin concentration was found in 67 cases (92%), with a mean difference between the pre- and post-operative values measuring 1.9 g/dL. Preoperative hemoglobin concentrations decreased from 13.4 g/dL to 11.5 g/dL. Mean blood loss volume was 82.3±12 cc.Conclusion: Although simultaneous bilateral cochlear implant surgery is reimbursed by the state for those who are greater than one year of age and who meet the appropriate audiological criteria, our findings suggest that these patients should weigh ≥10 kg to prevent hemodynamic instability due to blood loss during surgery

Effects of Phloretin and Phlorizin on Glutamate-Induced Neuron Injury: in Vitro Study

Aim:In this study, we aimed to investigate the effects of phloretin and phlorizin which are potent antioxidants, anti inflammatory and antiapoptotic agents on the prevention of glutamate-induced neurotoxicity which is an excitatory neurotransmitter.Materials and Methods:In our study, the newly born rat cortex was used. Glutamate was applied in concentration 3x10-3 and 6x10-3 M 2 hours after application of phloretin in concentrations 10-5 M and 2x10-5 M and phlorizin in concentrations 10-5 and 2x10-5 M. mRNA isolation was performed from the cells 6 hours after glutamate administration. 24 hours later, metiltiazol difenil tetrazolium (MTT) test, total oxidant and antioxidant capacity measurements were performed.Results:In our study, phloretin and phlorizin showed the best neuroprotective effect in high dose, while glutamate reduced cell viability in increased doses. Increased total oxidant capacity due to toxicity has been significantly improved by phloretin and phlorizin. Decreased antioxidant capacity in the toxicity group showed improvement with the application of phloretin and phlorizin. When phloretin and phlorizin were applied alone, they did not affect cell viability significantly, they increased antioxidant capacity and decreased oxidant capacity. İncreased tumor necrosis factor-alpha (TNF-α) mRNA expression after glutamate administration decreased significantly with the application of phloretin and phlorizin. Increased caspase 9 and caspase 3 mRNA expression due to glutamate showed improvement with the application of phloretin and phlorizin.Conclusion:These findings suggest that phloretin and phlorizin, potent antioxidant, antiinflammatory and antiapoptotic agents, may be protective in glutamate-induced neurotoxicity and can be used as therapeutic agents for preventing glutamate-induced neurological disorders

Permanent resiprokan kavşak taşikardisine bağlı dilate kardiyomiyopati: Bir olgu sunumu

We present a four-year-old girl who was admitted to our hospital with the complaints of dyspnea, tachypnea, cough, excess sweating and fatigue. Electrocardiogram (ECG) in the tachycardic girl showed inverted P waves in leads 2, 3 and aVF along with a P-R interval of 0.16 sec and an R-P interval of 0.28 sec. Transthoracic echocardiography revealed an enlarged and spherical left ventricle with diminished systolic functions. Holter ECG confirmed long R-P tachycardia with a rate of 140-160 beats/minute. She was diagnosed as having permanent junctional reciprocating tachycardia-induced dilated cardiomyopathy and successfully treated with catheter ablation and flecainide.Bu olgu sunumunda hastanemize dispne, takipne, öksürük, aşırı terleme ve yorgunluk yakınması ile başvuran dört yaşında kız olgu sunduk. Taşikardik olan hastanın elektrokardiyografisinde (EKG) V2, V3 ve aVF derivasyonlarında ters P dalgaları ile birlikte 0,16 sn P-R aralığı ve 0,28 sn R-P aralığı mevcuttu. Transtorasik ekokardiyografide sistolik fonksiyonları azalmış, geniş ve sferik sol ventrikül saptandı. Holter EKG'de kalp hızı 140-160/dk olan uzun R-P intervalli taşikardi konfirme edildi. Hastaya permanent resiprokan kavşak taşikardisine bağlı dilate kardiyomiyopati tanısı kondu ve hasta kateter ablasyonu ve flekainamid tedavisi ile başarılı bir şekilde tedavi edildi

Challenges in the Management of Ectopic Parathyroid Pathologies: A Case Series of Five Patients

In primary hyperparathyroidism (PHPT) the diagnosis and treatment of ectopic parathyroid adenomas (EPTA) is a challenging process for head and neck surgeons. We present five patients with EPTA in different locations, along with an in-depth discussion of imaging modalities. We used sestamibi scintigraphy (MIBI) and ultrasound as first line imaging tools in asymptomatic hypercalcemia and PHPT. Single photon emission computed tomography (SPECT) was combined with MIBI or computed tomography (CT) if a parathyroid pathology was not localized initially. Four-dimensional parathyroid CT (4D-CT) was the last imaging modality preferred to localize the ectopic parathyroid gland. We performed focused unilateral neck exploration (FUNE) with intraoperative frozen section analysis as a routine procedure for imaging-detected lesions. Bilateral neck exploration was performed for re-exploration cases and imaging-negative cases. Histopathology confirmed EPTA and postoperative serum calcium normalized in all cases. 4D-CT is promising for ectopic parathyroid gland localization if all other imaging modalities fail. Despite the advancements in imaging, surgical experience continues to play the central role in the management of ectopic parathyroid pathologies

The Relationship between Serum Uric Acid and Glucose, HbA1c, Lipid Profile, Body Mass Index and Blood Pressure in Patients with Chronic Kidney Disease

AMAÇ: Kronik böbrek hastalarında serum ürik asit düzeyi ile glukoz, HbA1c, lipid profili, vücut kitle indeksi ve kan basıncı arasındaki bir ilişkinin olup olmadığını incelemek. YÖNTEMLER: Çalışma, kronik böbrek hastalığı tanısı olan 55 ( 28 K, 27 E) hastada yapıldı. Hastaların biyokimyasal tetkikleri, 24 saatlik idrarda kreatinin klirensi ve proteinüri tetkikleri incelendi. Sistolik ve diastolik kan basıncı ölçüldü. İstatistiksel analizler SPSS 15.0 Windows versiyonu kullanılarak yapıldı. P<0.05 değeri istatistiksel olarak anlamlı olarak kabul edildi. BULGULAR: Verilerin analizinde serum ürik asit düzeyi ile glukoz, HbA1c ve vücut kitle indeksi arasında istatistiksel olarak anlamlı ilişkiler saptandı (sırasıyla P=0.01, P<0.01 ve P=0.03). Alt grup analizlerinde, hiperürisemili hastalarda glukoz, HbA1c ve vücut kitle indeksi düzeyleri ürik asit düzeyi normal olan hastalara göre anlamlı olarak daha yüksek bulundu (sırasıyla, P=0.02, P=0.02, P=0.04). HDL-kolesterol düzeyi ise hiperürisemili grupta daha düşük saptandı (P=0.02). Serum ürik asit düzeyi ile kan basıncı arasında anlamlı bir ilişki tespit edilmedi. SONUÇ: Çalışmamız, kronik böbrek hastalarında serum ürik asit düzeyi ile glukoz, HbA1c ve vücut kitle indeksi arasındaki anlamlı bir ilişkinin olduğunu göstermektedir. Ancak, daha fazla sayıda hastada yapılacak çalışmalara ihtiyaç vardır. OBJECTIVE: To investigate whether there is a relationship between serum uric acid and glucose, HbA1c, lipid profile, body mass index and blood pressure in patients with chronic kidney disease or not. METHODS: This study was performed in 55 (28 female, 27 male) patients with chronic kidney disease. Biochemical tests, 24 hour creatinine clearence and proteinuria were analysed. Systolic and diastolic blood pressures were measured. The statistical analysis was performed using SPSS version 15.0. P<0.05 was considered to be statistically significant. RESULTS: In data analysis, there were significant relationships between serum uric acid and glucose, HbA1c, and body mass index (P=0.01, P<0.01 and P=0.03, respectively). In subgroup analysis, it has been found that the level of glucose, HbA1c, and body mass index in hyperuricemic patients are significantly higher than in normouricemic patients (P=0.02, P=0.02, P=0.04, respectively). HDL-cholesterol level in hyperuricemic group is found to be higher than normouricemic group (P=0.02). There was no significant relation between serum uric acid and blood pressure. CONCLUSION: Our study suggests that serum uric acid level was significantly associated with glucose, HbA1c, and body mass index in chronic kidney disease. However, studies are needed in larger patients

Assessment of children with speech sound disorders in otolaryngology outpatient clinics

Objective To analyze the utility of Ankara Articulation Test (AAT) for the diagnosis of Speech Sound Disorders (SSD) in children by an Otolaryngologist independent of Speech-Language Pathologist (SLP). Methods In this prospective single-center study, 83 children comprising 45 boys (54.2%) and 38 girls (45.8%) were enrolled. AAT was applied to the children aged 3-12 years with primary SSD who presented to the otolaryngology outpatient service. Video recording was carried out while testing and the responses to the test were evaluated by another otolaryngologist and SLP. Results A perfectly significant agreement was found between the speech-language pathologist and otolaryngologist's assessments (Cronbach's Alpha > 0.80). Conclusion Otolaryngologists could evaluate SSD with the help of AAT as well as an SLP analysis. Standardized visual tests, such as the AAT, assist the otolaryngologist in the diagnosis of SSD in outpatient clinics

Comparison of Voice Quality of Life in Early Stage Glottic Carcinoma Treated with Endoscopic Cordectomy Using Radiofrequency Microdissection Electrodes, Laser Cordectomy, and Radiotherapy

Purpose. To compare the quality of life of patients with early glottic carcinoma who have been treated using three treatment modalities: endoscopic cordectomy using radiofrequency microdissection electrodes (ECRM), transoral laser cordectomy, and radiotherapy (RT). ECRM, transoral laser cordectomy, and RT can all be used as alternatives to invasive open surgery to treat the early stages of glottic cancer such as stage T1. Patients treated using these different modalities could have different outcomes with respect to voice quality of life. Materials and Methods. The voice quality of life was measured in patients who underwent ECRM, transoral diode laser excision, or RT for early laryngeal cancer. Post-treatment quality of voice was assessed using the Turkish version of the Voice-Related Quality of Life questionnaire in all patients after 1 year of cancer-free survival. A comparison was then made between the outcomes of the three groups. Results. The total score of the ECRM group, when compared independently to that of the laser and the RT groups, was found to be statistically higher in both cases. However, no statistically significant differences were found between laser and RT groups in terms of any parameters. There was a statistically significant difference between the RT group and the other groups in terms of percentage jitter, percentage shimmer, and fundamental frequency (F0) (P < 0.05). While the RT group had the longest maximum phonation time (P < 0.001), no significant differences were found between the maximum phonation time of the ECRM and the laser groups (P < 0.001). Conclusions. Overall, the worst outcome with respect to voice quality of life is seen with ECRM. Since there were no significant differences in quality of life between the other two treatment modalities, it is recommended to leave the choice between RT and laser surgery up to the patient

Is endoscopic endonasal transsphenoidal surgery increases the susceptibility to rhinosinusitis

The aim of the study was to analyze whether the measurement of changes in the anatomical position and volume of middle concha, the volume changes in the area between the middle concha and lamina papyracea, the evaluation of opacification in major paranasal sinuses, and osteomeatal complex occlusion in cases with middle concha by out-fracture technique during endoscopic endonasal transsphenoidal approach is a minimally invasive surgery, and also to find out whether these changes lead to the development of tendency to rhinosinusitis. It was a retrospective clinical study. Forty-five cases, between 2013 and 2015, planned for endoscopic endonasal transsphenoidal surgery due to hypophyseal pathology at the Neurosurgery Departments of Marmara University Hospital were evaluated retrospectively. The patients were evaluated for the changes in the anatomy of the middle concha and the effects of these changes to paranasal sinuses by paranasal computed tomographies were studied at the preoperative second week and postoperative 12 month. The Lund-Mackay scoring system was used for the evaluation of opacification in the five major paranasal sinuses and occlusion of the osteomeatal complex in the pre- and postoperative period. The Lund-Mackay scoring system was used to analyze the paranasal computed tomography of the patients at the preoperative 2 weeks and postoperative first year. According to the Lund-Mackay scoring system, no significant difference was detected between the preoperative and postoperative opacification of paranasal sinuses (p > 0.05). Besides, there was also no significant difference between the preoperative and postoperative osteomeatal complex occlusion (p > 0.05). Considering the distance between middle concha and lamina papyracea following the out-fracture of the middle concha, a significant lateralization of 0.5 mm between the preoperative and postoperative period was observed (p < 0.05). In addition, a significant change was also detected in the volume of middle concha (p < 0.05). The volume of the area between the middle concha and lamina papyracea was decreased with a statistical significance (p < 0.05). The endoscopic endonasal transsphenoidal surgery causes some variations in the structures of the middle concha, paranasal sinuses, and OMC, but these changes do not lead to significant rhinologic pathologies

Effectiveness of Recombinant Human Growth Hormone for Pharyngocutaneous Fistula Closure

Objectives. In laryngeal cancer, which comprises 25% of head and neck cancer, chemotherapy has come into prominence with the increase in organ-protective treatments. With such treatment, salvage surgery has increased following recurrence; the incidence of pharyngocutaneous fistula has also increased in both respiratory and digestive system surgery We investigated the effects of recombinant human growth hormone on pharyngocutaneous fistula closure in Sprague-Dawley rats, based on an increase in amino acid uptake and protein synthesis for wound healing, an increase in mitogenesis, and enhancement of collagen formation by recombinant human growth hormone. Methods. This study was experimental animal study. Forty Sprague-Dawley rats were separated into two groups, and pharyngoesophagotomy was perfouned. The pharyngoesophagotomy was sutured with vicryl in both groups. Rats in group 1 (control group) received no treatment, while those in group 2 were administered a subcutaneous injection of recombinant human growth hormone daily. On day 14, the pharynx, larynx, and upper oesophagus were excised and examined microscopically. Results. Pharyngocutaneous fistula exhibited better closure macroscopically in the recombinant human growth hormone group. There was a significant difference in collagen formation and epithelisation in the recombinant human growth hormone group compared to the control group. Conclusion. This study is believed to be the first in which the effect of recombinant human growth hormone on pharyngocutaneous fistula closure was evaluated, and the findings suggest the potential of use of growth hormone for treatment of pharyngocutaneous fistula