Re-Evaluation of Open Partial Horizontal Laryngectomies at Our Institution According to the New Classification Recommended by the European Laryngological Society

Objective: The aim of this study was to re-evaluate the open partial horizontal laryngectomies (OPHLs) performed at our institution in terms of the new classification of the European Laryngological Society and compare the differences with the new classification system.Methods: A retrospective analysis of 45 patients diagnosed with T1b, T2, and T3 laryngeal carcinoma who were treated with OPHLs in our department between 2010 and 2016 were conducted.Results: All supraglottic laryngectomies (31 operations) were classified as OPHL Type 1. Among these, 11 operations required a resection of an additional structure including arytenoid (ARY) in five operations, piriform sinus (PIR) in four operations, the base of tongue (BOT) in one surgery, and ARY + PIR in one patient. Five supracricoid laryngectomies with cricohyoidoepiglottopexy (CHEP), five supracricoid laryngectomies with cricohyoidopexy (CHP), and four near-total laryngectomy operations constituted Type 2 OPHL (7 operations) and Type 3 OPHL (7 operations). Among these operations, two were classified into Type 2b OPHL and four into Type 3b OPHL as the superior margin of incision included epiglottis.Conclusion: We consider that, this new classification, because it allows understanding the content of the surgery from the related title, will be useful in comparing different series and techniques

The Neolithic Worked Bone Assemblage from Ulucak Höyük, Western Anatolia

In this investigation we detail the results of a systematic analysis of worked animal bone from Ulucak, one of the earliest Neolithic sites in western Anatolia. The collection exhibits a wide range of types, including points, needles, spatulas, bevelled tools, perforated objects, and other unique objects. A study of the raw material shows a preference for sheep and goat long bones, while large-sized animal rib bones were also utilized. Manufacturing techniques employed included splitting, grooving, and abrasion, while a contextual analysis of the material underscores an intricate connection with other objects made from stone and clay. Items found in buildings relate to textile, leather, and ceramic production, while personal ornaments may have played a part in abandonment rituals. Examination of this assemblage is understood as a common set of regional tool types with some localized variations

Atipik Çölyak Hastalığı ve eşlik eden otoimmün hepatit

Burada tedaviye dirençli demir eksikliği, transaminaz yüksekliği ve boy kısalığı ile başvuran, çölyak serolojisi pozitif saptanan ve ince bağırsak biyopsisi ile çölyak hastalığı tanısı alan 10 yaşında olgu sunuldu. Anemi sadece glutensiz diyet ile bir ay içerisinde düzeldi. Başvuru anında hipergamaglobülinemi ve anti-düz kas antikor pozitifliği nedeniyle yapılan karaciğer biyopsisinde portal lenfoplazmositer infiltrasyon saptandı. Histolojik, klinik ve laboratuar bulgular ile otoimmün hepatit tanısı aldı ve immünsüpresif tedavi başlandı. Olgu, atipik prezentasyonun yanında eşlik eden otoimmün hepatitin glutensiz diyet altında immunsüpresif tedaviye alışılagelmişin dışında hızlı yanıt vermesi nedeniyle sunuma değer bulunmuştur.Celiac disease (CD) was diagnosed in a 10-year-old boy who was presented with refractory iron deficiency anemia (IDA), hypertransaminasemia and short stature. Anemia resolved within one month after the institution of gluten-free diet. We performed liver biopsy because of hypergamaglobulinemia and high titers of smooth muscle antibody. On the basis of histologic findings together with clinical and laboratory findings, type 1 autoimmune hepatitis (AIH) was diagnosed. We aimed to report a CD case displaying more than one type of atypical pictures. Concomitant AIH and unusual rapid response of hepatitis to conventional treatment are also emphasized

What do Turkish, Spanish, and Pakistani medical students value in specialty training positions? A discrete choice experiment

© The Authors 2022. This document is made available under the CC-BY 4.0 license http://creativecommons.org/licenses/by /4.0/ This document is the Accepted version of a Published Work that appeared in final form in BMC Medical Education. To access the final edited and published work see https://doi.org/10.1186/s12909-022-03798-6The aim of this study was to find out specialty training preferences of senior medical students from three medical schools in Turkey, Spain, and Pakistan.Methods:A Discrete Choice Experiment was carried out using an electronic form for students in three countries in 2021–2022 term. Each choice set in the form consisted of two hypothetical specialty training positions. The attributes were location, earnings, working conditions, personal perspective, quality of education, probability of malpractice, and prestige. Conditional logit model was used to estimate participants’ preferences and “willingness to accept” values.Results:The most valued attribute was “personal perspective on specialty area” for Turkish and Spanish students, while this attribute was not meaningful for Pakistani students. Turkish students needed a 204% of change in their income for a swap between the specialty that they like and not like. This tradeoff necessitated a 300% change for Spanish students. The most valued attribute for Pakistani students, which was “working conditions”, necessitated a 97% increase in income to switch from working in good conditions to working in poor conditions.Conclusion:In this first multinational DCE study in the medical education literature, we found the preferences of medical students in Turkey, Spain, and Pakistan are affected to various extents by several factors

Bilateral intracerebral hemorrhage of basal ganglion: a case report

Serebral kanamanın en sık gözlendigi bölgeler putamen, temporal lob, parietal lob veya frontal lobların santral maddesi, thalamus, serebllar hemisfer ve beyin sapında ponstur. Bazal ganglionlar hipertansiyona baglı intraserebral hemorajinin (ISH) en yaygın gözlendigi bölgedir. Etyolojisinde hipertansiyon, vasküler anomaliler, vaskülopatiler, hematolojik bozukluklar, tümörler, antikoagülanlar, ilaçlar rol oynar. Bilateral intraserebral hemoraji (BIH) gelisiminde hipertansiyondan baska metanol intoksikasyonu, etilen glikol intoksikasyonu, neonatal asfiksi, migren ve hiperglisemik hiperosmolar koma ile iliskili vakalar da bildirilmistir. Hipertansiyona baglı olarak bilateral bazal ganglion kanaması az rastlanılan bir tablodur. Bu olgu sunumunda, sol hemiparezisi olan, risk faktörü olarak hipertansiyon ve diabeti bulunan ve hipertansiyona baglı bilateral intraserebral hemoraji gelisen bir hastadan bahsedecegiz.Cerebral hemorrhages are mainly seen in the area of the central matter of putamen, temporal lobe, parietal lobe or frontal lobe, thalamus, cerebellar hemisphere and pons in the brainstem. Hypertension related intracranial hemorrhages are most commonly seen in basal ganglia. The etiology of the hemorrhages are hypertension, vascular anomalies, vasculopaties, hematological disease, tumors, anticoagulant drugs. Besides hypertension, methanol or ethylene glycol intoxication, neonatal asphyxia, migraine and hyperglycemic hyperosmolar coma are also related with this condition. In this case report we discuss a patient with hypertension and diabetes mellitus who developed bilateral intracerebral hemorrhages of the basal ganglia

Obstrüktif uyku apnesi tan›s›nda periferik arteriyel tonometrinin de¤erlendirilmesi

Objective:Peripheral arterial tonometry (PAT) as a portable method of monitoring sleep quality is a relatively recent innovation. The aim was to compare the results of PAT and polysomnography (PSG) and to evaluate the role of PAT in diagnosing obstructive sleep apnea syndrome (OSAS). Methods: This study included adult patients who admitted to ENT clinic with OSAS complaints (excessive daytime sleepiness, snoring, and witnessed apnea), undergone sleep monitorization using PAT system (WatchPAT 200TM; Itamar Medical Ltd., Caesarea, Israel) and had single-blind, level 1 polysomnography at sleep laboratory of Chest Diseases Department. Results: For the two sleep monitoring sessions as conducted at different times: the apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) values were strongly correlated between sessions (r=0.749, r=0.753; p<0.001). The oxygen desaturation index (ODI) values were very strongly correlated (r=0.861; p<0.001). When the AHI scores calculated using PAT for the patients enrolled in the trial were taken into consideration; 89.7% of the patients were correctly diagnosed with OSAS (AHI?5); for RDI calculated (RDI?5) using PAT, 100% of OSAS diagnoses were correct; for AHI values calculated with the PAT method, taking 15 as cut-off point, the sensitivity was found to be at an extremely high level of 96.1%. Conclusion: PAT and PSG values were highly correlated. This finding demonstrated that the reproducibility of the results obtained with PAT was also high. This study shows that PAT can be used as a screening test for OSAS and in a group of patients who are highly suspected for OSAS.Amaç: Periferik arteriyel tonometrinin (PAT), uyku monitörizasyonunda ta?›nabilir bir yöntem olarak kullan›m› k›smen yeni bir yöntemdir. Bu çal›?mada, PAT sonuçlar› ile polisomnografi (PSG) sonuçlar›n›n kar?›la?t›r›lmas› ve obstrüktif uyku apnesi sendromu tan›s›nda PAT’›n rolününün de¤erlendirilmesi amaçland›. Yöntem: Bu çal›?maya KBB klini¤ine OSAS ?ikayetleri (gündüz uykululuk hali, horlama ve tan›kl› apne) ile ba?vurmu? ve uyku monitörizasyonu PAT sistemi (WatchPAT 200TM; Itamar Medical Ltd., Caesarea, ‹srail) ile yap›lm›?, daha sonra Gö¤üs Hastal›klar› Uyku Laboratuvar›nda kör olarak level 1 polisomnografi uygulanm›? eri?kin hastalar dahil edildi. Bulgular: ‹ki farkl› zamanda yap›lm›? uyku monitörizasyonunda apne hipopne indeksi (AHI) ve solunum bozuklu¤u indeksi (RDI) de¤erleri yüksek oranda korele idi (r=0.749, r=0.753; p<0.001). Oksijen desatürasyon indeksi (ODI) de¤eri ise çok yüksek oranda korele saptand› (r=0.861; p<0.001). Çal›?maya dahil edilen hastalar›n AHI skorlar› PAT yöntemiyle ölçüldü¤ünde; hastalar›n %89.7’si OSAS için (AHI?5) do¤ru tan› ald›; PAT testinde, RDI’ye göre yap›lan de¤erlendirmede (RDI?5) OSAS tan›lar›n›n %100’ü do¤ru idi; PAT yöntemiyle yap›lan ölçümde AHI de¤eri için e?ik de¤eri 15 olarak kabul edildi¤inde, duyarl›l›k %96.1 olarak oldukça yüksek bulundu. Sonuç: PAT ve PSG de¤erleri yüksek oranda korele idi. Bu durum PAT ile elde edilen sonuçlar›n tekrarlanabilirli¤inin de yüksek oldu¤unu göstermi?tir. Çal›?mam›z PAT’›n OSAS’da tarama testi olarak ve yüksek oranda OSAS ?üphesi olan hasta grubunda kullan›labilece¤ini göstermektedir

Synthesis of an injectable heparin conjugated poloxamer hydrogel with high elastic recoverability for temporomandibular joint disorders

The temporomandibular joint (TMJ) is commonly affected during fundamental oral activities, reducing the quality of life. Herein, we synthesized a heparin-conjugated poloxamer hydrogel (HEP) as a thermo-responsive injectable hydrogel for the treatment of TMJ disorders. While the gelation temperature of synthesized HEP (25% [w/v]) was 29.8-30.0 degrees C, there was a slight difference between loss and storage modulus. HEP decreased the friction of the TMJ, thus requires less energy during load-bearing jaw movement in comparison to POL. Moreover, the oscillation test dependent on strain ranges from 0.01% to 1000% validated that POL and HEP3 hydrogels showed a similar critical strain of about 5.6%. The total elastic recovery percentage of HEP3 (53.50%) was higher than POL (45.55%), indicating a better recovery of the deformed hydrogel structure. Along with the suitable viscoelastic properties for temporomandibular cavity, both hydrogels increased the proliferation of fibroblasts (L929) and chondrocytes (ATDC5) (cell viabilities were above 100%). However, newly synthesized HEP induced differentiated cell proliferation of chondrogenic cells at increasing concentrations up to 0.0156 mg/mL (p < 0.0001) compared to POL and the control group. The promising rheological properties and effects on chondrogenic cell proliferation of injectable heparin-conjugated hydrogel make them candidates for intra-articular injections used for the treatment of TMJ

Retospective analysis of risk factors, etiological factors and treatment options in patients with cerebral venous thrombosis

PURPOSE: Cerebral venous thrombosis (CVT) is not a common disease. It is known to have a varied clinical spectrum. There is too much cause of the etiology of disease. In this manuscript we discussed our patients initial symptoms, cause of CVT and our patients' prognosis. MATERIALS and METHODS: This study was a retrospective database analysis of 29 patients who had CVT followed from 2004 to 2010. All of the patients had cranial magnetic resonans imaging (MR) and Mr /Computarized Tomography (CT) venography. RESULTS: There were 27 female, 2 male in this study. Mean age of the patients was 34.97 ±12.79 years old. Only eight patients had abnormal neurological examination (4 patients papilloedema, 2 patients confusion, 1 patient cerebellar dysfunction, 1 patient homonymous hemianopsia). Initial symptoms of patients were headache(n=19), epileptic seizures (n=6), blurred vision (n=1), diplopia (n=2) and one of the patient had vertigo. Ten patients had only one sinus thrombosis however 19 patients had more than one sinus thrombosis. Thrombotic risk factors were found in 21 patients. Most important risc factor were pregnancy, postpartum condition, oral contraceptive usage and acquired hypercoagulable disease. CONCLUSION: CVT is rare but important condition. Sometimes non specific headache is a herald of this condition. Especially pregnancy and postpartum period are susceptibility of this condition

Human Immunodeficiency Virus (HIV) Positive Case with Squamous Cell Larynx Cancer: Difficulties in the Choice of Treatment

Squamous cell carcinoma of the larynx is rarely encountered in HIV (human immunodeficiency virus)-positive patients compared with HIV-associated malignancies. Standard protocols are absent for the management of laryngeal carcinoma in HIV-positive patients. HIV infection- associated immune suppression increases the mortality and morbidity of laryngeal carcinoma treatment. In the management of laryngeal carcinoma in HIV-positive patients, beside the clinical staging, the detection of CD4+ cell count is important. Regular antiretroviral treatment may have favorable effects in the management of laryngeal carcinoma. The treatment modality in the presented HIV-positive case with the diagnosis of laryngeal cancer was determined with a multidisciplinary approach

Dynamic thiol/disulphide balance in patients undergoing hypotensive anesthesia in elective septoplasties

Objective We aimed to investigate the effects of hypotensive anaesthesia on oxidative stress with serum thiol/disulphide balance in patients undergoing elective septoplasty procedures under general anaesthesia. Methods Seventy-two patients between the ages of 18-60, with a physical condition I -II, according to the American Society of Anesthesiologists, were included in this prospective observational study. Septoplasty was chosen for standard surgical stress. According to the maintenance of anaesthesia, patients were divided into the groups as Hypotensive Anaesthesia (n = 40) and Normotensive Anaesthesia (n = 32). Serum thiol/disulphide levels were measured by the method developed by Erel & Neselioglu. Results The native thiol and total thiol values of both groups measured at the 60th min intraoperatively were significantly lower than the preoperative values (both P 40 years and female gender were found to have a significant effect on dynamic oxidative stress (P = .002 and .001, respectively). Conclusion This pilot study has found that hypotensive anaesthesia had no adverse effect on dynamic thiol/disulphide balance in elective surgeries