Otolaryngology consultations requested by palliative care services: a five-year analysis

Introduction: Otolaryngologists are required to possess the knowledge, skills, and confidence necessary to manage consultations requested by palliative care services. However, the inclusion of palliative care needs in otolaryngology residency training is limited. The goal of this study was to enhance awareness of otolaryngologists' palliative care knowledge and skills by evaluating otolaryngology consultations requested by tertiary palliative care services between 2016 and 2021. Methods: This retrospective cross-sectional study included patients who consulted the otolaryngology department from the palliative care service of Kutahya Health Sciences University between January 1, 2016 and September 31, 2021. A total of 80 otolaryngology consultations were requested between 2016 and 2021. Patients were evaluated for age, gender, diagnosis of palliative admission, reason for consultation, date of consultation, interventions, and additional investigations. Results: There were 27 female patients (33.7%) and 53 male patients (66.2%). The mean age was 65.0 (range: 22-97) years. It was found that the volume of consultations did not increase significantly over a five-year period (p=0.502) and 78.8 % of consultations were requested during working hours (08:00-16:00). In addition, the response time (minutes) for consultations during working hours (08:00-16:00) was significantly lower than outside working hours (16:01-07:59) (p lt;0.001). The reasons for requesting a consultation and the procedures performed were significantly different between patients under and over 65 years of age (p=0.019 and p=0.008, respectively). Conclusions: This is the first study to evaluate otolaryngology consultations requested by a tertiary palliative care service. Awareness of these consultations may provide guidance for the assessment and management of patients in palliative care services. Keywords: consultation, otolaryngology, tracheotomy, palliative car

The effects of the association of placenta previa and placenta accreta on the short-term maternal morbidity

Objective: We aimed to compare the effects of placenta previa (PP) and placenta accreta (PA) on the short-term maternal morbidity alone and together. Methods: The data of the patients who were diagnosed with PP, PA or placenta previa accreta (PPA) which includes both of them between January 2010 and December 2018 in a tertiary reference center were analyzed retrospectively. The records of the patients were compared between 3 groups for age, gravida, parity, week of gestation, previous cesarean section, history of curettage and myomectomy, gestational complications, placental location, hospitalization at hospital and intensive care unit, decreased level of hemoglobin, blood product transfusions, procedures to control bleeding and complications. Results: Six out of 192 patients were excluded from the study as they delivered in other hospitals, and the data of 186 patients were analyzed. There were 141 (75.8%) patients with PP only, 9 (4.8%) patients with PA only, and 36 (19.4%) patients with PPA. The erythrocyte transfusion was significantly higher in PPA patients than PP patients (p<0.001). The possibility for the transfusion of any blood product was lower in PP group than other groups. While the rate of hospitalization at intensive care unit was higher in PPA group, the number of hospitalization day at hospital was significantly lower in PP group than PA (p=0.042) and PPA (p<0.001) groups. Urinary complication was observed less in PP patients. The hysterectomy rate was higher in PPA patients with than PP and PA patients (p=0.004). Conclusion: The rates of maternal morbidity and hysterectomy increase when PP and PA are together compared to the cases where they are alone

The Effect of Preoperative and Intraoperative Clinical Findings on Success of Endoscopic Management of Ureteral Stone

Objective: We investigated the relationship between clinical data of patients who underwent ureterorenoscopy (URS) due to ureteral stone and stone free rates retro­spectively. Methods: Clinical data of 83 patients who underwent URS in our clinic were retrospectively analyzed. Pre­operative and intraoperative clinical parameters were recorded. Success was defined as not to detect > 4mm stone fragments 2 weeks after the operation. Appropriate statistical analysis were done for evaluating relationship between stone free rate and clinical data. Results: Mean age was 50.48±14.41 and male to female ratio was 2. Overall stone free rate was 83.2%. Postop­erative fever, ureteral perforation were detected in 7 and 2 patients, respectively. There were no differences between success and failure groups in terms of age, sex, opera­tion side, stone number, diameter, size, surface area, mean Hounsfield unit, usage of balloon dilatation. How­ever with respect to preoperative grade of hydronephrosis (low grade: 95.2% vs high grade: 69.4%, p=0.006), stone location (distal ureter: 92.9% vs proximal ureter: 72.5%, p=0.014) and operation time (success: 60.0 (45.0-60.0) min. vs failure: 85.0 (60.0-97.5) min. p=0.048) we found statistically significant differences between the study groups. In addition stone free rate was 91.7% with anti-retropulsion device Stone cone, whereas it was 81.4% without any ureteral occlusion (p=0.347). Conclusion: We assume that anti-retropulsion devices or flexible URS should be prefered especially in patients with hydronephrotic proximal ureteral stone for higher stone free rate with lower auxiliary procedure

Investigation of MEFV gene polymorphisms (G138G and A165A) in adult patients with familial Mediterranean fever

AbstractAimVarious mutations have been identified in the Mediterranean fever (MEFV) gene which is reported to be responsible from Familial Mediterranean fever (FMF). In our study, we aimed to determine the frequency of the MEFV mutations in our region and to investigate the impact of G138G (rs224224, c.414A>G) and A165A (rs224223, c.495C>A) gene polymorphisms on the clinical findings of the disease.MethodsOne hundred and sixteen patients diagnosed with FMF and 95 control subjects were included in this study. We used the DNA sequence analysis method to identify the most prevailing 10 mutations located in exon 2 and 10 of MEFV gene.ResultsAs a result of the MEFV mutation analysis, the most common mutation was the M694V mutation allele with a frequency rate of 41.8%. When the patients group and control group were compared in terms of frequency of both polymorphic alleles (G polymorphic allele, observed in G138G and the A polymorphic allele, observed in A165A), the variation was observed to be statistically significant (p<0.001). It was found that the MEFV mutation types have no relation with clinical findings and amyloidosis (p>0.05).ConclusionsTo our knowledge, our study is the first study in the Southern Marmara region that reports the frequency of MEFV mutations. Our findings imply that the polymorphisms of G138G and A165A may have an impact on progress of the disease. We think that more studies, having higher number of cases and investigating the polymorphisms of MEFV gene, are needed

The impact of Ki-67 index, squamous differentiation, and several clinicopathologic parameters on the recurrence of low and intermediate-risk endometrial cancer

Endometrial endometrioid carcinoma (EEC) represents approximately 75-80% of endometrial carcinoma cases. Three hundred and thirty-six patients with EEC followed-up in the authors’ medical center between 2010 and 2018 were included in our study. Two hundred and seventy-two low and intermediate EEC patients were identified using the European Society for Medical Oncology criteria and confirmed by histopathological examination. Recurrence was reported in 17 of these patients. The study group consisted of patients with relapse. A control group of 51 patients was formed at a ratio of 3:1 according to age, stage, and grade, similar to that in the study group. Of the 17 patients with recurrent disease, 13 patients (76.5%) were Stage 1A, and 4 patients (23.5%) were Stage 1B. No significant difference was found in age, stage, and grade between the case and control groups (p > 0.05). Body mass index, parity, tumor size, lower uterine segment involvement, SqD, and Ki-67 index with p<0.25 in the univariate logistic regression analysis were included in the multivariate analysis. Ki-67 was statistically significant in multivariate analysis (p = 0.018); however, there was no statistical significance in SqD and other parameters. Our data suggest that the Ki-67 index rather than SqD needs to be assessed for recurrence in patients with low- and intermediate-risk EEC

Investigation of FGFR4 (GLY388ARG) Gene polymorphism in primary lung cancer patients

Bazı kanser türlerinde yatkınlık ile fibroblast büyüme faktörü reseptörü-4 (FGFR-4) genin polimorfizmleri arasında ilişkiyi gösteren çalışmalar vardır. Bu çalışmada, primer akciğer kanseri (PAK) gelişimin ile FGFR-4 (Gly388Arg) gen polimorfizmi arasındaki ilişkiyi araştırmayı amaçladık.Çalışmamıza PAK tanısı almış 124 hasta ve herhangi bir kanser hikayesi olmayan 100 kişi alındı. FGFR-4 (Gly388Arg) gen polimorfizmi analizi için polimeraz zincir reaksiyonu-restriksiyon fragment uzunluk polimorfizmi (polymerase chain reaction-restriction fragment length polymorphism=PCR-RFLP) yöntemi uygulandı. Agaroz jeldeki bantlara göre genotipler belirlendi. İstatistiksel analizde p0.05).Bulgularımız FGFR-4 (Gly388Arg) gen polimorfizmi ile PAK arasında bir ilişki olmadığını göstermiştir. Bununla birlikte daha geniş olgu serilerinde bu sonuçlar desteklenmelidir.In some cancer types, there are studies showing the relationship between the predisposition and the gene polymorphisms of fibroblast growth factor receptor-4 (FGFR-4). In this study, we aimed to investigate the relationship between primary lung cancer (PLC) development and gene polymorphism of FGFR-4 (Gly388Arg).124 patients diagnosed with PLC and 100 people without any history of cancer were included in our study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was applied for gene polymorphism of FGFR-4 (Gly/Arg). Genotypes were determined according to the tapes in agarose gel. Statistical significance was considered to be p 0.05).Our findings showed that there was no relationship between the gene polymorphism of FGFR-4 (Gly388Arg) and PLC. However, these results should be supported in larger series of the cases

Microneurosurgical removal of thalamic lesions: surgical results and considerations from a large, single-surgeon consecutive series

OBJECTIVE The object of this study was to present the surgical results of a large, single-surgeon consecutive series of patients who had undergone transcisternal (TCi) or transcallosal-transventricular (TCTV) endoscope-assisted microsurgery for thalamic lesions. METHODS This is a retrospective study of a consecutive series of patients harboring thalamic lesions and undergoing surgery at one institution between February 2007 and August 2019. All surgical and patient-related data were prospectively collected. Depending on the relationship between the lesion and the surgically accessible thalamic surfaces (lateral ventricle, velar, cisternal, and third ventricle), one of the following surgical TCi or TCTV approaches was chosen: anterior interhemispheric transcallosal (AIT), posterior interhemispheric transtentorial subsplenial (PITS), perimedian supracerebellar transtentorial (PeST), or perimedian contralateral supracerebellar suprapineal (PeCSS). Since January 2018, intraoperative MRI has also been part of the protocol. The main study outcome was extent of resection. Complete neurological examination took place preoperatively, at discharge, and 3 months postoperatively. Descriptive statistics were calculated for the whole cohort. RESULTS In the study period, 92 patients underwent surgery for a thalamic lesion: 81 gliomas, 6 cavernous malformations, 2 germinomas, 1 metastasis, 1 arteriovenous malformation, and 1 ependymal cyst. In none of the cases was a transcortical approach adopted. Thirty-five patients underwent an AIT approach, 35 a PITS, 19 a PeST, and 3 a PeCSS. The mean follow-up was 38 months (median 20 months, range 1-137 months). No patient was lost to follow-up. The mean extent of resection was 95% (median 100%, range 21%-100%), and there was no surgical mortality. Most patients (59.8%) experienced improvement in their Karnofsky Performance Status. New permanent neurological deficits occurred in 8 patients (8.7%). Early postoperative (< 3 months after surgery) problems in CSF circulation requiring diversion occurred in 7 patients (7.6%; 6/7 cases in patients with high-grade glioma). CONCLUSIONS Endoscope-assisted microsurgery allows for the removal of thalamic lesions with acceptable morbidity. Surgeons must strive to access any given thalamic lesion through one of the four accessible thalamic surfaces, as they can be reached through either a TCTV or TCi approach with no or minimal damage to normal brain parenchyma. Patients harboring a high-grade glioma are likely to develop a postoperative disturbance of CSF circulation. For this reason, the AIT approach should be favored, as it facilitates a microsurgical third ventriculocisternostomy and allows intraoperative MRI to be done

Divanlardaki bahariye başlılkı kasideler

TEZ4845Tez (Yüksek Lisans) -- Çukurova Üniversitesi, Adana, 2003.Kaynakça (s. 181-183) var.viii, 183 s. ; 30 cm.