Kafa travması sonrası karşı kulakta ileri derecede işitme kaybı: olgu sunumu

Hearing loss is a known outcome following head trauma. The conductive as well as sensorineural hearing loss have been demonstrated both in cases of head injury. The labyrinthine concussion is postulated to be the underlying mechanism, and it is a common finding in head traumas. There is no specific treatment for labyrinthine concussion. The diagnosis mainly relies on audiometric tests. We reported a case of labyrinthine concussion in the opposite ear of a patient who had head trauma. At 2-month of follow-up, we observed that the contralateral hearing loss of our case persisted.Kafa travması sonrasında işitme kaybı görülebildiği bilinmektedir. Kafa yaralanmaları sonrası hem iletim tipi hem de sensörinöral tip işitme kaybı meydana geldiği gösterilmiştir. Altta yatan mekanizmanın kafa travmalarında sıklıkla rastlanan labirentin konküzyon olduğu varsayılmaktadır. Labirentin konküzyonun özel bir tedavisi yoktur. Tanı esasen odyometrik testlere dayanır. Bu yazıda kafa travması sonrası karşı kulakta labirentin konküzyon nedeniyle işitme kaybı oluşmuş bir hasta sunduk. İki aylık takip sonrasında, karşı kulaktaki işitme kaybının düzelmediğini gözlemledik

The presence of hydronephrosıs ın stagıng bladder cancer: an omınous sıgn

Objective: We investigated whether the presence of unilateral or bilateral upper tract obstruction could accurately predict advanced cancer stage. Methods: Six hundred and ten patients with bladder cancer entered into the tumor registries of our institutions between January 1990 and December 1994. The median patient age was 64 years (range 35 to 80). A total 75 (12%) patients had unilateral or bilateral hydronephrosis on an IVP at the time of initial diagnosis of the bladder cancer. Preoperative screening included physical examination, chest radiograph, complete blood count, blood urea nitrogen, creatinin, electrolyte analysis and IVP. Furthermore, patients were usually evaluated by bone scan and computerized tomography (CT). The diagnosis of transitional cell carcinoma was made by cystoscopy and transurethral resection of the tumor. Staging transurethral resection was done in all cases. Results: During a 5-year period 75 of 610 patients with carcinoma of the bladder had ureteral obstruction on excretory urography at the time of the initial diagnosis. Preoperative IVP revealed unilateral and bilateral hydronephrosis in 55 (73%) and 20 (27%) patients, respectively. Pathological staging revealed predominantly pT1 lesions for patients with unilateral obstruction. There were 30 (55%) patients with pT1, 10 (18%) with pT2, and 15 (27%) with pT3. Pathological staging revealed predominantly pT2 lesions for patients with bilateral obstruction. Pathological stage was pT2 in 10 (50%) cases, pT3 in 5 (25%), and pT4 in 5 (25%). Conclusion: IVP can be used in staging because hydronephrosis may Indicate the presence of a muscle-invasive bladder cancer, especially, bilateral hydronephrosis was strongly associated with advanced stage disease

Morphometric and Morphological Evaluation of the Atlas: Anatomic Study and Clinical Implications

Objective: Atlas is located at a critical point close to the vital centers of the medulla oblongata, which can be compressed by the dislocation of the atlantoaxial complex or instability of the atlantooccipital joint. This study aimed to determine in detail the morphometric and morphological characteristics of the atlas to guide the reduction of the risk of complications and increase the success rate in various surgical approaches for the craniovertebral junction. Methods: In this study, 17 atlas vertebrae whose measurement parameters were pronounced and unknown gender, age, and ethnic characteristics were examined. Results: Totally 16 parameters, 11 of which were bilateral and 5 were unilateral, were examined on the atlas. Also, no accessory foramen transversarium was found in these atlas vertebrae. Of the 23 foramina transversaria that were prominent and not broken, 7 were found to be round-shaped (30.43%), and 16 were oval-shaped (69.57%). Conclusion: It is deducted that the results obtained in this study will help to have information about the morphometry and morphology of atlas vertebrae. Although information such as age, gender, and ethnic origin is not known about the bones evaluated, it is the advantage of this study that a large number of parameters are evaluated and compared with previous publications. Nevertheless, it seems that there is a need for studies in which much more cases are assessed, and information such as age, gender, and ethnic origin is known

Clopidogrel versus ticagrelor in chronic kidney disease patients presenting with acute coronary syndrome: A retrospective evaluation

Aim: To compare the efficacy and bleeding risk of clopidogrel versus ticagrelor in patients presenting with the acute coronary syndrome (ACS). Method: This was a single-center retrospective comparison of in-hospital and 1-year major advance cardiovascular events (MACE) in patients with ACS and reduced estimated glomerular filtration rate (eGFR <60 mL/min) who were treated with clopidogrel or ticagrelor in addition to aspirin. Clinicodemographic features, medication use, and laboratory values were recorded. eGFR was calculated by means of the modification of diet in renal disease (MDRD) equation. The Killip classification was used to quantify the severity of heart failure. The primary outcome measures were in-hospital and 1-year MACEs and major and minor bleeding. MACE definition included recurrent myocardial infarction, stroke, and cardiovascular death. Results: In total, 235 patients (40.9% female, mean age 67.8 ± 12.4 years) were included. Of all patients, 56% presented with ST-elevation myocardial infarction (STEMI), whereas 44% had a non-ST-elevation myocardial infarction. Sixty-eight patients were treated with ticagrelor, while 167 patients were administered clopidogrel. The groups were comparable in terms of in-hospital mortality, cerebrovascular accident (CVA), and re-infarction rates. There was no statistical difference between the mortality, CVA and re-infarction rates between the groups at 12-month. In-hospital minor bleedings were more common among ticagrelor users. In-hospital major bleeding frequencies were similar in both groups. There was no statistical difference in terms of major or minor bleeding rates at 12 months. Conclusion: The findings of the present study showed comparable efficacy and bleeding risk in ACS patients who were treated clopidogrel or ticagrelor

Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration

This study aims to evaluate the severity of postoperative pain and the time to the onset of pain after arthroscopic surgical treatment of rotator cuff tear or instability under interscalene block. Patients and methods: Between October 2015 and June 2016, a total of 172 patients (82 males, 90 females; mean age: 47.9±16.9 years; range, 15 to 83 years) who underwent shoulder arthroscopy under interscalene block by a single surgeon were retrospectively analyzed. The relationship between the postoperative 24-h Visual Analog Scale (VAS), the time to the onset of pain with the type of surgical procedure (rotator cuff repair, n=101 or instability surgery, n=71), and the duration of surgery (<30 min n=92; ≥30 min n=80) was examined. Results: No significant relationship was found between the type of surgical procedure, VAS scores, and the onset of pain after the block (p=0.577 and p=0.780, respectively). No significant relationship was found between the operation duration, and VAS, and the onset of pain after the block (p=0.570 and p=0.408, respectively). The mean duration until the start of postoperative pain was 734±313 (range, 60 to 1,440) min. There was no statistically significant difference in the need for rescue analgesics at the postoperative 24th h and the duration of surgery between the two groups (p=0.393 and p=0.675, respectively). Conclusion: Our study results show no significant difference in the time for the onset of postoperative pain and the VAS scores according to the characteristics of the surgical procedure, operation duration, or age and sex of the patient. Shoulder arthroscopy performed by experienced surgeons under interscalene block eliminates the need for analgesics within the first 12 h postoperatively

Ani işitme kaybında internal akustik kanal çapı

Objective: The purpose of our study was to determine the corelation between internal acoustic channel diameter and idiopathic sensorineural hearing loss. Material and Method: We defined sudden sensorineural hearing loss according to the criteria of Wilson as a 30-dB sensorineural hearing loss occurring in at least three contiguous frequencies in less than 3 days. The internal acoustic channel diameter all of the patients was measured from three dimensional temporal CT scan. Results: Of the 15 patients, 7 were male and 8 were female, ranging in age from 17 to 59 and the mean age was 39.6 years. The right ear was involved in 6 patients, and the left ear in 9. There was no statistically significant difference between the patients’ affected and intact ears (p>0.05). However, the mean diameter of affected side of the patients was narrower than those of healthy controls (p0.05). Ancak kontrol grubuyla karşılaştırıldığında etkilenen kulakta istatistiksel olarak anlamlı darlık tespit edildi (p<0.05). Sonuç: Bulgularımız kontrol grubuyla karşılaştırıldığında, idiyopatik ani işitme kaybı gelişen hastalarda internal akustik kanal çapının nispeten daha dar olduğunu ve bunun bir risk faktörü olabileceğini düşündürmektedir

Pyeloplasty in the Pelvic Kidney: A Step-by-step Video

Ectopic kidneys, with a prevalence of 1/1000-4000, often manifest in the pelvic region, can be complicated with problems such as ureteropelvic junction (UPJ) obstruction. This video article presents a case of open pyeloplasty in a 15-month-old infant with a pelvic kidney, emphasizing technical details for educational purposes. The patient was prenatally diagnosed with pelvic kidney hydronephrosis at 22 weeks of gestation, progressing to grade 4 postnatally. MAG-3 scintigraphy confirmed UPJ obstruction, warranting open pyeloplasty. A Pfannenstiel incision provided access to the Retzius space. The ureter was dissected, revealing the adhered renal pelvis. Stay sutures facilitated dissection, and 5/0 polyglactin sutures were strategically placed due to anatomical anomalies. Ureteropelvic anastomosis was performed using 6/0 PDS sutures. A 3-Fr Double J catheter preceded the closure of the renal pelvis. The procedure was concluded with meticulous layer closure. The operation lasted for 50 min, with minimal blood loss (10 mL). Drain was removed on postoperative day 2, and the patient was discharged. Ureteral stent was removed at 4 weeks. A 3-month follow-up ultrasound revealed a notable reduction in hydronephrosis, with an anteroposterior diameter of 6 mm. This video article elucidates the nuances of open pyeloplasty in pelvic kidneys and serves as a valuable resource for residents and fellows. The concise procedure, with a brief operative time and minimal blood loss, indicates the efficacy of the surgery

Evaluation of bcl-2, bax and c-erbB-2 Levels in Chronic Otitis Patients with or without Cholesteatoma

Objective:The aim of this study was to evaluate bcl-2, bax, and c-erbB-2 expressions in primary and secondary acquired cholesteatoma and to indicate the role of apoptosis and accompanying increased cellular proliferation in the pathogenesis of cholesteatoma.Methods:Samples obtained from the skin of the external ear canal (EEC) of patients operated for chronic otitis media (COM) without cholesteatoma constituted Group 1; samples from the EEC skin of patients in Group 3 operated for COM with cholesteatoma and from the EEC skin of patients in Group 4 constituted Group 2; samples obtained from the cholesteatoma matrix of patients operated for COM with primary acquired cholesteatoma constituted Group 3; and samples obtained from the cholesteatoma matrix of patients operated for COM with secondary acquired cholesteatoma constituted Group 4. The assessment of the positive cell ratio was based on the presence of the following findings and was semiquantitatively classified into four groups: 0, no staining; + cell staining (weak positive staining: 1%–33%); ++ cell staining (moderately positive staining: 34%–66%); and +++ cell staining (strong positive staining: 67%–100%).Results:Comparison of the staining scores of bcl-2, bax, and c-erbB-2 revealed a statistically insignificant difference in the staining of samples obtained from the EEC skin (p>0.05). Decreased bcl-2 expression and increased bax and c-erbB-2 expressions were determined in primary and secondary acquired cholesteatoma epithelium compared with the EEC skin of patients operated for COM with or without cholesteatoma, and the differences were found to be statistically significant (p<0.05).Conclusion:In acquired cholesteatoma epithelium, the finding of decreased bcl-2 expression as well as increased bax and c-erbB-2 expressions compared with the EEC skin is an indicator of the increase in both cellular proliferation and apoptosis

Primary subcutaneous cyst hydatic disease in proximal thigh: an unusual localisation: a case report

BACKGROUND: Musculoskeletal hydatidosis is very rare and represents 1% – 5.4% of all cases of echinococcosis. On clinical basis, infection mimics a soft-tissue tumor, and the preoperative radiological diagnosis is very important to avoid biopsy. CASE PRESENTATION: We report an unusual case of primary subcutaneous hydatidosis in proximity to vastus lateralis muscle. It was diagnosed according to the computed tomography appearance, clinical and pathological findings. A 43 year old female patient was admitted with a history of pain at proximal thigh for the last 30 days. On physical examination, a mass which was 4 × 5 cm in diameter, painful and erythamatous, was palpated over greater trochanter. Sedimentation rate was 40 mm in the first hour. CT (Computed Tomography) scan demonstrated, a soft tissue mass with central cystic component in the subcutaneous tissue near vastus lateralis muscle. Histopathological examination of the specimen revealed a pericystic structure, which consisted of connective tissue and scattered hyaline cells showing a necrotic basophilic structure that resembled a cuticular membrane. Treatment with high dose albendazole was conducted for 4 weeks. CONCLUSIONS: This case illustrates that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when they occur in areas where the disease is endemic

Offensive or Neoclassical Realism? How a Great Power Shapes Its Environment

This thesis aims to shed light on the differences between offensive and a specific version of neoclassical realism on their expectations regarding how a great power shapes its environment. The neoclassical framework proposed in this work constitutes an independent variable captured by the polarity in the system, an intervening variable of state capacity, and a dependent variable of revisionist foreign policy. It is argued that along with multipolarity and bipolarity, there is a need to incorporate unipolarity in structural realist accounts. Analysed from this perspective, great powers feel high external pressure due to the nature of unipolarity, which diminishes the value of pure structural frameworks. In this respect, the incorporation of state-level factors provides more reliable analyses for explaining anxious great powers` strive for regional hegemony. As a result, neoclassical realism is better equipped to explain Russia`s revisionist foreign policy.