Treatment of gastro-esophageal reflux disease may improve surgical outcomes for chronic otitis media

This study has been designed to investigate the clinical association between gastro esophageal reflux disease [GERD] and chronic otitis media [COM] in adults and also the role of GERD treatment on the outcome of COM surgery. In a randomized clinical trial, 58 patients with COM who were candidates for surgery were evaluated for GERD and divided in two groups; GERD positive [case] and GERD negative [control] patients. The GERD positive patients were randomized to either receiving medical treatment for GERD or not prior to surgery. The surgical outcomes were assessed at 3 and 6 months after COM surgery in the three groups. Fifty-eight [26 males] patients were enrolled. Forty-two [72.4%] of these had GERD according to a validated questionnaire. Three months after surgery auditory recovery in GERD negative patients was significantly higher [16[100%]] than those suffering from GERD [28 out of 42 [66.7%]], p=0.008. The figures remained similar at six months follow up as well [100% vs. 72.5% in GERD negative and positive patients respectively, p=0.002]. In the GERD-positive group, 8 of 18 [44.4%] patients who did not receive GERD treatment before tympanomastoidectomy recovered after three months whereas, while 20 of 24 [83.3%] patients who received GERD treatment recovered during this time [p<0.001]. At six months 44.4% of non-treated GERD patients had auditory recovery as compared to 95.5% of those treated for GERD [p<0.01]. Our data show that the effect of GERD on the outcome of COM surgery may be considerable. On the other hand, treating COM patients for GERD medically for two months before tympanoplasty improves the surgical outcomes. Therefore, we suggest that COM patients be evaluated for GERD before undergoing tympanoplasty and if GERD is present, they be treated medically for a couple of months before undergoing surgery.

Huge myxoid liposarcoma of the esophagus: a case report

Although esophageal liposarcoma is an extremely rare tumor, liposarcoma is the most common soft tissue sarcoma in adults. Liposarcoma is currently classified into the types of well-differentiated, myxoid, round cell, pleomorphic and dedifferentiated liposarcoma. Up to now only a few cases of esophagus liposarcoma have been described in the world literature. We describe a myxoid type liposarcoma of the esophagus in a 68 year old man presented with hoarseness and intermittent dysphagea to solid food. He had a huge mass in his mouth which was mobile with gag reflex. A barium swallow, esophageal manometery and CT scan of the esophagus have not clearly revealed the mass. After endoscopic surgical resection of the tumor the histological examination revealed a myxoid liposarcoma. Both the presenting signs and symptoms and the histology type are rare for such tumor. This case demonstrate a rare differential diagnosis of intermittent dysphagia as early diagnosis is so important in those tumors and should kept in mind them, although they are quite rare

Acute phase reactants as a prognostic factor in acute stroke

Elevated levels of CRP are present among patients at risk for further first-ever myocardial infarction and stroke. It has been shown that after ischemic stroke, increased levels of CRP are associated with unfavorable outcomes. From 120 patients admitted to the emergency unit of our hospital with the diagnosis of stroke; CRP, D-dimer and ferritin level was measured and the patients were followed until discharge or death. CRP level was significantly different between the patients with TIA and stroke. D-Dimer level was also significantly different between the TIA and the admitted groups. Ferritin was not different between the prognosis groups. There was a correlation between CRP and D-Dimer [r = 0.381, p = 0.001], and also between CRP and ferritin [r = 0.478, p= 0.000]. CRP is a useful adjuvant marker to determine the prognosis of patients with cerebro-vascular events admitted to the hospital, in both patients with stroke positive history and first-ever stroke