An effective method for videorecording the nasal-dorsal part of a rhinoplasty - a multiple case study.

Rhinoplasty is a difficult procedure to record for several reasons which include the narrow, dark and deep surgical field cluttered with many instruments, and the heads and hands of the surgical team often blocking the view. This study discusses 13 rhinoplasty cases that were recorded using the authors' technique. A three-minute, unedited segment was extracted from the mid-portion of each surgical case, and that footage was evaluated by three specialist examiners. Results indicate that the authors' technique can offer a effective solution in the video recording of the nasal-dorsal part of a rhinoplasty.

[Subjective assessment of olfactory function]. / Koku fonksiyonunun subjektif degerlendirilmesi.

Of the five senses, the sense of smell is the most complex and unique in structure and organization. As diagnostic and therapeutic modalities are often underdeveloped, the sense of smell has been inadequately studied. Olfactory disorders may result from benign pathologies such as sinusitis as well as several diseases including Parkinson's disease, temporal lobe epilepsy, schizophrenia and Alzheimer disease. In this article, we aim to instruct the otorhinolaryngology specialists and residents regarding the tests which measure odor subjectively.

Unpredicted effects of Ankaferd® on cartilage tissue.

OBJECTIVE: This study aims to investigate the histopathological changes secondary to the administration of Ankaferd Blood Stopper® (ABS) into the auricular cartilage. MATERIALS AND METHODS: Both of the auricular cartilages of thirty New Zealand rabbits were marked with tattoo ink. A 0.2-cc ABS (study group, n: 30) and 0.2 cc physiological saline (control group, n: 30) were subcutaneously infused into the right auricle and left auricle, respectively. All layers were removed at 14 days. RESULTS: The ABS group had significantly higher level of fibrosis, necrosis, foreign body reaction, inflammation, and cartilage degeneration, compared to the controls. CONCLUSION: Our study results showed that ABS administration into a closed cavity led to a significantly increased fibrosis and necrosis in the auricular cartilage.

Schwannoma of the submandibular gland: a case report.

INTRODUCTION: Schwannoma is a benign, solitary, and slowly progressive encapsulated tumor originating from the sheath of myelinated nerve fibers. Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor. Here, we present an unusual case of a schwannoma of the submandibular gland in a 19-year-old man. Total excision of the submandibular gland resulted in complete resolution of symptoms with no cranial nerve deficits. The details of the histopathologic and immunohistochemical features are presented. CASE PRESENTATION: A 19-year-old Caucasian man was admitted to our clinic with a painless mass on the right side of his neck that he had had for the past four months. A neck examination revealed a smooth-surfaced, mobile, firm, and painless mass, 6cm in its greatest diameter, on the right side of the submandibular region. Fine-needle aspiration cytology was suggestive of a submandibular gland schwannoma. After the initial evaluation, our patient was prepared for surgical evaluation and resection with a presumptive diagnosis of a neurogenic tumor of the submandibular gland. The final diagnosis of schwannoma was verified by microscopic and immunohistochemical studies. At one-year follow-up of the case, there was no evidence of recurrence. CONCLUSIONS: Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor. Our findings indicate good prognosis in an unusual case of a submandibular gland schwannoma in a 19-year-old man treated by surgical excision with no recurrence within 12 months of follow-up.

Correlation of symptoms with total IgE and specific IgE levels in patients presenting with allergic rhinitis.

OBJECTIVE: The objective of this study was to investigate the correlation of symptoms in patients with presumed allergic rhinitis on the basis of their medical history and physical examination with the levels of total immunoglobulin E (IgE) and specific IgE, and to question the necessity of these tests in diagnosis. METHODS: The records of 295 patients, who had at least two complaints of nasal itching, nasal obstruction, runny discharge and sneezing, and/or presumed as allergic rhinitis on physical examination findings were retrospectively screened. The correlation between the levels of IgE, specific inhalant IgE, and food-specific serum IgE were evaluated in these patients. RESULTS: A total of 70 cases (23.7%) were determined to have a total value of IgE under 20 U/ml, 113 cases (38.3%) with IgE values between 20 U/ml and 100 U/ml, and 100 cases with IgE values above 100 U/ml. Results of total IgE could not be obtained in 12 (4.06%) patients. Dermatophagoides farinae was the most common allergy in this group with 74 (68.5%) cases. CONCLUSIONS: The determination of IgE in allergic rhinitis is a supportive method. However, it cannot be recommended for routine use because of the time loss and high cost.

Is there a need for audiologic evaluation in patients with Behçet disease?

Behçet disease is known to be a multisystem condition. We conducted a study to determine the prevalence of hearing loss in patients with Behçet disease and to identify any associations between audiologic findings and other clinical manifestations and treatment. Our study group was made up of 41 adults with Behçet disease and 41 healthy sex- and age-matched controls. All patients and controls underwent a complete clinical otolaryngologic examination, which included pure-tone audiometry, acoustic impedance testing, and otoacoustic emissions testing. Audiology revealed that the prevalence of sensorineural hearing loss (SNHL) was significantly higher in the Behçet patients than in the controls-68.3 vs. 22.0% (p < 0.002). The duration of Behçet disease had no significant impact on whether patients did or did not experience hearing loss. Hearing loss was the fourth most common clinical finding in the Behçet group, after oral ulcers, genital ulcers, and skin lesions. We conclude that SNHL is present in a significant number of Behçet patients, and we suggest the need for an adequate investigation of hearing in the routine follow-up of these patients.

Sleep disorders in Behçet's disease, and their relationship with fatigue and quality of life.

Behçet's disease, a systemic vasculitis, can cause varying degrees of activity limitation, fatigue and quality of life impairment. To date, there have been no studies regarding sleep disturbance and its relationship with fatigue and life quality in Behçet's disease. We aimed to evaluate sleep disorders and polysomnographic parameters, and to determine their relationship with fatigue and quality of life in Behçet's disease. Fifty-one patients with Behçet's disease without any neurological involvement were interviewed regarding sleep disorders. Twenty-one subjects with no sleep complaints were included as the control group. Sleep-related complaints were evaluated in a face-to-face interview. Sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, disease activity/severity, and quality of life questionnaires and an overnight polysomnography were performed. Prevalences of restless legs syndrome (35.3%) and obstructive sleep apnea syndrome with/without other sleep disorders (32.5%) were higher than in the control group and the general population. Fatigue was higher in patients with restless legs syndrome and obstructive sleep apnea syndrome, and in those with lower minimum oxygen saturation; hence, only patients with restless legs syndrome had quality of life impairment. Sleep efficiency index and sleep continuity index were lower, and wake after sleep onset, respiratory disturbance index and apnea-hypopnea index were higher than in controls (P < 0.01). Neither sleep disorders nor polysomnographic parameters were related to disease activity and severity. In conclusion, it is important to question sleep disorder followed by a polysomnography, if necessary, in order to improve quality of life and fatigue in Behçet's disease.

[Conservative approach to isolated cricoid cartilage fracture]. / Izole krikoid kartilaj kirigina konservatif yaklasim.

Isolated cricoid fracture is encountered rarely during the clinical follow-up. A 71-year-old female patient was referred to emergency service with complaints of fall from height, and urgent tracheotomy was performed due to dyspnea. During the examination, isolated fractures of the cricoid cartilage were identified. With the conservative approach, the patient remained symptom-free and was discharged after decannulation.

[The prevalence of allergic rhinitis in patients with simple snoring and obstructive sleep apnea syndrome]. / Basit horlama ve obstrüktif uyku apnesi sendromu hastalarinda alerjik rinit prevelansi

OBJECTIVES: This study aims to investigate the prevalence of allergic rhinitis and the relation between allergic rhinitis and the development of obstructive sleep apnea syndrome (OSAS) and OSAS severity in patients with simple snoring and OSAS. PATIENTS AND METHODS: A total of 80 patients (51 males, 29 females; mean age 45.4±8.1 years; range 18 to 69 years) who were admitted to our clinic with the complaints of snoring and nocturnal awakening and diagnosed with simple snoring and OSAS were included in the study and divided into four groups according to apnea-hypopnea indexes (AHIs) scores. The patients were interrogated about the presence of allergic rhinitis. Radioallergosorbent test (RAST) and prick tests were performed. RESULTS: We found allergic rhinitis in 18 of the 80 (23%) patients. The house mites were found to be the causative allergen in 13 of the 18 (72%) patients. CONCLUSION: We recommend that the allergy symptoms such as nasal obstruction and sneezing should be added to the questions that are asked to the patients with simple snoring and OSAS and that the investigations should include the skin prick and RAST tests in these patients.

Effects of the folk medicinal plant extract Ankaferd Blood Stopper® on the ocular surface.

PURPOSE: To investigate the effects of Ankaferd Blood Stopper(®) (ABS) on the ocular surface. METHODS: Twenty adult male Wistar albino rats, weighing 390-530 g, were used in this prospective, controlled trial. One drop of ABS and one drop of balanced salt solution (BSS) were instilled into the lower conjunctival sac of the right and left eyes, respectively. After the rats were anesthetized, the ocular surface was evaluated based on the Draize criteria, and fluorescein tests were performed at 1, 2, 4, 18, 24, and 48 h. Subsequently, the rats were killed and all eyes were enucleated for histopathological examination. RESULTS: The outcome of the Draize and fluorescein tests revealed that ABS caused more irritation of the ocular surface than BSS (P < 0.001). The highest mean ABS score was 4.9 for the Draize test and 0.4 for the fluorescein test, and ABS was considered to be a slight irritant. Histopathological examinations of the cornea and the conjunctiva revealed no significant difference between the eyes instilled with BSS and those instilled with ABS. CONCLUSIONS: ABS is a hemostatic drug that exerts a slight toxic effect on the ocular surface. Given its ease of use and antibacterial activity, as well as its efficiency in stopping bleeding, the use of ABS during ocular surgery should be further investigated in experimental and clinical studies.

Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation.

OBJECTIVE: To evaluate the effects of peritonsillar injection of levobupivacaine with epinephrine in children undergoing adenotonsillectomy, through an intraindividual study. PATIENTS AND METHODS: 20 children (age 6-13 years) undergoing elective tonsillectomy with or without adenoidectomy were enrolled in this prospective, randomized, intraindividual trial. After entubation and just prior to incision, 3 ml of 0.25% levobupivacaine with epinephrine was injected into one peritonsillar region while 0.9% saline was being used for the contralateral side. Amount of intraoperative blood loss, duration of tonsillectomy, postoperative pain, otalgia and hemorrhage were assessed for each side separately. Visual analog scale was used for postoperative pain assessment. Heart rate and mean arterial pressure during and after operation were also observed. The follow-up period after surgery was 10 days. RESULTS: Median visual analog scale values for the levobupivacaine with epinephrine injected side was significantly lower than the saline injected side, during the first postoperative 16h (p<0.05). There were also significant differences between the intraoperative blood losses of the two sides (p<0.05). However; no significant differences were observed with respect to duration of surgery, postoperative otalgia and hemorrhage (p>0.05). CONCLUSION: Preincisional injection of levobupivacaine with epinephrine decreases early postoperative pain and intraoperative blood loss as well.

[Foreign body which resembles concha bulloza in the middle meatus: a case report]. / Orta meatusta konka bullozaya benzer yabanci cisim: Olgu sunumu.

Diagnosis of foreign body in the nasal cavity may be difficult because it has a wide variety of presentations. Concha bullosa is defined as the pneumatization of the middle concha in various degrees. A 43-year-old female patient was admitted to our clinic with the complaint of breathing difficulty through her right nostril which had been going on for the last year. She had had some medical treatments previously in some different medical centers, there wasn't purulent discharge with unpleasant odour, bleeding and halitosis in the nose and there wasn't a history of a blow to the nose or a history of previous facial, nasal or dental surgery. In the computed tomography there was an image resembling concha bullosa. Transnasal endoscopic approach was used, under general anesthesia, in the patient, whose physical examination results, laboratory findings and allergy test results were normal. Endoscopic sinus surgery was performed including polypectomy, right uncinektomy and the foreign body was removed from the middle meatus using a forceps. No complications were observed in the follow-up control one month later.

Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations.

STUDY OBJECTIVE: To determine the effect of dexmedetomidine on intraoperative bleeding during septoplasty and tympanoplasty operations. DESIGN: Randomized, placebo-controlled study. SETTING: Univesity medical center. PATIENTS: 80 ASA physical status I and II patients, aged 18 to 65 years, 40 of whom were scheduled for septoplasty and 40 to undergo tympanoplasty operations. INTERVENTIONS: Patients undergoing septoplasty (S) and tympanoplasty (T) operations were randomly divided into 4 groups. Dexmedetomidine (D) was administered to Group SD and Group TD first as a bolus dose of one microg kg(-1), then intraoperative maintenance was supplied with dexmedetomidine 0.7 microg kg(-1) hour(-1). Groups S and T (controls) were given identical amounts of saline. If systolic blood pressure measurements are greater than 20% preoperative values, then fentanyl one microg kg(-1) was given. MEASUREMENTS: Intraoperative blood loss was determined with suction volumes and gauze counting. Bleeding was rated according to a 6-point scale. Hemodynamic parameters and fentanyl administration were recorded. MAIN RESULTS: Group SD had less bleeding and lower bleeding scores (P < 0.05). In addition, this group received less intraoperative fentanyl (P < 0.05). The only significant difference between Groups TD and T was the amount of intraoperative fentanyl given (35.4 +/- 58.8 vs 110.0 +/- 81.0 microg) (P < 0.05). CONCLUSION: Dexmedetomidine reduces bleeding, bleeding scores, and intraoperative fentanyl consumption during general anesthesia in septoplasty operations.

Could radiofrequency myringotomy be an alternative to incisional myringotomy?

OBJECTIVE: To evaluate the usefulness of radiofrequency myringotomy (RFM) and the closure time of the myringotomy site in comparison to incisional myringotomy (IM). METHODS: We performed conventional surgical myringotomy on the right ears and RFM on the left ears of 40 rabbits. In order to investigate the effect of the power of energy delivered on the patency period we arranged the animals into two groups: three power grade in RFM group 1 (RFMg1; n: 20) and six power grade in RFM group 2 (RFMg2; n: 20). The follow-up of the myringotomy procedure was performed on days 5, 8, 11, 14 and 17 with examination under the operating microscope. RESULTS: At the first examination on day 5 after the procedure, all IM openings were found to be closed while seven and eight (36 and 44%) of the tympanic membranes in the radiofrequency groups 1 and 2 remained open, respectively. In these remaining ears, RFM site was patent up to days 11 and 14, respectively in the two RFM groups. None of the RFMs was patent on study day 17. The difference between the closure time of myringotomy sites of the radiofrequency and IM groups was statistically significant (p < 0.05). In comparison of the two RFM groups, we found approximately equal rates regarding the myringotomy patency (p > 005; chi2 yates: 0.02). The complication rates were 5 and 2% for the IM and RFM groups, respectively. CONCLUSIONS: Radiofrequency myringotomies last longer than incisional myringotomies. With the low complication rate, it is possible to perform this bloodless RF procedure in an office setting. Increased power grade of radiofrequency has no effect on prolonging the myringotomy patency. RFM appears to be a safe and simple procedure that can be used as an alternative to IM.

Effect of adenoidectomy and/or tonsillectomy on cardiac functions in children with obstructive sleep apnea.

BACKGROUND/AIMS: We aimed to determine the effects of adenoidectomy and/or tonsillectomy (AT) on cardiac functions in children with adenoid and/or tonsillary hypertrophy and obstructive sleep apnea syndrome (OSAS) by using echocardiography with tissue Doppler imaging facility (TDI). METHODS: Twenty-nine children with adenoid and/or tonsillary hypertrophy and OSAS and 26 children with primary snoring entered the study. Cardiac functions were assessed by echocardiography with TDI in both groups. Tests were repeated in the OSAS group 6 months after treatment with AT. RESULTS: Echocardiography showed a decrease in estimated pulmonary artery systolic pressure from 31 +/- 4.2 to 13.1 +/- 2.3 (p < 0.001). In TDI, tricuspid E(m) and E(m)/A(m) increased from 11.0 +/- 2.7 to 13.5 +/- 2.7 cm/s (p < 0.001), and 1.46 +/- 0.52 to 1.82 +/- 0.53 (p = 0.004), respectively, following AT, indicating improvement in right ventricular diastolic dysfunction. Similarly, mitral E(m) and E(m)/A(m) increased from 12.3 +/- 2.1 to 16.3 +/- 2.7 cm/s, and from 1.65 +/- 0.51 to 2.30 +/- 0.54, respectively (p < 0.001). There was no significant difference between postoperative values and control group values. CONCLUSION: TDI is a technique able to detect diastolic dysfunction unnoticeable by conventional echocardiography. Following AT, we observed improvement in both left and right ventricular diastolic functions using TDI.

A reliable surface landmark for localizing supratrochlear artery: medial canthus.

OBJECTIVE: To determine the reliability of medial canthus as a surface landmark to locate supratrochlear vascular pedicle. STUDY DESIGN AND SETTING: The distance from medial canthal line to supratrochlear vascular pedicle was measured in 57 healthy volunteers (Doppler imaging study) and also in 15 fresh cadavers. RESULTS: In the Doppler study, the pedicle was found at most 3 mm lateral or medial to medial canthus (mean +/- SD, 0.8 +/- 0.7 mm). SVP mark tended to be medial to the medial canthus mark in females (males, 6; females, 42), whereas it was lateral to it in males (males, 20; females, 5). In the cadaver study, the pedicle was found 0.7 mm away from medial canthus on average. CONCLUSION: Medial canthus can be used as a reliable landmark for paramedian forehead flaps. When Doppler examination fails, pedicle may be found at most 3 mm away from medial canthus. SVP is more commonly located lateral to medial canthus in males and medial to it in females.

Effects of intramuscular and peritonsillar injection of tramadol before tonsillectomy: a double blind, randomized, placebo-controlled clinical trial.

BACKGROUND/AIMS: Our objective was to investigate the efficacy of intramuscular injection and peritonsillar infiltration of tramadol to prevent pain in children undergoing tonsillectomy. METHODS: In a double-blinded trial, 45 children were randomized into three groups: infiltration anesthesia with tramadol (2 mgkg(-1)) to the peritonsillar area (INF group, n=15), intramuscular analgesia with tramadol (2 mgkg(-1)) (IM group, n=15), and the placebo controls (PL group, n=15). Visual analog scale (VAS) scores for pain assessment, heart rate (HR) and mean arterial pressure (MAP) during and after anesthesia were recorded. RESULTS: Mean HR values were higher in INF than PL group at 10th, 20th, and 30th minutes of operation (P<0.05). Nine children required analgesics within the first hour after surgery in PL compared to 1 child in INF group (P=0.036). VAS scores on awakening were significantly better in INF than PL group (P=0.015). The difference between IM and PL groups was not significant for any of the parameters. CONCLUSION: Peritonsillar infiltration with tramadol provided good intraoperative analgesia, less postoperative pain on awakening and lower analgesic requirement within the first hour after surgery.

Tularemia, a reemerging disease in northwest Turkey: epidemiological investigation and evaluation of treatment responses.

An outbreak of tularemia occurred in three provinces in Turkey in February 2004 and reemerged in the same provinces in February 2005. A total of 61 cases, 54 of which were confirmed with the micro-agglutination test, were diagnosed with oropharyngeal tularemia. No culture for Francisella tularensis was attempted, but PCR for F. tularensis was positive in aspiration material of suppurated lymphadenitis of 7 patients. F. tularensis detection with PCR was negative in water samples, but epidemiologic and environmental findings suggested that contaminated water or food was the cause of the outbreaks. Late initiation antibiotic therapy could not prevent suppuration and draining of the involved lymph nodes.

[Long-term results of radiofrequency-assisted posterior transverse cordotomy in a rabbit model]. / Tavsan modelinde radyofrekans yardimli posterior transvers kordotominin uzun dönem sonuçlari.

OBJECTIVES: We evaluated the long-term results of radiofrequency-assisted posterior transverse cordotomy in a rabbit model. STUDY DESIGN: Ten healthy New Zealand rabbits were subjected to videolaryngoscopic examination following intraperitoneal anesthesia with 20 mg/kg thiopental. After local infiltration anesthesia with lidocaine, a laryngofissure procedure and exposition of the vocal cords were carried out and posterior transverse cordotomy was performed to the right vocal cord in the cutting mode using radiofrequency waves (Ellman Surgitron). The thyroid cartilage was closed in anatomic position and the rabbits were followed-up for three months, after which videolaryngoscopic examination was repeated. The rabbits were then sacrificed for histopathologic examination. RESULTS: At the end of the follow-up period, videolaryngoscopic examination showed neo-cordogenesis in the right vocal cord region. Histological examination showed closure of the operation site by granulation tissue and fibrosis. CONCLUSION: The opening created in the rabbit larynx using radiofrequency was filled by granulation tissue and fibrosis in the long-term.