Procalcitonin Levels in Chronic Rhinosinusitis.

OBJECTIVE: The aim of this study was to evaluate and compare procalcitonin levels of patients diagnosed with chronic rhinosinusitis (CRS) with nasal polyposis (CRSwNP) and CRS without nasal polyposis (CRSsNP) along with healthy controls. METHODS: A total of 67 subjects were included. Twenty-two CRSwNP patients were included in group A, 25 CRSsNP patients in group B, and the control group (group C) consisted of 20 healthy subjects. Procalcitonin level was assessed after CRSwNP or CRSsNP diagnosis. Healthy individuals scheduled for septorhinoplasty constituted the control group. Nasal polyposis was graded according to the Meltzer Clinical Scoring System. RESULTS: The mean procalcitonin levels of patients of groups A, B and C were 0.042±0.020 µg/L, 0.031±0.016 µg/L and 0.031±0.010 µg/L, respectively. Mean procalcitonin levels were significantly higher in group A compared to groups B and C (p=0.05 and p=0.032). However, mean procalcitonin levels were not significantly different between group B and group C (p=0.962). Four patients (18%) had grade 1, three had (13.6%) grade 2, eight had (36.4%) grade 3, and seven had (31.8%) grade 4 polyposis. Mean procalcitonin levels for grades 1, 2, 3 and 4 polyposis were 0.045±0.030 µg/L, 0.037±0.006 µg/L, 0.041±0.021 µg/L and 0.043±0.019 µg/L, respectively. No statistical significance was present regarding the mean procalcitonin levels of polyposis grades (p>0.05). CONCLUSION: Procalcitonin, which is an important inflammatory marker especially in sepsis and systemic inflammation, was significantly elevated in CRSwNP patients compared to CRSsNP patients and healthy controls. This may support the presence of chronic mucosal inflammation in CRSwNP patients. However, procalcitonin is an indirect marker of inflammation and further studies with larger patient groups are warranted.

Malignant Otitis Externa: A Retrospective Analysis and Treatment Outcomes.

OBJECTIVE: The purpose of this study was to analyze previous treatments and outcomes in patients with malignant otitis externa (MOE) retrospectively. The efficacy of medical and surgical treatments was also evaluated. METHODS: This study included 25 patients diagnosed with MOE and treated at the Department of Otorhinolaryngology, Ege University School of Medicine between 2006 and 2017. The duration of hospitalization, Hemoglobin A1c (HbA1c) levels of the patients, erythrocyte sedimentation rate (ESR), source of the infection, complications, and previous medical and surgical treatments were also retrospectively assessed. RESULTS: The mean age of the patients (7 females and 18 males) was 69.68±11.29 years. The mean length of hospital stay in patients with HbA1c levels ≤6 and in patients with HbA1c levels >6 was 26.86 and 33.39 days, respectively. The mean hospitalization time was significantly longer in patients with HbA1c levels >6 (p<0.05). Additionally, elderly patients (age>65 years) had a significantly longer hospital stay in our study (p<0.05). ESR was found to be 52.76±32.49 (9-108) mm/h at the first examination and 14.92±1.22 (4-32) mm/h at the time of discharge. CONCLUSION: MOE is an aggressive disease that requires conservative management, and ESR proved to be a good indicator of treatment response. Long-term antibiotherapy are recommended for treatment.

Endoscopic versus microscopic type 1 tympanoplasty in the same patients: a prospective randomized controlled trial.

The aim of this study was to compare the audiologic outcomes of the patients who underwent endoscopy on one ear and microscopic tympanoplasty on the other, and to investigate the operative time, graft success, postoperative pain and health status. This prospective randomized controlled study was carried out in Ege University ENT Department between February 2015 and September 2016. The patients who had bilateral chronic otitis media, normal middle ear mucosa and a hearing loss difference of 10 dB or less between the two ears randomly underwent microscopic tympanoplasty in one ear and endoscopic tympanoplasty in the contralateral ear, with 6-month intervals. 13 patients were included in the study with a mean age of 36.17 ± 3.61 years (range 17-53 years, 7 female, 6 male). The improvement in air-bone gap for groups 1 (endoscopic) and 2 (microscopic) was 9.48 ± 5.23 and 9.89 ± 2.79 dB, respectively. The duration of the surgery in group 1 was significantly lower than that in group 2 (p < 0.01). VAS scores were 2.15 ± 0.37 and 3.76 ± 1.64 cm for groups 1 and 2, respectively (p = 0.006). The endoscopic approach for type 1 tympanoplasty offers shorter surgery time, better health status and lower postoperative pain than microscopic surgery. In addition, endoscopic surgery offers comparable improvement in air-bone gap and similar graft success. The endoscopic approach has comparable audiological and morphological graft outcomes with the microscopic one. The endoscopic approach yielded better health and pain status for the same patients. Level of evidence This is an individual randomized controlled trial. The level of evidence is 1b.

The effect of creatinine clearance on the short-term outcome of neuropathic diabetic foot ulcers.

Reduced creatinine clearance is related to an increased risk for diabetic foot ulcer development. Wound healing has been reported to be worse in diabetic patients with impaired kidney functions than general diabetic population. This study aimed to investigate the effect of creatinine clearance on the short-term outcome of neuropathic diabetic foot ulcers. Data from 147 neuropathic diabetic foot ulcer episodes were included in this observational study. Patients were admitted to Dokuz Eylul University Hospital between January 2003 and June 2008. Patients were excluded if they had limb ischemia. Diabetic nephropathy was investigated by 24h urinary albumin excretion and serum creatinine levels. Creatinine clearance was calculated according to Cockcroft-Gault formula. Foot ulcers were followed up for 6 months to determine the outcome. Our short-term follow-up revealed that neuropathic diabetic ulcers healed worse in patients with decreased creatinine clearance than in those who had normal creatinine clearance. Amputation rates were also found to be higher. Our results suggest that creatinine clearance is an important factor affecting wound healing in patients with neuropathic diabetic foot ulcers.

Adrenal incidentaloma, clinical, metabolic, follow-up aspects: single centre experience.

To investigate clinical characteristics, metabolic parameters and follow-up findings of subjects with incidentally discovered adrenal tumors. 376 consecutive subjects who have been evaluated since 2002 were included. Initial radiological examination was CT. Hormonal evaluation included 8.00 a.m. cortisol, DHEA-S, ACTH and in hypertensive subjects, plasma renin activity, and serum aldosterone. Urinary free cortisol (UFC), urinary normetanephrine, and metanephrine were measured. Overnight 1 mg dexamethasone suppression test was performed. Radiological evaluation was performed at 6th and 12th months and annually in subsequent visits. Hormonal evaluation was performed 6 months after the initial visit and annually in subsequent visits. Additionally, patients were evaluated for the development of Type 2 diabetes mellitus, hypertension, hyperlipidemia, and metabolic syndrome in 6-month intervals. Mean age of the participants was 54.7 ± 13.1. Female subjects were more commonly affected (70%). CT was the most frequent radiological intervention that discovered adrenal masses (57%). The vast majority of the participants (85.6%) had benign adrenal adenomas. Primary adrenocortical malignancy was detected in 4 subjects (1.1%). Subjects with adrenal adenomas had significantly smaller tumor diameters (P ≤ 0.001 vs. other tumors). Sensitivity and specificity of 40 mm as a cut-off value in the differentiation of adrenal gland malignancies from benign tumors was 73.3 and 54.8%, respectively. Most of the adrenal adenomas were non-functioning (73.5%). Subclinical Cushing syndrome (sCS) was detected in 12.5%. The overall prevalence of Type 2 diabetes mellitus, hypertension, hyperlipidemia, and metabolic syndrome was 18.4, 54.9, 59.6, and 48.1%, respectively. They were significantly more common in middle-aged and elderly subjects. During 24 months follow-up 10.2% of adenomas featured increase in tumor diameter and 2.06% developed sCS. Young subjects featured more stable tumor diameter and hormonal status. Most of the incidentally discovered adrenal tumors were non-functioning adrenal adenomas. Clinically overt hormone hypersecretion syndromes were mainly shown in young subjects, while adrenal gland malignancies and sCS were more common in older ages. Mass enlargement and development of subclinical cortisol secretion were not rare and observed especially in middle-aged and elderly subjects. Metabolic derangements were common; however, a possible independent association between adrenal adenoma and metabolic problems need to be elucidated with prospective studies.

Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort.

OBJECTIVE: Prediction of diabetic foot ulcer outcome may be helpful for clinicians in optimizing and individualizing management strategy. The aim of the present study was to examine the possibility of predicting the outcome of patients with diabetic foot ulcers by using easily assessed clinical and laboratory parameters at baseline. DESIGN: In this observational study, data were collected prospectively in 670 consecutive diabetic foot ulcer episodes in 510 patients examined between January 1999 and June 2008 and were used to evaluate potential predictors of amputation retrospectively. After exclusion of patients who did not come to the hospital for follow-up for a minimum of six months, data of 574 foot ulcer episodes were evaluated. RESULTS: Limb ischemia, osteomyelitis and presence of gangrene and ulcer depth, determined by the Wagner classification system, were the major independent predictors of overall and major amputations. Older age, presence of coronary artery disease, smoking and ulcer size were found to be associated with either overall or major amputations. Baseline levels of acute phase reactants (white blood cell count, polymorphonuclear leukocyte count, platelet count, erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and albumin) and decreased hemoglobin levels were associated with amputation risk. Multivariate analysis showed that one standard deviation increase in baseline CRP and ESR levels were independent predictors of overall and major amputations, respectively. CONCLUSIONS: The presence of limb ischemia, osteomyelitis, local and diffuse gangrene and ulcer depth were independent predictors of amputation. Baseline levels of ESR and CRP appeared to be helpful for clinicians in predicting amputation.