A golden ratio for foramen magnum: an anatomical pilot study.

BACKGROUND: The foramen magnum (FM) is an important landmark because of its close relationship to key structures such as the brainstem and spinal cord, an extension of the medulla oblongata. Because of the similarity in their shape, the existence of a relationship between cranial length and anteroposterior diameter of the FM, and between cranial width and transverse diameter of the FM may reveal the magnificent harmony of the skull and FM. Based on this idea, we investigated the existence of this harmony in skulls that we used in our study. MATERIALS AND METHODS: In this study, 60 adult dry skulls belonging to the Turkish population were examined. The anteroposterior and transverse diameters of the foramen magnum and the length and width of the skull were measured. Measurements were made directly on the skull using a digital sliding calliper. New indices and ratios were applied with those measurements. RESULTS: Our study suggests that FM width and FM length could be estimated by using the cranial length and cranial width measurements in the skull by accepting the mean of these coefficients (4.62) as the golden ratio. The average of the coefficients of cranial width to FM width ratio (4.62 ± 0.35 [95% CI: 4.52-4.70]) and the average of the coefficients of cranial length to the FM length ratio (4.62 ± 0.50 [95% CI: 4.49-4.76]) were found to be equal to each other. In order to check the accuracy of this hypothesis, FM width and FM lengths were estimated with the help of new equations. CONCLUSIONS: In the present study, the ratio between the anteroposterior and transverse diameters of both FM and the cranium was estimated at 4.62, indicating a magnificent harmony between cranial and subcranial structures. With this ratio, it is easy to estimate FM's size based on simple cranial measurements.

Determination of the relationship between patient satisfaction and some global economic indicators using multidimensional scaling.

CONTEXT: The importance of labor that contributes to the economy and economic power of the country is increasing recently. There is a strong link between health and economy. People are happier, more productive, and provide more contribution to the economy in communities of healthy individuals. In countries with strong economy, serious economic investments are made in the field of health to grow healthy individuals. AIM: The purpose of this study is to determine whether patient satisfaction in primary healthcare services is related to economic strength of countries. MATERIALS AND METHODS: The data of European Patients Evaluate General/Family Practice (EUROPEP) scale from 2011 at 17 Organization for Economic Co-operation and Development (OECD) countries are used. The data were compiled from OECD reports and Republic of Turkey Ministry of Health Refik Saydam Hygiene Center Presidency School of Public Health patient satisfaction with primary healthcare services reports. STATISTICAL ANALYSIS USED: 17 OECD member countries in 2011 health expenditure data, some health indicators, and patient satisfaction are determined to show how grouping in two-dimensional space with the multidimensional scaling. RESULTS: It was observed to vary by countries and groupings that they located in terms of all three criteria. In some countries' economic and health indicators, although quite high compared to the OECD average, citizen satisfaction of healthcare services was low. In some countries, although health expenditure and health indicators are far below the OECD average, citizens' satisfaction with health services has proved to be very high. CONCLUSION: Multidimensional scaling analysis findings reveal that countries have different positions and groups in terms of each three indicators. According to these results, it cannot be said that high expenditures in the field of health will affect patients satisfaction. Having a strong economy or spending too much money on health does not increase human satisfaction in health care. Effective expenditures on the field of health will increase healthcare service satisfaction. Policy-makers should consider international criteria and take the right steps according to citizens' expectation and satisfaction of healthcare service to implement effective spending.

The determination of the levels of burnout syndrome, organizational commitment, and job satisfaction of the health workers.

CONTEXT: The concept of burnout is an important element for efficiency in occupational groups such as health and education, which necessitate constant communication with people and have a busy schedule. AIMS: The determination of the levels of burnout syndrome, organizational commitment, and job satisfaction of the health workers. MATERIALS AND METHODS: A questionnaire consisting of four parts was prepared so as to measure the levels of organizational commitment, job satisfaction, and burnout of the medical staff of the institution. The data for this research were gained by a questionnaire sent to 370 medical staff (doctors, nurses, contract staff, and other employees). STATISTICAL ANALYSIS USED: Kolmogorov Smirnov test, t-test, ANOVA, Tukey multiple comparison test and Pearson's correlation analysis were used to this study. RESULTS: The average age of the employees taking part in the questionnaire was calculated as 34.30 years (min: 18 years, max: 59 years). The proportional value of the individuals with their 0-5 years working period in the institution was observed as 58.1%. An individual's interior work satisfaction, education level, hours worked at the hospital and their titles are also statistically important (P< 0.05). There is a positive correlation and significant relation between medical staffs' emotional exhaustion and desensitization (r = 0.573). There is a positive correlation and significant relation between normative commitment sub dimension, interior and exterior job satisfaction (r = 0.449, r = 0.472). CONCLUSIONS: Efforts to reduce the job burnout and psychological support for health care workers support motivation in order to provide better services to increase significantly. Thus, both personal productivity will be increased, and gain will be obtained in the institutional sense.

Adjunctive use of mitomycin C in endoscopic revision dacryocystorhinostomy.

OBJECTIVES: Success rates for revision dacryocystorhinostomy (DCR) are lower than primary DCR. Scarring of the sac may limit the surgeon's ability to achieve good nasal and lacrimal mucosa apposition. The aims of this study were to assess the long term safety and efficacy of intra-operative use of adjunctive mitomycin C (MMC) treatment in endoscopic revision DCR surgery over 12-24 (mean 17) months. METHODOLOGY: This was a prospective, nonrandomized consecutive case series that included 20 adult patients (20 eyes) with failed primary external DCR who underwent revision surgery under assisted local anaesthesia. During revision endoscopic DCR, intra-operative adjunctive MMC (0.2 mg/mL) was applied to the osteotomy site of the lacrimal sac and scar tissue surrounding the surgical osteum for 5 minutes. RESULTS: The surgical success rate was determined based on the patency of the nasolacrimal system by irrigation and resolution of patient symptoms. Endoscopic revision DCR surgery with MMC was successful in 90% of cases (18 of 20 cases). No adverse effects (eg, abnormal nasal bleeding, mucosal necrosis, infection) or any other surgical adverse events were observed. CONCLUSIONS: Adjunctive intra-operative MMC application with endoscopic DCR surgery had a good success rate in patients with nasolacrimal duct obstruction that required revision surgery. Further large, double blind, placebo controlled, randomized studies are needed to confirm these findings.

Is there any correlation between chronic noise-induced hearing loss and mastoid pneumatization volume? A preliminary study.

OBJECTIVES: To investigate the possible association between chronic noise-induced hearing loss and the volume of mastoid pneumatization. METHODOLOGY: The study involved 46 subjects employed in the press and montage department of a gun factory: 28 in the study group with noise-induced hearing loss and 18 in the control group with no hearing loss. The volume of mastoid pneumatization was measured with computed tomography. Student's t test was used in the comparison of the mastoid volumes of the study and the control groups. RESULTS: The intergroup evaluations showed no significant difference between the study and control group with regards to age, use of substances or ototoxic drugs, systemic diseases, use of personal hearing protectors, duration of occupational and non-occupational noise exposure was observed (P > 0.05). The mean values of mastoid pneumatization in the study and the control groups were 9717.6 mm3 and 11005.8 mm3, respectively. Although the volume of mastoid pneumatization was smaller in the study group than in the control group, this difference was not statistically significant (P > 0.05). CONCLUSIONS: This preliminary study showed that there was no significant correlation between mastoid pneumatization volume and chronic noise-induced hearing loss. However, this correlation could be significant in further studies with a larger number of subjects.

Giant fibrovascular polyp of the hypopharynx: per-oral endoscopic removal.

OBJECTIVE: We report an extremely rare case of giant fibrovascular polyp of the hypopharynx. METHOD: We present a 49-year-old man who had increasing difficulty swallowing, advanced respiratory distress and weight loss, as well as a hypopharyngeal mass protruding from his mouth. RESULTS: Diagnosis was confirmed by endoscopic examination and computed tomography. A tracheostomy was required due to laryngeal obstruction by the regurgitated mass. The giant polyp was removed via per-oral endoscopic excision under general anaesthesia. CONCLUSION: Fibrovascular polyps occur most commonly in the cervical oesophagus, and are extremely rare in the hypopharynx. They can grow to a very large size over several years. We discuss the symptoms, diagnosis and surgical treatment techniques for upper aerodigestive tract fibrovascular polyps, in the light of the literature.

Evaluation of the roles of serum vitamin B(12), folate and homocysteine levels in laryngeal squamous cell carcinoma.

Metabolic changes in head and neck carcinogenesis are often non-specifically correlated with carcinomas. The study of metabolic disorders can improve the understanding of tumourigenesis at the cellular level. This study was designed to evaluate the role of serum homocysteine, folate, and vitamin B(12) levels in the pathogenesis of laryngeal squamous cell cancer (LSCC) by measuring serum levels in 60 consecutive untreated patients with LSCC and 60 controls (30 smokers and 30 non-smokers). Compared with smoker and non-smoker control groups, significantly lower levels of vitamin B(12) were found in patients with LSCC. Folate levels in patients with LSCC were also significantly lower than in the smoker and non-smoker control groups. There were no significant differences in the homocysteine levels between these three groups. Metabolic alterations in vitamin B(12) and folate levels, particularly hypofolataemia, could be associated with the development of LSCC, although further research is required to confirm their roles definitively.