A study on the efficacy of combined surgery in advanced-stage congenital cholesteatoma with canal-wall-up surgery.

PURPOSE: This study aimed to compare the outcomes of patients with advanced congenital cholesteatoma who underwent microscopic or endoscope-combined Canal Wall Up Tympanomastoidectomy (CWUT) in our clinic and to determine the contribution of endoscope use in reducing recurrence/residual rates. METHODS: In this retrospective study, the data of individuals who underwent microscopic or combined endoscopic surgery between 2008 and 2022 in our clinic were scanned from the database. Demographic data, preoperative computed tomography (CT) findings, preoperative and postoperative hearing results, operation and intraoperative status of the ossicles, duration of surgery, postoperative follow-up period, recurrence and residual disease status during follow-up were investigated. RESULTS: The data of 37 pediatric cases operated in our clinic were included in the study. All of the included cases were Potsic Stage 4 patients who underwent CWUT. The mean age of the operated individuals was 8.7 years (5-12 years) and the mean follow-up period was 47.3 months (12-112 months). 19 cases were performed microscopically only, 2 recurrences and 5 residuals were detected. 18 cases were performed combined and 1 recurrence and 1 residual was found. CONCLUSION: In this study, it was determined that using an endoscope together with a microscope in congenital cholesteatoma cases, decreased the rate of recurrence and residual disease by protecting the external auditory canal in patients with advanced mastoid invasion.

The Utility of the Cachexia Index and the Modified Glasgow Score in Young Patients With Breast Cancer.

Background Breast cancer is the most common cancer in women. Body composition and inflammatory markers are increasingly important for predicting cancer prognosis. The Cancer Cachexia Index (CXI) and the modified Glasgow Prognostic Score (GPS) are two new markers evaluating prognosis in cancer. In this study, we evaluated the utility of the CXI and the modified GPS in young patients with breast cancer. Methods Eighty patients diagnosed between 2012 and 2023 were included in the study. The following information was recorded: patient features, pathological subtype, estrogen receptor and human epidermal growth factor receptor-2 (HER-2) status, disease stage, therapies, disease recurrence, and last control or death date. The CXI and the modified GPS were calculated using clinical data, including skeletal muscle index, albumin, C-reactive protein, and neutrophil-to-lymphocyte ratio. Results There were no differences in overall survival with respect to the CXI in the study population (p=0.96). Only stage 4 patients showed statistically significant survival differences according to the CXI (p=0.046). Although the median survival time was not reached for the modified GPS groups, there was a statistical overall survival difference favoring the negative group (p=0.017). No significant differences were observed in disease-free survival due to the CXI (p=0.128). In multivariate analysis, no factors, including the modified GPS and the CXI, influenced overall survival. There was a significant effect of the modified GPS and body mass index on recurrence (p=0.037; p=0.034). The CXI had a non-significant marginal p-value (p=0.074). Conclusion Our study showed that the modified GPS may be related to disease-free survival and overall survival, whereas the CXI has a more prominent prognostic effect on overall survival in advanced-stage breast cancers. In early-stage and young patients, optimization of risk scores is lacking.

Assessment of lower extremity venous insufficiency and lipedema and their association with knee symptoms, functions, and quality of life in patients with knee osteoarthritis.

OBJECTIVE: To evaluate the effects of the venous insufficiency (VI) or lipedema on the symptoms, functions, and quality of life (QoL) of patients with knee osteoarthritis (OA). METHODS: 96 patients with stage 3/4 knee OA were included in the study. Patients were grouped as OA (n = 35), VI + OA (n = 35), and lipedema + OA (n = 26). Range of motion (ROM), Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), short-form (SF-36), and 6-minute walking test (6MWT) were evaluated. RESULTS: WOMAC stiffness score was significantly higher in the VI group than the other groups (p < .05). VAS resting, WOMAC pain, function, and total scores were significantly higher in the lipedema + OA and VI + OA groups than the OA group (p < .05). SF-36-physical role limitation was significantly lower in the lipedema and VI groups (p < .05). CONCLUSION: VI or lipedema accompanying knee OA increases the existing disability due to OA by negatively affecting patients regarding pain, QoL, and physical functioning.

Acute Otitis Media with Intracranial and Intratemporal Complications: A Case Study.

Acute otitis media continues to be one of the most common infections today and a major cause of the prescription of antibiotics in the pediatric age group. Complications of this condition are rare, especially when antibiotic therapy is started early; however, complications related to acute otitis media cause dramatic morbidity. This report provides a review related to a case of acute otitis media with bilateral intracranial and intratemporal complications.

Evaluation of an Immersive COVID-19 Data Visualization.

COVID-19 restrictions have detrimental effects on the population, both socially and economically. However, these restrictions are necessary as they help reduce the spread of the virus. For the public to comply, easily comprehensible communication between decision makers and the public is thus crucial. To address this, we propose a novel 3-D visualization of COVID-19 data, which could increase the awareness of COVID-19 trends in the general population. We conducted a user study and compared a conventional 2-D visualization with the proposed method in an immersive environment. Results showed that the our 3-D visualization approach facilitated understanding of the complexity of COVID-19. A majority of participants preferred to see the COVID-19 data with the 3-D method. Moreover, individual results revealed that our method increases the engagement of users with the data. We hope that our method will help governments to improve their communication with the public in the future.

A safety investigation into topical effects of naproxen sodium on nasal epithelial cells and potential toxicity in local application.

OBJECTIVES: We examined how topically-applied naproxen sodium affects human nasal epitheliocytes in culture. METHODS: Samples of healthy human primary nasal epithelium (NE) harvested during septoplasty from volunteers without rhinosinusitis were incubated in cell culture. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assays may be utilised when assessing cellular damage (toxicity), as evidenced by DNA fragmentation, nuclear condensation, alteration in the outer plasma membrane and cytoskeletal alteration. This was the method used in the study. Cultured epitheliocytes were incubated with naproxen sodium for 24 h at 37 °C. The MTT assay was then performed and the cells' morphology was examined by confocal microscopy. Additionally, cellular proliferation was assessed by the artificial scratch method followed by light microscopy. RESULTS: The results indicated that naproxen sodium does not cause any cytotoxic effects upon nasal epithelial cells when applied topically. There was no evidence indicating cytotoxicity on the nasal epitheliocytes in culture for the 24 h period over which the drug was applied. In particular, there was no alteration in cellular morphology, damage to the intracellular organelles structure or the cytoskeleton secondary to naproxen sodium. Furthermore, cellular proliferation occurred normally in these conditions, as on scratch test. CONCLUSION: Topical naproxen sodium may be used on nasal epithelial cells without inducing toxicity. This agent is therefore suitable, given its known anti-inflammatory effects, for use in patients suffering from diseases involving nasal and paranasal sinusal inflammation, including rhinosinusitis (both chronic and acute) and nasal polyposis which should be investigated. In the future, topical medication forms for nasal usage should be developed.

Attitudes and practices against COVID-19 vaccines in Turkiye.

OBJECTIVE: Vaccination is the primary way to mitigate the COVID-19 pandemic. Vaccine hesitancy and refusal are one of the most important challenges against to reach herd immunity. The aim of this study is to examine the reasons for not getting vaccinated and the attitudes toward vaccines by people in Turkiye, who were not vaccinated, even though a COVID-19 vaccine was available for them. METHODS: This cross-sectional study is conducted in Eyupsultan district of Istanbul. The study population is 12,540. A questionnaire consisted of three sections as sociodemographic characteristics, attitudes toward COVID-19 vaccines, and Vaccination Attitudes Examination (VAX) scale was used. Among the sample size, participation rate is 69.4%. RESULTS: About 50.2% of the participants (n=259) are male, 80.3% are married, 13.1% are university graduates, and 44.0% are working in a job. About 32.8% of the participants have COVID-19 history. About 34.4% of the participants stated that they would be vaccinated against COVID-19. Although those who define themselves as vaccine refuser are 5.4%, those who still refuse to be vaccinated for COVID-19 are 20.1%. In addition to this, those who are hesitant about COVID-19 vaccines are 45.6%. The most frequently preferred vaccine is comirnaty (41.7%). About 13.1% of the participants stated that "if we had a domestic COVID-19 vaccine, I would have it." The most common sources of information about vaccines are television with 78.4%, and health workers are in the last place with 14.7%. "Concerns about side effects" are the most frequently cited (85.9%) reason for not vaccinating. The mean score of the VAX scale is 42.34±10.93, and the "mistrust of vaccine benefit" is higher among primary school graduates than other educational status groups (p=0.001). CONCLUSION: Anti-vaccination attitudes have increased with the COVID-19 vaccines during pandemic. Our study is valuable in terms of examining the reasons of individuals who have not gotten vaccinated even though they had no access problems. Prominent concerns of the population should be approached seriously. Otherwise, vaccine hesitancy can be a decisive factor that would prevent the success of the struggle against pandemic.

Cardiac MRI findings in patients with Crohn's disease.

BACKGROUND: Early cardiac death is more common in patients with Crohn's disease (CD) than in healthy adults, but the exact cause is unknown. AIMS: The aim of this study is to investigate the cardiac magnetic resonance imaging (MRI) findings in patients with CD and compare the MRI findings with healthy controls (HCs). This study also aimed to demonstrate the possible cardiac involvement in patients with CD using MRI. METHODS: In this prospective study, participants with CD (n = 20) and HC (n = 20) underwent cardiac MRI. Erythrocyte sedimentation rate (ESR) and hematocrit levels were investigated before MRI in both groups. Two observers evaluated the ventricular functional and morphological parameters in consensus. Myocardial T1/T2-relaxation times were calculated by two observers independently using two different software, and hematocrit-corrected left ventricle extracellular volume (LV-ECV) was calculated. Observer-2 also performed histogram analysis for T1/T2-mapping images. RESULTS: Patients with CD had a significantly higher LV-ECV, mildly decreased right ventricle ejection fraction, and prolonged T2-relaxation time than HC. Moreover, histogram analysis showed that the maximum and mean T2-relaxation times were higher in patients with CD. There was an excellent agreement between observers for the assessment of mean native and post-contrast T1-relaxation time (intraclass correlation coefficient (ICC) of 0.991 and ICC of 0.941, respectively) and mean T2-relaxation time measurements (ICC of 0.983). Moreover, mean T2-relaxation time was found to be significantly correlated with ESR. CONCLUSIONS: This study suggests visually undetectable myocardial involvement due to chronic systemic inflammation in patients with Crohn's disease. Cardiac MRI can help assess and monitor cardiac involvement in patients with CD.

Quantitative computed tomography analysis of emphysema severity and distribution in chronic obstructive lung disease, correlation with clinical findings.

INTRODUCTION: This study aimed to evaluate the correlation between different densitometric parameters on chest computed tomography (CT) and pulmonary function tests (PFT) of patients with emphysema-predominant chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: A retrospective evaluation was made of 56 patients with COPD. The lungs were segmented into nine sections. Normal and emphysematous parenchyma were measured using low attenuation area percentage (%LAA), percentile density (PD), and mean lung density (MLD) parameters. The effects of emphysema distribution on PFT were evaluated using %LAA, PD, MLD, kurtosis and skewness methods. RESULT: Fifty-six patients, all diagnosed with COPD, were evaluated. The %LAA-910 method showed significant correlation with forced expiratory volume in one second (FEV1) compared to other densitometric parameters (p= <0.001, r= -0.556). Other densitometric parameters differed between segments in terms of sensitivity for FEV1. It was determined that right lung mid-zone segment involvement affected FEV1 more than other segments when the %LAA -910 method was used (p= <0.001, r= -0.569). %LAA -950 had the largest area under the curve in ROC curve analysis and was determined to have 2.2% diagnostic property for predicting Global Initiative for Obstructive Lung Disease (GOLD) AB-CD staging (sensitivity 81%, specificity 74%). CONCLUSIONS: Quantitative analysis is an objective method for determining the distribution and severity of emphysema. There was a significant correlation between densitometry and PFT values. Quantitative analysis may be considered suitable for use in evaluating the severity of emphysema and predicting the clinical findings of patients.

Does Foramen Magnum Morphometry Influence the Development of Chiari Malformation?

AIM: To examine foramen magnum morphometry and shape of Chiari malformation in comparison with a control group, and to contribute to the literature on whether Chiari malformation affects foramen magnum morphometry. MATERIAL AND METHODS: In this study, cranial magnetic resonance images of 71 people with Chiari malformation and 61 people as controls were examined. The anteroposterior diameter, transverse diameter, and area of the foramen magnum were measured, and the shape of the foramen magnum was determined. RESULTS: In the Chiari malformation group, the anteroposterior diameter of the foramen magnum was 39.11 ± 4.29 mm, the transverse diameter was 34.25 ± 3.27 mm, and its area was 969.21 ± 199.57 mm < sup > 2 < /sup > . These results were statistically higher in female patients in the Chiari malformation group than in the control group. No significant difference was found between male patients in the Chiari malformation group and those in the control group. Round-shaped foramen magnum was predominant in both groups, but this was not statistically significant. CONCLUSION: In Chiari malformation, the foramen magnum is affected. This effect can be a factor that influences development of a malformation. As a result of a malformation, the foramen magnum may have expanded due to the pressure effect. More detailed and extensive research is needed to explain this phenomenon.

Visual and Quantitative Assessment of COVID-19 Pneumonia on Chest CT: The Relationship with Disease Severity and Clinical Findings.

BACKGROUND: Lungs are the primary organ involved in COVID-19, and the severity of pneumonia in COVID-19 patients is an important cause of morbidity and mortality. AIM: We aimed to evaluate the pneumonia severity through the visual and quantitative assessment on chest computed tomography (CT) in patients with coronavirus disease 2019 (COVID-19) and compare the CT findings with clinical and laboratory findings. METHODS: We retrospectively evaluated adult COVID-19 patients who underwent chest CT along with theirclinical scores, laboratory findings, and length of hospital stay. Two independent radiologists visually evaluated the pneumonia severity on chest CT (VSQS). Quantitative CT (QCT) assessment was performed using a free DICOM viewer, and the percentage of the well-aerated lung (%WAL), high-attenuation areas (%HAA) at different threshold values, and mean lung attenuation (MLA) values were calculated. The relationship between CT scores and the clinical, laboratory data, and the length of hospital stay were evaluated in this cross-sectional study. The student's t-test and chi-square test were used to analyze the differences between the variables. The Pearson correlation test analyzed the correlation between the variables. The diagnostic performance of the variables was assessed using the receiver operating characteristic (ROC) analysis. RESULTS: The VSQS and QCT scores were significantly correlated with procalcitonin, d-dimer, ferritin, and C-reactive protein levels. Both VSQ and QCT scores were significantly correlated with the disease severity (p < 0.001). Among the QCT parameters, the %HAA-600 value showed the best correlation with the VSQS (r = 730, p < 0.001). VSQS and QCT scores had high sensitivity and specificity in distinguishing disease severity and predicting prolonged hospitalization. CONCLUSION: The VSQS and QCT scores can help manage the COVID-19 and predict the duration of the hospitalization.

Bone cement with screw augmentation technique for the management of moderate tibial bone defects in primary knee arthroplasty patients with high body mass index.

OBJECTIVES: This study aims to investigate whether variables such as body mass index (BMI), size of the cement with screw augmentation area (CSA), distance between the base of tibial plate and the deepest point of the defect area (DPDA) may cause any mechanical problems leading to deterioration in tibiofemoral alignment or impact clinical outcomes when the surgeon utilizes bone cement with screw augmentation (BCSA) technique in the treatment of moderate non-contained tibial bone defects in total knee arthroplasty (TKA). PATIENTS AND METHODS: This cross-sectional study, conducted between March 2018 and March 2019, included 37 knees of 28 patients (4 males, 24 females; mean age 71.3±8.9; range, 55 to 86 years) with moderate tibial bone defects requiring treatment with BCSA during primary TKA. Patients with BMI >30 were scored with Hospital for Special Surgery (HSS) score for clinical outcomes; besides, CSA, DPDA, and tibiofemoral alignment were calculated on plain X-rays. RESULTS: Mean BMI was 34.1±5.7 (range, 24.9 to 45.9). Patients had a mean follow-up period of 44±13.9 (range, 28 to 75) months. Mean postoperative CSA was 98.2±35.3 (range, 42 to 180) mm2 and DPDA was 7.4±2.6 (range, 3.5 to 12.9) mm. Mean HSS score at last follow-up was 88.0±7.5 (range, 71 to 97). CONCLUSION: Bone cement with screw augmentation technique was associated with satisfactory clinical outcomes and tibiofemoral alignment was not significantly deviated in patients with high BMI. We determined that neither the depth of DPDA nor the size of CSA had any correlation with clinical outcomes.

Augmented Reality Supported Cervical Transpedicular Fixation on 3D-Printed Vertebrae Model: An Experimental Education Study.

AIM: To investigate the use of Augmented Reality (AR) technology as it contributes to spinal surgery education with the free-hand technique, and might reduce the error ratio. MATERIAL AND METHODS: Ten candidates, with anatomy education but no surgical experience, applied 36 pedicle screws with C2-C3 posterior transpedicular fixation technique to nine vertebrae models produced via a three-dimensional (3D) printer. RESULTS: Using AR to apply pedicle screws to the experimental vertebrae model increased the safety screw ratio significantly. In comparison of Grade 0 screws to other grades: 6/18 screws (33.3%) in the free-hand technique Group (n=18), and 14/18 screws (77.8%) in the AR Group (n=18), were measured for screw insertion safety ratios. The difference was statistically significant (p=0.018). The resemblance between our results and the results of previous studies researching supportive systems indicates our 3D printed vertebra model might be a helpful educational material. CONCLUSION: AR increases the safety ratio of cervical pedicle screw fixation significantly. The parameters investigated and used for the production of vertebrae models in this study can be used for experimental material production for future studies to investigate pedicle screw positioning.

Non-thrombotic pulmonary embolism in emergency CT.

Non-thrombotic pulmonary embolism (NTPE) results from the embolization of non-thrombotic materials. It can often be a challenging diagnosis due to non-specific (similar to thrombotic pulmonary embolism) or uncommon clinical and imaging findings. Patients with NTPE often present to the emergency department with acute respiratory distress, and contrast-enhanced computed tomography (CT) of the chest and CT pulmonary angiography are the imaging modalities of choice for respiratory distress. Since the treatment of NTPE is entirely different from thromboembolism, its distinction is essential. Moreover, early diagnosis of NTPE is necessary. Radiologists must be familiar with the diagnostic findings of NTPE, and this article aims to review the imaging features of various causes of NTPE.

Sonoelastographic Assessment of the Achilles Tendon in Familial Mediterranean Fever Patients: Comparison With Healthy Subjects.

INTRODUCTION AND OBJECTIVE: This study aims at using sonoelastography as a novel technique to evaluate the stiffness and thickness of Achilles tendons in familial Mediterranean fever (FMF) patients. METHODS: Achilles tendons of 26 FMF patients and 23 control subjects were assessed with ultrasound and real-time sonoelastography. The Achilles tendons were divided into the distal, middle, and proximal thirds for elastographic image evaluation. Tendons were classified into three main types according to their elasticity features: grade 1 blue (hardest tissue) to green (hard tissue); grade 2, yellow (soft tissue); and grade 3, red (softest tissue). Tendons of the groups were compared in terms of thickness and stiffness. RESULTS: There were no significant differences in thickness and stiffness of the Achilles tendon between FMF patients and controls (p>0.05). Sonoelastography of Achilles tendons of FMF patients displayed no relationship between FMF and tendinopathy.  Conclusion: This issue should be explored in prospective studies in larger groups.

Diagnostic performance of contrast-enhanced and unenhanced combined pulmonary artery MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism.

OBJECTIVE:: We aimed to determine the diagnostic performance of the contrast-enhanced and unenhanced combined pulmonary arterial MRI and magnetic resonance venography techniques in the diagnosis of venous thromboembolism (VTE). METHODS:: 44 patients who underwent CT pulmonary angiography (CTPA) for suspected PE constituted the study population. Patients underwent combined pulmonary and lower extremity MRI, and Doppler ultrasonography within 72 h after CTPA. Combined MRI included two sequences: unenhanced steady-state free precession (SSFP) and contrast-enhanced three-dimensional (3D) gradient echo (GRE). The presence of emboli in pulmonary arteries and thrombi in lower extremity veins on 3D-GRE and SSFP sequences was recorded. RESULTS:: CTPA showed a total of 244 emboli in 33 (75%) patients whereas contrast-enhanced 3D-GRE MRI showed deep vein thrombosis (DVT) in 34 (77%) subjects. Sensitivities for SSFP vs 3D-GRE MRI respectively in PE detection were 87.9 vs 100% on a per-patient basis, and 53.7 vs 73% on a per-embolus basis. Of 34 patients with established DVT, 31 (91%) were detected by Doppler ultrasound and 29 (85%) were detected by SSFP technique respectively. CONCLUSION:: Both contrast-enhanced and unenhanced combined MRI of acute PE and DVT are feasible one-stop-shopping techniques in patients with suspected thromboembolism. ADVANCES IN KNOWLEDGE:: Pulmonary VTE is a common disease with high mortality. Non-invasive techniques withhigh accuracy are required for the assessment of VTE. CT-related radiation and contrast material risks cause concerns. MRI is a radiation-free technique evaluating the vessels with and without contrast. Combined contrast enhancedor unenhanced pulmonary and lower extremity MRI is feasible in patients with suspected thromboembolism.

Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation.

BACKGROUND: Urologic complications (UC) have gradually decreased in recent years after advanced surgical experience. The incidence of urologic complications varies between 0.22% and 30% in different medical studies. There is no routine usage of double-J stenting (DJS) during renal transplantation (RT) in the literature. It is a necessity, and optimal timing for stent removal is an important question for many transplantation centers. METHODS: This study includes 818 renal transplant patients whose ureteroneocystostomy anastomoses were completed by use of the Lich-Gregorie procedure during a 2-year period at a transplantation center. We performed 926 renal transplantations at Antalya Medical Park Hospital Renal Transplantation Center between January 2014 and January 2016. The patients were divided into four groups according to the timing of DJS removal. RESULTS: For group 1, removal time for DJS was between 5 and 7 days; group 2, Removal time for DJS was between 8 and 14 days; group 3, removal time for DJS was between 15 and 21 days; and group 4, removal time for DJS was later than 22 days. The patients were divided into two groups according to removal time of stent as 5 to 14 days and >15 days. DJS was performed again in the patients whose urine output was reduced during the first 5 days after removal of the DJS, whose creatine level increased, and whose graft ureter and collecting tubules were extended as an ultrasonographic finding. CONCLUSIONS: There is no declared optimal time for the removal of DJS. The removal time was reported between postoperative first week and 3 months in some of the reports of RT centers, according to their protocols. We emphasize that the optimal time for the removal of DJS is 14 to 21 days after RT, based on the findings of our large case report study.

Brucellar Testicular Abscess Presenting as a Testicular Mass: Can Color Doppler Sonography be used in Differentiation?

Brucellosis is an endemic disease in various regions of the world. Testicular abscess is a very rare complication of brucellosis which can be misdiagnosed as a testicular mass and may lead to unnecessary orchiectomy. To our knowledge there are only eight reported cases in the literature of a brucellar testicular abscess. We present a case of testicular abscess due to brucellosis diagnosed with serologic tests and color Doppler sonography, and treated with antibiotics and fine needle aspiration.