The Impact of Arterial Phase on the Detection of Cervical Lymph Node Metastasis From Papillary Thyroid Carcinoma: A Quantitative Evaluation on Multiphasic Computed Tomography.

OBJECTIVE: The purpose of this study was to assess the diagnostic performance of multiphasic computed tomography (CT) in the discrimination of metastatic lymph nodes (LNs) of papillary thyroid cancer by using quantitative parameters. METHODS: This study enrolled 272 pathologically proven metastatic and benign LNs. Multiphasic CT was utilized by using nonenhanced, arterial (25-second delay), and venous (80-second delay) phases. Mean tissue attenuation values (MAVs) of metastatic and benign LNs were measured, and normalized MAV (common carotid artery and paraspinal muscle) and wash-in and wash-out percentages were also calculated. RESULTS: The arterial phase showed the highest diagnostic performance in differentiation (area under the curve ± standard error, 0.97 ± 0.02; 95% confidence interval, 0.94-1.0; P < 0.001). Cutoff values for MAVs, normalized MAVs, and wash-in and wash-out percentages to predict metastatic LNs were calculated as 109 HU, 0.33, 1.93, 122.5, and -5.6 (sensitivity: 93.4%, 93.3%, 90.4%, 94.1%, and 97.8%, and specificity: 99.3%, 90.4%, 98.5%, 92.6%, and 99.3%, respectively). CONCLUSIONS: Early-phase enhanced CT and the use of quantitative parameters derived from multiphasic CT improve the detection of cervical lymph node metastasis from papillary thyroid cancer.

Vascular lesions of the vocal fold.

The aim of the study was to present symptoms, laryngological findings, clinical course, management modalities, and consequences of vascular lesions of vocal fold. This study examined 162 patients, the majority professional voice users, with vascular lesions regarding their presenting symptoms, laryngological findings, clinical courses and treatment results. The most common complaint was sudden hoarseness with hemorrhagic polyp. Microlaryngoscopic surgery was performed in 108 cases and the main indication of surgery was the presence of vocal fold mass or development of vocal polyp during clinical course. Cold microsurgery was utilized for removal of vocal fold masses and feeding vessels cauterized using low power, pulsed CO(2) laser. Acoustic analysis of patients revealed a significant improvement of jitter, shimmer and harmonics/noise ratio values after treatment. Depending on our clinical findings, we propose treatment algorithm where voice rest and behavioral therapy is the integral part and indications of surgery are individualized for each patient.

Sensorineural hearing loss in pseudoexfoliation.

BACKGROUND: Pseudoexfoliation (PEX), which affects anterior segment structures, is thought to be a systemic disorder. The purpose of this study was to determine the possible relation between PEX and sensorineural hearing loss. METHODS: The study group included 51 patients with PEX and 22 controls without PEX. The patients and controls underwent complete ophthalmic and otorhinolaryngologic examinations. Hearing levels were evaluated with audio-tympanogram battery in all cases, and pure-tone audiogram hearing levels were classified into 6 groups. RESULTS: The mean age of PEX subjects was 67.5 years. All patients had PEX in at least one eye. Seventeen eyes had no evidence of PEX syndrome or glaucoma, 14 eyes had PEX but no glaucoma, and 71 eyes had both PEX and glaucoma. Thirty-four patients had bilateral PEX while 17 patients had unilateral PEX. One hundred and two ears of the 51 PEX patients and 44 ears of 22 controls were evaluated with pure-tone audiogram after otologic examination. In PEX patients 34/102 ears (33.3%) had normal hearing level, and 68 (66.7%) had hearing loss at various levels. The mean age of the control group was 61 years. In this group, 27/44 ears (61.4%) had no hearing loss, and 17 (38.6%) ears had hearing loss. There was a statistically significant difference between control and PEX subjects (p<0.01) in terms of hearing loss. INTERPRETATION: This study shows that sensorineural hearing loss appears to be associated with PEX.

Is laryngopharyngeal reflux an important risk factor in the development of laryngeal carcinoma?

Laryngopharyngeal reflux (LPR) as a causative irritating factor in the development of laryngeal carcinoma has been suggested. However, the association between LPR and laryngeal carcinoma remains unclear. The aim of this study was to compare the prevalence and severity of reflux between patients with laryngeal carcinoma and clinical LPR. The intention was to find out if a correlation exists between the laryngeal findings and the level of acid reflux. The study population consisted of 29 patients with laryngeal cancer (group I), 33 LPR patients with normal laryngeal findings (group II) and 70 LPR patients with related laryngeal pathology (group III). The results of 24-h, double-channel ambulatory esophageal pH monitoring were analyzed comparing the three groups. The occurrence and severity of abnormal acid reflux at the upper and lower esophageal segments were evaluated. The incidence of LPR or gastroesophageal reflux (GER) did not vary in any of the three groups (LPR was present in 62, 42 and 56% of the patients, while GER was present in 45, 24 and 37% of the patients, respectively). Patients with LPR or GER from the three groups did not differ significantly in terms of the number of acid reflux episodes and percentage of times when the pH was <4. Our data do not support the hypothesis that LPR can be an independent risk factor in the development of larynx cancers. However, the data also do not thoroughly exclude the possibility. The reason why LPR leads to variable pathologies in the larynx may be uncovered by studies probing the differences between patients via detailed examinations of the local anti-reflux barriers such as epithelial morphology and functions.