Beyond symptomatology: A comparative analysis of unilateral and bilateral macronodular mild autonomous cortisol secretion.

OBJECTIVE: To investigate the clinical, laboratory findings and signal intensity index (SII) on magnetic resonance imaging (MRI) of patients with bilateral and unilateral macronodular mild autonomous cortisol secretion (MACS). PATIENTS AND MEASUREMENTS: Clinical and laboratory findings of 81 patients with MACS were examined from retrospective records. SII of adenomas and internodular areas were evaluated by MRI. The unilateral group included patients with an adrenal macronodule (≥1 cm) in a single adrenal gland, while the bilateral group included patients with at least one macronodule in both adrenal glands. RESULTS: In total, 46 patients were in the unilateral (57%), while 35 (43%) patients were in the bilateral groups. The dehydroepiandrosterone sulphate (DHEA-S) level was lower in the unilateral than in the bilateral group (p < .001). The presence of type 2 diabetes mellitus (T2DM), glycosylated haemoglobin (HbA1c) and low-density lipoprotein (LDL) concentrations were higher in the bilateral group (p < .05). However, no significant difference was detected in terms of adrenocorticotropic hormone (ACTH) and overnight 1 mg dexamethasone suppression test (DST) between the two groups (p > .05). There was no difference in SII between adenomas within the same patient, as well as between the unilateral and bilateral groups (p > .05). Logistic regression analysis based on the differentiation between unilateral and bilateral macronodular MACS demonstrated that DHEA-S, HbA1c and LDL concentrations were associated factors. CONCLUSION: DHEA-S levels may not be as suppressed in patients with bilateral macronodular MACS as compared to those with unilateral adenoma. T2DM and hypercholesterolaemia have a higher frequency in bilateral patients. However, ACTH, overnight 1 mg DST and SII may not provide additional information for differentiation of bilaterality and unilaterality.

The Radiolabeling of [161Tb]-PSMA-617 by a Novel Radiolabeling Method and Preclinical Evaluation by In Vitro/In Vivo Methods.

Background: Prostate cancer (PC) is the most common type of cancer in elderly men, with a positive correlation with age. As resistance to treatment has developed, particularly in the progressive stage of the disease and in the presence of microfocal multiple bone metastases, new generation radionuclide therapies have emerged. Recently, [161Tb], a radiolanthanide introduced for treating micrometastatic foci, has shown great promise for treating prostate cancer. Results: In this study, Terbium-161 [161Tb]Tb was radiolabeled with prostate-specific membrane antigen (PSMA)-617 ([161Tb]-PSMA-617) and the therapeutic efficacy of the radiolabeled compound investigated in vitro and in vivo. [161Tb]-PSMA-617 was found to have a radiochemical yield of 97.99 ± 2.01% and was hydrophilic. [161Tb]-PSMA-617 was also shown to have good stability, with a radiochemical yield of over 95% up to 72 hours. In vitro, [161Tb]-PSMA-617 showed a cytotoxic effect on LNCaP cells but not on PC-3 cells. In vivo, scintigraphy imaging visualized the accumulation of [161Tb]-PSMA-617 in the prostate, kidneys, and bladder. Conclusions: The results suggest that [161Tb]-PSMA-617 can be an effective radiolabeled agent for the treatment of PSMA positive foci in prostate cancer.

Should Targeted Biopsy be Performed in Patients Who Have Only Pi-rads 3 Lesions?

OBJECTIVE: To determine whether clinical or radiological parameters can predict clinically significant prostate cancer (csPC) in patients with the Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions. PATIENTS AND METHODS: Data were obtained from 247 patients with PI-RADS 3 lesions on mpMRI and who had received a software guided transperineal/transrectal MRI/transrectal ultrasonography (MRI/TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy following mpMRI in the prostate cancer and prostate biopsy database of Turkish Urooncology Association, between 2016 and 2020. The cut-off values of clinical parameters were determined using receiver operating characteristic (ROC) curve analysis. Simple and multiple logistic regression analyses were performed to determine the clinical parameters in predicting csPC. RESULTS: A total of 56 patients (22.6%) had prostate cancer, 23 (9.3%) of whom had csPC. In the lesion- based analysis, cancer detection rates (CDRs) of each lesion in targeted biopsy were found to be 6% and 5% for ISUP GG 1 and ISUP GG ≥ 2, respectively. In the patient-based analysis, clinically insignificant CDRs were significantly higher in systematic biopsy compared with targeted biopsy, whereas no significant difference was found in terms of clinically significant CDRs (p = 0.020 and p=0.422, respectively). The cut-off values were determined as 48.3 mL (AUC [95% CI] = 0.68 [0.53-0.82]) for prostate volume, and 0.213 ng/mL/mL (AUC [95% CI] = 0.64 (0.51-0.77]) for PSAD in predicting csPC. In the multiple logistic regression analysis, only PSAD was found to be an independent risk factor in predicting csPC (OR [95% CI]: 3.56 [1.15-10.91], p = 0.024). CONCLUSION: Since PSAD > 0.20 ng/mL/mL was found to be positive independent risk factor in predicting csPC, in the absence of advanced radiological parameters, PSAD could be used for the biopsy decision in patients with PI-RADS 3 lesions.

Oncological Outcomes of Patients with Non-Clear Cell Renal Cell Cancers: Subtypes of Unclassified and Translocation Renal Cell Cancers.

PURPOSE: We aimed to compare oncological outcomes in the two rare subtypes, unclassified renal cell cancer (unRCC) and translocation RCC (tRCC), vs clear cell RCC (ccRCC). MATERIALS AND METHODS: Between 2004 and 2019, from Turkish Urooncology Society Database, we identified 2324 patients for histological subtypes including 80 unRCC (3.4%), 19 tRCC (0.8%) and 2225 ccRCC (95.8%). RESULTS: The overall (15.8%) and cancer-specific mortalities (11.1%) were found to be higher in tRCC group and the recurrence free mortality (13.8%) was found to be higher in unRCC group. Larger pathological tumor size (p = 0.012) and advanced pathological T stage (p = 0.042) were independent predictive factors on overall mortality in patients with unRCC tumors. CONCLUSION: The oncological outcomes of the unRCC and tRCC are worse than ccRCC and pathological tumor size and pathological stage are predictive factors for mortality in the unRCC.

The reliability and validity of the Turkish version of the Facial Disability Index.

PURPOSE: To translate and cross-culturally adapt the Turkish version of the Facial Disability Index (FDI) and evaluate its psychometric properties, including reliability and validity. METHODS: Translation of the original FDI was followed by international guidelines. Paralysis classification was evaluated with House-Brackman Rating System (HBGS). Patients completed Short Form-36 (SF-36) along with the Turkish version of the FDI and refilled the Turkish FDI one week later. Internal consistency and test-retest reliability were analyzed using Cronbach's alpha coefficient and intraclass correlation coefficient (ICC), respectively. Construct validity was assessed by calculating the Spearman's correlation coefficient. Also, exploratory factor analysis was carried out by identifying the factor structure of the scale. RESULTS: After the pre-test of the Turkish FDI, there was no need for linguistic and cultural adaptation. The internal consistency of the physical function subscale was high (0.82). The social/well-being subscale's Cronbach alpha (0.63) was within the acceptable range. Test-retest reliability was excellent (ICC of physical function = 0.91 and social/well-being = 0.93, p < 0.05). The physical function subscale was correlated with the PF subscale of SF-36 and HBGS (r = -0.837 and 0.292, respectively; p < 0.05). Besides, the social/well-being function subscale was correlated with HBGS and all subscales of SF-36, except RP (p < 0.05). Factor analysis results of the Turkish FDI were similar to the other version studies. CONCLUSION: The Turkish version of the FDI is a valid and reliable questionnaire in patients with peripheral facial paralysis.IMPLICATIONS FOR REHABILITATIONThe Turkish version FDI is the first Turkish tool translated cross-culturally adapted for specific assessment of facial paralysis.The Turkish version of the FDI is a valid and reliable questionnaire and can be used in all native Turkish speaking patients in peripheral facial paralysis.This assessment tool can be used in clinical routine and research settings to evaluate facial paralysis.

Comparison of transperineal and transrectal targeted prostate biopsy using Mahalanobis distance matching within propensity score caliper method: A multicenter study of Turkish Urooncology Association.

OBJECTIVE: To compare the clinically significant prostate cancer (csPC)-detecting results of transperineal and transrectal targeted biopsy (TPTB and TRTB, respectively) by performing matching analysis. PATIENTS AND METHODS: This study has used the PC and prostate biopsy database from the Turkish Urooncology Association. A total of 1143 patients with Prostate Imaging-Reporting and Data System (PI-RADS) with ≥3 lesions on multiparametric magnetic resonance imaging (mpMRI) and who had received a software-guided transperineal/transrectal MRI/transrectal ultrasound (TRUS) fusion prostate biopsy with concomitant standard systematic 12-core biopsy were included in this study. csPC detection rates of the TP and TR approaches were compared following Mahalanobis distance matching within propensity score caliper method. The following four variables were selected as covariates for the matching procedure: age, digital rectal examination findings, PSA density, and the index lesion PI-RADS score. RESULTS: The matched sample included 508 TR and 276 TP patients. In both the TP and the TR groups, targeted biopsy was superior to systematic biopsy in detecting csPC (27.5% vs. 24.6%, p < 0.001 and 19.5% vs. 16.3%, p < 0.0001, respectively). Both TPTB and TP systematic biopsy was found to be superior to TRTB and TR systematic biopsy in terms of csPC detection (27.5% vs. 19.5%, p = 0.012 and 24.6% vs. 16.3%, p = 0.006). In patients with an anterior index lesion, an apical index lesion, and a larger prostate, the superiority of TPTB to TRTB was found to be more prominent in terms of csPC detection (37.8% vs. 18.3%, p = 0.044; 34.6% vs. 14.7%, p = 0.002; and 25% vs. 5.1%, p = 0.033, respectively). CONCLUSION: Targeted biopsy was found to be superior to systematic biopsy in detecting csPC in both the TP and the TR approaches. The TP approach is preferred because of its clear superiority in detecting csPC in targeted biopsy, especially in patients with anterior and apical lesions and with larger prostates.

[Comparison of magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy with standard systematic biopsy: A single center experience.] / Comparación de la resonancia magnética biopsia próstata transrectal guiada por ultrasonido con fusión de resonancia magnética con la biopsia próstata sistemática: resultados de un solo centro.

OBJECTIVE: To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms of cancer detection rates. PATIENTS AND METHODS: The data of the patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI and underwent MRI-TRUS fusion biopsy with simultaneous 12-core standard systematic biopsy from June 2016 to June 2019 in our tertiary center were retrospectively reviewed. Clinical, radiological and pathological data were recorded. Statistical difference among the groups was determined by using McNemar tests. RESULTS: A total of 344 patients were included in the study. As a result of transrectal targeted and systematic combined biopsy, 117 patients were diagnosed with prostate cancer. Benign pathology rates in patients with PI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were 93.8%, 68.5%, and 46.4%, respectively. Patients were divided into two groups as ISUP grade 1 and ISUP grade ≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy compared with the systematic biopsy (12.5% vs. %6.4, p=0.007 and 17.4% vs. 8.7%, p<0.001, respectively). Targeted biopsy CDRs were found significantly higher in the high PSA density group (24.5% vs. 41.4%, p=0.001) unlike the systematic biopsy. CONCLUSION: Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making a biopsy decision for patients with PI-RADS 3 lesions. PSA density can be used as a criterion for patient selection for targeted biopsy.

OBJETIVO: Comparar la biopsia sistemática próstata con fusión de resonancia transrectal vs la biopsia prostática sistemática, en términos de detección de cáncer de próstata.PACIENTES Y MÉTODOS: Los datos de pacientes con RNM y PIRADS (Prostate Imaging Reporting and Data System) 3 o más y que recibieron una biopsia prostática transrectal con biopsia simultanea de 12 cilindros sistemática entre junio 2016 y junio 2019 en nuestro centro académico fueron retrospectivamente revisados. Los datos radiológicos, clínicos y patológicos fueron también revisados. La diferencia estadística entre los grupos fue determinada utilizando los tests de McNemar. RESULTADOS: Un total de 344 pacientes fueron incluidos en el estudio. Como resultado de la biopsia transrectal sistemática y dirigida, 117 pacientes fueron diagnosticados de cáncer de próstata. Las tasas de patología benigna en pacientes con PIRADS 3, PIRADS 4 y PIRADS 5 fueron de 93,8%, 68,5%, y 46,4%, respectivamente. Los pacientes fueron divididos en 2 grupos como ISUP grado 1 y ISUP grado 2 o más, las tasas de detección de cáncer fueron superiores en los pacientes que recibieron una biopsia transrectal dirigida vs sistemática (12,5% vs. 6,4%, p=0,007 y 17,4% vs. 8,7%, p<0,001, respectivamente). La detección de cáncer por biopsia dirigida fue superior en pacientes con alta densidad de PSA (24,5% vs. 41,4%, p=0,001) a diferencia de la biopsia sistemática.CONCLUSIÓN: La biopsia transrectal dirigida fue superior a la biopsia sistemática en el diagnóstico de cáncer de próstata. Los clínicos deberían ser más selectivos al tomar la decisión de qué biopsia hacer en un paciente con PIRADS 3. La densidad de PSA se puede utilizar como criterio para realizar una biopsia dirigida.

Comparison of magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy with standard systematic biopsy: a single center experience / Comparación de biopsia de próstata por fusión de imágenes por resonancia magnética-ultrasonido transrectal con biopsia sistemática estándar: experiencia en un solo centro

Objetive: To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms ofcancer detection rates. Patients and methods: The data of the patientswho had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI andunderwent MRI-TRUS fusion biopsy with simultaneous12-core standard systematic biopsy from June 2016to June 2019 in our tertiary center were retrospectivelyreviewed. Clinical, radiological and pathological datawere recorded. Statistical difference among the groupswas determined by using McNemar tests. Results: A total of 344 patients were included in thestudy. As a result of transrectal targeted and systematiccombined biopsy, 117 patients were diagnosed withprostate cancer. Benign pathology rates in patients withPI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were93.8%, 68.5%, and 46.4%, respectively. Patients weredivided into two groups as ISUP grade 1 and ISUP grade≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy comparedwith the systematic biopsy (12.5% vs. %6.4, p=0.007and 17.4% vs. 8.7%, p<0.001, respectively). Targetedbiopsy CDRs were found significantly higher in the highPSA density group (24.5% vs. 41.4%, p=0.001) unlikethe systematic biopsy. Conclusions: Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making abiopsy decision for patients with PI-RADS 3 lesions. PSAdensity can be used as a criterion for patient selectionfor targeted biopsy.(AU)

Objetivo: Comparar la biopsia sistemática próstata con fusión de resonancia transrectal vs labiopsia prostática sistemática, en términos de detecciónde cáncer de próstata. Pacientes y métodos: Los datos de pacientes conRNM y PIRADS (Prostate Imaging Reporting and DataSystem) 3 o más y que recibieron una biopsia prostáticatransrectal con biopsia simultanea de 12 cilindros sistemática entre junio 2016 y junio 2019 en nuestro centroacadémico fueron retrospectivamente revisados. Los datos radiológicos, clínicos y patológicos fueron tambiénrevisados. La diferencia estadística entre los grupos fuedeterminada utilizando los tests de McNemar. Resultados: Un total de 344 pacientes fueron incluidos en el estudio. Como resultado de la biopsiatransrectal sistemática y dirigida, 117 pacientes fuerondiagnosticados de cáncer de próstata. Las tasas de patología benigna en pacientes con PIRADS 3, PIRADS 4y PIRADS 5 fueron de 93,8%, 68,5%, y 46,4%, respectivamente. Los pacientes fueron divididos en 2 gruposcomo ISUP grado 1 y ISUP grado 2 o más, las tasas dedetección de cáncer fueron superiores en los pacientesque recibieron una biopsia transrectal dirigida vs sistemática (12,5% vs. 6,4%, p=0,007 y 17,4% vs. 8,7%,p<0,001, respectivamente). La detección de cáncerpor biopsia dirigida fue superior en pacientes con altadensidad de PSA (24,5% vs. 41,4%, p=0,001) a diferencia de la biopsia sistemática. Conclusion: La biopsia transrectal dirigida fuesuperior a la biopsia sistemática en el diagnóstico decáncer de próstata. Los clínicos deberían ser más selectivos al tomar la decisión de qué biopsia hacer en unpaciente con PIRADS 3. La densidad de PSA se puedeutilizar como criterio para realizar una biopsia dirigida.(AU)

Role of steroid injection for skin thickness and edema in rhinoplasty patients.

OBJECTIVES: The aim of this study was to observe the effect of the triamcinolone acetonide injections in thick skinned patients with ultrasonographic measurements and to compare these results with the postoperative nasal skin thickness of patients that were not injected with steroids. METHODS: A prospective study was planned with 42 thick nasal skinned rhinoplasty candidates in our clinic. Skin thickness of specific points along nose was measured and documented. On the 10th day after surgery, triamcinolone acetonide injections were performed into the supratip region of 21 patients in the study group. No injections were made for the control group. Nasal ultrasonographic measurements were repeated 40 days after the surgery for all 42 patients by the same radiologist and results were evaluated. RESULTS: Seventeen women (40.5%) and 25 men (59.5%) were included in the study. Patients' ages ranged from 18 to 53 with an average age of 27.9. In study group, all injections sites showed thinning on the 40th day after surgery. These findings were statistically significant at B (rhinion), D (middle of supratip), and G (middle of the tip). In the control group, all injection sites except A (nasion) displayed thickening on the 40th day after surgery. These findings were statistically significant at B (rhinion), D (middle of supratip), H (left side of the tip), and J (left alar region). CONCLUSION: Triamcinolone acetonide injections are effective in the prevention of edema and provide thinning of the post-rhinoplasty skin envelope.

External validation of a prostate cancer nomogram on magnetic resonance/transrectal ultrasound fusion biopsy in men with prior negative systematic biopsy.

OBJECTIVE: To observe how the nomogram, which was created by Truong et al, works in an independent patient group by performing external validation. PATIENTS AND METHODS: One hundred and eighty-one patients who had at least one prior negative 12-core standard systematic biopsy and lesions with PI-RADS scores of 3 or higher that were detected as a result of mpMRI were included in the study. Targeted biopsy with 12-core standard systematic biopsy was performed on all patients. Clinical and pathological features of the patients were recorded. The discrimination, calibration and decision curve analysis were performed to externally validate the nomogram. RESULTS: A total of 181 patients with previous negative 12-core systematic biopsies were analysed. One hundred and thirty-four patients (74%) had benign pathology. Radiological volume and PI-RADS scores of 4 and 5 were found as independent predictors of benign pathology. The area under the curve (CI 95%) was found to be 0.80 (0.73-0.87), indicating good discrimination. The median residual was calculated as -0.0873, the intercept as -0.0690, the slope as 0.8927 and r2 as 0.2586, indicating good calibration. The standardised net benefit of follow-up decisions was found to be 0.54 and 0.36 at the probability threshold of 0.7 and 0.8, respectively. CONCLUSION: The original model showed good discrimination and calibration with our data. Defining a high probability threshold for clinical use would be appropriate for centres with high benign biopsy rates similar to our centre.

Diagnostic accuracy of 68 Ga-PSMA PET/MRI and multiparametric MRI in detecting index tumours in radical prostatectomy specimen.

OBJECTIVE: To evaluate the diagnostic accuracy of the 68 gallium (68 Ga) prostate-specific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) and multiparametric MRI (mpMRI) by region-based comparison of index tumour localisations using histopathological tumour maps of patients who underwent radical prostatectomy because of clinically significant prostate cancer. PATIENTS AND METHODS: The study included 64 patients who underwent radical prostatectomy after primary staging with mpMRI and 68 Ga-PSMA PET/MRI. Diagnostic analysis was performed by dividing the prostate into four anatomic regions as left/right anterior and left/right posterior. The extension of the lesions in mpMRI and the pathological uptake in 68 Ga-PSMA PET/MRI were matched separately for each region with the extension of the index tumour into each region. RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and the accuracy of mpMRI and 68 Ga-PSMA PET/MRI are shown as 55.7%, 91.8%, 80.6%, 77.2%, 78.1%, and 60.8%, 94.3%, 86.8% 79.8%, 83.5%, respectively. 68 Ga-PSMA PET/MRI has higher sensitivity and specificity compared with mpMRI. However, no statistically significant difference was found (P = .464). Combined imaging had significantly higher diagnostic accuracy compared with mpMRI and 68 Ga-PSMA PET/MRI (change in AUC: 0.084 and 0.046, P < .001 and P = .028, respectively), while no statistically significant difference was found between mpMRI and 68 Ga-PSMA PET/MRI (change in AUC: 0.038, P = .246). CONCLUSION: 68 Ga-PSMA PET/MRI had higher clinical diagnostic accuracy in prostate cancer compared with mpMRI. Diagnostic accuracy was significantly increased in the combined use of both imaging modalities.

External Splinting Is Not Mandatory After All Rhinoplasties: A Prospective Randomized Trial.

BACKGROUND: Although casts or external splint materials are commonly applied on the external nose after rhinoplasty, their beneficial effects have not been previously demonstrated in controlled studies. METHODS: A total of 40 adult patients who underwent primary rhinoplasty were included in this prospective study. The patients were randomized into 2 groups to use an external splint or not after surgery. Only surgical taping was applied to the nasal dorsum of the patients for whom external splints were not used. The periorbital edema and ecchymosis levels of the patients were recorded on the second and seventh days after surgery. Moreover, all patients had a computed tomography scan at the third postoperative week to measure the distance between the beginning of the osteotomy line on the right and left sides and the midline. RESULTS: On the second and seventh postoperative days, the levels of periorbital edema and ecchymosis were significantly lower in the patients with taping than in the patients with splints (P < 0.05 for each). No statistically significant difference was observed in terms of the difference in the distance between the beginning of the osteotomy line on the right and left sides to the midline between the group with external splints and that with tape (P = 0.661). CONCLUSIONS: External splinting may not be used in cases where osteotomy is not performed or in patients where the osteotomies are sufficiently stable. Thus, the disadvantages of external splinting are avoided, and at the same time, periorbital edema and ecchymosis are less common.

The Fibrin Glue Application Enhances Surgical Success Rate in Endonasal Endoscopic Dacryocystorhinostomy With Lacrimal Sac Preservation.

The purpose of this study to compare lacrimal sac flap preserving techniques with or without fibrin glue in patients undergoing endoscopic endonasal dacryocystorhinostomy. A retrospective study included 132 patients who underwent unilateral endonasal dacryocystorhinostomy between February 2011 and March 2016. Patients were divided into 2 groups: the nonfibrin glue group (n = 66) and fibrin glue anastomosis group (n = 66). Surgical success was defined as the patients' subjective report of relief of epiphora and objective endoscopic confirmation of ostium patency confirmed by a positive functional dye test. These parameters were compared between the 2 groups. Both groups were similar, in terms of demographic and clinical characteristics. The surgical success rate was significantly higher in the fibrin glue anastomosis group (95.5%) than in the nonfibrin glue group (84.8%; P = .041). Complication rate was 6.1% in the nonfibrin glue group, whereas in the fibrin glue anastomosis group, it was 4.5%. The complication rate was similar in both groups (P = .99). Creation of an anastomosis between the lacrimal sac flaps and the nasal mucosa using fibrin glue improves the outcome of endonasal endoscopic dacryocystorhinostomy.

Awareness of Facial Asymmetry and Its Impact on Postoperative Satisfaction of Rhinoplasty Patient.

INTRODUCTION: Rhinoplasty surgeons often find that despite their best efforts to straighten the nose, patients often continue to perceive their nose as deviated, and this perception is particularly prevalent in patients with concurrent facial asymmetry. The aims of this study were to determine whether facial asymmetry influences the satisfaction of rhinoplasty patients and whether there is a difference in postoperative happiness between patients with and without facial asymmetry. MATERIALS AND METHODS: In this retrospective study, we reviewed the charts and photographs of patients who underwent rhinoplasty between 2016 and 2018. Patient photographs were analysed; 30 patients with facial asymmetry and 30 patients with symmetric faces were randomly selected for the study. The preoperative and postoperative rhinoplasty outcome evaluation (ROE) and standardized cosmesis and health nasal outcomes survey (SCHNOS) scores were compared between the two groups. RESULTS: The mean preoperative symmetry scores of the group with facial asymmetry were significantly higher than those of the group with symmetric faces. The magnitude of increase in the average ROE score from pre- to postoperatively was significantly larger in the group with symmetric faces than in the group with facial asymmetry. The magnitude of decrease in the mean SCHNOS score from pre- to postoperatively was significantly larger in the group with symmetric faces than in the group with facial asymmetry (p: 0.006). CONCLUSION: It is important to clearly evaluate patients with facial asymmetries before surgery to increase their postoperative satisfaction and outcomes and make their expectations more realistic. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective Assessment of Nose Tip Light Reflections in Rhinoplasty.

PURPOSE: To assess the objective and subjective analysis of facet and infratip lobule in postoperative digital pictures of rhinoplasty patients and compare them with the people with good-looking noses. With the help of simple software that measures the brightness of the pixels, we investigated the relation between light reflections and patient satisfaction. METHODS: egardless of the technique, forty patients who underwent external open approach rhinoplasty were selected randomly. Twenty participants with a good-looking nose without operation history were selected as the control group. Digital Color Meter® in MacOS X® was used for measuring the brightness of the facets and infratip lobule. As a subjective outcome measure, the visual analog scale (VAS) was used and compared with brightness ratios. RESULTS: The mean brightness ratios and VAS of operated noses were statistically low from the control group. There was a significant positive correlation between brightness ratios and VAS in all groups. CONCLUSION: Our study presents the results of a simple method of measuring the light reflections of the nose tip. Noses with a good aesthetic outcome have more symmetric and subtle facets and infratip lobule. This method was feasible, and its results were correlated with patients' aesthetic perceptions. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effect of National Pneumococcal Vaccination Program on Incidence of Postmeningitis Sensorineural Hearing Loss and Current Treatment Modalities.

OBJECTIVES: The aim of the present study was to investigate the effect of the national pneumococcal vaccination program on postmeningitis sensorineural hearing loss (SNHL). MATERIALS AND METHODS: Overall, 2751 patients (2615 cochlear implantation and 136 auditory brainstem implantation) who underwent cochlear implantation (CI) and auditory brainstem implantation (ABI) at a tertiary referral hospital otolaryngology clinic were retrospectively analyzed. One hundred sixteen patients with a history of meningitis were included in the study. Patients were evaluated for their age at the time of surgery, gender, computerized tomography (CT) and magnetic resonance imaging (MRI) findings, implant type, side, and incidence before and after the vaccination program. RESULTS: When patients with cochlear implants or ABI were examined, the incidence of meningitis-induced hearing loss was 6.2% in the pre-vaccination period and 0.6% in the post-vaccination period. There is a significant difference between them when compared by chi-square test (p<0.001). CONCLUSION: The most important finding of the present study is the dramatic decrease in the number of CI and ABI surgeries performed in patients with SNHL due to meningitis. This shows the effectivity of pneumococcal vaccination in this special group of patients. If total ossification is detected on CT of patients with postmeningitis, ABI should be preferred to CI.

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma

ABSTRACT Purpose: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients. Patients and Methods: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS. Results: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively). Conclusion: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma.

PURPOSE: To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients. PATIENTS AND METHODS: 162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS. RESULTS: Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively). CONCLUSION: In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.

Association of Skin Thickness With Alar Base Reduction in Patients Undergoing Lateral Crural Repositioning and Strut Grafting.

IMPORTANCE: Knowing the operation plan is important for rhinoplasty surgeons to prevent unpredictable results. OBJECTIVES: To investigate the frequency of alar base resection in patients with different skin thickness who underwent lateral crural repositioning and lateral crural strut graft and to evaluate the results in the context of the current literature. DESIGN, SETTING, AND PARTICIPANTS: This retrospective case series study included 621 patients who underwent primary open septorhinoplasty by the same surgeon between January 1, 2012, and June 30, 2015. From the surgical notes, operation type (lateral crural repositioning [LCrep] with lateral crural strut grafting [LCSG] and with or without alar base resection) and skin type were recorded. Study participants' skin types were determined intraoperatively and divided into 3 groups: (1) thick skin (the tip definition was limited by skin thickness and subcutaneous tissue), (2) thin skin (the tip cartilage was visible and could be observed despite overlying soft tissue and skin), and (3) normal skin (the tip cartilage during the procedure had no effect on the tip definition). MAIN OUTCOMES AND MEASURES: The rate of alar base resection according to the type of operation performed and patient skin thickness. RESULTS: Of the 621 patients in the study, 95 (15.3%) were men and 526 (84.7%) were women. Lateral crural repositioning with LCSG was performed in 319 surgical procedures (51.4%), and alar base reduction was performed in 329 (53.0%). The rate of alar base resection differed significantly on the basis of whether LCrep with LCSG was performed (odds ratio [OR], 1.82; 95% CI, 1.32-2.50; P < .001). In patients with thin skin, there was no significant difference in the incidence of alar base resection associated with LCrep with LCSG (OR, 2.034; 95% CI, 0.912-4.539; P = .08). In patients with thick skin, a significant difference in the frequency of alar base resection was associated with the application of LCrep with LCSG (OR, 1.995; 95% CI, 1.228-3.241; P = .005). In patients with normal skin, LCrep with LCSG had no significant association with the frequency of alar base resection (OR, 1.557; 95% CI, 0.930-2.607; P = .09). CONCLUSIONS AND RELEVANCE: The necessity of alar base reduction after LCrep with LCSG is greater in patients with thick skin than in patients with thin and normal skin. This study is the first to our knowledge to examine this topic in rhinoplasty. LEVEL OF EVIDENCE: 3.

Anterior Glottic Web Formation for Voice Feminization: Experience of 27 Patients.

OBJECTIVE: Voice feminization is needed for male-to-female transsexuals, males with testicular feminization, and females with constitutional androphonia. Anterior glottic web formation affords advantages: endoscopic surgery without skin incision and scar, outpatient surgery, potential reversibility, and low risk for vocal fold and airway damage. STUDY DESIGN: This is a nonrandomized prospective cohort study. SETTING: University hospital. MATERIALS AND METHODS: All 27 cases of androphonia were treated with endoscopic anterior glottic web formation. Voice Handicap Index (VHI-30); acoustic analysis with /a/ including F0, jitter, shimmer, noise-to-harmonic ratio; and acoustic analysis of connected speech for speaking F0 were determined pre- and postoperatively. Patients and medical students rated pre- and postoperative voices as feminine, masculine, or neither. RESULTS: The pre- and postoperative mean total VHI scores of patients were 38 and 24, respectively; this difference was statistically significant (P < 0.001). Their pre- and postoperative mean F0 and speaking F0 were 152 and 158 and 195 and 200 Hz, respectively; these differences were statistically significant (P < 0.001). Their pre- and postoperative acoustic analysis results were not significantly different (P > 0.05). Seven patients (26%) needed laser reduction glottoplasty for voice feminization because they were not satisfied with the voice result. Patients' self-evaluations of their postoperative voice revealed 20 feminine, 2 masculine, and 5 neither results, giving a rise to patient satisfaction rate of 74%. Medical students rated 85% of postoperative voice samples as feminine, giving rise to overall success rate of 85%. CONCLUSION: Anterior commissure web formation is a successful surgical option for voice feminization. However, additional surgery may be necessary for patient satisfaction.