Babur Kucuk

Gastroesophageal Reflux Disease: Symptoms Versus pH Monitoring Results

OBJECTIVES The reason why some patients with gastroesophageal reflux disease (GERD) have symptoms of upper aerodigestive system irritation, while others mainly have gastroenterologic symptoms, is not well established. This retrospective case series study was designed to examine the existence of a correlation between symptoms and reflux characteristics, based on data obtained from esophageal pH monitoring. METHODS The study population consisted of 139 patients; 97 patients presented with laryngopharyngeal symptoms of GERD, including unexplained hoarseness, throat clearing, chronic cough, laryngospasm, globus, throat pain, and 42 patients presented with gastroenterologic symptoms, including heartburn and regurgitation. The results of 24-hour, double-channel ambulatory esophageal pH monitoring were analyzed comparing 2 symptom groups. The incidence of abnormal acid reflux at the upper and lower esophageal segments and the effects of upright and supine positions on reflux parameters were evaluated. RESULTS The incidence of laryngopharyngeal reflux was significantly higher in the laryngopharyngeal symptom group than in the other (52% versus 38%). The patients with laryngopharyngeal reflux from both groups showed no significant differences in terms of number of acid reflux episodes, percentage of times pH was 4, and esophageal acid clearance. Upright and supine parameters did not show significant differences between the patient groups. Upright acid reflux episodes were, however, common in both groups at the lower esophageal and laryngopharyngeal segments. CONCLUSION Recent studies suggesting that otolaryngologic patients commonly show upright, daytime reflux with normal esophageal clearance and that typical GERD patients commonly have supine, nocturnal reflux with prolonged esophageal clearance are not supported by this study. This study indicates that acid reflux parameters and positional changes are not sufficient to explain why patients with GERD experience different symptoms. The regional symptoms of GERD may be attributed to the impairment of epithelial resistance, motor activity, and buffering systems for the esophageal antireflux barrier.

Hidden unilateral agenesis of the frontal sinus: human cadaver study of a potential surgical pitfall

PURPOSE The aim of the study was to attract attention to the surgical significance of unilateral agenesis of the frontal sinus hidden by the overlapping expansion of the contralateral sinus toward the agenetic side. MATERIALS AND METHODS Retrospective review of endoscopic transnasal sinus dissections of 55 human cadavers (42, formalin fixated; 13, fresh frozen) was done in a tertiary care academic medical center. Surgical and radiologic findings were noted. RESULTS Absence of right frontal sinus ostium in the presence of a connection between the right and left frontal sinuses was demonstrated in 2 (3.6%) cadavers. An absent and an incomplete septum between the frontal sinuses were also noted in these cadavers. No accompanying abnormality of other sinuses was found, and no evidence of previous sinus surgery was noted in these 2 cadavers. CONCLUSIONS If one of the frontal sinus ostia cannot be found during sinus surgery, although this sinus and its recess can be seen on the thick-sliced coronal computed tomographic (CT) scans, keep in mind that it may be (3.6%) an agenetic frontal sinus hidden by the extensive pneumatization of the contralateral sinus that is crossing the midline. It may not be possible to foresee this variant preoperatively by endoscopic examinations or thick-sliced CT scans. If there is suspicion, thin-sliced CT scans with reconstruction will be ideal to confirm the agenesis of the frontal sinus and to avoid complications. In the presence of such variant of frontal sinus, 1-sided successful frontal sinusotomy is adequate because this sinus or cell will already be drained through the treated frontal recess.

Unique variation of digastric muscle: a confusing landmark for head and neck surgeons

An anatomical variation of the left digastric muscle was found during the functional neck dissection of a patient with laryngeal carcinoma. This variant of the digastric muscle had three bellies including an accessory posterior belly. The anterior and posterior bellies had normal origin and course and were linked to each other by an intermediate tendon, whereas the accessory posterior belly took its origin from the mastoid notch of the temporal bone, together with the original posterior belly, sloped inferiorly and anteriorly, and inserted to the lateral border of the strap muscles by an evident tendon. This unique variation has not been reported in the literature. Presentation of this variation will guide surgical procedures, as well as anatomical dissections and medical imaging of the neck.

Basaloid Squamous Cell Carcinoma of the Maxilla: A Case Report and Immunohistochemical Analysis

Basaloid squamous cell carcinoma (BSCC) is a recently recognized high-grade tumor with a propensity for nodal as well as systemic metastasis and can arise from different anatomic locations. The differential diagnosis includes adenoid cystic carcinoma, small cell neuroendocrine carcinoma and squamous cell carcinoma. Monoclonal antibodies reactive with cytokeratin (34 g E12, AE3, pancytokeratin), as well as other cellular antigens (vimentin [VIM]; synaptophysin [SYNF]; chromogranin A [ChA]; neuron-specific enolase [NSE]; S-100, desmin, smooth-muscle actin [SMA]), were used in an immunoperoxidase method with paraffin-embedded tissue to phenotypically characterize a case with features of BSCC arising in the maxillary sinus. Neoplastic cells reacted with the high-molecular-weight cytokeratin antibody 34 g E12, as well as with other antikeratin antibodies, but failed to react with the antibodies VIM, desmin and SMA and showed variable immunoreactivity for NSE, SYNF and S-100. The staining pattern for NSE was diffuse and intense and reactivity for ChA was inconsistent.

How Often Does Isolated Sphenoid Sinus Disease Turn Out to be a Neoplasm

AbstractIsolated sphenoid sinus disease (ISSD) describes a wide spectrum of pathologies including inflammatory, vascular, bony dysplastic, and neoplastic diseases. The aim of this study was to assess the frequency with which a neoplastic process was diagnosed in patients of ISSD and patient management strategies. A retrospective analysis was conducted for all ISSD patients who underwent surgery between January 2005 and January 2014 at a tertiary center. The clinical characteristics, radiologic studies, operative findings, endoscopic surgical techniques, pathology results, and treatment outcomes of the patients were analyzed. In all, 42 patients (31 women and 11 men) were included in the study. Histopathologic examinations revealed that 10 patients (23.4%) had neoplasms (8 benign and 2 malignant), 19 (45.2%) had mucocele, 7 (16.7%) had fungal disease, and 6 (14.3%) had meningoencephalocele and cerebrospinal fluid leakage. With the exception of 2 patients with plasmacytoma, complete removal of the lesions was achieved in all patients using transnasal or transethmoidal endoscopic approaches, and no local recurrences were observed during the mean follow-up period of 42 months. More than one fifth of the patients with ISSD were diagnosed with neoplasms. The results indicated that endonasal endoscopic approaches could effectively help manage patients with ISSD lesions, including those that were neoplastic. It is clear that precaution during preoperative planning is imperative to avoid unexpected situations and complications that may put surgeons in a difficult position during surgery.

Sarcomatoid carcinoma of the larynx: immunohistochemical analysis in two cases.

The great majority of cancers encountered in the upper respiratory tract and oral cavity are squamous cell carcinoma (SCC), with only infrequent examples of other histologic variants. Lane introduced the term pseudosarcoma to describe oropharyngeal and laryngeal tumors that he believed were non-neoplastic stromal responses to an adjacent epidermoid carcinoma. This rare tumor has occasionally been termed pseudosarcoma (PS), carcinosarcoma, spindle cell carcinoma, or sarcomatoid carcinoma (SC). The 3 theories of the histogenetic nature of the spindle cell (Sc) component are: (1) it is not neoplastic, (2) it is the mesenchymal metaplasia of SCC, and (3) it is a true sarcoma. Recent evidence supports the concept that this tumor is a pleomorphic variant of SCC and not a benign connective tissue response. SCs are problematic lesions for the clinician as well as the pathologist. In the following presentation, to further investigate the nature of the Sc component, we present 2 cases of PS of the larynx studied by immunohistochemistry with cytokeratins (CKs), vimentin (VIM), desmin, and smooth muscle actin (SMA).

Endonasal Endoscopic Management of Fibrous Dysplasia Involving Sphenoid Sinus and Optic Nerve: Postoperative Outcomes

Objective: To evaluate success of endonasal endoscopic surgery in removing fibrous dysplasia (FD) lesions involving sphenoid sinuses at areas close to important structures and to assess its effectiveness in management of patient symptoms and possible complications. Methods: Retrospective analysis of all patients operated between 2007 and 2015 at our tertiary care unit with sinonasal FD effecting sphenoid sinuses. Open or combined surgeries were excluded. Clinical examination results, radiological studies, operative findings and treatment outcomes were evaluated. Results: Ten patients with optic nerve encasement in 7 (70%) were included. All had headache which completely vanished in all postoperatively. Preoperative visual changes were detected only in 5 (50%) patients from whom symptoms have resolved completely in 2 (40%) and improved in 3 (60%) after surgery. No patients had postoperative additional visual deficit. During surgery there were no major bleedings, but in 2 (20%) cases CSF leakage was inevitable, which were recognized and repaired immediately. Postoperative imaging showed total resection in 7 (70%), gross total resection in 2 (20%) patients. One patient had only optic nerve decompression due to diffuse skull disease. In a mean follow-up time of 38 months, no recurrences or growth were detected except last mentioned patient. Conclusion: For removal of FD involving sphenoid sinuses, endonasal endoscopic approach reveals a viable technique with acceptable morbidity. Decision of surgery should be made carefully by evaluating radiological evidence for possible complications and by analyzing tumor growth and symptoms of the patients. For reducing recurrences total or gross total excision should be aimed which is achievable with this approach.

İnvitro Kazanç Analizleriyle İşitme Cihazı Seçimi Hearing Aid Selection By Insertion Gain Measurements

Amac: Bu calismada ilk kez isitme cihazi onerilen sensorinoral isitme kayipli hastalarda invitro kazanc olcumleri yapilarak optimum kazanc saglayan isitme cihazlarinin belirlenmesi amaclandi. Gerec ve Yontem: Ellisekiz hastada isitme cihazi invitro kazanc analizleri yapildi. Bulgular: Hem subjektif hem de objektif yontemlerle secilen isitme cihazlariyla yuksek performans elde edildi. Takip donemi boyunca cihazindan sikayet eden hasta olmadi. Sonuc: Isitme cihazi invitro kazanc olcumu pratik ve objektif bir degerlendirme yontemidir. Bu olcumler yardimi ile secilen isitme cihazlarindan beklenen performans alinabilmektedir.