Can Alper Cagici

Appropriate interslice gap for screening coronal paranasal sinus tomography for mucosal thickening

The objective of this study was to establish the appropriate interslice gap for screening coronal paranasal sinus tomography to identify sinus mucosal thickening. We reviewed 100 coronal paranasal sinus tomographic scans (interslice gap, 2 mm) that had been performed at our institution between January 2004 and November 2004 to evaluate rhinosinusitis. Digital photographs of all slices from each tomographic scan were taken. The intervening slices were eliminated to form six different sets of interslice gaps of 4, 6, 8, 10, 16, and 20 mm. The remaining slices for each set were moved to corresponding folders created on a computer to catalog each interslice gap. The same specialist evaluated each folder of interslice gap. The paranasal sinuses, the ethmoid infundibulum, and the frontal recess were evaluated for mucosal thickening. The sensitivity, specificity, and accuracy of each interslice gap in detecting mucosal thickening were calculated by accepting the results of 2-mm-thick slices as the gold standard. The interslice gap of 2 mm was compared with that of other interslice gaps using the chi-square test for dependent groups (the McNemar test). The value of 20 mm interslice gap in detecting sinus mucosal thickening was found to be significantly low when compared with the interslice gap of 2 mm (P = 0.022). Using coronal paranasal sinus tomography, an interslice gap up to 16 mm may be used to detect sinus mucosal thickening.

Ganglioneuroma of the internal auditory canal : A case report

Ganglioneuroma is a rare, benign, slow-growing tumor thought to develop from cells of neural crest origin, even though hypotheses on the pathogenesis of that lesion differ. Ganglioneuromas, which do not release excessive catecholamine or steroid hormones, develop primarily in the posterior mediastinum and retroperitoneum. Because of their slow growth, many ganglioneuromas are large when they are diagnosed. In this case report, a 50-year-old woman with hearing loss is described. Magnetic resonance imaging revealed a mass (3 × 4 mm) in the internal auditory canal (IAC). The encapsulated tumor was entirely excised via the middle fossa approach. The results of histopathological examination indicated that the excised lesion was a ganglioneuroma. To our knowledge, this is the first report of a ganglioneuroma of the IAC. We suggest that ganglioneuroma be considered in the differential diagnosis of all tumors of the IAC.

Epidermoid carcinoma arising in Warthin’s tumor

Warthin’s tumor is a well-defined salivary gland neoplasm consisting of benign epithelial and lymphoid components. However, malignant transformation is extremely rare and the differential diagnosis of metastasis from an epidermoid carcinoma in Warthin’s tumor is important. We present a case with epidermoid carcinoma arising in Warthin’s tumor of parotid gland in a 48-year-old woman, and differential diagnosis is discussed.

Three-slice computerized tomography for the diagnosis and follow-up of rhinosinusitis

Plain sinus radiography is the imaging technique most frequently used to investigate suspected rhinosinusitis, but it has low diagnostic sensitivity. Contiguous paranasal computerized tomography (CT) gives detailed information about the pathology, anatomy and anatomical variations of the paranasal sinuses, but this method also has limitations. The cost of using this technique for all cases of suspected rhinosinusitis is prohibitive, and complete CT scans involve considerable radiation exposure. The aim of this study was to devise a CT protocol for diagnosing and following rhinosinusitis that is more economical and involves much less radiation exposure than contiguous CT. In this retrospective study, three physicians independently reviewed the contiguous coronal paranasal CT studies of 136 patients. The study population comprised the adult patients who were investigated for suspected chronic rhinosinusitis. All scans had been obtained at the second visit, after the patient had completed a 3-week course of medical treatment. For each case, the same three slices were selected to form the “three-slice CT” exam, and the same physicians independently evaluated this set. Using the results from the contiguous set as the gold standard, we calculated the sensitivity and specificity of three-slice CT for identifying rhinosinusitis. The sensitivity and specificity of three-slice CT for identifying inflammatory sinus disease were 95.1 and 92.6%, respectively. Three-slice CT is a valuable method for diagnosing and following rhinosinusitis cases, and would be cheaper and involve less radiation exposure than contiguous coronal CT. However, despite the high cost and greater radiation exposure, contiguous CT remains the gold standard for evaluating detailed sinus anatomy and disease progression.

Effects of Different Suture Materials on Cartilage Reshaping

OBJECTIVE To examine the effects of different suture materials and suturation techniques on cartilage reshaping in a rabbit model. METHODS Twenty-two rabbits were used. Posterior skin flaps were elevated, and 4 cartilage struts were prepared on each auricula. Each strut was bent at its midpoint, and the skin under the bent area was elevated only in 1 side. The strut was sutured either with catgut, polyglactin 910, polydioxanone, or polypropylene sutures. Anteriorly, the suture was passed subcutaneously on 1 side, while transcutaneously on the other. Animals were killed at the first and fourth months. The shape of the struts was macroscopically evaluated. Inflammation and foreign body reaction around the suture were examined under light microscopy. RESULTS Maintenance of shape with all suture materials was significantly lower in the transcutaneously sutured group than in the subcutaneously sutured group. Because of high rates of suture loss in the transcutaneously sutured group, further evaluations on cartilage tissue were made only in subcutaneously sutured group. Success rate in maintenance of shape was similarly high in the polydioxanone, polyglactin 910, and polypropylene suture groups; however, it was significantly lower in the catgut suture group. CONCLUSION Long-lasting absorbable suture materials are as effective as nonabsorbable ones, and the subcutaneous technique is more effective than the transcutaneous technique.

Reversed ipsilateral acoustic reflex pattern.

OBJECTIVE To determine the characteristics and possible origin of reversed ipsilateral acoustic reflex. STUDY DESIGN Retrospective. SETTING University hospital. PATIENTS Sixty-three ears in 52 patients (mean age 37.6 years) with unilateral or bilateral sensorineural hearing loss and 45 age- and sex-matched persons as controls. METHODS Audiometry and impedance audiometry examinations were studied retrospectively. Hearing test records were investigated, and patients with unilateral or bilateral sensorineural hearing loss were included. Forty-five age- and sex-matched persons served as controls. The ipsilateral and contralateral acoustic reflex patterns of these patients were investigated. Reflex-forming acoustic thresholds and latencies of ipsilateral reversed (positive) reflexes were compared with ipsilateral negative (upward) reflexes. RESULTS The ipsilateral acoustic reflexes of 18 of 63 ears with sensorineural hearing loss were absent, and the remaining 45 were reversed (positive). A significant difference was found between ipsilateral reversed and ipsilateral negative acoustic reflex thresholds (p < .001) and latencies (p < .001). No statistically significant differences were found between ipsilateral and contralateral negative reflex latencies. CONCLUSIONS The reversed acoustic reflex pattern is not an artifact but a physiologic event. This reflex does not appear to be related to stapedius or tensor tympani muscle contraction. We believe that the etiology of the reversed reflex is related to the system that contains the tympanic membrane, malleus, and incus and their ligaments but not the middle ear muscles.

Comments on “Double-Blind Comparison of Ultrasonic and Conventional Osteotomy in Terms of Early Postoperative Edema and Ecchymosis”

2018, Vol 38(2) NP29–NP30

Comments on: “The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty.”

I read the manuscript written by Taskın et al. [1] with great interest. The authors performed a randomized study comparing two types of osteotomy in rhinoplasty: piezoelectric and conventional osteotomy. They did not find a significant difference between these osteotomies. Although the authors stated their study is “double-blinded” in the abstract section, I do not agree with them. In this study, 90 patients were randomized into two groups: conventional and piezoelectric osteotomy. The same surgeon did all operations. A blinded examiner evaluated the postoperative ecchymosis and edema of the patients. This is the only blinding in this study. That is why this study is not double blinded as stated in the abstract

Septorhinoplasty in sickle cell anemia: a case report☆

Sickle cell anemia is a hereditary disease caused by the presence of hemoglobin S, an abnormal type of hemoglobin. Hemolytic and vaso-occlusive crises are the main manifestations of sickle cell anemia. Deoxygenation of hemoglobin S may result in intracellular hemoglobin polymerization, which changes the cell morphology and flexibility. The loss of red blood cell flexibility results in occlusion of the capillaries and subsequent vaso-occlusive crises. Vasoocclusive crises are experienced as severe pain attacks. Recurrent vaso-occlusive crises may result in stroke, renal dysfunction, pulmonary hypertension, retinal disease, and avascular necrosis. Infection, hypoxia, dehydration, acidosis, overexercise, psychological stress, trauma, cocaine use, cold exposure, and high altitude are the predisposing factors to vaso-occlusive crises. Most of these factors may be seen during general anesthesia and may be controlled by antibiotic prophylaxis, oxygenation, hydration, maintenance of body temperature, and postoperative pain

No difference in polymorphism frequency in a Turkish population with allergic rhinitis.

The transporter antigen peptide (TAP) 1 and 2 genes, heterodimeric molecules first identified in 1990, represent likely candidates for atopy sensitivity genes since they are inducible by interferon gamma, are present in the HLA class II region, and participate in endogenous antigen processing [1,2]. The locus of HLA class II where they reside, however, is controversial DPB1 and DQB1 loci [3] or others (DQB1 and DRB1 loci, DQ-DP loci, DM-DQ loci). To clarify the contribution of TAP polymorphisms to allergic rhinitis, we determined the frequency of TAP1 (I333V) and TAP2 (A565T and R651C) polymorphisms in a Turkish population with allergic rhinitis. The current study was approved by the ethics board in accordance with Başkent University’s Agreement on Clinical Research. A total of 239 unrelated participants were enrolled, 113 allergic rhinitis patients and 126 healthy subjects, between December 2002 and March 2004. Subjects included 153 women and 86 men, with an average age of 35.19/17.2 years. Inclusion criteria for the patient group were defined as patients with serum total IgE above 100 IU/ml, positive specific IgE test results, a positive skin prick test, and eosinophils in the nasal smear. Genomic DNA was extracted from blood samples and used as a template for PCR amplification. Restriction fragment size analysis was performed for TAP1 (I333V) or TAP2 (A565T and R651C) by visualization of Sau3A1-, Sca l-, or Sma ldigested PCR products, respectively, after separation by polyacrylamide gel electrophoresis on a 10% ethidium bromide-stained gel. The x test was used for comparison of TAP allele frequencies between the two groups. A total size of 239 (TAP1 /41, TAP2 /72, and control /126) for groups was determined for a power of 95% at an a level of 0.05. Serum total IgE levels were compared using the Student t test. We found no significant differences in the frequency of TAP1 and TAP2 polymorphisms between the patient and control groups for any genotypes, and no significant differences among serum total IgE levels in the TAP1 or the TAP2 groups (p /0.05).