Imran San

Paranasal sinus computed tomographic findings of children with chronic cough

OBJECTIVE Chronic cough is a frequent problem in the practice of clinical pediatrics, and sinusitis is a common etiologic factor. In this study, our aim was to determine the prevalence of sinus abnormalities in pediatric patients presenting with chronic cough. METHODS Forty-two patients, ranging from 3 to 16 years of age from both sexes completed the study. Paranasal sinuses were examined by coronal paranasal sinus limited computed tomographic scan. The CT scan findings were categorized as no disease, minimal, moderate and severe sinusitis. RESULTS The most frequent symptoms after cough were rhinorrhea, sniffling, and halitosis. We found sinus abnormalities in 66.6% and no abnormality in 33.3% of the children. Age and sex were not important factors in sinus disease. There was no correlation between sinus findings and any of symptoms. The most common anatomical abnormalities were concha bullosa, paradoxical middle turbinate, Hallers cells, and deviated nasal septum. These abnormalities were not correlated with sinus disease. CONCLUSION Paranasal sinus abnormalities are common among pediatric patients with chronic cough and imaging studies of the sinuses should be considered in these children.

Nasal polyps and the severity of asthma.

Background and objectives:  Upper airway pathologies often accompany asthma. Because this represents a single airway, the diagnosis, follow up and treatment of both upper and lower respiratory diseases is essential. Samter Syndrome (SS) is known to be associated with more severe asthma. The presence of nasal polyps (NPs) is also associated with asthma. However, the incidence of NPs in asthma and the effect of NPs on asthma severity are not well documented.

Audiological findings in patients with ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease. The aim of this investigation was to study the relationship between AS and hearing loss. This study compared 28 patients with AS with 23 age-matched controls. All subjects underwent ENT examination, audiological and acoustic immittance measurements, and auditory brainstem response (ABR) tests. Sensorineural hearing loss was found in 28.6 per cent of the AS patients and in 4.35 per cent of the control group. For hearing levels at 250-500 Hz and 4000-8000 Hz, there was a statistically significant difference between the two groups. Acoustic reflex was not obtained in both ears of four patients and the left ear of one patient. There was a correlation between increase of tympanic volume and limitation in neck movement, between extension of 1-3 interpeak latency and limitation in the neck movement. In conclusion, AS affects the inner ear more than the middle ear.

GJB2 and mitochondrial A1555G gene mutations in nonsyndromic profound hearing loss and carrier frequencies in healthy individuals

This study aimed to assess mutations in GJB2 gene (connexin 26), as well as A1555G mitochondrial mutation in both the patients with profound genetic nonsyndromic hearing loss and healthy controls. Ninety-five patients with profound hearing loss (>90 dB) and 67 healthy controls were included. All patients had genetic nonsyndromic hearing loss. Molecular analyses were performed for connexin 26 (35delG, M34T, L90P, R184P, delE120, 167delT, 235delC and IVS1+1 A → G) mutations, and for mitochondrial A1555G mutation. Twenty-two connexin 26 mutations were found in 14.7% of the patients, which were 35delG, R184P, del120E and IVS1+1 A → G. Mitochondrial A1555G mutation was not encountered. The most common GJB2 gene mutation was 35delG, which was followed by del120E, IVS1+1 A → G and R184P, and 14.3% of the patients segregated with DFNB1. In consanguineous marriages, the most common mutation was 35delG. The carrier frequency for 35delG mutation was 1.4% in the controls. 35delG and del120E populations, seems the most common connexin 26 mutations that cause genetic nonsyndromic hearing loss in this country. Nonsyndromic hearing loss mostly shows DFNB1 form of segregation.

Ophthalmic techniques described by Serefeddin Sabuncuoğlu (1385-1468 AD).

¸Serefeddin Sabuncuoglu (1385−1468 ad) was a Turkish surgeon who lived in the Ottoman Empire during the fifteenth century, a time of progressive expansion. When in his eighties, he wrote Cerrahiyyetü’l‐Haniyye, which means Imperial Surgery. His book is the first example of an illustrated surgical textbook in the Turkish−Islamic medical literature. The importance of his book rests upon the inclusion of colour miniatures of the surgical procedures, incisional techniques and instruments, all drawn by Sabuncuog˘lu himself. Only three hand‐written copies exist, two of which were originally written by the author and are currently exhibited in Paris and Istanbul. The book was rediscovered in 1936, but some parts of it are still suspected to be missing. At present, the book consists of three chapters divided into 193 known sections. The sections deal with all fields of surgery including ophthalmology, and cite relevant Greek, Arabic and Persian textbooks. In this historical article the sections of Cerrahiyyetü’l‐Haniyye pertinent to ophthalmology are critically reviewed, including a selection of the coloured drawings.

Nasal polyp diseases in allergic and nonallergic patients and steroid therapy

Objective To investigate widespread disease causes, cellular-structural differences, and steroid response of nasal polyps (NPs). Method Study group consisted of NPs, allergic-NPs, NPs with steroid therapy (ST), antrochoanal polyp (ACP), and controls. We investigated stromal eosinophil, mast cell, CD4+ and CD8+ cell counts and presence of squamous metaplasia, Ki-67 expression, intraepithelial eosinophils-mast cells, epithelial damage, edema, fibrosis, hyalinization, polymorphonuclear leukocyte, and glandular hyperplasia. Results In allergic-NPs, intraepithelial eosinophils and epithelial damage CD4+ were significantly higher than NPs and also, eosinophils, mast cells, intraepithelial eosinophils, and epithelial damage were significantly higher than ACP. Only stromal eosinophilic infiltration was significantly higher in NPs than ACP. There was significant increased glandular hyperplasia and decreased intraepithelial eosinophils, mast cells, CD4+ cells, squamous metaplasia, and epithelial damage with ST in allergic-NPs. There were no significant differences with ST in NPs. Conclusion NPs in allergic and nonallergic patients may differ in their histology and in their histologic responses to ST. EBM rating: B-3b

The hemostatic efficacy of Ankaferd Blood Stopper in adenoidectomy

OBJECTIVE To evaluate the efficacy of Ankaferd Blood Stopper (ABS) in the control of intraoperative and postoperative bleeding in adenoidectomy. METHODS In total, 90 patients underwent traditional cold steel adenoidectomy and were then randomized to receive ABS or 0.9% physiological saline solution to obtain hemostasis. Objective data collected included time of operation and blood loss during operation. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal and ease of operation. RESULTS In a comparison between patients in the ABS group (n = 46) and the control group (n = 44), those in the ABS group had significantly shorter operation times (9.11 ± 1.02 vs. 13.16 ± 3.96 min; p < 0.001) and less blood loss during the operation (20.19 ± 8.59 vs. 25.48 ± 12.96 ml; p ≤ 0.05) and a shorter hemostasis time (3.83 ± 0.8 vs. 5.82 ± 1.67 min; p < 0.001). Regarding hemorrhage after tampon removal, 40 patients (87%) in the ABS group and 17 patients (38.6%) in the control group did not suffer from hemorrhage (p < 0.001). Regarding ease of hemostasis, 40 patients (87%) in the ABS group experienced very easy or easy hemostasis while 26 patients in the control group did so (59.1%; p = 0.004). Patients in the ABS group returned to a regular diet earlier and had less use of analgesics at 7 days postoperatively. Use of electrocautery was less in the ABS group than in the control group (10.9 vs. 40.9%; p = 0.001). CONCLUSIONS The side on which ABS was used showed significant differences in hemostasis time, blood loss, and ease of hemostasis. ABS appears to be safe and effective; it decreases intraoperative bleeding and reduces operating time when compared to traditional hemostasis methods after curette adenoidectomy.

Pneumatization of the inferior turbinates: incidence and radiologic appearance.

Objective: The objective of this work was to determine the incidence and radiologic appearance of pneumatized inferior turbinates (PITs). Methods: Pneumatized inferior turbinates were investigated among 2500 consecutive cases with coronal paranasal sinus computed tomography (CT) scans that were performed for different reasons between 2000 and 2004. Results: Ten new PIT cases diagnosed with CT were identified. Pneumatization was diagnosed in 2 patients aged 7 and 14 years. Therefore, this is the first time that PIT has been described in the pediatric age group. Complete or incomplete pneumatizations were unilateral in 7 cases and bilateral in 3 cases. In bilateral PIT cases, pneumatizations were asymmetric. In 2 cases, only bulbous parts of the inferior turbinates (ITs) were involved. Inferior turbinate expansion related to pneumatization was not observed in any case. In cases with maxillary sinus communication, axial CT sections revealed a defect on the medial wall of the maxillary sinus. Conclusions: The incidence of PIT was found to be 1 in 250 cases. It is suggested that most PIT cases may be a result of articulation defects between the maxillary process of the palatine bone and the maxillary bone. In such a situation, the maxillary process of the palatine bone and the nasal process of the maxillary bone, which form the medial wall of the maxillary sinus at the IT level, can attach to the IT separately.

An unusual dark pigmentation on the tympanic membrane.

OBJECTIVE To report an extremely rare case of dark pigmentation on the tympanic membrane due to alkaptonuria, and to discuss the probable association between this condition and hearing loss. CASE REPORT A 58-year-old man with alkaptonuria was admitted with tinnitus and hearing loss in both ears. Physical examination showed bluish-black pigmentation on the helixes of both ears and both sclerae. Otoscopic examination revealed dark discolouration of both tympanic membranes. Audiological evaluation revealed mixed high frequency hearing loss in both ears. Tympanometric examination revealed type A tympanograms bilaterally, and absence of acoustic reflexes both ipsilaterally and contralaterally. Computed tomography of the temporal bones revealed no abnormality. CONCLUSION Clinicians should consider alkaptonuria in the differential diagnosis of patients with abnormal tympanic membrane pigmentation and hearing loss.

Partial Neuromuscular Blockage Levels with Mivacurium during Mastoidectomy Allows Intraoperative Facial Nerve Monitoring

Background: Facial nerve monitoring during otologic surgery is helpful for facial nerve preservation, but its usage is closely related to anesthetic procedures. Objectives: The aim of this study was to investigate the effectiveness of mivacurium-based partial neuromuscular blockade on facial nerve monitoring during otologic surgery. Methods: Forty-three patients scheduled for elective otologic surgery (mastoidectomy with and without tympanoplasty) participated in the study. After induction with propofol 2–3 mg · kg–1, remifentanil 1 µg · kg–1 and mivacurium 0.2 mg · kg–1, anesthesia was maintained with isoflurane 0.6–1.6 minimum alveolar concentration and remifentanil 0.25 µg · kg–1 · min–1. Following complete recovery of neuromuscular blockade during induction, mivacurium infusion was initiated at 6 µg · kg–1 · min–1 in an adjusted dose to reflect adductor pollicis activity of 50, 75 or 100% of normal. The minimum stimulation thresholds obtained from each case were recorded. Results: Pre- and postoperatively, all 43 patients demonstrated clinically normal facial nerve function. In all cases, intraoperative facial nerve monitoring was performed successfully. There were no differences in threshold levels of the facial nerve stimulation between group I (1.84 ± 0.4 mA ) and group II (1.97 ± 0.2 mA). However, the stimulation thresholds of group III (1.53 ± 0.4 mA ) were found to be lower than those of groups I and II (p < 0.05). Conclusion: We conclude that partial neuromuscular blockade with mivacurium permits intraoperative facial nerve monitoring.