Korhan Kilic

Bone mineral density in patients with obstructive sleep apnea syndrome.

PurposeObstructive sleep apnea syndrome (OSAS) is a disorder that is characterized by repetitive pauses in breathing during sleep. Airway obstruction episodes can lead to ischemia or hypoxia in tissues. Hypoxia may also have an effect on bone metabolism. In this study, we aim to investigate both the bone metabolic abnormalities and bone mineral density (BMD) in OSAS patients compared to individuals without OSAS.MethodsTwenty-one male patients with OSAS and 26 control subjects, also male, enrolled in this study. Serum calcium, phosphorus, alkaline phosphatase, and urinary desoxypiridinoline levels were measured in all participants, and BMD was evaluated using DEXA (Hologic QDR 2000). The BMD was measured in the lumbar spine (L1–L4), the femoral neck, and total femur region.ResultsNo statistically significant difference was noted between the two groups with respect to demographic data, except for body mass index (BMI). We adjusted the statistical analyses in line with the BMI and noted significant differences between OSAS patients and control subjects with regard to lumbar L1–L4 t score, lumbar L1–L4 BMD, and femoral neck BMD values (p ≤ 0.001). We find significant correlations with lumbar L1-L4 BMD (r = −0.4; p = 0.023) and lumbar L1–L4 t score values (r = −0.5; p = 0.012).ConclusionOur study indicates that there is a relationship between OSAS and osteoporosis. However, further controlled studies comprising a greater number of patients are needed to investigate the relationship between osteoporosis and OSAS.

Comminuted Frontal Sinus Fracture Reconstructed With Titanium Mesh.

Frontal sinus fractures (FSF) are relatively uncommon maxillofacial injuries. The most common cause of FSF is motor vehicle accidents with 62% percentage. Management of FSF depends on type of fracture, associated injuries, and involvement of naso-frontal duct. In this report, the authors presented a patient with comminuted fracture of anterior wall of frontal sinus reconstructed with titanium mesh. A 40-year-old man presented with depression of the frontal bone, facial pain, and epistaxis consisting of a motor vehicle accident. Computerized tomography scan revealed multiple comminuted fractures of anterior wall of frontal sinus and fractures of left orbital medial and superior walls. Titanium mesh was used for reconstruction. Postoperative course was uneventful. The titanium mesh, which is easy to handle with no complications, may provide excellent frontal contour after comminuted anterior wall fractures.

Glomuvenous malformations in the buccal area.

Glomuvenous malformations (GVMs) are relatively rare lesions in the head and neck area. A 30-year-old woman presented to our clinic with a large mass on the right buccal area with tenderness and hypersensitivity to palpation. The lesion was excised totally under general anesthesia. Microscopic evaluation and immunostaining method confirmed the diagnosis of GVM. We concluded that a solitary form of GVMs as a large mass on the buccal region could occur, and a mass with tenderness and hypersensitivity on palpation could be significant in its differential diagnosis.

Cephalometric Measurements With Multislice Computed Tomography in Patients With Obstructive Sleep Apnea Syndrome.

Introduction:Obstructive sleep apnea syndrome (OSAS) is characterized by episodes of upper respiratory tract obstruction, decreased oxygen saturation, and sleep fragmentation during sleep, as well as excessive daytime somnolence. Cephalometric analysis offers distance, angle, area, and volume measurements between separate reference points belonging to bony and soft tissues on a film. Cephalometric measurements made with multislice computed tomography (CT) are quite helpful for standardization of measurements and obtaining highly reliable results. The aim of the current study was to make cephalometric measurements with multislice CT in OSAS patients and compare their results with those of a healthy control population. The authors also aimed to determine, which cephalometric parameters might be more valuable for diagnosis of OSAS. Materials and Method:This study included 30 patients who were diagnosed with severe OSAS (apnea-hypopnea index >30) by an overnight polysomnography study, performed for suspected OSAS and 10 healthy controls without snoring or apnea who underwent three-dimensional head & neck multislice CT for any indication. All patients underwent a three-dimensional head & neck multislice CT to make cephalometric measurements and compare them across the groups. Results:ANS-PNS (anterior and posterior nasal spine), Go-Gn, and UP-PhW distances, as well as sella-nasion–A and sella-nasion–B angles, were significantly lower in the OSAS group compared with the controls (P < 0.05). Mandibulas plane -H, UD, TT-EA, ANS-B, PNS-TB, TT-TB, B-N, and PNS-PhW distances were significantly higher in the patient group compared with the controls (P < 0.05). Conclusions:Our study reached the conclusion that some cephalometric measurements showed significant differences in patients with obstructive sleep apnea compared with the control group, and hence may lead to a susceptibility to having OSAS. Cephalometric measurements performed with multislice CT have come to the forefront as one of the most important tools for diagnosis of OSAS. An inferiorly located hyoid bone may be most commonly responsible for apnea episodes. It was also concluded that an inferiorly located hyoid bone might have been the result of maxillomandibular underdevelopment.

Pharmacological agents used for treatment and prevention in noise-induced hearing loss

Noise is a stress factor that causes auditory, psychological and physiological effects. The realization that sudden loud noises or chronic exposure to noise in social and working environments can cause hearing loss has led to increased interest in noise-induced hearing loss (NIHL). The best means of preventing primary damage is protection against noise. Since this protection is not always possible for various reasons, the use of pharmacological agents to prevent or treat NIHL should also be considered. The purpose of this study is to discuss current pharmacological protection and treatment options in the light of the literature, since no such extensive reviews have been performed to date, including agents used for protection against and treatment of NIHL. We reviewed both animal and clinical studies, and these are discussed separately for ease of comprehension. For each agent, first animal studies, then clinical studies, if available, are discussed. We also performed a two-step search of the literature. In the first step, we searched the terms “noise induced hearing loss”, “treatment” and “protection” in Pubmed. Based on the results obtained, we identified the agents used for the treatment of and protection against NIHL. In the second step, we searched the names of the agents identified in the first step, together with the term “noise induced hearing loss,” and reviewed the results.

Lymphoepithelial Cyst in the Palatine Tonsil

Lymphoepithelial cyst (LEC) is the most commonly encountered congenital neck pathology in the lateral part of the neck. A 66-year-old woman presented to the ENT clinic due to difficulty in swallowing persisting for approximately 1 year. Magnetic resonance imaging revealed a cystic mass at right tonsil. Surgery was performed due to this unilateral tonsillar mass, which was excised together with the right tonsil. LEC was diagnosed at histopathological examination. LEC in the palatine tonsil is rare, and only a few cases have been reported in the literature. We report a rare case of LEC in the palatine tonsil.

Deep Neck Infection Accompanied by Descending Necrotizing Mediastinitis.

Ethicon). Subsequently bilateral vertical bipedicled cutaneous flaps 6-cm wide were designed making 11-cm lateral incisions. Flaps were advanced medially to overlap the muscular fascia with 6-0 nylon (Ethilon, Ethicon) stitches, and donor sites were closed directly. Hydrocephalus treatment with a ventriculoperitoneal shunt was postponed to the following day and an orthopedic plaster was splinted to correct foot deformities. Left releasing incision required to be resutured. No other surgical complications were observed. In the following months, the child required a new surgery for excision of a hyperostosis at the level of the posterior part of the foramen magnum, which was impinging on the brainstem, and 4 uneventful shunt revisions. At the age of 10 months, the patient was admitted to the hospital for central apnea with asystole, which eventually resulted in cardiac arrest 2 days later (Fig. 1). The presence of multiple risk factors entailed a life-threatening condition to our patient. First, the newborn presented with a severe type III Chiari malformation associated to a thoracic diastematomyelia. Second, the area of the MMC was significantly large (54 cm) extending to a high thoracic level. Early operative repair is mandatory to prevent serious bacterial infections and subsequent permanent neurological sequelae. Our plan was to provide adequate soft-tissue coverage of the neural elements but with minimal morbidity using the less traumatic technique available. Bipedicled skin advancement flaps have been described in the literature to repair defects up to 8.5 cm in diameter and may result in up to 20% risk of skin necrosis resulting from excessive tension at the midline sutures. Although our defect was larger, the patient did not suffer any complication such as skin necrosis, CSF leak, or infection. However, the association of paraspinous fascial turnover flaps was aimed to reinforce the dural closure and increase the distance between the spinal cord and the skin, diminishing the rate of CSF leak and the subsequent risk of meningitis. This procedure provided an additional vascularized layer of soft tissue avoiding the dysfunction of the gluteus or lattisimus dorsi muscles in a neurologically compromised patient. Literature on this type of severe cases is sparse. We consider our patient’s case illustrative for 2 main reasons. First, it outlines how a simple technique like bilateral bipedicled flaps associated with paraspinal fascial turnover flaps can provide adequate coverage for a large MMC, and second, it demonstrates in cases of newborns with severe neural tube defects how an adequate multidisciplinary team should work to offer the best quality of life possible during their lifetime.

Evaluation of Hearing in Children with Metabolic Syndrome

Objective The frequency of metabolic syndrome is increasing in both children and adults. In addition to metabolic complications such as obesity, hypertension, cardiovascular diseases, insulin resistance, and type 2 diabetes, metabolic syndrome may affect all systems of the body. The aim of the present study was to investigate the effect of metabolic syndrome on hearing in childhood. Methods A prospective, controlled study was performed on 38 obese children diagnosed with metabolic syndrome and 34 healthy children. Anthropometric measurements and biochemical studies were performed. All individuals underwent pure-tone audiometry, tympanogram, and transient evoked otoacoustic emission (TEOAE) tests. The hearing thresholds of the patients were compared with healthy volunteers. Results There was no significant difference in terms of age and gender between the groups (p>0.05). There was no significant difference in mean hearing levels between the groups. When frequencies were compared, significantly increased hearing threshold levels were determined at low frequencies in children with metabolic syndrome. Analysis of the TEOAE results elicited no statistically significant variation in terms of signal-to-noise ratio values, signal amplitudes, or test reproducibility values between the study groups. Conclusion Identification of the potential hearing losses early by means of detailed hearing examinations in children with metabolic syndrome is important. To the best of our knowledge, this is the first study to examine the effect of metabolic syndrome on hearing in this age group.

The effectiveness of eugenol against cisplatin-induced ototoxicity

INTRODUCTION Ototoxicity refers to cellular damage or function impairment developing in the inner ear in association with any therapeutic agent or chemical substance, and still represents the principal side-effect restricting the use of cisplatin. OBJECTIVE The aim of this study was to perform a biochemical, functional and histopathological investigation of the potential protective effect of eugenol against cisplatin-induced ototoxicity. METHODS The study was performed with 24 female Sprague Dawley rats. Distortion product otoacoustic emissions tests were performed on all animals, which were randomized into four equal groups. A single intraperitoneal dose of 15mg/kg cisplatin was administered to cisplatin group, while the eugenol group received 100mg/kg eugenol intraperitoneal for five consecutive days. 100mg/kg eugenol was administered to cisplatin+eugenol group for 5 days. On the third day, these rats were received a single dose of 15mg/kg cisplatin. The control group was given 8mL/kg/day intraperitoneal saline solution for five days. The distortion product otoacoustic emissions test was repeated 24h after the final drug administration. All animals were sacrificed, and the cochleas were subsequently used for biochemical and histopathological examinations. RESULTS Cisplatin caused oxidative stress in the cochlea, impaired the cochlear structure and significantly reduced signal noise ratio levels. Administration of eugenol together with cisplatin reversed these effects and provided functional, biochemical and histopathological protection. CONCLUSION The study findings represent the first indication in the literature that eugenol may protect against ototoxicity by raising levels of antioxidant enzymes and lowering those of oxidant parameters.

Protective effect of gallic acid against cisplatin-induced ototoxicity in rats

INTRODUCTION Cisplatin is an antineoplastic agent widely used in the treatment of a variety of cancers. Ototoxicity is one of the main side-effects restricting the use of cisplatin. OBJECTIVE The purpose of this study was to investigate the protective efficacy of gallic acid, in biochemical, functional and histopathological terms, against ototoxicity induced by cisplatin. METHODS Twenty-eight female Sprague Dawley rats were included. Rats were randomly assigned into four groups of seven animals each. Cisplatin group received a single intraperitoneal dose of 15mg/kg cisplatin. Gallic acid group received intraperitoneal gallic acid at 100mg/kg for five consecutive days. Cisplatin+gallic acid group received intraperitoneal gallic acid at 100mg/kg for five consecutive days and a single intraperitoneal dose of 15mg/kg cisplatin at 3rd day. A control group received 1mL intraperitoneal saline solution for five consecutive days. Prior to drug administration, all rats were exposed to the distortion product otoacoustic emissions test. The test was repeated on the 6th day of the study. All rats were then sacrificed; the cochleas were removed and set aside for biochemical and histopathological analyses. RESULTS In cisplatin group, Day 6 signal noise ratio values were significantly lower than those of the other groups. Also, malondialdehyde levels in cochlear tissues were significantly higher, superoxide dismutase and glutathione peroxidase activities were significantly lower compared to the control group. Histopathologic evaluation revealed erosion in the stria vascularis, degeneration and edema in the connective tissue layer in endothelial cells, impairment of outer hair cells and a decrease in the number of these calls. In the cisplatin+gallic acid group, this biochemical, histopathological and functional changes were reversed. CONCLUSION In the light of our findings, we think that gallic acid may have played a protective role against cisplatin-induced ototoxicity in rats, as indicated by the distortion product otoacoustic emissions test results, biochemical findings and immunohistochemical analyses.