Mehmet Birol Ugur

Effectiveness of dexmedetomidine in reducing bleeding during septoplasty and tympanoplasty operations.

STUDY OBJECTIVE To determine the effect of dexmedetomidine on intraoperative bleeding during septoplasty and tympanoplasty operations. DESIGN Randomized, placebo-controlled study. SETTING Univesity medical center. PATIENTS 80 ASA physical status I and II patients, aged 18 to 65 years, 40 of whom were scheduled for septoplasty and 40 to undergo tympanoplasty operations. INTERVENTIONS Patients undergoing septoplasty (S) and tympanoplasty (T) operations were randomly divided into 4 groups. Dexmedetomidine (D) was administered to Group SD and Group TD first as a bolus dose of one microg kg(-1), then intraoperative maintenance was supplied with dexmedetomidine 0.7 microg kg(-1) hour(-1). Groups S and T (controls) were given identical amounts of saline. If systolic blood pressure measurements are greater than 20% preoperative values, then fentanyl one microg kg(-1) was given. MEASUREMENTS Intraoperative blood loss was determined with suction volumes and gauze counting. Bleeding was rated according to a 6-point scale. Hemodynamic parameters and fentanyl administration were recorded. MAIN RESULTS Group SD had less bleeding and lower bleeding scores (P < 0.05). In addition, this group received less intraoperative fentanyl (P < 0.05). The only significant difference between Groups TD and T was the amount of intraoperative fentanyl given (35.4 +/- 58.8 vs 110.0 +/- 81.0 microg) (P < 0.05). CONCLUSION Dexmedetomidine reduces bleeding, bleeding scores, and intraoperative fentanyl consumption during general anesthesia in septoplasty operations.

Effect of adenoidectomy and/or tonsillectomy on cardiac functions in children with obstructive sleep apnea.

Background/Aims: We aimed to determine the effects of adenoidectomy and/or tonsillectomy (AT) on cardiac functions in children with adenoid and/or tonsillary hypertrophy and obstructive sleep apnea syndrome (OSAS) by using echocardiography with tissue Doppler imaging facility (TDI). Methods: Twenty-nine children with adenoid and/or tonsillary hypertrophy and OSAS and 26 children with primary snoring entered the study. Cardiac functions were assessed by echocardiography with TDI in both groups. Tests were repeated in the OSAS group 6 months after treatment with AT. Results: Echocardiography showed a decrease in estimated pulmonary artery systolic pressure from 31 ± 4.2 to 13.1 ± 2.3 (p < 0.001). In TDI, tricuspid Em and Em/Am increased from 11.0 ± 2.7 to 13.5 ± 2.7 cm/s (p < 0.001), and 1.46 ± 0.52 to 1.82 ± 0.53 (p = 0.004), respectively, following AT, indicating improvement in right ventricular diastolic dysfunction. Similarly, mitral Em and Em /Am increased from 12.3 ± 2.1 to 16.3 ± 2.7 cm/s, and from 1.65 ± 0.51 to 2.30 ± 0.54, respectively (p < 0.001). There was no significant difference between postoperative values and control group values. Conclusion: TDI is a technique able to detect diastolic dysfunction unnoticeable by conventional echocardiography. Following AT, we observed improvement in both left and right ventricular diastolic functions using TDI.

Otoacoustic emissions and effects of contralateral white noise stimulation on transient evoked otoacoustic emissions in diabetic children

OBJECTIVE In this study, our aim was to determine presence of dysfunction in the efferent auditory system of children with type-I diabetes mellitus (DM) presenting no evidence of symptomatic neuropathy. METHODS Thirty children with type-I DM (DM group) and 31 age matched healthy children (control group) with normal hearing and middle ear function were entered to the study. Distortion product otoacoustic emissions (DPOAE), transiently evoked otoacoustic emissions (TEOAE), and spontaneous otoacoustic emissions (SOAE) measurements were performed. Then, the TEOAE recording was repeated while a continuous broadband white noise (bandwidth: 50-8000 Hz) presented at 40 dB SL was delivered to the contralateral ear for efferent auditory system suppression. RESULTS We found that contralateral stimulation (CS) with white noise resulted in significantly more pronounced suppression of the TEOAE response amplitude in healthy controls compared to DM group at 2000 and 4000 Hz frequencies. Further, a relatively higher percentage of the controls had suppression in at least three frequencies compared to DM group. SOAE prevalence was found to be higher in the DM group. CONCLUSIONS Our findings suggest presence of a dysfunction in medial olivocochlear efferent system in diabetic children. This may be regarded as an early central manifestation of diabetic neuropathy.

Effectiveness of the Jaw-Thrust Maneuver in Opening the Airway: A Flexible Fiberoptic Endoscopic Study

Objective: A prospective study was carried out to find the exact site of obstruction in sleep model and to quantitatively evaluate the effect of Jaw-thrust maneuver (JTM) in opening the obstructed airway using flexible fiberoptic endoscope. Methods: Twenty-eight ASA physical status I or II patients with snoring symptom undergoing elective surgery were included. The patients were held in supine position without hyperextension of the neck. Having induced anesthesia, the base of the tongue and laryngeal inlet and/or epiglottis were visualized using endoscope. The patients’ epiglottides were classified as leaf-shaped, curved (concaved or omega-shaped) and floppy types. We graded the airway opening at the level of epiglottis into six grades and obstruction at the tongue base level into four grades. The grades during inspiration (GrIns), expiration (GrExp) and after JTM (GrJTM) were recorded and compared with Pearson chi-square test. Results: The strictly curved (Ω-shaped or concaved) epiglottis supplied a salvage pathway for airflow that resisted collapsing with the posterior movement of the tongue base in 2 patients. When we compared GrIns with GrExp for epiglottis the difference was statistically significant (χ2 = 0.001), but the difference for tongue base was not (χ2 = 0.152). After JTM, GrJTM for both epiglottis and tongue base were significantly better than GrIns and GrExp (χ2 < 0.001). Conclusion: Tongue base was the principal site of obstruction although during the respiratory cycle the position of epiglottis changed prominently and increased the obstruction in inspiration. JTM alone significantly relieved the obstruction at the tongue base and epiglottis levels and increased the retroglossal airway.

Enlargement of the bone component in different parts of compensatorily hypertrophied inferior turbinate.

Background To evaluate the unilateral compensatorily hypertrophied inferior turbinate (CHIT) by computed tomography (CT) and determine the enlargement of the bone component in different parts of the CHIT. Methods Patients were studied in three groups: those with a straight or nearly straight septum (n = 143), with mild deviation (n = 42), and with moderate to severe deviation (n = 99). The cross sectional area (CSA) of the inferior turbinate (IT) bone and the whole turbinate were measured at anterior, middle, and posterior thirds of the IT in coronal sections. The ratio of CSA of the IT bone on two sides of the septum (interturbinate ratio) and the ratio of the CSA of the overall turbinate to the IT bone (intraturbinate ratio) were calculated. Results The interturbinate ratio of the bony turbinate CSA for the severe deviation group was significantly higher compared with other groups in anterior and middle segments (p < 0.0001). The intraturbinate ratio was highest in the posterior segment and lowest in the middle segments in compensatorily hypertrophied sides for all groups (p < 0.001). Conclusion Skeletal enlargement is prominent in anterior and middle thirds of CHIT in patients with pronounced septal deviation.

Does preincisional injection of levobupivacaine with epinephrine have any benefits for children undergoing tonsillectomy? An intraindividual evaluation

OBJECTIVE To evaluate the effects of peritonsillar injection of levobupivacaine with epinephrine in children undergoing adenotonsillectomy, through an intraindividual study. PATIENTS AND METHODS 20 children (age 6-13 years) undergoing elective tonsillectomy with or without adenoidectomy were enrolled in this prospective, randomized, intraindividual trial. After entubation and just prior to incision, 3 ml of 0.25% levobupivacaine with epinephrine was injected into one peritonsillar region while 0.9% saline was being used for the contralateral side. Amount of intraoperative blood loss, duration of tonsillectomy, postoperative pain, otalgia and hemorrhage were assessed for each side separately. Visual analog scale was used for postoperative pain assessment. Heart rate and mean arterial pressure during and after operation were also observed. The follow-up period after surgery was 10 days. RESULTS Median visual analog scale values for the levobupivacaine with epinephrine injected side was significantly lower than the saline injected side, during the first postoperative 16h (p<0.05). There were also significant differences between the intraoperative blood losses of the two sides (p<0.05). However; no significant differences were observed with respect to duration of surgery, postoperative otalgia and hemorrhage (p>0.05). CONCLUSION Preincisional injection of levobupivacaine with epinephrine decreases early postoperative pain and intraoperative blood loss as well.

A reliable surface landmark for localizing supratrochlear artery: Medial canthus

OBJECTIVE: To determine the reliability of medial canthus as a surface landmark to locate supratrochlear vascular pedicle. STUDY DESIGN AND SETTING: The distance from medial canthal line to supratrochlear vascular pedicle was measured in 57 healthy volunteers (Doppler imaging study) and also in 15 fresh cadavers. RESULTS: In the Doppler study, the pedicle was found at most 3 mm lateral or medial to medial canthus (mean ± SD, 0.8 ± 0.7 mm). SVP mark tended to be medial to the medial canthus mark in females (males, 6; females, 42), whereas it was lateral to it in males (males, 20; females, 5). In the cadaver study, the pedicle was found 0.7 mm away from medial canthus on average. CONCLUSION: Medial canthus can be used as a reliable landmark for paramedian forehead flaps. When Doppler examination fails, pedicle may be found at most 3 mm away from medial canthus. SVP is more commonly located lateral to medial canthus in males and medial to it in females.

Correlation of symptoms with total IgE and specific IgE levels in patients presenting with allergic rhinitis

Objective: The objective of this study was to investigate the correlation of symptoms in patients with presumed allergic rhinitis on the basis of their medical history and physical examination with the levels of total immunoglobulin E (IgE) and specific IgE, and to question the necessity of these tests in diagnosis. Methods: The records of 295 patients, who had at least two complaints of nasal itching, nasal obstruction, runny discharge and sneezing, and/or presumed as allergic rhinitis on physical examination findings were retrospectively screened. The correlation between the levels of IgE, specific inhalant IgE, and food-specific serum IgE were evaluated in these patients. Results: A total of 70 cases (23.7%) were determined to have a total value of IgE under 20 U/ml, 113 cases (38.3%) with IgE values between 20 U/ml and 100 U/ml, and 100 cases with IgE values above 100 U/ml. Results of total IgE could not be obtained in 12 (4.06%) patients. Dermatophagoides farinae was the most common allergy in this group with 74 (68.5%) cases. Conclusions: The determination of IgE in allergic rhinitis is a supportive method. However, it cannot be recommended for routine use because of the time loss and high cost.

Unilateral inferior turbinate bone hypertrophy: is it compensatory or congenital?

Background This study evaluates the degree of the unilateral hypertrophied inferior turbinate (HIT) by computed tomography (CT) and determines and compares the enlargement of the turbinate bone and soft tissue in different parts of the HIT in pediatric and adult groups. Methods Both pediatric and adult patients were studied in two groups: those with a straight or nearly straight septum (n = 25 and 124, respectively) and those with deviation (n = 64 and 129, respectively). The cross-sectional area (CSA) of the IT bone and soft tissue were measured at anterior, middle, and posterior thirds of the IT in coronal CT sections. The ratio of CSA of the IT bone and soft tissue on two sides of the septum (interturbinate ratio [IR]) were calculated. IRs were then compared among straight septum and deviation groups for both the pediatric and the adult groups. Results IR of the bony concha CSA for the deviation group was significantly higher compared with the straight septum group in anterior, middle, and posterior segments in adults (p = 0.028, 0.018, and <0.001, respectively; independent samples t-test). The soft tissue component hypertrophy was prominent only in the middle segment (p = 0.15); however, there was no significant difference for pediatric patients. Also, there was a statistically significant difference between the adult group with septum deviation and the pediatric group with septum deviation for both soft tissue and bone components (p < 0.001 for all segments; independent samples t-test). Conclusion We claim that these results indicate that skeletal and soft tissue IT hypertrophy seem to be compensatory and evolves with age rather than being congenital. Therefore, skeletal enlargement is prominent in anterior, middle, and posterior thirds of HIT in patients with septal deviation in adults but not in the pediatric group.

Evaluation of Nasal Mucociliary Functions with Rhinoscintigraphy in Coal Workers’ Pneumoconiosis

Objective: To compare nasal mucociliary clearance (NMC) functions in coal workers with pneumoconiosis, coal workers without pneumoconiosis and healthy controls by using technetium-99m-labeled macroaggregated albumin rhinoscintigraphy. Methods: Sixty-five of the 86 coal workers were clinically documented as suffering from coal workers’ pneumoconiosis (CWP group). CWP workers were divided into two groups according to smoking status: 44 smokers (CWP-S) and 21 nonsmokers (CWP-NS). Twenty-one workers without pneumoconiosis (NCWP group) were similarly divided into two groups: 12 smokers (NCWP-S) and 9 nonsmokers (NCWP-NS). Thirty-three healthy male volunteers were selected for the control group [15 smokers (control-S), 18 nonsmokers (control-NS)]. The half-time (t½) value for the clearance of the radiopharmaceutical was calculated for each patient. Results: Mean t½ values for CWP-S, CWP-NS, NCWP-S, NCWP-NS, control-S and control-NS were 25.10 ± 7.75, 10.97 ± 3.24, 14.68 ± 4.98, 9.17 ± 3.71, 19.15 ± 5.04 and 15.08 ± 5.11, respectively (p < 0.001, Kruskal-Wallis variance analysis). Further, mean t½ values of smokers versus nonsmokers in CWP, NCWP and control groups were compared, and it was found that although smoking prolonged nasal transport time in all three groups, the difference was significant only in the CWP group (p < 0.001, p < 0.023 and p < 0.027, respectively, Bonferroni-adjusted Mann-Whitney test). Conclusion: Our findings demonstrated a synergistic detrimental effect of smoking with coal dust exposure on nasal transport time.