Ömer Faruk Ünal

Pediatric tracheotomies: A 37-year experience in 282 children

OBJECTIVE To study the outcomes, complications, and indications for pediatric tracheotomies performed at a tertiary referral center. METHODS A retrospective review of hospital records from 1968 to 2005 was conducted to assess all pediatric patients who had undergone tracheotomies. RESULTS A total of 282 tracheotomies were performed on patients under 16 years of age. The median age at tracheotomy was 27 months. Upper airway obstruction (infectious diseases, n=101; laryngeal anomalies, n=33; trauma, n=36; tumor, n=33) was the most common indication for tracheotomy (n=203; 72%). Lesser number of patients (n=79; 28%) required tracheotomy for prolonged ventilation. Decannulation was carried out successfully in 71 patients (35%). Total complication rate was 18%; only three patients (1%) died from tracheotomy-related complications, with an overall mortality rate of 19%. CONCLUSIONS Pediatric tracheotomies were associated with a low incidence of procedure-related mortality and morbidity and successful decannulation in 35% of cases. The majority of procedures were performed due to upper airway obstruction which were most commonly caused by infectious diseases.

Melanotic neuroectodermal tumor of infancy: report of two cases and review of literature.

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, distinctive neoplasm containing melanin; it primarily affects the maxilla of the infants during the first year of life. Approximately 150 instances of this tumor are reported in the medical literature. Genesis of the tumor is obscure and the diagnosis is challenging for the pathologist. Two cases operated by the first author are presented, and the diagnostic features and treatment alternatives of MNTI discussed.

Possible prognostic value of histopathologic parameters in patients with carcinoma of the oral tongue

Abstract The current TNM staging system is helpful but still not enough to accurately determine prognosis of the patients with squamous cell carcinomas of the oral tongue. Histopathologic variables, however, may be more helpful for predicting nodal metastasis and locoregional recurrences. In this respect, histopathologic examinations were done retrospectively of tumor specimens from 60 patients with squamous cell carcinomas of the oral tongue. Besides T-stage and nodal involvement, histopathologic parameters of tumor thickness, perineural invasion, lymphovascular space invasion, the extent of lymphocyte infiltration and the invasion pattern statistically correlated with locoregional recurrences. For nodal metastasis, tumor thickness of 10 mm or more and the type of invasion pattern were statistically significant. These results revealed that the variables described should be used for managing oral tongue cancers.

Prognostic value of p53 expression and histopathological parameters in squamous cell carcinoma of oral tongue

The TNM staging system is helpful but not enough to determine prognosis of the patients with squamous cell carcinoma of the oral tongue. T-stage alone is not suggestive for prediction of occult nodal metastases. For this reason, histopathological examination of 70 patients with squamous cell carcinoma of the oral tongue was done retrospectively. The histological differentiation, tumour thickness, perineural and lymphovascular space invasions, the amount of lymphocyte infiltration and pattern of tumour invasion were examined. Immunohistochemical examination was used to determine p53 immunoreactivity as well. The effect of these histopathological parameters and p53 immunoreactivity on nodal metastases and locoregional recurrence were analyzed using the chi-squared test. In terms of nodal metastases the only statistically significant difference between the two groups was tumour thickness, either < 9 mm or > 9 mm (p < 0.05, chi 2 = 17.182). Tumour thickness, perineural invasion, lymphovascular space invasion, the amount of lymphocyte infiltration all correlated statistically with locoregional recurrence (p < 0.05, chi 2 = 6.293 for tumour thickness; p < 0.06, p = 0.054 for perineural invasion; p < 0.05, chi 2 = 8.689 for lymphovascular space invasion; p < 0.05, chi 2 = 5.320 for lymphocyte infiltration). The immunoreactivity of p53 correlated significantly with larger primary tumour size (p < 0.05, chi 2 = 5.440, lymph node metastases (p < 0.05, chi 2 = 4.093) and with pathological tumour stage (p < 0.05, chi 2 = 5.713). These results reveal that the above-mentioned histological parameters and p53 determination could be used for handling a specimen from an anterior tongue squamous cell carcinoma.

Mucocele of the anterior lingual salivary glands: from extravasation to an alarming mass with a benign course

Mucoceles are common cystic lesions in the oral cavity. However, mucoceles located on the ventral surface of the tongue originating from anterior lingual salivary glands are rare. Only 24 cases were reported in the medical literature, of which most were relatively small lesions measuring less than 20 mm in diameter. This report describes a large-sized mucocele of the anterior lingual salivary glands in an 8-year-old boy who was treated by surgical excision of the lesion. The authors emphasize the importance of preoperative awareness and en bloc excision of the lesion even in asymptomatic patients to avoid further enlargement and complications.

Sinus histiocytosis with massive lymphadenopathy (Rosai–Dorfman disease)

Sinus histiocytosis with massive lymphadenopathy (SHML) is a distinct clinicopathological entity described by Rosai and Dorfman and differentiated by other childhood histiocytoses by its distinct characteristics. This is a rare pathology and should be kept in mind for differential diagnosis of neck masses, especially in childhood. In this article a case with SHML is presented and clinical features of the disease given.

Clinical and histopathological response to acitretin therapy in lipoid proteinosis.

Abstract Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis associated with deposition of periodic acid-Shiff (PAS)-positive hyaline material in skin, mucosa, and other tissues. LP is caused by loss-of-function mutations in the extracellular matrix protein 1 gene (ECM1). No curative therapy is available. In this report, we describe the clinicopathological and genetic features of a Turkish LP family with four cases, and evaluate the response of acitretin therapy. Patients were presented with hoarseness and beaded eyelid papules, thickened frenulum, hyperkeratotic plaques and infiltrated warty papules and nodules. Skin biopsies revealed deposition of PAS-positive hyaline material in dermis. A homozygous nonsense mutation in exon 3 of the ECM1 gene, R53X, was detected in the family. Acitretin therapy was administered in two patients, in whom some regression and softening of skin lesions were achieved. However, no histopathological change in PAS-positive deposition could be detected. Although there is no current effective treatment for LP, acitretin may be helpful for patients, especially those who complain about hyperkeratosis.

Reliability of high-pitch ultra-low-dose paranasal sinus computed tomography for evaluating paranasal sinus anatomy and sinus disease.

Objectives The aim of this study was to evaluate the reliability of high-pitch ultra-low-dose computed tomography (CT) for detecting important paranasal sinus anatomic landmarks and pathologies. Materials and Methods Sixty patients (22 females, 38 males) aged 15 to 67 years (mean age, 33.68 y; SD, 9.83 y) underwent high-pitch ultra-low-dose CT of the paranasal sinuses between February and June 2012. To determine the lowest possible dose for evaluation of the paranasal sinuses, the patients were divided into three groups randomly and prospectively. A different low-dose CT protocol was applied to each group. The image quality was assessed subjectively by a radiologist and an otorhinolaryngology head and neck surgeon independently using a 4-point grading scale (0 = structures could not be identified, 1 = indistinctly defined structures, 1.5 = relatively well-defined structures, 2 = very well-defined structures). Anatomic landmarks and mucosal structures were evaluated. Mean scores were evaluated to assess statistical significance. Results According to the anatomic landmark scoring, excluding the ethmoid foramen for ethmoid artery identification, all of the structures in all 3 groups were very well-defined structures. The ethmoid foramen for ethmoid artery identification was scored as either could not be identified or an indistinctly defined structure in all groups. On evaluating the mucosa of the paranasal sinuses, normal and pathologic mucosal structures were scored as very well defined in all of the patients. The interobserver agreement was excellent. Conclusion High-pitch ultra-low-dose CT is a safe, reliable paranasal sinus screening tool.

A comparison of procaine penicillin with sulbactam-ampicillin in the treatment of peritonsillar abscesses

Abstract The clinical efficacy of procaine penicillin and sulbactam-ampicillin was compared in patients with peritonsillar abscesses after peroral abscess drainage. Forty-two patients were randomly assigned to receive either procaine penicillin or sulbactam-ampicillin intramuscularly on an outpatient basis. The mean time required for clinical symptoms (throat pain, dysphagia and fever) to resolve was compared. No statistically significant difference was found between the clinical recoveries of patients using either antibiotic (P > 0.05). The authors conclude that intramuscular procaine penicillin can be safely prescribed on an outpatient basis to most patients with peritonsillar abscess after incision and drainage. In contrast, a broader spectrum and more expensive antibiotic, such as sulbactam-ampicillin, should be reserved for non-responders.

Evaluation of the effect of dexamethasone in experimentally induced endolymphatic hydrops in guinea pigs.

PURPOSE The aim of this study was to investigate the audiological and histopathologic effects of dexamethasone in the treatment of experimentally induced endolymphatic hydrops. MATERIALS AND METHODS Thirty mature, male guinea pigs weighing 400 +/- 50 g were operated on to induce experimental endolymphatic hydrops in their right ear. Left ear served as control. Subjects were separated into control and dexamethasone groups, with the latter receiving dexamethasone 5 mg/(kg d) intraperitoneally for 10 days. Electrocochleography and auditory brainstem response were applied to all subjects at preoperation, on the second postoperative day and also on the 15th postoperative day in animals that lived for a long time. The histopathologic examination of the inner ear in all animals was done at the end of the study. RESULTS The summating potential and the ratio of the summating potential to the action potential measured on the second postoperative day were found to be increased in both groups, but more significantly in the control one. When the left and right ears were compared, significant difference was found in the control group; however, no significant difference was found between the ears in the dexamethasone group. Histopathologic examination revealed varying degrees of hydrops in the control group, but showed only normal findings or minor changes in the dexamethasone group. CONCLUSIONS Dexamethasone can prevent the audiological and histopathologic findings of experimentally induced endolymphatic hydrops. However, these results must be supported by clinical and experimental studies designed with a large number of subjects.