Yilmaz Palanci

Deep neck space infections: a retrospective review of 173 cases

PURPOSE The purpose of this study is to review our recent experience with deep neck infections and emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients. MATERIALS AND METHODS The records of 173 patients treated for deep neck infection at the Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital during the period from 2003 to 2010 were retrospectively reviewed. Their demography, symptoms, etiology, seasonal distribution, bacteriology, radiology, site of deep neck infection, durations of the hospital admission and hospital stay, treatment, complications, and outcomes were evaluated. The findings were compared to those in the available literature. RESULTS Dental infection was the most common cause of deep neck infection (48.6%). Peritonsillar infections (19.7%) and tuberculosis (6.9%) were the other most common cause. Pain, odynophagia, dysphagia, and fever were the most common presenting symptoms. Radiologic evaluation was performed on almost all of the patients (98.3%) to identify the location, extent, and character (cellulitis or abscesses) of the infections. Computed tomography was performed in 85.3% of patients. The most common involved site was the submandibular space (26.1%). In 29.5% of cases, the infection involved more than one space. All the patients were taken to intravenous antibiotic therapy. Surgical intervention was required in 95 patients (59.5%), whereas 78 patients (40.5%) were treated with intravenous antibiotic therapy alone. Life-threatening complications were developed in 13.8% of cases; 170 patients (98.3%) were discharged in stable condition. CONCLUSION Despite the wide use of antibiotics, deep neck space infections are commonly seen. Today, complications of deep neck infections are often life threatening. Although surgical drainage remains the main method of treating deep neck abscesses, conservative medical treatment are effective in selective cases.

A clinical, radiographic and laboratory evaluation of prognostic factors in 363 patients with malignant pleural mesothelioma.

Background: Malignant pleural mesothelioma (MPM) has a poor prognosis. Objectives: Only few studies in literature investigated the presence of pleural fluid and radiographic findings for the prognosis of MPM. Methods: We retrospectively investigated the hospital charts of 363 MPM patients who were diagnosed from January 1989 to March 2010. Survival time was calculated by the Kaplan-Meier method. Pretreatment clinical, laboratory and radiographic features of each patient at the time of diagnosis were obtained from patients’ charts. Results: The mean age of 363 patients (217 men, 146 women) was 50.6 ± 11.2 years (range 19–85) and the mean survival time was 11.7 ± 8.6 months (range 1–53). Histological types of MPM were epithelial (71.2%), mixed (15.9%) and sarcomatous type (4.9%). The frequency of disease stages were 31.4% for stage 1, 24.2% for stage 2, 28.6% for stage 3 and 15.8% for stage 4. The most frequent symptoms were dyspnea (82.1%), chest pain (68.3%) and weight loss (58.9%). Results of univariate and multivariate analyses revealed that a Karnofsky performance score ≤60, a pleural fluid glucose level ≤40 mg/dl, a C-reactive protein level >50 mg/l, a serum lactate dehydrogenase level >500 U/l, the presence of pleural fluid, pleural thickening >1 cm and a platelet count of >420 × 103/µl were found to be associated with poor prognosis in MPM. Conclusions: Our data suggest that low pleural fluid glucose and high C-reactive protein, the presence of pleural fluid and pleural thickening were associated with poor MPM prognosis. Further prospective studies are needed to highlight prognostic factors more clearly.

Patterns of active and passive smoking, and associated factors, in the South-east Anatolian Project (SEAP) region in Turkey

BackgroundSmoking is an important health threat in Turkey. This study aimed to determine the frequency of and main factors associated with smoking in persons of 15 years and over, and the frequency of passive smoking in homes in the South-east Anatolian Project (SEAP) Region in Turkey.MethodsA cross sectional design was employed. The sample waschosen by the State Institute of Statistics using a stratified cluster probability sampling method. 1126 houses representing the SEAP Region were visited.Questionnaires about tobacco smoking and related factors were applied to 2166 women and 1906 men (of 15 years old and above) in their homes. Face-to-face interview methods were employed. Participants were classified as current, ex, and non-smokers. The presence of a regular daily smoker in a house was used as an indication of passive smoking. The chi-square andlogistic regressionanalysis methods were used for the statistical analysis.ResultsThe prevalence of smoking, in those of 15 years and over, was 11.8% in women and 49.7% in men. The prevalence of current smokers was higher in urban (34.5 %) than in rural (22.8 %) regions. The mean of total cigarette consumption was 6.5 packs/year in women and 17.9 packs/year in men. There was at least one current smoker in 70.1% of the houses.ConclusionSmoking is a serious problem in the South-eastern Anatolian Region. Male gender, middle age, a high level of education and urban residency were most strongly associated with smoking.

Pilonidal sinus disease: risk factors for postoperative complications and recurrence.

The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P  =  0.039). Regarding recurrence, family tendency (P  =  0.011), sinus number (P  =  0.005), cavity diameter (P  =  0.002), and primary closure (P  =  0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.

The value of inflammatory parameters in the prognosis of malignant mesothelioma

Objective This study investigated the relationship between potential prognostic parameters that may be associated with increased inflammation and survival in patients with malignant mesothelioma (MM). Methods This retrospective study assessed potential prognostic parameters measured at the time of MM diagnosis. Data on asbestos exposure, histopathological subtype of MM and laboratory parameters were collected. Results In 155 patients with MM (90 male), mean survival time was 13.9 months. In univariate analysis, age ≥60 years and neutrophil-to-lymphocyte ratio (NLR) ≥3 were associated with significantly shortened median survival times. In multivariate analysis, nonepithelial subtype, red cell distribution width (RDW) ≥20% and NLR ≥3 were associated with significantly shortened median survival times. Mortality rate was increased 2.77-, 1.67- and 1.52-fold in patients with RDW ≥20%, NLR ≥3 and nonepithelial subtype, respectively. Nonepithelial subtype, white blood cell count ≥11 200 µl and platelet-to-lymphocyte ratio ≥300 at baseline were associated with a heightened NLR value. Conclusions The NLR and RDW were significant predictive factors for MM prognosis.

Evaluation of risk factors affecting hospital-acquired infections in the neurosurgery intensive care unit.

The aim of the present study was to identify nosocomial infections (NIs), and their associated risk factors, in patients treated in the neurosurgery intensive care unit (NICU) of our hospital. Patients determined to have NIs between January 2008 and December 2012 were included in the study. Each patients age, gender, microbiological culture results, underlying conditions, type of NIs, device utilization, total parenteral nutrition, reason for hospitalization, Glasgow score, and treatment were recorded and evaluated using statistical analysis. Risk factors for NIs were analyzed with a logistic regression model. During the five-year period, 60 NI episodes were detected in 56 out of 1643 patients. The mean age of the patient population was 33.3 (1–79) years. Of the patients, 22 were female and 34 were male. The overall incidence rate (NIs/100) and incidence density (NIs /1000 days of stay) of NIs were 3.65% and 6.5/1000 patient days, respectively. Regardless of the year of surveillance, the three most commonly detected NIs were bloodstream infection, shunt infection, and ventilator-associated pneumonia. No statistically significant difference was detected between infected and uninfected patients in terms of sex, age, blood transfusions, or mannitol and steroid use (p ≥ 0.05). In the present study, Glasgow scores, the frequency of prior usage of broad-spectrum antibiotics, and NICU stay durations were significantly higher among patients with infections (p < 0.001). Univariate analysis demonstrated that a low Glasgow score, re-operation, and use of mechanical ventilation were risk factors for NIs. We identified low Glasgow coma scores, long hospital stay duration, use of wide spectrum antibiotics, mechanical ventilation, total parenteral nutrition, and re-operation as risk factors for NIs.

Effects of enuresis nocturna on parents of affected children: Case–control study

Enuresis nocturna (EN) is a chronic medical disorder that may cause a parent to question their parenting ability and contribute to an inability to perform the parental role. The aim of the study was to investigate the effects of EN on the relationship between parents, and the effect of mood changes in the couples on the children.

Occupational skin diseases in automotive industry workers.

Abstract Context: Studies on occupational skin diseases in workers of the automotive industry are few. Aim: To investigate the prevalence of occupational skin diseases in workers of the automotive industry. Materials and methods: Between September and December 2011, a total of 405 workers from the automotive repair industry in Diyarbakır were interviewed. They were active workers in the repair industry who had been employed for at least six months. Business owners, sellers of spare parts and accounting officers were not included. The employees were examined at their workplaces and the working conditions were observed. Detailed dermatological examination was performed. Results: The mean age of the 405 workers who participated in the study was 27.7 ± 10.3. The mean working time of employees was 13.3 ± 10.4 years. All of the employees were male. Dermatological diseases were not detected in 144 out of 405 workers (35.6%) and at least one condition was diagnosed in 261 (64.4%). The most frequent diagnosis was callus, hyperkeratosis, clavus (27.7%), followed by nail changes (16.8%) and superficial mycoses (12.1%). Contact dermatitis was seen at a rate of 5.9%. Discussion: Traumatic lesions such as hyperkeratotic lesions and nail changes were found most frequently. Traumatic lesions were common among individuals who did not use gloves. Most nail changes were localized leuconychia, a finding not reported in the studies on automotive industry workers. In accordance with the literature, irritant contact dermatitis was observed in patients with a history of atopy and who had been working for a long time. Conclusion: Occupational skin diseases comprise an important field in dermatology, deserving much attention. Further studies on occupational dermatology are necessary.

The effects of nosocomial rotavirus gastroenteritis on the length of hospital stay and cost

INTRODUCTION In this study, the goal was to evaluate the impact of nosocomial rotavirus gastroenteritis in pediatric patients by determining the incidence of nosocomial rotavirus gastroenteritis, the resulting duration of hospital stay, and direct cost. To our knowledge, this is the first study in Turkey that evaluates the impact of pediatric nosocomial rotavirus gastroenteritis on duration of hospital stay and calculates the direct cost. METHODOLOGY Forty-nine patients who were diagnosed with nosocomial rotavirus gastroenteritis and hospitalized were included in the study. Nosocomial infection rates, organ systems affected by the nosocomial infections, and patients who had nosocomial rotavirus gastroenteritis were identified. A direct cost analysis of patients who were diagnosed with nosocomial rotavirus gastroenteritis was performed using copies of the invoices for the hospital bills. RESULTS During the study period, there were 49 cases of nosocomial rotavirus gastroenteritis. The length of hospitalization was extended, on average, by more than 6.3 days in cases of nosocomial rotavirus gastroenteritis. The cost of hospitalization for patients with nosocomial rotavirus gastroenteritis was on average 1,554 ± 2,067 US dollars, compared to a cost of only 244 ± 103 US dollars for patients who did not have nosocomial rotavirus gastroenteritis. This difference in cost was statistically significant (p < 0.05). CONCLUSIONS Nosocomial rotavirus gastroenteritis is important because it significantly prolongs hospital stay and increases the social and economic burden of the hospitalization. Nosocomial rotavirus gastroenteritis can be reduced with prevention measures such as handwashing, isolation, and cohorting.

The prevalence and level of awareness for metabolic syndrome among primary health care professionals in the Southeastern Anatolia

1) Dicle Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı, Diyarbakır 2) Dicle Üniversitesi Tıp Fakültesi Biyokimya Anabilim Dalı, Diyarbakır 3) Dicle Üniversitesi Tıp Fakültesi Halk Sağlığıi Anabilim Dalı, Diyarbakır 4) Merkez 11 Nolu ASM, Batman 5) Katip Çelebi Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı, İzmir 6) Adıyaman Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı, Adıyaman 7) Yenişehir 7 Nolu ASM, Diyarbakır 8) Çınar Devlet Hastanesi, Diyarbakır 9) Yenişehir 5 Nolu ASM, Diyarbakır 10) Dicle Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, Diyarbakır