Correlation of PET-CT, MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer / Correlação dos achados de PET-CT, RM e histopatologia no seguimento de pacientes com carcinoma nasofaríngeo

Abstract Introduction: Surgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the postradiotherapy period is improved. Objective: The role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings. Methods: A total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients' age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed. Results: Recurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036). Conclusions: Magnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.

Resumo Introdução: As opções de tratamento cirúrgico são limitadas para o carcinoma nasofaríngeo por várias razões, inclusive aspectos epidemiológicos e histológicos, proximidade de estruturas importantes, drenagem linfática carregada e dificuldade de garantir uma margem cirúrgica segura; portanto, o tratamento primário é geralmente radioterapia e quimioterapia. Com a tecnologia atual de radioterapia, o sucesso oncológico aumentou e a qualidade de vida dos pacientes durante o período pós-radioterapia é garantida. Objetivo: O papel da ressonância magnética e da tomografia computadorizada por emissão de pósitrons no seguimento de pacientes com carcinoma nasofaríngeo recorrente, inicialmente tratados com radioterapia, foi avaliado em relação aos achados histopatológicos. Método: Foram incluídos no estudo 110 pacientes com carcinoma nasofaríngeo que receberam radioterapia. Pacientes com suspeita de recorrência de acordo com o exame endoscópico nasofaríngeo e com achados de ressonância magnética foram solicitados a fazer tomografia computadorizada por emissão de pósitrons. Foram feitas biópsias de 40 pacientes com lesões suspeitas nas imagens de tomografia computadorizada por emissão de pósitrons. Os pacientes foram avaliados segundo idade, sexo, presença/ausência de realce por contraste na ressonância magnética, valores SUVmax de lesões nasofaríngeas e cervicais, estágios T/N no diagnóstico inicial, recorrência histopatológica e histórico de esvaziamento cervical. Resultados: A recorrência foi observada em 8 pacientes (20,0%). Entre esses, 4 (10,0%) apresentaram recorrência na nasofaringe e 4 (10,0%) no pescoço. Pacientes com recorrência eram do sexo masculino, apresentavam idade mais avançada, estágio avançado T/N, realce por contraste na ressonância magnética e maiores valores de SuvMax nasofaríngeo e cervical na tomografia computadorizada por emissão de pósitrons. Entretanto, essas diferenças não foram estatisticamente significantes. Apenas o histórico de esvaziamento cervical foi significantemente mais comum entre aqueles com recorrência (p < 0,001). No entanto, na análise multivariada, aqueles com um valor de SUVmax nasofaríngeo superior a 4,58 apresentaram um risco 7,667 vezes maior de recorrência (p = 0,036). Conclusão A ressonância magnética e a tomografia computadorizada por emissão de pósitrons devem ser avaliadas em conjunto no seguimento da doença. Pacientes com valor de SUVmax mínimo de 4,58 na tomografia computadorizada por emissão de pósitrons após realce com contraste na sequência T2 na ressonância magnética podem ser considerados mais adequados para biópsia. Biópsias em pacientes com um valor de SUVmax menor do que 4,58 podem ser evitadas. Dessa forma, podemos evitar o estresse cirúrgico para o paciente e custos desnecessários.

Serum Levels of Vitamin D in Children with or without Isolated Distal Radius Fractures: A Prospective Clinical Study.

Objective To compare the serum levels of vitamin D and minerals in children with or without isolated distal radius fractures. Methods The present prospective clinical study included 50 children (aged between 5 and 15 years) with isolated distal radius fractures who were admitted to our emergency unit between February and May 2018 as the study group (group A), and 50 healthy children with no history of fracture as the control group (group B). Peripheral venous blood samples were obtained and analyzed for measurements of 25-hydroxyvitamin D (25(OH)D), calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) in both groups. Patient characteristics and peripheral venous blood samples were compared between the groups. Results The mean age, height, weight, body mass index (BMI) and gender distribution were similar in both groups. There were no statistical differences in the blood analyses, including Ca, Mg, P, ALP, and PTH. However, the serum levels of 25(OH)D were statistically lower in group A when compared to group B ( p < 0.001), and the number of patients with 25(OH)D insufficiency was statistically higher in group A than in group B (p = 0.012). Conclusion Children with isolated distal radius fracture should be informed about vitamin D deficiency, and, in children with low levels of vitamin D, supplementation may be considered.

Serum Levels of Vitamin D in Children with or without Isolated Distal Radius Fractures: A Prospective Clinical Study / Níveis séricos de vitamina D de crianças com ou sem fraturas isoladas da extremidade distal do rádio: Um estudo clínico prospectivo

Abstract Objective To compare the serum levels of vitamin D and minerals in children with or without isolated distal radius fractures. Methods The present prospective clinical study included 50 children (aged between 5 and 15 years) with isolated distal radius fractures who were admitted to our emergency unit between February and May 2018 as the study group (group A), and 50 healthy children with no history of fracture as the control group (group B). Peripheral venous blood samples were obtained and analyzed for measurements of 25-hydroxyvitamin D (25(OH)D), calcium (Ca), magnesium (Mg), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) in both groups. Patient characteristics and peripheral venous blood samples were compared between the groups. Results The mean age, height, weight, body mass index (BMI) and gender distribution were similar in both groups. There were no statistical differences in the blood analyses, including Ca, Mg, P, ALP, and PTH. However, the serum levels of 25(OH)D were statistically lower in group A when compared to group B (p < 0.001), and the number of patients with 25(OH)D insufficiency was statistically higher in group A than in group B (p = 0.012). Conclusion Children with isolated distal radius fracture should be informed about vitamin D deficiency, and, in children with low levels of vitamin D, supplementation may be considered.

Resumo Objetivo Comparar os níveis séricos de vitamina D e minerais de crianças com ou sem fraturas isoladas da extremidade distal do rádio. Métodos Este estudo clínico prospectivo incluiu 50 crianças (com idade entre 5 e 15 anos) com fratura isolada distal do rádio que deram entrada em nossa unidade de emergência entre fevereiro e maio de 2018 como grupo de estudo (grupo A), e 50 crianças saudáveis sem histórico de fratura como grupo controle (grupo B). Foram obtidas e analisadas amostras de sangue venoso periférico para medições de 25-hidroxivitamina D (25(OH)D), Cálcio (Ca), Magnésio (Mg), Fósforo (P), fosfatase alcalina (FA) e hormônio da paratireoide (HPT) em ambos os grupos. As características dos pacientes e as amostras de sangue venoso periférico foram comparadas entre os grupos. Resultados A média de idade, altura, peso, índice de massa corporal (IMC) e distribuição de gênero foram semelhantes em ambos os grupos. Não houve diferenças estatísticas nas análises sanguíneas, incluindo Ca, Mg, P, FA e HPT. No entanto, os níveis séricos de 25(OH)D foram estatisticamente menores no grupo A do que no grupo B (p < 0,001), e o número de pacientes com insuficiência de 25(OH)D foi estatisticamente maior no grupo A do que no grupo B (p = 0,012). Conclusão Crianças com fratura isolada distal do rádio devem ser informadas sobre deficiência de vitamina D, e, em crianças com baixos níveis de vitamina D, a suplementação pode ser considerada.

Cranial nerve involvement in COVID-19.

INTRODUCTION: The COVID-19 disease emerged in Wuhan province of China in November 2019 and spread across the world in a short time, resulting in a pandemic. The first case in Turkey was detected on March 11, 2020. The aim of the current study was to reveal the effects of COVID-19 on cranial nerves by monitoring people infected with the disease based on repeated examinations and surveys. MATERIAL AND METHOD: The data of 356 patients with a positive COVID-19 polymerase chain reaction (PCR) test who received treatment between June 2020 and August 2020 in our hospital were prospectively evaluated after the study was approved by the relevant ethics committee. RESULTS: Of the 356 patients included in the study, 47 under the age of 18 years were excluded due to their unreliable examination and anamnesis findings. In addition, seven patients that died while in hospital were excluded from the study due to the lack of examination and survey records during their hospitalization. The data of the remaining 302 patients were statistically analyzed. Symptoms of cranial nerve involvement were observed in 135 patients. CONCLUSION: The COVID-19 disease caused by the SARS-CoV2 virus commonly results in cranial nerve symptoms. The fact that these findings are more common and severe in COVID-19 than previous SARS and MERS outbreaks suggests that it has a more neurotrophic and more aggressive neuroinvasion. While the negative effects of the virus on sensory functions resulting from cranial nerve involvement are evident, motor functions are rarely affected.

Prospective, randomized evaluation of latissimus dorsi transfer and superior capsular reconstruction in massive, irreparable rotator cuff tears.

BACKGROUND: The treatment of massive, irreparable rotator cuff tears remains controversial today because there is no consensus on the ideal treatment option. This investigation aimed to prospectively evaluate and compare the outcomes of arthroscopy-assisted latissimus dorsi transfer and superior capsular reconstruction in the treatment of massive, irreparable rotator cuff tears. METHODS: Forty-two patients at an average age of 62.8 years with massive, irreparable rotator cuff tears were randomized into 2 treatment groups. Twenty-one patients underwent arthroscopy-assisted latissimus dorsi tendon transfer (LDT), and 21 patients underwent arthroscopy-assisted superior capsular reconstruction (SCR). The patients were followed up prospectively for 31 months on average. One patient in the SCR group was lost to follow-up. The outcomes were evaluated with American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Western Ontario Rotator Cuff Index (WORC), visual analog scale (VAS), and Constant scores clinically and with acromiohumeral distance (AHD) measurements radiologically. RESULTS: Both groups displayed improved results in ASES, WORC, Constant, and VAS scores in the final follow-up (P < .001). The LDT group had significantly better results in AHD (P = .006), whereas the SCR group yielded significantly higher improvements in ASES (P = .007) and Constant (P = .008) scores. The rate of successful pseudoparalysis treatment was 45% (5/11) in the LDT group and 92% (12/13) in the SCR group (P = .011). The graft failure rate was 5% (1 patient) in each group postoperatively; 1 patient in the SCR group had a traumatic graft rupture and 1 patient in the LDT group was complicated with septic arthritis, which required graft removal. CONCLUSION: Both SCR and LDT yielded promising short-term results in treatment of massive, irreparable rotator cuff tears in this study. The SCR group displayed better overall outcomes clinically, particularly in the pseudoparalytic shoulders, whereas the LDT group displayed better radiologic results.

Is the Measurement of Pedicle Axial Axes on Computed Tomography in Adolescent Idiopathic Scoliosis Also a Guide for Safer Screwing?

OBJECTIVE: To evaluate the effect of pedicle angle measurement in preoperative axial computed tomography in patients with adolescent idiopathic scoliosis (AIS) on correct thoracic screw placement in free-hand technique on 3-dimensional printing AIS models. METHODS: In this study, 14 3-dimensional spine models with a scale of 1:1, including the entire spine of a patient with Lenke type 1 curve, were used. Group 1 included screwing applications with unknown pedicle axial angles, and group 2 included screwing applications with known pedicle axial angles. The number and direction of screws in malposition were recorded. In addition, medial encroachment distances of the screws were classified as 0-4 mm and greater than 4 mm, and lateral encroachment distances were classified as 0-6 mm and greater than 6 mm. Evaluation parameters were compared statistically between the groups. RESULTS: The number of screws in the correct position in group 1 was lower than that in group 2 (P < 0.05). The medial and lateral malposition rate in group 1 was greater than that in group 2 (P < 0.05). The medial encroachment rate of 4 mm and greater and lateral encroachment rate of 6 mm and greater in group 1 was greater than that in group 2 (P < 0.05). The medial encroachment rate of 0-4 mm and lateral encroachment rate of 0-6 mm were similar between groups 1 and 2 (P > 0.05). CONCLUSIONS: Measurement of pedicle axial axes of preoperative thoracic vertebrae on computed tomography in patients with AIS offers more reliable screwing in free-hand technique.

Correlation of PET-CT, MRI and histopathology findings in the follow-up of patients with nasopharyngeal cancer.

INTRODUCTION: Surgical treatment options are limited for nasopharyngeal cancer for many reasons including epidemiological and histological properties, proximity to important structures, heavy lymphatic drainage, and the difficulty in ensuring a safe surgical margin; therefore primary treatment is generally radiotherapy and chemotherapy. With current radiotherapy technology, oncological success has been increased and the quality of life of patients during the post- radiotherapy period is improved. OBJECTIVE: The role of magnetic resonance imaging and positron emission-computed tomography in the follow-up of recurrent nasopharyngeal cancer patients who were initially treated with radiotherapy was evaluated with respect to histopathological findings. METHODS: A total of 110 patients with nasopharyngeal cancer who had received radiotherapy were included in the study. Patients who were suspected to have recurrence according to endoscopic nasopharyngeal examination and magnetic resonance imaging findings were requested to undergo positron emission-computed tomography. Biopsies were taken from 40 patients who had suspicious lesions in positron emission-computed tomography images. These patients' age, gender, presence/absence of contrast enhancement on magnetic resonance imaging, the SuvMax values of nasopharyngeal and neck lesions, T/N phases at initial diagnosis, histopathological recurrence, and history of neck dissection were assessed. RESULTS: Recurrence was observed in 8 patients (20.0%). Among these, 4 (10.0%) had recurrence at the nasopharynx and 4 (10.0%) at the neck. Patients with recurrence were found to be of older age, male gender, advanced T/N phase, contrast enhancement on magnetic resonance imaging, and higher nasopharyngeal and neck SuvMax values in positron emission-computed tomography. However, these differences were not statistically significant. Only the history of neck dissection was significantly more common among those with recurrence (p < 0.001). However, in multivariate analysis, those with a nasopharyngeal SuvMax value higher than 4.58 were found to have 7.667-fold higher risk for recurrence (p = 0.036). CONCLUSIONS: Magnetic resonance imaging and positron emission-computed tomography should be evaluated together in the follow-up of nasopharyngeal cancer. Patients with minimal SuvMax 4.58 on positron emission-computed tomography after contrast enhancement in the T2 sequence on magnetic resonance imaging may considered appropriate for biopsy. Biopsies in patients with a SuvMax value lower than 4.58 can be avoided. Thus, patients avoid surgical stress and unnecessary costs.

Is Rhinoplasty Surgery a Risk Factor for Low Back Pain among Otorhinolaryngologists?

This study aimed to investigate the relationship between low back pain and performing rhinoplasty and presents the data related to the prevalence of low back pain among the otorhinolaryngologists included in a sample. The questionnaire prepared by the researchers was completed by volunteer otorhinolaryngologists who participated in the 22nd International Rhinocamp Congress. The questionnaire prepared to investigate low back problems contained items to obtain the demographic features of the participants, whether they were performing septorhinoplasty, how many years they had been performing this procedure, whether they had any problem (ache, pain, or discomfort) in the lumbar region, whether they had been hospitalized or had surgery due to this problem, low back pain frequency and intensity, and the presence of low back pathologies (e.g., protrusion, perforated disc, and bulging) detected by magnetic resonance imaging. The research was performed with the participation of 110 otorhinolaryngologists, of whom 37.3% (n = 41) were women and 62.7% (n = 69) were men, 79.1% (n = 87) were performing rhinoplasty surgery, and 69.1% (n = 76) had low back pain. Low back pain was reported in 72.4% (n = 63) of the doctors performing rhinoplasty and 56.5% (n = 13) of those who did not perform this surgery. There was a statistically significant relationship between the presence of low back pain and whether the doctors performed rhinoplasty surgery (χ2 = 4.151; p = 0.042 [< 0.05]). In addition, the complaints of low back pain were affected by the number of years the doctors had been performing rhinoplasty (p = 0.001 < 0.01). Low back pain was found to be frequent among otorhinolaryngologists performing rhinoplasty. Training, exercises, and performing the operation in a position that will prevent the occurrence of lower back pain can improve quality of life and minimize labor loss caused by pain among rhinoplasty surgeons.

Effects of hookah and cigarette smoking on the recovery after septoplasty.

BACKGROUND: Hookah is a tobacco product of Middle Eastern origin; however, its popularity increases in Europe and the US. Despite its frequent use, hookah's potentially detrimental effects are underestimated as a result of the scarcity of the relevant research. Since septoplasty is one of the most commonly performed procedures of otolaryngology practice, we aimed to investigate the impact of hookah consumption on recovery after septoplasty. METHODS: Patients who underwent septoplasty in Sanliurfa Training and Research Hospital Department of Otolaryngology between January 2017 and December 2019 were divided into four groups based on their history of hookah and cigarette smoking. The patients' prospectively collected data, including demographic features, healing time, and presence or absence of septal perforation during follow-up, were compared between these four groups. RESULTS: The entire cohort included 270 patients. The mean patient age was 29.2 ± 5.8 years. One hundred and thirty-two (48.9%) patients were non-smokers, 96 (35.5%) were cigarette smokers, 27 (10%) were hookah smokers and 15 (5.6%) consumed both tobacco products regularly. Mean healing time was 10 days, and septal perforation was encountered in 10 patients (3.7%). A comparison of the groups revealed that cigarette smoking did not impact septal perforation rates (P = .326) but prolonged the healing time. However, hookah smoking with or without cigarette smoking significantly influenced septal perforation rates and healing times. CONCLUSION: Patients should be questioned about hookah smoking in addition to cigarette smoking before the septoplasty procedure. Patients with a positive history of hookah smoking should be followed closely in terms of delayed healing and increased septal perforation rates.

Newborn hearing screening results: Comparison of Syrian and Turkish newborns; factors influencing the difference.

OBJECTIVES: This study aimed to compare the hearing screening results of Syrian and Turkish newborns and reveal the risk factors faced by Syrian refugees. METHODS: The neonatal hearing screening results of newborns born in, or admitted to, the Sanliurfa Research and Education Hospital, Sanliurfa/Turkey, between January 01, 2018, and December 31, 2018, were analyzed. Newborns with congenital anomalies and syndromes were excluded from the study. Also, the neonatal hearing screening results and risk factors of newborns diagnosed with hearing loss were analyzed. RESULTS: A total of 6034 Syrian and 37,219 Turkish newborns were included in the study. Hearing loss was found in 84 (0.2%) of 37,219 Turkish newborns and 26 (0.4%) of 6034 Syrian newborns. In this study, the risk factors such as consanguineous marriages, familial hearing loss, hospitalization in intensive care, prematurity, low birth weight (less than 1500 g), hyperbilirubinemia, use of ototoxic drugs, history of congenital infection, blood incompatibility, and trauma at birth were found in newborns with hearing loss. The risk factors were present in 41.7% of Turkish newborns and 65.4% of Syrian newborns with hearing loss. CONCLUSIONS: The high hearing loss rates found in Syrian newborns showed how accurate it was to include the Syrian migrants born in Turkey into the neonatal hearing screening program and the newborns with hearing loss into appropriate rehabilitation programs. Further studies should focus on the risk factors faced by Syrian migrants so that the number of Syrian newborns with hearing loss can be reduced.

Treatment strategy for elderly patients with the isolated greater trochanteric fracture.

BACKGROUND: The objective of this study was to evaluate the risk of femur intertrochanteric fracture associated with femur trochanter major fractures in patients over 65 years of age with magnetic resonance examination for better diagnosis and treatment. METHODS: Thirty-one patients who had incomplete femur intertrochanteric fracture diagnosed were included in the study. Patients were classified according to the length of the fracture line crossing the intertrochanteric border. Fracture patterns were described on magnetic resonance imaging coronal views. Group A, pattern 1, greater trochanteric fracture extends to intertrochanteric region with both cortices; Group B, pattern 2, fracture has characteristics of pattern 1 fracture including diametaphysis fracture line; Group C, pattern 3, greater trochanteric fracture only has extending superolateral cortex fracture line of intertrochanteric region; and Group D, pattern 4, fracture has characteristics of pattern 1 fracture and including superior extension to the baso-cervical line. Surgical treatment with dynamic hip screw was applied to all patients with intertrochanteric extension after magnetic resonance examination. RESULTS: This study included 16 women (80.3 ± 6.7 years) and 15 men (76.9 ± 10.94 years). Group A had 11 patients, group B had 8 patients, group C had 6 patients, and group D had 6 patients. Ambulation was initially prescribed for these patients 1 day after the surgery. The average surgery durations of the A, B, C, and D patterns were 44.54 ± 7.56, 49.37 ± 12.65, 49.16 ± 3.76, and 44.16 ± 5.84 min, respectively. No statistically significant differences were observed among the four patterns (P = 0.404). CONCLUSION: Surgical treatment of the greater trochanteric fracture which is considered an indicator of occult intertrochanteric fracture is a good choice for the treatment because of the procedure safety and early mobilization after the surgery.

The results of hearing screening in refugee school children living in Sanliurfa /Turkey and the related risk factors.

OBJECTIVES: Determining the frequency of and the risk factors for hearing loss among school-age children by comparing the results of hearing screening in children from Syrian refugee and native Turkish population. METHODS: The results of the official hearing test, which was conducted by the Ministry of Health of the Republic of Turkey for schoolchildren in the first grade in the 2017-2018 academic year in the Province of Sanliurfa, were analyzed. RESULTS: A total of 23,664 children were screened; 20,603 (87.1%) were Turkish native, and 3,061 (12.9%) were Syrian refugees. The age range was between 69 and 84 months. The screening results indicated in Turkish children, sensorineural hearing loss (SNHL) in 0.26%, otitis media with effusion (OME) in 0.41%, and chronic otitis media (COM) in 0.08%. In the refugee children, the frequency of SNHL was 1.11%, OME was 0.94%, and COM was 0.62%. The rate of COM and SNHL was significantly higher in the refugee children (p < 0.001). Moreover, among those with hearing loss, the frequency of low birth weight, inflammatory diseases, and the family history of consanguineous marriage was significantly higher in refugee children compared to those in Turkish native population (p = 0.018, p = 0.003, and p = 0.022, respectively). CONCLUSION: Hearing loss is a major preventable and treatable cause of developmental disorder in childhood. When untreated, hearing loss may delay speaking and prevent socio-emotional development, leading to longterm negative consequences. We believe that programs for hearing screening in schoolchildren should be expanded and that immigrants who carry several risk factors for developmental hearing loss should be included in these programs.

Negative-Pressure Pulmonary Edema After Septoplasty.

Negative-pressure pulmonary edema is a rare but life-threatening complication of septoplasty seen in the early-postoperative period. The main cause is laryngospasm; often with hypoxia and hemoptysis. In our case, a 36-year-old septoplasty recipient developed symptoms of hypotension, tachycardia and low oxygen saturation 3 hours after extubation. The patient was diagnosed with negative-pressure pulmonary edema. Treatment was applied with noninvasive positive pressure ventilation and diuretics. It should be noted that negative pressure pulmonary edema may vary in terms of presentation and may not be accompanied by laryngospasm.

The Effect of Platelet-Rich Plasma on the Temporomandibular Joint After Radiotherapy in Rabbits.

OBJECTIVES: Platelet-rich plasma (PRP) was administered into the temporomandibular joint (TMJ) space, which had been exposed to radiotherapy (RT), in an attempt to prevent and/or treat the late-term complications associated with RT when used for the treatment of head and neck cancers (nasopharyngeal cancer in particular) on the musculoskeletal system. METHODS: A total of 13 adult male New Zealand ( Oryctolagus cuniculus) rabbits were used in the study. The animals were classified into 3 groups: 6 in the RT group, 6 in the RT+PRP group, and 1 in the control group (exposed to neither). The TMJ space of each rabbit was exposed to 2240 cGy external RT in total, and PRP was administered into the TMJ space 1 month later. The joints were surgically removed 1 month later and examined histopathologically. RESULTS: In the group given RT+PRP, the level of inflammation, amount of muscle fibrosis, vascular wall fibrosis, synovial membrane and condyle cartilage thickness, temporal extrabone fibrous cell layer count, and intramuscular changes were similar to those recorded in the control group, although the positive effects of PRP were not found to be statistically significant. CONCLUSIONS: The findings of the present study demonstrate that injections of PRP may increase joint inflammation and therefore enhance blood supply, resulting in the onset of regeneration. These favorable effects of PRP may be helpful in the fight against late-term musculoskeletal complications of RT and may minimize such side effects as sore jaw, malnutrition, and weight loss.