Effect of Piezoelectric Technique on Auditory Function on Postoperative Day One in Septorhinoplasty Surgery.

AIM: To examine the effect of the piezoelectric application used increasingly for osteotomy and correction of nasal dorsum in septorhinoplasty surgeries on early auditory functions. METHODS: Our study was conducted after the decision of 10840098-604.01.01-E.9057 taken from Istanbul Medipol University Clinical Research Local Ethics Committee. This study was designed to be prospective, randomized and controlled. Twenty patients between 18 and 50 years of age that piezoelectric technique was used in the study group and 10 patients in the same age range who underwent nasal surgery (endoscopic sinus surgery, septoplasty, lower concha radiofrequency and nasal valve surgery) for any reason in the control group were included in the study. Audiologic functions of the patients in both the groups were assessed by pure audio audiometry, tympanometry and distortion product otoacoustic emission test before the surgery and 24 hours after the surgery. The data obtained were statistically compared using the SPSS 22.0 program and P < 0.05 was considered significant. RESULTS: Twenty patients (5 males, 15 females) that piezoelectric (ultrasonics) technique was used during septorhinoplasty in the study group and 10 patients (5 males, 5 females) in the control group were included in the study. In the study and the control groups, preoperative and postoperative air/bone path thresholds at the right and left ears did not differ significantly (P > 0.05) at 250, 500, 1000, 2000, 4000, 6000, and 8000 Hz. The results of distortion product otoacoustic emission results (signal/noise ratio) obtained postoperatively were not statistically significant (P > 0.05) with the results obtained preoperatively. CONCLUSION: The results of the study show that the piezoelectric technique used in septorhinoplasty does not cause a negative effect on auditory functions. This study is the first comparative study to investigate the effect of piezoelectric technique used in septorhinoplasty surgery on auditory functions. After further clinical studies performed with well-selected and large patient population, the piezoelectric techniques can be a preferred technique during septorhinoplasty operations.

Effects of Rhinoplasty on Labyrinthine Function.

BACKGROUND: Rhinoplasty is a common surgical procedure that is requested and accepted by patients for cosmetic and functional reasons. Osteotomies are performed on nasal bone, maxillary crest, or vomer to fix the deviations of the nasal dorsum or septum. During the percussion of the osteotomes with the surgical mallet, the vibration energy diffuses to the cranium. Auditory and vestibular systems may be affected by these vibrations. OBJECTIVES: To assess the effects of rhinoplasty, in which osteotomies were performed using a hammer, on the audiovestibular system. METHODS: Thirty adults who underwent rhinoplasty were included in the study group. Ten age and gender matched adults who had nasal surgery without surgical mallet or osteotome served as the control group. The patients in both groups were assessed using pure tone audiometry, tympanometry, distortion product otoacoustic emission testing, and vestibular-evoked myogenic potential, as well as video head impulse tests (vHIT) before the operation and 1 week after the operation. RESULTS: On auditory assessment, there was no significant difference between the study and control groups regarding pure tone thresholds at frequencies of 250 Hz to 8 kHz (P > 0.05) as well as otoacoustic emissions. The vestibular assessment performed by using vestibular-evoked myogenic potential and vHIT did not reveal a statistically significant difference between the groups, before surgery or after surgery (P > 0.05). CONCLUSIONS: Rhinoplasty appears to be a safe operation in terms of audiovestibular functions, and osteotomy, in which a hammer is usually used, does not have an impact on hearing or balance functions of the ear.

Assessment of Patient Satisfaction With Evaluation Methods in Open Technique Septorhinoplasty.

The aim of this study was to measure the postoperative satisfaction of patients who underwent open technique septorhinoplasty (SRP) using Nasal Obstruction Symptoms Evaluation (NOSE), Rhinoplasty Outcomes Evaluation (ROE) and visual analog scale (VAS), and to assess the reliability and usability of these forms in the outcome of SRP.Forty-five patients who underwent primary open technique SRP were included in the study. The levels of patient satisfaction were assessed before the surgery and in the long-term using NOSE, ROE, and VAS.Nasal Obstruction Symptoms Evaluation scores were found to be decreased significantly after surgery, whereas ROE scores were increased postoperatively (P < 0.01). Patients' either functional (VAS) and aesthetic (VAS) increased significantly in the long-term after surgery (P < 0.01). There were no statistically significant differences between preoperative and postoperative measurements of NOSE, ROE, functional VAS, and aesthetic VAS by sex (P > 0.05).There was a statistically significant positive relationship between ROE difference before and after surgery, and functional VAS difference (r = 0.544, P = 0.001).There was a positive correlation between pre-postoperative ROE difference, and aesthetic VAS difference (r = 0.766, P = 0.001). The relationship between the pre-postoperative NOSE score difference and functional VAS difference was found to be significantly negative (r = -0.833, P = 0.001). The relationship between pre-postoperative NOSE difference and aesthetic VAS difference was also significantly negative (r = -0.475, P = 0.001). There was a significant negative correlation between ROE difference between before and after surgery, and NOSE difference (r = -0.640, P = 0.00).The disease-specific quality of life assessment forms used to evaluate patient esthetic and functional satisfaction correlate significantly with nasal obstruction and ROE.

Morphometric analysis of the maxillary sinus in patients with nasal septum deviation.

The aim of this study was to evaluate the relationship between nasal septum deviation, which is common in the general population, and maxillary sinus volume. A retrospective assessment was made for 96 patients with nasal septum deviation without coexisting sinonasal morbidity and compared to 60 healthy individuals. A three-dimensional reconstruction of computed tomography images was used to assess a total of 312 maxillary sinus volumes. Septal deviation angles and volumes were also measured to standardize and determine the severity of the septal deviations. Septal deviations were right-sided in 36.5% of the cases (n = 35) and left-sided in 63.5% (n = 61). Deviation angles varied between 5° and 24.4°, with a mean value of 12.9 ± 5.0. The mean value for the deviation volume was 4.6 ± 1.5 cm(3) (range 1.7-9.4). The right and left maxillary sinus volumes were 11.8 ± 4.7 cm(3) and 11.5 ± 4.4 cm(3), respectively, in control group. Statistically significant discrepancy was observed between the ipsilateral and contralateral maxillary sinus volumes, in regard to the side of the septal deviation in study group. Maxillary sinus volumes were found to be significantly smaller on the ipsilateral side of septal deviation compared with the contralateral side.

Oropharyngeal branchial cyst in a young child.

Second branchial cleft cysts are almost always located in the neck. Their presence in the oropharynx is extremely rare. An oropharyngeal branchial cyst in a 4-year-old child diagnosed by magnetic resonance and histopathology was presented. Anatomic location and pathological findings indicated the second branchial pouch origin. The cyst was excised transorally. Six months' follow-up of the child was uneventful and there was no recurrence.

Concha bullosa surgery and the distribution of human olfactory neuroepithelium.

In bullous middle turbinate surgery, controversy exists over which side of the bullous middle turbinate should be removed, as the distribution of human olfactory neuroepithelium is unclear. This study evaluated whether the middle turbinate tissue of patients undergoing endoscopic concha bullosa surgery contains functional olfactory epithelium. This prospective clinical study was conducted in tertiary referable center. It detected 70 conchae bullosa in 48 patients with sinonasal symptoms, who underwent paranasal computed tomography (CT) that showed pneumatization of the middle concha. All samples were obtained under general anesthesia. Three samples were obtained from each bullous middle turbinate: one each from the anterior, medial, and lateral portions. The mucosa from each sample was stained with olfactory marker protein (OMP). In total, 210 middle turbinate samples were taken from 48 patients during endoscopic surgery for conchae bullosa. The patients were 22 females and 26 males. Of the 70 conchae bullosa, OMP-stained nerve tissue was found in the lateral, anterior and medial aspects of 57 (81.4 %), 42 (60.0 %) and 23 (32.8 %) of the bullous middle turbinates, respectively. OMP-stained nerve tissue was found in 122 (58.1 %) of the 210 bullous middle turbinate tissue samples. OMP-stained nerve tissue was found on the lateral surface of the bullous middle turbinate more often than the medial surface. Therefore, during the concha bullosa surgery, OMP-stained nerve tissue found at least in the medial part of concha, suggested that the opening of the medial part of middle concha.

[An efficacy comparison of betahistin, trimetazidine and ginkgo biloba extract in patients with tinnitus]. / Tinnituslu hastalarda trimetazidin, betahistin ve ginkgo biloba ekstresi etkinliginin karsilastirilmasi

OBJECTIVES: This study aims to investigate the efficacy of trimetazidine, betahistine and ginkgo biloba extract in the treatment of tinnitus. PATIENTS AND METHODS: Complete clinical data of 90 patients (48 males, 42 females; mean age 52.3±15.1 years; range 20 to 61 years) who received betahistine, trimetazidine and ginkgo biloba extract for three months were retrospectively analyzed. The patients were divided into three groups including 30 in each group according to treatments received. Pre-treatment and post-treatment scores of tinnitus disability questionnaire were compared statistically. RESULTS: There was no statistically significant difference between pre-treatment scores of tinnitus disability questionnaire among all three groups (p>0.05), while there was a statistically significant difference among the groups following treatment (p=0.019, p<0.05). After a-three-month treatment, a decrease of 19.7±15.5 units in trimetazidine group, 12.2±12.7 units in betahistine group, and 3.80±5.9 units in ginkgo biloba extract group were found to be statistically significant, compared to the mean pretreatment tinnitus disability questionnaire scores (p=0.002, p<0.01). CONCLUSION: Our study results suggest that trimetazidine, betahistin and ginkgo biloba extract reduce tinnitus symptoms. However, symptomatic relief can be mostly achieved with trimetazidine treatment.

Cytotoxic effects of nasal buserelin on nasal mucosal tissue in rabbits.

To investigate the cytotoxic effects of nasal buserelin on rabbit nasal mucosal tissue, twenty-four female rabbits were studied prospectively. The rabbits were divided into 4 groups including 6 rabbits. The rabbits' left noses were included in the all study groups: 150 µg/puff/day of buserelin acetate was administered topically twice daily during 21, 42 and 63 days. Saline was administered topically twice daily to the left nasal cavity in the control group. The nasal septal mucosal stripe tissue was carefully removed from underlaying cartilage after sedation. HE staining, Masson's trichrome, toluidine blue and TUNEL staining were used to evaluate mucosal changes. Each preparation was investigated via apoptotic cells, and they were accounted. Kruskal-Wallis test was used to evaluate nonparametric comparison of apoptotic cells. Mononuclear cells have been raised in the sub-epithelial connective tissue, nucleuses of epithelial cells in the apical region were pyknotic, and apoptotic cells were determined on 21-day group. In the 42-day group, nasal epithelial tissue was similar to 21-day group and epithelial cells including pyknotic nucleus were present in this group, too. In the 63-day group, epithelial cells were light colored. Venous sinuses in the sub-epithelial connective tissue were wide but not congested and not raised collagen filaments. In the intra-epithelial tissue, some of cells were TUNEL (+). Apoptotic cells were fewer in the control group according to 21-day group. In 42- and 63-day groups, these cells were fewer than in 21-day group. Numerical difference was present between the groups, but statistical significance was not found between the groups. We concluded that nasal buserelin cytotoxicity was not potent in the nasal cavity in rabbits. We use nasal buserelin in all indications with confidence.

Eustachian tube function following total laryngectomy.

OBJECTIVE: The function of the Eustachian tube has been investigated in various conditions. However, its status has not been evaluated in total laryngectomized patients. This study was designed to investigate short-term and long-term changes of the Eustachian tube that occur following total laryngectomy. METHOD: We enrolled a total of 53 patients who have undergone total laryngectomy in a tertiary referral center. These patients were divided into 2 groups, as those within the last 2 years after surgery (group 1) and those more than 2 years after surgery (group 2). In addition, 51 healthy volunteers were studied as a control group (group 3). We tested Eustachian tube function with P1, P2, and P3. P1 is the tympanometric measurement while resting. P2 is the tympanometric measurement after the Toynbee maneuver. P3 is the tympanometric testing after the Valsalva maneuver. To evaluate the functionality of the Eustachian tube, we used the P1-P2 >10 daPa or Pmax - Pmin >15 daPa criteria. RESULTS: A statistically significant difference was not detected between Pmax - Pmin, P2, and P1-P2 values among the groups. Moreover, a statistically significant difference was also not detected between the right and left sides through the Pmax - Pmin values when assessing the groups among themselves. CONCLUSIONS: We determined that the functions of Eustachian tubes were not different between the patients who underwent total laryngectomy and the healthy volunteers at nearly the same age. The lack of active airflow in the upper respiratory tract following total laryngectomy has no effect on the function of the Eustachian tube in the short and long term.

Montelukast protects axial pattern rat skin flaps against ischemia/reperfusion injury.

BACKGROUND: Recent studies have shown that neutrophils play an important role in the pathogenesis of reperfusion injury. Using an inferior epigastric artery skin flap as a flap ischemia/reperfusion (I/R) injury model, we investigated whether the administration of montelukast sodium, a selective reversible cysteinyl leukotriene 1 (CysLT1) receptor antagonist, decreases neutrophil infiltration and promotes flap survival. METHODS: Eighteen rats were used and randomly divided into three groups (n=6 for each group). Group I was the sham group and did not undergo ischemic insult; rather, normal saline (1 mL) was administrated intraperitonealy (i.p.) 30 min before surgery and continued for 6 d. Group II (control) and Group III (montelukast) underwent 12 h of ischemic insult. For Group II, normal saline (1 mL) was injected i.p. 30 min before the surgery and immediately before reperfusion, and this continued for 6 d. In Group III, 1 mL of montelukast (10mg/kg) was injected i.p. and continued for 6 d. Malondialdehyde (MDA) and glutathione (GSH) levels and myeloperoxidase (MPO) enzyme activities were investigated. Histological evaluation was made to investigate the tissue neutrophil count. Survival areas were assessed at 7 d postoperatively. RESULTS: Group III (montelukast- treated) showed a significantly higher survival rate than Group II (control) (P=0.029) but a lower survival rate than Group I (sham). Histological and biochemical assays corroborated this data. CONCLUSION: This study suggests that montelukast CysLT1 receptor antagonist montelukast reversed I/R-induced oxidant responses and improved flap survival by inhibiting neutrophil infiltration and balancing oxidant and antioxidant status.

The effects of levobupivacaine versus levobupivacaine plus magnesium infiltration on postoperative analgesia and laryngospasm in pediatric tonsillectomy patients.

BACKGROUND: The aim of this study was to evaluate whether the addition of magnesium to levobupivacaine will decrease the postoperative analgesic requirement or not, and to investigate the possible preventive effects on laryngospasm. METHODS: Seventy-five children undergoing elective tonsillectomy and/or adenoidectomy surgery. The drug was prepared as only NaCl 0.9% for the first group (Group S, n=25), levobupivacaine 0.25% for the second group (Group L, n=25), and levobupivacaine 0.25% plus magnesium sulphate 2mg/kg for the third group (Group M, n=25). Pain was recorded at 15th minute, 1st, 4th, 8th, 16th, and 24th hour postoperatively. Pain was evaluated using a modified Children's Hospital of Eastern Ontario pain scale (mCHEOPS). Incidence of postoperative nausea and vomiting (PONV) was assessed at various time intervals (0-2, 2-6, 6-24h) by numeric rank score. Patients were followed for laryngospasm for 1h in recovery room after extubation. Other complications appeared within 24h postoperatively were recorded. RESULTS: All postoperative CHEOPS values were lower than control in both groups. Analgesic requirement was decreased significantly in both groups in comparison with control patients, but this requirement was significantly lower in Group M (p<0.05). Although laryngospasm was not observed in Group M, the difference between groups was not statistically significant. PONV was similar in both groups. CONCLUSIONS: Levobupivacaine and Levobupivacaine plus magnesium infiltration decrease the post-tonsillectomy analgesic requirement. Insignificant preventive effect of low doses of magnesium infiltration on laryngospasm observed in this study needs to be clarified by larger series.

The effects of montelukast on random pattern skin flap survival: An experimental study in rats.

BACKGROUND: A variety of methods to improve skin flap survival, including the use of pharmacologic agents, have been intensively investigated. Decreasing neutrophil-mediated inflammation and tissue injury has been reported to be effective in improving flap survival. Montelukast is a selective reversible cysteinyl leukotriene receptor-1 antagonist that has been found to have protective effects against renal ischemia reperfusion injury and burn-induced oxidative injury of the skin in rats. However, its effects on skin flap survival have not been previously reported. OBJECTIVE: The aim of this study was to investigate the effects of montelukast on neutrophil-mediated random pattern skin flap survival. METHODS: Male Sprague-Dawley rats weighing 230 to 250 g were randomly divided into 2 groups-the montelukast-treated group and the control group. Caudally based rectangular random pattern skin flaps 3 × 9 cm were elevated on the backs of the rats. The flaps were sutured into their original places. In the montelukast group, 1 mL of solution containing 10 mg/kg montelukast was administered intraperitoneally (IP) 30 minutes before surgery and then daily for 6 days. In the control group, 1 mL of saline was administered IP 30 minutes before surgery and then daily for 6 days. To observe the effects of montelukast, myeloperoxidase (MPO) activity, an index of tissue neutrophil infiltration, was measured from extracted skin tissue 12 hours after flap elevation. Flap viability was evaluated 7 days after surgery by measuring necrotic flap area and total flap area. RESULTS: Sixteen rats (mean [SD] weight, 240.6 [6.6] g) were equally divided between the 2 groups. All rats survived throughout the study period. Mean (SD) MPO activity in flap tissue was significantly lower in the montelukast group than in the control group (14.57 [2.33] vs 21.28 [4.86] U/g protein; P = 0.005). The percentage of necrotic flap area was significantly lower in the montelukast group than in the control group (17.17 [7.95] vs 37.51 [10.72]; P = 0.001). CONCLUSION: This small, experimental, in vivo animal study found that montelukast was associated with both lower MPO activity and a lower percentage of necrotic random pattern skin flap area. Future studies are needed to clarify these findings.

[Effectiveness of rapid antigen test with throat gargle in detecting group A beta-hemolytic streptococci]. / Bogaz gargarasi ile yapilan hizli antijen testinin grup A beta-hemolitik streptokoklari saptamadaki etkinligi.

OBJECTIVES: The most important disadvantage of rapid antigen tests (RAT) is low sensitivity for the diagnosis of group A beta-hemolytic streptococci (BHS). We determined the sensitivity, specificity, positive and negative predictive values of RAT in gargling samples. PATIENTS AND METHODS: The study included 106 patients (53 females, 53 males, mean age 22+/-12 years; range 16-65 years) with an initial diagnosis of tonsillopharyngitis. Swab samples were taken from the posterior pharyngeal wall and tonsil surface with a sterile cotton swab. Then, gargle samples were obtained by gargling for 10 seconds with sterile 0.9% NaCl to be examined by the RAT for group A BHS. Throat cultures were processed using standard microbiologic techniques. RESULTS: Throat cultures were positive in 12 patients (11.3%) and negative in 94 patients (88.6%). Rapid antigen test yielded five positive (4.7%) and 101 negative (95.2%) results. The sensitivity and specificity rates of RAT with throat gargling were 41.7% and 100%, with positive and negative predictive values of 100% and 93.1%, respectively. CONCLUSION: Despite satisfactory specificity, positive and negative predictive rates of RAT with throat gargling, its low sensitivity limits its use for the diagnosis of group A BHS.

Does the prevalence of nasal polyps increase in patients using statins?

Several statins inhibit T-helper 1 development and induce T-helper 2 polarization and production of T-helper 2 cytokines that promote the activation and chemotaxis of eosinophils. Whether statins promote the development of nasal polyps has so far been uncertain. No studies have evaluated the frequency of the development of nasal polyps in patients using statins. To better define the relationship of statin use to the presence of nasal polyps, the investigators explored the frequency of the development of nasal polyps in patients who were using statins. A total of 200 patients who were using statins and 200 who were not using statins (400 cases) were investigated. All patients were examined for nasal polyps by anterior rhinoscopy or investigation with a fiberoptic endoscope. In addition, immunoglobulin E levels were measured, a skin prick test was performed, and the results from the 2 groups were compared. Nasal polyps were detected in 4 subjects who were using statins, whereas 5 nasal polyps were found in the control group; differences between the 2 groups were statistically insignificant (P>.05). When the atopy status of the 2 groups was compared, prick test positivity and serum immunoglobulin E levels were found to be 15% and 44+/-31 IU/mL in the statin group and 19% and 68+/-23 IU/mL in the control group (P>.05). These results show that nasal polyposis is a multifactorial disease with several different causes; however, the frequency of the development of nasal polyps does not increase in patients who use statins.

The effect of prilocaine and prilocaine plus meperidine infiltration on the pain during nasal packing removal.

OBJECTIVE: Removing the nasal packing after nasal surgery is an uncomfortable and painful procedure. Since there is no controlled trial described in the literature about the local use of meperidine during packing removal, we aimed to compare the analgesic and sedative effects of the meperidine-prilocaine combination, injected into the packing 15 minutes before the procedure, with that of prilocaine during packing removal. METHODS: Fifty adult patients, for whom nasal packing removal after nasal septoplasty was scheduled, were randomly allocated into one of two groups. In the prilocaine group (Group P, n = 25), 5 ml of 1% prilocaine in saline was injected into the pack 15 minutes before removal. In the prilocaine-meperidine group (Group MP, n = 25), 5 ml fluid combination containing prilocaine (10 mg/ml) and meperidine (1 mg/kg) was injected in nasal packs. Five ml saline was injected into the package in the contra-lateral nostril in both groups as control. Visual analogue scale (VAS) score was recorded during injections (t) and packing removal (t), and the Ramsay sedation score was evaluated. RESULTS: VAS score was not different from the control nostril in Group P (p > 0.05), where as it was significantly lower than the control nostril in Group MP (p < 0.05). Ramsay sedation scores were significantly higher in Group MP compared to the control nostril and actively treated nostril of Group P (p < 0.05). CONCLUSION: The injection of prilocaine plus meperidine into the nasal pack 15 minutes before nasal packing removal provides effective analgesia and mild sedation during the procedure.

Relation between middle ear pressure changes and postoperative nausea and vomiting in pediatric strabismus surgery.

STUDY OBJECTIVE: To investigate the effects of tympanometric changes on the frequency of postoperative nausea and vomiting (PONV). DESIGN: Prospective, observational study. SETTING: University hospital. PATIENTS: 49 ASA physical status I, nonpremedicated children undergoing elective strabismus surgery. INTERVENTIONS: Frequency of PONV was assessed at various time intervals (0-2, 2-6, and 6-24 hours) with a 4-point scale (0, no nausea; 1, nausea but no vomiting; 2, one episode of vomiting; 3, two or more episodes of vomiting), and correlation with tympanometric data was investigated. MEASUREMENTS: Tympanogram was obtained before induction of standardized anesthesia and after full recovery. Fourteen (28.6%) patients had nausea, and 10 (20.4%) patients vomited. The tympanic gradient, compliance, and pressure values were found to be significantly higher in postoperative measurements than their preoperative counterparts (P < 0.05). The volumes of both ears increased postoperatively, but these differences were not statistically significant (P > 0.05). Changes in middle ear pressure, volume, compliance, and gradient did not correlate with PONV (P > 0.05). CONCLUSIONS: Gradient, compliance, volume, and pressure changes in middle ears were not found to be related to the frequency of nausea and vomiting after strabismus surgery.

Comparison of dexmedetomidine and midazolam for monitored anesthesia care combined with tramadol via patient-controlled analgesia in endoscopic nasal surgery: A prospective, randomized, double-blind, clinical study.

UNLABELLED: Abstract. BACKGROUND: Monitored anesthesia care (MAC) may be applied for septoplasty or endoscopic sinus surgery in which an adequate sedation and analgesia without respiratory depression are desired for comfort of both the patient and the surgeon. Several combinations with different agents have been used for this purpose in these patients. However, analgesic properties for these agents have not been reported. OBJECTIVE: The aim of this study was to investigate the analgesic and sedative effects of dexmedetomidine or midazolam infusion combined with tramadol that was used via patient-controlled analgesia (PCA), and to document the effects of these drugs on early cognitive functions. METHODS: This prospective, randomized, double-blind, clinical study enrolled patients undergoing septoplasty or endoscopic sinus surgery at the Abant Izzet Baysal University Hospital, Bolu, Turkey, between February and September 2006. Patients were randomly allocated in a 1:1 ratio into 1 of 2 groups: the dexmedetomidine group (group D) patients received IV dexmedetomidine 1 µg/kg for 10 minutes followed by continuous infusion of 0.5 µg/kg · h(-1); and the midazolam group (group M) patients were administered a loading dose of IV midazolam 40 µg/kg for 10 minutes followed by infusion at the rate of 50 µg/kg · h(-1). A 1-minute bolus dose of IV tramadol (1.5 mg/kg) was administered in both groups 10 minutes after the administration of the primary drug, and continued via infusion using a PCA device. After baseline measurements, systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), oxygen saturation, and rate of respiration were recorded after the loading dose of study drug, after the bolus tramadol dose, at 10-minute intervals during the operation, and twice in the recovery rooms; 5 minutes after arrival and 5 minutes before discharge. Verbal rating score (VRS) and Ramsay sedation score were determined at baseline (after surgery was started), every 10 minutes thereafter until the end of the operation, and 2 times during recovery. All patients were assessed with the Wechsler Memory Scale-Revised at baseline (preoperatively) and 4 hours after the operation. RESULTS: Seventy patients were enrolled in the study and randomly assigned to 1 of 2 groups: group D (sex, male/female, 23/12; mean [SEM] age, 32.53 [2.07] years; mean [SEM] weight, 73.03 [2.41] kg) or group M (sex, male/female, 21/14; mean [SEM] age, 34.43 [1.83] years; mean [SEM] weight, 67.90 [2.32] kg). All hemodynamic parameters (SAP, DAP, MAP, HR) were significantly higher in group M compared with group D from the onset of the surgery to discharge time (P < 0.05). Pain and sedation scores were similar in both groups, but the amount of PCA-administered rescue tramadol was significantly higher in group M (P = 0.001). A higher, though not statistically significant, prevalence of adverse events (ie, hypotension, bradycardia, and perioperative nausea and vomiting) were observed in group D. Postoperative logical verbal memory and digit span values were significantly higher in group D when compared with group M (P < 0.05). Postoperative digit span and visual reproduction scores were significantly higher than preoperative values in group D (P < 0.05). Postoperative personality functioning scores were significantly higher than preoperative values in group M (P < 0.05). CONCLUSIONS: Based on VRS, Ramsay sedation scores, and surgeon and anesthesiologist satisfaction scores, dexmedetomidine or midazolam combined with tramadol PCA provided adequate analgesia and sedation in these adult patients undergoing septoplasty or endoscopic sinus surgery with MAC. A significantly larger amount of rescue tramadol was used by group M, suggesting that a better analgesic effect was achieved with dexmedetomidine.

Holter analyses in children with adenotonsillar hypertrophy.

OBJECTIVE: The cardiac complications of adenotonsillar hypertrophy (ATH) have been investigated by many scientists by using supplemental diagnostic modalities such as echocardiography. But, arrhythmia analysis has not been studied adequately in patients with ATH. This study aimed at evaluating the prevalence of arrhythmias, heart rate variability (HRV) and heart rate turbulence (HRT) analyses by means of 24 h Holter ECG monitoring in pre- and post-operative periods in children with ATH. METHODS: Twenty-five children with ATH consisting of 12 female and 13 male patients (mean age 66+/-15 months, range 24-108 months) included in this study. All children were assessed pre-operatively and at 1 month post-operatively with 24-h Holter monitoring and ECG analysis. The prevalence analysis of arrhythmias, heart rate variability and heart rate turbulence analysis was assessed. These data were compared. RESULTS: Although some ECG and holter findings such as sinusal tachycardia, Mobitz type 1 second-degree AV block improved after the operation, the prevalence of arrhythmias, HRV and HRT values were not changed significantly in post-operative period (p>0.05). CONCLUSION: Measurement of HRT and HRV are attractive and easily applicable ways of non-invasive risk prediction of cardiac complications. But, these parameters have not changed significantly in post-operative period. However, ECG and 24-h Holter monitoring of electrocardiography may be useful at evaluating the prevalence of arrhythmias and determining cardiac complications in pre-operative period.

The impact of incubating the throat culture for 72 h on the diagnosis of group A beta-hemolytic streptococci.

OBJECTIVE: The accurate detection and treatment of group A beta-hemolytic streptococcal pharyngitis is important to prevent the potential sequels. Throat culture remains the gold standard for the diagnosis of streptococcal pharyngitis. Many authors recommended 48 h incubation time for the isolation of group A Streptococcus (GAS). In this study the diagnostic efficacy of prolonging the incubation time of throat cultures to 72 h for isolation of GAS was researched. METHODS: Throat swab specimens were inoculated to 5% sheep blood agar plate and incubated at 37 degrees C, and evaluated at the 24th hour. GAS negative plates were incubated again for another 24h and read at the 48th hour. Negative plates at 48 h were incubated again, read at the 72nd hour, and positive results of all measurements were evaluated. RESULTS: A total of 367 cultures were examined. At the 24th hour evaluation 34 (9.3%) cultures were positive for GAS. Evaluation of 333 cultures that were found to be negative in the first 24th hour evaluation revealed 44 (13.6%) positive cultures at 48th hour evaluation. Out of 289 cultures that were negative during the 48th hour evaluation, an additional 13 (4.7%) cultures were found to be positive during the 72nd hour evaluation. The agreement between 24th-48th and 24th and 72nd were both moderate (kappa 0.54 and 0. 46, respectively), and between 48th and 72nd hour was very good (kappa: 0.90). CONCLUSION: Throat cultures that are negative for GAS at 24h should be incubated for second day. We conclude that, to confirm the throat cultures GAS negative, results of throat cultures need to be incubated for 72 h, since 72nd hour evaluations revealed additional 5% positive results.

Efficacy of throat gargling for detection of group a beta-hemolytic streptococcus.

The purpose of our study was to investigate the suitability of throat gargling with sterile saline as an alternative method to throat swabs for detection of group A beta- hemolytic streptococcus (GAS). Throat specimens were obtained from 601 cases belonging to different age groups. Sterile Dacron swabs and gargle residue were first streaked on the side of a 5% sheep blood agar plate to which a 0.04 U bacitracin disk had been applied, and then 1.25 mg trimethoprim and 23.75 mg sulphamethoxazole were added to the plate. After incubation, beta-hemolytic colonies were classified serologically by latex agglutination. GAS was detected in both throat swabs and throat gargle specimens in 49 cases, but GAS was also detected in 12 throat swabs from patients with culture-negative gargles and in 8 gargle specimens from subjects in whom throat swabs were culture negative. The strength of agreement was evaluated by calculating the kappa coefficient (K = 0.82, P = 0.000). The sensitivity, specificity, positive predictive value, and negative predictive value of throat gargle specimens were 80.3, 98.5, 85.9, and 97.8%, respectively. Although the conventional throat swab culture remains the gold standard, the throat gargle method is a quick, safe, and easy method for detection of GAS that serves as an effective alternative to throat swab culture.