Serum hypoxia-inducible factor-2: A candidate prognostic biomarker for laryngeal cancer.

OBJECTIVES: To determine the serum hypoxia-inducible factor-1, -2 and -3 (HIF-1, -2 and -3) levels in patients with laryngeal neoplasm, and to investigate their role in differential diagnosis, prediction of tumour characteristic and extension, and prognosis and survival. STUDY DESIGN: Prospective, cohort study at a tertiary referral centre. SETTINGS: The study was conducted in a tertiary medical centre. PARTICIPANTS: Patients with benign, premalignant and malignant laryngeal neoplasms were included. Sixty-four patients with a laryngeal neoplasm were enrolled. MAIN OUTCOME MEASURES: Serum HIF-1, -2 and -3 levels were measured from blood samples that were drawn before treatment, using ELISA. RESULTS: A statistically significant difference between benign (HIF-1, -2, -3:4046,1 pg/mL; 2581,5 pg/mL; 1321,0 pg/mL), premalignant (HIF-1, -2, -3:3630,3 pg/mL; 3229,7 pg/mL; 2549,8 pg/mL) and malignant (HIF-1, -2, -3:3576,7 pg/mL; 2595,8 pg/mL; 1106,3 pg/mL) laryngeal neoplasms was not detected when serum HIF-1, -2 and -3 levels were compared. However, high serum HIF-2 level adversely affected survival and locoregional control and had more than 7-fold increase in hazard ratio. Moreover, serum HIF-2 was an independent prognostic factor for 2-year overall, disease-free, distant metastasis-free survival and locoregional control. CONCLUSION: This is the first clinical study in which the diagnostic, predictive and prognostic roles of hypoxia-related biomolecules were examined in laryngeal neoplasms. Hypoxia-inducible factor-2 is a prognostic factor in larynx cancer irrespective of treatment modality.

Hemodynamic Changes in Paramedian Forehead Flap.

Paramedian forehead flap is a workhorse for nasal reconstruction. However, vascular complications may lead to flap failure. The purpose of this study was to evaluate the blood flow objectively and determine the hemodynamic changes in paramedian forehead flap with respect to influential factors of age, gender, and smoking. Thirty patients who had paramedian forehead flap were followed up prospectively between 2010 and 2013. The blood flow was assessed by resistance index using Color Duplex-Doppler Ultrasonography. Resistance index was measured at the proximal and distal ends of each flap on the postoperative first day, first week, and second week. All data were analyzed using SPSS 15.0 for Windows. Fifteen patients were female and the mean of age was 60.9 years. Our results demonstrated statistically significant differences with gradual decreases in resistance to blood flow, when the resistance index values at the proximal and distal ends of paramedian forehead flap were compared (P < 0.001 and P < 0.001). Age, gender, and smoking did not have a negative impact on the resistance index values of paramedian forehead flap. To the best of our knowledge, this is the first study in which resistance in blood flow and hemodynamic changes of paramedian forehead flap were objectively determined using Color Duplex-Doppler Ultrasonography. The resistance index gradually decreases, although it is considerably high at the early postoperative interval. Age, gender, and smoking do not adversely influence the blood flow in a well-designed paramedian forehead flap.

Two-Piece Extraoral Prosthetic Rehabilitation to a Perineural Invasion Lip Cancer.

Lip cancers can severely affect a person in terms of function, esthetics, and psychological trauma. After surgical resection, lip defects require special rehabilitation. This clinical report describes a neck prosthesis of a male patient diagnosed with lower lip squamous cell carcinoma with perineural involvement. The neck prosthesis was connected to the mandibular complete denture with cobalt samarium magnets. Both prostheses improved the patient's mastication, deglutition, and esthetics.

The Safety of Open Surgical Tracheotomy Performed by Otorhinolaryngology Residents.

OBJECTIVE: We aimed to clarify the safety of open surgical tracheotomy performed by supervised residents, and the impact of "reason for hospitalization" on complication rates in open surgical tracheotomy technique. METHODS: In this retrospective cohort study, the medical files and documents of 277 patients who underwent open surgical tracheotomy (OST) over a period of 12 years from October 2005 to July 2017 were analyzed. Forty four patients were excluded due to emergent tracheotomy and presence of malignancy. Remaining 223 cases were divided into two groups as "OSTs done by supervised residents" and "OSTs done by attending surgeons". Age, gender, reason for hospitalization, observation time and complications were noted. The overall minor and major complication rates and each complication rate were compared with regard to the operating surgeons. RESULTS: No statistically significant difference between two groups was demonstrated in terms of observation time (p=0.127). Minor complication rate for residents and attending surgeons was 14.7% and 17.5%, whereas major complication rate was 6.3% and 5.0%, respectively. No significant difference was found between two groups both in terms of minor (p=0.58) and major (p=0.43) complication rates. No risk of "reason for hospitalization" on minor and major complications was found (p=0.06, p=0.15). CONCLUSION: Open surgical tracheotomy performed by supervised residents is as safer as the ones performed by the attending surgeons. The study also showed that "reason for hospitalization" does not potentiate the occurrence of tracheotomy related complications.

Predictive and prognostic factors for patients with locoregionally advanced laryngeal carcinoma treated with surgical multimodality protocol.

The prognosis is suboptimal in patients with locoregionally advanced laryngeal carcinoma even after multimodality protocols. The purpose of this study was to determine the potential influential factors that have an impact on the development of locoregional recurrence, distant metastasis, and oncological outcomes in patients with locoregionally advanced laryngeal carcinoma who had surgical multimodality protocols. A sample size of 85 cases was determined based on a power of 90% and an effect size of α 2 = 0.05. A retrospective analysis of 357 patients with a diagnosis of laryngeal cancer between 2002 and 2015 was performed. Eighteen variables based on sociodemographic, clinical, histopathological and treatment data were analyzed. Medical records of 85 consecutive patients with locoregionally advanced laryngeal carcinoma who underwent surgical multimodality protocols were reviewed. Five-year overall, disease-specific, disease-free, locoregional recurrence-free and distant metastasis-free survival were 68.7, 78.0, 69.6, 68.9 and 69.2%, respectively. Extracapsular extension was an independent predictive factor for locoregional recurrence. Pathologic tumor volume was an independent predictive factor for distant metastasis. pT-stage was an independent prognostic factor for 5-year overall survival, disease-free survival, locoregional recurrence-free survival and distant metastasis-free survival. High volume, pT4a laryngeal tumors with extracapsular extension are associated with a high risk of locoregional recurrence and distant metastasis; and have poor oncological outcomes in patients with locoregionally advanced laryngeal carcinoma treated with surgical multimodality protocols.

Microscopic Transnasal Approach: A New Technique for the Reconstruction of Frontoethmoidal Meningoencephalocele.

Frontoethmoidal meningoencephalocele is a rare congenital malformation, which occurs due to a deficiency in neural tube closure. It may present as an external mass over the nose, nasal obstruction, rhinorrhea and attacks of central nervous system infections. Herein, the authors present a 3-month-old infant with naso-ethmoidal form of frontoethmoidal meningoencephalocele, who was operated on using a newly described approach that was performed under microscope.

Jak-Stat signaling pathway may play a role in the pathogenesis of cholesteatoma.

PURPOSE: Jak-Stat signaling pathway is one of the major signal transduction cascades which regulates most of the cellular events such as cell proliferation, differentiation, cell migration and apoptosis. This study aims to determine the activity of Jak-Stat signaling pathway in the pathogenesis of cholesteatoma. MATERIALS AND METHODS: Cholesteatoma and skin samples were obtained from 10 patients who underwent tympanomastoidectomy for chronic otitis media with cholesteatoma. Immunohistochemical analysis of cholesteatoma and skin was performed using anti-Jak1, anti-Jak2, anti-Jak3, anti-Stat1, anti-Stat2, anti-Stat3, anti-Stat4 and anti-Stat5 antibodies. The immunoreactivities in cholesteatoma and skin were quantified using H-score measurement and statistical comparison was performed. RESULTS: Jak1, Jak2, Jak3, Stat1 and Stat3 immunoreactivities were not detected in cholesteatoma; in contrast to the skin (129.8; 226.7; 33.0; 66.4;115.9). In addition, when H-score measurements of Stat2, Stat4 and Stat5 immunoreactivities were compared between cholesteatoma (172.8; 166.7; 120.0) and skin (400.0; 284.9; 292.0), statistically significant differences were found (p<0.0001, p<0.0001, p<0.0001). CONCLUSIONS: A remarkable deficiency in the family members of Jak-Stat signaling pathway was demonstrated in cholesteatoma. Therefore, perturbations in Jak-Stat signaling pathway may play a role in the pathogenesis of cholesteatoma.

Effects of high altitude on sleep and respiratory system and theirs adaptations.

High-altitude (HA) environments have adverse effects on the normal functioning body of people accustomed to living at low altitudes because of the change in barometric pressure which causes decrease in the amount of oxygen leading to hypobaric hypoxia. Sustained exposure to hypoxia has adverse effects on body weight, muscle structure and exercise capacity, mental functioning, and sleep quality. The most important step of acclimatization is the hyperventilation which is achieved by hypoxic ventilatory response of the peripheral chemoreceptors. Hyperventilation results in increase in arterial carbon-dioxide concentration. Altitude also affects sleep and cardiac output, which is the other determinant of oxygen delivery. Upon initial exposure to HA, the resting pulse rate increases rapidly, but with acclimatization, heart rate and cardiac output tend to fall. Another important component that leads to decrease in cardiac output is the reduction in the stroke volume with acclimatization. During sleep at HA, the levels of CO2 in the blood can drop very low and this can switch off the drive to breathe. Only after the body senses a further drop in O2 levels breathing is started again. Periodic breathing is thought to result from instability in the control system through the hypoxic drive or the response to CO2.

p53 and PTEN expression evaluation with molecular evident recent criteria in laryngeal carcinoma.

The prognosis of laryngeal cancer is affected by clinicopathological factors. Because of that, an effective prognostic marker is very valuable in managing the clinical process. The p53 evaluation method, used in the literature recently, was used for the first time in laryngeal cancer. We evaluated PTEN with 2 methods with the highest significance in the literature on laryngeal cancer. All demographic and histopathological data from 140 laryngeal cancers were compared with p53 and PTEN expressions and survival. p53 staining patterns were classified as wild and mutant. PTEN expression was evaluated according to the staining intensity named PTEN1 and according to the proportion of stained cells named PTEN2. In the series, 93.6% were males, and the mean survival was 38 months. 69.3% of cases were p53 mutants. PTEN loss was found to be 85.7% and 57.9%, respectively. Tumor size and thyroid cartilage invasion for PTEN1 and age for p53 were identified as independent predictive factors (P < .01). Advanced age, total laryngectomy, and extranodal spread were independent poor prognostic factors for overall survival and the presence of subglottic involvement, perineural invasion, and extranodal spread were for disease-free survival (P < .01). This is the first study in which the new p53 classification was used in laryngeal cancer, and will contribute significantly to the literature with differences from the previous evaluation patterns. Evaluation of PTEN based on staining intensity is more appropriate compared to the percentage of stained cells.

Comparative analysis of primary and secondary rhinoplasties according to surgeon's perspective, patient satisfaction, and quality of life.

OBJECTIVES: We sought to analyze and compare the problems and technical difficulties related to surgical intervention, patient satisfaction, and quality of life after primary and secondary rhinoplasties. METHODS: A total of 168 cases of rhinoplasty were grouped as primary or secondary according to the patient's history of rhinoplasty. The type of nasal deformity, the surgical approach, and the difficulty of the surgery were recorded. The levels of patient satisfaction and the quality of life were assessed before and after the operation with the Rhinoplasty Outcomes Evaluation (ROE) and European Quality of Life-5 Dimension (EQ-5D) questionnaires. A quantitative and statistical analysis was performed. RESULTS: Thirty-three patients had secondary rhinoplasty, and 135 patients had primary rhinoplasty. Relatively high rates of saddle nose deformity, crooked nose, and tip asymmetry were observed in the secondary rhinoplasty group. The preoperative and postoperative scores on the ROE and EQ-5D questionnaires demonstrated statistically significant differences in both the primary and secondary rhinoplasty groups. The comparison of postoperative change between the primary and secondary rhinoplasty groups did not demonstrate a statistically significant difference. CONCLUSIONS: The surgical difficulty of secondary rhinoplasty is approximately twice that of primary rhinoplasty because of the high rate of major deformities. However, the levels of patient satisfaction and improvements in quality of life are similar after primary and secondary rhinoplasties.

Chronic inflammation: a poor prognostic factor for endoscopic dacryocystorhinostomy.

Endoscopic endonasal dacryocystorhinostomy (En-DCR) success can be affected by many factors. In this study, we aimed to determine the effect of chronic inflammation on the surgical outcome of En-DCR. A series of 25 primary En-DCR cases and their lacrimal sac specimens were involved in the study. The surgical outcomes were assessed subjectively (satisfied and unsatisfied) and objectively (successful and unsuccessful). All the specimens were examined for the chronic inflammation related histopathological features (inflammatory cell infiltration, fibrosis and capillary proliferation) and graded according to their severity. Moreover, a "chronic inflammation score" was established to determine the intensity of chronic inflammation using the grade of histopathological features. A quantitative and statistical analysis of histopathological features and chronic inflammation were performed between patients with satisfactory and unsatisfactory outcome; and patients with successful and unsuccessful outcome. The overall success rate according to subjective and objective assessment was 60%. However, 9 of 10 patients with unsatisfactory and/or unsuccessful outcome (90%) had severe chronic inflammation of lacrimal sac. In subjective assessment, inflammatory cell infiltration (p = 0.050), fibrosis (p = 0.037), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003) had a statistically significant difference between patients with satisfactory and unsatisfactory outcome. In objective assessment, statistically significant differences were detected between patients with successful and unsuccessful outcome when they compared according to inflammatory cell infiltration (p = 0.027), capillary proliferation (p = 0.007) and chronic inflammation (p = 0.003). Chronic inflammation related histopathological features of variable degree may have a role on En-DCR outcome. Chronic inflammatory score can be used as an indicator of En-DCR success.

New modification of cephalic resection of lateral crus in endonasal rhinoplasty.

A successful rhinoplasty mainly depends on maintaining adequate nasal tip projection and achieving the desired tip refinement. In endonasal rhinoplasty, the surgeon can modify the tip anatomy while still preserving the key structural support mechanisms. Herein, we describe a new modification of retrograde technique for the resection of the cephalic margin of the lateral crus in endonasal rhinoplasty in which a combined resection of the cephalic margin of the lateral crus and its underlying mucoperichondrium are performed.

Suction tube facilitates the transfer of nasal tip sutures in endonasal rhinoplasty.

Nasal tip sculpturing is the most challenging aspect of rhinoplasty. It is principally performed by the reduction or increment of the nasal tip characteristics with sutures or grafts using endonasal or external approach. In endonasal approach, although most of the key structural mechanisms of the nasal tip can be preserved, the transfer of nasal tip sutures, which are used for contouring the alar cartilages and/or graft stabilization, from 1 nasal cavity to another has several difficulties such as time loss, need for extensive dissection, or injuring the soft tissue and alar cartilages. In the current article, we aimed to represent our surgical technique that facilitates suture contouring using a suction tube during the transfer of nasal tip sutures in endonasal rhinoplasty.

[The evaluation of tumor histopathology, location, characteristic, size and thickness of nonmelanoma skin cancers of the head and neck]. / Bas ve boyun melanom disi deri kanserlerinde tümör histopatolojisi, konumu, karakteristigi, boyut ve kalinliginin incelenmesi.

OBJECTIVES: This study aims to investigate the characteristic features of tumors and relationship between features in cases who underwent surgery for nonmelanoma skin cancer (NMSC) of the head and neck. PATIENTS AND METHODS: Between December 2007 and March 2011, 106 lesions of 90 cases who underwent excision of NMSC of the head and neck in our clinic were included. The statistical analysis was performed by evaluating the demographic data, histopathologic type, size and thickness of tumor, location, Clark stage, T stage, risk of recurrence and the presence of recurrence, reconstruction technique and success rate of surgery. RESULTS: Basal cell carcinoma (BCC) was approximately two-fold more common than squamous cell carcinoma (SCC). The most common locations of tumors were the nose and lip. Most of lesions (71.7%) were at high-risk of recurrence. When the relationship of histopathologic type with the size and depth of tumor were analyzed, it was found that the size and thickness of tumor in SCC were relatively higher with a statistically significant difference. The relationship between histopathologic type and the location of tumors was also statistically significant. CONCLUSION: Basal cell carcinoma is the most common NMSC of the head and neck. Most of these cases have the potential of high rate of recurrence. The size and thickness of SCC are higher than BCC.

A comparative analysis of the decongestive effect of oxymetazoline and xylometazoline in healthy subjects.

BACKGROUND: Oxymetazoline and xylometazoline are locally effective and direct acting drugs that relieve nasal congestion. The aim of this study was to objectively determine and compare the decongestive effects of oxymetazoline and xylometazoline in healthy subjects. METHODS: The study population comprised thirty healthy adults. All subjects underwent active anterior rhinomanometry (AARhm) and acoustic rhinometry (AR) tests following the application of oxymetazoline, xylometazoline, or placebo (physiological saline). The change in nasal resistance, nasal airflow, and different cross-sectional areas (CSAs) of the nasal cavity in the subjects were examined for each solution separately. The measurements were obtained over a 1-h period (baseline and 1, 15, 30, and 60 min post-dosing). All results were analyzed using the Kruskal-Wallis test and the Mann-Whitney U test. RESULTS: A total of 6,300 measurements of AARhm and AR were obtained. The application of placebo did not cause a statistically significant change in nasal resistance, nasal airflow, and CSAs (CSA1, 2, and 3, respectively) of the nasal cavity. In contrast, statistically significant changes in nasal resistance (inspiration p = 0.000 and p = 0.004; expiration p = 0.000 and p = 0.000), nasal airflow (inspiration p = 0.000 and p = 0.004; expiration p = 0.000 and p = 0.000), and CSAs of the nasal cavity (CSA2 p = 0.000 and p = 0.000, CSA3 p = 0.000 and p = 0.00), with the exception of CSA1 (p = 0.982 and p = 0.994), were obtained after the application of oxymetazoline and xylometazoline. A comparison of oxymetazoline and xylometazoline based on nasal resistance, nasal airflow, and CSAs of the nasal cavity demonstrated no statistically significant difference, except for CSA3. CONCLUSION: Oxymetazoline and xylometazoline are fast-acting and potent topical decongestants that have similar decongestive effects.

The importance of metric view for photodocumentation of facial reconstructive surgery: a single blinded survey.

Photodocumentation is an essential part of dermatooncology and reconstructive surgery. The purpose of this study is to suggest an imaging technique named metric view (photograph of the lesion with a surgical ruler) and to assess the accuracy of different views. Frontal, close-up and metric views were taken from the lesions of ten different cases. All the photographs were showed to 30 medical professionals and a prediction about the size of the lesion was requested individually. The relationship between the prediction values for three views and the exact size of the lesions were statistically analysed. The precise prediction of the exact size was only achieved in metric view of one case. In addition, the most approximate prediction values were obtained in metric views. The statistical analysis demonstrated that there was no statistically significant difference between the prediction values for metric view and exact size of the lesions in half of the cases. In contrast, statistically significant differences were detected in almost all of the prediction values for frontal and close-up views. Frontal and close-up views are not adequate to represent the size of the lesions. Metric view may enable a rational solution for a better representation.

Staged-surgery with permanent pathology for the management of high-risk nonmelanoma skin cancer of the nose.

The objective of the study was to investigate the effect of staged-surgery with permanent pathology on tumour recurrence of high-risk nonmelanoma skin cancers (NMSCs) of the nose and to determine the factors associated with subclinical spread and deep-margin involvement. Twenty-one patients who underwent staged-surgery with permanent pathology for high-risk NMSCs of the nose between 2007 and 2008 were prospectively followed-up for tumour recurrence. The incidence of tumour recurrence after staged-surgery with permanent pathology was 0%. A positive correlation between perineural involvement and subclinical spread (p = .012); and a statistically significant relationship between infiltrative type basal cell carcinoma (BCC) and deep-margin involvement (p = .033) was detected. Staged-surgery with permanent pathology is a reliable surgical method for complete excision of high-risk NMSCs of the nose and provides a significant decrease in tumour recurrence. Perineural involvement may cause subclinical spread, and infiltrative type BCC may invade deeper structures of the nose.

Acute spiral ganglion cell degeneration following acoustic overstimulation: an experimental study.

BACKGROUND: To evaluate acoustic overstimulation-induced spiral ganglion cell (SGC) degeneration, and determine the relationship between the duration of acoustic overstimulation and rate of SGC degeneration. METHODS: Fifteen guinea pigs were randomized equally to 4 experimental groups, which were exposed to different durations (7.5, 15, 30 and 60 min) of acoustic overstimulation (120 dB at 4 kHz), and a control group. Every bulla was examined histopathologically and immunohistochemically. A quantitative and statistical analysis of acidophilic and TUNEL-positive SGCs was performed. RESULTS: In the control group, 2.1% of SGCs were acidophilic and no TUNEL-positive SGC was detected. In contrast, a statistically significant number of acidophilic (p = 0.000) and TUNEL-positive SGCs (p = 0.002) was determined in the experimental groups. Moreover, a positive correlation between the duration of acoustic overstimulation and acidophilic SGCs (p = 0.000), and a statistically significant relationship between the duration of acoustic overstimulation and TUNEL-positive SGCs (p = 0.000) were demonstrated. CONCLUSION: Acoustic overstimulation may induce acute SGC degeneration. A positive correlation was determined between the duration of acoustic overstimulation and rate of degenerated SGCs.

Angiokeratoma circumscriptum of the tongue.

Angiokeratoma circumscriptum of the tongue is a rare mucocutaneous vascular disorder. To date, only three cases of angiokeratoma circumscriptum of the tongue have been reported in the English literature. In this article, a case with angiokeratoma circumscriptum of the tongue was presented, and all the aspects of this clinical entity including clinical evaluation, differential diagnosis, histopathological features, and treatment modalities were discussed.

Sensitivity, predictive values, pretest-posttest probabilities, and likelihood ratios of presurgery clinical diagnosis of nonmelanoma skin cancers.

BACKGROUND: The precision of clinical diagnosis of skin tumors is not commonly measured and, therefore, very little is known about the diagnostic ability of clinicians. OBJECTIVE: This study aimed to compare clinical and histopathologic diagnoses of nonmelanoma skin cancers with regard to sensitivity, predictive values, pretest-posttest probabilities, and likelihood ratios. METHODS: Two hundred nineteen patients with 241 nonmelanoma skin cancers were enrolled in this study. Of these patients, 49.4% were female and 50.6% were male. The mean age ± standard deviation (SD) was 63.66 ± 16.44 years for the female patients and 64.77 ± 14.88 years for the male patients. The mean duration of the lesions was 20.90 ± 32.95 months. One hundred forty-eight (61.5%) of the lesions were diagnosed as basal cell carcinoma (BCC) and 93 (38.5%) were diagnosed as squamous cell carcinoma (SCC) histopathologically. RESULTS: Sensitivity, positive predictive value, and posttest probability were calculated as 75.96%, 87.77%, and 87.78% for BCC and 70.37%, 37.25%, and 37.20% for SCC, respectively. The correlation between clinical and histopathologic diagnoses was found to be higher in BCC. CONCLUSION: Knowledge of sensitivity, predictive values, likelihood ratios, and posttest probabilities may have implications for the management of skin cancers. To prevent unnecessary surgeries and achieve high diagnostic accuracies, multidisciplinary approaches are recommended.