Objective analysis of voice changes in a hemodialysis session and its correlation with ultrafiltration.

INTRODUCTION: The aim of the study is to analyze the voice changes occurring during a hemodialysis session objectively and to investigate the statistical correlation between voice changes and ultrafiltration, blood pressure, dry weight and the other variables of the patients. MATERIALS AND METHODS: A total of 169 patients were included in the study. Electronic voice recordings of the patients were performed with the aim of making objective voice analysis before and after dialysis. Fundamental frequency measurements occurring at the level of the larynx (Fo) and harmonic-to-noise ratio (HNR) were measured from these voice recordings. RESULTS: When the voice recordings obtained from 169 hemodialysis patients before and after dialysis were investigated, it was observed that a significant increase occurred in the Fo (from 164.52±43.36 Hz to 193.19±47.08 Hz, p<0.01). When the change in HNR was investigated, a significant reduction was determined in the post-dialysis measurements (4.6±3.23 dB) compared to the pre-dialysis measurements (16.10±4.06 dB, p<0.01). Mean 2.49±0.83 L of ultrafiltration was performed and a significant reduction was observed in post-session body weights of the patients (p<0.01). There was a highly statistical significance between the measurements of post-dialysis Fo and post-dialysis body weights. A highly significant correlation was determined between the amount of ultrafiltration performed and a significant increase observed in Fo before and after dialysis. Also a significant correlation was determined between the reduction in the mean post-session blood pressures and the reduction in the HNRs. CONCLUSION: Objective voice analysis is suggesting that it can be a simple and applicable method that can be used to determine the dry weight.

The oldest patient in literature of spontaneous true giant superficial temporal artery aneurysm.

Background: Superficial temporal artery (STA) aneurysms are very rare compared to vascular aneurysms of other regions. They are divided into two as true and pseudo. Pseudoaneurysm were much more common and often depend on an etiological factor but spontaneous true aneurysms are extremely uncommon and the etiologic causes are not clear yet. Case presentation: We present a 91-year-old female patient who consulted to us with swelling in front of the ear; there was no history of previous surgery or any trauma. The patient had a pulsatile mass in the preauricular region, which started 4 years ago and growed faster for the last 2 months. Conclusion: There was a mass consistent with a saccular type aneurysm whose continuity was observed with the temporal artery in imaging studies. The mass was excised under general anesthesia. The patient whose pathological examination was a true STA aneurysm was discussed in the light of the literature.

[Prevalence of chronic otitis media in the young male population in Turkey]. / Türkiye'de genç erkek nüfusunda kronik otitis media prevalansi

OBJECTIVES: In this study, we investigate the prevalence of chronic otitis media (COM) in young men. PATIENTS AND METHODS: Twenty thousand consecutive young men (mean age 22 years) who were under election for high performance military positions were examined by two otolaryngologists in the Military Hospital, Izmir. The otologic examination findings were noted. We evaluated the patients who have tympanic membrane perforation, retraction, adhesion, myringosclerosis and the patients who had underwent surgery before. RESULTS: Three-hundred and fifty-five young men (1.77%) had COM. Other findings were retraction (n=66; 0.33%), adhesion (n=36; 0.18%), myringosclerosis (n=720; 3.6%) and cerumen (n=3200; 16%). We found out that five (0.025%) of the cases had radical mastoidectomy surgery and 16 (0.08%) of them had tympanoplasty. CONCLUSION: The prevalence of COM in young men is 1.77%. Although our study has a limitation because all of our samples are young men, the study is unique due to its large sample size.

An analysis of skin prick test reactions in allergic rhinitis patients in Istanbul, Turkey.

This retrospective, population-based study reviewed skin prick test (SPT) results against various allergens of 1,552 patients with allergic rhinitis (AR) in the district of Kartal, Istanbul, Turkey. The skin prick tests yielded a positive result in 946 patients (60.9%). Seven hundred and forty-give (48%) patients had perennial AR, 558 (36%) perennial AR with seasonal exacerbations and 249 (16%) had seasonal AR. The prevalence of AR was highest in the age of 21-40 years with 48.7%. The allergen group with the highest SPT positivity was pollens at 44.3%, followed by molds at 38.4%, mites at 35.1%, and epithelia-insect at 30.8%. The strongest single allergen was Altemaria altemata with 33.3%, followed by Dermatophagoides farinae with 29.3%, Dermatophagoides pteronyssinus with 25.3% and a mix of four cereals (barley, maize, oat, wheat) with 25.2%. This information will help etiological research as well as the development of more efficient treatment plans for patients with allergic rhinitis in our country.

[Infraorbitally located tuberculous lypmhadenitis: a case report]. / Infraorbital yerlesimli tüberküloz lenfadenit: Olgu sunumu.

Tuberculosis, which is one of the oldest diseases of the human kind, is again becoming an important health issue in recent years. Although mostly seen in lungs, it can also be localized in the lymph nodes, skin, meninges, spleen, surrenal tissues, which is referred to as extrapulmonary forms of tuberculosis. Tuberculous lymphadenitis is the most common clinical form of extrapulmonary tuberculosis and it is generally localized in cervical lymph nodes. A 50-year-old female patient presented with a hard fixed mass originating from medial canthus ending at nasolabial sulcus. In the magnetic resonance imaging examination, a solid contrast enhancing mass 20 x 18 x 15 mm in size, which was isointensely monitored with muscular structures in T1 based visuals and hyperintense in T2 sequences, was seen. The mass was excised under general anesthesia and histopathological examination revealed tuberculous lymphadenitis. Thus, the case is discussed according to literature and shows us that tuberculosis may be the reason for lymphadenitis in the areas out of the cervical region and it should always be kept in mind in the differential diagnosis.

[The comparison of the expansion of polyps according to the Ki-67 and computed tomography scores]. / Polip yayginliginin Ki-67 ve bilgisayarli tomografi skorlarina göre karsilastirilmasi.

OBJECTIVES: The disease extention in nasal polyps was compared by using the mitotic activity rates and the computed tomography scores. PATIENTS AND METHODS: This study was conducted on 19 nasal polyposis patients (8 males, 11 females; mean age 40.0+/-13.7 years; range 20 to 63 years). The preoperative computed tomography records of the patients were evaluated according to the Lund-Mackay grading system. The polyp tissues of the same patients were stained with the Ki-67 antigen for immunohistochemical evaluation. The correlation between the radiologic results and the Ki-67 values was compared by means of the Spearman's correlation test. RESULTS: The mean computed tomography score was observed as 14.3+/-4.7 (range 7-24). The mean Ki-67 score resulting from the immunohistochemical staining was calculated as 24.3+/-18.5 (range 3.3-73.5%). A significant correlation was determined between the Ki-67 values and the computed tomography scores. ("Spearman's" correlation factor: 0.677; p<0.001). CONCLUSION: As the mitotic activity rate of nasal polyps increases, both the volume of the polyps and the computed tomography scores increase as a result of the blockage of the sinus ostiums by the increased polyp volume.

Prevalence of adenoid hypertrophy and nocturnal enuresis in primary school children in Istanbul, Turkey.

OBJECTIVE: The purpose of this study is to investigate the prevalence of an existing relationship between adenoid hypertrophy and nocturnal enuresis in primary school children. METHODS: The study was performed in four primary schools that were chosen randomly in Kartal, Istanbul. The children's parents were asked to fill out a questionnaire that included questions concerning the associated symptoms of adenoid hypertrophy and nocturnal enuresis. The interrelations between adenoid hypertrophy and nocturnal enuresis items were examined by X2 tests. RESULTS: The study population consisted of 1132 (625 girls, 621 boys) primary school children between 5 and 14 years of age (mean 9.59+/-2.60 years). The children were divided into three groups with 5-7 years old children in Group I (n=232), 8-10 years old children in Group II (n=506) and 11-14 years old children in Group III (n=394). Of the 1132 distributed questionnaires, 1090 (87.4%) were filled in adequately and were accepted for evaluation. Prevalence of adenoid hypertrophy in school children was found to be 58 in Group I (27%), 94 in Group II (19.5%) and 78 in Group III (19.9%). Prevalence of nocturnal enuresis in school children was found to be 35 in Group I (15.1%), 51 in Group II (10.1%) and 18 in Group III (4.6%). No statistically significant association was present between adenoid hypertrophy and nocturnal enuresis in either Group I, II or III school children. CONCLUSION: In contrast to previous studies, our prevalence study did not find an association between adenoid hypertrophy and nocturnal enuresis. Thus, this prevalence study provides otolaryngologists new and interesting information.

[The role of concha bullosa in nasal pathologies]. / Konka bullozanin nazal patolojilerdeki rolü

OBJECTIVES: We investigated the relationship between the size of concha bullosa (CB) detected by coronal paranasal sinus computed tomography (CT) and the frequency of sinonasal symptoms. PATIENTS AND METHODS: The study included 60 patients (39 females, 21 males; mean age 38.3 years; range 17 to 67 years) who had CB on CT scans and underwent endoscopic sinus surgery for symptoms of chronic sinusitis, nasal obstruction and/or headache. The patients were evaluated in three groups according to the ratio of the cross-section area of CB to that of the nasal cavity (NC); hence, group 1, 0-14%; group 2, 15-29%; and group 3, = or >30%. The relationship of CB/NC with clinical symptoms and nasal pathologies were examined. RESULTS: The presenting complaints were sinusitis in 28 (46.7%), nasal obstruction in 56 (93.3%), and headache in 36 (60%) patients. Concha bullosa was on the right side in 16 (26.7%), on the left side in 13 (21.7%), and bilateral in 31 patients (51.7%). Of 91 CB, 29 (31.9%) were in group 1, 43 (47.3%) were in group 2, and 19 (20.9%) were in group 3. The cross-section area of CB was greater than 1 cm2 in 25.6%, and less than 0.5 cm2 in 53.4%. The most common pathology accompanying CB was nasal septal deviation (n=36, 60%). The distribution of symptoms and accompanying pathologies was similar in the three groups. CONCLUSION: Our findings show that symptoms and accompanying pathologies do not differ in patients with varying sizes of CB.

[Evaluation of Ki-67 expression in recurrent cases of cholesteatoma]. / Tekrarlayan kolesteatomlu olgularda Ki-67 ekspresyonunun degerlendirilmesi.

OBJECTIVES: Recurrences are still a challenge despite appropriate techniques in cholesteatoma surgery. This study was designed to evaluate the level of Ki-67 expression in recurrent cases of cholesteatoma. PATIENTS AND METHODS: The study included 32 patients (18 males, 14 females; mean age 34 years; range 12 to 63 years) who underwent surgery for otitis media. Of these, 19 patients had cholesteatoma, and eight patients had recurrent cholesteatoma. Five patients who underwent tympanoplasty for chronic otitis media comprised the control group. All the patients with cholesteatoma underwent radical mastoidectomy. At surgery, tissue samples of cholesteatoma were taken and prepared for immunohistochemical staining. In controls, retroauricular skin samples were used. The two patient groups with cholesteatoma were compared with respect to Ki-67 expression. RESULTS: Increased cellular proliferation was detected in both groups of cholesteatoma. No significant difference was found between two cholesteatoma groups with respect to Ki-67 staining (p>0.05). Compared to the controls, patients with cholesteatoma and those with recurrent cholesteatoma had significantly higher levels of Ki-67 staining (p<0.05 and p<0.01, respectively). CONCLUSION: Our results suggest that, despite a higher degree of proliferation in recurrent cholesteatoma cases, treatment failures may be mainly associated with the surgical technique, accompanying infections, and the type of cholesteatoma.

Effectiveness of intratympanic dexamethasone in otitis media with effusion resistant to conventional therapy.

The aim of this study was to determine the efficiency of intratympanic dexamethasone (ITD) injections as a new treatment modality in otitis media with effusion resistant to conventional therapy. We planned a nonrandomized prospective study to determine the safety and effectiveness of the direct administration of dexamethasone into middle ear cavity with chronic eustachian tube dysfunction. This study was applied on 75 ears of 64 patients aged from 12 to 60 years. ITD received 47 ears of 41 patients who had previously been treated by medical or surgical therapy middle ear effusion without resolution classified as study group. They were taken conventional medical therapy again 28 ears of 23 patients classified as a control group. ITDs were administered 0.5 ml/4 mg per mm directly in antero-superior quadrant of tympanic membrane. These injections were repeated once a week for 4 weeks. Results were evaluated by using audiometric and tympanometric measurements 1 and 3 months after the treatments. Audiometric measurement shows that 9.91 dB improvement in the mean air-bone gap 15.17 dB in air conduction (AC) pure-tone averages (PTA) and 5.25 dB bone conduction (BC) PTA. But the control group data showed only 2 dB improvement in the mean air-bone gap, 3 dB AC-PTA and 1.36 dB BC-PTA. Tympanometric improvement was found. In 28 ears of patients (59.6%) like type B or C converted to type A in study group without complication but only in three ears (10.7%) of control group. ITD administration to the middle ear is safe and effective for the treatment of otitis media with effusion or chronic eustachian tube dysfunction. No complications like tympanic membrane perforation and/or sensorineural hearing loss have occurred.

Transoral ultrasonography in the diagnosis and treatment of peritonsillar abscess.

PURPOSE: To evaluate the contribution of transoral ultrasonography (TUS) in the diagnosis and treatment of peritonsillar abscess. METHODS: We assessed the records of the patients who underwent TUS for suspected peritonsillar abscess. RESULTS: We identified a total of 26 patients with a prediagnosis of peritonsillar abscess. Following TUS examination, while the diagnosis was confirmed for 23 of the 26 patients (88.46%), the remaining 3 (11.53%) were diagnosed as having peritonsillar cellulitis. CONCLUSION: TUS allows the differentiation of peritonsillar abscess from cellulitis, hence to avoid an unnecessary invasive procedure in the case of a peritonsillar cellulitis.

Expression of cathepsin D and E-cadherin in primary laryngeal cancers correlation with neck lymph node involvement.

OBJECTIVE: The aim of this study was to investigate the relation between Cathepsin D (Cath-D) and E-Cadherin (E-Cad) expression levels in tumor tissue and neck lymph node metastasis. This attempt should be made to identify new factors that one could be useful in predicting clinical behavior. STUDY DESIGN: In this study, we investigated rates of dying for E-Cad and Cath-D in paraphin blocks of larynx and neck dissection specimens taken from 56 selected patients. Laryngeal specimens dyed by ECad and Cath-D immunohistochemically. Immunoreactivity classified for E-Cad as positive (75% and above), reduced (25-75%) and negative (below 25%). Immunoreactivity classified for Cath-D:dye absorption rates higher than 50% evaluated positive and absorption rates lower than 50% evaluated negative. We compared the rates of dying for E-Cad and Cath-D groups to with or without neck lymph node metastasis in specimens. RESULTS: Neck metastasis were found in 41% of patients, in 55.6% of patients, if the E-Cad was negative, 40.6% if it was reduced, 33.3% if it was positive in specimens. The neck metastasis was found in 35.4% of patients with Cath-D expression negative, while 75% of patients was found with Cath-D expression positive. CONCLUSION: Neck metastasis was found higher in E-Cad reduced group than positive group. Neck node metastasis was significantly higher in Cath-D positive group than Cath-D negative group. Cath-D and E-Cad essays may useful in identifying neck lymph node involvement. Cath-D expression levels are more in this predictive factor than E-Cad levels for possibility of neck lymph node metastasis in LSCC.

The effects of allergic rhinitis on growth, development and body mass indexes in school children.

OBJECTIVE: The purpose of this study is to determine the frequency of allergic rhinitis (AR) in children and investigate if allergenic rhinitis demonstrated any effects on developmental growth levels and body mass indexes (BMI) in children. MATERIALS AND METHODS: 651 students, between 3-15 years of age who were randomly selected from four elementary schools located at Kartal, Istanbul were assessed according to symptoms and the presence of AR by nasal examination with the aid of a 0 degree 2.7 mm hand rigid endoscope. Height and weight percentile values of students regarding growth according to age and their BMI were calculated and statically assessed. Results obtained are presented. RESULTS: Findings obtained from a questionnaire and clinical examination does not allow us to perform a definite differentiation regarding in school children at age 3-5. The prevalence of AR in girls is higher. However, there are no any significant differences regarding BMIs in children with or without AR (p < 0,142). But there are statistically significant differences regarding height and weight percentiles in children with and without AR. Accordingly, there was a tendency in children diagnosed with AR to display low values related with height and weight percentiles. In Pearson chi-square testing, p values of percentile values related with weight (p < 0,032) and p values of percentiles related with height (p < 0,001) were determined. CONCLUSION: AR prevalence was higher in girls independently from BMI values. We determined a strong relationship between BMI values and AR dependant to age and gender.

Rosai-Dorfman disease: sinus histiocytosis with massive lymphadenopathy.

A 25-year-old man presented with a 3 month history of a painless mass on the right side of his neck. Physical examination revealed a smooth surfaced, bilobed, 4×3 cm, semimobile mass at the right and 3×2 cm at the left jugulodigastric region. Endoscopic examination of the patient showed a granular tumour in both nasal cavities. After biopsies were taken from the mass from the nasal cavity, a diagnosis of Rosai-Dorfman disease was made. A conservative approach was taken to treatment and after the 6 month follow-up period, the patient was in a stable condition.