The effectiveness of repairment of traumatic tympanic membrane perforations with cigarette paper.

BACKGROUND: The aim of this study was to evaluate the effects of repairment of traumatic tympanic membrane perforation (TTMP) with cigarette paper patch (CPP) on perforation closure and hearing functions. METHODS: A retrospective evaluation was made of 67 ears of 61 patients diagnosed with TTMP and treated with CPP in our clinic between January 2015 and 2019. In the classification of TTMP size, the entire tympanic membrane was evaluated as 100%, perforation of <25% was considered small, perforation of between 25% and 50% was considered medium and perforation of ≥50% was considered large. Audiological examination was performed before and at 3 months after the CPP procedure. Air conduction (AC) and bone conduction (BC) pure tone averages (PTAs) and air-bone gap (ABG) at 0.5, 1, 2, and 4 khz frequencies were compared. RESULTS: Perforations were small in 20 (29.9%) of 67 ears, medium in 27 (40.2%), and large in 20 ears (29.9%). AC PTA before CPP was found to be 28.26±5.63 dB hearing level (HL), BC PTA was 8.80±4.35 dB HL and ABG was 19.26±5.80 dB HL. After CPP, the AC PTA was found to be 11.90±6.59 dB HL, BC PTA was 8.29±4.05 dB HL, and ABG was 14.10±4.66 dB HL. TTMP was determined to have improved in 61 ears (91%) in the 1st month after CPP application. There was no statistically significant difference between perforation size and improvement rates (p>0.05). AC PTA values after CPP application were determined to be significantly lower than AC PTA values before CPP application at 0.5, 1, 2, and 4 khz (p<0.001). The ABG values measured at 0.5 khz after CPP were significantly higher than the values measured at 2 khz. and 4 khz. (p<0.001, p<0.001, respectively). The amount of decrease in PTA value after CPP was found to be significantly greater at 0.5 khz than at 2 khz and 4 khz (p<0.001, p<0.001, respectively). CONCLUSION: In the treatment of TTMP, early application of CPP is an effective treatment method in terms of both perforation closure and hearing gain.

Congenital myasthenic syndromes in Turkey: Clinical clues and prognosis with long term follow-up.

Congenital myasthenic syndromes (CMS) are a group of hereditary disorders affecting the neuromuscular junction. Here, we present clinical, electrophysiological and genetic findings of 69 patients from 51 unrelated kinships from Turkey. Genetic tests of 60 patients were performed at Mayo Clinic. Median follow-up time was 9.8 years (range 1-22 years). The most common CMS was primary acetylcholine receptor (AChR) deficiency (31/51) and the most common mutations in AChR were c.1219 + 2T > G (12/51) and c.1327delG (6/51) in CHRNE. Four of our 5 kinships with AChE deficiency carried p.W148X that truncates the collagen domain of COLQ, and was previously reported only in patients from Turkey. These were followed by GFPT1 deficiency (4/51), DOK7 deficiency (3/51), slow channel CMS (3/51), fast channel CMS (3/51), choline acetyltransferase deficiency (1/51) and a CMS associated with desmin deficiency (1/51). Distribution of muscle weakness was sometimes useful in giving a clue to the CMS subtype. Presence of repetitive compound muscle action potentials pointed to AChE deficiency or slow channel CMS. Our experience confirms that one needs to be cautious using pyridostigmine, since it can worsen some types of CMS. Ephedrine/salbutamol were very effective in AChE and DOK7 deficiencies and were useful as adjuncts in other types of CMS. Long follow-up gave us a chance to assess progression of the disease, and to witness 12 mainly uneventful pregnancies in 8 patients. In this study, we describe some new phenotypes and detail the clinical features of the well-known CMS.

Infected giant lymphangioma circumscriptum treated with a combination therapy.

Lymphangioma circumscriptum is an uncommon benign disorder of skin and subcutaneous tissues characterized by dilated lymphatic channels. It is an uncommon vascular tumor and it rarely becomes infected. We report a 20-year-old man who had an infected giant tumor in his left thigh. After an extensive resection and radiofrequency energy therapy, he recovered well with an acceptable cosmetic result. We followed up the patient for 2 years without any recurrence.

An alternative agent for radial arterial graft spasm: application of topical iloprost.

OBJECTIVE: This study is planned bringing about a new choice for the prophylaxis of RA spasm which is topical iloprost and compares its efficacy with papaverine and diltiazem. DESIGN: Twenty eight CABG patients with RA grafts were categorized into four groups by taking into account the topical vasodilator (papaverine, diltiazem, iloprost and saline) that was utilized during harvesting. Arterial segments were separated into four rings and were than soaked with KCL, norepinephrine, phenylephrine and serotonin. Then, acetylcholine was given to induce relaxation and the preparations were put to rest for 10 minute. RESULTS: The contraction response achieved by the vasoreactive agents was most effectively inhibited by papaverine. The effectiveness of the response obtained by iloprost was similar to that of papaverine and significantly stronger than that of diltiazem. Especially at high vasoreactive substance concentrations, diltiazem had a contraction close to that of the control while the protective effect was weaker than those of papaverine and iloprost. CONCLUSION: Iloprost can be recommended as a strong alternative to the topical agents used for preventing arterial graft spasm.

Decrement pattern in Lambert-Eaton myasthenic syndrome is different from myasthenia gravis.

The decrement pattern at low rates of repetitive nerve stimulation in myasthenia gravis (MG) is characterized by a decrease of compound muscle action potential size within the first 4-5 responses. With subsequent stimuli, compound muscle action potential size either increases or does not change. Following an observation that the pattern of decrement might be different in patients with Lambert-Eaton myasthenic syndrome (LEMS), we retrospectively studied traces from eight LEMS patients and 14 patients with seropositive generalized MG, calculating decrement percent from first to fourth and from first to ninth compound muscle action potential. In the LEMS patients, compound muscle action potential amplitude decreased progressively from first to ninth stimulus at 2, 3 or 5Hz in all traces but one. In contrast, MG patients demonstrated the expected improvement after the initial decrement in all traces except one. In the evaluation of patients suspected of having myasthenia gravis, the finding of progressive decrement pattern at low rates of repetitive nerve stimulation may alert the electromyographer to the possibility of Lambert-Eaton syndrome and prompt the performance of further electrodiagnostic tests.

Does radial artery harvesting for coronary revascularization cause neurological injury in the forearm and hand?

OBJECTIVE: Radial artery (RA) is now used widely as a conduit of choice in coronary artery bypass grafting. Although RA removal is considered safe in the presence of adequate collateral arterial supply, there is still a considerable suspicion on the functional status of the forearm and hand. However, a neurological dysfunction may occur owing to either surgical trauma or ischemic neuropathy. This study was aimed to investigate the functional outcome of the donor forearm nerves of the patients who underwent coronary artery bypass grafting surgery with RA conduits. METHODS: A consecutive series of 50 patients who underwent coronary artery bypass graft surgery with one or two RA grafts were investigated in the study. Motor and sensory functions of donor forearm nerves were measured by ENMG studies, pre- and postoperatively at the third week and sixth month of the operation. The conduction velocities, distal latencies and amplitudes of action potentials for motor and sensorial conductions of radial, ulnar and median nerves were measured in each ENMG examination. Neurologic status of the donor forearm and hand was assessed by the same neurologist who performed a detailed neurologic physical examination and ENMG studies. Results were statistically compared using one-way ANOVA test. RESULTS: The incidence of any neurologic symptoms was 32% in early postoperative period. All reported neurologic complaints were associated with sensory conduction deceleration in ENMG investigations of related nerves. In postoperative assessment, median nerve sensory-motor, and ulnar nerve motor conduction records were slightly lower than the preoperative values, but no statistical difference was observed. Pre- and postoperative radial nerve motor and sensory conduction records were statistically similar (P>0.05). CONCLUSIONS: We advocate that removal of RA does not lead to any major neurologic hand complications in the presence of adequate collateral arterial blood supply. ENMG studies confirmed minimal conduction alterations with no statistical significance, even if neurologic symptoms were stated.

[The effect of glutamate and aspartate on myocardial protection at cardiopulmonary bypass]. / Kardiyopulmoner Baypasta Glutamat ve Aspartatin Miyokardiyal Koruma Uzerine Etkisi.

OBJECTIVE: To determine whether glutamat and aspartat enriched cold crystalloid cardioplegia which was given in antegrade way has any effect on the myocardial protection during cardiopulmonary bypass. METHODS: Thirty-four patients who were electively undergone open heart surgery at Osmangazi University Faculty of Medicine, thoracic and cardiovascular surgery department, between March 2001 and May 2001 were included in this study. The patients were divided in two groups, each consisting of 17 patients. In group 1 coronary artery bypass surgery (CABG) was performed in 11 patients, mitral valve replacement (MVR) in 3 patients, aortic valve replacement (AVR) in 1 patient and AVR and MVR in 2 patients. While in group 2 CABG was performed in 13 patients and MVR was done in 4 patients. Group 1 patients received antegrade glutamat and aspartat (15 mmol/L) enriched cold crystalloid cardioplegia and group 2 patients were given cold crystalloid cardioplegia by antegrade route. Age, gender, diabetes mellitus, hypertension, preoperative myocardial infarction, smoking, ejection fraction, aortic cross-clamp time, need to defibrillation, inotropic support, and intraaortic balloon pump were recorded. The levels of cardiac troponin I (cTI) and creatine kinase myocardial band fraction (CK-MB) were measured in arterial blood samples at five different times. Statistical analysis was performed using Student's t-test and Chi-square test. RESULTS: There were no statistically significant differences in cTI and CK-MB values in blood samples taken at 5 different times pre and postoperatively between group 1 and group 2. CONCLUSION: It is concluded that glutamat and aspartat enriched cold crystalloid cardioplegia does not have any effect on myocardial protection.

Distribution of extremity muscle weakness in myasthenia gravis: sparing of tibialis anterior muscle.

We evaluated the distribution of muscle weakness in 70 myasthenia gravis (MG) patients, using the MRC scale. Extensors in the upper extremities and proximal flexors in the lower extremities (LE) were found to be weak. Tibialis anterior muscle was rarely affected and only when there was substantial weakness in LE proximal muscles. Attention to this distribution may help in differentiating MG, particularly MG with only limb weakness, from muscular dystrophies.