An anatomical variant: evaluation of accessory canals of the canalis sinuosus using cone beam computed tomography.

BACKGROUND: The anatomical variation of the anterior superior alveolar nerve described as canalis sinuosus (CS) is a less known structure of anterior maxilla. Due to the fact that it contains anterior superior alveolar nerve as well as veins and arteries, exact localisation of this structure will allow surgeons to avoid complications. Hence, the aim of this study was to verify the presence, reveal the frequency and characteristics of accessory canals of CS. MATERIALS AND METHODS: This study was based on retrospective evaluation of cone beam computed tomography (CBCT) scans. A total of 1460 CBCT images were analysed and collected data were noted. The following parameters were recorded: age, sex, presence or absence of CS, location in relation to the adjacent teeth and impaction of canine teeth. RESULTS: A total of 6668 accessory canals were found in 1460 CBCT images. Of these, 672 (46.0%) were from female patients, and 788 (54.0%) were from male patients. 1034 (70.8%) of 1460 images had at least one accessory canal of CS. Maxillary intercentral region is the area where accessory canals were seen most frequently (n = 653, 44.72%). CONCLUSIONS: Canalis sinuosus is a bony canal which is incidentally found and less known structure of anterior portion of maxilla. Knowing the accessory canals deriving from this structure will allow surgeons to avoid complications and non-integration after dental implant procedures. Conventional imaging modalities have limited value in detecting this neurovascular structures. Therefore CBCT may have an important role for accurate diagnosis to reveal anatomical variations.

ROSACEA IS ASSOCIATED WITH THYROID AUTOIMMUNITY: A CASE CONTROL STUDY.

BACKGROUND AND AIMS: There are numerous intrinsic and extrinsic factors associated with the pathophysiology of rosacea, including immune dysregulation. The aim of this study is to determine the relationship between rosacea and thyroid autoimmunity. METHODS: Seventy-two patients with rosacea and 62 rosacea-free control subjects were included in the study. Serum free triiodothyronine (fT3), free thyroxine (fT4), thyrotropin releasing hormone (TSH), antithyroidperoxidase antibody (ATPO), antithyroglobulin (anti-Tg), prolactin, dehydroepiandrosterone sulfate (DHEAS), basal cortisol, serum CRP concentrations and erythrocyte sedimentation rate were measured. RESULTS: The number of the cases with high levels of CRP, anti-M and prolactin in rosacea group were significantly higher than the controls (p<0.05), there was no significant difference according to other parameters in both groups (p>0.05). There was no significant difference according to the presence of a thyroid disease in both groups (p>0.05). The decrease in the CRP parameter in patients with the disease duration of 1-5 years was found to be statistically significant (ßCRP=-0.251, pCRP<0.05). There was no statistically significant difference according to disease severity or disease duration (p>0.05). CONCLUSIONS: Rosacea may be associated with high thyroid autoantibodies, prolactin and CRP levels, in which immune-endocrine interactions are important.

The dynamics of prehospital/hospital care and modes of transport during civil conflict and terrorist incidents.

OBJECTIVE: Prehospital and hospital care during incidents of mass violence and civil conflict involve a number of aspects that distinguish it from care during times of peace. We aimed to analyze the dynamics and outcomes of prehospital and hospital care during ongoing conflicts. STUDY DESIGN: Multicentric prospective observational study. METHOD: Patients enrolled in the study, which was conducted in Turkey, were all injured in armed conflict and taken to level 1 trauma centers. On admittance, patients were requested to complete a semistructured questionnaire containing questions on patient demographics, transport type, weapons used, injury severity score (ISS), and other incident-related factors. We analyzed patient outcomes (mortality, morbidity, complications, and length of hospital stay) and transfers of patients between hospitals. The present study evaluated the cases of 390 victims enrolled over a 9-month period and followed up for 6 months. RESULTS: The majority of patients were transported by ambulances (n = 334, 85.6%); other transport modes were helicopters (n = 32, 8.2%) and private vehicles (n = 24, 6.2%). Nearly half of patients (48.7%) did not benefit by changing hospitals. During transport to hospitals, 4.1% of the vehicles in the study were involved in accidents. Using multiple regression analysis, only ISS (odds ratio [OR]: 1.098, 95% confidence interval [CI]: 1.044-1.156) and the Glasgow Coma Scale (OR: 0.744, 95% CI: 0.639-0.866) were found to affect mortality. In Receiver-operator characteristic analysis, a cutoff value of 22.5 for ISS had a sensitivity of 100% and a specificity of 89.6% for mortality. CONCLUSIONS: Despite lower ISS values, patient outcomes were worse in terror incidents/civil conflicts. Transport modes did not significantly affect outcomes, whereas hospital transport was found to be inefficiently used.

Prognostic value of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with epithelial ovarian cancer.

PURPOSE: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have recently been evaluated in many cancers in prediction of survival outcomes. The purpose of this study was to investigate the impact of NLR and PLR on the prognosis of patients with epithelial ovarian cancer (EOC). MATERIALS AND METHODS: A total of 208 patients with EOC were included in the study. Hematological parameters and clinicopathological data during diagnosis were retrospectively evaluated. The cut-off values were determined by calculating receiver operating characteristic (ROC) curve analysis of the patients. RESULTS: The median over-all survival (OS) of patients with low NLR was 69 months (95% CI, 43.0-94.9) whereas high NLR was 36 months (95% CI, 29.1-42.8). The median OS with low PLR patients was 76 months (95% CI, 46.4-105.5) and high PLR was 35 months (95% CI, 28.5-41.4). In serous tumors (70.7%), the median OS with low NLR and high NLR was 54 months (95% CI, 27.9-80.0) and 34 months (95% CI, 28.2-39.7), and for the median OS with low PLR and high PLR it was 51 months (95% CI, 2 1.2-80.7) and 35 months (95% CI, 27.8-42.1), respectively. CONCLUSION: The present findings showed that the high NLR and high PLR were associated with poor prognosis and these values are significantly remarkable in EOC patients.

The relationship of insulin resistance and metabolic syndrome with known breast cancer prognostic factors in postmenopausal breast cancer patients.

PURPOSE: The aim of this study was to investigate the effect of metabolic syndrome and insulin resistance at the time of diagnosis on the known prognostic factors of breast cancer in postmenopausal breast cancer patients. METHODS: The study included 71 patients with a recent diagnosis of postmenopausal breast cancer, admitted at the Medical Oncology outpatient clinic of the Izmir Ataturk Training and Research Hospital between June 2010 and June 2011. We determined whether the patients had metabolic syndrome and insulin resistance at diagnosis, and recorded known prognostic factors, such as tumor size, axillary lymph node involvement, presence of distant metastasis, tumor grade, estrogen receptor (ER), progesterone receptor (PR), and CerbB-2 status. RESULTS: Among 71 patients, 25 (35%) had metabolic syndrome at the time of diagnosis, and 33 (46%) had insulin resistance with Homeostasis Model of Assessment-Insulin Resistance (HOMA-IR)>2.7. No statistically significant difference was found in the prognostic values of breast cancer, i.e. tumor size, axillary lymph node involvement, distant metastasis, tumor grade, ER, PR, and CerbB-2 status between the patients with and without metabolic syndrome. There was no statistically significant difference in the prognostic factors of breast cancer at the time of diagnosis between 33 patients with insulin resistance and 38 patients without insulin resistance. CONCLUSION: Several previous studies showed a negative relationship between metabolic syndrome and insulin resistance and prognostic factors of breast cancer in postmenopausal breast cancer patients. However, our study failed to show such a relationship. The relationship between metabolic syndrome and insulin resistance and postmenopausal breast cancer was not well demonstrated due to the small number of patients, unknown duration of the metabolic syndrome and insulin resistance, and shorter follow-up period. Further studies are required to demonstrate the effect of metabolic syndrome and insulin resistance on the prognosis of breast cancer, including larger number of patients and longer follow-up periods.

The association of hematologic parameters on the prognosis of patients with metastatic renal cell carcinoma.

PURPOSE: Metastatic renal cell carcinoma (mRCC) bears a poor prognosis. We investigated the prognostic significance of some hematologic parameters of patients with mRCC. METHODS: We retrospectively reviewed the records of 53 patients with mRCC . The mean follow up time was 34 months (range 5-142).We assessed the prognostic value of hematologic parameters (leukocytes ,neutrophils, lymphocytes, platelets, neutrophil to lymphocyte ratio/NLR, platelet to lymphocyte ratio/PLR), and other clinical parameters with univariate and multivariate analysis. RESULTS: Memorial Sloan-Kettering Cancer Center (MSKCC) risk group , lung metastases, sunitinib treatment, lymphocyte count, NLR, and anemia significantly correlated with median overall survival (OS) on univariate analysis. The median OS in patients with a NLR < 3.4 was 32.2 months , significantly higher than the 13.9 months in patients with a ratio ≥ 3.4 (p = 0.006). Multivariate analysis revealed that MSKCC risk group and the NLR were independent predictors of OS. CONCLUSION: Hematologic parameters may be associated with OS in mRCC. However, further studies are needed to establish their routine use.

A randomized trial of the effects of platelet- rich plasma on postoperative complications after meningomyelocele sac repair.

OBJECTIVE: Meningomyelocele is a common congenital neural tube defect. To reduce complications, we need early surgery and a multidisciplinary approach. In this study, we administered platelet-rich plasma (PRP) to babies with meningomyelocele following corrective surgery to minimize cerebrospinal fluid (CSF) leakage and accelerate the healing of the immature pouch tissue. We compared these with a control group that did not receive PRP. PATIENTS AND METHODS: Of the 40 babies who had surgery with the diagnosis of meningomyelocele, 20 patients received PRP after surgical repair, and 20 were followed up without PRP. In the PRP group, 10 of the 20 patients underwent primary defect repair, the other 10 underwent flap repair. In the group that did not receive PRP, primary closure was performed in 14 patients and flap closure in six. RESULTS: In the PRP group, CSF leakage occurred in one (5%) patient, and none developed meningitis. Partial skin necrosis occurred in three (15%) patients and wound dehiscence in three (15%) patients. In the group that did not receive PRP, CSF leakage occurred in nine (45%) patients, meningitis in seven (35%), partial skin necrosis in 13 (65%), and wound dehiscence in seven (35%) patients. The rate of CSF leakage and skin necrosis in the PRP group was significantly (p<0.05) lower than that in the PRP group. Furthermore, wound closure and healing were also improved in the PRP group. CONCLUSIONS: We have shown that PRP treatment of postoperative meningomyelocele infants facilitates healing and lowers the risk of CSF leakage, meningitis, and skin necrosis.

Treatment and outcomes of patients with metastatic spinal cord compression: a double-center study.

OBJECTIVE: Spinal metastases may only affect the bone tissue and result in spinal instability or may additionally result in epidural compression, leading to neurological deficits. Surgery has emerged as a popular method in treating metastatic epidural spinal cord compression (MESCC) due to the advances in surgical techniques and instrumentation. In this study, we evaluated patients with MESCC regarding neurological status, pain status, and survival rates, and presented our experience managing MESCC. PATIENTS AND METHODS: Clinical and radiographic records of 53 patients diagnosed with MESCC between January 2011 and March 2017 were retrospectively evaluated. The study included patients with a pathological diagnosis of primary cancer, those who complained of spinal metastasis, and those who had indications of MESCC on Magnetic Resonance Imaging (MRI). Bone structure and spinal stability were evaluated using assessed Computed Tomography (CT), and metastatic spread was considered using assessed Positron Emission Tomography (PET) in suitable cases. For each patient, the presence of a tumor compressing the spinal cord, age, gender, preoperative, and postoperative American Spinal Injury Association scores (ASIA), Tokuhashi prognostic score (TPS), affected spinal segment, pathological diagnosis, preoperative, and postoperative Visual Analog Scale (VAS), the status of spinal stability, follow-up period, and complications were evaluated. RESULTS: Forty-five patients (82.2% of them were women) underwent surgery with a mean age of 58.29 ± 15.14 years. The most frequent type of primary tumor was multiple myeloma (33.9%), followed by lung (24.6%), gastric (7.5%), and prostate (5.7%). The most common site of metastasis was the thoracic region (43.4%), followed by lumbar (24.5%), multiple (24.5%), and cervical (5.7%). The analysis indicated that a significant difference was found between the survival rates of the TPS categories. CONCLUSIONS: Common symptoms of MESCC include spinal pain and neurological deficit below the level of the injury. Prompt surgical treatment followed by oncological treatment leads to significant neurological recovery, more prolonged survival, pain relief, and improved quality of life in patients with a short survival time. Oncological treatments, including radiotherapy (RT), should be recommended after surgical treatment.

Effect of complete denture wearing on deglutition time: a cine-magnetic resonance imaging study.

Purpose of the study was to evaluate the effect of complete denture wearing on deglutition time (DT), hyoid bone and larynx movements in edentulous patients with real-time balanced turbo field echo cine-magnetic resonance imaging. Subjects were examined by cine-magnetic resonance imaging in supine position during swallowing water. Two sets of images for 23 edentulous (with/without wearing complete dentures) and one for 23 dentulous patients were obtained. Radiographic outputs representing three consecutive deglutition stages (oral, pharyngeal and oesophageal) were provided to perform measurements. Deglutition time significantly increased when edentulous patients wore their dentures (mean 0·75 s increased to 1·17 s), whereas dentulous patients' DT was about 0·91 s (P ≤ 0.05). The duration of deglutition is crucial because prolonged pharyngeal transit times increases the risk of aspiration. Within the limitations of the study, complete denture wearing could increase the shortened DT of the edentulous patients.

Who is responsible for inadequate lymph node retrieval after colorectal surgery: surgeon or pathologist?

BACKGROUND: Many factors have been described influencing survival of patients with colorectal cancer. The most important prognostic factor is lymph node involvement. The National Comprehensive Cancer Network indicates that at least 12 lymph nodes (LN12) must be retrieved for proper staging and treatment planning. The surgeon and the pathologist influence the number of retrieved lymph nodes. METHODS: We retrospectively reviewed all patients with diagnosis and subsequent surgery for colorectal cancer from January 2004 to January 2010 at Gulhane Military Medical Academy in Ankara, Turkey. We investigated the relationship between LN 12 and the independent variables of tumour size, lymph node involvement, metastasis, age, gender, surgeon, pathologist, surgical specimen length, tumour stage, and localization. Statistical analysis utilized the Shapiro-Wilk test, interquartile range, Mann-Whitney test, chi-square and chi-square likelihood ratio tests, and Kruskal-Wallis nonparametric variance analysis. In order to identify influencing factors for retrieval of lymph nodes, multiple linear regression was performed. In order to identify the direction and extent of effects of these influencing factors, logistic regression was performed. OR (Odds Ratio) and 95% CI (Confidence Interval) of the OR were calculated. RESULTS: There were 223 study patients, 134 with colon cancer and 89 with rectal cancer. There was no statistical significance in terms of age, gender, cancer type and postoperative tumour size, number of metastatic lymph nodes > 4, or LN12 (p > 0.05). Statistical significance was found between surgeons and LN12, the number of operations and LN12 (p < 0.001), and pathologists and LN12 (p = 0.049). CONCLUSIONS: Harvesting an adequate number of lymph nodes is crucial for patients with colorectal cancer in terms of staging and planning further treatment modalities such as adjuvant chemotherapy. Multidisciplinary collaboration between surgeons and pathologists is vital for optimal patient outcomes.

Hydrocephalus in encephalocele.

OBJECTIVE: Encephalocele is a rare congenital neural tube defect (NTD) characterized by herniation of intracranial contents through a defect in the skull. In our study, encephalocele was diagnosed in our clinic and its association with hydrocephalus was evaluated. The effect of this association on the prognosis was discussed. PATIENTS AND METHODS: Patients who underwent surgery and follow-up with the diagnosis of encephalocele in the neurosurgery clinic of our hospital in an 8-year period from 2013 to 2021 were retrospectively examined. RESULTS: Patient records were obtained from the case notes of patients who underwent excision and repair for encephalocele. Of the 78 patients included in the study, 88.4% underwent surgery in the neonatal period. Moreover, 47% of the patients are male, and 31% are female. Encephalocele was present in 62.8% of patients and meningocele in 37.2%. Furthermore, 82.1% of encephalocele sacs were located in the occipital region. Chiari type 3 malformation was present in 57.6% of patients. Hydrocephalus developed in 56.4% of patients. There was an additional syndrome in 10.3% of the cases. The most common additional syndromes were corpus callosum dysgenesis with 39.7% and colpocephaly with 29.5%. The additional disease was present in 43.6% of patients. Preoperative and postoperative examination findings of more than half of patients were normal, but 33.3% were apathetic. Furthermore, 67.9% of patients, who underwent complete repair, survived, and 32.1% died. Hydrocephalus was present in 73.5% of patients with encephalocele (p<0.05). Hydrocephalus developed in 77.8% of patients with Chiari type 3 malformation (p<0.05). Hydrocephalus was found in 88.0% of patients with Ex (p<0.05). CONCLUSIONS: Encephalocele, which is a subgroup of NTD, differs clinically by its location and accompanying additional anomalies. In encephaloceles, the risk of morbidity and mortality can only be reduced with the multidisciplinary approach. Hydrocephalus and Chiari type 3 malformation are common in patients with encephalocele. These associations adversely affect the prognosis of the disease. Further research should be conducted on the evaluation of risk factors of NTD and methods of prevention from NTD. In this regard, we recommend that the training be repeated at certain intervals and that people's awareness should be raised.

Cold machine perfusion versus static cold storage of kidneys donated after cardiac death: a UK multicenter randomized controlled trial.

One third of deceased donor kidneys for transplantation in the UK are donated following cardiac death (DCD). Such kidneys have a high rate of delayed graft function (DGF) following transplantation. We conducted a multicenter, randomized controlled trial to determine whether kidney preservation using cold, pulsatile machine perfusion (MP) was superior to simple cold storage (CS) for DCD kidneys. One kidney from each DCD donor was randomly allocated to CS, the other to MP. A sequential trial design was used with the primary endpoint being DGF, defined as the necessity for dialysis within the first 7 days following transplant. The trial was stopped when data were available for 45 pairs of kidneys. There was no difference in the incidence of DGF between kidneys assigned to MP or CS (58% vs. 56%, respectively), in the context of an asystolic period of 15 min and median cold ischemic times of 13.9 h for MP and 14.3 h for CS kidneys. Renal function at 3 and 12 months was similar between groups, as was graft and patient survival. For kidneys from controlled DCD donors (with mean cold ischemic times around 14 h), MP offers no advantage over CS, which is cheaper and more straightforward.

Subjective sleep quality of cancer patients.

PURPOSE: to determine the quality of sleep, to locate the reasons for sleep disturbances and to define strategies overcoming sleep disturbances of cancer patients. METHODS: 175 cancer patients were included in this study. Data were collected using the Pittsburgh Sleep Quality Index (PSQI); a demographic data form and two open-ended questions on the reasons and coping strategies for sleep disturbances were filled in. RESULTS: the mean sleep quality score was 9.46 ± 4.669. The reasons given by patients for sleep disturbances were mostly cancer diagnosis (61.71%), adverse effects of therapy (58.85%), and financial problems (36.00%). Most patients (83.82%) used no pharmacologic strategies like lifestyle practices (64.25%), behavioral practices (21.25%), and biologic treatments (4.34%). Total PSQI scores of female patients were significantly higher compared to male patients, indicating poor sleep quality (Z=3.189; p=0.001). There was no statistically significant difference between age, education, illness duration, types of cancer and total PSQI scores (p>0.05). CONCLUSION: This research implied that cancer patients had poor sleep quality. Healthcare professionals should assess the sleep quality of cancer patients and solve this problem in a holistic perspective in order to provide a supportive environment during the caregiving process.

Two-site phacotrabeculectomy versus bimanual microincision cataract surgery combined with trabeculectomy.

PURPOSE: To compare the results of two-site phacotrabeculectomy with microincision cataract surgery (MICS) and trabeculectomy. METHODS: Fifty-eight eyes with coexisting cataract and glaucoma were randomly assigned to have a trabeculectomy in a superior quadrant combined with phacoemulsification and intraocular lens (IOL) implantation through temporal clear corneal incision (two-site phacotrabeculectomy group), or a trabeculectomy in a superior quadrant combined with MICS followed by IOL implantation from the trabeculectomy incision (MICS + trabeculectomy group). The main outcome measures were preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity (BCVA), and complications. Follow-up was period was 12 months. RESULTS: Twenty-eight two-site phacotrabeculectomies and 30 MICS + trabeculectomies were performed. Mean age of the subjects was 67.4 years. Mean preoperative IOP was 24.6+/-5.7 mmHg in the two-site phacotrabeculectomy group and 23.7+/-5.5 mmHg in the MICS + trabeculectomy group (p=0.52). At 12 months postoperatively mean IOP was 14.5+/-3.0 and 14.3+/-3.4 mmHg in two-site phacotrabeculectomy and MICS + trabeculectomy groups, respectively (p=0.8). Preoperative and postoperative glaucoma medication numbers were similar and mean number of glaucoma medications decreased in both groups after the surgery (p<0.05). BCVA improved in both groups. Twenty-six of 28 eyes (92%) in the two-site + trabeculectomy group and 27 of 30 (90%) in the MICS + trabeculectomy group had clinically apparent filtering blebs at 12 months (p=0.71). Postoperative complications were comparable. CONCLUSIONS: MICS + trabeculectomy provided 1 year IOP control comparable to that with two-site phacotrabeculectomy with similar amount of complications and similar final BCVA.

Dentin hypersensitivity: a randomized clinical comparison of three different agents in a short-term treatment period.

OBJECTIVE: Dentin hypersensitivity, or what patients may describe as "sensitive teeth," is defined as a short, sharp pain arising from exposed dentin in response to thermal, evaporative, tactile, electrical, osmotic or chemical stimuli. It is widely accepted that dentin hypersensitivity is an uncomfortable condition that also affects function and quality of life. This study determines the differences in efficiency of three desensitizing products when compared with a placebo. METHODS: A randomized controlled clinical trial was conducted to compare three different professional dentin desensitizer agents in 52 patients. The age and sex of the patients was recorded. Gluma Desensitizer (Heraeus Kulzer), UltraEZ (Ultradent Products, Inc) and Duraphat (Colgate Oral Pharmaceuticals, Inc, New York, NY, USA) were used as desensitizer agents and distilled water was used as the placebo. The baseline measurement of the dentin hypersensitivity was made by using a visual analog scale (VAS). Twenty-four hours and seven days after application of the desensitizer agents and placebo, a new VAS analysis was conducted for patients' sensitivity level. The desensitizer agents were compared in terms of mean values, and ANOVA was used for testing differences among the groups (p<0.05). RESULTS: The results showed that the mean pain scores of the placebo group were significantly higher than that of the study groups (p<0.05). The VAS analysis revealed a significant decrease in dentin hypersensitivity over time with the use of agents (p<0.05). No statistically significant difference was found among the three desensitizing agents (p>0.05). CONCLUSIONS: These three desensitizing agents, which contain different active ingredients, were effective in relieving dentin hypersensitivity. However, no superiority was found in dentin sensitivity relief among the agents.

Length of the styloid process and anatomical implications for Eagle's syndrome.

The styloid process is a bony projection, located just anterior to the stylomastoid foramen, the normal length of which is approximately 20-25 mm. Elongation of the process may cause various clinical symptoms such as neck and cervicofacial pain, described as Eagle's syndrome. The present study aimed to determine the mean length of the styloid process on cadavers, panoramic radiographs, and dry skulls, and to investigate the incidence of the elongated styloid process, while assessing the elongation in relation to Eagle's syndrome. When the measurements from the panoramic radiographs were assessed, the mean length of the styloid processes in males and females on the right and left sides were found to be the following: 25.78 + or - 5.68 mm; 22.69 + or - 3.68 mm, 25.80 + or - 5.75 mm; and 22.75 + or - 3.65 mm, respectively. The males had greater styloid process lengths than the females, and the differences in length on both the right and left sides were statistically significant. Descriptive statistics and comparison results according to age groups were determined. There was no statistically significant difference between right or left styloid process lengths according to age groups. The mean length of the styloid process of the cadavers and dry bones was 22.54 + or - 4.24, and there was no significant difference between the right and left sides of the cadavers and dry bones. The incidence of the elongated styloid process was determined as 3.3%, and the elongations revealed a female dominance. The average length of the elongated styloid process was 36.06 + or - 6.12 mm, while the mean length of the styloid processes of the subjects reporting Eagle's syndrome was 40 + or - 4.72 mm. The results of this morphological study will assist clinicians in the diagnosis of Eagle's syndrome.

Selection of patients for liver transplantation and allocation of donated livers in the UK.

BACKGROUND: The increasing shortfall between the number of patients who would benefit from liver transplantation and the availability of donor livers means that rationing has to occur. The processes of selection of patients for transplantation and for allocation of donor livers should be done according to ethical and, where possible, evidence-based criteria so that there is clarity and that the competing requirements of equity, justice, utility and benefit can be balanced. METHODS: To achieve these goals for patients in the United Kingdom in need of transplantation, we have developed guidelines for the selection of patients to the national waiting list based on the risk of death without a transplant and the ability of the procedure to improve the recipient's quality of life. Guidelines have been developed for both those with acute liver failure and chronic liver disease. Allocation will depend on matching of the donor liver to the recipient. RESULTS: The proposed system, to be introduced into the UK compares with some other systems, where different models for selection and allocation have been introduced.

Investigation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume in patients with tinnitus.

OBJECTIVE: This study aimed to evaluate patients with tinnitus in terms of mean platelet volume and platelet distribution width, and to explore neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, recently reported in the literature as being possible inflammation markers. METHODS: This study comprised 64 tinnitus patients and 64 age-matched healthy controls. Statistical significance level was accepted as p < 0.05. RESULTS: Mean platelet volume (t = 3.245, p = 0.002) and platelet distribution width (Z = 3.945, p < 0.001) were significantly higher in the patient group than the control group. CONCLUSION: The results suggest that a prothrombotic condition might play a role in the pathophysiology of tinnitus.

The role of topical nasal steroids in the treatment of children with otitis media with effusion and/or adenoid hypertrophy.

OBJECTIVES: Topical steroid treatment can be a powerful alternative to surgery in controlling adenoid hypertrophy and otitis media with effusion (OME). METHODS: A prospective, controlled, randomized, clinical study in an academic tertiary care center. A total of 122 children (3-15-year-old) on the waiting list for an adenoidectomy and/or ventilation tube placement were enrolled into the study and control groups. The study group (67 patients with adenoid hypertrophy, 34 of them with otitis media with effusion) received intranasal mometasone furoate monohydrate 100 mcg/day, and the control group (55 patients with adenoid hypertrophy, 29 of them with otitis media with effusion) was followed up without any treatment. All patients were evaluated at 0 and 6 weeks. The assessment of each patient included history, a symptom questionnaire, a skin prick test, a tympanogram, if possible a pure tone audiogram, and otoscopic and endoscopic examinations. The size of adenoid tissue was graded as a percentage according to obliteration of the choanae. The adenoid/choana ratio (A/C) was recorded for each patient. Symptoms were scored as 0 (absent), 1 (intermittent/periodic), or 2 (continuous). The data were analyzed with the "Statistical Package for the Social Sciences" (SPSS 9.0) using the appropriate nonparametric tests for nominal and ordinal data. RESULTS: Resolution of otitis media with effusion in the study group (42.2%) was significantly higher than that in the control group (14.5%) (p<0.001). Forty-five patients (67.2%) with adenoid hypertrophy in the study group showed a significant decrease in adenoid size according to the endoscopic evaluation compared to the control group (p<0.001). A significant improvement in obstructive symptoms was seen in the study group (p<0.001). The endoscopically measured adenoid/choana ratio and degree of obstructive symptoms showed a significant correlation (r=0.838 p<0.001, r=0.879 p<0.001, r=0.838 p<0.001, r=0.879 p<0.001). The adenoid/choana ratio improved significantly in atopic patients in the study group (p<0.05), whereas in atopic patients in the control group there was no change (p=0.221). CONCLUSION: Nasal mometasone furoate monohydrate treatment can significantly reduce adenoid hypertrophy and eliminate obstructive symptoms. It is a useful alternative to surgery, at least in the short term, for otitis media with effusion.