Successful surgical treatment of left ventricular free wall rupture.

Left ventricular free wall rupture (LVFWR) is a rare mechanical complication of acute myocardial infarction. The clinical course of LVFWR is very poor. Direct or patch closure of the rupture area and sutureless procedures constitute the treatment for LVFWR. We present the surgical treatment of a patient who developed LVFWR after high lateral myocardial infarction, and its successful outcome. Successful salvage of LVFWR remains relatively rare. Transthoracic echocardiography, myocardial contrast echocardiography and thoracic computed tomography are important diagnostic tools for LVFWR. These patients usually present with acute cardiac tamponade symptoms requiring immediate treatment.

Evaluation of Post-Swallow Residue with Visual Analysis of Swallowing Efficiency and Safety in Patients with Idiopathic Parkinson's Disease.

Objectives: Dysphagia is common in idiopathic Parkinson's disease (IPD) and is associated with impairments in both swallowing safety and swallowing efficiency. The goals of this study were to define post-swallow residue patterns in people with IPD and describe pathophysiological endoscopic findings affecting residue accumulation. Methods: This was a prospective single-blinded cross-sectional cohort study of patients with the diagnosis of IPD recruited from a Movement Disorder Clinic. Clinical variables included patient age, cognitive function, and measures of disease severity, and laryngoscopic examinations with a flexible endoscopic evaluation of swallowing (FEES) were completed for each patient. Visual Analysis of Swallowing Efficiency and Safety (VASES) was used to analyze FEES. Post-swallow residue outcomes and non-residue endoscopic outcomes including the Bowing index, Penetration Aspiration Scale (PAS) score, premature leakage, and build-up phenomenon were evaluated. Multiple regression models were used to evaluate factors affecting the residue at different anatomic levels. Results: Overall 53 patients completed the study. The multiple regression analyses showed a relation between (1) the presence of residue at the level of oropharynx and epiglottis with premature leakage, (2) the presence of residue at the level of the laryngeal vestibule and vocal folds with build-up phenomenon, and (3) the presence of residue at the level of the hypopharynx, laryngeal vestibule, and subglottis with airway invasion. Conclusion: Residue pattern during FEES is associated with specific swallow dysfunctions in IPD. Using residue localization and quantification may be a helpful tool in assessing the impact of targeted swallowing interventions in patients with IPD and dysphagia.

The effect of bony obliteration on quality of life after tympano-mastoidectomy surgery: A prospective observational controlled cohort study.

Objectives: The study's primary objective was to compare the quality of life (QoL) and external auditory canal (EAC) hygiene among patients who underwent bony mastoid obliteration or meatoplasty after canal wall down (CWD) mastoidectomy. Methods: A prospective, observational, controlled cohort study was conducted at our tertiary referral university hospital. Twenty-eight patients older than 16 years of age with chronic otitis media who underwent CWD mastoidectomy were included. Two cohorts were followed: CWD mastoidectomy followed by mastoid obliteration (Group 1, n = 14) and CWD mastoidectomy followed by meatoplasty (Group 2, n = 14). The main outcome measures of total COMBI score (postoperative 6-month QoL) and EAC hygiene were compared between the groups. Results: The average age of the patients was 36.14 (12. 22) years; 15 (53.6%) were female and 13 (46.4%) were male. There were no differences in demographic variables, preoperative findings, or COMQ-12 (preoperative QoL) scores between groups. The average COMBI score of Group 1 (49.0 [8.66]) was not significantly different from Group 2 (46.79 [7.76]) (p = .482). Poor EAC hygiene was observed in eight (57.1%) patients in Group 2 and three (21.4%) patients in Group 1 (p = .06). In Group 1, no resorption of graft material was observed in 10 (71.4%) patients, minor resorption was observed in three (21.4%) patients, and significant resorption was observed in one (7.1%) patient. There were no significant differences in audiological findings between groups (p > .05). Conclusion: There were no significant differences regarding short-term postoperative QoL, EAC hygiene, or hearing outcomes between patients who underwent bony mastoid obliteration or meatoplasty after CWD mastoidectomy. Level of Evidence: 1b (individual prospective cohort study).

Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis.

OBJECTIVES: To evaluate and compare the long-term results of patients who underwent facial nerve decompression surgery with either transmastoid-supralabyrinthine (TMSL) or combined transmastoid- middle cranial fossa (MCF) approach for traumatic facial nerve paralysis. MATERIALS AND METHODS: This is a single-center retrospective case-control study. The medical records of traumatic facial paralysis patients with House Brackmann (HB) Grade 6 who underwent facial nerve decompression surgery at via either TMSL or MCF approach between January 2011 and December 2017 were reviewed. The patients who had otic capsule involvement and total sensorineural hearing loss, therefore underwent translabyrinthine facial nerve decompression, and the patients follow-up period has not yet reached four years were excluded from the study. Postoperative HB score and hearing status were compared. RESULTS: Eleven patients were operated with MCF approach (group 1), while 9 patients with TMSL approach (group 2). Average age of patients was 20.04 + 15.2 (range:4-47) years. Three (15 %) patients were female, while 17 (85 %) was male. Geniculate ganglion (90 %) was the most affected segment of the facial nerve. Facial nerve edema was observed in all cases, while intraneural hematoma were encountered in 4 (20 %) cases. Statistically significant improvement in median HB scores were reached in both groups, and no significant difference was observed in post-operative HB scores between both techniques. No significant difference in median AC 0,5-4 khZ and BC 0,5-3 kHz thresholds was observed between both techniques. CONCLUSION: Even middle fossa approach is the best surgical technique to explore geniculate ganglion and labyrinthine segment of facial nerve, the functional results of transmastoid supralabrynthine approach, which is not needed craniotomy with low complication rate are as successful as middle fossa approach in selected patients.

Cross-cultural adaptation and validation of the Turkish version of the sinus and nasal quality of life survey (SN-5).

Objective: The Sinus and Nasal Quality of Life (QoL) Survey (SN-5) is a valid questionnaire that evaluates the QoL of the pediatric population associated with sinonasal diseases and symptoms. The aims of this study were to translate the SN-5 test to Turkish language (SN-5t), evaluate the internal consistency of the test and test-retest reliability and validate the translation for further use in studies in Turkish language. Methods: In this prospective study, 50 healthy subjects and 50 patients, age between 2 and 12, with sinonasal symptoms prolonged over 1 month were included to the study. Families of healthy subjects were asked to fill the SN-5t twice with 1-week interval. The patient group completed test once prior the treatment and once 4 weeks after the treatment. Cronbach's test was performed to test internal consistency and Spearman's test was performed to evaluate test-retest validity. Results: The median value of the pre-treatment tests of the patient group and control group was 25 (23-28) and 14.25 (12-16), respectively. A statistically significant difference was found between groups (p<0.001). Area under the receiver operating characteristics (ROC) curve (Aroc) value was calculated as 0.992 which stated the strong diagnostic accuracy, and the cutoff point was defined as 16.5. Cronbach's alpha value of 0.75 was found. The Spearman's rank correlation coefficient value (Spearman's rho) was calculated as 0.946. Conclusion: The Turkish translation of the SN-5 is a consistent and valid test with high sensitivity and specificity that can be used in studies including Turkish speaking population.

The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study / Alterações na pressão intracuff do tubo endotraqueal após posições cirúrgicas nas cirurgias de orelha e cabeça e pescoço: estudo observacional prospectivo

Abstract Introduction The cuff of an endotracheal tube seals the airway to facilitate positive-pressure ventilation and reduce subglottic secretion aspiration. However, an increase or decrease in endotracheal tube intracuff pressure can lead to many morbidities. Objective The main purpose of this study is to investigate the effect of different head and neck positions on endotracheal tube intracuff pressure during ear and head and neck surgeries. Methods A total of 90 patients undergoing elective right ear (Group 1: n = 30), left ear (Group 2: n = 30) or head and neck (Group 3: n = 30) surgery were involved in the study. A standardized general anesthetic was given and cuffed endotracheal tubes by the assistance of video laryngoscope were placed in all patients. The pilot balloon of each endotracheal tube was connected to the pressure transducer and standard invasive pressure monitoring was set to measure intracuff pressure values continuously. The first intracuff pressure value was adjusted to 18.4 mmHg (25 cm H2O) at supine and neutral neck position. The patients then were given appropriate head and neck positions before related-surgery started. These positions were left rotation, right rotation and extension by under-shoulder pillow with left/right rotation for Groups 1, 2 and 3, respectively. The intracuff pressures were measured and noted after each position, at 15th, 30th, 60th, 90th minutes and before the extubation. If intracuff pressure deviated from the targeted value of 20-30 cm H2O at anytime, it was set to 25 cm H2O again. Results The intracuff pressure values were increased from 25 to 26.73 (25-28.61) cm H2O after left neck rotation (p = 0.009) and from 25 to 27.20 (25.52-28.67) cm H2O after right neck rotation (p = 0.012) in Groups 1 and 2, respectively. In Group 3, intracuff pressure values at the neutral position, after extension by under-shoulder pillow and left or right rotation were 25, 29.41 (27.02-36.94) and 34.55 (28.43-37.31) cm H2O, respectively. There were significant differences between the neutral position and extension by under-shoulder pillow (p < 0.001), and also between neutral position and rotation after extension (p < 0.001). However, there was no statistically significant increase of intracuff pressure between extension by under-shoulder pillow and neck rotation after extension positions (p = 0.033). Conclusion Accessing the continuous intracuff pressure value measurements before and during ear and head and neck surgeries is beneficial to avoid possible adverse effects/complications of surgical position-related pressure changes.

Resumo Introdução O manguito ou cuff de um tubo endotraqueal sela as vias aéreas para facilitar a ventilação com pressão positiva e reduzir a aspiração de secreção subglótica. Entretanto, o aumento ou diminuição da pressão intracuff do tubo endotraqueal pode levar a muitas morbidades. Objetivo Investigar o efeito de diferentes posições da cabeça e pescoço da pressão intracuff do tubo endotraqueal durante cirurgias de orelha e cabeça e pescoço. Método Participaram do estudo 90 pacientes submetidos à cirurgia eletiva na orelha direita (Grupo 1: n = 30), orelha esquerda (Grupo 2: n = 30) ou cabeça e pescoço (Grupo 3: n = 30). Um anestésico geral padronizado foi administrado e o tubo endotraqueal com cuff foi colocado em todos os pacientes através de videolaringoscopia. O balão-piloto de cada tubo endotraqueal foi conectado ao transdutor de pressão e o monitoramento-padrão da pressão invasiva foi estabelecido para medir continuamente os valores da pressão intracuff. O primeiro valor de pressão intracuff foi ajustado para 18,4 mmHg (25 cm H2O) na posição supina e neutra do pescoço. Em seguida, os pacientes foram colocados nas posições cirúrgicas apropriadas de cabeça e pescoço antes do início da cirurgia. Essas posições foram rotação esquerda, rotação direita e extensão por rotação esquerda/direita com almofada sob o ombro, para os grupos 1, 2 e 3, respectivamente. As pressões intracuff s foram medidas e anotadas após cada posição, aos 15, 30, 60, 90 minutos e antes da extubação. Se a pressão intracuff saísse do valor desejado de 20 ~ 30 cm H2O a qualquer momento, ela era definida em 25 cm H2O novamente. Resultados Os valores de pressão intracuff aumentaram de 25 para 26,73 (25-28,61) cm H2O após a rotação do pescoço para a esquerda (p = 0,009) e de 25 a 27,20 (25,52-28,67) cm H2O após rotação do pescoço para a direita (p = 0,012) nos grupos 1 e 2, respectivamente. No Grupo 3, os valores da pressão intracuff na posição neutra, após extensão com almofada sob o ombro e rotação para a esquerda ou direita, foram 25, 29,41 (27,02-36,94) e 34,55 (28,43-37,31) cm H2O, respectivamente. Houve diferenças significativas entre a posição neutra e a extensão com almofada sob o ombro (p < 0,001) e também entre a posição neutra e a rotação após a extensão (p < 0,001). Entretanto, não houve aumento estatisticamente significante da pressão intracuff entre extensão com almofada sob o ombro e rotação do pescoço após as posições de extensão (p = 0,033). Conclusão As medições contínuas do valor da pressão intracuff antes e durante cirurgias de orelha e cabeça e pescoço são benéficas para evitar possíveis efeitos adversos/complicações de alterações de pressão relacionadas à posição cirúrgica.

The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study.

INTRODUCTION: The cuff of an endotracheal tube seals the airway to facilitate positive-pressure ventilation and reduce subglottic secretion aspiration. However, an increase or decrease in endotracheal tube intracuff pressure can lead to many morbidities. OBJECTIVE: The main purpose of this study is to investigate the effect of different head and neck positions on endotracheal tube intracuff pressure during ear and head and neck surgeries. METHODS: A total of 90 patients undergoing elective right ear (Group 1: n=30), left ear (Group 2: n=30) or head and neck (Group 3: n=30) surgery were involved in the study. A standardized general anesthetic was given and cuffed endotracheal tubes by the assistance of video laryngoscope were placed in all patients. The pilot balloon of each endotracheal tube was connected to the pressure transducer and standard invasive pressure monitoring was set to measure intracuff pressure values continuously. The first intracuff pressure value was adjusted to 18.4mmHg (25cm H2O) at supine and neutral neck position. The patients then were given appropriate head and neck positions before related-surgery started. These positions were left rotation, right rotation and extension by under-shoulder pillow with left/right rotation for Groups 1, 2 and 3, respectively. The intracuff pressures were measured and noted after each position, at 15th, 30th, 60th, 90th minutes and before the extubation. If intracuff pressure deviated from the targeted value of 20-30cm H2O at anytime, it was set to 25cm H2O again. RESULTS: The intracuff pressure values were increased from 25 to 26.73 (25-28.61) cm H2O after left neck rotation (p=0.009) and from 25 to 27.20 (25.52-28.67) cm H2O after right neck rotation (p=0.012) in Groups 1 and 2, respectively. In Group 3, intracuff pressure values at the neutral position, after extension by under-shoulder pillow and left or right rotation were 25, 29.41 (27.02-36.94) and 34.55 (28.43-37.31) cm H2O, respectively. There were significant differences between the neutral position and extension by under-shoulder pillow (p<0.001), and also between neutral position and rotation after extension (p<0.001). However, there was no statistically significant increase of intracuff pressure between extension by under-shoulder pillow and neck rotation after extension positions (p=0.033). CONCLUSION: Accessing the continuous intracuff pressure value measurements before and during ear and head and neck surgeries is beneficial to avoid possible adverse effects/complications of surgical position-related pressure changes.

Presentation of dizziness in individuals with chronic otitis media: data from the multinational collaborative COMQ-12 study.

PURPOSE: In chronic otitis media (COM), disease chronicity and severity of middle ear inflammation may influence the development of inner ear deficits, increasing the risk of vestibular impairment. This secondary analysis of the multinational collaborative Chronic Otitis Media Questionnaire-12 (COMQ-12) dataset sought to determine the prevalence of vestibular symptoms in patients with COM and identify associated disease-related characteristics. METHODS: Adult patients with a diagnosis of COM in outpatient settings at nine otology referral centers across eight countries were included. We investigated the presence of vestibular symptoms (dizziness and/or disequilibrium) using participant responses to item 6 of a native version of the COMQ-12. Audiometric data and otoscopic assessment were also recorded. RESULTS: This analysis included 477 participants suffering from COM, with 56.2% (n = 268) reporting at least mild inconvenience related to dizziness or disequilibrium. There was a significant association between air conduction thresholds in the worse hearing ear and presence of dizziness [adjusted odds ratio (AOR), 1.01; 95% CI 1.00-1.02; p = 0.0177]. Study participants in European countries (AOR 1.53; 95% CI 1.03-2.28; p = 0.0344) and Colombia (AOR 2.48; 95% CI 1.25-4.92; p = 0.0096) were more likely to report dizziness than participants in Asian countries. However, ear discharge and cholesteatoma showed no association with dizziness in the adjusted analyses. CONCLUSION: Vestibular symptoms contribute to burden of disease in patients with COM and associates with hearing disability in the worse hearing ear. Geographical variation in presentation of dizziness may reflect financial barriers to treatment or cultural differences in how patients reflect on their health state.

Evaluation of the factors affecting the necessity for revision surgery in choanal atresia.

OBJECTIVE: This study aims to compare the effects of different surgical techniques for congenital choanal atresia (CCA), and particular emphasis is given to the analysis of the factors affecting the surgical outcome. The necessity for revision surgery and surgical outcomes were retrospectively investigated in patients undergoing revision surgery according to a recently proposed classification system. MATERIAL AND METHOD: A retrospective study was conducted on patients operated for CCA between January 2007 and December 2018 at a university hospital. Data in the medical records, including patient age when the initial surgery was performed, gender, additional anomalies and medical conditions, the duration of gestation, side and type of atresia, type of surgery and need for revision surgery were reviewed. RESULTS: Forty-five patients treated for CCA in our university hospital were screened. The mean follow-up duration was 82.16 months. Revision surgery was required in 9 of 26 cases, which are included in the study (34.6%). Fourteen patients presented with bilateral CCA, while 12 were unilateral cases. Sixteen patients (61.5%) had comorbid medical conditions. While the removal of vomer and mucoperiosteal flap use affects successful surgical repair, no differences were observed in choanal atresia type, laterality, use of stent and the presence of additional medical conditions. CONCLUSION: The most important factors affecting surgical success for CCA are the removal of the vomer and closure of all bare bone tissues using a mucoperiosteal flap. Use of stents provides no additional benefit, apart from preventing synechiae formation.

Impact of Hearing Disability and Ear Discharge on Quality-of-Life in Patients with Chronic Otitis Media: Data from the Multinational Collaborative COMQ-12 Study.

OBJECTIVE: This study aimed to assess how two disease-related factors, hearing disability and ear discharge, affect health-related quality-of-life (HRQoL) in patients with chronic otitis media (COM). STUDY DESIGN: Multinational prospective cohort study. SETTING: Nine otology referral centers in eight countries. PATIENTS: Adult patients suffering from COM. MAIN OUTCOME MEASURES: Hearing disability and ear discharge were assessed by audiometry (Department of Health and Social Security formula) and otoscopy, respectively. Participants completed a native version of the Chronic Otitis Media Questionnaire-12 (COMQ-12). We determined how the two disease-related factors affect HRQoL by performing two separate analyses: (1) using a 6-item score combining responses to COMQ-12 items independent of hearing loss and ear discharge and (2) using item 12 alone as a proxy for global HRQoL. RESULTS: This study included 478 participants suffering from COM. There was a significant association between HRQoL and hearing disability in the adjusted analysis. For every unit increase in the Department of Health and Social Security average hearing threshold (1) there was an increase of 0.06 (95% CI [0.007, 0.121], p = 0.0282) in the 6-item score and (2) the adjusted odds of having a higher item 12 score was 1.03 (95% CI [1.01, 1.04], p = 0.0004). There was no association between the presence of ear discharge and HRQoL in both COMQ-12 score analyses. CONCLUSIONS: Knowledge of disease-related factors that influence HRQoL will aid interpretation of patient-reported measures for COM. Patients with a greater degree of hearing impairment appear to have poorer HRQoL, which is not exacerbated by the presence of ear discharge. The magnitude of postoperative hearing improvement rather than the attainment of a dry ear may be a better indicator of surgical success from the patient's perspective.

The Role of Indirect Laryngoscopy, Clinical and Ultrasonographic Assessment in Prediction of Difficult Airway.

OBJECTIVES: Pre-operative airway evaluation is essential to decrease the proportion of possible mortality and morbidity due to difficult airway (DA). The study aimed to evaluate the accuracy of pre-operative ultrasonographic airway assessment (UAA) and indirect laryngoscopy (IL) in predicting DA. STUDY DESIGN: Prospective obsevational study. METHODS: Preoperative clinical examination (body mass index [BMI], mallampati classification [MP], thyromental distance, sternomental distance, neck circumference), UAA (epiglottis-skin distance [ESD], hyoid bone-skin distance [HSD], the thickness of tongue root [ToTR], anterior commissure-skin distance [ACSD]) and IL with the rigid 70-degree laryngoscope were performed to predict DA (Cormack-Lehane grade 3 and 4). The sensitivity, specificity, positive predictive value (PP), and negative predictive values of the parameters were assessed. RESULTS: Twenty-two of 140 (15.7%) patients were diagnosed with DA. The cut-off points of ESD, HSD, ToTR, ACSD, and BMI were 2.09 cm, 0.835 cm, 4.05 cm, 0.545 cm, and 27.10, respectively. AUC values were 0.874, 0.885, 0.871, 0.658, and 0.751 in the same order. AUC values for IL and MP were 0.773 and 0.925, respectively. MP and HSD had the best sensitivity (91%), IL grading had the best specificity (100%), and PP (100%) value among all measurements. The best-balanced sensitivity (91%), specificity (97%), and PP (88%) values were obtained by combining the IL with MP and ESD or with MP and HSD. CONCLUSIONS: Ultrasonographic measurements and IL were found significantly correlated to predict DA. Combined parameters, the IL with MP and ESD or with MP and HSD, are the best parameters in predicting the DA. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E555-E560, 2021.

Multinational Appraisal of the Chronic Otitis Media Questionnaire 12 (COMQ-12).

OBJECTIVES: The Chronic Otitis Media Questionnaire-12 (COMQ-12) assesses patient-reported health-related quality of life. A multinational collaborative project was performed to translate and appraise the psychometric properties of the COMQ-12 across Europe, Asia, and South America. METHODS: Eight otology units from seven countries (China, Colombia, France, Italy, Japan, Korea, Turkey) created native versions of the COMQ-12 by the process of translation and back-translation. Questionnaire reliability was assessed on the basis of internal consistency by calculating Cronbach's coefficient alpha. Exploratory factor analysis was performed to identify underlying correlations between individual questionnaire items. RESULTS: This study included 478 participants from 8 countries. Calculated values for Cronbach's coefficient alpha were between 0.71 and 0.90. Exploratory factor analysis allowed the identification of three dominant factors, the primary factor (related to hearing problems) explaining 42% of the total variance, the secondary factor (related to daily activities) explaining 30% of the variance, and the third factor (related to acute disease activity) explaining 28% of the variance. CONCLUSIONS: This is a large study of patients with chronic otitis media, from centers from within many different countries spanning Europe, Asia, and South America. This study supports the use of the COMQ-12 within the individual countries where it was tested.

Internal compression therapy, a novel method in the treatment of deep venous insufficiency: 18-month clinical results.

OBJECTIVE: To present 18-month clinical results for internal compression therapy (ICT) applied percutaneously and as a novel method in the treatment of primary deep venous insufficiency. MATERIAL AND METHOD: Thirty patients diagnosed with isolated primary femoral vein (FV) insufficiency between October 2017 and February 2018 were included in the study. Pre-procedural femoral vein diameters and reflux durations were measured. CEAP classification and Venous Clinical Severity Score (VCSS) were recorded. Pre-procedural CEAP classifications were CEAP 4 in nine patients and CEAP 3 in 21. Quality of life assessments were carried out using a Chronic Venous Insufficiency Questionnaire (CIVIQ-2). FV diameters were then reduced, and valve coaptation was established with the percutaneous application of hyaluronic acid and cyanoacrylate injected adjacent to a valve with non coapting leaflets. Venous diameters and reflux duration were again measured immediately after the procedure. Patients were followed-up at months 1, 6, and 18, at which times all parameters were re-evaluated. RESULTS: Eighteen of the 30 patients were women, and 12 were men. The mean duration of the procedure was 22.7 ± 2.9 (20-30) min. Patients' FV diameters were 12.8 (11-14.7) mm before the procedure, 9.9 (9-11.5) mm immediately after, and also 9.9 (9-11.2) mm after 1.5 years (p < 0.001). Pre-procedural reflux duration ranged between 2 and 6 (median: 3) sec, and no reflux was observed in any patient immediately or one month after the procedure (p < 0.001). At 18-month follow-up, reflux lasting only 1 sec was determined in two patients. VCSS scores were 11 (10-12) pre-procedurally and 6 (4-9) at 18 months (p < 0.001). Venous Quality of Life scores were 32 (30-36) before the procedure and 18 (14-24) at 18 months (p < 0.001). CONCLUSION: Preliminary investigation of the injection of cyanoacrylate and hyaluronic acid around one valve in an incompetent FV can result in improved hemodynamics, CEAP, VCSS and patient QOL at 18 months, without complications.

Investigation of DFNB4 SLC26A4 mutation in patients with enlarged vestibular aquaduct.

OBJECTIVES: Mutations of the SLC26A4 gene causing enlarged vestibular aqueduct (EVA) syndrome have not yet been fully elucidated. The study aimed to investigate SLC26A4 mutations in patients with EVA syndrome in the Turkish population. Identifying these mutations may play an essential role in determining the prognosis, follow-up, and management options of these patients. METHODS: Whole exome sequencing and/or Sanger sequencing of SLC26A4 in 22 patients with sensorineural hearing loss associated with isolated EVA without inner ear anomalies, and 22 controls were performed. RESULTS: Twenty-two patients and 22 control subjects were included in the study. The onset of hearing loss was pre-lingual in 15 patients, and post-lingual in 7. The mean (standard deviation) vestibular aqueduct width of the patients was 3.23 mm (1.28). Twenty SLC26A4 variants, 15 of them unique, were identified in 22 patients. Among them, seven variants were heterozygous, and 13 were homozygous. The variants p.E37X (c.109G > T), p.Y27H (c.79T > C), p.C706Y (c.2117G > A) have not been previously reported. CONCLUSION: The detection of rare and previously unreported mutations in our study showed that studies with a larger number of patients with EVA might reveal more role of the SLC26A4 gene. Besides, to understand the etiopathogenesis of the disease, other related genes also should be investigated.

Chylous ascites developing after open thoracoabdominal aortic aneurysm repair in a patient with marfan syndrome

Abstract Chylous ascites is the pathologic accumulation of chylous fluid in the peritoneal cavity, caused by lymphomas, metastatic malignancies, and abdominal surgeries, rarely due to surgical trauma of the cisterna chyli or its major branches. A 24-year-old man with history of Marfan syndrome presented to our hospital with abdominal distention, abdominal pain, fluid in the incision region, and weakness. He had underwent an elective open aneurysm repair surgery nine days before for thoracoabdominal aortic aneurysm. Computed tomography revealed massive fluid collection in the abdominal cavity, which was drained surgically. He was diagnosed with chylous ascites and was discharged after conservative treatment.

Translation and Validation of Chronic Otitis Media Benefit Inventory (COMBI) in Turkish Language.

OBJECTIVE: The aim of this study was to translate the Chronic Otitis Media Benefit Inventory (COMBI) into Turkish and evaluate the questionnaire's reliability in assessing benefit outcomes in patients after ear surgery. METHODS: A total of 30 patients with chronic otitis media who underwent ear surgery were asked to fill out the translated Turkish version of the COMBI questionnaire six months after their surgery twice, 10 days apart. The patients were divided into two groups in two different ways based on surgical and audiological outcomes. These were surgical success (SS), surgical failure (SF), audiological success (AS), audiological failure (AF) groups. Student's -t test was performed to show the differences in the COMBI scores of the groups. Cronbach's alpha value was calculated to test internal consistency, Pearson's correlation coefficient was measured to demonstrate test-retest reliability and factor analysis was run. RESULTS: The average score of the SS group was 51.08 and significantly higher than the score of the SF group (42.40) (p=0.012). There was, however, no statistically significant difference between the average scores of the AS and the AF groups (p=0.330). A Cronbach's alpha value of 0.862 was found. Pearson's r value was calculated 0.810. Factor analysis showed that a three-factor solution explained the 70.2% of the variance. CONCLUSION: The Turkish version of the COMBI is a valid test with high test-retest reliability. It should be used with objective assessment tools for better understanding how patients benefit from the surgery.

YouTube™ as an information source for larynx cancer: a systematic review of video content.

PURPOSE: The increasing availability of Internet as a health-care source causes both positive and negative effects on public health. Though reaching to information about diseases is faster and easier, the contents are not always correct and might be misleading. In our study, we aim to investigate the quality of YouTube™ videos on larynx cancer. METHODS: A YouTube™ search by using terms "throat cancer" and "larynx cancer" was done and, after eliminating the irrelevant videos, the first 200 videos were evaluated by three authors on quality, content and usefulness by using a pre-developed questionnaire. Videos were categorized according to the type and uploader separately to two (testimonial and educational) and five groups (health care, university, individual users, television channel/news and undetermined), respectively. RESULTS: Videos that are uploaded by university-affiliated accounts have significantly better audiovisual quality score and have significantly higher accuracy and usefulness score results. Furthermore, the accuracy and usefulness scores of the educational group were found to be statistically higher than those of the testimonial group. CONCLUSIONS: Videos uploaded by universities and videos that are created for educational purposes are superior to other sources in terms of quality, accuracy and content. Patient information videos discussing common health problems should be prepared and disseminated only by universities or health-care institutions.

Malignant Transformation of Parotid Gland Non-sebaceous Lymphadenoma: Case Report and Review of Literature.

Non-sebaceous lymphadenoma is a sporadic benign tumor of salivary glands. Histopathologic and immunohistochemical properties, diagnostic criteria, and theories for the histologic origin of the disease have been defined and well-discussed in the literature. However, none of the cases showed malignant transformation to date. We reported a case of 54 years old female patient with a right preauricular mass. Magnetic resonance imaging demonstrated a 2 cm, well-defined contrast-enhanced mass in the right parotid gland. Fine needle aspiration cytology was undiagnostic but suspicious for malignancy. Total parotidectomy with facial nerve preservation was done. In the histopathological examination, non-sebaceous lymphadenoma regions and malignant cells with abundant cytoplasm, large vesicular nuclei, and prominent nucleoli, which occupied approximately 70% of the mass, were seen. The diagnosis was undifferentiated carcinoma arisen from non-sebaceous lymphadenoma. Adjuvant radiotherapy was given. No recurrence was detected during ten months of follow-up. This case is the first case of a malignancy developed from non-sebaceous lymphadenoma.

Effects of high-dose vitamin D supplementation on the occurrence of post-operative atrial fibrillation after coronary artery bypass grafting: randomized controlled trial.

OBJECTIVE: This study aimed to investigate the preventive effects of a high-dose vitamin D administered preoperatively on the post-operative atrial fibrillation (POAF) occurrence in patients with insufficient or deficient serum vitamin D levels who underwent coronary artery bypass grafting (CABG) surgery. METHODS: The study was a randomized controlled, blinded and parallel-arm trial conducted on 116 who had vitamin D deficiency or insufficiency during the pre-operative evaluation were included in the study conducted between January 2018 and January 2019. Patients were divided into those who received oral vitamin D (treatment group; n = 58) and those who did not (control group; n = 58) 48 h before CABG surgery. In the treatment group, patients with vitamin D deficiency were administered 300.000 IU vitamin D orally and those with vitamin D insufficiency 150.000 IU 48 h preoperatively. Patients were followed up during hospitalisation process with respect to POAF. RESULTS: Both groups showed no significant differences with regard to age, gender, body mass index, creatine level, left atrial diameter, pre-operative drug use, calcium level, ejection fraction, diabetes mellitus and hypertension. The ratio of POAF occurrence found in the treatment and control groups were 12.07% and 27.59%, respectively. Vitamin D treatment was found to reduce the risk of POAF development by 0.24 times (p = 0.034). CONCLUSION: In this study with sufficient sample size, preoperative short-term high-dose vitamin D supplementation was found to be significantly preventive to the occurrence of POAF in patients with vitamin D insufficiency and deficiency who underwent CABG surgery.

Internal Jugular Vein Thrombosis due to Chronic Kidney Disease: A Case Report.

Internal jugular vein (IJV) thrombosis is a rare vascular event. The most common causes of internal jugular vein thrombosis are prolonged central venous catheterization, infection, malignancy and ovarian hyperstimulation syndrome. We have presented here a case of an 82-year-old male with chronic kidney disease who presented with left neck swelling and pain who was found to have a thrombus in the left IJV. He was successfully treated with conservative treatment without any complications.