Radiation-induced osteosarcoma of the larynx: case report and literature review.

Laryngeal osteosarcoma is an extremely rare disease. Only 23 cases have been published in the literature. Radiation-induced laryngeal osteosarcoma is even rarer; this is only the third such case to be reported. A 59-year-old man underwent radiotherapy for an in situ laryngeal squamous cell carcinoma at another institution. Five years later he developed a laryngeal osteosarcoma, and a total laryngectomy was performed. Although previous reports showed a poor prognosis, our patient was without disease at the 8-year follow-up. To the best of our knowledge, this is the longest disease-free follow-up to be reported in the literature. We also present a review of the world's literature.

Incidentally detected asymptomatic metal foreign bodies (two nails) in shoemaker's maxillary sinus.

The diagnosis metal foreign bodies of maxillary sinus cannot be usually made in an acute setting and patients may present with chronic symptoms due to drainage and chronic irritation of the mucosa years later. Metal foreign bodies can be generally displaced to the maxillary sinus at the time of dental intervention. In this article, we report a very interesting case of 23-year-old male shoemaker with two metal foreign bodies (nails) which were non-related with any surgical intervention or trauma and found incidentally in the right maxillary sinus.

A comparison of unilevel and multilevel surgery in obstructive sleep apnea syndrome.

We conducted a retrospective study of 35 adults who had undergone tongue base suspension in addition to other surgery for the treatment of obstructive sleep apnea syndrome (OSAS). Our goal was to determine the most effective surgical approach by comparing these patients' preoperative apnea-hypopnea index (AHI) with their postoperative scores at 6 months. The 35 patients were divided into three groups based on a preoperative assessment of their level of airway obstruction; the assessment included a determination of AHI and endoscopic findings during the MÜller maneuver. Patients in group 1 (n = 9) exhibited unilevel obstruction, and they were treated with lateral pharyngoplasty; patients in group 2 (n = 13) also had unilevel obstruction, and they underwent Z-palatoplasty; patients in group 3 (n = 13) had multilevel obstruction, and they underwent combined surgery. Postoperatively, all three groups exhibited statistically significant improvements in AHI, but we determined that of the three approaches, multilevel surgery was significantly more effective (p < 0.001).

[Evaluation of the duration of postoperative pain control obtained with bupivacaine injection into the tonsillar region in children who underwent tonsillectomy]. / Tonsillektomi yapilan çocuklarda tonsiller bölgeye bupivakain enjeksiyonu ile saglanan ameliyat sonrasi agri kontrolü süresinin degerlendirilmesi.

OBJECTIVES: In this study the effectiveness of postoperative pain control and its probable duration, in the group of pediatric tonsillectomy patients after peroperative application of long acting local anesthetic agent bupivacain to tonsillar fossa is searched. PATIENTS AND METHODS: Our study is a prospective, double-blind, case-control study. A total of 80 children consisting of 50 cases (24 girls, 26 boys; mean age 8.4 ± 2.1 years; range 6 to 12 years) and 30 controls (16 girls, 14 boys; mean age 8.1 ± 1.7 years; range 6 to 12 years) undergoing tonsillectomy were included in this study. Before tonsillectomy 2 ml (0.5 mg/ml) adrenaline-free bupivacain (Marcain, AstraZeneca) injected both of tonsillar fossa in study group, and normal saline injected with the same technique to control group. Face scale is used for pain measurement in both groups. Pain scores were measured at 2, 6, and 24 hours, seventh day and during the first oral intake postoperatively in both groups. RESULTS: We found a significant difference in postoperative second and sixth hours value, when compared control and study groups (p<0.001). No significant difference is found in postoperative 24th hours and first week between study and control group (p>0.001). In our study preincisional bupivacain infiltration makes significant reduction in postoperative pain according to placebo at postoperative second and sixth hours. In both groups at postoperative 24th hours and first week we ascertain significant pain reduction according to postoperative second and sixth hours, but no difference is found between study and control group. CONCLUSION: Intraoperative preincisional bupivacain injection is useful in postoperative pain control at early period of time in children undergoing tonsillectomy. But it has no effect in pain reduction after 24 hours.

Arco-palato-uvular flap: a new surgical technique for the treatment of palatal snoring in tonsillectomized patients.

OBJECTIVES: We describe a new surgical technique called "arco-palato-uvular flap (APUF)" which can be used for the surgical management of palatal snoring in previously tonsillectomized patients. PATIENTS AND METHODS: Among patients who were admitted to the Military Hospital of Novi Sad between January 2000 and December 2004, 36 patients (19 males, 17 females; mean age 45.3 years; range 21 to 60 years) who had previously undergone tonsillectomy for various reasons and who were thought to have palatal snoring based on physical and endoscopic examinations were evaluated on the basis of the visual analog scale (VAS), Epworth sleepiness scale (EPSS) and apnea hypopnea index (AHI) scores and underwent APUF surgery after giving informed consent. RESULTS: Twenty-seven patients with a body mass index (BMI) of <30 kg/m2 had socially-bothersome snoring and nine had mild sleep apnea (AHI 5-15/hour, SO2 >90%). The mean visual analog scale scores were 8.6 ± 1.0 preoperatively and 2.3 ± 1.5 postoperatively. The Epworth Sleepiness Scale scores averaged 10.0 ± 3.0 preoperatively and 4.0 ± 1.0 postoperatively. In patients with mild apnea, the average preoperative AHI was 11.58 ± 3.58 and dropped to 4.75 ± 2.92 postoperatively. Statistical analysis revealed significant reductions in all variables (p<0.001). CONCLUSION: The APUF procedure may treat palatal snoring and mild obstructive sleep apnea in previously tonsillectomized patients by widening the oropharyngeal airway, and stabilizing the uvulopalatal segment. Further studies are needed to determine the long-term success rates of the technique and to modify the patient selection and exclusion criteria.

[Management of recurrent lower lip carcinomas]. / Nüks alt dudak kanserlerine yaklasim.

OBJECTIVES: In this study patients who had locoregional recurrence of lower lip carcinomas after therapies such as surgery, electrocoagulation, cryotherapy or traditional local therapies are discussed. PATIENTS AND METHODS: The records of 16 cases (1 female, 15 males; mean age 58 years; range 30 to 83 years) with recurrent lower lip carcinoma admitted between March 2002 and September 2007 to Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital, Ear, Nose and Throat Department were retrospectively reviewed. RESULTS: Fourteen patients had been treated in other institutions, while two had been treated in our center. Four of the patients had recurrence in the lip, four patients had recurrence only in the neck, and the remaining eight patients had both lip and neck recurrence. Ten patients received modified radical or radical neck dissection because of their palpable lymphadenopathies, three patients received supraomohyoid neck dissection due to non palpable lymphadenopathies, and the remaining three patients did not have neck dissection because of co-morbid diseases. Seven patients (43%) died in the first postoperative year because of lower lip carcinomas and three patients died because of other reasons. Six patients survived for the first two years without any evidence of disease. CONCLUSION: Patient survival will be affected by the applied treatment. For patients with primary lower lip cancers, otolaryngologists experienced in oncology must plan surgery rather than local treatments. In case of locoregional recurrence, immediate treatment should be planned.

Preventing cisplatin induced ototoxicity by N-acetylcysteine and salicylate.

OBJECTIVES: In this study we investigated if CP induced ototoxicity could be prevented or reduced by the use of salicylate and N-acetylcysteine. PATIENTS AND METHODS: Fifty-four patients (28 females, 26 males; mean age 37+/-9.5 years; range 29 to 71 years) who had cisplatin chemotherapy due to solid organ tumors were enrolled in the study. The patients were randomized into three groups, with 18 patients in each group. The first group (control group) received cisplatin, second group received N-acetylcysteine (NAC; 600 mg/day) with cisplatin and the third group received salicylate (300 mg/day) with cisplatin. All patients evaluated audiologically including high frequency audiometry and auditory brainstem response. RESULTS: The cisplatin-induced ototoxic damage could be reduced in 10,000 and 12,000 Hz frequencies when N-acetylcysteine was added to the cisplatin therapy protocol. There was no decrease in the hearing loss levels of the patients who were receiving cisplatin with salicylate. CONCLUSION: According to auditory brainstem response testing results, there was no difference detected between N-acetylcysteine or salicylate for the amelioration of cisplatin induced ototoxicity.

Measurement of tympanic cavity volume by the Cavalieri principle in Turkish population.

OBJECTIVES: The aim of this study is to measure the tympanic cavity (TC) volumes with Cavalieri principle using computed tomography (CT) scanning of temporal bones, to investigate the difference between the right and the left ears with respect to sexes and to exemplify the TC volume measurements. PATIENTS AND METHODS: Clinical records of 91 patients (46 females 45 males; mean age 48.1 years; range 15 to 60 years) whose TCs were measured at ear nose throat clinic of Ankara Oncology Education and Research Hospital between January 2007 and March 2008, were retrospectively investigated. The CT scans which were obtained from two sides with a slice thickness of 1 mm were evaluated. Measurements of TC volumes were made with using the Cavalieri method. RESULTS: The mean TC volume in male subjects was 0.4721+/-0.0406 cm(3) on the left ears and 0.4883+/-0.0352 cm(3) on the right ears. In females the mean cavity volume was 0.4943+/-0.0501 cm(3) on the left ears and 0.4881+/-0.0485 cm(3) on the right ears. CONCLUSION: There was no statistically difference in between of the both sexes for the TC volume measurements and between both sites of the same individuals.

Can the Müller maneuver detect multilevel obstruction of the upper airway in patients with obstructive sleep apnea syndrome?

OBJECTIVES: Our aim is to figure out the role of Müller maneuver (MM) to detect the level of upper airway obstruction and the severity of obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: In this study, polysomnographies were made after the routine otorhinolaryngological examination including MM in patients admitted with OSAS suspicion in Ankara Oncology Training and Research Hospital's Department of Otorhinolaryngology, Sleep Medicine Policlinic. Two-hundred and twenty-one OSAS patients (142 males, 179 females; mean age 47.63 years; range 18 to 82 years) were included to the study. RESULTS: There weren't any significant correlation among apnea hypopnea index (AHI) results and body mass index (BMI), tonsil size and obstruction severity due to MM (p>0.05). Müller maneuver scores are positively correlated to the Epworth sleepiness scale (EPSS) scores (r=0.213 and p<0.001). Epworth sleepiness scale scores are found to be correlated to BMI and neck circumference (p<0.05). Level of the airway obstruction doesn't affects the EPSS scores (p=0.235). Also EPSS scores are not affected from uni or multilevel obstruction (p=0.088). CONCLUSION: The severity of the MM score is not correlated to the severity of OSAS according to AHI results, but it is found to be correlated to EPSS. Vibrating tissues caused local and systemic inflammation in OSAS patients. The correlation between EPSS and MM scores can be explained by this inflammatory process. Further prospective studies have to be done in this field. Müller maneuver in an awake patient might reflect the levels of the obstruction in sleep conditions even though insufficient for figuring out the severity of OSAS.

The effect of tumor width and depth on extracapsular lymp node metastases in tongue tumors.

OBJECTIVES: In this study, we investigate the relationship between the effects of tumor width and depth with the extracapsular nodal spread (ECS) in oral tumors. PATIENTS AND METHODS: In this study we investigate retrospectively data of 107 patients (69 males, 38 females; mean age 45 years; range 25 to 79 years) with tongue tumors, who had undergone surgery in our clinic, between 1994 and 2004. Twenty-one of them had ECS. The effects of tumor width and depth on various parameters such as nodal metastases, survival, grade and ECS are investigated. RESULTS: It was found that tumor width and depth were the most important factors that affect ECS and logistic regression analysis point out tumor width influence more than tumor depth. Receiver operating characteristic (ROC) curve analysis shows us when tumor width exceeds 3.7 cm or tumor depth exceeds 2.4 cm, rate of ECS reaches the maximum sensitivity and specificity. CONCLUSION: Tumor width and depth has affects on survival and prognosis but also they have significant relation with ECS.

Modified sling snoreplasty: double triangle shaped suture uvulopalatopexy.

Following the uvulopalatopharyngoplasty and laser assisted uvulopalatoplasty as treatments for mild obstructive sleep apnea syndrome (OSAS) originating from the soft palate, palatal stiffening operations began to be described as causing less morbidity, interfering less with velopharyngeal and mucosal functions, and being applicable in outpatient settings. We present modified uvulopalatopexy procedure which can be used in mild OSAS patients is a simple, minimally invasive and effective new method. In this article, we present a modified form of sling snoreplasty method and two cases in whom this method was used.

Obstructive sleep apnea syndrome and upper airway inflammation.

Obstructive sleep apnea syndrome (OSAS) is associated with inflammatory processes and elevated plasma cytokines. Inflammatory processes associated with OSAS may also act as potential mediators of cardiovascular morbidity in these patients. OSAS is associated with elevated levels of C reactive protein (CRP), as a marker of inflammation and cardiovascular risk. At the inflammatory point of view, the levels of TNF-alpha, IL-6, hsCRP, adhesion molecules, monocyte chemo attractant protein-1 and resist in were markedly and significantly elevated in patients with sleep apnea than those in normal control subjects. We reviewed several recent patents and literature in English about OSAS and upper airway inflammation relation since 1966 from the Medline database.

[The incidence of group A beta haemolytic streptococci in upper respiratory tract infections in Erzurum]. / Erzurum'da üst solunum yolu enfeksiyonlarinda A grubu beta hemolitik streptokok insidansi.

OBJECTIVES: The incidence of group A beta hemolytic streptococci (GABHS) in upper respiratory tract infections in Erzurum was investigated. PATIENTS AND METHODS: In this descriptive study throat swabs were obtained from 4112 patients (1989 males, 2123 females; mean age 21+/-1.5 years; range 14 to 46 years) with upper respiratory tract infections in Erzurum, Turkey between January 2006 and December 2006 and they were cultured for isolation of GABHS. RESULTS: In this study GABHS were isolated in 268 (6.51%) of patients. Group A beta hemolytic streptococci were isolated in 51 of 941 patients (5.42%) in the spring, in 23 of 592 patients (3.88%) in the summer, in 69 of 968 patients (7.13%) in the autumn, and in 125 of 1611 patients in the winter. Of those patients in whom GABHS were isolated, 128 (6.43%) were male and 140 (6.59%) were female. At Chi square test, (Range for alpha value, p=0.01 and p=0.05) there was a significant difference in the frequency of infection between the seasons (p<0.01). There was no significant difference between men and women with respect to carrier rate (p>0.05). CONCLUSION: The incidence of GABHS detected in Erzurum was lower than that in other countries. There were statistically significant differences in frequency between the seasons (p<0.01). The highest incidence was in the winter. Low incidence of GABHS in this region may be due to prevention of the colonization because of geographic features, nutritional habits and other factors.

Bacterial and fungal organisms in otitis externa patients without fungal infection risk factors in Erzurum, Turkey.

AIM: To describe the bacterial and fungal organisms in otitis externa patients without other risk factors for fungal infections. STUDY DESIGN: Cross sectional cohort descriptive study. MATERIALS AND METHODS: Ear swabs were obtained from 362 patients aged 1 to 55 years old with clinically diagnosed otitis externa in Erzurum, Turkey, between January 2006 and April 2007, and cultured for aerobic and anaerobic bacteria and fungi, using EMB, 5% sheep's blood, chocolate agar, anaerobic blood agar plate, thioglycollate broth and sabaroud agar using standard microbiological technique to diagnose isolates. RESULTS: 219 cultures were positive and a total of 267 isolates were obtained. Of the isolates, 68.16% (n: 182) were aerobic or facultative bacteria, 1.12 % (3) were anaerobic bacteria, 30.71 % (82) were fungi and 17.5 % (38) were polymicrobial infections. CONCLUSION: Fungal organisms especially Candida species may be isolated from ears of otitis externa patients without fungal infection risk factors such as ear self-cleaning, local antimicrobial, antifungal or corticosteroid drops or systemic antimicrobial or antifungal agents within the preceding week. Bacterial and fungal cultures may be recommended, and anti-fungal agents may be added, to treatment regimens in patients with otitis externa.

[The health problems which can brougth by 3G cell phones to our country]. / 3G cep telefonlarinin saglik açisindan ülkemize getirebilecegi sorunlar.

At present, we are being exposed to electromagnetic pollution which is steadily increasing parallel to the technological advancements and which is invisible and unnoticeable in the short run. Electromagnetic waves which were previously used for therapeutic reasons have recently been uncontrollably used in daily life. By widespread use of 3rd generation (3G) cellular phones, the electromagnetic pollution has multiplied and brought us a huge amount of health dangers in our country. In this article, electromagnetic pollution, which is a comprehensive topic, and problems related with this kind of pollution which is rapidly increasing due to recent wide use of 3G cell phones are summarized in the light of the literature.

Bacterial and fungal organisms in otitis externa patients without fungal infection risk factors in Erzurum, Turkey / Organismos bacterianos e fúngicos em pacientes com otite externa sem fatores de risco para infecção fúngica em Erzurum, Turquia

AIM: To describe the bacterial and fungal organisms in otitis externa patients without other risk factors for fungal infections. STUDY DESIGN: Cross sectional cohort descriptive study. MATERIALS AND METHODS: Ear swabs were obtained from 362 patients aged 1 to 55 years old with clinically diagnosed otitis externa in Erzurum, Turkey, between January 2006 and April 2007, and cultured for aerobic and anaerobic bacteria and fungi, using EMB, 5 percent sheep's blood, chocolate agar, anaerobic blood agar plate, thioglycollate broth and sabaroud agar using standard microbiological technique to diagnose isolates. RESULTS: 219 cultures were positive and a total of 267 isolates were obtained. Of the isolates, 68.16 percent (n: 182) were aerobic or facultative bacteria, 1.12 percent (3) were anaerobic bacteria, 30.71 percent (82) were fungi and 17.5 percent (38) were polymicrobial infections. CONCLUSION: Fungal organisms especially Candida species may be isolated from ears of otitis externa patients without fungal infection risk factors such as ear self-cleaning, local antimicrobial, antifungal or corticosteroid drops or systemic antimicrobial or antifungal agents within the preceding week. Bacterial and fungal cultures may be recommended, and anti-fungal agents may be added, to treatment regimens in patients with otitis externa.

OBJETIVO: Descrever fungos e bactérias presentes em pacientes com otite externa sem fator de risco para infecções fúngicas. FORMA DE ESTUDO: Estudo descritivo de coorte transversal. MATERIAIS E MÉTODOS: Amostras por raspagem de cotonetes (swabs) no ouvido foram obtidas de 362 pacientes com idades entre 1 e 55 anos, com diagnóstico clínico de otite externa em Erzurum, Turquia, entre janeiro de 2006 e abril de 2007. Essas amostras foram cultivadas em meio de cultura, 5 por cento de sangue de ovelha, ágar chocolate, ágar sangue anaeróbio, banho em tioglicolato e ágar Saboroud, usando técnicas padrão de microbiologia para identificar os isolados. RESULTADOS: Obtivemos 219 culturas positivas e 267 isolados. Dos isolados, 68,16 por cento (n: 182) eram bactérias aeróbias ou facultativas, 1,12 por cento (3) eram bactérias anaeróbias, 30,71 por cento (82) eram fungos e 17.5 por cento (38) eram germes polimicrobianos. CONCLUSÃO: Fungos, especialmente espécies de Candida podem ser encontradas em ouvidos de pacientes com otite externa sem fatores de risco para infecção fúngica tais como autolimpeza do ouvido, uso de antimicrobiano local, corticosteroides ou antifúngicos tópicos ou agentes antibacterianos e antifúngicos sistêmicos na semana anterior. Culturas de bactérias e fungos podem ser recomendadas, e agentes antifúngicos podem ser acrescentados a esquemas de tratamento de pacientes com otite externa.