Lower Urinary Tract Reconstruction for Ectopic Ureterocele: What Happens in the Long-term Follow-up?

BACKGROUND: We aimed to analyze the long-term clinical and lower urinary tract function outcomes in children with duplex system ectopic ureterocele who underwent ureteroneocystostomy and ureterocelectomy. METHODS: Fifty-one patients (28 females, 23 males) who underwent a series of surgical interventions including lower urinary tract reconstruction in childhood for duplex system ectopic ureterocele in our center between 1998 and 2019, were retrospectively reviewed. The demographic and clinical data, surgical history, and the indication for ureterocelectomy were noted. Lower urinary tract dysfunction (LUTD) status was assessed through dysfunctional voiding symptom scores (DVSS) and uroflowmetry in all patients at the last follow-up. The clinical outcomes, and LUTD were evaluated. RESULTS: At the last visit at a mean follow-up of 117.18 ± 57.87 months after ureterocelectomy, ipsilateral persistent lower pole VUR was detected in 5.6% (3/54 renal units, 2 females and 1 male) of the cases, who were treated using the subureteric injection. Abnormal DVSS (median 11, range 9-15) was detected in 27.4% (14/51 pts) of the patients. Out of these, 57.1% (8/14 pts) had storage symptoms, 35.7% (5/14 pts) had voiding symptoms, and 7.1% (1/14 pts) had both storage and voiding symptoms while 71.4%(10/14 pts) had abnormal uroflowmetry findings (plateau shaped flow curve in 2, staccato shaped curve with sustained EMG activity in 3, tower shaped curve in 2, interrupted shaped curve in 3 patients). Five patients had elevated residual volume. Anticholinergics were administered to six patients who had overactive bladder symptoms. In addition, two girls required open bladder neck reconstruction due to stress incontinence caused by bladder neck insufficiency. CONCLUSIONS: Our findings showed that clinical success was achieved using the lower urinary tract reconstruction with no need for re-operation in 90.2% of patients with duplex system ectopic ureterocele. However, LUTD was present in 27.4% of our patients in the long-term follow-up. Therefore, LUTD should be carefully assessed in the long-term follow-up of these patients.

Salicylic acid alleviates the effects of cadmium and drought stress by regulating water status, ions, and antioxidant defense in Pterocarya fraxinifolia.

Introduction: Pterocarya fraxinifolia (Poiret) Spach (Caucasian wingnut, Juglandaceae) is a relict tree species, and little is known about its tolerance to abiotic stress factors, including drought stress and heavy metal toxicity. In addition, salicylic acid (SA) has been shown to have a pivotal role in plant responses to biotic and abiotic stresses. Methods: The current study is focused on evaluating the impact of foliar application of SA in mediating Caucasian wingnut physiological and biochemical responses, including growth, relative water content (RWC), osmotic potential (Ψs), quantum yield (Fv/Fm), electrolyte leakage, lipid peroxidation, hydrogen peroxide, and antioxidant enzymes, to cadmium (Cd; 100 µM) and drought stress, as well as their interaction. Moreover, the antioxidant activity (e.g., ascorbate peroxidase, catalase, glutathione reductase, peroxidase, and superoxide dismutase activities) of the stressed trees was investigated. The study was conducted on 6-month-old seedlings under controlled environmental conditions in a greenhouse for 3 weeks. Results and discussion: Leaf length, RWC, Ψs, and Fv/Fm were decreased under all treatments, although the effect of drought stress was the most pronounced. An efficient antioxidant defense mechanism was detected in Caucasian wingnut. Moreover, SA-treated Caucasian wingnut plants had lower lipid peroxidation, as one of the indicators of oxidative stress, when compared to non-SA-treated groups, suggesting the tolerance of this plant to Cd stress, drought stress, and their combination. Cadmium and drought stress also changed the ion concentrations in Caucasian wingnut, causing excessive accumulation of Cd in leaves. These results highlight the beneficial function of SA in reducing the negative effects of Cd and drought stress on Caucasian wingnut plants.

Does pre-fellowship experience alter success rates of endoscopic treatment of vesicoureteral reflux during pediatric urology fellowship?

INTRODUCTION: Learning curve is a well-known factor that affects the success rate of endoscopic injection for vesicoureteral reflux (VUR). OBJECTIVE: To our knowledge, the significance of pre-fellowship training has not been studied. In the present study, our aim was to investigate the effect of pre-fellowship training on the endoscopic treatment success rates of pediatric urology fellows. DESIGN: A total of 78 patients aged 2-16 years (132 renal units) who underwent subureteric injection for the treatment of primary VUR by four pediatric urology fellows between 2014 and 2020 were retrospectively evaluated. Fellows were grouped into two as experienced and non-experienced according to the presence of pre-fellowship experience (defined as a minimum of 20 procedures). Patients in both groups were divided into two subgroups as non-dilating (grade I-II) and dilating VUR (grade III-V). Also, the change in success rate throughout the fellowship was analyzed. HIT or Double HIT method was used in all interventions. RESULTS: Experienced fellows carried out subureteric injection in 54 (40.9%) renal units while non-experienced fellows performed in 78 (59.1%). There was no success rate difference between experienced and non-experienced fellow groups in non-dilating VUR (100% vs. 88%, respectively p = 0.268), whereas the success rate of the experienced group was significantly higher in dilated VUR (78.9% vs. 50.9%, p = 0.006). Moreover, the amount of material used in the treatment of non-dilating VUR were similar between two fellow groups (0.6 ml vs. 0.6 ml, p = 0.500), while experienced group achieved higher success rates in dilating VUR by statistically significant less amount of injected volume (0.7 ml vs. 0.9 ml, p = 0.026).Overall complete VUR resolution rates were similar throughout the fellowship period in the experienced fellows (81.5% vs. 88.9%, p = 0.444), while it significantly increased in the non-experienced group implicating the completion of the learning curve (51.3% vs. 74.4%, p = 0.035). DISCUSSION: There has been no published reports on the effect of pre-fellowship experience on subureteric injection success. While many researchers reported on the importance of learning curve, various studies assessed the effect of injected volume on success rate implicating contradictory results. Furthermore, others indicated that the ideal technique providing accurate needle placement and obtaining proper depth during injection which is associated with surgical experience is more important than the injected volume in achieving success. CONCLUSION: Our results implicate that similar success rates in non-dilating VUR can be achieved regardless of previous subureteric injection training. However, higher failure rates may be expected when the procedures are performed by non-experienced pediatric urology fellows at the beginning of their fellowship in dilating VUR.

Effects of systemic androgens on late-stage urethral wound healing: An animal study.

BACKGROUND: There are limited data regarding the effects of systemic androgens on late-stage urethral wound healing. OBJECTIVE: To evaluate the effects of systemic androgens on fibrosis and scar formation in late-stage urethral wound healing. MATERIALS AND METHODS: Forty-five male Sprague Dawley rats were divided into three groups. First group consisted of 15 rats that were castrated on 23 days of age and were given 5 mg/kg testosterone undecanoate with 1/25 ml cottonseed oil intraperitoneally at weekly intervals for 3 weeks (castrated and replaced with testosterone rats [CAS+T] group). The castrated rats (CAS) group included 15 castrated rats. The remaining 15 rats underwent sham surgery. CAS and sham groups also received 1/25 ml cottonseed oil intraperitoneally at weekly intervals for 3 weeks. Furthermore, all groups were divided into three subgroups after testosterone/placebo administration (urethroplasty performed after first, second, and third weeks) in accordance with the urethroplasty timing. All animals were sacrificed 6 weeks after urethroplasty. Serum testosterone level was measured, tissue samples were investigated using hematoxylin and eosin and Masson's trichrome. Alpha-SMA, Coll 1 and Coll 3 primary antibodies were applied for immunohistochemical examination. Expression of cytokines and growth factors, such as Bax, Bcl2, IL-10, IP-10, TNF-alpha, TGFb1, MMP9, Col-I, Col-III, TIMP-1, fibronectin, fibroblast growth factor 10, platelet-derived growth factor, alpha-SMA, were also evaluated in the tissues. RESULTS: The blood testosterone levels were significantly higher in CAS+T group at the time of urethroplasty compared with the levels in CAS group; however, this difference was not observed at the time of sacrification (p < 0.001 and 0.97, respectively). Histological analysis with hematoxylin and eosin and Masson's trichrome staining revealed a significantly higher fibrosis in the sham group compared with the others. Significantly lower fibrosis was detected in the CAS group in the pairwise comparison of the pathological fibrosis area between the CAS and CAS+T groups (p < 0.001). Furthermore, tissue collagen-1, collagen-3, and alpha-SMA expression levels were statistically different between CAS and CAS+T groups (p < 0.001, <0.05, and <0.001, respectively). The tissue levels of BAX, TIM-1, MMP-9, Coll-I, Coll-III, TGF-beta, TNF-alpha, and IL-10 mRNA expressions in the CAS+T group were different than the levels in CAS group (as <0.5-fold and >1.5-fold changes, respectively). The expressions of all these markers were significantly higher in the sham group. The subgroup analysis of CAS+T group (urethroplasty performed after first, second, and third weeks) revealed similar histopathological wound healing findings. DISCUSSION: Debate continues on the effects and benefits of androgen use regarding urethral healing. There are two main routes for administration as systemic or local. This study focuses on the late-stage histologic and biochemical effects of systemic androgens. CONCLUSION: Systemic androgens adversely affect wound healing and cause abnormal extracellular matrix as well as scar formation.

Synthesis of modified nanocomposite material and its use on removal of cesium from aqueous media.

A nanocomposite containing Fe3O4, chitosan (Ch), and hexacyanoferrate (HCF) was synthesized in the form of powder. The physicochemical properties of this nanocomposite are determined using different techniques including Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), scanning electron microscopy (SEM). The existence of Cs (Cs) ions onto the surface of the nanocomposite was verified by dispersive X-ray spectroscopy (EDX). FTIR spectra confirmed that the nanocomposite was well coordinated. The batch technique was applied to evaluate the influences of initial pH value, temperature, contact time, shaking rate, initial Cs concentration, and competing cations on the efficiency of Cs removal. The maximum adsorption capacity for Cs ions of nanocomposite was determined as 34.36 mg/g at the initial pH = 5 of the aqueous solution. The equilibrium data fitted well the linearized Langmuir isotherm equation, which has the higher correlation coefficient (0.999). Thermodynamic parameters such as free energy (ΔG°), enthalpy (ΔH°), and entropy (ΔS°) indicated that the adsorption was exothermic and not spontaneous.

Prenatal diagnosis and outcome of unilateral multicystic kidney.

We reviewed the records of 144 patients. The mean gestational age at first US diagnosis was 27.5 ± 4.3 weeks. An anomaly of the contralateral kidney was detected in 25% of cases. An extrarenal anomaly was detected in 13.8%. Karyotype analysis was performed in 16.6% of cases and revealed trisomy 18 in 2 cases with extrarenal defects. Karyotype analysis was normal in all the patients who had isolated multicystic dysplastic kidney (MCDK). The diagnostic accuracy of prenatal ultrasound was 92.2%. Contralateral kidney anomaly was detected 33.9% of patients, and half of these were vesicoureteral reflux. Antihypertensive therapy was required in 2.6% of cases. Nephrectomy was performed in 8%, and partial or total involution of MCDK was achieved in 33.9% of patients. MCDK can be accurately diagnosed by prenatal sonography, and prognosis depends on extrarenal and contralateral renal abnormalities. In isolated cases, require of surgery is rare, and serial follow-up is suggested to determine involution.Impact statementWhat is already known on this subject? Multicystic dysplastic kidney (MCDK) is one of the most renal anomalies and is associated with numerous renal and extrarenal abnormalities. It can lead to severe consequences in the neonatal period.What do the results of this study add? The accuracy of prenatal ultrasonography is excellent for detecting MCDK. In isolated unilateral cases, chromosomal aberrations are low, and the majority of them involute spontaneously. A periodic follow-up of the contralateral kidney is mandatory due to an increased risk of an anomaly. Genital anomaly risk is increased in males.What are the implications of these findings for clinical practice and/or further research? Detailed evaluation and follow-up of the contralateral kidney are crucial for counselling in isolated cases. Karyotype analysis in isolated unilateral MCDK is debateable. Postnatal prognosis is encountering, and the majority of patients have no requirement of surgery.

An adolescent girl with obstructive uropathy requiring nephro-ureterectomy was subsequently diagnosed with renal tuberculosis: case report.

A 15-year-old girl was followed up for 2 years in a district hospital for management of vesicoureteral reflux and, subsequently, hydronephrosis of both kidneys and required bilateral ureteroneocystostomy. Despite surgery, there was continuous progression of the left hydronephrosis. Referral to a tertiary hospital because of continued sterile pyuria prompted investigation for tuberculosis (TB): she was diagnosed with bilateral pulmonary TB and urine culture confirmed Mycobacterium tuberculosis. Despite tuberculous chemotherapy and dexamethasone, she required a left nephrectomy. Histology demonstrated necrotising granulomatous pyelonephritis. She remains well with normal function of the right kidney. Despite the rarity, chronic urinary tract disorders should always prompt investigation for tuberculosis.

Renal, Bladder and Sexual Outcomes in Adult Men with History of Posterior Urethral Valves Treated in Childhood.

OBJECTIVE: To determine the adulthood outcomes of bladder, kidney, and sexual functions of posterior urethral valve (PUV) patients. MATERIALS AND METHODS: The records of patients who were treated for PUV between 1980, and 2001 and aged ≥18 years by the end of 2019 were retrospectively reviewed. Patients with complete adulthood data were included in the study. Renal, bladder, and sexual functions were assessed. Adulthood uroflowmetry results of 22 patients were also evaluated. RESULTS: Thirty-nine patients with complete adulthood data out of 89 were included. The median follow-up time was 22.7 years (15-33 years). Median age at initial surgery for PUV was 36 months (1-168 months), and median age at last follow-up was 26 years (18-46 years). Lower urinary tract dysfunction was noted in 15 (38%) patients. In 22 patients (56%) with uroflowmetric analyses, median values of Qmax, voided volume, and post voiding residual urine volume were 20.5 mL/sec (7-43 mL/sec), 389 mL (154-1750 mL), and 18.5 mL (range 0-190 mL), respectively. Nineteen patients (48.7%) had normal glomerular filtration rate, 2 patients (5.1%) had chronic kidney disease, and the remaining 18 patients (46.1%) had end stage renal disease, 14 (35.9%) of whom underwent renal transplantation. Thirty-two patients (82%) had sexual function evaluation, none of which reported erectile dysfunction. However, 4 patients (12.5%) reported slow ejaculation. Five patients fathered a child whereas infertility was observed in 2 patients. CONCLUSION: After 2 decades, glomerular filtration rate was normal almost in half of the PUV patients while lower urinary tract dysfunction was detected in 38%. Furthermore, erectile dysfunction was rare.

Can urinary biomarkers detect obstruction defined by renal functional loss in antenatal hydronephrosis?

INTRODUCTION: Diagnosing obstruction and thus, assessment of need for surgery in the management of antenatal hydronephrosis may be challenging. Current diagnostic tests are not capable of indicating which patients are at risk for obstructive nephropathy. Biomarkers may play an important role in distinguishing these patients. OBJECTIVE: The aim of this study is to evaluate if urinary biomarkers could differentiate obstruction (OBS) from non-obstructive dilation (NOD) in patients with antenatal hydronephrosis (AH) that underwent pyeloplasty due to loss of differential renal function (DRF). STUDY DESIGN: Children with a history of AH and postnatal anteroposterior (AP) diameter ≥15 mm were included in this study of prospectively collected data between 2010 and 2018. The OBS group included patients who underwent pyeloplasty due to solely ≥10% subsequent decrease in DRF on a MAG-3 scan during follow-up. Patients with stable or improving hydronephrosis with no significant reduction in ipsilateral DRF (<10%) during follow-up formed the NOD group. Healthy children with no history of AH and a normal urinary ultrasound were taken as the control group. Urinary IP-10, MCP-1, KIM-1, NGAL, and Ca19-9 levels using ELISA were measured. In the OBS group, urine samples were obtained preoperatively and at 3rd post operative-month whereas in the NOD and control groups, samples were collected at the time of enrollment. RESULTS: There were 24 children in the OBS and 27 children in the NOD groups. The control group consisted of 27 healthy children. The pre-operative bladder urine levels of biomarkers of the OBS group were significantly higher than in the NOD and control group (p < 0.05, for all). In terms of differentiating OBS from NOD, results of ROC analyses for the given cut-off values were as follows: 135.06 ng/mgCr (sensitivity 75%; specificity 66%, AUC = 0.735) for IP-10, 0.89 ng/mgCr (sensitivity 79.2%; specificity 88%, AUC = 0.802) for KIM-1, 367.65 pg/mgCr (sensitivity 62.5%; specificity 52%, AUC = 0.660) for MCP-1, 16.15 ng/mgCr (sensitivity 70.8%; specificity 70.4%, AUC = 0.669) for NGAL, and 55.5 U/mgCr (sensitivity 75%; specificity 66%, AUC = 0.676) for Ca 19-9. Moreover, when KIM-1 was combined with IP-10 and Ca19-9, sensitivity and specificity levels were 83% and 85% (AUC = 0.919), respectively. CONCLUSION: In this novel study, which focused on scintigraphic DRF loss, KIM-1 was the most successful among all the biomarkers evaluated. Combination of IP-10, Ca19-9 and KIM-1 resulted increased diagnostic ability.

What predicts spontaneous passage of ≤1 cm ureteral stones in children?

PURPOSE: The aim of this study is to determine what factors predict spontaneous passage of ≤1 cm ureteral stones in children. METHODS: Files of the patients diagnosed with a single ureteral stone on a given side between 2008 and 2017 were retrospectively reviewed. Patients with congenital obstructive uropathy, neurogenic bladder, vesicoureteral reflux and those with a stone diameter of >1 cm were excluded. Detection of ureteral stones was done using ultrasonography (US) primarily, and computed tomography when US findings were inconclusive. Patients were treated either conservatively or surgically. Conservative treatment included adequate hydration and pain management whereas surgical treatment included ureteroscopic intervention. Apart from those who required urgent intervention, patients were referred for surgical treatment after 2-4 weeks of follow-up with no spontaneous passage. Factors analyzed for association of spontaneous passage included age, gender, type of hematuria, stone localization, laterality, presence of concomitant kidney stone, degree of hydronephrosis, stone size and stone composition. RESULTS: A total of 70 patients (38 males, 32 females); median age 4.7 years had a ≤ 1 cm ureteral stone (median diameter 7 mm). US was able to diagnose the ureteric stone in 47 patients while computed tomography was required in 23 patients. Spontaneous passage was observed in 40 patients (57.1%). Median time for stone passage was 8 days (3-34 days). Stone size and presence of hematuria (macroscopic and microscopic combined) were factors associated with spontaneous passage and 6.7 mm was found to be the cut-off (AUC = 0.953; 95% CI 0.905-1.000; sensitivity 96.7%, specificity 82.5%, p < 0.001). Moreover, age, degree of hydronephrosis or stone location were not associated with spontaneous passage. CONCLUSION: Patients with a ureteric stone size <6.7 mm can safely be followed conservatively, with a spontaneous passage rate of 82.5%. Type of Study Case series with no comparison group. Level of Evidence IV.

Antenatally detected ureterocele: Associated anomalies and postnatal prognosis.

OBJECTIVE: We purposed to review prenatal diagnoses of ureterocele, to determine the sonographic findings and additional abnormalities, and to illustrate the pregnancy outcomes of these patients. MATERIAL AND METHODS: We reviewed the records of 24 patients with the diagnosis of ureterocele in our referral center between January 2010-March 2017. Prenatal sonographic findings, antenatal course, and postnatal follow-up were obtained. RESULTS: The mean gestational age at first US diagnosis was 24.5 ± 2.9 weeks. 13 (54.1%) of fetuses were female, and 11 (45.9%) were male. Ureterocele was associated with the duplex kidney in 17 (70.8%), MCDK in 5 (20.8%) and hydronephrosis with a single system in 1 (4.2%) and pelvic kidney in 1 (4.2%) fetuses. Postnatal follow-up was achieved in 22 of 24 (91.6%) cases, and mean follow-up interval was 56 ± 14.2. Months. The diagnosis of ureterocele was confirmed in 22 (91.6%) cases postnatally. 15 of 22 (68%) cases were classified as extravesical ureterocele, and 7 (32%) cases were intravesical ureterocele. Postnatal confirmation of duplex kidney achieved in 16 of 17 (94.1%) patients. 17 (77.2%) patients were required surgical intervention, and 5 (22.8%) cases were managed conservatively. 15 of 16 (93.7%) cases who were diagnosed duplex kidney underwent surgery however 2 of 5 (40%) cases which were confirmed MCDK required an operation. Cystoscopic ureterocele incision was the initial approach for the surgical management and performed all of the cases which required surgery. It was curative in 10 of 17 (58.8%) patients and 7 (41.2%) cases needed to further operations. Ureteroselectomy and common-sheath ureteroneocystostomy was performed in 5 (29.1%) cases and. 2 (%11.7%) cases underwent partial nephrectomy. CONCLUSION: Ureterocele can be accurately diagnosed by prenatal sonography, and it is a significant clue for the diagnosis of a duplex kidney. Postnatal prognosis depends on associated anomaly and presence of reflux and upper pole function.

Experimental arid land afforestation in Central Anatolia, Turkey.

The afforestation of arid lands faces many challenges, and perhaps the most important key for success is choosing one or more species that are adapted well for local environmental conditions. We explored species that would be suitable for the steppe region of Central Anatolia. Intensive site preparation included ripping the subsoil (to 80 cm) and plowing the upper soil before planting seedlings of Elaeagnus angustifolia, Robinia pseudoacacia, Fraxinus angustifolia, and Pinus nigra were used as tree species. We also tested the success of several shrub species: Amygdalus orientalis, Calligonum polygonoides, and Spartium junceum. After five growing seasons, E. angustifolia showed the highest survival, with 80% of planted seedlings remaining. For the shrubs, A. orientalis was the most successful species with a 95% survival rate. Broad-leaved trees grew a cumulative average of 34 cm in height in 5 years, whereas P. nigra seedings grew only 9 cm. The greatest height growth occurred in the shrubs, with A. orientalis gaining 40 cm in height in 5 years. Overall, E. angustifolia and A. orientalis appeared best suited for afforestation in these areas. R. pseodoacacia and F. angustifolia may also be used as alternative species.

Shear wave elastography evaluation in pediatric testicular microlithiasis: a comparative study.

PURPOSE: The aim of this study was to evaluate the testicular parenchyma in pediatric patients with testicular microlithiasis by shear wave elastography (SWE) and compare the values with normal control subjects. METHODS: Twenty-three patients previously diagnosed with testicular microlithiasis under follow-up for 20 ± 11 months were included in the study group. In the control group, 31 patients with no medical history that could affect testicular tissue were prospectively included. Forty-six testes in the study group and 62 testes in the control group were evaluated with gray-scale ultrasound and SWE. RESULTS: There were no differences in age and testes volume between the study and control groups. The mean SWE values of all testes based on elasticity and speed parameters in the study group were 8.84 ± 2.86 kPa and 1.66 ± 0.26 m/s, respectively. In the control group, mean SWE values were 5.26 ± 1.17 kPa and 1.31 ± 0.14 m/s, respectively. Elasticity values were significantly higher in testes with microlithiasis as compared with the control group (p < 0.001). CONCLUSIONS: SWE evaluation demonstrates the effects of ultrastructural changes in elasticity that are not detected on gray-scale ultrasound. SWE is a more reliable method in follow-up examinations for pediatric testicular microlithiasis.

Olfactory and Gustatory Functions after Anterior Palatoplasty in Patients with Primary Snoring.

OBJECTIVE: In this study, we investigated the chemical senses (namely, olfaction), the 4 basic tastes, and umami taste in patients who underwent anterior palatoplasty (AP) for primary snoring. STUDY DESIGN: Prospective clinical study. SETTING: Multicenter, tertiary care hospitals. SUBJECTS AND METHODS: The age range of the 28 participants was 22 to 47 years, and all had been diagnosed with primary snoring by polysomnography. Orthonasal and retronasal olfactory testing was performed using the respective "Sniffin' Sticks." Tests for the 4 basic tastes (sweet, sour, salty, and bitter) and umami were performed before and 6 months after AP. RESULTS: The changes between the preoperative and postoperative results for the 4 basic tastes, which were applied to the anterior tongue region, were not significant. Retronasal olfactory function improved significantly 6 months after AP (P = .007). After AP, umami scores for the soft palate but not those of the anterior and posterior tongue decreased significantly (P = .001). CONCLUSION: Patients scheduled for AP should be properly informed about potential postoperative taste and flavor changes. They should also be warned of a possible loss of appetite due to a postoperative decrease in the umami taste sensation of the soft palate.

Sudden hearing loss associated with methylphenidate therapy.

An 8-year-old child diagnosed with attention deficit/hyperactivity disorder presented to our Department of Otolaryngology 4 days after suffering hearing loss, loss of balance, tinnitus, and fullness sensation of the left ear. Her symptoms occured with the first dose of methylphenidate. The medical history and physical examination revealed no other diseases associated with sudden hearing loss. The audiogram revealed a total hearing loss on the left ear. Stapedial reflexes, distortion product and transient-evoked otoacoustic emissions were absent in left ear. The absence of clinical, laboratory and radiological evidence of a possible cause for complaints, an association between methylphenidate and sudden hearing loss was suggested. The patient received a standard course of oral corticosteroid and hyperbaric oxygen therapy. Weekly otological and audiological examinations were performed. Conservative and medical treatments offered no relief from hearing loss. Sudden hearing loss is a serious and irreversible adverse effect of methylphenidate. Therefore, the risk of hearing loss should be taken into consideration when initiating methylphenidate therapy.

The course of the marginal mandibular branch of the facial nerve in adult cadavers. An anatomic study.

OBJECTIVE: To observe the course of the marginal mandibular branch of the facial nerve (MMBFN) and its relation to the inferior border of the mandible and facial vessels. METHODS: This cadaveric study was conducted at the Department of Anatomy, Gulhane Military Medical Academy, Ankara, Turkey from April to September 2012. The 44 facial halves of 22 adult cadavers were dissected under a stereomicroscope. RESULTS: The nerve was found to be presented by one branch (36.4%), and 2 branches (63.6%). The distance of the nerve from the inferior border of the mandible varied from 13.06-40.08 mm, with an average distance of 21.91 mm. There were communications with buccal branch only in 2 specimens (4.6%). All the branches of the marginal mandibular branch ran laterally to the facial artery in 43 (97.7%) of the 44 specimens. In one specimen, the 2 marginal mandibular branches ran between the facial artery and vein. CONCLUSION: The MMBFN can occasionally be damaged during surgeries confined to the submandibular region due to its location and anatomical variant. The most common pattern of MMBFN was nerve with 2 branches. The maximum distance between the MMBFN and the mandible was 40.08 mm. This anatomical knowledge may be useful to surgeons of the head and neck in planning incisions and procedures in the submandibular region.

Comparison of uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty and cautery-assisted uvulopalatoplasty in the treatment of primary snoring.

OBJECTIVE: Our aim was to compare the postoperative pain and surgical results of uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP), and cautery-assisted uvulopalatoplasty (CAUP) procedures in the treatment of primary snoring. METHODS: 54 patients were stratified according to a modified Friedman staging system (MFSS) for sleep-disordered breathing. Tonsil size (1, 2, 3) and palatal position scale (grade 1-2) and body mass index <30 according to the MFSS were included for standardization. Three workgroups consisting of 18 patients each were formed and UPPP, LAUP and CAUP procedures were performed. The success of the surgical procedures was evaluated by applying the Epworth Sleepiness Scale to the patients, and the patients' bed partners were asked to evaluate the snoring level preoperative and 45 days after the operation to determine any improvement in snoring complaints. Patients were followed for postoperative pain, secondary infection, bleeding, permanent velopharyngeal insufficiency and nasopharyngeal stenosis. RESULTS: Snoring was relieved in 83.3% of UPPP and CAUP groups and in 88.8% of LAUP 45 days after operation. The mean pain duration was 5.71 days for the UPPP patients, 6.28 days for the LAUP patients and, 4.12 days for the CAUP patients. The mean pain score was 2.1 for the UPPP patients, 2.38 for the LAUP patients, and 1.6 for the CAUP patients. Only 1 patient was hospitalized due to pain in the LAUP group. CONCLUSION: The effectiveness of UPPP, LAUP and CAUP procedures were found to be similar (more than 83%). Postoperative pain was mostly seen in LAUP and UPPP cases. The CAUP procedure was easy and the least painful.