Predictive role of trigeminal ganglion ischemia on scalp survival affected by temporal artery diameters: The first experimental study.

Scalp arteries are mainly innervated by trigeminal, facial, and vagal nerves. The ischemic neurodegeneration of the trigeminal ganglion can impede scalp circulation via vasospasm-creating effects. This study was designed to investigate whether there is any link between the vasospasm index of deep temporal arteries and ischemic neuron densities of the trigeminal ganglion after subarachnoid hemorrhage. The study subjects included five normal control rabbits, six sham rabbits, and nine rabbits chosen from a formerly established experimental subarachnoid hemorrhage group created by cisternal homologous blood injection (0.75 mL). These rabbits, all male, were followed up for 3 weeks. The trigeminal ganglion and deep temporal artery vasospasm indexes were examined by stereological methods. Ischemic neuron densities of the trigeminal ganglion and vasospasm index values of deep temporal arteries were compared statistically. Postmortem examinations showed important vasospasms of deep temporal arteries, foramen magnum herniations, and neurodegeneration of the trigeminal ganglion. The mean vasospasm index values and degenerated neuron densities of the trigeminal ganglion were determined as 1.03 ± 0.13 and 10 ± 3/mm3 (p > 0.5) in the control group, 1.21 ± 0.18 and 35 ± 9/mm3 in the sham group (p < 0.005 for sham vs. control), and 2.54 ± 0.84 and 698 ± 134/mm3 in the experimental group (p < 0.0005 for sham vs. control and p < 0.00001 for study vs. control). There was an inverse relationship between the vasospasm index values and the degenerated neuronal density of the trigeminal ganglion. The high degenerated neuron density in the trigeminal ganglion had a facilitative effect on temporal artery vasospasm. Trigeminal ganglion neurodegeneration may promote temporal artery vasospasms after subarachnoid hemorrhage, which has not been previously mentioned in the literature.

Effect of thyroidectomy in patients with tracheal compression.

OBJECTIVE: Various therapeutic methods are employed to reduce thyroid gland compression of the trachea. Differences in the amount of shrinkage in the thyroid gland, in the amount of amelioration of tracheal compression, and in the amount of fibrosis after treatment may occur with these different methods. Although the compression of the trachea decreases after thyroidectomy, the number of studies showing the extent of this is limited. The purpose of this study was to investigate the effect of thyroidectomy performed due to tracheal compression, to reveal the extent of improvement using magnetic resonance imaging (MRI), and to evaluate our results. METHODS: In total, 30 patients, i.e., 24 women and 6 men, with tracheal compression secondary to thyroid gland enlargement and undergoing total thyroidectomy were included in this study. MRI performed before surgery and 6 months after surgery. The amount of deviation from the tracheal midline and the tracheal lateral and anteroposterior (AP) diameters were measured, compared, and subjected to statistical analysis. RESULTS: Statistical analysis revealed significant differences between pre- and postoperative tracheal deviations, and lateral and AP diameters (p<0.001, p<0.001, and p=0.006, respectively). Histopathologically, benign or malignant pathology caused no significant difference in the postoperative improvement of tracheal anatomy (p=0.348 and p=0.148, respectively). CONCLUSIONS: Thyroidectomy performed due to tracheal compression provides significant improvement in tracheal anatomy. Due to its rapid and effective results, thyroidectomy should be one of the first options considered in the treatment of thyroid diseases with compression findings.

Comparison of the effects of articaine, tetracaine, and lidocaine application on pain and hemorrhage during and after nasal pack removal.

OBJECTIVE: We purposed to compare the effects of certain local anesthetic applications on pain and hemorrhage caused by nasal pack removal. METHODS: Design: Prospective, placebo-controlled study. Setting: Ataturk University Medical Faculty Hospital. This study was done in 90 patients who applied nasal packing after septoplasty. All patients were divided randomly into four groups. Each group was applied 2% lidocaine, 2% tetracaine, 4% articaine or 0.9% sodium chloride (NaCl) into their Merocel packs 15 min before removing. Verbal analog scale (VAS) score was registered from all patients, and the amount of hemorrhage was noted during the removal of the nasal packs and then for 30 min. RESULTS: The study groups had significantly better pain scores than the control group during nasal pack removal and after 5 min (p<0.001). The articaine and the lidocaine groups had also better pain scores than the control group at 15th min after the removal of the nasal packs (p<0.05), but the tetracaine group had no better pain scores than the control group, which is statistically significant at p>0.05. Analysis of bleeding scores after the removal of packs showed that the articaine and the lidocaine groups had better bleeding scores than the control group (p<0.004 and p<0.033, respectively). CONCLUSION: Topical articaine application into nasal packs just before removing in the patients who underwent septoplasty can be safely used for less pain, less hemorrhage, and more patient tolerance.

Assessing the Learning Process of Laparoscopic Sleeve Gastrectomy with Different Approaches.

OBJECTIVE:  To determine the learning curve (LC) of laparoscopic sleeve gastrectomy (LSG) based on an excess weight loss (EWL). STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Ondokuz Mayis University, Faculty of Medicine, Department of General Surgery, from December 2012 to April 2018. METHODOLOGY: Data of patients, who were admitted to the general surgery clinic of a tertiary care hospital and underwent LSG, were retrospectively analysed. Three hundred and twenty-five patients, who had completed at least three months of follow-up after their operations, were included in the study. Patients were divided into three groups according to the number of cases in which the lowest expected EWL values were achieved in the postoperative 3, 6, 12 and 24 months as per literature. Comorbidities, complications, duration of surgery and hospital stay were also evaluated in these groups. RESULTS: The groups were homogeneous in terms of age and body mass index. Group 3 had a significantly higher median EWL when compared to the other two groups (p <0.001). There was a statistically significant difference between Group 2 and Group 3 in terms of diabetes mellitus and remission of thyroid function tests (p = 0.013 and p=0.017, respectively). There were 40 minutes difference in operating time and two-day difference in hospital stay between the median values of Group 1 and Group 3 (p <0.001). CONCLUSION: LSG can be safely performed even in centres that have just started bariatric/metabolic surgical operations. Although proficiency seems to require at least 40 cases, more than 80 operations are needed to complete the LC and achieve ideal results. Key Words: Bariatric surgery, Learning curve, Metabolic surgery, Laparoscopic sleeve gastrectomy (LSG).

Comparision of Hem-o-lok polymeric clip and tri-staple in laparoscopic splenectomy.

AIM: This study aimed to compare the hem-o-lok polymeric clip (HC) and tri-staple (TS) methods used in dividing the splenic hilum in terms of results, and to reveal their superiority to each other. MATERIAL AND METHODS: Medical records of patients undergoing elective laparoscopic splenectomy at the Ondokuz Mayis University Faculty of Medicine General Surgery Clinic between March 2011 and March 2020 were retrospectively analyzed. Forty-two laparoscopic splenectomy cases performed using hem-o-lok polymeric clip (HC) or tri-staple (TS) were included in this study. Demographic features, primary diagnoses, splenic size, intraoperative data and postoperative complications, as well as the clip and stapler prices used in the surgery were analyzed. RESULTS: The mean operative time was significantly longer for HC group than TS group (116.7 min vs. 87.6 min, p<0.05). The mean cost of surgical instruments used to divide the splenic hilum was significantly lower for HC group than TS group (34.1 usd vs. 165.4 usd, p<0.05). There was no postoperative mortality, with a morbidity rate 6 (26.1%) for TS group and 4 (21.1%) for HC group (p>0.05). No significant difference existed in the complication rates. CONCLUSIONS: In the HC group, the operation time was longer, but the surgical cost was significantly lower. There was no significant difference when comparing other perioperative results. Although both techniques can be applied safely, we would like to emphasize that hemostasis is the most important factor for good results. KEY WORDS: Hem-o-lok polymeric clip, Laparoscopic splenectomy, Tri-staple.

Substernal Goiter with Carinal Involvement Presenting as Mediastinal Mass / Bocio subesternal con afectación carinal que se presenta como masa mediastínica

No disponible

Magnetic Resonance Imaging Features of Collet-Sicard Syndrome Associated With Glomus Jugulare Paraganglioma.

Collet-Sicard syndrome is an unusual disorder. The authors here demonstrated the Magnetic resonance (MR) imaging findings of the Collet-Sicard syndrome associated with glomus jugulare tumor. Neoplastic or non-neoplastic lesion of skull base can cause Collet-Sicard syndrome. MR imaging can be used successfully to demonstrate the etiology of this syndrome.

Which Surgical Method is Superior for the Treatment of Parotid Tumor? Is it Classical? Is it New?

OBJECTIVE: We aimed to compare the incidence of parotid tumors seen in our region in the last ten years with the literature values and to compare the recently proposed new parotidectomy methods with classical parotidectomy methods which we applied for ten years. MATERIALS AND METHODS: 37 females and 36 males total 73 patients who made parotidectomy between 2008 and 2018 were included in the study. The patients age, sex, histopathological diagnosis, surgical methods applied to malignant or benign tumors and side of the disease were recorded. Histopathological results and the results of surgical methods applied were compared with literature. RESULTS: The mean age of the 73 patients underwent parotidectomy was 54±34. Of the cases, 57 (78%) cases were benign and 16 (22%) were malignant. Histopathologically benign masses were found 3.5 time more common than malignant masses. The sides of diseases were observed at the near rates (right, left; 52%, 48%, respectively). The most often detected benign neoplasm was pleomorphic adenoma with 42 (74%) cases. The most often detected malignant neoplasm was mucoepidermoid carcinoma with 6 (43%) cases. As surgical method, superficial parotidectomy was applied to 64 (88%) patients, total parotidectomy to 9 (12%) patients and the neck dissection to 7 (10%) patients. CONCLUSION: We recommend that to be applied the superficial parotidectomy as the smallest procedure to be performed in the surgery of parotid tumors and to be avoided from partial superficial parotidectomies. In short, we advocate to classical methods for the parotid tumor surgery.

Effect of Prostaglandin E1 Analog Misoprostol in An Ovalbumin-Induced Allergic Rhinitis Model.

OBJECTIVE: The aim of the present study was to demonstrate the effects of misoprostol in ovalbumin-induced allergic rhinitis (AR). The second purpose was to compare the effect profile of the combination of an antihistamine with misoprostol during treatment of AR. MATERIALS AND METHODS: Twenty-five adult male rats were used and were randomly classified into five groups (n=5): healthy+saline, AR, AR and desloratadine (D)-treated group, AR and misoprostol (M)-treated group, and AR and combined-treated group. RESULTS: Desloratadine administration had significantly lower nasal symptoms than the AR group, but nasal symptoms in the AR+M group were better than those in the AR+D group. The best improvement in serum IgE levels was seen in the misoprostol alone and combination treatment groups. CONCLUSION: We suggest that prostaglandins should be considered in the treatment of AR, and that the effects of these types of drugs should be tested clinically in patients.

A novel surgical technique: Crushed septal cartilage graft application in endonasal septoplasty.

OBJECTIVE: Nowadays, different septoplasty procedures are applied for therapy of nasal septum deviation. However, various complications of the septoplasty procedures have been described. Several techniques have been developed to decrease the incidence of these complications by surgeons. We aimed to present the effectiveness of the crushed septal cartilage graft, which is a novel septoplasty technique. METHODS: Patients: Patients The study was performed based on the parameters of 500 patients who underwent surgery with crushed cartilage graft technique in our clinic between the dates 2013 and 2016. TECHNIQUE: This novel operation technique was performed under general anestesia. The NOSE (Nasal obstruction symptom evaluation) scale was applied to all patients in both the preoperative period and the 2nd month of the postoperative period, and then the both values were statistically compared. Additionally, all the patients were followed up for complications that may occur after the operation for a year. RESULTS: The study included 140 (28%) female and 360 (72%) male patients, which totally makes 500 patients. The average age of the participants was 35±12.5. When compared to the preoperative NOSE scale values (P˂0.001), the postoperative NOSE scale values were found to be significant. We watched intranasal infection and incrustation in 7(1.4%) patients in early postoperative period and the epistaxis in 3(0.6%) patients in late postoperative period. We did not see any postoperative complications apart from these two minor and insignificant complications during the follow-up along a year. CONCLUSION: The crushed cartilage technique is a feasible, safe and effective alternative surgery technique to traditional septoplasty. What is more, complications of septoplasty can be prevented with the help of this novel surgical technique.

Preemptive intravenous ibuprofen application reduces pain and opioid consumption following thyroid surgery.

OBJECTIVE: The primary aim of this study was to investigate the effects of preemptive a single dose IV ibuprofen on postoperative 48 h opioid consumption and postoperative pain in patients undergoing thyroidectomy. METHODS: The study included 40 patients aged 18 to 65, scheduled for elective thyroidectomy. Patients were randomly divided into 2 groups. Control group (n = 20) received 100 mL saline solution 15 min before surgery, while study group (n = 20) received 800 mg IV ibuprofen in 100 mL saline. The same general anesthesia protocol was applied in both groups, and all operations were performed by the same surgical team using the same technique. Postoperative analgesia was assessed using a visual analogue scale (VAS) and the amount of consumption of 48 h postoperative fentanyl with patient-controlled analgesia (PCA) and additional analgesia requirements were recorded. When additional analgesia was required, 1000 mg IV paracetamol was used. RESULTS: VAS scores in the ibuprofen group were found lower than the control group in the all-time points (p < 0.05). Opioid consumption in the 48 h was significantly higher in the control group than the ibuprofen group (p < 0.001). Using of rescue analgesia was significantly higher in the control group than the ibuprofen group, statistically (p < 0.05). A significant difference was observed between two groups in terms of side effects of fentanyl consumption (nausea and vomiting) (p < 0.001). CONCLUSION: To use preemptive a single dose IV ibuprofen decreases pain scores and postoperative opioid consumption in patients following thyroidectomy. Additionally, this application increase the patient comfort reducing nausea and vomiting in early postoperative period.

Preoperative Serum Thyroglobulin Level as a Useful Predictive Marker to Differentiate Thyroid Cancer.

INTRODUCTION: Thyroid cancer is the most common endocrine system cancer. Although fine-needle aspiration biopsy is the most commonly used method for diagnosis, it is not always sufficient. The aim of this study was to investigate the influence of preoperative serum thyroglobulin (Tg) concentration on differentiated thyroid cancer risk. MATERIAL AND METHODS: A total of 133 patients who underwent total thyroidectomy due to various indications at the Ear-Nose-Throat Department, Ataturk University Medical School, between April 2015 and December 2015, were included in this prospective study. Histopathological diagnosis and preoperative Tg levels were compared. Receiver operating characteristic (ROC) analysis was used for detection of the cut-off to discriminate malignant from benign thyroid masses using preoperative Tg as a variable. RESULTS: Malignant pathology (differentiated thyroid carcinoma) was detected in 59 out of 133 patients (44.4%) and benign pathology in 74 (55.6%). A statistically significant difference in preoperative Tg value was detected between malignant and benign cases (p < 0.05). CONCLUSION: The prevalence of differentiated thyroid carcinoma was higher among patients with a preoperative serum Tg value > 188.5 ng/mL, and this may thus be used as a marker for the diagnosis of this malignancy.

Comparison of the effect of the lidocaine, tetracaine, and articaine application into nasal packs on pain and hemorrhage after septoplasty.

OBJECTIVE: We purposed to compare the effects of certain local anesthetics soaked Merocel nasal packs on hemorrhage and pain after septoplasty. MATERIALS AND METHODS: This study is a prospective double-blind study that was done in patients undergoing septoplasty. The study was created with 90 patients. All patients were divided into four groups. The each group was applied 2% lidocaine plus adrenaline, 2% tetracaine, 4% articaine plus adrenaline as study groups or 0.9% sodium chloride (NaCl) as control group in their Merocel packs after septoplasty. Verbal analog scale (VAS) was applied to all patients and the amount of postoperative hemorrhage was noted during postoperative period. The statistical analysis was performed using Student's t test and Chi-square test on each patient group at each time point. RESULTS: The study groups (2% lidocaine plus adrenaline, 2% tetracaine and 4% articaine plus adrenaline groups) had significantly better pain scores versus control group in the 1st, 4th, 8th, 16th and 24th postoperative hours (p < 0.05). The articaine plus adrenaline group had better pain scores than the lidocaine plus adrenaline group, and the lidocaine plus adrenaline group had better pain scores than the tetracaine group in the postoperative first day. Also articaine plus adrenaline group had less postoperative bleeding rate than the lidocaine plus adrenaline, tetracaine and control groups (p < 0.05). There was no statistically significant difference between the lidocaine plus adrenaline, tetracaine and control groups in terms of postoperative hemorrhage (p > 0.05). CONCLUSION: Topical articaine plus adrenaline application in the nasal packs can be safely used for less pain and bleeding following septoplasty.

Thymectomy in Myasthenia Gravis.

In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Likelihood of remission was highest in preoperative mild disease classification (Osserman classification 1, 2A). In absence of thymoma or hyperplasia, there was no relationship between age and gender in remission with thymectomy. In MG treatment, randomized trials that compare conservative treatment with thymectomy have started, recently. As with non-randomized trials, remission with thymectomy in MG treatment was better than conservative treatment with only medication. There are four major methods for the surgical approach: transcervical, minimally invasive, transsternal, and combined transcervical transsternal thymectomy. Transsternal approach with thymectomy is the accepted standard surgical approach for many years. In recent years, the incidence of thymectomy has been increasing with minimally invasive techniques using thoracoscopic and robotic methods. There are not any randomized, controlled studies which are comparing surgical techniques. However, when comparing non-randomized trials, it is seen that minimally invasive thymectomy approaches give similar results to more aggressive approaches.

Early Diagnosis of Lymphedema after Breast Cancer Treatment: Bio-Impedance Spectroscopy.

OBJECTIVE: Breast cancer-related lymphedema is an important health problem. The aim of this study is to ensure early diagnosis of patients at risk of developing lymphedema and revealing the predisposing factors. MATERIALS AND METHODS: Measurements in the pre-operative period and in postoperative months 3, 6, 9 and 12 and years 2 and 3 were performed prospectively with bio-impedance spectroscopy for patients treated for breast cancer between November, 2013 and November, 2016. Demographic and clinical-pathological data of the patients were investigated to assess the factors that affect the development of lymphedema. RESULTS: 245 measurements were obtained from the 67 patients who participated in the study. 18 (26.8%) patients were diagnosed with lymphedema and 16 (89%) of these patients were clinically diagnosed with stage 0 and 2 (1%) patients with stage 1 lymphedema. The median age was 50.7 (32-77) years. Performing axillary dissection and positivity in more than 3 nodes were found to be statistically significant with a percentage of 63.3% (n=15) and 64.7% (n=11) p=0.049 and p<0.001, respectively. CONCLUSION: Periodic measurements with bio impedance spectroscopy can be an effective method to diagnose early stage lymphedema after breast cancer, and enable selecting the group of patients who would benefit from early treatment.

Coincidence of Eagle Syndrome and Diffuse Idiopathic Skeletal Hyperostosis Presenting With Dysphagia as a Result of Compression of the Hypopharynx.

Coincidence of the Eagle syndrome and diffuse idiopathic skeletal hyperostosis can very rarely result with compression of the hypopharynx. The authors here described a very rare case of hypopharyngeal airway compression secondary to cervical osteophytes in a patient with coincidence of Eagle syndrome and diffuse idiopathic skeletal hyperostosis. Multidetector computed tomography accuracy showed compression to the hypopharyngeal air column by the Eagle syndrome and diffuse idiopathic skeletal hyperostosis.

Magnetic Resonance Imaging and Magnetic Resonance Angiography Findings of External Carotid Artery Aneurysm and Coexisting Carotid Body Tumor.

Carotid body tumors originate from paraganglionic tissue in the bifurcation of the common carotid artery. Magnetic resonance imaging is a frequently used diagnostic method in the preoperative diagnosis of these tumors and provides appropriate information for surgical planning. In this study, the authors emphasize magnetic resonance imaging and magnetic resonance angiography findings of the external carotid artery aneurysm associated with carotid body tumor. This highlights that the diagnosis of carotid artery aneurysms is essential to avoid accidental injury to the vessel during tumor surgery.

Angiofibroma from the tail of the inferior turbinate.

Nasopharyngeal angiofibromas are benign and vascular neoplasms, which originate characteristically in the posterior lateral wall of the nasopharynx. They account for less than 0.5% of all head and neck tumours. Although angiofibromas extend beyond the nasopharynx usually, they rarely originate outside the nasopharynx. Reports of primary extranasopharyngeal angiofibromas have appeared sporadically in the literature. The maxillary sinus is the most common site involved, while the inferior turbinate represents an extremely rare localization. We report a case of angiofibroma which arising from the tail of the inferior turbinate in the right nasal cavity.