Synchronous ossiculoplasty with titanium prosthesis during canal wall down surgery for advanced cholesteatoma: anatomical and hearing outcomes.

OBJECTIVE: To analyse patients with cholesteatoma undergoing canal wall down mastoidectomy together with ossicular reconstruction with a titanium prosthesis, in order to identify factors associated with hearing outcomes. STUDY DESIGN: Retrospective review of 97 cases undergoing single-stage surgical management. METHODS: All patients underwent canal wall down mastoidectomy. Kurz titanium ossicular prostheses were used for ossicular chain reconstruction. Pre-operative and post-operative air conduction and bone conduction hearing thresholds were obtained at 500, 1000, 2000 and 3000 Hz. RESULTS: The mean pure tone average improved from 46.02 ± 14.54 dB pre-operatively to 29.32 ± 14.64 dB post-operatively, for both total and partial ossicular replacement prosthesis groups combined. The mean air-bone gap improved from 30.38 ± 11.12 dB pre-operatively to 15.62 ± 9.65 dB post-operatively, for both groups combined. CONCLUSION: Reconstruction with a titanium prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single-stage procedure.

Thyroid hormone profile in children with goiter in an endemic goiter area.

The thyroid hormone profile was investigated in goitrous schoolchildren aged 6-11 years living in Antalya, an area with mild/ moderate iodine deficiency. With few exceptions, the serum levels of T4 and TSH were in the normal range in children with different grades of goiter. Compensatory elevated T3 levels were detected in 24% of the subjects. Thyroid hormones did not differ significantly with respect to the urinary iodine (UI) level. No correlations were found between thyroid volume, UI excretion level and thyroid hormones. It was concluded that thyroid hormones, except compensatory T3 elevation in some subjects, were not affected significantly in a mild/moderate iodine deficient area.

Orbital Doppler sonography findings in cases of brain death.

In this study, we investigated the blood flow velocity changes in orbital arteries by using Doppler sonography in eight patients with brain death. Peak-systolic and end-diastolic velocities and resistive indices of the ophthalmic and central retinal arteries were evaluated. We observed the absence or reversal of end-diastolic blood flow in these arteries. To our knowledge, this finding has not been previously reported to be associated with brain death.

Thyroid gland volume and urinary iodine excretion in children 6-11 years old in an endemic area.

Goiter prevalence and urinary iodine excretion levels were assessed in 605 schoolchildren (301 males and 304 females), aged 6-11 years, living in the Antalya region, a well known endemic goiter area in Turkey. Goiter prevalence was evaluated by clinical examination and ultrasound of the thyroid gland. Urinary iodine levels were expressed as microg/g creatinine. Goiter by inspection and palpation was found in 35% (n = 212) of all subjects, in 37.5% (n = 114) of girls and 32.5% (n = 98) of boys. Iodine deficiency of moderate degree was detected from the point of goiter prevalence. With regard to the upper limits of reference thyroid volumes reported by WHO and ICCIDD, goiter by ultrasonography was found in 34% (n = 206) of all subjects, in 36.8% (n = 112) of girls and 31% (n = 94) of boys. Median iodine/creatinine ratios of all subjects, and goitrous and non-goitrous subjects, were 64.1+/-20.1, 62.8+/-21.8 and 64.9+/-19.1 microg/g, respectively. Urinary iodine excretion levels revealed mild iodine deficiency in the region. No significant correlation was observed between urinary iodine excretion levels and thyroid volumes (r = 0.12, p>0.05). Iodine deficiency of mild to moderate degree in schoolchildren aged 6-11 years was detected in Antalya. It was concluded that urgent measures must be undertaken to eradicate iodine deficiency in the region.

Acute colonic obstruction caused by intussusception and extrusion of a sigmoid lipoma through the anus after barium enema.

Colonic lipomas are often asymptomatic, but large lipomas may produce abdominal pain, diarrhea, constipation, hemorrhage, and intussusception. We report a young woman with a colonic lipoma who presented as an acute abdominal emergency with total colonic obstruction and severe pain associated with intussusception and extrusion of the tumor through the anus. The case was interesting because of its presentation after a double-contrast barium enema and because of the patient's young age and the tumor's location on the left side of the colon.