Children's Perioperative Multidimensional Anxiety Scale (CPMAS): Turkish Validity and Reliability Study.

PURPOSE: To test the validity and reliability of the Turkish version of the Children's Perioperative Multidimensional Anxiety Scale (CPMAS). DESIGN: Methodological research model. METHODS: One hundred children (81% male) aged 7 to 13 years undergoing elective surgery at a tertiary university hospital were included. Self-administered CPMAS and State-Trait Anxiety Inventory-Children were used to collect data at preoperative, operation day, and a month after the operation. Internal consistency, test-retest reliability, parallel form reliability, and content and construct validity of the tools were determined across all three visits. FINDINGS: The CPMAS demonstrated good test-retest reliability (ICC = 0.51 to 0.78) and good internal consistency (Cronbach's alpha = 0.78 to 0.81). Inter item correlation values were ranged from 0.20 to 0.62 at preoperative, 0.32 to 0.64 on the day of operation and 0.36 to 0.75 at a month after the operation. CPMAS single-factor construct and the explanatory percentages were 0.54 and above. After Pearson correlation analysis, CPMAS was moderately correlated with State-Trait Anxiety Inventory-Children at T1 (r = 0.54, P < .01) and T2 (r = 0.56, P < .01). CONCLUSIONS: The Turkish version of CPMAS has good reliability and validity score. Therefore, it is a suitable instrument to assess perioperative anxiety in 7 to 13 years old children in a clinical setting.

Can Wideband Tympanometry Predict the Prognosis of Otitis Media With Effusion?

Background and Objectives: This study aims to evaluate the capacity of wideband tympanometry (WBT) in predicting the prognosis of otitis media with effusion (OME). Subjects and Methods: Sixty-one ears with effusion and 30 healthy ears of children were enrolled. The patients were followed up monthly using WBT. After the completion of measurements, the ears were separated into four groups according to the duration of recovery; Group 1: Good prognosis (≤1-month, n=18), Group 2: Worse prognosis (>1-month, n=29), Group 3: Surgical (no recovery, n=14), and Group 4: Control (healthy ears, n=30). Tympanometric peak pressure (TPP), resonance frequency (RF), and absorbance levels were compared within and between the groups. Results: The TPP and RF values of the study group were lower than those of the controls (p<0.001). The ears with OME had lower absorbance measures than the controls at all frequencies; the differences were significant at 250, 500, and 1,000 Hz (p<0.001). However, at 2,000 Hz, the absorbance levels of the ears with OME were similar with those of the control group only in the good prognosis group (p>0.05). The receiver-operating characteristic analysis revealed that absorbance measures over 0.237 and 0.311 at 1,000 Hz and 2,000 Hz, respectively, have sensitivities and specificities over 70% for prediction of good prognosis, and the calculated odd ratio for these measures were 6 (p<0.05). Conclusions: WBT measurement is promising in predicting the recovery of OME in children.

A Unique Cause of Upper Airway Obstruction in a Child: Laryngeal Lipoma.

There are lots of diseases causing pediatric upper airway obstruction and stridor. They can be both congenital or acquired. While congenital causes are laryngomalacia, vocal cord palsy, congenital subglottic stenosis, acquired ones range from infections to foreign bodies or neoplasms. Laryngeal neoplasms develop almost epithelial in origin. Non-epithelial tumors consist 1% of laryngeal neoplasms. Although lipoma is the most common soft tissue tumor, laryngeal involvement is very rare and seen in the ages between 40-60 years. A 13-month-old child who had laryngeal lipoma and upper airway obstruction was aimed to present in this paper.

Mucociliary clearance in patients with continuous ambulatory peritoneal dialysis / Aclaramiento mucociliar en pacientes con diálisis peritoneal ambulatoria continua

INTRODUCTION: Mucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections. OBJECTIVE: The aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis. METHODS: Forty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1 mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed. RESULTS: Patient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p < 0.05). CONCLUSIONS: Unique for being conducted with patients in continuous ambulatory peritoneal dialysis, the current study shows that although the MC of CKD patients and healthy individuals is similar, patients with low rates of MC appear to present an increased incidence of peritoneal infection. Considering the small sample investigated, an invitation to future confirmatory studies would be appropriate

INTRODUCCIÓN: El aclaramiento mucociliar (AM) es un mecanismo de defensa fundamental para la protección del sistema respiratorio. La colonización nasal de algunos patógenos y las infecciones nasales crónicas son factores de riesgo importantes de peritonitis. Cualquier alteración en el AM provoca estasis de secreciones e infecciones secundarias. OBJETIVO: El objetivo de este estudio fue evaluar el AM nasal de los pacientes con nefropatía crónica (NC) que recibían diálisis peritoneal ambulatoria continua (DPAC). Más concretamente, el objetivo fue estudiar la posible relación entre el AM nasal y la peritonitis. MÉTODOS: Cuarenta pacientes en DPAC y 39 voluntarios sanos participaron en el estudio. El AM nasal se evaluó con la prueba de sacarina, en la que se colocó cuidadosamente una partícula de sacarina, de 1 mm de diámetro, en la superficie anteromedial del cornete nasal inferior. El tiempo transcurrido desde el momento en que se colocó la partícula hasta que los pacientes percibieron el sabor dulce se consideró el tiempo de aclaramiento mucociliar (TAM), parámetro que se empleó para hacer la comparación entre los grupos. Se evaluaron los antecedentes de peritonitis en el grupo de pacientes y se analizaron las correlaciones con el AM. RESULTADOS: El grupo de pacientes con NC constó de 16 mujeres y 24 hombres con una media de edad de 32,4 años. Los pacientes sanos en el grupo control fueron 17 mujeres y 22 hombres con una media de edad de 33,3 años. No se observó una diferencia significativa en el tiempo medio de AM en pacientes con NC respecto a los pacientes del grupo control. La comparación entre el TAM medio en los pacientes con antecedentes de peritonitis y en pacientes sin peritonitis fue estadísticamente significativa (p < 0,05). CONCLUSIONES: Único por llevarse a cabo en pacientes con diálisis peritoneal ambulatoria continua, el estudio actual muestra que, aunque el AM de pacientes con NC y pacientes sanos es similar, los pacientes con tasas bajas de AM parecen presentar un aumento de la incidencia de infección peritoneal. Teniendo en cuenta la pequeña muestra estudiada, consideramos conveniente realizar nuevos estudios de confirmación

Mucociliary clearance in patients with continuous ambulatory peritoneal dialysis.

INTRODUCTION: Mucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections. OBJECTIVE: The aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis. METHODS: Forty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed. RESULTS: Patient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p<0.05). CONCLUSIONS: Unique for being conducted with patients in continuous ambulatory peritoneal dialysis, the current study shows that although the MC of CKD patients and healthy individuals is similar, patients with low rates of MC appear to present an increased incidence of peritoneal infection. Considering the small sample investigated, an invitation to future confirmatory studies would be appropriate.

A case of laryngeal atresia accompanied by persistent pharyngotracheal ductus.

Laryngeal atresia is generally a fatal congenital anomaly with an incidence of 1: 50,000 births. This congenital anomaly is a condition of multifactorial inheritance, in which the fetus has a dilated trachea, enlarged echogenic lungs, an inverted or flattened diaphragm, fetal hydrops, and ascites. Diagnosis is usually made when there is failure to perform endotracheal intubation in a neonate with severe respiratory distress and absence of audible cry. Here, we present a very rare case of a newborn with laryngeal atresia who had respiratory distress and was sustained for the first few minutes of life using partial ventilation via a persistent pharyngotracheal duct. We would like to draw the attention of all physicians to this issue by reporting a rare fatal case of a newborn with a congenital presentation.

Laringeal atrezi, 50.000 dogumda bir görülen ve üst hava yolu tikanikligi ile giden ölümcül bir dogustan anomalidir. Çok etmenli kalitilir. Fetal ultrasonografide trakeada genisleme, akcigerlerde genisleme ve hiperekojenite, diyafragmada düzlesme ya da tersine dönme, hidrops ve asit saptanir. Dogumda agir solunum sikintisi olan yenidoganlarda endotrakeal entübasyonun basarilamamasi ve aglama çabasina ragmen ses duyulmamasi ile tani konulur. Bu yazida dogumdan sonra solunum sikintisi gelisen, ancak entübe edilemeyen, yasamin ilk dakikalarinda persistan faringotrakeal kanal yardimiyla kismi solunum yaparak hayatta kalabilen laringeal atrezili bir preterm olgu klinisyenlerin dikkatine sunuldu.

Effects of Dexmedetomidine Infusion During Sevoflurane Anesthesia on Otoacoustic Emissions.

BACKGROUND AND OBJECTIVES: Knowing the ototoxic potential of the agents used in medical treatments is important for the protection of hearing. Although we have knowledge regarding some effects of dexmedetomidine, which is an anesthetic-sparing drug, its influence over the hearing system has never been studied and is obscure yet. The aim of this study is to determine the effects of intravenous dexmedetomidine application during sevoflurane anesthesia on otoacoustic emissions (OAEs). SUBJECT AND METHODS: This prospective randomized study was performed on 60 patients (34 male, 26 female, mean age: 30.6±9.2 years) who were scheduled for an elective surgery under general anesthesia and the patients were enrolled and randomly divided into 2 groups. They received dexmedetomidine (Group D) or Saline (Group S) infusion during a standardized Sevoflurane anesthesia. Transient and distortion product OAEs were measured preoperatively and postoperatively (24th hour). OAE results were compared within and between groups. RESULTS: In group D postoperative OAEs were lower than preoperative OAEs and postoperative levels of group S, especially at low frequencies (p<0.05). CONCLUSIONS: Dexmedetomidine infusion affects the micromechanical function of cochlea especially in the low-frequency region. Dexmedetomidine should be carefully used during general anesthesia to avoid its probable harmful effects on cochlear micromechanics.

Long-Term Protective Effect of N-Acetylcysteine against Amikacin-Induced Ototoxicity in End-Stage Renal Disease: A Randomized Trial.

BACKGROUND: The aim of the study is to evaluate the long-term protective effect of N-acetylcysteine (NAC), an antioxidant agent, against aminoglycoside (AG)-induced ototoxicity. METHODS: A total of 40 patients receiving continuous ambulatory peritoneal dialysis (CAPD) and having their first peritonitis attacks and planned to be treated with AGs were enrolled in the study. They were randomized into 2 groups: 1 group received additional NAC and the other did not. All patients underwent hearing tests with pure tone audiometry (PTA) after the diagnosis, at 1 month and 12 months and at the same time the tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels were measured. RESULTS: Patients taking NAC had better hearing test results in both ears at 1 month except 2,000 Hz for the left ear, which wasn't significantly different between the 2 groups. Although patients taking NAC had generally better PTA results at 12 months, differences between the 2 groups were not statistically significant. Baseline IL-6 level was significantly higher in the NAC group than the control group. Both TNF-α and IL-6 levels at 1 month were significantly lower in the NAC group than in the control group. On the other hand, there was no significant difference between the 2 groups in terms of TNF-α and IL-6 levels at 12 months. CONCLUSIONS: The results of the current study showed that NAC, a potent anti-inflamatory drug, may be otoprotective, but that the effect is not long-lasting.

Premedication Methods in Nasal Endoscopy: A Prospective, Randomized, Double-Blind Study.

OBJECTIVES: To identify the optimal pharmacological method of preparing patients for nasal endoscopy. METHODS: Twenty healthy volunteers were enrolled in this prospective, randomized, double-blind study. Four types of medications were applied in their nostrils with binary combinations of spray bottles on four different days in a random order: placebo (normal saline [NS]+NS), decongestant (NS+oxymetazoline), anesthetic (NS+lidocaine), and decongestant plus anesthetic (oxymetazoline+lidocaine). Rigid nasal endoscopy was performed 10 minutes after spray application. The volunteers evaluated the discomfort caused by each spray application, and nasal pain scores due to the passage of the endoscope. The physicians quantified nasal decongestion using a visual analogue scale. Endoscopy duration as well as pulse and mean blood pressure (MBP) before spray application, 10 minutes after the application, and immediately after endoscopic examination were also recorded. RESULTS: The discomfort caused by lidocaine was significantly higher than that caused by the other sprays (P<0.001). The lowest pain score related to endoscopy was obtained for oxymetazoline+lidocaine (P<0.001). Nasal decongestion was best achieved with NS+oxymetazoline (P<0.001). Endoscopy duration was the shortest for oxymetazoline+ lidocaine (P<0.05). Statistically significant MBP changes were only seen with the application of NS+oxymetazoline (P<0.05). However, neither MBP nor pulse rate change was significant clinically. CONCLUSION: Application of decongestant and anesthetic sprays together seems to be the best method of pharmacological preparation of patients for nasal endoscopy.

A Rare Cause of Positional Dyspnea: Hypopharyngeal Hamartoma.

Hypopharyngeal hamartomas are quite rare tumors that may cause nutritional or respiratory problems in neonates and infants. They may be confused with other benign laryngeal lesions. In this study a 7-month-old infant with congenital stridor and positional dyspnea caused by a hypopharyngeal hamartoma was reported with review of the literature. Hypopharyngeal hamartomas should be considered in the differential diagnosis of pathologies that cause respiratory or feeding problems in neonates or infants.

Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery / Comparação entre dexmedetomidina e sulfato de magnésio em hipotensão controlada durante cirurgia funcional endoscópica dos seios paranasais / Comparación entre el sulfato de magnesio y la dexmedetomidina en hipotensión controlada durante cirugía funcional endoscópica de los senos paranasales

BACKGROUND AND OBJECTIVES: It is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site. METHODS: 60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate group (Group M), patients were administered 40 mg/kg magnesium sulfate in 100 mL saline solution over 10 min as the intravenous loading dose 10 min before induction, with a subsequent 10-15 µg/kg/h infusion during surgery. In the dexmedetomidine group (Group D), patients were administered 1 µg/kg dexmedetomidine in 100 mL saline solution as the loading dose 10 min before surgery and 0.5-1 µg/kg/h dexmedetomidine during surgery. Deliberate hypotension was defined as a mean arterial pressure of 60-70 mmHg. RESULTS: Bleeding score was significantly decreased in Group D (p = 0.002). Mean arterial pressure values were significantly decreased in Group D compared to that in Group M, except for the initial stage, after induction and 5 min after intubation (p < 0.05). The number of patients who required nitroglycerine was significantly lower in Group D (p = 0.01) and surgeon satisfaction was significantly increased in the same group (p = 0.001). Aldrete recovery score ≥9 duration was significantly shorter in Group D (p = 0.001). There was no difference between the two groups in terms of recovery room verbal numerical rating scale. CONCLUSIONS: Dexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site. .

JUSTIFICATIVA E OBJETIVOS: Diminuir o sangramento durante a cirurgia funcional endoscópica dos seios paranasais é essencial. Nosso objetivo primário foi investigar os efeitos de dexmedetomidina e sulfato de magnésio, usados para o controle da hipotensão, sobre a visibilidade do sítio cirúrgico. MÉTODOS: Foram incluídos no estudo 60 pacientes entre 18 e 65 anos. No grupo sulfato de magnésio (Grupo M), receberam 40 mg de sulfato de magnésio em 100 mL kg-1 de solução salina durante 10 minutos como dose de carga intravenosa 10 minutos antes da indução e infusão subsequente de 10-15 µg kg-1 h-1 durante a cirurgia. No grupo dexmedetomidina (Grupo D), receberam 1 µg kg-1 de dexmedetomidina em 100 mL de solução salina durante 10 minutos como dose de carga 10 minutos antes da cirurgia e 0,5-1 µg kg-1 h-1 de dexmedetomidina durante a cirurgia. Hipotensão controlada foi definida como pressão arterial média de 60-70 mmHg. RESULTADOS: O volume de sangramento diminuiu significativamente no grupo D (p = 0,002). Os valores da pressão arterial média foram significativamente menores no Grupo D, em comparação com o Grupo M, exceto no estágio inicial, pós-indução e cinco minutos pós-intubação (p < 0,05). No Grupo D, o número de pacientes que necessitou de nitroglicerina foi significativamente menor (p = 0,01) e o grau de satisfação do cirurgião foi significativamente maior (p = 0,001). O tempo de recuperação para atingir o escore de Aldrete ≥ 9 foi significativamente menor no grupo D (p = 0,001). Não houve diferença entre os dois grupos em relação aos escores da escala numérica de classificação verbal na sala de recuperação. CONCLUSÕES: Dexmedetomidina pode proporcionar um controle mais eficaz da hipotensão e contribuir, assim, para uma melhor visibilidade do sítio cirúrgico. .

JUSTIFICACIÓN Y OBJETIVOS: Disminuir el sangrado durante la cirugía funcional endoscópica de los senos paranasales es esencial. Nuestro objetivo primario fue investigar los efectos de la dexmedetomidina y del sulfato de magnesio, usados para el control de la hipotensión, sobre la visibilidad del campo quirúrgico. MÉTODOS: Fueron incluidos en el estudio 60 pacientes entre 18 y 65 años. En el grupo sulfato de magnesio (grupo M), recibieron 40 mg de sulfato de magnesio en 100 mL/kg-1 de solución salina durante 10 min como dosis de carga intravenosa 10 min antes de la inducción e infusión subsecuente de 10-15 µg/kg-1/h-1 durante la cirugía. En el grupo dexmedetomidina (grupo D), recibieron 1 µg/kg-1 de dexmedetomidina en 100 mL de solución salina durante 10 min como dosis de carga 10 min antes de la cirugía y 0,5-1 µg/kg-1/h-1 de dexmedetomidina durante la cirugía. La hipotensión controlada se definió como presión arterial media de 60-70 mmHg. RESULTADOS: El volumen de sangrado disminuyó significativamente en el grupo D (p = 0,002). Los valores de la presión arterial media fueron significativamente menores en el grupo D en comparación con el grupo M, excepto en el estadio inicial, postinducción y 5 min postintubación (p < 0,05). En el grupo D, el número de pacientes que necesitó nitroglicerina fue significativamente menor (p = 0,01) y el grado de satisfacción del cirujano fue significativamente mayor (p = 0,001). El tiempo de recuperación para alcanzar la puntuación de Aldrete ≥ 9 fue significativamente menor en el grupo D (p = 0,001). No hubo diferencia entre los 2 grupos con relación a las puntuaciones de la escala numérica de clasificación verbal en la sala de recuperación. CONCLUSIONES: La dexmedetomidina puede proporcionar un control más eficaz de la hipotensión y contribuir así a una mejor visibilidad del campo quirúrgico. .

[Comparison between magnesium sulfate and dexmedetomidine in controlled hypotension during functional endoscopic sinus surgery]. / Comparação entre dexmedetomidina e sulfato de magnésio em hipotensão controlada durante cirurgia funcional endoscópica dos seios paranasais.

BACKGROUND AND OBJECTIVES: It is crucial to decrease bleeding during functional endoscopic sinus surgery. Our primary goal was to investigate the effects of magnesium sulfate and dexmedetomidine used for controlled hypotension on the visibility of the surgical site. METHODS: 60 patients aged between 18 and 65 years were enrolled. In the magnesium sulfate group (Group M), patients were administered 40mg/kg magnesium sulfate in 100mL saline solution over 10min as the intravenous loading dose 10min before induction, with a subsequent 10-15mg/kg/h infusion during surgery. In the dexmedetomidine group (Group D), patients were administered 1µg/kg dexmedetomidine in 100mL saline solution as the loading dose 10min before surgery and 0.5-1µg/kg/h dexmedetomidine during surgery. Deliberate hypotension was defined as a mean arterial pressure of 60-70mmHg. RESULTS: Bleeding score was significantly decreased in Group D (p=0.002). Mean arterial pressure values were significantly decreased in Group D compared to that in Group M, except for the initial stage, after induction and 5min after intubation (p<0.05). The number of patients who required nitroglycerine was significantly lower in Group D (p=0.01) and surgeon satisfaction was significantly increased in the same group (p=0.001). Aldrete recovery score ≥9 duration was significantly shorter in Group D (p=0.001). There was no difference between the two groups in terms of recovery room verbal numerical rating scale. CONCLUSIONS: Dexmedetomidine can provide more effective controlled hypotension and thus contribute to improved visibility of the surgical site.

Ectopic salivary gland of the base of the tongue: a rare cause of neonatal respiratory distress.

Neonatal upper airway obstruction is a life-threatening condition and requires rapid assessment and effective treatment. Malformations of the upper airway of a newborn can lead to acute respiratory distress. The aim of the present paper is to report the case of a newborn with respiratory distress due to a tongue base mass, which was removed surgically. The patient needed a tracheostomy tube for only three days and then could breathe spontaneously. However, he had swallowing problems, which decreased gradually over 9 months. Histopathologically, the mass was found to consist of mucous salivary glands, and was recorded as an ectopic salivary gland, which is extremely rare among the types of masses that may cause upper airway obstruction in a newborn.

Approaches to subperiosteal orbital abscesses.

The purpose of this paper is to evaluate the epidemiology, clinical features, management and complications of subperiosteal orbital abscesses (SPOA)-a serious complication of rhinosinusitis. Retrospective data of 36 patients with SPOA secondary to acute rhinosinusitis from January 1998 to December 2011 were evaluated. Patients were analyzed in terms of age, gender, clinical features, CT findings, surgical procedures, microbiology, and complications. Twenty-three males and 13 females aged from 3 to 76 were evaluated. Nine patients-seven of which were under the age of 10-with small medial SPOA were treated only with medical management. Of the 13 with medial SPOA, transnasal endoscopic approach was performed for 10 and external approach for 3 to drain the abscess. As for the 12 patients with superior SPOA, 8 were treated via combined approach and 4 via external approach. The most common microorganisms were streptococci in children and anaerobes in adults. Total loss of vision developed in two adults with diabetes mellitus (DM). One patient with superior SPOA died due to frontal lobe abscess. Young children with small medial SPOA without significant ocular signs may successfully be managed medically. Surgical drainage is indicated for nonmedial abscesses, large medial abscesses with severe visual loss and with insufficient response to medical management. The risk of blindness from SPOA is higher in patients with DM.

The Pott's puffy tumor: a dangerous sign for intracranial complications.

The Pott's puffy tumor is a subperiosteal abscess of the frontal bone associated with osteomyelitis. The purpose of this article is to alert the physician to the severe complications of this entity. The records of six patients were reviewed retrospectively. There were four adults and two adolescents. Nasal endoscopy showed edematous, polypoid mucosa in middle meatus in three and nasal polyps in the rest. At initial admission, two had orbital subperiosteal abscess, but normal cranial CT findings. During hospitalization, three experienced frontal lobe abscess and one frontal cerebritis. Endoscopic sinus surgery was performed in all with external drainage of Pott's puffy tumor in addition to antibiotherapy. Three patients underwent craniotomy/craniectomy for removal of frontal lobe abscesses. One patient with frontal lobe abscess died. Pott's puffy tumor may result in potentially dangerous intracranial complications. Early diagnosis and treatment are essential to reduce morbidity and mortality.

Effect of nasal packing and haemostatic septal suture on mucociliary activity after septoplasty: an assessment by rhinoscintigraphy.

Nasal packing may influence the mucociliary clearance of the nose in the postoperative healing phase. In an attempt to overcome some of this problem, a haemostatic septal suturing technique was conceived. In this prospective study, we aimed to investigate the effects of nasal packing and septal suturing technique on mucociliary clearance by rhinoscintigraphy. Forty-eight adult patients who had undergone septoplasty were included in the investigation. Preoperatively, the patients were allocated into three groups: group 1, fingerstall packs filled with gauze and smeared with vaseline were used (11 male, 4 female); group 2, silicon septal splint packs were used (11 male, 4 female); group 3, haemostatic septal sutures were used (14 male, 4 female). Mucociliary clearance was measured by rhinoscintigraphy in all patients before surgery and 6 weeks after surgery. The nasal mucociliary clearance was presented as the velocity (mm/min) of nasal mucociliary transport of the (99m)Tc-MAA droplet. The mean velocity of nasal mucociliary clearances before and after surgery for group 1, group 2 and group 3 were 1.85 +/- 0.67 versus 2.43 +/- 0.78 mm/min, 2.36 +/- 0.80 versus 2.92 +/- 0.96 mm/min and 2.03 +/- 0.58 versus 2.62 +/- 0.65 mm/min, respectively. A significant difference in nasal mucociliary clearance was observed after surgery in all groups (p < 0.001). No significant differences were found between the groups regarding mucociliary clearance before and after surgery. Patients with septal deviation have a prolonged mucociliary transit time as compared with postoperative. Nasal packing did not significantly influence the mucociliary clearance in the postoperative healing phase.

[Adenoidal vegetations in adults: an evaluation of 12 cases]. / Eriskinlerde görülen adenoid vejetasyonlar: 12 olgunun degerlendirilmesi.

OBJECTIVES: We evaluated the clinical significance of adenoidal vegetations which are overlooked as a cause of nasal obstruction in adults. PATIENTS AND METHODS: The study included 12 patients older than 15 years of age (10 males, 2 females; mean age 23.5 years; range 15 to 32 years) who presented with nasal obstruction due to adenoidal vegetations. The patients were evaluated with respect to age, sex, complaints, findings of physical examination, computed tomography of the nasopharynx, and nasal endoscopy, and histopathologic results. RESULTS: All the patients had nasal obstruction. The most common symptom was snoring. Physical examination showed a vegetative mass in the posterior wall of the nasopharynx obstructing the choana. Five patients had bilateral serous otitis media and eight patients had postnasal purulent drainage. All the patients underwent adenoidectomy under general anesthesia and with transnasal endoscopic control. Histopathologic examination of surgical specimens showed lymphoid hyperplasia. CONCLUSION: Although adenoidal tissue undergoes regression toward the adolescent period, it may present as the chief cause of nasal obstruction in adults.

Figure-of-eight vertical mattress suture technique for anterior flap suspension to overlying tissues in external dacryocystorhinostomy.

PURPOSE: To describe figure-of-eight vertical mattress suture technique in external dacryocystorhinostomy for a combined one-step closure of anterior mucosal flaps and overlying wound tissues and to evaluate its effectiveness on surgical outcome. DESIGN: A prospective, single surgeon, uncontrolled, interventional case series. METHODS: A total of 112 consecutive lacrimal drainage systems of 106 patients (84 women, 22 men; 100 unilateral, six bilateral) from June 2002 to January 2006 with acquired nasolacrimal duct obstruction without canalicular disease underwent external dacryocystorhinostomy with this modified technique. Relief of epiphora and anatomic patency were defined as success. Operative time and success rate were evaluated and advantages were stressed and compared with our previous reports. RESULTS: Mean age was 40.1 years (range, 6 to 75). The etiology was idiopathic in 109 patients and traumatic in three cases. Of 112 lacrimal drainage systems, epiphora was the presenting symptom in 88, combined epiphora and recurrent dacryocystitis in 15, and combined epiphora and mucocele in nine cases. Seven lacrimal drainage systems were revision cases. Mean follow-up was 26.3 months (range, 6 to 48). Success rate was 99.1% (111/112) and mean operative time was 38.2 minutes (range, 28 to 69). CONCLUSIONS: Such a modified suture technique reveals a rapid and simultaneous one-step closure of two different layers that speeds up surgical procedure; simplifies closure process as the knots are tied completely outside the wound, avoiding the disadvantages of suture tying in a small and deep area; eliminates the dead space between anterior flaps and overlying wound tissues; keeps anterior mucosal flap complex away from posterior flaps that prevents collapse back onto the anastomosis and decreases the possibility of mucosal adhesions and, therefore, fibrotic band formation with underlying tissues that may also be useful in cases with small sacs or osseous openings and in revision cases where scarring is a large concern.

[An etiological study in a school for the deaf and radiological findings]. / Sagirlar okulunda etyolojiye yönelik bir çalisma ve radyolojik bulgular.

OBJECTIVES: The causes of sensorineural hearing loss were assessed in a population of students in a school for the deaf. PATIENTS AND METHODS: Ninety-one students (34 girls, 57 boys; mean age 10.6 years; range 7 to 20 years) from a school for the deaf were evaluated together with their family tree. Otolaryngologic, ophthalmologic, and systemic physical examinations and audiologic and radiologic investigations were performed. RESULTS: Sensorineural hearing loss was of genetic origin in 32.9% of the students. No etiologic factor could be determined in 31.9% of the cases. Infectious diseases (38.3%) and consanguinity (26.3%) were found as the most common etiologic factors in nongenetic and genetic sensorineural hearing losses, respectively. CONCLUSION: Sensorineural hearing losses due to infectious diseases and consanguineous marriages are preventable conditions. The incidence of sensorineural hearing loss will decline if these two conditions are controlled.