Longitudinal Success of Tonsillectomy for Obstructive Sleep Apnea in Children with Down Syndrome.

OBJECTIVE: Obstructive sleep apnea is common in children with Down syndrome (DS). Tonsillectomy is recommended as the first-line approach in treating children with obstructive sleep apnea (OSA), however, there is limited data on the long-term outcomes in children with DS who undergo tonsillectomy. In this retrospective study, we examined the long-term polysomnographic and symptomatic outcomes in children with DS who underwent tonsillectomy with or without an adenoidectomy (T&A). We hypothesize that the success of T&A to treat OSA in children with DS will diminish with time. STUDY DESIGN: A retrospective chart review of children with DS who underwent T&A between 2009 and 2015 was conducted. Inclusion criteria were children with at least 1 postoperative polysomnogram (PSG) within 6 months of T&A with an obstructive apnea/hypopnea index (OAHI) < 5. Outcomes were determined by subsequent clinic visits and postoperative polysomnograms: OAHI ≥ 5, snoring reported during clinic visit and time to reoccurrence. SETTING: Childrens Hospital Colorado. RESULTS: Of the 57 children with mild OSA at 1st (initial) PSG, 13/40 (33%) children had OAHI ≥ 5 at the 2nd postoperative PSG. Of the 18 patients who underwent a 3rd PSG, 4 (22%) progressed to moderate/severe OSA. A total of 17 patients out of the original 57 (30%) progressed to moderate/severe OSA with the median time for the additional post-op PSG's being 2.3 years. CONCLUSION: Children with DS who have at most mild OSA (OAHI < 5) following a T&A are at risk for progressing to at least moderate OSA within 2 years after their T&A. A surveillance PSG 2 years following surgery will identify these children.

Improvement of Neuropathy Symptoms With Treatment of Obstructive Sleep Apnea in a Patient With Charcot-Marie-Tooth Disease.

ABSTRACT: This is a case report describing a 53-year-old woman with Charcot-Marie-Tooth disease, obstructive sleep apnea, and a 6-year history of numbness in bilateral upper extremities, feet, and in the trunk that resolved with initiation of continuous positive airway pressure for her obstructive sleep apnea.

Mammary tuberculosis -- importance of recognition and differentiation from that of a breast malignancy: report of three cases and review of the literature.

BACKGROUND: While tuberculosis of the breast is an extremely uncommon entity seen in western populations, it accounts for up to 3% of all treatable breast lesions in developing countries. CASE PRESENTATIONS: We reviewed three female cases of mammary tuberculosis that were diagnosed and treated in Turkey during the same calendar year. All three patients presented with a painful breast mass. In all cases, fine needle aspiration was nondiagnostic for mammary tuberculosis. However, the diagnosis of mammary tuberculosis was confirmed by histopathologic evaluation at the time of open surgical biopsy. All three patients were treated with antituberculous therapy for six months. At the end of the treatment period, each patient appeared to be clinically and radiologically without evidence of residual disease. CONCLUSION: The diagnosis of mammary tuberculosis rests on the appropriate clinical suspicion and the histopathologic findings of the breast lesion. Its recognition and differentiation from that of a breast malignancy is absolutely necessary. Antituberculous chemotherapy, initiated immediately upon diagnosis, forms the mainstay of treatment for mammary tuberculosis.

A rare case of neuro-Behçet's disease presenting with limbic encephalitis.

Behçet's syndrome is a recurrent systemic inflammation with an unknown etiology. The onset of the condition often occurs in the second decade of life and it is more common in males than in females. One of the most feared organ involvements associated with BS is neurological involvement, which often affects the brain stem, although hemispheric involvement may be primary in a limited number of patients. Parenchymal neurological involvement in BS affects the prognosis unfavorably, as it may result in severe sequelae or mortality. Early diagnosis and treatment is important to prevent sequelae. Herein, we report the first case of neuro-Behçet's disease presenting with limbic encephalitis who received early stage immunotherapy.

Preoperative staging of esophageal carcinoma with multidetector CT and virtual endoscopy.

PURPOSE: The aim of this study was to assess the accuracy of multidetector computed tomography (MDCT), including virtual endoscopy (VE) for detection, precise localization, preoperative evaluation and staging of esophageal cancer (EC) by comparison with surgical and histopathological findings. MATERIALS AND METHODS: Between September 2003 and April 2005, 44 patients with histologically proven EC underwent MDCT and VE. Among 44 patients, the findings were confirmed in 24 at surgery. The accuracy of three-dimensional MDCT for detection, localization, and staging of EC was determined, and compared with surgical finding and histopathology. RESULTS: The overall accuracy of three-dimensional multidetector row CT for detection of EC was 100% (24/24). MDCT staging was correct in 20 patients (83.3%). The T parameter was correctly assessed in 22 (91.7%) cases (understaged in 1 and overstaged in 1). The N parameter was correctly evaluated in 20 (83.4%) patients (understaged in 2 and overstaged in 2). The overall accuracy of VE for the morphologic classification of EC was 81.5%. CONCLUSIONS: Three-dimensional MDCT, along with VE is a promising method for preoperative evaluation and staging of EC. Although accuracy in N staging remains low in comparison to PET, it provides a larger amount of diagnostic and staging information.

Effects of tamoxifen on pulmonary fibrosis after cobalt-60 radiotherapy in breast cancer patients.

BACKGROUND AND PURPOSE: This study was performed to investigate whether the tamoxifen (TAM) induced the development of pulmonary fibrosis after post-mastectomy cobalt-60 (Co-60) irradiation of chest wall and regional lymphatics in patients with breast cancer along with patient age, menopausal status, body weight, observation time and adjuvant chemotherapy regimens. MATERIALS AND METHODS: In this prospective study, 74 patients treated with post-mastectomy adjuvant radiotherapy (RT) and TAM and 37 patients treated with RT were evaluated by axial computerized tomography (CT). CT was first performed before initiation of radiotherapy and TAM treatment. A total of 824 thorax CT sections were evaluated by a radiologist blindly. Comparison of pre-treatment and post-treatment CT sections was used to monitor the development of pulmonary fibrosis. RESULTS: Pulmonary fibrosis developed in 26 of 74 patients who were treated with RT and TAM combination. It was found in five of 37 women treated only with RT. The difference was statistically significant (P<0.01). The median time for the development of pulmonary fibrosis was 8 months in TAM-treated patients whereas it was 10 months in non-TAM-treated patients. Among 111 patients who participated in that study, 65 were in the post-menopausal state and 46 in pre-menopausal state. In the multivariate analysis, the independent prognostic factors were age (P=0.010) and menopausal status (P=0.019). Advanced age and post-menopausal status predisposed to pulmonary fibrosis. The time interval in the development of lung fibrosis and body weight did not significantly influence the results. The time interval which is one independent prognostic factor was found to be associated with lung fibrosis under only-RT group in multivariate analysis (P<0.01). CONCLUSION: TAM treatment during post-mastectomy RT in breast cancer patients significantly increases the risk of the development of lung fibrosis along with the patient age and menopausal status.

Complications of albendazole treatment in hydatid disease of lung.

We present rupture of lung hydatid cyst in a patient with multiple organ involvement during albendazole treatment. The patient was first provided mechanical ventilation than residue cavity and the other intact cyst was treated surgically. We concluded that albendazole should be used in postoperative period in patients with hydatid disease of the lung to prevent recurrent disease.

Left ventricular systolic and diastolic functions in children living in a moderate-severe iodine deficiency area.

Although the effects of impaired thyroid functions on the cardiovascular system is well known, there is no report investigating left ventricular functions in children with iodine deficiency. We evaluated left ventricular functions in children living in a moderate-severe iodine deficient area of northern Turkey. Of 40 children, 13 had stage I, 19 had stage II and eight had stage III goiter. None of the children had clinical signs of hypothyroidism, hyperthyroidism or cardiac dysfunction. Urinary iodine concentration decreased significantly from mild (Group 1) to moderate (Group 2) and severe (Group 3) iodine deficient groups (p <0.05). Mean serum free T3 levels did not differ significantly between the groups. However, a significant difference in mean serum free T4 level was found between Groups 1 and 2 (p <0.05), but remained in the normal range. Although the mean serum TSH level differed significantly between Group 1 and Group 3 and Group 2 and Group 3 (p <0.05), mean values were in the normal range. Mean left ventricular ejection fraction, shortening fraction and diastolic filling parameters did not differ significantly between groups. In conclusion, in case of preserved thyroid hormone levels, a moderate-severe iodine deficiency does not seem to affect left ventricular functions.

Tension pneumothorax associated with hydatid cyst rupture.

SUMMARY: Hydatid disease is common in Turkey. Tension pneumothorax is rare, but it is an important complication of the hydatid cyst with significant morbidity and mortality. Tension hydropneumothorax secondary to the rupture of a hydatid cyst was detected in 5 of 185 spontaneous pneumothorax cases that were treated in the authors' clinic between 1992 and 1998. All patients were subjected to surgical treatment after urgent tube thoracostomy. No mortality or recurrence was observed at follow-ups of 9 to 24 months.

A giant cystic hygroma on the leg of a newborn infant complicated by hyponatremia.

Cystic hygromas are large cystic masses resulting from failure of lymph drainage. The vast majority occur in the neck or axilla. Cases of cystic hygroma of the extremity are extremely rare. We present a newborn infant with a giant cystic hygroma on her left leg, complicated by severe hyponatremia.

Assessment of goiter prevalence, iodine status and thyroid functions in school-age children of rural Yusufeli district in eastern Turkey.

According to previous studies, Turkey has generally been accepted as a moderate endemic iodine deficient country. However, it has recently been reported that there are regions in Turkey where iodine deficiency is more severe than previously known. The current study was aimed at ascertaining the goiter prevalence by thyroid volumes, iodine status and thyroid functions in school-age children living in an area which is suspected to have moderate or severe iodine deficiency. Overall goiter was found in 47.6% of children, in 22.8% of girls and in 24.8% of boys. Mean thyroid volumes did not differ significantly according to sex. Significant correlation was found between thyroid volume and body surface area and age. There was a negative correlation between the urinary iodine concentration and thyroid volume (r = 0.45, p < 0.01). Median urinary iodine concentrations in subjects with and without goiter were 20 microg/dl and 5.2 microg/dl, respectively. While median urinary iodine levels of the subjects with goiter were consistent with severe-moderate iodine deficiency, levels in subjects without goiter were comparable to moderate-mild iodine deficiency. None of the subjects had the signs or symptoms of hyper-or hypothyroidism. The differences in the mean values of thyroid hormones and TSH levels between subjects with or without goiter were not significant (p > 0.05). No correlation was found between urinary iodine concentrations and thyroid hormone levels. A weak correlation was found between urinary iodine concentration and TSH levels (r = 0.12, p = 0.05). Individuals with goiter were investigated etiologically: biochemical hypothyroidism was detected in 2%, compensated hypothyroidism in 12.6%, autoimmune thyroiditis in 2%, nodular goiter in 3% and isolated high TSH level with autoimmune thyroiditis in 0.08%. In conclusion, although a salt iodization program has been started in Turkey, our study indicates that some regions with severe iodine deficiency are still present. This research suggests that this program should be re-evaluated for remote areas with self-contained economic systems, and should be expanded and more effectively applied nation-wide.

Handedness differences in widths of right and left craniofacial regions in healthy young adults.

In this work, handedness differences in the widths of right and left craniofacial regions were studied in a healthy sample of 39 male and 43 female students, 17 to 23 years old. Width of craniofacial regions was assessed by computerized tomography. Handedness was associated with the left face width especially for women. The left facial region was larger for right-handers than left-handers. The smaller measure for the left face of left-handers might be associated with an advantage of left ear sensitivity.

Relations among hand preference, craniofacial asymmetry, and ear advantage in young subjects.

The relations for hand preference with craniofacial asymmetry and ear advantage, and between craniofacial asymmetry and ear advantage were investigated in young healthy subjects. Ear advantage was recorded as duration of hearing, craniofacial asymmetry by computerized tomography in 44 right-handed and 38 left-handed male and female high school students. Right-handers had a right ear advantage and a larger left craniofacial region, whereas left-handers had a left ear advantage and a larger right craniofacial region. These results are consistent with the speculation that hand preference may be related to craniofacial and consequently aural asymmetries.

Radiographic Findings in Hyperimmunoglobulin E Syndrome.

The aim of this study is to demonstrate the spectrum of radiologic findings of hyperimmunoglobulin E (hyper- IgE) syndrome that is relatively rare in adults. We describe the imaging findings of this rare disease in five patients. The study group consisted of 4 men and 1 woman. The final diagnosis was made according to laboratory findings in all cases. We detected lung involvement in 3 cases, paranasal sinus involvement in 4 cases and vascular involvement in 1 case. Soft tissues were involved in 5 cases. Bone involvement was demonstrated in 3 patients. The most frequent radiologic finding was widespread infectious involvement of soft tissues, bones and neighboring structures such as bursae and tendons and respiratory system.

Bilateral vertebral artery stenosis present with vertigo.

Of ischaemic stroke patients, about 25% rise from the posterior or vertebrobasilar system. The ischaemia of vertebral arteries may emerge for different vascular pathological reasons, at different localisations and with different clinical findings. Despite its low morbidity and mortality risk, early diagnosis and treatment is of importance. Vertebrobasilar ischaemia symptoms can be observed clinically such as vertigo, tinnitus, double vision, headache, hypokinesis and hearing disorders, etc. In this article, a 42-year-old stroke patient case is presented, who applied to the emergency service with vertigo and then, was diagnosed with bilateral vertebral artery stenosis by means of cranial MR angiography.

Hepatic hydatid disease: radiographics findings.

Hydatid disease (HD) is a unique parasitic disease that primarily affects the liver and is endemic in many parts of the world. There are four types of hydatid cysts (HCs) with various levels of organ involvement. All four HC types can be seen in the liver, with the right lobe being the most common site of involvement. There are many potential intrahepatic and extrahepatic complications that affect the liver and other organs. Intrahepatic complications include vascular and biliary complications and infection. With rare portal vein compression and decreased vascular supply, the involved lobe may show atrophic changes while the other lobe becomes hypertrophic. Intrahepatic biliary dilatation results from large cysts compressing intrahepatic ducts or due to cyst rupture into the biliary ducts. Cyst infection may also occur via a similar mechanism. Extrahepatic complications result from exophytic growth and hematogeneous dissemination. Exophytic growth causes migration of cysts into the lungs, mediastinum, heart and peritoneum. Hematogeneous dissemination involves all other organs.

Can the Function-Morphology Association Be a Model for the Early Detection of COPD in Asymptomatic Smokers?

OBJECTIVE: In the present study, we aimed to evaluate the morphological and functional characteristics in symptomatic and asymptomatic smokers in comparison to nonsmokers in order to gain better understanding of the pathogenesis and early diagnosis of Chronic Obstructive Pulmonary Disease (COPD). MATERIALS AND METHODS: A Randomized, double-blind, placebo -controlled, parallel-group trial vas performed. PATIENTS AND INTERVENTIONS: A total of 50 male patients (40 smokers and 10 non-smokers) who completed a questionnaire, between the ages of 18-60 (mean age 32), were included the study. Of the smokers, 23 were symptomatic, and 17 were asymptomatic. High-resolution computerized tomography (HRCT) and pulmonary function tests (PFTs) were performed in all cases. RESULTS: In the evaluation of all smokers, a comparison of the PFTs and morphological changes revealed a significant correlation between all morphological parameters and ΔN2/l. Although a relationship was found between the smoking score and the closing volume (CV), ΔN2/l and anatomic dead space (ADS) in all cases, the smoking score was significantly correlated with only the CV in symptomatic cases and with only the ADS in asymptomatic cases. There was a positive correlation between the emphysema parameters on HRCT and smoking, but no correlation was found between the parameters and the pulmonary function tests. CONCLUSION: The relationship between morphology and function is better, although different, in the asymptomatic period of lung injury caused by smoking compared with the symptomatic period, and the relationship is increasingly weakened in the further stages of the disease.