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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.
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Estimulantes do Sistema Nervoso Central/efeitos adversos , Perda Auditiva Súbita/induzido quimicamente , Metilfenidato/efeitos adversos , Estimulantes do Sistema Nervoso Central/administração & dosagem , Criança , Feminino , Glucocorticoides/administração & dosagem , Audição/efeitos dos fármacos , Perda Auditiva Súbita/terapia , Humanos , Oxigenoterapia Hiperbárica , Metilfenidato/administração & dosagem , Prednisona/administração & dosagemRESUMO
Introduction: Metastatic disease is one of the main causes of death and factors affecting overall survival. It is known that selected patients with pulmonary oligometastases whose primary tumor is under control and who have adequate respiratory capacity may benefit from metastasectomy by resecting all detected lesions. Aim: To report our findings on the use of video-assisted thoracoscopic surgery (VATS) for pulmonary metastasectomy, with a focus on identifying suitable candidates. Material and methods: Between August 2010 and 2023 a total of 532 pulmonary metastasectomy procedures were performed in our institution. Metastasectomy was performed with VATS for 281 of those patients. Results: VATS metastasectomy was performed in 131 patients with a single lesion on preoperative imaging, while 110 patients underwent metastasectomy for multiple lesions. The rate was significantly (p < 0.05) lower in the group with multiple lesions removed during surgery (38 months) than in the group with only one lesion removed during surgery (60 months). The predicted survival time in the group with other tumor histology (79 months) was significantly (p < 0.05) higher than in the groups with tumor histology carcinoma (41.4 months) and sarcoma (55.5 months). Conclusions: The best prognosis after metastasectomy is provided in cases with a single nodule. Grade is also an important prognostic factor affecting survival, particularly for grade 1 tumor. The histopathological type of the primary tumor is also a significant prognostic factor affecting survival after pulmonary metastasectomy in secondary pulmonary neoplasms, particularly for sarcoma and carcinoma.
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Tumors of the smooth muscles are rarely seen, as the number of smooth muscles is low within the intraoral region. Leiomyosarcoma is a type of malign tumor originating from smooth muscles. The most common regions of leiomyosarcoma of the oral cavity are the maxilla and mandible. In this article, we present a leiomyosarcoma detected in a 20-year-old male patient who was admitted to the clinic with the complaint of a mass for about three months. The mass was located in the left half of the soft palate and it was resected en bloc with the mucosa. No recurrence was observed during the two-year follow-up period of the patient.
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Leiomiossarcoma/patologia , Neoplasias Palatinas/patologia , Palato Mole/patologia , Diagnóstico Diferencial , Humanos , Leiomiossarcoma/cirurgia , Masculino , Neoplasias Palatinas/cirurgia , Adulto JovemRESUMO
Introduction: The most common chest wall deformities are pectus excavatum and pectus carinatum. Surgical repair of these deformities via minimally invasive technique using pectus bars is commonly preferred by numerous thoracic surgeons. Despite this common choice for treatment, the duration of the bar stay, the bar removal process, the possible complications and ways to prevent them have been debated over the years and still there is no single decision. Aim: To determine the decision making, surgical outcomes and negative factors in the bar removal process. Material and methods: There were 1032 patients underwent bar removal between 2006-2020 and their data was recorded prospectively. We analyzed patients' demographics, family history, Haller index, bar count, body mass index, stabilizer and wire usage, length of hospital stay, time until bar removal, incision side and complications retrospectively. Results: There was no significant correlation between BMI and surgery time (p = 0.748). There was no statistically significant correlation between the age groups and the number of pectus bars removed. The other factors showed no significant difference. The surgery time was found to be significantly longer in those with callus tissue (p = 0.002). Conclusions: These findings suggest that pectus bars can be left in place for a shorter time than the standard 3-year interval without any additional recurrence risk and without compromising quality of life. As a result, patients with persistent pain after pectus repair should be well evaluated for the possibility of life-threatening complications during bar removal.
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INTRODUCTION: Mediastinal lymph node (MLN) removal by video-assisted mediastinoscopic lymphadenectomy (VAMLA) for preoperative cancer staging was reported to be associated with increased survival. The aim of this study was to evaluate the immunologic effects of complete MLN removal by VAMLA on cytotoxic T lymphocyte (CTL) phenotype and function. METHODS: Seventeen patients with non-small cell lung cancer (NSCLC) (stage cT1-4N0-3M0-1A) and 20 healthy participants were included in this study. Blood samples were collected before and 4 weeks after the procedure. Lymphocytes were isolated from the removed MLNs. CTL phenotypes and functions were evaluated by flow cytometry. Plasma levels of soluble programmed cell death protein 1 (sPD-1), soluble programmed cell death protein 1 ligand, and soluble CTL antigen 4 (sCTLA-4) were measured with enzyme-linked immunosorbent assay. RESULTS: The ratio of the immunosenescent CTLs (CD3+CD8+CD28-) was increased in peripheral blood and MLNs of the patients with NSCLC compared to controls (p = 0.037), and MLN removal did not change this ratio. PD-1 and CTL antigen 4 expressions were significantly reduced in peripheral blood CTLs after MLN removal by VAMLA (p = 0.01 and p = 0.01, respectively). Granzyme A expression was significantly reduced in the peripheral blood CTLs of the patients compared to controls (p = 0.006) and MLN removal by VAMLA significantly improved Granzyme A expression in CTLs (p = 0.003). Plasma concentrations of sPD-1 and sCTLA-4 remained unchanged after VAMLA. CONCLUSION: CTLs in the MLNs and peripheral blood of the patients with NSCLC had an immunosenescent phenotype, increased immune checkpoint receptor expression, and impaired cytotoxicity. MLN removal by VAMLA improved these phenotypic and functional characteristics of CTLs. These changes may explain the potential contribution of VAMLA to improved survival.
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Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Linfócitos T Citotóxicos , Granzimas , Receptor de Morte Celular Programada 1 , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/patologia , Excisão de Linfonodo/métodos , Linfonodos/patologiaRESUMO
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death globally. In this study, the effect of complete removal of mediastinal lymph nodes by video-assisted mediastinoscopic lymphadenectomy (VAMLA) on natural killer (NK) cell phenotype and functions in patients with NSCLC was evaluated. The study included 21 NSCLC patients (cIA-IVA) undergoing VAMLA staging and 33 healthy controls. Mononuclear cells were isolated from peripheral blood of all participants and mediastinal lymph nodes of the patients. NK cells were analyzed by flow cytometry to define NK subsets, expressions of PD-1, CTLA-4, activating/inhibitory receptors, granzyme A, and CD107a. The plasma levels of soluble PD-1, PDL-1, and CTLA-4 were measured by ELISA. Mediastinal lymph nodes of NSCLC patients had increased ratios of exhausted NK cells, increased expression of PD-1 and IL-10, and impaired cytotoxicity. Mediastinal lymph nodes removal increased CD56dimCD16bright cytotoxic effector phenotype and reduced exhausted NK cells. PD-1+ NK cells were significantly more abundant in patients' blood, and VAMLA significantly reduced their ratio as well. The ratio of IL-10 secreting regulatory NK cells was also reduced after VAMLA. Blood NK cells had increased cytotoxic functions and spontaneous IFN-γ secretion, and these NK cell functions were also recovered by VAMLA. Mediastinal lymph node removal reversed NK cell exhaustion, reduced regulatory NK cells, and improved antitumoral functions of NK cells. Tumor-draining lymph nodes may contribute to tumor evasion from antitumoral immune responses. The role of their removal needs to be further studied both to better understand this mechanism and as a potential immunotherapeutic approach.
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Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Humanos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Interleucina-10/metabolismo , Antígeno CTLA-4/metabolismo , Neoplasias Pulmonares/cirurgia , Receptor de Morte Celular Programada 1/metabolismo , Excisão de Linfonodo , Linfonodos/patologia , Células Matadoras Naturais , Antígeno CD56/metabolismoRESUMO
Numerous techniques have been described to correct deviated nose deformities. This article discussed the Z-shaped asymmetric hump resection combined with unilateral osteotomy. Fifty-eight cases that we operated between 2003 and 2009 for deviated nose deformity were included in the study. In this study, septoplasty was performed in all patients, and hump was resected Z-shaped whereas osteotomy was carried out in a unilateral low to low fashion. Edema and periorbital ecchymosis were minimal on the nonosteotomy side in early postoperative period in all cases, and deviation was noted to be satisfactorily corrected in the late postoperative period. Three cases were reoperated in late stage for mucosal synechiae and 1 case for a new postoperative trauma (6.8% revision). Z-shaped asymmetric hump resection combined with unilateral osteotomy is one of the minimally traumatic methods that can safely be used to correct deviated nose.
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Osso Nasal/cirurgia , Septo Nasal/cirurgia , Deformidades Adquiridas Nasais/cirurgia , Osteotomia/métodos , Adulto , Estudos de Coortes , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osso Nasal/fisiopatologia , Septo Nasal/fisiopatologia , Deformidades Adquiridas Nasais/diagnóstico , Estudos Retrospectivos , Rinoplastia/métodos , Medição de Risco , Resultado do Tratamento , Adulto JovemRESUMO
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.
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Transtornos do Olfato/etiologia , Palato Mole/cirurgia , Ronco/cirurgia , Distúrbios do Paladar/etiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos ProspectivosRESUMO
OBJECTIVE: We evaluated the halimetric, olfactory, and taste functions of patients with laryngopharyngeal reflux (LPR). STUDY DESIGN: Prospective clinical study. SETTING: Multicenter tertiary care hospital. METHODS: Patients who were diagnosed with LPR for the first time on the basis of a Reflux Finding Score (RFS) >11 and a Reflux Symptom Index (RSI) >13 were enrolled in this study. A control group was selected from patients without a complaint of LPR. OralChroma was used for the halimetric measurement; Sniffin' Sticks were used for the smelling test; Taste Strips were used for the taste test; and monosodium L-glutamate was used for the umami test. RESULTS: A total of 110 subjects were included, with a mean age of 36.8 ± 10 years (range, 19-57 years). The differences in odor threshold scores were significant between the groups (P < .001), but no change was detected for the odor identification or discrimination scores between the groups. Bitter taste scores were significantly diminished in the reflux group compared with those in the control group (P = .001), whereas no impairments were found in the other taste scores (sweet, salty, and sour). The reflux group had significantly higher umami taste scores than those of the control group for the posterior tongue and soft palate anatomic sites (P < .001 and P < .001, respectively). Dimethyl sulfite levels were significantly higher in the reflux group than in the control (P = .001). CONCLUSION: Questioning patients who present with halitosis, taste, or smelling disorders is important to diagnose LPR.
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Refluxo Laringofaríngeo/fisiopatologia , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/fisiopatologia , Distúrbios do Paladar/diagnóstico , Distúrbios do Paladar/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
OBJECTIVE: The effects of topical application of Mitomycin-C (MMC) and 5-fluorouracil (5-FU) for maintaining myringotomy patency were investigated in this experimental study. STUDY DESIGN: We performed simple myringotomy with a knife on 140 tympanic membranes of 70 rats. Rats were divided in two study groups and a control group. Each study group had 60 tympanic membranes, and the control group had 20. We applied Mitomycin-C (0.4 mg/ml) in Group A, 5-fluorouracil (50 mg/ml) in Group B topically, and sterile saline in the control group for 10 minutes. Examination was made with otoendoscope on days 1, 3, 5, 7, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, and 70, and patency rates were recorded. RESULTS: MMC and 5-FU Groups remained open for a mean of 46.17 days and 14.62 days, respectively. The control ears healed within 10.4 days. Fibrosis of the MMC-treated group was the same as that of 5-FU-treated groups. Fibrosis of both study groups was significantly lower than that of the control group. CONCLUSIONS: MMC is more effective than 5-FU, which is more effective than the simple myringotomy procedure in extending the patency of myringotomies in rat tympanic membranes (p < 0.05). Both medications are useful as an adjunct in preventing myringotomy closure.
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Antimetabólitos/administração & dosagem , Fluoruracila/administração & dosagem , Ventilação da Orelha Média , Mitomicina/administração & dosagem , Administração Tópica , Animais , Antimetabólitos/farmacologia , Fibrose , Fluoruracila/farmacologia , Mitomicina/farmacologia , Otoscopia , Ratos , Ratos Sprague-Dawley , Membrana Timpânica/efeitos dos fármacos , Membrana Timpânica/patologia , Membrana Timpânica/fisiopatologia , Cicatrização/efeitos dos fármacosRESUMO
OBJECTIVES/HYPOTHESIS: Patients with olfactory dysfunction benefit from repeated exposure to odors, so-called olfactory training (OT). This does not mean occasional smelling but the structured sniffing of a defined set of odors, twice daily, for a period of 4 months or longer. In this prospective study, we investigated whether the effect of OT might increase through the use of more odors and extension of the training period. STUDY DESIGN AND METHODS: This study shows OT results when performed with four or 12 odors for 36 weeks in patients with postinfectious olfactory dysfunction. A total of 85 subjects participated (mean age 45.6 ± 10.5 years, range 24-68 years). Three groups were formed: 1) In the modified olfactory training (MOT) group, patients used three sets of four different odors sequentially. 2) Participants in the classical odor training (COT) group used four odors. 3) Participants in the control group did not perform OT. All groups were matched for age and sex distribution of participants. RESULTS: Both participants in the COT and MOT groups reached better scores than controls in terms of odor discrimination and odor identification. Continuing OT with four different odors after the 12th and 24th weeks produced better results in terms of odor discrimination and odor identification scores as compared to using the same four odors throughout the entire study. CONCLUSION: This study confirmed the effectiveness of OT. Increasing the duration of OT and changing the odors enhances the success rate of this therapy. LEVEL OF EVIDENCE: 2b. Laryngoscope, 125:1763-1766, 2015.
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Infecções/complicações , Transtornos do Olfato/reabilitação , Educação de Pacientes como Assunto/métodos , Satisfação do Paciente , Olfato/fisiologia , Adulto , Idoso , Endoscopia , Feminino , Seguimentos , Humanos , Infecções/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia , Transtornos do Olfato/fisiopatologia , Adulto JovemRESUMO
BACKGROUND: The University of Pennsylvania Smell Identification Test (UPSIT) is a well-developed and popular olfactory test, which has been validated in various populations. However, there was only one study in a Turkish population, and this study indicated that the North American version of the UPSIT was not enough to evaluate the olfactory functions of Turkish population. So, we developed a cross-cultural adaptation of the UPSIT, the UPSIT-Turkish (UPSIT-T). Thus, the goal of this study was to investigate the applicability of the UPSIT-T in healthy Turkish subjects. MATERIAL AND METHODS: The study included 51 healthy individuals who reported having normal olfactory function. The participants were administered the North American version of the UPSIT firstly, and then, after a day UPSIT-T was applied to the participants. The results of two smell tests were compared, and the applicability of UPSIT-T was evaluated. RESULTS: The mean (standard deviation) value for correctly identified odors was 27.2 ± 5.7 (range, 14-38) with the UPSIT application, whereas the mean (standard deviation) value for correctly identified odors was 35.9 ± 3.1 for UPSIT-T. There was a statistically significant increase in the scores of the participants when UPSIT-T was performed (p < 0.001). The identification rates of 10 test odorants were <80% for our study group, and 2 of 10 were <70% for the UPSIT-T. CONCLUSION: The UPSIT-T modification is an adequate olfactory test for clinical use in a Turkish population.
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Comparação Transcultural , Odorantes , Transtornos do Olfato/diagnóstico , Percepção Olfatória/fisiologia , Olfato/fisiologia , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Olfato/epidemiologia , Turquia/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Myasthenia gravis (MG) is commonly viewed as a muscle disorder. Less is known about neurosensory function and dysfunction in MG. We aim to evaluate olfactory and gustatory behavior in Turkish patients with MG, and compare these results with age and sex-matched healthy controls. MATERIAL/METHODS: 30 individuals with MG, and 30 healthy volunteers were studied. Olfactory function was studied with the Sniffin' sticks test. Taste strip test was used for studying taste function. The t-test was used for analyzing continuous variables, and the chi-square test for categorical data. Clinical staging and medication status were included in a model analyzed using analysis of variances. RESULTS: MG patients showed significantly lower olfactory (p<0.001) and gustatory scores (p<0.001) than the healthy controls. In addition, olfactory loss correlated with the severity of the disease. Medications for MG did not influence these results. CONCLUSION: This study replicates the olfactory dysfunction found elsewhere in MG. Further, gustatory dysfunction, an activity unrelated to muscle strength, was also unveiled. Medications used for treating MG must not be blamed for the chemosensory dysfunction found in this neurological disorder.
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Gastroenteropatias/etiologia , Miastenia Gravis/complicações , Transtornos do Olfato/etiologia , Adulto , Análise de Variância , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Miastenia Gravis/epidemiologia , Limiar Sensorial/fisiologia , Olfato/fisiologia , Paladar/fisiologia , Turquia/epidemiologiaRESUMO
OBJECTIVE: To discuss the differential diagnosis of two cases with mastoid mass. STUDY DESIGN: Case report and review of the literature. SETTING: The study was carried out in Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey. PATIENT, INTERVENTION, AND RESULTS: Both cases were 23-year-old males. They admitted to our clinic with masses behind their left ears that had been progressively enlarging for 5 years. In both cases, coronal and axial computerized tomography scans revealed a wide-based lesion involving temporal bone cortex. The cases were operated on for diagnosis and for correction of the cosmetic deformity. Histopathological examinations were consistent with mixed and spongiotic osteoma. CONCLUSIONS: Mastoid osteoma is a rare, benign tumor of bone. It may cause cosmetic deformity such as external mass or an auricular protrusion. Other neoplasms of the mastoid region, such as osteosarcoma and osteoblastic metastasis, should be considered for the differential diagnosis.