| ORIGINAL ARTICLE | |
| 1. | Evaluation of predisposing factors and bacteriologic agents in pediatric rhinosinusitis Hülya Eyigör, Sema Başak Pages 49 - 55 FREE FULL TEXT Objectives: This study was conducted to investigate the predisposing factors and bacteriologic agents of acute rhinosinusitis in children. Patients and Methods: The study included 76 patients (47 girls, 29 boys; mean age 10.2 years; range 4 to 18 years) with acute rhinosinusitis. Following a detailed history, the patients were investigated by otolaryngologic examination including nasal endoscopy, allergy tests, Water's graphy, and aspiration cultures from the middle meatal region. Results: The leading complaints were nasal obstruction (92.1%), rhinorrhea (89.4%), and headache (51.3%). Allergy tests were positive in nine of 23 patients (30.3%) with a history of allergy. Concerning smoking, 39 patients (51.3%) had a secondary, two patients (2.6%) had a primary history. Sixteen patients (21.1%) had septal deviation, and 25 patients (32.9%) had benign adenoid tissue obstructing choanal spaces. Water’s graphies showed pathology in 69 patients (93.2%). Cultures were positive in 51 patients (67.1%), with Streptococcus pneumoniae in 23 (41.1%), Haemophilus influenzae in 17 (30.4%), and beta-hemolytic streptococci in eight patients (14.2%). Treatment was comprised of ampicillin-sulbactam in 31 (40.8%), loracarbef in 20 (26.3%), and amoxicillin-clavulanate in 13 (17.1%) patients. After a year follow-up, recurrence was detected in 12 patients (15.8%). No significant effect of the size of adenoid tissue and allergy was found on the success of treatment (p>0.05). Conclusion: Smoking, choanal obstruction by the adenoid tissue, anatomical variations, and allergy were the most frequent predisposing factors, while S. pneumoniae and H. influenzae were the commonest pathogens. |
| 2. | The predictive value of assessing mastoid pneumatization in pre-dive examinations Cem Uzun, Abdullah Taş, Recep Yağız, Mustafa K. Adalı, Muhsin Koten, Haldun Şan, Ahmet R. Karasalihoğlu Pages 56 - 61 FREE FULL TEXT Objectives: We investigated the value of assessing the degree of mastoid pneumatization in predicting middle ear barotrauma -the most common problem in sport SCUBA divers- in comparison with that of the conventional predive examination method, the Valsalva maneuver. Materials and Methods: Thirty-four volunteer sport SCUBA divers having normal pre-dive examination findings were included. The Valsalva test was performed in all the divers. Mastoid pneumatization for each ear was calculated on a Schuller’s view radiography. Pneumatization of ≤30 cm2 was accepted as poor (prone to barotrauma) and >30 cm2 was accepted as good (not prone to barotrauma). During the observation period, the divers were monitored with regard to barotrauma symptoms or signs. Results: The degree of mastoid pneumatization was ≤30 cm2 in 26 ears (38%) of 16 divers (47%). The Valsalva test was negative in eight ears (12%) of six divers (18%). During a total of 1001 dives, symptomatic middle ear barotrauma occurred in 28 dives (2.8%), i.e. in 21 ears (31%) of 16 divers (47%). Of these, the degree of mastoid pneumatization predicted barotrauma in 11 (69%) divers, whereas the Valsalva test was negative in only three (19%) (p<0.05), with sensitivity, specificity, positive and negative predictive values, and efficiency being 69% and 19%, 72% and 83%, 69% and 50%, 72% and 54%, and 71% and 53%, respectively. Conclusion: The value of assessing mastoid pneumatization in predicting middle ear barotrauma in sport SCUBA divers is higher than that of the Valsalva test. |
| 3. | The value of laryngeal electromyography in the prognosis of vocal cord paralysis Timur Akçam, Murat Köse, Ümit Hıdır Ulaş, Mustafa Gerek, Yalçın Özkaptan Pages 62 - 69 FREE FULL TEXT Objectives: We investigated the value of laryngeal electromyography (EMG) in monitoring patients with vocal cord paralysis. Patients and Methods: Cricothyroid and thyroarytenoid muscles of 40 patients (10 females, 30 males; mean age 32 years; range 18 to 61 years) with vocal cord paralysis were monitored with laryngeal electromyography. The patients were divided into two groups according to time to presentation after symptom onset, i.e. within 1-3 months (group 1; n=14), and after at least 12 months (group 2; n=26). Electromyography was repeated every three months in group 1, and in the third and sixth months in group 2. Results: Initial EMG examinations showed polyphasic reinnervation potentials and partial axonal degeneration in 21 laryngeal nerves in group 1. Recovery was expected in these patients. Repeat EMGs revealed normal findings in 17 laryngeal nerves, yielding a prognostic estimation of 80.9% (17/21). In group 2, none of the patients demonstrated polyphasic potentials or motor unit potentials suggesting reinnervation on admission. The earliest and latest recoveries were observed in the fourth and eleventh months (mean 6.4 months) in group 1, respectively. However, group 2 patients were followed-up for at least 18 months after the onset of their symptoms and none manifested clinical and electrophysiologic improvement. Conclusion: Our data suggest that EMG is a useful technique in the estimation of prognosis of patients presenting in the early period of vocal cord paralysis. |
| EXPERIMENTAL STUDY | |
| 4. | Evaluation of the protective effect of magnesium on amikacin ototoxicity by electrophysiologic tests in guinea pigs Erdoğan Bulut, Recep Yağız, Abdullah Taş, Cem Uzun, Çetin Yıldırım, Kadir Kaymak, Ahmet R. Karasalihoğlu Pages 70 - 77 FREE FULL TEXT Objectives: This experimental study was performed to evaluate the protective effect of magnesium on amikacin ototoxicity. Study Design: Twenty seven guinea pigs (54 ears) with normal auropalpebral reflexes and otomicroscopic examination, auditory brain stem responses (ABR), and transient evoked otoacoustic emissions (TEOAE) were randomly divided into four groups to receive amikacin once 15 mg/kg daily (group 1 and 3) and twice 7.5 mg/kg daily (group 2 and 4) for seven days. Groups 3 and 4 were administered oral MgCl an hour after amikacin use at a dose of 39 mmol/l and 19.5 mmol/l, respectively, for seven days. Otomicroscopic examination, ABR and TEOAE measurements were repeated on the third, fifth, and seventh days. Results: Compared to group 1, decreases in TEOAE amplitudes and reproducibility and increases in ABR thresholds were significant in group 2 (p<0.05). However, in groups 3 and 4, TEOAE amplitudes remained unchanged, or even increased and the reproducibility of TEOAE responses and ABR thresholds showed no significant changes (p>0.05). Conclusion: Our data show that oral magnesium may play a protective role on amikacin ototoxicity. |
| CASE REPORTS | |
| 5. | Simultaneous existence of papillary carcinoma in the thyroid gland and thyroglossal duct cyst in two patients Deniz Demir, Yusufhan Süoğlu, Mehmet Güven, Yersu Kapran Pages 78 - 82 FREE FULL TEXT Papillary carcinoma of the thyroglossal duct cyst is a rare occurrence. Two patients presenting with medial neck masses were diagnosed as having thyroglossal duct cysts by ultrasonography. The Sistrunk operation was performed. Histopathologic evaluation demonstrated papillary carcinoma in the surgical specimens of both patients. The thyroid glands were examined by ultrasonography, scintigraphy, and fine-needle aspiration biopsy. Biopsy showed papillary carcinoma, and total thyroidectomies were performed. Micropapillary carcinoma was detected in the resected thyroid glands. The patients were asymptomatic without complications after 24 and 32 months of follow-up, respectively. |
| 6. | Dermatofibroma accompanied by perforating dermatosis in the auricle: a case report Erdinç Aydın, Ö. Süha Vardareli, Banu Bilezikçi, O. Nuri Özgirgin Pages 83 - 86 FREE FULL TEXT Although dermatofibroma is one of the most common soft tissue tumors, it is rarely seen in the face. Perforating dermatosis is characterized by papulonodules measuring 1-10 cm, with a central cup-shaped epidermal depression filled with a keratotic plug. An 82-year-old woman presented with a hyperkeratotic erythematous papular lesion, 0.8 cm in diameter, on the posterior side of the left auricle, showing no infiltration to the peripheral tissues. Total excisional biopsy was performed, which showed dermatofibroma accompanied by perforating dermatosis. No recurrence was detected during her follow-up. Our literature search did not yield any reported case of dermatofibroma accompanied by perforating dermatosis. |
| 7. | Three cases of mucosal malignant melanoma of the nose and paranasal sinuses Mustafa Kaymakçı, Özer Erdem Gür, Erdinç Aygenç, Fatih Fidan, Cafer Özdem Pages 87 - 90 FREE FULL TEXT We evaluated the clinical course and treatment of three patients who were found to have mucosal malignant melanoma of the nose and paranasal sinuses. The presenting complaint was recurrent epistaxis in all the patients. One patient had been followed-up for nasal polyposis for a long time. In older patients with recurrent epistaxis, endoscopic examination of the nasal cavity and obtaining a biopsy from suspected regions are essential for early diagnosis of mucosal malignant melanomas. |
| REVIEW | |
| 8. | Vertigo and medico-legal problems Ali Fuat Işık Pages 91 - 95 FREE FULL TEXT Forensic medicine deals with the interactions of medical science with the law. All branches of medicine can play a role in dealing with medico-legal problems. Clinical and forensic evaluators need to be able to recognize variations of symptoms or syndromes that “don’t read the textbooks”. Atypical presentations of dizziness or vertigo have the potential to cause much confusion in diagnosis, treatment planning, and legal adjudication, if not correctly recognized. This article describes the forensic medicine in the legal system and forensic aspects of other medical specialities, gives an overview about medicolegal viewpoint of vertigo and at last underline the importance of objective clinical and forensic evaluation of the patient with vertigo. |