|1.||Evaluation of predisposing factors and bacteriologic agents in pediatric rhinosinusitis|
Hülya Eyigör, Sema Başak
Pages 49 - 55
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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. Waters 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
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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 Schullers 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
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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.
|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
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Objectives: This experimental study was performed to
evaluate the protective effect of magnesium on amikacin
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.
|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
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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
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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
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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.
|8.||Vertigo and medico-legal problems|
Ali Fuat Işık
Pages 91 - 95
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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 dont
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.