Impact of Intranasal Splint Removal Time on Postoperative Complications after Septoplasty

BACKGROUND

Various types of nasal tampons are used for packing after septoplasty. Intranasal splints are widely used as they are more advantageous than other materials regarding the lower complication rates of synechia, and lesser pain during removal. However, there is no consensus on the timing of intranasal splint removal after septoplasty operations.

AIM

In this study, we aimed to investigate the effects of removal time of intranasal splints on postoperative complications after septoplasty.

METHODS

One hundred patients who had septoplasty were randomly divided into two groups according to splint removal time. In group I, the splints were removed on the third postoperative day and in group II, splints were removed on the seventh postoperative day. Pain during splint removal was evaluated by visual analog scale (VAS). Complications of hemorrhage, septal hematoma, crusting, mucosal injury, and infection were recorded during splint removal and compared. In the first postoperative month, hemorrhage, crusting, mucosal injury, infection, synechia, and in the second postoperative month, synechia and perforation rates were compared between two groups.

RESULTS

Mucosal crusting was significantly higher in group II during splint removal. There was no statistically significant difference between the two groups regarding the complication rates and pain scores. Our findings showed no significant difference in pain scores during splint removal and postoperative complications between the two groups except for mucosal crusting.

CONCLUSION

Based on our findings, although there is no consensus on the optimal time for splint removal, earlier removal of splints can be considered a favorable option after septoplasty operations.

Comparison of Computed Tomography-Based Artificial Intelligence Modeling and Magnetic Resonance Imaging in Diagnosis of Cholesteatoma

BACKGROUND

In this study, we aimed to compare the success rates of computed tomography image-based artificial intelligence models and magnetic resonance imaging in the diagnosis of preoperative cholesteatoma.

METHODS

The files of 75 patients who underwent tympanomastoid surgery with the diagnosis of chronic otitis media between January 2010 and January 2021 in our clinic were reviewed retrospectively. The patients were classified into the chronic otitis group without cholesteatoma (n=34) and the chronic otitis group with cholesteatoma (n=41) according to the presence of cholesteatoma at surgery. A dataset was created from the preoperative computed tomography images of the patients. In this dataset, the success rates of artificial intelligence in the diagnosis of cholesteatoma were determined by using the most frequently used artificial intelligence models in the literature. In addition, preoperative MRI were evaluated and the success rates were compared.

RESULTS

Among the artificial intelligence architectures used in the paper, the lowest result was obtained in MobileNetV2 with an accuracy of 83.30%, while the highest result was obtained in DenseNet201 with an accuracy of 90.99%. In our paper, the specificity of preoperative magnetic resonance imaging in the diagnosis of cholesteatoma was 88.23% and the sensitivity was 87.80%.

CONCLUSION

In this study, we showed that artificial intelligence can be used with similar reliability to magnetic resonance imaging in the diagnosis of cholesteatoma. This is the first study that, to our knowledge, compares magnetic resonance imaging with artificial intelligence models for the purpose of identifying preoperative cholesteatomas.

[A Histopathologically Diagnosed Neurocysticercosis Case from Türkiye]

Cysticercosis is a parasitic tissue infection caused by larval cysts of Taenia solium. Although the disease affects many tissues, it primarily affects the brain and muscles. The most common form is neurocysticercosis, a term used for human central nervous system involvement with T.solium cysts. Neurocysticercosis is an important public health problem in many parts of the world. Its prevalence is particularly high in places where T.solium tapeworms are common, such as Mexico, Central America, South America, Southeast Asia, Africa, China, India, and Nepal. Its incidence has been increasing rapidly in recent years in non-endemic countries, due to both import and local cases, while in some highly endemic areas, numbers appear to have decreased, possibly due to better sanitation and increased public awareness. It is extremely rare in Türkiye. Cysticercosis is usually caused by drinking water or eating food containing tapeworm eggs. Clinical manifestations can range from completely asymptomatic infection to severe illness or death. Although the infection can involve any part of the central nervous system, symptomatic patients mostly have spinal cord involvement, intracerebral lesion, intraventricular cyst or subarachnoid lesion. An intraparenchymal cerebral cyst typically grows slowly and causes minimal symptoms for years or decades after the onset of infection. The site of involvement and the symptoms experienced determine the diagnosis and treatment method. The current general consensus supports antihelmintic and corticosteroid therapy for viable parenchymal lesions. In this report, a neurocysticercosis case with a single brain lesion that was surgically removed and histologically examined was presented. The patient had complaints of lisp in the tongue, numbness in the lips and left face. The patient had no concomitant chronic disease. The patient did not have a travel history or a history of eating pork but had a history of contact with a dead pig two months ago. Upon detection of a central mass in the brain computed tomography examination, surgical procedure was performed on the patient. Based on the identification of a larval stage of T.solium in biopsy material neurocysticercosis was diagnosed. However, histopathologically demonstration of the parasite is not possible in most cases. The patient received an antiparasitic treatment with albendazole 1000 mg/d in combination with dexamethasone. The patient was successfully treated and is still being followed up by calling for controls.

Is it useful to use computerized tomography image-based artificial intelligence modelling in the differential diagnosis of chronic otitis media with and without cholesteatoma?

OBJECTIVE

Cholesteatoma is an aggressive form of chronic otitis media (COM). For this reason, it is important to distinguish between COM with and without cholesteatoma. In this study, the role of artificial intelligence modelling in differentiating COM with and without cholesteatoma on computed tomography images was evaluated.

METHODS

The files of 200 patients who underwent mastoidectomy and/or tympanoplasty for COM in our clinic between January 2016 and January 2021 were retrospectively reviewed. According to the presence of cholesteatoma, the patients were divided into two groups as chronic otitis with cholesteatoma (n = 100) and chronic otitis without cholesteatoma (n = 100). The control group (n = 100) consisted of patients who did not have any previous ear disease and did not have any active complaints about the ear. Temporal bone computed tomography (CT) images of all patients were analyzed. The distinction between cholesteatoma and COM was evaluated by using 80% of the CT images obtained for the training of artificial intelligence modelling and the remaining 20% for testing purposes.

RESULTS

The accuracy rate obtained in the hybrid model we used in our study was 95.4%. The proposed model correctly predicted 2952 out of 3093 CT images, while it predicted 141 incorrectly. It correctly predicted 936 (93.78%) of 998 images in the COM group with cholesteatoma, 835 (92.77%) of 900 images in the COM group without cholesteatoma, and 1181 (98.82%) of 1195 images in the normal group.

CONCLUSION

In our study, it has been shown that the differentiation of COM with and without cholesteatoma with artificial intelligence modelling can be made with highly accurate diagnosis rates by using CT images. With the deep learning modelling we proposed, the highest correct diagnosis rate in the literature was obtained. According to the results of our study, we think that with the use of artificial intelligence in practice, the diagnosis of cholesteatoma can be made earlier, it will help in the selection of the most appropriate treatment approach, and the complications can be reduced.

Investigation of the prevalence of impacted third molars and the effects of eruption level and angulation on caries development by panoramic radiographs

Background

This study is aimed to determine the prevalence of impacted third molars and to investigate the effects of their eruption level and angulation on caries formation in the distal of the adjacent tooth.

Material and Methods

This cross-sectional study was conducted on panoramic radiographs of 38481 patients who were admitted to the Trakya University, Faculty of Dentistry. The panoramic radiographs of 7998 patients with at least one impacted third molar were included. Third molars were classified according to Winter’s classification and Pell and Gregory’s classification. The frequency of caries in partially impacted third molars and adjacent second molars was determined. The chi-square tests were used to determine potential associations between the third molars' level of eruption, angulation, and caries development.

Results

The study group consisted of 4423 females (55.3%) and 3575 males (44.7%) with a mean age of 36.3±13.4 years. The prevalence of the third molar impaction rate was 23%. The impaction pattern of partially erupted third molars was characterized by an eruption level of A with the vertical position in both jaws. Partially erupted and vertically placed maxillary third molars in the level of position A caused more caries in the adjacent tooth and mesioangularly located partially erupted mandibular third molars were associated with more caries in the adjacent tooth.

Conclusions

The angulation and eruption level of partially erupted third molars should be carefully examined. The prophylactic extraction of vertically and mesioangularly located third molars, especially with an eruption level of position A can be suggested to eliminate the related complications and risk of caries.

Key words:Dental caries, digital radiography, impacted tooth, panoramic radiography, third molar.

Modified Electroconvulsive Therapy in Pseudocholinesterase Deficiency: A Case Report

Introduction.

Pseudocholinesterase (PCHE) deficiency is an inherited condition, in which recovery from anesthetic agents like succinylcholine and mivacurium is slow and complicated with prolonged paralysis of respiratory muscles in susceptible patients. Succinylcholine is used very frequently as a muscle relaxant during the procedure.

Objectives.

In Bakirkoy research and training hospital for psychiatric and neurological diseases, 24.310 patients were hospitalized for acute conditions and 3490 of these patients were treated with electroconvulsive therapy (ECT) in 3 years. We present a very rare case that we encountered in our practice; a severe PCHE deficiency case that could have complicated the modified ECT procedure unless necessary precautions were taken.

Aims.

Detection of PCHE levels of all patients eligible for ECT is part of our pre-ECT assessments procedure, and the case presented here shows the benefits of this method.

Methods.

The patient is a 29-year-old woman, with a 15 year history of schizophrenia. She was hospitalized for homicidal risk and refusal of treatment. Inadequate clinical response with pharmacological interventions and continuous aggressive excitations directed us to consider ECT.

Results.

After the detection of PCHE deficiency (PCHE level: 126 U/L), we performed the modified ECT with propophol and rocuronium instead of succinylcholine as usual. Sugammadex 100 mg was used for fastening the recovery. Response to treatment, which is recorded with positive and negative syndrome scale, was good and we completed 9 ECT sessions without complication.

Conclusions.

Screening for PCHE levels in the pre-ECT assessments is efficacious in order to decrease the complications of the ECT procedure.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Exact solution of the neutron transport equation in spherical geometry

Solution of the neutron transport equation in one dimensional slab geometry construct a basis for the solution of neutron transport equation in a curvilinear geometry. Therefore, in this work, we attempt to derive an exact analytical benchmark solution for both neutron transport equations in slab and spherical medium by using PN approximation which is widely used in neutron transport theory.

Is there a relationship between the diameter of the inferior vena cava and hemodynamic parameters in critically ill patients?

INTRODUCTION

The early detection of critically ill patients together with the rapid initiation of effective treatment in emergency departments(ED) increase the survival rates.

AIM

This study investigated whether a correlation exists between haemodynamic parameters of critically ill patients and the diameter of the inferior vena cava (IVC).

MATERIALS AND METHODS

A cross-sectional study was performed included patients aged ≥18 years with an unstable haemodynamic and/or respiratory status who were referred to the ED for non-traumatic issues. IVC diameters were measured by ultrasound (US) and then central venous pressures (CVP) were measured. Anteroposterior (AP) and mediolateral (ML) diameters of the IVC, both in the inspirium (IAP, IML) and expirium (EAP, EML), were measured by US.

RESULTS

102 patients were evaluated with a median age of 59. The relationship between the diameters of IVC and CVP was evaluated and significant correlation was found in IAP, EAP according to CVP values (p<0.001). ROC analyses were performed and significant relationship was found between the EAP diameter with haemoglobin (Hmg), haemotocrit (Hct), and central venous oxygen saturation (ScvO2) and also significant correlation was detected between the IAP diameter and white blood cell (WBC).

DISCUSSION

We detected significant correlation between the CVP and the IVC diameter in our study compatible with recent studies besides, significant correlation was found between the diameter of the IVC and CVP values as well as between the EAP diameter and Hmg, Hct, ScvO2 levels.

CONCLUSION

Measurement of IVC diameters, especially EAP may be useful at the monitoring of critically ill patients in ED.