Massive pulmonary embolism presenting with hemoptysis and S1Q3T3 ECG findings

BACKGROUND

Venous thromboembolism clinically presenting with a deep vein thrombosis or pulmonary embolism is among the most commonly seen cardiovascular syndromes. The aim of this case presentation is to emphasise the typical electrocardiographic findings that are detected with massive pulmonary embolism along with the electrocardiographic S1Q3 and S1Q3T3 accompanied by T negativity at the D3 derivation based on prevalent T negativity.

CASE PRESENTATION

We present the case of an adult male who presented with a massive pulmonary embolism that was associated with tachycardia, haemoptysis and typical S1Q3T3 electrocardiographic findings. Tomographic findings showed filling defects in the two main pulmonary artery lumens, which were found to be compatible with a massive embolism. Intravenous heparin was injected (5000 IU), and low molecule weight heparin (LMWH) treatment was initiated. After two days of observation and treatment in the coronary intensive care unit, the patient was discharged for outpatient care.

DISCUSSION

Massive pulmonary embolism is an urgent life-threatening clinical situation that is frequently confused with acute ST elevation myocardial infarction. The definitive diagnosis of massive pulmonary embolism was made with a computed tomography pulmonary angiogram. Electrocardiographic findings and hypoxic hypercarbia in the blood gas analysis are typical. Early diagnosis with laboratory and imaging investigations is vital in the treatment and prognosis of pulmonary embolism.

CONCLUSIONS

Ventricular overload signs accompanied by ST segment elevation in electrocardiography and S1Q3 and prevalent T negativity are crucial features in terms of distinguishing between pulmonary embolism and myocardial infarction and selecting effective treatments for patients admitted to the emergency department.

The relationship between positivity for COVID-19 RT-PCR and symptoms, clinical findings, and mortality in Turkey

Introduction: This study aimed to assess the correlation between nucleic acid amplification test (real-time reverse transcription-polymerase chain reaction, RT-PCR) positivity of patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19-specific pneumonia diagnosis on thoracic computed tomography (CT), with symptoms, laboratory findings, and clinical progression.

Methods: The study included 286 patients (female:male 131:155; mean age, 53.3 ± 17.9 years) who were divided into two groups according to their RT-PCR test results. The symptoms, laboratory examinations, clinical findings, and thoracic CT imaging of the patients were evaluated.

Results: While the physical examination, comorbidities, and total CT scores were similar between the groups, taste/smell abnormalities were observed more frequently in the PCR-positive group. The use of moxifloxacin, lopinavir/ritonavir, and tocilizumab was higher in the PCR-positive group (p = 0.016, p < 0.001, and p = 0.002, respectively). The duration of hospitalization, intensive care requirement, and mortality rate of the studied groups did not differ between the groups.

Conclusions: Among patients presenting with suspected COVID-19 and pneumonic infiltration consistent with COVID-19 on thoracic CT, the symptoms, physical examination, total CT scores, duration of hospitalization, intensive care requirement, and mortality rate were similar between RT-PCR-positive and RT-PCR-negative patients. However, PCR-positive patients appeared to require more specific treatments.

Memantine and Q-VD-OPh Treatments in Experimental Spinal Cord Injury: Combined Inhibition of Necrosis and Apoptosis

AIM

To evaluate the effects of NMDA receptor antagonist memantine and pancaspase inhibitor Q-VD-Oph in combination or alone in experimental spinal cord injury.

MATERIAL AND METHODS

45 male Sprague-Dawley rats were divided into five groups. Spinal cord injury was created with the clip compression technique. The drugs were administered either alone of in combination to the subjects according to their groups. Motor function was assessed with Tarlov's motor grading scale and the inclined plane technique. The subjects were sacrificed at the fifth postoperative day. Histopathological examination was done with the use of hematoxylin eosin and TUNEL staining.

RESULTS

The results for TUNEL staining and apoptotic cell counts revealed statistically significant differences in Q-VD-Oph and combined treatment groups. Tarlov motor grading scale and inclined plane test results were also found significantly better in these two groups.

CONCLUSION

Combined use of memantine and Q-VD-OPh provides better histological and clinical results. The combined inhibition of the two major pathways, necrosis and apoptosis, needs to be further assessed with in-vivo or in-vitro studies.

Tracheostomy in Pediatric Intensive Care Unit: When and Where?

Background:

Tracheostomy was first observed in Egyptian drawings in 3600 BC and performed frequently during the 1800’s diphtheria epidemic.

Objectives:

The aim of this study was to elucidate the indications, complications, mortality rate, and the effect of pediatric tracheostomy on length of PICU or hospital stay.

Materials and Methods:

Demographic characteristics, diagnosis at admission, duration of ventilation of 152 patients were analyzed retrospectively.

Results:

The most common tracheostomy indication was prolonged intubation. The mean duration of mechanical ventilation before tracheostomy was 23.8 days. Forty five percent of the tracheostomy procedures were performed at bedside. Neither the place nor the age had any effect on the development of complications (P = 0.701, P = 0.622). The procedure enabled 62% of the patients to be discharged from hospital.

Conclusions:

Tracheostomy facilitates discharge and weaning of mechanical ventilation. Although the timing of tracheostomy has to be determined for each individual patient, three weeks of ventilation seems to be a suitable period for tracheostomy. Tracheostomy can be performed at bedside safely but patient selection should be made carefully.

Neuronavigation-assisted percutaneous balloon compression for the treatment of trigeminal neuralgia: The technique and short-term clinical results

BACKGROUND

Percutaneous balloon compression (PBC) has been widely used in the treatment of trigeminal neuralgia. However, this technique has a steep learning curve and significant complications were reported that were related to foramen ovale puncturing. The aim of this study was to evaluate the clinical results of a small patient group who underwent neuronavigation-assisted PBC.

METHODS

An intraoperative computed tomography (CT) device (CereTom, Neurologica, Danvers, MA/USA) was used to obtain CT scans with 2-mm slice thicknesses. The data were transferred to a neuronavigation system planning station (BrainLab, Feldkirchen, Germany). A soft touch registration system was used for image registration. With the image guidance, a trajectory was defined and the foramen ovale was cannulated using neuronavigation and Hartel's landmarks.

RESULTS

Sixteen procedures were performed on 13 patients (4 female and 9 male) without complications. The total length of the procedure was not more than 57 min in all instances.

CONCLUSIONS

We believe that image-guided neuronavigation is useful for neurosurgeons who are at the beginning of their PBC learning curve. It may also be an alternative for particular patients with significant anatomic variations that result in an unsuccessful foramen ovale puncture.

Intraoperative ultrasonography is useful in surgical management of neck metastases in differentiated thyroid cancers

Differentiated thyroid carcinomas are the most common malignancies of endocrine organs. Metastases to cervical lymph nodes occur in 20-50% of cases. Recurrence and survival rates are closely related to the type of surgery performed. High-resolution ultrasonography (USG) is a sensitive imaging method used to detect occult lymph node metastases in patients with thyroid cancer. We evaluated how intraoperative USG affected surgical success. This was a retrospective study comparing two groups of patients with thyroid carcinoma who underwent cervical lymph node dissection. A total of 101 patients (33 males and 68 females) were included. Group 1 included 53 patients who underwent surgery with intraoperative USG guidance. Group 2 included 48 patients who underwent surgery without the use of USG. All patients were followed up (mean 23 months; range 5-44 months) with thyroglobulin measurements and USG evaluations. Group 1 (intraoperative USG) had a residual/recurrent tumor rate of 1.9% (1/53 patients). Group 2 had a residual/recurrent tumor rate of 12.5% (6/48 patients). A statistically significant difference appeared between the residual/recurrent tumor rates in Groups 1 and 2 (p<0.05). In addition to its classical use in diagnosis and follow-up, intraoperative use of high-resolution USG can improve surgical success and may decrease the number of residual/recurrent tumors encountered during follow-up.

Unilateral endoscopic optic nerve decompression for idiopathic intracranial hypertension: a series of 10 patients

OBJECTIVE

Several surgical treatment modalities, including lumboperitoneal or ventriculoperitoneal shunt surgery, subtemporal decompression, endovascular venous sinus stenting, optic nerve decompression (OND), were used in the management of idiopathic intracranial hypertension (IIH). Each surgical technique has different advantages and disadvantages. Endoscopic OND is rarely used in the management of IIH. There are only four reported cases. The aim of this study is to describe the surgical results of patients treated with this less invasive surgical technique.

METHODS

A series of 10 consecutive cases of unilateral OND was reviewed. Between December 2008 and December 2012 these patients underwent the endoscopic approach without nerve sheath opening. Presenting symptoms, neurological examination findings, magnetic resonance venography imaging results, fundoscopic and visual acuity examination findings, and automated perimetry test results were recorded. Perioperative results, including complications and length of hospital stay, were evaluated. Findings at follow-up evaluations were also recorded.

RESULTS

This report is the first series of unilateral OND performed using the endoscopic approach. The mean patient age was 34.1 years (range, 9-49 years); there were nine female and one male patients. Visual impairment was the main symptom in this patient group, whereas headache was a secondary complaint. The patients were first managed with medical treatment for at least 3 months. Unilateral endoscopic OND was performed on the side with the most visual failure. Mean follow-up was 28.4 months (range, 8-55 months). The visual field defects and visual acuity improved in eight of nine patients, whereas papilloedema improved in seven of nine patients. Also headaches resolved in four of seven patients. There were no complications in this relatively small series.

CONCLUSIONS

The surgical treatment of IIH by using the unilateral endoscopic OND technique is a safe and effective method in the hands of experienced surgeons with advanced endoscopic skills. A collaboration with the ophthalmology team is needed for the follow-up. Further studies with larger patient numbers is needed to compare unilateral endoscopic OND technique with the current techniques used in the surgical management of IIH.

Emergency management of an acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus

Tension pneumocephalus is a rare and life threatening complication of intracranial surgical procedures, and requires immediate recognition and surgical intervention. Tension pneumocephalus following ventriculoperitoneal shunt surgery is extremely rare and commonly seen as a delayed complication. To our knowledge, early postoperative tension pneumocephalus after shunt surgery was reported only in one other publication. We present a case of acute tension pneumocephalus following ventriculoperitoneal shunt surgery for normal pressure hydrocephalus, which was managed well with close neurological follow-up and rapid surgical intervention. The use of the portable CT scanner in this case saved significant time, without the transport of the patient to the radiology unit, made early surgical intervention possible, and prevented morbidity and mortality.

Relationship between Epiglottis and Severity of Obstructive Sleep Apnea

Objectives:

The aim of this retrospective case-control study was to define epiglottis morphologies and to investigate the relationship between the angle of the laryngeal surface of the epiglottis (ALSE) and the severity of obstructive sleep apnea (OSA) using flexible optic laryngoscopy (FOL) images.

Methods:

Eighty-three patients with OSA (Group 1) and 87 patients with no complaints of OSA (Group 2) were evaluated. The ALSE was measured using ImageJ through FOL images. ALSE measurements were compared between the two groups. The correlation of ALSE measurements to the respiratory disturbance index (RDI) was analyzed.

Results:

Group 1 comprised 79 male and 4 female patients with a mean age of 43 years. Group 2 comprised 72 male and 15 female patients with a mean age of 39 years. The mean ALSE measurement was 139.7 degrees in Group 1 and 140.08 degrees in Group 2 and was not significantly different between the two groups (P value greater than 0.05). The mean RDI in Group 1 was 28.83, showing evidence of a low correlation between ALSE measurements and RDI. Epiglottis morphology revealed three different shapes: concave epiglottis and slightly observed petiole, minimally concave epiglottis with petiole dominancy, and severe concave epiglottis (omega epiglottis).

Conclusions:

Three different morphologies were observed through FOL examinations. The ALSE measurements were not significantly different between patients with OSA (Group 1) and control subjects (Group 2). This might indicate that the ALSE cannot be used as a predictive factor in OSA pathophysiology.

Will a crushed concha bullosa form again?

OBJECTIVES/HYPOTHESIS

This study endoscopically and radiologically evaluated whether a surgically crushed concha bullosa (CB) can form again.

STUDY DESIGN

Prospective study.

METHODS

This study included 14 adults who underwent CB surgery between March 2010 and February 2011. The middle turbinate was examined endoscopically and classified pre- and postoperatively into four groups according to size. The CB volume of all patients was measured using pre- and postoperative paranasal sinus computed tomography (CT). The pre- and postoperative measurements were compared using the paired t test.

RESULTS

This study included 22 CB in 11 men and 3 women with a mean age of 35.85 (range, 20-47) years. The mean follow-up period was 4.42 (range, 2-10) months. The middle turbinates were significantly smaller postoperatively (P < .0005), as was the CB volume measured using paranasal sinus CT (P < .0005).

CONCLUSIONS

The CB crushing technique is an easy, conservative treatment modality. As the CB does not appear to reform after crushing, this technique can be considered a definitive treatment. Nevertheless, these patients should be followed for the long term.

Evaluation of pediatric subglottic cysts

INTRODUCTION

Subglottic cysts (SGCs) are increasingly recognized as a cause of upper airway obstruction in previously intubated infants. Endoscopic marsupialization with cold steel instruments or CO(2) laser has been reported to be the standardised treatment method for SGCs. SGC case series of 9 patients who were treated with endoscopic marsupialization with cold steel instruments or CO(2) laser and mechanical decompression with balloon dilatation are presented.

PATIENTS AND METHODS

Retrospective study of 9 cases of subglottic cysts treated between 2003 and 2010 was done. Diagnoses were made by performing flexible nasopharyngolaryngoscopy and surgical treatment was done through endoscopic marsupialization with cold steel instruments or CO(2) laser.

RESULTS

The age range of SGC patients were between 3 months and 36 months (average 12, 11 months). Two of the patients were female (2/9), 7 of them were male (7/9). SGC diagnoses were made by flexible nasopharyngolaryngoscopy. History of intubation was noted in 3 of the patients (3/9). Duration of intubation was 28 days, 6 days, and 8 days respectively. Cysts were multiple in all cases, and located posteriorly and laterally at the subglottic area and upper trachea. The patients presented with were stridor, fail to thrive, and recurrent croup attacks. Treatment methods preferred for these patients were endoscopic marsupialization with cold steel instruments or CO(2) laser and mechanical decompression with balloon dilatation. The follow-up period after treatment ranged between 8 months and 3 years. Recurrence of the SGCs did not happen and re-evaluation under general anesthesia was reserved for the symptomatic patients.

CONCLUSION

Diagnostic laryngoscopy and bronchoscopy are important in diagnosing SGC. History of premature birth and intubation are not 'sine qua non' of SGC as SGC may be congenital as well. Symptoms of SGCs may mimic the characteristic features of chronic obstructive lung disease, so evaluation of the airway should be considered in such infants if they have stridor or hoarseness not responding to routine treatment. Laryngoscopy and bronchoscopy are routinely indicated for airway evaluation in at-risk infants.

Ascending transaqueductal cystoventriculoperitoneal shunting in Dandy-Walker malformation: technical note

The optimal treatment for Dandy-Walker malformation is still controversial. Ventriculoperitoneal shunting, cystoperitoneal shunting or combinations are the most common surgical options in the management of this clinical entity. Endoscopic procedures like ventriculocystostomy, 3rd ventriculostomy or endoscopy-assisted shunt surgeries have become the focus of recent publications. We describe a new transcystic endoscopic technique, with the usage of a single ascending transaqueductal shunt catheter with additional holes, whereby both the posterior fossa cyst and supratentorial ventricular compartments are drained effectively. By using this new technique complications associated with combined shunting can be avoided. In addition, by equalizing the pressure within the supra- and infratentorial compartments, the upward or downward herniations associated with single-catheter shunting can be prevented.

Bone marrow necrosis secondary to imatinib usage, mimicking spinal metastasis on magnetic resonance imaging and FDG-PET/CT

Imatinib mesylate has become the treatment of choice for gastrointestinal stromal tumors (GISTs) and has made a revolutionary impact on survival rates. Bone marrow necrosis is a very rare adverse event in malignant GIST. Bone metastases are also rarely encountered in the setting of this disease. The authors report on a patient with malignant GIST who developed a bone lesion, mimicking spinal metastasis on both MR imaging and FDG-PET/CT. Corpectomy and anterior fusion was performed, but the pathology report was consistent with bone marrow necrosis. Radiological and clinical similarities made the distinction between metastasis and bone marrow necrosis challenging for the treating physicians. Instead of radical surgical excision, more conservative methods such as percutaneous or endoscopic bone biopsies may be more useful for pathological confirmation, even though investigations such as MR imaging and FDG-PET/CT indicate metastatic disease.

Clinical and histopathological response to acitretin therapy in lipoid proteinosis

Lipoid proteinosis (LP) is a rare autosomal recessive genodermatosis associated with deposition of periodic acid-Shiff (PAS)-positive hyaline material in skin, mucosa, and other tissues. LP is caused by loss-of-function mutations in the extracellular matrix protein 1 gene (ECM1). No curative therapy is available. In this report, we describe the clinicopathological and genetic features of a Turkish LP family with four cases, and evaluate the response of acitretin therapy. Patients were presented with hoarseness and beaded eyelid papules, thickened frenulum, hyperkeratotic plaques and infiltrated warty papules and nodules. Skin biopsies revealed deposition of PAS-positive hyaline material in dermis. A homozygous nonsense mutation in exon 3 of the ECM1 gene, R53X, was detected in the family. Acitretin therapy was administered in two patients, in whom some regression and softening of skin lesions were achieved. However, no histopathological change in PAS-positive deposition could be detected. Although there is no current effective treatment for LP, acitretin may be helpful for patients, especially those who complain about hyperkeratosis.

Determination of trace metals in different fish species and sediments from the River Yeşilirmak in Tokat, Turkey

In the presented study, five different fish species and sediment samples were collected from polluted areas, control samples from unpolluted areas in Yeşilirmak River during 2008-2009. The samples were analyzed using flame and/or graphite furnace atomic absorption spectrometry after various digestion methods. The relative standard deviations (RSD) were found below 10%. The accuracy of the methods was confirmed by certified reference materials. The maximum iron, zinc, copper, lead, manganese, nickel and cadmium concentrations were found to be as 116 (Fe), 63.5 (Zn), 2.5 (Cu), 0.56 (Pb), 9.4 (Mn), 10.2 (Ni) and 0.75 (Cd) microg/g in fish samples. The maximum metal concentration in sediment was 3566 microg/g for Fe, 463 microg/g for Mn, 45.5 microg/g for Zn, 38.7 microg/g for Cu, 17.3 microg/g for Pb, 79.2 microg/g for Ni and 0.55 microg/g for Cd, respectively. Some species is accumulated trace metals at high ratio.

Pediatric tracheotomies: a 37-year experience in 282 children

OBJECTIVE

To study the outcomes, complications, and indications for pediatric tracheotomies performed at a tertiary referral center.

METHODS

A retrospective review of hospital records from 1968 to 2005 was conducted to assess all pediatric patients who had undergone tracheotomies.

RESULTS

A total of 282 tracheotomies were performed on patients under 16 years of age. The median age at tracheotomy was 27 months. Upper airway obstruction (infectious diseases, n=101; laryngeal anomalies, n=33; trauma, n=36; tumor, n=33) was the most common indication for tracheotomy (n=203; 72%). Lesser number of patients (n=79; 28%) required tracheotomy for prolonged ventilation. Decannulation was carried out successfully in 71 patients (35%). Total complication rate was 18%; only three patients (1%) died from tracheotomy-related complications, with an overall mortality rate of 19%.

CONCLUSIONS

Pediatric tracheotomies were associated with a low incidence of procedure-related mortality and morbidity and successful decannulation in 35% of cases. The majority of procedures were performed due to upper airway obstruction which were most commonly caused by infectious diseases.

Evaluation of the effect of dexamethasone in experimentally induced endolymphatic hydrops in guinea pigs

PURPOSE

The aim of this study was to investigate the audiological and histopathologic effects of dexamethasone in the treatment of experimentally induced endolymphatic hydrops.

MATERIALS AND METHODS

Thirty mature, male guinea pigs weighing 400 +/- 50 g were operated on to induce experimental endolymphatic hydrops in their right ear. Left ear served as control. Subjects were separated into control and dexamethasone groups, with the latter receiving dexamethasone 5 mg/(kg d) intraperitoneally for 10 days. Electrocochleography and auditory brainstem response were applied to all subjects at preoperation, on the second postoperative day and also on the 15th postoperative day in animals that lived for a long time. The histopathologic examination of the inner ear in all animals was done at the end of the study.

RESULTS

The summating potential and the ratio of the summating potential to the action potential measured on the second postoperative day were found to be increased in both groups, but more significantly in the control one. When the left and right ears were compared, significant difference was found in the control group; however, no significant difference was found between the ears in the dexamethasone group. Histopathologic examination revealed varying degrees of hydrops in the control group, but showed only normal findings or minor changes in the dexamethasone group.

CONCLUSIONS

Dexamethasone can prevent the audiological and histopathologic findings of experimentally induced endolymphatic hydrops. However, these results must be supported by clinical and experimental studies designed with a large number of subjects.

Reversible sensorineural hearing loss in a girl with Kawasaki disease

Kawasaki disease is an acute, self-limited vasculitis of infants and children that is now the most common cause of acquired heart disease in the pediatric age group in the United States and Japan. This report presents a case of classic Kawasaki disease with reversible sensorineural hearing loss that was treated with steroid. In conclusion, Kawasaki disease caregivers must be aware of possible sensorineural hearing loss, which is reversible by early intervention and thus improves quality of life.

Tracheobronchopathia osteochondroplastica in a 9-year-old girl

Tracheobroncopathia osteochondroplastica (TO) is a rare disease of adult males characterized by osteocartilagious submucosal nodules protruding into the airway lumen, causing variable degrees of airway obstruction. Here we describe a case of TO in a 9-year-old girl patient presenting with chronic cough, along with a brief review of this rare benign condition.

An Unusual Case of Thyroid Hurtle Cell Carcinoma with Direct Extension to the Right Brachiocephalic Vein, Right Auricle, and Right Atrium: Case Report

The clinical behavior of various types of thryroid tumor have been much studied during the past several decades, and the histologic features, surgical management, and prognostic factors of follicular and papillary tumors in particular have been clarified to a considerable degree. On the other hand, there is still controversy concerning management of Hurtle cell tumor (HCT) of the thyroid. HCT is not a common disease, making it impossible to obtain sufficient clinical data at a single institution. It has been reported that all HCT are aggressive and should be treated as malignant tumors. It is believed that an accurate differential diagnosis can be made between cancer and adenoma on the basis of pathological studies. We describe a patient with HCT of the thyroid extending into the right atrium. To our knowledge, after a Medline search, this is the first such case in the medical literature. The interesting features are described, and the relevant literature is briefly reviewed.

Prevention of gentamicin induced ototoxicity by trimetazidine in animal model

OBJECTIVE

To show the efficacy of intra-peritoneally administered trimetazidine to prevent gentamicin ototoxicity, which is still an important cause of profound deafness among children in different parts of the world.

METHODS

Two groups of Swiss albino mice received daily intra-muscular injections of gentamicin for 30 days. One of the groups received trimetazidine intra peritoneally in addition to the gentamicin. Auditory thresholds of the animals were measured by evoked brain stem response at the beginning and the end of the study. Results were compared to the results of the control group, which received intra peritoneal saline injections.

RESULTS

Both groups receiving gentamicin injections had significant auditory threshold shifts, but in the group receiving additional trimetazidine, the threshold shift was not statistically significant when compared to control group. Threshold shift in gentamicin group significantly differed from that of the control group (p=0.0001) and gentamicin+trimetazidine group (p=0.0001), on the other hand there was no statistically significant difference between control group and trimetazidine+gentamicin group (p=0.102).

CONCLUSION

Gentamicin ototoxicity can be prevented by intra peritoneal trimetazidine injections in animal model. This treatment modality may be a mode of protection from gentamicin ototoxicity in children.

Histopathological predictors of occult lymph node metastases in supraglottic squamous cell carcinomas

Lymph node metastasis appears to be the most important factor determining survival in patients with squamous cell carcinoma of the larynx. Supraglottic laryngeal carcinomas have a known tendency to metastasize to cervical lymph nodes because of the extensive lymphatic network present. This retrospective cohort study was conducted to define possible histopathological parameters affecting cervical lymph node metastasis and then using these parameters to create a scale to predict occult lymph node metastasis in supraglottic squamous cell carcinoma. The pathological slides of 61 operated patients were reevaluated for tumor grade, lymphatic-vascular invasion, invasion pattern of tumor margins, perineural invasion and lymphocytic infiltration. Grade (P < 0.001), lymphatic-vascular invasion (P < 0.001) and tumor margins (P = 0.007) were found to be closely associated with neck metastasis. To define the risk factors for occult metastasis, a grading scale was created by using grade (G), lymphatic-vascular invasion (L) and tumor margin (M) findings of patients. None of the patients with a GLM value of zero developed occult metastasis. On the other hand occult metastasis was found in 58.8% of N0 patients with a GLM value that was more than zero. These findings indicate that patients with high-grade tumors having infiltrating borders and lymphatic-vascular invasion have a high risk for occult metastasis so that elective treatment of the neck either by neck dissection or radiotherapy should be added to therapy. Serial sections of specimens are needed to avoid missing metastatic loci of disease.

Effect of teflon piston diameter on hearing result after stapedotomy

This study compares hearing results after stapedotomy by 0.6 mm and 0.8 mm teflon pistons. Retrospective analysis studied 100 patients randomly selected who underwent stapedotomy for otosclerosis with insertion of 0.8 mm teflon piston prosthesis and 100 patients with 0.6 mm teflon piston prosthesis. Air-conduction hearing level in both groups were measured before and after the procedure and the gain of the air conduction between the 2 groups at different frequencies were compared statistically. The group with the 0.8 mm prosthesis had better results that were statistically significant and more pronounced at lower frequencies.

Melanotic neuroectodermal tumor of infancy: report of two cases and review of literature

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, distinctive neoplasm containing melanin; it primarily affects the maxilla of the infants during the first year of life. Approximately 150 instances of this tumor are reported in the medical literature. Genesis of the tumor is obscure and the diagnosis is challenging for the pathologist. Two cases operated by the first author are presented, and the diagnostic features and treatment alternatives of MNTI discussed.

Osteoma of the middle ear

Osteomas are benign pedunculated tumours of the lamellar bone, which commonly originates from paranasal sinuses. Within the temporal bone they are seen commonly in the external ear canal. Osteomas originating from the middle ear are very rare. There are only 12 cases reported in the medical literature up to now. Five of those cases caused conductive hearing loss and the others were asymptomatic and diagnosed incidentally.

Distant metastases in laryngeal squamous cell carcinoma

Distant metastases (DM) is the point of concern and seems to be on the rise with the improved control of the laryngeal cancer in the primary site and neck regions. Prognostic factors must be evaluated to improve the detection of DM at early stage of the disease. Therefore, we have analyzed our cases of laryngeal squamous cell carcinoma with DM to find out the risk factors in these patients. We analyzed the records of laryngeal squamous cell carcinoma patients with DM. The records were evaluated according to distant metastases site, TNM staging, the metastases at the neck, treatment and survival. The incidence of DM was 7.2% in our series. Lung is the most common site of DM in laryngeal squamous cell carcinoma. Staging grouping has been helpful in predicting DM, most of the cases were in stage III and IV (85%). Supraglottic lesions is the most common site in patients with DM. The recurrence in the locoregional site was observed in 47% of cases. The overall survival with DM is 28 months, without DM 22 months. The patients with DM in laryngeal squamous cell carcinoma were from the group with supraglottic lesions, stage 3, 4a and 4b. Stage grouping seems to be a better indicator of DM rather than T or N stage alone. The most common site of metastasis is the lung.

Prognostic value of p53 expression and histopathological parameters in squamous cell carcinoma of oral tongue

The TNM staging system is helpful but not enough to determine prognosis of the patients with squamous cell carcinoma of the oral tongue. T-stage alone is not suggestive for prediction of occult nodal metastases. For this reason, histopathological examination of 70 patients with squamous cell carcinoma of the oral tongue was done retrospectively. The histological differentiation, tumour thickness, perineural and lymphovascular space invasions, the amount of lymphocyte infiltration and pattern of tumour invasion were examined. Immunohistochemical examination was used to determine p53 immunoreactivity as well. The effect of these histopathological parameters and p53 immunoreactivity on nodal metastases and locoregional recurrence were analyzed using the chi-squared test. In terms of nodal metastases the only statistically significant difference between the two groups was tumour thickness, either < 9 mm or > 9 mm (p < 0.05, chi 2 = 17.182). Tumour thickness, perineural invasion, lymphovascular space invasion, the amount of lymphocyte infiltration all correlated statistically with locoregional recurrence (p < 0.05, chi 2 = 6.293 for tumour thickness; p < 0.06, p = 0.054 for perineural invasion; p < 0.05, chi 2 = 8.689 for lymphovascular space invasion; p < 0.05, chi 2 = 5.320 for lymphocyte infiltration). The immunoreactivity of p53 correlated significantly with larger primary tumour size (p < 0.05, chi 2 = 5.440, lymph node metastases (p < 0.05, chi 2 = 4.093) and with pathological tumour stage (p < 0.05, chi 2 = 5.713). These results reveal that the above-mentioned histological parameters and p53 determination could be used for handling a specimen from an anterior tongue squamous cell carcinoma.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease)

Sinus histiocytosis with massive lymphadenopathy (SHML) is a distinct clinicopathological entity described by Rosai and Dorfman and differentiated by other childhood histiocytoses by its distinct characteristics. This is a rare pathology and should be kept in mind for differential diagnosis of neck masses, especially in childhood. In this article a case with SHML is presented and clinical features of the disease given.

Possible prognostic value of histopathologic parameters in patients with carcinoma of the oral tongue

The current TNM staging system is helpful but still not enough to accurately determine prognosis of the patients with squamous cell carcinomas of the oral tongue. Histopathologic variables, however, may be more helpful for predicting nodal metastasis and locoregional recurrences. In this respect, histopathologic examinations were done retrospectively of tumor specimens from 60 patients with squamous cell carcinomas of the oral tongue. Besides T-stage and nodal involvement, histopathologic parameters of tumor thickness, perineural invasion, lymphovascular space invasion, the extent of lymphocyte infiltration and the invasion pattern statistically correlated with locoregional recurrences. For nodal metastasis, tumor thickness of 10 mm or more and the type of invasion pattern were statistically significant. These results revealed that the variables described should be used for managing oral tongue cancers.

A comparison of procaine penicillin with sulbactam-ampicillin in the treatment of peritonsillar abscesses

The clinical efficacy of procaine penicillin and sulbactam-ampicillin was compared in patients with peritonsillar abscesses after peroral abscess drainage. Forty-two patients were randomly assigned to receive either procaine penicillin or sulbactam-ampicillin intramuscularly on an outpatient basis. The mean time required for clinical symptoms (throat pain, dysphagia and fever) to resolve was compared. No statistically significant difference was found between the clinical recoveries of patients using either antibiotic (P > 0.05). The authors conclude that intramuscular procaine penicillin can be safely prescribed on an outpatient basis to most patients with peritonsillar abscess after incision and drainage. In contrast, a broader spectrum and more expensive antibiotic, such as sulbactam-ampicillin, should be reserved for non-responders.

Blindness as a rare complication of neck dissection

Blindness is a rare and rather unexpected complication of neck dissection. There have been only a few cases reported to date, all following bilateral neck dissections. We present a case of blindness after one-sided neck dissection and an insidious finding of bilateral common carotid artery occlusion.

Extracranial carotid artery aneurysm in a child misdiagnosed as a parapharyngeal abscess: a case report

An extracranial carotid artery aneurysm in a child misdiagnosed as a parapharyngeal abscess is presented. Diagnosis modalities of cervical masses and features of aneurysms are discussed. It is stressed that, regardless of age, in the presence of a pulsating and tender cervical or parapharyngeal mass, an aneurysm is probable. Prior to any intervention, at least non-invasive screening tests must be performed. Failure may lead to disastrous results.