Surgery and adjuvant radiotherapy for cutaneous melanoma considered high-risk for local–regional recurrence

Purpose

To assess the efficacy of postoperative radiotherapy (RT) in the treatment of cutaneous melanoma.

Materials

Between August 1981 and December 2009, 82 patients were treated with surgery and postoperative RT for cutaneous melanoma. Patients were thought to be high risk for local–regional recurrence after surgery alone because of the presence of one or more risk factors including recurrence after prior surgery, positive lymph nodes, extracapsular extension, incomplete regional node dissection, microscopically positive margins, gross residual disease, and in-transit metastases. The primary site was located in the head and neck in 64 patients and elsewhere in the remainder. Forty-two patients (47%) were treated with hypofractionated RT and the remainder with conventional fractionation. Median age was 62 years (range, 21 to > 89 years). Median follow-up overall and for survivors was 3.0 years (range, 0.1 to 17.4 years) and 6.4 years (1.6 to 17.4 years), respectively.

Results

The 5-year outcomes were: in-field local–regional control 82%; local–regional control, 76%; distant metastasis-free survival, 48%; cause-specific survival, 56%; and overall survival, 43%. In-field local–regional control at 5 years was 87% after hypofractionated RT and 78% after conventionally fractionated RT.

Conclusions

Postoperative adjuvant RT likely reduces the risk of local–regional recurrence after surgery for patients with high risk cutaneous melanoma. Hypofractionated RT is as effective as conventional fractionation and is logistically advantageous, particularly for patients with a relatively poor prognosis. The risk of RT complications is low.     

Incidence and predictors of malignancy in children with persistent cervical lymphadenopathy

Objective

The aim of this study was to analyze the clinical and histopathologic aspects of persistent cervical lymphadenopathies in children.

Methods

This retrospective study included 98 children who underwent surgical excision for persistently swollen cervical lymph nodes between 2001 and 2013. Lymph nodes greater than 1.5 cm that persisted for more than 4 weeks and were unresponsive to an initial antibiotic treatment were considered “persistent”. The largest lymph node with an abnormal ultrasonographic appearance was selected for surgical biopsy. The patients were divided into 2 groups according to the histopathologic outcome: benign or malignant.

Results

No significant differences were found between the groups regarding the mean size and mean duration of the swollen cervical lymph nodes (p = 0.147 and p = 0.446, respectively). The area under the ROC curve was 0.567 (95% confidence interval = 0.463–0.667, p = 0.259) for lymph node size and 0.507 (95% confidence interval = 0.404–0.609, p = 0.909) for the duration of the cervical lymphadenopathy. There was no significant difference in the presence of B symptoms between the two groups (p = 0.519). No significant difference was found between benign and malignant groups regarding bilaterality (p = 0.913).

Conclusions

The findings of our study demonstrated that the size and duration of cervical lymphadenopathy, bilateral or unilateral involvement and the presence or absence of B symptoms are not indicators of malignancy. We found a high incidence of malignancy in pediatric cervical lymphadenopathy cases in contrast to other current studies.     

Is elective neck dissection necessary for the surgical management of T2N0 glottic carcinoma?

Objective

Evaluation of neck metastasis incidence in surgically treated T2N0M0 glottic carcinoma patients and discussion the necessity of elective neck dissection in this subset of larynx carcinomas.

Materials and methods

The patients who were staged clinically and radiologically as T2N0M0 glottic carcinoma having surgical intervention for their primary tumor and elective neck dissection between March 1996 and July 2009 with at least 2 years of follow up were included in the study. The recordings of patients were evaluated retrospectively for primary tumor location, vocal cord mobility, type of laryngectomy and neck dissection, results of histopathological examination, number of dissected lymph nodes for each specimen and for local and regional failure during the follow up.

Results

In the 13-year study period, 24 consecutive patients with a mean age of 56.4 were treated surgically with 20 frontolateral, three vertical laryngectomies and one cricohyoido-epiglottopexy; 19 lateral and 5 functional neck dissections were performed for the necks. Histopathological examinations of the neck dissection specimens revealed an average of 32 lymph nodes (8–65) and there was no metastasis in any of these specimens. After an average 58 months of follow-up, only one patient had local failure and no patients had regional failure.

Conclusion

As occult metastasis was not detected in any of the neck dissection specimens in cT2N0M0 patients and no regional failure was experienced during the follow-up period, it was concluded that the neck could be followed up without performing elective neck dissection in the surgical management of cT2N0M0 glottic carcinoma patients.     

Effectiveness of MESNA on the success of cholesteatoma surgery

Importance

It is important that chronic otitis media with cholesteatoma be treated successfully in patients to protect them from having repeated surgeries with related surgical co-morbidities and hearing loss.

Objective

To evaluate the effectiveness of MESNA usage on the residual cholesteatoma rates of the patients who underwent surgery due to chronic otitis media with cholesteatoma.

Design

Retrospective single-institution study of a prospectively collected database.

Setting

Tertiary University Hospital.

Participants

Nine hundred and thirty-four patients underwent surgery due to chronic otitis media between September 2000 and March 2012 by the same surgeon. One hundred and forty-one cases out of 934 patients were selected who had cholesteatoma for the study. These randomly selected 141 cases were divided into two groups as follows: I. Forty-six cases were applied MESNA (Sodium 2-mercaptoethanesulfonate) intraoperatively, and II. Ninety-five cases were not applied MESNA intraoperatively. The cases that were followed-up at least one year were included in this study.

Intervention

MESNA (Ureomitexan, MESNA, Baxter oncology, Germany) was diluted with saline (20% MESNA and 80% saline) that was applied, and then a waiting period of approximately 5 min followed to start to dissect cholesteatoma matrix.

Main outcomes and measures

Residual cholesteatoma rates between intraoperative MESNA, a disulfide bond breaking chemical agent, applied and MESNA non-applied cases in the postoperative follow-up period were compared for the success of the surgery.

Results

MESNA was used in 46 patients out of 141 cases intraoperatively. Twenty-four of these patients underwent CWD (canal wall down), and twenty-two patients underwent CWU (canal wall up) mastoidectomy. For the other 95 subjects, 56 patients with CWD and 39 with CWU mastoidectomy, MESNA was not applied. Residual cholesteatoma rates were found to be significantly higher in MESNA non-applied group than MESNA applied group (p < 0.05). Residual cholesteatoma rates between CWD and CWU mastoidectomy procedures were not statistically significant (p > 0.05).

Conclusions and relevance

MESNA application that breaks disulfide bonds in the structure of the matrix in cholesteatoma surgery may assist the elimination of the disease, and increase surgical success by facilitating the elevation of the epithelium. Thereby, it causes a decrease in the possibility of remaining residual epithelium after surgery, which decreases the need for second-look surgery.

Trial registration

The retrospective research protocol was approved by the Inonu University Clinical Research Ethics Committee. Registration number:………     

Multidisciplinary clinic care improves adherence to best practice in head and neck cancer

Purpose

Multidisciplinary team (MDT) care is widely accepted as best practice for patients with head and neck cancer, although there is little evidence that MDT care improves head and neck cancer related outcomes. This study aims to determine the impact of MDT care on measurable clinical quality indicators (CQIs) associated with improved patient outcomes.

Materials and methods

Patients treated for head and neck cancer at Ipswich Hospital from 2001 to 2008 were identified. Comparisons were made in adherence to CQIs between patients treated before (pre MDT) and after (post MDT) the introduction of the MDT. Associations were tested using the Chi-square and Whitney U-test.

Results

Treatment post MDT was associated with greater adherence to CQIs than pre MDT. Post MDT had higher rates of: dental assessment (59% versus 22%, p < .0001), nutritional assessment (57% versus 39%, p = .015), PET staging (41% versus 2%, p < .0001), chemo-radiotherapy (CRT) for locally advanced disease (66% versus 16%, p < .0001) and use of adjuvant CRT for high risk disease (49% versus 16%, p < .0001). The interval between surgery and radiotherapy was shorter in the post MDT group (p = .009) as was the mean length of hospitalization (p = .002).

Conclusions

This study highlights the measurable advantages of MDT care over the standard, less formalized, referral process.     

The association between T-stage and clinical nodal metastasis In HPV-positive oropharyngeal cancer

Purpose

To evaluate the association between T-stage and primary tumor subsite with clinical nodal metastasis in HPV-positive oropharyngeal squamous cell carcinomas.

Study Design

Retrospective medical record review.

Materials and Methods

A retrospective analysis of all previously untreated patients with HPV-positive oropharyngeal squamous cell carcinoma evaluated by the senior author in a tertiary-care center over a 5-year period was performed. Medical records were evaluated for HPV status, clinical T-stage, clinical nodal stage, and anatomic location of primary oropharyngeal subsite.

Results

83% (59/71) of patients presented with clinical nodal disease. T-stage was not associated with the absence of regional disease (cN0) in tonsillar complex or base of tongue cancers. However, early T1/T2 tonsillar complex cancers were less likely to present with cN2c disease compared to T3/T4 lesions (0% vs. 18–33%, p = 0.03). Further, base of tongue cancers were more likely to present with cN2c disease compared to tonsillar complex tumors (35% vs. 7%, p = 0.01).

Conclusion

In HPV-positive tonsillar complex cancers, T-stage does not appear to predict the presence of clinical nodal metastasis (N0 vs. N1-N3), but may predict the extent of metastasis when present. This association does not appear to affect base of tongue cancers. Further, base of tongue cancers have a greater incidence of cN2c disease compared to tonsillar complex cancers.     

Preoperative subclinical hypothyroidism in patients with papillary thyroid carcinoma

Objective

To assess the effect of preoperative subclinical hypothyroidism on prognosis and on the tumour's clinicopathological features at initial diagnosis of papillary thyroid carcinoma (PTC).

Materials and methods

328 patients who underwent surgery for PTC between January 2001 and December 2006 were enrolled in this study. Of these, we compared 35 patients with preoperative subclinical hypothyroidism with 257 patients who were euthyroid before the operation, with respect to clinicopathological characteristics and prognosis.

Results

No significant differences were observed in tumour size, extrathyroidal extension, and multifocality between subclinical hypothyroidism and euthyroid patients. Patients with subclinical hypothyroidism had a considerably lower percentage of lymph node metastasis than did euthyroid patients (8.6% vs. 21.8%, p = 0.068). Although preoperative subclinical hypothyroidism decreased the risk of lymph node metastasis at 0.313 of odds ratio in the multivariate analysis, its significance was not verified (95% confidence internal, 0.089–1.092; p = 0.068). Patients with preoperative subclinical hypothyroidism tended to have a better prognosis than did preoperative euthyroid patients, for both recurrence (2.9% vs. 14.0%, p = 0.099) and 7-year disease-free survival (97.1% vs. 87.8%, p = 0.079), during the 82-month mean follow-up period. However, even as thyroid-stimulating hormone (TSH) concentration increased, there were no consistent relationships observed between the TSH levels and the prognostic parameters.

Conclusion

We could find neither a consistent positive nor a negative linear relationship between TSH levels and several prognostic parameters, indicating that subclinical hypothyroidism with elevated TSH is not an independent predictor of tumour aggressiveness and poor prognosis in PTC.     

Results of Baha® implantation using a small horizontal incision

Purpose

Techniques for Baha® implantation continue to evolve. The Weber technique, utilizing a 1.5 cm horizontal incision for Baha® implantation is evaluated.

Methods

Retrospective review of patients undergoing Baha® implantation by a single surgeon over three years.

Results

33 Baha®s implanted in 30 patients. Fourteen used an Inverted J (IJ) incision with an anteriorly-based skin-flap, 13 with the Weber technique (W). Five were not included as other techniques were used. Demographics and weeks to activation (14.58 vs 13.4, p = 0.12) were similar. There were no differences in the number of patients with minor complications (5 vs 2, p = 0.22) or number of minor complications (20 vs 4, p = 0.09). One patient in the IJ Group required operative revision for overgrowth. There were no infections in the IJ Group, and one requiring oral antibiotics in the W Group. Follow-up was longer in the IJ Group (41 vs 13 weeks, p = 0.016), no complications occurred after 14 weeks post-op. Mean operative times were similar (43 vs 39 min, p = 0.59). There were no cases of skin flap necrosis in either group.

Conclusion

A small incision for Baha® implantation proved as effective, without increased complications as a skin-flap based technique.     

Melatonin and cortisol rhythm in patients with extensive nasal polyposis

Purpose

Extensive nasal polyposis is an inflammatory disease which effects 1%–4% of normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in ENP have not investigated.

Materials and methods

Salivary levels of melatonin and cortisol were measured by radioimmunoassay in 31 patients with extensive nasal polyposis and in 27 control subjects matched for age and gender. In both groups none of the subjects did not have obstructive sleep apnea.

Results

The baseline and the peak levels of salivary melatonin in the extensive nasal polyposis group were significantly lower than in the control group (p < 0.001). However, no differences were found in the acrophase and the peak duration of salivary melatonin between the study and control groups (p > 0.05). The highest values of melatonin were recorded at 04:00 h in both the study and control groups.The amplitude and the 24 h mean levels of salivary cortisol in the extensive nasal polyposis group were significantly lower than in the control group (p < 0.001). The acrophase was delayed by about 8 h in extensive nasal polyposis patients (p < 0.001).

Conclusion

The circadian rhythms of salivary melatonin and cortisol were found to be disrupted in patients with extensive nasal polyposis. These results may be applicable as therapeutic tools in the future and melatonin drugs might be useful in the therapy of nasal polyposis like cortisol drugs.     

The impacts of adenotonsillar hypertrophy on periodontal health in children: A prospective controlled pilot study

Objectives

To evaluate the impacts of obstructive adenotonsillar disease on periodontal health and to assess the efficacy of adenotonsillectomy in the prevention of chronic periodontitis in children.

Methods

This prospective and controlled clinical study was conducted between August 2012 and February 2013 with 35 pediatric patients who had permanent anterior dentition. The study group included twenty patients (n = 20) who had complaints of chronic mouth breathing and snoring and were diagnosed with obstructive adenotonsillar disease. These patients underwent adenoidectomy with or without tonsillectomy. We performed periodontal examinations to assess the periodontal health status in these children before and two months after surgery. The periodontal measures included plaque index (PI), pocket depth (PD) and gingival index scores (GI). Subsequently, these periodontal measures were compared with healthy control group who had no adenotonsillar disease (n = 15).

Results

Among the study group six patients underwent adenoidectomy and 14 patients underwent adenoidectomy combined with either tonsillectomy or tonsillotomy. The preoperative PI, PD and GI scores of the study group were 1.27 ± 0.39, 1.34 ± 0.31 and 0.97 ± 0.37 respectively. These scores were significantly higher compared to the control group (p < 0.001). These periodontal index scores were significantly improved after surgery (p = 0.008 for PI and p < 0.001 for both PD and GI). In addition, we found no difference in postoperative values of PD and GI between the study group and control group.

Conclusion

We concluded that obstructive adenotonsillar disease adversely affects periodontal health in children and surgical management of obstruction improves the clinical findings. However, more comprehensive research is required to elucidate the association between adenotonsillar hypertrophy and periodontal disease.     

Managing regional metastasis in patients with cutaneous head and neck melanoma – is selective neck dissection appropriate?

Background

Neck dissection is recommended for patients with head and neck cutaneous melanoma and nodal metastasis. However, there appears to be no clear evidence to guide the extent of nodal resection.

Methods

Loco-regional recurrence (LR), overall survival (OS) and progression free survival (PFS) was retrospectively compared between patients who had Comprehensive neck dissection (CND) and Selective neck dissection (SND).

Results

There was no difference in LR, OS and PFS between CND (n = 18) and SND groups (n = 79). Extra capsular extension (ECE), frontal disease and increasing number of involved nodes resulted in worse OS and PFS but had no impact on LR.

Conclusion

Patients with disease limited to one node without ECE can be effectively treated by SND alone. In patients who have these unfavourable pathological features more extensive nodal resection does not improve outcome if they receive radiotherapy. Extent of neck dissection or adjuvant radiotherapy has no impact on overall survival.     

Pilomatricoma of the cheek: A benign tumor mimicking metastatic squamous cell carcinoma on FDG PET/CT

Background

Pilomatricomas are benign skin tumors originating from hair matrix cells in the dermal layer of the skin, especially in the head and neck region. They may mimick malignant lesions on fine-needle aspirate cytology.

Methods

This is a case report of a pilomatricoma of the cheek which was initially diagnosed as squamous cell carcinoma on fine-needle aspirate cytology. As part of the staging work-up, a PET/CT scan was performed, revealing a FDG-avid superficial cheek lesion and also an ipsilateral FDG-avid level II cervical lymph node, giving the impression of metastatic squamous cell carcinoma.

Results

The cheek lesion, as well as the cervical lymph node was excised. The final histology showed benign pilomatricoma and reactive lymphadenopathy.

Conclusion

Pilomatricoma should be considered as an uncommon differential diagnosis for an FDG-avid cutaneous lesion on PET/CT, even in the presence of ipsilateral FDG-avid cervical lymphadenopathy.     

Comparison of clinical features and EBV expression in histiocytic necrotizing lymphadenitis of children and adults

Objective

Histiocytic necrotizing lymphadenitis (HNL) is a self-limiting disease characterized by cervical lymphadenopathy and fever. Epstein–Barr virus (EBV) has been implicated as a cause of HNL in some reports but not in others. The aim of this study was to compare the clinical features and laboratory findings in children and adults with HNL and to evaluate the relationship between EBV infection and HNL.

Methods

The records of patients diagnosed with biopsy-confirmed HNL at Gyeongsang National University Hospital from May 2009 to December 2012 were retrospectively reviewed. Clinical features, laboratory data (blood count, biochemistry, and serology), and computed tomography findings were collected. Immunohistochemistry for CD4, CD8, CD68, and myeloperoxidase (MPO), and in situ hybridization for EBV RNA were performed on archived lymph node biopsies from pediatric and adult patients.

Results

A total of 16 children and 31 adults were diagnosed with HNL. Fever was present in 87.5% of children and 25.8% of adults (P < 0.0001). Fever duration was longer for children (mean, 5.06 days) than for adults (mean, 0.63 days; P = 0.008). Necrosis of the involved lymph nodes was observed in eight (50%) children and six (19.4%) adults (P = 0.045). HNL recurred in five (31.35%) children and one (3.2%) adult (P = 0.015). All had detectable CD4, CD8, CD68, and MPO immunoreactivity. EBV reactivity was higher in children (26.7%) than in adults (6.7%) without statistical support.

Conclusions

There is more variability in the clinical presentation and laboratory findings in children with HNL than in adults. In particular, the degree and duration of fever was more severe in children than in adults, and necrosis of lymph nodes was more frequent in children than in adults. There was no definitive correlation between EBV reactivity and NHL. Further study of the relationship between EBV and HNL is needed with a larger number of patients.     

Management of neck metastases in T2N0 lip squamous cell carcinoma

Background

Prophylactic neck dissection (PND) is indicated when the chance of occult lymph node metastases from head and neck tumors is significant. There is no consensus regarding which tumor size PND would be indicated in cases of lip cancer.

Methods

A total of 139 patients with surgically treated lip cancer were selected. The size of the lesion (T) and the presence of lymph node metastases (N) were assessed by examining the medical records. For analysis purposes, the T2 group was divided into T2a (2 to 3 cm) and T2b (3 to 4 cm).

Results

The following distribution of incidence of neck metastases was observed in the study groups: 11.7% in T1, 9% in T2a, 43.7% in T2b, and 52.2% in T3 + T4. Statistical comparison of the groups (p) revealed the following results: T2a X T2b = 0.03; T2a X T3 + T4 = 0.001.

Conclusion

PND is indicated for tumors larger than 3 cm.     

Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer

Objectives

Although concurrrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age ≥ 65 who received concurrent chemoradiation for head and neck cancer.

Design

Retrospective review.

Setting

Tertiary care center.

Participants

Between 6/2003 and 8/2011, 40 consecutive patients age ≥ 65 underwent combined chemoradiation for head and neck cancer. Ten patients were treated in the postoperative setting and 30 underwent definitive chemoradiation. Twenty-eight patients received concurrent platinum-based chemotherapy and 12 received concurrent weekly paclitaxel. Treatment plans were designed to provide a dose of 66–72 Gy at 2–2.12 Gy/fraction to > 95% of the gross tumor volume in the definitive setting or for positive margins and 60–66 Gy at 2 Gy/fraction post-operatively. Median follow-up was 23.2 months (range: 0–94.4 months).

Main outcomes measures

Acute skin and mucosal toxicity, unplanned treatment interruptions, and chronic treatment related toxicity including gastrostomy tube dependence as graded by the CTCAE v3.0.

Results

Eight patients (20%) required a radiation treatment break of ≥ 3 days. Thirteen (33%) required unplanned hospitalization during or immediately following treatment. No grade 4 + skin or mucosal toxicity was noted. Five patients remained PEG tube dependent at > 1 year. One patient developed non-healing mandibular osteoradionecrosis > 3 years following chemoradiation. The 2-year Kaplan–Meier estimate of overall survival was 55%.

Conclusion

Higher-than-expected rates of in-patient hospitalization with significant acute toxicity were noted in this cohort with a correspondingly high rate of radiation treatment breaks. Late toxicity rates were similar to those observed in historical controls with younger patients. Careful patient selection criteria should be employed for elderly patients considering concurrent chemoradiation for head and neck cancer.     

Clinical indicators that predict the presence of moderate to severe obstructive sleep apnea after adenotonsillectomy in children

Objective

To determine if clinical indicators can predict the presence of moderate to severe Obstructive Sleep Apnea (OSA) after Adenotonsillectomy (T&A) in children.

Study Design

Retrospective study.

Setting

Urban Tertiary Care Pediatric Hospital.

Methods

Parents of children (< 18 yrs.) with OSA completed a 55-item questionnaire based on their child’s symptoms at the time of preoperative polysomnography and then again at the follow up polysomnography completed 3 to 6 months after T&A.

Main outcome measures

55 item questionnaire, polysomnography variables.

Results

97 children were included (59 Male and 38 Female). The mean preoperative apnea hypopnea index (AHI) was 30.5 ± 31.6/h and the mean postoperative AHI was 4.4 ± 6.0/h. After T&A, all 97 children had reduction in AHI, and 35 (36.1%) no longer had OSA (AHI < 1/h). The total symptom scores decreased from 15.8 ± 9.4 to 11.3 ± 8.7 after T&A (p < .0001). Fourteen symptoms highly predictive of moderate to severe OSA were identified in the univariate analysis (p < 0.1). Using a cut-point of 4, this 14-item subscale illustrated an overall predictability of 72.2% (73.7% sensitivity and 70.0% specificity) for identifying children with moderate to severe OSA.

Conclusion

A cluster of 14 clinical sleep symptoms are highly predictive of moderate to severe OSA and can serve as clinical predictor for the presence of moderate to severe OSA after T&A.     

Adenoid cystic carcinomas of minor salivary glands

Objectives

Adenoid cystic carcinoma (ACC) is a very rare epithelioid tumor with different prognostic factors relating to overall survival. This study aims to analyze the prognostic factors, outcome and the value of surgical therapy on recurrent disease.

Materials and methods

From 1992 to 2006, a total of 33 patients with ACC originating in minor salivary glands of the oral cavity were clinicopathologically reviewed. Clinical and histological data was analyzed by univariate analysis using the log-rank test.

Results

64% of patients had a low-grade and 36% had a high grade disease. The 2-, 5- and 10-year survivals were 89.7%, 62.1% and 54.2%. The T category (p = 0.001), N category (p = 0.027), UICC stage (p < 0.0001), and resection margins (p = 0.024) influenced survival. Salvage treatment influenced patient's overall survival (p = 0.002).

Conclusion

This study confirms that in ACC T category, N category, UICC stage, and resection margin status correlates well with prognosis. Salvage surgery of patients with recurrent ACC should be performed if possible as the survival is significantly increased.     

Use of fracture size and soft tissue herniation on computed tomography to predict diplopia in isolated orbital floor fractures

Purpose

To determine the role of fracture size and soft tissue herniation as measured by computed tomography in predicting the development of persistent diplopia in patients with isolated orbital floor fractures.

Methods

A retrospective chart review identified patients presenting between March 2009 and 2012 with isolated orbital floor fractures. Computed tomographic scans were assessed for transverse fracture size and absence or presence of soft tissue herniation and rectus involvement. Presence of diplopia at 6–10 days, decision for surgical repair, and presence of diplopia were recorded.

Results

Fifty-six patients fulfilled inclusion criteria. Eighteen of 56 patients (32%) had preoperative diplopia. In Type A fractures, 0/9 (0%) small, 1/8 (12.5%) medium, and 2/14 (14%) large fractures had diplopia. For Type B fractures, 3/4 (75%) small, 9/13 (69%) medium, and 4/8 (50%) large fractures had diplopia. Type B fractures were significantly more likely to cause diplopia than Type A fractures in the small (p = 0.003) and medium (p = 0.007) size groups but not in the large groups (p = 0.07).

Conclusion

Transverse fracture size and presence of soft tissue herniation on CT imaging can predict development of persistent diplopia in isolated orbital floor fractures. Small and medium sized fractures with soft tissue herniation are more likely to cause diplopia than large sized fractures. We recommend early repair or closer observation of small and medium sized orbital floor fractures with soft tissue herniation due to the high risk of diplopia.     

Alkaline pH in middle meatus in cases of chronic rhinosinusitis

Study type

Prospective and observational study.

Methods

The study group was divided in two groups consisted of 50 normal subjects (100 meati) and 50 patients (100 meati) of chronic rhinosinusitis (CRS). All subjects underwent nasal endoscopy along with measurement of the pH of the middle meatus using a portable pH monitoring device. Statistical analysis was done to compare mean pH of normal middle meatus with the diseased one.

Results

The mean pH of normal 100 middle meati was measured to be 7.35(± 0.82). The mean pH of 100 middle meatii in CRS patients was higher 7.81(± 0.83) and was found to be statistically significant (p = 0.00011).

Conclusion

Alkaline pH (7.81) was observed in the middle meatus of CRS patients.     

Evaluation of ceruloplasmin levels in patients undergoing surgical interventions with nasal polyps

Objective

Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that ceruloplasmin (CP), an acute phase protein, limits oxidative stress. The purpose of this study was to evaluate the ceruloplasmin levels in patients with NPs.

Methods

One hundred and twenty patients with NPs, septal deviations and concha hypertrophies were recruited to the study. Patients were divided in two groups; group 1 (n = 60) consisted of patients with NPs, and group 2 (n = 60) consisted of septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery due to NPs, as well as control specimens were acquired who underwent an operation due to septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess CP levels.

Results

There were no statistical differences in gender, age and biochemical values between two groups (p > 0.05 for all). Compared to group 2, group 1 had significantly higher CP levels both in serum and the tissue samples (both p < 0.001).

Conclusion

As a result of our study; CP levels both in serum and the tissue in patients with NPs were higher, may be consequence of the inflammation, than in patients without NPs.