Ethmomaxillary sinus

Ethmomaxillary sinus is a variation of the posterior ethmoid cells. It is formed by the extension of the posterior ethmoid cells into the maxillary sinus and drains into superior nasal meatus. It is incidentally seen on paranasal sinus computerized tomography (CT) scans. Its prevalence has been reported as 0.7 and 2% in two studies. In this study, paranasal CT scans of 466 patients were investigated for the presence of ethmomaxillary sinus. The patients had paranasal CT with the preliminary diagnoses of septal deviation, chronic inflammatory paranasal sinus disease and nasal turbinate disorders. The ethmomaxillary sinus was present in nine of those patients (1.93%). It was septated in one of them. The CTs were further investigated for other anatomical variations and co-existent mucosal disease of the paranasal sinuses.     

Comparison of the efficacy of conventional special blue light phototherapy and fiberoptic phototherapy in the management of neonatal hyperbilirubinaemia

The efficacy and usefulness of two types of phototherapy differing in the source, wavelength and irradiance of the light, conventional phototherapy consisting of special blue light and fiberoptic phototherapy, were compared in a relatively larger series of term newborns with non-haemolytic and more significant hyperbilirubinaemia than those in previous studies. In total, 108 newborns were allocated sequentially to receive either conventional phototherapy consisting of five special blue lamps or fiberoptic phototherapy. The average spectral irradiance measured at the skin surface level of newborns during the study period was significantly greater in the conventional phototherapy group. The special blue lamp of the conventional phototherapy unit had an emission spectrum almost identical to the bilirubin absorption spectrum, whereas the tungsten-halogen lamp of the fiberoptic phototherapy had a broad emission through the blue and green wavelengths (mainly in the green spectrum). Phototherapy was more effective in the conventional phototherapy group; the duration of exposure to phototherapy (h) was significantly shorter, and the overall bilirubin decline rate (as micromol/l/h and %/h) was significantly greater in the conventional phototherapy group. According to the nursing personnel, fiberoptic phototherapy was more comfortable than the conventional phototherapy frame because of the easier accessibility and handling of the infants during phototherapy. They complained of giddiness, nausea, glare, temporary blurring of vision and difficulty in detecting the skin colour changes of newborns with the blue light of the conventional phototherapy unit. Conventional phototherapy consisting of special blue fluorescent lamps with approximately twofold higher irradiance and an emission spectrum almost identical to the bilirubin absorption spectrum is preferable to fiberoptic phototherapy in the standard treatment of term newborns with non-haemolytic hyperbilirubinaemia.     

Coronary artery-left ventricular fistulae associated with apical hypertrophic cardiomyopathy.

We describe an unusual case of coronary artery-left ventricular fistulae associated with apical hypertrophic cardiomyopathy in a 63-year-old man who had a 2-year history of angina pectoris without significant coronary atherosclerosis. It is important to recognize this anomaly as it may be the source of angina in patients without angiographic evidence of major atherosclerotic coronary artery disease.     

Bilateral choroidal infiltration from indolent non-Hodgkin's lymphoma: a rapid course with poor prognosis

A 42-year-old-woman, with a 2 year history of non-Hodgkin's lymphoma suffered sudden bilateral visual loss. This unusual patient presented with an unifocal choroidal tumor in the superionasal quadrant in both eyes. Fluorescein angiography revealed early and late intense subretinal fluorescence. Cytological examination of the anterior chamber and vitreous tap material revealed abnormal lymphocytes compatible with NHL. Diffuse choroidal infiltration was diagnosed and treated with radiotherapy. Radiotherapy did not provide local control and preservation of the vision. Non-Hodgkin's lymphoma can infiltrate to the choroid and radiotherapy may not be efffective in every case.     

Effect of linear alkylbenzene sulphonate (LAS) on non-specific defence mechanisms in rainbow trout (Oncorhynchus mykiss)

Linear alkylbenzene sulphonate (LAS) is among the most widely disseminated xenobiotics to enter waste streams and the aquatic environment. In the present investigation, we present a novel approach to evaluate in toxicity of LAS. The effects of sublethal levels (0.2 and 0.4 mg/l) of LAS on non-specific immune system, phagocytosis, respiratory burst and lyzosyme activity, and specific growth rate in the rainbow trout, Oncorhynchus mykiss, during a 54-day exposure were examined by a static bioassay test procedure. The phagocytic activity of leukocytes from fish exposed to 0.4 mg/l LAS statistically decreased compared with the control fish values. No significant reductions were observed in the extra-intracellular respiratory burst and lysozyme activities after exposure to LAS at any of the concentrations tested. The final body weight in fish groups exposed to the LAS were found to be significantly lower than in the control. The specific growth rate results also supported the result above. The results of this study showed sublethal doses (0.2-0.4 mg/l) of LAS caused to statistically insignificant suppression of non-specific immune system mechanisms excluding phagocytosis in fish at laboratory conditions. These doses of LAS may produce potential synergism on immune system when presented with other environmental pollutants.     

Cauda-filar paraganglioma with 'silk cocoon' appearance on spinal angiography

'Silk cocoon' appearance on spinal angiography is pathognomonic to differentiate paragangliomas from several vascular tumors and malformations of cauda-filar region.     

Spontaneous small bowel perforations due to intestinal tuberculosis should not be repaired by simple closure

Intestinal tuberculosis is a major problem in many regions of the world. The incidence of it is rising in Western countries due to immigration from Third World countries and human immunodeficiency virus infection. The difference between the simple closure and resection and anastomosis was evaluated in this study. Retrospectively, 12 patients with intestinal tuberculosis diagnosed histopathologically among 50 patients with free intestinal perforations operated on between 1995 and 2003 at Turgut Ozal Medical Center were evaluated. Each patient underwent routine laboratory tests and radiologic studies. The most common symptoms of patients were abdominal pain, night sweats, and weight loss. Sites of perforation were ileum in 10 patients (multiple perforation in 4) and jejunum in 2 patients (both had multiple perforations). The perforation was closed by primary closure in 7 patients. Resection-anastomosis was performed in 5 patients. Leaks occurred in overall 3 of 7 patients with primary closure. Three of the 7 patients with leaks due to septicemia died. The mortality rate among all patients was 25%. Intestinal tuberculosis should be kept in mind as a cause in free intestinal perforations. Because of high mortality rate, the resection of the affected area and anastomosis may be the treatment of choice rather than primary closure.     

End-to-side nerve coaptation: is an additional proximal coaptation useful when available?

The aim of this experimental study was to evaluate the effects of end-to-side coaptation of the proximal end of a severed nerve to the same intact nerve, in addition to traditional end-to-side coaptation of the distal end, with an aim to use the intact nerve as a nerve conduit in a rat model and to compare the functional and histologic results of this modality to those obtained after nerve grafting and traditional end-to-side nerve coaptation. In group A, a peroneal nerve defect measuring 1 cm was created in the left hind limb, and a nerve graft 1 cm long was used to bridge the defect. In group B, only the distal stump of the peroneal nerve was coapted to the intact tibial nerve. In group C, both ends of the peroneal nerve defect were coapted to the intact tibial nerve in an end-to-side fashion 1.5 cm apart from each other, and in group D, the peroneal nerve defect was left unrepaired. Group E was consisted of nonoperated peroneal nerves that were used to obtain normative data. Although significantly higher myelinated axon densities were observed in groups B and C compared with group A and group E, total number of the myelinated axons was significantly higher only in group C. Peroneal functional index assessments demonstrated that nerve recovery in the peroneal nerve was similar in groups A and C, and both were better than those observed in groups B and D. Collectively, these results suggest that end-to-side coaptation of both ends of a severed nerve to an intact nerve, in case of a nerve defect in this length, may serve as an alternative for nerve grafting.     

Combined intraoral and nasal approach to Tessier No:0 cleft with bifid nose

The surgical correction of craniofacial clefts is an extremely difficult field in pediatric plastic surgery. Facial clefts are rare entities that most plastic surgeons will rarely have to manage. Various surgical techniques devised by some authors for facial clefts have not still widely accepted.The bifid nose deformity is generally an indicator of Tessier No:0 clefts, with various degrees of skeletal problems. The nasal roof area is an important key point in determining the appropriate surgical technique for reconstruction. In this report, a case of Tessier No:0 with a moderate nasal bifidity and ours novel surgical repair technique combining oral and nasal incision are presented.     

Measuring the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children

OBJECTIVE: To evaluate the correlation between adenoidal-nasopharyngeal ratio (AN ratio) and tympanogram in children. STUDY DESIGN: A prospective clinical study from June 2002 to May 2003. METHOD: A total of 64 children, aged 6-9 years who presented with nasal obstruction, snoring, mouth breathing, and hyponasal speech were examined and AN ratio was calculated by using the lateral neck radiograms and compared with the tympanometric values. The relationship between AN ratio and middle-ear pressure was evaluated, regarding the AN ratio of 0.71. The chi-square test was used to analyze the correlation between AN ratio and middle ear pressures and Wilcoxon test was used to compare the changes between the mean AN ratio values, and mean middle ear pressures (including A and C type tympanograms) before and after medical therapy. RESULTS: Middle-ear effusions and C type tympanograms in impedance audiometry were both related to eustachian tube dysfunction resulting from enlargement of the adenoids with AN ratios higher than 0.71. Middle ear pressures were found lower in children with AN ratio greater than 0.71 than in children AN ratio less than 0.71 and the difference was highly significant (p<0.001). Although medical treatment of large adenoids was rather effective to shrink the adenoid tissue (p<0.001), it did not cause a statistically significant change in tympanometric values (p>0.05). CONCLUSIONS: Antibiotherapy is effective in reducing adenoid size without signs and symptoms of infection. The reduction of the adenoids in size after 3 weeks of antibiotherapy has an positive effect on recovery of eustachian tube function but is not sufficient in patients with middle ear effusion. Early ventilation tube insertion may be an alternative therapy for the middle ear effusions not improving by 3 weeks medical therapy.