Upper lateral cartilage-sparing component dorsal hump reduction in primary rhinoplasty

Background : Dorsal hump reduction is a critical step in rhinoplasty. Most of the reasons behind revisional procedures are related to incorrect hump reduction. Methods : The authors used a modified dorsal hump reduction method in their primary cases, the steps of which are as follows: 1) dissection of the nasal vault; 2) bilateral submucoperichondrial dissections to free the cartilaginous septum; 3) separation of the upper lateral cartilages from the cartilaginous septum; 4) partial dissection of the upper lateral cartilages from the inner surfaces of the nasal bones bilaterally; 5) separation of the bony septum from the nasal bones bilaterally; 6) reduction of the partially isolated nasal bones; 7) en bloc cartilaginous and bony septum removal. The authors have operated on 68 primary cases over a 2 year period (30 mo). Results : In the great majority of cases, the results were satisfactory. No revisions were performed in this patient group. Conclusions : This method is a good alternative to traditional techniques in noses with a high and narrow roof, thin skin, and weak middle nasal vault. Revision could be performed more easily when required. Initially, wide noses may not seem good candidates for this procedure; however, careful case‐based preoperative planning may overcome this difficulty.     

Assessment of bone mineral density should be considered earlier in perimenopausal women with vasomotor symptoms

Objective

To investigate the relationship between vasomotor symptoms (hot flashes) and osteopenia or osteoporosis in perimenopausal women.

Method

In this cross-sectional study 79 perimenopausal women aged between 45 and 55 years and seen at the Gynecology or Menopause Outpatient Clinic of Marmara University School of Medicine were allotted to one of 2 groups according to the presence or absence of hot flashes. The groups were then compared for bone mineral density (BMD) of the lumbar vertebrae, as measured by dual energy X-ray absorptiometry.

Results

The mean BMD measurement for vertebrae L2 to L4 was 0.32 ± 0.19 for the group with no hot flashes and  − 0.53 ± 0.21 for the group with hot flashes (P = 0.007). In the former, 6.1% of the women and in the latter, 32.6% of the women had a BMD value less than a 1.5 standard deviation from the mean (P = 0.005).

Conclusion

Women with vasomotor symptoms are more prone to have osteopenia or osteoporosis.     

'Time is a GIFT in GIST'--the medical and paramedical perspective of a case with metastatic gastrointestinal stromal tumor

Few recent developments in oncology have generated comparable interest as have the dramatic successes in the therapy of gastrointestinal stromal tumors (GIST) with imatinib mesylate. Imatinib, a selective tyrosine kinase inhibitor, is currently the standard of care first-line treatment for unresectable or metastatic GIST, improving survival time and delaying disease progression. The authors report a 50-year-old male patient referred as relapsed chemotherapy-resistant CD117- leiomyosarcoma. After learning about the failure of chemotherapy, the patient became depressive and considered committing a suicide. We performed a second CD117 staining. As the second analysis was found to be positive, the diagnosis of leiomyosarcoma was changed to GIST. Imatinib 600 mg/day was started. The result with imatinib was appraised as a partial response/stable disease after the chemotherapy failure. The patient's depressive mood was also improved after imatinib. The medical and paramedical perspectives of the case are presented to emphasize the importance of immunohistochemical staining and its inhibition by a novel tyrosine kinase inhibitor in GIST. All nonepithelial tumors, particularly nonepithelial abdominal tumors of leiomyoblastic appearance should be considered to be GIST unless an experienced pathologist who does CD117 staining routinely confirms a different diagnosis. Interestingly, depression due to chemotherapy failure was also alleviated with imatinib. According to a recent study, median time to progression was 24 months, and overall survival was 57 months, reaching 5 years with imatinib. Conclusion: time is a GIFT in GIST.     

Echocardiographic Follow-Up of Children with Isolated Discrete Subaortic Stenosis

This study evaluates the progression of stenosis, onset and progression of aortic regurgitation (AR), and the results of surgical outcomes in children with isolated discrete subaortic stenosis (SAS). The medical records of 108 patients (mean age, 5.5 ± 3.8 years; range, 3 days to 18 years) with isolated discrete SAS were reviewed. Patients with lesions other than AR were excluded. Very mild stenosis was defined as Doppler peak systolic instantaneous gradient (PSIG) less than 25 mmHg, mild stenosis as 25–49 mmHg, moderate stenosis as 50–75 mmHg, and severe stenosis as more than 75 mmHg. Seventy-eight of 108 patients were followed for 2 months to 14 years (mean, 4.8 ± 3.7 years; median, 5 years) with medical treatment alone. In these patients, the mean PSIG at last echocardiogram was higher than the mean PSIG at initial echocardiogram (39 ± 19 vs 31 ± 12 mmHg, respectively; p < 0.001). Among 24 patients with very mild stenosis at initial echocardiogram, 10 had mild and 2 had moderate stenosis after a mean period of 5.6 years. Among 46 patients with mild stenosis at initial echocardiogram, 11 had moderate and 5 had severe stenosis after a mean period of 4.1 years. Only 1 patient among the 8 patients with moderate stenosis at initial echocardiogram had severe stenosis after a mean period of 2.7 years. Thirty-nine patients (50%) had AR (13% trivial, 33% mild, and 4% moderate) at initial echocardiogram. After a mean period of 4.8 years, 77% of the patients had AR (10% trivial, 53% mild, 9% mild–moderate, and 5% moderate). Twenty-four patients underwent surgery. Preoperatively, mean Doppler PSIG and AR incidence were 64 ± 17 mmHg and 91% (22/24), respectively. The mean Doppler PSIG was 30 ± 19 mmHg and AR was present in all of the patients a mean period of 4.1 years after surgery. Two patients underwent reoperation for recurrent SAS and AR. Patients with very mild or mild stenosis may be followed noninvasively every year. One patient of the 8 patients with moderate stenosis progressed to severe stenosis, and moderate AR developed in 2 patients after a mean of 2.7 years. We recommend that patients with moderate stenosis undergo careful evaluation to determine whether surgery is necessary due to the severity of stenosis and AR.