Analysis of ethmoid roof and skull base with coronal section paranasal sinus computed tomography

ABSTRACT: Chronic paranasal sinus disease is one of the most common causes of application to physicians in pediatric and adult patients. In the surgical treatment of these diseases, endoscopic sinus surgery is an application that is often done to increase the quality of the patient's life. On account of this, the anatomic variations in skull basement must be well known to avoid possible major complications that may occur during the operation.Recent developments in paranasal sinus surgery also enhanced the need for examining exhaustively the anatomy of this region and existing pathology. Superiority of computed tomography (CT) has an unquestionable importance for the evaluation of anatomic structure and pathology compared with conventional radiographs. A likely anatomic knowledge is needed for a safe surgery. Before the surgery, determining the anatomic variations makes the operation safer and increases the prospects, so we can prevent complications that may occur during the surgery.In this study, CT coronal sections of 300 patients who were admitted to the Department of Ear Nose Throat of Medical Faculty of Cumhuriyet University Research and Training Hospital between the dates December 2008 and January 2011 with complaints of nasal flow and postnasal drip were studied. According to coronal section CT examinations, the patients were divided into 2 groups. Group 1, with 156 cases (64%), showed mucosal changes, and in 144 cases (36%), no mucosal changes were established (group 2). In comparison between the sexes, in groups 1 and 2 females, significant difference was determined for other parameters except the average height of the ethmoid roof. In the comparison between the sexes, in groups 1 and 2 males, significant difference was determined for all parameters. The difference between these 2 rates was statistically significant.Keros types 1 and 2 cases were compared with the control group, and there was no statistically significant difference. Notwithstanding, at the comparison of the Keros type 3 with the control group, there was a statistically significant difference for all the parameters (maximum orbital height, the length of the middle concha, and the nasal wall).It seems to be important for us to know the average length of the peripheral anatomic structures to avoid serious complications that may occur during the operation. Careful preoperative review of paranasal sinus CT scans in patients undergoing sinus surgery seems to be the most important to prevent severe intraoperative complications.     

Are intraspinal anomalies in early onset idiopathic scoliosis as common as once thought? A two centre United Kingdom study

Purpose

Rates of neural axis abnormalities in infantile and juvenile idiopathic scoliosis may be as high as 50 %. We aimed to determine the rates of neural axis abnormalities in early onset idiopathic scoliosis patients in a British population.

Methods

This retrospective study at two British spinal deformity clinics identified 72 patients satisfying the inclusion criteria of: (1) age at diagnosis of 7 years and younger, (2) idiopathic scoliosis and (3) magnetic resonance imaging of the neuraxis.

Results

The mean age at diagnosis was 3.6 years and the mean Cobb angle was 47° with a near equal distribution of left (32) and right (36) sided curves. Eight (11.1 %) neural axis abnormalities consisting of two syrinxes, one Arnold–chiari Type I malformation and five combined (Arnold–chiari malformation Type I and syrinx) anomalies were identified.

Conclusions

This multi-centre study on the largest number of British subjects to date helps to establish the rates of neural axis abnormalities.     

Serum C-reactive protein in elderly men and women: association with mortality, morbidity and various biochemical values

OBJECTIVE: The primary aim of this study was to define the distribution and the prognostic value of serum C-reactive protein (s-CRP) measured by a high-sensitivity method in elderly subjects of both genders with special reference to the distribution below 10 mg/l. As a secondary aim, a possible gender difference of s-CRP was examined. MATERIAL AND METHODS: Baseline s-CRP was described in a population-based sample of opposite-sex, twin-pairs (197 F, 189 M available for blood-sampling) aged 71-80 years (mean age 74.5 years), considering mortality through the next 4 years, morbidity (myocardial infarction, angina pectoris, congestive heart failure, arterial hypertension, venous thromboembolism, stroke, diabetes, gout, psoriasis, rheumatoid arthritis) before and after blood sampling, biochemical values (serum levels of urate, urea, ApoA1, ApoB, folate, FSH, LH, oestradiol, progesterone, testosterone, cortisol) and anthropometric measurements (body mass index (BMI), circumference of waist, buttocks and hips). RESULTS: The level of s-CRP did not deviate substantially from what has been reported for younger subjects. Higher values indicated an increased risk of cardiovascular morbidity and diabetes in women but not in men. The s-CRP level was associated with serum levels of urate, progesterone, folate, ApoA1, ApoB and the quotient ApoB/ApoA1 as well as with BMI and waist circumference. CONCLUSIONS: For the 71-80 years age group, s-CRP below the 80th percentile (4.3 mg/l) seems to have prognostic capacity mainly in women. The highest association with mortality as well as with cardiovascular diseases, diabetes and rheumatoid arthritis is found for s-CRP above 10 mg/l, which is the arbitrary lower level for the earlier routine low-sensitivity s-CRP methods. The association of s-CRP with serum urate, folate and the ApoB/ApoA1 quotient should be considered.     

Urine Dipstick of Sputum for the Rapid Diagnosis of Community Acquired Pneumonia

Introduction

Community acquired pneumonia (CAP) is responsible for an important part of treatment costs across the world. Even though posterior-anterior lung radiography (PALG) and direct sputum smear microscopy are required or routine diagnoses. The purpose of this study is to determine the diagnostic value of the bedside urine strip tests in CAP.

Buried Kirschner wires in hand trauma

There has been little research comparing rates of infectious complications between buried and percutaneous Kirschner wire (K-wire) use in hand trauma surgery. The additional cost of removing buried wires should be justified by a demonstrable reduction in the frequency and/or severity of infectious complications. We prospectively collected data on infective complications associated with K-wire use during the course of 1?year at our hand trauma unit. We observed seven (10%) infections in 70 patients where wires were left protruding and three (9%) infections in 34 patients where wires were buried. There was no statistically significant difference in the rate of infectious complications. A cost analysis was performed, taking into account infectious complications and the cost of their management. Burying K-wires resulted in an extra cost of ￡235.51 per patient compared to ￡90.80 per patient for percutaneous K-wires. Thus, the use of buried K-wires results in a ￡144.71 increase in cost per patient. Clinicians should consider these findings, as well as other (medical) considerations, when making the decision whether to bury K-wires.     

Serum 2 -microglobulin in various disorders

In 216 patients admitted to hospital for various disorders serum β₂-microglobulin was determined by a radioimmunoassay. Only subjects with a serum creatinine value in the lower half of the normal range were studied as the level of serum β₂-microglobulin is known to increase when there is an impairment of the renal function. Most patients had normal serum levels but high values of serum β₂-microglobulin were relatively often found in patients with malignant disease. Elevated values were also found in a few subjects with inflammatory disorders thought to be connected with a pronounced or abnormal immune response.     

Surgical management of elongated styloid process: intraoral or transcervical?

The purpose of this study is to compare the results of surgical approaches in management of elongated styloid process. Eight patients with Eagle’s syndrome due to elongated styloid process were included in this study. All necessary preoperative diagnostic work-ups were done and four of them were operated transorally and four were operated extraorally. Preoperative and postoperative symptoms and postoperative patient satisfaction were investigated. No early or late postoperative complications were encountered in transoral group. One of the patients who was operated transcervically experienced a transient weakness in the marginal mandibular branch of facial nerve which resolved spontaneously within 2 weeks. Complete remission of symptoms was achieved in seven patients at the final follow-up, only one of the patients, who was operated intraorally, had partial remission. Only one of the patients who had unilateral excision of elongated styloid process transcervically complained about the permanent scar. Transoral approach is a safe surgical alternative achieving adequate treatment. The advantages of intraoral approach include less surgical travma, less surgical time and lack of servical scar, with similar outcomes when compared with transcervical approach.     

Morbidity does not influence the T-cell immune risk phenotype in the elderly: findings in the Swedish NONA Immune Study using sample selection protocols

A critical issue in our understanding of ageing and the immune system refers to the health status of the population from which inferences are drawn. The commonly used SENIEUR protocol, selecting individuals representing 'normal ageing' has recently been under debate because a substantial amount of individuals with various health problems are excluded. The aim of the present study was to investigate the influence of morbidity on immune parameters and to evaluate the associations with the T-cell immune risk phenotype (IRP), related to cytomegalovirus (CMV) seropositivity by applying the SENIEUR protocol and the OCTO-Immune protocol in the unselected population based sample (n=138) of oldest-olds, participating in the Swedish NONA Immune Study. The SENIEUR protocol excluded over 90% of the sample whereas the OCTO-Immune protocol excluded almost 65% of the sample. Three independent groups, very healthy (SENIEUR), moderately healthy (OCTO-Immune) and frail (non-SENIEUR/non-OCTO-Immune) were created. Flow cytometry studies on lymphocyte sub-populations revealed no significant difference in CD4/CD8 ratio, CD3+CD4-CD8+, CD3+CD4+CD8-, CD8+CD57+CD28-, CD8+CD56+CD57- or CD8+CD56+CD57+ between the very healthy, moderately healthy and the frail subsamples. Our findings indicate that morbidity does not significantly influence the T-cell immune risk profile in the elderly, and we suggest the inclusion of broader samples in future immunogerontological studies.