Outcomes of external septorhinoplasty in a Turkish male population

Introduction

The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development.

Objective

To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population.

Methods

In total, 28 consecutive adult male patients with a mean age of 32.14 ± 10.66 years (range: 18–61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study.

Results

Mean preoperative and postoperative nasofrontal angles were 148.04° ± 8.18° and 144.50° ± 7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59° ± 14.01° and 98.50° ± 9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56 ± 0.05 and 0.60 ± 0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted “V” incisions were performed in 15 (53.6%) patients while “V” incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty.

Conclusions

This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Timely management of penetrating neck trauma: Report of three cases

In head and neck surgery, penetrating neck injuries are uncommon. The neck contains many important structures, so such trauma can cause significant morbidity and mortality. A patient with penetrating neck trauma should be examined promptly in the emergency room. If possible, damaged tissue and organ fragments should be preserved carefully.

A Turkish newborn infant with cerebellar agenesis/neonatal diabetes mellitus and PTF1A mutation

Classical neonatal diabetes mellitus is defined as hyperglycemia that occurs within the first month of life in term infants. It can be either permanent or transient. Cerebellar agenesis and permanent neonatal diabetes has been previously reported as a new autosomal recessive disorder. Pancreas Transcription Factor 1 Alpha (PTF1A) mutations have been related with this constellation of abnormalities. Here we report a new case of cerebellar agenesis and neonatal diabetes mellitus whose parents are PTF1A mutation carriers.

Fatigue and sleep disturbance in multiple sclerosis

Considering the association of sleep disturbance and fatigue in multiple sclerosis (MS), we investigated the presence of sleep disturbances that may be related to fatigue by using objective and subjective measures. We included 27 MS patients with fatigue, 10 MS patients without fatigue and 13 controls. The Pittsburgh sleep quality index score showed significant differences between patient groups and controls. Beck depression inventory scores were significantly higher in fatigued than non-fatigued patients. Comparison of patient groups and controls revealed significant differences for time in bed, sleep efficiency index, sleep continuity index, wake time after sleep onset, total arousal index and periodic limb movement arousal index. Our study confirms that MS causes sleep fragmentation in terms of both macro and microstructure. Fatigue in MS could be partially explained by disruption of sleep microstructure, poor subjective sleep quality and depression.

The R110C mutation in Notch3 causes variable clinical features in two Turkish families with CADASIL syndrome

Mutations in Notch3 gene are responsible for the cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). It is a late onset neurological disorder recognized by recurrent strokes and dementia. We describe here the clinical and molecular findings of three unrelated Turkish families with CADASIL syndrome. Two of the families were identified to have the same mutation, p.R110C (c.C328T), located in exon 3 of the Notch3 gene. Interestingly, the phenotypic expression of the disease in these two families was markedly different in severity and age of onset implicating additional genetic and/or non-genetic modulating factors involved in the pathogenesis. In addition, we identified the novel p.C201R (c.T601C) mutation in exon 4 of the Notch3 gene in a proband of the third family with two consecutive stroke-like episodes and typical MRI findings. Mutations described here cause an odd number of cysteines in the N-terminal of the EGF domain of Notch3 protein, which seems to have an important functional effect in the pathophysiology of CADASIL. The phenotypic variability in families carrying the same molecular defect as presented here makes the prediction of prognosis inconceivable. Although DNA analysis is effective and valuable in diagnosing approximately 90% of the CADASIL patients, lack of genotype-phenotype correlation and prognostic parameters makes the presymptomatic genetic counseling very difficult.

Ovarian actinomycosis mimicking malignancy

OBJECTIVE

To emphasize the importance of frozen section diagnosis in the treatment of ovarian carcinoma and to remind physicians that it may mimic ovarian carcinoma and occur in women without intrauterine contraceptive devices (IUDs).

METHODS

Three cases operated on in Adana University Hospital between the year 2001-2003 with the diagnosis of ovarian actinomycosis were reported.

CASE REPORT

Three female patients who had never used IUDs, aged 37, 45 and 47, who presented with pelvic pain and tumoral masses in the pelvis were operated on with the initial diagnosis of ovarian carcinoma between the years 2001 and 2003. Intraoperative frozen-section diagnoses of the pelvic masses were actinomycosis. In the postoperative period the patients received long-term antibiotic therapy initially intravenously (15 days), and later orally with 4 g/day for three months. They were healthy without evidence of actinomycosis infection for two years after the treatment.

DISCUSSION

Pelvic actinomycosis is uncommon and may present a diagnostic dilemma because of an atypical clinical presentation. The behavior of the disease, which mimics malignancy and urogenital manifestation, poses difficulties in diagnosis and management. Preoperative examinations could not establish the nature of the tumour. An initial diagnosis of ovarian carcinoma is usually considered in all cases. Surgeons should be aware of this infection to potentially spare women morbidity from excessive surgical procedures.

[Tuhfetü'l-Tib, as a pioneer periodical of the medical history]

Tuhfetü'l-Tib is a Turkish medical history periodical published regularly every two weeks in Istanbul since December 27th, 1867. Its collection comprises totally 15 issues, every one of which is consisted of 16 pages with a hard cover, printed at the Maltepe Military Hospital printing press for more than seven months. As far as we know, Tuhfetü'l-Tib's last issue was dated on July 21st, 1868. The aim of its publication was to introduce contemporary medical knowledge by translating articles from the respected academic periodicals in the West. Among the issues wer have studied, twenty chapters were about gynecology, while twenty five ones about the newborn diseases. Tuhfetü'l-Tib is the second Turkish medical review ever printed in Turkey, succeeding Vakayi-i Tibbiye (1849). It is also the first periodical in Turkey, publishing articles on gynecology and pediatrics. Having played an important role in struggle for the Turkish education at the Imperial Medical School, it was issued on the basis of the principles defended by the Ottoman Association of Medicine.

[The medical drugs at Divanü Lügat-it Türk]

Divanü Lügat-It Türk is a great encyclopaedical work written by Kaşgarli Mahmud in the 11th century. This masterpiece gives us detailed information on the Turkish culture of the time. This paper is constituted of five parts and covers all medical drugs mentioned in the book. On the first part, information is given about the physicians and pharmacists charged in drug preparation. The medical drugs of the 11th century have been listed alphabetically in the second part. This list comprises 190 medical drugs each of which has been shown by their counterparts in the Divan up to its volumes and pages in the original text.

Central nervous system involvement in gestational trophoblastic neoplasia

OBJECTIVE

To evaluate characteristics of patients with central nervous system (CNS) lesions of gestational trophoblastic disease and determine prognostic and therapeutic implications applicable to management.

METHODS

Nine patients among 56 cases of malignant gestational trophoblastic neoplasia (GTN) were analyzed prospectively in a single institution between the years 1990 and 1997 with at least two years of follow-up. Brain metastases were documented by physical exam and computed tomography scan or magnetic resonance imaging. In terms of therapy, all of the patients received an etoposide, methotraxate, actinomycin, cyclosphamide and vincristine (EMA-CO) regimen for 5 to 9 courses. To prevent unexpected intracranial hemorrhage, all patients received radiation therapy. No intrathecal chemotherapy was given. Remission was defined as three weekly beta-hCG levels below assay sensitivity (<5 mIU/ml).

RESULTS

The mean age of the patients at diagnosis was 29.6 years. While two of the patients initially presented with symptoms related to cranial involvement, five were diagnosed during routine investigation for metastasis in malignant GTD and the remaining two developed cerebral metastases during the therapy. Besides central nervous system involvement, six had additional lung, two had hepatic and splenic and one had pelvic metastases. Overall survival was 66.6%. Two patients had a fulminant clinical course and were lost one month after initial diagnosis.

CONCLUSION

Early diagnosis via computed tomography of the head and beta-hCG serum testing along with aggressive, multiagent intervention (EMA-CO) have greatly improved patient prognosis of this once highly fatal condition.

Hepatitis B vaccine related-myelitis?

We present four incidental cases that developed partial myelitis following the administration of hepatitis B vaccine in 1998. The first two cases, a 33-year-old man and a 42-year-old woman developed progressive sensory symptoms without motor involvement within 4 weeks following the vaccination. Their magnetic resonance imaging (MRI) disclosed similar lesions consistent with myelitis at their cervical spinal cord. A comparable inflammatory lesion was seen at the T9-T10 levels of the spinal cord in the third case, who was a 40-year-old woman presenting with numbness in her legs and urinary retention following the vaccination. The fourth case who was a 42-year-old woman, presented with sensory symptoms in her left extremities, which developed 3 months after the vaccination. Her MRI showed a hyperintense lesion at C6. She also had two tiny lesions in her cranial MRI. In all cases, there was no history of preceding infections and no clinical evidence suggestive of any other disorders that may cause myelopathy. All patients recovered completely within 3 months with the exception of the third patient who developed new neurological symptoms after 12 months. Similar clinical and imaging presentation of myelitis following hepatitis B vaccination within a 1 year period with no other demonstrable clinical and laboratory evidence for any other disorder raise the probability of a causal link between these two events.

[Abolishment of the office of the Ottoman head physician]

The office of the Ottoman head physician which had been an important organisation for 400 years, was abolished by a decree given by Sultan Abdülmecid on 17 April 1850. This article discusses the factors leading to this abolishment. Some researchers say that the foundation of the Council of Health Affairs (Meclisi Umuru Tibbikye) in the Medical school (Mektebi Tibbiye) just before the decree, might be one of the reasons. Here it is concluded that this factor was not responsible for the decree because the duty of presiding management and chairmanship of the council was already assigned to the Head Physician. There was also another council which had been founded ten years before the decree and it was equipped with the same functions. When the point whether the decree was due to the Head Physician Salih Efendi is studies, we see that didn't have any influence on the said decision, although Salih Efendi had been appointed by Sultan Abdülmecid as the Head Physician and as the Minister of the Medical School both of his duties were withdrawn from him. But later he was again appointed as the Head Physician by the same Sultlan. Another reason was said to be the transfer of the Head physician's duties to the Minister of the Medical School (Tibbiye Nezareti). But the Ministry of the Medical School existed since 1827 and according to the Sultan's order its only duty was stated as providing the discipline of the School. Another reason said to be responsible for the abolition of the Head Physician's office was the several attempts to poison Sultan Abdülmecid. But this also is not enough to explain the problem. Another possibility regarding this subject is the possibility of giving personal opportunities to the Doekyard's Supervisor Ziver Efendi, who after the abolition was appointed as the minister of the Medical School. Thus Ziver Efendi was to be promoted to one of the highest ranks of the state and there was to be great increase in his salary, even having studied all the sources available which might contribute to the solution of the question, it is still not enough to solve the problem satisfactorily.

Gestational trophoblastic disease: the significance of vaginal metastases

PURPOSE

To evaluate patients with vaginal lesions in gestational trophoblastic disease and determine prognostic and therapeutic implications applicable to management.

METHODS

Twelve patients among 75 cases of gestational trophoblastic neoplasia were analyzed retrospectively between 1990 and 1997. Vaginal metastases were documented by physical examination and biopsy. Two patients received MAC III regimen (5 and 7 courses), 4 patients received EMA-CO regimen for 2 to 11 courses, while 6 were administered methotrexate alone. Remission was defined as 3 weekly beta hCG levels below assay sensitivity (<5 mIU/ml).

RESULTS

The mean age of the patients was 25.4 years. While 10 of the patients presented initially with hemorrhage and bloody leukorrhea, the remaining 2 were diagnosed during a routine study of hydatidiform mole. The sites of involvement were almost always the anterior distal vaginal wall. Five cases had additional lung and 1 case had lung, liver, spleen and brain metastases. Three of the patients who received methotrexate as monotherapy did not respond to therapy and were switched to EMA-CO. Overall survival was 91.6%. One patient died in the first month of the initial therapy.

CONCLUSION

The presence of large vaginal metastases should be classified as a high-risk factor and these patients must be treated by multiple agent chemotherapy.

Uterus didelphys with unilateral imperforate hemivagina and ipsilateral renal agenesis

Eight patients with a double uterus, unilateral vaginal obstruction, and ipsilateral renal agenesis are described. The most common clinical presentation was that of the onset of pelvic pain and dysmenorrhea, in association with the finding of a pelvic mass. In seven patients, a window was created between two vaginae by transvaginal route. In one patient, the blind vagina with hematocolpos and attending uterus were extirpated by an abdominal approach. The postoperative courses were uncomplicated in all patients. A greater awareness of this syndrome should lead to accurate diagnosis. Excision of the obstructing vaginal septum offers a complete relief of symptoms while preserving reproductive capacity.

[Assignment of students for the Royal School of Medicine on the basis of ethnic minority population in the Ottoman Empire]

Tibhane-i Amire (Royal School of Medicine) was founded in 1827 in order to train Muslim physicians and surgeons equipped with modern medical knowledge ("novel medicine"). Following the Declaration of Tanzimat (Imperial Decree of Reformation) Non-Muslims were permitted to enroll to the School of Medicine just after the decree on January 16, 1841. At the beginning, to room, board and educate students of different religions and sects were not approved. But the Chief Physician and the Dean of the School of Medicine solved the problem by undertaking all the responsibilities. The first year following the afore-mentioned decree, 38 Christian students were enrolled and their number increased to 76 in the next year. In 1847, 29 students from the Jewish community were accepted to the School, for whom all the facilities covering their religious deeds, needs and customs were provided. The same year some Serbian students were accepted and special treatment was requested, since they were kins to the Serbian Prince. Greeks and Walachians were also accepted to the School, as there had not been any political restriction. In 1851 the total student number was 459, among whom there were 14 Non-Muslims. The same year, day students were also admitted as boarders, since it was hard to go to school in winter. In 1857, the Armenian Patriarch was given an audience by the Grand Vizier on an official demand stating that the assignment to them was not in proportion with their population, so it should be increased. This was approved by the Superior Council of Tanzimat. In 1855 the Greek Patriarch demanded officially that this decree should be withdrawn by stating that the Greek population was much larger than the Armenian's. Upon this, the council rearranged the assignment based on a reliable source and determined that it ought to be 30 for Armenians, 46 for Jews and Latin community, 74 for Greeks (including 15 Bulgarians) and totally 150 Non-Muslims. Together with 300 Muslim students, the student number reached up to 450. ...

Prognostic value of mitotic activity, eosinophilic and inflammatory reaction in stage I cancer of the uterine cervix

This study includes 110 patients treated surgically for stage I squamous cell carcinoma of the cervix. The prognostic significances of mitotic activity, stromal inflammatory and eosinophilic reactions were studied. The 5-year survival rate varied from 75.0% to 93.3% and pelvic lymph node metastases (PLNM) varied from 23.0% to 31.2% according to degree of these variables. None of these pathological parameters was found to be a significant predictor of pelvic lymph node metastases and 5-year survival.