Demans; hafıza, düşünce, davranış ve günlük yaşam aktivitelerini yapma
yeteneğini etkileyen, birçok hastalığın sebep olduğu bir sendromdur. Dünyanda
47,5 milyon demanslı birey bulunmaktadır ve bu sayının 2030'da 75,6 milyona ve
2050’de 135,5 milyona çıkması beklenmektedir. Bu hastalarda, hastalığın progresyonu
sırasında motor, duyu, davranışsal problemlerin veya bunların kombinasyonunun
bir sonucu olarak yutma mekanizmasının etkilenmesi ile oluşan ve
yutma güçlüğü olarak tanımlanan disfaji görülebilmektedir. Demansta disfaji prevelansına
yönelik çalışmalardaki sonuçlar farklılık göstermektedir. Demansın tipi,
şiddeti ve değerlendirme yöntemi disfajinin prevelans sonuçlarını etkilemektedir.
Disfajinin iştah azalması, kilo kaybı, sıvı kaybı, malnutrisyon, yeme-içme
korkusuyla birlikte yaşam kalitesinde gerileme, tekrarlayıcı akciğer enfeksiyonları,
aspirasyon ve pnömoni gibi birçok olumsuz sonucu olabilmektedir. Özellikle
Alzheimer tip demans hastalarının en yaygın ölüm nedeni aspirasyon
pnömonisidir. Fakat demanslı bireylerde, daha çok bilişsel ve davranışsal bozuklukların
üzerinde durulduğu için disfaji gözden kaçabilmektedir. Bu yüzden
demanslı bireyler, disfaji açısından erkenden ayrıntılı olarak değerlendirilmeli ve
gerekli koruyucu önlemler ile kişiye özgü disfaji tedavisi uygulanmalıdır. Ayrıca
hastaların aileleri, bakıcıları da disfaji, aspirasyon belirtileri konusunda bilgilendirilmelidir.
Böylelikle komplikasyonlardan kaçınılabilir, yaşam kalitesi artırılabilir
ve ölüm oranları azaltılabilir. Bu derlemede, demansın prevalansı, etiyolojisi,
yutma değerlendirmesi ve disfaji tedavisine ait literatür çalışmaları incelenmiştir.
|
Objective: To investigate the effects of surgical treatment on blood parameters in patients with parathyroid adenoma. Methods: Patients with a diagnosis of parathyroid adenoma, who underwent surgery between November 2011 and April 2016, were investigated retrospectively. These patients were evaluated according to white blood cell, lymphocyte, neutrophil, and platelet counts, hematocrit, mean platelet volume (MPV), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and calcium and parathormone (PTH) levels before and after the surgery. Results: The study included 103 patients. The number of male patients was 22 (21.4%), and the number of female patients was 81 (78.6%). The age of the patients ranged between 7 and 87, and the mean age was 54.7 ± 14.3. Preoperative and postoperative changes in lymphocyte, platelet, hematocrit, MPV, calcium and PTH levels were found to be statistically significant in our study, but the changes in NLR and PLR were not. Conclusion: Hyperparathyroidism is a reason for chronic inflammation and may affect blood inflammation parameters. However, the correlation between NLR, PLR, and serum PTH levels was not statistically significant. This can be explained by the fact that surgery causes a significant change in the number of both platelets and lymphocytes. We found a positive correlation between lymphocyte, neutrophil, and platelet counts, hematocrit, MPV, and serum PTH levels.
|
Ömer BAYIR ,
Tuğba KARAGÖZ ,
Ferda ALPASLAN PINARLI ,
GÜLİSTAN SANEM SARIBAŞ ,
Candan ÖZOĞUL ,
Kemal KESEROĞLU ,
Güleser SAYLAM ,
Emel ÇADALLI TATAR ,
Sevilay KARAHAN ,
Bülent ÖCAL ,
Mehmet Hakan KORKMAZ
Background/aim: To evaluate the clinical and histopathological effects of fetal brain tissue derived mesenchymal stem cells (FBTMSC) and fibrin glue (FG) on the facial nerve (FN) regeneration in rats with traumatic FN injury. Materials and methods: Twenty-eight Sprague Dawley rats were included in the study and divided into 4 groups. Traumatic FN injury (FP) was created by a surgical clamp compression to the main trunk of left FN in all groups. In the control group (group 1) no treatment was applied, in group 2 (FBTMSC group) 2 × 106 FBTMSC was injected, in group 3 (FG group) only FG was applied, in group 4 (FBTMSC and FG groups) both FBTMSC and FG were applied to the injured section of the nerve. The FN functions were evaluated clinically, immediately after the procedure and at 3rd, 5th, and 8th weeks postoperatively. The FNs of all subjects were excised after the 8th week; then the rats were sacrificed. The presence of stem cells in the injured zone was assessed using bromo-deoxyuridine (BrdU), and apoptosis was determined by the TUNEL method. Results: After the damage, total FP was observed in all subjects. Statistically significant functional improvement was observed in group 4 compared to all other groups (P < 0.005). TUNEL-positive cell count was statistically significantly higher in the control group than the other groups (P < 0.001). TUNEL-positive cell count was statistically significantly lower in group 4 than the other groups. The proportion of BrdU-stained cells in group 4 (5%) was higher than group 2 (2%). Conclusion: Clinically and histopathologically FBTMSC applied with FG may play a promising role as a regenerative treatment in posttraumatic FP. Key words: Facial nerve, facial nerve palsy, trauma, stem cell implantation, fetal brain tissue derived mesenchymal stem cells
|
Objective: To investigate the side effects of systemic corticosteroid (CS) treatment in the idiopathic sudden sensorineural hearing loss (ISSHL) and Bell’s palsy patients. Material and Meth-ods: The patients were retrospectively evaluated for the major side ef-fects of systemic CS. The patients with systemic diseases (hypertension and diabetes mellitus) were further investigated with respect to alter-ations on antidiabetic or antihypertensive drug regimens. The catego-rization was performed according to the dosage alterations of antidiabetic or antihypertensive drugs and the patients were divided into 3 groups: Group 1 (stable group), Group 2 (acute dysregulated group) and Group 3 (chronic dysregulated group). Results: Among the 276 patients, there was only one major complication which was a femur avascular necrosis during a mean follow up 4,5 months. In the diabetic group, the acute and chronic drug alteration was statistically signifi-cantly higher with respect to hypertensive group (p<0.001). HbA1c≥8% (64 mmol/mol) caused a significant increase in Group 3 ratio (p<0.05). Conclusion: The risk of major side effect of the systemic CS was ex-tremely low (<1%). Corticosteroids in patients with hypertension did not alter the antihypertensive doses however, diabetic patients needed drug alteration. HbA1c level<8% (64 mmol/mol) can be used as a safety criterion for starting systemic CS therapy in the diabetic patients with ISSHL and Bell’s palsy.
|
COVID-19 tedavisinde çeşitli algoritmalar oluşturulmakla birlikte henüz kesin ve etkinliği kanıtlanmış bir tedavi mevcut değildir. Ayrıca, ülkemizin de içinde bulunduğu birçok ülkede aşı çalışmaları olancahızıyla devam etmekle birlikte, kullanıma girmesi yakın zamanda olasıgörülmemektedir. Bu nedenlerle COVID-19’dan bireysel ve toplumsalkorunma, pandemi kontrolünde büyük önem kazanmaktadır. Korunmanın en önem taşıyan kısmı ise COVID-19 hastalarına hızlı ve doğru biçimde tanı konularak hastaların izole edilmesi ve filyasyon yöntemiylebağlantıların ortaya çıkarılmasıdır. Enfekte kişileri tespit etmek için kullandığımız esas yöntem, nazofaringeal ve orofaringeal sürüntüde çalışılan polimeraz zincir reaksiyonu antijen testidir. Ancak, hastalığın bulaşıyüksek oranda damlacık ve yüz bölgesindeki mukoza ile temas sonucunda oluşmaktadır. Örnek alınması işlemi yüksek düzeyde damlacıkoluşturabilecek bir işlem olduğundan sağlık personeli örnek alma sırasında yüksek risk altındadır. Bu nedenle örnek alınması sırasında kişisel koruyucu ekipmanların ve bariyer önlemlerinin doğru ve etkin olarakkullanılması sağlık personelinde bulaş riskini en az düzeye indirecektir.Bu çalışmada, COVID-19 pandemi sürecinde orofaringeal ve nazofaringeal örnek alma işlemi ve örnek alma alanlarının özellikleri sunulacaktır.
|
Objective: In this study, we aimed to determine ipsilateral and contralateral occult neck metastasis rate in patients who underwent bilateral neck dissection due to T1-T4 N0 laryngeal carcinoma,and put forward the need for bilateral neck dissection. Material andMethods: This study included 60 patients who underwent bilateral neckdissections due to T1-T4 N0 laryngeal carcinoma between 1998 and2015. The patients were divided into three groups according to the localization of the tumor (supraglottic, glottic, and transglottic). Eachgroup was divided into 3 subgroups as unilateral lesion, midline lesion,and unilateral lesion passing across the midline. The neck metastaseswere classified as ipsilateral, contralateral, or bilateral. Results: Thetumor was supraglottic in 14, glottic in 13, and transglottic in 33 patients. There was neck metastasis in 9 of 60 patients (3 patients had N1,3 patients had N2b, and 3 patients had N2c necks). Contralateral neckmetastasis was not seen in any of the patients with unilateral tumors.Contralateral neck metastasis was not evident when there was not an ipsilateral neck metastasis. The rate of contralateral neck metastasis inpresence of ipsilateral neck metastasis was 33% in supraglottic, 50% inglottic T4a, and 25% in transglottic tumors. Conclusion: The results ofthis study indicated that unilateral neck dissection was sufficient in allgroups in case of unilateral tumors, and unilateral tumors passing acrossthe midline when there is no ipsilateral neck metastasis, but bilateralneck dissection is needed in midline tumors.
|
Yeni koronavirüs hastalığı (COVID-19), Çin’in Wuhan şehrinde Aralık 2019 sonlarında ortaya çıkmış ve dünyaya hızla yayılarakbir pandemi hâlini almıştır. Hem üst hem de alt solunum yollarını tutanbu hastalık uzun kuluçka süresi, asemptomatik taşıyıcı oranlarının yüksekliği ve virüsün yüksek bulaşıcılık riski nedenleri ile ciddi bir küresel problem oluşturmaktadır. Ayrıca, nazofarinks ve orofarinksteyüksek miktarda virüs bulunabilmesi ve virüsün damlacık yoluyla yayılması bu bölgeler ile sürekli temas hâlinde olan sağlık personeli içinciddi risk oluşturmaktadır. Tüm bu nedenlerden dolayı, risk altındakisağlık personelinin korunması ve kişisel koruyucu ekipmanların doğruve etkin bir biçimde kullanılması hayati önem arz etmektedir. Bu çalışmada, COVID-19 pandemisi süresince kulak burun boğaz hastalarının değerlendirilmesi açısından alınması gereken önlemler sunulacaktır.
|
Objectives: This study aims to investigate the effect of acupuncture treatment on hearing and tinnitus in patients with suddensensorineural hearing loss (SNHL) refractory to treatment.Patients and Methods: Between January 2013 and May 2015, a total of 25 patients (8 males, 17 females; median age: 43.3 years;range, 18 to 65 years) resistant to medical treatment who underwent acupuncture as salvage therapy were retrospectively analyzed.The patients were evaluated with pure-tone audiometry, Speech Discrimination Score (SDS), and Tinnitus Handicap Inventory (THI)at pre-treatment (T0), and after 10th (T1) and 20th sessions (T2) of acupuncture.Results: Hearing loss evaluated according to the four-frequency pure-tone average (PTA; 500, 1,000, 2,000, and 4,000 kHz)showed a statistically significant improvement at the end of the 10th session of acupuncture (p=0.017). There was also a significantimprovement in the PTA values of the worst three consecutive frequencies at the end of the 20th session (p=0.034). A significantimprovement in SDS (p=0.022) and THI (p<0.001) was found at the end of the 20th session.Conclusion: Acupuncture treatment yields promising results in the improvement of PTA. The therapeutic effect of acupuncture isalso evident in the treatment of tinnitus secondary to SNHL...
|
Backround/aim: Papillary thyroid carcinomas (PTC) frequently metastasize to regional lymph nodes. Our purpose was to investigatethe predictive role of tumor location for lymph node metastasis pattern in PTCs.Materials and methods: Medical records of 110 PTC patients were reviewed retrospectively. Tumor location was determined as upper,middle, and lower pole according to ultrasonography (USG) findings. The effects of age, sex, tumor size, and location on lymph nodemetastasis were investigated.Results: The series comprised 87% females (n = 96) and 13% males (n = 14). Forty-three patients had central neck metastasis (CNM)and 14 had lateral neck metastasis (LNM). Upper pole tumors (UPT) metastasized to the central neck (CN) at a lower rate (17.6%)than middle (40.0%) or lower (48.5%) poles overall (P = 0.104), while it was at a significantly lower rate (13.3%) in the PTC group (P <0.05). UPTs (n = 17) metastasized to the lateral neck (LN) almost 2-fold more. It was observed that 3 of 4 UPTs spread directly to theLN without CNM.Conclusion: In our opinion, UPTs have propensity to demonstrate metastasis to LN rather than the CN in PTCs. Therefore, UPTsshould be evaluated meticulously in terms of LNM. New studies could suggest that CN dissection is not performed for low-risk PTCsin UPTs.
|
