The role of endogenous cholecystokinin (CCK) in the regulation of gastric emptying remains contro... more The role of endogenous cholecystokinin (CCK) in the regulation of gastric emptying remains controversial. We therefore studied the effect of the CCK-A receptor antagonist loxiglumide on gastric emptying of a high-caloric solid-liquid meal in humans. Gastric emptying was assessed in eight volunteers using intravenous loxiglumide or placebo in a randomized double-blind order. Subjects were studied by a dual-headed gamma camera after ingestion of a pancake (570 kcal) labeled with 99mTc-sulfur colloid and 500 ml 10% glucose containing 111In-diethylenetriamine pentaacetic acid. Plasma CCK was measured by a specific radioimmunoassay. Loxiglumide markedly accelerated gastric emptying of both phases of the meal. The lag period was shortened by 26% (P < 0.03); the area under the emptying curve and half-emptying time of solid emptying were lowered by 19 and 24% (P < 0.02) and of liquid emptying by 18 and 24% (P < 0.04), respectively. Plasma CCK levels were higher during infusion of l...
The erythropoietin receptor (EPOR) is expressed in the brain and erythropoietin (EPO) has been sh... more The erythropoietin receptor (EPOR) is expressed in the brain and erythropoietin (EPO) has been shown to have neurotrophic and neuroprotective functions in the central nervous system and in the retina. These findings may be applied to the inner ear, pending EPO receptor presence. Accordingly, this study determines expression of EPO and EPOR in the inner ear of the guinea pig. Normal guinea pig inner ears were processed for immunohistochemistry, using poly-clonal antibodies against EPO and the EPO receptor. EPO expression was exclusively found in most, but not all spiral ganglion neurons. Expression of the EPO receptor was found in the cytoplasm of the inner and outer phalangeal cells (Deiters' cells), as well as the inner sulcus cells and the supporting cells of the organ of Corti (Hensen, Claudius and some Boettcher cells). Some spiral ganglion neurons or glial cells expressed the receptor, as did spiral ligament fibrocytes, some intermediate cells of stria vascularis and the en...
Angiomatous polyps are the extremely rare variant of sinochoanal polyps that are characterised by... more Angiomatous polyps are the extremely rare variant of sinochoanal polyps that are characterised by dilated, large vascular spaces. A 27-year-old female patient presented with a three-month history of unilateral right-sided nasal obstruction and recurrent mild epistaxis. Paranasal computed tomography demonstrated a mass in the right maxillary sinus extending through the nasal cavity. It was resected with both endonasal endoscopic and Caldwell-Luc approaches. Histopathological examination identified an angiomatous nasal polyp. Follow-up of thirteen months showed no recurrence.
Salivary gland involvement is a rare presenting clinical feature of Wegener's granulomatosis ... more Salivary gland involvement is a rare presenting clinical feature of Wegener's granulomatosis (WG). Early recognition and identification of any unusual presentations of WG may enable the early commencement of appropriate treatment. We report a case in which the initial manifestation of the disease was parotid gland swelling, and discuss the management of the patient. WG should be considered in the differential diagnosis when salivary gland enlargement occurs with other otolaryngological symptoms.
ZET Pitüiter fossaya transnazal transsfenoidal yaklaşım, cerrahi sonrası nazal ve paranazal morbi... more ZET Pitüiter fossaya transnazal transsfenoidal yaklaşım, cerrahi sonrası nazal ve paranazal morbiditeyi artırabilmektedir. Nazal ve paranazal komplikasyonlar, cerrahi sonrası takipte kulak-burun-boğaz takibini de gerekli kılmaktadır. Hipofiz tümörü nedeniyle transnazal transsfenoidal yaklaşım tercih edilmiş olan 15 hasta, postoperatif dönemde, nazal ve paranazal şikayetleri sorgulayan bir anket, anterior rinoskopik muayene, nazal endoskopi ve paranazal sinüs bilgisayarlı tomografisi (PNSBT) ile değerlendirildi. En sık karşılaşılan semptomlar burun tıkanıklığı (%60), burunda kuruluk (%53), burunda kabuklanma (%53), başağrısı (%40), geniz akıntısı (%40), rinore (%26) ve epistaksis (%20) oldu. Septal perforasyon, hastaların %60'ında, intranazal sineşi ise %30'unda görüldü. Postoperatif dönemde PNSBT'de 3 hastada kronik sinüzit, 1 hastada ise sfenoid mukosel saptandı. SUMMARY Transnasal-transsphenoidal approach to the pituitary gland may increase morbidity related to the nos...
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2004
To define the role of epiglottic anteversion in the etiology of globus pharyngeus (GP) and to eva... more To define the role of epiglottic anteversion in the etiology of globus pharyngeus (GP) and to evaluate the effectiveness of laser partial epiglottectomy in its treatment. Four patients who admitted to our clinic between 2001 and 2003 with the complaint of GP underwent laryngoscopic examination, which revealed a structurally anteverted epiglottis that was in contact with the tongue base and vallecula. After ruling out other etiologic factors of GP, the patients were operated on under general anesthesia and laser partial epiglottectomy was carried out. In this procedure, the part of the epiglottis 1 cm from the free margin, forming the contact points with the tongue base and vallecula was excised with laser. Three patients were symptom-free totally, while one patient reported a partial cure. Epiglottic anteversion should be kept in mind in the etiology of GP. Laser partial epiglottectomy may be helpful in the treatment of selected cases.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2007
We investigated the hemodynamic effects of local anesthetics with adrenaline used before septal s... more We investigated the hemodynamic effects of local anesthetics with adrenaline used before septal surgery. In a prospective, controlled design, administration of local anesthetics was performed with and without adrenaline in 39 patients and 10 patients, respectively, undergoing septal surgery. Plasma adrenaline concentrations were measured before anesthesia, and after 2, 5, and 10 minutes from anesthesia. The patients were monitored with respect to pulse rate, electrocardiographic findings, and blood pressure. Preoperative plasma adrenaline levels were similar in patients receiving local anesthetics with or without adrenaline (0.8 nmol/l vs 0.7 nmol/l). Following adrenaline administration, adrenaline levels showed significant increases to 2.2, 1.9, and 1.7 nmol/l after 2, 5, and 10 minutes, respectively (p<0.001), whereas they remained similar in the control group. No side effects related to adrenaline use were detected. Despite systemic absorption of local injections, adrenaline-r...
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2006
Inverted papilloma is a rare benign sinonasal tumor characterized by a potentially invasive natur... more Inverted papilloma is a rare benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin, whereas paranasal sinuses are frequently involved by extension. In contrast, primary sinus inverted papillomas have rarely been reported. The present study describes a 52-year-old man that presented with a one-year history of unilateral nasal obstruction, nasal discharge, epistaxis, occipital headache and decreased sense of smell. After nasal endoscopic examination, computed tomography was taken and endoscopic biopsy was performed which demonstrated isolated inverted papilloma of the left sphenoid sinus. Tumor was taken via transnasal endoscopic sphenoidotomy. No evidence for recurrent disease was seen after 12 months of follow-up and his symptoms were completely relieved. Endoscopic transnasal sphenoidotomy remains an effective treatment for these lesions.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2004
We investigated the value of some tumor markers in the diagnosis and treatment follow-up of squam... more We investigated the value of some tumor markers in the diagnosis and treatment follow-up of squamous cell carcinoma of the head and neck. Ferritin, lipid-associated sialic acid (LSA), carcinoembryonic antigen (CEA), squamous cell carcinoma (SCC) antigen and CYFRA 21-1 levels were determined in 28 patients with squamous cell carcinoma and in a control group of 20 patients with benign lesions of the head and neck. The measurements were made before treatment and in the first and third months of treatment. The sensitivity rates were as follows: 10.7% for ferritin, 89.3% for LSA, 21.4% for CEA, 42.9% for SCC antigen, and 14.3% for CYFRA 21-1. The specificity was 100% for all the markers. The sensitivity increased to 96.4% when CEA and LSA were used in combination. Declines in the levels after treatment were significant for ferritin, CEA, SCC antigen, and LSA. No significant relationship was found between the marker levels and lymph node metastasis, stage, and histologic differentiation o...
We studied the incidence of Frey's syndrome and facial contour deformity in two groups of pat... more We studied the incidence of Frey's syndrome and facial contour deformity in two groups of patients who had undergone superficial parotidectomy. One group was made up of 12 patients who were randomized to undergo reconstruction of the surgical defect with a sternocleidomastoid muscle flap; the other 12 patients did not receive a flap. All 24 patients were evaluated via a short questionnaire, the starch-iodine test, and a visual examination. On the questionnaire, none of the 24 patients said they experienced abnormal facial sweating, flushing, or warmth while eating, although 6 of the 12 patients in the nonflap group had a mildly positive starch-iodine test. No patient in the flap group had a positive test. The difference between the two groups was statistically significant (p < 0.05). No statistically significant difference was seen between the two groups with respect to cosmetic results.
The role of lipase in the regulation of upper gastrointestinal function is poorly understood. We ... more The role of lipase in the regulation of upper gastrointestinal function is poorly understood. We studied the effect of orlistat, a new, potent, and highly specific lipase inhibitor, on gastric emptying, cholecystokinin (CCK) release, and pancreaticobiliary secretion. Three groups of studies were performed in nine healthy volunteers, using the double-indicator technique with a triple-lumen duodenal tube, polyethylene glycol 4000 as a duodenal perfusion marker, and 99mTc-diethylenetriamine pentaacetic acid as a meal marker. Gastric emptying, pancreaticobiliary output, and postprandial plasma CCK levels were measured after ingestion of the following isocaloric 500-ml liquid meals with or without 200 mg orlistat: 1) a pure fat meal (10% Intralipid), 2) a meal containing free fatty acids, or 3) an albumin-glucose meal. All experiments were performed in a randomized, placebo-controlled, crossover design. Orlistat markedly inhibited lipase activity in all three experiments. Orlistat given ...
Gastric lipase (HGL) contributes significantly to fat digestion. However, little is known about i... more Gastric lipase (HGL) contributes significantly to fat digestion. However, little is known about its neurohormonal regulation in humans. We studied the role of CCK and cholinergic mechanisms in the postprandial regulation of HGL and pancreatic lipase (HPL) secretion in six healthy subjects. Gastric emptying of a mixed meal and outputs of HGL, pepsin, acid, and HPL were determined with a double-indicator technique. Three experiments were performed in random order: intravenous infusion of 1) placebo, 2) low-dose atropine (5 micrograms.kg-.h-1), and 3) the CCK-A receptor antagonist loxiglumide (22 mumol.kg-.h-1). Atropine decreased postprandial outputs of HGL, pepsin, gastric acid, and HPL (P < 0.03) while slowing gastric emptying (P < 0.05). Loxiglumide markedly increased the secretion of HGL, pepsin, and acid while distinctly reducing HPL outputs and accelerating gastric emptying (P < 0.03). Plasma CCK and gastrin levels increased during loxiglumide infusion (P < 0.03). At...
The precise motor mechanisms associated with gastric emptying of nutrient liquids are unclear, in... more The precise motor mechanisms associated with gastric emptying of nutrient liquids are unclear, in part because of difficulties in measuring the motility from the proximal and distal stomach simultaneously. We have now examined proximal and distal gastric motility, using a novel magnetic resonance imaging (MRI) technique. In seven healthy volunteers (4 males, 3 females; 27-37 yr), gastric emptying and motility were determined on two occasions after ingestion of 500 ml 10% and 25% dextrose labeled with 1 mM gadolinium tetraazacyclododecane tetraacetic acid, using a 1.5-tesla Philips Gyroscan ACS II scanner. Gastric emptying was determined every 15 min with a series of transaxial scans. After each series of transaxial scans, 120 coronal scans, 1.2 s apart, were performed through the antrum and proximal stomach. For each coronal slice the diameters of the proximal stomach and the antrum were measured to determine the number of contractions per minute and depth (%basal diameter). Gastric...
The Annals of Otology Rhinology and Laryngology, Feb 1, 2002
In order to evaluate lymphatic metastasis to the supraretrospinal recess (SRSR) in laryngeal squa... more In order to evaluate lymphatic metastasis to the supraretrospinal recess (SRSR) in laryngeal squamous cell carcinoma (SCC), we separately dissected SRSR lymph nodes and submitted them to pathological examination. Fifty-three lateral neck dissections (LNDs), 2 radical neck dissections (RNDs), and 19 modified RNDs were performed in 49 previously untreated patients with laryngeal SCC. The nodal status of the patients was N0 in 29 patients, N1 in 17, and N2 in 3. The neck was pathologically positive in both RNDs (100%), in 7 of 19 modified RNDs (37%), and in 7 of 53 LNDs (13%). No SRSR lymph nodes were positive in any of the dissection materials. No metastasis was found in the SRSR lymph nodes in the N0 necks treated with LND, and none was found even in N1 and N2 necks treated with RND or modified RND. We conclude that the SRSR may be left undissected during treatment of an N0 neck with LND so that accessory nerve dysfunction can be minimized and operative time can be saved.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2004
To assess the rate of thyroid gland invasion and the need for thyroidectomy in advanced laryngeal... more To assess the rate of thyroid gland invasion and the need for thyroidectomy in advanced laryngeal and hypopharyngeal carcinomas that require total laryngectomy. Between 1994 and 2001, 129 total laryngectomy with ipsilateral hemithyroidectomy and 14 total laryngopharyngectomy with total thyroidectomy operations were performed for primary squamous cell carcinoma of the larynx and hypopharynx. In the surgical specimens of the patients, the presence of tumor invasion to the thyroid cartilage and thyroid gland was evaluated retrospectively by light microscopic examination. None of the laryngeal carcinoma patients had thyroid gland invasion whereas eight (57%) hypopharyngeal carcinoma patients had thyroid gland invasion. Twenty patients (16%) had evidence for thyroid cartilage invasion in the laryngeal carcinoma group. There were only three cases (21%) with thyroid cartilage invasion in the hypopharyngeal carcinoma patients. There may be no need for performing thyroidectomy in all total l...
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2003
We compared the effects of pharyngeal neurectomy (PN) and cricopharyngeal myotomy (CPM) on postop... more We compared the effects of pharyngeal neurectomy (PN) and cricopharyngeal myotomy (CPM) on postoperative deglutition in patients undergoing horizontal supraglottic laryngectomy (HSL). The study included 20 male patients (mean age 53 years; range 39 to 67 years) who underwent HSL for squamous cell carcinoma of the larynx. Tumor stages were T1 in two, T2 in 16 , and T3 in two patients. None had received radiotherapy before surgery. In order to decrease cricopharyngeal muscle spasm following HSL, the patients were randomly chosen for CPM (n=11) and PN (n=9). The two groups were compared with respect to the time to postoperative oral food intake. No significant difference was found with respect to the time to postoperative oral feeding (mean 27 days, range 16 to 45 days in the CPM group; mean 25 days, range 16 to 36 days in the PN group; p>0.05). No significant relationship existed between primary tumor stages and the time to oral feeding (p>0.05). No complications were encountere...
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2006
Sphenochoanal polyp is a rare entity originating from the sphenoid sinus. It may be confused with... more Sphenochoanal polyp is a rare entity originating from the sphenoid sinus. It may be confused with an antrochoanal polyp on anterior rhinoscopy. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. We present a case of sphenochoanal polyp in a child that was operated by endonasal endoscopic approach. She was free of symptoms after surgery. No complications and recurrences were observed at 16 months of follow-up periods respectively.
Primary nasopharyngeal Kaposi sarcoma is extremely rare, as only 1 case has been previously repor... more Primary nasopharyngeal Kaposi sarcoma is extremely rare, as only 1 case has been previously reported in the literature. We report a new case, which occurred in a 37-year-old man with a known history of acquired immune deficiency syndrome (AIDS). The patient presented with complaints of recurrent epistaxis and postnasal hemorrhage. Endoscopic examination detected a bluish, smooth, firm, nonpulsatile mass in the nasopharyngeal wall. Histopathologic findings on biopsy were consistent with Kaposi sarcoma. The tumor was successfully treated with radiotherapy. Kaposi sarcoma should be considered in the differential diagnosis of any AIDS patient who presents with recurrent unilateral nasal bleeding.
The role of endogenous cholecystokinin (CCK) in the regulation of gastric emptying remains contro... more The role of endogenous cholecystokinin (CCK) in the regulation of gastric emptying remains controversial. We therefore studied the effect of the CCK-A receptor antagonist loxiglumide on gastric emptying of a high-caloric solid-liquid meal in humans. Gastric emptying was assessed in eight volunteers using intravenous loxiglumide or placebo in a randomized double-blind order. Subjects were studied by a dual-headed gamma camera after ingestion of a pancake (570 kcal) labeled with 99mTc-sulfur colloid and 500 ml 10% glucose containing 111In-diethylenetriamine pentaacetic acid. Plasma CCK was measured by a specific radioimmunoassay. Loxiglumide markedly accelerated gastric emptying of both phases of the meal. The lag period was shortened by 26% (P < 0.03); the area under the emptying curve and half-emptying time of solid emptying were lowered by 19 and 24% (P < 0.02) and of liquid emptying by 18 and 24% (P < 0.04), respectively. Plasma CCK levels were higher during infusion of l...
The erythropoietin receptor (EPOR) is expressed in the brain and erythropoietin (EPO) has been sh... more The erythropoietin receptor (EPOR) is expressed in the brain and erythropoietin (EPO) has been shown to have neurotrophic and neuroprotective functions in the central nervous system and in the retina. These findings may be applied to the inner ear, pending EPO receptor presence. Accordingly, this study determines expression of EPO and EPOR in the inner ear of the guinea pig. Normal guinea pig inner ears were processed for immunohistochemistry, using poly-clonal antibodies against EPO and the EPO receptor. EPO expression was exclusively found in most, but not all spiral ganglion neurons. Expression of the EPO receptor was found in the cytoplasm of the inner and outer phalangeal cells (Deiters' cells), as well as the inner sulcus cells and the supporting cells of the organ of Corti (Hensen, Claudius and some Boettcher cells). Some spiral ganglion neurons or glial cells expressed the receptor, as did spiral ligament fibrocytes, some intermediate cells of stria vascularis and the en...
Angiomatous polyps are the extremely rare variant of sinochoanal polyps that are characterised by... more Angiomatous polyps are the extremely rare variant of sinochoanal polyps that are characterised by dilated, large vascular spaces. A 27-year-old female patient presented with a three-month history of unilateral right-sided nasal obstruction and recurrent mild epistaxis. Paranasal computed tomography demonstrated a mass in the right maxillary sinus extending through the nasal cavity. It was resected with both endonasal endoscopic and Caldwell-Luc approaches. Histopathological examination identified an angiomatous nasal polyp. Follow-up of thirteen months showed no recurrence.
Salivary gland involvement is a rare presenting clinical feature of Wegener's granulomatosis ... more Salivary gland involvement is a rare presenting clinical feature of Wegener's granulomatosis (WG). Early recognition and identification of any unusual presentations of WG may enable the early commencement of appropriate treatment. We report a case in which the initial manifestation of the disease was parotid gland swelling, and discuss the management of the patient. WG should be considered in the differential diagnosis when salivary gland enlargement occurs with other otolaryngological symptoms.
ZET Pitüiter fossaya transnazal transsfenoidal yaklaşım, cerrahi sonrası nazal ve paranazal morbi... more ZET Pitüiter fossaya transnazal transsfenoidal yaklaşım, cerrahi sonrası nazal ve paranazal morbiditeyi artırabilmektedir. Nazal ve paranazal komplikasyonlar, cerrahi sonrası takipte kulak-burun-boğaz takibini de gerekli kılmaktadır. Hipofiz tümörü nedeniyle transnazal transsfenoidal yaklaşım tercih edilmiş olan 15 hasta, postoperatif dönemde, nazal ve paranazal şikayetleri sorgulayan bir anket, anterior rinoskopik muayene, nazal endoskopi ve paranazal sinüs bilgisayarlı tomografisi (PNSBT) ile değerlendirildi. En sık karşılaşılan semptomlar burun tıkanıklığı (%60), burunda kuruluk (%53), burunda kabuklanma (%53), başağrısı (%40), geniz akıntısı (%40), rinore (%26) ve epistaksis (%20) oldu. Septal perforasyon, hastaların %60'ında, intranazal sineşi ise %30'unda görüldü. Postoperatif dönemde PNSBT'de 3 hastada kronik sinüzit, 1 hastada ise sfenoid mukosel saptandı. SUMMARY Transnasal-transsphenoidal approach to the pituitary gland may increase morbidity related to the nos...
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2004
To define the role of epiglottic anteversion in the etiology of globus pharyngeus (GP) and to eva... more To define the role of epiglottic anteversion in the etiology of globus pharyngeus (GP) and to evaluate the effectiveness of laser partial epiglottectomy in its treatment. Four patients who admitted to our clinic between 2001 and 2003 with the complaint of GP underwent laryngoscopic examination, which revealed a structurally anteverted epiglottis that was in contact with the tongue base and vallecula. After ruling out other etiologic factors of GP, the patients were operated on under general anesthesia and laser partial epiglottectomy was carried out. In this procedure, the part of the epiglottis 1 cm from the free margin, forming the contact points with the tongue base and vallecula was excised with laser. Three patients were symptom-free totally, while one patient reported a partial cure. Epiglottic anteversion should be kept in mind in the etiology of GP. Laser partial epiglottectomy may be helpful in the treatment of selected cases.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2007
We investigated the hemodynamic effects of local anesthetics with adrenaline used before septal s... more We investigated the hemodynamic effects of local anesthetics with adrenaline used before septal surgery. In a prospective, controlled design, administration of local anesthetics was performed with and without adrenaline in 39 patients and 10 patients, respectively, undergoing septal surgery. Plasma adrenaline concentrations were measured before anesthesia, and after 2, 5, and 10 minutes from anesthesia. The patients were monitored with respect to pulse rate, electrocardiographic findings, and blood pressure. Preoperative plasma adrenaline levels were similar in patients receiving local anesthetics with or without adrenaline (0.8 nmol/l vs 0.7 nmol/l). Following adrenaline administration, adrenaline levels showed significant increases to 2.2, 1.9, and 1.7 nmol/l after 2, 5, and 10 minutes, respectively (p<0.001), whereas they remained similar in the control group. No side effects related to adrenaline use were detected. Despite systemic absorption of local injections, adrenaline-r...
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2006
Inverted papilloma is a rare benign sinonasal tumor characterized by a potentially invasive natur... more Inverted papilloma is a rare benign sinonasal tumor characterized by a potentially invasive nature. The lateral nasal wall represents the most common site of origin, whereas paranasal sinuses are frequently involved by extension. In contrast, primary sinus inverted papillomas have rarely been reported. The present study describes a 52-year-old man that presented with a one-year history of unilateral nasal obstruction, nasal discharge, epistaxis, occipital headache and decreased sense of smell. After nasal endoscopic examination, computed tomography was taken and endoscopic biopsy was performed which demonstrated isolated inverted papilloma of the left sphenoid sinus. Tumor was taken via transnasal endoscopic sphenoidotomy. No evidence for recurrent disease was seen after 12 months of follow-up and his symptoms were completely relieved. Endoscopic transnasal sphenoidotomy remains an effective treatment for these lesions.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2004
We investigated the value of some tumor markers in the diagnosis and treatment follow-up of squam... more We investigated the value of some tumor markers in the diagnosis and treatment follow-up of squamous cell carcinoma of the head and neck. Ferritin, lipid-associated sialic acid (LSA), carcinoembryonic antigen (CEA), squamous cell carcinoma (SCC) antigen and CYFRA 21-1 levels were determined in 28 patients with squamous cell carcinoma and in a control group of 20 patients with benign lesions of the head and neck. The measurements were made before treatment and in the first and third months of treatment. The sensitivity rates were as follows: 10.7% for ferritin, 89.3% for LSA, 21.4% for CEA, 42.9% for SCC antigen, and 14.3% for CYFRA 21-1. The specificity was 100% for all the markers. The sensitivity increased to 96.4% when CEA and LSA were used in combination. Declines in the levels after treatment were significant for ferritin, CEA, SCC antigen, and LSA. No significant relationship was found between the marker levels and lymph node metastasis, stage, and histologic differentiation o...
We studied the incidence of Frey's syndrome and facial contour deformity in two groups of pat... more We studied the incidence of Frey's syndrome and facial contour deformity in two groups of patients who had undergone superficial parotidectomy. One group was made up of 12 patients who were randomized to undergo reconstruction of the surgical defect with a sternocleidomastoid muscle flap; the other 12 patients did not receive a flap. All 24 patients were evaluated via a short questionnaire, the starch-iodine test, and a visual examination. On the questionnaire, none of the 24 patients said they experienced abnormal facial sweating, flushing, or warmth while eating, although 6 of the 12 patients in the nonflap group had a mildly positive starch-iodine test. No patient in the flap group had a positive test. The difference between the two groups was statistically significant (p < 0.05). No statistically significant difference was seen between the two groups with respect to cosmetic results.
The role of lipase in the regulation of upper gastrointestinal function is poorly understood. We ... more The role of lipase in the regulation of upper gastrointestinal function is poorly understood. We studied the effect of orlistat, a new, potent, and highly specific lipase inhibitor, on gastric emptying, cholecystokinin (CCK) release, and pancreaticobiliary secretion. Three groups of studies were performed in nine healthy volunteers, using the double-indicator technique with a triple-lumen duodenal tube, polyethylene glycol 4000 as a duodenal perfusion marker, and 99mTc-diethylenetriamine pentaacetic acid as a meal marker. Gastric emptying, pancreaticobiliary output, and postprandial plasma CCK levels were measured after ingestion of the following isocaloric 500-ml liquid meals with or without 200 mg orlistat: 1) a pure fat meal (10% Intralipid), 2) a meal containing free fatty acids, or 3) an albumin-glucose meal. All experiments were performed in a randomized, placebo-controlled, crossover design. Orlistat markedly inhibited lipase activity in all three experiments. Orlistat given ...
Gastric lipase (HGL) contributes significantly to fat digestion. However, little is known about i... more Gastric lipase (HGL) contributes significantly to fat digestion. However, little is known about its neurohormonal regulation in humans. We studied the role of CCK and cholinergic mechanisms in the postprandial regulation of HGL and pancreatic lipase (HPL) secretion in six healthy subjects. Gastric emptying of a mixed meal and outputs of HGL, pepsin, acid, and HPL were determined with a double-indicator technique. Three experiments were performed in random order: intravenous infusion of 1) placebo, 2) low-dose atropine (5 micrograms.kg-.h-1), and 3) the CCK-A receptor antagonist loxiglumide (22 mumol.kg-.h-1). Atropine decreased postprandial outputs of HGL, pepsin, gastric acid, and HPL (P < 0.03) while slowing gastric emptying (P < 0.05). Loxiglumide markedly increased the secretion of HGL, pepsin, and acid while distinctly reducing HPL outputs and accelerating gastric emptying (P < 0.03). Plasma CCK and gastrin levels increased during loxiglumide infusion (P < 0.03). At...
The precise motor mechanisms associated with gastric emptying of nutrient liquids are unclear, in... more The precise motor mechanisms associated with gastric emptying of nutrient liquids are unclear, in part because of difficulties in measuring the motility from the proximal and distal stomach simultaneously. We have now examined proximal and distal gastric motility, using a novel magnetic resonance imaging (MRI) technique. In seven healthy volunteers (4 males, 3 females; 27-37 yr), gastric emptying and motility were determined on two occasions after ingestion of 500 ml 10% and 25% dextrose labeled with 1 mM gadolinium tetraazacyclododecane tetraacetic acid, using a 1.5-tesla Philips Gyroscan ACS II scanner. Gastric emptying was determined every 15 min with a series of transaxial scans. After each series of transaxial scans, 120 coronal scans, 1.2 s apart, were performed through the antrum and proximal stomach. For each coronal slice the diameters of the proximal stomach and the antrum were measured to determine the number of contractions per minute and depth (%basal diameter). Gastric...
The Annals of Otology Rhinology and Laryngology, Feb 1, 2002
In order to evaluate lymphatic metastasis to the supraretrospinal recess (SRSR) in laryngeal squa... more In order to evaluate lymphatic metastasis to the supraretrospinal recess (SRSR) in laryngeal squamous cell carcinoma (SCC), we separately dissected SRSR lymph nodes and submitted them to pathological examination. Fifty-three lateral neck dissections (LNDs), 2 radical neck dissections (RNDs), and 19 modified RNDs were performed in 49 previously untreated patients with laryngeal SCC. The nodal status of the patients was N0 in 29 patients, N1 in 17, and N2 in 3. The neck was pathologically positive in both RNDs (100%), in 7 of 19 modified RNDs (37%), and in 7 of 53 LNDs (13%). No SRSR lymph nodes were positive in any of the dissection materials. No metastasis was found in the SRSR lymph nodes in the N0 necks treated with LND, and none was found even in N1 and N2 necks treated with RND or modified RND. We conclude that the SRSR may be left undissected during treatment of an N0 neck with LND so that accessory nerve dysfunction can be minimized and operative time can be saved.
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2004
To assess the rate of thyroid gland invasion and the need for thyroidectomy in advanced laryngeal... more To assess the rate of thyroid gland invasion and the need for thyroidectomy in advanced laryngeal and hypopharyngeal carcinomas that require total laryngectomy. Between 1994 and 2001, 129 total laryngectomy with ipsilateral hemithyroidectomy and 14 total laryngopharyngectomy with total thyroidectomy operations were performed for primary squamous cell carcinoma of the larynx and hypopharynx. In the surgical specimens of the patients, the presence of tumor invasion to the thyroid cartilage and thyroid gland was evaluated retrospectively by light microscopic examination. None of the laryngeal carcinoma patients had thyroid gland invasion whereas eight (57%) hypopharyngeal carcinoma patients had thyroid gland invasion. Twenty patients (16%) had evidence for thyroid cartilage invasion in the laryngeal carcinoma group. There were only three cases (21%) with thyroid cartilage invasion in the hypopharyngeal carcinoma patients. There may be no need for performing thyroidectomy in all total l...
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2003
We compared the effects of pharyngeal neurectomy (PN) and cricopharyngeal myotomy (CPM) on postop... more We compared the effects of pharyngeal neurectomy (PN) and cricopharyngeal myotomy (CPM) on postoperative deglutition in patients undergoing horizontal supraglottic laryngectomy (HSL). The study included 20 male patients (mean age 53 years; range 39 to 67 years) who underwent HSL for squamous cell carcinoma of the larynx. Tumor stages were T1 in two, T2 in 16 , and T3 in two patients. None had received radiotherapy before surgery. In order to decrease cricopharyngeal muscle spasm following HSL, the patients were randomly chosen for CPM (n=11) and PN (n=9). The two groups were compared with respect to the time to postoperative oral food intake. No significant difference was found with respect to the time to postoperative oral feeding (mean 27 days, range 16 to 45 days in the CPM group; mean 25 days, range 16 to 36 days in the PN group; p>0.05). No significant relationship existed between primary tumor stages and the time to oral feeding (p>0.05). No complications were encountere...
Kulak burun boğaz ihtisas dergisi : KBB = Journal of ear, nose, and throat, 2006
Sphenochoanal polyp is a rare entity originating from the sphenoid sinus. It may be confused with... more Sphenochoanal polyp is a rare entity originating from the sphenoid sinus. It may be confused with an antrochoanal polyp on anterior rhinoscopy. Computerized tomography and nasal endoscopy have contributed to an increase of accuracy in the diagnosis of these masses. Simple polypectomy that leaves some part of the polyp inside the sphenoid sinus carries a high risk of recurrence. We present a case of sphenochoanal polyp in a child that was operated by endonasal endoscopic approach. She was free of symptoms after surgery. No complications and recurrences were observed at 16 months of follow-up periods respectively.
Primary nasopharyngeal Kaposi sarcoma is extremely rare, as only 1 case has been previously repor... more Primary nasopharyngeal Kaposi sarcoma is extremely rare, as only 1 case has been previously reported in the literature. We report a new case, which occurred in a 37-year-old man with a known history of acquired immune deficiency syndrome (AIDS). The patient presented with complaints of recurrent epistaxis and postnasal hemorrhage. Endoscopic examination detected a bluish, smooth, firm, nonpulsatile mass in the nasopharyngeal wall. Histopathologic findings on biopsy were consistent with Kaposi sarcoma. The tumor was successfully treated with radiotherapy. Kaposi sarcoma should be considered in the differential diagnosis of any AIDS patient who presents with recurrent unilateral nasal bleeding.
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