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OBJECTIVE: To examine the complication rate in adult patients during and after cochlear implantation. METHODS: A retrospective chart review was conducted of patients who had undergone cochlear implantation at a tertiary referral centre between 2009 and 2018. All complications and their treatments were categorised as either minor or major, as well as intra- or post-operative. RESULTS: The records of 392 patients with 395 implants were reviewed. The mean follow-up period was 89 ± 65.5 months (range, 6-408 months). The mean age of patients was 46 ± 15.2 years (range, 19-84 years). Sixty-two patients (16 per cent) had minor complications and 31 (8 per cent) had major complications. CONCLUSION: Although cochlear implantation has the potential for significant intra- and post-operative complications, the actual complication rate is relatively low, and it can therefore be considered a safe procedure.

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BACKGROUND: To describe of the experiences of parents regarding the transition to sexual development of their adolescents with intellectual disabilities who are 15-19 years old. METHODS: This study employs a descriptive interpretative approach and uses Meleis's transitions theory as its theoretical frame of reference. This study uses purposive sampling methods for recruitment. We collected data through individual semi-structured interviews (n = 11) and researcher observations between February 2021 and April 2021 and employed an inductive content analysis approach. RESULTS: Three main themes emerged from the data: parental factors driving the transition process, parents' needs regarding the transition process, and outcomes of the transition process. In addition, most parents struggled to remodel their identities following the transition due to concerns over their adolescent's ability to cope with the challenges of adulthood. CONCLUSION: Considered in the context of middle-range transitions theory, we suggest that parental experiences regarding adolescents' transition to sexual development stem from varying levels of uncertainty and depend on the situation, preferences, and family needs of each individual parent. It is useful to utilise Meleis's transitions theory to understand deeply and explore the impact of the sexual development of adolescents with intellectual disabilities on parents.

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OBJECTIVE: This study aimed to evaluate and compare cases of simultaneous and consecutive bilateral cochlear implantation from the perspective of the duration of anaesthesia, surgical complications and hospitalisation. METHOD: Fifty patients with simultaneous bilateral cochlear implantation (group 1) and 47 patients with consecutive bilateral cochlear implantation (group 2) were included in this study. The two groups were compared in terms of the duration of anaesthesia, the duration of surgery, radiological findings, the complications and the post-operative hospitalisation time. RESULTS: Group 1 had a significantly shorter operation time than group 2 (p < 0.01). The mean total operation time was 189 minutes in group 1. In group 2, the mean operation times for the first and second surgery were 134 minutes and 136 minutes, respectively, and the total operation time for both surgical procedures in group 2 was 270 minutes. The duration of post-operative hospitalisation of the patients in group 1 was significantly shorter than the total post-operative hospitalisation after both operations for the patients in group 2 (p < 0.01). CONCLUSION: In conclusion, if there is no anatomical problem that may lead to a prolonged operation time or any risk regarding anaesthesia, simultaneous bilateral cochlear implantation can be performed safely.

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OBJECTIVE: Olfactory dysfunction is one of the comorbidities associated with allergic rhinitis (AR) and AR is one of the common causes of olfactory problems. We aimed to evaluate by the Sniffin' Sticks test the effects on olfactory functions of nasal steroids and leukotriene antagonists used for allergic rhinitis. METHODS: Thirty patients with seasonal rhinitis were included in this study. Patients were randomly divided into three groups of 10 patients; group 1 received montelukast sodium and mometasone furoate (MF) therapy, group 2 received only montelukast, and group 3 only MF. Patients' olfactory functions were determined using the Sniffin' Sticks olfactory test before and after a month treatment. RESULTS: Threshold, discrimination, identification, and the sum of threshold, discrimination, and identification (TDI) values were not significantly different among the groups before treatment. For Group 1 and Group 3 patients, there were statistically significant differences in threshold, discrimination, identification, and TDI values before and after treatment (P<0.05) (Wilcoxon signed ranks analysis). For Group 2 patients, the before and after treatment values of threshold, discrimination, identification, and TDI showed no significant difference (P>0.05). CONCLUSION: According to the findings of our study, MF is superior to montelukast in improving olfactory function. Although montelukast has been shown to be effective against AR symptoms, its effect on olfactory function was not demonstrated in this study.

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OBJECTIVE: This study aimed to present the histopathological and audiological effects of mechanical trauma associated with the placement of a model electrode in the scala tympani in rats, and the effects of continuous topical corticosteroid application. METHOD: The study comprised three groups of rats. The round window membrane was perforated in all three groups and a model electrode was inserted in the round window. Group one received no further treatments. Groups two and three also had an intrathecal microcatheter compatible with a mini-osmotic pump inserted; in group two this was used to release normal saline and in group three the pump released 400 µg/ml dexamethasone. RESULTS: Dexamethasone infusion given after implantation of the intracochlear model electrode was more effective for preventing hearing loss than the administration of just one dose of dexamethasone. CONCLUSION: The findings suggest that continuous dexamethasone infusion is beneficial for preventing the loss of hair cells and neurons associated with early and late periods of intracochlear electrode trauma.

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We analyzed 25 pediatric renal transplantation patients on sirolimus (SRL) therapy to assess changes in serum creatinine, glomerular filtration rate, electrolytes, triglycerides, cholesterol, and side effects. Mean time to initiate SRL therapy was 3.2 years. The serum creatinine levels of patients on SRL treatment at 1, 6, 12, and 24 months were 1.67 ± 1.15 mg/dL, 1.18 ± 0.52 mg/dL, 1.24 ± 0.32 mg/dL, 1.15 ± 0.31 mg/dL, and 1.17 ± 0.12 mg/dL, respectively. We observed proteinuria in 3, hyperlipidemia in 5, and anemia in 2 patients, but none had the treatment discontinued. We diagnosed interstitial pneumonia in (n = 1), nasal acneiform lesions (n = 1), and lower extremity edema (n = 1). Hypokalemia developed in 1 subject with high blood SRL levels. In the follow-up period there was no case of acute rejection episode during SRL therapy.

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INTRODUCTION: The recurrent laryngeal nerve can be injured during surgery. This study investigated recurrent laryngeal nerve reinnervation. OBJECTIVE: To study the short-term effects of primary anastomosis of the recurrent laryngeal nerve, by laryngeal electromyography and histopathological analysis, in a rabbit model. METHOD: Twenty Zealand rabbits underwent either right recurrent laryngeal nerve (1) transection with excision of 1 cm or (2) transection and end-to-end primary anastomosis. Vocal fold movements, laryngeal electromyography results and histological changes were recorded. RESULTS: Vocal fold analysis showed a paramedian vocal fold in both groups, with perceptible vibratory movements in group two. Electromyography revealed total denervation potentials in group one, but denervation and regeneration signs in group two. Histopathologically, hyperkeratosis and parakeratosis of the vocal fold mucosa were seen in group one, and signs of parakeratosis and hyperplasia in group two. CONCLUSION: Even under ideal conditions for primary recurrent laryngeal nerve anastomosis, a return to normal muscle function is unlikely. However, such anastomosis prevents muscle atrophy, and should be performed as soon as possible. The degree of nerve recovery is associated with the number, amplitude and myelination level of fibrils returning to the original motor end-plaque.

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The extreme organ shortage in Turkey has led to expansion of living and diseased donors. We retrospectively analyzed patient data to determine the outcomes of elderly donors. Among 210 donors, 28 (13.3%) were atleast ≥55 years old. In this group, 17 were from living and 11 from diseased donors. Mean cold ischemia time was 68 ± 21 minutes. The immunosuppressive protocol consisted of induction therapy (simulect 20 mg on days 0 and 4) and immunosuppression with calcineurin inhibitors, mycophenolic acid, and steroids. Nine patients (32.6%) with delayed graft function (DGF) required transient hemodialysis. None of the recipients or their grafts were lost due to surgical complications. We noted 5 acute rejection episodes which were all reversed by pulse steroids. Mean creatinine levels at 1, 3, and 5 years were 1.7, 2.1 and 2.3 mg/dL respectively. Patient and graft survivals at 1, 3, and 5 years were 100%, 96%, and 92% and 100%, 92%, and 92%, respectively. Although 3.6% of recipients displayed DGF, it did not affect graft outcomes. In conclusion, kidney transplantation from older donors should be considered to be an option for kidney transplantation.

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INTRODUCTION: Unilateral hemilaminotomy (ULH) and/or bilateral hemilaminotomy (BLH) with limited facetectomy are defined approaches to decompress the thecal sac and exiting lumbar nerve roots without increasing the risk of subsequent spinal instability. METHODS: We retrospectively analyzed 18 cases with degenerative lumbar spinal stenosis (LSS) with BLH or ULH that was performed in 11 and 7 cases, respectively. Magnetic resonance imaging (MRI) was performed at the follow-up examination and dural sac area (DSA) was calculated on T(2)-weighted MRI images and then compared statistically. In addition, the economic and functional status of the patients were evaluated with the Prolo scale. RESULTS: The mean preoperative values on the visual analogue scale (VAS) were 7.1 for lumbalgia and 7.0 for leg pain, respectively. These values were calculated as 4.8 and 4.4 at the follow-up, respectively. The VAS was significantly improved after operation compared to preoperative values (p=0.001). The mean value of the DSA was 84 (+/-32) mm(2) before the operation and 126 (+/-35) mm(2) at the follow-up and the comparison was statistically significant (p=0.001). No statistical correlation was found between VAS and DSA or between VAS and ULH-BLH groups, however, DSA of the BLH cases was significantly higher than in the ULH group (p=0.035). There was a significant negative correlation between VAS scores (back and leg pain) and Prolo status. However, there was no significant difference between DSA and Prolo scores, and between ULH or BLH groups in terms of Prolo scores. CONCLUSION: A unilateral approach with bilateral decompression and bilateral approach with bilateral hemilaminotomy are both minimal invasive, adequate and safe approaches with excellent prognosis. However, BLH leads to a bigger expansion of DSA.

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Orbital penetrating injuries may cause significant harm to the optic nerves and eyeball as well as to the brain and cerebral vessels. Management of orbital foreign bodies should include prompt recognition of the extent of the injury, broad-spectrum parenteral antibiotics, tetanus prophylaxis, anticonvulsant medication and early surgical intervention under direct vision to remove the foreign body and to avoid immediate and long-term complications. We report a penetrating orbital injury caused by a bread knife that extended from the orbit to the tegmental dura mater of the temporal bone. The knife's main trajectory coursed through the temporal lobe. Adjacent cerebral structures were explored before removal of the knife.

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Orbital penetrating injuries may cause significantharm to the optic nerves and eyeball as well as to thebrain and cerebral vessels. Management of orbitalforeign bodies should include prompt recognition of theextent of the injury, broad-spectrum parenteral antibiotics,tetanus prophylaxis, anticonvulsant medicationand early surgical intervention under direct vision toremove the foreign body and to avoid immediate andlong-term complications. We report a penetrating orbitalinjury caused by a bread knife that extended fromthe orbit to the tegmental dura mater of the temporalbone. The knife’s main trajectory coursed through thetemporal lobe. Adjacent cerebral structures were exploredbefore removal of the knife (AU)

Los traumatismos perforantes orbitarios suelencausar un daño importante al nervio óptico y globoocular, así como al cerebro y vasos cerebrales. Laórbita permite un acceso fácil hacia la cavidad cranealdebido a que tiene una pared ósea delgada y a la presenciadel agujero óptico. El enfoque terapéutico de lostraumatismos orbitarios por cuerpo extraño dependefundamentalmente del tipo de traumatismo y delcuerpo extraño. El tratamiento de este tipo de lesionesincluirá un rápido diagnostico de la magnitud del dañoocasionado, el empleo por vía parenteral de antibióticosde amplio espectro, profilaxis del tétanos, medicaciónanticonvulsivante y cirugía urgente que permita, bajovisión directa, la extracción del cuerpo extraño, a fin de evitar complicaciones inmediatas o a largo plazo. Presentamosel caso de un traumatismo perforante ocularocasionado por un cuchillo de pan que se extendíadesde la órbita hasta el tegmentum del hueso temporal.El cuchillo seguía una trayectoria directa a través dellóbulo temporal. Se practicó una exploración quirúrgicade las estructuras cerebrales adyacentes para poderextirpar el cuchillo. Se revisan y analizan las opcionesde tratamiento de los traumatismos perforantes de laórbita (AU)

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Spinal epidural abscess due to Brucella species is usually associated with spondylodiscitis. Urgent surgical decompression should be performed in cases with moderate to severe neurological deficits particularly if progressive. We report clinical features of two cases operated for lumbar epidural abscess caused by Brucella species. Early surgical decompression combined with medical treatment could decrease progression of neurological findings or the severity of complications. Iatrogenic dural tear at the operation should be repaired immediately with fine sutures and fibrin tissue glue to prevent further innoculation into the cerebrospinal axis. These cases should be cautiously followed for any recurrence or neurobrucellosis.

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Spinal epidural abscess due to Brucella species isusually associated with spondylodiscitis. Urgent surgicaldecompression should be performed in cases withmoderate to severe neurological deficits particularlyif progressive. We report clinical features of two casesoperated for lumbar epidural abscess caused by Brucellaspecies. Early surgical decompression combinedwith medical treatment could decrease progression ofneurological findings or the severity of complications.Iatrogenic dural tear at the operation should be repairedimmediately with fine sutures and fibrin tissue glueto prevent further innoculation into the cerebrospinalaxis. These cases should be cautiously followed for anyrecurrence or neurobrucellosis (AU)

Los abscesos epidurales espinales debidos a Brucellase asocian habitualmente a espondilodiscitis. Ladescompresión quirúrgica urgente debe ser realizadaen casos con déficit neurológico moderado o graveparticularmente si este es progresivo. Describimos losaspectos clínicos de dos casos operados por abscesosepidurales causados por Brucella. El tratamiento quirúrgicotemprano asociado con tratamiento médicopuede disminuir la progresión de la sintomatologíaneurológica y la gravedad de las complicaciones. Laaparición de desgarros durales durante la cirugía debeser reparada de forma inmediata con sutura o pegamentosde fibrina para prevenir la inoculación dentrodel neuroeje. Estos casos deben ser seguidos de formacuidadosa para evitar la recurrencia de la neurobrucelosis (AU)

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Cerebrospinal fluid (CSF) leakage may develop when a defect is formed in dural layers by traumatic or iatrogenic processes. Traumatic CSF leakage was encountered in 2% of head injuries. CSF leakage is an associated feature of 12-30% of skull base fractures. Numerous treatment modalities are proposed for the management of CSF leaks. A closed lumbar drainage system (CLDS) is recommended as an alternative method to surgery for preventing complications related to leakage. In the present study, we report the clinical details of 46 patients who suffered from rhinorrhea/otorrhea (R/O), three of whom were urgently operated due to other causes like subdural hematoma and tension pneumocephalus. Leakage spontaneously ceased in 26 (60.4%) patients whereas CLDS insertion was found to be necessary in 17 patients. A prophylactic antibiotic regimen was started in the CLDS group and these patients were followed with daily CSF cell counts. Fifteen patients (88.2%) were successfully treated by CLDS, however meningitis developed in 2 patients (11.7%). Severe complications like meningitis could be avoided by a simple daily microbiological analysis of CSF.

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INTRODUCTION: The gap between cadaver organ donation and waiting list forces us to develop new strategies. Many institutions have turned to emergency departments (ED). METHODS: Patients evaluated as potential organ donors were studied prospectively. RESULTS: Organ Procurement Organizations (OPO) were established in 2006. The Transplantation Department has two coordinators who initiated educational seminars and organized campaigns to improve public awareness about organ donation. A new law that it was mandatory to declare brain death for donors has been accepted. Thereafter, 19 patients were assessed as potential donors, 6 of whom were from the ED. Family consent was obtained for harvest from 9. DISCUSSION: Deaths in the ED are often sudden, unexpected, and traumatic, involving young patients. The emergency physician (EP) has an obligation to care for a dying person to the best of one's abilities. Then, the duty of care is owed to the relatives and friends of the deceased to meet their needs. Finally, the EP should use resources of the health care system in the most efficient manner. Any patient who has been declared brain dead or is scheduled to be taken off life-support measures should be seen as a candidate for transplantation. The coordination between the EP and OPO can change a life lost at the ED into a source of light for others waiting for transplantation. Emergency staff must be alert while evaluating people suffering sudden traumatic and medical death for the possibility that they might be added to the donor pool. CONCLUSION: Educational support and proper management from OPO-like organizations to emergency medical staff will provide better outcomes.

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Systemic donor infections especially with gram-negative organisms are regarded as an absolute contraindication to cadaveric organ donation for transplantation. This is largely due to fear of transmitting the pathogenic organisms to the immunosuppressed recipient. However, due to the current shortage of organs available for transplantation, clinicians are faced with the option to use organs from infected donors. Between 1996 to January 2006, we collected 44 solid organs. Two out of nine donors had microorganisms from blood cultured. Case 1 was of 23-year old woman whose cause of brain death was intracerebral bleeding due to a traffic accident. The donor had stayed 9 days in the intensive care unit prior to brain death. Two kidneys, two livers (split), and or heart were used. Klebsiella was the organism on blood culture. Case 2 was of 35-year-old man; cause of brain death was cerebral hematoma due to traffic accident. The donor had stayed 6 days prior to brain death onset. The liver and two kidneys were used. Acinetobacter baumannii was yielded upon blood culture. All donors were treated with appropriate antibiotics for at least 48 hours prior to organ procurement with consequent negative blood cultures, while the recipients received the same culture-specific antibiotics for 10 days following transplantation. One donor (case 1) heart and both donor corneas were not used due to infection. All patients are alive with excellent graft function at a median of 90 days following transplantation. In conclusion, our results suggested that bacteremic donors with severe sepsis under proper treatment can be considered for transplantation.

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Posttransplant renal dysfunction episodes can result from a variety of causes, including polyomavirus (BK virus)-associated nephropathy (PVAN). It is a well-recognized entity with a high incidence of graft failure. The delicate balance of viral infection and immune regulation in the transplant population would allow development of successful long-term strategies. In this presentation, we have described two PVAN cases of our institution and reviewed the literature.

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Ergonomics is a broad science encompassing the wide variety of working conditions that can affect worker comfort and health, including factors such as lighting, noise, temperature, vibration, workstation design, tool design, machine design, etc. This paper describes noise-human response and a fuzzy logic model developed by comprehensive field studies on noise measurements (including atmospheric parameters) and control measures. The model has two subsystems constructed on noise reduction quantity in dB. The first subsystem of the fuzzy model depending on 549 linguistic rules comprises acoustical features of all materials used in any workplace. Totally 984 patterns were used, 503 patterns for model development and the rest 481 patterns for testing the model. The second subsystem deals with atmospheric parameter interactions with noise and has 52 linguistic rules. Similarly, 94 field patterns were obtained; 68 patterns were used for training stage of the model and the rest 26 patterns for testing the model. These rules were determined by taking into consideration formal standards, experiences of specialists and the measurements patterns. The results of the model were compared with various statistics (correlation coefficients, max-min, standard deviation, average and coefficient of skewness) and error modes (root mean square error and relative error). The correlation coefficients were significantly high, error modes were quite low and the other statistics were very close to the data. This statement indicates the validity of the model. Therefore, the model can be used for noise control in any workplace and helpful to the designer in planning stage of a workplace.

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INTRODUCTION: Various immunological, metabolic, and technical factors render pediatric recipients with end-stage renal disease unique from their adult counterparts. In addition, the potential for complications after renal transplantation is far greater in children than in adults. In this study, we retrospectively analyzed 83 pediatric recipients who underwent kidney transplantation at our institution from 1975 to 2004. MATERIALS AND METHODS: From November 1975 to December 2004, 1523 renal transplantations were performed at our institution with 56 procedures in 83 pediatric patients (44 boys and 39 girls; age range, 7 to 17 years; mean age, 14.9 +/- 2.2 years). RESULTS: Long-term follow-up revealed the following morbidities in 14 (16.3%) recipients: lymphocele in 7 (8.1%) patients, perirenal hematoma in 2 (2.3%), graft renal artery stenosis in 2 (2.3%), ureteral stenosis in 2 (2.3%), and ureteral anastomotic leak in 1 (1.2%). Six (7.2%) recipients with a functioning graft died during follow-up (five deaths were infection related, and the cause of one death was unknown). Five grafts failed (four for immunological reasons and one as a result of recurrent disease). The 1-, 3-, 5-year patient and graft survival rates were 98%, 93%, 92% and 91%, 78%, 67% for living related transplantations versus 98%, 91%, 90% and 92%, 76%, 65% for cadaveric transplantations, respectively. DISCUSSION: Better outcomes for renal transplantation in children may be obtained by strict adherence to precise surgical techniques, better immunosuppressive management, and early diagnosis/effective treatment of complications.

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BACKGROUND: There are numerous recent reports on the use of lamivudine for hepatitis B virus (HBV) infection after renal transplantation. However, the optimal strategy (prophylactic, preemptive, or salvage approach) for starting lamivudine treatment in this patient group has not been determined. The aim of this study was to assess how the timing of lamivudine therapy affected the HBV serological status and the transaminase levels in renal allograft recipients with chronic HBV infection. METHODS: We investigated outcomes for patients who were seropositive for hepatitis B surface antigen (HBsAg) and underwent transplantation before or after October 2004 (the date our institution implemented a prophylactic lamivudine treatment strategy against HBV). The data included serum liver enzyme levels and polymerase chain reaction (PCR) screening results for HBV-DNA in serum. RESULTS: Fifteen patients (11 before October 2004, four after October 2004) were included in the study. Preoperatively all patients had normal transaminases levels and 2 of 15 patients had detectable HBV-DNA on PCR. Eight of the 15 total HBsAg-positive patients in our series were not placed on lamivudine at the time of renal transplantation. Half of those who were not treated initially showed transaminase elevations in the first year of follow-up requiring lamivudine therapy at that time. In contrast, all seven individuals who received lamivudine at the time of transplantation were negative for HBV-DNA throughout the follow-up. CONCLUSION: To prevent viral replication in HBsAg-positive patients who are scheduled for renal transplantation, it is best to initiate lamivudine therapy before or immediately after transplantation.

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