Abstract. Pediatric sinonasal rhabdomyosarcoma (PSR) is a rare condition, with a limited number of previously reported cases. It is an aggressive malignancy associated with poor outcomes, and no consensus has been reached on the optimal therapeutic strategy. The present study reported the case of embryonal PSR in a 2-year old girl, presenting with unilateral nasal obstruction and a polypoid mass protruding from the left nasal cavity. The pediatric patient was initially treated with surgical resection, followed by adjuvant chemotherapy containing vincristine (1.5 mg/m 2 , weekly) and actinomycin-D (1.5 mg/m 2 , three times weekly). On the 10th month of follow-up, tumor recurrence was detected and a salvage surgery was performed, while the same chemotherapy regimen was resumed. Following the first cycle of chemotherapy, the patient developed a fungal bronchopneumonia and succumbed due to disease progression, acute respiratory distress syndrome and septic shock 12 months after diagnosis.
The functional resemblance between kidney proximal tubular and inner ear epithelial cells which has often been pointed out in the literature led us to hypothesize that nephrotoxic agents that cause renal tubular injury might also impair the function of inner ear cells. As one of the most toxic environmental nephrotoxic agents is cadmium, we aimed to study its effects on hearing experimentally in rats. In this study, increased blood and renal cortical cadmium levels were associated with high cadmium accumulation in ear ossicles and labyrinth in rats exposed to cadmium. The changes in auditory brainstem response (ABR) and otoacoustic emission in 2-month-old male rats exposed to drinking water containing 5 and 15 ppm CdCl2 for 30 days showed that cadmium-induced nephrotoxicity was associated with signs of defective hearing at a concentration of 15 ppm CdCl2 but that 5 ppm CdCl2 caused hearing loss without affecting kidney function. The mean latency of ABR wave 1, which indicates the function of the cochlea, was 1.335 +/- 0.31 ms in the control group and 1.641 +/- 0.052 and 1.74 +/- 0.88 ms in the rats subjected to 5 and 15 ppm CdCl2, respectively (p < 0.001). In the cadmium-treated groups short interpeak wave I-III latencies (p < 0.01) indicated cochlear dysfunction and this was also supported by the distortion product otoacoustic emission results (p < 0.001). Non-significant changes in wave III and V latencies were accepted as evidence of unaltered function of the other parts of the auditory system. These results suggest that hair cells are more sensitive to cadmium than kidney tubule cells and that the cochlear component of hearing is more vulnerable to cadmium toxicity than other parts of the auditory system.
The aim of this study was to evaluate the effects of modified tongue base suspension (mTBS) procedure on continuous positive airway pressure (CPAP) levels in patients with severe obstructive sleep apnea (OSA). From November 2011 to December 2012, a total of 31 patients with severe OSA who underwent mTBS were included into this prospective case series with planned data collection. Prior to surgery, all the patients were subjected to a polysomnography (PSG) and CPAP titration on two separate nights. Following the surgery, patients were subjected to a control PSG and CPAP titration at the sixth month of follow-up period. The preoperative and postoperative mean apnea hypopnea index (AHI), CPAP titration values, AHI during CPAP use and amount of sleeping time with CPAP were compared. Median age was 48 years (range 31-66), and most patients were male (87.0 %). Postoperative mean AHI (44.73 ± 17.05 vs. 19.96 ± 19.52), optimal CPAP value (12.64 ± 1.60 vs. 8.00 ± 1.77) and AHI during CPAP use (3.79 ± 1.78 vs. 2.25 ± 1.81) were decreased, and the amount of sleeping time with CPAP (5.29 ± 0.84 vs. 6.52 ± 0.89) was increased significantly (p < 0.001 for all parameters). The surgery was considered to be successful when 50 % reduction in the mean AHI and/or the decrease of AHI below 20/h were obtained. A total of 24 patients (77.4 %) met the surgical success criteria. The mTBS is a safe and feasible procedure with favorable effects on CPAP levels in patients with severe OSA.
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