Publications by authors named "Volkan Akdogan"

18 Publications

  • Page 1 of 1

Do three-dimensional modeling and printing technologies have an impact on the surgical success of percutaneous transsacral screw fixation?

Jt Dis Relat Surg 2020 18;31(2):273-280. Epub 2020 Jun 18.

Yozgat Bozok Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği, 66900 Yozgat, Türkiye.

Objectives: This study aims to determine the role of computed tomography (CT)-derived templates, produced by three- dimensional (3D) modeling, image processing and printing technology, in percutaneous transsacral screw fixation and evaluate the effects of their use on surgical success.

Materials And Methods: This prospective study conducted between June 2018 and December 2019 utilized 15 composite pelvis models for transsacral-transiliac screw fixation. For the procedure, modeled templates were utilized for wiring on the left side of the pelvis models, while the conventional method was performed on the right side of the pelvis models. In the computed tomography images acquired after wiring, appropriate wire position was evaluated.

Results: The placed wires held the S1 body appropriately in all of the procedures with or without template use. With the template use, the wires were placed appropriately in the surgical bone corridor suitable for the transsacral-transiliac screw fixation in all of the models. However, with the conventional methods, the wires were not placed in the safe surgical bone corridor in four models. The wire deviation angle in the axial plane was significantly lower in the template group (p=0.001), whereas it was not different between the template group and the conventional method group in the coronal plane (p=0.054). The amount of deviation from the ideal wire entry site was significantly reduced in the template group compared to the conventional method group (p=0.001).

Conclusion: With the use of 3D modeling and printing technology, CT-derived templates can be produced and utilized for transsacral screw fixation procedures and their use increases surgical success by reducing the surgical margin of error.
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http://dx.doi.org/10.5606/ehc.2020.73115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489170PMC
November 2020

Automatic Segmentation of Meniscus in Multispectral MRI Using Regions with Convolutional Neural Network (R-CNN).

J Digit Imaging 2020 08;33(4):916-929

Department of Computer Engineering, Yozgat Bozok University, 66200, Yozgat, Turkey.

The meniscus has a significant function in human anatomy, and Magnetic Resonance Imaging (MRI) has an essential role in meniscus examination. Due to a variety of MRI data, it is excessively difficult to segment the meniscus with image processing methods. An MRI data sequence contains multiple images, and the region features we are looking for may vary from each image in the sequence. Therefore, feature extraction becomes more difficult, and hence, explicitly programming for segmentation becomes more difficult. Convolutional Neural Network (CNN) extracts features directly from images and thus eliminates the need for manual feature extraction. Regions with Convolutional Neural Network (R-CNN) allow us to use CNN features in object detection problems by combining CNN features with Region Proposals. In this study, we designed and trained an R-CNN for detecting meniscus region in MRI data sequence. We used transfer learning for training R-CNN with a small amount of meniscus data. After detection of the meniscus region by R-CNN, we segmented meniscus by morphological image analysis using two different MRI sequences. Automatic detection of the meniscus region with R-CNN made the meniscus segmentation process easier, and the use of different contrast features of two different image sequences allowed us to differentiate the meniscus from its surroundings.
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http://dx.doi.org/10.1007/s10278-020-00329-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522137PMC
August 2020

Assessment of Vestibular Function in Adults with Prelingual Hearing Loss Using c/oVEMP Tests.

J Int Adv Otol 2020 Apr;16(1):24-27

Department of Otorhinolaryngology, Baskent University School of Medicine, Ankara, Turkey.

Objectives: The aim of the present study was to compare the vestibular system integrity of individuals with normal hearing with that of prelingual hearing impaired individuals. It is well known that ocular vestibular evoked myogenic potentials (oVEMPs) reflect utricular function, whereas cervical vestibular evoked myogenic potentials (cVEMPs) reflect saccular function. Therefore, oVEMP and cVEMP tests were applied to evaluate the vestibular system integrity of hearing impaired individuals participating in the research.

Materials And Methods: The study group consisted of sensorineural prelingual hearing-loss volunteers aged from 18 to 60 years, whereas the control group consisted of age- and gender-matched healthy volunteers. cVEMP and oVEMP tests were performed to evaluate the integrity of the vestibular system, and the results were compared with those of the control group.

Results: The study included 20 (76.9%) women and 6 (23.1%) men in the study group; on the other hand, the control group consisted of 19 (73.1%) women and 7 (26.9%) men. There was a difference between the study group and the control group when oVEMP and cVEMP responses were compared, and the response percentage was higher in the control group. The response rates of oVEMP and cVEMP in patients with prelingual hearing loss were 44.2% and 59.6%, respectively. There was also a statistically significant difference between the groups for oVEMP amplitude and cVEMP P1 latency (p≤0.05).

Conclusion: These findings suggest that prelingual hearing loss is related to both utricular and saccular dysfunctions. However, oVEMPs were more often abnormal in prelingual deaf patients than cVEMPs, suggesting that utricular dysfunction may be more common than saccular dysfunction.
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http://dx.doi.org/10.5152/iao.2019.7280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224435PMC
April 2020

The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis.

Ear Nose Throat J 2018 Sep;97(9):E1-E5

Department of Otorhinolaryngology, Baskent University Konya Research and Teaching Center, Saray Caddesi No:1 Selcuklu, Konya, 42080 Turkey.

Fluctuations in atmospheric temperature, humidity, and air pollution are associated with the incidence of epistaxis. To date, no study in the literature has evaluated the effect of air pollution and meteorologic conditions on the pediatric population. We aimed to evaluate the effect of meteorologic factors and air pollution on the frequency of epistaxis in children. Children presenting to an outpatient clinical setting at a tertiary care hospital during a 5-year period (July 1, 2009, to June 30, 2014) and diagnosed with epistaxis formed the study population. Daily temperature and humidity parameters and average daily atmospheric water vapor pressure, average daily concentration of particulate matter <10 μm in diameter, and sulfur dioxide readings were obtained. The distribution of daily parameters was analyzed. Of the 1,559 children with the primary diagnosis of epistaxis, data from 1,330 children were analyzed after excluding patients with coexisting pathologies. Positive correlations were found between the frequency of epistaxis and both the average daily temperature and the difference between the maximum and minimum daily temperature. There was a negative correlation between the epistaxis frequency and the average daily humidity, the difference between the maximum and minimum daily humidity, the average daily concentration of particulate matter, and the sulfur dioxide levels. Our findings suggest that epistaxis in children is related to high temperatures and low humidity.
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http://dx.doi.org/10.1177/014556131809700901DOI Listing
September 2018

Letter to the editor regarding 'Evaluation of vitamin D levels in children with primary epistaxis'.

Int J Pediatr Otorhinolaryngol 2017 08 16;99:156. Epub 2017 Jun 16.

Baskent University, Faculty of Medicine, Department of Otolaryngology, Ankara, Turkey.

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http://dx.doi.org/10.1016/j.ijporl.2017.06.017DOI Listing
August 2017

[Cochlear implantation in far advanced otosclerosis: series of four cases].

Kulak Burun Bogaz Ihtis Derg 2016 Nov-Dec;26(6):360-5

Department of Otolaryngology, Medical Faculty of Başkent University, 06490 Bahçelievler, Ankara, Turkey.

In this article, we present four patients who underwent cochlear implantation due to far advanced otosclerosis. Preoperative evaluations, intraoperative findings, complications, and postoperative benefits were analyzed. Cochlear implantation is a treatment option providing excellent audiological results for rehabilitation of patients with far advanced otosclerosis. However, facial nerve stimulation after cochlear implantation is observed more frequently in patients with otosclerosis. Also, caution should be paid in patients with otosclerosis in terms of cochlear ossification and inconsistent results.
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http://dx.doi.org/10.5606/kbbihtisas.2016.37541DOI Listing
March 2017

Pediatric Mass Lesions of the Head and Neck Region and Fine-Needle Aspiration Biopsy Results.

Turk Arch Otorhinolaryngol 2016 Mar 1;54(1):29-34. Epub 2016 Mar 1.

Department of Otorhinolaryngology, Başkent University School of Medicine, Ankara, Turkey.

Objective: 1. To provide a classification of pediatric mass of the head and neck region and evaluate their frequency. 2. To examine the findings of fine-needle aspiration biopsy (FNAB) in pediatric patients along with its contribution to diagnosis.

Methods: Totally, 233 pediatric patients (125 boys and 108 girls) operated at Başkent University for head and neck mass were included. Clinical, radiological, and histopathological data were retrieved from medical records.

Results: The mean age was 119±65 months, and the mean duration of follow-up was 75±49 months. Localization of the masses was as follows: 208 (89%) in the neck, 21 (9%) in the oral cavity, 2 (1%) in the neck and nasopharynx, and two (1%) in the larynx. The most common surgical procedure was open excisional biopsy (n=105, 45%) followed by cystic mass excision (n=72, 31%) and salivary gland excision (n=33, 14%). Based on histopathological findings, benign cystic lesions were the most common disease group (n=77, 33.1%), whereas reactive lymphadenopathy was the most common condition (n=36, 15%) when a single disease was considered. Infectious/inflammatory diseases, malignancies, and benign salivary gland diseases were present in 49 (21%), 24 (10.3%), and 22 (9.4%) patients, respectively. FNAB was performed in 29.8% of the patients with an accuracy of 90.3% (95% CI, 80.1-96.4).

Conclusion: The differential diagnosis of head and neck masses during childhood includes a wide spectrum with the different conditions being benign cystic diseases of congenital origin and reactive lymphadenopathies. Owing to its high predictive value, FNAB represents a rapid and reliable method that can be commonly used in both adult and pediatric patients.
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http://dx.doi.org/10.5152/tao.2016.1371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782972PMC
March 2016

[Our surgical treatment results in pediatric cholesteatoma].

Kulak Burun Bogaz Ihtis Derg 2015 ;25(4):224-8

Department of Otolaryngology, Medical Faculty of Başkent University, 06490 Bahçelievler, Ankara, Turkey.

Objectives: This study aims to evaluate surgical techniques and obtained outcomes in pediatric cholesteatoma.

Patients And Methods: A total of 62 patients (41 males, 21 females; mean age 13 years; range 3 to 17 years) diagnosed as pediatric cholesteatoma between January 1998 and December 2014 were enrolled into the study. Of the patients, canal wall down (CWD) mastoidectomy was performed in 31, canal wall up (CWU) mastoidectomy in 13, inside-out (ISO) mastoidectomy in eight, and tympanoplasty in 10. Surgical approaches, staging, hearing outcomes, relapse status, and surgical data were retrospectively analyzed.

Results: Cholesteatoma recurred in seven patients (11%). Recurrence rates for CWU and CWD mastoidectomies were 31% and 6%, respectively. While the number of patients with good serviceable hearing (pure-tone average ≥25 dB) was 10 preoperatively, it became 16 postoperatively. Ossicular erosion was higher in CWD group. Twenty-nine patients (47%) had extensive disease and CWD mastoidectomy was performed in 86% of these. Number of patients not requiring care was 45 (72.6%).

Conclusion: In this study, we observed no differences in terms of good serviceable hearing between CWU and CWD mastoidectomies. The preferred method was mainly CWD in patients with extensive disease and ossicular erosion. Recurrence rates were higher in CWU group. Therefore, ISO or CWD mastoidectomy come to the forefront as appropriate treatment options in the treatment of pediatric cholesteatomas according to the extensiveness of disease.
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http://dx.doi.org/10.5606/kbbihtisas.2015.98123DOI Listing
June 2016

Positron emission tomography evaluation of sinonasal inverted papilloma and related conditions: a prospective clinical study.

Kulak Burun Bogaz Ihtis Derg 2015 ;25(1):9-15

Department of Otolaryngology, Medical Faculty of Başkent University, Adana Seyhan Hospital, 01110 Seyhan, Adana, Turkey.

Objectives: This study aims to determine whether there is a difference between inverted papilloma (IP) and nasal polyp, and squamous cell carcinoma (SCC) with regard to fluorodeoxyglucose uptake.

Patients And Methods: Between September 2007 and May 2014, positron emission tomography computed tomography (PET/CT) images of 27 patients (20 males, 7 females; mean age 53.4 years; range 18 to 74 years), with unilateral polyposis diagnosed on examination and tomographic scans of paranasal sinus were obtained. Nasal polyps in eight of the patients (group 1), IP in 10 patients (group 2), and SCC in nine patients (group 3) were found. The data were compared with Kruskal-Wallis and Mann-Whitney U tests.

Results: The mean maximum standardized uptake (SUVmax) values were found to be 2.9 in the group 1; 7.8 in the group 2, and 17.8 in the group 3. There was significant difference in the SUVmax values between the group 1 and the group 2 (p=0.016), the group 1 and the group 3 (p=0.001), and the group 2 and the group 3 (p=0.01).

Conclusion: According to the results of this study, PET/CT scan in the patients with unilateral polyposis is invaluable to distinguish nasal polyp from IP and SCC. It is also useful to recognize the distinctions between IP and SCC. In our study of 27 patients, a SUVmax of 6 or higher ruled out the presence of nasal polyp [95% CI (5.93 to 13.39), specificity 100%] might also be clinically useful.
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http://dx.doi.org/10.5606/kbbihtisas.2015.45212DOI Listing
June 2016

Idiopathic incus necrosis: Analysis of 4 cases.

Ear Nose Throat J 2013 Feb;92(2):E10-3

Department of Otolaryngology-Head and Neck Surgery, Alanya Medical and Research Center, Baskent University, Alanya, Antalya, Turkey.

We evaluated ossicular chain reconstruction in patients with idiopathic incus necrosis who have conductive hearing loss and an intact ear drum. The study included four patients (3 women and 1 man; the ages of the patients were 22, 31, 35, and 56 years, respectively) with unilateral conductive hearing loss, no history of chronic serous otitis media, an intact ear drum, normal middle ear mucosa, and necrosis of the long processes of the incus. On preoperative pure tone audiometry, air-bone gaps were 24, 25, 38, and 33 dB. Bilateral tympanometry and temporal bone computed tomography results were normal. All 4 patients underwent an exploratory tympanotomy. During the operation, the mucosa of the middle ear was normal, with a mobile stapes foot plate and malleus. No evidence of any granulation tissue was found; however, necrosis of the incus long processes was seen. For ossicular reconstruction, we used tragal cartilage between the incus and the stapes in 1 patient; in the other 3 patients, glass ionomer bone cement was used (an interposition cartilage graft also was used in the patients who received the glass ionomer bone cement). In all patients, air-bone gaps under 20 dB were established in the first year after surgery. In the ossicular disorders within the middle ear, the incus is the most commonly affected ossicle. While, the most common cause of these disorders is chronic otitis media, it may be idiopathic rarely. Several ossicular reconstruction techniques have been used to repair incudostapedial discontinuity.
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February 2013

Sinonasal schwannoma of the middle turbinate.

Diagn Interv Radiol 2010 Jun 9;16(2):129-31. Epub 2009 Oct 9.

Department of Radiology, Başkent University School of Medicine, Ankara, Turkey.

Paranasal schwannomas are uncommon lesions, representing less than 4% of all head and neck schwannomas. They give rise to nonspecific symptoms such as nasal obstruction, epistaxis, and anosmia. Imaging features are generally nonspecific. Here, we present the radiologic features of a benign schwannoma of the middle turbinate with dural invasion in a 71-year-old woman.
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http://dx.doi.org/10.4261/1305-3825.DIR.1710-08.1DOI Listing
June 2010

[Utility of fine-needle aspiration biopsy in head and neck masses].

Kulak Burun Bogaz Ihtis Derg 2008 Jul-Aug;18(4):211-5

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara, Turkey.

Objectives: We investigated the utility of fine-needle aspiration biopsy (FNAB) for head and neck masses, and compared FNAB results with histopathologic diagnoses.

Patients And Methods: In a group of 352 patients (168 males, 184 females; mean age 44+/-19 years; range 2 to 94 years) who were operated on for head and neck masses, FNAB was performed in 167 patients (47.4%). The results of FNAB were compared with histopathologic diagnoses in four groups of localization: parotid, thyroid, submandibular gland, and cervical levels. Sensitivity, specificity, positive predictive and negative predictive rates of FNAB were calculated for each group.

Results: There were 64 parotid (38.3%), 29 thyroid (17.4%), 19 level V (11.4%), 18 level II (10.8%), 14 level III (8.4%), 9 level I (5.4%), and 7 submandibular gland (4.2%) masses. The overall correlation of FNAB with histopathologic diagnoses was 71.9%, being 76.6% in parotid, 75.9% in thyroid, 57.1% in submandibular gland, and 67.2% in neck (levels I-VI) masses. The highest sensitivity, specificity, positive predictive and negative predictive rates were determined for parotid masses (98%, 93.3%, 98%, 93.3%, respectively), whereas the lowest rates were obtained in submandibular gland masses (50%, 66.7%, 66.7%, 50%, respectively).

Conclusion: The use of FNAB for head and neck masses, in particular parotid masses, provides considerable contribution to treatment planning.
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August 2010

Comparison of AlloDerm, fat, fascia, cartilage, and dermal grafts in rabbits.

Arch Facial Plast Surg 2008 May-Jun;10(3):187-93

Department of Otorhinolaryngology, Baskent University Faculty of Medicine, Ankara, Turkey.

Objective: To compare various graft materials in the rabbit model, including autologous cartilage, dermal tissue, fat, and AlloDerm (a cadaver-derived material).

Methods: Twenty-five New Zealand white rabbits were used. Equally sized autogenous (fat, fascia, cartilage, and dermal) grafts and AlloDerm were implanted into subcutaneous dorsal pockets on the rabbits. Animals were killed 1, 2, 3, and 4 months after surgery. The grafts were examined microscopically for thickness, resorption, fibrosis, neovascularization, inflammation, eosinophilia, and the presence of multinucleated giant cells or microcysts.

Results: The cartilage grafts revealed excellent viability with no resorption. The fascial grafts showed negligible volume loss. The dermal grafts developed epidermoid cysts. The AlloDerm grafts demonstrated graft thickening at 1 month and total resorption at 3 and 4 months. The fat grafts demonstrated 30% to 60% partial resorption.

Conclusions: The major disadvantage of using an autogenous fat graft was partial resorption, whereas cyst formation was observed with dermal grafts. AlloDerm caused tissue reaction and resorption. The best graft material was cartilage, with a low absorption rate, good biocompatibility, and minimal tissue reaction or fibrosis, followed by fascia, with a minimal shrinkage capacity and tissue reaction.
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http://dx.doi.org/10.1001/archfaci.10.3.187DOI Listing
September 2008

[Comparison of patients undergoing functional endoscopic sinus surgery combined with septoplasty or septorhinoplasty].

Kulak Burun Bogaz Ihtis Derg 2007 ;17(5):253-9

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara, Turkey.

Objectives: We compared patients who underwent functional endoscopic sinus surgery combined with septoplasty or septorhinoplasty and evaluated the concurrent applicability of septorhinoplasty and endoscopic sinus surgery.

Patients And Methods: We retrospectively analyzed 145 patients (96 males, 49 females; age range 16 to 78 years) who underwent endoscopic sinus surgery in conjunction with septoplasty or septorhinoplasty. The two patient groups were compared with respect to demographic characteristics, systemic diseases, allergy histories, the presence of nasal polyposis, preoperative paranasal sinus tomographies, Lund-Mackay scores, surgical procedures, operation times, and complication rates.

Results: Patients who underwent septorhinoplasty were younger than those undergoing septoplasty. There were no significant differences between the two groups in terms of paranasal sinus tomography scores, allergy histories, systemic diseases, and complication rates (p>0.05). The number of patients with nasal polyposis was significantly greater in the septoplasty group (p<0.05). Septorhinoplasty in conjunction with endoscopic sinus surgery required a significantly longer operation time (p<0.05).

Conclusion: Complications and the severity of sinus pathologies were similar in the two groups. Concurrent applications of septorhinoplasty and endoscopic sinus surgery significantly increase operation time.
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March 2008

[Classic Kaposi's sarcoma of the tongue: a case report].

Kulak Burun Bogaz Ihtis Derg 2007 ;17(2):116-9

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara, Turkey.

An 81-year-old male patient presented with a painful mass in the tongue that showed a progressive growth within the past two months. Examination revealed a polypoid mass in the midline of the tongue, purple in color, and 1.5x1.5 cm in size. There was no palpable lymph node on neck examination. An excisional biopsy was performed with adequate surgical margins. The histopathological diagnosis was Kaposi's sarcoma. Clinical and radiological evaluations did not show any systemic involvement. An HIV test was negative. He was referred to the medical oncology department. No recurrence was detected during a year follow-up.
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October 2007

[Non-Hodgkin's lymphoma of the parotid gland].

Kulak Burun Bogaz Ihtis Derg 2006 ;16(4):183-8

Department of Otolaryngology, Medicine Faculty of Başkent University, Ankara, Turkey.

Most of the primary malignant lymphomas of the salivary glands originate from the parotid gland. We presented two patients who were admitted with a painless mass in the parotid region and diagnosed to have a lymphoma. Physical examination of a 66-year-old male patient showed a relatively mobile, painless, and firm mass at the inferior aspect of the right parotid gland. Ultrasonography, computed tomography, and magnetic resonance imaging (MRI) were performed and a needle biopsy was obtained from the solid lesion extending from the right parotid superficial lobe to the medial deep lobe. Pathological examination revealed large B-cell lymphoma. The patient was treated according to the CHOP chemotherapy protocol. The second patient had undergone surgery for orbital lymphoma and received CHOP chemotherapy. On physical examination, there was a painless mass in the parotid cauda on the left and a subcutaneous lymph node, 0.5 x 1 cm in size, inferior to the parotid cauda. Computed tomography and MRI showed an irregularly contoured solid lesion, 2 x 1 cm in size, in the posteroinferior aspect of the superficial lobe. Lymph node biopsy yielded a diagnosis of small cell malignant lymphoma. The patient was referred to the medical oncology department for staging, further investigation, and planning of the treatment.
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October 2006

Six cases of Forestier syndrome, a rare cause of dysphagia.

Acta Otolaryngol 2006 Jul;126(7):775-8

Department of Otorhinolaryngology, Baskent University Faculty of Medicine, Bahcelievler-Ankara, Turkey.

Dysphagia is a common presenting complaint in otolaryngology practice, and there are many causes. Forestier syndrome is a rare cause of dysphagia. It is also known as diffuse idiopathic skeletal hyperostosis (DISH) syndrome or vertebral ankylosing hyperostosis. Forestier syndrome consists of anterolateral perivertebral ligament calcification. It was first described by Forestier and Rotes-Querol in 1950; diagnosis is primarily radiological and the etiology is unknown. In addition to dysphagia Forestier syndrome has been reported to cause laryngeal stridor, dyspnea, snoring and hoarseness. Other important symptoms associated with Forestier syndrome are stiffness and pain in the back, pain related to tendinitis, myelopathy related to core compression associated with the ossification of the posterior longitudinal ligament, and pain related to vertebral complications such as fracture or subluxation. We report six cases of Forestier syndrome as an etiologic factor in dysphagia and present clinical and radiological findings.
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http://dx.doi.org/10.1080/00016480500504192DOI Listing
July 2006

Malignant eccrine poroma invading the parotid gland.

Acta Otolaryngol 2006 Apr;126(4):435-7

Departments of Otorhinolaryngology, Baskent University Faculty of Medicine, Ankara, Turkey.

Malignant eccrine poroma was first described by Pinkus and Mehregon in 1963. Because of the histologic characteristics of the tumor, these authors concluded that the tumor was likely of eccrine origin. Malignant eccrine poroma originates from the intraepidermal ductal portion of the eccrine gland. Like other tumors of skin adnexa, malignant eccrine poroma is a rare tumor. It mostly affects older persons. Clinical diagnosis is difficult, and lesions are often mistakenly identified as squamous cell carcinoma or pyogenic granuloma. We report a case of malignant eccrine poroma invading the parotid gland. A 65-year-old man presented with an ulcerated mass (2x3 cm) below the ear lobule of 3 months' duration. The mass was fixed to the skin and underlying parotid gland. The lesion was treated using a superficial parotidectomy approach including the overlying skin. Simultaneous neck dissection was performed. The diagnosis was malignant eccrine poroma invading the parotid gland.
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http://dx.doi.org/10.1080/00016480500395187DOI Listing
April 2006