Cellular blue nevus tumor presenting as a submandibular lymph node in a 16-year-old

The cellular blue nevus tumor is a type of dendritic melanocytic nevus that is typically benign and exceedingly rare. The incidence of all blue nevi is about 1%, usually affecting the adult population and appearing on the extremities, sacrococcygeal or gluteal regions. There have only been a handful of case reports cited in the literature where cellular blue nevi present in the head and neck region, usually affecting the scalp and young adult population (7, 8). As such, it is exceedingly rare to encounter a cellular blue nevus tumor in the neck or infiltrating into neck lymph nodes. Here we report a rare case of a cellular blue nevus tumor presenting as a right neck mass in a pediatric 16-year-old patient, shown to invade into the submandibular lymph node and surrounding soft tissue. It is important to be aware of the cellular blue nevus tumor as a differential diagnosis in pediatric neck masses. Histological evaluation is necessary to determine tumor aggression and malignant potential which can guide further treatment in pediatric patients.

External carotid artery pseudoaneurysm following upper respiratory infection masquerading as a pharyngeal abscess in an 8-month-old

Pseudoaneurysms are very rare with an incidence of less than 0.1% in the pediatric population. Approximately 30 cases of carotid artery aneurysms in children have been published in the literature, usually affecting children over one year of age. We present one of the youngest cases in the literature; the patient is an 8-month old female with a strep throat infection complicated by pseudoaneurysm development of the external carotid artery. Because of the rarity of these lesions, there is little known regarding the types of clinical presentation and management. They are commonly the result of direct arterial trauma; however, they can also occur secondary to infection, connective tissue disease or arteritis. We are presenting a case with a highly atypical presentation. When present, pseudoaneurysms harbor the potential risk of life-threatening hemorrhage and warrant immediate management. It is important to be aware of cases and the treatment modalities used to guide future diagnosis and planning.

Evaluation of the mir-126, mir-182, and mir-486-5p Expression Signature of Head and Neck Squamous Cell Carcinomas and Lung Squamous Cell Carcinomas

OBJECTIVE

Although squamous cell carcinomas (SCCs) originating from different anatomic localizations display a similar histological appearance under light microscopy, they may differ in terms of epigenetic and genetic features. The aim of this study was to analyze mir-126, mir-182, and mir-486-5p expression levels in head and neck SCCs and lung SCCs, and to identify localization-specific miRNA expression profiles.

MATERIAL AND METHOD

The expression levels of mir-126, mir-182, and mir-486-5p were analyzed in lung, oral cavity, laryngeal, and hypopharyngeal SCCs in 40 patients, using quantitative real-time polymerase chain reaction.

RESULTS

The findings showed that lung, oral cavity, laryngeal, and hypopharyngeal SCCs have distinct mir-126 and mir-486-5p expression profiles. It was also observed that mir-126 and mir-486-5p expression levels were highly specific to the tumor localization.

CONCLUSION

These findings highlighted that SCCs originating from different anatomic localizations have different miRNA expression profiles. miRNA expression analysis can be used to predict the primary localizations of those SCCs.

Investigating the Knowledge, Attitudes and Behaviours of Parents Regarding Vaccine Rejection

Background

With an escalating prevalence, vaccine rejection is one of the ten threats to global health as identified by the World Health Organization in 2019. Vaccine rejection and hesitancy can be defined as the hesitancy of individuals to get vaccinated against diseases that can be prevented by vaccination. This study aimed to investigate the knowledge, attitudes and behaviours of parents who use primary healthcare services.

Methods

Conducted between August and September 2019, this study adopted a descriptive cross-sectional design. The sample size of the study was calculated to be 378, considering a 95% confidence interval and 80% power. The survey form, the data collection tool of the study, included questions concerning sociodemographic characteristics of individuals and their knowledge, attitudes and behaviours regarding vaccination. The data were analysed on SPSS 22.0. Chi-square test was used in statistical analyses, and the significance level was set as p < 0.05.

Results

In the study group, 15.5% of the parents stated that they were hesitant about vaccines in childhood, 81.3% stated that their source of information on vaccines was healthcare staff and 28% stated that it was the internet. The hesitancy level was significantly high among those who believed that vaccines led to autism and infertility and those who did not trust pharmaceutical companies (p < 0.05). The hesitancy level regarding vaccines was significantly lower among those whose source of information was healthcare staff, whereas it was significantly higher among those whose source of information was the internet (p < 0.05).

Conclusions

Parents' beliefs that vaccines led to autism and infertility increased their hesitancy levels. The inaccurate information on the internet and social media increased their hesitancy levels. Hesitancy levels were lower among the parents who received information from healthcare staff.

Key messages

Healthcare staff should organise public trainings on vaccines to reduce the hesitancy levels of parents. Anti-vaccination statements on the internet and social media influence individuals’ vaccination behaviours.

Duplication of the pituitary gland and basilar artery, with multiple midline fusion defects and craniofacial anomalies

Duplication of the pituitary gland (DPG) is a phenomenon with no clear syndromic association. This case adds to the literature as a DPG-plus syndrome patient with multiple fusion defects of unknown etiology, fetal risk factors of first trimester tobacco usage and intrauterine drug exposure. An 8-month old female presented with noisy breathing, poor feeding, cleft palate, seizures and failure to thrive. MRI scan revealed duplicate pituitary gland, tubomammillary fusion, absent cleavage of brainstem and superior cerebellar peduncles, and cervical spinal malformations. We performed an airway evaluation, with a glossomandibulopexy for glossoptosis, and a primary palate repair.

Effect of chitosan on sealer penetration into the dentinal tubules

Objective

The objective of this study is to compare the effectiveness of final irrigation with chitosan, ethylenediaminetetraacetic acid (EDTA), and citric acid (CA) on a resin-based sealer (AH plus sealer [Dentsply DeTrey, Konstanz, Germany]) penetration into dentinal tubules using confocal laser scanning microscopy.

Materials and Methods

Seventy recently extracted human mandibular premolars were instrumented and irrigated with sodium hypochlorite (NaOCl), then divided into four groups according to the final irrigation regimen used: (1) the EDTA group: 17% EDTA + 2.5% NaOCl, (2) the CA group: 10% CA + 2.5% NaOCl, (3) the chitosan group: 0.2% chitosan + 2.5% NaOCl, and (4) the control group: 2.5% NaOCl. All teeth were obturated using the cold lateral condensation technique with gutta-percha and AH Plus sealer labeled with fluorescent dye. The apical 2 mm of specimen was discarded, and slices were obtained for apical, middle, and coronal thirds of the root with 1 mm intervals. Maximum, mean, and percentage of sealer penetration (SP) inside tubules were measured using confocal laser scanning microscopy.

Results

The percentage of SP was significantly higher in chitosan, EDTA, and CA group than control group for coronal thirds (P < 0.05), whereas there was no significant difference among all groups for middle and apical thirds. Chitosan and EDTA showed increased mean values of SP depth for middle thirds (P < 0.05). In all sections, the maximum depth of SP was significantly lower in EDTA group than other groups (P < 0.05).

Conclusions

Chitosan, EDTA, and CA significantly improved the percentage of SP for coronal thirds.

Traumatic Rupture of Giant Pulmonary Hydatid Cyst in a Child

Introduction

Trauma as a cause of hydatid cyst rupture leads to various clinical conditions, especially in children. Current literatures regarding the clinical presentation and management of such patients are rare.

Case report

A 14-year-old child was admitted with chest pain and dyspnoea due to blunt thoracic trauma after falling off a bicycle. Chest computed tomography showed right hydropneumothorax and cystic cavity. After chest tube insertion, massive air leak was observed from the tube. Cystotomy and capitonnage were performed on the right lower lobe via a posterolateral thoracotomy. He was discharged from the hospital in good condition.

Conclusion

Ruptured hydatid cysts into the pleura are difficult to diagnose radiologically. It can be misdiagnosed radiologically as empyema or hydrothorax. In undetermined cases, all the findings may be suggestive but not diagnostic. Operation must be performed early for exploration when the condition is suspected. High complication rate has been found in children who were operated late.

Ototoxicity of boric acid powder in a rat animal model

Introduction

Boric acid, which has antiseptic and acidic properties, is used to treat external and middle ear infections. However, we have not found any literature about the effect of boric acid powder on middle ear mucosa and inner ear.

Objective

The purpose of this study is to investigate possible ototoxic effects of boric acid powder on cochlear outer hair cell function and histological changes in middle ear mucosa in a rat animal model.

Methods

Twenty healthy, mature Wistar albino rats were used in this study. The rats were divided into two groups, Group A and Group B, each of which consisted of 10 rats. Initially, the animals in each group underwent distortion product otoacoustic emissions testing of their right and left ears. After the first distortion product otoacoustic emissions test, a surgical microscope was used to make a small perforation in both ears of the rats in each group, and a second distortion product otoacoustic emissions test was used to measure both ears in all of the rats. Boric acid powder was applied to the right middle ear of the rats using tympanic membrane perforation, and the distortion product otoacoustic emissions were measured immediately after the boric acid powder application. The histological changes and distortion product otoacoustic emissions were evaluated three days later in Group A and 40 days later in Group B.

Results

No significant differences were found at all of the distortion product otoacoustic emissions frequencies. In Group A, mild inflammation of the middle ear mucosa was found on the third day after boric acid powder application. In Group B, boric acid powder caused mild inflammatory changes on the 40th day, which declined over time. Those changes did not lead to significant fibrosis within the mucosa.

Conclusion

In rats, boric acid powder causes mild inflammation in middle ear mucosa and it has no ototoxic effects on cochlear outer hair cell function in the inner ear of rats.

The presence and prognostic significance of human papillomavirus in squamous cell carcinoma of the larynx

The aim of the present study was to evaluate the role of HPV in laryngeal squamous cell carcinoma and correlate it with patients' clinicopathological data. In total, 78 laryngeal squamous cell carcinoma patients enrolled in this study. The presence of genotype-specific HPV DNA was evaluated using Genotyping Assay in formalin-fixed paraffin-embedded tissue which was diagnosed between 2005 and 2015. All samples were also evaluated for p16 immunohistochemical staining. HPV DNA and p16 status were assessed in terms of location, smoking, alcohol consumption, lymph node status, tumor stage, overall survival, disease-free survival, perineural invasion, and vascular invasion retrospectively. Five test samples were excluded from the study due to inadequate deoxyribonucleic acid purity. HPV DNA was detected in 19 of 73 (26.02%) in patients with laryngeal squamous cell carcinoma. Human papilloma virus genotyping revealed double human papilloma virus in one case (types 16 and 59) and HPV 16 in the remaining cases. Although HPV-positive cases showed slightly better 3 years survival than HPV-negative ones, this finding was not statistically significant (overall survival p = 0.417, HPV positive: 92.3%, HPV negative: 81.4%, and disease-free survival p = 0.526, HPV positive: 93.8%, HPV negative: 80.9%). The presence of HPV DNA was not significantly associated with any clinicopathological features (p > 0.05). Among 73 patients, only 4 had an immunohistochemical staining of p16 and these patients were also HPV DNA 16 positive. Although our study results revealed a slightly better survival in patients with HPV DNA positivity for HPV 16 compared to the negative ones, the difference was not statistically significant. However, an increasing rate in especially high-risk-type HPV-16 prevalence in laryngeal squamous cell carcinoma by RT-PCR method was observed compared to our previous study. Although the presence of HPV in laryngeal SCCs seems to be associated with slightly better prognosis, additional studies may be needed, since our results were not statistically significant. We believed that HPV is not an adequate biomarker for diagnostic and prognostic purposes in laryngeal squamous cell carcinoma.

Diffuse, encasing lymphangioma of the supraglottis

BACKGROUND

Lymphangioma of the head and neck is considered a rare congenital tumor with the vast majority presenting before two years of age. Surgical excision and sclerosing therapy using OK-432 are recognized as effective treatment options for the majority of these lesions; however, treatment options of laryngeal lesions are less straightforward due to the risk of airway compromise and the desire to maintain the integrity of a functional larynx. We present the case of a four month old male who presented with chief complaint of inspiratory stridor after a single episode of pneumonia. His clinical presentation, flexible fiberoptic laryngoscopic examination, and operative evaluation were consistent with a lymphangioma completely encasing the epiglottis and arytenoids and isolated to the supraglottis. This report outlines our approach to workup and treatment of this rare lesion.

METHOD

Case report of presentation, diagnosis and treatment is presented.

RESULTS

A four-month old male presented to ENT clinic with inspiratory stridor, worsened with crying, without frank respiratory distress. History and initial examination was consistent with airway obstruction. Flexible fiberoptic laryngoscopy showed laryngomalacia as well as diffuse and symmetric supraglottic edema. Surgical evaluation identified edema limited to the supraglottis, notably along the ventral surface of the epiglottis and dorsal surface of bilateral arytenoids. Biopsies were taken and immunohistochemical staining was performed with strong positivity for D2-40 and CD31, supporting the diagnosis of isolated lymphangioma of the supraglottis. Treatment was performed through multiple point spot welding with a fiber equipped CO2 LASER (OmniGuide TM) at 5 watt continuous power.

CONCLUSION

Isolated supraglottic lymphangioma was diagnosed via direct laryngoscopy, with pathologic and immunohistochemical confirmation. Carbon dioxide laser spot welding technique was used with excellent clinical improvement in stridor. Clinical improvement is sustained after 6 months follow-up.

Investigating the Effects of Smoking on Young Adult Male Voice by Using Multidimensional Methods

OBJECTIVES

Smoking is one of the most common harmful habits in the world, especially common among young adult male population in Turkey. The purpose of this study was to evaluate the effect of smoking on the young adults' male voice using multidimensional voice assessment methods.

STUDY DESIGN

This is a case-control study.

METHODS

The study included 109 young adult men, 51 nonsmokers and 58 smokers between the ages of 20 and 34 years. The voice evaluation protocol consisted of voice handicap index (VHI), maximum phonation time (MPT), and perceptual, acoustic, and videostroboscopic analyses.

RESULTS

A statistically significant increase for physical, physiological, and total scores of VHI was found in smokers group (P < 0.05). MPT showed significantly lower values among smokers (P < 0.05). There were no significant changes in perceptual analysis of voice samples between smoker and nonsmoker groups. There were no significant changes in any of the acoustic parameters between smoker and nonsmoker groups. Results of videostroboscopic analysis showed significant relationships between smoking and increased vocal fold erythema (P < 0.05). In addition, significantly asymmetry, amplitude, and periodicity abnormality of vocal fold movements were observed in smoker group during phonation (P < 0.05).

CONCLUSIONS

The results of this study indicate that observable signs of laryngeal irritation and disturbed phonatory physiology occur even in young adults with relatively brief smoking habits. Subjective symptoms of smoking on voice appear to occur earlier than objective findings.

TRAIL and TRAIL receptors in patients with laryngeal cancer

BACKGROUND

Tumor necrosis factor-related associated-inducing ligand (TRAIL) is a death ligand currently under clinical trials for laryngeal carcinoma.

METHODS

Paraffin-embedded tissues from 40 patients with laryngeal carcinoma and 20 patients with benign laryngeal pathologies were retrospectively analyzed using immunohistochemistry in terms of distribution and intensity, and for final analysis of immunoreactivity of receptors, H-score was used. The study group was assessed in terms of localization, lymph node staging, tumor stage, overall survival, disease-free survival, locoregional control, perineural invasion, and vascular invasion.

RESULTS

The H-score of decoy-R2 (DcR2) staining were increased significantly in tumor tissue (p = .04). A significantly greater increase in terms of H-score of DR5 receptor staining (p = .06) was detected in tumor tissue.

CONCLUSION

TRAIL-mediated gene therapy may not be effective. Indeed, the findings may indicate treatment resistance. TRAIL and TRAIL receptor levels were not associated with prognosis © 2015 Wiley Periodicals, Inc. Head Neck 38: E535-E541, 2016.

Evaluation of MMP-9 and TIMP-1 Levels of the Patients with Nasal Polyposis After Corticosteroid Therapies

The aim of this study is to evaluate the effects of intrapolyp, systemic and local corticosteroid treatment modalities on MMP-9 and TIMP-1 level in polyp tissues. This study included 71 patients and five groups. Group A treated with oral methylprednisolone, Group B, treated with topical steroid spray, Group C treated with intralesional triamcinolone acetonide, Group D patients with nasal polyposis who has not given any medication, Group E had surgery for concha bullosa without nasal polyp disease. Samples from group A were collected endoscopically 1 day after treatment was stopped. Group B samples were collected at the end of the first month. Video guided sample collection from Group C was also performed on the 7th day after treatment. MMP-9 and TIMP-1 levels were measured by Enzyme-linked immunosorbent assay method. When we compared the MMP-9 levels of all groups, there were no significant differences. There was significant difference of TIMP-1 level between Groups C and E (pC-E = 0.0019), however there was no difference among the level of the other groups. When MMP-9/TIMP1 rates of all groups were compared, there were significant difference between Group A and D (pA-D = 0.005) and between Group A and E, also between Group C and E. Our study is the first study to evaluate the effects of different corticosteroid treatment modalities on MMP-9 and TIMP-1 in nasal polyps and concluded that corticosteroid did not do a significant impact on this pathway.

Role of mRNA Expression in the Nasal Polyp Pathogenesis

Objective: Nasal polyposis (NP) not only has a significant impact on the life quality of patients but also affects 2.11% of the population is a chronic inflammatory disease of the upper airway. The aim of this study is to evaluate and understand nasal polyp pathogenesis.

Method: Healthy mucosa and polyp samples were taken from 27 patients with nasal polyposis who underwent FESS. Total RNA was extracted from samples and converted to cDNA. Expressions of five given genes namely CC10, DMBT1, LTF, STAT, PIP were detected using QRT-PCR technique. GAPDH gene were used for normalization.

Results: While there was no significant change in CC10 expression levels, we observed significant increase in the expressions of DMBT1, LTF, STAT and PIP compared to polyp tissue with healty mucosa.

Conclusion: We observed significant changes in the expressions of DMBT1, LTF, STAT and PIP genes which are kniwn with anti-inflammatory, antimicrobial, immunomodulatory, and antineoplastic properties.

Bullous skin reaction seen after extravasation of calcium gluconate

Intravenous (IV) calcium is usually given to temporarily treat the effects of hyperkalaemia on muscle and heart. When extravasation of a calcium gluconate infusion occurs, there may be rapid and marked swelling and erythema, with signs of soft-tissue necrosis or infection, and ensuing extensive local calcification, called calcinosis cutis. We report a 26-year-old woman who was hospitalized for exacerbation of acute intermittent porphyria. She had a history of hypertension and chronic renal failure. On the second day of her hospitalization, she developed hyperpotassaemia (6.7 mEq/L potassium; normal range 3.5-5 mEq/L). She was given an IV infusion of 10 mL calcium gluconate into the left dorsal pedal vein. Bullous skin reactions occurred in the infusion area nearly 2 h after administration. The patient's leg was elevated and the lesions cleaned with 0.9% saline. By day 9 of hospitalization, the lesions had markedly regressed. Several drugs have been associated with dermoepidermal blistering as an adverse drug reaction, but there is only one existing report in the literature about this side-effect associated with calcium gluconate. Clinicians should be alert to the possibility of bullous skin reactions, which may be a predictor of extravasation and necrosis, when treating patients with IV calcium gluconate.

The effects of systemic, topical, and intralesional steroid treatments on apoptosis level of nasal polyps

OBJECTIVE

The purpose of this study was to compare the apoptotic responses to systemic, topical, and intrapolyp injection of glucocorticoid with no treatment in nasal polyps.

STUDY DESIGN

Prospective, randomized controlled study.

SETTING

Tertiary training hospital.

SUBJECTS AND METHODS

The study was performed on 48 patients with nasal polyposis in the Department of Otorhinolaryngology between 2008 and 2009. Patients were assigned to 1 of 4 groups of 12 patients. Group A was treated with oral methylprednisolone 1 mg/kg/d, and the dose was tapered gradually. Group B received 0.3 mL triamcinolone acetonide (40 mg/mL), which was injected into polyp tissue. Group C was treated with topical 55 µg triamcinolone acetonide 2 times daily for 1 month. Group D received no medication. Samples were collected endoscopically after the seventh day for groups A and B, the first month for group C, and the first visit for group D. Apoptotic indexes were determined using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method.

RESULTS

Statistically significant differences in apoptotic index were found between each steroid-medicated group and the control group (P (D-A) = .0001; P (D-B) = .003; P (D-C) = .026) and between groups A and C (P (A-C) = .012). Group B did not differ significantly from either group A or C (P (A-B) = .11; P (B-C) = .75).

CONCLUSIONS

The apoptotic index in nasal polyps treated with systemic, topical, and intrapolyp injection forms of glucocorticoids was higher than that in the control group. Systemic steroid treatment induced the most apoptosis.

The Association between Helicobacter Pylori and Laryngopharyngeal Reflux in Laryngeal Pathologies

We conducted a study to determine the presence or absence of Helicobacter pylori and laryngopharyngeal reflux (LPR) in 43 previously untreated patients who had presented with a laryngeal lesion. Our aim was to determine if there was any association among H pylori, LPR, and laryngeal lesions. H pylori status was determined by real-time polymerase chain reaction (PCR) assays of biopsy tissue obtained during direct laryngoscopy. The presence or absence of LPR was determined on the basis of patients’ reflux symptom index (RSI) and reflux finding score (RFS), which were based on their questionnaire responses and findings on endoscopic examination of the larynx, respectively. Patients with an RSI of 14 or more and/or an RFS of 8 or more were considered to have LPR. H pylori was present in 24 patients (55.8%) and absent in 19 (44.2%)—not a statistically significant difference. The prevalence of LPR was higher than the prevalence of H pylori; it was present in 30 patients (69.8%) and absent in 13 (30.2%). The difference was statistically significant (p = 0.01). We found no association between H pylori status and LPR status. Additionally, we analyzed two subgroups based on whether their lesions were benign or malignant/premalignant and found a significant relationship between LPR positivity and the presence of malignant/premalignant laryngeal lesions (p = 0.03). We found no association between H pylori status and either of the two subgroup categories.

The Effects of Septoplasty on QTc Dispersion

Objective: Studies have shown that nasopharyngeal airway diseases, such as obstructive sleep apnea, are closely associated with cardiovascular diseases. The purpose of this study was to investigate whether there is any impact of septoplasty operation on QTc dispersion (QTcD) in patients with nasal septum deviation.

Method: This study included 28 young deviated nasal septum patients. All patients underwent septoplasty. The QT interval, the heart rate-corrected QT, and the QT dispersion were calculated digitally using computerized electrocardiograms (ECG) by Holter ECG. Heart rates, QT intervals, QTc, and QTcD values were compared preoperatively and one-month postoperatively.

Results: QTcD was measured 62.9 ± 7.9 in young patients with nasal septal deviation. While there was no significant change in ECG QT interval periods obtained from the patients taken after the procedure (354.8 ± 25.7 and 360 ± 25.4, P > .05), there was a significant decrease in QTc values (398 ± 22.9 and 383.7 ± 21.2, P = .013 [<0.05]), and there was a significant decrease in QTcD values (62.9 ± 7.9 and 45.7 ± 6.7, P = .000). In addition, heart rates were significantly decreased after surgery (76.5 ± 13.2 and 67.4 ± 10.4, P = .007).

Conclusion: In our study, QTcD values were increased in young patients with nasal septal deviation. High QTcD value indicates increased heterogeneity of ventricular repolarization. Septoplasty is important for young people with nasal deviations to provide improvement of QTc dispersion. Nasopharyngeal airway diseases have negative effects on myocardial repolarization.

Ideal Duration of Nasal Packing after Septoplasty

Objective: Septoplasty is a corrective surgical procedure for nasal septal deviation, and nasal packing is usually applied after septoplasty to avoid some complications. The objective of this study was to evaluate the complications and subjective discomfort of 24-hour nasal packing compared to that of 48-hour nasal packing in patients undergoing septoplasty.

Method: A total of 149 patients were divided into two groups according to time of nasal packing removal. Nasal packings were removed 24 (group 1) and 48 (group 2) hours after septoplasty. Patients with complications were recorded, and verbal analog pain scores (VAS) of all patients were calculated after surgical procedure.

Results: Postoperative hemorrhage rates were 17.5% in the first group and 6.6% in the second group. Hemorrhages in the first group were mostly reactionary, and only two of them required repacking. None of the patients in the second group required repacking. There was no statistically significant difference between the two groups depending on hemorrhage. First day mean VAS scores were similar in both groups. Second day mean VAS score of the second group was higher compared to first day VAS scores of both groups.

Conclusion: According to our study, routine use of 48-hour nasal packing after septoplasty is not necessary. We observed that prolonged nasal packing increases the postoperative pain significantly and has no significant beneficial effect on postoperative complications except in patients with hypertension.

Hydroxyproline levels in nasal polyps

The aim of this study was to evaluate hydroxyproline levels in nasal specimens from patients with nasal polyps, and to examine hydroxyproline levels after nasal steroid spray and oral steroid treatments. This study was performed on 41 patients. The subjects were divided into four groups: no medication group (group A, n 11), oral methylprednisolone group (group B, n 8), topical steroid spray group (group C, n 8) and control group (group D, n 14). Nasal polyp samples were collected endoscopically. Healthy subjects were studied as a control group, and their nasal samples were taken during turbine reduction surgery. All samples were analyzed using the immunocytochemistry method. Hydroxyproline levels were investigated and compared with the control group. Mean hydroxyproline levels in groups A-D were 98.48, 24.20, 8.97 and 4.52, respectively. The hydroxyproline levels were significantly higher in group A compared with that of group D. The treatment that revealed significant decreases in hydroxyproline levels was group C. Although there was also a noticeable reduction in group B, there were no statistically significant differences between group B and group A. Our study revealed a significant correlation between nasal polyp and hydroxyproline levels. The hydroxyproline levels were significantly higher in nasal polyps. Both oral and topical steroid treatments decrease hydroxyproline levels in nasal polyps. Thus, in theory, steroid treatment can directly decrease hydroxyproline levels by inhibiting proline hydroxylase and indirectly by lowering the inflammatory process.

Primary malignant melanoma of the trachea: case report

A 22-year-old man was admitted with complaints of dyspnea and hoarseness. Laryngoscopy and computed tomography of the neck revealed a 1.5 x 2-cm solid mass obstructing the trachea. The black, pedunculated mass was completely removed through a tracheal incision, and a paratracheal lymph node dissection was performed. Histopathologic examination revealed nodular-type mucosal malignant melanoma. Cranial and thoracic computed tomography, abdominal ultrasonography, and histopathologic examination of the paratracheal lymph nodes showed no metastases. No recurrence has been noted in more than 3 years of follow-up.

Efficacy of topical halofuginone in myringotomy patency

The objective of the study is to determine whether topical halofuginone (HF) application has an impact on prolonging the time for healing of myringotomy incision, and to investigate histopathologic effects of HF on tympanic membrane (TM) in rat model. Forty rats with normal eardrums were involved in this study. The study group and control group consisted of 30 and 10 rats, respectively. A posterior incision 1 mm in diameter was made on healthy eardrums of the rats. Following incision, gelfoam soaked with HF hydrobromide of 30 mg/dl was applied on the perforation in study group, whereas gelfoam soaked with isotonic saline was applied on the perforation in control group. On days 1, 3, 7, 10, 14, 18, 21, 24, 27, and 30, otoendoscopic evaluation of eardrums under general anesthesia was conducted and perforations were screened. A rat of each group was killed in control days and TMs were dissected to evaluate histopathological changes. The average times for patency of perforation in study and control groups were 21.43 and 7.50 days, respectively. The difference was found to be statistically significant (p < 0.05). Histopathological evaluation revealed that HF reduces hyalinisation and fibrosis in eardrum, when compared with the control group. In conclusion, HF significantly delays closure time of myringotomies in rat model. However, this delay may not be enough for recovery of otitis media with effusion.

Real-time PCR detection of Helicobacter pylori and virulence-associated cagA in nasal polyps and laryngeal disorders

OBJECTIVE

To identify Helicobacter pylori and major virulence factor, cagA, in patients with laryngeal diseases and nasal polyps.

STUDY DESIGN

Cross-sectional study with planned data collection.

SETTING

The study was performed on fresh tissue samples from patients with 32 nasal polyps, 29 normal nasal mucosa, and 27 laryngeal diseases presenting to the Otolaryngology-Head and Neck Surgery department of a major military hospital in Istanbul, Turkey.

SUBJECTS AND METHODS

Tissue specimens were evaluated by in-house polymerase chain reaction (PCR) and real-time PCR for bacterial DNA and by real-time PCR for cagA. The impact of commercial and in-house DNA extraction methods was also evaluated.

RESULTS

H pylori DNA was detected only by real-time PCR in 59.4 percent of nasal polyps, 70.4 percent of nasal mucosa samples, and 58.6 percent of larynx samples. cagA was identified in 78.9, 89.5, and 82.4 percent of positive polyp, nasal mucosa, and larynx samples, respectively. No statistically significant differences were observed between groups. DNA purification methods were equally effective.

CONCLUSION

H pylori DNA is present in nasal polyp and larynx tissues as well as normal nasal mucosa, as detected by a sensitive real-time PCR assay. cagA-positive strains dominate in all groups.

The association of oxidative stress and nasal polyposis

Many diseases are linked to damage from reactive oxygen species that occurs from an imbalance between reactive oxygen species and antioxidants, a condition called oxidative stress. Nasal polyposis is considered to be an inflammatory condition in nasal and paranasal sinus cavities and its aetiology is still unclear. There are very few data on epithelial changes in nasal polyposis and their relationship with free radical damage. Malondialdehyde as a major end-product of lipid peroxidation, and superoxide dismutase and nitric oxide as antioxidants play important roles in oxidative stress. In this study, the concentrations of malondialdehyde, superoxide dismutase and nitric oxide were compared in normal and nasal polyposis-affected tissue samples. Malondialdehyde levels were significantly higher, and superoxide dismutase and nitric oxide levels were significantly lower in patients with nasal polyposis compared with the control group. This study demonstrates that there is a strong relationship between oxidative stress and the pathogenesis of nasal polyposis.

Histologic analysis of the effects of three different support materials within rat middle ear

Objective: To investigate histologic changes in the mucosa of rat middle ear after implantation of three different support materials.

Study Design: A prospective, controlled animal study.

Subjects and Methods: Three types of absorbable materials were implanted into the middle ear cavity of rats: (1) Gelfoam (purified gelatin) (Pharmacia & Upjohn Company, New York, NY), (2) Sepragel (viscoelastic gel composed of cross-linked polymers of hyaluronan) (GENZYME Corp, Ridgefield, NJ), and (3) Nasopore (a biodegradable/fragmentable, synthetic polyurethane foam) (Polyganics, Groningen, The Netherlands). Rats were sacrificed after 3 and 20 days to ascertain early and late histologic changes. The bulla of each rat was excised and prepared for microscopic examination. The histologic changes were evaluated by observation of the middle ear cavity and mucosa in terms of polymorphonuclear leucocytes (PMNL), macrophages, giant cells, fibroblasts and other cells, fibrosis, and remnant materials.

Results: The histologic appearance of gelfoam-treated middle ears was characterized by more severe acute inflammation in the short-term and prominent fibrosis in the long-term in comparison with sepragel- and nasopore-treated groups. Nasopore appeared to be prone to remnant formation and reorganization by means of fibroblastic activity.

Conclusion: Compared with gelfoam, both sepragel and nasopore caused less histologic alterations.

Effectiveness of transmeatal low power laser irradiation for chronic tinnitus

Objective:

To evaluate effectiveness of 5 mW laser irradiation in the treatment of chronic tinnitus.

Study design:

Prospective, randomised, double-blind study.

Methods:

This investigation included 66 ears in 45 patients with chronic unilateral or bilateral tinnitus. A 5 mW laser with a wavelength of 650 nm, or placebo laser, was applied transmeatally for 15 minutes, once daily for a week. A questionnaire was administered which asked patients to score their symptoms on a five-point scale, before and two weeks after laser irradiation. A decrease of one scale point, regarding the loudness, duration and degree of annoyance of tinnitus, was accepted to represent an improvement.

Results:

The loudness, duration and degree of annoyance of tinnitus were improved, respectively, in up to 48.8, 57.7 and 55.5 per cent of the patients in the active laser group. No significant improvement was observed in the placebo laser group.

Conclusion:

Transmeatal, low power (5 mW) laser irradiation was found to be useful for the treatment of chronic tinnitus.

Effects of halofuginone on fibrosis formation secondary to experimentally induced subglottic trauma

OBJECTIVE

The aim of the study was to assess the antifibrotic effect of systemically applied halofuginone after subglottic injury.

MATERIALS AND METHODS

After standardized trauma to subglottic area, rats were divided into two groups: a study group that received treatment and a control group that did not. The rats were treated with 0.1 mg/kg/day intraperitoneal halofuginone injection for 30 days. The larynx specimens were examined histopathologically under light microscope for epithelization, inflammation, necrosis, and fibrosis.

RESULTS

The fibrosis indexes of the treated group were significantly less than those of the control group (P < .01).

CONCLUSIONS

Systemically applied halofuginone hydrobromide decreases fibrosis/scar tissue formation secondary to experimentally induced acute subglottic trauma.

Iloprost-induced sudden hearing loss

We report a patient who developed sudden, bilateral, sensorineural hearing loss during therapeutic use of iloprost for Raynaud's phenomenon. The sudden hearing loss was attributed to iloprost use and completely reversed in eight days with conservative therapy. Iloprost may be a potentially ototoxic drug, causing sudden hearing loss.

Human papilloma virus prevalence in laryngeal squamous cell carcinoma

PURPOSE

To determine the prevalence and type of human papilloma virus deoxyribonucleic acid (DNA) in cases of laryngeal squamous cell carcinoma.

METHODS

We analysed the prevalence of human papilloma virus infection in archived paraffin block specimens taken from 99 cases of laryngeal squamous cell carcinoma between 1990 and 2005, using polymerase chain reaction techniques. Biopsy specimens from five proven verrucous skin lesions were used as positive controls, and peripheral blood samples from five healthy volunteers were used as negative controls.

RESULTS

Four test samples were found to have inadequate deoxyribonucleic acid purity and were therefore excluded from the study. Human papilloma virus deoxyribonucleic acid was detected in seven of 95 cases of laryngeal squamous cell carcinoma (7.36 per cent). Human papilloma virus genotyping revealed double human papilloma virus infection in three cases and single human papilloma virus infection in the remaining four cases. The human papilloma virus genotypes detected were 6, 11 and 16 (the latter detected in only one case).

CONCLUSION

In our series, a very low human papilloma virus prevalence was found among laryngeal squamous cell carcinoma cases. The human papilloma virus genotypes detected were mostly 6 and/or 11, and 16 in only one case. To the best of our knowledge, this is the first report of human papilloma virus prevalence in laryngeal squamous cell carcinoma, based on polymerase chain reaction genotyping in a Turkish population.

Peripheral osteoma of the mandible mimicking a parotid mass

We report the case of a peripheral osteoma mimicking a benign tumor in the left parotid gland of a 75-year-old woman. The clinical presentation of the painless mass on the lateral surface of the mandibular ascending ramus was suggestive of a benign parotid tumor such as a pleomorphic adenoma. It was diagnosed using computed tomography (CT) and further delineated using 3D spiral CT scanning. Mandibular osteoma should be considered in differential diagnosis of parotid masses, which can be revealed by conventional radiographs.

Juvenile Spring Eruption: A Report of Two Cases

Juvenile spring eruption is a photodermatosis characterized by the development of papules and vesicles on the light-exposed helix of the ears after sun exposure, usually in the springtime. It mainly affects boys and young male adults, and has a tendency to occur in the form of small epidemics. We report an outbreak in a group of soldiers who were performing military exercises during cold and sunny weather during a midwinter season. The clinicopathologic features and laboratory test results are described in two of these cases.

Comparison of uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty and cautery-assisted uvulopalatoplasty in the treatment of primary snoring

OBJECTIVE

Our aim was to compare the postoperative pain and surgical results of uvulopalatopharyngoplasty (UPPP), laser-assisted uvulopalatoplasty (LAUP), and cautery-assisted uvulopalatoplasty (CAUP) procedures in the treatment of primary snoring.

METHODS

54 patients were stratified according to a modified Friedman staging system (MFSS) for sleep-disordered breathing. Tonsil size (1, 2, 3) and palatal position scale (grade 1-2) and body mass index <30 according to the MFSS were included for standardization. Three workgroups consisting of 18 patients each were formed and UPPP, LAUP and CAUP procedures were performed. The success of the surgical procedures was evaluated by applying the Epworth Sleepiness Scale to the patients, and the patients' bed partners were asked to evaluate the snoring level preoperative and 45 days after the operation to determine any improvement in snoring complaints. Patients were followed for postoperative pain, secondary infection, bleeding, permanent velopharyngeal insufficiency and nasopharyngeal stenosis.

RESULTS

Snoring was relieved in 83.3% of UPPP and CAUP groups and in 88.8% of LAUP 45 days after operation. The mean pain duration was 5.71 days for the UPPP patients, 6.28 days for the LAUP patients and, 4.12 days for the CAUP patients. The mean pain score was 2.1 for the UPPP patients, 2.38 for the LAUP patients, and 1.6 for the CAUP patients. Only 1 patient was hospitalized due to pain in the LAUP group.

CONCLUSION

The effectiveness of UPPP, LAUP and CAUP procedures were found to be similar (more than 83%). Postoperative pain was mostly seen in LAUP and UPPP cases. The CAUP procedure was easy and the least painful.

The effects of mitomycin C and 5-fluorouracil/triamcinolone on fibrosis/scar tissue formation secondary to subglottic trauma (experimental study)

PURPOSE

The aim of the study was to compare the effects of mitomycin-C (MMC) and 5-fluorouracil/triamcinolone acetonide (5-FU/TA) on the development of fibrosis/scar tissue formation of rabbit subglottic area, which is injured acutely.

MATERIALS AND METHODS

After standardized trauma to subglottic area the rabbits were divided into those that received treatment and those that did not (controls). The subjects were treated with either topical 0.4 mg/mL MMC or 5 mg 5-FU/TA injection. Those groups were further divided into subgroups depending on the time of examination: at 2 or 6 weeks. Each subgroup had 4 rabbits. The specimens were examined histopathologically and the measurements were performed using a software.

RESULTS

The fibrosis indices (FIs) of the treated subgroups were significantly less than the FIs of their corresponding control subgroups (P<.05). The difference in FIs of the MMC-treated and 5-FU/TA-treated groups was not statistically significant (P>.05). MMC and 5-FU/TA did not interfere with regeneration of the epithelium although in 2 cases treated with 5-FU/TA the regenerated epithelium showed squamous metaplasia.

CONCLUSIONS

Both MMC and 5-FU/TA decrease fibrosis/scar tissue formation secondary to experimentally induced acute subglottic trauma. There is no significant difference between the effects of the 2 drugs.

Evaluation of the outcomes of short bowel syndrome and indications for intestinal transplantation

Long-term parenteral nutrition (PN) and intestinal transplantation (IT) are life-saving therapies for patients with short bowel syndrome (SBS). However, indications and timing of these therapies are controversial. In this study we aimed to evaluate the indications for IT. Forty-two patients, each with <100 cm of small bowel, were divided into three groups according to the length of remnant: group I patients (n = 18): colon plus 50 to 100 cm of small bowel (SB); group II patients (n = 14): colon plus <50 cm of SB; and group III patients (n = 10): <50 cm of SB without colon. One-year mortality rates for groups I, II, and III were 50%, 72%, and 100%, respectively. All group I survivors developed intestinal adaptation, returning to regular oral feedings at 1 year. Interestingly, three of four surviving patients in group II developed adaptation and were fed an oral short bowel diet (SBD) at 1 year. None of the group III patients survived >1 year, dying due to multiorgan failure in the early postoperative period or from sepsis within 1 year. We conclude that patients with a very short bowel are candidates for IT when stable. If the colon is intact, however, regardless of small bowel remnant length, the patient should be given a chance to develop intestinal adaptation before making the decision for permanent PN or IT.