Evaluation of Volume of Nasopharyngeal Cancers by the Cavalieri Principle

Prediction of tumor volume using the Cavalieri method may be helpful in management of therapy and evaluation of treatment results. The aim of this study was to adapt the Cavalieri stereological method to magnetic resonance imaging for determining volume of nasopharyngeal cancers and assess changes after treatment using the Cavalieri method. Serial MRI images in the sagittal plane were obtained from a total of 33 patients with nasopharyngeal carcinomas (11 with stage T2, 11 with stage T3, and 11 with stage T4 lesions). The images were analyzed retrospectively before and two months following the cessation of radiochemotherapy for comparison. Average tumor volumes before and after treatment in patients with stage T2 were 21. 5±10.5 cm3 and 2.82±3.43 cm³, respectively (p=0.000). The respective figures were 35.1±19.0 cm3 and 6.27±7.82 cm³ (p=0.000) for stage T3 cases, and 62.8±27.8 cm3 and 11. 6±11.9 cm3 (p=0.000) for stage T4. Post-treatment tumor volumes were statistically reduced when compared to pre-treatment volumes in all stages.

The value of Nigella sativa in the treatment of experimentally induced rhinosinusitis

The aim of this study was to investigate the effect of Nigella sativa and cephalexin in the therapy of experimental bacterial rhinosinusitis. Bacterial rhinosinusitis was induced with Staphylococcus aureus. Rabbits were divided into five groups; control (n = 6), N. sativa 50 mg/ kg/d (n = 6), N. sativa 100 mg/kg/d (n = 6), N. sativa 200 mg/kg/d (n = 6), and cephalexin 20 mg/kg/d (n = 6) groups. N. sativa was given orally for 7 days. The same volume of normal saline (0.9% NaCl) was given as a vehicle to the control group for the same period. After treatment period, sinus mucosa samples were evaluated using stereological and histopathological methods. Half of the maxillary sinus mucosa samples were frozen at -800C for further analysis of NO levels. Pathology revealed a severe acute inflammatory process in rabbits treated with saline. Only mild inflammation was determined in cephalexin group, N. sativa 100 mg/kg/d and N. sativa 200 mg/kg/d groups. The level of NO increased in the saline group was significantly reduced in all treatment groups. N. sativa may prevent histopathological changes of rhinosinusitis via decreased NO levels in a dose dependent manner and can be used in the treatment of rhinosinusitis diseases.

Measuring Oxidative DNA Damage With 8-Hydroxy-2'-Deoxyguanosine Levels in Patients With Laryngeal Cancer

OBJECTIVES

8-Hydroxy-2'-deoxyguanosine is a biomolecule associated with DNA damage. We evaluated oxidative stress and DNA damage in patients with laryngeal cancer by measuring 8-hydroxy-2'-deoxyguanosine levels.

METHODS

This study enrolled 117 subjects, including 64 controls and 53 patients who had benign vocal cord lesions or laryngeal cancer. The benign excised lesions, tumor tissue, noncancerous laryngeal tissue, blood, and urine were subjected to high-performance liquid chromatography, and 8-hydroxy-2'-deoxyguanosine levels were compared between groups.

RESULTS

Blood and urine 8-hydroxy-2'-deoxyguanosine levels in patients with laryngeal carcinoma were significantly higher than in the controls ( P = .00002, P = .00001). The 8-hydroxy-2'-deoxyguanosine level was significantly higher in tumor tissues than in non-tumor tissue and benign vocal cord lesion tissues ( P = .00002, P = .000001).

CONCLUSIONS

We determined that laryngeal cancer was associated with oxidative stress, which may be quantified by measuring 8-hydroxy-2'-deoxyguanosine. For a patient with a suspicious laryngeal lesion, 8-hydroxy-2'-deoxyguanosine levels in blood and urine can provide advance information about the likely diagnosis.

The role of endothelin-1 and endothelin receptor antagonists in allergic rhinitis inflammation: ovalbumin-induced rat model

OBJECTIVE

Desloratadine is a biologically active metabolite of loratadine which is indicated for the treatment of allergic rhinitis. Bosentan is a dual endothelin receptor antagonist used to treatment of pulmonary artery hypertension (PAH). In this study, we aimed to determine the role of endothelins in allergic rhinitis (AR) and the effects of endothelin receptor antagonists in AR rat models through comparison with desloratadine.

METHODS

In total, 20 adult Sprague-Dawley rats were used in this study. An ovalbumin-induced allergic rhinitis model was formed in three study groups except for the control group. Bosentan (100 mg/kg/day) was given to the bosentan-treated group for 7 days and desloratadine (10 mg/kg/day) was administered to the antihistaminic-treated group for 7 days. Nasal symptom scorings and histopathological examinations of the nasal tissues were carried out. Serum IgE levels and ET-1 and TNF-alpha mRNA expression levels were analysed. Between group comparisons for nasal symptoms, histopathological analysis, and molecular analyses were performed with a one-way ANOVA and Duncans multiple comparison tests. Significance was accepted at p smaller than 0.05.

RESULTS

Bosentan inhibited nasal symptom more significantly than desloratadine. The IgE level, ET-1 and TNF-alpha mRNA expression levels statistically increased in the allergic rhinitis group when compared to other groups. Conversely, the bosentan-treatment group showed a significant recovery from the same parameters. The deterioration in histopathological parameters reached the highest levels in the allergic rhinitis group. The histopathological findings were close to those of the control group in the bosentan and antihistaminic-treated group.

CONCLUSIONS

ET-1 is one of the mediators that impact AR development and ET-1 antagonists can be useful for symptom control and for decreasing allergic inflammation in AR patients.

Mitochondrial DNA deletions in patients with chronic suppurative otitis media

The aim of this study was to investigate the 4977 and 7400 bp deletions of mitochondrial DNA in patients with chronic suppurative otitis media and to indicate the possible association of mitochondrial DNA deletions with chronic suppurative otitis media. Thirty-six patients with chronic suppurative otitis media were randomly selected to assess the mitochondrial DNA deletions. Tympanomastoidectomy was applied for the treatment of chronic suppurative otitis media, and the curettage materials including middle ear tissues were collected. The 4977 and 7400 bp deletion regions and two control regions of mitochondrial DNA were assessed by using the four pair primers. DNA was extracted from middle ear tissues and peripheral blood samples of the patients, and then polymerase chain reactions (PCRs) were performed. PCR products were separated in 2 % agarose gel. Seventeen of 36 patients had the heterozygote 4977 bp deletion in the middle ear tissue but not in peripheral blood. There wasn't any patient who had the 7400 bp deletion in mtDNA of their middle ear tissue or peripheral blood tissue. The patients with the 4977 bp deletion had a longer duration of chronic suppurative otitis media and a higher level of hearing loss than the others (p < 0.01). Long time chronic suppurative otitis media and the reactive oxygen species can cause the mitochondrial DNA deletions and this may be a predisposing factor to sensorineural hearing loss in chronic suppurative otitis media. An antioxidant drug as a scavenger agent may be used in long-term chronic suppurative otitis media.

Estimation of the efficacy of chemo-radiotherapy on tumor regression in the patients with laryngeal cancer via computerized tomography using the Cavalieri method

CONCLUSION

Calculating tumor volume using the Cavalieri method in laryngeal tumors before and after treatment may be useful to optimize the treatment and to minimize the side-effects of radiotherapy.

PURPOSE

This study aimed to estimate the pre-treatment and post-treatment tumor volumes of the patients to whom radiotherapy or radio-chemotherapy was applied as a treatment using Cavalieri's Principle as a stereological method and to assess tumor regression rates in the patients with Laryngeal Squamous Cell Carcinoma (LSCC) statistically.

MATERIALS AND METHOD

Sixteen patients (eight patients with stage T3 and eight patients with stage T4) diagnosed with LCCC bearing the appropriate characteristics to criteria in the otorhinolaryngology clinic were included. Patients had computerized tomography (CT) scans in the axial plane before treatment and 2 months after the treatment. Pre-treatment and post-treatment tumor volumes on CT images were calculated using Cavalieri's principle as a stereological method and then compared.

FINDINGS

Average tumor volumes in patients with stage T3 before and after treatment were 10.12 ± 3.58 cm(3) and 1.33 ± 1.74 cm(3), respectively (p = 0.008). These volumes were 11.92 ± 4.61 cm(3) and 2.17 ± 2.34 cm(3) (p = 0.008) for patients with stage T4, respectively. Post-treatment tumor volumes were statistically reduced compared to pre-treatment volumes in all stages.

Does Montelukast Have an Effect on Post-tonsillectomy Pain Control in Children? A Randomized Trial Study

OBJECTIVE

Tonsillectomy surgery is associated with severe postoperative pain that usually requires analgesics including opioids. Pain control is still a big problem after tonsillectomy surgery. We aimed to evaluate the efficacy of preemptive analgesia using montelukast for pediatric post-tonsillectomy pain management. This is the first-time use of montelukast in post-tonsillectomy pain.

STUDY DESIGN

Double-blind, controlled-randomized study.

SETTINGS

University teaching and research hospital.

SUBJECTS AND METHODS

A total of 60 children, aged 5 to 15 years, American Society of Anesthesiologist class I-II, scheduled for elective tonsillectomy were enrolled in this clinical trial study. The patients were randomized into 2 groups: the montelukast group (group M, n = 30) and control group (group C, n = 30). Group M recieved an oral montelukast tablet and group C recieved placebo at 2400pm on the morning before surgery. Post-tonsillectomy pain was evaluated with the Wong-Baker FACES Scale during the 24 hours after surgery. Patients' intraoperative hemodynamic parameters and intraoperative and postoperative complications were recorded.

RESULTS

There were statistically significant differences between group C and group M for Wong-Baker FACES pain rating scale scores (P < .05). In the 24 hours after surgery, the total number of patients using rescue analgesics was higher in group C than in group M, and the difference was statistically significant (P < .001). There was no significant difference in demographic parameters (P > .05). There were no significant differences in postoperative nausea and vomiting, otalgia, trismus, fever, or halitosis between the groups (P > .05).

CONCLUSION

Preemptive montelukast can be used safely to reduce the serious pain caused by tonsillectomy in children.

Does Montelukast Have an Effect on Posttonsillectomy Pain Control in Children?

Objectives:

Investigate the efficacy of preemptive montelukast, which is leukotreine receptor blocker for pediatric posttonsillectomy pain management. This is the first time montelucast has been used in posttonsillectomy pain control.

Methods:

A total of 60 children, aged 5 to 15 years, American Society of Anesthesiologist (ASA) class I-II, scheduled for elective tonsillectomy were enrolled in this double-blinded and controlled study from April of 2013 until January of 2014. The patients were randomized into 2 groups: Montelukast group (Group M, n:30) and control group (Group C, n:30). Group M received 5 mg oral montelukast tablet and Group C received placebo at 24:00 pm the night before surgery. The posttonsillectomy pain was evaluated with Wong-Baker Face Scale during the 24 hours after surgery. Postoperative complications were recorded. The data were analyzed using the Student t test. Data were presented as a mean + SD, and differences were considered significant at P < .05.

Results:

There were statistically significant differences between Wong-Baker Face Scale scores of the Group C and Group M ( P < .05). The first time, analgesic requirement was higher in group C than in group M ( P < .05).There was no significant difference in demographic parameters and postoperative complications ( P > .05 for both).

Conclusions:

Preemptive montelukast usage is more effective than the control group in posttonsillectomy pain relief.

The effect of antiallergic treatment with desloratadine-montelukast on salivary glands function in allergic rhinitis

The aim of this study was to evaluate the possible favorable effect of desloratadine-montelukast combination on salivary glands (SG) function in patients with allergic rhinitis (AR) using SG scintigraphy. The study population consisted of 64 patients with AR and 28 healthy controls: 14 males and 14 females, with mean age 32.3±8.6 years. The patients were divided into two groups: the untreated patients group of 32 patients, 16 males and 16 females, mean age 28.5±5.4 years and the treated group, who received the standard clinically recommended oral dose of montelukast 10mg/d and desloratadine 5mg/d for 6 weeks. This group consisted of 32 patients, 16 males and 16 females, mean age 38.3±8.4 years. All patients and healthy controls underwent SG scintigraphy. After the intravenous injection of technetium-99m pertechnetate, ((99m)Tc-P), dynamic SG scintigraphy was performed for 25min. Using the time-activity curves, the following glandular function parameters were calculated for the parotid and the submandibular SG: uptake ratio, maximum accumulation and ejection fraction. Results showed SG hypofunction. All functional parameters obtained for the untreated patients and for the desloratadine-montelukast treated patients were significantly lower than those in healthy controls (P<0.05). There was no statistically significant difference between treated and untreated patients (P>0.05). In conclusion, our study showed that hypofunction of SG was present in all patients with AR. This hypofunction, as tested by semi-quantitative SG scintigraphy, and also the quality of life did not improve after treatment with montelukast and desloratadine.

The association of human leukocyte antigen polymorphisms with disease severity and latency period in patients with silicosis

Background: Denim sandblasting may cause silicosis as a result of free crystalline silica inhalation. Its pathogenesis remains unclear, but autoimmunity may play a role in the development of silicosis. The present study aimed to investigate the relationships between human leukocyte antigen (HLA) and the severity and latency period of silicosis. Methods: 48 silicotic patients in the Eastern part of Turkey were classified according to their latency period and disease severity. The distribution of HLAs according to disease severity and latency period was assessed. Results: A23 (7.5%), B49 (7.5%), and B51 (25%) were more common in the mild group than in the severe group, and B55 (8.9%) and DR4 (17.9%) were more common in the severe group than in the mild one. Only B51 was significantly more common in the mild group than in the severe one (25%, n = 10 vs. 7.1%, n = 4; p = 0.016). Conclusions: This study suggests that HLA antigens may play a particular role in the severity of silica-induced lung disease, but there was no association between HLA and progression time of the disease.

The association of human leukocyte antigen polymorphisms with disease severity and latency period in patients with silicosis

Background

Denim sandblasting may cause silicosis as a result of free crystalline silica inhalation. Its pathogenesis remains unclear, but autoimmunity may play a role in the development of silicosis. The present study aimed to investigate the relationships between human leukocyte antigen (HLA) and the severity and latency period of silicosis.

Methods

48 silicotic patients in the Eastern part of Turkey were classified according to their latency period and disease severity. The distribution of HLAs according to disease severity and latency period was assessed.

Results

A23 (7.5%), B49 (7.5%), and B51 (25%) were more common in the mild group than in the severe group, and B55 (8.9%) and DR4 (17.9%) were more common in the severe group than in the mild one. Only B51 was significantly more common in the mild group than in the severe one (25%, n = 10 vs. 7.1%, n = 4; p = 0.016).

Conclusions

This study suggests that HLA antigens may play a particular role in the severity of silica-induced lung disease, but there was no association between HLA and progression time of the disease.

"Mustache sign" due to Stensen duct dilation

An 80-year-old woman presented with a 5-year history of painless swellings of the left and right cheeks. The degree of swelling did not change with mastication. On palpation, the cheeks were soft, well defined, and movable. Compression and massage of the swollen areas caused increased salivary discharge from the orifices of the Stensen ducts. Three-dimensional computed tomography showed well-bordered, 15- to 20-mm wide, bilateral, tube-like dilatations of the ducts. The ductal origin of the swellings was explained to the patient, but she refused invasive procedures, thus no sialogram or surgical procedure was performed. We describe the clinical and radiographic features of a case of bilateral, congenital Stensen duct dilatation with bilateral swelling of the cheeks.

Left-right asymmetry in neck lymph nodes distribution in patients with bilateral laryngeal cancer

OBJECTIVE

We aimed to examine left-right asymmetry in involved and total neck lymph nodes distribution in patients with bilateral laryngeal cancer in the present study.

METHODS

Forty-six patients with bilateral laryngeal cancer was included the study. The oncologic database of our otorhinolaryngology department was used. The right and left lymph node with and without involvement by cancer cells counts were retrieved from pathological reports.

RESULTS

The numbers of both involved and total neck lymph nodes were significantly higher on right side than on left side for all neck levels in laryngeal malignancies.

CONCLUSIONS

The results of the present study suggest the existence of a left-right asymmetry in neck lymph node distribution and in the neck lymph node distribution involved by laryngeal cancer cells. The stronger cell-mediated immune activity in the left side of humans may be associated with the blocking of the metastatic invasion of cancer cells from laryngeal malignancies in the left body side.

DNA Damage in Children with Snoring

Objective: Learning the levels of oxidative DNA damage in children with obstructive adenotonsillar hypertrophy. We determined the 8-hydroxy 2-deoxyguanosine levels in leukocyte DNA and in urine samples as a specific marker of oxidative damage to DNA, and the plasma and urine malondialdehyde levels as an index of lipid peroxidation in children.

Method: Prospective, randomized controlled study conducted between 2010 and 2011. The study consisted of 30 patients and 25 healthy controls. Patients had snoring and pauses of breathing during sleep. We obtained blood and urine samples from each child to measure 8-hydroxy 2-deoxyguanosine and malondialdehyde levels in their initial visit.

Results: A significant difference was observed in leukocyte and urine 8-hydroxy 2-deoxyguanosine levels in patients with obstructive adenotonsillar hypertrophy compared to controls (P < .001 for both). Similarly, a significant difference was observed in plasma and urine malondialdehyde levels in patients with obstructive adenotonsillar hypertrophy compared to controls ( P < .001 for both). In addition, significant correlations were observed between the levels of 8-hydroxy 2-deoxyguanosine in leukocyte DNA and plasma malondialdehyde ( r = 0.648, P < .001), and between the levels of urine 8-hydroxy 2-deoxyguanosine excretion and urine malondialdehyde ( r = 0.588, P < .001).

Conclusion: 8-hydroxy 2-deoxyguanosine in leukocyte DNA and urine levels in children can be useful as an indicator for obstructive adenotonsillar hypertrophy screening.

Aural Myiasis by Wohlfahrtia magnifica: Case Report

A 5-year-old child living in Erzurum, Turkey, complaining of otalgia, otorrhea and pruritus in the right ear for three days, was examined. Otoscopic examination at the Department of Otorhinolaryngology revealed live maggots in the external auditory canal. Ten maggots were recovered and were identified as third stage larvae of Wohlfahrtia magnifica (Diptera: Sarcophagidae). Local and systemic antibiotic therapies were applied. No pathological findings were present at the follow-up examination after 15 days of therapy.

Rhinolithiasis: the importance of flat panel detector-based cone beam computed tomography in diagnosis and treatment

Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity. A nidus may be endogenous or exogenous. Rhinoliths are uncommon and often an asymptomatic condition diagnosed accidentally during a routine examination; but sometimes they may cause complications such as unilateral nasal obstruction, fetid rhinorrhea, or epistaxis. This article describes a case of rhinolith involving a 21-year-old female. The flat panel detector-based cone beam computed tomography (FPD-CBCT) findings, differential diagnosis, and treatment in a case of rhinolith are presented.

The effects of methylprednisolone and cefazolin sodium on antioxidant status in experimentally induced maxillary sinusitis

CONCLUSION

Sinusitis is accompanied by deteriorated antioxidant status, which can be alleviated with administration of cefazolin sodium or methylprednisolone. Steroids improve sinusitis when combined with antibiotics.

OBJECTIVE

To evaluate the antioxidant status in response to treatment of maxillary sinusitis with methylprednisolone and cefazolin sodium.

MATERIALS AND METHODS

Twenty-eight rabbits were inoculated with Staphylococcus aureus and then treated with saline, methylprednisolone, cefazolin sodium, and methylprednisolone plus cefazolin sodium, twice daily for 7 days. After the animals were sacrificed, mucosa samples were obtained to determine catalase (CAT), superoxide dismutase (SOD), and glutathione reductase (GPx) activities and levels of nitric oxide (NO) and malondialdehyde (MDA).

RESULTS

Catalase activity among untreated rabbits and those treated with either methylprednisolone or cefazolin sodium was not different. Activities of SOD and GPx were lower for rabbits treated with cefazolin sodium than for those treated with methylprednisolone and for untreated rabbits (p<0.0001). Rabbits treated with cefazolin sodium had lower NO and MDA levels than those treated with methylprednisolone and untreated rabbits (p<0.0001). Combined administration of cefazolin sodium with methylprednisolone increased CAT, SOD, and GPx activities further and decreased NO and MDA levels further in comparison with their administration alone (p<0.0001).

Lateralizations of head-neck cancers are not associated with peripheral asymmetry of cell-mediated immunity

Earlier studies have reported right-sided lateralization for different organ cancers except breast cancer. In the present study, lateralization of head-neck cancers and their relation with the peripheral cell-mediated immune asymmetry was investigated. The sample was comprised of 42 men and 20 women diagnosed with cancer in the head-neck region. The diagnosis of cancer was made histopathologically. To measure the cell-mediated (type IV) immunity of both forearms, the tuberculin test (PPD test) was used in the subjects previously sensitized by BCG vaccine during the first year of age. Significant right-sided lateralization in men and the significant left-sided lateralization in women were observed in this study. There was no relation between the lateralization of cancer and the asymmetry of tuberculin reaction or the peripheral cell-mediated immune asymmetry.

Evaluation by (99m)Tc-pertechnetate scintigraphy of the effect of levocetirizine on salivary glands function, in allergic rhinitis patients

The purpose of this study was to assess the effect of levocetirizine (xyzal) on salivary glands function in patients with allergic rhinitis using technetium-99m pertechnetate ((99m)Tc-P) salivary gland scintigraphy. The study population consisted of 67 patients with allergic rhinitis and 31 healthy controls (14 males and 17 females, mean age 30.1+/-6.8 years). The patients were divided into two groups: an untreated patient Group of 32 patients, 17 males and 15 females, mean age 29.9+/-6.5 years and a levocetirizine-treated with 5mg.day(-1) for 4 weeks patient Group, consisted of 35 patients, 16 males and 19 females, mean age 33.5+/-7.8 years. All patients and healthy controls underwent salivary glands scintigraphy. After the intravenous administration of 185 MBq of (99m)Tc-P, dynamic salivary glands scintigraphy was performed for 25 min. By the time-activity curves, the following glandular function parameters were calculated for the parotid and submandibular salivary glands: uptake ratio, maximum accumulation, and ejection fraction. Our results showed: All functional parameters obtained for the untreated patient Group were significantly lower than for the levocetirizine-treated patient Group and healthy controls (P<0.05). There was no significant difference in any functional parameters between the levocetirizine-treated patient Group and healthy controls (P>0.05). In conclusion, results of our study indicate that patients with allergic rhinitis treated with levocetirizine showed a significantly higher salivary glands function compared with untreated patients and healthy controls. Levocetirizine treatment showed no side effects on salivary glands function.

The effects of silica exposure on upper airways and eyes in denim sandblasters

OBJECTIVE

Silicosis due to denim (or jean) sandblasters is newly described cause of silicosis. In such cases lungs are severely affected due to heavy exposure to silica without serious protection. We aimed to investigate whether silica had an effect on the upper airways and eyes.

METHODS

The study included the patients recently diagnosed with silicosis. For comparisons, a control group was constituted. Firstly, a questionnaire was performed to obtain demographic and exposure characteristics of the cases. Later, routine nasal examination by endoscope and routine eye examination by slit-lamp microscope were performed to investigate presence of rhinitis and/or adenoid vegetation and eye findings associated with dust exposure, respectively, in both patient and control groups. Punch biopsies of the adenoid tissue were obtained using an endoscopic telescope with the patient under local anesthesia and sent for histopathologic examination. In addition, nasal pH and mucociliary clearance were investigated. Both pH and saccharin nasal transport time (SNTT) measurements were performed by two physicians, who reached a final consensus.

RESULTS

The study group consisted of 83 male silicotics with an average age of 23 +/- 6 years, and the control group consisted of 84 age and gender matched healthy individuals. Their mean exposure time was 40 +/- 26 months. On routine nasal examination, silicotics had higher rates of rhinitis (28.9% versus 16.7%) mostly ipsilaterally (p = 0.01), adenoid vegetation (32.5% versus 13.3%/, p < 0.05), conjunctival hyperaemia (70% versus 45%, p < 0.001), pingueculae (68% versus 23%, p < 0.01), papillar formation (40% versus 28%), and higher nasal pH values (7.9 +/- 0.7 versus 6.9 +/- 0.6, p < 0.001), higher SNTT values (19.9 +/- 2.9 versus 10.9 +/- 1.9, p < 0.001) compared with the controls.

CONCLUSION

The results of our study suggest that upper airways and eyes are considerably affected in the patients with silicosis. Thus, appropriate protection is required to prevent the development of such problems in denim sandblasters.

Subhypnotic propofol infusion plus dexamethasone is more effective than dexamethasone alone for the prevention of vomiting in children after tonsillectomy

BACKGROUND

Postoperative vomiting (POV) is a common complication after tonsillectomy. Dexamethasone is known to decrease postsurgical vomiting. In this study, we compared the effects of dexamethasone alone to dexamethasone plus propofol on postoperative vomiting in children undergoing tonsillectomy.

METHODS

In a randomized double-blinded study, we evaluated 80 healthy children, aged 4-12 years, who underwent tonsillectomy with or without adenoidectomy. After anesthesia was induced by inhalation of sevoflurane, 0.15 mg x kg(-1) dexamethasone and 2 microg x kg(-1) fentanyl was administered i.v. to all patients. The patients in the dexamethasone plus propofol group received 1 mg x kg(-1) propofol before intubation and continuously after intubation at a rate of 20 microg x kg(-1) x min(-1) until the surgery was completed. Data for postoperative vomiting were grouped into the following time periods: 0-4 and 4-24 h. Data were analyzed using a Student's t-test and chi-squared analysis.

RESULTS

The percentage of patients exhibiting a complete response (defined as no retching or vomiting for 24 h) increased from 37.5% in the dexamethasone-alone group to 75% in the dexamethasone plus propofol group (P = 0.001). Twenty-two patients (55%) in the dexamethasone-alone and nine patients (22.5%) in the dexamethasone plus propofol groups experienced vomited during 0-4 h (P = 0.003). Eight patients in the dexamethasone-alone group and three patients in the dexamethasone plus propofol group received ondansetron as a rescue antiemetic during the postoperative period.

CONCLUSION

For children undergoing tonsillectomy, intraoperative subhypnotic propofol infusion combined with dexamethasone treatment provides a better prophylaxis against postoperative vomiting than does dexamethasone alone.

A rare location of Castleman's disease: parotid region

Castleman's disease in the parotid gland region is very rare. The most frequent site of involvement is the mediastinum. A 15-year-old female with Castleman's disease in the parotid region is herein reported.

Treatment of Sinusitis with Corticosteroids in Combination with Antibiotics in Experimentally Induced Rhinosinusitis

Objectives:

The objective of this study was to investigate the effects of corticosteroids, antibiotics, and their combination in the therapy of experimental bacterial rhinosinusitis.

Methods:

Twenty-eight rabbits underwent experimental induction of bacterial rhinosinusitis with Staphylococcus aureus. The animals were assigned randomly to 1 of 4 treatments (saline solution, methylprednisolone, cefazolin sodium, methylprednisolone–cefazolin sodium) for 7 days. After the treatment period, sinus mucosa samples of the animals were examined stereologically. In addition, mucosa samples were used in the determination of myeloperoxidase (MPO) activity.

Results:

Methylprednisolone, cefazolin, and methylprednisolone-cefazolin had a positive effect on the reduction of neutrophil infiltration to the sinus mucosa in experimental bacterial rhinosinusitis as compared to the group treated with saline solution. However, the effects of methylprednisolone, cefazolin, and methylprednisolone-cefazolin did not significantly differ (p > .05). Similarly, the use of methylprednisolone, cefazolin, and methylprednisolone-cefazolin decreased MPO activity as compared to the group with saline solution (p < .05), and the difference among methylprednisolone, cefazolin, and methylprednisolone-cefazolin was statistically significant (p < .05). The most significant decrease in MPO (neutrophil marker enzyme) activity was determined in the animals treated with methylprednisolone-cefazolin (p < .05).

Conclusions:

Administering corticosteroids as an adjunct to antibiotics may accelerate the healing process in experimentally induced rhinosinusitis. In this model of rhinosinusitis, an MPO assay was supportive of this hypothesis, although stereological examination showed no statistically significant difference.

Epithelioid hemangioendothelioma of the submandibular gland

Epithelioid hemangioendothelioma (EH) is a seldom tumor of vascular origin, which occurs at sites such as liver, lung or soft tissues, and has a highly unpredictable malignant potential and clinical course. We submitted a case with epithelioid hemangioendothelioma of submandibular gland. The patient was a 44-year-old woman who presented with left submandibular painly mass. Fine needle aspiration showed a mixed lymphoid population. Contrast enhanced Computerize Tomography (CT) scan revealed that to be a well-circumscribed and including microcalcification in centre 2.5 cm x 2.0 cm mass in diameter without evidence of bony invasion. Submandibular gland was excised. The pathological result was interpretated as epithelioid hemangioendothelioma of the submandibular gland. The patient was seen regularly for recurrence.

Evaluation of the effect of levocetirizine on nasal mucociliary clearance in allergic rhinitis patients by rhinoscintigraphy

OBJECTIVE

The purpose of this study was to assess the effect of levocetirizine on nasal mucociliary clearance in allergic rhinitis patients using rhinoscintigraphy.

METHODS

Twenty patients with allergic rhinitis (12 males and eight females, mean age 37.7 +/- 10.5 years) were evaluated. All the patients received levocetirizine (5 mg x day(-1)) for 4 weeks, and the speed of nasal mucociliary clearance was assessed before and after treatment. Twenty healthy controls (11 males and nine females, mean age 39.4 +/- 7.8 years) were also evaluated.

RESULTS

The clearance values obtained for the treated group before and after treatment were significantly lower than those of the control group (P = 0.0001), but there was no significant difference in clearance speeds before and after treatment in the patient group (P = 0.444).

CONCLUSION

The study demonstrated that levocetirizine did not affect the speed of nasal mucociliary clearance in allergic rhinitis patients, and that nasal mucociliary clearance can easily be evaluated by rhinoscintigraphy.

Unilateral anterior uveitis in Melkersson-Rosenthal syndrome: a case report

Melkersson-Rosenthal syndrome (MRS) is an uncommon granulomatous condition characterized by persistent or recurrent orofacial oedema, relapsing facial paralysis and fissured tongue. We report here a case of MRS with the classical triad of signs accompanied by unilateral anterior uveitis. A 35-year-old man with a fissured tongue, recurrent facial palsy and orofacial oedema presented with a 3-month history of conjunctival redness and decreased vision in the right eye. On evaluation of visual acuity, the patient was only able to count fingers. Slit lamp examination revealed severe conjunctival injection, cells and flare, posterior synechiae and keratic precipitates. Examination of the left eye revealed no evidence of inflammation. Examination of the other systems was normal. The patient was treated with topical corticosteroids and cycloplegics and the visual acuity improved to 7/10. To our knowledge, there are no previous reports of an association between uveitis and MRS.