Alperen Vural

The Pott’s puffy tumor: a dangerous sign for intracranial complications

The Pott’s puffy tumor is a subperiosteal abscess of the frontal bone associated with osteomyelitis. The purpose of this article is to alert the physician to the severe complications of this entity. The records of six patients were reviewed retrospectively. There were four adults and two adolescents. Nasal endoscopy showed edematous, polypoid mucosa in middle meatus in three and nasal polyps in the rest. At initial admission, two had orbital subperiosteal abscess, but normal cranial CT findings. During hospitalization, three experienced frontal lobe abscess and one frontal cerebritis. Endoscopic sinus surgery was performed in all with external drainage of Pott’s puffy tumor in addition to antibiotherapy. Three patients underwent craniotomy/craniectomy for removal of frontal lobe abscesses. One patient with frontal lobe abscess died. Pott’s puffy tumor may result in potentially dangerous intracranial complications. Early diagnosis and treatment are essential to reduce morbidity and mortality.

Tularemia: a rare cause of neck mass, evaluation of 33 patients

The objective of the study is to report 33 cases presenting with neck masses later diagnosed with tularemia and to raise attention to this rare zoonotic infection. A retrospective analysis of 33 patients, who were diagnosed with tularemia and treated at Erciyes University Department of Otorhinolaryngology between January 2010 and December 2010 was conducted. In conclusion, because tularemia is a rare infection, its diagnosis is frequently delayed and the symptoms of the patients may last for months without any appropriate treatment. The diagnosis of tularemia rests on clinical suspicion. For the patients, who carry risk factors for tularemia and having cervical lymphadenopathies with or without oropharyngeal symptoms and who do not response to treatment with beta-lactam antibiotics, tularemia must be kept in mind.

Protective effect of N-acetylcysteine from drug-induced ototoxicity in uraemic patients with CAPD peritonitis

AIM Peritonitis is currently one of the leading complications of continuous ambulatory peritoneal dialysis (CAPD) treatment. Aminoglycosides and vancomycin are used in the treatment of CAPD peritonitis despite their potential risk for ototoxicity. N-acetylcysteine (NAC) is a molecule used in the treatment and prophylaxis of many diseases related to oxidative stress. The aim of this study was to examine whether ototoxicity due to antibiotics used in the treatment of CAPD peritonitis can be prevented by NAC. METHODS Sixty patients, who first developed CAPD peritonitis attacks from February 2008 to April 2010 were included in this study. Patients were divided into two groups, those taking an additional NAC treatment (n = 30) and a control group (n = 30). Low- and high-frequency hearing function tests were performed on the two groups before treatment (baseline), at the end of the first (early follow-up) and the fourth week after the treatment (late follow-up). Total doses of vancomycin and amikacin were recorded. RESULTS There was no statistically significant difference between the groups in terms of hearing functions at the beginning. However, patients taking NAC had better hearing function test results 4 weeks after the treatment compared with those of the control group (P < 0.05). There were no statistical differences between posttreatment low-frequency hearing function tests conducted at the baseline and the first and the fourth weeks in patients taking NAC. The first and the fourth weeks low-frequency hearing functions worsened when compared with the baseline low-frequency results in the control group (P < 0.001). It was found that NAC had a protective effect against ototoxicity on low-frequency (0.25-8 KHz) hearing functions. The first and the fourth weeks high-frequency hearing functions improved when compared with baseline high-frequency hearing functions in patients taking NAC (P < 0.05), while they worsened. The first and fourth weeks high-frequency tests worsened when compared with the baseline high-frequency tests in the control group (P < 0.001). CONCLUSIONS The present study suggests that intraperitoneal aminoglycoside and vancomycin administration in CAPD patients may cause low- and high-frequency hearing loss, and this ototoxic effect is related to the dose given. It was found that when the antioxidant NAC is administered alone, it prevents ototoxicity, associated with intraperitoneal amikacin and vancomycin in patients with CAPD peritonitis. In addition, it was revealed that NAC may also have a curative effect on impaired high-frequency hearing functions.

Approaches to subperiosteal orbital abscesses

The purpose of this paper is to evaluate the epidemiology, clinical features, management and complications of subperiosteal orbital abscesses (SPOA)—a serious complication of rhinosinusitis. Retrospective data of 36 patients with SPOA secondary to acute rhinosinusitis from January 1998 to December 2011 were evaluated. Patients were analyzed in terms of age, gender, clinical features, CT findings, surgical procedures, microbiology, and complications. Twenty-three males and 13 females aged from 3 to 76 were evaluated. Nine patients—seven of which were under the age of 10—with small medial SPOA were treated only with medical management. Of the 13 with medial SPOA, transnasal endoscopic approach was performed for 10 and external approach for 3 to drain the abscess. As for the 12 patients with superior SPOA, 8 were treated via combined approach and 4 via external approach. The most common microorganisms were streptococci in children and anaerobes in adults. Total loss of vision developed in two adults with diabetes mellitus (DM). One patient with superior SPOA died due to frontal lobe abscess. Young children with small medial SPOA without significant ocular signs may successfully be managed medically. Surgical drainage is indicated for nonmedial abscesses, large medial abscesses with severe visual loss and with insufficient response to medical management. The risk of blindness from SPOA is higher in patients with DM.

The Effect of Nystatin Solution on Otoacoustic Emissions in Rats.

OBJECTIVE In patients with a perforated tympanic membrane, topically administered medication reaches the middle ear and thus creates a risk of ototoxicity. The aim of the present study was to evaluate the possible ototoxic effect of the antifungal medication nystatin when administered to the rat middle ear cavity. MATERIALS AND METHODS Three groups (negative control, positive control, and study groups), each containing eight rats, were formed. Before the drug administration, distortion product otoacoustic emissions were recorded in both ears of each rat. Saline (0.09% NaCl), gentamycin, and nystatin solutions were transtympanically injected into the middle ear cavities of the negative control, positive control, and study groups, respectively, for five consecutive days. Seven days after the last infiltration, the control otoacoustic emission was measured, and the data of the 2, 3, 4, 6, 8 kHz frequencies were statistically analyzed. RESULTS There were no significant changes between the 1st and 2nd measures in the negative control group (0.09% NaCl) (p>0.05), whereas there were significant changes between the 1st and 2nd measures in the positive control group (gentamycin) and study group (nystatin) (p<0.05). CONCLUSION Ototopical medications carry a risk of ototoxicity in patients with perforated ear drums. In the present study, it was shown that nystatin, an antifungal that can be ototopically used in the treatment of otomycosis, may cause a decrease in otoacoustic emissions in rats when administered into the middle ear cavities.

Evaluation of the effect of intranasal infiltrated botulinum toxin-A on a model of allergic rhinitis in rabbits: An Experimental Study

INTRODUCTION Allergic Rhinitis (AR) effects 20-40% of the global population and its prevalance increases. Medical treatment and immunotherapy could be used in AR management. But they are not definitive solution. Medical treatment must be used a long time and has side effects. Immunotherapy cannot be applied to every patient and it also takes a long time. The aim of this study is to evaluate symptomatic and histopathological effects of intranasal infiltrated Botulinum Toxin-A (Btx-A) on an animal model of AR. MATERIAL-METHOD 15 rabbits were divided into 3 groups as control, disease and treatment. AR was formed in disease and treatment groups by intraperitoneal and intranasal ovalbumine. Allergic symptoms were observed and serum IgE levels were estimated to prove forming of AR. Btx-A was infiltrated in inferior turbinates of rabbits in treatment group. Rabbits were sacrified on 32nd day. Paranasal structures were disected and investigated histopathologically. RESULTS Serous nasal discharge and sneezing were observed after ovalbumine applying in disease and treatment groups. Serum IgE levels on 21st day were higher than 1st day and this difference was significant statistically in disease and treatment groups. Serous discharge and sneezing decreased after Btx-A infiltration in treatment group. In histopathological examination, there were significant difference between disease and treatment group in terms of some histopathological findings. CONCLUSION Considering the effect of Btx-A on AR in animal, it can be said that Btx-A can decrease symptoms and reorganize histopathological findings of AR.

Does central lymph node dissection in patients with papillary thyroid carcinoma increase morbidity rates? – a comperative study

Papillary thyroid carcinoma (PTC) is the most frequent malignant disease of the thyroid gland. One of the most prominent features of PTCs, even for microcarcinomas, is high regional lymph node metastasis (LNM) in particular in the central compartment. Lymph node metastases of PTCs have never been accepted as poor prognostic factor in most of the proposed prognostic indexes. However recent studies have shown that regional LNM were associated with more frequent disease recurrence and the presence of LNM have been described as an independent risk factor of recurrence (1-3). A deleterious impact of cervical LNM on survival has also been reported (1, 4).

A Rare Cause of Positional Dyspnea: Hypopharyngeal Hamartoma

Hypopharyngeal hamartomas are quite rare tumors that may cause nutritional or respiratory problems in neonates and infants. They may be confused with other benign laryngeal lesions. In this study a 7-month-old infant with congenital stridor and positional dyspnea caused by a hypopharyngeal hamartoma was reported with review of the literature. Hypopharyngeal hamartomas should be considered in the differential diagnosis of pathologies that cause respiratory or feeding problems in neonates or infants.

Thyroid leiomyosarcoma: presentation of two cases and review of the literature ☆

INTRODUCTION Leiomyosarcoma is a tumor which is rarely seen in the thyroid gland. The diagnosis may be difficult and the treatment is controversial. OBJECTIVE The objective of the study is to review the literature about a rare malignant disease of the thyroid gland which has high mortality. METHODS Two cases of thyroid leiomyosarcoma are presented and the previous 23 cases in the current literature are reviewed. RESULTS A total of 25 cases of thyroid leiomyosarcoma are reviewed; the most common complaint was rapidly growing anterior neck mass, and ten of the 25 patients had distant metastasis at the initial admission. Fifteen of the 25 patients died with the disease in the first 12 months after the diagnosis. CONCLUSION The differential diagnosis of thyroid leiomyosarcoma is important and should be performed with other malignancies of the gland, especially with anaplastic carcinoma. The prognosis is poor and there is no consensus regarding the treatment.

Experimental autotransplantation and cryopreservation of the thyroid gland.

The purpose of this study was to investigate the functionality of autotransplanted thyroid tissues immediately or after cryopreservation in rabbits.