Derya Talas

Ultrasound-guided versus 'blind' intraparotid injections of botulinum toxin-A for the treatment of sialorrhoea in patients with Parkinson's disease.

OBJECTIVE To investigate the efficacy and safety of intraparotid botulinum toxin-A (BTX-A) injections into parotid gland using ultrasound-guided versus nonguided techniques for the treatment of sialorrhoea in patients with Parkinsons disease (PD). METHODS 15 patients with PD and sialorrhoea were included and divided into two groups. Group A patients (n=8) were injected with BTX-A using ultrasound guidance. Group B patients (n=7) were injected with BTX-A without ultrasound guidance. Saliva secretion was assessed quantitatively at baseline and at weeks 1, 4, and 12. Patients and/or caregivers also assessed the saliva secretion using visual analog scale (VAS). RESULTS All patients except one reported subjective improvement in sialorrhoea at the first week. Group A patients showed significantly higher rate of saliva reduction at the first week, whereas in Group B the reduction was not statistically significant from baseline at the first week (P>0.05). Comparisons of quantitative saliva assessments at each follow-up visit also showed that ultrasound-guided injections were superior to blind injections for saliva reduction. VAS scores showed an improvement in the mean rate of saliva secretion in each group at first week (P<0.05). Two patients suffered from dry mouth in mild severity lasting 1 month. CONCLUSION Intraparotid BTX-A injections using ultrasound guidance may be an effective, easy, and safe treatment for parkinsonian sialorrhoea.

The inhibitory effect of topical N-acetylcysteine application on myringosclerosis in perforated rat tympanic membrane

OBJECTIVE Myringosclerosis often occurs in patients in whom ventilation tube insertion and tympanoplasty procedures are performed. Recent studies have revealed a relationship between the development of myringosclerosis and oxygen-derived free radicals, and some investigations have demonstrated that free radical scavengers prevent the development of myringosclerosis. N-acetylcysteine is a well-known anti-oxidant and anti-inflammatory agent. In this study, we aimed to investigate the preventive effect of N-acetylcysteine on myringosclerosis in myringotomized rat tympanic membranes. METHODS Twenty Sprague-Dawley rats were bilaterally myringotomized and divided into four groups. Group 1 received no treatment, group 2 was treated with topical saline solution in Spongostan, group 3 received topical 0.6 mg N-acetylcysteine in Spongostan and group 4 received 1.2 mg N-acetylcysteine in Spongostan daily for 12 days. Tympanic membranes were examined by otomicroscopy on day 12. Then, the membranes were harvested and evaluated histologically by light microscopy. RESULTS The tympanic membranes of groups 1 and 2 (saline and non-treated) showed extensive occurrence of myringosclerosis, whereas groups 3 and 4 (treated with N-acetylcysteine) showed lesser occurrence of myringosclerosis in otomicroscopic evaluation (P<0.01). Under light microscopic examination, lamina propria of pars tensa was found thicker in groups 3 and 4 when compared with groups 1 and 2. There was no significant difference between groups 3 and 4 (P: 0.30). CONCLUSIONS Topically applied N-acetylcysteine was found to be effective in the prevention of sclerotic lesions in myringotomized rat tympanic membranes.

Posterior cranial fossa morphometry in symptomatic adult Chiari I malformation patients: comparative clinical and anatomical study.

BACKGROUND AND OBJECTIVES The cerebellar tonsillar herniation occurring in Chiari malformation Type I (CMI) mainly results from overcrowding of a normally developing hindbrain within a primary small posterior cranial fossa (PCF) due to an anomaly in the embryological development of the occipital bone. In the present study, the lengths of PCF parameters were studied in adult CMI patients. PATIENTS AND METHODS The authors retrospectively examined 15 adult patients with CMI. Multiple measurements were made on magnetic resonance images (MRIs). The results were compared with the findings in 25 controls and 30 dry skulls. RESULTS Length of the neural structures did not significantly differ between the CMI and the control groups. The average length of the basiocciput was significantly shorter in the CMI group as compared with the control group. The mean length of the supraocciput was significantly shorter and the average diameter of the foramen magnum was significantly longer in the CMI group when compared to the control group and dry skulls. CONCLUSIONS The morphometric data suggest that, in CMI, a hypoplastic occipital bone, possibly due to the paraxial mesodermal defect of the parachordal plate, causes overcrowding in PCF, which contains the normally developed neural structures.

Antrochoanal polyp: a transmission electron and light microscopic study

Antrochoanal polyp (ACP) is a soft tissue mass originating from the maxillary antrum, emerging from the ostium and extending to the choana through the nasal cavity. Our aim was to investigate the light microscopic and ultrastructural features of ACP and to compare these with nasal polyps originating from the middle meatus (MMP). Seven ACP and seven MMP specimens were evaluated by transmission electron microscopy (TEM) and light microscopy. TEM examination showed epithelial cells with intact cilia covering both polyps. In some MMP cases, degeneration of the epithelium associated with some cilia loss was noted. Goblet cell hyperplasia was more prominent in MMP cases. Degeneration and partial destruction of the endothelial cells of the blood vessels were common findings in ACP cases; however, in the MMP group, endothelial cells were mostly intact with a few aggregates of ribosomes, and intact cell junctions were noted. Light microscopic examination revealed that inflammatory cells in the ACP group were numerous. However, eosinophils were predominant in MMP cases. Squamous metaplasia of the surface epithelium was detected in five ACP cases, but in none of the MMP cases. Basement membrane thickening was detected in two cases of the ACP and in four cases of the MMP group. There was a statistically significant difference between the two groups for inflammatory cells, eosinophilic cell infiltration, squamous cell metaplasia, endothelial cell destruction and goblet cell metaplasia. In conclusion, the low number of eosinophils, the high number of other inflammatory cells, the normal appearing basement membrane and intact and normal surface epithelium may reveal that the etiology of ACP might arise from chronic inflammatory processes rather than allergy. The destruction of the endothelium may be considered as a further sign of chronic inflammation.

THE EFFECTS OF DEXAMETHASONE ON LIPID PEROXIDATION AND NITRIC OXIDE LEVELS ON THE HEALING OF TRACHEAL ANASTOMOSES: AN EXPERIMENTAL STUDY IN RATS

Corticosteroids are shown to have deleterious effects on wound healing for various tissues. Arginine metabolism and nitric oxide (NO) synthesis play an important role in many aspects of inflammation and wound healing. The study was designed to evaluate the relationship of dexamethasone impaired healing of tracheal anastomoses to NO metabolism and lipid peroxidation. Forty-two adult Wistar rats were randomly divided into five groups. The animals underwent tracheal transection and primary anastomoses. The groups were assigned as follows: Group I (GI) (sham, N = 6); Group II (GII) (control, N = 6); Group III (GIII), dexamethasone, 0.1 mg kg(-1) per day, intramuscularly for a week (N = 10); Group IV (GIV), dexamethasone, 1 mg kg(-1) per day, intramuscularly for a week (N = 10); Group V (GV), dexamethasone, 6 mg kg(-1) intramuscularly as a single dose (N = 10). After 7 days, bursting pressure was used to evaluate anastomotic healing. Serum nitrite/nitrate and malondialdehyde (MDA) levels were measured as an index of NO synthesis and lipid peroxidation, respectively. The bursting pressure significantly decreased in GIII and GIV when compared to the control group. The difference between GIII and GIV was also statistically significant. Nitrite/nitrate and MDA levels of GIII were found to be significantly higher than the control group. Also, the difference was found to be statistically significant between GIII and GIV in regard to nitrite/nitrate levels. The present study demonstrates that daily administration of dexamethasone for a week inhibits NO synthesis in a dose-dependent manner on tracheal anastomotic healing. Besides the generally accepted evaluation parameters including bursting pressure and hydoxyproline content; NO and MDA levels may be helpful in the assessment of wound healing especially for the investigation of impairment mechanism.

An unusual presentation of neck dermoid cyst

Congenital masses are the most common non-inflammatory neck lesions in children. Although usually present at birth, they can appear at any age. Dermoid cysts are benign lesions of congenital origin usually presenting as a midline neck mass. They rarely appear in the lateral region of the neck. Lateral cervical dermoid cyst is presented as a rare, unusual case, and differential diagnosis and management are discussed in light of recent literature.

Grisel's syndrome

Summary Atlantoaxial subluxation is a rare complication of the upper neck inflammatory processes of head and neck region. Grisels syndrome is a non-traumatic subluxation of the atlanto axial joint. It is not associated with trauma or bone disease. It typically occurs in children after serious infection in the head and neck region. Several theories have been proposed to explain the pathogenesis of inflammatory subluxation. The primary treatment of Grisels syndrome is medical. We report a case of atlantoaxial rotatory subluxation treated with external fixation and antibiotic therapy.

The effects of corticosteroids and vitamin A on the healing of tracheal anastomoses

OBJECTIVE This study investigates the deleterious effects of corticosteroids on tracheal anastomotic healing and the ability of vitamin A to reverse these effects in a rat model. METHODS Forty-two adult Wistar rats were randomly divided into five groups. The animals underwent tracheal transection and primary anastomoses. The groups were assigned as follows: Group I, sham (N=6); Group II, control (N=6); Group III, dexamethasone, 0.1 mg/kg/day intramuscularly (N=10); Group IV, dexamethasone 0.1 mg/kg/day intramuscularly+vitamin A 10000 IU/kg/day by gavages (N=10); and Group V, vitamin A 10000 IU/kg/day by gavages for a week (N=10). After 7 days, anastomotic healing was assessed by measurement of bursting pressure, hydroxyproline content and subsequent histological grading using the modified Ehrlich/Hunt scale. RESULTS Bursting pressures and hydroxyproline contents were as follows: Group I: 977+/-8 mmHg and 11.80+/-0.3 microg/mg (mean+/-standard error of the mean); Group II: 890+/-55 mmHg and 9.93+/-0.6 microg/mg; Group III: 555+/-26 mmHg and 11.90+/-1.3 microg/mg; Group IV: 873+/-73 mmHg and 10.24+/-2.2 microg/mg; Group V: 905+/-45 mmHg and 7.51+/-0.8 microg/mg, respectively. Bursting pressure of Group III was found to be significantly lower when compared to other groups (P<0.0001). However, statistical significance was not found among the study groups for the hydroxyproline content. Except for inflammatory cell infiltration, histological parameters including epithelial regeneration, fibroblast proliferation, collagen content, and angiogenesis demonstrated significant differences among the groups. CONCLUSION The present study demonstrates that dexamethasone significantly impairs the healing of tracheal anastomoses in rats and postoperative administration of vitamin A appreciably reverses this inhibitory effect. Patients receiving corticosteroids may benefit from vitamin A when undergoing prolonged intubation and laryngotracheal reconstruction.

Antrolithiasis: a retrospective study.

In this retrospective study, the computed tomography (CT) archives of paranasal sinus examinations were reviewed and three cases of antroliths are presented. The archives of paranasal sinus CT studies of 1957 patients (1023 females, 934 males, mean age 36.5 years) were surveyed. CT studies were performed using 3 mm collimation and interval in the coronal, axial or both coronal and axial planes. Three out of 1957 patients demonstrated antroliths, all in the left maxillary sinus. Associated sinusitis was detected in all three patients. Only one patient was operated. The chemical analysis of the antrolith revealed it to be a calcium oxalate stone. All the relevant literature is reviewed and only 25 other cases of true antrolithiasis were encountered. The clinical and radiological features of antroliths, as well as differential diagnosis were discussed. Antrolithiasis should be considered in any case of sinusitis, that does not respond to appropriate medical therapy.

Actinomycosis of the middle turbinate : an unusual cause of nasal obstruction

Actinomycosis is a rare chronic infectious disease caused by Actinomyces israelii, which is an anaerobic filamentous, gram-positive saprophyte organism of the oral cavity. Historically, these bacteria were known as fungi because of their light microscopic appearance. Actinomycosis consists of three different forms: cervico-facial (the most common form), abdominal and pulmonothoracic. It commonly involves the head and neck region including the mandible, paranasal sinuses, lacrimal gland, parotid gland and orbit. Poor oral hygiene and dental diseases have been known to be the source of actinomycosis. Actinomycosis is diagnosed with positive culture or detecting actinomyces colonies and sulfur granules in histopathologic specimens. The treatment of choice is surgical excision of the lesion and long-term penicillin therapy. Actinomycosis of the internal nose is extremely rare. There was only one nasal septum actinomycosis reported in the English literature, but there was no lateral nasal wall actiomycosis regarding the turbinate. Therefore, actinomycosis should not be overlooked for the differential diagnosis of intra-nasal lesions for the initiation of appropriate and early treatment.