Engin Acioglu

The effect of corticosteroid on metalloproteinase levels of nasal polyposis.

The aim of this study was to investigate the effect of corticosteroid treatment on topical and systemic metalloproteinase levels of patients with nasal polyposis (NP).

Head and neck hemangiopericytomas: diagnostic contradictions.

Purpose: To identify misdiagnostic points of hemangiopericytomas (HPs) of the head and neck. Patients and Methods: We reviewed our clinical records from 2000 to 2007 retrospectively and identified 5 patients with HP of the head and neck. The records of each patient with head and neck HP were evaluated for age, sex, location of primary, clinical course, treatment, and tumor embolization (if performed). Pathologic slides of all patients were reviewed to identify histologic features and correlation with the clinical course and outcome for each lesion. Results: Five patients with HP that arose from head and neck sites were identified. Five patients included 3 women and 2 men aged 9 to 52 years, with an average of 33.2 years. Each lesion of the patients derived from different parts of the head and neck. The most common complaints were painless mass (3 of 5) and nasal airway obstruction (3of 5). Magnetic resonance imaging of the 3 patients reflected hyperintense on T2-weighted imaging and hypointense on T1-weighted imaging with diffuse enhancement after intravenous administration of gadolinium. Angiography was performed to all these 3 patients, and only 1 patient with cranial HP involvement did not show significant vascularity. Two patients had preoperative histopathologic results. All patients were operated on with appropriate approach. Pathologic slides of all patients were investigated and graded according to the tumor diameter, cellularity, mitotic rate, and necrosis. Conclusion: Differential diagnosis of clinical features and radiologic and pathologic aspects must be managed more carefully. Diagnostic way of these tumors has different pitfalls for the clinician.

Laryngeal chondroma presenting as a laryngopyocele

The abnormal dilatation of saccules in direct communication with the laryngeal lumen is termed laryngocele. A simple laryngocele is an air-filled dilatation of the saccule and is mostly asymptomatic. When the neck of the laryngocele is obstructed, the laryngocele becomes filled with mucus. If a mucus-filled laryngocele is infected, it is called a laryngopyocele. The etiology of laryngoceles is not well understood. However, there is an association between laryngoceles and carcinoma of the supraglottic larynx. The main reasons are probably obstruction and mucosal retention of the saccule, increasing intralaryngeal pressure due to airway obstruction or abnormal contraction of the involved laryngeal muscles due to tumoral spreading. We present a patient with laryngopyocele that arose because of a laryngeal chondroma

Unilateral sudden hearing loss as the first sign of chronic myeloid leukemia

Chronic myeloid leukemia (CML) is one of the etiologic causes of sudden hearing loss and vertigo. However, deafness in association with vestibular symptoms rarely occurs in CML as the first sign. In this article, a 50-year-old male with CML whose first signs and symptoms were unilateral sudden hearing loss and tinnitus in the right ear, vertigo and nausea was presented. Aetiopathogenetic mechanisms, clinical and radiological aspects and therapeutic options for CML with deafness and vertigo were discussed reviewing the literature.

The role of matrix metalloproteinases in recurrent tonsillitis

OBJECTIVE The aim of this study was to investigate the status of matrix metalloproteinases (MMP-2, MMP-7, MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) due to dysregulated turnover of connective tissue matrices in children with recurrent tonsillitis (RT). METHODS Forty-four patients with RT were enrolled in the study. All patients with RT were graded according to the hypertrophy degree of the tonsillar tissue from grade I to grade IV. Patients with grade I tonsillar hypertrophy and grade II tonsillar hypertrophy were accepted as group A, patients with grade III tonsillar hypertrophy and grade IV tonsillar hypertrophy were accepted as group B Tonsillectomy was performed via the usual dissection-snare method. Tonsillar specimens of superficial and core region were evaluated for MMP-2, MMP-7, MMP-9 and TIMP-1 analysis. RESULTS There was no statistical significance according to the MMP-2, MMP-7, MMP-9 and TIMP-1 activity of superficial part and core regions in both groups individually, MMP-9 level of both the superficial and core regions in group B had statistical significant higher results than group A (p=0.026, p=0.06 respectively). MMP-7 level of the superficial part in group B patients also had statistical significant higher results than group A (p=0.025). However, there was no statistical difference found between superficial and core region MMP-2 and TIMP-1 levels of group A and group B. Related to this, balance between MMP-7-9 and TIMP-1 activities tended to slip MMP-7 and MMP-9 sides with increased tonsillar grade. CONCLUSIONS Results from this study suggest that the presence of MMPs in tonsil tissue consolidates the involvement of degraded extracellular matrix proteins in the pathophysiology of chronic tonsillitis. MMPs activity showed diffuse dissemination in the tonsillar tissue and especially MMP-9 and MMP-7 are the main promoters of the extracellular matrix that responded to inflammatory changes in the tonsillar tissue. Further studies are needed concerning the possible efficiency of selective MMP inhibitors on tonsillar tissue.

Tensile Characteristics of Costal and Septal Cartilages Used as Graft Materials

OBJECTIVES To determine the biomechanical characteristics of septal cartilage (SC) and costal cartilage (CC) taken from fresh cadavers using tensile testing and to establish CC graft material of a suitable thickness (ie, with tensile characteristics closest to those of SC). METHODS Grafts of varying thickness were harvested from the central part of the seventh-rib CC and SC of 18 fresh cadavers. Tensile testing was performed with a 0.5-kilonewton load calibrated at 7 mm/min. The results were shown as a force-elongation curve. RESULTS No significant difference according to tensile force was observed between the SC group and the 1.0-mm and 1.5-mm CC groups (P = .09 and P = .32, respectively). However, a significant difference was observed between the SC group and the 2.0-mm CC group (P = .04). Although the strength value of the CC group was 5.03 MPa, the modulus of elasticity was 1.33 MPa. In the SC group, the strength value was 12.42, but the modulus of elasticity was 1.39 MPa. The strength value of the SC group was higher than that of the CC group (P = .001), but the modulus of elasticity value of the CC group was higher than that of the SC group (P = .001). CONCLUSIONS From the standpoint of tensile testing for preparing columellar struts, 1.0-mm and 1.5-mm CC have similar characteristics to SC and thus can be used instead of it. However, it is important to determine the thickness of CC by considering the expected characteristics of the established material and the forces that affect the area in the nose where the graft will be placed.

Determining the Most Suitable Costal Cartilage Level for Rhinoplasty An Experimental Study

Objective. The aim of this study was to compare the biomechanical properties of septal cartilage (SC) and costal cartilage (CC) grafts harvested from different ribs and to find at which level CC has characteristics closest to SC. Study Design. Experimental cadaver study. Setting. Istanbul Training and Research Hospital. Material and Method. Cartilage grafts were harvested from the 6th, 7th, and 8th ribs and the SC of 10 fresh cadavers. Shaped cartilage grafts were subjected to a bending test. Results were measured, and the force-deflection curve was plotted. Flexural strength (σf) and flexural modulus of elasticity (Ef) were determined. Fractured surfaces were evaluated by scanning electron microscopy (SEM). Results. According to Fmax, it was determined that ribs 6, 7, and 8 have significantly more durability compared with the SC (Ps = .030, .004, and .001). With regard to deflection, there was no significant difference between the SC and the 6th and 7th ribs and between the 6th and 7th ribs (Ps = 1.000, .088, and .306), while a significant difference was found between the SC and the 8th rib (P = .001). According to σf, no differences were seen between the 6th and 7th rib (P = .782), while difference was detected between the 6th and 8th and the 7th and 8th ribs (p = .001). Similar trends were established in Ef values as in σf. These results were confirmed by SEM images. Conclusion. The 7th CC can be used as autograft because it shows similar properties to SC. However, the 6th CC is preferred if more flexibility is desired, and the 8th CC is preferred where more strength is needed.

Atypical lipomatous tumour of the head and neck region with dyspnea and dysphagia: a case report

Liposarcoma is one of the most common soft tissue sarcomas in adults. Atypical lipomatous tumour (ALT) rarely occurs in the head and neck region. Histopathologic grade of these tumours affect prognosis of this disease. The mainstay of treatment for ALT is surgical excision. In this article, a case of a huge ALT arising from the head and neck region and invading nearly entire left hemi-facial region is presented. Clinical and histopathologic features and therapeutic approaches related to this tumour are discussed reviewing the literature.

Unusual extension of the first branchial cleft anomaly

First branchial cleft is the only branchial structure that persists as the external ear canal, while all other clefts are resorbed. Incomplete obliteration and the degree of closure cause the varied types of first branchial cleft anomalies. They were classified based on the anatomical and histological features. We present an unusual type of first branchial cleft anomaly involving the external auditory canal, the middle ear and the nasopharynx through the eustachian tube.

A difficult case: sarcoidosis of the middle ear

Sarcoidosis is a common multisystemic granulomatous disorder affecting several organs and tissues. However, the respiratory tract is the region commonly involved in more than 90% of patients, and the middle ear is a direct extension of it. In spite of this, direct middle ear and/or mastoid involvement of sarcoidosis is more rarely seen. Otological involvement may mimic a number of other diseases of the ear; sarcoidosis will probably not be considered prospectively. In addition, pulmonary symptoms of the patients often go unnoticed for some time. We report a patient presenting with hearing loss and tinnitus as the primary manifestation of sarcoidosis of the ear.