Erol Keles

Leeches in the larynx

Abstract This is a report of four patients who inhaled leeches. They presented with severe attacks of inspiratory stridor, difficulty in breathing and spitting blood. Indirect laryngoscopy revealed a dark greenish living foreign body in the larynx in each case. Laryngoscopy was performed with local anaesthesia in two of the cases and general anaesthesia was used in the other two. The leeches were removed with forceps.

Bacteremia during tonsillectomy

OBJECTIVE To investigate bacteremia in patients who underwent tonsillectomy with a dissection method due to chronic tonsillitis, which may lead to dramatic results in patients that have a cardiovascular infection risk. In this study, it was explored whether the tonsil surface and the tonsil tissue interior microorganisms are different or not, and whether these microorganisms carry bacteremia development risk. METHODS Forty patients were enrolled in the study in ENT Clinic, Firat University. A bacteriological research was performed on patients with no treatment with antibiotics for a month before the operation. Tonsil surface and deep tissue cultures were performed, and venous blood samples were taken for cultures before and after the operation. RESULTS Surface and deep tissue cultures of tonsils of the cases represented a different result in 27.5% of the patients. No reproduction was observed regarding the blood cultures taken before tonsillectomy. Bacteremia was found in blood samples of ten patients (25%) taken immediately after tonsillectomy. CONCLUSION Hence, it has been concluded that different microorganisms may be present among the tonsil surface and tonsil deep tissue cultures and that bacteremia may develop after tonsillectomy. Therefore, to prevent the possible dramatic outcomes after tonsillectomy the required measures during the preoperative period should be taken into consideration, especially in patients that have chronic tonsillitis with cardiovascular disease.

Evaluation of long-term impacts of tonsillectomy on immune functions of children : A follow-up study

OBJECTIVE The purpose of this follow-up study was to investigate the long-term effects of tonsillectomy in comparison with their short-term results. PATIENTS AND METHODS We successfully retrieved 20 out of our previously reported 37 patients who underwent tonsillectomy in our clinic 54 months ago. The blood levels of CD3+, CD4+, CD8+, CD19+, CD25+ and CD16++56+ (cellular immunity), and IgG, IgA, IgM, C3 and C4 (humoral immunity) were determined and compared with their previously reported short-term respective values. RESULTS There were no statistically significant differences between the short-term (1 month) and long-term (54 months) values of IgA, IgG, IgM and C4 levels of the patients (P>0.05). There was a slight but statistically significant decrease in complement factor C3 value compared to its the early-stage value (P<0.05) but this was not significantly different from age-matched healthy controls (P>0.05). The levels of CD4+ and CD19+ were higher and the levels of CD16++56+ and CD25+ were lower in the late-stage (54 months) compared to their early-stage values (P<0.05). When the long-term immune parameters of the tonsillectomized patients were compared with aged-match healthy controls, there were no significant differences between the levels of immunoglobulins, complements and lymphocytes (IgA, IgG, IgM, C3, C4, CD3+, CD4+, CD8+, CD19+, CD25+, CD16++56+) (P>0.05). CONCLUSION The results of this long-term follow-up study indicate that tonsillectomy do not compromise the immune functions of children as humoral and cellular immunity of patients recovered compared to their early-stage immune status (1 month), as they have similar immune capacity compared to their age-matched healthy controls at both early- and late-stages. Although a small sample of patients enrolled, our results are of importance with respect to the reassuring in settling the widely held urban myth that tonsillectomy compromises life long immunity.

Detection of Helicobacter pylori in children with otitis media with effusion : A preliminary report

Objective: To determine the presence of Helicobacter pylori in the middle ear effusion of patients with otitis media with effusion (OME) by polymerase chain reaction (PCR).

Free radicals and scavenging enzymes in chronic tonsillitis

OBJECTIVE: This study aimed to define the relationship between chronic tonsillitis and levels of malondialdehyde and superoxide dismutase in free radical and antioxidant forms. It is suggested that free oxygen radicals may play a role in chronic tonsillitis. MATERIALS AND METHODS: One hundred twenty-four patients were enrolled in the study. Tonsillectomy was performed via the usual dissection-snare method. Venous blood was taken preoperatively and at 2 weeks postoperatively. Blood samples and tonsil specimens were evaluated for malondialdehyde and superoxide dismutase analysis. RESULTS: The levels of malondialdehyde and superoxide dismutase in plasma were compared preoperatively and postoperatively, and there were statistically significant differences between these levels (P < 0.05). In contrast, the levels of malondialdehyde and superoxide dismutase in tonsil tissue were not correlated with the plasma levels of malondialdehyde and superoxide dismutase in pretonsillectomy and posttonsillectomy terms (P > 0.05). CONCLUSION: The presence of malondialdehyde and superoxide dismutase in plasma and tonsil tissue reinforces the involvement of oxidative stress in the pathophysiology of chronic tonsillitis.

Ménière’s disease and allergy: allergens and cytokines

The aim of this article is to evaluate the role of allergy in the pathogenesis of Menieres disease by means of cytokine profiles, allergic parameters and lymphocyte subgroups. A total of 46 patients aged between 26-68 years diagnosed with Menieres disease between 1993-2002 were recruited to this study. The control group consisted of 46 healthy volunteers who were from the same age group, living in the same region and possessing similar socioeconomic indicators. Lymphocyte subgroups were measured from the peripheral blood by employing Becton Dickinson (BD) monoclonal CD4, CD8, CD23 antibodies. IFN-gamma, IL4, total IgE levels, and specific IgE levels pertaining to tree, fungus, fruit, egg-white, cows milk, wheat flour, corn flour, beef, and rice allergens, in all seasons, were measured and compared in the patient and control groups. In patient serum samples there were positive correlations between CD23 and IgE, CD8 and IgE, CD4/CD8 and IgE, and CD23 and CD8 (p <0.01). There were negative correlations between IL-4 and IFN-gamma, IFN-gamma and IgE, and a positive correlation between IL-4 and IgE. Total IgE levels were above the normal values in 19/46 (41.3 per cent) of the patient group, but the ratio was nine out of 46 (19.5 per cent) in the control group. A history of allergy was found in 31/46 (67.3 per cent) when the patients were questioned. The ratio of a history of allergy was 16/46 (34.7 per cent) in the control group. When specific IgE levels were evaluated the ratio of patients with all the panels negative was eight out of 46 (17.9 per cent), but it was 31/46 (67.3 per cent) in the control group. This study found that the prevalence of allergy was higher in patients with Menieres disease than in the control group. Thus the authors suggest that allergy should be taken into account when patients with this disease are treated.

The microbiology of ethmoid and maxillary sinuses in patients with chronic sinusitis

PURPOSE To investigate aerob-anaerob microorganisms growth in maxillary and ethmoid sinuses by evaluating aspiration materials from patients with chronic sinusitis. PATIENTS AND METHODS The study was performed prospectively, and there were 31 patients (23 men, 8 women; mean age, 31.4+/-14.15, between 18-65 years) who had endoscopic sinus surgery because of chronic sinusitis. During the operation, when the maxillary sinus ostium and ethmoid sinus were opened, readily aspirated materials from sinuses were evaluated regarding aerob and anaerob bacteria. Nose and throat swap samples were collected preoperatively to determine the upper respiratory tract flora and also to understand the relationship between the flora and the microorganisms aspirated from sinuses. RESULTS Total aerob bacteria count, which was isolated from preoperative nasal swab cultures, was 36, and aerob-anaerob bacteria count that included cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery was 42. For each 2 samples, the most common isolated aerob bacteria were coagulase (-) staphylococci. Microorganisms were isolated in 87.0% of 27 patients, in which cultures taken from maxillary and ethmoid sinuses during the functional endoscopic sinus surgery were included. It is determined that the isolated aerob bacteria rate was 90.4%, and the isolated anaerob bacteria rate was 14.2%. All of the 6 samples in which anaerob bacteria isolated were all maxillary sinus aspiration materials. Microorganisms that isolated from the nose and the sinuses were similar with the rate of 25.8%, and microorganisms that isolated from the throat cultures and sinuses were similar with the rate of 22.5%. CONCLUSIONS This study reveals the aerob and anaerob microbiology of the maxillary and ethmoid sinuses so the treatment of chronic sinusitis will be easier.

Roles of Free Radicals, Nitric Oxide, and Scavenging Enzymes in Nasal Polyp Development

The aim of this study was to investigate the role of nitric oxide (NO), free oxygen radicals, and scavenging enzymes in the development of nasal polyp (NP) disease. This study included 41 patients who underwent endoscopic surgery because of NPs. Control specimens were taken from the inferior turbinate of 32 patients who underwent septoplasty. The levels of malondialdehyde (MDA), NO, and superoxide dismutase (SOD) were measured in intraoperative specimens of polyp tissue and turbinate mucosa. The levels of tissue NO were 191.06 ± 26.62 μmol/mg of protein in patients with NPs and 145.30 ± 19.19 μmol/mg of protein (p < .001) in the control group. The levels of MDA in the study and control groups were 12.47 ± 2.12 nmol/mg and 8.83 ± 1.08 nmol/mg (p < .01), respectively. The levels of SOD in the study and control groups were 50.77 ± 14.74 U/mg and 77.93 ± 15.31 U/mg (p < .001), respectively. It was determined that the levels of MDA in plasma and erythrocytes were higher in the patients with NPs than in the control group (p < .05). The levels of NO in plasma and erythrocytes in both groups were similar. The levels of SOD in plasma and erythrocytes were lower in patients with NPs than in the control group (p > .05). Increases in the levels of tissue MDA and NO and decreases in scavenging enzymes in patients with NPs as compared to control groups may indicate the presence of free radical damage in patients with nasal NPs. New studies are needed to clarify the efficacy of using antioxidants in the treatment of NPs.

Comparison of Free Radicals and Antioxidant Enzymes in Chronic Otitis Media With and Without Tympanosclerosis

Objective/Hypothesis The pathogenesis of tympanosclerosis is unclear. The study was performed to investigate the role of nitric oxide, free oxygen radicals, and antioxidants in development of tympanosclerosis in patients with chronic otitis media.

Effects of Interferon-α-2b and Octreotide on Healing of Esophageal Corrosive Burns

Objective The aim of this study was to investigate the effect of interferon‐α to 2b and octreotide on the treatment of esophagus corrosive burns.