Hanifi Kurtaran

Role of Helicobacter pylori in pathogenesis of upper respiratory system diseases.

Helicobacter pylori (H. pylori) is one of the frequently encountered micro-organisms in the aerodigestive tract. Although infections caused by H. pylori are this common, the exact mode of transmission has not been fully understood yet. Oral-oral, fecal-oral and gastrointestinal-oral routes are the possible modes of transmission. This infection is usually acquired in childhood and may persist for the whole life of the patient. However, about 80% of the infected humans are asymptomatic. Human stomach was considered to be the only reservoir of H. pylori until bacteria were discovered in human dental plaque, in oral lesions, in saliva, in tonsil and adenoid tissue. It is suggested that H. pylori enters the nasopharyngeal cavity by gastroesophageal reflux and colonize in the dental plaques, adenoid tissues and tonsils. From these localizations, the bacteria ascend to the middle ear and to the paranasal sinuses directly or by the reflux again and may trigger some diseases, including otitis, sinusitis, phyrangitis, laryngitis and glossitis. But still, the exact mechanism remains unclear.

Lobular capillary haemangioma of the middle turbinate

Lobular capillary haemangioma (LCH) is a benign, vascular lesion of unknown origin. It usually affects skin and mucous membranes of the oral cavity. It rarely occurs in the nose. Microtrauma and hormonal factors are considered in the aetiology. The most frequently seen symptoms of nasal LCH are epistaxis and nasal obstruction. LCH can be pedinculated or wide based. Its size ranges from several millimetres to centimetres. LCH cases secondary to postoperative use of nasal packs have been reported. Here we present an LCH which was located on the middle turbinate and occurred after the usage of nasal packing. It is known that the nose is a rare location for LCH but middle turbinate location has not been described so far in the literature. LCH should be considered in the differential diagnosis of all endonasal masses with bleeding.

Comparison of adenoidectomy methods: Examining with digital palpation vs. visualizing the placement of the curette

OBJECTIVE To evaluate the effectiveness of adenoidectomy by defining the remnant volume and localization in nasopharynx, following being satisfied with completeness of removal of the adenoid tissue with digital palpation. METHODS A prospective study conducted on 99 patients undergoing adenoidectomy+/-tonsillectomy. The main mass of the patients adenoid tissue was removed with a sharp adenoid curette without visualization and the surgeon was allowed to palpate the adenoid bed and repeat the curettage until satisfied with completeness of removal. Then nasopharynx was visualized with a laryngeal mirror for defining the anatomical localization of the residual adenoid tissue and curettage completed under indirect mirror visualization. The volumes of the adenoid tissue excised at both stages were measured. RESULTS By blunt curettage and digital palpation, only 20.2% of the patients (20) had no residual adenoid tissue. In patients who had residual adenoid tissue, the proportion of the median percentage of residual adenoid tissue to total adenoid tissue was 19.98% (range 3.22-50%). The anatomical localization of the residual adenoid tissue were, along the torus tubarius on either side of the nasopharynx in 9 (11.4%), on the pharyngeal roof near choanal openings in 64 (81%), along the torus tubarius on either side of the nasopharynx+on the pharyngeal roof near choanal openings in 5 (6.3%), and on the pharyngeal roof near choanal openings+on the posterior wall of nasopharynx in 1 (1.3%) patients. There was no difference found among surgeons in the percentage and the location of the residue left (p>0.05). CONCLUSION Digital palpation is not a dependable technique and visualization of the nasopharynx is crucial for a complete adenoidectomy.

Relationship between Retinopathy and Cognitive Impairment among Hypertensive Subjects

Background: The relationship between hypertension and cognitive impairment has been investigated in the literature; several clinical studies suggested a relationship between hypertension and retinopathy. Methods: We examined the relationship between the retinopathy status and cognitive functions by using the Mini-Mental State Examination (MMSE) among hypertensive subjects older than 40 years who were admitted to our Family Medicine, Internal Medicine and Ophthalmology clinics. The subjects were categorized into three groups: group 1 = control subjects (n = 39), group 2 = hypertensive patients without retinopathy (n = 32), and group 3 = hypertensive patients with retinopathy (n = 25). Results: The number of patients with total MMSE scores less than 24 was distributed as follows: group 1: 3 patients (7.7%), group 2: 4 patients (12.5%), and group 3: 14 patients (56%). Hypertension was found to be related with a significant decrease in total MMSE scores in comparison with group 1 subjects (p < 0.001). Furthermore, retinopathy significantly correlated with lower MMSE scores among hypertensive patients (p = 0.001). Compared with group 1, group 3 showed a significant decrease in orientation (p = 0.001), registration (p = 0.001), attention and calculation (p = 0.004), recall (p = 0.009), and total (p < 0.001) MMSE scores. We also found a significant decrease in recall (p = 0.032) and total (p = 0.034) scores in group 3 when compared with group 2. There was a significant decrease in registration (p = 0.002) and total (p = 0.029) MMSE scores in group 2 when compared with group 1. We also observed negative correlations between duration of the disease and orientation (R = –0.597, n = 32, p = 0.001), and between duration of the disease and total (R = –0.495, n = 32, p = 0.006) scores in group 2. Conclusions: Hypertension was found to be related with a decline in MMSE scores. This relation was even more significant in the group of hypertensive patients with retinopathy. Thus, we suggest that cognitive tests be routinely used in the follow-up of hypertensive patients.

Comparison of Scores of Application Methods of the Epworth Sleepiness Scale: Self Administered or Nurse Administered

Purpose of the Study: The aim of this study was to investigate the impact of two different application methods (self or nurse administered) on Epworth Sleepiness Scale (ESS) scores and compare the scores according to their correlations between polysomnographic findings. Procedures: 114 patients agreed to participate by completing the Turkish version of the ESS with 2 different methods of application, but the complete results of polysomnography (PSG) were available for 101 patients. Results: The scores of the nurse-administered ESS were clinically significantly correlated with the apnea-hypoapnea index. Scores of the self-administered ESS were not correlated with any of the demographic and PSG parameters. In the reliability analysis, the scores of the self-administered and the nurse-administered ESS were quite consistent. Conclusion and Message: We considered that to complete the ESS with the method of nurse administration could change the reliability and sensitivity. In conclusion, the ESS may be a more reliable tool for measuring the severity of excessive daytime sleepiness or obstructive sleep apnea by a change in the administration method.

Effects of a topical hemostatic agent on an epistaxis model in rabbits.

BACKGROUND Ankaferd BloodStopper (ABS) is a standardized herbal compound consisting of 5 different plant extracts. ABS, as a topical medicinal product, has been approved by the Turkish Ministry of Health for the management of dermal, external postsurgical and postdental surgery bleedings. OBJECTIVE The aim of this study was to assess the hemostatic effect of ABS in an experimental epistaxis model. METHODS Adult female New Zealand rabbits were used in this study. Standardized full-thickness mucosal wounds were created to provide bleeding on the right and left side of the nasal septum of rabbits with a 3-mm surgical punch. To stop bleeding, the wounds were treated with topical ABS on one side and with topical isotonic saline solution as a control on the other side of the nasal septum. Investigators were blinded to treatment. The duration of bleeding was measured in order to compare the hemo-static effect with ABS or topical isotonic saline solution. The wounds were observed for the duration of bleeding in order to compare the hemostatic effect of ABS with isotonic saline solution and acute adverse effects (AEs) for 30 minutes by a researcher blinded to treatment groups. RESULTS Six rabbits (mean weight, 2.6 kg [range, 2.3-3.1 kg]) were used in this study. Mean (SD) bleeding time in the wounds administered ABS (98 [17] sec) was significantly less than that of the controls (266 [36] sec; P = 0.004). No AEs were observed up to 30 minutes after study initiation. CONCLUSION This study suggests that ABS may be more effective in reducing time to hemostasis when compared with isotonic saline solution in this epistaxis model in rabbits.

Is hypertonic saline better than normal saline for allergic rhinitis in children

Editor, We have taken an interest in a recently published article in your journal by Garavello et al. (1). The authors reported that nasal hypertonic saline irrigation in symptomatic allergic rhinitis has reduced the mean daily score of allergic rhinitis. However, the use of nasal hyperosmolar saline administration is known to have some adverse effects. Hyperosmolar challenge leads to histamine release and can be used as a simple diagnostic test for allergic rhinitis and may provide a model for nasal hyper-reactivity (2). In the same study saline does not make these symptoms as hyperosmolar challenge (2). Nasal hypersaline provacation leads to substance P release and glandular secretion by means of stimulation of nociceptive nerves, so that there can be pain in patients (3). Garavello et al. have not determined their patients’ nasal pain in their study. It is necessary to take care about this adverse effect for the patients administered nasal hypertonic saline. Moreover, it is well known that hypertonic saline decreases ciliary movement in human nasal epithelium in vitro (4). We would like to bring to the attention that nasal saline washing has been used effectively in the treatment of some respiratory tract infections (5–7). Saline nose drops facilitate nasal drainage without affecting ciliary activity. In nasal irrigation the normal saline does not cause the adverse effects seen in hypertonic saline use since it is physiologic. Overall, we do believe that the controlled trials comparing the effectivenesses and the adverse effects of the normal saline and hypertonic saline use in allergic rhinitis will determine whether the hypertonic or the normal saline is superior.

Tongue abscess with actinomycosis.

Actinomycosis of the tongue is uncommon, but without proper treatment, it causes extensive tissue destruction. A mass that may mimic both benign and malignant neoplasms can be seen at clinical presentation and may mislead the diagnosis. Early diagnosis is critical but usually difficult with cultures or imaging. We report a patient who presented with a tumor-like deeply localized primary actinomycosis of the tongue with its magnetic resonance imaging findings.

Nasal saline for allergic rhinitis: an alternative treatment method

Sir, We have taken an interest in a recently published article in your journal by Unal et al (1). In their study, Unal et al. concluded that, in allergic rhinitis, injection of 40 units of botulinum toxin type A (BTX-A) was superior to injection of 2 ml of isotonic saline solution to both nasal cavities as placebo for the management of allergic symptoms. However, we think that the use of isotonic saline solution as placebo is inappropriate. Nasal washing with isotonic saline solution certainly facilitates nasal drainage and cleans the airway of any postnasal discharge; however, it is effective only when applied appropriately (2, 3). As described in the aforementioned studies, five dropperfuls of saline solution were applied to each nostril at least four times a day (2, 3). In the study of Unal et al., the inferior results obtained in the control group may have been due to saline solution not being applied using the technique described above. It is well known that irrigation with saline solution reduces levels of inflammatory mediators in nasal secretions and indirectly reinforces the clinical efficacy of other treatments for chronic rhinitis. Therefore, nasal washing with saline solution is effective against pathologies of the upper respiratory tract that occur via inflammatory mediators, namely the common cold, acute and chronic sinusitis and, in particular, chronic rhinitis (2 /6). Given all these factors, we consider that nasal washing with saline solution will be as effective as BTX-A injection if the correct technique is used. REFERENCES

Chronologic presentation of a severe case of progressive hemifacial atrophy (parry-romberg syndrome) with the loss of an eye.

Progressive hemifacial atrophy, also known as Parry-Romberg syndrome, is a slowly advancing degenerative disease that mostly affects the cutaneous, subcutaneous fatty tissue, muscle tissue, and bone structures on one side of the face. We describe the chronological progression of this very rare syndrome from early childhood until adulthood in a patient who developed severe atrophy and lost one eye. We also discuss the aetiology and pathophysiology of this syndrome.