Hayrettin Cengiz Alpay

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.

Thermal burn of the larynx in an adult following hot water aspiration.

Thermal burns of the intraoral area after swallowing hot beverages are common and usually result in minor injuries with no serious lesions. However, burns of the oropharynx and larynx caused by swallowing hot beverages, while rare, can be much more serious and warrant special consideration. Most reported cases of such burns involve young children; among adults, only a few cases have been reported in the literature. We report the case of an adult person approval by the Local Ethics Committee who scalded his larynx after swallowing hot water. A 43-year-old man, who had been repairing a frozen motor with hot water, inadvertently sucked some of the boiling water into his mouth and throat. He aspirated a small amount of the hot water and immediately spit out the rest because of the extreme temperature. On initial physical examination, he had first-degree burns on his lips and slight scalding of the oral floor, buccal mucosa, and soft palate. Fiberoptic examination of the larynx revealed a swollen epiglottis. The surrounding supraglottic structures, including the aryepiglottic folds, arytenoids, and false vocal cords, were erythematous and edematous. The piriform fossae were narrowed. The vocal folds were reddish with no swelling (Fig 1). The patient’s oxygen saturation was 92 percent. The initial x-ray film showed clear pulmonary fields. After his emergency admission, the patient was treated with intravenous dexamethasone sodium phosphate 1 mg/kg and sefazolin sodium 2 g/day daily and periodic cold steam inhalation, and analgesic agents were added to the management for 4 days. Repeated fiberscopic examination of the larynx demonstrated reduced swelling of the epiglottis and its surrounding structures. The patient was discharged from the hospital on the fourth day.

Evaluation of the polymorphism in the Toll-like receptor 4 (TLR4) genes of tympanosclerosis patients

OBJECTIVE Although eardrum perforations which endure etiopathogenesis for a long-time and middle ear infections are proposed for causing the tympanosclerosis (TS), tympanosclerosis emerges in some chronic otitis media (COM), some of them do not appear although a continuing COM and enduring perforation last. In this study, the effect of the molecular reasons which display genetic differences in TS formation is evaluated; our aim is to determine the Asp299Gly polymorphism frequencies in the TLR4 gene of patients with TS who have COM, and patients who do not. MATERIALS AND METHODS Patients who have undergone COM surgery, were divided into two groups of 50 persons who were selected in accordance with the fact, whether they had TS in their middle ear cavity or not during operation. 100 healthy persons who had similar demographic data, were evaluated as the control group. The DNA isolation was executed by using standard methods with peripheric blood specimen of the diseased group and control group. The Restriction Fragment Length Polymorphism method was used in determining the Asp299Gly allel in the TLR4 gene. Items of 249 bc for the wild tip (Asp) post-restriction enzyme segment wild tip (Asp) allel, and 23 bc and 196 bc post-restriction enzyme segment polymorphic allel (Gly) were obtained. RESULTS TLR4 Asp299Gly polymorphism (10%) was asserted in a total of five specimens in the diseased group with TS. TLR4 Asp299Gly polymorphism was found positive in only one (2%) of the 50 phenomenons in the group without TS. TLR4 Asp299Gly polymorphism was found positive in six (6%) of the 100 phenomenons in the control group. The positive polymorphism in phenomenons with TS was significant in accordance with statistics, when compared with the group without TS (p<0.05). However, although the polymorphism rates were higher than the rates of the control group, it was not statistically significant (p>0.05). CONCLUSION TS may not appear in many patients who had undergone middle ear infection, and had perforation for many years. The polymorphism in arteriosclerosis in the TLR4 gene which caused the inflammatory cytokines oscillation recognize the bacterial LPS, was also accused. It is engrossing to find out from the results of our study on a restricted number of patients, and on only one gene, that molecular reasons which display genetic differences can also be effective in forming TS. Serial researches of greater dimensions are required.

The effect of BMP-2, BMP-4 and BMP-6 on bone destruction of cholesteatoma presence.

OBJECTIVE The aim of our study was to investigate the relationship between the destruction of temporal bone structures, ossicular chain destruction, dissemination of cholesteatoma and the expressions of bone morphogenetic proteins (BMPs), BMP-2, BMP-4 and BMP-6 in patients with acquired cholesteatoma. MATERIAL AND METHODS This study was performed in a total of 80 patients with cholesteatoma and without cholesteatoma who had undergone surgery due to chronic otitis media. The patients were grouped as the study and the control groups. The study group comprised patients with primary acquired cholesteatoma, and the control group consisted of chronic otitis media patients without cholesteatoma. The samples were obtained from cholesteatoma tissue and the external acoustic meatus skin in study group patients and they were obtained from the external acoustic meatus skin only in control group patients. The Reverse Transcriptase Polymerase Chain Reaction method was used for the measurements of BMPs, BMP-2, BMP-4 and BMP-6 expressions. Polymerase Chain Reaction was studied by isolation of Ribonucleic Acid from the tissue samples. RESULTS When the expressions of BMP in the external acoustic meatus skin were compared between the study and the control groups, the BMPs, BMP-2 and BMP-6 were determined to have a statistically significant relation in the study group (p<0.05), but BMP-4 was not significant (p>0.05). When the expression of BMP in cholesteatoma tissue was investigated in the study group patients, the BMPs, BMP-2 and BMP-6 were determined with statistically significant positivity (p<0.05), but there was no significant positivity for BMP-4 (p>0.05). In the study group, there was no statistical significance between the expressions of BMPs, BMP-2, BMP-4 and BMP-6 in cholesteatoma tissue, in the external acoustic meatus skin, and temporal and ossicular chain destruction, and dissemination of cholesteatoma (p>0.05). A statistically significant positivity for BMPs expression in cholesteatoma tissue was determined in patients with destruction of the incus+malleus+stapes (p<0.05). CONCLUSION The expressions of BMPs, BMP-2 and BMP-6, were elevated in cholesteatoma tissue. Furthermore, the positivity of BMPs expression was statistically significant in patients with destruction of all the ossicles, and we think that this marker can be used for evaluation of the aggressiveness of cholesteatoma.

Bacteriemia during mastoidectomy and/or tympanoplasty.

OBJECTIVE: To investigate the risk of bacteriemia development during surgery in patients who underwent mastoidectomy and/or tympanoplasty for chronic otitis media. PATIENTS AND METHODS: A total of 59 patients with chronic otitis media who were undergoing tympanoplasty operation with or without mastoidectomy were enrolled in this study. Smear cultures were obtained from outer ear canal and/or middle ears of all patients before the operation. Venous blood samples were obtained before and after the operation for bacteriologic analysis. Smear cultures were also obtained from the pressure dressing material that was applied during the operation for retrieval of the outer ear canal pressure. RESULTS: There was a 13.5% difference between the outer ear canal and/or middle ear smear cultures and ear pressure dressing smear cultures of the same case. There was no growth in the blood cultures obtained before tympanoplasty in any of the involved cases, however, in 5 (8.4%) of the culture samples obtained immediately after the tympanoplasty operation, there was bacteriemia. In the pressure dressing smear cultures obtained after the operation, 11 patients had microbial growth. CONCLUSION: Risk of bacteriemia should be considered in the preoperative period for the patients undergoing mastoidectomy especially in patients with cardiovascular diseases, this is of importance for the dramatic consequences that might arise after the operation. We also think that bacteriemia is also one of the factors that influences graft success rate.

Septum perforation due to the use of Ecbalium elaterium

Ecbalium elaterium is a weedy ciliated oval shaped plant from Cucurbitacea family. The surface of the plant is covered with thorn-like hard cilia. The plant has fruits of 3–5 cm in diameter; the fruits are green in colour and get yellowish during the process of ripening. The fruits, roots, leaves and the stem of the plant have been the topic of many research studies (1). The roots and pickle-like fruits of E. elaterium have been used for medicinal purposes by the local people since ancient times. The juice of the fruit is reported to have potent cathartic, analgesic and anti-inflammatory effects (1,2). Local people widely use it for the treatment of sinusitis after diluting (2). It is also used for constipation, jaundice and as an anti-inflammatory agent (3). Dilution is thought to reduce its efficacy by 10-fold. When used without dilution, the juice of the fruit is very toxic causing oedema of the upper respiratory tract, dyspnea and headache. Moreover, the utilisation of the fruit juice without dilution is reported to cause life-threatening conditions (2,4). The utilisation of E. elaterium extract has been reported to cause acute glaucoma crisis, laryngeal oedema, sensorineural hearing loss and fatal cardiac and renal failure (2–5). The juice of the fruit exerts its cathartic, purgative and antitumoral effects by a substance called belaterin that precipitates upon waiting (6). The extract called Ecbalium is extracted from the roots and the leaves and used for dermal health; the product obtained with ethanol extraction from the roots has been used in the treatment of alopesia (3). Nasal septum perforations are well-known yet rare complications of septal surgery. Other than septum surgery, traumas, infections, neoplasia, collagen-vascular diseases and inhaled agents might result in septal perforation (7). In this article, we present a case who developed nasal perforation due to toxic effects of E. elaterium extract after using it as a nasal drop for the treatment of sinusitis without diluting, and we discuss this case together with the findings in the literature.

Chemical injury of larynx after organophosphate ingestion.

Organophosphate (OPs) compounds are important insecticides used in agriculture and are possibly the most common acute poisonings in developing countries. Accidental exposure is the main cause for mild poisonings; severe cases are mostly due to suicidal use. We here report a person who attempted suicide by ingesting OPs. Laryngeal damage subsequent to aspiration of OP is herein described and discussed. Local ethics committee approval was obtained. A 38-year-old woman presented with severe cholinergic crisis after ingestion of an unknown amount of dichlorvos in a suicide attempt. In the intensive care unit, the diagnosis of OP intoxication was based on history, and confirmed by the clinical picture and decreased serum cholinesterase. The cholinergic crisis was improved by administration of antidotes. On day 3, the patient complained of progressive dyspnea and dysphonia after removal of the endotracheal tube. Fiberoptic examination of the larynx revealed epiglottitis. The surrounding supraglottic structures, including the aryepiglottic folds and false vocal cords, were erythematous and edematous. The vocal folds were swollen but found to have normal motility (Fig 1). The patient was administered antibiotic therapy and steroid intravenously. After consultation, periodic cold steam inhalation and analgesic agents were added to the therapy for 3 days. Two weeks after discharge, the larynx was completely healed with no evidence of residual damage.

Histopathologic changes in guinea pig mastoid mucosa after topical mitomycin C application followed by mastoidectomy

PURPOSE This study was performed to investigate the histopathologic changes observed in mastoid cavity of guinea pigs after the application of mitomycin C after mastoidectomy. MATERIALS AND METHODS The study was performed on 50 guinea pigs. Unilateral (right ear) mastoidectomy was performed on all guinea pigs. Twenty-five guinea pigs were separated as study group and the remaining were separated as control group. A mitomycin C-soaked sponge was placed in the mastoid cavities of the study group and a dry sponge was placed in those of the control group. Their mastoid cavities were examined histopathologically for absorbable sponge waste, abscess formation, fibrosis, vascularization, polymorphonuclear leukocyte infiltration, edema, lymphoplasmacytic inflammatory infiltration, and granulation tissue. RESULTS Absorbable sponge waste, abscess formation, fibrosis, vascularization, edema, and lymphoplasmacytic inflammatory infiltration were not significantly different between the groups. However, polymorphonuclear leukocyte infiltration and granulation tissue were statistically different between the groups. CONCLUSION Mitomycin C can be used after mastoidectomy to decrease the granulation tissue formation in ear discharges and to prevent the discharge.