İbrahim Aladağ

Paradoxical vocal fold motion dysfunction in asthma patients.

Background and objective:  Paradoxical vocal fold motion dysfunction (PVFMD) is a disorder of the larynx characterized by adduction of the vocal cords during the respiratory cycle leading to symptoms of extrathoracic airway obstruction. PVFMD mimics asthma and patients with PVFMD (PVFMD+) are often diagnosed incorrectly as refractory asthma and receive unnecessary treatment. This study determined the prevalence of PVFMD in asthma patients and describedthe relationship between asthma and PVFMD.

The effectiveness of steroids for edema, ecchymosis, and intraoperative bleeding in rhinoplasty.

Background The aim of this study was to investigate the dose-related effectiveness of steroids on periorbital edema, ecchymosis, and intraoperative bleeding in patients who underwent open rhinoplasty with osteotomy. Methods Forty patients were divided into three groups: those in group 1 (n = 15) were given a single dose of 1-mg/kg intravenous (i.v.) methylprednisolone, those in group 2 (n = 15) were given a single dose of 3-mg/kg i.v. methylprednisolone preoperatively, and group 3 (n = 10) was the control group. Eyelid edema and periorbital soft-tissue ecchymosis were evaluated separately using a scale of 0–4. Results In groups using the steroid preoperatively, periorbital edema and ecchymosis were significantly lower compared with the control group (p < 0.05). No significant differences were seen clinically or statistically in preventing or reducing either the periorbital ecchymosis or the periorbital edema between groups 1 and 2. Also, there was no significant difference among the groups in terms of bleeding (p > 0.05). No complications with regard to the operation or steroid use were observed. Conclusion Our results support that steroids significantly decrease periorbital ecchymosis and periorbital edema in open rhinoplasty with osteotomy. Additionally, our results suggest that if the dose of steroids is adjusted according to body weight, there is no significant benefit in a single dose of 3 mg/kg of methylprednisolone over a lower dose of 1 mg/kg and there is no need for higher doses of methylprednisolone administration.

Role of oxidative stress in hearing impairment in patients with type two diabetes mellitus

OBJECTIVE Although many clinical investigations have found a relationship between hearing loss and diabetes mellitus, the pathophysiology of this effect remains controversial. To date, the mechanisms of hearing loss in diabetic patients have been explained in terms of microangiopathy, neuropathy and encephalopathy. However, many reports indicate that some diabetic complications are associated with oxidative stress related to the diabetes itself. In the present study, we hypothesised that oxidative stress may be a cause of hearing loss in diabetic patients. METHODS The study group comprised non-insulin dependent diabetic patients with no signs of microangiopathy or peripheral neuropathy. The control group comprised sex-, age- and body weight matched, non-diabetic subjects. Auditory function was evaluated using pure tone audiometry and tympanometry. Subjects with normal hearing and sensorineural hearing loss were included in the study, whereas subjects with conductive hearing loss were excluded. Both the study group (n = 63) and the control group (n = 37) were divided into subgroups based on the presence and absence of hearing loss. Oxidative stress was evaluated by measuring serum indicators of protein oxidation and lipid peroxidation, serum levels of nitric oxide and various non-enzymatic antioxidants, and the activity of various enzymatic antioxidants. RESULTS The non-insulin dependent diabetic patients had significantly higher serum levels of protein oxidation products, nitric oxide, enzymatic antioxidant activity (i.e. glutathione peroxidase and superoxide dismutase), compared with the control group (p < 0.05). When we compared the groups in relation to the presence of hearing loss, the nitric oxide level was significantly increased in the diabetic group with good hearing, compared with diabetic patients with hearing loss (p = 0.014). In the diabetic group, a clear, negative correlation was observed between serum levels of nitric oxide and vitamins C and E, and hearing impairment (r = -0.395, r = -0.318, r = -0.500, respectively). There was also a positive correlation between serum vitamin C concentrations and hearing levels in the control group (r = 0.417). CONCLUSION These results suggest that oxidative stress may play an important role in hearing impairment in diabetic patients. In this process, increased protein oxidation appears to be more important than lipid peroxidation. Nitric oxide may have a protective effect on hearing, as may some nonenzymatic antioxidants such as vitamin C and E.

The comparison of bacteremia and amount of bleeding during adenotonsillectomy

OBJECTIVE Adenoidectomies and/or tonsillectomies are among the most frequently performed otolaryngological surgical procedures.The goals of this study were to investigate the relationship between the amount of bleeding and bacteremia during adenoidectomy and/or tonsillectomy procedures. METHODS Seventy-eight patients who underwent tonsillectomy with or without adenoidectomy and adenoidectomy with or without tube insertion were included in the study. Patients with severe chronic underlying diseases (including cardiovascular disorders, renal or hepatic disease, or immunodeficiency) were excluded from study, as were those who had suffered an acute episode of respiratory infection or had received antibiotics for any reason within three weeks prior to the operation. The amount of bleeding was measured and recorded for each patient during the surgery. Preoperative blood cultures immediately after the induction of anesthesia and postoperative blood cultures 20 min after the operation were collected. RESULTS While none of the blood cultures taken preoperatively was positive for any organisms, the cultures obtained postoperatively were positive in 16 (20.5%) of 78 patients who underwent tonsillectomy with or without adenoidectomy and adenoidectomy with or without tube insertion, and bacteremia was more frequent among those with greater amount of bleeding during the surgery. CONCLUSION The results of this study suggest that although bacteremia had no clinical consequences in patients, it should be kept in mind that patients with greater amount of bleeding are at higher risk for developing bacteremia and it may produce vital results in patients at risk.

Impairment of Voice Quality in Paradoxical Vocal Fold Motion Dysfunction

OBJECTIVES/HYPOTHESIS To compare subjective and objective voice-quality parameters between asymptomatic paradoxical vocal fold motion dysfunction (PVFMD) patients and healthy individuals. STUDY DESIGN Prospective. METHODS A total number of 12 patients with PVFMD and 12 healthy control subjects had voice evaluations by means of laryngostroboscopy, acoustic analysis (jitter, shimmer, and harmonics-to-noise ratio [HNR]), aerodynamic measurements (maximum phonation time [MPT], s/z ratio), and perceptual analysis (Grade, Roughness, Breathiness, Asthenicity, and Strain Scale [GRBAS] and Voice Handicap Index-10 [VHI-10] scales). Evaluations were conducted when all the patients were asymptomatic. RESULTS False vocal cord adduction, anteroposterior constriction of the supraglottic larynx, decreased amplitude, and decreased mucosal wave were observed in the great majority of the PVFMD patients during laryngostroboscopy. Mean jitter and shimmer rates were significantly high in PVFMD patients and there was no significant difference in mean HNR between groups (P<0.05). Mean MPT was significantly long in control subjects (P<0.05) and mean s/z ratio was nearly equal between patients and control subjects. There was a statistically significant difference between groups about GRBAS and VHI-10 scales (P<0.05). CONCLUSIONS Based on the subjective and objective voice parameters, voice quality is significantly impaired in asymptomatic PVFMD patients when compared with the healthy control subjects.

Expressions of p53, cyclinD1 and histopathological features in basal cell carcinomas

BACKGROUND We planned this study to analyze probable associations between p53, cyclinD1, Ki67 and histopathological features in basal cell carcinomas (BCC). METHODS Histological differentiation types, histological growth patterns and tissue responses were analyzed in 50 cases of BCC. In immunohistochemical analysis, p53, cyclinD1 and Ki67 antibodies were investigated. P53 expression was evaluated based on a cut-off value of 25% positivity. CyclinD1 expression was graded from 0 to 3+ according to the percentage of positive nuclear staining. The percentage of positively staining cells for Ki67 was recorded. RESULTS The following significant correlations were detected. Solid infiltrative type differentiation was related to the infiltrative histological growth pattern. The rates of p53 positivity and severe fibrosis in the groups of mixed and infiltrative growth patterns were higher than others. Besides, p53-positive cases showed more severe fibrosis and had a higher mean value for Ki67 index. Epidermal p53 and cyclinD1 clones in normal epidermal areas adjacent to tumors were noticed in 42% and 52% of the cases, respectively. CONCLUSIONS P53 expression seems to be related to Ki67 index and some histopathological features of BCC, such as infiltrative histological growth pattern and probably fibrosis.

Seroprevalence of Helicobacter pylori infection in patients with chronic nonspecific pharyngitis: preliminary study.

BACKGROUND AND OBJECTIVES Chronic nonspecific pharyngitis is a chronic inflammation of the pharynx. It is found worldwide, and treatment is difficult. The underlying aetiopathogenesis is still controversial. The aim of this study was to investigate Helicobacter pylori seroprevalence in chronic nonspecific pharyngitis patients without other possible causative factors for chronic pharyngeal irritation and without H. pylori gastric mucosal infection. MATERIALS AND METHODS Forty-one patients with symptoms of chronic nonspecific pharyngitis and 30 healthy control subjects were enrolled in this prospective, controlled, clinical study. In both study and control groups, selected patients were shown to have gastric mucosa uninfected by H. pylori, as demonstrated by the 14C-urea breath test. Comprehensive otorhinolaryngological examination did not elicit any factor contributing to the chronic pharyngeal complaint. Serum H. pylori immunoglobulin G antibody titres were assayed using serum enzyme-linked immunosorbent assay. The difference between the study and control groups was analysed by the chi-square test (the likelihood ratio was used). RESULTS Thirty-two of the 41 patients (78 per cent) and 14 of the 30 control subjects (46.7 per cent) were found to be H. pylori positive. Patients with chronic nonspecific pharyngitis were found to have a significantly higher rate of H. pylori seropositivity than the control group (p = 0.016). CONCLUSION These data may be important in developing future treatment strategies for chronic nonspecific pharyngitis.

Experimentally induced acute sinusitis and efficacy of vitamin A

Conclusions. Although antibiotics are the mainstays for treatment of sinusitis, they do not specifically treat tissue damage due to free radicals. We propose that antioxidant, anti-infective, immunomodulator vitamin A may be a useful addition in the management of sinusitis. Objectives. Acute sinusitis is one of the most common diseases in humans. Vitamin A is a fat-soluble vitamin and essential for immunity, cellular differentiation, and maintenance of respiratory and gastrointestinal epithelial surfaces, growth, reproduction, and vision. The objective of this study was to investigate the therapeutic role of vitamin A on healing of acute sinusitis. Materials and methods. This was a prospective controlled animal trial. Experimental sinusitis was induced by blocking the right nose and inoculating Streptococcus pneumoniae into the right maxillary sinuses. Left maxillary sinuses were used as controls. Rabbits were divided in to two groups. At 48h after inoculation, group I received only parenteral ampicillin-sulbactam (50mg/kg), group II was treated with parenteral ampicillin-sulbactam (50mg/kg) and parenteral a dose of 100000 IU vitamin A in palmitate form. All animals were sacrificed on the 10th day. Mucosal samples were excised from the infected and control sinuses for histopathologic examination, for measurement of activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT), and for evaluation of levels of malondialdehyde (MDA) and nitric oxide (NO). Results. All the infected sinuses displayed signs of inflammation, but there was no statistically significant difference between the study and control groups. In our study, epithelial integrity as well as NO and MDA levels were better in the group receiving both antibiotic and vitamin A than the group receiving antibiotic alone. Nevertheless, SOD activity was significantly increased in the group receiving only antibiotics, compared with the control mucosal SOD activity. There was no difference between the groups as regards CAT and GSH activity.

Jab1 expression is associated with TGF-β1 signaling in chronic rhinosinusitis and nasal polyposis

Jab1, which is a fifth component of COP9 signalosome, plays an essential role in cell growth and proliferation. Jab1 is also shown to regulate transforming growth factor-beta (TGF-β) signaling in carcinoma cells. The aim of the present study was to investigate the expression and the correlation of Jab1 and TGF-β1 in chronic rhinosinusitis and nasal polyposis. Here, we show the elevated expression of Jab1 and TGF-β1 in diseased mucosa without nasal polyps and a correlation between Jab1 and TGF-β1 expression. Forty-six samples (26 patients with nasal polyps, 10 patients with chronic rhinosinusitis and 10 control subjects) were included to this study. Immunohistochemistry and Western blotting were performed for the assessment of Jab1 and TGF-β1 localization and the expression of proteins. Double staining of both proteins showed that Jab1 and TGF-β1 were colocalized in the epithelium, inflammatory cells and the vascular endothelium of nasal mucosa. There was a significant increase in the expression of TGF-β1 and Jab1 in patients without nasal polyps and a significant decrease in patients with nasal polyps compared to controls. Moreover, correlation was detected between the expression of Jab1 and TGF-β1 in chronic rhinosinusitis and nasal polyposis. Our results demonstrate that chronic rhinosinusitis is characterized by elevated expression of Jab1 and TGF-β1 compared to nasal polyposis and Jab1 may play a vital role in the pathogenesis of both chronic rhinosinusitis and nasal polyposis.

Serum leptin levels in patients with nasal polyposis

BACKGROUND Nasal polyposis is one of the most common inflammatory pathologies of the nasal cavity. The aetiopathogenetic mechanisms of nasal polyp formation are still unclear. OBJECTIVES The aim of this study was to investigate the serum leptin levels in patients with nasal polyposis. DESIGN A randomised, prospective study was performed of 28 adult patients with nasal polyposis and 22 control subjects of a similar age, sex and body mass index. RESULTS Serum leptin levels were 12.10 +/- 9.39 ng/ml in the nasal polyposis patients and 6.17 +/- 7.68 ng/ml in the controls. A significant difference (p = 0.021) was observed in the mean serum leptin levels between nasal polyposis patients and controls. CONCLUSION Serum leptin levels were found to be significantly higher in patients with nasal polyposis. Leptin, apart from its primary role in the regulation of body weight and energy expenditure, may have a role in the inflammatory response of nasal polyposis.