Istemihan Akin

Comparison of montelukast and mometasone furoate in the prevention of recurrent nasal polyps

Background: The aim of our study was to compare the effects of montelukast and mometasone furoate nasal spray on the postoperative course of patients with nasal polyposis. Patients and methods: Fifty patients diagnosed with nasal polyposis between March 2006 and August 2007 were included in the study. All patients underwent bilateral endoscopic sphenoethmoidectomy and were randomized postoperatively into two groups. Group A (n = 25) received 10 mg montelukast per day and group B (n = 25) received 400 µg mometasone furoate nasal spray twice daily. All patients were followed up for 6 months. Sino-Nasal Outcome Test (SNOT)-22 scores, polyp grades, computerized tomography (CT) scores (Lund–Mackay), eosinophils in peripheral blood and polyp tissue were evaluated before and after surgery. Results: There was a significant reduction in SNOT-22 scores in both groups throughout the study period. There was a significant difference in the recurrence rate between both groups with a marginal advantage of mometasone furoate nasal spray. Eosinophils in peripheral blood were found to be effective on the recurrence rate (p < 0.05). Conclusions: In conclusion, both drugs seem to have a complementary action and further studies are needed to determine which patients should receive which treatment.

Effect of antioxidants on the clinical outcome of patients with nasal polyposis.

AIM To investigate the therapeutic effects of antioxidants on the clinical and biochemical outcome of patients with nasal polyposis. METHODS Thirty-four patients with nasal polyposis were divided into two groups receiving either intranasal steroid or intranasal steroid plus per-oral vitamins A, C and E and selenium. Paranasal sinus computed tomography, endoscopy, and polyp tissue and serum sampling were conducted pre- and post-therapy. Serum levels of malondialdehyde, superoxide dismutase, nitrite and myeloperoxidase and tissue levels of malondialdehyde and superoxide dismutase were measured. Group results were compared using the Mann-Whitney U test and Wilcoxon signed-rank test. RESULTS Both groups had significantly lower tissue parameters, computed tomography scores and serum malondialdehyde levels, comparing pre- versus post-treatment results. Post-treatment, the steroid plus antioxidant group had significantly lower tissue malondialdehyde levels and a greater fall in tissue and serum malondialdehyde, compared with the steroid group. CONCLUSION Serum and tissue levels of malondialdehyde (an oxidative marker) were significantly decreased by adding antioxidants to standard therapy. This is the first report of the positive effects of adding antioxidants to steroid therapy for nasal polyposis.

Effect of local use of L-carnitine after myringotomy on myringosclerosis development in rats.

OBJECTIVES This study aimed to investigate the effect of local and intraperitoneal administration of L-carnitine on the prevention of experimentally induced myringosclerosis, and to compare treatment efficiency. METHODS Twenty-four Albino-Wistar rats (48 ears) were bilaterally myringotomised and divided randomly into four groups: group one received no treatment, group two received intraperitoneal L-carnitine, group three received local L-carnitine, and group four received both intraperitoneal and local L-carnitine. On the 15th day after treatment, tympanic membranes were harvested and evaluated histopathologically for myringosclerotic plaque formation, fibroblastic proliferation, tympanic membrane thickness and new vessel formation. RESULTS The group one tympanic membranes showed extensive thickness, and the incidence of myringosclerosis and fibroblast proliferation were greater than in groups two and four. There were statistically significant differences in tympanic membrane thickness between groups three and four, and in myringosclerosis incidence and fibroblast proliferation, comparing groups two, three and four. CONCLUSION Myringosclerosis development was significantly reduced in rats receiving myringotomy plus intraperitoneal L-carnitine. Intraperitoneal L-carnitine administration prevented fibroblastic proliferation and tympanic membrane thickening (both of which cause further tympanic membrane destruction), thus reducing myringotomy-associated morbidity. Local L-carnitine administration had limited effectiveness in this experimental setting.

Early paper patching versus observation in patients with traumatic eardrum perforations: comparisons of anatomical and functional outcomes.

&NA; The purpose of this study was to compare the outcomes of patients with acute tympanic membrane perforation after spontaneous healing and paper-patching procedure. Methods: Design, Setting, and Participants In this study, we performed a retrospective chart review with a prospective follow-up in 63 patients with tympanic membrane perforations. The patients undergoing a paper-patching procedure were assigned to group 1 (n = 33), whereas the patients that healed spontaneously were included in group 2 (n = 30). Retrospective analyses of the otoscopic examination findings and audiometric test results of the groups at the sixth-week follow-up were compared. Results Eardrum healing was achieved in 90.9% of the patients in group 1 and 76.7% of the patients in group 2 at the sixth week (P > 0.05). The mean values of air conduction were significantly improved, and the air-bone gap was markedly decreased in the patients treated with paper patching, when compared with the patients in group 2 (P < 0.001). The area of perforation was found to be inversely related to the healing success. Conclusions Early intervention by paper patching, which is a readily applicable procedure, may be offered to the patients with acute perforation of the tympanic membrane, because of the slightly better closure rates and significantly higher hearing functions when compared with simple observation.

Effects of adenoid/tonsillectomy on inflammatory response in snoring children with witnessed apnoea

The aim of this study was to investigate the clinical significance of preoperative serum C‐reactive protein (CRP), interleukin‐6 (IL‐6), fetuin‐A, cystatin C, adiponectin and tumour necrosis factor‐alpha (TNF‐α) levels in children with adenoid/tonsillar hypertrophy and compare these results with postoperative values.

Vasoconstrictive and analgesic efficacy of locally infiltrated levobupivacaine in tonsillectomy patients.

OBJECTIVES The use of preincisional plain levobupivacaine, lidocaine adrenaline and saline for perioperative blood loss and postoperative analgesia in pediatric tonsillectomy patients are compared. METHODS Ninety patients were randomly assigned into one of the 3 groups to receive preincisional peritonsillar infiltration of levobupivacaine 0.25% (group LB), lidocaine-adrenaline 1% with 1:200,000 (group LA) and saline (group S) under general anesthesia. Intraoperative blood loss, pre- and postoperative hemoglobin (hb) and haematocrit (htc) values, hemostasis time, operation duration, number of cautery used (20 W, 1s) and heart rates were recorded. Pain scores in PACU, at 6th, 12th and 24th hours postoperatively and the number of the patients requiring analgesic treatment for first 24h was also recorded. RESULTS There was a 30% reduction in perioperative blood loss in group LB and 63% reduction in group LA compared to group S (39 ± 6, 21 ± 4 and 55 ± 7 ml respectively) (p<0.001). Even though all three groups have significantly lower postoperative hb and htc values with respect to preoperative levels both local anesthetic groups had significantly higher postoperative hb and htc values than saline (p<0.001). Time required for hemostasis, the number of cautery used for haemostasis and operation duration were lower in groups LB and LA with respect to group S. Pain scores of the group LB revealed a significantly lower score throughout 24h. Only 14 patients in group LB demanded additional analgesic where as all patients in the other groups had. Adding adrenaline to the local anesthetic solution showed no side effects. Also we did not happened to see any complications related to local anesthetic injections. There was no postoperative major bleeding in groups. CONCLUSION Levobupivacaine has a vasoconstrictive effect in 0.25% concentrations that may be beneficial in tonsillectomy patients and has a consistent analgesic effect.

Bilateral epithelial-myoepithelial carcinoma: an extraordinary tumor of the paranasal sinuses.

A 54-year-old woman presented with a 6-month history of swelling on the right side of her face. On physical examination she was found to have a huge mass in the right nasal cavity. Magnetic resonance images of the paranasal sinuses revealed a soft tissue mass in the right maxillary sinus and a mass was also seen in the left maxillary sinus. On histopathologic examination, the tumor had a lobular structure with infiltrating margins. Two cell types, an outer layer of myoepithelial and an inner layer of duct-like cells, were found. On immunohistochemical examination, myoepithelial cells stained positively for calponin, p63, GFAP, S-100 protein, alpha-smooth muscle actin cytokeratin-14. The tumors were resected completely and no recurrence or metastasis was found 30 months after surgery. We describe here an unusual case of epithelial-myoepithelial carcinoma (EMC) arising from the paranasal sinuses. This is the first case report in the literature describing bilateral EMC in the maxillary sinuses.

Association between XRCC3 Thr241Met polymorphism and laryngeal cancer susceptibility in Turkish population

DNA repair systems are essential for normal cell function. Genetic alterations in the DNA repair genes such as X-ray repair cross-complementing group 3 (XRCC3), can cause a change in protein activity which results in cancer susceptibility. The aim of this study was to investigate the association of XRCC3 Thr241Met single nucleotide polymorphism (SNP), smoking and alcohol consumption with the risk of laryngeal cancer in Turkish population. The frequencies of Thr241Met SNP were studied in 58 laryngeal cancer cases (SSC) and 67 healthy individuals. Genomic DNA was isolated from peripheral blood samples of both controls and laryngeal cancer cases. Thr241Met SNP was genotyped by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) method. The genotype and allele frequencies of Thr241Met polymorphism were not statistically significant between the laryngeal cancer and control groups. Carrying mutant allele was not associated with the risk of laryngeal cancer. On the other hand, smoking and chronic alcohol consumption were associated with the risk of laryngeal cancer but there is no association between Thr241Met, smoking and alcohol consumption in laryngeal cancer cases. These results indicate that Thr241Met polymorphism was not associated with the development of laryngeal cancer in Turkish population. However, it should be kept in mind that the association of a polymorphism with cancer susceptibility can differ due to several factors such as cancer type, selection criteria, ethnic differences and size of the studied population.

The Impact of Systemic and Local Administration of Ascorbic Acid on Traumatic Perforation of Tympanic Membrane and Myringosclerosis

OBJECTIVE In the present study, tympanic membranes (TM) harvested from myringotomized rats were analyzed histopathologically to compare the systemic and local effects of ascorbic acid on the development of myringosclerosis. MATERIALS AND METHODS Forty male Wistar-Albino rats weighing between 350-400 g were included in this study. Under otomicroscopic examination, a standard 2-mm myringotomy incision was made on the posteroinferior quadrant of the TM of both ears. Rats were randomized into five groups as control, topical ascorbic acid 50 mg/kg, systemic ascorbic acid 50, 100, and 200 mg/kg groups, each group containing eight rats. On the 15th day of the study, the rats were decapitated, and bullas of the rats were extracted. Sections were stained with hematoxylin-eosin and examined through light microscopy. Inflammation, distribution width of plaques, edema, and neovascularization were observed on the lamina propria. Thickness of the TM was evaluated under the microscope and scored semiquantitatively. RESULTS When intergroup comparisons of parameters related to total TM thickness were performed, differences between the control group and topical AA (ascorbic acid) or systemic treatment groups were found to be statistically significant (p<0.005). A statistically significant difference was detected among control, topical and systemic 200 mg/kg ascorbic acid groups for the edematous lamina propria (p=0.003 and p<0.05, respectively). CONCLUSION For the total TM thickness, systemic and topical ascorbic acid use was effective when compared with the control group. It has been concluded that systemic use of higher doses of (200 mg/kg) ascorbic acid is beneficial in the resolution of the edematous lamina propria.

Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) provokes oxidative stress and ischemia, which affects the central nervous system. The degeneration of neurons in the brainstem due to periodic hypoxia can be evaluated by vestibular and audiologic tests. The objective of this study is to determine brainstem damage in severe OSAS patients with the help of vestibular evoked myogenic potential (VEMP) responses. Prospective, randomize, double-blind. Research—training hospital. We compared cervical vestibular evoked myogenic potential (cVEMP) responses between severe OSAS patients and a control group. 54 patients were included and divided into the OSAS group, with severe OSAS (apnea-hypopnea index, AHI >70), and a control group with snoring without OSAS (AHI <5). Both groups underwent cVEMP. Bilateral recordings with simultaneous binaural logon stimulations were used during VEMP recordings. The existing p1n1 and n2p2 responses, p1, n1, n2, and p2 latencies and amplitudes, and p1n1 and n2p2 intervals were measured. Statistically significant differences were revealed between patients and controls for the response rate of the p1n1, n2p2 and p1n1, n2p2 amplitudes. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, or the p1n1 and n2p2 intervals. The VEMP response rate was lower in severe OSAS patients, and all amplitudes were shorter than in healthy subjects. VEMP recordings in severe OSAS subjects demonstrates abnormalities in brainstem pathways. It appears that brainstem damage in severe OSAS can be detected by cVEMP recordings.