Kemal Görür

Preoperative and postoperative cardiac and clinical findings of patients with adenotonsillar hypertrophy.

OBJECTIVE Our aim was to determine if there was any detectable clinical and cardiac changes in hypertrophied adenotonsillary disease with obstructive sleep apnea syndrome and to demonstrate the curative effect of adenotonsillectomy on these patients. METHODS Thirty-three children with adenotonsillary hypertrophy and sleep related breathing disorders were included in this study group. There were 16 female and 17 male patients and the mean age was 6.9+/-2 years. Age and sex matched control group consisted of 33 children (16 female, 17 male) with a mean age of 6.3+/-2. Complete clinical and laboratory examinations were done for each patient. The results were analysed with the SPSS (statistical package for social sciences) computer program. The significance of changes was performed by means of the independent samples of one-tailed t-test. For categorical variables, chi-square analysis was performed. RESULTS According to our snoring scale, snoring was mild in six patients (18.2%), moderate in 19 patients (57.5%) and severe in eight patients (24.3%). Severe apnea was not observed in any patients, moderate apnea in ten patients (30.3%) and mild apnea was observed in 23 patients (69.7%) preoperatively. Nine patients had Grade IV tonsils, 14 patients Grade III, seven patients Grade II, three patients Grade I. Twelve patients had 3+ (obstructive) adenoids, 21 patients had 2+ adenoids. Chest X-rays showed cardiomegaly in two patients with moderate degree of apnea. Electrocardiogram results were abnormal in four patients. When we compared echocardiographic results of study and control groups, we found several significant differences (RV: 1.6+/-0.3 vs 1.4+/-0.2; P<0.05, LVEDD: 3.6+/-0.5 cm vs 3.3+/-0.4; P<0.05, IVS: 6.8+/-1.4 mm vs 6.1+/-1.1 mm; P<0.05). Also a decreased left ventricular compliance measured by prolongation of deceleration time was found in patient group (DT: 173+/-44 vs. 126+/-22 ms; P<0.001). The echocardiographic results in postoperative group were similar to control group. CONCLUSION This study illustrated that adenotonsillary disease with obstructive sleep apnea symptoms leaded to right and/or left ventricular enlargement, hypertrophy when compared with control subjects, which were recovered postoperatively.

The inhibitory effect of topical N-acetylcysteine application on myringosclerosis in perforated rat tympanic membrane

OBJECTIVE Myringosclerosis often occurs in patients in whom ventilation tube insertion and tympanoplasty procedures are performed. Recent studies have revealed a relationship between the development of myringosclerosis and oxygen-derived free radicals, and some investigations have demonstrated that free radical scavengers prevent the development of myringosclerosis. N-acetylcysteine is a well-known anti-oxidant and anti-inflammatory agent. In this study, we aimed to investigate the preventive effect of N-acetylcysteine on myringosclerosis in myringotomized rat tympanic membranes. METHODS Twenty Sprague-Dawley rats were bilaterally myringotomized and divided into four groups. Group 1 received no treatment, group 2 was treated with topical saline solution in Spongostan, group 3 received topical 0.6 mg N-acetylcysteine in Spongostan and group 4 received 1.2 mg N-acetylcysteine in Spongostan daily for 12 days. Tympanic membranes were examined by otomicroscopy on day 12. Then, the membranes were harvested and evaluated histologically by light microscopy. RESULTS The tympanic membranes of groups 1 and 2 (saline and non-treated) showed extensive occurrence of myringosclerosis, whereas groups 3 and 4 (treated with N-acetylcysteine) showed lesser occurrence of myringosclerosis in otomicroscopic evaluation (P<0.01). Under light microscopic examination, lamina propria of pars tensa was found thicker in groups 3 and 4 when compared with groups 1 and 2. There was no significant difference between groups 3 and 4 (P: 0.30). CONCLUSIONS Topically applied N-acetylcysteine was found to be effective in the prevention of sclerotic lesions in myringotomized rat tympanic membranes.

Antrochoanal polyp: a transmission electron and light microscopic study

Antrochoanal polyp (ACP) is a soft tissue mass originating from the maxillary antrum, emerging from the ostium and extending to the choana through the nasal cavity. Our aim was to investigate the light microscopic and ultrastructural features of ACP and to compare these with nasal polyps originating from the middle meatus (MMP). Seven ACP and seven MMP specimens were evaluated by transmission electron microscopy (TEM) and light microscopy. TEM examination showed epithelial cells with intact cilia covering both polyps. In some MMP cases, degeneration of the epithelium associated with some cilia loss was noted. Goblet cell hyperplasia was more prominent in MMP cases. Degeneration and partial destruction of the endothelial cells of the blood vessels were common findings in ACP cases; however, in the MMP group, endothelial cells were mostly intact with a few aggregates of ribosomes, and intact cell junctions were noted. Light microscopic examination revealed that inflammatory cells in the ACP group were numerous. However, eosinophils were predominant in MMP cases. Squamous metaplasia of the surface epithelium was detected in five ACP cases, but in none of the MMP cases. Basement membrane thickening was detected in two cases of the ACP and in four cases of the MMP group. There was a statistically significant difference between the two groups for inflammatory cells, eosinophilic cell infiltration, squamous cell metaplasia, endothelial cell destruction and goblet cell metaplasia. In conclusion, the low number of eosinophils, the high number of other inflammatory cells, the normal appearing basement membrane and intact and normal surface epithelium may reveal that the etiology of ACP might arise from chronic inflammatory processes rather than allergy. The destruction of the endothelium may be considered as a further sign of chronic inflammation.

The effect of L-carnitine on the prevention of experimentally induced myringosclerosis in rats

The objective of this study was to investigate the possible effect of L-carnitine on the prevention of experimentally induced myringosclerosis. Twenty Sprague-Dawley rats were bilaterally myringotomized. The rats were divided into two groups randomly: group 1 which were intraperitoneally administered saline and group 2 which were intraperitoneally administered L-carnitine. Blood samples were collected for biochemical evaluation and the tympanic membranes were harvested after 28 days. Histopathological and immunohistochemical evaluation were done under light microscopy. The mean malondialdehyde levels were 3.9+/-0.9 in group 2, and 7.9+/-1.1 in group 1 (P<0.001), nitric oxide levels were 25.6+/-6.4 in group 2 and 30.8+/-8.2 in group 1 (P=0.14) and acetylcholinesterase was 1035+/-60 in group 2 and 678+/-35 in group 1 (P=0.001). Myringosclerosis was more frequent and severe in group 1 than group 2 (P<0.007). Immunoreactivity was seen in 16 of 20 tympanic membranes in group 2 and six of 20 tympanic membranes in group 1 (P=0.005). We conclude that L-carnitine diminishes the occurrence of myringosclerosis in rats after myringotomy possibly by antioxidant activity and decreasing the formation of reactive oxygen species.

An unusual presentation of neck dermoid cyst

Congenital masses are the most common non-inflammatory neck lesions in children. Although usually present at birth, they can appear at any age. Dermoid cysts are benign lesions of congenital origin usually presenting as a midline neck mass. They rarely appear in the lateral region of the neck. Lateral cervical dermoid cyst is presented as a rare, unusual case, and differential diagnosis and management are discussed in light of recent literature.

The anti-oxidant and anti-apoptotic activities of selenium in the prevention of myringosclerosis in rats

The possible effect of selenium on the prevention or reduction in occurrence of myringosclerosis was investigated. Fifteen rats were myringotomized bilaterally and separated into two groups. Nine rats were treated with selenium in the study group. Six rats were administered physiological serum and formed the control group. The occurrence of myringosclerotic lesions and anti-apoptotic activity in the tympanic membranes of the two groups were compared otomicroscopically and histopathologically. The sclerosis was occasional in three, moderate in five and severe in three tympanic membranes in the control group. On the other hand sclerosis was observed in only two of 18 specimens in the study group and sclerosis was seen only occasionally in these two sections. Although Bcl-2 staining, which indicates apoptosis, was not statistically different between the groups, it was observed that apoptosis was slightly more apparent in the study group (eight of 18 tympanic membranes versus two of 12 tympanic membranes in the control group). In conclusion, the formation of myringosclerosis following myringtomoy in rats can be reduced by intraperitoneal selenium administration.

Ringer-Lactate solution versus isotonic saline solution on mucociliary function after nasal septal surgery

Irrigation with isotonic saline is one of the most frequently used solutions after nasal surgery. However, the effect of saline solutions on mucociliary clearance is not well known. In a previous study, it was found that isotonic saline solution had a negative effect on ciliary beat frequency but Ringer-Locke solution had no effect in vitro. In this study we compared the effects of Ringer-Lactate solution and isotonic saline solution on mucociliary transport time before, and after, nasal septal surgery in patients with nasal septal deviation. We found that patients who used Ringer-Lactate solution as irrigation after surgery had a significantly better mucociliary transport time than the patients using isotonic saline solution (p < 0.05). In conclusion, it is better to use Ringer-Lactate solution instead of 0.9 per cent saline solution for nasal irrigation.

Actinomycosis of the middle turbinate : an unusual cause of nasal obstruction

Actinomycosis is a rare chronic infectious disease caused by Actinomyces israelii, which is an anaerobic filamentous, gram-positive saprophyte organism of the oral cavity. Historically, these bacteria were known as fungi because of their light microscopic appearance. Actinomycosis consists of three different forms: cervico-facial (the most common form), abdominal and pulmonothoracic. It commonly involves the head and neck region including the mandible, paranasal sinuses, lacrimal gland, parotid gland and orbit. Poor oral hygiene and dental diseases have been known to be the source of actinomycosis. Actinomycosis is diagnosed with positive culture or detecting actinomyces colonies and sulfur granules in histopathologic specimens. The treatment of choice is surgical excision of the lesion and long-term penicillin therapy. Actinomycosis of the internal nose is extremely rare. There was only one nasal septum actinomycosis reported in the English literature, but there was no lateral nasal wall actiomycosis regarding the turbinate. Therefore, actinomycosis should not be overlooked for the differential diagnosis of intra-nasal lesions for the initiation of appropriate and early treatment.

Does Helicobacter pylori play a role in the development of chronic adenotonsillitis

OBJECTIVE Evaluation of the possible relationship between chronic adenotonsillitis and Helicobacter pylori (HP). PATIENTS AND METHODS The study was performed prospectively on 91 pediatric patients who underwent tonsillectomy, adenoidectomy or adenotonsillectomy due to chronic tonsillitis and/or adenoiditis. The adenotonsillectomy specimens were examined for HP colonization by rapid urease test (RUT) and immunohistochemical evaluation. Before surgery, anti-HP IgG and IgA antibody titers were detected by enzyme linked immunosorbent assay (ELISA) test in venous blood samples of the patients. RESULTS The RUT was positive in only two of the adenoidectomy specimens (2.2%) and in none of the tonsillectomy specimens. A positive result was not detected in any tonsillectomy specimens using immunohistochemical examination. Serum IgG antibody was positive in 21 (23%) patients, IgA antibody was detected in 7 (7.69%) patients and both tests were positive only in 3 (3.29%) patients. CONCLUSION The results of this study suggested that HP would not colonize in tonsil tissue of patients with chronic tonsillitis.

Has cerumen a protective role in recurrent external otitis

PURPOSE We investigated the bactericidal activity of the cerumen in patients with recurrent otitis externa. MATERIALS AND METHODS Cerumen samples were collected from 2 groups. Group A (n = 20) consisted of patients with recurrent otitis externa (2 or more acute otitis externa attack in the current year) and group B (n = 30) consisted of cerumen from a healthy population. We examined the bactericidal activity against the common microorganisms (Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Enterococcus) that encounter the recurrent otitis externa. RESULTS A significant decrease in the count of S epidermidis was observed in group A (P <.05) and B (P <.01) was observed. A comparison of decreases and increases in the percentages of microorganisms between the groups A and B showed that there was a significant difference only in the count of E coli (P <or=.05). The count of E coli decreased in cerumen suspension in group A, but it increased in the normal population. CONCLUSION We did not confirm that cerumen from patients with recurrent otitis externa had less bactericidal activity than from a healthy population.