Murat Enoz

Upper respiratory tract involvement of sarcoidosis in the Turkish population

PRINCIPLES AND METHODS: Upper respiratory tract (URT) involvement is rare in sarcoidosis. In this descriptive study, we retrospectively evaluated the clinical and demographic features of 12 (2.19%) patients with URT involvement out of the 546 sarcoidosis patients with follow-up visits at our center within the last 40-year period. RESULTS: Out of the 546 patients, 12 (2.19%) had upper respiratory tract involvement, 5 (0.91%) had laryngeal involvement, 4 (0.73%) had sinonasal tract involvement, 2 (0.36) patients had salivary gland involvement, and 1 patient had tonsillary involvement. The number of stage 0 subjects among other sarcoidosis patients was significantly lower than that among those with URT involvement. CONCLUSIONS: URT involvement is rarely diagnosed in patients with systemic sarcoidosis. The most common site for URT involvement among the Turkish population is the larynx, followed by the sinonasal tract. EBM rating: C-4

Salivary Gland Choristoma of the Middle Ear

Choristoma is a mass of tissue histologically normal for an organ or part of the body other than the site at which it is located. A rare case of ectopic salivary gland choristoma in the middle ear is described in a 14‐year‐old girl whose only symptom was a 55 dB conductive hearing loss. The left middle ear mass appeared whitish and was located behind the intact tympanic membrane. We first suspected it to be congenital middle ear cholesteatoma. Exploratory tympanotomy, however, revealed a salivary gland choristoma that adhered tightly to the facial nerve. Differential diagnosis and treatment of this rare condition are discussed.

Obstructive Sleep Apnea Syndrome and Upper Airway Inflammation

Obstructive sleep apnea syndrome (OSAS) is associated with inflammatory processes and elevated plasma cytokines. Inflammatory processes associated with OSAS may also act as potential mediators of cardiovascular morbidity in these patients. OSAS is associated with elevated levels of C reactive protein (CRP), as a marker of inflammation and cardiovascular risk. At the inflammatory point of view, the levels of TNF-alpha, IL-6, hsCRP, adhesion molecules, monocyte chemo attractant protein-1 and resist in were markedly and significantly elevated in patients with sleep apnea than those in normal control subjects. We reviewed several recent patents and literature in English about OSAS and upper airway inflammation relation since 1966 from the Medline database.

Bacterial and fungal organisms in otitis externa patients without fungal infection risk factors in Erzurum, Turkey

AIMnTo describe the bacterial and fungal organisms in otitis externa patients without other risk factors for fungal infections.nnnSTUDY DESIGNnCross sectional cohort descriptive study.nnnMATERIALS AND METHODSnEar swabs were obtained from 362 patients aged 1 to 55 years old with clinically diagnosed otitis externa in Erzurum, Turkey, between January 2006 and April 2007, and cultured for aerobic and anaerobic bacteria and fungi, using EMB, 5% sheeps blood, chocolate agar, anaerobic blood agar plate, thioglycollate broth and sabaroud agar using standard microbiological technique to diagnose isolates.nnnRESULTSn219 cultures were positive and a total of 267 isolates were obtained. Of the isolates, 68.16% (n: 182) were aerobic or facultative bacteria, 1.12 % (3) were anaerobic bacteria, 30.71 % (82) were fungi and 17.5 % (38) were polymicrobial infections.nnnCONCLUSIONnFungal organisms especially Candida species may be isolated from ears of otitis externa patients without fungal infection risk factors such as ear self-cleaning, local antimicrobial, antifungal or corticosteroid drops or systemic antimicrobial or antifungal agents within the preceding week. Bacterial and fungal cultures may be recommended, and anti-fungal agents may be added, to treatment regimens in patients with otitis externa.

Robotic thyroidectomy using a transaxillary approach can be performed by experienced surgeons in selected surgical clinics

We read the article by Kang et al. [1] entitled RobotAssisted Endoscopic Surgery for Thyroid Cancer: Experience With the First 100 Patients with a great interest. These authors emphasized that robot-assisted endoscopic thyroid operations using a gasless transaxillary approach is a feasible, safe, and effective method for selected patients with thyroid cancer [1]. However, this robotic approach has several disadvantages. The surgeon must be experienced before performing the robotic operation. This new technique needs a da Vinci Surgical System, and its set of instruments requires excessive time. Moreover, the procedure may not be suitable for removing large thyroid tumors. Management complications due to this new technique may be require additional neck incisions and thus a longer operation time due to the narrow surgical area with transaxillary approach. Consequently, robotic thyroidectomy with a transaxillary approach is not a simple method. It can be performed by experienced surgeons in selected surgical clinics.

Organismos bacterianos e fúngicos em pacientes com otite externa sem fatores de risco para infecção fúngica em Erzurum, Turquia

OBJETIVO: Descrever fungos e bacterias presentes em pacientes com otite externa sem fator de risco para infeccoes fungicas. FORMA DE ESTUDO: Estudo descritivo de coorte transversal. MATERIAIS E METODOS: Amostras por raspagem de cotonetes (swabs) no ouvido foram obtidas de 362 pacientes com idades entre 1 e 55 anos, com diagnostico clinico de otite externa em Erzurum, Turquia, entre janeiro de 2006 e abril de 2007. Essas amostras foram cultivadas em meio de cultura, 5% de sangue de ovelha, agar chocolate, agar sangue anaerobio, banho em tioglicolato e agar Saboroud, usando tecnicas padrao de microbiologia para identificar os isolados. RESULTADOS: Obtivemos 219 culturas positivas e 267 isolados. Dos isolados, 68,16% (n: 182) eram bacterias aerobias ou facultativas, 1,12 % (3) eram bacterias anaerobias, 30,71 % (82) eram fungos e 17.5 % (38) eram germes polimicrobianos. CONCLUSAO: Fungos, especialmente especies de Candida podem ser encontradas em ouvidos de pacientes com otite externa sem fatores de risco para infeccao fungica tais como autolimpeza do ouvido, uso de antimicrobiano local, corticosteroides ou antifungicos topicos ou agentes antibacterianos e antifungicos sistemicos na semana anterior. Culturas de bacterias e fungos podem ser recomendadas, e agentes antifungicos podem ser acrescentados a esquemas de tratamento de pacientes com otite externa.

Precautions for the Prevention of Plagiarism

Se invita a los lectores a enviar cartas al Editor, con comentarios,preguntas o criticas sobre articulos que hayan sido publicados en la Revista y a las que los autoresaludidos puedan responder. Tambien seran bienvenidos los comentarios sobre problemas deactualidad biomedica, clinica, de salud publica, de etica y de educacion medica. Podraaceptarse la comunicacion preliminar de datos parciales de una investigacion en marcha, queno haya sido publicada ni sometida a publicacion en otra revista. La extension maximaaceptable es de 1.000 palabras, con un maximo de 6 referencias bibliograficas (incluyendo elarticulo que la motivo) y 1 Tabla o Figura. Se recomienda adjuntar una copia identica para PC,en diskette de 3,5’’, un espaciado a 1,5 lineas, tamano de letra 12 pt y justificada a la izquierda.Las cartas que se acepten podran ser acortadas y modificadas formalmente, por los Editores.

The incidence of group a beta hemolytic streptococci in throat specimens from upper respiratory infections.

OBJECTIVEnThe aim of the study is researching the incidence of group A beta hemolytic streptococci (GABHS) in upper respiratory tract infections in Turkey.nnnSTUDY DESIGNnThis is a descriptive study.nnnSUBJECT AND METHODSnTotally, 3964 throat swabs obtained from patients with upper respiratory tract infections were cultured for isolation of GABHS in Corlu Military Hospital, Department of Microbiology, between April 2002 and April 2004. Standard microbiological techniques were used in the screening.nnnRESULTSnIn this study, GABHS were isolated from 230 (5.80%) of 3964 patients. The rate of isolation was 79 (5.65%)/914 in 2002 year, 103 (5.55%)/1857 in 2003 year, and 48 (6.77%)/709 in 2004 year. The rate of isolation was 50 (5.47%)/914 in the spring, 21 (3.21%)/642 in the summer, 49 (5.81%)/844 in the autumn, and 110 (7.03%)/1564 in the winter.nnnCONCLUSIONnWe found that the overall incidence of GABHS in respiratory tract infections (5.80%) was lower than other studies and the incidence was the highest in the winter.

Cautery-assisted palatal stiffening operation for the treatment of obstructive sleep apnea syndrome.

The cited case report involves a proband of a family with 5 subjects in 3 generations affected by BOR syndrome. These patients have been found as affected also by dilation of the vestibules. This association has been detected also by other authors in other BOR families, suggesting a possible additional feature of inner ear malformations in BOR. Radiologic sections of the cited patient were reviewed by the attending neuroradiologist at that time (1999), and rereviewed these days, confirming the malformation. Inner ear canal was more posterior. Mistaken interpretation seems out of discussion, also because this article had been peer-reviewed prior to publication in year 2001. Riccardo D’eredita, MD Division of Pediatric Otolaryngology, Department of Otorhinolaryngology—Head and Neck Surgery, Vicenza Civil Hospital, Vicenza, Italy

Was there evidence of pre-existing taste disturbance in the five patients with postoperative abnormality?

I have read with great interest the article by Dr Li et al entitled “Taste disturbance after uvulopalatopharyngoplasty for obstructive sleep apnea” in the June 2006 issue of Otolaryngology–Head and Neck Surgery. However, this study is a retrospective longitudinal study that evaluated taste disturbance after EUPF (extended uvulopalatal flap) alone, EUPF with septomeatoplasty, and EUPF combined with midline laser glossectomy. Five patients presented with taste disturbance unrelated to the procedure with the most common disturbance to sweet tastes. Loss of sweet sense (sugar) was the most common type of taste disturbance (four patients, 80%). The incidence of taste disturbance was not different among EUPF, EUPF with septomeatoplasty, and EUPF with midline laser glossectomy groups. Was there evidence of pre-existing taste disturbance in the five patients with postoperative abnormality? Each patient must be examined with 3-drop-method gustatory function test preoperatively and postoperatively for investigation of the pre-existing taste disturbance. Murat Enoz Maresal Cakmak Military Hospital 25700, Yenisehir, Erzurum, Turkey E-mail, muratenoz@gmail.com