Salih Bakir

Deep neck space infections: a retrospective review of 173 cases

PURPOSE The purpose of this study is to review our recent experience with deep neck infections and emphasize the importance of radiologic evaluation and appropriate treatment selection in those patients. MATERIALS AND METHODS The records of 173 patients treated for deep neck infection at the Department of Otolaryngology and Head and Neck Surgery of Dicle University Hospital during the period from 2003 to 2010 were retrospectively reviewed. Their demography, symptoms, etiology, seasonal distribution, bacteriology, radiology, site of deep neck infection, durations of the hospital admission and hospital stay, treatment, complications, and outcomes were evaluated. The findings were compared to those in the available literature. RESULTS Dental infection was the most common cause of deep neck infection (48.6%). Peritonsillar infections (19.7%) and tuberculosis (6.9%) were the other most common cause. Pain, odynophagia, dysphagia, and fever were the most common presenting symptoms. Radiologic evaluation was performed on almost all of the patients (98.3%) to identify the location, extent, and character (cellulitis or abscesses) of the infections. Computed tomography was performed in 85.3% of patients. The most common involved site was the submandibular space (26.1%). In 29.5% of cases, the infection involved more than one space. All the patients were taken to intravenous antibiotic therapy. Surgical intervention was required in 95 patients (59.5%), whereas 78 patients (40.5%) were treated with intravenous antibiotic therapy alone. Life-threatening complications were developed in 13.8% of cases; 170 patients (98.3%) were discharged in stable condition. CONCLUSION Despite the wide use of antibiotics, deep neck space infections are commonly seen. Today, complications of deep neck infections are often life threatening. Although surgical drainage remains the main method of treating deep neck abscesses, conservative medical treatment are effective in selective cases.

Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty

Nasal osteotomies are the most important cause of periorbital edema and ecchymosis. Injection of lidocaine and adrenaline is recommended to reduce bleeding. Whilst the lidocaine and adrenaline combination (LAC) is claimed to reduce postoperative ecchymosis and edema, this effect remains to be proven conclusively. This study, on 48 patients, was designed to investigate the effects of LAC injection on postoperative edema/ecchymosis in rhinoplasty. LAC was applied at a random side prior to the lateral osteotomy. The opposite side was used as a control. The relationship between edema/ecchymosis and the degree of LAC on the injected and uninjected sides was evaluated on the first, third and seventh day postoperatively. The relationships between edema and ecchymosis with operation time and intraoperative systolic blood pressure were also evaluated. Bleeding was reduced on the side treated with LAC (p=0.050). The degrees of edema/ecchymosis increased with increases in the duration of operation and the systolic blood pressure on the first postoperative day for the LAC-applied side (p<0.05). This correlation was not observed on the opposite side (p>0.05). Application of LAC reduces bleeding during rhinoplasty and pain control postoperatively but reduced edema and ecchymosis should not be expected following LAC application.

Determination of trigeminocardiac reflex during rhinoplasty

In most rhinoplasty procedures, osteotomies are usually required. The osteotomy areas are innervated by sensory branches of the trigeminal nerve. The trigeminocardiac reflex (TCR) is clinically defined as the sudden onset of parasympathetic activity during stimulation of the trigeminal nerve. When an osteotomy is performed or external pressure is applied over the nasal bone, the infraorbital nerve may send signals via this nerve. The aim of this prospective study is to determine the blood pressure changes and occurrence of TCR during rhinoplasty. one hundred and eight patients were enrolled into the study. Lidocaine and adrenaline combination (LAC) was injected only into the left lateral osteotomy sites. All patients underwent median, right-side, then left-side lateral osteotomies and nasal pyramid infracture. The haemodynamic changes were recorded. A 10% or more decrease in the heart rate from baseline was considered a TCR. TCR was detected in nine patients following lateral osteotomies and nasal pyramid infracture procedures (8.3%). The authors determined that LAC injection prior to osteotomy did not prevent TCR. Manipulation at or near the infraorbital nerve during rhinoplasty may cause TCR, even if local anaesthetic infiltration is used.

The protective role of caffeic acid phenethyl ester against streptomycin ototoxicity.

OBJECTIVE The aim of this experimental study was to investigate the efficacy of caffeic acid phenethyl ester (CAPE) in the prevention of streptomycin-induced ototoxicity. MATERIALS AND METHODS Thirty-two adult Wistar albino rats were divided into 4 groups: control (n = 8), streptomycin (n = 8), CAPE (n = 8), and streptomycin + CAPE (n = 8). Rats were tested with distortion product otoacoustic emissions (DPOAEs) before drug administration. The animals in all groups were killed under general anesthesia on the 45th day following last DPOAE measurements. Hearing results were analyzed statistically to determine differences in amplitudes of DPOAE. Also, the cochleas of each rat were evaluated by histopathological and immunohistochemical examination. RESULTS Significant difference was not observed in cochlear hair cells in the control and CAPE groups. In the streptomycin group, severe degeneration of hair cells and increased apoptotic cells were observed. In the streptomycin + CAPE group, although some deteriorations were observed, hair cells were mostly preserved. The DPgram of the streptomycin and streptomycin + CAPE groups was significantly deteriorated (P < .05). The analysis of the DPgram results revealed statistically significant differences between the groups of streptomycin and streptomycin + CAPE (P < .05). CONCLUSIONS Caffeic acid phenethyl ester treatment attenuated hair cells injury in the inner ear, possibly via its antioxidant effect. Prophylactic administration of CAPE for streptomycin ototoxicity ameliorated hearing deterioration in rats.

Management of orbital complications of sinusitis in pediatric patients.

Abstract The most common reason of orbital infections is sinusitis. Orbital complications of sinusitis are mostly seen in children. Loss of vision and intracranial infections are among the complications of sinusitis. Prompt diagnosis and treatment is very important in the management of orbital complications. The orbital complication can be in the form of cellulitis or abscess. A retrospective review of 26 pediatric patients with orbital complications due to sinusitis was presented in this study. Of 26 patients, there were 13 cases of preseptal cellulitis, 2 cases of orbital cellulitis, and 11 cases of subperiosteal abscess. We grouped the preseptal and orbital cellulites in one category and the subperiosteal abscess in the other. All patients in the cellulitis group recovered by medical treatment. All the patients were treated by surgical drainage. Early diagnosis and appropriate treatment method are vital for the treatment of orbital complications secondary to sinusitis.

Evaluation of hyperactivity, attention deficit, and impulsivity before and after adenoidectomy/adenotonsillectomy surgery.

ObjectiveThe objective of this study was to determine the severity of attention deficit, hyperactivity, and impulsivity symptoms in patients with obstructive airway problems scheduled to undergo adenoidectomy or adenotonsillectomy operation. The effects of the surgical treatment on these symptoms will also be investigated in a case-control design. MethodsThis prospective study included 63 patients (29 girls, 34 boys) who were operated on at the Department of Otorhinolaryngology, Dicle University Medical School, between January 2010 and May 2011 because of obstructive symptoms caused by adenoid or adenotonsillar hypertrophy. The age range of the patients was between 4 and 13 years. The control group consisted of 33 (17 girls, 16 boys) healthy children. ResultsAmong the patients, 15 children underwent adenoidectomy because of adenoid hypertrophy; 13 patients had adenotonsillectomy because of adenotonsillar hypertrophy, and the remaining patients underwent adenotonsillectomy related with chronic or recurrent tonsillitis with adenoid hypertrophy. Based on the preoperative data, statistically significant difference was observed between the patient and control groups. The patients’ attention deficit, hyperactivity, and impulsivity symptoms preoperatively and postoperatively have shown statistically significant differences. ConclusionsAttention deficit, hyperactivity, and impulsivity symptoms were common among the children who show signs of airway obstruction due to adenotonsillar hypertrophy. Adenoidectomy or adenotonsillectomy operations were both observed to be associated with improvement in these symptoms.

The protective effect of pomegranate extract against cisplatin toxicity in rat liver and kidney tissue

Abstract Objectives: The purpose of this study was to perform a histopathological investigation, at the light microscopy level, of the protective effects of pomegranate extract in cisplatin-induced liver and kidney damage in rats. Material and methods: Twenty-eight adult male Wistar albino rats were randomly divided into four groups of seven animals: Group 1: Control; Group 2: Treated for 10 consecutive days by gavage with pomegranate juice (2 ml/kg/day); Group 3: Injected intraperitoneally with cisplatin (8 mg/kg body weight, single dose) onset of the day 5, and Group 4: Treated by gavage with pomegranate juice 10 days before and after a single injection of cisplatin onset of the day 5. After 10 days, the animals were sacrificed and their kidneys and liver tissue samples were removed from each animal after experimental procedures. Cisplatin-induced renal and hepatic toxicity and the effect of pomegranate juice were evaluated by histopatological examinations. Results: In the kidney tissue, pomegranate juice significantly ameliorated cisplatin-induced structural alterations when compared with the cisplatin alone group. But in the liver tissue, although pomegranate juice attenuated the cisplatin-induced toxicity only in two rats, significant improvement was not observed. Conclusion: In conclusion, these results demonstrate that the anti-oxidant pomegranate juice might have a protective effect against cisplatin-induced toxicity in rat kidney, but not in liver. Pomegranate juice could be beneficial as a dietary supplement in patients receiving chemotherapy medications.

The reconstruction of full-thickness ear defects including the helix using the superior pedicle postauricular chondrocutaneous flap.

AbstractThe ear is a complex structure with specific anatomical landmarks and different surface contour properties. In this article, we present the results that we obtained after reconstruction of full-thickness defects of the upper and middle third of the ear including the helix using a superior auricular artery (SAA) pedicled chondrocutaneous flap.In this study, 8 patients underwent reconstructions with postauricular SAA pedicled chondrocutaneous flaps between March 2009 and May 2011. Seven patients were male (88%), and 1 patient was female (12%). The age range was between 27 and 78 years, with a mean age of 57 years. The causes of the defects were tumor excisions in 6 patients and trauma in 2 patients. No serious postoperative complications such as wound infection, wound dehiscence, or partial or total flap loss were observed in any of the patients. A good cosmetic result was obtained with this technique with maximum preservation of the anatomical landmarks and without an effect on the vertical height or projection of the ear.In our experience, the postauricular SAA pedicled chondrocutaneous flap can be used as an appropriate alternative for the treatment of full-thickness defects of the upper and middle thirds of the ear including the helix.

Histopathologic results of long-term sildenafil administration on rat inner ear.

OBJECTIVES Sildenafil, a selective inhibitor of phosphodiesterase type 5, is widely used for the treatment of erectile dysfunction. Although cochlear effects of phosphodiesterase type 5 inhibitors remain still unclear because of inadequate data, some evidence that recently emerged indicates that these medications may be responsible for hearing impairment. In the present study, we aimed to examine the histopathologic effects of long-term sildenafil use on the cochlea in a rat model. METHODS The study was performed with adult male Wistar albino rats. The control group was fed on standard laboratory diet. The study group was applied orally with sildenafil therapy, 1.5 mg/kg once a day for 45 days. Rats were anesthetized and decapitated. Each temporal bone was dissected, and the cochleas were removed en bloc. The inner-ear biopsy specimens were examined histologically with hematoxylin and eosin and caspase 3 immunoreaction under light microscopy. RESULTS Hematoxylin and eosin staining showed no distinctive difference between the control group and the sildenafil group. With immunohistochemical examination, caspase 3 immunoreactivity was observed in the sildenafil group. In the control group, caspase 3 immunoreactivity was not observed. CONCLUSIONS The caspase 3 immunoreactivity in the sildenafil group was strongly associated with an increase in apoptotic events in the cochlea. Long-term use of sildenafil can cause hearing impairment through increased apoptosis.

Burun kanaması, anemi ve üst solunum yolunda obstrüksiyon yapan nadir bir etken, Sülükler: Üç olgu sunumu

The leech is an endoparasite for man and may cause lethal complications. In this article, we report two cases of 4 and 6-year-old who presented epistaxis due to leech infestasyon in nasopharynx and other case of 65-year-old adult with alzheimer who presented obstruction of upper respiratory tracks and anemia due to leech infestation in larynx. Especially in rural areas, it should always be borne in mind that leech might cause high mortality and morbidity due to serious complications such as anemia and obstruction of upper respiratory tracts and should be considered in evaluating the differential diagnosis of upper airway obstruction. J Clin Exp Invest 2012; 3 (3): 401-403