Uzeyir Yildizoglu

Coexistence of Epstein-Barr virus and Parvovirus B19 in tonsillar tissue samples: quantitative measurement by real-time PCR.

OBJECTIVE In this study, we aimed to investigate the presence and copy number of six different viruses in tonsillar tissue samples removed surgically because of chronic recurrent tonsillitis or chronic obstructive tonsillar hypertrophy. METHODS In total, 56 tissue samples (tonsillar core) collected from 44 children and 12 adults were included in this study. The presence of viruses was investigated using a new TaqMan-based quantitative real-time PCR assay. RESULTS Of the 56 tissue samples, 67.9% (38/56) were positive for at least one of the six viruses. Epstein-Barr virus was the most frequently detected virus, being found in 53.6% (30/56), followed by human Parvovirus B19 21.4% (12/56), human adenovirus 12.5% (7/56), human Cytomegalovirus 5.4% (3/56), BK polyomavirus 1.8% (1/56), and Herpes simplex virus 1.8% (1/56). Precancerous or cancerous changes were not detected in the tonsillar tissue samples by pathologic examination, whereas lymphoid hyperplasia was observed in 24 patients. In contrast to other viruses, B19 virus was present in high copy number in tonsillar tissues. The rates of EBV and B19 virus with high copy number (>500.000 copies/ml) were higher in children than in adults, and a positive relationship was also found between the presence of EBV and the presence of B19 virus with high copy number (P=0.037). CONCLUSIONS It is previously reported that some viral agents are associated with different chronic tonsillar pathologies. In the present study, the presence of B19 virus in tonsillar core samples was investigated quantitatively for the first time, and our data suggests that EBV infections could be associated with B19 virus infections or could facilitate B19 virus replication. However, further detailed studies are needed to clarify this observation.

A case of rhinoorbital mucormycosis in a leukemic patient with a literature review from Turkey.

Mucormycosis (Zygomycosis) is a rare, invasive, opportunistic fungal infection of the paranasal sinuses, caused by a fungus of the order Mucorales. We report a case of rhinoorbital mucormycosis caused by Rhizopusoryzae in an acute lymphoblastic leukemia patient and review the 79 Mucormycosis cases reported in the last decade from Turkey. In our case, the diagnosis was made with endoscopic appearance, computerized tomography of the paranasal sinuses, and culture of the surgical materials. Following aggressive surgical debridement and parenteral amphotericin B therapy, the patient recovered completely. In Turkish literature, rhinocerebral manifestations were the most common form of the mucormycosis (64 cases), followed by pulmonary form (6 cases). The most common risk factor was hematologic malignancies (32 cases) and diabetes mellitus (32 cases), similar to those reported from the rest of the world. The etiologic agents responsible for the review cases were Rhizopus sp., Mucor spp., Rhizomucor spp., Rhizopusoryzae, Mucorcircinelloides, and Lichtheimia corymbifera. Although various treatment modalities were used, amphotericin B was the mainstay of therapy. Mortality rate was found to be 49.4% in review cases. It seems that strong clinical suspicion and early diagnosis, along with aggressive antifungal therapy and endoscopic sinus surgery, have great importance for better prognosis in mucormycosis.

EVALUATION OF THE CHANGES IN THE NASAL CAVITY DURING THE MIGRAINE ATTACK

Objectives There are some subjective symptoms involving the nasal cavity such as nasal congestion during a migraine attack. In this study, we aimed to evaluate the possible changes occurring in the nasal cavity during headache in patients with migraine. Materials and Methods Patients with migraine were studied. The control group consisted of patients with tension-type headache. The severity of the headache and accompanying complaints were assessed using visual analog scale, and the nasal mucosa was assessed through anterior rhinoscopy and endoscopy. Resistance of the nasal cavity was evaluated through anterior rhinomanometry. Data obtained during the attack periods and attack-free periods were compared. Results Twenty-five patients with migraine and 15 patients with tension-type headache were enrolled. It was found that 19 patients (76%) of the group with migraine and 5 patients of the group with tension-type headache were experiencing nasal congestion during the attack and that the differences between the groups were statistically significant (P < 0.05). The average of total nasal resistance in the patients with migraine was 0.57 ± 0.60 kPa/L/sn during migraine attacks and 0.28 ± 0.14 kPa/L/sn during attack-free periods. The average of total nasal resistance in the patients with tension-type headache was 0.32 ± 0.14 kPa/L/sn during attack periods and 0.31 ± 0.20 kPa/L/sn during attack-free periods. In the group with migraine, the change of nasal resistance between during the attack and attack-free periods was found statistically significant, whereas there was no statistically significant difference in the group with tension-type headache. Conclusions According to the results of this study, complaints regarding nasal obstruction and nasal airway resistance increase during migraine attacks. Cause-and-effect relationship between nasal obstruction and pain is not clear, and clinical trials are needed to determine the effect of nasal obstruction treatment (mucosal decongestion, etc) on the complaint of pain.

The effects of different suture materials in the nasal cavity.

OBJECTIVE To investigate the effects of different suture materials in the nasal cavity on encrustation and micro-organism colonisation. METHODS Four different suture materials were used to suture the nasal septum. The effects of suture materials on intranasal encrustation were evaluated with anterior rhinoscopy. The sutures were removed and evaluated in terms of micro-organism colonisation on the 7th and 21st post-operative days. RESULTS Monofilament sutures were found to cause less encrustation and micro-organism colonisation. There was increased late-stage encrustation if an absorbable monofilament suture remained in place for a long time. The removal of a non-absorbable monofilament suture in the early or late post-operative period made no difference in terms of micro-organism growth on the suture. CONCLUSION The material and physical characteristics of sutures placed inside the nose may indirectly affect the healing process. It may be more appropriate to use different materials depending on the length of time the suture is to remain in place.

A Middle Cranial Fossa Dermoid Cyst Treated by an Endonasal Endoscopic Approach.

Dermoid cysts are rare, benign, congenital ectodermal inclusion cysts in the skull base, comprising skin supplements surrounded by squamous epithelium. In the period of embryological development, the cysts originate from ectodermal cells left behind in the cranial region by the closure of the neural tube and are primarily located at the midline, especially in the subarachnoid spaces. These lesions are usually asymptomatic and diagnosed incidentally. When the cysts reach large sizes, they can be symptomatic due to infection, rupture, or mass effect around neurovascular tissue. The cysts typically demonstrate accurate radiological diagnostic features. In this case report, we present a rare dermoid cyst in the middle cranial fossa, treated by an endonasal endoscopic approach. The endonasal endoscopic management of appropriate middle cranial fossa is discussed as a recent advance in the extended applications of endoscopic sinus surgery.

Types of endoscopic endonasal resections for sinonasal malignancies.

AimThe aim of this study was to define the types of endoscopic endonasal resection for sinonasal malignancies according to their origin and extension. MethodsPatients who underwent endoscopic endonasal surgery for the removal of malignant tumors of the nasal passages, paranasal sinuses, and the anterior cranial base between 2003 and 2010 were included in the study. Patients’ data were collected retrospectively. Patients were grouped according to types of endoscopic tumor resection as follows: type I: en bloc resection, type II: resection of intranasal free part piecemeal and origin of tumor en bloc, type III: resection of intranasal free part and origin of tumor piecemeal with curative intent, and type IV: resection of intranasal free part and origin of tumor piecemeal with palliative intent or removal of tumor with positive margin. The follow-up period varied from 2 to 7 years (mean, 4.35 years). ResultsTwenty patients were included in the study. Five patients underwent type I, 6 patients type II, 4 patients type III, and 5 patients underwent type IV resection. No local tumor recurrence was seen after types I, II, and III resections, whereas 2 patients (10%) with the type IV resection had a local recurrence. Distant metastasis was observed in 4 patients (20%) postoperatively (1 patient in type I, 1 patient in type III, and 2 patients in type IV resection). Disease-specific death was 15% (1 case in type I and 2 cases in type IV). ConclusionClassification of endoscopic tumor resection used in the present study may help preoperative planning.

Bilateral Nasoalveolar Cyst Causing Nasal Obstruction

Nasoalveolar cysts, which originate from epithelial remnants of nasolacrimal duct, are nonodontogenic soft tissue lesions of the upper jaw. These cysts are thought to be developmental and are presented with fullness in the upper lip and nose, swelling on the palate, and sometimes nasal obstruction. Because of cosmetic problems, they are often diagnosed at an early stage. These lesions are mostly revealed unilaterally but also can be seen on both sides. In this case report, a patient who complained of nasal obstruction and then diagnosed with bilateral nasoalveolar cysts and treated by sublabial excision is presented and clinical features and treatment approaches are discussed with the review of literature.

Right statistical methods should be driven to get the right answers from research studies

As argued by Güldner et al. in “Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT)” (1), this is the first study that has found “a correlation between the incidence of free courses of the internal carotid artery or optical nerve and the degree of sphenoid pneumatization”. It is also emphasized in the discussion section that “a strong correlation between the different courses of internal carotid artery and optical nerve had been found” (1). Especially in case of challenging endoscopic vision due to massive polyposis, bleeding, extensive soft tissue, et cetera, during the sphenoid sinus surgery, the relationship of the sphenoid sinus with the optic and the carotid canal is very important in terms of complications. This study therefore warns the surgeons about the possible complications. There are a few studies that have evaluated sphenoid sinus pneumatization and internal carotid artery or optic canal course together, however, none of them have presented a statistical correlation between the free courses of the artery or optical nerve and the degree of sphenoid pneumatization (2, 3). The present study is one of them presenting no correlation between the degree of sphenoid sinus aeration and the free course of the carotid artery and the optic canal; but reporting only a significant correlation between the free course of the carotid canal and pneumatization of the anterior clinoids (R 1⁄4 0.7899, P 1⁄4 0.001) (2). It has also been noted in cadaver studies that the more pneumatized the sphenoid sinus, the more frequently the structures bulged out into the sphenoid sinus. These structures, which are existent before the sinus development, may protrude into the sinus wall in different degrees as the cavity develops or they may course freely in the sinus (2, 3). The prevalence of bulging of the surrounding structures differed according to sphenoid sinus pneumatization (3). In such studies, no correlation has been referred. We think that the main problem of the article written by Güldner et al. is an incorrect choice of statistical method. They analyzed differences between the sexes with a t-test for independent pairs. Further analyses were done by t-test for matched pairs and bivariate correlations (1). They classified the sphenoid sinus pneumatization as conchal, presellar, sellar, and postsellar types. The postsellar type was furthermore divided into types a and b (1). Thus they have five groups of the sphenoid pneumatization and these data are nominal inputs. The course of the carotid bony canal was investigated regarding two possibilities. First the smooth course in the posterior wall of the sphenoid sinus (“smooth course”) and second a distinct protrusion (“free course”) into the sphenoid sinus. The last one was defined by more than the half diameter of the carotid diameter prolonged in the pneumatized sphenoid sinus (1). So while comparing these groups, we think that the chi-square test should have been used instead of the t-test which is used for comparing continuous variables with a normal distribution (4). They stated a correlation between the incidence of the free course of the internal carotid artery or optical nerve and the degree of pneumatization, and likewise a strong correlation between the different courses of the internal carotid artery and optical nerve (1). As mentioned above, the authors stated that bivariate correlations were used for searching correlations. However, it remains unclear which test is used, either Pearson or Spearman or Kendal tau? The choice of the convenient test is important, because it may change the results and comments. Also, the convenient test should be mentioned for eliminating the suspicion of repeated wrong selection of t-test. In addition, the correlation coefficient (R) of the strong correlation should have been specified (4). In Material and Methods, a sentence confounds the reader’s mind. This sentence is “Furthermore, bony defects in the bony courses of the optical nerve and internal sphenoid artery were analyzed and defined by a bone gap of more than 0.3 mm.” We think that “internal carotid artery” should replace “internal sphenoid artery”.