Microbiology of sinusitis and the predictive value of throat culture for the aetiology of sinusitis.

A prospective study of throat cultures and maxillary sinus aspirates from children with chronic sinusitis (n = 21), acute sinusitis (n = 28) or a clinical diagnosis of chronic adenoiditis (n = 41) was performed. Seventy-two bacterial pathogens were isolated from sinus aspirates from 52% of the study population. Haemophilus influenzae was most common pathogen, followed by Moraxella catarrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and group A streptococci. Quantitative throat cultures had positive predictive values of 41%, 53% and 75% for H. influenzae, Strep. pneumoniae and M. catarrhalis, respectively, while negative predictive values were 93-98%, indicating that these three pathogens do not cause sinusitis when absent from the throat.

Prevalence of human papillomavirus (HPV) DNA in larynx and lung carcinomas.

In this retrospective study, we investigated the HPV DNA occurrence in 21 laryngeal and 26 primary lung squamous cell carcinomas. Nonisotopic in situ hybridization (NISH) technique was performed with commercially available digoxigenin-labelled DNA probes for HPV screening. Subtyping for HPV subtypes 6/11, 16/18 and 31/33 was also performed. We observed HPV DNA signals in 10 (47.6%) cases of laryngeal SCC and in only 3 (11.5%) cases of lung SCC. Typing showed signals of HPV 6/11, 16/18 and 31/33 infection in 80%, 40%, 30% of the laryngeal carcinomas, respectively. In the lung, we demonstrated type 16/18 positivity in two and type 6/11 in one of the HPV-positive cases. We found a statistically significant correlation between HPV infection and tumour recurrence (p < 0.035) in laryngeal carcinomas, but not between HPV presence and tumour stage or grade in neither larynx nor lung.

Clinical importance of supratubal recess in cholesteatoma surgery.

OBJECTIVE: To determine the importance of supratubal recess in cholesteatoma surgery by presenting the clinical presentation, imaging findings, and surgical treatment methods of 66 patients with cholesteatoma. We propose that the management of supratubal recess allows the opportunity for total removal of the cholesteatoma with the prevention of recurrence. STUDY DESIGN: Retrospective review of surgical cases. SETTING: Tertiary referral center. INTERVENTIONS: Diagnostic and therapeutic procedures were performed. PATIENTS AND METHODS: We present a series of patients with involvement of supratubal recess by reviewing the operative charts of 347 patients surgically treated for aural cholesteatoma between 1990 and 1999. RESULTS: We detected the involvement of supratubal recess in 19% (n = 66) of our operations for aural cholesteatoma removal. CONCLUSION: The intent of this study is to improve the chance for a successful outcome by decreasing the rate of recurrence. The surgical approach to supratubal recess in cholesteatoma operations is emphasized with our series.

Endolymphatic sac tumor: a case report.

Papillary tumors of the temporal bone are aggressive neoplasms which may occur sporadically or as a part of von Hippel-Lindau disease. The term 'endolymphatic sac tumor' identifies the origin of these rare tumors. The clinical manifestations are sensorineural hearing loss, facial paralysis, cerebellar disorders and vertigo. The tumor is locally invasive, destructive and hypervascular exhibiting consistent imaging and histopathologic features. The treatment of choice is the total removal of the lesion although complete excision of the advanced lesion is nearly impossible due to the anatomic complexity of the endolymphatic sac and distinct patterns of extension. We present a 50-year-old male patient with endolymphatic sac tumor with left sided sensorineural hearing loss and review the literature.

Cardiotoxicity of 5-flourouracil: two case reports.

Cardiotoxicity is a rare but serious side effect of 5-flourouracil (5-FU). The cardiotoxicity incidence of 5-FU is increasing with its frequent use in chemotherapy protocols. To explain the mechanism of this cardiotoxicity, many theories have been suggested by different authors. Most commonly, coronary artery vasospasm and flouroacetate,a toxic metabolite of 5-FU, are considered responsible for the toxicity. Ischemic symptoms and signs related to 5-FU are observed during the late phase of the administration of the drug. The close and careful monitorization of all the patients, especially the ones with pre-existent coronary artery disease, during 5-FU infusion is mandatory. Because there is not a single and effective modality of treatment or prophylaxis for 5-FU cardiotoxicity, the patients should be selected carefully for 5-FU administration and 5-FU infusion should be stopped as soon as a symptom is encountered.

The effect of endoscopic sinus surgery on mucociliary activity and healing of maxillary sinus mucosa.

The aim of this study was to determine histologic findings in the maxilaarysinus mucosa by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), and ciliary activity within the nasal cavity by measuring the speed of mucociliary transport and after endoscopic sinus surgery (ESS). Thirty patients were enrolled. Thirty-eight antral mucosae of 24 24 patients were investigated according to ultrastructural changes and 6 patients were accepted as controls. At the 12th week, 12 antral nasal mucosae specimens of 8 patients were evaluated. All the specimens were taken from the medial rear wall of the antrum. The specimens were observed under a SEM and TEM. The mucociliary activity was measured within the nasal cavity by a saccharin test in all patients before the operation and after 12 weeks. Twenty people served as controls. In the specimens of the preoperative mucosa, the ciliated epithelium was heavily deciliated, interdigitation of the cell was loosened. In the samples taken 12 weeks after the operation, the ciliated cells were irregularly seen, the number of goblet cells was about the same as in the preoperative group and in the control, the number of the gland openings was higher than in the preoperative group and in the control. Also the interdigitation of the cells was enhanced. The histological and morphological features of the mucosa had improved. The period of the preoperative saccharin test was 12.15 minutes, whereas the period of the postoperative test was 9.08 minutes. The improvement was significant but both results were also significantly longer compared to the controls. These observations suggest that the histological, morphological and mucocilliary activity of the mucosa have not yet improved completely, it takes more than 12 weeks to recover, and the patients should be closely monitored in the postoperative months.