Comparative efficacy of topical lidocaine, tetracaine, and articaine for post-tonsillectomy pain management in children: a prospective, placebo-controlled study.

BACKGROUND: The most important problem in tonsillectomy is pain in the early postoperative period. OBJECTIVE: We purposed to compare the effects of lidocaine, tetracaine, and articaine application to the peritonsillar bed on post-tonsillectomy pain in children. METHODS: The prospective, placebo-controlled study included 80 patients, ages 3-14, who were scheduled for elective tonsillectomy. Patients were randomly divided into four groups. Group 1 received 0.9% NaCl; group 2 received 2% lidocaine; group 3 received 2% tetracaine; and group 4 received 4% articaine to the tonsillary bed for 5 min just after the operation. All patients were evaluated in terms of pain and pain-related adverse events in the postoperative 24 h. RESULTS: All groups that used local anesthetics had significantly lower pain levels than the control group in the first eight hours (p < .001). Furthermore, the articaine group had a lower pain score than the tetracaine group at the eighth hour (p < .05). The articaine group had a lower pain score at the 16th hour than both the control and tetracaine groups (p < .05). There was no significant difference between the groups at the 24th hour (p > .05). CONCLUSION AND SIGNIFICANCE: We recommend the immediate application of topical articaine to the tonsillar bed following the procedure to enhance postoperative pain management.

Predictive role of trigeminal ganglion ischemia on scalp survival affected by temporal artery diameters: The first experimental study.

Scalp arteries are mainly innervated by trigeminal, facial, and vagal nerves. The ischemic neurodegeneration of the trigeminal ganglion can impede scalp circulation via vasospasm-creating effects. This study was designed to investigate whether there is any link between the vasospasm index of deep temporal arteries and ischemic neuron densities of the trigeminal ganglion after subarachnoid hemorrhage. The study subjects included five normal control rabbits, six sham rabbits, and nine rabbits chosen from a formerly established experimental subarachnoid hemorrhage group created by cisternal homologous blood injection (0.75 mL). These rabbits, all male, were followed up for 3 weeks. The trigeminal ganglion and deep temporal artery vasospasm indexes were examined by stereological methods. Ischemic neuron densities of the trigeminal ganglion and vasospasm index values of deep temporal arteries were compared statistically. Postmortem examinations showed important vasospasms of deep temporal arteries, foramen magnum herniations, and neurodegeneration of the trigeminal ganglion. The mean vasospasm index values and degenerated neuron densities of the trigeminal ganglion were determined as 1.03 ± 0.13 and 10 ± 3/mm3 (p > 0.5) in the control group, 1.21 ± 0.18 and 35 ± 9/mm3 in the sham group (p < 0.005 for sham vs. control), and 2.54 ± 0.84 and 698 ± 134/mm3 in the experimental group (p < 0.0005 for sham vs. control and p < 0.00001 for study vs. control). There was an inverse relationship between the vasospasm index values and the degenerated neuronal density of the trigeminal ganglion. The high degenerated neuron density in the trigeminal ganglion had a facilitative effect on temporal artery vasospasm. Trigeminal ganglion neurodegeneration may promote temporal artery vasospasms after subarachnoid hemorrhage, which has not been previously mentioned in the literature.

An antihypertensive agent benidipine is an effective neuroprotective and antiepileptic agent: an experimental rat study.

BACKGROUND: Benidipine is an L, N and T type calcium channel blocker drug that is widely used as an antihypertensive drug. OBJECTIVE: For the first time in the literature, it was aimed to investigate the effectiveness of benidipine in controlling epileptic seizure and preventing the development of neurodegeneration in epilepsy. METHODS: An experimentally epilepsy model was produced with pentylenetetrazole, and rats were divided into seven groups, in different benidipine treatment doses or with valproic acid combinations. The epileptic activities of all rats were recorded according to the Fisher&Kittner classification. Biochemical parameters, histopathological Caspase-3 activity, Wyler hippocampal sclerosis, gliosis and neuronal degenerations were investigated. RESULTS: It was found that in the post-hoc analysis of epileptic activities, there was a similar antiepileptic scores among the treatment groups. IL-1 level was found to be significantly lower in the benidipine 4 mg/kg group, and TNF-alpha was lower in the group given valproic acid+benidipine 2 mg/kg (p<0.05). The other biochemical parameters were not found to be significant. Neural degeneration levels in the brain tissues were statistically significant (p<0.001). Compared with the healthy group, the most neural degeneration was in the control group, the least neural degeneration was in the valproic acid+benidipine 4 mg/kg group. CONCLUSIONS: For the first time in the literature, benidipine, alone or combined with valproic acid, were found to have a statistically significant antiepileptic efficacy, and provided neuroprotection when combined with valproic acid. Benidipine will be a promising agent in the treatment of epilepsy with its antiepileptic and neuroprotective effects.

Effects of Nasal and Paranasal Sinus Variations on Chronic Otitis Media Development in Pediatric Patients.

OBJECTIVE: Chronic otitis media is an inflammatory disease of the middle ear. The airflow in the nasal passage affects the development of mastoid air cells through the eustachian tube.Nasal and paranasal pathologies and their anatomical variations cause chronic sinonasal inflammation and affect the middle ear mucosa. This study aims to reveal whether the nasal and paranasal sinus variations in pediatric patients are a factor in developing chronic otitis media. MATERIALS AND METHODS: Eighty patients, with unilateral chronic otitis media, who were admitted to the otorhinolaryngology clinic between May 2015 and July 2019, were included in this retrospective study. The control group (Group 2) consisted of a total of 51 patients. None of the patients in Group 2 had otorrhea history and no signs of chronic otitis in their otoscopic examination, middle ear pathologies. The patient's anatomical variations of the nasal cavity and sinuses were evaluated with CT by a radiologist Results: Nasal septum deviation was found to be 53% in children with chronic otitis media. It was found 31.4% in the control group. Since the P value was found to be .04, this rate was considered as significant. Inferior concha hypertrophy was found to be 17.6% in the control group and 38.8% in the group with chronic otitis media, and this rate was considered significant since the P value was .035 Conclusion: We detected that septum deviation and inferior concha hypertrophy increased chronic otitis media formation in children. All these studies show that cases causing nasal obstruction, such as septum deviation, have a negative effect on middle ear pressure and increase the rate of ear diseases.

The Role of Manganese, Cadmium, Chromium and Selenium on Subjective Tinnitus.

Elevated levels of heavy metals like cadmium (Cd) and manganese (Mn) are known to lead to oxidative damage-related oto-toxicity and decreased levels of chromium (Cr) and selenium (Se) are known to lead to oto-toxicity due to reduced anti-oxidant activity. The aim of the present study was to evaluate serum levels of Cd, Mn, Cr, and Se and their relationship with tinnitus. A total of 48 patients with tinnitus (Group 1) and 40 healthy controls (Group 2) were included in the study. All participants were applied audiology tests. Severity of tinnitus was measured with Tinnitus Severity Index Questionnaire (TSIQ) in group 1. Serum Mn, Cd, Cr, and Se measurements were done by using The Agilent ICP-MS system consisted of a 7700 coupled plasma mass spectrometry (ICP-MS). Serum Cd, Mn, and Cr levels were higher in group 1 and Se level was lower in group 1 than that of group 2. We may conclude that Cd, Mn, Cr, and Se levels could play an important role in etio-pathogenesis of tinnitus, and thereby supplementation or reduction of these elements could be considered as novel therapeutic goals.

Differential Diagnosis of Ischemic Vertigo by Optical Coherence Tomography.

OBJECTIVE: This study aimed to evaluate the differences in the mean retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) in patients with early stage central vertigo with or without vertebrobasilar stenosis detected by Doppler ultrasound. MATERIALS AND METHODS: A total of 50 patients with ischemic vertigo and 50 healthy individuals were included in the study. The distinction between central and peripheral vertigo was determined by physical and neurological examinations and the Dix-Hallpike maneuver. For all patients, the mean RNFL thickness was determined using OCT performed by 2 independent ophthalmologists. RESULTS: There were no significant differences between the groups in terms of age and sex distribution (p>0.05). On average, in superior, inferior, and temporal quadrants, there was a statistically significant difference between the control and patient groups (p<0.001). CONCLUSION: The retina may be affected in patients with ischemic vertigo because of atherosclerotic ischemic lesions in the carotid and vertebral arteries. Neuroimaging methods and OCT were evaluated together to develop a new diagnostic approach. With OCT, which is a non-invasive method, early and more objective differential diagnosis will be possible.

A Rare Neurologic Disease that Mimics Cranial Hydatid Cyst: Leukoencephalopathy, Cerebral Calcifications, and Cysts.

A 33-year-old male patient was admitted to the clinic with seizures and progressive neurologic symptoms. In the family history of the patient, a first degree relative had a history of hydatid cyst surgery. Cranial computed tomography images showed intracranial cysts and calcifications. Thus, it was suspected that it might be hydatid cyst. However, the patient was diagnosed with leukoencephalopathy with intracranial calcifications and cysts, a rare neurologic entity by advanced radiologic imaging, serologic and pathologic evaluation.

Postoperative analgesic efficacy of perioperative intravenous lidocaine infusion in patients undergoing septorhinoplasty: a prospective, randomized, double-blind study.

PURPOSE: Intravenous lidocaine infusion has been used for postoperative analgesia in many surgical procedures in recent years. The aim of this randomized, double-blind study was to investigate the postoperative analgesic efficacy of perioperative intravenous lidocaine infusion in patients undergoing septorhinoplasty surgery. MATERIALS AND METHODS: Forty-eight American Society of Anesthesiologists I and II patients, aged 18-40 years scheduled for septorhinoplasty surgery, were assigned into two groups. Before anesthesia induction, patients in the lidocaine group (Group L, n = 24) received an intravenous bolus infusion of 1.5 mg/kg lidocaine followed by a continuous infusion of 1.5 mg/kg/h during the operation and until the end of the first postoperative hour. Patients in the control group (Group C, n = 24) received normal saline according to the same protocol. In the postoperative period, 50 mg dexketoprofen trometamol was administered and repeated every 12 h. Postoperative pain scores, rescue analgesia, intraoperative opioid requirements, and side effects were recorded. RESULTS: Postoperative pain scores were significantly lower in Group L than in Group C at postoperative 30 min, 1, 2, 4, 8, 12 and 24 h (p < 0.05). There was no difference between groups intraoperative remifentanil consumption (p > 0.05). Rescue analgesia use was statistically significantly higher in Group C than in Group L (12/24 versus 1/24, respectively, p â€Š= â€Š0.001). Postoperative nausea was statistically higher in Group C than in Group L (13/24 versus 5/24 respectively, p â€Š= â€Š0.017), whereas other side-effects were similar for the two groups (p > 0.05). DISCUSSION: We recommended the use of intravenous lidocaine infusion for intraoperatively and first postoperative hours in septorhinoplasty surgery as it reduces pain scores and the need for additional opioid use.

Which Surgical Method is Superior for the Treatment of Parotid Tumor? Is it Classical? Is it New?

OBJECTIVE: We aimed to compare the incidence of parotid tumors seen in our region in the last ten years with the literature values and to compare the recently proposed new parotidectomy methods with classical parotidectomy methods which we applied for ten years. MATERIALS AND METHODS: 37 females and 36 males total 73 patients who made parotidectomy between 2008 and 2018 were included in the study. The patients age, sex, histopathological diagnosis, surgical methods applied to malignant or benign tumors and side of the disease were recorded. Histopathological results and the results of surgical methods applied were compared with literature. RESULTS: The mean age of the 73 patients underwent parotidectomy was 54±34. Of the cases, 57 (78%) cases were benign and 16 (22%) were malignant. Histopathologically benign masses were found 3.5 time more common than malignant masses. The sides of diseases were observed at the near rates (right, left; 52%, 48%, respectively). The most often detected benign neoplasm was pleomorphic adenoma with 42 (74%) cases. The most often detected malignant neoplasm was mucoepidermoid carcinoma with 6 (43%) cases. As surgical method, superficial parotidectomy was applied to 64 (88%) patients, total parotidectomy to 9 (12%) patients and the neck dissection to 7 (10%) patients. CONCLUSION: We recommend that to be applied the superficial parotidectomy as the smallest procedure to be performed in the surgery of parotid tumors and to be avoided from partial superficial parotidectomies. In short, we advocate to classical methods for the parotid tumor surgery.

Epigallocatechin-3-gallate (EGCG) exert therapeutic effect on acute inflammatory otitis media in rats.

INTRODUCTION: That EGCG has strong antioxidant and anti-inflammatory activities as well as antibacterial activity against many streptococcus species suggests that it may be beneficial in the treatment of AOM. OBJECTIVE: Aim of the study is to reveal the molecular and biochemical effects of EGCG on LPS induced otitis media in rats. METHODS: Forty-two male albino Wistar rats were randomly divided into 7 groups. Inflammation was induced by administrating 50 µL of 1 mg/ml lipopolysaccharide (LPS). EGCG used 50 and 100 mg/kg/day and combined penicillin G (PENG) 48 h after LPS injection. RESULTS: The combined EGCG 50 and PENG group and the group with EGCG 50 alone showed the best anti-inflammatory effect on LPS-induced AOM. TNF-α and IL-1ß gene expression significantly down regulated EGCG 50 and combined with PENG compared to the otitis media group. The combination of PenG and EGCG 50 led to the best histopathological improvement. Both the inflammation and the membrane thickness of this group were at almost the same level as the healthy group and tympanum was seen normal. CONCLUSION: The results of this study make it clear that EGCG plays an important role in antioxidant and anti-inflammatory activity during AOM.

Effect of Prostaglandin E1 Analog Misoprostol in An Ovalbumin-Induced Allergic Rhinitis Model.

OBJECTIVE: The aim of the present study was to demonstrate the effects of misoprostol in ovalbumin-induced allergic rhinitis (AR). The second purpose was to compare the effect profile of the combination of an antihistamine with misoprostol during treatment of AR. MATERIALS AND METHODS: Twenty-five adult male rats were used and were randomly classified into five groups (n=5): healthy+saline, AR, AR and desloratadine (D)-treated group, AR and misoprostol (M)-treated group, and AR and combined-treated group. RESULTS: Desloratadine administration had significantly lower nasal symptoms than the AR group, but nasal symptoms in the AR+M group were better than those in the AR+D group. The best improvement in serum IgE levels was seen in the misoprostol alone and combination treatment groups. CONCLUSION: We suggest that prostaglandins should be considered in the treatment of AR, and that the effects of these types of drugs should be tested clinically in patients.

Comparison of the effect of the lidocaine, tetracaine, and articaine application into nasal packs on pain and hemorrhage after septoplasty.

OBJECTIVE: We purposed to compare the effects of certain local anesthetics soaked Merocel nasal packs on hemorrhage and pain after septoplasty. MATERIALS AND METHODS: This study is a prospective double-blind study that was done in patients undergoing septoplasty. The study was created with 90 patients. All patients were divided into four groups. The each group was applied 2% lidocaine plus adrenaline, 2% tetracaine, 4% articaine plus adrenaline as study groups or 0.9% sodium chloride (NaCl) as control group in their Merocel packs after septoplasty. Verbal analog scale (VAS) was applied to all patients and the amount of postoperative hemorrhage was noted during postoperative period. The statistical analysis was performed using Student's t test and Chi-square test on each patient group at each time point. RESULTS: The study groups (2% lidocaine plus adrenaline, 2% tetracaine and 4% articaine plus adrenaline groups) had significantly better pain scores versus control group in the 1st, 4th, 8th, 16th and 24th postoperative hours (p < 0.05). The articaine plus adrenaline group had better pain scores than the lidocaine plus adrenaline group, and the lidocaine plus adrenaline group had better pain scores than the tetracaine group in the postoperative first day. Also articaine plus adrenaline group had less postoperative bleeding rate than the lidocaine plus adrenaline, tetracaine and control groups (p < 0.05). There was no statistically significant difference between the lidocaine plus adrenaline, tetracaine and control groups in terms of postoperative hemorrhage (p > 0.05). CONCLUSION: Topical articaine plus adrenaline application in the nasal packs can be safely used for less pain and bleeding following septoplasty.

Psychological Evaluation of Patients Seeking Rhinoplasty.

OBJECTIVE: The aim of this study was to evaluate different determinants of the patient's psychosocial functioning that might possibly affect the outcome of rhinoplastic surgery. MATERIALS AND METHODS: Forty-one patients undergoing rhinoplasty, consecutively admitted to and operated upon at the Department of Otolaryngology, Erzurum Regional Training and Research Hospital, Turkey, were studied with regard to their psychological characteristics. RESULTS: In the patient group, Liebowitz anxiety, Liebowitz/avoidance, and Liebowitz/total scores were significantly higher than the control group (p<0.001). No significant differences were found between the patient and control groups according to Rosenberg self-esteem scale and The Hospital Anxiety and Depression Scale. In the Quality of Life SF-36 results, significant differences were found between the patient and control groups apart from SF-36 scores of pain (p<0.05), vitality (p<0.05), social functioning (p<0.05) and emotional role difficulties (p<0.05). CONCLUSION: Patient selection must be done very carefully to obviate not only physical, but also psychological postoperative complications. The SF-36 questionnaire may be of value in screening-patients for psychological problems prior to rhinoplasty.

A case of papillary carcinoma in a thyroglossal cyst without a carcinoma in the thyroid gland.

The thyroglossal duct cyst is the most common developmental anomaly of the thyroid gland. We present a patient with a papillary thyroid carcinoma diagnosed after surgical resection of a thyroglossal cyst. The 39-year-old patient reported to our hospital due to a swelling of this throat. The results of the ultrasonography were reported as showing multiple nodules in both thyroid lobes, and an ~3-cm diameter image in the submental area, in keeping with lymphadenomegalia. In the fine-needle aspiration cytology (FNAC) evaluation from the nodules in the thyroid, it was observed that the thyrocites with uniform nuclei made up single-layer groups. FNAC from the thyroglossal cyst, a few histiocytes were observed on a ground with a large number of erythrocytes. The patient was subjected to a total thyroidectomy, pyramidal lobe excision, and total excision of the 3-cm diameter soft mass, starting at the tip of the pyramidal lobe. The case was diagnosed as papillary thyroid carcinoma in thyroglossal duct cyst with histopathological and immunohistochemical findings. If the thyroglossal channel cyst had been diagnosed preoperatively, total thyroidectomy and a Sistrunk operation would have been performed. For this reason, repeated FNAC, particularly, if performed under ultrasound guidance, may improve the diagnostic value of FNAC. Thus, in such patients, throat ultrasonography must be carried out in expert hands, thin-needle aspiration biopsy, computerized tomography, and thyroid scintigraphy must be done if necessary, and the necessary treatment protocols carried out after a definite diagnosis.

Analysis of Ki-67 immunoreactivity in recurring and nonrecurring nasal polyps.

OBJECTIVE: Nasal polyps are common, abnormal lesions. Recurrence of the nasal polyposis is prevalent and a severe problem. The aim of this study was to investigate the relationship between Ki-67 immunoreactivity and the risk of recurrence of nasal polyps. Ki-67 staining of polypectomy material was tested as a risk factor for recurrence independent of etiologic factors or treatment modalities. DESIGN: Retrospective study. SETTING: University hospital. MAIN OUTCOME MEASURE: Ki-67 immunoreactivity. METHODS: Pathologic specimens from patients with nonrecurrent and recurrent nasal polyps archived at the Department of Pathology were reviewed, and the most suitable blocks were chosen among the excision materials. Ki-67 antibody staining was investigated immunohistochemically using the avidin-biotin-peroxidase method. The percentages of nuclei immunostained for Ki-67 of at least 1000 epithelial cells in the most intensive staining areas at final magnification (x400) were calculated and defined as the labeling index. The Mann-Whitney U-test was used to compare the Ki-67 labeling index in the nonrecurring and recurring nasal polyp groups. RESULTS: The mean Ki-67 labeling index was 1.4 +/- 1.972 (range 1-87 in 1000 epithelial cells) in the nonrecurrent nasal polyp group and 17.8 +/- 5.67 (range 82-446 in 1000 epithelial cells) in the recurrent nasal polyp group; the difference between the nonrecurrent and the recurrent group was significant (p < .01). CONCLUSION: The results of this study clearly demonstrate that proliferative activity in the surface epithelial cells of recurring nasal polyps is significantly higher than that in nonrecurring nasal polyps.

[Evaluation of factors that affect the technique to be used in cholesteatoma surgery]. / Kolesteatomlu kronik otitis media tedavisinde cerrahi teknik seçimini etkileyen faktörlerin degerlendirilmesi.

OBJECTIVES: We investigated factors that affect the technique to be used in cholesteatoma surgery. PATIENTS AND METHODS: The study included 186 patients who underwent surgery for suppurative chronic otitis media with cholesteatoma. Open technique (group A) was used in 143 patients, and closed technique (group B) was used in 43 patients. The two groups were compared with respect to medical (age, sex, hearing loss, mastoid pneumatization, site of cholesteatoma, complications) and paramedical (education level, postoperative patient compliance, health insurance, the season at the time of operation) factors. RESULTS: Medical factors that differed significantly between the two groups included the degree of hearing loss, site of cholesteatoma, and presence of complications. The only significant difference was in education level among the paramedical factors. A great majority of patients with a hearing loss above 60 dB were in group A. Cholesteatoma was localized in the middle ear and attic in 10 patients, and in the antrum and/or mastoid cells in 133 patients in group A, compared to 37 and six patients in group B, respectively. All the patients (n=34) who had chronic otitis media complications associated with cholesteatoma were in group A. CONCLUSION: Our findings suggest that selection of the technique for cholesteatoma surgery depends on more than one factor.

The effects of compost prepared from waste material of banana on the growth, yield and quality properties of banana plants.

Three doses (15-30-45 kg plant(-1)) of the compost prepared from the clone of Dwarf cavendish banana were compared with farmyard manure (50 kg plant(-1)), mineral fertilizers (180 g N+ 150 g P +335 g K plant(-1)) and farmyard manure+ mineral fertilizers (25 kg FM+ 180 g N+ 150 g P +335 g K plant(-1)) which determined positive effects on the growth, yield and fruit quality characteristics of banana plants. The banana plants were grown under a heated glasshouse and in a soil with physical and chemical properties are suitable for banana growing. The contents of N, P, K and Mg in compost and in farmyard manure were found to be similar. Farmyard manure, farmyard manure + mineral fertilizers and 45 kg plant(-1) of compost increased growth, yield and fruit quality characteristics. According to obtained results, 45 kg plant(-1) of compost was determined more suitable in terms of economical production and organic farming than the other fertilizer types.

The effects of compost prepared from waste material of banana plants on the nutrient contents of banana leaves.

In this study, the possible utilization of removed shoots and plant parts of banana as compost after fruit harvest were investigated. Three doses (15-30-45 kg plan(-1)) of the compost prepared from the clone of Dwarf Cavendish banana were compared with Farmyard manure (50 kg plant(-1), Mineral fertilizers (180 g N + 150 g P + 335 g K plant(-1)) and Farmyard manure + Mineral fertilizers (25 kg FM + 180 g N + 150 g P + 335 g K plant(-1)) which determined positive effects on the nutrient contents of banana leaves. The banana plants were grown under a heated glasshouse and in a soil with physical and chemical properties suitable for banana growing. The contents of N, P, K and Mg in compost and in farmyard manure were found to be similar. Nitrogen, phosphorus and potassium contents of leaves in all applications except control, and Ca, Mg, Fe, Zn, Mn, Cu contents in all applications were determined between optimum levels of reference values. There were positive correlations among some nutrient contents of leaves, growth, yield and fruit quality characteristics. Farmyard manure, Farmyard manure + Mineral fertilizers and 45 kg plant(-1) of compost increased the nutrient contents of banana leaves. According to obtained results, 45 kg plant(-1) of compost was determined more suitable in terms of economical production and organic farming than the other fertiliser types.