Investigation of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume in patients with tinnitus.

OBJECTIVE: This study aimed to evaluate patients with tinnitus in terms of mean platelet volume and platelet distribution width, and to explore neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio, recently reported in the literature as being possible inflammation markers. METHODS: This study comprised 64 tinnitus patients and 64 age-matched healthy controls. Statistical significance level was accepted as p < 0.05. RESULTS: Mean platelet volume (t = 3.245, p = 0.002) and platelet distribution width (Z = 3.945, p < 0.001) were significantly higher in the patient group than the control group. CONCLUSION: The results suggest that a prothrombotic condition might play a role in the pathophysiology of tinnitus.

Detection of cholesteatoma: High-resolution DWI using RS-EPI and parallel imaging at 3 tesla.

The purpose of this study is to evaluate the impact of RS-EPI-DWI in the detection of cholesteatoma and to compare with single-shot echo-planar DWI (SS-EPI-DWI). Diffusion-weighted and apparent diffusion-coefficient (ADC) images were obtained using RS-EPI and SS-EPI techniques in 30 patients. Presence of cholesteatoma (3 point scale), amount of artefacts (4 point scale), visibility (4 point scale), and ADC values of the lesions were assessed. The results of both techniques were compared with each other and gold-standard (GS) test results. Lesion visibility and presence of artefact scores of RS-EPI-DWI group were significantly different from those of the SS-EPI group. RS-EPI-DWI images had fewer artefacts and higher visibility scores. The sensitivity, specificity, negative/positive-predictive, and overall-agreement values of RS-EPI-DWI technique were 100%, 78%, 100%, 74%, and 87%; respectively. These values for SS-EPI-DWI technique were 91%, 60%, 88%, 67%, and 75%; respectively. Also, these values were higher on axial plane than coronal plane images for ADC measurements. Based on gold-standard test findings, agreement values were good (κ=0.74) for RS-EPI-DWI and moderate for SS-EP-DWI (κ=0.50) techniques (P<0.001 for both). The RS-EPI-DWI technique allows a higher spatial-resolution and this technique is less susceptible to artefacts when compared with SS-EPI technique.

The treatment of tongue haemangioma by plasma knife surgery.

A seven-year-old girl presented with a 4 cm x 2 cm lesion of the tongue which was located at the posterior one-third in the midline. The lesion was excised by plasma knife surgery. No complication, such as bleeding, shortness of breath or infection, occurred after the treatment. Plasma knife surgery is an acceptable choice for selected benign lingual vascular malformations.

Volatile anesthetics and mucociliary clearance.

BACKGROUND: The aim of this prospective, randomized, double blind study was to evaluate the possible modification of in vivo nasal mucociliary clearance by three different volatile agents: sevoflurane, isoflurane and desflurane, following intravenous induction and tracheal intubation. METHODS: Following institutional approval and informed consent, 60 patients scheduled for ear and neck surgery under general anaesthesia were randomized into three groups. Each group received sevoflurane (Group S), isoflurane (Group I) or desflurane (Group D) at 1 MAC concentrations after anaesthesia induction with propofol, remifentanil and tracheal intubation with cis-atracurium. Mucociliary clearance time was assessed by in vivo saccharin transit time (STT). We recorded the time elapsed until the first recognition of sweet taste, which was taken to represent transport of saccharin to the oropharynx. We noted the time in minutes at two time points, pre- and post-anaesthesia, under the same climatic conditions (room temperature 23 degrees C, relative humidity 60%). RESULTS: The mean STT values after sevoflurane, isoflurane and desflurane anaesthesia were 9.1+/-4.3, 6.7+/-2.8 and 7.1+/-3.1 min respectively (P>0.05). These were not significantly different among volatile anaesthetics in two measurements. CONCLUSION: Anaesthesia with volatile agents does not modify mucociliary clearance of nasal epithelium.

Maxillary and temporal fibrous dysplasia: three cases.

PROBLEMS/OBJECTIVES: Fibrous dysplasia (FD) is a benign, expansile lesion of bone with slow progression and unknown origin. The purpose of this report is to make physicians aware of the symptoms, methods for differential diagnosis, and treatment options. METHODOLOGY: Three cases of monostotic FD are presented; two involving the maxillary sinus, and one in temporal bone. CT scans are the definitive diagnostic and follow-up method. Surgical approaches to alleviate the symptoms, including facial deformity, are described. RESULTS: FD went undiagnosed for three years in these patients. All three patients were relieved of the symptoms by limited surgery, and remained asymptomatic for up to two years after the surgery, with no signs of recurrence. CONCLUSIONS: Practitioners should be alert to the possibility of FD, particularly if patients develop narrowing of the ear canal, or progressive postauricular or maxillofacial enlargement. Minimal surgery to alleviate the symptoms is the treatment of choice.

Squamous cell carcinoma of the lower lip and supra-omohyoid neck dissection.

PURPOSE: The aim of this study is to evaluate our approach to patients with squamous cell carcinoma of lower lip. PATIENTS AND METHODS: This study includes 31 lower lip squamous cell carcinomas followed up between 1994 and 2000. Primary treatment was applied to 28 patients of whom 23 were in stages I-II and five in stages III-IV. Three patients presented locoregional recurrence. Neck dissection was performed during primary lip resection in patients with palpable cervical lymph node involvement. Patients with unpalpable cervical lymph nodes were divided into two subgroups: one was submitted to elective neck dissection (n = 11) and the other had isolated lip resection (n = 8). Unilateral or bilateral selective supra-omohyoid neck dissection (SOHND) was performed according to the localisation of the disease. Radical dissection was performed in a secondary intervention, when SOHND revealed lymph node metastases. Radiotherapy and chemotherapy were applied for curative and/or adjuvant treatment in addition to surgery in patients with locoregional recurrence and metastatic lymph nodes or with perineural involvement. RESULTS: Occult cervical metastasis within a single lymph node was found in one of the 11 No patients who underwent elective neck dissection. Delayed neck metastasis developed in one of the eight patients in whom isolated lip resection (without neck exploration) was performed. Chemoradiotherapy was administered to this patient, but he died. Neck metastasis was established histologically in four of five patients in stages III-IV. Postoperative radiotherapy was used on these patients. One of the patients in this group died due to inoperable local recurrence in the neck, another died because of distant metastasis. Local mandibular recurrence was seen in one of these patients after three years. COMMENT: Six patients (19%) died due to lower lip carcinoma in this series. Our findings show the importance of elective neck dissection and intact surgical resection margins.

Pneumatization of the concha inferior as a cause of nasal obstruction.

Chronic nasal obstruction is a common disorder. Hypertrophy of the inferior turbinates is responsible for nasal obstruction more frequently than it is commonly thought. A pneumatized inferior turbinate has recently been described as a cause for nasal obstruction and only two cases have been reported until now. Inferior nasal turbinate develops by endochondral ossification of components of the mesethmoid and ectethmoid. The chondral framework of the inferior turbinate consists of a double lamella and two separate ossification centers that develop between the fifth and seventh month of fetal life. The separate ossification centers meet by the eighth fetal month. During ossification, the inferior turbinate detaches from the ectethmoid and becomes an independent bony structure. During that time the epithelium may misinvaginate into double lamellas and such double lamellas formed by the inferior turbinate may become persistent. A patient was referred to our clinic with headaches and nasal obstruction. A CT scan was performed which showed that the right lower concha was pneumatized. The headache of the patient disappeared after partial resection of the lower and middle turbinate.

Congenital infiltrating lipomatosis of the face with cerebral abnormalities.

The aim of this study was to describe a possible variant of encephalo-craniocutaneous lipomatosis syndrome. Three cases of congenital infiltrating lipomatosis of the face, associated with cutaneous, subcutaneous, and cerebral abnormalities, are presented. This neurocutaneous syndrome appears very similar to encephalo-craniocutaneous lipomatosis syndrome but lacks the typical eye lesions.

Power Doppler scanning in the diagnosis of carotid body tumors.

The aim of this work was to show contribution of power Doppler imaging in the diagnosis of the carotid body tumors. Six patients with a nontender mass beneath the mandibular angle were evaluated with gray scale and power Doppler sonography. Well-defined, solid, weakly hyperechoic masses were noted on gray scale sonography in the carotid bifurcation. Power Doppler sonography showed abundant flow, characterized as an intense blush, throughout the entire tumor in all patients. We believe that invasive and expensive diagnostic modalities are not necessary to evaluate carotid body tumors. Gray scale sonography and power Doppler imaging are sufficient for primary diagnosis of carotid body tumors.

Fronto-orbitonasal intradiploic meningioma in a child.

Intradiploic meningioma, which may be classified as a subgroup of intraosseous meningioma, is a rarely encountered disorder. To date, less than 10 cases have been reported. Here, we report a case of fronto-orbitonasal intradiploic meningioma. A 12-year-old female with exophthalmos and diplopia was operated on for a cranial intradiploic mass lesion. Histopathological evaluation of the specimen confirmed the diagnosis of intradiploic psammomatous meningioma. Her exophthalmos did not change, but the diplopia disappeared. This case is unique in that it is an extensive case of intradiploic meningioma of the orbital roof and frontal base in a child. Intradiploic meningiomas generally are of psammomatous type. Especially tumors adjacent to the orbita cause exophthalmos; cases located on the other side of the calvarium may not cause any symptom or sign other than headache or sometimes a mass on the scalp. Treatment, as with meningiomas located in the intracranial cavity, is total resection of the lesion.

Otorhinolaryngological aspects of Xeroderma pigmentosum.

OBJECTIVE: to evaluate the probable presence of otorhinolaryngological pathology accompanied by head and neck region skin findings in patients with Xeroderma pigmentosum. METHODS: a total of 19 patients with Xeroderma pigmentosum were investigated for otorhinolaryngological findings. The patients gave their anamnesis and underwent physical examination, audiological tests and endoscopic examination. RESULTS: various malignancies developed in 14 patients on the sun-exposed areas of the head and neck region. Multiple malignancies were found in six of them. There was no other pathological condition secondary to this rare clinical entity. CONCLUSION: Xeroderma pigmentosum causes skin lesions. Some otolaryngological findings such as rhinitis, sinusitis etc. were thought to be coincidental.

Polyostotic fibrous dysplasia with craniofacial localization presenting with frontal lobe compression in a 14-year-old girl.

We describe a rare case of polyostotic fibrous dysplasia with craniofacial localization associated with involvement of the spine and extremities. A 14-year-old girl presented with progressive headache, left frontal swelling, exophthalmos of the left eye, deformity and palpable mass in the left frontal area. Cranial computerized tomography revealed extensive involvement of all cranial bones except right frontal and right parietal bones. Most of the facial bones were invaded. Especially, there was the involvement of ethmoidal air sinuses and frontal sinus also. Computerized tomography showed left frontal lobe compression. In addition, the spine and bones of the extremities were involved in the patient. Craniofacial approach was planned. Cranial surgery was performed by an extradural frontal approach. Firstly, the frontal cyst was excised. For left frontal lobe decompression, we removed successfully all the abnormal bones causing mass effect and frontal deformity. Secondly, facial surgery was performed with external approach. An attempt to remove all of the involved bone is necessary, as the lesion may recur and grow if a portion of dysplastic bone is left in place. However, the present case suggests that removal of all the involved bones in the polyostotic fibrous dysplasia may be possible in spite of extensive involvement. In this situation, it may be removal of only abnormal bones responsible for compression of affected neural elements is indicated.

Endodermal sinus (yolk sac) tumor of oral cavity originating from gingiva.

Endodermal sinus tumor is a malignant germ cell tumor which usually arises in gonads. Extragonadal endodermal sinus tumors in the head and neck are very rare. Here a gingival endodermal sinus tumor is reported. The lesion demonstrated typical microscopic features of the endodermal sinus tumors of gonads. The tumor cells showed alpha-fetoprotein immunoreactivity in immunohistochemical evaluation. The serum alpha-fetoprotein level was high. This is the first gingival case in the related literature.

The efficacy of topical ciprofloxacin in the treatment of chronic suppurative otitis media.

We conducted a test of the efficacy of ciprofloxacin eardrops in 80 patients (95 ears) with otorrhea due to chronic suppurative otitis media in two treatment settings. One group (n = 40; 47 ears) received daily ciprofloxacin therapy plus aspiration in the clinic. The other group (n = 40; 48 ears) self-administered ciprofloxacin at home. Overall, otorrhea resolved in 88% of all ears within 12 days of the initiation of treatment. The clinic-treated patients tended to respond more rapidly than did the self-treated patients, but there was no statistically significant difference in success rates between the two groups. Side effects were negligible. We conclude that empiric topical ciprofloxacin therapy is an effective, safe and relatively inexpensive treatment for otorrhea in patients with chronic otitis media.

Clinical value of preoperative intraoral ultrasonography in tonsillectomy.

In this prospective study, 43 chronic tonsillitis patients underwent intraoral ultrasonography preoperatively and the width and thickness of tonsils and tonsillocarotid distances were measured. Positive correlation was obtained in postoperative measurements compared with ultrasonographic measurements of tonsils. The mean tonsillocarotid distances were 8.6 mm in the left and 8.25 mm in the right tonsillar fossa. This study showed that preoperative intraoral ultrasonography was to be help of tonsillectomy operations particularly in surgical anatomical orientation.

Prevention of adriamycin-induced skin necrosis with various free radical scavengers.

Infiltration of antitumor agents into subcutaneous tissues may either result in a local area of self-resolving inflammation or progress to full-thickness loss of skin and underlying vital structures. Inadvertent extravasation of adriamycin can result in severe tissue necrosis. The mechanism of this tissue damage is believed to be release of oxygen free radicals into the tissue. After adriamycin extravasation, the treatment groups were made up according to drugs used, EGb 761, pentoxifylline, alpha-tocopherol acetate, and alpha-tocopherol succinate in rats. To prevent the necrosis and to decrease the tissue malondialdehyde levels, the most effective agent was found to be EGb 761, and pentoxifylline was also effective (P < 0.001). No difference was found between topical lanoline and saline (P > 0.05). The maximum ulcer diameter was obtained in 2 weeks. The maximum tissue malondialdehyde levels were obtained in 24 h, and in comparison to the control group the treatment groups showed lower levels. Our aim is to show the role of free radicals in the formation of skin necrosis as a cause of adriamycin extravasation and to prevent or decrease the skin necrosis using various free radical scavengers.

The effect of the suture-induced delay phenomenon on skin flap survival and lipid peroxidation in rats.

Skin flap ischemia has been associated with the presence of free radicals. In this study we designed a suture-induced delay model in 30 rats using two different suture techniques. A total of 13 rats that underwent McFarlane's acute random-flap model served as controls. We found a statistically significant difference between the flaps of the experimental and control groups regarding the viability of flaps. Malondialdehyde levels in tissue samples taken from the proximal and distal ends of each flap were estimated at 6 and 24 hours postoperatively. Malondialdehyde levels in the experimental groups were found to be quite lower than those of the controls. In conclusion, the suture-induced delay model seems to be effective in improving flap viability. Also, we found lower malondialdehyde levels in experimental groups compared with controls.

Immunohistochemical study on histogenesis of congenital epulis and review of the literature.

Congenital epulis is a very rare lesion found only in newborn infants. This tumor is multiple in about 10% of reported cases, rarely with the simultaneous involvement of the maxilla and mandibula, as in this article. In the presented case, light microscopy demonstrated large eosinophilic granular cells arranged in solid nests that are separated by thin fibrovascular areas. The tumors in the maxilla and mandibula were investigated with a panel of polyclonal and monoclonal antibodies, and using immunoperoxidase methods on formalin-fixed, paraffin-embedded sections. Immunohistochemical studies revealed strong and diffuse cytoplasmic staining for neuron specific enolase and vimentin. However, all other reactions were negative. These results suggest that the congenital epulis may be derived from uncommitted nerve-related mesenchymal cells.

Possible value of nasal smear in acute maxillary sinusitis: an experimental study.

The aim of this study is to determine the role of nasal smear in evaluating diagnosis and response to the treatment by the patient of acute maxillary sinusitis. We compared nasal smear and histopathological findings obtained from rabbits experimentally induced acute maxillary sinusitis. The animals were divided into two groups; one with blocked ostium and treated with antibiotic and the other applied natural ostiotomy, during a 4-week period. There was no statistically significant difference between the two groups in respect of recovery period. This conclusion was derived from nasal smear and biopsy findings. It was observed that nasal smear and biopsy findings were consistent with each other and with clinical findings. The results of this study revealed that nasal smear may be used in the diagnosis and treatment follow-up of acute maxillary sinusitis.