Multifocal Langerhans' Cell Histiocytosis in an Adult.

Introduction: Multifocal Langerhans' cell histocytosis is a rare condition that can affect multiple organs and manifest in various scenarios. While the condition is more commonly found in children, it can also occur in adults. Case Report: A 43-year-old female presented with refractory otorrhea and had a rubbery neck mass in the left mid-cervical area, as well as an itchy eczematoid lesion in the left parietal area. The otic lesion was eventually resected, and histopathologic examination confirmed the diagnosis of Langerhans histiocytosis. Conclusions: Although rare in adults, Langerhans histiocytosis should be considered as one of the differential diagnoses for ear canal polyps. If diagnosed, medical treatment should be pursued.

Effect of fluoxetine on seizures in rats with high susceptibility to audiogenic stress.

BACKGROUND: The seizures, triggered by a loud sound in laboratory animals, are associated with the imbalance of the brain monoamines. Serotonin (5-HT) is regarded as one of the principal neurotransmitters to be involved in regulation of wide variety of physiological and psychological processes. Among the drugs that affect 5-HT synaptic transmission, the leading role is given to selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine. AIM: The aim of the study is to investigate the effects of fluoxetine on seizures in Wistar rats with high susceptibility to audiogenic stress. METHODS: The study was performed on male Wistar rats. Before the experiments, the animals were tested for susceptibility to audiogenic seizures by exposure to a sound of 90-110 dB for 2 min in the soundproof box. The difference between congenital susceptibility to seizures served as a basis for dividing animals into two groups: Seizure-susceptible (SS) and seizure-tolerant (ST) rats. One hour before the experiment, the experimental animals were orally administered with fluoxetine, while the control rats were treated with distilled water. The effect of fluoxetine on the level of the biogenic amines in different regions of the brain was determined by enzyme-linked immunosorbent assay (ELISA). RESULTS: It has been shown that in 100% of the cases, the control SS rats, exposed to audiogenic stimulus, exhibited wild running around in circles and jumping as some of the signs of seizure responses that evolved into tonic-clonic seizures in 70% of the cases. As regards the experimental SS animals: Only in 60% of the cases (P<0.05), they exhibited wild running and flinch, which did not evolve into the tonic-clonic phase. CONCLUSION: Decreased manifestation of seizures in the experimental SS rats under acute administration of fluoxetine may be explained by highly distinctive repertoire and spatial distribution of 5-HT receptors in their brain structures in comparison to the ST rats. RELEVANCE FOR PATIENTS: The study of the monoaminergic mechanisms of seizure generation is of practical importance due to the existence of pharmacological agents, which selectively affect the activity of the monoaminergic systems of the brain, as well as the metabolism of the monoamines synthesized by them.

Effect of Functional Endoscopic Sinus Surgery on the Voice Quality among Patients with Rhinosinus Polyposis.

INTRODUCTION: Rhinosinus polyposis is associated with voice quality reduction. There has been little evidence about the efficacy of rhinosinus polyps surgery on patients' voice quality so far. The aim of the present study was to evaluate the nasality and acoustic voice changes after rhinosinus polyposis surgery. MATERIALS AND METHODS: The population in this study composed of 30 eligible patients with rhinosinusitis and rhinosinus polyposiss. The functional endoscopic sinus surgery (FESS) was the therapeutic intervention. Acoustic voice parameters were jitter (%), shimmer (db), noise to harmonic ratio (NHR), and fundamental frequency (F0) for the vowels [a, o, e, aa, ie, and ou]. For nasality evaluation, the articulation of vowel [a] was examined using nasometer device. The changes regarding the patients' voice were evaluated one day before and one month after the surgery. RESULTS: The mean age of the participants was 41.2±14.3 years. Considering gender distribution, 20 (66.7%) subjects were men. After the operation, the nasality increased significantly from 40.8% to 74.3% (P<0.001). In addition, the findings revealed the increase of shimmer and F0 (P>0.05). On the other hand, jitter and NHR changes were insignificant. CONCLUSION: The findings of the current study showed that hyponasality decreased a month after the treatment of rhinosinus polyposis with FESS. However, the acoustic quality of voice had no significant changes after the surgery.

Sleep quality after endoscopic sinus surgery in patients with sinonasal polyposis.

OBJECTIVES: Evaluate the effect of functional endoscopic sinus surgery (FESS) for nasal polyposis on sleep efficiency and polysomnographic parameters. SUBJECTS AND METHODS: This clinical trial was conducted on 15 patients with bilateral massive sinonasal polyposis who underwent FESS between August 2012 and September 2013. All participants were evaluated subjectively by employing the Pittsburgh Sleep Quality Index (PSQI) questionnaire and objectively (provided by polysomnographic parameters) before and 2 months after surgery. RESULTS: The evaluation of subjective criteria of sleep quality assessed by PSQI showed significant improvement, particularly in nocturnal awakening (P = 0.002). However, Apnea Hypopnea Index (AHI) was not reduced significantly after surgery (P = 0.233). Among patients who had suffered from obstructive sleep apnea, AHI was improved in 7 patients, deteriorated in 3 patients, and did not change in 1 patient. Although the mean duration of REM sleep stage increased from 15.2 ± 10.7 to 18.9 ± 7.9, this change was not statistically significant. Furthermore, arousal index decreased dramatically from 31.6 to 17.1 (P = 0.02) and sleep efficiency index was improved after the surgery (P = 0.008). CONCLUSIONS: This study documented the effect of resuming nasal cavity patency on improvement of sleep efficiency after FESS. In spite of insignificant effect of FESS on apnea index, alteration of other sleep parameters like arousal index following surgery may have a positive effect on sleep quality.

Long-Term Survival of Cutaneous Malignant Melanoma with Metastasis to Paranasal Sinuses: A Case Report and Literature Review.

BACKGROUND: Malignant melanoma (MM) usually present with metastases to unexpected regions of the body. Metastatic MM is a highly lethal condition, and the median survival in this setting is 6 to 7.5 months; however, few reports rarely describe long-term after chemotherapy. CASE REPORT: We describe a 31-year-old man with MM, which got metastatic (to paranasal sinuses) after local and systemic therapy showed complete responses with long-term survival after endonasal endoscopic metastasectomy and radiotherapy of the nasal cavity, paranasal sinuses, and base of the skull. CONCLUSION: Although long-term survival is rare, few reports describe cases after chemotherapy. MM could be associated with metastasis to any regions and clinicians should be aware of its behavior and perform complete investigation in the presence of any suspicious symptoms, and this should be reinforced periodically. However, the survival is poor in the metastatic setting, and the treatment of choice is debatable, some patients may benefit from metastasectomy and local radiotherapy.

Acute invasive fungal rhinosinusitis: our experience with 18 cases.

Acute invasive fungal rhinosinusitis (AIFRS) is a rapidly progressive life threatening infection that is seen most commonly among immunocompromised patients. We present a case series of 18 patients clinically and histopathologically diagnosed with AIFRS with a mean follow-up of 9.11 ± 2.51 months (range 6-17). Demographic data, apparent symptoms and signs, underlying disorders, and outcomes are discussed. The mean age was 39.56 ± 20.66 years (range 2-75). The most common underlying diseases were diabetes mellitus (50 %) and leukemia (44.44 %). Mucosal biopsy confirmed fungal invasion of the nasal mucosa in all cases. The main fungi were Rhizopus oryzae (55.56 %), Absidia mucor (16.67 %), and Aspergillus fumigatus (27.78 %). Headache and facial pain (77.8 %), facial paresthesia (55.6 %), and ophthalmoplegia (33.3 %) were the most common symptoms and signs. Computed tomography and endoscopic findings showed various stages of sinonasal (100 %), pterygopalatine fossa (55.56 %), orbital (44.45 %), and cerebral (5.56 %) involvement. All patients underwent serial surgical debridement (3.78 ± 1.80 times; range 2-8) simultaneously with systemic antifungal therapy and proper management of the underlying disease. The most extreme case with brain involvement survived and recovered with no evidence of recurrent disease following treatment. All patients were considered cured after two endoscopic negative histopathologic evaluations. Three patients (16.67 %) died, one from uncontrolled leukemia and two due to renal failure. AIFRS is a potentially fatal condition, however, early diagnosis and management of the underlying disease accompanied with systemic antifungal and aggressive serial surgical intervention appears to be effective in reducing mortality in most patients.

Facial soft-tissue morphology of adolescent patients with nonsyndromic bilateral cleft lip and palate.

The purpose of this study was to cephalometrically evaluate the facial soft-tissue characteristics of adolescent patients with bilateral cleft lip and palate (BCLP) and to compare them with a noncleft control group. Lateral cephalometric radiographs obtained from 56 adolescents with nonsyndromic BCLP (29 boys and 27 girls) were analyzed and compared with 67 control subjects (29 boys and 38 girls) who were matched for sex, age, and ethnicity. All patients had been operated on before the age of 2 years for the surgical repair of cleft lip and palate. None had received any orthopedic or orthodontic treatment. Independent-samples t test revealed that patients with BCLP significantly differed from the control group by having a flatter facial profile, thinner and more retruded nasal base, flatter nasal tip (in males), and reduced upper-lip length. Furthermore, thicker lower-lip pit, shallower mentolabial sulcus, and increased inclination angles of the upper and lower lips relative to the horizontal plane were observed in female patients compared with the normal group. The findings of the current study suggested that adolescent patients with BCLP showed several facial soft-tissue deformities when compared with normal individuals with the same age, sex, and ethnic origin. This study provides objective measures that could lead to better treatment planning and prediction of the need for corrective surgeries in patients with BCLP.

Nodular fasciitis of the auricle: a case report.

INTRODUCTION: Nodular fasciitis is described as a benign reactive proliferation of myofibroblasts. Due to its rapid-growing nature, a precise clinical diagnosis is difficult and the condition is frequently misdiagnosed as malignant lesions. CASE REPORT: In this study, we present the case of a young woman with an auricular nodular fasciitis as an example of one of the rarest sites of this tumor. The patient underwent an excision of the lesion under general anesthesia. The literature choices for treatment include complete excision, partial excision, or intralesional injection of steroids. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision. CONCLUSION: Auricular nodular fasciitis is a rare lesion. Due to its associated local discomfort, and in order to exclude other differential diagnosis, we recommend a complete surgical excision.

Prevalence of dental anomalies in patients with cleft lip and palate.

The aim of the present study was to investigate the prevalence of dental anomalies in a group of patients with cleft lip and palate (CL/P) in the northeast of Iran. Ninety-one patients referring to the Cleft Lip and Palate Clinic of Mashhad Dental School were enrolled and classified into right CL/P, left CL/P, and bilateral CL/P groups. Photographs, dental casts, and panoramic and periapical radiographs were retrieved, and dental anomalies were recorded. χ test was used to analyze the frequency of dental anomalies according to type of cleft and sex. Missing maxillary lateral incisors was the most frequent dental anomaly, which was slightly higher in the bilateral group (61.1%). There were significantly more cases of missing lateral incisors outside the cleft area in right CL/P (P = 0.015). Peg lateral incisors were observed in 33.3% of bilateral CL/P compared with 28% of right and 23.3% of left unilateral cases. The sample presented rotations of central incisors in the cleft area in 33.3% of bilateral clefts. In unilateral clefts, it occurred more frequently in the right side (48%). Sexual dimorphism appeared only for maxillary central incisor rotation in the cleft area, which showed significantly greater frequency in females (P = 0.025). Transposition of maxillary canine and first premolars was found in 5.5% of bilateral, 8% of right, and 3.3% of left unilateral clefts. The prevalence of dental anomalies in the studied sample seems to be higher than that reported in the normal population. More anomalies were observed at the cleft side. The frequency of most anomalies was not significantly different between the 2 sexes.

Oral health-related quality of life in children with cleft lip and palate.

Considering the essential need for oral health-related quality-of-life measures for patients with craniofacial malformations, the current study aimed to investigate the oral health-related quality of life of Iranian patients with cleft lip and palate. Fifty children referred to Cleft lip/Palate Research Center of Mashhad Dental School (Iran) were recruited. Participants were asked to complete the Child Oral Health Impact Profile questionnaire. The questionnaire comprised 38 items and was divided over 5 subscales. The scores on all subscales were compared with regard to patients' age, sex, and type of cleft. A significant difference between boys and girls was found on the subscale "emotional well-being" (P = 0.027). There was no significant difference between 8- to 12-year-old patients and those older than 12 years. Also, no significant difference was found between bilateral and unilateral cleft lip and palate patients regarding mean score of Child Oral Health Impact Profile questionnaire and its subscales. Oral health-related quality of life of cleft lip and palate patients did not change with patients' age. Also, the impact of unilateral and bilateral clefts on OHRQoL was similar. Quality of life of girls was more affected by oral health.

The prevalence of allergic fungal rhinosinusitis in sinonasal polyposis.

Allergic fungal sinusitis (AFS) is a noninvasive form of fungal rhinosinusitis with a prevalence of 6-9 % among all rhinosinusitis cases requiring surgery. The fungi causing AFRS have a great diversity and regional variation in the incidence of AFS has been reported worldwide. The aim of this study was to evaluate the prevalence of AFS among rhinosinusitis patients in the north east of Iran. In a prospective cross-sectional study 127 patients with sinonasal polyposis who were candidates for surgery were recruited. All cases were evaluated by sinonasal CT scan, Prick test for common regional allergens, total serum immunoglobulin E (IgE) level, and allergic mucin culture for fungi in suspected cases. Data analyses were done using SPSS version 13.0. Their mean age was 37.4 ± 11.6 years, the male-to-female ratio was 69/58. Eleven patients (9.45 %) met the AFS criteria. Nine cases had a positive culture for Aspergillus specimen and three for Alternaria. Prick test was positive for at least one allergen in 28 cases (22.05 %). The most common allergen was weed. The total IgE level was significantly higher in AFS patients. This study showed the prevalence of AFS among patients with nasal polyposis to be 9.45 %.

Plasmapheresis in acute Fatty liver of pregnancy: an effective treatment.

Acute fatty liver of pregnancy (AFLP) is an idiopathic disorder with an unknown cause occurring in late pregnancy. The treatment in these patients is often immediate termination of pregnancy, and plasmapheresis provides an effective treatment option. In this paper, we introduce three pregnant women treated with plasmapheresis. The first case was a 22-year-old primigravida woman treated with 22 sessions of plasmapheresis due to AFLP, hepatic and renal failure, coagulopathy, and ventilator-dependent respiratory failure. The second case was a 23-year-old woman in her second pregnancy treated with 4 plasmapheresis sessions due to AFLP, hepatic and renal failure, coagulopathy, and hypoglycemia. The third patient was a 23-year-old primigravida woman treated with 3 plasmapheresis sessions due to AFLP, renal failure, and coagulopathy. Plasmapheresis can be a life-saving treatment in patients with AFLP and is strongly recommended for patients with severity of their disease accompanied by other organ disorders. In addition, shortening the time interval between the termination of pregnancy and initializing plasmapheresis improves the outcome and reduces the duration of hospital stay and sessions of plasmapheresis.

Postoperative histological changes in polypose rhinosinusitis.

The aim of this study was to evaluate the effect of surgery on the histology of nasal mucosa in patients with nasal polyposis and the comparison/also to compare it with normal population. This case-control study was conducted on 20 patients at the Otorhinolaryngology-Head and Neck Surgery Department, Qaem Hospital, Mashhad University of Medical Sciences during October 2007 to June 2008. Patients with polyposis and patients with septal deviation who were candidate for septoplasty were considered as case and control groups, respectively, including 10 subjects in each. Specimens of polyp tissue and the inferior conchae (mucosa) were taken during sinus endoscopy from the case group. One month later, another specimen was taken from the inferior conchae (mucosa). Moreover, specimens of the inferior conchae (mucosa) were taken of the control group. Percentage of goblet cells among the epithelial cells was determined for each group. Goblet cell percentage found to be 15.7% in polyps, consistent with significant difference with that of in postoperative (13.3%) and in preoperative nasal mucosa specimens (39.86%), (P = 0.043 and P = 0.03, respectively). Goblet cell percentage was 39.86% and 4.9% in the case and control groups, in that order, which were significantly high (P < 0.001). Percentage of goblet cells showed to be lower in polyps than mucosa. Also percentage of goblet cells in postoperative nasal mucosa specimens was significantly lower than preoperative specimens. Therefore, surgery has additional benefit of histological improvement rather than opening nasal airway.

Lobular capillary hemangioma of middle turbinate literature survey and case report.

INTRODUCTION: Lobular capillary hemangioma (LCH) is a benign lesion of vascular origin. It rarely involves nasal cavity which most commonly manifests as progressive nasal obstruction and epistaxis. CASE REPORT: In this report we present a case of LCH of the nasal cavity which occurred approximately one month after delivery. There was no recurrence after complete endoscopic resection during one year follow up.

The right of all nations to access science, new technologies and sustainable development.

This article explores the need for reflection on the right of developing countries to science and technology in addition to explaining the place of the scientific rights of nations in human rights as a whole. The discussion was conducted in relation to sustainable development. Through the examination of the current situation and the challenges to sustainable development, and taking into account the imbalance in the distribution of the benefits of science and new technologies, the authors advocate a comprehensive approach to promote cooperation and capacity-building in this area. They argue that linkages should be adopted between micro-levels and macro-levels of analysis by elevating rights and related issues from individuals to the national level in the field of the right to science and technology, and from the national to the international level in the field of sustainable development in order to institutionalise and ensure individual and national rights to science, technology and sustainable development. The authors also believe in a multidimensional perspective based on the balanced flourishing of the material and immaterial aspects of humankind in order to realise these rights in the context of dialogue and cultural diversity and to promote the culture of sustainable and dynamic peace based on justice in knowledge societies.