Bacteriological profile in conjunctival, lacrimal sac, and nasal specimens and conjunctival normalization time following external, endoscopic, and transcanalicular multidiode laser dacryocystorhinostomy.

PURPOSE: To compare the conjunctival, lacrimal sac, and nasal flora cultures and conjunctival normalization time following external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) dacryocystorhinostomy (DCR) and to evaluate the relationship between culture positivity and surgical success. We further performed antibiotic sensitivity analyses for lacrimal sac culture samples. METHODS: A total of 90 patients with primary acquired nasolacrimal duct obstruction were recruited and divided into EX-DCR (n=32), EN-DCR (n=28), and TC-DCR (n=30) groups. Conjunctival, nasal, and lacrimal sac cultures and antibiograms were analyzed. RESULTS: In all three groups, coagulase-negative Staphylococcus (CNS) was predominantly isolated preoperatively from the conjunctiva, nose, and lacrimal sac and postoperatively from the conjunctiva. Preoperative and postoperative conjunctival culture positivity rates were similar between all the groups (p>0.05). A statistically significant difference in the growth rate of culture in the lacrimal sac was observed between the three groups (p=0.001). CNS and Staphylococcus aureus cultures were predominantly sensitive to linezolid, teicoplanin, tigecycline, vancomycin, and mupirocin. Conjunctival normalization times were similar between the three groups (p>0.05). Anatomical and functional success rates were not found to be significantly correlated with preoperative conjunctival and lacrimal sac culture positivity (p>0.05). CONCLUSIONS: Similar rates of preoperative and 1-week postoperative conjunctival culture positivity were observed in all the groups; a significantly lower bacterial growth rate was observed in postoperative conjunctival cultures. CNS was the most commonly isolated organism. Bacterial growth rates in the lacrimal sac samples were significantly higher in the EN-DCR group. Bacterial growth rates obtained preoperatively from the conjunctival and lacrimal sac culture samples were not correlated with DCR success.

Bacteriological profile in conjunctival, lacrimal sac, and nasal specimens and conjunctival normalization time following external, endoscopic, and transcanalicular multidiode laser dacryocystorhinostomy / Perfil bacteriológico e tempo de normalização conjuntival de espécimes de conjuntiva, saco lacrimal e nasais após dacriocistorrinostomia externa, endoscópica e transcanalicular com laser de multi diodo

ABSTRACT Purpose: To compare the conjunctival, lacrimal sac, and nasal flora cultures and conjunctival normalization time following external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) dacryocystorhinostomy (DCR) and to evaluate the relationship between culture positivity and surgical success. We further performed antibiotic sensitivity analyses for lacrimal sac culture samples. Methods: A total of 90 patients with primary acquired nasolacrimal duct obstruction were recruited and divided into EX-DCR (n=32), EN-DCR (n=28), and TC-DCR (n=30) groups. Conjunctival, nasal, and lacrimal sac cultures and antibiograms were analyzed. Results: In all three groups, coagulase-negative Staphylococcus (CNS) was predominantly isolated preoperatively from the conjunctiva, nose, and lacrimal sac and postoperatively from the conjunctiva. Preoperative and postoperative conjunctival culture positivity rates were similar between all the groups (p>0.05). A statistically significant difference in the growth rate of culture in the lacrimal sac was observed between the three groups (p=0.001). CNS and Staphylococcus aureus cultures were predominantly sensitive to linezolid, teicoplanin, tigecycline, vancomycin, and mupirocin. Conjunctival normalization times were similar between the three groups (p>0.05). Anatomical and functional success rates were not found to be significantly correlated with preoperative conjunctival and lacrimal sac culture positivity (p>0.05). Conclusions: Similar rates of preoperative and 1-week postoperative conjunctival culture positivity were observed in all the groups; a significantly lower bacterial growth rate was observed in postoperative conjunctival cultures. CNS was the most commonly isolated organism. Bacterial growth rates in the lacrimal sac samples were significantly higher in the EN-DCR group. Bacterial growth rates obtained preoperatively from the conjunctival and lacrimal sac culture samples were not correlated with DCR success.

RESUMO Objetivo: Comparar a flora conjuntival, do saco lacrimal e nasal com o tempo de normalização após dacriocistorrinostomia (DCR) externa (EX-), endoscópica (EN-) e transcanalicular a laser de multi diodo (TC-) para correlacionar a positividade da cultura com o sucesso cirúrgico, assim como identificar a sensibilidade aos antibióticos em amostras de saco lacrimal. Métodos: Neste estudo prospectivo, 90 pacientes com obstrução do canal nasolacrimal adquirida primária foram incluídos e divididos em grupos EX-DCR (n=32), EN-DCR (n=28) e TC-DCR (n=30). Culturas e antibiogramas conjuntivais, nasais e do saco lacrimal foram analisados. Resultados: Staphylococcus coagulase-negativo (CNS) foi o organismo predominante isolado no pré-operatório (conjuntiva e nariz), no transoperatório (saco lacrimal) e pós-operatório (conjuntiva), nos 3 grupos. Taxas de positividade de cultura da conjuntiva pré- e pós-operatórias nos três grupos foram semelhantes (p>0,05). A diferença nas taxas de crescimento do saco lacrimal dos três grupos foi estatisticamente significativa (p=0,001). CNS e S. aureus foram mais sensíveis a linezolida, teicoplanina, a tigeciclina, vancomicina e mupirocina. O tempo de normalização conjuntival foi semelhante nos três grupos (p>0,05). Não houve relação estatisticamente significativa entre as taxas de sucesso anatômicas e funcionais e a positividade da cultura conjuntival e de saco lacrimal pré-operatória (p>0,05). Conclusões: Pacientes submetidos a EX-DCR, EN-DCR, e TC-DCR apresentaram positividades de cultura conjuntival semelhantes no pré-operatório e na 1a semana pós-operatória. Houve uma redução significativa na taxa de crescimento das culturas da conjuntiva pós-operatórias. O organismo mais comumente isolado foi o CNS. A taxa de crescimento de bactérias a partir do saco lacrimal foi significativamente maior no grupo PT-DCR. O crescimento bacteriano da conjuntiva no pré-operatório e de amostras do saco lacrimal no transoperatório não se relacionaram com o sucesso da DCR.

Prospective comparison of 3 dacryocystorhinostomy surgeries: external versus endoscopic versus transcanalicular multidiode laser.

PURPOSE: To analyze the clinical outcomes of external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) with dacryocystorhinostomy (DCR). METHODS: Ninety-two patients with primary acquired nasolacrimal duct obstruction were enrolled (divided into EX-DCR [n = 33], EN-DCR [n = 30], and TC-DCR groups [n = 29]) in this prospective study. Primary outcome measures were the anatomical and functional success of operations at the last control examination. Secondary outcome measures were the ostium size, surgical time, and complications. RESULTS: The difference in mean surgical time among the 3 groups was statistically significant (p < 0.0001). External DCR required the longest surgical time (46.6 ± 15.3 minutes), while TC-DCR was the shortest (20.3 ± 7.7 minutes). There were no significant differences between the groups regarding anatomical (81.8%, 75.9%, and 76.7% in EX-, EN-, and TC-DCR groups, respectively; p = 0.824) and functional success rates (81.8%, 72.4%, and 73.3% in EX-, EN-, and TC-DCR groups, respectively; p = 0.626). Final ostium size was the largest with EX-DCR (33.7 ± 17.4 mm) and smallest with EN-DCR (19.0 ± 8.9 mm; p = 0.001). The complication rate was similar in all groups. The most common complications were the formation of granulation tissue (16.3%) and intranasal synechiae (9.8%), all of which led to surgical failure and were more frequent in the EN- and TC-DCR groups. CONCLUSIONS: External DCR, EN-DCR, and TC-DCR had similar success and complication rates in patients with primary acquired nasolacrimal duct obstruction. External DCR resulted in the largest ostium size. Transcanalicular DCR appeared to be effective with the shortest surgical time.

Auricular mucormycosis: a case report.

Mucormycosis is a rare, saprophytic, invasive, and fulminant fungal disease. It occurs in immunocompromised patients such as those with diabetes mellitus or blood dyscrasia, or in patients under immunosuppressive therapy. A 17-year-old female patient with diabetic ketoacidosis presented with a black-colored lesion in the auricle and external ear canal. Physical examination showed necrosis of the auricle, external ear canal, and neighboring skin. She also had facial paralysis. Debridement of the necrotic tissues was performed and the samples were submitted for microbiologic and histopathologic examination, which showed nonseptate hyphae. Postoperatively, systemic amphotericin B was empirically administered. The patient died on the seventh day.

Effects of antineoplastic agents on the peripheral nerves under a surgical tissue expansion procedure: an experimental study.

BACKGROUND: Elongation of peripheral nerve by the use of a tissue expander is helpful to repair nerve defects. This study was designed to investigate the effects of some antineoplastic agents on the peripheral nerves under a surgical tissue expansion procedure. MATERIALS AND METHODS: Twenty-five Wistar rats were used in this study. Following the exposition of the sciatic nerve and placement of two 10/0-nylon sutures in the epineurium 20 mm apart, a tissue expander was then placed under it. Inflation of the expander was immediately accomplished by the separate percutaneous injections of 6, 6, and 8 ml for every 3 min under general anesthesia. The expander was fully deflated at the end of each 3 min The distance between two sutures was measured 1 h later to measure the rate of elongation. Rats were randomly divided into five groups (according to the administered drugs), each consisting of five rats (10 sciatic nerves). Normal saline (1 ml) in the control group (group I), cyclophosphamide (15 mg/kg) in the group II, cisplatinum (3 microg/kg) in the group III, mitomycin-C (0.5 mg/kg) in the group IV and 5-fluorouracil (10 mg/kg) in the group V were injected intravenously. Intravenous injections of drugs were performed via the tail vein 30 min before expansion, 48 and 96 h after removal of expander. The incision was reopened on the third and seventh postoperative days, and five sciatic nerves of each group were exposed and then the pinching test was performed to measure regeneration distance. Electroneurographic changes were recorded. The expanded portion of the sciatic nerve between two sutures was harvested for histological evaluation. RESULTS: There is no significant difference between the elongation rates of all groups (P < 0.05). Histologic evaluation showed that inflammatory changes, vacuolization, intraneural edema, demyelination, axonal changes in the control group, the cisplatinum group, and the mitomycin-C group. These changes were significantly decreased in the cyclophosphamide group and the 5-fluorouracil group. In the cyclophosphamide group and the 5-fluorouracil group, the amplitude of compound action potential (CAP) values were significantly higher and the latency was significantly shorter (P > 0.05). CONCLUSION: We believed that cyclophosphamide and 5-fluorouracil may be helpful in tissue expansion of peripheral nerves, by decreasing the effects of the ischemia-reperfusion injury on the expanded peripheral nerves.

Effects of intensive and moderate cellular phone use on hearing function.

The purpose of this study is to investigate the effects of radiation emitted by mobile phones on the hearing of users. The study was carried out on three groups: 1) 20 men who have used a cellular phone frequently and spoken approximately 2 h per day for four years; 2) 20 men who have used a cellular phone for 10-20 min per day for four years; and 3) 20 healthy men who have never used a cellular phone (the control group). Brainstem evoked response audiometric (BERA) and pure tone audiometric (PTA) methods were used to measure the effects of exposure on hearing function of the subjects. In BERA measurements, I-III, III-V, and I-V interpeak latencies were evaluated. Interpeak latency of subjects in two experimental groups was compared to that of subjects in the control group. The BERA results showed no differences among the groups (p > 0.05). In PTA measurements, detection thresholds at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz frequencies were measured in all three groups. No differences were observed between moderate mobile phone users (10-20 min. per day) and control subjects. However, detection thresholds in those who talked approximately 2 h per day were found to be higher than those in either moderate users or control subjects. Differences at 4000 Hz for both bone and air conduction for right ears, and 500 Hz, and 4000 Hz bone and air conduction for left ears were significant for mean hearing threshold. This study shows that a higher degree of hearing loss is associated with long-term exposure to electromagnetic (EM) field generated by cellular phones.

Protective effects of some antineoplastic agents on ischemia-reperfusion injury in epigastric island skin flaps.

Neutrophil depletion has a beneficial effect on ischemic myocardium and skeletal muscle upon reperfusion. Antineoplastic agents reduce blood neutrophils effectively, and lead to neutrophil depletion. The purpose of this study was to investigate the effects of four antineoplastic agents in low doses (cyclophosphamide, cisplatinum, mitomycin-C, and 5-fluorouracil) on ischemia-reperfusion injury, using an epigastric island skin-flap model in rats. Fifty male Sprague-Dawley rats, weighing 250-300 g, were randomly divided into five groups, each consisting of 10 rats: control, cyclophosphamide, cisplatinum, mitomycin-C, and 5-fluorouracil groups. Epigastric island skin flaps (measuring 3.5 x 4 cm) were raised and subjected to 10 h of in situ ischemia, followed by 7-day reperfusion and evaluation. Treatment with antineoplastic agents (cyclophosphamide, cisplatinum, mitomycin-C, and 5-fluorouracil) was used to introduce neutropenia. Complete blood counts, cutaneous bleeding time, and skin-flap survival were evaluated. Additionally, levels of malonyldialdehyde (MDA), nitric oxide (NO), glutathione (GSH), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) were measured from extracted skin tissue. Numbers of leukocytes and platelets were decreased in all experimental groups. However, neutropenia and thrombocytopenia were not seen. Cutaneous bleeding activity was prolonged in all experimental groups, but not above the normal value. MDA and NO levels were found to be lower in all four antineoplastic agent groups than in the control group, while GSH, GSH-Px, and SOD enzyme activities were significantly higher (P < 0.05). However, MDA and NO levels were significantly decreased in the cyclophosphamide and 5-fluorouracil groups, as compared to the cisplatinum and mitomycin-C groups (P < 0.01). Also, GSH, GSH-Px, and SOD enzyme activities were significantly increased in the cyclophosphamide and 5-fluorouracil groups, compared to the other two antineoplastic agent groups (P < 0.01). We conclude that antineoplastic agents have beneficial effects on ischemia-reperfusion injuries when their doses are carefully adjusted, by decreasing the number of leukocytes and platelets, and altering the activity of free oxygen radicals.

Salutary effects of radiopaque contrast media on the survival of random-pattern skin flaps in the rat: an experimental study.

The radiopaque contrast medium diatrizoate, has a vasodilator effect so that it is used in sudden-deafness secondary ischemic injury. However, ischemic problems are encountered, especially when longer flaps are elevated. A longer flap also has ischemic and relatively ischemic tissue, and may obtain some benefit from contrast media. Forty male Sprague-Dawley rats, weighing about 350-400 g, were used, and randomly divided into four groups (n = 10 rats each group): group 1 was the control, group 2 the diatrizoate, group 3 the iopamidol, and group 4 the iothalamate group. A rectangular 3 x 10 cm caudally based dorsal skin flap was elevated, and sutured back to its original place. In the control group, no pharmacologic agent was administered. Sodium-meglumine-diatrizoate 10 mg/kg/day was administered parenterally in the first experimental group (diatrizoate group); iopamidol 10 mg/kg/day in the second experimental group (iopamidol group); and iothalamate sodium 10 mg/kg/day in the third experimental group (iothalamate group) for 7 postoperative days. On postoperative day 7, all flaps were photographed, and the area of flap survival was measured by using a polar planimeter. The results were statistically evaluated with the Kruskal-Wallis test and Mann-Whitney U-test (P = 0.05). The mean flap survival ranged from 79% in the iopamidol group to 83% in the diatrizoate group, and was significantly greater in all experimental groups (P < 0.05) compared to the control group (59%). There was no significant difference between experimental groups (P < 0.05). We believe that radiopaque contrast media have a beneficial effect in improving skin flap viability when distal flap necrosis is a potential complication of longer flaps.

Occupational safety: effects of workplace radiofrequencies on hearing function.

BACKGROUND: The effects of radio frequency (RF) and microwave radiation on humans have been the subject of continuous investigation. Clinical investigations related to occupational RF/microwave exposure have been reported by investigators (1). Since one of the major groups occupationally exposed to RF and microwave radiation includes those working in radio broadcasting and TV transmitter stations, this study investigates whether RF affects auditory systems of people exposed to RF. METHODS: The study is carried out with people working in radio broadcasting stations and living in employee residential houses close to the broadcasting stations. All subjects in the control group were similar in age, work regime, socioeconomic status, and lack of experience in working with RF sources. Brainstem Evoked Response Audiometer (BERA) and Pure Tone Audiometry (PTA) were used to measure the effects of RF under investigation on hearing functions of the subjects. In BERA measurements, I-III, III-V and I-V interpeak latencies were evaluated. In pure tone audiometric measurements, 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and 8000 Hz frequencies of hearing threshold were measured in subjects of experimental and control groups. Interpeak latencies and bone conduction hearing thresholds of subjects in the experimental group were compared with those of the control group. RESULTS: BERA results showed that I-III, I-V and III-V interpeak latencies of people occupationally exposed to RF were not higher than subjects in control groups (p>0.05). Results of BERA indicated no statistically significant differences between exposure and control subjects. In audiometric evaluation, hearing threshold of people occupationally exposed to RF were found higher than the control group subjects for frequencies of 4000 Hz and 8000 Hz in terms of bone and air conduction of right and left ear (p < 0.01). CONCLUSIONS: The results of traditional audiometer indicated that RF promotes sensorineural hearing loss and affects cochlea parts related to 4000 Hz and 8000 Hz. These findings may have immediate implications and considerations for workplace safety in order to provide an occupationally safe environment to employees working in such settings.

Use of radial forearm free flap with palmaris longus tendon in reconstruction of total maxillectomy with sparing of orbital contents.

Nasal paragangliomas are extremely rare. The most adequate treatment is total excision. After surgical excision requiring total maxillectomy, there has been no ideal technique for reconstruction. A 47-year-old man was admitted to our clinic because of recurrent epistaxis, which lasted for 2 months. He was also suffering from nasal airway obstruction. The physical examination revealed a mass originating from the medial aspect of the middle turbinate of the right nasal cavity. It invaded the anterior maxillary wall and hard and soft palate. Endoscopic examination showed that the mass pushed the nasal septum to the left side and protruded into the nasopharynx. The mass was fleshy and had a rich capillary network. Conventional paranasal sinus radiographs were normal. Computerized tomography of the skull showed the mass protruding into the nasopharynx. A total maxillectomy was performed. Histopathological evaluation showed neoplastic tissue consisting of round, oval, or slightly elongated cells, altogether of a rather monomorphous appearance, tending to arrange themselves in clusters adjacent to or around capillary blood vessels. The blood vessels were numerous and branched. Reticulum staining showed a typical Zellballen arrangement of the neoplastic cells to provide a firmer basis for the diagnosis of paraganglioma. To reconstruct the total maxillectomy defect, a radial forearm free flap with the palmaris longus tendon was elevated to inlay the nasal cavity and the oral cavity and to suspend the ocular globe. The flap was placed into the defect, and the palmaris longus tendon was medially and laterally anchored to the periosteum of the frontal bone to suspend the ocular globe in the orbital cavity. One part of the skin island was used to close the defect of the nasal mucosal cavity, and the other part was used to repair the oral mucosal defect of the palate. Consequently, speech was considered near normal; the patient was able to eat an unrestricted diet and to retain both solid and liquid food inside the oral cavity without drooling, and there was no diplopia or enophthalmos. Six months later, porous polyethylene was inserted and fixed to the zygomatic bone with a miniplate and miniscrews to restore malar contour. No further procedure was believed to be necessary later on. Two years later, a satisfactory and functional esthetic result was obtained, providing an acceptable suspension of the ocular globe and filling of the total maxillectomy defect. We believe that a total maxillectomy is indicated if it is needed in nasal paragangliomas and that microsurgical repair with the composite radial forearm-palmaris longus free flap has several advantages: 1) it can offer en bloc reconstruction of the entire defect after a total maxillectomy in terms of good function and cosmesis; 2) it can repair mucosal defects; and 3) it can anchor and suspend the ocular globe in its original anatomical location, protecting against gravity through the sling effect of the palmaris longus tendon. The composite radial forearm-palmaris longus free flap has not been described previously for suspension of the ocular globe.

Use of distant V-Y plasty in reconstruction of defects on the nasal dorsum: A new modification of V-Y plasty.

Nasal reconstruction requires a good aesthetic outcome because the nose is located in the centre of the face. Two problems commonly occur after reconstruction of the nose: abnormal appearance of the new nose, and nasal airway obstruction. The nasal dorsum should be treated as a separate unit. Several local flaps have been described for reconstruction of tissue defects on the dorsum of the nose. Most of these techniques have some disadvantages, such as colour mismatch, dog-ear formation, thickness of flaps and requirement of surgery for revision. Two patients in whom the nasal dorsum was reconstructed with distant V-Y plasty are presented. Six months later, cosmetically acceptable results were obtained. The authors believe that the distant V-Y plasty is an effective alternative to the current techniques in reconstruction of the nasal dorsum. The advantages of this technique include the following: distant V-Y plasty is a safe and useful way to reconstruct medium and large defects of the nasal dorsum; it provides good texture and colour match; the resultant scar cannot cause contour deformity because it is not a bulky flap; there are no formation of dog-ear; it can be used to cover larger defects in elderly patients; it can be used under local anesthesia in almost all cases; it requires a shorter period of operating time and hospitalization; and it is less costly.

La reconstruction du nez exige de bons résultats sur le plan de l'esthétique étant donné que le nez se trouve au centre de la face. Toutefois, l'opération donne souvent lieu à deux types de problème : l'apparence anormale du nouveau nez et l'obstruction des voies nasales. Il faudrait que le dos du nez soit traité comme une entité distincte. Il existe plusieurs techniques de plastie par lambeau de voisinage pour la reconstruction du dos du nez, mais la plupart comportent des désavantages comme la différence de couleur, la formation de bourgeons, l'épaisseur des lambeaux et la nécessité de recourir à la chirurgie pour les reprises. Voici deux cas de reconstruction du dos du nez par lambeau en VY à distance, qui a donné, au bout de six mois, des résultats acceptables du point de vue esthétique. Les auteurs sont d'avis que la plastie par lambeau en VY à distance constitue une bonne solution de rechange aux techniques actuelles de reconstruction du dos du nez. En effet, la nouvelle technique offre plusieurs avantages, notamment son innocuité et ses possibilités de reconstruction de parties relativement grandes du dos du nez, sa texture et l'absence de différence de couleur, la non-déformation du contour par la cicatrice en raison de l'utilisation de lambeaux plutôt minces, l'absence de formation de bourgeons et sa capacité de couvrir de grandes surfaces chez les personnes âgées. De plus, elle peut être pratiquée sous anesthésie locale dans la plupart des cas, elle nécessite un temps d'intervention moins long et un séjour plus court à l'hôpital et elle coûte moins cher que les autres techniques.