PAPILLARY THYROID CARCINOMA FOLLOWING ADALIMUMAB TREATMENT IN ANKYLOSING SPONDYLITIS: A CAUSAL OR COINCIDENTAL ASSOCIATION?

The introduction of tumor necrosis factor-alpha (TNF-α) targeting drugs has given new opportunities in the treatment of various inflammatory rheumatic diseases and has been the most important development in the treatment of ankylosing spondylitis (AS). However, the increasing use and longer follow-up periods of treatment also pose risks of developing various adverse effects, ranging from common ones, including infections, to uncommon thyroid neoplasms. Adalimumab (ADA), a fully human monoclonal antibody targeted against TNF-α, is indicated for AS. We describe the case of a patient with AS who developed a papillary thyroid carcinoma (PTC) while on therapy with ADA. Cervical lymphadenopathy and a heterogeneous nodule in the right thyroid lobe were detected in the 48-year-old female patient who had been using ADA (40 mg subcutaneously every 2 weeks) for 2 years with the diagnosis of AS. Fine-needle aspiration cytology confirmed PTC. ADA treatment was discontinued, and a total thyroidectomy surgery was performed. We believe that the thyroid gland should also be taken into consideration while screening for malignancy before and during TNF inhibitors (TNFi).

Assessment of novel biomarkers: sTREM-1, pentraxin-3 and pro-adrenomedullin in the early diagnosis of neonatal early onset sepsis.

BACKGROUND: Early onset bacterial sepsis in neonates (EOS) is recognized as an important health condition. Early diagnosis is crucial. However, blood culture results are released in 48-72 hours. Many biomarkers have been investigated but none have been accepted as the gold standard. This study aimed to investigate the diagnostic value of the molecules: soluble form of triggering receptor expressed on myeloid cells-1 (sTREM-1), pentraxin-3 (PTX-3) and pro adrenomedullin (pro-ADM) in EOS and compare with currently used biomarkers. METHODS: In this multicenter prospective study, patients were enrolled from different NICUs around the Turkey. Patient data were collected via web-based registry system from attending centers. Neonates, hospitalized with a suspicion of EOS were enrolled. Blood culture and routine blood tests were collected and a serum sample was obtained and kept in - 80°C for studying the molecules. According to laboratory results, patients were divided into three groups as; proven sepsis, clinical sepsis and control group. Groups were compared in terms of demographic, clinical and laboratory findings. The primary outcome of the study was to assess any difference between groups in terms of the diagnostic value of the markers aforementioned. RESULTS: A total of 130 patients were enrolled; proven sepsis (n = 36), clinical sepsis (n = 53) and control (n = 41) groups. Groups were similar in terms of demographic findings; mean WBC (P = 0.445), procalcitonin (PCT) (P = 0.083) and IL-6 (P = 0.814) levels. Mean C-reactive protein (CRP) level was significantly higher in clinical sepsis and proven sepsis groups compared to control group (P < 0.001). Mean PTX-3 (P = 0.547), pro-ADM (P = 0.766) and sTREM-1 (P = 0.838) levels were similar between groups. CONCLUSION: These promising molecules failed to help in early diagnosis of EOS. Their relation to correlation with disease progression may make more sense as they seem to be expressed in higher amounts with the progression of the disease in previous studies. CRP was the most frequently used biomarker for detecting the sepsis in our study population.

The effects of aerobic exercise frequencies on liver fibrosis, α-fetoprotein and cytokeratin 19 in experimental type 2 diabetes-induced rats: an immunohistochemistry study.

We investigated using immunohistochemistry the effects of frequency of aerobic exercise on liver fibrosis and measured the expression of the oval cell marker, alpha fetoprotein (AFP), and the hepatocellular carcinoma marker, CK 19, in rats with early-period induced type 2 diabetes (T2DM). Rats were divided into four groups: control sedentary rats, diabetic sedentary rats, diabetic rats with continuous exercise (30 min/day, 5 days/week) and diabetic rats with short periods of exercise (3 x 10 min/day, 5 days/week). T2DM was induced using an intraperitoneal (i.p.) injection of nicotinamide (NA) and streptozotocin (STZ). Liver samples were obtained 8 weeks after injection. Tissue sections were stained with hematoxylin and eosin, periodic acid-Schiff and Masson's trichrome. We also used immunochemical staining for AFP, smooth muscle actin (α-SMA) and CK19. Continuous and short periods of aerobic exercise produced similar effects during the early period of liver damage in the STZ-NA model, i.e., decreased blood glucose levels and improved body weight, improved liver histology and reduced fibrosis, necrosis and steatosis; and reduced expression of AFP and α-SMA. Moderate aerobic exercise for 150 min/week appeared to reduce early liver damage in a rat model of T2DM.

Effects of serum uric acid levels on the arginase pathway in women with metabolic syndrome.

BACKGROUND: Elevated serum uric acid levels and increased arginase activity are risk factors for cardiovascular diseases (CVD). The aim of the present study was to investigate effects of serum uric acid levels on the arginase pathway in women with metabolic syndrome (MetS). METHODS: Serum arginase activity, and nitrite and uric acid levels were measured in 48 women with MetS and in 20 healthy controls. The correlation of these parameters with components of MetS was also evaluated. RESULTS: Our data show statistically higher arginase activity and uric acid levels but lower nitrite levels in women with MetS compared to controls. Serum uric acid levels were negatively correlated with HDL cholesterol, nitrite levels and positively with Body Mass Index, waist to hip ratio, triglyceride and total cholesterol levels, systolic blood pressure, Homeostasis Model Assessment-Insulin Resistance-Index, serum arginase activity, and LDL-cholesterol levels in women with MetS. CONCLUSION: Results of the present study suggest that serum uric acid levels may contribute to the pathogenesis of MetS through a process mediated by arginase pathway, and serum arginase activity and nitrite and uric acid levels can be used as indicators of CVD in women with MetS.

Circulating adhesion molecules and arterial stiffness.

AIM: VCAM-1 and ICAM-1 are two important members of the immunoglobulin gene superfamily of adhesion molecules, and their potential role as biomarkers of diagnosis, severity and prognosis of cardiovascular disease has been investigated in a number of clinical studies. The aim of the present study was to determine the relationship between circulating ICAM-1 and VCAM-1 levels and aortic stiffness in patients referred for echocardiographic examination. METHODS: Aortic distensibility was determined by echocardiography using systolic and diastolic aortic diameters in 63 consecutive patients referred for echocardiography. Venous samples were collected in the morning after a 12-hour overnight fast, and serum concentrations of ICAM-1 and VCAM-1 were measured using commercial enzyme immunoassay kits. RESULTS: Data of a total of 63 participants (mean age 55.6 ± 10.5 years, 31 male) were included in the study. Circulating levels of adhesion molecules were VCAM-1: 12.604 ± 3.904 ng/ml and ICAM-1: 45.417 ± 31.429 ng/ml. We were unable to demonstrate any correlation between indices of aortic stiffness and VCAM-1 and ICAM-1 levels. CONCLUSION: The role of soluble adhesion molecules in cardiovascular disease has not been fully established and clinical studies show inconsistent results. Our results indicate that levels of circulating adhesion molecules cannot be used as markers of aortic stiffness in patients.

[The image of general practitioners from the perspective of patients with and without a Turkish migration background - a qualitative study]. / Das Image von Hausärzten aus Perspektive von Patienten mit und ohne türkischem Migrationshintergrund - eine qualitative Studie.

OBJECTIVE: In order to improve the medical care of people with migration background, the existing specialties in medical understanding must be taken into account. The aim of this study was to explore the image of general practitioners from the viewpoint of patients and to evaluate possible differences in the perception of patients with and without a Turkish migration background. METHODS: 5 focus groups with participants with and without migration background were assessed in German language. In addition to a predefined interview guideline, the collage technique was used in order to explore the image of the practitioners through pictures. The content analysis was conducted according to Mayring using the software program ATLAS.ti. RESULTS: The patients revealed a highly positive image about the general practitioners. By means of the collage technique some negative aspects could be identified which were not discussed in the focus groups. Only minimal differences in the opinions of participants with and without Turkish migration background could be observed. These were a strongly negative attribution to the general practitioners with regard to financial aspects by the participants without migration background on the one hand and a rather paternalistic viewpoint by the participants with Turkish migration background on the other hand. Asked about an image change of general practitioners, the overall opinion has changed over the years from doctors being considered to be "powerful" and "unapproachable" to a "normal" level. Major reasons for this image change were attributed to the fact that patients are becoming increasingly informed about medical issues through the internet and the high work pressure of general practitioners. The image of general practitioners in Turkey was perceived more negative as compared to Germany. CONCLUSION: The image of general practitioners from the perspective of patients is predominantly positive. Altogether, only minor differences in the perception of German speaking patients with and without Turkish migration background could be identified. Therefore, specific ways of proceeding or qualification measures for general practitioners do not seem necessary in this context.

Hepatic progenitor cell inhibition during embryonic period with high dose verapamil; liable joint to the cancer therapy.

Cancer stem cells (CSCs) have been observed to share certain characteristics with normal stem cells. It was an important argument for cancer therapy and a successful progenitor inhibition could show us targeted cell type for a novel strategy. In this study, we aimed to constitute an inhibition in different stages of hepatic stem/progenitor cells (HPCs) with verapamil. Expression patterns of alpha-fetoprotein (AFP), c-kit (CD117) and p-glycoprotein were investigated in developing mouse on the embryonic day (E) 15, E18 and E21 to characterize early and late stages of HPCs. Proliferation inhibition with 5-Bromo-2-Deoxyuridin (BrdU) incorporation and maturation inhibition with PAS staining results were supported by morphometrical analysis during these periods. AFP, c-kit and p-glycoprotein immunoreactivity increased especially in E15 but decreased in E18 and E21 of the control groups during embryonic development. Verapamil treatment effected particularly E15 cells and immunoexpression of HPCs significantly decreased. Proliferation inhibition was observed in all embryonic days of mouse with verapamil and this drug inhibited not only maturation of HPCs in E18 and E21 embryos, but also decreased HPC number in the same embryonic period. According to our results, we estimated that similar to the early and late progenitor stages of HPCs, CSCc can also be in different stages in a heterogenic tumour bulk and the difficulty of CSC inhibition could be the main mechanism of tumour relapses. In this study, HPCs inhibition by verapamil in E15 was not observed in E18 and E21. As similar, CSCs treatments targeting different stages may be impotent to cells in tumour initiating cell stage. We can speculate that ineffectiveness of CSC-specific therapies may be attributed to the highly selective specificity of the treatment (Fig. 6, Ref. 28).

Transient neonatal methemoglobinemia caused by maternal pudendal anesthesia in delivery with prilocaine: report of two cases.

This paper reports two cases of transient neonatal methemoglobinemia caused by maternal pudendal anesthesia with prilocaine. In the first case a two-hour-old, 3100 gram term-male infant was admitted to Neonatal Intensive Care Unit (NICU) because of central cyanosis. He was born from a 21-year-old mother with spontaneous vaginal delivery. Central cyanosis was noted without respiratory distress. Oxygen saturation was recorded as 72% with pulse oximetry in room air and with oxygen given by mask. Chest radiogram, echocardiography and laboratory findings were found to be normal except a methemoglobin level of 28%. No etiology was found, except for maternal prilocaine administration during labor. In the second case a six-hour-old 3300 gram, full-term male neonate born by spontaneous vaginal delivery was admitted to NICU for central cyanosis. The neonate was noted to have central cyanosis with respiratory distress. Oxygen saturation with pulse oximetry was 70% with mask oxygen therapy. Methemoglobin level was 42%. The neonate was treated with single dose intravenous ascorbic acid (300 mg/kg) to which he responded dramatically at 24 hours of life. No other etiology was detected except pudendal anesthesia during delivery with prilocaine. According to the authors, prilocaine administered before delivery to provide maternal local pudendal anesthesia may cause transient neonatal methemoglobinemia. All neonates born to mothers who receive potential oxidant drugs like prilocaine just before the time of delivery should be carefully monitored for methemoglobinemia.

Leptin receptor (Ob-R) mRNA expression and serum leptin concentration in patients with colorectal and metastatic colorectal cancer.

The objective of the present study was to investigate the effect of leptin on the progression of colorectal carcinoma to metastatic disease by analyzing the serum leptin concentration and Ob-R gene expression in colon cancer tissues. Tissue samples were obtained from 31 patients who underwent surgical resection for colon (18 cases) and metastatic colon (13 cases) cancer. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA) and Ob-R mRNA expression by real-time polymerase chain reaction (RT-PCR) for both groups. ELISA data were analyzed by the Student t-test and RT-PCR data were analyzed by the Mann-Whitney U-test. RT-PCR results demonstrated that mRNA expression of Ob-R in human metastatic colorectal cancer was higher than in local colorectal cancer tissues. On the other hand, mean serum leptin concentration was significantly higher in local colorectal cancer patients compared to patients with metastatic colorectal cancer. The results of the present study suggest a role for leptin in the progression of colon cancer to metastatic disease without weight loss. In other words, significantly increased Ob-R mRNA expression and decreased serum leptin concentration in patients with metastatic colon cancer indicate that sensitization to leptin activity may be a major indicator of metastasis to the colon tissue and the determination of leptin concentration and leptin gene expression may be used to aid the diagnosis.

Leptin receptor (Ob-R) mRNA expression and serum leptin concentration in patients with colorectal and metastatic colorectal cancer

The objective of the present study was to investigate the effect of leptin on the progression of colorectal carcinoma to metastatic disease by analyzing the serum leptin concentration and Ob-R gene expression in colon cancer tissues. Tissue samples were obtained from 31 patients who underwent surgical resection for colon (18 cases) and metastatic colon (13 cases) cancer. Serum leptin concentration was determined by an enzyme-linked immunosorbent assay (ELISA) and Ob-R mRNA expression by real-time polymerase chain reaction (RT-PCR) for both groups. ELISA data were analyzed by the Student t-test and RT-PCR data were analyzed by the Mann-Whitney U-test. RT-PCR results demonstrated that mRNA expression of Ob-R in human metastatic colorectal cancer was higher than in local colorectal cancer tissues. On the other hand, mean serum leptin concentration was significantly higher in local colorectal cancer patients compared to patients with metastatic colorectal cancer. The results of the present study suggest a role for leptin in the progression of colon cancer to metastatic disease without weight loss. In other words, significantly increased Ob-R mRNA expression and decreased serum leptin concentration in patients with metastatic colon cancer indicate that sensitization to leptin activity may be a major indicator of metastasis to the colon tissue and the determination of leptin concentration and leptin gene expression may be used to aid the diagnosis.

The effect of royal jelly on CD3+, CD5+, CD45+ T-cell and CD68+ cell distribution in the colon of rats with acetic acid-induced colitis

Background: Traditional medicines and health supplements have historically been used to treat many illnesses but most of them have not been evaluated objectively to prove their efficacy. We have been investigating the effects of royal jelly (RJ) supplements on acetic acid-induced colitis on the distribution of CD3+, CD5+, CD45+ T-cell and CD68+ cells in rats. Methods: The rats were divided into four equal groups: control group, royal jelly-treated (RJ - 150mgkg−1 body weight), acetic acid-treated (colitis) and acetic acid-treated (colitis) +royal jelly (CRJ - 150mgkg−1 body weight). Colitis was induced by intracolonic instillation of 4% acetic acid; the control group received physiological saline (10mLkg−1). Colon samples were obtained under deep anaesthesia from animals in four groups. Tissues were fixed in 10% formalin neutral buffer solution for 24h and embedded in paraffin. Results: The proliferative response of CD3+ and CD45+ T cells stimulated with colitis was affected by colitis treated with RJ. No differences were found in CD5+ T cells and CD68+ macrophages in the colitis treated with RJ. Conclusions: This study has shown that RJ has anti-inflammatory and cell regeneration effect in the colon of rats with acetic acid induced colitis(AU)

No disponible

Control of an Acinetobacter [corrected] baumannii outbreak in a neonatal ICU without suspension of service: a devastating outbreak in Diyarbakir, Turkey.

BACKGROUND: A nosocomial outbreak of Acinetobacter baumannii bloodstream infections (Ab-BSI) was identified in Diyarbakir Children's Hospital's (Diyarbakir, Turkey) 60-bed Neonatal Intensive Care Unit (NICU) in 2006 and 2007. METHODS: The investigation and control of the outbreak were based on case-control and epidemiological studies as well as multifaceted interventions. Sixty-four neonates (case patients) with Ab-BSI and 128 neonates (control patients) free of Ab-BSI, who had been hospitalized at the unit during the outbreak period, were included in the study. Case and control patients were compared for possible predisposing factors (e.g., gender, length of NICU stay, antibiotic use, intubation, etc.). An intervention program (cohorting, education, reinforcing hand hygiene, antibiotic restriction, improving processes of patient care, environmental cleaning, and barrier isolation) was implemented to control the outbreak. Surveillance cultures were collected from all possible sources, and the epidemiological investigation was supplemented by a pulsed field gel electrophoresis (PFGE) study. RESULTS: Fifty-three neonates (82.8%) died in the case group and 51 (39.8%) in the control group (P < 0.001). The duration of stay at the NICU [odds ratio (OR) 1.15; 95% confidence interval (CI) 1.07-1.23; P < 0.001] and re-intubation (OR 38.62; CI 12.66-117.87; P < 0.001) were found to be significant risk factors for Ab-BSI. Surveillance cultures showed a heavy contamination in the NICU, and the outbreak ended after a series multifaceted interventions. All A. baumannii isolates, both from the cases and environmental samples, had an identical PFGE fingerprint pattern. CONCLUSION: The control of Ab-BSI requires a multifaceted intervention program and complex efforts and implementations, especially if the ICU does not implement any suspension of care provision.

The effect of royal jelly on CD3(+), CD5(+), CD45(+) T-cell and CD68(+) cell distribution in the colon of rats with acetic acid-induced colitis.

BACKGROUND: Traditional medicines and health supplements have historically been used to treat many illnesses but most of them have not been evaluated objectively to prove their efficacy. We have been investigating the effects of royal jelly (RJ) supplements on acetic acid-induced colitis on the distribution of CD3(+), CD5(+), CD45(+) T-cell and CD68(+) cells in rats. METHODS: The rats were divided into four equal groups: control group, royal jelly-treated (RJ - 150mgkg(-1) body weight), acetic acid-treated (colitis) and acetic acid-treated (colitis)+royal jelly (CRJ - 150mgkg(-1) body weight). Colitis was induced by intracolonic instillation of 4% acetic acid; the control group received physiological saline (10mLkg(-1)). Colon samples were obtained under deep anaesthesia from animals in four groups. Tissues were fixed in 10% formalin neutral buffer solution for 24h and embedded in paraffin. RESULTS: The proliferative response of CD3(+) and CD45(+) T cells stimulated with colitis was affected by colitis treated with RJ. No differences were found in CD5(+) T cells and CD68(+) macrophages in the colitis treated with RJ. CONCLUSIONS: This study has shown that RJ has anti-inflammatory and cell regeneration effect in the colon of rats with acetic acid induced colitis.

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates.

OBJECTIVE: To evaluate the effect of low-dose heparin on duration of peripherally inserted percutaneous central venous catheter (PCVC) patency and catheter occlusion. STUDY DESIGN: Our research was a prospective, randomized, controlled, double-blind clinical study including 246 eligible neonates with PCVCs. It was conducted at the neonatal intensive care unit (NICU) of Diyarbakir Children's Hospital between 1 February 2007 and 31 October 2008. In the heparin group (n=118), the total parenteral nutrition (TPN) solutions contained heparin, which was infused at a rate of 0.5 IU kg⁻¹ h⁻¹ . The no-heparin group (n=121) received TPN fluids without heparin. RESULT: In the heparin group, the duration of catheter patency was longer than that of the no-heparin group reaching a statistically significant difference (12.4 ± 4.5 vs 9.7 ± 4.0, P<0.0001). In the heparin group, the proportion of patients completing the TPN therapy successfully was higher than in the no-heparin group (P=0.0001; relative risk (RR): 3.32 (95% confidence interval (CI): 1.92 to 5.73)) also demonstrating a statistically significant difference. The rate of catheter occlusion among infants in the heparin group was smaller (P=0.0001; RR: 3.44 (95% CI: 1.92 to 6.44)). There were no statistically significant differences between the two groups in the incidence of other catheter-related problems. The length of the occluded catheter outside the skin, TPN infusion rate and catheter duration time were found to be the factors associated with catheter occlusion. Heparin prevented catheter occlusion with a mechanism unrelated to these factors. CONCLUSION: In neonates with PCVCs, low-dose continuous infusion of heparin (0.5 IU kg ⁻¹h⁻¹ within TPN fluids is an effective measure in terms of reducing catheter occlusion, allowing successful completion of the therapy, without increasing adverse effects. Furthermore, this effect of heparin may occur independently via occlusion-related factors that we evaluated in the study.

A case of Seckel syndrome with Tetralogy of Fallot.

Seckel syndrome, also known as Harper's Syndrome and Virchow-Seckel-Syndrome, was first described by Seckel in 1960, and is a rare (<1:10,000 live births) autosomal recessive trait. The syndrome (OMIM 210600) is a form of primordial dwarfism, characterized by severe intrauterine growth restriction, postnatal dwarfism, severe microcephaly with variable mental retardation, facial anomalies and skeletal abnormalities. Cardiac anomalies have been described in only five case. We report a male newborn with typical findings of Seckel sydrome associated with Tetrology of Fallot. This is the first case reported in concomitance with Tetralogy of Fallot, and might be a new finding of the syndrome. We would like to emphasize that clinicians should perform diagnostic interventions for congenital cardiac defects in Seckel Syndrome.

Effect of royal jelly on experimental colitis Induced by acetic acid and alteration of mast cell distribution in the colon of rats.

This study investigated the effects of royal jelly (RJ) on acetic acid-induced colitis in rats. Twenty adult female Wistar albino rats were divided into four treatment groups of 5 animals each, including a control group (Group I); Group II was treated orally with RJ (150 mg kg(-1) body weight); Group III had acetic acid-induced colitis; and Group IV had acetic acid-induced colitis treated orally with RJ (150 mg kg(-1) body weight) for 4 weeks. Colitis was induced by intracolonic instillation of 4% acetic acid; the control group received physiological saline (10 mL kg(-1)). Colon samples were obtained under deep anaesthesia from animals in all groups. Tissues were fixed in 10% formalin neutral buffer solution for 24 h and embedded in paraffin. Six-micrometre-thick sections were stained with Mallory's triple stain and toluidine blue in 1% aqueous solution at pH 1.0 for 5 min (for Mast Cells). RJ was shown to protect the colonic mucosa against the injurious effect of acetic acid. Colitis (colonic damage) was confirmed histomorphometrically as significant increases in the number of mast cells (MC) and colonic erosions in rats with acetic acid-induced colitis. The RJ treatment significantly decreased the number of MC and reduced the area of colonic erosion in the colon of RJ-treated rats compared with rats with untreated colitis. The results suggest that oral treatment with RJ could be used to treat colitis.

Impact of isotonic and hypertonic saline solutions on mucociliary activity in various nasal pathologies: clinical study.

OBJECTIVE: To investigate the impact of nasal irrigation with isotonic or hypertonic sodium chloride solution on mucociliary clearance time in patients with allergic rhinitis, acute sinusitis and chronic sinusitis. PATIENTS AND METHODS: Mucociliary clearance time was measured using the saccharine clearance test on 132 adults before and after 10 days' application of intranasal isotonic or hypertonic saline. Patient numbers were as follows: controls, 45; allergic rhinitis, 21; acute sinusitis, 24; and chronic sinusitis, 42. The results before and after irrigation were compared using the Wilcoxon t-test. RESULTS: Before application of saline solutions, mucociliary clearance times in the three patient treatment groups were found to be significantly delayed, compared with the control group. Irrigation with hypertonic saline restored impaired mucociliary clearance in chronic sinusitis patients (p < 0.05), while isotonic saline improved mucociliary clearance times significantly in allergic rhinitis and acute sinusitis patients (p < 0.05). CONCLUSION: Nasal irrigation with isotonic or hypertonic saline can improve mucociliary clearance time in various nasal pathologies. However, these solutions should be selectively prescribed rather than used based on anecdotal evidence. Further studies should be conducted to develop a protocol for standardised use of saline solution irrigation in various nasal pathologies.

Histopathological examination of the effects of radiofrequency treatment on mucosa in patients with inferior nasal concha hypertrophy.

Radiofrequency reduction has become one of the most popular methods in the treatment of inferior nasal concha hypertrophy. During surgical treatment of inferior nasal concha hypertrophy, it is important to cause minimal injury to the overlying ciliated epithelium, since if the ciliated structure of this epithelium is permanently disrupted, it is hard to carry out one of the important functions of lining of the nasal cavity, mucociliary clearance. In this study, the ultrastructure of inferior nasal concha epithelium was examined by transmission and scanning electron microscopy in 40 patients with inferior nasal concha hypertrophy. The biopsy specimens were taken before the radiofrequency treatment and 8 weeks after the radiofrequency treatment. Then, the effects of radiofrequency treatment on concha epithelium and morphology of ciliae were examined ultrastructurally. In the scanning and transmission electron microscopic examination of the tissue samples taken before radiofrequency treatment, no ultrastructural pathology was observed in the number and morphology of the ciliae and the inferior nasal concha epithelium. The biopsy specimens obtained 8 weeks after radiofrequency treatment also did not show any ultrastructural pathology in these parameters. However, in the transmission electron microscopic examination of the subepithelial tissue, fibrosis was observed in local areas in the biopsy specimens obtained 8 weeks after radiofrequency treatment. In conclusion, the results obtained from this study suggest that ciliated epithelium of the inferior nasal concha is not destroyed by radiofrequency reduction.

Haemangiopericytoma of the hard palate.

Haemangiopericytoma is an aggressive vascular tumour with a high propensity for recurrence and metastasis. It typically occurs in the soft tissues of the extremities and trunk, and is rarely seen in the oral cavity. A case of haemangiopericytoma of the hard palate is presented. A 48-year-old woman presented with a gradually enlarging mass on the left side of her hard palate for 3 months. CT scans revealed a mass on the left side of the hard palate which extended to the nasal cavity and left maxillary sinus by causing erosion in the bones. Due to the possibility of local recurrence and occasional metastasis, a wide local excision was performed. There was no recurrence over 1 year's follow up.

An angiomatous nasal polyp: a very rare variant of sinochoanal nasal polyps.

Angiomatous polyps are the extremely rare variant of sinochoanal polyps that are characterised by dilated, large vascular spaces. A 27-year-old female patient presented with a three-month history of unilateral right-sided nasal obstruction and recurrent mild epistaxis. Paranasal computed tomography demonstrated a mass in the right maxillary sinus extending through the nasal cavity. It was resected with both endonasal endoscopic and Caldwell-Luc approaches. Histopathological examination identified an angiomatous nasal polyp. Follow-up of thirteen months showed no recurrence.