Effect of corticosteroid (triamcinolone acetonide) and chlorhexidin on chemotherapy- induced oxidative stress in buccal mucosa of rats.

Oral mucositis (OM) refers to erythematous and ulcerative lesions of the oral mucosa. This pathology can occur by various causes. Cancer therapy is one of the well-known causes of OM such as chemotherapy and/or with radiation therapy. It has been widely mentioned that oxidative stress parameters such as lipid peroxidation (LP) levels increase during cancer process. Glutathione (GSH) is one of the major intracellular enzymes to detoxify oxidant molecules. The aim of this study was to investigate and compare the effects of Triamcinolone Acetonide (TA), a synthetic steroid chlorhexidine (CHX), a chemical antiseptic, on 5- fluorouracil (5-FU), a chemotherapeutic agent and soft abrasion induced OM in buccal mucosa of rats.OM was induced in rats through a combination of 5-FU treatment and mild abrasion of the cheek pouch with a wire brush. Buccal mucosa lipid peroxidation (LP) levels were higher (p< 0.05) in 5-FU group than in control although LP levels were lower (p<0.05) in TA group than in control group. The reduced glutathione levels were lower (p<0.05) in 5-FU group than in the control group although its level was higher (p<0.05) in TA and CHX groups than in the 5-FU group. Glutathione peroxidase activity was also higher (p<0.05) in TA group than the 5- FU group. In histopathological analyses, treatment with TA reduced 5-FU induced inflammatory cell infiltration and ulceration (p<0.001) but not with CHX.In conclusion, we observed that TA and CHX treatment modulated chemotherapy induced oxidative injury in the rat OM. However, only TA histopathologically ameliorated the 5-FU induced OM of rats. These findings suggest that TA is a useful agent for management of experimental oxidative injury and OM caused by the chemotherapy.

A clinical threat in patients with granulomatosis polyangiitis in remission: Subglottic stenosis.

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing granulomatous disease that involves small- and medium-sized arteries and affects the main respiratory tracts and kidneys. Upper respiratory tract involvement usually occurs in 90% of patients, who most frequently present with symptoms of chronic sinusitis. Subglottic stenosis (SS) is a rare and severe complication that is usually observed in approximately 15% of patients. Here we present a case of SS in a patient with limited form of GPA during remission.

Is There A System Inflammatory Effect of Cholesteatoma?

Abstract Introduction Inflammation causes squamous epithelial transformation of the mucosa in the middle ear cavity and plays a role in the onset, growth, spread, and recurrence of cholesteatoma. Objectives The objective of this study is to investigate the systemic inflammatory effect in chronic otitis with cholesteatoma. Methods The study included a total of 311 patients comprising 156 patients with a pathology diagnosis of cholesteatoma and a control group of 155 with no active inflammation. The Neutrophil-to-lymphocyte Ratio (NLR) was calculated by dividing the neutrophil value by the lymphocyte value. Results The mean NLR was 1.94 ± 0.91 in the patients with cholesteatoma and 1.94 ± 0.85 in the control group. We determined no statistically significant difference between the groups in respect of NLR (p = 0.983). We calculated the NLR as 2.01 ± 1.00 in patients with ossicle erosion and 1.82 ± 0.69 in those without ossicle erosion, 1.86 ± 0.85 in patients with bone erosion and 1.98 ± 0.95 in those without bone erosion. We determined no statistical difference between these values (p = 0.175). Conclusion The results of this study showed that NLR had no predictive value in respect of bone erosions and associated complications in patients with cholesteatoma. The inflammatory effect of cholesteatoma is not systemic but remains more local.

Is There A Systemic Inflammatory Effect of Cholesteatoma?

Introduction Inflammation causes squamous epithelial transformation of the mucosa in the middle ear cavity and plays a role in the onset, growth, spread, and recurrence of cholesteatoma. Objectives The objective of this study is to investigate the systemic inflammatory effect in chronic otitis with cholesteatoma. Methods The study included a total of 311 patients comprising 156 patients with a pathology diagnosis of cholesteatoma and a control group of 155 with no active inflammation. The Neutrophil-to-lymphocyte Ratio (NLR) was calculated by dividing the neutrophil value by the lymphocyte value. Results The mean NLR was 1.94 ± 0.91 in the patients with cholesteatoma and 1.94 ± 0.85 in the control group. We determined no statistically significant difference between the groups in respect of NLR (p = 0.983). We calculated the NLR as 2.01 ± 1.00 in patients with ossicle erosion and 1.82 ± 0.69 in those without ossicle erosion, 1.86 ± 0.85 in patients with bone erosion and 1.98 ± 0.95 in those without bone erosion. We determined no statistical difference between these values (p = 0.175). Conclusion The results of this study showed that NLR had no predictive value in respect of bone erosions and associated complications in patients with cholesteatoma. The inflammatory effect of cholesteatoma is not systemic but remains more local.

Effect of a corticosteroid (triamcinolone) and chlorhexidine on chemotherapy-induced oxidative stress in the buccal mucosa of rats.

Oral mucositis manifests as erythematous and ulcerative lesions of the oral mucosa. Among its various causes, cancer treatment (e.g., chemotherapy with or without radiation therapy) is one of the more well known. It has been widely mentioned that oxidative stress parameters such as lipid peroxidation levels increase during the cancer process. Glutathione is one of the major intracellular enzymes used to detoxify oxidant molecules; it exists in both a reduced and oxidized state. Reduced glutathione is used as a substrate to synthesize glutathione peroxidase. We conducted a study to investigate and compare the effects of triamcinolone (a synthetic steroid) and chlorhexidine (a chemical antiseptic) on 5-fluorouracil (5-FU; a chemotherapeutic agent)-induced oral mucositis in the buccal mucosa of 36 rats. Oral mucositis was induced through a combination of 5-FU treatment and mild abrasion of the cheek pouch with a wire brush. The rats were treated with one of four regimens: saline placebo (group I), 5-FU only (group II), 5-FU plus triamcinolone (group III), and 5-FU plus chlorhexidine (group IV). Three rats in the triamcinolone group died of unknown causes on days 7 and 8, and 3 rats in the chlorhexidine group died on days 7 and 9. On day 9, the remaining 30 rats were sacrificed and examined. Buccal mucosa lipid peroxidation levels were significantly higher in the 5-FU-only group than in the control group and significantly higher in the control group than in the triamcinolone group (p < 0.05 for both). Levels of reduced glutathione were significantly lower in the 5-FU-only group than in both the triamcinolone group and the chlorhexidine group (p < 0.05). Glutathione peroxidase activity was significantly higher in the triamcinolone group than in the 5-FU-only group (p < 0.01). Histopathologic analysis revealed that treatment with triamcinolone significantly reduced 5-FU-induced inflammatory cell infiltration and ulceration (p < 0.001); no such reduction was seen with chlorhexidine. In conclusion, we observed that triamcinolone and chlorhexidine treatment modulated chemotherapy-induced oxidative injury in rat oral mucositis. However, only triamcinolone histopathologically ameliorated 5-FU-induced oral mucositis. These findings suggest that triamcinolone is a useful agent for the management of experimental oxidative injury and oral mucositis caused by 5-FU chemotherapy.

Metastatic Malignant Melanoma of Parotid Gland with a Regressed Primary Tumor.

Malignant melanoma of the parotid gland is often metastatic and mainly originates from malignant melanomas in the head and neck. Nevertheless, some malignant melanomas may metastasize and subsequently regress. Therefore, it may not be possible to observe a metastatic malignant melanoma and its primary melanoma simultaneously. The investigation of a patient's old photographs may help in the detection of preexisting and regressed pigmented lesions in the facial and neck regions.

The Importance of the Neutrophil-Lymphocyte Ratio in Patients with Idiopathic Peripheral Facial Palsy.

Objective. The purpose of this study was to investigate whether or not there was a correlation between the neutrophil-to-lymphocyte ratio (NLR) value and the severity of idiopathic peripheral facial palsy (IPFP) and to determine whether or not NLR could be used as an early predictive parameter in the prognosis of IPFP patients. Material and Method. This retrospective study was conducted on 146 patients who were diagnosed with IPFP. The control group comprised 140 patients. Patients with IPFP were categorized according to the House-Brackmann grading system (HBS). The NLR value was obtained by dividing the neutrophil value by the lymphocyte value. Results. In the IPFP group, the mean NLR value was 3.63 ± 2.74 and, in the control group, 1.84 ± 0.78. The mean NLR value was significantly higher in IPFP patients than in the control subjects (p < 0.0001). The mean NLR value in group A (Grades I-II ) was 2.61 ± 2.28, in group B (Grades III-IV) 3.22 ± 2.65, and in group C (Grades V-VI) 10.69 ± 6.30. Conclusion. We determined that as the severity of IPFP increased, the NLR value increased. The NLR value can be used as a prognostic factor in the early prediction of IPFP prognosis.

Submandibular hemangioma with multiple phleboliths mimicking sialolithiasis: the first pediatric case.

Hemangiomas are the most common masses of the major salivary glands in parotid glands in childhood particularly. They occur more frequently in the parotid gland and rarely the submandibular gland. Changes in blood flow dynamics within hemangiomas may induce thrombus formation and phleboliths. Cavernous hemangioma may lead to thrombophlebitis in major salivary glands in adults. To our knowledge, cavernous hemangioma of submandibular glands containing phleboliths in childhood has not been described so far in the literature. In this article, we report the first pediatric case of a cavernous hemangioma containing multiple phleboliths in the submandibular gland mimicking submandibular sialolithiasis in a seven-year-old boy.

[The evaluation of serum vitamin B12, folic acid and hemoglobin levels in patients with recurrent minor aphthous stomatitis]. / Tekrarlayan minör aftöz stomatitli hastalarda serum vitamin B12, folik asit ve hemoglobin düzeylerinin degerlendirilmesi.

OBJECTIVES: This study aims to evaluate the serum levels of hemoglobin, vitamin B12 and folic acid in patients with recurrent minor aphthous stomatitis. PATIENTS AND METHODS: Between June 2010 and January 2012, a total of 112 patients including 57 with recurrent aphthous stomatitis (study group; 30 males 27 females; mean age 36.7±13.9 years; range 13 to 74 years) and 45 with chronic tinnitus patients without recurrent aphthous stomatitis (control group; 18 males 27 females; mean age 39.7±15.1 years; range 20 to 80 years) who were admitted to our clinic were included in this study. The serum hemoglobin, vitamin B12 and folic acid levels of the patients were measured and statistically compared. RESULTS: There was no significant difference in serum levels of hemoglobin and folic acid between the groups. Serum levels of vitamin B12 were significantly lower in the study group, compared to the control group (p<0.05). Serum levels of hemoglobin and folic acid were significantly lower in women compared to men in both groups (p<0.05). CONCLUSION: Vitamin B12 deficiency, but not lower levels of folic acid and hemoglobin, may play a role in the underlying etiology of aphthous stomatitis. Vitamin B12 supplements may be added to the treatment of recurrent aphthous stomatitis.

Modulation of wireless (2.45 GHz)-induced oxidative toxicity in laryngotracheal mucosa of rat by melatonin.

It is well known that oxidative stress induces larynx cancer, although antioxidants induce modulator role on etiology of the cancer. It is well known that electromagnetic radiation (EMR) induces oxidative stress in different cell systems. The aim of this study was to investigate the possible protective role of melatonin on oxidative stress induced by Wi-Fi (2.45 GHz) EMR in laryngotracheal mucosa of rat. For this purpose, 32 male rats were equally categorized into four groups, namely controls, sham controls, EMR-exposed rats, EMR-exposed rats treated with melatonin at a dose of 10 mg/kg/day. Except for the controls and sham controls, the animals were exposed to 2.45 GHz radiation during 60 min/day for 28 days. The lipid peroxidation levels were significantly (p < 0.05) higher in the radiation-exposed groups than in the control and sham control groups. The lipid peroxidation level in the irradiated animals treated with melatonin was significantly (p < 0.01) lower than in those that were only exposed to Wi-Fi radiation. The activity of glutathione peroxidase was lower in the irradiated-only group relative to control and sham control groups but its activity was significantly (p < 0.05) increased in the groups treated with melatonin. The reduced glutathione levels in the mucosa of rat did not change in the four groups. There is an apparent protective effect of melatonin on the Wi-Fi-induced oxidative stress in the laryngotracheal mucosa of rats by inhibition of free radical formation and support of the glutathione peroxidase antioxidant system.

The significance of routine laboratory parameters in patients with sudden sensorineural hearing loss.

There are several factors (viral infections, metabolic and ototoxic disorders etc.) accused for the development of sudden sensorineural hearing loss. Some prognostic factors (late onset of treatment etc.) had been evaluated in the literature. There is no sufficient data on the effect of routine laboratory parameters on the development and/or prognosis of sudden sensorineural hearing loss. The aim of this study is to investigate the effects of routine blood chemistry and hematological parameters on the development and prognosis of disease in patients with idiopathic sudden sensorineural hearing loss. One hundred and forty-seven patients with the diagnosis of idiopathic sudden sensorineural hearing loss followed up during the periods of 2000-2010 years were included in this study. One hundred and three septoplasty patients with no otologic complaints were enrolled as control group. Following the clinical and demographic evaluations, patients with idiopathic sudden sensorineural hearing loss and control groups, and patients treated successfully and patients with poor outcome were compared with each other. Data were analyzed by T test. All hematological and biochemical parameters were compared. Hemoglobin, hematocrit, white blood cell count, total and direct bilirubin, fasting blood glucose level and aspartate aminotransferase were significantly different between idiopathic sudden sensorineural hearing loss and control groups. There was no significantly different parameter between patients treated successfully and patients with poor outcome. Hemoglobin, hematocrit, white blood cell count, total and direct bilirubin, fasting blood glucose level and AST all can be risk factors for SHL, or they can be the result of undetermined pathology, because these parameters have no effect on the prognosis. Other routine parameters seem to have no effect on the development and/or prognosis of idiopathic sudden sensorineural hearing loss.

Carotid CT-angiography: low versus standard volume contrast media and low kV protocol for 128-slice MDCT.

Availability and utilization of computed tomography angiography has been increasing recently. We aimed to assess the effectiveness of low amount of contrast media and low kV value in order to reduce possible side effects of contrast media and to provide optimization of kV value in the evaluation of the carotid artery with multi-detector computed tomography angiography. Forty one patients were randomized into two groups. Contrast media was administered at a dose of 1 ml/kg in group A patients and of 0.5 ml/kg in group B patients. kV value of 120 in group A and 100 in group B were chosen. Bolus tracking technique was used. Attenuation values of certain arterial segments were measured, and values over 200 HU were considered as significant. North American Symptomatic Carotid Endartherectomy Trial criteria were utilized in the evaluation of stenosis. Image quality in arterial segments of all cases was found to be sufficient for diagnosis. Arterial attenuation values were found to be higher in group B than group A. When compared separately in all arterial segments, there was no statistically significant difference between the groups. For stenosis, 615 arterial segments were evaluated. Moderate stenosis in eight segments and severe stenosis in three segments were identified in group A. Occlusion in three segments, severe stenosis in three segments, and moderate stenosis in 25 segments were detected in group B. Better image quality can be obtained, and the amount of contrast media can be reduced using low kV technique in carotid artery multi-detector computed tomography angiography examination.

Does subjective tonsillar grading reflect the real volume of palatine tonsils?

OBJECTIVES: The aim of this prospective clinical study was to compare the subjective tonsil size (grade) with real palatine tonsil volume, body mass index, body surface area, age, and gender. PATIENTS AND METHODS: Two hundred and ninety-two patients with the diagnosis of recurrent acute tonsillitis, ages 3-15 years, (156 male and 136 female) who underwent tonsillectomy were enrolled into this study. The correlation of subjective tonsil size to objective tonsil volume, body mass index, body surface area, age, and gender size was investigated. The statistical correlations were evaluated by Pearsons' bivariate correlation method. RESULTS: There was statistically significant correlation between objective volume of tonsils and subjective grading of tonsils (p<0.001). There was statistically significant correlation between objective volume of tonsils (both right and left tonsil) and body mass index (p=0.008 and 0.013) respectively. There was statistically significant correlation between objective volume of tonsils and body surface area (p=0.009). There was statistically significant correlation between volume of tonsils and age (p=0.017). CONCLUSIONS: Objective tonsil volume is correlated with subjective tonsil size, body mass index, body surface area and age in patients with recurrent acute tonsillitis. Follow-up of palatine tonsil status (volume) of patients with recurrent acute tonsillitis may be decided according to the subjective tonsil size. The correlations of aforementioned parameters to objective tonsil volume should be searched for other pathologies of palatine tonsils.

The effects of methylprednisolone, montelukast and indomethacine in experimental otitis media with effusion.

OBJECTIVES: The present study aimed to investigate the effects of indomethacine, montelukast and methylprednisolone in management of experimental otitis media with effusion. METHODS: Forty Wistar albino rats of which the weights ranged between 310 and 370 g were included in this study. Middle ear effusion was created by transtympanic histamine injection. The presence of effusion was confirmed by otomicroscopic examination. Thirty-seven rats with effusion were divided into 4 groups (methylprednisolone, montelukast, indomethacine and saline-control groups). All agents were administered for a period of consecutive 10 days. At the 11th days of administration, the recovery of effusion was confirmed by otomicroscopic examination. Tympanic bullae of the rats were removed and histopathological examinations were carried out. In the histopathological examination, the neutrophil leukocytes accumulated in the middle ear submucosa were counted. RESULTS: The mean numbers of submucosal neutrophils in the methylprednisolone, montelukast, indomethacine, and saline groups were 24.6±8.1, 54.1±6.2, 52.3±7.3, 55.7±8.3, respectively. The otomicroscopic recovery rates of effusion in the methylprednisolone, montelukast, indomethacine, and saline groups were 18/18 (100%), 8/18 (44%), 2/14 (14%), 2/18 (11%) respectively. CONCLUSIONS: Methylprednisolone and montelukast ameliorate the middle ear effusion. However, only methylprednisolone reduces the submucosal infiltration of the neutrophil leukocytes which are the most evident cell of inflammatory process. Montelukast is effective in the resolution of experimental otitis media with effusion.

Relationship between Toxocara seropositivity and allergic rhinitis.

BACKGROUND: Allergic rhinitis is the most common chronic disease in the upper respiratory tract, requiring better diagnostic methodology to counteract its onslaught. The purpose of this study was to investigate the association between Toxocara seropositivity and allergic rhinitis. METHODS: Sixty-four consecutive patients with allergic rhinitis and 61 healthy volunteers in the control group were included in this study. The diagnosis of allergic rhinitis was defined by positive epicutaneous prick test. The diagnosis of toxocariasis was established by IgG and specific IgE antibodies against Toxocara by ELISA method. All cases were examined for intestinal parasites also. The seropositive cases with Toxocara were reevaluated for symptoms and signs of toxocariasis. RESULTS: Higher toxocariasis seropositivity (ELISA IgG; 28.1%) rate was determined in the patients with allergic rhinitis and compared with the control groups (11.5%; p < 0.05). Specific IgE seropositivity (17.2%) was high for the patients with allergic rhinitis compared with the control group (3.3%; p < 0.05). CONCLUSION: Our results show that there was a possible causal relationship between Toxocara infection and allergic rhinitis. Patients with allergic rhinitis from a region with high prevalence for this parasitic infection should be evaluated for Toxocara infection.

Microbiologic findings of sinusitis by a novel method for obtaining culture.

Many different methods have been described to obtain sinus culture from patients with chronic sinusitis. However, these methods presented limited information how they had prevented from the contamination with nasal flora. The purpose of this study is to demonstrate and describe a contamination-free technique to obtain culture from involved sinus during endoscopic sinus surgery (ESS). We prepared a cotton-tipped contamination-free swab. This applicator was inserted inside the sinus through ostium or inside the cavity directly established during ESS, and the swab was introduced directly into the implicated area. Thirty-five adult patients with chronic sinusitis who underwent ESS participated in the study. During ESS, the number of cultivated pathogenic microorganisms of the cultures obtained by our method was statistically significantly higher than the cultures obtained by the classic nasal cavity cultures (P = .0296). However, the number of cultivated bacteria (coagulase-negative Staphylococcus, alpha-hemolytic Streptococcus, and Corynebacterium spp.) after the contamination was lower than those of nasal cavity culture (P = .0296). During ESS, the identification of the pathogen in sinusitis with endoscopically guided narrow-bore sinus culture applicator is a reliable diagnostic method compared with the classic culture techniques.