Oropharyngeal angioneurotic edema due to recombinant tissue plasminogen activator following massive pulmonary thromboembolism.

Although hypersensitivity reactions secondary to recombinant tissue plasminogen activator (rtPA) are rarely encountered, they may have important consequences. In this case presentation, oropharyngeal angioneurotic edema due to rtPA following pulmonary thromboembolism is presented. On the 4th hour of initiation of treatment, throat pain, laryngeal stridor and expansive edema in the neck ensued, upon which the patient was intubated and mechanically ventilated. The patient was extubated after her findings showed a remission on the 48th hour of his inotropic, antihistaminic and intravenous corticosteroid therapy.

Odontogenic myxoma of the maxilla: a case report.

A 38-year-old male presented with a slowly progressive and painful swelling in the right cheek. On palpation, a firm, fixed and tender mass was detected over the right maxilla, with normal overlying skin. Endoscopic examination revealed a submucosal mass protruding into the right nasal cavity along the lateral wall, extending from the vestibule to the sphenoid sinus. Computed tomography showed a well-defined, 4x4 cm mass with cystic compartments, obliterating the right maxillary sinus, with destruction to the medial wall and extension into the nasal cavity. Magnetic resonance imaging showed similar findings of extension. A transnasal biopsy yielded a diagnosis of myxoma. En bloc resection of the mass was performed through a medial maxillectomy. No clinical or radiological recurrences were noted during a follow-up period of 24 months.

Lipoid proteinosis of larynx: review of four cases.

Lipoid proteinosis is a rare autosomal recessive disorder characterized by intercellular deposition of an amorphous hyaline material. It mainly involves skin and mucosal membranes of upper aerodigestive tract as well as central nervous system, lung, lymph nodes and striated muscles. Etiology and pathogenesis are unknown. Infantile hoarseness is a common presenting feature of the disease due to infiltration of larynx. In two-thirds of the cases, voice changes are present at birth or in early infancy as the first manifestation. We present four patients with lipoid proteinosis involving skin, oropharynx and larynx.

Collagenous fibroma (desmoplastic fibroblastoma).

A Collagenous Fibroma (Desmoplastic Fibroblastoma) is a rare, benign, slowly growing, fibroblastic, soft tissue lesion. Here, the case of a 28-year-old woman, who presented with a 1-year history of a slowly growing painless mass in the right anterior aspect of her neck, is described. This type of tumor was first described by Evans in 1995, and named as a Desmoplastic fibroblastoma but was renamed, by Nielsen in 1996 as a Collagenous Fibroma. This type of tumor is frequently reported in men with a mean age at occurance of 50 years. Clinically, a Collagenous fibroma presents as a firm, well-circumscribed subcutaneous, or intramuscular, painless mass of long duration. They are mostly located in the neck and extremities. The tumors range in size from 1 to 20 cm and predominantly occurs within the subcutaneous tissue, but fascial and skeletal muscle involvement is common. The treatment of a Collagenous Fibroma is a total surgical excision. No tumor recurrence has been reported the literature during the follow-up period and no tumor recurrence was observed in our case at the 1-year follow-up.

Role of free radicals and antioxidants in nasal polyps.

OBJECTIVES/HYPOTHESIS: The aim of this study is to determine the role of free radicals and antioxidants in nasal polyps. STUDY DESIGN: Prospective, randomized, controlled study. METHODS: Thirty-one patients with nasal polyposis and a control group consisting of 19 patients with septal deviation and lower turbinate hypertrophy were included in the study. Levels of the antioxidants retinol, beta-carotene, alpha-tocopherol, and ascorbic acid were measured from the sera of the patients with nasal polyposis and the control group. Plasma levels of superoxide dismutase activity (SOD), glutathione peroxidase (GSHPX) activity, and reduced glutathione (GSH) were also obtained. As a peroxidation product, the levels of the malondialdehyde-thiobarbituric acid (MDA) combination were measured from the plasma of patient and control groups. Measurements of MDA, GSH, and alpha-tocopherol levels were also taken from the polyp tissue and turbinate mucosa of the control group. RESULTS: The blood levels of antioxidants and MDA as an oxidant were significantly different in the patient group compared with the control group (P <.01). The tissue levels of antioxidants and MDA were significantly different in the patients with polyposis compared with the control group (P <.01). The blood and tissue anti-oxidant levels were found to be decreased, and MDA levels as an oxidant increased significantly in the patient group with polyposis when compared with the control group, and there was a negative correlation between oxidative stress and antioxidants. CONCLUSION: This study demonstrates that oxidative stress and tissue and blood antioxidants in the patients with polyposis were significantly different compared with the control group. The blood and tissue antioxidant levels decreased, and MDA levels, as an oxidant, increased significantly in the patient group with polyposis when compared with the control group. The current study demonstrates that there is strong evidence related to oxidative stress in the pathogenesis of nasal polyposis, and antioxidants can have a preventive role in free-radical-mediated tissue damage in nasal polyposis.

Ultrastructural and electrophysiologic changes of rat cochlea after irradiation.

OBJECTIVE/HYPOTHESIS: To determine the acute and subacute cochlear effects of sublethal total body irradiation. STUDY DESIGN: The study was designed prospectively as a Sprague-Dawley (SD) rat model with otoacoustic emission measurement. METHODS AND MATERIALS: Ten rats and 20 ears were included in the study. Distortion product otoacoustic emission (DPOAE) measurements were performed under ketamine anesthesia before and 1 to 8 weeks after sublethal dose total body irradiation. Eight and six rats survived at the first and eighth week measurements, respectively. The frequency bandwidth was set to 1,067 Hz (referenced to f1) - 9,512 Hz (referenced to f2) (2f1 - f2 = 832 - 6,076 Hz) and eight points were sampled per octave, but low-frequency (<2,549 Hz [referenced to 2f1 - f2]) results were not included in the analysis. Averages were obtained at each frequency, and statistical analysis was performed to compare the pre-and postradiation values. Then, three of the rats were killed for transient electron microscopy (TEM) of the temporal bones. RESULTS: The posttreatment DPOAEs at almost all frequencies showed a trend toward decline at both the first and eighth weeks, but significant reduction was only detected at 3,600 and 3,961 Hz (referenced to 2f1 - f2) in the first week. TEM of the cochlea revealed ultrastructural changes in the outer hair cells (OHCs) and stria vascularis of the basal turn. The cochlear ganglion nuclei and cochlear nerve axons were unaffected. CONCLUSION: Radiation can affect the cochlea in the acute phase at the mid to high frequencies; further prediction for long-term effects requires longer follow-ups.

Which is important in the evaluation of metastatic lymph nodes in head and neck cancer: palpation, ultrasonography, or computed tomography?

OBJECTIVE: Evaluate palpation, ultrasonography (USG), and computed tomography (CT) with respect to their value for comparative determination of metastatic lymph nodes in head and neck cancer. STUDY DESIGN: A prospective study was conducted in a tertiary referral hospital. During September 1996 and April 1999, clinical investigation, USG, and CT were performed preoperatively on 48 patients who would undergo neck dissection for primary head and neck malignancy. The presence of metastatic lymph nodes in pathologic specimens were compared with the findings of palpation, CT, and USG. RESULTS: Twenty-two of the patients had positive lymph nodes on pathologic investigation. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for palpation are 64%, 85%, 74%, 78%, and 75% respectively. Respective values for USG and CT for sensitivity, specificity, negative predictive value, positive predictive value, and accuracy are 72%, 96%, 80%, 94%, and 85% and 81%, 96%, 85%, 90%, and 87%. CONCLUSION: All of the pretreatment evaluation methods, palpation, CT, and USG yield results that are significantly different from the histopathologic results, suggesting that no pretreatment study can accurately assess the requirement to histopathologically stage the neck. USG findings are more correlated with the pathologic findings than palpation, but CT gives the most effective and reliable results when it is combined with USG in neck staging. Preoperative USG and CT scanning of the neck by an experienced radiologist is essential and useful for diagnosis, staging, and therapy choices. SIGNIFICANCE: Statistical analysis was done with chi(2) test. The difference between histologic findings and palpation is significant (P = 0.0005). The difference between histologic findings and USG and CT is significant (P = 0.0001 and P = 0.0001).

Evaluation of sentinel nodes in the assessment of cervical metastases from head and neck squamous cell carcinomas.

AIMS AND BACKGROUND: To delineate the lymphatic drainage in head and neck squamous cell carcinoma (SCC) patients by lymphoscintigraphy and to investigate whether the results of histopathological evaluation of sentinel nodes have any diagnostic relevance with regard to the metastatic involvement of all cervical lymph nodes. METHODS: Forty-one patients clinically pre-diagnosed as having primary head and neck SCC underwent Tc-99m nanocolloid lymphoscintigraphy and were evaluated according to the Memorial Sloan Kettering cervical lymph nodes level system. Treatment of 24 of these patients included neck dissection in addition to surgery for the primary tumor. RESULTS: Among the 24 operated patients nine were found to be pathologically N+. In two (22%) of these nine patients there were histopathological metastases in non-sentinel lymph nodes. In one patient with a metastatic lymph node, no sentinel nodes were identified. Altogether, lymphoscintigraphic sentinel node detection failed in three (33%) cases. CONCLUSION: The procedure of lymphoscintigraphic imaging of sentinel lymph nodes and its use in the determination of squamous cell carcinoma metastases is theoretically promising. However, in order to assess the true value of sentinel lymph node imaging and make treatment plans based on this technique, it's necessary to increase the number of cases included in the studies, and obtain results that are specific for the primary tumor and involved lymph nodes.

The incidence of anatomic variations and sinus opacities in pediatric patients with chronic sinonasal symptoms.

OBJECTIVES: In this study, our purpose was to determine the incidence of paranasal sinus anatomic variations and their relationship with sinus opacities in pediatric patients. PATIENTS AND METHODS: A total of 44 children (age range 3 to 16 years) unresponsive to maximum medical therapy were evaluated with coronal paranasal sinus computed tomography. RESULTS: Computed tomographic evaluations revealed that 70.5% (31/44) of the patients had at least one anatomic variation, the most common being septal deviation, followed by concha bullosa and agger nasi cells. Sinus opacities were found in 81.8% (36/44) of the patients, of whom 9 had single and 27 had multiple involvement of sinus groups. The most commonly involved sinuses were anterior ethmoids and maxillary sinuses, followed by posterior ethmoids, sphenoid and frontal sinuses. Patients with single, multiple, and no anatomic variations had 78.9% (15/19), 83.3% (10/12), and 84.6% (11/13) opacities, respectively. CONCLUSION: The incidence of anatomic variations was found to be similar to that reported for adults in the literature except for nasal septal deformity which was found lower. Our results showed no correlation between bony anatomic variations and sinus opacities in children.

The role of 70-degree telescopic examination during direct laryngoscopic evaluation of laryngeal cancers.

Endoscopy has currently been an indispensable method in many areas of otorhinolaryngology, especially in paranasal sinus surgery. Telescopic evaluation of the larynx has not drawn much attention. In this study, a 70-degree angled rigid telescope was used along with computerized tomography (CT), indirect and direct laryngoscopy in the evaluation of laryngeal cancer. The critical areas such as the anterior commissure, subglottic region and ventricles were investigated specifically. Nineteen patients were collected in the study. We found the sensitivity for indirect laryngoscopy to be 20-25% and for direct laryngoscopy to be 50-70%. The scores for CT and 70-degree telescopy were 70-100%. In the subglottic region telescopy was superior to CT. We believe that, when it is used in association with CT, telescopy provides better insight when deciding between partial or total laryngectomy and a healthier evaluation of the resection margin.

Squamous cell carcinoma of the lacrimal sac.

The clinical and histopathological findings in a 40-year-old man with a lacrimal sac tumor are reported. Although the clinical history indicated a lacrimal sac obstruction and recurrent dacryocystitis, the lesion was diagnosed by light microscopy as a squamous cell carcinoma.