Evaluation of ceruloplasmin levels in patients undergoing surgical interventions with nasal polyps.

OBJECTIVE: Oxidative stress is believed to have a role in the development of nasal polyps (NPs). It is also known that ceruloplasmin (CP), an acute phase protein, limits oxidative stress. The purpose of this study was to evaluate the ceruloplasmin levels in patients with NPs. METHODS: One hundred and twenty patients with NPs, septal deviations and concha hypertrophies were recruited to the study. Patients were divided in two groups; group 1 (n=60) consisted of patients with NPs, and group 2 (n=60) consisted of septal deviations and concha hypertrophies. Polyp specimens were taken from all patients who underwent endoscopic surgery due to NPs, as well as control specimens were acquired who underwent an operation due to septoplasty or concha hypertrophy. Blood and tissue samples were obtained to assess CP levels. RESULTS: There were no statistical differences in gender, age and biochemical values between two groups (p>0.05 for all). Compared to group 2, group 1 had significantly higher CP levels both in serum and the tissue samples (both p<0.001). CONCLUSION: As a result of our study; CP levels both in serum and the tissue in patients with NPs were higher, may be consequence of the inflammation, than in patients without NPs.

The hemostatic efficacy of Ankaferd Blood Stopper in adenoidectomy.

OBJECTIVE: To evaluate the efficacy of Ankaferd Blood Stopper (ABS) in the control of intraoperative and postoperative bleeding in adenoidectomy. METHODS: In total, 90 patients underwent traditional cold steel adenoidectomy and were then randomized to receive ABS or 0.9% physiological saline solution to obtain hemostasis. Objective data collected included time of operation and blood loss during operation. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal and ease of operation. RESULTS: In a comparison between patients in the ABS group (n = 46) and the control group (n = 44), those in the ABS group had significantly shorter operation times (9.11 ± 1.02 vs. 13.16 ± 3.96 min; p < 0.001) and less blood loss during the operation (20.19 ± 8.59 vs. 25.48 ± 12.96 ml; p ≤ 0.05) and a shorter hemostasis time (3.83 ± 0.8 vs. 5.82 ± 1.67 min; p < 0.001). Regarding hemorrhage after tampon removal, 40 patients (87%) in the ABS group and 17 patients (38.6%) in the control group did not suffer from hemorrhage (p < 0.001). Regarding ease of hemostasis, 40 patients (87%) in the ABS group experienced very easy or easy hemostasis while 26 patients in the control group did so (59.1%; p = 0.004). Patients in the ABS group returned to a regular diet earlier and had less use of analgesics at 7 days postoperatively. Use of electrocautery was less in the ABS group than in the control group (10.9 vs. 40.9%; p = 0.001). CONCLUSIONS: The side on which ABS was used showed significant differences in hemostasis time, blood loss, and ease of hemostasis. ABS appears to be safe and effective; it decreases intraoperative bleeding and reduces operating time when compared to traditional hemostasis methods after curette adenoidectomy.

GJB2 and mitochondrial A1555G gene mutations in nonsyndromic profound hearing loss and carrier frequencies in healthy individuals.

This study aimed to assess mutations in GJB2 gene (connexin 26), as well as A1555G mitochondrial mutation in both the patients with profound genetic nonsyndromic hearing loss and healthy controls. Ninety-five patients with profound hearing loss (>90 dB) and 67 healthy controls were included. All patients had genetic nonsyndromic hearing loss. Molecular analyses were performed for connexin 26 (35delG, M34T, L90P, R184P, delE120, 167delT, 235delC and IVS1+1 A-->G) mutations, and for mitochondrial A1555G mutation. Twenty-two connexin 26 mutations were found in 14.7% of the patients, which were 35delG, R184P, del120E and IVS1+1 A-->G. Mitochondrial A1555G mutation was not encountered. The most common GJB2 gene mutation was 35delG, which was followed by del120E, IVS1+1 A-->G and R184P, and 14.3% of the patients segregated with DFNB1. In consanguineous marriages, the most common mutation was 35delG. The carrier frequency for 35delG mutation was 1.4% in the controls. 35delG and del120E populations, seems the most common connexin 26 mutations that cause genetic nonsyndromic hearing loss in this country. Nonsyndromic hearing loss mostly shows DFNB1 form of segregation.

Nasal polyps and the severity of asthma.

BACKGROUND AND OBJECTIVES: Upper airway pathologies often accompany asthma. Because this represents a single airway, the diagnosis, follow up and treatment of both upper and lower respiratory diseases is essential. Samter Syndrome (SS) is known to be associated with more severe asthma. The presence of nasal polyps (NPs) is also associated with asthma. However, the incidence of NPs in asthma and the effect of NPs on asthma severity are not well documented. METHODS: Three hundred and forty-two asthma patients were evaluated by endoscopic nasal examination, pulmonary function test, skin prick tests and paranasal sinus tomography. RESULTS: Three hundred and eleven patients with asthma without NP, 19 asthma patients with NP and 12 patients with SS were included. It was found that 54.3% of patients without NPs, 63.2% with NP and 66.7% with SS were at step 3 on the Global Initiative for Asthma scale of severity, and 1.9%, 15.8% and 33.3% were at step 4, respectively. CONCLUSIONS: The presence of NPs in asthma patients is associated with an increase in asthma severity. In patients with asthma, the possibility of NPs should be investigated and treatment planned accordingly.

Nasal polyp diseases in allergic and nonallergic patients and steroid therapy.

OBJECTIVE: To investigate widespread disease causes, cellular-structural differences, and steroid response of nasal polyps (NPs). METHOD: Study group consisted of NPs, allergic-NPs, NPs with steroid therapy (ST), antrochoanal polyp (ACP), and controls. We investigated stromal eosinophil, mast cell, CD4+ and CD8+ cell counts and presence of squamous metaplasia, Ki-67 expression, intraepithelial eosinophils-mast cells, epithelial damage, edema, fibrosis, hyalinization, polymorphonuclear leukocyte, and glandular hyperplasia. RESULTS: In allergic-NPs, intraepithelial eosinophils and epithelial damage CD4+ were significantly higher than NPs and also, eosinophils, mast cells, intraepithelial eosinophils, and epithelial damage were significantly higher than ACP. Only stromal eosinophilic infiltration was significantly higher in NPs than ACP. There was significant increased glandular hyperplasia and decreased intraepithelial eosinophils, mast cells, CD4+ cells, squamous metaplasia, and epithelial damage with ST in allergic-NPs. There were no significant differences with ST in NPs. CONCLUSION: NPs in allergic and nonallergic patients may differ in their histology and in their histologic responses to ST. EBM RATING: B-3b.

[The efficacy of botulinum toxin-A in the treatment of hypersalivation in children with cerebral palsy]. / Serebral palsili çocuklarda hipersalivasyon tedavisinde botulinum toksin-A uygulamasi.

OBJECTIVES: We evaluated the efficacy of botulinum toxin A (BTX-A) injection into the submandibular salivary gland to decrease hypersalivation in children with cerebral palsy (CP). PATIENTS AND METHODS: Three children (1 girl, 2 boys; mean age 10; range 7 to 13 years) with CP received BTX-A injections. Due to hypersalivation, two patients dirtied 50 napkins and 5-6 pieces of clothes daily, and one patient dirtied 100 napkins and 8-9 pieces of clothes. The severity of hypersalivation was assessed using the drool rating scale. Injections were performed in the submandibular gland under ultrasound localization and under local anesthesia. The amount of saliva flow at the mouth two hours after the meals and in a duration of 30 minutes was assessed seven times: before the first injection and at different intervals after injections up to 12 weeks. The dose of BTX-A was increased from 5 to 20 units per gland in two patients, while one patient received a standard dose of 20 units. At least 50% reduction in saliva secretion at the end of three months was accepted as a successful outcome. RESULTS: Lower doses of BTX-A were not effective to provide the desired amount of reduction in saliva in two patients. However, application of 20 units resulted in a satisfactory decrease in all the patients. CONCLUSION: In selected patients and with appropriate doses, ultrasound-guided BTX-A injections may improve hypersalivation in patients with CP.

A mean red blood cell volume loss in tonsillectomy, adenoidectomy and adenotonsillectomy.

OBJECTIVE: To calculate a mean red blood cell volume (RBCV) loss per kilogram (kg) in adenoidectomy, tonsillectomy, and adeno-tonsillectomy. MATERIALS AND METHODS: Pre- and post-operative complete blood cell count, and pre-operative clotting studies of 144 patients were measured. Total blood volume (75 or 70 ml/kg), pre- and post-operative RBCV (hematocritxtotal blood volume), RBCV loss, per kg RBCV loss and per cent RBCV loss were calculated. RESULTS: There was significant differences between pre- and post-operative RBCV, Hb, and Htc values for tonsillectomy, adenoidectomy and A&T groups, respectively (p<0.001 for all groups). We found a mean RBCV loss of 33 ml (5.56% of total RBCV) for adenoidectomy, 128 ml (10.63% of RBCV) for tonsillectomy and 60 ml (10.71% of RBCV) for A&T. RBCV loss per kg was 1.57+/-1.29 for adenoidectomy, 2.96+/-1.91 for adeno-tonsillectomy, and 3.02+/-1.66 for tonsillectomy. CONCLUSION: According to us, for management of the patients, knowledge of a mean nature loss of RBCV per kg is important because bleeding seems to be unavoidable in the intra-operative or maybe post-operative period in these operations.

Audiological findings in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease. The aim of this investigation was to study the relationship between AS and hearing loss. This study compared 28 patients with AS with 23 age-matched controls. All subjects underwent ENT examination, audiological and acoustic immittance measurements, and auditory brainstem response (ABR) tests. Sensorineural hearing loss was found in 28.6 per cent of the AS patients and in 4.35 per cent of the control group. For hearing levels at 250-500 Hz and 4000-8000 Hz, there was a statistically significant difference between the two groups. Acoustic reflex was not obtained in both ears of four patients and the left ear of one patient. There was a correlation between increase of tympanic volume and limitation in neck movement, between extension of 1-3 interpeak latency and limitation in the neck movement. In conclusion, AS affects the inner ear more than the middle ear.

Colored illustrations of pediatric otorhinolaryngologic surgical techniques of a Turkish surgeon, Serefeddin Sabuncuoglu, in the 15th century.

OBJECTIVES: Serefeddin Sabuncuoglu is known to be the author of the first illustrated surgery book, Cerrahiyyetu'l Haniyye (Imperial Surgery), which was written in Turkish in 1465 a.d. at the age of 80. The purpose of this paper is to describe his contributions to pediatric otorhinolaryngology. RESULTS: Cerrahiyyetu'l Haniyye consists of three chapters totaling 412 pages, in which there are 191 sections dealing with a wide range of surgical specialties, including pediatric otorhinolaryngologic surgery. Sabuncuoglu explains some of child diseases and their treatment in a whole section, and gives information on the same subject in relevant part of sections. The illustrations he provides are not at a state of the art level with those of his contemporaries, but they bear a great importance considering the attitudes of Islam to the art of painting. For each section, a single, poetic sentence describes in detail the diagnosis, classification and surgical technique. Some authors have claimed that he only translated Ebu Kasim-al Zahravi (Albucasis)'s Al-Tasrif (Textbook of Surgery) and added the illustrations of the surgical techniques. Even if this is accepted, the illustrations are enough to entitle this work as a milestone. Serefeddin Sabuncuoglu describes medical and surgical management pediatric otorhinolaryngologic diseases such as harelip, hypertrophy of adenoids, atresia of external auditory canal, a foreign body in external auditory canal, short frenulum, abscess of head, mass and abscess of neck in children and unpleasant odor in nose in his textbook. CONCLUSIONS: Although not recognized and rewarded in his time, Serefeddin Sabuncuoglu was a great surgeon in Turkish medical history. The sections on children in his book are of great importance in pediatric otorhinolaryngology which became a different speciality in the last century. Writing his book at his 80's, he deserves to be considered as a distinguished scientist, medical doctor and illustrator of his era, considering the insulting and discriminating ideas toward women and children, especially girls, at that period.

Pneumatization of the inferior turbinates: incidence and radiologic appearance.

OBJECTIVE: The objective of this work was to determine the incidence and radiologic appearance of pneumatized inferior turbinates (PITs). METHODS: Pneumatized inferior turbinates were investigated among 2500 consecutive cases with coronal paranasal sinus computed tomography (CT) scans that were performed for different reasons between 2000 and 2004. RESULTS: Ten new PIT cases diagnosed with CT were identified. Pneumatization was diagnosed in 2 patients aged 7 and 14 years. Therefore, this is the first time that PIT has been described in the pediatric age group. Complete or incomplete pneumatizations were unilateral in 7 cases and bilateral in 3 cases. In bilateral PIT cases, pneumatizations were asymmetric. In 2 cases, only bulbous parts of the inferior turbinates (ITs) were involved. Inferior turbinate expansion related to pneumatization was not observed in any case. In cases with maxillary sinus communication, axial CT sections revealed a defect on the medial wall of the maxillary sinus. CONCLUSIONS: The incidence of PIT was found to be 1 in 250 cases. It is suggested that most PIT cases may be a result of articulation defects between the maxillary process of the palatine bone and the maxillary bone. In such a situation, the maxillary process of the palatine bone and the nasal process of the maxillary bone, which form the medial wall of the maxillary sinus at the IT level, can attach to the IT separately.

A case of factitious disorder involving menstrual blood smeared on the face.

This article presents a case of factitious disorder in which a female smeared menstrual blood on her face. The patient was admitted to our otolaryngology clinic complaining of bleeding from the mouth, nose, ears and eyes. This event reportedly occurred three to four times on a daily basis. She acknowledged nine prior admissions to different specialists over the last two years. Following psychiatric consultation, we diagnosed factitious disorder with predominantly physical signs and symptoms. She was started on Fluoxetine 20 mg/day and supportive interviews were organized. After diagnosis, we observed that her symptoms decreased over two months. The symptoms did not reoccur three to nine months after treatment. This case report outlines two important features. The first is that a case of this type has not been reported before, and the second feature is that this case demonstrates the effect of cultural factors greatly different from those seen in classical factitious disorder.

Ophthalmic techniques described by Serefeddin Sabuncuoglu (1385-1468 AD).

Serefeddin Sabuncuoglu (1385-1468 AD) was a Turkish surgeon who lived in the Ottoman Empire during the fifteenth century, a time of progressive expansion. When in his eighties, he wrote Cerrahiyyetü'l-Haniyye, which means Imperial Surgery. His book is the first example of an illustrated surgical textbook in the Turkish-Islamic medical literature. The importance of his book rests upon the inclusion of colour miniatures of the surgical procedures, incisional techniques and instruments, all drawn by Sabuncuoglu himself. Only three hand-written copies exist, two of which were originally written by the author and are currently exhibited in Paris and Istanbul. The book was rediscovered in 1936, but some parts of it are still suspected to be missing. At present, the book consists of three chapters divided into 193 known sections. The sections deal with all fields of surgery including ophthalmology, and cite relevant Greek, Arabic and Persian textbooks. In this historical article the sections of Cerrahiyyetü'l-Haniyye pertinent to ophthalmology are critically reviewed, including a selection of the coloured drawings.

Congenital nasolacrimal duct occlusion with clinical anophthalmos: a possible new association.

PURPOSE: To report the association of congenital nasolacrimal duct occlusion and clinical anophthalmos in an eight-year-old girl. METHODS: A case report. The patient suffered from epiphora and clinical anophthalmos on the right side since birth. This paper presents the clinical presentation, workup, and surgical approach of the case. RESULTS: The nasolacrimal system of the patient was occluded on irrigation. Computed tomography showed a blockage at the level of the sac-duct junction, an enlarged nasolacrimal duct below the obstruction, and a sclera-like ball of tissue surrounded by extraocular muscles in the right orbit. Treatment included a right bicanalicular silicon intubation performed under general anesthesia. CONCLUSION: This case may represent a new association that has not been previously reported.

Colored illustrations of obstetrics manipulations and instrumentation techniques of a Turkish surgeon Serafeddin Sabuncuoglu in the 15th century.

Serafeddin Sabuncuoglu (1385-1470) was the author of the first illustrated surgical textbook Cerrahiyyet'ül Haniyye (Imperial Surgery) in the Turkish-Islamic literature. In the obstetric section he gave detailed descriptions of normal and abnormal presentation, surgical manipulation of intrauterine foetal death and retained placenta. He wrote about previously described procedures and the obstetric culture of his time. Some authors have claimed that he only translated Abu Kasim-al Zahrawa (Albucasis)'s Al-Tasrif (Textbook of Surgery) and added the illustrations of the surgical techniques. Even if this is accepted, the illustrations are enough to entitle this work as a milestone. In this paper, we describe the contributions of this pioneer in obstetrics and compare his recommendations with the current practice.

A simplified laparoscopic technique for enteral access in cancer patients.

BACKGROUND/AIMS: A feeding jejunostomy may be required for cancer patients who have obstructed upper gastrointestinal tract. Numerous minimally invasive techniques have been described for laparoscopic enteral access. We presented here a simple technique for laparoscopic jejunostomy that requires only two ports and no specialized tools. METHODOLOGY: Seven patients with laryngeal and foregut tumors underwent laparoscopic feeding jejunostomy. Briefly, umbilical port houses the camera and a second port placed at the proposed jejunostomy site are used to identify the appropriate segment of jejunum and exteriorize through the port opening. After jejunostomy a catheter is placed in the usual fashion, intestine segment is returned to the abdomen, then the jejunostomy site is secured to fascia edges by several non-absorbable sutures. Operative time and postoperative complications were evaluated. RESULTS: All patients tolerated the procedure well. Average operative time was 35 min. The only complication seen after the procedure was minor skin extrusion in two patients. CONCLUSIONS: This technique appears as a minimally invasive, safe, quick and easily applicable method for enteral access in selected patients.

[An unusual tracheobronchial aspiration in a patient with total laryngectomy]. / Total larenjektomili bir olguda ilginç trakeobronsial aspirasyon.

Laryngectomized patients use a variety of tools for tracheostomy cleaning, some of which may vary greatly depending on their sociocultural status. The use of inappropriate tools may lead to complications. A seventy-eight-year-old male patient who had a history of total laryngectomy 12 years ago presented with difficulty in breathing and sputum production. Tracheoscopy showed two nails and chest x-rays showed one nail that had been aspirated during stromal care. The three ordinary nails were removed under general anesthesia. This case illustrates the need for detailed and consistent education of laryngectomy patients on proper stomal cleaning and on the associated complications that may arise from the use of inappropriate tools.

Giant orf on the nose.

Ecthyma contagiosum, or orf, is a viral zoonosis of sheep and goats that can be transmitted to humans. In humans, it generally manifests as a solitary skin lesion, although rarely it can have an unusual course or be accompanied by systemic symptoms or complications. We present a case of giant orf lesion on the nose of a 9-year-old. The lesion grew rapidly and measured 5 cm by 4 cm and was attached to the right ala nasi by a base 2 cm round in diameter. The diagnosis was suggested by clinical and histopathologic appearance and confirmed by electron microscopic visualization of the virus. The lesion resolved spontaneously with minimal scarring and the entire cycle lasted about 3 months.