The Role of Serum Adhesion Molecules s-ICAM-1 and s-VCAM-1 in Chronic Otitis Media Pathogenesis: A Prospective Controlled Study.

The aim of this study was to determine the levels of soluble intracellular adhesion molecule-1 (s-ICAM-1) and soluble vascular cell adhesion molecule- 1 (s-VCAM-1) in patients with chronic otitis media (COM) according to the disease profile and to compare with ears without otitis media. Eighty-nine patients had ear surgery were included in the study prospectively. 78 patients who underwent tympanomastoidectomy included in the study group and 11 patients who underwent exploratory tympanotomy included in the control group prospectively. The level of s-ICAM-1 and s-VCAM-1 measured with ELISA technique. s-ICAM-1 and s-VCAM-1 levels compared between COM specific diseases group and with the control group. Levels of s-ICAM-1 and s-VCAM-1 measured as 584.5 ± 165.3 ng/ml and 541.1 ± 237.3 ng/ml in patients with COM, 384.4 ± 99.6 ng/ml and 551.7 ± 336.4 ng/ml in the control group respectively. The mean of s-ICAM-1 detected significantly higher in the COM group (p < 0.001). But the mean of s-VCAM-1 in the COM and control group was similar (p = 0.895). Also, s-ICAM-1 was significantly higher in patients with cholesteatoma, ossicular chain defects and tympanic membrane retraction (p = 0.037, 0.045 and 0.032, respectively). Although s-VCAM-1 level was not affected by cholesteatoma, ossicular chain defect and tympanic membrane retraction (p = 0.178, 0.243, p = 0.164, respectively). While the mean of s-ICAM-1 was detected significantly higher in COM and related pathologies therefore, increased serum levels may reflect the severity of the disease. But, s-VCAM-1 was not affected by COM and COM-specific diseases.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer / Valor prognóstico de parâmetros de PET/TC com 18F-FDG e variáveis histopatológicas em câncer de cabeça e pescoço

Abstract Introduction 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. Objective To investigate the prognostic value of these parameters in patients with head and neck cancers. Methods We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. Results The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63 cm3 (0.6-34.3), 68.9 g (2.58-524.5 g), 13.89 (4.89-33.03 g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. Conclusion Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Resumo Introdução Os parâmetros da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose, como os máximos valores de captação padronizados, o volume metabólico tumoral padrão e a glicólise total da lesão são importantes biomarcadores prognósticos de câncer. Objetivo Investigar o valor prognóstico desses parâmetros em pacientes com câncer de cabeça e pescoço. Método Fizemos um estudo retrospectivo que incluiu 47 pacientes com câncer de cabeça e pescoço e que foram submetidos à tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose antes do tratamento. Volume metabólico tumoral, glicólise total da lesão e valores de captação padronizados foram aferidos em cada paciente. O valor prognóstico de parâmetros quantitativos da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose e das variáveis clínico-patológicas sobre a sobrevida livre de doença e a sobrevida geral foi analisado. Resultados A média (intervalo) de volume metabólico tumoral e glicólise total da lesão e valores de captação padronizados foram 7,63 cm3 (0,6-34,3), 68,9 g (2,58-524,5) e 13,89 g/mL (4,89-33,03), respectivamente. Metástase nos nódulos linfáticos e diferenciação tumoral foram variáveis significativas de sobrevida livre de doença e sobrevida geral; contudo, nenhum parâmetro da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose estava associado a sobrevida livre de doença e sobrevida geral. Conclusão As quantidades dos parâmetros da tomografia por emissão de pósitrons pré-tratamento não previram a sobrevida em câncer de cabeça e pescoço.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer.

INTRODUCTION: 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. OBJECTIVE: To investigate the prognostic value of these parameters in patients with head and neck cancers. METHODS: We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. RESULTS: The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63cm3 (0.6-34.3), 68.9g (2.58-524.5g), 13.89 (4.89-33.03g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. CONCLUSION: Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

High PI3K/mTOR and low MAPK/JNK activity results in decreased apoptosis and autophagy in nasal polyposis.

INTRODUCTION: Nasal polyposis is a progressive inflammatory disease that reduces the quality of life. The role of apoptotic and autophagic pathways in nasal polyposis pathogenesis is not yet clearly known. OBJECTIVE: In this study we aimed to investigate apoptotic (MAPK/JNK), anti-apoptotic (PI3K/mTOR) and autophagic (LC3) pathways which are related each other in the nasal polyposis tissues. METHODS: Twenty patients with nasal polyps and fifteen patients going through an inferior turbinate reduction were included in this study. Patients with asthma, Samter triad and allergic fungal sinusitis were excluded from the study. The apoptotic and autophagic pathways were investigated in paraffin-embedded nasal tissue sections of 20 NP and 15 samples from inferior turbinate reduction by H&E and immunohistochemistry with h-score. TUNEL method with apoptotic index was used to demonstrate apoptotic cells. RESULTS: Decreased immunoreactivity of P38 MAPK (p < 0.005) and JNK (p < 0.005) were observed in nasal polyposis compared to material from inferior turbinate reduction. This decrease may indicate a downregulation of apoptosis as demonstrated by decreased TUNEL staining in nasal polyposis (p < 0.005). The PI3K (p < 0.002) and mTOR (p < 0.005) immunoreactivities were increased in nasal polyposis. This increase indicates a downregulation of autophagy as demonstrated by decreased LC3 staining in nasal polyposis (p < 0.001). CONCLUSION: Deficient apoptosis and autophagy through MAPK/JNK and PI3K/mTOR pathways may have a role in the pathogenesis of nasal polyposis.

Internal Nasal Valve Expanding Graft for Middle Vault Reconstruction.

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre- and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P < 0.05). Based upon pre- and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P < 0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.

Superficial Parotidectomy Versus Partial Superficial Parotidectomy: A Comparison of Complication Rates, Operative Time, and Hospital Stay.

PURPOSE: The type and extent of surgery for benign parotid tumors are a subject of debate. We aimed to measure and compare hospital stay, operative time, and complication rates associated with superficial parotidectomy (SP) and partial superficial parotidectomy (PSP). MATERIALS AND METHODS: This retrospective cohort study included all patients who underwent surgery for benign parotid gland tumors in our tertiary center between January 2006 and March 2014 and were followed up for at least 3 years. The predictor variable was the type of parotidectomy, and the main outcome parameters were operative time, hospital stay, and postoperative complications. The demographic characteristics (age and gender), clinical history, and preoperative findings were obtained from patient records. The Kolmogorov-Smirnov test, Mann-Whitney U test, and χ2 test were used to analyze the data. P < .05 was considered statistically significant. RESULTS: The sample was composed of 321 patients (184 men and 137 women) with a mean age of 54.0 ± 14.7 years (range, 18 to 87 years). Of these, 190 underwent SP and 131 underwent PSP. Pleomorphic adenoma was the most common tumor (83 patients, 53%), followed by Warthin tumor (50 patients, 32%). The mean hospital stay was 6.7 ± 2.3 days in the SP group and 4.8 ± 2.4 days in the PSP group (P < .001). The mean operative times in the SP and PSP groups were 134.0 ± 24.6 and 92.1 ± 21.9 minutes, respectively (P < .001). The overall complication rates were 21.6% and 12.2% in the SP and PSP groups, respectively (P = .031). No tumor recurrence was observed in either group. CONCLUSIONS: Compared with the SP group, the PSP group had shorter operative and hospital stay durations and fewer postoperative complications with a comparable recurrence rate. Therefore, PSP should be considered in suitable cases.

Endoscopic Repair of Persistent Oroantral Communications Using the Caldwell-Luc Approach.

In this article, a novel endoscopic technique used to close oro-antral fistulas will be described. In the technique described here, 24 cases were surgically treated between May 2011, and November 2014. Under endonasal endoscopic examination following partial inferior uncinectomy, the natural ostium of the maxillary sinus was identified; through this tract, a curved aspirator was advanced into the sinus. If present, we extracted endoscopically tissues causing obliteration of the ostium through the Caldwell-Luc antrostomy, taking care to preserve the integrity of the natural ostium. In the technique described here, endoscopic examination using the Caldwell-Luc approach, the inside of the maxillary sinus is explored fully, existing infection and polyps are eliminated locally, and natural patency of the maxillary sinus ostium can be achieved. The graft used to obliterate the oroantral fistula can be easily harvested from the bone of the anterior wall of the maxillary sinus by accessing the surgical entry tract.

Intraperitoneal curcumin and vitamin E combination for the treatment of cisplatin-induced ototoxicity in rats.

INTRODUCTION: Cisplatin ototoxicity is characterized by irreversible, progressive, bilateral sensorineural hearing loss at high frequencies, accompanied by tinnitus. The aim of this study is to demonstrate the protective action of curcumin alone or in combination with vitamin E against cisplatin-induced ototoxicity in animal models. MATERIAL AND METHODS: The study included 42 rats. Experimental animals were randomized into 6 groups. In the first group, intra-peritoneal cisplatin was administered alone. In the second group, intra-peritoneal cisplatin and curcumin were administered together. In the third group, intra-peritoneal cisplatin and vitamin E were administered together. In the fourth group, intra-peritoneal cisplatin was administered together with curcumin in combination with vitamin E. In the fifth group, intra-peritoneal curcumin was administered alone. The sixth group was sacrificed directly without administration of any drugs. A distortion product otoacoustic emission (DPOAE) test was applied to both ears of all experimental animals. Curcumin was administered 1 h before cisplatin treatment continued for three successive days. Vitamin E was administered only as a single dose 30 min prior to cisplatin. All animals were sacrificed following DPOAE testing on the 5th day of cisplatin administration. Histopathological findings included a TUNEL (TdT-mediated deoxyuridine triphosphate nick end-labeling) assay, and the percentage of apoptotic cells was calculated. DPOAE values and the percentage of apoptotic cells were compared before and after treatment and between experimental groups. RESULTS: In Group 1, DPOAE values were significantly decreased at all frequencies (3000 Hz, 4000 Hz and 6000 Hz; P < 0.05). In Groups 2, 3, 4 and 5 there was no significant difference between the pre- and post-treatment DPOAE results (p > 0.05). Apoptotic index values were lower in all treatment groups compared to the cisplatin group, however the difference was only statistically significant in group 3 (p = 0.009). CONCLUSION: In rats, cisplatin ototoxicity can be prevented with curcumin or curcumin-vitamin E combination.

Benign Paroxysmal Positional Vertigo Following Sinus Floor Elevation in Patient with Antecedents of Vertigo.

Benign paroxysmal positional vertigo (BPPV) is an unfamiliar and rare complication occurring following osteotome sinus floor elevation (OSFE) and simultaneous implant placement. Etiology of this disorder is commonly displacement of otoliths by vibratory forces transmitted by osteotomes and mallet along with the hyperextension of the head during the operation, causing them to float around in the endolymph. This report presents a case of protracted BPPV following OSFE and simultaneous implant placement. A 43-year-old female suffered intense vertigo and nausea immediately after implant placement using an OSFE procedure. Upon further questioning after the procedure she gave an account of two times vertigo history within the last 9 years. Despite nootropic drug medication and canalith repositioning procedure applied by a specialist at operation night, the condition did not improve. Patient did not totally recover and was admitted again after 1 month. After repeated maneuvers, nine dosage intravenous serous fluid and piracetam administration the patient recovered. Duration of these procedures took 10 days and the patient was successfully treated with no recurrence of dizziness. Prevention and management of OSFE related BPPV are reviewed especially in patients having prior vertigo history in this report.

Lymph Node Density in Node-Positive Laryngeal Carcinoma: Analysis of Prognostic Value for Survival.

OBJECTIVE: We investigated the value of lymph node density (LND) as a predictor of survival in patients with laryngeal squamous cell carcinoma (SCC) and positive neck node (pN+) after laryngectomy. STUDY DESIGN: Case series with chart review. SETTING: Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECTS AND METHODS: We reviewed the records of 289 patients with newly diagnosed primary laryngeal carcinomas who underwent partial or total laryngectomy and combined neck dissection at a tertiary referral center between June 2006 and December 2014. Patients with pN+ laryngeal SCC (n = 101) were included in the study. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of LND. RESULTS: In 101 patients with pN+ laryngeal SCC, LND ≥0.09 and number of metastatic lymph nodes >4 were significantly associated with OS and DFS but not the overall tumor, node, and metastasis stage. Forward stepwise Cox regression analysis revealed that LND ≥0.09 was the only independent predictor of both DFS and OS. Furthermore, the odds ratio of LND ≥0.09 was 10 times higher in patients with regional recurrence when compared patients without regional recurrence. CONCLUSIONS: LND was the only independent prognostic predictor of OS and DFS in patients with pN+ laryngeal SCC. Moreover, patients with LND ≥0.09 were significantly associated with high risk of regional recurrence. Thus, patients with LND ≥0.09 are at high risk of regional recurrence and death and may be considered for adjuvant chemoradiation.

The effects of hypotensive anaesthesia on otoacoustic emissions: a prospective, randomized, double-blind study with objective outcome measures.

The aim of the present study was to compare pre- and post-operative otoacoustic emission examinations of patients who experienced surgery under hypotensive anaesthesia using distortion product otoacoustic emission (DPOAE) and transient evoked otoacoustic emission (TEOAE). Forty-one patients, admitted to our tertiary centre for nasal valve surgery, were prospectively and randomly assigned into two groups. Hypotensive group included 20 patients, while control group included 21 patients. All investigators and patients were blinded to anaesthesia assignment throughout the course of the study. DPOAEs and TEOAEs were performed before surgery and repeated after 15 days in both groups. In control group, DPOAE-DP1 levels per frequency increased significantly in the post-operative period when compared with the pre-operative values in all patients. However, DPOAE-DP1 levels decreased significantly in hypotensive group. Similarly, DPOAE-SNR levels per frequency decreased significantly in hypotensive group. In conclusion, we have observed that under the influence of hypotensive general anaesthesia, the amplitudes of OAEs are affected.

Transection of Nasolacrimal Duct in Endoscopic Medial Maxillectomy: Implication on Epiphora.

OBJECTIVE: Management of the nasolacrimal system is usually recommended during medial maxillectomy via external approach because of reported higher rates of postoperative epiphora. Association of the endoscopic medial maxillectomy (EMM) with epiphora, however, is not clearly stated. In this study, we attempted to evaluate whether patients develop epiphora after simple transection of the nasolacrimal duct during EMM. PATIENTS AND METHODS: Medical records of 26 patients who underwent endoscopic tumor resection for inverted papilloma (IP) were retrospectively reviewed. Patients who underwent EMM with nasolacrimal canal transection were included and recalled for lacrimal system evaluation. Twelve patients were eligible for inclusion and fluorescein dye disappearance test (FDDT) was performed for each patient. Patient demographics, tumor data, surgical procedures, and follow-up time were recorded. RESULTS: Of the 12 patients included in the study, 6 underwent canine fossa transantral approach concurrently with EMM. The mean duration of follow-up was 21.1 months (range, 6-84 months). Eight patients were graded as 0, whereas 4 patients were graded as 1 according to FDDT. All test results were interpreted as negative for epiphora. All patients were completely symptom free of epiphora. CONCLUSIONS: Epiphora after EMM with nasolacrimal canal transection among patients with sinonasal tumors appears to be uncommon. Therefore, prophylactic concurrent management of nasolacrimal system including stenting, dacryocystorhinostomy (DCR), or postoperative lacrimal lavage are not mandatory for all patients.

[Does Onodi cell limit the exposure of sella during transsphenoidal pituitary surgery?]. / Onodi hücresi transsfenoidal hipofiz cerrahisinde sella ekspojurunu kisitlar mi?

OBJECTIVES: This study aims to evaluate the association between the presence of Onodi cell and sella exposure during endonasal endoscopic transsphenoidal pituitary surgery (EETPS). PATIENTS AND METHODS: Forty-two patients who underwent EETPS for a pituitary adenoma with the collaboration of Neurosurgery and Otorhinolaryngology Departments at Katip Çelebi University Atatürk Training and Research Hospital between February 2011 and March 2014 were retrospectively analyzed. Preoperative paranasal sinus tomography and intraoperative findings were evaluated for the presence of Onodi cells. The location of the Onodi cell and its relation with sella exposure during surgery were also assessed. RESULTS: The incidence of Onodi cell was 19%. The Onodi cells were observed in eight of 42 patients on preoperative paranasal sinus computed tomography. The Onodi cells were unilateral in five patients and bilateral in three. Intraoperative findings were correlated with tomographic findings. In seven patients, Onodi cells limited the exposure of sellar floor and the inferior-medial wall of these cells were removed and connected with the sphenoid sinus and the entire sellar floor was exposed. In the remaining one patient, the Onodi cell was smaller and located superolaterally. This cell was not removed, as it did not limited the sellar exposure. CONCLUSION: The Onodi cell may limit the sella exposure during transsphenoidal surgery. Onodi cell should be removed and connected with the sphenoid sinus cavity for the entire sellar floor exposure.

Prevertebral space invasion in head and neck cancer: negative predictive value of imaging techniques.

OBJECTIVE: This study evaluated the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in prevertebral space invasion in patients with head and neck squamous cell carcinomas (HNSCC). SUBJECTS AND METHODS: This study retrospectively reviewed 197 patients with advanced primary laryngeal or hypopharyngeal carcinoma who underwent laryngectomy and neck dissection at our institution. The MRI and CT findings were compared with the surgical findings and postoperative pathology. RESULTS: In 191 patients, the macro- and microscopic margins of the surgical specimens were tumor-free. In the remaining 6 patients, prevertebral space involvement was observed intraoperatively. MRI predicted the absence of prevertebral fascia invasion in 40 of 42 patients with a negative predictive value of 100% and specificity of 95.2%, while the negative predictive value and specificity of CT were 99.2% and 88.2%, respectively. CONCLUSION: Preservation of the retropharyngeal fat plane on MRI reliably predicts the absence of prevertebral space fixation in patients with advanced HNSCC.

Tortuosity of the internal carotid artery detected during tonsillectomy: two case reports.

Tonsillectomy is one of the most common performed surgical procedures in childhood. Tortuosity of the internal carotid artery (ICA) is an anatomical variation of the course of the ICA, and can be seen at any levels along the course of the artery, even in lateral oropharyngeal wall. In this article, we present two cases in which ICA tortuosity detected as a pulsating mass in the lateral oropharyngeal wall in an eight-year and a five-year-old girls, during tonsillectomy.

Comparison of transient and distortion-product otoacoustic emissions during the luteal and follicular phases of the menstrual cycle.

We conducted a study to examine cochlear activity in women with a naturally occurring menstrual cycle by measuring transient otoacoustic emissions (TOAEs) and distortion-product otoacoustic emissions (DPOAEs). Our study population was made up of 11 women aged 20 to 40 years (mean: 35.6) who were not taking a contraceptive medication or hormone therapy. Measurements of TOAEs and DPOAEs were made during both the follicular phase and the luteal phase of the menstrual cycle. We found no statistically significant difference in any of the TOAE amplitude values between the two phases. Although a sharp decrease at the 0.75 kHz frequency was seen in DPOAEs during both phases, none of the amplitude values in the tested frequencies were significantly different between the two phases. The absence of TOAE and DPOAE amplitude changes suggests that it is unnecessary to take into account the phase of the menstrual cycle when interpreting the results of otoacoustic emissions testing.

Behcet's disease impairs voice quality without laryngeal and hypopharyngeal involvement.

The objective of the study was to investigate voice evaluation parameters in Behcet's disease patients. A prospective controlled study was performed in a tertiary referral center. A total of 31 patients (21 female, 10 male) with a diagnosis of Behcet's disease had voice evaluations by means of laryngostroboscopy, acoustic analysis, aerodynamic measurements and perceptual assessment. Data obtained from the patients were compared to 31 healthy control subjects. Laryngeal endoscopy was within normal limits in all patients. The mean fundamental frequency in male control subjects (134 ± 14 Hz) was significantly higher than in male patients (124 ± 20 Hz), (p = 0.043). Mean intensity was significantly higher in control subjects (74 ± 5 dB) than in the patients (63 ± 4.6 dB), (p < 0.001). Shimmer in patients (3.4 ± 2.5) was significantly higher than in control subjects (2 ± 1.3), (p = 0.01). Maximum phonation time in control subjects (25 ± 5.8 s) was significantly longer than in patients (20 ± 7.9 s), (p = 0.007), and s/z ratio was found to be nearly equal between patients (0.9 ± 0.2) and control subjects (0.96 ± 0.1), (p > 0.05). The patients showed a mean GRBAS score of 1.8 ± 1.9 and the control group showed a mean score of 0.48 ± 1.06, (p = 0.002). The VHI-10 scale revealed a mean score of 2.2 ± 4.8 in BD patients and 2 ± 2 in control subjects (p > 0.05). Behcet's disease impaired voice quality without laryngostroboscopically visible laryngeal and hypopharyngeal involvement. This impairment was documented by objective voice evaluation methods including acoustic analysis and aerodynamic voice measurements and by subjective voice evaluation method including perceptual assessment.

Clinical and laboratory findings of tularemia: a retrospective analysis.

OBJECTIVES: This study aims to define demographic characteristics and clinical and laboratory findings of the patients with tularemia and to assess the treatment outcomes. PATIENTS AND METHODS: A total of 58 consecutive patients (26 males, 32 females; mean age 37±22 years; range 6 to 80 years) with tularemia were retrospectively analyzed in this study. Demographic characteristics, laboratory findings, physical examination findings and treatment outcomes were recorded. RESULTS: Forty patients (86.2%) had glandular tularemia; seven (12.1%) had oropharyngeal tularemia, and one (1.7%) patient had oculoglandular tularemia. The most common symptoms were swollen neck lymph nodes high fever and sore throat. Fifty seven patients (98.2%) had swollen neck lymph nodes; 39 (67.2%) patients had high fever (67.2%) and 36 (62.1%) patients had sore throat. Complete recovery was obtained in 45 patients (77.6%), while 13 (22.4%) were unresponsive to the treatment. The most frequent laboratory findings were high level of C-reactive protein (CRP) and increased erythrocyte sedimentation rate (ESR). Mean leukocyte counts, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine levels were within normal range in all patients. CONCLUSION: Tularemia should be differentiated from upper respiratory tract infections and cervical lymphadenopathy. The most commonly used hematological and biochemical assays do not provide significant benefits for the diagnosis of tularemia. However, increased level of ESR and CRP at one month may support the diagnosis. Early diagnosis and appropriate treatment may prevent therapeutic failure.

Jab1 expression is associated with TGF-ß1 signaling in chronic rhinosinusitis and nasal polyposis.

Jab1, which is a fifth component of COP9 signalosome, plays an essential role in cell growth and proliferation. Jab1 is also shown to regulate transforming growth factor-beta (TGF-ß) signaling in carcinoma cells. The aim of the present study was to investigate the expression and the correlation of Jab1 and TGF-ß1 in chronic rhinosinusitis and nasal polyposis. Here, we show the elevated expression of Jab1 and TGF-ß1 in diseased mucosa without nasal polyps and a correlation between Jab1 and TGF-ß1 expression. Forty-six samples (26 patients with nasal polyps, 10 patients with chronic rhinosinusitis and 10 control subjects) were included to this study. Immunohistochemistry and Western blotting were performed for the assessment of Jab1 and TGF-ß1 localization and the expression of proteins. Double staining of both proteins showed that Jab1 and TGF-ß1 were colocalized in the epithelium, inflammatory cells and the vascular endothelium of nasal mucosa. There was a significant increase in the expression of TGF-ß1 and Jab1 in patients without nasal polyps and a significant decrease in patients with nasal polyps compared to controls. Moreover, correlation was detected between the expression of Jab1 and TGF-ß1 in chronic rhinosinusitis and nasal polyposis. Our results demonstrate that chronic rhinosinusitis is characterized by elevated expression of Jab1 and TGF-ß1 compared to nasal polyposis and Jab1 may play a vital role in the pathogenesis of both chronic rhinosinusitis and nasal polyposis.