Beyond aesthetics: A case report of pneumosinus dilatans frontalis presenting with headache.

INTRODUCTION AND IMPORTANCE: The Pneumosinus Dilatans (PSD) Frontalis is an uncommon condition characterized by abnormal enlargement of the aerated frontal sinus with normal thickness sinus walls. The major complication is aesthetics; however, some cases present with sinus obstructive symptoms. CASE PRESENTATION: A 32-year-old male presented with complaints of an asymmetrical protrusion on his forehead, as well as recurrent headaches. No signs of sinusitis were detected by periodic examination. Computed tomography demonstrated the presence of large frontal PSD. Due to aesthetic concerns, the patient was selected for forehead aesthetic surgery. The operation was performed through a bi-coronal incision to expose the supraorbital areas. The anterior wall of the right frontal sinus was removed, divided into 2 sections, and fixed into the proper location, and then the sinus outflow was widened. An asymmetric brow lift was then performed to correct the asymmetric brow position. Good results were attained, the patient's headache was resolved, and he was pleased with his appearance. DISCUSSION: Although the most prevalent complaint of patients with PSD is aesthetic, some patients exhibit concomitant symptoms, including headaches and sinus obstruction. The constriction and partial obstruction of the sinus ostium may cause sinus cavity hypertrophy. Therefore, re-establishing sufficient drainage for the sinus by opening the sinus ostium is recommended during the reconstruction of the forehead's natural architecture to reduce headaches and recurrence of sinus hypertrophy. CONCLUSION: A combination of a bi-coronal approach regarding aesthetic surgery and sinus outflow widening achieves a desirable outcome that gives a good short-term follow-up result.

Evaluating the Effect of Endoscopic Sinus Surgery on Laryngeal Mucosa Stroboscopic Features.

INTRODUCTION: The major presenting symptom of nasal polyps is nasal obstruction. The role of nasal obstruction in the genesis of laryngeal disorders is still unknown. MATERIALS AND METHODS: The aim of this study was to evaluate laryngeal videostroboscopic changes after functional endoscopic sinus surgery (FESS) in patients with nasal polyposis. A longitudinal study was carried out from March 2012 to June 2013. Thirty patients with bilateral nasal polyposis who did not respond to maximum medical treatment and were candidates for FESS were recruited. Laryngeal videostroboscopy was performed before and 3 months after FESS. Glottic gap, true vocal cord (TVC) borders and pliability, false vocal cord (FVC) movement, laryngeal erythema and mucosal edema were documented. RESULTS: Laryngeal erythema and TVC edema were significantly decreased after FESS. Laryngeal erythema was documented in 18 patients after a 3-month follow-up. Four patients (13.3%) showed mild-to-moderate TVC edema and 26 patients (86.7%) had normal TVC mucosa. CONCLUSION: The results of this study show that FESS has a significant impact on laryngeal videostroboscopic features including laryngeal erythema and TVC edema.

Comparison between topical honey and mafenide acetate in treatment of auricular burn.

The auricle is a frequently injured part of the head and neck during thermal injury leading to ear deformity. The burned ear represents one of the most difficult problems for reconstructive surgeons. Mafenide acetate is a topical agent used routinely for these patients, but it has some disadvantages including painful application and allergic rash. Some authors have reported the healing effect and antibacterial activity of honey. The study reported here was undertaken to compare the effect of honey and mafenide acetate on auricular burn in rabbit. In our study, although the pathologic score of the honey group was better than that of the mafenide group both on 14 and 21 days after burning, it was not statistically significant. In the mafenide acetate group, deep complication of burn (chondritis) was significantly lower than that of the honey group. In conclusion, in contrast to healing and antibiotic activity reported for honey, it may have failure in preventing deep bacterial complications of wound (like chondritis). So in deep wounds, the use of honey as dressing is not recommended.

Polymerase chain reaction, bacteriologic detection and antibiogram of bacteria isolated from otitis media with effusion in children, shiraz, iran.

BACKGROUND: Otitis media with effusion is one of the leading causes of hearing loss in children. Effective treatment of effusion in the middle ear requires appropriate empirical treatment and characterization of responsible pathogens. Objective of the present study was to detect pathogens in clinical samples from patients with otitis media with effusion in our area and to determine the sensitivity profile of isolated organisms to commonly used antibiotics. METHODS: Sixty three samples of middle ear effusion were aseptically obtained from 36 children, who had been treated up to at least two weeks before sampling. They were analyzed using standard bacteriological and multiplex polymerase chain reaction (PCR) assays. Antibiotic susceptibility tests were also performed. RESULTS: PCR analysis showed that DNA of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were present in 60 (95.2%) of the samples. The culture-positive effusion for Streptococcus Pneumoniae, HaemophilusInfluenzae and Moraxella catarrhalis was 34.9%. Almost all isolates of Streptococcus pneumoniaee were sensitive to ciprofloxacin and erythromycin, and none of them was sensitive to co-trimoxazole. None of H. Influenzae isolates was sensitive to erythromycin, cefixim, co-trimoxazole, ampicillin and amoxicillin. None of M. Catarrhalis isolates was sensitive to ceftriaxone, co-trimoxazole, ampicillin and amoxicillin. CONCLUSION: Compared with other studies using PCR method, the number of H.influenza isolates was in higher in the present study (95.2%). Antibiotic sensitivity profiles of pathogens isolated in this study were different from others. Thus, we can determine empirical antibiotic therapy based on sensitivity profile in our geographic area.

Salivary gland myoepithelial neoplasms: a clinical and cytopathologic study of 15 cases and review of the literature.

OBJECTIVE: To describe the clinical and cytopathologic findings in 15 cases of salivary gland myoepithelial neoplasms and to assess the value of fine needle aspiration in the diagnosis of these tumors. STUDY DESIGN: Between 2000 and 2007, 15 consecutive patients were diagnosed with benign and malignant myoepithelioma of the head and neck region. A literature review of PubMed using the search terms myoepithelioma, myoepithelial carcinoma and salivary gland was performed. RESULTS: There were 8 men and 7 women. The age at presentation was 12-79 years (mean, 44.5). Parotid gland consisted of 73% of all primary sites. There were 10 benign and 5 malignant myoepitheliomas. In the benign group, only in 1 case did fine needle aspiration (FNA) revealed benign spindle cell variant, and in others, FNA diagnosis was mixed tumor. Similarly, in the malignant group, FNA diagnosis was malignant in only I case. The predominant cell morphology in the benign group was plasmacytoid cells, followed by a spindle and clear cell population. The cell morphology in the malignant lesions was epithelioid cell, clear cell and spindle cell. Scant fibrillary myxoid material was observed in both benign and malignant specimens. In the literature review and by analyzing the pooled data from 24 major reported series including 601 patients, the mean age at diagnosis was 51 years, and the mean male/female ratio was 1/.01. In addition, 39% of all tumors were malignant, and parotid gland consisted of 45% of all primary sites. CONCLUSION: According to the findings of the present study and review of the literature, the cytologic criteria for preoperative diagnosis ofsalivary gland myoepithelial neoplasms remain unsatisfactory and need to be clarified.

Outcomes of septoplasty in young adults: the Nasal Obstruction Septoplasty Effectiveness study.

The goal of this study was to compare the outcome of septoplasty in our patients with previous reports. We found some different outcomes of septoplasty at our center compared with the reports in the literature. One of the major differences between this and previous studies is in the mean age of patients undergoing surgery, 22.44 years in our study vs more than 40 years in most studies. In this study, 86 patients with septal deviation were asked using an outcomes instrument (the Nasal Obstruction Symptom Evaluation scale) before and 3 and 6 months after septoplasty. Seventy-seven patients (89.5%) reported a subjective improvement in their nasal obstruction, which is more than the experience of most authors. There was a significant improvement in mean Nasal Obstruction Symptom Evaluation score at 3 months after septoplasty, and some symptom improvement continued to 6 months. We conclude that younger patients who have nasal obstruction with septal deviation benefit more from septoplasty.

Preparation and characterization of insulin nanoparticles using chitosan and its quaternized derivatives.

Insulin (INS), like other peptides, has low therapeutic activity when administered orally due to degradation by proteolytic enzymes. Polymeric nanoparticles have been introduced as a useful carrier for peptide oral delivery, because they can protect these compounds from degradation. The objective of the present study is to develop an INS nanoparticulate system by using chitosan (CS), triethylchitosan (TEC), and dimethyl-ethylchitosan (DMEC, a new quaternized derivative of CS). INS-polymer nanoparticles were prepared by the polyelectrolyte complexation method. The physicochemical properties of the nanoparticles including particle size distribution, zeta potential, and polydispersity index were determined by using dynamic light scattering technique. Transmission electron microscopy was also used to observe the morphology of the nanoparticles. The amount of INS loaded into the nanoparticles was determined by measuring the association efficiency and also the content of INS in the nanoparticles. In vitro release studies showed a relatively small burst effect at the beginning and then a sustained release characteristic for 5 hours.

Nanoparticles of quaternized chitosan derivatives as a carrier for colon delivery of insulin: ex vivo and in vivo studies.

The aim of the present study was to develop insulin nanoparticulate systems by using chitosan (CS), triethylchitosan (TEC) and dimethyl-ethylchitosan (DMEC, a new quaternized derivative of chitosan) for colon delivery. The nanoparticles were prepared by the polyelectrolyte complexation (PEC) method. Particle size distribution, zeta potential and polydispersity index of the nanoparticles were determined using dynamic light scattering technique. Transmission electron microscopy (TEM) was also used to observe the morphology of the nanoparticles. It was found that the nanoparticles carried positive charges and showed a size distribution in the range of 170-270 nm with spherical morphology and smooth surface structure. The amount of insulin loaded into the nanoparticles was determined by measuring the association efficiency and also the content of insulin in the nanoparticles. Insulin loading was found to be more than 80% for all of the nanoparticles. In vitro release studies showed a small burst effect at the beginning and then a sustained release characteristic for 5h. Ex vivo investigations revealed better insulin transport across the colon membrane of rats for nanoparticles made with quaternized derivatives than those made of chitosan. In vivo studies in rats have showed enhanced colon absorption of insulin by using these nanoparticles compared to free insulin in diabetic rats. The insulin absorption from the rat's colon was evaluated by its hypoglycemic effect.