An investigation into the cellular-level adverse effects of tourniquet use on the infrapatellar fat pad in primary total knee arthroplasty: A prospective randomized study.

OBJECTIVE: This study aimed to examine the cellular-level adverse effects of tourniquet use on the infrapatellar fat pad (IPFP) in patients undergoing primary total knee arthroplasty (TKA). METHODS: Infrapatellar fat pad samples were collected in a prospective, randomized design to compare 2 groups of primary TKA patients with a tourniquet (T) and without a tourniquet (NT). The study included 80 knees of 58 patients with a mean age of 65.91 ± 9.04 years. The authors collected 3 samples from the T group (after exposure to the fat pad "t1," just before deflating the tourniquet "t2," just before fascia closure "t3") and 2 samples from the NT group (t1 and t3) for each patient. BAX, Bcl-2, and HIF-1α staining showed the extent of cellular hypoxia and apoptosis in IPFP cells, whereas the oxidative stress index (OSI) was determined using a biochemical method. The Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), and Kujala score were used as clinical outcome measures. RESULTS: The mean HIF-1α, BAX/Bcl-2, and OSI scores across all time points were significantly higher in the T group than in the NT group (p<0.001) (d=1.16, 2.9, and 0.9, respectively). The mean BAX/Bcl-2 (P=.030) and HIF-1α (P < .001) scores significantly peaked at t2 in the T group (d=-1.2 and -3.9, respectively). The OSI had higher levels at t1 (P=.011) and t3 (P=.073) (d=0.2 and 0.1, respectively) than at t2 in the T group. The third-month postoperative follow-up revealed that the mean KOOS, KSS, and Kujala score improved significantly compared to the baseline preoperative values (P < .001); however, there was no difference between the T and NT groups regarding the maximum and total knee range of motion or clinical outcome scores. CONCLUSION: Evidence from this study has shown that tourniquet use during primary TKA may be associated with significantly increased cellular hypoxia, oxidative stress, and apoptosis in the IPFP. LEVEL OF EVIDENCE: Level I, Therapeutic study.

Effects of Stabilization of the Sinus Membrane by Dental Implant Insertion and Membrane Suturing on Endo-Sinus Bone Gain in Cases of Lateral Sinus Lift Performed Without Graft Material.

PURPOSE: The aim of this study was to investigate the effects of membrane stabilization by suturing the sinus membrane and dental implant insertion on endo-sinus bone formation in lateral sinus lifting performed without grafting. MATERIALS AND METHODS: Maxillary sinus lift surgery using the lateral approach was performed bilaterally in 30 New Zealand white rabbits. The maxillary sinus areas were divided into control and test groups. In the control group, a titanium screw was placed after sinus membrane elevation, while in the test group, the sinus membrane was sutured to the lateral walls and a titanium screw was placed in the center of the alveolar crest. The animals were sacrificed at 4 and 8 weeks. Samples were collected, and micro-computed tomography (micro-CT) analysis was performed. The volume of newly formed bone, percentage of osseointegration, sinus volume, residual bone height, and protrusion length of the implants were measured using micro-CT analysis. RESULTS: The sinus volume, volume of newly formed bone, and percentage of osseointegration in the test group were significantly higher than those in the control group at 4 weeks (p = 0.01, p = 0.04, p = 0.02, respectively) While the volume of newly formed bone was 17.1 ± 3.08 mm3 in the control group, it was 26.9 ± 14.26 mm3 in the test group at 4 weeks. The volume of newly formed bone was significantly decreased from 26.9 ± 14.26 mm3 to 17 ± 3.66 mm3 at 8 weeks (p = 0.02). No significant difference in residual bone height was found at 4 and 8 weeks (p = 0.07). No significant difference in implant protrusion length was found between the control and test groups (p = 0.18). Protrusion length and new bone formation in the sinus showed a negative relationship (p = 0.01). CONCLUSION: Suturing the sinus membrane to the lateral sinus wall is an effective approach for increasing osseointegration, bone volume, and sinus volume in the short-term. A slow-absorbing suture material can be used to maintain sinus and bone volumes in the long-term.

The effect of drug holiday before tooth extraction on the development of medication-related osteonecrosis of the jaw in cancer patients receiving intravenous bisphosphonates.

Objectives: Drug holidays are suggested to reduce the formation of osteonecrosis in patients under intravenous (IV) bisphosphonates (BPs) therapy. The objectives of this study are to evaluate the incidence of medication-related osteonecrosis of the jaw (MRONJ) following tooth extraction in cancer patients using IV BP, and to assess the effect of drug holiday on the development of MRONJ. Patients and. Methods: A manuel search of the patient folders of Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Hacettepe University was undertaken to identify cancer patients who used IV BPs and had at least one tooth extraction between 2012 and 2022. Patents' age, sex, systemic condition, the type of BP used, duration of BP used, number of tooth extraction, duration of drug holiday, localization of tooth extraction and incidence of MRONJ were recorded. Results: One hundred nine teeth were removed from 57 jaws in 51 patients. All tooth extractions were performed under perioperative antibiotic prophylaxis and with primary wound closure. The incidence of MRONJ was 5.3%. Stage 1 MRONJ developed in 3 patients (only one had a drug holiday). The median duration of drug holiday was 2 months. No significant difference between the patients with and without a drug holiday and MRONJ development was found (P=0.315). The mean age of patients developed MRONJ was 40.33±8.08 years. A statistically significant difference was found between age and MRONJ development (P=0.002). Conclusion: The effect of a short-term drug holiday on the development of MRONJ may be limited because BPs remain in bone tissue for a long time. Drug holidays should be applied with the approval of an oncologist with other preventive measurements.

Comparison of Stress Distribution Among Standard Dental Implants Placed in Grafted Bone, Zygomatic Implants, and Subperiosteal Implants in the Atrophic Edentulous Maxilla: 3D Finite Element Analysis.

Purpose: To compare the biomechanical behaviors of different surgical options that are preferred for implant-supported fixed prosthetic rehabilitation of the atrophic edentulous maxilla. Materials and Methods: A 3D finite element analysis (FEA) model was generated from the computed tomography data of a patient with an atrophic edentulous maxilla. Four scenarios were created in the atrophic maxilla. In model 1, the maxilla was reconstructed with an onlay bone graft harvested from the anterior iliac crest, and sinus augmentation procedures were performed. Standard dental implants were placed in the lateral incisor, first premolar, and first molar regions on each side. In model 2, the anterior part of the atrophic maxilla was reconstructed with an onlay bone graft harvested from the mandibular ramus, and zygomatic implants were placed in the posterior part of the maxilla. In models 3 and 4, two-piece subperiosteal implants made of titanium and polyether ether ketone (PEEK) materials, respectively, were placed in the atrophic maxilla. All implants were loaded with 150-N and 50-N forces in vertical and lateral directions, respectively. Stress accumulation on bones, implants, abutments, and prosthetic frameworks was investigated. Results: The tensile stress in both cortical and trabecular bone was highest in the iliac bone grafting group under vertical loading. The compressive stress in both cortical and trabecular bone was the highest in the PEEK subperiosteal implant model, and the compressive stress value on the trabecular bone exceeded the strength of the trabecular bone. The highest von Mises stress in the implants was obtained in the iliac bone grafting group under vertical loading. The highest stress value in the abutments was detected for the titanium subperiosteal implant. The highest von Mises stress in the prosthetic framework was detected in the titanium subperiosteal implant group, under both vertical and lateral loading. Conclusion: Based on the stress accumulation results of the four different scenarios, it can be seen that there is no ideal treatment modality for the fixed implant-supported prosthetic rehabilitation of the atrophic edentulous maxilla. Various intraoperative and prosthetic modifications are suggested to decrease the risk of biomechanical complications during long-term follow-up.

The Role of Substance P Receptor Antagonists in Allergic Rhinitis: Ovalbumin-Induced Rat Model.

OBJECTIVE: Substance P is a peptide from the tachykinin family, which is found in peripheral and central nervous systems, causing vasodilation and increased secretion in the nasal mucosa. In this study, we aimed to investigate whether the experimental model of allergic rhinitis will cause allergic changes in the larynx and to compare the effects of aprepitant, a substance P antagonist, on nasal symptoms in allergic rhinitis, and histopathological changes in the nasal and laryngeal mucosa with antihistamine and leukotriene receptor antagonists (LTRA). STUDY DESIGN: An experimental animal study. METHOD: The study was carried out on 34 healthy 8-12 weeks old female Sprague Dawley rats in 5 groups. The rats in which an experimental allergic rhinitis model was created with ovalbumin were scored by observing their nasal symptoms, and nasal and laryngeal mucous membranes included in the study were evaluated histopathologically after medications. RESULTS: As a result of the analysis of the data obtained from the study, antihistamine and LTRA significantly reduced the symptoms of nose scratching and sneezing, while aprepitant did not affect nasal symptoms. In the histopathological examination of the larynx, effects that would make a significant difference were found in the allergy group when compared to the control group. On the larynx, aprepitant reduced pseudostratification significantly compared to the allergy group. CONCLUSION: Aprepitant provides histopathological changes in the treatment of allergic rhinitis, but does not have sufficient effect on nasal symptoms. The effect of aprepitant on the larynx has not been clearly demonstrated. LEVEL OF EVIDENCE: NA Laryngoscope, 133:2891-2897, 2023.

The Effects of Systemic Coenzyme Q10 Treatment on Corneal Histology in Streptozocin-Induced Diabetic Rats.

OBJECTIVE: This study investigate the histopathological changes and VEGF, IL-1ß, and IL-6 immunoreactivities in cornea treated with Coenzyme Q10 (CoQ10) in a Streptozocin (STZ) induced diabetic rat model. METHODS: A total of 20 male Wistar Albino rats including a group of STZ diabetic rats, diabetic rats treated with CoQ10, rats were given CoQ10 without being diabetic and a Control group were included the study. The groups were followed up for 2 months. Eye tissues were stained with Hematoxylin-Eosin (HE), Periodic Acid-Schiff (PAS), and immunohistochemical staining (IHC). FINDINGS: The mean corneal thickness was found to be lower in the group with DM (126,62 ± 18,1) compared to the other groups. However, this decrease was found to be significant only in comparison with the control group (181,75 ± 13,87) (p = 0.000). In diabetic corneas, PAS positivity was observed in in Descemet's membrane (p = 0.021). Staining with VEGF, IL-1ß, IL-6antibodies was found to be lower in the DM+CoQ10 group compared to the group with DM (p < 0.001, p < 0.001, p < 0.001). RESULTS: We observed that diabetes increases inflammation and tendency to angiogenesis in the corneal tissue, and CoQ10 treatment reduces the corneal thickness, inflammation, and tendency to angiogenesis caused by diabetes.

Nasal Mucociliary Clearance and Sinonasal Symptoms in Healthcare Professionals Wearing FFP3 Respirators: A Prospective Cross-Sectional Study.

INTRODUCTION: The purpose of the present study was to assess nasal mucociliary clearance (NMC) and sinonasal symptoms of healthcare professionals wearing filtering facepiece-3 (FFP3) respirators. METHODS: This prospective cross-sectional study was conducted at a large tertiary care academic center. Thirty-four healthcare professionals working at a coronavirus disease-19 patient care unit were included in the study. Visual analog scale (VAS) scores of sinonasal symptoms (nasal discharge, postnasal discharge, nasal blockage, hyposmia, facial pain/pressure, facial fullness, headache, fatigue, halitosis, cough) and the NMC times of the participants were assessed immediately before wearing FFP3 respirators and after 4 h of work with FFP3 respirators. RESULTS: The mean age of the participants was 28.82 ± 4.95 (range, 26-31) years. Twenty participants were female and 14 were male. After wearing the FFP3 respirators for 4 h, a statistically significant increase was observed in total VAS scores for all sinonasal symptoms and NMC times (p < 0.001). When the VAS score of each sinonasal symptom was evaluated separately, a statistically significant increase was found for VAS scores of nasal discharge, postnasal discharge, nasal blockage, hyposmia, facial pain/pressure, and facial fullness (p < 0.05). CONCLUSION: The present study shows that nasal mucosal functions might be affected significantly after 4 h of using FFP3 respirators. The long-term effects and clinical significance of these short-term changes should be investigated on healthcare professionals in further studies.

Evaluation of Sinus Membrane Perforation in Osteotome Sinus Floor Elevation With and Without Grafting.

The purpose of this study was to evaluate, using cone-beam computerized tomography (CBCT), the rate of sinus membrane perforation in osteotome sinus floor elevation (OSFE) performed with and without a graft material. Thirty patients with 52 OSFE sites were included in the study. Patients were divided into the control group (OSFE performed without graft material) and test groups (OSFE performed with autograft or xenograft). The autograft was harvested from the maxillary tuberosity using bone forceps. The xenograft was a commercial product originating from bovine bone. Graft volume was measured using the water displacement method. CBCT was performed at the initial examination and immediately after surgery to measure the residual bone height and to evaluate the endo-sinus bone gain and membrane perforation. The rate of sinus membrane perforation was 15.4%. Of the 52 OSFE procedures, 26.9% were performed without grafting and 34.6% and 38.5% were performed with autografts and xenografts, respectively. Membrane perforation was significantly higher in the autograft group (P = .033). The median volume of graft materials was 0.3 mL. The difference in graft volume between the autograft and xenograft was not statistically significant (P = .768). The mean endo-sinus bone gain was 6.55 mm in patients without membrane perforation and 8.71 mm in patients with membrane perforation; this difference was statistically significant (P = .035). The volume and physical properties of graft materials are important factors in membrane perforation. Further clinical studies with larger and standardized samples are needed to confirm the effect of graft materials on sinus membrane perforation in OSFE.

Effect of suprahyoid muscles on mouth opening with and without lateral pterygoid muscle: 3D inverse dynamic model analysis.

Objective: To evaluate the contribution of suprahyoid muscles to mouth opening in different hyoid bone positions.Methods: The jaw-opening and closing movements were imposed on the 3D inverse dynamic jaw model with and without the lateral pterygoid muscle (LPM). The activation of the muscles was evaluated for eight different positions of the hyoid bone.Results: The muscles with 100% activation provided maximum mouth opening (MMO). When the hyoid bone was replaced, the muscles could achieve MMO at the 135º, 180º, and 225º points with the LPM. Mouth opening was estimated to be 36.8 mm in the absence of the LPM. A jaw opening greater than 36.8 mm was seen when the hyoid bone was repositioned at the 90º, 180º, and 135º points.Discussion: The contribution of suprahyoid muscles to mouth opening varies in different hyoid bone positions, with the inferior and anterior positions having a positive impact.

Fine-Needle Aspiration Cytology of Salivary Gland Tumors Before the Milan System: Ten Years of Experience at a Tertiary Care Center in Turkey.

Objective: The role of fine-needle aspiration cytology (FNAC) is well established for preoperative evaluation of patients with salivary gland lesions. However, the lack of a uniform system for salivary gland FNAC has limited its effectiveness. In recent years, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been in use around the world to report the cytology results. We aimed to investigate the efficacy and accuracy of FNAC examined according to pre-MSRSGC era dichotomous benign/malignant classification in salivary gland tumors. Methods: Patients who underwent surgery between January 2011 and December 2020 due to major salivary gland tumors were retrospectively analyzed. Two hundred and four patients were included in the analysis. Preoperative FNAC results and final histopatological diagnoses were grouped as benign or malignant. Final histopatological diagnoses were compared with the preoperative FNAC results. Also, sensitivity, specificity, and accuracy of the preoperative FNAC results, as well as the agreement between both tests were investigated. Results: The sensitivity, specificity, accuracy, positive and negative predictive values of the preoperative FNAC for the diagnosis of malignancy were 59.09%, 97.85%, 93.75%, 76.47%, and 95.29%, respectively. There was a moderate agreement between the preoperative FNAC results and final histopatological diagnoses. Conclusion: The accuracy of the preoperative FNAC and the information given about malignancy risk are the most important criteria for patient management and decision-making. The MSRSGC, which consists of a six-tiered classification rather than a dichotomous "yes/no" system, may contribute to patient management and decision-making by increasing the efficacy and accuracy of FNAC.

The effect of vascular complications of diabetes mellitus on human umbilical cord tissue and the number of Wharton Jelly's mesenchymal stem cells.

The current study investigated the change in umbilical cord tissue and the number of markers of Wharton's jelly mesenchymal stem cells (WJ-MSC) in pregnant women with gestational diabetes (GDM), with chronic diabetes who developed nephropathy as vascular complication (VC-PGDM), and healthy pregnant women as the control. The umbilical cords (UC) were investigated by the histomorphological method and the number of WJ-MSC were detected by flow-cytometry using the CD90, CD44, CD105, and CD73 markers in Wharton's jelly (WJ) isolated from fresh umbilical cords. The number of positive cells for CD 90, CD44, CD105, and CD73 were found to be elevated in the GDM group, whereas it was significantly diminished in the VC-PGDM group (p = 0.001, p = 0.001, p = 0.001, and p = 0.001). The only histopathological sign in the GDM group were an increased number of pores in the Wharton jelly. Artery wall thickness/cord diamater ratio was increased, which indicates an increase of the artery wall thickness in the VC- PGDM group (p = 0.039 and p = 0.048). The increase in umbilical cord diameter and number of Wharton jelly mesenchymal stem cells in babies of gestational diabetic mothers was considered as an effect of macrosomia seen in babies of mothers with gestational diabetes. Vasculopathy, a long-term complication of diabetes, is known to affect all tissues by causing marked lower perfusion and hypoxia, as well as a decrease in the MSC number in our study.

A small library of chalcones induce liver cancer cell death through Akt phosphorylation inhibition.

Hepatocellular carcinoma (HCC) ranks as the fifth most common and the second deadliest cancer worldwide. HCC is extremely resistant to the conventional chemotherapeutics. Hence, it is vital to develop new treatment options. Chalcones were previously shown to have anticancer activities in other cancer types. In this study, 11 chalcones along with quercetin, papaverin, catechin, Sorafenib and 5FU were analyzed for their bioactivities on 6 HCC cell lines and on dental pulp stem cells (DPSC) which differentiates into hepatocytes, and is used as a model for untransformed control cells. 3 of the chalcones (1, 9 and 11) were selected for further investigation due to their high cytotoxicity against liver cancer cells and compared to the other clinically established compounds. Chalcones did not show significant bioactivity ([Formula: see text]) on dental pulp stem cells. Cell cycle analysis revealed that these 3 chalcone-molecules induced SubG1/G1 arrest. Akt protein phosphorylation was inhibited by these molecules in PTEN deficient, drug resistant, mesenchymal like Mahlavu cells leading to the activation of p21 and the inhibition of NF[Formula: see text]B-p65 transcription factor. Hence the chalcones induced apoptotic cell death pathway through NF[Formula: see text]B-p65 inhibition. On the other hand, these molecules triggered p21 dependent activation of Rb protein and thereby inhibition of cell cycle and cell growth in liver cancer cells. Involvement of PI3K/Akt pathway hyperactivation was previously described in survival of liver cancer cells as carcinogenic event. Therefore, our results indicated that these chalcones can be considered as candidates for liver cancer therapeutics particularly when PI3K/Akt pathway involved in tumor development.

Simultaneous Coexistence of Complications of Chronic Otitis Media in the Same Case.

Chronic otitis media (COM) is a common clinical entity, but the incidence of COM complications has declined recently due to broad use of antibiotics. Independent of this, these complications are still a significant challenge in otorhinolaryngology practice because of high morbidity and mortality rates. The most common etiologic diagnosis was cholesteatomatous COM. Simultaneous coexistence of complications of COM in the same case is a rare situation, and the present report describes a case with mastoiditis, Bezold abscess, lateral sinus thrombophlebitis, meningitis, and paraspinal abscess.

The effect of chronic dental inflammation on development of Stage 0 medication-related osteonecrosis of the jaw.

OBJECTIVE: The pathogenesis of medication-related osteonecrosis of jaw (MRONJ) is poorly understood. The aim of this prospective study was to determine the effect of chronic dental inflammation on the development of Stage 0 MRONJ based on histopathological findings. METHODS: The study involved patients with a history of bisphosphonate use and an indication for tooth extraction. Before surgery, C-terminal telopeptide test (CTX) values were collected from all patients. All tooth extractions were performed according to a determined protocol. To detect whether any medication-related osteonecrotic changes were present in the non-exposed bone, biopsy samples were taken from the alveolar bone. RESULTS: A total of 50 patients were included in the study (39 women and 11 men). The patients were mean age of 57.4 ± 12.1 years. In total, 74 teeth were extracted (29 maxillary and 45 mandibular). Histologic examination of three patients (6%) revealed Stage 0 MRONJ. Postoperatively, the complete mucosal healing success rate was 96%. MRONJ risk was not significantly correlated with low CTX value (p = 0.285). CONCLUSIONS: Chronic inflammation may contribute to Stage 0 MRONJ; however, its role may not be sufficient alone for its development. Application of a predetermined protocol for dentoalveolar processes will help to prevent MRONJ development.

Effect of laryngopharyngeal reflux on the improvement of chronic rhinosinusitis without polyposis after primary endoscopic sinus surgery.

OBJECTIVES: This study aims to investigate the influence of laryngopharyngeal reflux on the improvement of chronic rhinosinusitis (CRS) in patients who underwent endoscopic sinus surgery (ESS). PATIENTS AND METHODS: A total of 48 patients (28 males, 20 females; mean age 41.6±15.1 years; range 18 to 75 years) with CRS without polyposis were assessed for the presence of gastric reflux with Reflux Symptom Index (RSI) and Reflux Finding Scores (RFS) before undergoing primary ESS. Patients with a RSI >12 and RFS >7 were included in the reflux(+) and those with either score under these cutoffs in the reflux(-) group. Improvement scores were accepted as the difference between preoperative scores and postoperative sixth-month Lund-Mackay Radiology Scores, Lund-Kennedy Endoscopy Scores (LKES), and Sinusitis Symptom Scores (SSS). RESULTS: There was no significant difference between improvements of the reflux(+) and reflux(-) groups in terms of radiology, endoscopy, and symptom scores (p>0.05). However, preoperative and postoperative six-month radiology scores were significantly higher in reflux(+) patients (p<0.01). Also, postoperative six-month LKES were significantly higher in reflux(+) patients. No statistically significant differences were detected between preoperative and postoperative six-month SSS in reflux(+) or reflux(-) patients. CONCLUSION: Laryngopharyngeal reflux was associated with worse radiology and endoscopy scores in CRS without polyposis; however, it had no role on the improvement scores after primary ESS.

Is septoplasty effective on habitual snoring in patients with nasal obstruction?

We aimed to find out whether snoring relieve with nasal surgery in patients with nasal obstruction. Sixty-four patients who underwent septoplasty under general anesthesia with complaint of nasal obstruction and snoring at Haydarpasa Numune Education and Research Hospital were enrolled in the study. All patients were evaluated by otolaryngological examination. Septal deviation was graded as mild, moderate and severe with endoscopy. Variables examined included age, sex, body mass index. All patients also completed the questionnaires, including Nose Obstruction Symptom Evaluation scale (NOSE), Epworth Sleepiness Scale (ESS), and Snore Symptom Inventory (SSI) before and after septoplasty. NOSE scale, ESS, and SSI scores showed statistically significant improvement after nasal surgery (p < 0.01) but we could not find any statistically significant association between septal deviation grading and improvement in scores of NOSE scale, ESS, and SSI (p > 0.05). Added to this, the association between body mass index (BMI) and improvement in scores of NOSE scale, ESS, and SSI did not reach statistical significance (p > 0.05). Our results demonstrated that septoplasty is effective on the subjective parameters of nasal obstruction in habitual snorers irrespective of the nasal septal deviation and severity of BMI.

Extramedullary plasmacytoma of the frontal sinus: case report and Turkish literature review.

Solitary extramedullary plasmacytomas (EMPs) are nonepithelial neoplasms of plasma cell origin categorized among non-Hodgkin lymphomas, without the bone marrow involvement and systemic spread seen in multiple myeloma. They are uncommon tumors comprising 3% of all plasma cell neoplasias. Although they usually occur in the upper respiratory tract, only 1 case of EMP localized to the frontal sinus has been reported in the English literature. We present in this report a rare case of EMP originated from the left frontal sinus leading to left eyeball proptosis and movement restriction. A survey of sinonasal EMPs in the Turkish literature is reported, as well. Paranasal computerized tomography and magnetic resonance imaging of a 69-year-old female who presented with left eyeball proptosis and left-sided headache revealed a solid mass in the left frontal sinus. Histopathological analysis of the completely excised mass supported the diagnosis of plasmacytoma. The definitive diagnosis of solitary EMP was confirmed with further investigations at hematology and oncology clinics. The patient was treated with surgery followed by local radiotherapy to the head and neck region, and she was disease-free at her 1-year follow-up. Treatment of sinonasal EMP is surgery alone or surgery combined with radiotherapy. Long-term follow-up is a requisite for systemic control because of the disease's high potential to transform into multiple myeloma.

A rare tumor of nasal cavity: glomangiopericytoma.

Glomangiopericytoma is a rare vascular neoplasm characterized by a pattern of prominent perivascular growth. A 72-year-old woman was admitted to our clinic complaining of nasal obstruction, frequent epistaxis, and facial pain. A reddish tumor filling the left nasal cavity was observed on endoscopy and treated with endoscopic excision. Microscopically, closely packed cells interspersed with numerous thin-walled, branching staghorn vessels were seen. Glomangiopericytoma is categorized as a borderline low malignancy tumor by WHO classification. Long-term follow-up with systemic examination is necessary due to high risk of recurrence.

Clinical outcome parameters for necrotizing otitis externa.

OBJECTIVE: To investigate the duration of time elapsed between the onset of symptoms for necrotizing external otitis (NEO) and admission to hospital that may play a role in patient outcome. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Fourteen consecutive male patients with NEO with no improvement from the previous course of antibiotherapy and with findings of osteomyelitis on temporal bone CT, MRI, and positive detection of Tc-99m methylene diphosphonate on temporal bone, admitted as inpatients between 2008 and 2012. INTERVENTION(S): Medical treatment of NEO and surgical debridement. MAIN OUTCOME MEASURE(S): Patients were divided into 2 groups according to median time elapsed between onset of symptoms and hospitalization (<30 d or >30 d). HbA1c, fasting blood sugar, erythrocyte sedimentation rate, C-reactive protein, pain intensity, radiologic grade, improvement since diagnosis, and total time to cure were compared according to the groups. The relationships between the laboratory data were analyzed to determine the parameters associated with time to recovery. RESULTS: Otalgia was significantly worse in patients who were admitted to hospital greater than 30 days after symptom onset (Mann-Whitney U test, p < 0.002). Blood glucose increased related to delayed admission time (p < 0.001). CRP results were independently elevated from the admission time (p < 0.112). There was a statistically significant difference between groups according to ESR levels and recovery time (Mann-Whitney U test, p < 0.004 and p < 0.01). There was a positive correlation between HbA1c levels and recovery time in Group 1 and between ESR levels and recovery time in Group 2 (r = 0.872, p = 0.044; r = 0.630, p = 0.039). CONCLUSION: Clinical, laboratory, and outcome data worsen later than 30 days in NEO.

Association between laryngeal squamous cell carcinoma and polymorphisms in tumor necrosis factor related apoptosis induce ligand (TRAIL), TRAIL receptor and sTRAIL levels.

The laryngeal squamous cell carcinoma (LSCC) is one of the most common malignant tumors occurring in the head and neck. Tumor necrosis factor related apoptosis induce ligand (TRAIL) and TRAIL-receptors (DR4, DR5, DcR1, DcR2) are known as important members of TRAIL-mediated biochemical signaling pathway. Associations between polymorphisms in these genes and clinicopathological characteristics of human laryngeal carcinoma are not well defined. This study therefore aimed to investigate a possible relationship among the TRAIL and TRAIL-DR4 polymorphisms and sTRAIL levels in the risk or progression of LSCC. A total of 99 patients with laryngeal cancer and 120 healthy subjects were enrolled in the study. DR4 C626G and TRAIL 1595 C/T genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis and sTRAIL levels were measured by ELISA. There were significant differences in the distribution of DR4 C626G genotypes and frequencies of the alleles between laryngeal cancer patients and controls (p<0.001) but not in TRAIL 1595 C/T. We found the increased frequency of the DR4 C626G homozygote CC genotype in patients than in controls (p<0.001). Haplotype analysis revealed that there was also a statistically significant relationship between TRAIL and TRAIL-DR4 polymorphisms and laryngeal cancer. Serum sTRAIL levels in the laryngeal patients with CC genotype who had advanced tumour stage were lower than those of patients with early tumor stage (p=0.014). Our findings suggest that DR4 C626G genotypes and sTRAIL levels might be associated with progression of laryngeal cancer in the Turkish population.