Satisfaction in rhinoplasty: the possible impact of anxiety and functional outcome.

BACKGROUND: Rhinoplasty is a complex but commonly applied surgical procedure. Patient satisfaction is the least discussed but one of the most important determinants of surgical success. OBJECTIVES: Evaluation of the patient satisfaction together with surgeon satisfaction were the main goals of this study. The roles of anxiety, gender, age and follow-up period were also studied. PATIENTS AND METHODS: 53 eligible patients operated by the first two authors within the previous 2 years were enrolled in the study. The medical records were reviewed for demographic data as well as the details of the surgical procedure. Functional and esthetic satisfactions of the patients were evaluated by VAS and ROE respectively. Surgeon satisfaction was evaluated by VAS in crosswise manner. Anxiety was measured by STAI_s and STAI_t scales. RESULTS: The analysis concerning esthetic results as well as functional results did not reveal any significant difference between the two surgeons (p = 0.132, p = 0.43 respectively). ROE scores were significantly different among patients with "good" and "very good" functional results. The difference between surgeon satisfaction and patient satisfaction was found to be insignificant (p = 0.273). Correlation analysis yielded a positive correlation between STAI_I and STAI_II (Pearson r = 0.335, p = 0.014) but not between STAI scores and ROE scores. Moreover, there was no relation between anxiety scores and the functional results. Likely, gender as well as age, follow-up, and surgical technique were not found to have any effect on patient satisfaction either. CONCLUSION: Patient satisfaction is preferential in rhinoplasty. In our patient series, patient satisfaction was shown to be correlated with functional outcome but not with surgeon satisfaction. Anxiety was not found to have a significant impact on results of rhinoplasty. Our results should be interpreted cautiously keeping in mind that our patients' primary drive for rhinoplasty was functional.

Nasal type natural killer T-cell lymphoma involving nasooropharynx and larynx.

Lymphoma is one of the malignant non-squamous tumors involving the head and neck. Lymphomas in this region are mostly B-cell type in origin and usually seen in Waldeyer's ring. In this article, we report a 45-year-old female case of primary natural killer T cell lymphoma-nasal type involving the nasooropharynx and larynx. This is a very rare entity with poor prognosis.

Submandibular gland pleomorphic adenoma in a seven-year-old child: a case report.

Salivary gland neoplasms are rare in the pediatric age group. Pleomorphic adenomas in the submandibular gland are rarer. In this article, we present a seven-year-old female with a slowly growing mass in her right submandibular area. The firm, mobile and painless mass was about 2x3 cm in size and with bimanual palpation it was indiscriminated from the submandibular gland. Magnetic resonance imaging with contrast revealed a heterogeneous and minimally lobulated mass within the submandibular gland with clearly defined borders. Fine needle aspiration biopsy revealed a diagnosis of pleomorphic adenoma and we performed right submandibular gland excision under general anesthesia. The histopathological diagnosis was pleomorphic adenoma with sparse mitotic figures that may be interpreted as having a potential of malignant transformation. This patient who was followed up for one year without any complication is to our knowledge the youngest case cited in the English-language literature.

Clinical relevance of ceramide metabolism in the pathogenesis of human head and neck squamous cell carcinoma (HNSCC): attenuation of C(18)-ceramide in HNSCC tumors correlates with lymphovascular invasion and nodal metastasis.

It has been documented previously that defects in the generation of C(18)-ceramide, a product of ceramide synthase 1 (CerS1), also known as longevity assurance gene 1 (hLASS1), play important roles in the pathogenesis and/or progression of HNSCC. However, whether altered levels of ceramide generation in HNSCC tumors have any clinical relevance remains unknown. In this study, the levels of endogenous ceramides were measured in tumor tissues of 45 HNSCC patients as compared to their normal tissues using high-pressure liquid chromatography/mass spectrometry (LC/MS), and then possible link between ceramide levels and the clinical parameters of HNSCC were examined. The data showed that the levels of C(16)-, C(24)-, C(24:1)-ceramides were significantly elevated in the majority of tumor tissues compared to their normal tissues, while the levels of only C(18)-ceramide were significantly decreased in HNSCC tumors, especially in tumor tissues of male patients. Importantly, it was also shown here that decreased C(18)-ceramide levels in HNSCC tumor tissues were significantly associated with the higher incidences of lymphovascular invasion, and pathologic nodal metastasis. Importantly, attenuation of C(18)-ceramide was also positively linked to the higher overall stages of the primary HNSCC tumors. Therefore, these data suggest, for the first time, that the defects in the generation/accumulation of C(18)-ceramide might have important clinical roles in HNSCC, especially in lymphovascular invasion and nodal disease.

Sympathetic skin responses from postauricular region in Meniere's disease.

OBJECTIVE: To investigate the sympathetic nervous system activity in Meniere's disease (MD) by recording sympathetic skin responses (SSRs) from the postauricular region (PA). METHODS: Twenty-one patients with definite unilateral MD diagnosis and 12 healthy volunteers were studied by evoking right and left PA-SSRs with electrical stimulation of the left median nerve at the wrist in attack and interval periods of MD. Mean latencies and maximum amplitudes were used in statistical analyses. RESULTS: In unilateral definite MD patients, the mean latencies were longer and the maximum amplitudes were smaller on the involved ear side than those on the normal ear side (p<0.01 for both amplitude and latency) and than those from the controls (p<0.01 and p<0.05). In three patients, there was no detectable PA-SSR on the involved ear side while there were SSRs on the healthy side. In four patients, the responses were absent bilaterally during the attack period. CONCLUSIONS: There is a marked asymmetric sympathetic hypofunction in the area of the PA region of the involved ear in MD patients. SIGNIFICANCE: The PA region is a new site for recording sympathetic skin responses. PA-SSR is a useful tool to investigate sympathetic nervous system function in MD patients.

Relation between middle ear pressure changes and postoperative nausea and vomiting in pediatric strabismus surgery.

STUDY OBJECTIVE: To investigate the effects of tympanometric changes on the frequency of postoperative nausea and vomiting (PONV). DESIGN: Prospective, observational study. SETTING: University hospital. PATIENTS: 49 ASA physical status I, nonpremedicated children undergoing elective strabismus surgery. INTERVENTIONS: Frequency of PONV was assessed at various time intervals (0-2, 2-6, and 6-24 hours) with a 4-point scale (0, no nausea; 1, nausea but no vomiting; 2, one episode of vomiting; 3, two or more episodes of vomiting), and correlation with tympanometric data was investigated. MEASUREMENTS: Tympanogram was obtained before induction of standardized anesthesia and after full recovery. Fourteen (28.6%) patients had nausea, and 10 (20.4%) patients vomited. The tympanic gradient, compliance, and pressure values were found to be significantly higher in postoperative measurements than their preoperative counterparts (P < 0.05). The volumes of both ears increased postoperatively, but these differences were not statistically significant (P > 0.05). Changes in middle ear pressure, volume, compliance, and gradient did not correlate with PONV (P > 0.05). CONCLUSIONS: Gradient, compliance, volume, and pressure changes in middle ears were not found to be related to the frequency of nausea and vomiting after strabismus surgery.

Inhibition of growth and telomerase activity by novel cationic ceramide analogs with high solubility in human head and neck squamous cell carcinoma cells.

OBJECTIVES: Head and neck squamous cell carcinoma (HNSCC) is notoriously resistant to chemotherapy. The sphingolipid ceramide and its analogs have been demonstrated to exert antitumor activity in many cell types; however, the effectiveness of these analogs has been limited by potency and solubility. This study focuses on the effects of novel highly soluble cationic pyridinium-ceramides, alone and in combination with various chemotherapeutic agents, on cell survival, telomerase activity, and cell cycle arrest in HNSCC cell lines in vitro. METHODS: The concentration of pyridinium-ceramides and chemotherapeutic agents that inhibited cell growth by 50% (IC50) was determined by MTT cell survival assays. The cell cycle profiles were determined by flow cytometry. Telomerase activity was determined by telomerase repeat amplification protocol (TRAP) assay. RESULTS: Treatment of the human UM-SCC-22A (SCC of the hypopharynx) cells, as well as various other HNSCC cell lines, with C6-Pyr-Cer resulted in the inhibition of cell survival with an IC50 concentration of approximately 250 to 300 nM at 96 hours, whereas its IC50 was greater than 1000 nM in noncancerous Wi-38 human lung fibroblasts, and adult human epidermal keratinocytes. Moreover, treatment with C6-Pyr-Cer also resulted in cell cycle arrest in G0/G1, which correlated with a significant inhibition of telomerase activity in UM-SCC-22A cells. Additional results demonstrated that the combination of C6-Pyr-Cer with gemcitabine (GMZ) or doxorubicin (DOX), which have the lowest IC50 concentrations among various chemotherapeutic drugs in these cells, enhances the effects of these drugs in the inhibition of telomerase and cell growth. CONCLUSIONS: These data suggest that the novel C6-Pyr-Cer with high solubility and bioavailability may lead to the development of new therapeutic strategies that target telomerase for the treatment of HNSCC.

Lipoid proteinosis: an unusual presentation with verruca vulgaris.

Lipoid proteinosis (LP) is a very rare, autosomally recessive, inherited disease. It is also known as Urbach Wiethe disease or Hyalinosis cutis et mucosa. LP usually runs a benign, stable, and slowly progressing course. We present one LP case with additional unusual dermatologic involvement; verruca vulgaris was superimposed on papular lesions of LP. To our knowledge, this case is the first and only one described in the literature. In this presentation, we discuss the possibility of predisposition to Human Papilloma Virus (HPV) infections in LP.

Effect of n-butyl-2-cyanoacrylate on the tensile strength and pressure resistance of tracheal anastomoses ex vivo.

OBJECTIVES: To investigate the effects of n-butyl-2-cyanoacrylate on tracheal anastomoses in terms of increased tension and intraluminal pressure ex vivo. STUDY DESIGN: Ex vivo experimental study. SETTING: Tertiary referral center (Department of Otolaryngology). SUBJECTS AND METHODS: Thirty sheep tracheas were used. Four cartilage rings were resected from the tracheas that were 20 cm in length. End-to-end anastomoses were performed by using Vicryl only (group 1), Vicryl and n-butyl-2-cyanoacrylate (group 2), and n-butyl-2-cyanoacrylate only (group 3). The amount of force to break off the anastomosis and the amount of intraluminal pressure to arouse air leakage through the anastomosis were measured. RESULTS: The mean force required to break off was 171.9 ± 29.7 N in group 1, 164.8 ± 26 N in group 2, and 13.52 ± 2 N in group 3. The mean force required to break off in group 3 was significantly lower than those in groups 1 and 2 (P = .008 and P = .008, respectively). The mean pressure required to cause air leakage was 49.6 ± 9.1 mm Hg in group 1, 113 ± 14.4 mm Hg in group 2, and 15 ± 4.2 mm Hg in group 3. Group 2 was found to be more resistant to intraluminal pressure than groups 1 and 3 (P = .008 and P = .008, respectively). CONCLUSION: n-Butyl-2-cyanoacrylate had no significant effect on tensile strength. However, its application on the suture line provided extra pressure resistance ex vivo. We believe that further studies need to be conducted to investigate its long-term effects and histological impact on tracheal anastomoses in vivo.

Outcomes from Cyanoacrylate Use in Tracheal Anastomosis in a Rat Model.

OBJECTIVES: We aimed to investigate the histologic effects of N-butyl-2-cyanoacrylate (NBCA) and metacryloxisulfolane (MS) comonomer on tracheal anastomosis in vivo on a rat model of tracheal resection and end-to-end anastomosis. STUDY DESIGN: Animal experiment. Rat model of tracheal resection and end-to-end anastomosis. SETTING: Animal laboratory. SUBJECTS AND METHODS: Tracheal resection and end-to-end anastomosis were performed in 28 Wistar albino rats. Rats were randomly divided into 2 groups: control (n = 14), in which anastomoses were performed with 8/0 Vicryl, and study (n = 14), in which NBCA and MS comonomer was used in addition to 8/0 Vicryl to perform anastomosis. Seven rats from each group were sacrificed on day 7 and the remaining on day 28 for gross and histologic examination. RESULTS: Indurations at the site of anastomoses were detected in all rats of study group. Slight narrowing at the site of anastomosis was observed in 8 rats of the study group and in only 1 of the control group. The difference was significant on day 28 (P = .021). The inflammatory cell infiltration was significantly increased in the study group on day 28 (P = .022). Epithelial regeneration was found to be worse in the study group on day 28 (P = .022). CONCLUSIONS: The use of NBCA and MS comonomer increased the inflammation in rat tracheal anastomosis with respect to inflammatory cell count and epithelial regeneration. So the use of NBCA and MS comonomer in tracheal surgery cannot be recommended yet in the light of our data.

Malignant eccrine spiradenoma of the external ear.

Eccrine spiradenoma is a benign tumor of sweat gland origin. Malignant eccrine spiradenoma is a rare neoplasm which almost always arises from a pre-existing spiradenoma lesion. In this article, we present a patient with malignant eccrine spiradenoma of the auricula with a prior diagnosis as benign eccrine spiradenoma. Although malignant transformation is usually associated with aggressive behavior, we did not detect recurrence or metastasis in four years of follow-up after performing wide excision.

Facial, cervical, and mediastinal emphysema of the clarinet player: case report.

BACKGROUND: Cervicofacial emphysema may arise due to the leakage of air from a defect in the aerodigestive tract to the fascial layers of neck and face. Rarely, it may be caused by insufflation of air through the Stensen's duct. CASE REPORT: We present a case with diffuse facial, cervical and mediastinal emphysema due to playing a wind instrument immediately after a facial trauma. There was no mucosal defect or laceration noticed by examination which could explain the origin of the emphysema. Despite the widespread cervicofacial emphysema with mediastinal involvement, the patient significantly improved within 48 hours without any intervention. CONCLUSION: Even though cervicofacial emphysema ameliorates spontaneously, increased care must be taken, especially when there is pneumomediastinum and/or pneumothorax.

Effect of heparin on inflammation: an animal model of tracheal stents.

OBJECTIVES/HYPOTHESIS: The objective of this study was to investigate the effect of systemic heparin on tracheal and wound healing. STUDY DESIGN: An animal experiment using a tracheal stent model. METHODS: Twenty Wistar albino rats were divided into two groups; a heparin group (n = 10) that received 210 U/kg/d heparin sodium, and a saline group (n = 10) that received 0.1 mL of 9% NaCl. Stents of 1 cm in length made of 8F feeding tube were placed into the tracheas of rats in both groups and stayed in place for 10 days. Ten days after removal of the stents, the rats were sacrificed and the tracheas were harvested. Histological evaluations of the tracheas were performed with respect to inflammatory parameters. RESULTS: We observed significantly milder inflammation in the heparin group compared to the saline group in terms of inflammatory cell count, fibroblastic proliferation, edema, and vascularity at the site where the tracheal incision was made (P < .05). Inflammation tended to be of a lesser extent in the stent site in the heparin group (P > .05). CONCLUSIONS: We could demonstrate that heparin does inhibit fibroblast proliferation, inflammatory cell count, edema, and angiogenesis in this animal model. We believe that future studies can elucidate on laryngotracheal wound healing as well as their molecular mechanisms.

Cochlear involvement in Familial Mediterranean Fever: a new feature of an old disease.

OBJECTIVES: In this study we first aimed to assess the cochlear functions in children with Familial Mediterranean Fever. The second aim was to investigate the correlation between the hearing levels and some clinical features of Familial Mediterranean Fever including the duration of the disease, age at onset, genetic analysis and colchicine use. METHODS: Thirty-four children with Familial Mediterranean Fever and 27 age matched children were included in the study. Following otologic examination, all children underwent audiometric evaluation, including Pure Tone Average measurements and Distortion Product Otoaoustic Emission testing. Audiological results of the two groups were compared and correlation between the audiologic status and clinical parameters of the disease like the duration of disease, age at onset, mutations and colchicine treatment were studied. RESULTS: Pure tone audiometry hearing levels were within normal levels in both groups. Hearing thresholds of Familial Mediterranean Fever patients were found to be increased at frequencies 8000, 10,000, 12,500 and 16,000 (p<0.05). In otoacoustic emission evaluation, distortion products and signal-noise ratio of FMF children were lower in the tested frequencies, from 1400 Hz to 4000 Hz (p<0.05). Interaction of the disease duration and age of disease onset was found to predict hearing levels, distortion products and signal-noise ratios of children with Familial Mediterranean Fever (F value=2.034; p=0.033). CONCLUSIONS: To our knowledge this is the first study demonstrating cochlear involvement in children with Familial Mediterranean Fever which showed increased hearing thresholds at higher frequencies in audiometry together with decreased distortion products and signal-noise ratios demonstrated by distortion product otoacoustic emission testing. Similar studies must be carried out on adult patients to see if a clinical hearing impairment develops. The possible mechanisms that cause cochlear involvement and the effect of colchicine treatment on cochlear functions must be enlightened.

Inner ear involvement in Behçet's disease.

OBJECTIVE: To assess cochlear involvement and hearing loss in patients with Behçet's disease (BD). METHOD: Forty-two patients with BD and 24 sex and age matched healthy subjects were included in the study. pure-tone audiometry including high frequencies (250-16000Hz) and DPOAE were performed to all participants. Results of the audiological evaluation were compared and correlation between the audiologic status and clinical manifestations of the BD were investigated. RESULTS: Bilateral sensorineural hearing loss was detected in 27 (64.3%) patients. Hearing thresholds were found to be higher in patients with BD at all of the frequencies except at 500Hz when compared to control group (p<0.05). The difference in the hearing levels tend to increase in high frequencies. Compared with control group, distortion products and SNR of the BD patients were lower in all of the tested frequencies (p<0.05) which indicates weaker outer hair cell motility. There was no correlation between the clinical manifestations and the audiological parameters. CONCLUSION: Even having hearing levels within normal limits in speech frequencies, increased hearing thresholds in high frequencies and decreased signal-noise ratios (SNR) in distortion product otoacoustic emission (DPOAE) indicate a cochlear involvement in patients with BD.

Acquired toxoplasmosis of the buccal area with extranodular involvement: report of an unusual case.

Acquired toxoplasmosis is a common parasitic infection in humans. It can be caused by ingestion of infected meat or other food that has been contaminated by the feces of infected cats. Approximately 90% of immunocompetent patients with acquired toxoplasmosis are asymptomatic and undiagnosed; in the other 10%, toxoplasmosis manifests as a nonspecific, self-limited illness that usually does not require treatment. In symptomatic cases, cervical lymphadenopathy is one of the most common clinical findings. We report the case of a 33-year-old woman who experienced unilateral facial swelling secondary to toxoplasmosis. In addition to the atypical location of her disease (i.e., the buccal area), the atypical histopathologic findings in this case (e.g., extranodular involvement) constituted a very unusual presentation of toxoplasmosis.

The effect of triamcinolone acetonide aqueous nasal spray on the nasal carriage of Staphylococcus aureus.

BACKGROUND: In this study we aimed to investigate the effect of triamcinolone acetonide aqueous (TAA) intranasal spray that was used for 2 months to treat allergic rhinitis (AR) on the nasal carriage of Staphylococcus aureus (NCSA). METHODS: A total of 125 adult AR patients (study group) and 133 healthy individuals (control group) were enrolled for the study. The subjects were diagnosed with AR after a detailed history, physical examination, and prick testing. The AR subjects were administered TAA in a daily dosage of a 220-microg intranasal route. Nasal cultures were obtained on the 1st (baseline), 55th, and 60th days, and the subjects in the last two cultures of whom S. aureus was detected were accepted as NCSA. RESULTS: After all exclusion criteria were used, 110 AR and 114 control group subjects were enrolled in the study. Based on the culture results that were obtained on the 55th and 60th days, 10 (%9.1) patients from the study group and 18 (%15.7) individuals from the control group were defined to be NCSA (p > 0.05). CONCLUSION: We conclude that the use of TAA treatment for AR does not increase the prevalence of NCSA. However, additional studies with a larger series are required to explain the effects of steroids on nasal colonization of S. aureus.

Recurrent aphthous stomatitis: investigation of possible etiologic factors.

OBJECTIVE: To investigate the association of serum vitamin B(12), folic acid, iron, calcium, magnesium, and phosphorus levels as well as family history and cigarette smoking with recurrent aphthous stomatitis (RAS). METHODS: Thirty-four patients with RAS and 32 control subjects were included in this controlled prospective screening study. Both groups received a questionnaire, and serum screening tests were performed. The collected data were analyzed using chi(2) test and binary logistic regression analysis. RESULTS: Family history was found to be the most significant predisposing factor for RAS among the investigated ones. Regarding the serum tests, only vitamin B(12) was found to have significant correlation with RAS. Patients with vitamin B(12) deficiency, positive family history, and nonsmoking status have been found to have the highest risk for having RAS. CONCLUSIONS: RAS is a multifactorial disease. Positive family history, vitamin B(12) deficiency, and nonsmoking status are among the important predisposing factors.

Potent antitumor activity of a novel cationic pyridinium-ceramide alone or in combination with gemcitabine against human head and neck squamous cell carcinomas in vitro and in vivo.

In this study, a cationic water-soluble ceramide analog L-threo-C6-pyridinium-ceramide-bromide (L-t-C6-Pyr-Cer), which exhibits high solubility and bioavailability, inhibited the growth of various human head and neck squamous cell carcinoma (HNSCC) cell lines at low IC50 concentrations, independent of their p53 status. Consistent with its design to target negatively charged intracellular compartments, L-t-C6-Pyr-Cer accumulated mainly in mitochondria-, and nuclei-enriched fractions upon treatment of human UM-SCC-22A cells [human squamous cell carcinoma (SCC) of the hypopharynx] at 1 to 6 h. In addition to its growth-inhibitory function as a single agent, the supra-additive interaction of L-t-C6-Pyr-Cer with gemcitabine (GMZ), a chemotherapeutic agent used in HNSCC, was determined using isobologram studies. Then, the effects of this ceramide, alone or in combination with GMZ, on the growth of UM-SCC-22A xenografts in SCID mice was assessed following the determination of preclinical parameters, such as maximum tolerated dose, clearance from the blood, and bioaccumulation. Results demonstrated that treatment with L-t-C6-Pyr-Cer in combination with GMZ significantly prevented the growth of HNSCC tumors in vivo. The therapeutic efficacy of L-t-C6-Pyr-Cer/GMZ combination against HNSCC tumors was approximately 2.5-fold better than that of the combination of 5-fluorouracil/cis-platin. In addition, liquid chromatography/mass spectroscopy analysis showed that the levels of L-t-C6-Pyr-Cer in HNSCC tumors were significantly higher than its levels in the liver and intestines; interestingly, the combination with GMZ increased the sustained accumulation of this ceramide by approximately 40%. Moreover, treatment with L-t-C6-Pyr-Cer/GMZ combination resulted in a significant inhibition of telomerase activity and decrease in telomere length in vivo, which are among downstream targets of ceramide.