Comparison of inflammatory cytokine release from nasal epithelial cells of non-atopic non-rhinitic, allergic rhinitic and polyp subjects and effects of diesel exhaust particles in vitro

Background. Although studies have reported an association between air pollutants and increased allergic airway diseases, such as allergic rhinitis and nasal polyposis, the underlying mechanisms are not fully understood. A limited number of studies have suggested that diesel exhaust particles (DEP) play a role in atopy and the pathogenesis of allergic upper airway diseases. The aim of this study was to investigate the effect of DEP on inflammatory cytokine release, and mRNA expression of transcription factors such as JNK and NF-Beta in primary nasal epithelial cells (NECs), in vitro. Methods: NECs from non-atopic, non-rhinitic subjects (controls) and patients with allergic rhinitis and nasal polyps were cultured and incubated with 0-100 μg/ml DEP for 24 h. ELISA and RT-PCR were used to assess the release of IL-8, GM-CSF, and RANTES, and mRNA expression for JNK and NF-κB, respectively. Results: Compared to control cells, NECs from subjects with atopic polyps released significantly greater amounts of IL-8 (median = 887 vs. 176.6 pg/μg cellular protein; p < 0.0001) and RANTES (median = 0.191 vs. 0.02 pg/μg cellular protein; p < 0.001). While 50 μg/ml DEP induced release of RANTES in NECs from patients with allergic rhinitis, 100 μg/ml DEP decreased IL-8 levels in NECs from both control and allergic rhinitic subjects. DEP did not affect mRNA expression for JNK and NF-κB from NECs of subjects with polyps. Conclusions: NECs from subjects with various pathologies may respond differently to DEP (AU)

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Comparison of inflammatory cytokine release from nasal epithelial cells of non-atopic non-rhinitic, allergic rhinitic and polyp subjects and effects of diesel exhaust particles in vitro.

BACKGROUND: Although studies have reported an association between air pollutants and increased allergic airway diseases, such as allergic rhinitis and nasal polyposis, the underlying mechanisms are not fully understood. A limited number of studies have suggested that diesel exhaust particles (DEP) play a role in atopy and the pathogenesis of allergic upper airway diseases. The aim of this study was to investigate the effect of DEP on inflammatory cytokine release, and mRNA expression of transcription factors such as JNK and NF-ß in primary nasal epithelial cells (NECs), in vitro. METHODS: NECs from non-atopic, non-rhinitic subjects (controls) and patients with allergic rhinitis and nasal polyps were cultured and incubated with 0-100µg/ml DEP for 24h. ELISA and RT-PCR were used to assess the release of IL-8, GM-CSF, and RANTES, and mRNA expression for JNK and NF-κB, respectively. RESULTS: Compared to control cells, NECs from subjects with atopic polyps released significantly greater amounts of IL-8 (median=887 vs. 176.6pg/µg cellular protein; p<0.0001) and RANTES (median=0.191 vs. 0.02pg/µg cellular protein; p<0.001). While 50µg/ml DEP induced release of RANTES in NECs from patients with allergic rhinitis, 100µg/ml DEP decreased IL-8 levels in NECs from both control and allergic rhinitic subjects. DEP did not affect mRNA expression for JNK and NF-κB from NECs of subjects with polyps. CONCLUSIONS: NECs from subjects with various pathologies may respond differently to DEP.

Management of incus long process defects: incus interposition versus incudostapedial rebridging with bone cement.

OBJECTIVE: This study aimed to compare the hearing results of incus interposition and bone cement ossiculoplasty in patients with incus long process defects. MATERIALS AND METHODS: Ninety-nine patients with incus long process defects were included. Incus interposition was performed in 49 patients (group 1) and bone cement ossiculoplasty was performed in 50 patients (group 2). Group 1 included 29 female and 20 male patients, with a mean age ± standard deviation of 29.43 ± 12.5 years (range, 8­58 years). Group 2 comprised 32 female and 18 male patients, with a mean age ± standard deviation of 29.1 ± 14.89 years (range, 8­67 years). RESULTS: The mean hearing gain ± standard deviation was 15.2 ± 9.01 dB in group 1 and 19.36 ± 9.08 dB in group 2. Hearing gain was significantly greater in the bone cement group than in the incus interposition group (p = 0.0186). Successful hearing results (i.e. air­bone gap < 20 dB) were achieved by 63.2 per cent of group 1 patients and 78 per cent of group 2 patients. CONCLUSION: Incus interposition and bone cement ossiculoplasty are safe and reliable methods with which to manage incus long process defects. Bone cement ossiculoplasty gives a greater hearing gain in appropriate cases.

Serum paraoxonase, arylesterase activity and oxidative status in patients with obstructive sleep apnea syndrome (OSAS).

INTRODUCTION: The aim of this study was to evaluate the serum paraoxonase (PON), arylesterase activities, lipid hydroperoxide (LOOH), sulfhydryl (-SH), and ceruloplasmin (Cp) levels, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) in adults with obstructive sleep apnea syndrome (OSAS) and to determine whether these oxidant and antioxidant levels can be used as OSAS markers. The results were compared with measurements from healthy control subjects. METHODS AND METHODS: This study was a prospective, controlled trial including 26 OSAS patients and 35 healthy controls (61 subjects total). Peripheral venous blood samples were taken from the OSAS patients and from the healthy volunteers. The serum PON, arylesterase activities LOOH, -SH, Cp, TAS, TOS, and OSI levels were measured. RESULTS: LOOH and Cp levels were higher in the OSAS group than in the control group (p < 0.01). The -SH levels were lower in the OSAS group than in the control group (p < 0.01). The PON and arylesterase enzyme activity levels were lower in the OSAS group than in the control group (p < 0.05). The TOS and OSI levels were significantly higher in the OSAS group (p < 0.01), while their TAS levels were significantly lower (p < 0.01) compared with the control group. CONCLUSIONS: Patients with OSAS have increased systemic oxidative stress and reduced levels of circulating antioxidant enzymes. Oxidative stress appears to be an underlying condition associated with OSAS.

The role of high frequency tympanometry in newborn hearing screening programme.

BACKGROUNDS AND OBJECTIVE: The hearing assessment of the newborns ideally should detect both middle and inner ear functions. The aim of this study is to control the association between otoscopic evaluation, multifrequency tympanometry and TEOAE results. METHODS: Fifty new-borns otherwise healthy were tested after the otolaryngological evaluation by 226 and 1000 Hz tympanometries and transient evoked otoacoustic emissions (TEOAE's). The study was performed in three steps and 17 babies that could not pass from the first step they were tested in the second step with the same tests (226 Hz and 1000 Hz tympanometry and TEOAE) The babies that could not pass from the second step were evaluated by multifrequency tympanometries, TEOAE and acoustic brainstem responses (ABR) at the third step. RESULTS: The association between the results obtained from otoscopic evaluation, multifrequency tympanometry and TEOAE were assessed. We found that 1000 Hz tympanometry results were more sensitive and gives more correlated with TEOAE and otoscopic evaluation. CONCLUSIONS: Multifrequency tympanometry can detect the middle ear pathologies of the infants sensitively and should be a part of neonatal hearing screening test battery.

Comparison of pre-emptive tonsillar lodge infiltration with ropivacaine versus intravenous tramadol in pediatric tonsillectomies: a randomized placebo-controlled study.

OBJECTIVE: To investigate the placebo controlled effect of pre-emptive local infiltration of ropivacaine and intravenous tramadol in postoperative pain and nausea-vomiting in pediatric tonsillectomy cases. METHODS: 90 children at ASA I-II physical status, who are between 2 and 9 years old, underwent tonsillectomy were included to the study. Patients were randomized into one of three study groups. Group I was i.v. saline group (placebo group), Group II was preemptive 1.5 ml 0.75% ropivakain to the tonsil lodge and Group III was preemptive 1mg/kg i.v. tramadol. Hemodynamic parameters and synchronized Maunuksela pain scores were evaluated in the post anesthetic care unit. RESULTS: There was no difference in age, weight, sex and hemodynamic parameters of children included to the study groups. Postoperative nausea vomiting was significantly lower in Group II and pain scores at resting and swallowing are significantly lower than the other study groups. Maunuksela pain scores at 2nd, 3rd, 6th and 9th hours while resting were significantly lower in Group II compared with Groups I and III (p<0.001). The comparison of scores between groups I and III were similar. Maunuksela pain scores during swallowing were significantly lower in Group II compared with Group I and III at 2nd, 3rd, 6th, 9th, 12th, 21st and 24th hours postoperatively (p<0.001). While comparing Maunuksela pain scores of Groups I and III, significantly lower scores are determined at 2nd and 24th hours in Group III (p<0.001). Analgesic needs were significantly low in Group II at postoperative period (150 ± 30 mg paracetamol) (p<0.05). It was similar in Groups I and III (Group I: 400 ± 40 mg, Group III: 360 ± 40 mg paracetamol). CONCLUSION: This study showed that peritonsillar ropivacaine infiltration might produce an effective postoperative analgesia probably due to a preventing effect on sensitization of the pain pathways.

Effects of dexmedetomidine infusion in patients undergoing functional endoscopic sinus surgery under local anaesthesia.

BACKGROUND AND OBJECTIVES: Functional endoscopic sinus surgery can be performed under either local or general anaesthesia. The objective of this study was to investigate the haemodynamic effects of perioperatively administered dexmedetomidine, a new generation alpha-2-agonist, in patients for functional endoscopic sinus surgery. METHODS: Sixty-two patients who were planned to undergo functional endoscopic sinus surgery under local anaesthesia were included in the study. Following meperidine premedication, both groups were monitored in a standard manner with electrocardiogram, non-invasive blood pressure and percentages of peripheral saturation of oxygen. Saline intravenous infusion was started in the placebo group, and dexmedetomidine bolus intravenous infusion (an initial loading dose of 1 microg kg-1 given for a 10-min period followed by 0.7 microg kg-1 h-1) was administered to the treatment group. Maintenance dose infusion was stopped 15 min before the end of the surgical procedure. RESULTS: Systolic, diastolic and mean arterial pressures, and heart rate markedly decreased in the dexmedetomidine group. However, dexmedetomidine had no effect on serum nitric oxide levels, measured by a nitric oxide/ozone chemiluminescence method. No significant difference was found in oxygen saturation levels of the two groups. Postoperative nausea and vomiting rates were significantly lower in the dexmedetomidine group. No adverse effects were observed with this alpha-2-agonist. Dexmedetomidine provided appropriate levels of sedation. CONCLUSION: These results suggest that dexmedetomidine provides analgesia, adequate sedation and surgical comfort without adverse effects for patients undergoing functional endoscopic sinus surgery under local anaesthesia.

Immunohistochemical analysis of PCNA, Ki67 and p53 in nasal polyposis and sinonasal inverted papillomas.

Immunoreactivity of proliferating cell nuclear antigen (PCNA), Ki67 and p53 in inflammatory nasal polyp and inverted papilloma tissues was investigated. Immunohistochemistry was performed using a standard avidin-biotin-peroxidase method, and the immunoreactivity of PCNA, Ki67 and p53 was quantified by counting immunostained nuclei in at least 1000 epithelial cells. The mean labelling index (percentage of immunostained cells) for PCNA was 40.68 in the inverted papilloma group and 14.73 in the nasal polyp group, and for Ki67 was 15.43 in the inverted papilloma group and 2.64 in the nasal polyp group. Both of these differences between the inverted papilloma and nasal polyp groups were significant. Immunoreactivity for p53 was detected in five (35.7%) inverted papilloma patients and two (9.5%) nasal polyp patients. The increase in epithelial cell proliferation seemed to be greater in inverted papillomas than in inflammatory nasal polyps. Increased epithelial cell proliferation may be involved in the development of inverted papillomas.

Körner's septum (petrosquamosal lamina) and chronic ear disease.

To assess the clinical significance of Körner's septum (KS) or petrosquamosal (PS) lamina in different chronic ear pathologies, a surgical and anatomic study was carried out, in which the significance of KS was assessed in various otologic diseases. Of 639 patients who underwent ear surgery between 1998 and 2001, 426 were included in the study. The diagnoses were chronic otitis media without cholesteatoma (COM), tympanosclerosis (TS), adhesive otitis media (AOM) and cholesteatoma (COL) in 160, 100, 70 and 96 patients respectively. The operative records of the patients were reviewed for the presence of KS. There was antral blockage by KS in all patients who also had Cog (the middle portion of the PS lamina). KS was mostly seen in cases of TS. The prevalence of KS was not significantly different when the result of the COM group was compared with that of the COL and AOM groups ( p>0.05). The prevalence of KS was significantly higher in patients with TS than in those with COM. Both antral and epitympanic blockages were more prevalent in cases of TS than in those of COM (chi(2) =3.9, p =0.04 and chi(2) =6.6, p =0.01 respectively). There is a significant association between the presence of KS and TS. Based on this finding, it is recommended that a mastoidectomy be performed in cases of severe tympanosclerosis in order to remove KS. How the removal of this anatomic impact will affect the natural course of the disease is still a question that needs further investigation.

Clinical and histopathological correlates of the proliferative activity in squamous cell laryngeal carcinoma.

OBJECTIVES: To elucidate the clinical and histopathological significance of the proliferative activity as determined by PCNA and Ki67 levels and mitotic counting (MC) in laryngeal squamous cell cancer (LSCC). STUDY DESIGN: An analysis of clinical, histopathological and immunhistochemical (PCNA0 and Ki67) results of 28 patients, who were treated for LSCC, was made. METHODS: Clinical data of the patients were reviewed and corresponding archival paraffin embedded tissue samples were obtained. Histopathological studies and MC were performed, and PCNA and Ki67 positivity was assessed. RESULTS: There was no association between the mean values of the proliferative markers, and N stage and T stage of the patients as well as laryngeal site of involvement (p > 0.05). There was a correlation between the proliferative indicators and tumor grade (p < 0.05). A correlation was also encountered between the PCNA, Ki67 and MC values (p = 0.02). CONCLUSION: The proliferative markers studied are not reliable indicators for the presumptive diagnosis of occult neck metastasis. They may be used as complementary tools to the conventional histopathologic grading systems to assess the tumour differentiation in LSCC.

Assessment of migraine-related cochleovestibular symptoms.

The objective was to assess the cochleovestibular symptoms in migraine. Therefore, a questionnaire form was prepared to record the data obtained from 20 migraineurs. All patients were assessed with audiometry, bithermal caloric testing and auditory brainstem response testing (ABR) between the migraine attacks, and 8 of them were also assessed during the attacks. Dizziness (30%) was the most common symptom that was followed by vertigo (25%) and tinnitus (20%). All patients had hearing within normal limits. Positional test (Hallpike maneuver) was positive in 2 (10%). Bithermal caloric testing revealed canal paresis in 3 (15%) patients. ABR results were normal in 13 patients. Seven patients (35%) had abnormal ABR results. Four of them (20%) had elongation in the absolute wave latencies (wave I, III and V) and normal IPLs of wave I-III, III-V and I-V. Three (15%) patients had elongation in the absolute wave latencies as well as in the IPLs of wave I-III, III-V and I-V. In conclusion, cochleovestibular symptoms can be seen in migraineurs. The test results between and during attacks are similar. The subjective cochleovestibular symptoms did not correlate with the objective tests performed (audiometry, ABR and caloric testing).

Malignant mixed tumor of the larynx: a case report.

Malignant mixed tumour (MMT), which is a salivary gland tumour, is the malignant form of pleomorphic adenoma. Although the tumour can also originate from the minor salivary glands throughout the submucosa in the head and neck region, laryngeal involvement is quite rare. An additional case of laryngeal MMT presented in a forty-five year old man, and the diagnostic, immunohistochemical (S-100, actin, vimentin, epithelial membrane antigen) and therapeutic procedures were presented.

Use of the auditory brainstem response testing in the clinical evaluation of the patients with diabetes mellitus.

The objective of the study was to assess whether a relationship exists between the auditory brain stem response (ABR) results and diabetes mellitus with and without complications. In the clinical and audiometry laboratory settings, diabetic patients with and without complications (retinopathy and/or nephropathy) were examined using ABR testing, and the results were interpreted for their applicability in clinical practice. Fifty-nine patients with diabetic retinopathy or nephropathy (study group) and 20 diabetic patients without any known diabetic complication (control group) were assessed with audiometry and ABR testing. ABR revealed that the absolute latencies and interwave intervals of the waves I through V were prolonged significantly in the study group when compared to the control group. The amplitudes of waves I through V were diminished in the study group when compared to the control group, but a statistical significance was present only for wave V amplitude. Quantitative (wave I to wave V amplitude ratio) and qualitative analyses of the ABR waves showed abnormal waveforms in the study and control groups by 55.2 and 27.6%, respectively. There is a brain stem neuropathy in diabetes mellitus which can be assessed with ABR testing. The likelihood of encountering a diabetic complication increases as the ABR results become abnormal.

Significance of Fas protein in squamous cell carcinoma of the larynx.

The purpose was to elucidate the clinical significance of Fas protein in laryngeal squamous cell carcinoma (LSSC). Medical records of 30 patients who were operated for LSCC between 1991 and 1997 were reviewed, and histopathological and immunohistochemical studies of the archival tumor tissues were performed. Conventional histopathology included tumor grading, mitotic counting (MC) and status of the cervical lymph nodes. The monoclonal antibodies to Fas (DAKO M 3554) and nm23 (DAKO A0096 Lot 035) proteins were used for immunohistochemical staining. Streptavidin-Biotin, horseradish method was used. Positive staining for both Fas and nm23 was obtained in 27 (90%) tumor samples. There was no correlation between neck metastasis and Fas positivity (r = 0.126, p = 0.505 and chi2 = 0.062, p = 0.996, respectively). Fas positivity did not correlate to grade (r = 0.282, p = 0.130), tumor size or T (r = 0.0457, p = 0.810, chi2 = 0.0.018, p = 0.999) or laryngeal site of involvement (chi2 = 0.0937, p = 0.992). However, a correlation was found between Fas and MC (r = 0.482. p = 0.007). There was also a correlation between Fas and nm23 positivity (r = 0.614, p < 0.0001). Fas protein expression has no prognostic value in LSCC, because the Fas values do not correlate with grade, stage or nodal status of neck. However, 90% of LSCCs expressed Fas protein. Understanding the functional status of the Fas receptor proteins may lead to development of new therapeutic options for LSSC in the future.

Management strategy of mycobacterial cervical lymphadenitis.

The objectives of this study were to investigate the typical clinical presentation, diagnosis and treatment of mycobacterial cervical lymphadenitis (MCL). Medical records of 87 patients who were treated for MCL were retrospectively reviewed. Definitive diagnosis of MCL was made when a neck mass persisted for several weeks or months and one or more of the following was obtained: (1) positive mycobacterial cultures from biopsy material; (2) Positive mycobacterial staining of biopsy material; (3) Granulomatous inflammation and caseating necrosis on histopathological examination of biopsy material. Clinical findings were reviewed prior to treatment. The treatment included standard antituberculous medications followed by surgery in which either total excision or selective nodal dissection of the cervical lump was made. Follow-up results are presented. The chief complaint was a cervical mass that was localized mostly to the posterior cervical or submandibular regions. A fistula formation was encountered in 11.5 per cent. All patients recovered from MCL by combined antituberculous drug and surgical treatments. Clinical presentation of the disease and histopathological assessment are important in the diagnosis of MCL as well as in the differential diagnosis of tuberculous and nontuberculous MCL. Utilizing the combined medical and surgical treatment options, both tuberculous and non-tuberculous cervical adenitis can be treated successfully.

The predictive value of auditory brainstem responses for diabetic retinopathy.

OBJECTIVE: The purpose was to find out whether there is a relationship between the central nervous system involvement and retinopathy in diabetes mellitus. STUDY DESIGN: In a multidisciplinary clinical study, diabetic patients with and without retinopathy were examined utilising auditory brainstem response (ABR) testing, and the results were interpreted from clinical and pathophysiological point of view. PATIENTS AND METHODS: Thirty-three diabetic patients with retinopathy (study group) and 20 diabetic patients without retinopathy (control group) were included. Audiometry and ABR testing were made. The results of both groups were compared for ABR parameters. RESULTS: Audimetric results of the study and control groups were similar. In the study group, ABR testing revealed prolonged absolute and interpeak latency of the waves. The difference was significant for I-III interval (P<0.01). The amplitudes of the waves were similar in both groups and wave V amplitude was significantly diminished in the study group. Abnormal waveforms were recorded by 40 and 12.5% in the study and control groups, respectively. CONCLUSION: Retinopathy is accompanied with lower brainstem disintegration. Microangiopathy is the possible mechanism that is involved in the occurrence of retinopathy and brainstem neuropathy. ABR can help diagnose retinopathy. Better understanding the role of ABR in diagnosis and early detection of retinopathy in diabetic patients needs further study.

Variations of sphenoid and related structures.

The aim of this study was to delineate the precise relationship between the sphenoid sinus and internal carotid artery and the optic nerve, as well as to assess incidence of the anatomic variations of these structures. A review of 92 paranasal sinus tomographic scans was made for anatomic variations of the sphenoid sinus and related bony and neurovascular structures. Coronal and axial tomographic sections were obtained with 2.5-mm section thickness. We assessed the protrusion of the internal carotid artery (ICA) and the optic nerve (ON) into the sphenoid sinus, bone dehiscence of these structures, and pneumatization of the anterior clinoid process (ACP) and pterygoid recess (PR), as well as the variations of the sphenoid sinus septum. The protrusion of the ICA into the sphenoid sinus was found in 24 (26.1%) patients. An ON protrusion was present in 29 (31.5%) patients. Pneumatization of the PR was encountered in 27 (29.3%) patients. There was not a statistically significant relationship between the pneumatization of the PR and ICA protrusion into the sphenoid sinus (chi2 = 0.258, p = 0.168). A significant relationship between the ACP pneumatization and protrusion of the ON into the sphenoid sinus was found (chi2= 0.481,p = 0.007). Preoperative recognition of the anatomic variations by the radiologist is beneficial for identification of the limits of dissection. This is particularly important in the sphenoid sinus area where extensive pneumatization of the skull base bones may distort the anatomic configuration. Therefore, axial and coronal CT sections should always be obtained prior to any surgery in the sphenoid sinus area.