Cyclooxygenase-2 expression and clinical parameters in laryngeal squamous cell carcinoma, vocal fold nodule, and laryngeal atypical hyperplasia.

BACKGROUND: The diagnostic role of cyclooxygenase-2 (COX-2) expression in laryngeal atypical hyperplasia, vocal fold nodule, and laryngeal squamous cell carcinoma was examined. METHODS: Specimens obtained from patients diagnosed with vocal fold nodule (n = 35), atypical hyperplasia (n = 35), laryngeal squamous cell carcinoma (n = 35), and clinical parameters were evaluated retrospectively. RESULTS: Although no staining was observed in patients with vocal fold nodules, staining was noted in laryngeal atypical hyperplasia and squamous cell carcinoma. The percentage of COX-2 staining was the highest in the carcinoma group. CONCLUSION: It was determined that COX-2 staining was significantly associated with laryngeal squamous cell carcinoma. It should be noted that overexpression of COX-2, a potentially important factor in the evolution of carcinogenesis in precancerous lesions, might be an indicator of the development of carcinoma.

Analysis of the roles of smoking and allergy in nasal polyposis.

OBJECTIVES: Recent studies on the etiopathogenesis of nasal polyps have shown that smoking and nonallergenic inhalants such as occupational dust exposure cause chronic inflammation of the nasal mucosa. These factors may be associated with nasal polyps. The aim of this study was to use laboratory tests to investigate the effects of smoking and allergens on the development of nasal polyps. METHODS: The study included 60 consecutive patients with a diagnosis of nasal polyposis who were treated with functional endoscopic sinus surgery at our clinic and 25 smoker and 25 nonsmoker participants who constituted a control group. RESULTS: In the patient and control groups, the mean absorbance value for cotinine in smokers was found to be statistically significantly lower than that in nonsmokers. There was a significant difference between the groups with respect to blood cotinine positivity. No significant difference was found between the groups in terms of allergy parameters. In the regression model, smoking was found to be the only significant risk factor for the development of nasal polyps, independent of smoking duration, absorbance value, or cotinine positivity. CONCLUSIONS: Smoking restriction and avoiding exposure to cigarette smoke by patients with nasal polyps may be an important strategy in the prevention and recurrence of nasal polyposis. No direct relationship was determined between allergy and nasal polyposis.

An unusual co-presentation of rhinolithiasis and squamous cell carcinoma in the nasal cavity.

Rhinoliths are nasal stones that result from mineralisation of salts around an endogenous or exogenous nidus within the nasal cavity. They are uncommon nasal masses and usually unilateral and single, situated in the floor of the nose. The patient typically presents with nasal obstruction, facial pain and foul-smelling nasal secretion. To the best of our knowledge, the occurrence of squamous cell carcinoma with rhinolithiasis has not been previously reported in the English-language literature. In this article, we present a 63-year-old man, who had unilateral rhinolithiasis with squamous cell carcinoma within the nasal cavity.

Rhinolithiasis: review of 21 cases.

BACKGROUND: Rhinolithiasis is masses that result from the deposition of salts around an intranasal foreign body. Rhinoliths are rare and rhinolithiasis is generally reported in the literature in single case studies. This study presents 21 cases of rhinolithiasis with a large series of clinical findings, diagnosis, and treatment. METHODS: A total of 21 patients diagnosed with rhinolithiasis were identified. Clinical presentations, signs, and symptoms of the patients with radiological findings are presented, and x-ray diffraction analyses of three of the removed rhinoliths were performed to assess their mineralogical composition. RESULTS: A total of 21 patients (9 male and 12 female patients; age range, 4-63 years) diagnosed with rhinolithiasis were reviewed in this study. The most common symptoms were noted as purulent rhinorrhea and nasal obstruction. The other symptoms were headache, oral malodor, and recurrent epistaxis. Nasal endoscopic examination was used for diagnosis of all patients. Endoscopic nasal examinations and computerized tomography (CT) findings revealed that rhinolithiasis was accompanied by sinusitis, chronic vestibulitis, allergic rhinitis, septum deviation, and squamous cell carcinoma. Rhinoliths were fully excised by using endoscopic nasal surgery. Mineralogical analyses of the three removed stones revealed dahllite [Ca(5)(PO(4),CO(3))(3)OH]. CONCLUSION: Cases of rhinolithiasis are seen rarely. It should always be considered in patients complaining from long-term unilateral nasal obstruction and unilateral purulent rhinorrhea. The treatment involves the removal of the rhinolith and the use of appropriate antibiotic therapy to control local infection. Rigid nasal endoscopy is the most important method to be used in diagnosis and treatment.

Serum leptin levels in patients with allergic rhinitis.

OBJECTIVE: To investigate the serum leptin levels in patients with allergic rhinitis during the symptomatic period. STUDY DESIGN AND SETTING: A randomized, prospective study was performed on 26 adult patients with allergic rhinitis and 20 control subjects with similar age, sex and body mass index in a tertiary otolaryngology center. RESULTS: Leptin levels were 28.8 +/- 14.1 ng/mL in the patients with allergic rhinitis, and 20.8 +/- 13.5 ng/mL in the control group respectively. The difference between the groups was statistically significant (p = 0.04). CONCLUSION: Serum leptin levels were found to be significantly higher in patients with allergic rhinitis in symptomatic period. SIGNIFICANCE: Apart from its primary role in the regulation of body weight and energy expenditure, leptin may have a role in the inflammatory process of the allergic rhinitis.

Central giant cell reparative granuloma of the mandible caused by a molar tooth extraction: special reference to the maneuver of drilling the surgical field.

Central giant cell reparative granuloma (CGCRG) is an uncommon benign, reactive osseous lesion usually located in the mandible and maxilla. Although it is histologically benign, it may be locally destructive. There is still controversy on its development and growth pattern. Surgery is the treatment traditionally recommended. In this article, we presented a 12 year-old girl CGCRG of the mandible caused by a molar tooth extraction and discussed its histopathological, clinical, radiological and therapeutic features in the light of the current literature. Also we described our additional surgical maneuver 'drilling the surgical field' after the removal of the lesion.

A case of intranasal schwannoma with bilateral nasal polyposis.

Schwannoma is a benign neoplasm originating from schwann cells of the peripheral nerve sheath, and its occurrence in the nasal cavity and paranasal sinuses is rare. We present a case of nasal schwannoma originating from the left nasal cavity, accompanied by bilateral nasal polyposis. A 66-year-old man presented with complaints of progressive left nasal obstruction, hyposmia, and headache. Anterior rhinoscopic and endoscopic examinations revealed a mass that almost completely filled the left nasal cavity. A polypoid mass was present in the right nasal cavity, as well. On computed tomography, the mass occupied the left ethmoidal cells, left maxillary sinus, left sphenoid sinus, and posterior area of the left nasal cavity. Endoscopic sinus surgery was performed under general anesthesia and the mass was completely removed via the nasopharynx because of its size. Endoscopic anterior ethmoidectomy was also performed in the right nasal cavity for nasal polyposis. Histopathological diagnosis of the left nasal mass was schwannoma. The patient was symptom-free with no recurrence after nine months.

Genetic polymorphism of N-acetyltransferase 2 in the susceptibility to laryngeal squamous cell carcinoma.

BACKGROUND: The purpose of this study was to investigate whether polymorphism of N-acetyltransferase 2 (NAT2) genotypes are associated with the risk of laryngeal squamous cell carcinoma (SCC). METHODS: The study group consisted of 45 white patients with laryngeal SCC (42 men, with a mean age of 54 years [range, 37-70 years] and three women, with a mean age of 47 years [range, 32-55 years]) and 104 control subjects (68 men and 36 women; mean age, 50 years; range, 28-73 years). All of the patients were primarily treated with surgical intervention. Blood samples (5 mL) were obtained before surgery or from the patients under follow-up to 5 years after surgery (mean follow-up, 27 months; range, 6-48 months). DNA was extracted from the lymphocytes by high pure template preparation kit. NAT2*5A, NAT2*6A, NAT2*7A/B, and NAT2*14A were detected by use of LightCycler-NAT2 mutation detection kit by real-time polymerase chain reaction with Light Cycler instruments. The association between NAT2 polymorphisms and laryngeal SCC was prospectively modeled through multivariate logistic regression analysis. RESULTS: We found that the risk of laryngeal SCC was 7.3-fold higher in individuals with NAT2*5 mutant allele, 3.8-fold higher in subjects with NAT2*6 heterozygote allele, and 38.3-fold higher in NAT2*6 mutant allele. We also found that individuals with NAT2*7 heterozygote allele had a 0.2-fold less risk for the development of laryngeal SCC (p = .018). CONCLUSION: In this population, patients with NAT2*5 mutant and *6 heterozygous and mutant genotypes had a significantly higher risk for development of laryngeal SCC.

Glutathione S-transferase gene polymorphisms in presbycusis.

HYPOTHESIS: Glutathione and glutathione-related antioxidant enzymes are involved in the metabolism and detoxification of cytotoxic and carcinogenic compounds as well as reactive oxygen species. Reactive oxygen species generation occurs in prolonged relative hypoperfusion conditions such as in aging. The etiology of presbycusis is much less certain; however, a complex genetic cause is most likely. The effect of aging shows a wide interindividual range; we aimed to investigate whether profiles of (glutathione S-transferase (GST) M1, T1 and P1 genotypes may be associated with the risk of age-related hearing loss. PATIENTS AND METHODS: We examined 68 adults with presbycusis and 69 healthy controls. DNA was extracted from whole blood, and the GSTM1, GSTT1 and GSTP1 polymorphisms were determined using a real-time polymerase chain reaction and fluorescence resonance energy transfer with a Light-Cycler Instrument. Associations between specific genotypes and the development of presbycusis were examined by use of logistic regression analyses to calculate odds ratios and 95% confidence intervals. RESULTS: Gene polymorphisms at GSTM1, GSTT1, and GSTP1 in subjects with presbycusis were not significantly different than in the controls (p > 0.05). Also, the combinations of different GSTM1, GSTT1, and GSTP1 genotypes were not an increased risk of presbycusis (p > 0.05). CONCLUSION: We could not demonstrate any significant association between the GSTM1, GSTT1, and GSTP1 polymorphism and age-related hearing loss in this population. This may be because of our sample size, and further studies need to investigate the exact role of GST gene polymorphisms in the etiopathogenesis of the presbycusis.

Oncologic and functional results of supracricoid partial laryngectomy with cricohyoidopexy.

OBJECTIVE: Supracricoid partial laryngectomy with cricohyoidopexy (SPL-CHP) is an alternative technique described for extensive tumors of the larynx that are beyond the limits of classical conservation partial laryngectomy and otherwise would be treated by total laryngectomy. STUDY DESIGN AND SETTING: Forty-six patients with carcinoma of the larynx underwent SPL-CHP between 1991 and 2003. The median age was 54 (range, 37 to 72). In 28 cases both arytenoids were spared; in 17 cases, 1 arytenoid was spared; and in 1 case, 2 arytenoids were resected. Bilateral elective neck dissections were performed in supraglottic carcinomas. In glottic carcinomas, neck dissection was performed in the presence of clinically positive lymph nodes. None of the patients were treated with postoperative radiation therapy. RESULTS: Forty-five patients were successfully decannulated; 1 patient with 2 arytenoids resected could not tolerate decannulation. The mean time for decannulation was 20 days (range, 9 to 60 days) when both arytenoids were spared with SPL-CHP, and 41 days (range, 13 to 150 days) for SPL-CHP when 1 arytenoid was spared. The average time for removal of the feeding tube was 21 days (range, 9 to 60 days) when both arytenoids were spared, and 40 days (range, 16 to 127 days) when 1 arytenoid was spared. The removal time of the feeding tube of the patient with 2 arytenoids resected was postoperative day 63. In 2 patients, aspiration pneumonia occurred as a result of swallowing impairment. In none of the patients temporary or permanent gastrostomy was needed. Two patients had local recurrence and were treated with a total laryngectomy; they are still alive. In 2 patients, secondary primary tumors were detected. The 3-year overall and cause-specific actuarial survival rates were 95.7 % and 87.5 % , respectively. CONCLUSIONS: Although prolonged hospitalization and delaying physiological functions can be termed as disadvantages of SPL-CHP, the operation is a reliable and oncologically valid procedure in selected cases of cancer of the larynx who would otherwise be operated by total laryngectomy.

Cytogenetic biomonitoring in children with chronic tonsillitis: micronucleus frequency in exfoliated buccal epithelium cells.

OBJECTIVE: To investigate the possible harmful cytogenetic effects associated with chronic tonsillitis by analyzing the micronucleus frequency and other nuclear abnormalities in exfoliated buccal epithelial cells. MATERIALS AND METHODS: The study consisted of 20 children with chronic tonsillitis, and 20 control subjects with similar age and sex. The ages ranged between 5 and 12 years old (mean age: 7.5). The patients were diagnosed as having chronic tonsillitis on the basis of history, throat culture and clinical examinations. Buccal cell samples were collected with a wooden spatula. The samples were then applied to clean microscope slides. Smears were air dried and fixed in methanol:acetic acid. Then slides were stained by the Feulgen reaction technique. Three slides were prepared for each subject and 1000 cells were evaluated per slide to determine the frequencies of micronucleus and other nuclear abnormalities (binucleats, karyorrhexis and karyolysis). Statistically, Mann-Whitney U-test was used to analyze and compare the data. RESULTS: The mean micronucleus frequencies in patient and control groups were 5.29+/-1.67 and 1.58+/-0.33, respectively. In the patient group, mean binucleus, karyorrhexis and karyolysis frequencies were 3.13+/-1.2, 2.04+/-0.64, and 1.74+/-0.47, respectively. However, in the control group, mean binucleus, karyorrhexis and karyolysis frequencies were 1.43+/-0.47, 1.26+/-0.45, and 0.88+/-0.27, respectively. The mean frequencies of all parameters in the patient group were higher than the control values, and the difference was found to be statistically significant (p<0.001). CONCLUSION: Our results revealed that children with chronic tonsillitis could be under risk of significant cytogenetic damage.

Cervical cystic metastasis of squamous cell carcinoma: a case report with an unusual presentation.

Cervical cystic masses may be a diagnostic challenge, especially in patients older than 40 years. We present the case of a 62-year-old male patient with a large cystic metastasis of squamous cell carcinoma to the neck and discuss this rare condition regarding diagnostic, pathologic and therapeutic features.

Glutathione S-transferase M1, T1, and P1 gene polymorphism in laryngeal squamous cell carcinoma.

PURPOSE: To investigate the influence of the glutathione S-transferase (GST) M1, T1, and P1 genotypes on the laryngeal squamous cell carcinoma risk. MATERIAL AND METHODS: The study group consisted of 42 white patients with laryngeal squamous cell carcinoma (39 of them were male, mean age: 53, range: 37-67 and 3 of them were female, mean age: 47, range: 32-55) and 89 control subjects (nonsmokers = 47, smokers = 42) (58 male and 31 female, mean age: 51, range: 30-72). DNA samples were isolated from blood samples using high pure polymerase chain reaction (PCR) Template Preparation Kit. The detection of GST T1, GST M1, and P1 polymorphisms were detected by using real-time PCR. RESULTS: Gene polymorphisms at GST M1 and P1 were not significantly different in patient and control groups. However, GST T1 null type significantly increased in laryngeal cancer patients when compared with the nonsmoking controls (P =.04). CONCLUSIONS: There was a significant association between GST T1 null genotype and laryngeal squamous cell carcinoma. However the potential role of GSTs as markers of susceptibility to laryngeal carcinoma needs further studies in a larger number of patients.

Malondialdehyde and antioxidant enzymes in children with obstructive adenotonsillar hypertrophy.

OBJECTIVE: Free radical induced tissue damage has been implicated in the pathogenesis of several diseases. We aimed to investigate the role of free radicals and scavenging enzymes in children with obstructive adenotonsillar hypertrophy. MATERIALS AND METHODS: The study consisted of 29 children with obstructive adenotonsillar hypertrophy and 51 control subjects with similar age and sex. All the patients and/or their parents had complaints of snoring, mouth breathing, and pausing of breath during sleep for at least 6 months. All patients underwent an adenotonsillectomy operation under general anesthesia with curettage and cold dissection methods. Venous blood was taken preoperatively and 4 weeks postoperatively. After collection of blood samples into citrate (3.5 mg/ml blood) containing glass tubes, erythrocyte sediments were prepared for the analyses. Then malondialdehyde (MDA) level, and superoxide dismutase (SOD), glutathione peroxidase (GSHPx), and catalase (CAT) activities were measured. RESULTS: The levels of MDA and activities of SOD and GSHPx were significantly higher in the pre-tonsillectomy period than in the post-tonsillectomy period. However, CAT activity was not different in pre- and postoperative period. CONCLUSION: Our study supports the notion that oxidant and antioxidant defense mechanisms are altered in children with obstructive adenotonsillar hypertrophy, and this alteration improves after tonsillectomy.

The effect of fusafungine on post-operative pain and wound healing after pediatric tonsillectomy.

OBJECTIVE: To investigate the effect of fusafungine spray on pain and healing process after pediatric tonsillectomy. METHODS: Sixty children with ages between 4 and 14 years underwent tonsillectomy or adenotonsillectomy. The patients were randomly divided into three groups and each group consisted of 20 patients. Group 1 was treated with antibiotic (amoxicillin-clavulanic acid) plus analgesic (acetaminophen), group 2 was treated with fusafungine plus analgesic (acetaminophen) and group 3 was treated with only fusafungine. The average ages were 7.8 + 3.4, 6.6 + 2.9, and 8.2 + 3.7 for groups 1, 2, and 3, respectively. Clinical evaluations were made after the operation on the 1st (T1), 3rd (T3), 7th (T7), 10th (T10), and 14th days (T14). RESULTS: There was no significant difference in post-operative pain between study groups on the post-operative 1st, 3rd, and 7th days (P > 0.05), a statistically significant difference was present between groups 1 and 3, and groups 1 and 2 on the post-operative 10th and 14th day (P = 0.018 and 0.037, respectively). Pain was less in groups 2 and 3 than in group 1 on the 10th and 14th day. Also there was a significant difference in healing time of the tonsillary beds between groups 1 and 2, and groups 1 and 3 on the 10th and 14th post-operative day (P = 0.031 and 0.001, respectively). Healing was better in groups 2 and 3 than in group 1 on the 10th and 14th day. CONCLUSION: Fusafungine administration after tonsillectomy was found to be beneficial on post-operative pain and wound healing of tonsillary beds in pediatric population.

Microbiology of cerumen in patients with recurrent otitis externa and cases with open mastoidectomy cavities.

This study investigated the common flora of human cerumen in patients with recurrent otitis externa, and subjects who had been operated on and had an open mastoidectomy cavity from chronic otitis media. Cerumen samples were collected from three groups; group A (n = 20) consisted of patients with recurrent otitis externa, group B (n = 20) consisted of patients with an open cavity and group C (n = 30) consisted of healthy subjects. The mean of the microbial count was 3.4 x 10(4) in group A, 3.08 x 10(4) in group B and 2.48 x 10(4) in group C. The most commonly isolated microorganism from the three groups was Staphylococcus epidermidis. No growth was observed in five cases (25 per cent) in group A and in three cases (10 per cent) in group C. In group B antimicrobial growth was observed in all samples. In 46 (65 per cent) of the cerumen samples, the isolates were monomicrobial and 24 (35 per cent) of the cerumen samples were polymicrobial. The isolates were polymicrobial in 65 per cent of group A, 20 per cent in group B and 23.3 per cent in group C. In the process of investigating the microbial flora of cerumen in all the three groups, microbial growth was observed from all the samples from patients with an open cavity, unlike the other groups, and it was determined that the group with recurrent external otitis had the most abundant microbial flora.

Polymorphous low-grade adenocarcinoma of the tongue.

Polymorphous low-grade adenocarcinoma has been recently recognized as a distinct entity with a predilection for minor salivary glands. We present an unusual case of polymorphous low-grade adenocarcinoma of the tongue. Only a few cases located at the tongue have been reported in the English literature. Current literature concerning the histopathological and clinical features of this tumor was discussed.

The relationship between presbycusis and mastoid pneumatization.

Presbycusis is defined as the natural hearing loss accompanying aging, caused by degenerative changes in the inner ear. The etiology of presbycusis is uncertain. However, it would appear that a complex genetic cause is most likely. The determinants of mastoid size continue to be controversial. One of the pneumatization theories is the hereditary theory. In this study, the possible relationship between presbycusis and the extent of mastoid pneumatization was investigated. This study was carried out on 21 patients with presbycusis and 21 normal subjects of similar ages. The pneumatized volume was measured by computerized tomography. The temporal bone was scanned at 2 mm thickness intervals. Exposure (kV 130, mA105). The scan plane was parallel to the orbitomeatal line and the CT images covered the entire mastoid region. The average mastoid pneumatization in presbycusis group was 6.08 +/- 2.52 cm(3) in the right ear and 6.19 +/- 2.93 cm(3) in the left ear. However, in the control group it was 4.69 +/- 3.17 cm(3) in the right ear (p=0.12) and 5.10 +/- 3.49 cm(3) in the left ear (p=0.28). No significant difference was found between the presbycusis patients and normal subjects in terms of the volume of mastoid pneumatization.