Hydroxyzine, cimetidine and vitamin C in reducing skin flap necrosis in ischemia-reperfusion injury in rats. A comparative study.

PURPOSE: The purpose of the current experimental research was to investigate whether hydroxyzine can reduce the necrotic area in ischemia-reperfusion injury in epigastric rat skin flaps and to compare its role with cimetidine and vitamin C. METHODS: From a total of 77 ischemic rat skin flaps, 18 were treated with normal saline, 18 with vitamin C, 18 with cimetidine and 18 with hydroxyzine before reperfusion. Flap necrotic area, neutrophils and mast cells were measured on the 7th day. Analysis of variance for multiple comparisons and post hoc Dunnett's test were used for statistical analyses. RESULTS: The sham group of animals (n=5) showed 0% flap necrosis. The saline-treated group demonstrated 75±15.3% of necrosis. The vitamin C, cimetidine and hydroxyzine groups had 56.2 ± 24.4%, 25.8 ± 19.3%, and 33.6 ± 27.8% of flap necrosis, respectively. In addition, the number of neutrophils and mast cells were decreased in the pharmacologically treated groups compared with flaps perfused with normal saline (p<0.05). CONCLUSION: Our data suggest that administering hydroxyzine in rat epigastric skin flaps before reperfusion may attenuate necrosis, neutrophils and mast cell counts. The beneficial effect of cimetidine was the same as hydroxyzine's but the use of vitamin C was less effective.

Increased frequency of rhinitis medicamentosa due to media advertising for nasal topical decongestants.

AIM: The aim of this study was to investigate the frequency of rhinitis medicamentosa (RM) in patients attending the ENT outpatient clinic of the General Hospital of Rethymnon (Crete, Greece) before and after the launch of an intensive nasal decongestant advertising campaign in Greece. METHODS: We reviewed the medical records of the patients with RM seen at the ENT outpatient clinic in May, June and July of 2003 and 2006. We analyzed and recorded the gender, age, and related clinical information of the patients with RM. RESULTS: In May, June and July of 2003, 41 patients out of a total of 1780 patients attending the ENT outpatient clinic were diagnosed with RM (2.3%). In the same months in 2006, 161 patients out a total of 1898 patients were diagnosed with RM (8.5%). The frequency of RM in these groups was therefore found to have increased significantly between 2003 and 2006. In 2006, 8 out of 10 patients with RM reported that they had made their purchasing decision solely on the basis of the information supplied by the drug advertisement without consulting their doctor or pharmacist. CONCLUSION: We suggest that the intensive media advertising campaign for nasal topical decongestants (particularly on TV) which started in 2004 is probably the main reason for this "endemic" RM.

Intraparotid lymph node tuberculosis.

PROBLEM: Parotid gland Mycobacterial infection is a rare disease that causes parotid swelling without disease-specific manifestations. CASE REPORT: We present a case of intraparotid lymph node tuberculosis that mimicked a tumour. Computed tomography of the head and neck indicated a left parotid enlargement involving two intraparotid lymph nodes. The cervical lymph nodes of the ipsilateral posterior triangle and the submandibular and jugulodigastric areas were also enlarged. Contrast enhancement indicated homogenous tissue with no necrotic areas. A biopsy revealed a caseating granuloma most likely due to tuberculosis. A purified protein derivative test gave strong positive results (35 mm). After one month of antituberculous treatment, the cervical lymphadenopathy and left parotid lumpiness disappeared. CONCLUSIONS: Tuberculous parotitis and neoplasms have similar clinical manifestations. In patients with a mass in the parotid gland, a high clinical suspicion of underlying tuberculosis is crucial for establishing an accurate diagnosis and the proper management.

Cavernous haemangioma of the left nasal cavity.

Cavernous haemangioma of the nose is a rare lesion but it has to be added to the differential diagnosis of an intra-nasal bleeding mass. A high index of suspicion, upon computed tomography delineation of the extent of the mass, including the presence of bone remodelling plus histological evaluation can be usefully employed to define an accurate diagnosis. In the present case of an adult female with a huge cavernous haemangioma arising from the mucosa of the left middle nasal meatus, the two most interesting points were the rarity as a site of occurrence of this tumour and the successful extirpation of this lesion with the minimally invasive trans-nasal endoscopic technique. We recommend the minimal invasive trans-nasal endoscopic technique for adequate exposure, sufficient control of bleeding and for complete removal of a nasal haemangioma reaching the nasopharynx and paranasal sinuses.