Honey and beehive products in otorhinolaryngology: a narrative review.

BACKGROUND: Honey and beehive products were rediscovered as an alternative treatment in wounds. The medicinal properties also raised interest of their use in Otorhinolaryngology. OBJECTIVE OF REVIEW: To give an overview of the effectiveness of beehive products in Otorhinolaryngology. TYPE OF REVIEW: Narrative. SEARCH STRATEGY AND EVALUATION: A literature search of the databases PubMed, EMBASE and Cochrane was performed from the last two decades till December 2014. The search terms 'honey', 'propolis' or 'royal jelly' were used. Articles, which evaluated the effectiveness of beehive products in Otorhinolaryngology, were included. The quality assessment of included studies was performed using the Cochrane Collaboration's risk of bias tool. DISCUSSION AND CONCLUSION: A total of 36 studies were identified and evaluated. Eighteen studies investigated their effect in oral infections, seven in infection of the respiratory tract, six in rhino-sinusal diseases, four investigated the use in tonsillectomy and head and neck surgery and one study explored the preventive effect in otitis media. Honey can be considered as effective (additional) treatment in mucositis, childhood cough, persistent post-infectious cough and after tonsillectomy. Propolis may have a role in the treatment of (aphthous) stomatitis, mouth ulcer and prevention of acute otitis media. Royal jelly showed to reduce mucositis. In the presented studies, beehive products proved to be safe, with only minor adverse reactions. Studies showed to be diverse and had some methodological limitations.

Necrotising fasciitis of the thigh.

Necrotising fasciitis (NF) is an extremely virulent form of infectious fasciitis. It affects skin, subcutaneous fat and superficial and deep muscular fascia by rapidly progressive necrosis. Expeditious diagnosis and radical debridement is necessary to prevent the onset of sepsis, multisystem organ failure and possible death. Perforated rectal cancer resulting in NF can spread to the perineum and genitals known as Fournier gangrene. This case describes an unusual case of NF of the right thigh as first presentation highly suggestive for rectal cancer.

The reliability and value of determining mediastinal involvement and width on chest radiographs in patients with Hodgkin's disease.

Over the years several methods for evaluating mediastinal involvement in Hodgkin's disease have been applied to chest radiographs and conflicting results have been reported. In a retrospective study of 104 patients we evaluated interobserver variability in assessing mediastinal involvement and investigated various cut-off points for mediastinal size as to their ability to identify patients with high- and low-risk for recurrence. For mediastinal involvement the concordance rate for two reviewing radiologists was 94% (98/104) and compared with prior assessment by outside radiologists the concordance rates were 90% (94/104) and 88% (92/104), respectively. A good correlation between the reviewing radiologists was found for the quantitative evaluation of mediastinal diameter and thoracic ratios. ROC curves and relative risk figures were used to investigate the various cut-off points for mediastinal width and for the ratios of the maximal mediastinal diameter to the chest diameter at Th 5-6 (M1) and to the chest diameter at the widest thoracic level (M2). Neither the ROC curve analysis nor the use of relative risk figures revealed a cut-off point clearly more accurate in predicting recurrence. In conclusion, our results do not suggest that interobserver variability in mediastinal assessment, differences in the method of mediastinal measurement, or the cut-off points applied to mediastinal width can explain the discrepancies in the reported data on the prognostic value of mediastinal width in Hodgkin's disease, but rather factors such as patient selection and differences in treatment given may be responsible.

Percutaneous transluminal coronary angioplasty more than twice for the same coronary lesion.

To determine outcome and predictors of restenosis after three or more PTCAs for the same coronary lesion we studied 23 patients (17 patients three PTCAs; five patients four PTCAs; one patient six PTCAs). The primary success rate was 100%. Myocardial infarction was seen in one patient; there was no emergency surgery or mortality. Duration of follow-up after the last PTCA was 11-58 months (mean 26 months). Restenosis occurred in 6 of 23 patients (26.1%) after the last PTCA. The symptom-free interval before the last PTCA was less than or equal to 3 months in five of these six patients, a larger balloon for the last PTCA was used in two patients. After the last PTCA 17 of the 23 patients (73.9%) were asymptomatic; repeat angiography in seven of them revealed no restenosis. The symptom-free interval before the last PTCA was less than 3 months in eight patients, and a larger balloon was used in six of these. In nine patients the interval was greater than 3 months, and a larger balloon was used in two. When the symptom-free interval before the last PTCA was less than or equal to 3 months, restenosis occurred in two of eight patients (25%) in whom a larger balloon was used, but in three of five patients (60%) in whom a larger balloon was not used. When the interval before the last PTCA was less than or equal to 3 months five of 13 patients (38.5%) developed restenosis, but when it was greater than 3 months only one of 10 patients did so.