Topical Corticosteroids Decrease IL-25 Expression by Immunohistochemistry.

BACKGROUND: Interleukin-25 (IL-25) is an important contributing factor in the pathogenesis of allergic rhinitis. It leads to increasing peripheral and infiltrating eosinophilia as well as serum IgE, IgG, and Th2 cytokines (IL-4, IL-5, IL-13), which are responsible for the allergic symptoms. Intranasal steroids (INS) are effective in treating allergic rhinitis, but their effect on IL-25 release has not been studied. We aimed to study the link between IL-25 and the pathophysiology of allergic rhinitis as well as the effect of INS on its release. METHODOLOGY: This was a cohort, prospective, nonrandomized study that included 60 patients, 35 allergic rhinitis patients and 25 controls. We studied the effect of INS on IL-25 release. RESULTS: Of allergic rhinitis patients 68.6% had strong cytoplasmic stain of IL-25 in the epithelial layer, while 25.7% had intermediate stain. INS caused significantly reduced IL-25 stain as only 14.3% of patients had intermediate stain and 85.7% had weak stain. Moreover, a correlation was found between nasal smear eosinophilia and the degree of IL-25 staining in the epithelial layer. CONCLUSION: Intranasal corticosteroids appear to be effective in the downregulation of IL-25, which may explain some of the utility of intranasal corticosteroid treatment in improving allergic rhinitis symptoms.

Single Stage Canal Wall Down Mastoidectomy with Reconstruction of the Canal Wall: 5 Years' Experience in Fayoum Province, Egypt.

OBJECTIVE: Removing the posterior canal wall or canal wall down mastoidectomy (CWDM) for the management of cholesteatoma remains controversial. We advocate partial removal of the posterior canal wall for complete eradication, followed by canal wall defect reconstruction to restore the normal anatomy and avoid the complications of CWDM. MATERIALS AND METHODS: Sixty-four patients with cholesteatoma (71 ears) were included. This study was conducted between 2009 and 2012. Single-stage mastoidectomy was performed by drilling the upper third of the posterior canal wall together with the attic, leaving the remaining lower two-thirds intact. Conchal cartilage was used to reconstruct the upper third of the posterior canal wall. RESULTS: The mean±SD healing time was 7.5±2.3 (range, 4-14) weeks. The mean±SD preoperative and postoperative air bone gaps were 35.8±6.2 dB and 22.9±6.8 dB, respectively. Nearly 84.2% of the patients were followed up for at least 3 years and had dry healthy ears. Complications were noted and statistically examined. CONCLUSION: Single-stage CWDM with reconstruction of the posterior canal wall, ossicular chain, and tympanic membrane is a safe and reliable technique with the advantages of Canal wall up Mastoidectomy (CWUM). Its recurrence rate is 4.2%. Longer follow-up durations are required.

Epstein-Barr virus infection as a cause of cervical lymphadenopathy in children.

OBJECTIVE: Cervical lymphadenopathy is a common pediatric problem; reactive hyperplasia, specific infective agents, and malignancy are mainly the differential diagnosis. The aim of our study was to detect the prevalence of Epstein-Barr virus infection among children who complained of cervical lymphadenopathy and also to evaluate the clinical manifestations of the disease in pediatric patients. METHODS: One hundred and sixty children presented with cervical lymphadenopathy were subjected to Epstein-Barr Virus (EBV) serology testing. Cases that showed positivity to heterophile antibody test, and/or EBV-specific antibodies; IgM against viral capsid antigen (VCA-IgM) and IgG against viral capsid antigen (VCA-IgG) were evaluated clinically for manifestations of the disease. RESULTS: Twenty-four cases (15%) showed positivity to EBV serology, all of them had posterior cervical lymph nodes enlargement, 70.8% had fever, 66.6% had tonsillo-pharyngitis, 58.3% had splenomegaly, 25% had hepatomegaly, 41.6% had generalized lymphadenopathy, while skin rash was detected in 12.5%, and both palatal petechiae and palpebral edema were detected in 8.3%. CONCLUSIONS: EBV infection is not a rare cause of cervical lymphadenopathy in children. Posterior cervical lymphadenopathy in pediatric age group may represent a password for suspicion of EBV infection, while other clinical manifestations of the disease may include hepato-splenomegaly, skin rash, palpebral edema and palatal petechiae.

Nasal encephalocele: endoscopic excision with anesthetic consideration.

OBJECTIVE: Nasal encephalocele may presents as a nasal mass, its treatment is surgical and it should be done early in life. When removal is indicated, there are multiple surgical approaches; including lateral rhinotomy, a transnasal approach and a coronal flap approach. However, the treatment of a basal intranasal encephalocele using transnasal endoscopic approach could obviates the possible morbidity associated with other approaches. The aim of this study was to evaluate the efficacy of endoscopic removal of intranasal encephalocele, also to document the role of anesthetist in the operative and postoperative periods. METHODS: Nine cases with nasal encephalocele were included in this study; CT and/or MRI were used in their examination. The lesions were removed via transnasal endoscopic approach. Preoperative evaluation, intervention and postoperative follow-up were presented with discussion of anesthesia used for those children. RESULTS: The lesions of all patients were removed successfully with no recurrence through the follow-up period of at least 21 months. No cases showed morbidity or mortality intra- or post-operatively. CONCLUSIONS: Endoscopic excision of intranasal encephalocele is an effective method with high success rate. Anesthetist plays an important role in the operative and postoperative period, even during the endoscopic follow up; sedation of the children is usually needed.

Quantitative analysis of uvular muscles in cases of simple snoring and obstructive sleep apnea: an image analysis study.

Studies on the histopathological changes of the palatine muscles in cases of obstructive sleep apnea (OSA) and simple snoring are controversial, while some authors confirm the presence of muscle hypertrophy and increase in total muscle bulk (obstructive theory), others deny this confirming the presence of muscle atrophy and decrease in the muscle bulk (neurogenic theory), but all these studies depended on subjective observer dependent methods to calculate the muscle bulk. We are carrying a unique study to calculate the muscle bulk in uvular specimens in ten cases of OSA comparing it to ten cases with simple snoring and controls using digital computer dependent software (image analysis). Cases of OSA are associated with definite increase in the total muscle bulk of the palatine muscles when compared to cases of simple snoring and controls. Uvular muscular hypertrophy and the obstructive theory seem to explain the pathophysiology of OSA.