The term concha bullosa describes aerated turbinate and it is most common on middle turbinate. Symptoms of concha bullosa depends on the amount of pneumatization and location. Concha bullosa without symptoms does not need surgical treatment, however, surgical treatment is indicated when it causes nasal obstruction. There are many reports of concha bullosa because it is a common anatomic variation. Despite many reports of concha bullosa, there is no definite statistics on the size of concha bullosa, and there has been no reports on what its largest size is. This report deals with a giant concha bullosa of middle trubinate of 4.5 cm in length, 2.2 cm in width size causing complete nasal obstruction.
Anatomic Variation ; Nasal Cavity ; Nasal Obstruction ; Turbinates

BACKGROUND AND OBJECTIVES: Post-tonsillectomy pain is unavoidable and related to the dysphagia, dehydration and loss of time in returning to normal activities. This study was performed to investigate whether fibrin glue (Tissucol(R) Duo Quick, Baxter AG, Wien, Austria) applied to tonsillar bed after the completion of tonsillectomy reduced pain. SUBJECTS AND METHOD: Twenty-five adults scheduled for an elective tonsillectomy were included in this prospective double-blind study. After removal of both tonsils electrocauterization was done on both tonsillar bed for adequate hemostasis. And then, one side of tonsillar bed randomly selected by operating surgeon was coated with the fibrin glue and the other side was left without coating. Pain scores were measured at the first (postoperative day, POD1), third (POD3) and tenth (POD10) day of the operation by using visual analogue scale (VAS). RESULTS: The VAS scores of the side treated with fibrin glue and the non-coated side were 3.67+/-1.16/3.14+/-0.96/1.52+/-0.81 (POD1/POD3/POD10) and 5.33+/-1.28/4.19+/-1.21/1.71+/- 0.96 (POD1/POD3/POD10), respectively. The VAS score difference between both sides were 1.67+/-0.58/1.05+/-0.59/0.19+/-0.40 (POD1/PO3/POD10). CONCLUSION: This study shows that the application of fibrin glue on tonsillectomy site was effective for postoperative pain control. Moreover, the efficacy was prominent at early postoperative days known as period of severe pain.
Adult ; Deglutition Disorders ; Dehydration ; Double-Blind Method ; Fibrin ; Fibrin Tissue Adhesive ; Hemostasis ; Humans ; Pain, Postoperative ; Palatine Tonsil ; Prospective Studies ; Tonsillectomy

Patients with erythropoiesis-stimulating agent (ESA)-induced pure red cell aplasia (PRCA) should not routinely be switched to an alternative ESA or to darbepoetin-alpha because anti-erythropoietin (anti-EPO) antibodies cross-react with all kinds of recombinant ESAs. We present a case of ESA-induced PRCA in a 69-year-old man on hemodialysis whose anemia improved with reintroduction of darbepoetin-alpha following immunosuppressive therapy. The patient developed severe anemia after 15 months of subcutaneous administration of erythropoietin-alpha. After the diagnosis of PRCA, erythropoietin-alpha was discontinued and immunosuppressive therapy with a combination of prednisolone and oral cyclophosphamide was initiated. After 4 months of immunosuppressive therapy, the anti-EPO antibody titer was markedly decreased; however, esophageal candidiasis developed. Additional therapy with cyclosporine alone instead of prednisone and cyclophosphamide was performed, and anti-EPO antibody was subsequently not detected. Darbepoetin-alpha was then reintroduced, and the patient's anemia improved without red cell transfusion. In conclusion, ESA-induced PRCA was successfully treated with reintroduction of darbepoetin-alpha following immunosuppressive therapy.
Anemia ; Antibodies ; Candidiasis ; Cyclophosphamide ; Cyclosporine ; Dialysis ; Erythropoietin ; Humans ; Prednisolone ; Prednisone ; Red-Cell Aplasia, Pure ; Renal Dialysis