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The oxidative status of chronic adenotonsillar hypertrophy
Original article
Clin Ter 2013; 164 (3):e163-167. doi: 10.7417/CT.2013.1562
The preoperative and postoperative oxidative status of children with chronic adenotonsillar hypertrophy M. Abuhandan1, F. Bozkuş2, N. Demir4, E. Eren1, B. Koca1, O. Kadir Guler2, S. Selek3 Departments of 1Pediatrics, 2Otolaryngology, 3Clinical Biochemistry, Harran University Medical Faculty, Sanliurfa; 4Department of Pediatrics, Yuzuncuyıl University Medical Faculty, Van, Turkey
Abstract Aim. This study aimed to evaluate the preoperative and postoperative oxidative status of children with chronic adenotonsillar hypertrophy. Materials and Methods. The study comprised 25 patients with indications for tonsillectomy and/or adenoidectomy following a diagnosis of chronic adenotonsillar hypertrophy and 25 age-gender matched control patients were included to the study. Blood samples were taken from the patients preoperatively and at four weeks postoperatively. Preoperative and postoperative serum total oxidant (TOS) and total antioxidant (TAS) levels were measured and the oxidative stress index (OSI) was calculated. Results. The serum total oxidant level and oxidant stress index values in the preoperative and postoperative periods of the patients were found to be significantly high compared to those of the control group. While the preoperative serum total oxidant level values were found to be significantly high compared to the postoperative values, no statistical significance was found between the total antioxidant and oxidative stress index values. Conclusion. The development of chronic adenotonsillar hypertrophy plays a role in oxidative status and therefore, to neutralize high levels of oxidants in patients, the use of antioxidants for a period preoperatively and postoperatively is thought to be necessary. Clin Ter 2013; 164(3):e163-167. doi: 10.7417/CT.2013.1562 Key words: adenoidectomy, oxidative stress index, tonsillectomy, total antioxidant status
Introduction
Mucosal lymphoid tissue hyperplasia (Waldeyer ring) in children because of repeated inflammation and infections results in the development of adenotonsillar hypertrophy (ATH) (1). Associated with this, symptoms such as upper respiratory tract obstruction, repeated adenotonsillitis, impaired eustachian tube function, repeated otitis media at a level which will cause hearing loss, difficulty in swallowing, breathing difficulties, disturbed sleep and peritonsillar and/
or retrotonsillar apse are the reason for tonsillectomy and/or adenoidectomy to be made by an otolaryngologist (2). Although the pathogenesis of developing adenotonsillar hypertrophy has not been fully clarified (3), when there is inflammation and infection, production of free oxygen radicals (ROS) and lipid peroxidation increases (4-6). This increase in free radicals and lipid peroxidation causes cell damage (7). To prevent the harmful effects of oxidants such as free radicals and lipid peroxidation, the body develops the antioxidant defense systems such as glutathione reductase, glutathione peroxidase, superoxide dismutase and catalase (7, 8) and thus prevents damage. This study aimed to evaluate the preoperative and postoperative serum total oxidant levels (TOS) and total antioxidant levels (TAS) of patients undergoing tonsillectomy and/or adenoidectomy and to compare the data obtained with those of healthy individuals. Materials and Methods
This prospective controlled study was conducted at Harran University Medical Faculty, Sanliurfa, Turkey. Prior to subject recruitment, study was granted by the Ethics Committee of Harran University according to the Second Declaration of Helsinki, and written informed consents were obtained from all participants’ proxies. From January to September 2012, consecutively 25 patients with adenoidectomy and/or tonsillectomy patient, who were admitted to the pediatric and otolaryngologist polyclinics and who had no exclusion criteria, and 25 age-gender matched control patients were included to the study. Study patients were divided into three groups: group 1 (n=25) consisted of patients with pre-operative, group 2 (n=25) consisted of patients with post-operative and group 3 (n=25) consisted of healthy subjects. The control group children comprised who were brought to the general pediatric polyclinic for vaccinations or health examination, and had no history of upper airway obstruction, recurrent adenotonsillitis.
Correspondence: Dr. Mahmut Abuhandan. Pediatric Department, Harran University Medical Faculty, 63100 Yenisehir, Sanliurfa, Turkey. Tel.: +90 414 318 30 00; Fax: +90 414 315 11 81. E-mail:
[email protected] Copyright © Società Editrice Universo (SEU)
ISSN 1972-6007
e164 Baseline definitions
A detailed anamnesis was taken of all the children and their status was determined by physical examination, endoscopical examinations and lateral radiography. Demographical and clinical characteristics were achieved from institutional records and clinical evaluation at admission. Indications for tonsillectomy were seven or more well-documented, clinically prominent and adequately treated episodes of throat infection during preceding year or recurrent acute tonsillitis for at least 2 years with 5 or more acute attacks per year. Indications for adenoidectomy were obstructive nasal symptoms due to hypertrophic chronic adenoiditis (9, 10). In all patients, adenoidectomy and/or tonsillectomy was performed by otolaryngologist, using Standard surgical techniques under general anesthesia. Tonsillectomy was performed by routine dissection-snare method with general anesthesia under operating room conditions. Adenoid tissue was removed using curettes under indirect mirror visualization. Patients were discharged from hospital on the morning of first postoperative day uneventfully. Exclusion criteria
The exclusion criteria were as follows: any cases of metabolic disease; chronic disease (including cardiovascular disorders, malignancy, asthma, allergic rhinitis, cystic fibrosis, renal or liver disease or immunodeficiency); history of asphyxia and; neurological sequelae; neurological findings following a seizure with a diagnosis of degenerative and demyelinating disease of the central nervous system. Blood samples
Peripheral venous blood samples were taken from patients into empty tubes before adenotonsillectomy and a second sample was obtained in four weeks postoperatively. In the control group, blood samples from healthy volunteers were collected for one time only. At the start of the study, total blood count, electrolytes, kidney and liver function tests were made by automatic blood count instrument (Celldyn 3500®) for all the children in the study and control groups. For biochemical analysis, the blood samples taken from the cases selected for research were centrifuged at 3500 rpm for 10 minutes then the formed elements were discarded with the tube and the serum samples were stored at -80°C. The Total Antioxidant Status (TAS) and Total Oxidant Status (TOS) were measured on the study day colormetrically using the Erel method by auto-analyser (Abbott Aeroset®, Abbott Diagnostics, Abbott Park, IL, USA). The Oxidative Stress Index (OSI) was defined as percentage rate of TAS values to TOS values. Measurement of the Total Antioxidant Status
TAS of plasma was determined using a novel automated measurement method, developed by Erel (11). In this method, the most potent biological radical, hydroxyl radical, is
M. Abuhandan et al. produced. In the assay, ferrous ion solution, which is present in reagent 1 [o-dianisidine (10 mM), ferrous ion (45 AM) in the Clark and Lubs solution (75 mM, pH 1.8] is mixed with hydrogen peroxide, which is present in reagent 2 [H2O2 (7.5 mM) in the Clark and Lubs solution]. The sequentially produced radicals such as brown colored dianisidinyl radical cation, produced by the hydroxyl radical, are also potent radicals. Using this method, the antioxidative effect of the sample against the potent free radical reactions that is initiated by the produced hydroxyl radical, is measured. The assay has excellent precision values of lower than 3%. The results were expressed as mmol Trolox Equiv. L-1. Measurement of Total Oxidant Status
TOS of plasma was determined using a novel automated measurement method, developed by Erel. (12) Oxidants present in the sample oxidize the ferrous ion-o-dianisidine complex to ferric ion. The oxidation reaction is enhanced by glycerol molecules, which are abundantly present in the reaction medium. The ferric ion makes a colored complex with xylenol orange in an acidic medium. The color intensity, which can be measured spectrophotometrically, is related to the total amount of oxidant molecules present in the sample. The assay is calibrated with hydrogen peroxide and the results were expressed in terms of micromolar hydrogen peroxide equivalent per liter (lmol H2O2 Equiv. L-1. Oxidative Stress Index
The Oxidative Stress Index (OSI) was defined as percentage rate of TAS values to TOS values. Before the calculation the TAS test mmol unit value was translated to micromol units as in the TOS test. The results were expressed as Arbitrary units, calculated by the following formula: OSI (arbitrary unit) = TOS (μmol H2O2 equivalent/L) / TAS (mmol Trolox equivalent/L) x 10 (12). Statistical Analysis
Data were analyzed using SPSS (Statistical Package for the Social Sciences, version 11.5 for Windows, SPSS® Inc, Chicago, IL). Distribution of parametric variables was assessed with one-sample Kolmogorov–Smirnov test and all parametric variables were found to be normally distributed. The results were presented as mean ± standard deviation. Demographic data was performed using chi-square test. Independent Samples t test was used to data among groups. Paired t test was used to detect differences between preoperative and postoperative periods A two-tailed p value ≤0.05 was considered statistically significant. Results
The 25 patients included in the study were 14 (56%) male and 11 (44%) female, with a mean age of 8.4±3.7 years (range, 3-15 years). The control group of 25 healthy individuals was composed by 11 (44%) males and 14 (56%)
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The oxidative status of chronic adenotonsillar hypertrophy females with a mean age of 7.8±3.3 years (range, 4-16 years). No statistically significant difference was found between the two groups in terms of age or gender (p>0.05) (Table 1). While the preoperative mean TOS and OSI values of the patients were found to be statistically significantly high compare to the mean TOS and OSI values of the control group, the TAS values were found to be significantly low (p
