Liposomal doxorubicin and conventionally fractionated radiotherapy in the treatment of locally advanced non-small-cell lung cancer and head and neck cancer.

PURPOSE: Stealth (ALZA Corporation, Palo Alto, CA) liposomal drug formulation allows a higher intratumoral accumulation and a prolonged plasma half-life of the encapsulated drugs. In the study presented here, we evaluated the feasibility of Stealth liposomal doxorubicin (Caelyx; ALZA Corporation) administered concurrently with conventionally fractionated radiotherapy in the treatment of non-small-cell lung cancer (NSCLC) and head and neck cancer (HNC). PATIENTS AND METHODS: Fifteen patients with NSCLC and 15 with squamous-cell HNC were recruited in two phase I dose-escalation trials. The starting dose of Caelyx was 10 mg/m(2) every 2 weeks (for three cycles during radiotherapy) and was increased by 5 mg/m(2) dose increments for every three patients. RESULTS: The maximum tolerated dose of Caelyx was 20 mg/m(2) for HNC and 25 mg/m(2) in NSCLC patients. Oral/pharyngeal mucositis was the dose-limiting toxicity for HNC patients. "In field" radiation skin toxicity was slightly increased. Hematologic toxicity was minimal. Single photon emission computed tomographic evaluation of Caelyx distribution, using technetium-99m-diethylenetriamine pentaacetic acid labeling, revealed a high intratumoral accumulation of the drug. The tumor to thoracic vessel area count ratio in the NSCLC cases ranged from 0.6 to 1.6 (mean +/- SD, 1.01 +/- 0.29), whereas this ratio was higher (0.8 to 1.85; mean +/- SD, 1.35 +/- 0.39) in HNC cases (P =.049). The complete response rate was 21% in the NSCLC cases and 75% in the HNC cases. NSCLC cases with higher Caelyx tumor accumulation responded better to the regimen. The tumor microvessel density assessed with the anti-CD31 monoclonal antibody directly correlated with the degree of the Caelyx accumulation (P =.007; r =. 92). CONCLUSION: We conclude that combination of radiotherapy with Stealth liposomal doxorubicin is feasible. The potential role of such a regimen in the treatment of highly angiogenic tumors requires further investigation.

Metastasis of malignant melanoma of the nasal mucosa to the small intestine.

Malignant melanoma of the mucous membranes is rare and has a very poor prognosis. When localized in the nose, the tumor becomes apparent late in the course of the disease with nasal obstruction and epistaxis. Distant metastases are uncommon, but any organ of the body can be involved. A case of a malignant melanoma of the nasal mucosa with metastasis to the small intestine is presented, and the natural history of the metastatic disease is discussed.

In vivo detection and staging of epithelial dysplasias and malignancies based on the quantitative assessment of acetic acid-tissue interaction kinetics.

A novel approach to the problem of non-destructive detection and staging of tissue lesions is presented. The method relies on the in vivo quantitative assessment of the spatial and temporal alterations of light-scattering properties, induced in epithelial dysplasias and malignancies of the cervix and larynx, after topical application of acetic acid solution. Initial clinical trials show that the method is capable of detecting incipient lesions and that differences in the dysplasia and malignancy grade are clearly manifested in the measured temporal characteristics of the phenomenon.

Assessment of nasal mucosa blood supply by quantitative endoscopic imaging of the back-scattered light.

In this article we present a method for the objective assessment and monitoring of tissue blood supply using a specially developed endoscopic imaging colorimeter that enables quantitative color modeling of the back-scattered light during endoscopic examination. Tissue blood volume changes in the nasal mucosa, induced by xylometazoline hydrochloride nasal spray, were evaluated with this method. It was found that quantitative imaging provides sensitive, reproducible, and reliable means for the monitoring and mapping of tissue blood supply and is easy to use routinely. The results showed that saturation decreases with time, being the most sensitive color parameter to the vasoconstriction procedure. It appears that objective indexes for optical tissue characterization and analysis may be promising in the understanding of the pathophysiology of tissue changes and in the objective evaluation of their response to different therapeutic schemes.

In vitro ear cartilage shaping with carbon dioxide laser: an experimental study.

Deformed cartilage remodeling appears to be a challenge, as cartilage tends to keep its initial shape because of internal stresses. Cartilage can be remodeled with heat, and this report describes the use of a CO2 laser beam for in vitro cartilaginous tissue remodeling. Straight cartilage samples were removed from the ears of 21 rabbits deprived of perichondrium and remodeled with the CO2 laser at an output power of 3 W, a spot diameter of 2 mm, and an exposure time of 0.5 second. The remodeled cartilages and control samples were implanted into the rabbits' backs and retrieved 6 to 12 months later. Histologic and morphological analysis showed that the irradiated cartilages retained both their shape and their viability. This may be a useful clinical technique for in situ remodeling of a deformed cartilage in operations such as septoplasty.

The silent epidural abscess as a complication of acute otitis media in children.

Acute otitis media with complications is a persistent problem in the modern antibiotic era with a relatively high mortality rate. Acute mastoiditis is a serious complication of acute otitis media with potentially grave consequences and the epidural abscess constitutes the commonest of all intracranial complications, arising from middle ear infections. We report two cases of children with acute mastoiditis without evidence of intracranial complication or subperiosteal abscess, in whom the early evaluation with computed tomography (CT) disclosed an unsuspected epidural abscess. Therefore, we stress the use of CT as a rule of thumb for every child with acute mastoiditis.

Bronchoscopy for foreign body removal in children. A review and analysis of 210 cases.

OBJECTIVE: A foreign body aspiration in the tracheobronchial tree is a dangerous and common medical emergency in childhood, with serious and potentially lethal consequences. It must be suspected in children with a suggestive history, even though the clinical symptoms or radiographic findings are not pathognomonic for foreign body aspiration. METHODS: In this study 210 pediatric cases, with a suggestive history of foreign body aspiration undergoing bronchoscopy in the last 8 years in the department, were reviewed. In all cases bronchoscopy was performed under general anesthesia using a Storz ventilation bronchoscope with distal cold light illumination. RESULTS: In 130 patients a foreign body was discovered, in 17 cases pus was aspirated and in 63 cases there were no findings. Seventy-eight (60%) foreign bodies were found in the right main bronchus, 43 (33.1%) in left main bronchus, seven (5.4%) in both bronchi and two (1.5%) were found in the subglottic area. The incidence of bronchoscopy during the last 8 years was 28 procedures per 100000 children population per year in the island of Crete. CONCLUSION: More attention should be given to the need for a careful history and the use of radiographs as supplemental information to make the decision to perform a bronchoscopy. The parents, also, should pay attention not to allow children dry fruits and small toys, as well as, teaching their children to avoid any physical or emotional activity while having a full mouth.

Meningitis as a complication of tonsillectomy.

Adenotonsillar surgery remains among the most commonly-performed pediatric surgical procedures. The complication rate of tonsillectomy is generally considered to be in a range of 1-5%. Bacterial meningitis following adenotonsillectomy is a rarely reported complication. Bacterial meningitis is a potentially fatal acute infectious disease caused by a variety of micro-organisms. Current case fatality rates associated with this entity can be as low as 2% in infants and children and as high as 30% in neonates. The successful management of meningitis depends on early clinical suspicion and diagnosis, with prompt medical treatment using high-dose, broad-spectrum antibiotics that adequately cross the blood-brain barrier. We present a case of meningitis complicating a tonsillectomy procedure, in a 7-year-old girl. The diagnosis and treatment of this rare complication is illustrated, and the possible etiology is discussed.

Mucocele of the maxillary antrum in an eight-year-old boy.

Mucocele is a rare clinical entity in children. It is considered to be associated with fibrocystic disease. The capacity of mucocele to erode through the bone walls along with the increased density of its content, make the diagnosis difficult when mucocele has to be differentiated from benign or malignant tumors. In this paper, we present the case of an 8-year-old boy with mucocele of the left maxillary antrum. Both the differential diagnosis and the surgical treatment are described.

CT-based radiotherapy treatment planning for cancer of the nasopharynx.

We analysed 32 cases of nasopharyngeal carcinoma (NPC) treated with radiotherapy trying to define the role of CT scan during radiotherapy planning, as well as radiation treatment and the follow-up of the patients. CT scan was found to help 15 cases with low-parapharyngeal involvement and/or bone erosion. Persistent abnormal CT findings at 2 mo after the end of radiation treatment were related to a 30% local recurrence rate. This rate went up to 100% in case of skull-base destruction.

Negative pressure suction in nasal septum surgery.

Operations for the correction of septal deviations are among the most common in otorhinolaryngology. Several approaches and techniques have been proposed, for securing the mucoperichondrial flap back in place. A new method of stabilizing the septum by applying a negative pressure suction tube, without the insertion of any kind of packing, is described. The advantages of the negative pressure suction are that the patient can breathe through the nose immediately after the operation, there is no pressure sensation and the pain, if any, is reduced, there is no epiphora, no skin edema and the patient feels very comfortable. Risks for complications are minimal.

Frontal lobe abscess secondary to head trauma and nasal polyposis.

Cerebral frontal lobe abscess may be a frequent intracranial complication of paranasal sinusitis. An unusual case of cerebral abscess complicating massive polyposis is described in a patient with history of previous severe head trauma 30 years ago. Imaging evaluation using both computed tomography and magnetic resonance imaging is important to diagnose such rare entities.

Angiosarcoma of the maxillary sinus.

Angiosarcomas are rapidly growing malignant neoplasms arising from the vascular endothelial cells. Most common sites are the extremities and the retroperitoneal space, with only four per cent of angiosarcomas arising in the head and neck area, whilst the paranasal sinuses are one of the rarest locations. We report the case of a maxillary sinus angiosarcoma in a 72-year-old male patient. The first biopsy was inconclusive, whereas the second revealed an angiosarcoma. Medial maxillectomy was performed with subsequent external irradiation.

Osteoblastoma of the nasal cavity arising from the perpendicular plate of the ethmoid bone.

The presence of a benign osteoblastoma in the ethmoid sinus is rare and only a few cases have been reported. This is a case of a benign osteoblastoma arising from the perpendicular plate of the ethmoid bone with extension to the nasal cavity. The diagnosis and management of this unusual lesion, as well as the histopathology and the imaging characteristics are reviewed. We also review the previously reported cases of benign osteoblastomas of different origin, with nasal cavity involvement.

Fibrous dysplasia of the temporal bone: report of a case and a review of its characteristics.

Fibrous dysplasia is an uncommon benign disorder of unknown etiology. It represents a disturbance of normal bone development--specifically a defect in osteoblastic differentiation and maturation that originates in the mesenchymal precursor of the bone. Because fibrous dysplasia shows a predilection for the facial and cranial bones, where it causes deformity and dysfunction, the disease is of particular interest to the otolaryngologist. In this paper, we report a case of fibrous dysplasia of the temporal bone, the first symptom of which was a mixed hearing loss. We discuss the characteristic features of this specific location of the disease, the differential diagnosis, and the treatment policy. We also address the issue of secondary sensorineural hearing loss.

Basaloid squamous cell carcinoma of the soft palate: case report.

Basaloid squamous cell carcinoma (BSCC) is a histologically distinct variant of squamous cell carcinoma. It occurs in various sites of the head and neck region and is believed to carry a dismal prognosis. The palate is a very rare site of BSCC development and only three cases have been reported in the international literature. In this report, we present a case of basaloid squamous cell carcinoma of the soft palate. The therapeutic strategy and histological findings are described in detail, including immunohistochemistry with the use of involucrin, an agent used for the first time for BSCC diagnosis. In addition, a brief review of the literature is presented.

Transtympanic versus intramuscular steroid administration in a histamine-induced inflammatory middle-ear model.

OBJECTIVES: Assessment of the histopathologic effect of transtympanic and intramuscular administration of dexamethasone in an in vivo experimental animal model of middle-ear mucosal inflammation. METHODS: Fifty healthy rabbits weighting 1500-1800 g were randomly divided in three groups. In 10 animals (control group), 0.5 ml of a 20 mg/ml histamine solution was injected transtympanically. In 20 rabbits (group A), histamine challenge followed a three day intramuscular pretreatment with dexamethasone at 1 mg/kg per day. In 20 rabbits (group B), histamine challenge followed pretreatment with dexamethasone via a transtympanic route (0.3 ml, 1.2 mg dexamethasone). Middle-ear mucosa was obtained for histopathology 30 minutes after histamine administration. The following parameters were assessed: inflammation, acute inflammatory component, presence of eosinophils, inflammatory activity and fibrosis. RESULTS: Oedema, vascular dilatation and congestion, inflammation, the presence of an acute (polymorphonuclear) inflammatory component, the presence of eosinophils, and inflammatory activity were found to be of a lesser grade in the mucosae of group B. All differences were found to be statistically highly significant (p<0.01) using the Mann-Whitney test. CONCLUSION: Our findings validate the transtympanic route of dexamethasone administration in counteracting histamine effects.

A new stapedotomy prosthesis: preliminary report.

Our study describes a newly designed stapedotomy prosthesis which consists of two components: (1) a platinum ribbon, and (2) a Teflon shaft. The first innovation is a flattened 'tab' on the posterior aspect of the platinum ribbon. The second innovation concerns the dual diameter cylinder-like shaft. Our prosthesis was implanted into 25 individuals, who underwent stapedotomy for stapes fixation, and the results are shown and discussed. Our innovations offer a proper and safe insertion of the prosthesis into the oval window associated with excellent manipulation and handling. At the same time, maximum visualization of the surgical field is achieved, while the stepped-down design of the shaft prevents the prosthesis protruding into the vestibule.

Nd:YAG laser treatment of recurrent epistaxis in heredity hemorrhagic telangiectasia.

OBJECTIVE: Hereditary hemorrhagic telangiectasia (HHT) is an inherited abnormality passed down as a dominant autosomal feature. Recurrent epistaxis usually constitutes the major clinical manifestation of this disease. The unsatisfactory results of conservative therapy have stimulated a research interest for the role of laser photocoagulation in telangiectatic vessels associated with this clinical entity. METHOD: The Nd:YAG laser was used to treat a group of 11 individuals suffering from HHT, all of whom had been previously treated using other modalities. RESULTS AND CONCLUSION: The excellent results of Nd:YAG laser irradiation are addressed in view of all treatment modalities proposed for the treatment of recurrent epistaxis in HHT.

Sucralfate alleviating post-laser-assisted uvulopalatoplasty pain.

Laser-assisted uvulopalatoplasty (LAUP) is an outpatient mode of treatment for snoring and perhaps for some mild cases of obstructive sleep apnea syndrome. LAUP results in severe throat pain that usually lasts for 8 to 14 days. Sucralfate adheres to proteins at the duodenal ulcer site, forming a protective coating against gastric acid, pepsin, and bile salts, that promotes healing. If a similar protective coating could be created at the area of LAUP trauma, morbidity may be diminished. Twenty-eight patients have undergone LAUP treatment-2 with mild obstructive sleep apnea syndrome and 26 with simple snoring. A block-randomized, single blind clinical study was performed. Sucralfate was administered in 14 patients (group A) every 6 hours for 15 days as a swish and swallow, whereas the other 14 patients (group B) received water for injection with a strawberry flavor as placebo with the same dosing. As a conclusion, sucralfate significantly lowered postoperative pain and the need for analgesic drug use as well as the total number of the days the patients needed to almost reach their normal diet quantity (> or = 80% of normal quantity).