Monoclonal antibodies for the treatment of chronic rhinosinusitis with nasal polyposis: a systematic review.

BACKGROUND: Monoclonal antibodies have been proposed as a novel therapy in patients suffering from chronic rhinosinusitis with nasal polyposis (CRSwNP). The purpose of this systematic review was to evaluate their efficacy and safety. METHODOLOGY: A literature search was performed in MEDLINE, Web of Science, the Cochrane Library and multiple trial registries followed by extensive hand-searching for the identification of relevant studies. Only randomized controlled trials (RCTs) comparing the use of monoclonal antibodies with placebo or another therapy in adult patients with CRSwNP were included. RESULTS: Anti-immunoglobin E (IgE) therapy with omalizumab was assessed in two studies, anti-interleukin (IL)-5 therapy in three studies (1 reslizumab, 2 mepolizumab) and finally anti-IL-4 and anti-IL-13 therapy in only one. With the exception of one study, biologic therapy was proved to be effective in reducing total nasal endoscopic polyp score (TPS) in treatment as compared to placebo groups. Monoclonal antibodies brought about improvement in several other outcomes, such as opacification in computed tomography (CT), quality of life measures, nasal airflow, olfaction and type 2 helper T-cell (Th2) associated biomarkers. Overall, the use of these agents was deemed safe and well-tolerated. CONCLUSIONS: This is the first systematic review showing encouraging results for the use of all three main categories of monoclonal antibodies in CRSwNP patients and highlights the need for further well-designed and with larger sample sizes RCTs.

A systematic review of the surgical techniques for the treatment of internal nasal valve collapse: where do we stand?

BACKGROUND: A myriad of interventions have been described to address the restoration or preservation of the internal nasal valve, the narrowest portion of nasal airway. OBJECTIVE OF REVIEW: To review systematically available knowledge and evidence about management options of the collapse of the internal nasal valve area. TYPE OF REVIEW: Systematic review. SEARCH STRATEGY: A MEDLINE, EMBASE, Cochrane Library and CENTRAL database search, followed by extensive hand searching for the identification of relevant studies. EVALUATION METHOD: Review of all English-language studies addressing the treatment of the internal nasal valve collapse. RESULTS: Fifty-three studies were eventually identified and systematically reviewed. The majority (50 of 53) of the included articles are graded as level IV evidence and only one randomised trial was identified. The included randomised study reported no significant difference in improvement between the intervention group (autospreader flap) and placebo arms. The majority of the included studies presented in this systematic review provide level IV evidence concerning the optimal approach for cases of nasal valve collapse. Current research is driven more by reports of techniques than patient outcomes. CONCLUSIONS: Proper evaluation and identification of the cause of the internal nasal valve collapse is paramount prior to selection of the preferred surgical solution. The three-dimensional construction of the nasal valve implies that many pathologies cannot be restored by a single solution. Treatment approaches should be directed at specific involved sites. Present systematic review of the literature revealed that the available evidence is based on low-level studies and focuses more on the description of various surgical techniques rather than on patient-reported outcome measures. Future studies are needed, including homogenous patient groups, comparing different surgical techniques and incorporating patient-reported outcome measures.

Endoscopic versus microscopic trans-sphenoidal pituitary surgery: a systematic review and meta-analysis.

BACKGROUND: Endoscopic trans-sphenoidal surgery has been increasingly replacing microscopic surgery as the state of the art trans-sphenoidal approach. OBJECTIVE OF REVIEW: To assess the efficacy and safety of pure endoscopic approach in comparison with microscopic approach in pituitary surgery. TYPE OF REVIEW: Literature review and meta-analysis. SEARCH STRATEGY: Systematic literature searches of MEDLINE (1952-10th February 2010), EMBASE (1974-10th February 2010) and the Cochrane Central Register of Controlled Trials to the 10th February 2010. EVALUATION METHOD: Review of all English-language studies comparing endoscopic and microscopic techniques. RESULTS: Eleven relevant studies were identified with a total of 806 patients, 369 of whom had endoscopic surgery and 437 microscopic surgery. The initial remission rate of hypersecretion of functioning adenomas was not significantly different between the endoscopic and the microscopic group [(OR: 1.34(95% CI: 0.73-2.47); P=0.35; 66% remission rate in endoscopic group versus 60% in microscopic)].The proportion of patients with complete tumour removal was not significantly different in the endoscopic group than in the microscopic group [(OR: 0.83, (95% CI: 0.52-1.33); P=0.44]. The rate of CSF leak attributable to the surgical method did not differ significantly between endoscopic and microscopic group. Post-operative diabetes insipidus was less frequent in those having endoscopic surgery [15%versus 28%P=0.003]. Regarding the other intra cranial and nasal complications attributable to surgical technique, the occurrence rate in endoscopic group was significant lower compared with microscopic group (13%versus 1.2% respectively, P<0.05). Patients in the endoscopic group had significant shorter postoperative hospital stay with a range from 3.7 to 4.4 days, than those of microscopic group with a range from 5.4 to 5.7 days [(WMD: -1.53, (95% CI: -2.30 to -0.77); P<0.00001)]. CONCLUSIONS: Notwithstanding its limitations, the present systematic review, based on the currently available evidence, suggests that endoscopic trans-sphenoidal pituitary surgery is associated with similar rates of complete tumour excision and remission rates. Endoscopic surgery was associated with fewer complications related to surgical technique and a shorter hospital stay.

Castleman's disease of the neck: report of a case and review of the literature.

OBJECTIVES: Castleman's disease is an uncommon disease of benign lymph node hyperplasia primarily affecting the mediastinum, with the head and neck region being the second most common site. CASE REPORT: A 27-year-old woman was admitted to our department due to a left lateral cervical mass. After a complete clinical and imaging examination, a neck dissection was performed, in which a mass, size 3.5 x 2.7 x 4.5 cm, was excised. The patient was diagnosed with Castleman's disease of the neck after histopathological examination. CONCLUSIONS: The diagnosis of Castleman's disease is always a clinical challenge, as the patient commonly presents with nonspecific signs and symptoms resembling other lymphatic diseases. Consequently, Castleman's disease should be in the differential diagnosis of congenital, inflammatory, or neoplastic cervical alterations. A review of literature, including histopathological characteristics, differential diagnosis, and treatment options is also presented.

Management of the clinically negative neck (N0) of supraglottic laryngeal carcinoma: a systematic review.

AIM: The most effective therapeutic approach for patients with supraglottic laryngeal carcinoma (SGLC) and clinically negative neck (cN0) remains a subject of much debate. The purpose of this systematic review was to answer the following question: among patients with SGLC and cN0 neck, are the survival and occurrence of neck metastases significantly different between patients that received neck dissection and those that had another therapeutic treatment (radiotherapy, combined therapy, 'wait and see' policy)? MATERIALS AND METHODS: An electronic literature search was performed in MEDLINE, EMBASE, Cochrane Library and CENTRAL databases, followed by extensive hand-searching for the identification of relevant studies. The following inclusion criteria were established: the study should (a) include a comparison of neck dissection with one of the other therapeutic procedures for cN0 of SGLC; (b) report the therapy for the initial supraglottic cancer; and (c) use time-to-event analysis of its results. Six studies were eventually identified and systematically reviewed. RESULTS: All studies included in the systematic review were retrospective (n=792 patients). The survival (overall, disease-specific and neck disease-free) and the site of neck recurrence of the patients with N0 supraglottic cancer were not significantly different between patients in the neck dissection treatment group and those of the rest of the therapeutic strategies examined (neck radiotherapy, combined therapy and 'wait and see' policy). CONCLUSIONS: The present systematic review highlights the need for further well-designed prospective studies that will provide more reliable answers to the debatable issue of the management of cN0 of SGLC. Currently, based on the best available evidence, it seems that neck dissection is not superior to radiotherapy or combined therapy or a 'wait and see' policy in terms of survival and control of neck disease.