From ancient Greek medicine to EP³OS.

The manuscripts of eminent Byzantine physicians from the 4th to the 14th century contain extensive information on various otorhinolaryngological issues. In their work, the early knowledge of rhinological disease from definition and symptoms to conservative treatment and surgical intervention is intriguing. Most of this meticulous knowledge was developed through time, beginning mainly from Hippocrates and the Hellenistic period. Thereafter, medicine developed through Roman and Byzantium times to finally influence European medicine and later the rest of the Western world. History of medicine reflects the history of mankind itself, and otorhinolaryngology follows closely this path. Our goal is to slim down and illuminate the most challenging of the vast amount of information on rhinological issues contained in the original Greek text of Hippocrates, and mainly in the hagiographical texts of Byzantine medical writers. In particular, we focus on rhinological diseases from antiquity till the time being, following the journey of evolution of topical and nebulizer therapy for sinonasal inflammatory diseases in Greece, from "milothris" to modern nasal sprays, leading to an understanding of the philosophy of our predecessors and the roots of modern rhinology.

The role of skull base surgery for the treatment of adenoid cystic carcinoma of the sinonasal tract.

BACKGROUND: Adenoid cystic carcinoma (ACC) of the sinonasal tract is an aggressive malignancy associated with a poor 5-year survival rate. The role of skull base surgery for the treatment of patients presenting with sinonasal ACC and its impact upon their survival has not previously been evaluated. METHODS: A retrospective review of 35 patients with ACC of the sinonasal tract who were treated with surgery and radiation therapy at the University of Pittsburgh Medical Center was performed to evaluate patient outcome. RESULTS: Local recurrence of tumor following surgery and radiation therapy was observed in 36% of the patients originally treated at the University of Pittsburgh Medical Center. Fourteen percent of these patients developed a regional tumor recurrence, and 21% developed distant metastases. We did not identify any tumor-related factors that predicted patient outcome. Local recurrences were treated with salvage surgical excision, and, despite aggressive management, only 1 of 17 patients with local recurrence was considered cured (NED) at 24 months (follow-up after salvage surgery). Overall, disease-free survival was 46.4%, at a median follow-up of 40 months. CONCLUSIONS: ACC of the sinonasal tract is an aggressive malignancy. Skull base surgery has facilitated the gross total excision of advanced lesions that were deemed inoperable in the past, but has not resulted in an overall improvement in disease-free survival. Local recurrence portends a very poor prognosis, despite aggressive salvage regimens. Alternative therapies for local recurrences warrant further investigation. Prospective, randomized studies are necessary to evaluate the outcome of patients treated with aggressive multimodal treatment regimens, including chemotherapeutic regimens.