Pre and post functional endoscopic sinus surgery nasal cavity volume assessment by acoustic rhinometry.

UNLABELLED: Acoustic rhinometry is an objective method to determine nasal cavity geometry. The technique is based on sound wave reflexion analysis in the nasal cavity, and determines crossectional areas as a function of distance as well as volume. AIM: The purpose of this study is to analyse nasal cavity volume changes caused by functional endoscopic sinus surgery (FESS) in adults with chronic rhinosinusitis by acoustic rhinometry, and to correlate these changes with improvements in the sensation of nasal obstruction. MATERIAL AND METHOD: Forty patients aged from 18 to 73 years were prospectively evaluated between August and October 1999 at the Graz University Hospital, Austria. All patients were diagnosed with chronic rhinosinusitis, and undertook acoustic rhinometry before and after FESS. SCIENTIFIC DESIGN: A clinical prospective study. RESULTS: The nasal cavity total volume increased significantly after surgery. Nasal obstruction was improved in 88% of the patients, 20% with partial improvement and 68% with total improvement. There was no correlation between volume increase and improvement of the sensation of nasal obstruction. CONCLUSION: Total nasal cavity volume significantly increased after surgery; however, there was no correlation between volume increase and improvements of nasal obstruction. No significant pre or postoperative increase in total nasal cavity volume after decongestion were observed.

Endoscopic resection of juvenile angiofibromas--long term results.

OBJECTIVE: To evaluate the long term outcome after endoscopic endonasal resection of juvenile nasopharyngeal angiofibromas (JNA). METHODS: Retrospective study of a series of 21 consecutive patients undergoing endoscopic resection of JNA (type I - IIIa according to Fisch) at two Hospital Centers between 1993 and 2002. Mean follow-up was 51.7 months (range 5-120). Extension to the medial aspect of infratemporal fossa and retromaxillary space was no contraindication against an endonasal endoscopic approach. In three cases of type IIIa tumours a computer assisted intraoperative guiding system was applied (ENTrak, GE Medical, Lawrence, USA). RESULTS: Fifteen patients (71.4%) were free of disease after one endoscopic resection. Three patients (14.3%) had an unmistakable recurrence with the need for further treatment at 6, 14, and 23 months, respectively. Two of the three recurrent tumours have been successfully resected endoscopically, one case was treated with gamma knife. In three patients (14.3%) postoperative MRI showed localized enhanced signal, presumably minimal persistent tumour tissue. Without further treatment all of these patients remained free of symptoms and MRI follow up showed no tumour growth over three, five and ten years, respectively. No postoperative long term sequela was observed. CONCLUSIONS: Resection of nasopharyngeal angiofibromas type I-IIIa can be safely achieved endoscopically. The advantage of this minimally invasive technique is avoidance of external scars and low morbidity. The intraoperative computer assisted guiding system ENTrak was highly accurate and provided substantial help in selected cases.

Influence of preservatives and topical steroids on ciliary beat frequency in vitro.

OBJECTIVE: To measure the influence of topical steroids and the preservative potassium sorbate on the ciliary beat frequency (CBF) of human nasal mucosa in vitro. DESIGN: In vitro study of cultured ciliated cells of human nasal mucosa. METHODS: Human nasal mucosa was removed endoscopically and cultured for 10 days. Cell cultures with ciliated cells grown on an object slide were exposed to benzalkonium chloride and topical steroids in an exposure chamber. The CBF was measured with a photometer. RESULTS: The preservative potassium sorbate did not influence CBF in different concentrations. The glucocorticoid budesonide spray containing potassium sorbate did not affect CBF at 10% dilution and showed moderate reversible decrease of CBF at 50% dilution. The glucocorticoid sprays fluticasone propionate and mometasone fuorate containing the preservative benzalkonium chloride caused a reversible decrease of CBF at 10% dilution and a complete irreversible standstill at 50% dilution. CONCLUSIONS: In vitro, the steroid sprays containing fluticasone or mometasone, both with benzalkonium chloride, caused slowing or standstill of CBF depending on the concentration. The isolated preservative potassium sorbate and the budesonide nasal spray containing this preservative did not have negative influence on CBF in vitro. Potassium sorbate can therefore be considered harmless to the motility of ciliated cells.

Endolacrimal KTP laser-assisted dacryocystorhinostomy.

OBJECTIVE: To describe our experience with potassium-titanyl-phosphate (KTP) laser-assisted dacryocystorhinostomy, controlled via endolacrimal and endonasal endoscopy. The development of miniendoscopes enables endoscopy of the lacrimal drainage system via the lacrimal puncta to visualize the exact site of a stenosis. DESIGN: A case series of 78 patients, with 1-year postoperative follow-up. SETTINGS: A university medical center. PATIENTS: Consecutive sample of 78 adult patients who required surgery for dacryostenosis. INTERVENTION: Endolacrimal use of a KTP laser to perform a bony osteotomy of the lacrimal sac into the nasal cavity. The position for the perforation was controlled by endonasal endoscopy. The procedure was performed under either general or local anesthesia. RESULTS: One year after surgery, 65 (83%) of the 78 patients were free of symptoms. Seven patients experienced intermittent tearing, and 6 had revision surgery because of restenosis. CONCLUSIONS: The success rate of 83% achieved with KTP laser-assisted dacryocystorhinostomy, using miniendoscopes for lacrimal endoscopy to visualize the exact site of obstruction, is better compared with that of prior studies without the use of miniendoscopes (with success rates of 47%-85%). The advantages of this technique are that it is a minimally invasive procedure, requires a short operating time, and avoids use of an external incision.

Influence of sensitization to inhalative allergens on adenotonsillar disease.

OBJECTIVE: We sought to determine the influence of IgE-mediated sensitization on adenotonsillar disease in children. We compared follow-up after tonsillectomy/adenoidectomy of atopic and nonatopic children.Study design and setting A prospective study of 293 children consecutively undergoing tonsillectomy/adenoidectomy was conducted at a university hospital center. Preoperative and postoperative (1-year follow-up) allergy-related symptom scores were obtained by parents. Intraoperative total serum IgE, the screening test sx1 (Pharmacia), and, if positive, serum specific IgE to inhalative allergens were carried out. RESULTS: Sixty-seven children (22.9%) showed positive RAST results to inhalative allergens (class 1 to 6). In both sensitized and nonsensitized groups, the general health was improved in more than 89% at 1 year postoperatively. No significant difference of postoperative nasal symptoms between the atopic and nonatopic groups was found. CONCLUSION: Both atopic and nonatopic children with adenotonsillar disease improve health after adenoidectomy or adenotonsillectomy. In our opinion, routine allergy tests before adenotonsillectomy or adenoidectomy are not justified. Only if allergy is suspected due to clinical findings or family history should an allergy test be carried out.

Case report of bilateral cervical chondrocutaneous branchial remnants.

Cervical chondrocutaneous branchial remnants are rare and not well known lesions. Histologically the lesion per definition presents as a Choristoma. Choristoma is the pathohistological term for a developmental tumor-like anomaly consisting of tissues foreign to the site at which it is located. Treatment is complete surgical removal as promptly as possible in order to get an exact histopathological diagnosis. A case of a 4-month-old boy with cervical chondrocutaneous branchial remnants anterior to the sternocleidomastoid muscles on both sides is presented. According to literature search this appears to be the second case published on such a bilateral lesion.

Influence of topical antifungal drugs on ciliary beat frequency of human nasal mucosa: an in vitro study.

OBJECTIVES/HYPOTHESIS: Topical antifungal treatment is a subject of discussion in the treatment of chronic rhinosinusitis. The aim of this research was to study the effects of antifungal drugs on ciliary beat frequency (CBF) of human nasal mucosa under in vitro conditions. STUDY DESIGN: Case series of in vitro experiments and in vitro study of cultured ciliated cells of human nasal mucosa. METHODS: Human nasal mucosa was acquired during routine endoscopic sinus surgery. Cells were cultivated on object slides and exposed to different antifungal drugs in a newly developed test system. This system allowed continuous and reproducible exposure to different drugs at constant temperature, pH value, and osmolarity. The drugs were amphotericin B in two different concentrations and itraconazole. RESULTS: Rinsing with higher concentrations of amphotericin B led to an immediate decrease of CBF, with a total stop after 15 minutes. A different result was seen in the group with lower concentrations; CBF decreased again quickly after rinsing with the test drug, but all of them recovered after rinsing with neutral solution. When using itraconazole a decline in CBF was observed again; one half of the samples returned to activity. CONCLUSIONS: Our in vitro results demonstrate a dose-dependent effect of the antifungal drugs amphotericin B and itraconazole on ciliary beat frequency of human nose epithelium.

Comprehensive genomic analysis identifies MDM2 and AURKA as novel amplified genes in juvenile angiofibromas.

BACKGROUND: Frequent beta-catenin mutations have been detected in juvenile angiofibromas, but the tumor pathogenesis remains unknown. METHODS: Metaphase-comparative genomic hybridization (CGH) was used to identify chromosomal aberrations in 29 tumor specimens. Two tumors were investigated using genome DNA microarrays. RESULTS: Three hundred eleven chromosomal gains and losses were detected by metaphase-CGH. Frequent chromosomal gains were detected at 4q, 6, 12, and X, while frequent chromosomal losses affected regions of chromosomes 8, 16, 17, 22, and Y. Genome DNA microarray analysis in 2 tumors of the series confirmed chromosomal aberrations, detected by metaphase-CGH, and indicated genes such as AURKA (20q13.2) not being recognized by metaphase-CGH. CONCLUSION: Metaphase-CGH results confirmed numerous chromosomal aberrations in juvenile angiofibromas. The most frequent aberrations affected sex chromosomes. Further consensus regions of chromosomal aberrations were detected at 4q, 6, 8, 12, 16, 17, and 22. AURKA and MDM2 were identified as interesting novel amplified genes in juvenile angiofibromas.

Solitary fibrous tumor of the submandibular gland.

Solitary fibrous tumors (SFT) are generally benign, well-circumscribed soft-tissue tumors of mesenchymal origin. CD34 antigen expression is characteristic for this tumor. A rare subgroup shows malignant histological patterns with aggressive behavior. The common site of occurrence is the pleura, but various other sites, including the head and neck, have been described. We present a 56-year-old, white, female patient with a solitary fibrous tumor developing in the right submandibular salivary gland. The tumor was surgically removed, and no recurrence or metastases have occurred during the 43 months of follow-up. All solitary fibrous tumors reported in the salivary glands were benign. However, new cases should be presented and followed up carefully to monitor their biological behavior.

Verrucous carcinoma of the skin: long-term follow-up results following surgical therapy.

BACKGROUND: Owing to the benign appearance and slow growth of verrucous carcinoma of the skin, its diagnosis and therapeutic management still pose problems. OBJECTIVE: This study was undertaken to point out clinical and histopathologic features of verrucous carcinoma of the skin and to provide diagnostic and therapeutic guidelines on the basis of the long-term results from 20 patients. METHODS: A retrospective study of the long-term results of 20 patients treated surgically for verrucous carcinoma of the skin is presented. In 16 cases, a wide resection with histopathologic examination of the margins was possible. Two tumors were shaved; 1 case required below-knee amputation and 1 patient refused primary amputation. In April 1999, 9 of the 10 surviving patients underwent physical examination, ultrasonography of the regional lymph nodes and the abdomen, and chest X-ray. The protocols of autopsies or postmortem examinations of the deceased patients were consulted. RESULTS: The deceased patients achieved an average tumor-free survival period of 86.1 months; eight of the surviving patients had an average tumor-free follow-up of 127.4 months. Two patients suffered recurrences. CONCLUSION: Curative treatment can be achieved by timely and complete resection of verrucous carcinoma of the skin, even in advanced cases.

Avaliação do volume da cavidade nasal por rinometria acústica, pré e pós-cirurgia endoscópica funcional dos seios paranasais / Pre and post functional endoscopic sinus surgery nasal cavity volume assessment by acoustic rhinometry

A rinometria acústica é um método objetivo de determinar a geometria da cavidade nasal, pela análise da reflexão de ondas sonoras. Determina a área de secção transversal da cavidade em função da distância da narina e seu volume. OBJETIVO: Analisar a alteração do volume da cavidade nasal causada pela cirurgia endoscópica funcional dos seios paranasais, em adultos com rinossinusite crônica, e correlacionar esta alteração com a melhora da obstrução nasal. MATERIAL E MÉTODO: Foram avaliados 40 pacientes de 18 a 73 anos, entre agosto e outubro de 1999, na Universidade de Graz - Austria, com rinossinusite crônica, antes e depois de serem submetidos à CEFSP. FORMA DE ESTUDO: Clínico prospectivo. RESULTADOS: O volume total da cavidade nasal aumentou significativamente no pós-operatório. 88 por cento dos pacientes referiram melhora da obstrução nasal, 20 por cento de forma parcial e 68 por cento total. Nenhum paciente piorou deste sintoma. Não houve relação linear entre o aumento do volume da cavidade nasal e melhora subjetiva da obstrução nasal. CONCLUSÃO: O volume total da cavidade nasal aumentou no pós-operatório, mas não houve relação entre aumento do volume e melhora da obstrução nasal. Não houve aumento do volume da cavidade nasal após o uso do vasoconstritor, seja no pré ou no pós-operatório.

Acoustic rhinometry is an objective method to determine nasal cavity geometry. The technique is based on sound wave reflexion analysis in the nasal cavity, and determines crossectional areas as a function of distance as well as volume. AIM: The purpose of this study is to analyse nasal cavity volume changes caused by functional endoscopic sinus surgery (FESS) in adults with chronic rhinosinusitis by acoustic rhinometry, and to correlate these changes with improvements in the sensation of nasal obstruction. MATERIAL AND METHOD: Forty patients aged from 18 to 73 years were prospectively evaluated between August and October 1999 at the Graz University Hospital, Austria. All patients were diagnosed with chronic rhinosinusitis, and undertook acoustic rhinometry before and after FESS. SCIENTIFIC DESIGN: A clinical prospective study. RESULTS: The nasal cavity total volume increased significantly after surgery. Nasal obstruction was improved in 88 percent of the patients, 20 percent with partial improvement and 68 percent with total improvement. There was no correlation between volume increase and improvement of the sensation of nasal obstruction. CONCLUSION: Total nasal cavity volume significantly increased after surgery; however, there was no correlation between volume increase and improvements of nasal obstruction. No significant pre or postoperative increase in total nasal cavity volume after decongestion were observed.