Extensive endoscopic sinus surgery from the viewpoint of out-patients in a metropolitan area.

Extensive functional endoscopic sinus surgery (FESS) was assessed retrospectively from the viewpoint of out-patients on the basis of their responses to a postal questionnaire, particularly in the Tokyo metropolitan area. Seventeen patients were included in this study (six females and 11 males) with an age range of 22-70 years. All the patients had at least ethmoid sinusitis. Additionally, some patients had maxillary or sphenoid sinusitis or polyps obstructing the nasal cavities. The average operation time and blood loss were 36 minutes and 31 ml, respectively. Four patients had to travel more than one hour to reach home. All of them used the train for travelling to and from the hospital. 'Doctors' advice' was the most common reason for the decision to undergo this ambulatory surgery. Nine (53 per cent) had some unexpected problems post-operatively. The establishment of a care pathway may improve the outcome of extensive FESS on an out-patient basis.

Increased nasal patency caused by smoking and contraction of isolated human nasal mucosa.

In this study, we investigated the effects of smoking and nicotine, an important constituent of cigarettes, on the nasal patency using acoustic rhinometry (AR) and an in vitro bioassay technique. In the AR study, the nasal cavity volume of volunteers classified into two groups, smoking and nicotine chewing gum groups, was measured. The nasal cavity volumes immediately after smoking and 5 minutes after smoking significantly increased compared with that before smoking (P < 0.05), whereas the nasal cavity volume after chewing a nicotine gum was unchanged compared with that before chewing the gum. An in vitro study showed significant nicotine-induced contraction of the human nasal mucosa (50.2 +/- 14.0% noradrenaline-induced contraction: n = 10). The threshold nicotine level that can induce human nasal mucosa contraction was 3.0 x 10(-7) M. Prazosin (10(-6) M) inhibited nicotine-induced contraction incompletely (20.5 +/- 7.5% of noradrenaline-induced contraction n = 5). These results indicate that smoking increases nasal patency and that nicotine induces contraction of the human nasal mucosa. The nicotine-induced contraction is likely mediated, at least in part by alpha1-adrenoceptors.

Rosai-Dorfman disease revealed in the upper airway: a case report and review of the literature.

Rosai-Dorfman disease (RDD) is a systemic disease and its etiology is not well understood. It is a very rare but established disease. We report a case of RDD diagnosed in the upper airway that became a life-threatening condition because of the stricture of the subglottic space. A 49-year-old female complained of nasal obstruction, hoarseness and lacrimation. After evaluation following by fiberscopic examination and CT scanning of the head and neck, sinusitis and laryngeal masses were detected. Endoscopic sinus surgery and endolaryngeal microsurgery were performed simultaneously. The masses in the nasal cavity and larynx showed the same histological findings. Proliferative large histiocytes with voluminous clear cytoplasm and rounded nuclei, and lymphophagocytosis known as emperipolesis are the characteristic features of RDD. In this case, extranodal manifestations in the subglottic space gradually emerged postoperatively. Tracheotomy was performed to ensure an airway and prevent suffocation. An extensive treatment is not required in most patients with RDD, however, some patients who have extranodal manifestations involving the airway may detoriorate into a life-threatening condition.

[A case of pulmonary metastases from laryngeal cancer showing a complete response to chemotherapy with docetaxel].

Docetaxel (TXT) is a new cytotoxic agent against head and neck, (H and N) cancer since the emergence of cisplatin. We herein describe the efficacy of TXT in treating distant metastases from H and N cancer. The patient was a 61-year-old man who had undergone laryngectomy and irradiation for laryngeal cancer (glottic type: T3N0M0). More than 2 years later after the first course of therapy, pulmonary metastases involved in the left lower area were revealed by lung CT. The divided TXT therapy (20 mg, 3 times, and 40 mg, 3 times) was carried out without any sequelae. This consecutive therapy resulted in complete disappearance of the metastases on follow-up CT. It is suggested that divided TXT therapy has potential as a new treatment modality for distant metastases of H and N cancer.

[Surgical treatment of patients with severe obstructive sleep apnea syndrome].

No standard indications currently exist for surgical treatment of severe obstructive sleep apnea syndrome (OSAS). We treated 15 patients with severe OSAS surgically, evaluated surgical indications, and evaluated surgical success. We retrospectively reviewed 15 cases of surgery for OSAS in which polysomnography met 2 or more criteria for the following surgical indications: (1) apnea hypopnea index (AHI) > or = 50, (2) minimum SpO2 below 80%, and (3) enlarged tonsils (grade III, Mackenzie's classification). Among the 15, mean AHI was 85.1. Surgery was done under general anesthesia, with uvulopalatopharyngoplasty (UPPP) in 13 and tonsillectomy alone in 2. Postoperative AHI was measured in 9 patients. According to Nishimura's criteria for assessing surgical success, improvement was "excellent" in 5, "good" in 1, "fair" in 1, and "poor" in 2. When we compared preoperative and postoperative use of continuous positive airway pressure (CPAP) in 7, we found that surgery decreased CPAP requirements. Surgical success was assessed in patients requiring CPAP and improvement was "excellent" in 5, "good" in 1, and "fair" in 1. In conclusion, surgical indications for severe OSAS, including the criterion of enlarged tonsils, were useful. Surgery decreased CPAP requirements and the degree of improvement in this requirement and AHI was valuable in assessing surgical success.