The prognostic relevance of angiogenesis and mast cells in squamous cell carcinoma of the oesophagus.

AIMS: Angiogenesis, an important prognostic factor in several tumours, is a complex event mediated by angiogenic factors released from cancer cells and host immune cells. Among the host immune cells, a role has been implicated for mast cells in tumour progression via promoting angiogenesis. Data have been recorded that indicate a correlation between intratumoral neovascularisation, as assessed by microvessel density (MVD), and prognosis in squamous cell carcinoma (SCC) of the oesophagus. However, a correlation between mast cell density (MCD) and either prognosis or angiogenesis has not been delineated yet in this disease. The aim of this study was to investigate the prognostic value of MVD and MCD in SCC of the oesophagus. The correlation between MVD and MCD was also evaluated. METHODS: MVD and MCD were investigated in tumour specimens from 53 patients diagnosed with SCC of the oesophagus. Intratumoral microvessels were stained with anti-CD34 antibody and mast cells with toluidine blue before being measured by light microscopy. RESULTS: Both MVD and MCD were associated with the depth of wall invasion, lymph node metastasis, and tumour progression (stage). A significant correlation was noted between MVD and MCD values (r = 0.72). The prognosis was significantly worse in patients with high MVD (> or = 92) and high MCD (> or = 18) values. Multivariate analysis indicated that MVD and stage were independent predictors of survival. CONCLUSIONS: These findings support the suggestion that MVD is a reliable prognostic marker in SCC of the oesophagus. Moreover, MCD may have a role in the angiogenesis of these tumours and might be responsible for their aggressive behaviour.

Endonasal endoscopic surgical treatment of paranasal sinus inverted papilloma--first experiences.

PURPOSE: Surgical excision is generally regarded as the treatment of choice for inverted papilloma. However, the approach and extent of surgery has been subject of much debate. The purpose of this study is to evaluate the results of endoscopic sinus surgery in the treatment of paranasal sinus inverted papilloma. PATIENTS AND METHODS: Thirteen cases of inverted papilloma of the paranasal sinuses treated via endoscopic sinus surgery were evaluated. The follow-up averaged from 9 months to 48 months with a mean of 27 months. RESULTS: A close follow-up of all patients was maintained. Seventy-seven per cent (10/13) of the patients had no recurrence after the initial endoscopic procedure. Three patients had recurrences of their tumor within 11 months after surgery, which means a rate of 23% (3/13). In 2 patients, the recurrences were treated endoscopically. In one patient, recurrence and malignant transformation (squamous cell carcinoma) developed after 36 months, which means that the associated carcinoma rate was 7% (1/13). This patient underwent radical maxillectomy and postoperative radiotherapy. None of the patients died of inverted papilloma. CONCLUSION: Endoscopic sinus surgery is a viable treatment alternative for paranasal sinus inverted papilloma in selected cases. This approach should be performed by experienced surgeons and a close follow-up is mandatory. When the disease is more extensive, it should be approached by radical surgery, e.g. en-bloc excision by medial maxillectomy via lateral rhinotomy or mid-facial degloving.

Evaluation of ultrastructural changes in paranasal sinus mucosa after functional endoscopic sinus surgery in patients with chronic rhinosinusitis.

The purpose of this study was to compare the preoperative and postoperative ultrastructural changes of paranasal sinus mucosa in patients treated with functional endoscopic sinus surgery for chronic rhinosinusitis. Twelve patients undergoing functional endoscopic sinus surgery for the treatment of chronic rhinosinusitis were involved. The ethmoid sinus mucosa was sampled during the operation and approximately 6 months after the operation. The ciliated epithelium of sinus mucosa was evaluated with transmission electron microscopy. The samples were taken at the Otolaryngology Department of Istanbul University School of Medicine. Electron microscopic study was performed at the Histology and Embryology Department of the same University. Preoperatively, ciliated epithelial cells of the sinus mucosa of the patients showed degenerated ultrastructure with decreased number of cilia, cytoplasmic protrusions, cisternal dilatations of endoplasmic reticulum, and mitochondrial swellings. Remnants of degenerated cells and cellular separations at cell junctions were evident in the diseased epithelium. Goblet cells were frequent along the epithelial lining. Postoperatively, normal architecture and ultrastructure of the ciliated epithelium was restored. These observations showed that unlike other surgical operations, paranasal sinus mucosa can regenerate and the ciliated epithelium can return to normal after functional endoscopic sinus surgergy.

Clinicopathologic evaluation of CDw75 antigen expression in patients with gastric carcinoma.

Situated on mature B lymphocytes, CDw75 antigen is a sialylated carbohydrate epitope generated by the enzyme beta-galactosyl alpha-2,6-sialyltransferase. Although CDw75 antigen expression was found to be correlated with aggressive behaviour of tumour cells in gastric adenocarcinomas, its prognostic role still remains unknown. The objective of this study was to determine the value of CDw75 antigen expression as a marker of the metastatic potential and prognosis of gastric adenocarcinomas. CDw75 antigen expression was evaluated immunohistochemically in 64 tumours and their nodal metastases. The correlation was analysed between CDw75 antigen expression and selected clinicopathological variables, including survival. Positive staining was detected in 31 cases. Non-neoplastic gastric mucosa was consistently negative. CDw75 expression was correlated with larger tumour size (p<0.006), infiltrative growth pattern (p<0.044), advanced stage (p<0.0006), and positive lymph nodes (p<0.0003). The overall survival rate of patients with CDw75 expression was 28%, which was significantly worse than that of patients without CDw75 expression (53%) (p<0.0005). Multivariate analysis showed that CDw75 expression was an independent prognostic indicator, together with the growth pattern of the tumour. These results indicate that immunohistochemical detection of CDw75 antigen expression may be a good indicator of metastatic potential and of prognosis in patients with gastric carcinomas.

Evaluation of the effect of passive smoking on otitis media in children by an objective method: urinary cotinine analysis.

OBJECTIVES: We aimed to determine objectively the effect of the passive smoking on otitis media with effusion (OME) and recurrent otitis media (ROM) by using the method of cotinine urinalysis. STUDY DESIGN: We designed a prospective case-control study with follow-up of the case group for 1 year after insertion of tympanostomy tubes to evaluate postoperative complications such as otorrhea and early extrusion (<6 months), in case a significant risk factor was found. METHODS: One hundred fourteen children between 3 and 8 years of age requiring tympanostomy tubes because of OME and ROM were chosen and compared with 40 age-matched children. Exposure to environmental tobacco smoke was assessed by cotinine urinalysis, which was performed by means of the radioimmunoassay method. RESULTS: In this study, 73.7% (84 of 114) of the children in the case group and 55.0% (22 of 40) of the children in the control group were found to be "exposed" (P = .0461). This difference was statistically significant. Comparing the cotinine urinalysis results with parental smoking histories, 23.1% (9 of 39) of the children without parental smoking histories were "exposed" to tobacco smoke versus 84.3% (97 of 115) of the children with parental smoking histories (at least one person smoking). CONCLUSIONS: Our results indicate that sidestream smoking increases the risk of OME and ROM. Legal regulations and guidelines must be established to protect children from passive smoking. Because cotinine urinalysis is a noninvasive and reliable method for the determination of passive smoking, it can be used for that purpose.

Microvessel count, proliferating cell nuclear antigen and Ki-67 indices in gastric adenocarcinoma.

The aim of the present study was to immunohistochemically investigate the prognostic value of neovascularization (expressed as microvessel count-MVC) and tumor cell proliferation (expressed as PCNA labeling index PLI and Ki-67 labeling index KLI) in gastric adenocarcinoma. Correlations with clinicopathologic features were also evaluated. Tumor specimens from 74 patients diagnosed as gastric adenocarcinoma were included in this study. Formalin fixed, paraffin embedded tissue sections stained immunohistochemically with F-VIII, PC10 and MIB-1 monoclonal antibodies. By ocular grid subdivided into 100 areas, number of microvessels and PC10, MIB-1 positive and negative cells were counted at x400 magnification. Chi-square test, Kaplan-Meier method and cox regression analysis were used for statistical analysis. The results showed that, MVC and PLI had a significant correlation with invasion and lymph node metastasis. The prognosis was significantly worse in patients with high MVC (>14 ) and with high PLI (>49%). However any relationship was not observed between KLI (38%) and clinicopathologic parameters, so KLI failed to predict the prognosis. Cox model showed that, MVC and PLI were independent prognostic variables. Ki-67 labeling index in gastric carcinomas has no prognostic relevance. However, the evaluation of microvessel count and proliferating cell nuclear antigen index in gastric carcinomas could be reliable indicators of prognosis.

The effects of different levels of air pollution on atopy and symptoms of allergic rhinitis.

We evaluated the prevalence of symptoms of allergic rhinitis and atopy among two groups living in areas with different pollution levels. The study was conducted among high school students living in Bayrampasa (polluted by SO2 and TSP) and Beykoz (unpolluted, residential area) in Istanbul (n = 386). Each subject filled out a standardized self-administered questionnaire. Atopic status was evaluated by skin-prick testing using eight different allergens. Also, anterior active rhinomanometry was performed to evaluate the symptoms objectively. Significantly higher prevalence rates for symptoms of allergic rhinitis were found in Bayrampasa (22.8%) compared to Beykoz (6%). However, no significant difference was found for atopic status among the two groups. When we evaluated the atopic status of subjects with symptoms of allergic rhinitis between the two areas, the prevalence of atopic students was found to be relatively higher in the unpolluted area (BZ). This difference was not statistically significant. Within the atopic population, subjects complaining of symptoms of allergic rhinitis were significantly more frequent in the polluted area (BP), suggesting that air pollution causes an increase in symptoms of allergic rhinitis in the atopic population, but this is not significantly higher than the increase in symptoms of allergic rhinitis of the total study group. Our results suggest that pollutants exert irritant effects on mucous membranes of the population in general rather than aggrevating symptoms in predisposed individuals. Smoking was more frequent in the unpolluted area. Exposure to parental smoking in childhood and heating systems in houses were evenly distributed. Household crowding was lower in Beykoz. Rhinomanometric measurements among the two groups did not show significant difference. Multiple logistic regression models estimating the role of each risk factor independently showed significant odds ratio associated with residence in Bayrampasa for symptoms of allergic rhinitis (OR = 4.6, 95% CI = 9.0-2.3). In conclusion, this study suggests that outdoor pollution has adverse effects on the symptoms of allergic rhinitis, while it has no effect on the prevalence of atopy in Istanbul in the 1990s.

Relationship of passive cigarette smoking to otitis media.

OBJECTIVE: To determine the effect of passive smoking on otitis media with effusion (OME) and recurrent otitis media (ROM). DESIGN: A case-control study of children who received ventilation tubes and who were followed up for 1 year to determine the risk of developing postoperative otorrhea and early extrusion in relation to exposure to passive cigarette smoke. SETTING: Otorhinolaryngology Clinic of Istanbul School of Medicine, Istanbul, Turkey. PATIENTS: A total of 166 children 3 to 7 years old who required tympanostomy tubes because of OME and ROM (case group) compared with an age-matched control group of 166 children. The control group consisted of children who did not meet and never had met criteria for insertion of tympanostomy tubes. MAIN OUTCOME MEASURES: Statistical analysis of factors associated with a higher prevalence of OME or ROM, postoperative otorrhea, and early tube extrusion. RESULTS: Passive smoking was a significant risk factor for OME and ROM. The case group was exposed to a mean of 19.6 cigarettes per day vs 14.4 cigarettes per day for the control group (P<.004). Only maternal smoking was a significant factor (P<.001); no association was found with paternal smoking. Prospective follow-up of the case group showed no significant difference in the clinical course of OME and ROM between maternally exposed and non-maternally exposed children. CONCLUSIONS: Passive smoking increases the risk of OME and ROM in children between 3 and 7 years old. The avoidance of daily exposure to domestic tobacco smoke could have a public health impact.

Auditory rehabilitation in neurofibromatosis type 2: a case for cochlear implantation.

Cochlear implantation has a limited but definite role in the rehabilitation of certain neurofibromatosis type 2 (NF2) patients. The presence of a dead ear either before, or after, tumour removal does not necessarily imply loss of function in the eighth nerve; in some instances the hearing loss will be cochlear. Promontory or round window electrical stimulation may help to identify those individuals with surviving eighth nerve function. In such patients multichannel cochlear implantation promises a better level of audition than the auditory brain stem implant. This paper highlights such a case and the management problems are discussed.

Physiologic and hypertonic saline solutions impair ciliary activity in vitro.

OBJECTIVE/HYPOTHESIS: Physiologic saline (NaCl 0.9%) is commonly used in treating acute and chronic rhinosinusitis. Moreover, physiologic saline is used as a control medium, vehicle, or solvent in studies on ciliary beat frequency (CBF). Hypertonic saline (NaCl 7% and 14.4%) has been applied in attempts to enhance mucociliary transport in patients with cystic fibrosis or asthma and in healthy subjects. Therefore the objective of this study is to document in vitro effects of saline solutions in different concentrations on CBF. STUDY DESIGN: Experimental, in vitro. METHODS: The effects on CBF of cryopreserved mucosa of the sphenoidal sinus was measured by a photoelectrical method. Initial frequencies, measured in Locke-Ringer's solution (LR), were compared with CBF after exposure to NaCl in concentrations of 0.9%, 7.0%, and 14.4% (w/v). RESULTS: NaCl 0.9% has a moderately negative effect on CBF. The 7% solution leads to a complete ciliostasis within 5 minutes, although this effect turns out to be reversible after rinsing with LR. A hypertonic solution of 14.4% has an irreversible ciliostatic effect. CONCLUSION: LR is an isotonic solution that has no effect on CBF. Therefore it is probable that this solution is more appropriate than saline for nasal irrigation and nebulization or antral lavage. Moreover, the results of this study suggest that mucolytic effects induced by hyperosmolarity should be attained preferably with hypertonic saline 7% in patients with cystic fibrosis or asthma. At this concentration, the ciliostatic effect is reversible, whereas irreversible changes are to be expected at higher concentrations.

Impact of air pollution on prevalence of rhinitis in Istanbul.

The effects of air pollution on health are of concern worldwide. There are several pollutants of concern, among which are sulfur dioxide, total suspended particulates, nitrogen dioxide, carbon monoxide, and volatile organic chemicals. In several studies, researchers investigated the effects of those pollutants on lung and nasal functions, although in very few studies has nasal function been addressed. We evaluated the effects of air pollution on the prevalence of rhinitis in a metropolitan of Turkey, Istanbul. Until 1994, coal was used for both domestic heating and industrial processes in the city. Consequently, sulfur dioxide and total suspended particulate concentrations in the ambient air exceeded limits of air-quality standards. In recent years, especially during the early 1990s, hazardous air pollution levels were reached in Istanbul. In this study, we evaluated the incidence of rhinitis before and after installation of a natural-gas network in a polluted area of the city. In 1994, 62.5% of the individuals studied suffered from rhinitis, compared with 51% of the sample in 1996 (p < .05). Age, gender, smoking status, heating source, nor household crowding significantly affected this outcome. The findings strengthened the role of pollutant levels as risk factors for rhinitis.

Objective and subjective assessment of nasal obstruction in patients undergoing endoscopic sinus surgery.

Functional endoscopic sinus surgery (FESS) is the surgical treatment of choice for many physicians in chronic inflammatory diseases of the sinuses. Although subjective benefit has been claimed after surgery, there are not enough studies reporting objective improvement. We evaluated 40 patients undergoing FESS for chronic and recurrent sinusitis with visual analog scale (VAS) scoring of sensation of nasal obstruction and active anterior rhinomanometry of nasal resistance. The results of postoperative measurements demonstrated that baseline total nasal resistance measured with rhinomanometry and evaluated with VAS scoring (baseline and after decongestion) were significantly lower than preoperative measurements. However, improvement in nasal resistance was not statistically significant after decongestion, whereas VAS scoring was. These findings indicate that FESS improves nasal mucosal edema but does not change the structural anatomy of the nose.

The impact of outdoor pollution on upper respiratory diseases.

We evaluated the prevalence of upper airway diseases among two groups living in areas with different pollution levels. The study was conducted among highschool students living in Bayrampasa (an area polluted by SO2 and total suspended particulates) and Beykoz (an unpolluted residential area) in Istanbul (n = 386). Each subject filled out a standardized zelf-administered questionnaire. Also, anterior active rhinomanometry was performed to objectively evaluate the symptoms in all students. A significantly higher prevalence rate for rhinitis was found in Bayrampasa, as compared to Beykoz. However, the prevalence rate for pharyngitis was not significantly different between both groups. Smoking was more frequent in the unpolluted area. Exposure to parental smoking in childhood and heating systems in houses were evenly distributed. Household crowding was lower in Beykoz. Rhinomanometric measurements did not show any significant difference between both groups. Multiple logistic regression models estimating the role of each risk factor independently, showed a significant odds ratio associated with residence in Bayrampasa for rhinitis (OR: 2.0; 95% CI: 3.0-1.3). In conclusion, this study indicates that outdoor pollution has adverse effects on the degree of upper airway diseases in Istanbul in the 1990s.